October 27, 2016

Director's Letter 
Carole Baggerly 
Director, GrassrootsHealth 

We have the attention of the...

12-12:45 pm 
November 1, 2016 
Exhibit Hall - Industry Expert Theater 
Joan M. Lappe, PhD, RN, FAAN, Creighton University 
Keith A. Baggerly, PhD, MD Anderson Cancer Center 
Carole A. Baggerly, Director, GrassrootsHealth

Our talk will present research data and show how to take action to prevent cancer. The data is there, it shouldn't be ignored. We have developed methods that can be implemented, NOW! 

We will be sharing our cancer paper showing > 65% prevention, published earlier this year; Dr. Lappe will be talking about the results from her recent randomized controlled trial (not yet published) which also shows a significant preventive effect with vitamin D and calcium.

It's time! Dr. Lappe's first study in 2007, showed approximately over 65% prevention at that time.  That was nine years ago! Action is needed.
GrassrootsHealth is moving rapidly into medical centers and hospitals with our 'Moving Research into Practice' program. The goal of the program is to change a center's standard of care - so that they test and supplement every patient to achieve the 40-60 ng/ml range, the range acknowledged by our 48 member research panel to be that which can afford health protection. We provide a complete program of vitamin D education and training for the physicians and staff as well as the patients; on-the-ground staff support for the initiative; a documented and proven procedure for creating new standards of practice for vitamin D testing. 
And, to enable complete spreading of the word, we will be publishing the results of each institution and, working with their state and local officials to help these programs expand quickly. 

If you are part of a medical institution that is ready to consider how to implement a primary prevention program at your site, please contact me to explore how to make this happen. 

Please note Dr. Garland's information below about some key ideas about why the 'time is now' for making these changes. Dr. Garland has been working on cancer and vitamin D for 40 (yes, forty) years now! Indeed, it is time.  
Carole Baggerly 
Director, GrassrootsHealth 
A Public Health Promotion & Research Organization 
Moving Research into Practice NOW!
Dr. Cedric Garland

Tipping Point Coming Soon for Eradicating Postmenopausal Breast Cancer

Written by Cedric F. Garland, Dr. P.H. F.A.C.E.
University of California at San Diego Medical Center
Note: References (in parenthesis) are located in the sidebar.
State of the union

Age-adjusted breast cancer incidence rates have tripled in the USA since the mid-1930's. Some of this increase may be due to detecting more cases by mammographic screening, but some is probably real. Either way, it is upsetting for a woman and her family to be told she has breast cancer. The treatments are often painful. The chemotherapy is often nauseating and toxic to heart and lungs.

While incidence rates have gone up, annual age-adjusted breast cancer mortality rates have declined from about 27 per 100,000 in 1930 to about 20 per 100,000 now. That is a little progress, but the USA still has far higher breast cancer death rates than most countries. The decline in mortality may be due to improvements in surgery and post surgical care, and possibly a little due to greater intake of vitamin D in recent years.

If all society does during Breast Cancer Awareness Month is to recommend mammography screening every other year, though, we will sadly continue spinning our wheels for another 50 years in our efforts to defeat breast cancer.

Trying to improve early detection is not the answer. If we make the test more sensitive we will have higher incidence rate of breast cancer each year than we do now.

Primary prevention starts with vitamin D levels
> 40 ng/ml

Where do we go from here? The answer is to place the focus before early detection, on primary prevention of breast cancer. We know that raising the serum 25-hydroxyvitamin D to 50 ng/ml (125 nmol/L) will prevent half of postmenopausal breast cancer(1). This is based on 14 supportive observational studies and a randomized trial in the effective range for vitamin D3.

If every woman maintains a 25-hydroxyvitamin D of 50 ng/ml, incidence of breast cancer will be cut in half. Some might argue that cutting incidence of breast cancer by half is not enough.

50% reduction leads to eradication

This is where the magic of epidemiology enters the picture.

Epidemiology as a science goes back to the venerable Italian epidemiologist, Bernardino Rammazzini (1633-1714), who studied the influence of type of work on risk of disease. There's a long history from which to draw.

Here's the magic. With few exceptions, once humanity has divined enough about the cause of a disease to account for 50% of its incidence, and act upon the knowledge, the disease will soon be defeated.

Table 1 summarizes some diseases where epidemiology determined the cause and allowed action to focus on eradication of the disease.

Click to Expand

Once a method is discovered that prevents 50% of a disease, most diseases are defeated, and are usually nearly 100% eradicated within the locale of the discovery. This typically happens within 10-20 years of reaching the 50% point.

It may take hundreds of years to discover how to prevent 50% of a disease. But, after that discovery it takes relatively few years to defeat it.  Based on our current data, we're already there! 

We'll maybe a little facetiously call the above the "Garland Law of Defeating Disease." This is a general rule, but there are occasional exceptions.

An analogous phenomenon was described by Malcolm Gladwell in The Tipping Point. The idea adapted from Gladwell is that a preventive measure, once discovered, confirmed and clearly described is likely in a position to "go viral". Once enough people implement the preventive measure, induction or disease or death by the causal factor will drop rapidly. Widespread application of the newly-discovered preventive measure will lead to its refinement and result in its greater efficacy. 

Is vitamin D the tipping point for breast cancer?

For vitamin D, the widespread application - that will lead to widespread implementation, is refinement of the dosage, serum concentration target and form of the vitamin (now known to be vitamin D3, not vitamin D2).

We now believe that a serum 25-hydroxy vitamin D concentration of less than 100 ng/ml is safe, according to research collated by the National Academy of Sciences(2).
A distinguished panel of vitamin D scientists and physicians recommends 40-60 ng/ml as the target for serum 25(OH)D(3). Today we may just have reached the tipping point for eradicating postmenopausal breast cancer. The rapid pathway to its defeat could be stunning. 

First vitamin D and cancer research in 1989

The knowledge on vitamin D and cancer has been painstakingly acquired through scientific research starting in approximately 1989 with different studies reporting the link of vitamin D deficiency and cancer.(4,5,6) This research was confirmed by a study at Creighton University by Joan Lappe and associates, including the late Dr. Robert Heaney(7) and a cohort study by Sharon McDonnell and colleagues of the GrassrootsHealth cohort(8).

The refinements are usually adjustment of dose and form of administration of the preventive agent. Historical examples include using citrus fruit to prevent scurvy in sailors, sunlight and vitamin D to prevent rickets, and niacin to prevent pellagra. There are many other examples of an originally approximately 50% effective approach ultimately resulting in eradicating 100% of a disease.

Even vaccines that seem relatively ineffective at first can conquer a disease. The Salk polio vaccine was maybe about 70% effective, but it ended up preventing 100% of polio. The concept is that of a tipping point. That tipping point is historically about 50% effectiveness for most diseases.

We do not always know for sure why this happens but it almost always does. It is probably that the blockage to effective prevention was not knowing the right strategy. Once the strategy is identified, it's usually only a matter of time until the strategy evolves in a way that results in preventing 99-100% of the disease.

Divining the right strategy is the bottleneck. Once past the bottleneck, the journey to 100% eradication is a matter of corrections that require faith in the idea and persistence.

In summary, there is good reason from epidemiological history and specialized knowledge to believe that we are on the threshold of eradicating postmenopausal breast cancer. We need just a little more activism now to make this happen. This will be the start of a golden era of preventing cancer.

Join GrassrootsHealth with its Moving Research into Practice program to help make this happen now. 
Paper of the week

Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial
Joan M. Lappe, PhD, RN, FAAN
Creighton University
American Journal Clinical Nutrition
June 2007
This study is the first randomized controlled trial that involved a vitamin D intervention sufficient to raise vitamin D levels > 32 ng/ml (80 nmol/L) and report a cancer outcome. Its strengths were that it was population based; it has a low drop-out rate (<3.5%/year) and a high level of treatment adherence; and it used a vitamin D dose sufficient to raise vitamin D blood levels by a biologically meaningful amount. A weakness was that cancer outcomes were its secondary hypothesis - which is why Lappe decided to re-create the study with cancer as a primary outcome.

It was a four year, population-based, double-blind, randomized placebo-controlled trail. The subjects were 1179 community-dwelling women over 55 years of age (mean age 67) living in rural Nebraska and free from all cancer for over 10 years prior to enrollment. Due to the population, all study participants were white in ancestry.

They were randomized into three groups:
  1. 40% received 1500 mg calcium and 1000 IU vitamin D daily
  2. 40% received 1500 mg calcium and placebo vitamin D
  3. 20% received 2 placebos
The initial mean serum level for all three groups was virtually the same - 28 ng/ml 8 ng/ml (70 nmol/L 20 nmol/L). But, after one year the first group, taking vitamin D, raised their blood levels to almost 40 ng/ml (96 nmol/L 20 nmol/L).

During the study 50 women developed non-skin cancer, 13 in the first year and 37 in subsequent years. They hypothesized that cancers diagnosed in that first year of study may have been present, although unrecognized, on entry to the study. By removing those incidents, the relative risk (RR) of developing cancer at study end was .232 for the calcium + vitamin D group as compared to the placebo group - this is an overall reduction in incidence risk of 77%!

Figure 1 from results section of paper

Read Paper
Editor's Letter 
Susan Siljander 
Marketing Director, GrassrootsHealth

As we wrap up breast cancer prevention month, I want to encourage you. I talk to people about vitamin D all the time and most of the time people think I am crazy. "What do you mean you sunbathe? Isn't that dangerous?" or "My doctor has me taking 1000 IU/day." 

I feel good in continuing to evangelize, since I know it will really help their health - or the future health of their children. So, just because Jane or John Doe doesn't listen when you tell them, persevere... it might be that 57th person that needs the information and if you stop short, at the 55th one, then you won't have done your job.

Keep up the good work!

Susan Siljander
Marketing Director, GrassrootsHealth
A Public Health Promotion & Research Organization  
Moving Research into Practice NOW!

Order Now
Order Your Home Vitamin D Test TODAY!
Your participation in this project helps provide answers to your D questions and funds all the GrassrootsHealth research and promotion.

GrassrootsHealth exhibiting and speaking at APHA annual meeting and expo

Visit us at booth # 609

October 31, 2:30 pm
Session by Joan Lappe, PhD
Vitamin D3 and calcium supplementation significantly decreases cancer risk in older women

November 1, noon
Industry Expert Theater 
(in exhibit hall)
Preventing Cancer with Vitamin D
Joan M. Lappe
Keith A. Baggerly
Carole A. Baggerly

With the continuing high incidence of cancer, the issue of primary prevention with vitamin D is addressed in this presentation.  Dr. Lappe's talk on Monday will be expanded on. 
This was the first RCT of vitamin D supplementation analyzing cancer as a primary outcome. There was a significant reduction in risk. 
The methodology of implementation used by GrassrootsHealth, Moving Research into Practice, will be presented to demonstrate the way such a public health program can be quickly implemented.
Cited Sources from Dr. Cedric Garland
(1) Garland CF et al.  Meta-analysis of 25-hydroxyvitamin D and risk of postmenopausal breast cancer. Abstracts of the Vitamin D Workshop, Boston, April 2016.   Submitted for publication.

(2National Academy of Sciences, Institute of Medicine, Food and Nutrition Board, eds. Ross AC et al. Review of recommended daily intakes of vitamin D and calcium. Washington DC: NAS, 2011

(3)  Garland CF, et al.   Vitamin D for cancer prevention: global perspective. Annals of Epidemiology 2009;19:468-483

(4) Gorham ED et al.  Acid haze air pollution and breast and colon cancer mortality in 20 Canadian cities.  Canadian Journal of Public Health 1989; 80: 96-100; 

(6) Gorham ED et al. Sunlight and breast cancer incidence in the U.S.S.R.  International Journal of Epidemiology 1990;19:820-824

We've Won an Award!

The American College of Nutrition has selected GrassrootsHealth to be the American College of Nutrition's Humanitarian Award recipient for 2016. 

This special award acknowledges an individual or organization who has worked selflessly and effectively in the broader field of nutrition to benefit humanity. 
Please attend ACN's annual conference, November 9-11, 2016, San Diego, CA.

Breast Cancer Prevention with Vitamin D

Raising vitamin D levels to the recommended range of 40-60 ng/ml may reduce incidence of breast cancer by 50-80%. On this page you will find resources to dive deeper into this subject. 

Joan Lappe
Creighton University

About the Lappe Cohort:
  • four years
  • double-blind
  • placebo-controlled
  • women aged 55 years and older
  • no known cancer at enrollment or within 10 years prior
  • 1500 mg/day Calcium
  • 1000 IU/day vitamin D
  • recorded cancer incidence over 4 years

Vitamin D and

calcium supplementation reduces cancer risk: results of a randomized trial
Joan M. Lappe, et al.
American Journal Clinical Nutrition
June 2007

Vitamin D status in a rural postmenopausal female population
Joan M. Lappe, et al.
The Journal of the American College of Nutrition
October 2006

Vitamin D and Breast Cancer Studies

A 2007 randomized clinical trial at Creighton University led by Joan Lappe, PhD, RN, FAAN, found that a dose of 1100 IU/day of vitamin D along with 1400-1500 mg/day of calcium helped women aged 55 and older raise their average serum vitamin D level to 38 ng/ml (from a baseline of 29 ng/ml) and prevent approximately 4 out of 5, or 80%, of all invasive cancers including breast cancer. 

A 2013 case control study at UCSD School of Medicine, Mohr et al.  found that the three months prior to tumor diagnosis was a relevant window of time for cancer prevention and that those with vitamin D levels ≥35 ng/ml had a 70% reduction in risk of developing breast cancer than those with levels <15 ng/ml. 

Lowe et al. demonstrated in a 2005 case control study that women with serum levels of >60 ng/ml had more than a five-fold (80%) reduction in breast cancer risk compared to women with levels <20 ng/ml. 

In a 2008 case control study, Abbas et al. found that those with 25(OH)D levels ≥30 ng/ml had an almost 70% reduced risk of post-menopausal breast cancer compared to those with levels <12 ng/ml.  

In a 2009 case control study, Abbas et al. found that women with 25(OH)D levels ≥24 ng/ml had more than a 50% reduction in risk of pre-menopausal breast cancer compared to those with levels <12 ng/ml.   

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