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TORONTO (CP) - Sunlight may be the easiest and most natural way to get a health-enhancing dose of vitamin D, but Canadians should know that a little sun goes a long way, says a Canada-U.S. consensus group formed to determine the risks and benefits of exposure to ultraviolet rays.

In what has turned out to be a delicate balancing act, the group is advising that while too much time in the sun raises the risk of skin cancer, avoiding it entirely can lead to a deficiency in vitamin D - and that may elevate the risk of other types of cancers and diseases.

Many Canadians and Americans from northern states are deficient in vitamin D, a nutrient produced by the body through the skin's exposure to sunlight. The consensus group acknowledges that a decade of public health messages to limit exposure to the sun may be responsible in part for that widespread deficiency.

"This is an issue of weighing risks and benefits," said Heather Logan, director of cancer control policy for the Canadian Cancer Society, one of the organizations involved in the consensus group, which released its findings and recommendations Thursday.

"So while sunlight is important for a person's health, we know that you don't need to get a tan in order to get the benefits," Logan said. "Just a little bit of sun goes a long way."

The advisory group, a coalition of health-related associations from Canada and the United States, has reiterated the long-standing caution that too much UV radiation from the sun or tanning lights is potentially dangerous: it can cause skin cancer (including the deadliest form, malignant melanoma) and cataracts.

Experts agree that sun protection is needed when the UV index is three or higher, usually between 11 a.m. and 4 p.m. during warm-weather months.

But at the same time, adequate levels of vitamin D can promote health by helping to build strong bones in children and maintaining them into old age, as well as possibly preventing certain malignancies, in particular colorectal cancer.

Vitamin D deficiency has also been linked to multiple sclerosis, a disease that tends to occur more frequently among populations in northern or extreme southern climes.

"It might be possible for some people to get enough sun to produce adequate vitamin D levels through a five-minute walk, perhaps early in the morning," said Logan. "Five minutes a day is an example, but it's going to vary depending" on the individual.

"Unfortunately, we need more research to be able to be more crisp in telling people exactly how long to be out in the sun . . . There's no simple answer."

How much sun someone can safely tolerate to produce enough vitamin D depends on their age, where they live and their complexion. Darker-skinned people take longer to absorb UV rays compared with lighter-skinned individuals because they have higher melanin levels. While that may mean dark-skinned Canadians can safely stay out in the summer sun a bit longer, the downside is that they have more difficulty making vitamin D during winter months when sunshine is low.

Because few foods contain vitamin D - it is found naturally in such oily fish as salmon, tuna and sardines and is added to milk, soy beverages and margarine - the Dietitians of Canada is recommending for the first time that Canadians take supplements.

"The amount that we think people need now is a lot more than you could possibly get from diet unless you ate fish every day, and not just fish but the right kind of fish," said Susan Whiting of the Dietitians of Canada, one of the organizations that helped formulate the recommendations.

"In order to compensate for not getting as much sun exposure, we need more dietary (sources) and it has to be supplements," Whiting, a professor of nutrition at the University of Saskatchewan, said from Saskatoon.

Current recommended daily allowances for vitamin D - which experts say are woefully outdated and inadequate - advise that children and adults over age 70 need 400 international units (IUs) a day, while adults up to age 50 require only half that amount.

Whiting said 1,000 IUs of vitamin D is a far more realistic amount for all ages, up to a maximum of 2,000 IUs daily, depending on the individual.

Reinhold Vieth, director of the Bone and Mineral Laboratory at Mount Sinai Hospital in Toronto, said the recommendations break new ground because they endorse supplementation of a vitamin for the first time.

"Supplementation means 'Take more vitamin pills.' To me that's new," said Vieth, an internationally recognized expert on vitamin D.

He's also pleased to see a subtle shift in the message about sun safety, which he called an evolution in thinking.

"What they're recognizing in regards to the UV message is that it does not apply to everybody. They've accepted the fact that some Canadians don't have white skin, and that they're at particular risk for vitamin D deficiency."

Orig link:
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I'm not an expert, but I don't agree that recommending Canadians take a walk early in the morning for five minutes to get their vitamin D is valid. I don't know where Dr. Logan gets that recommendation from. From what I understand, vitamin D synthesis is triggered by UVB radiation, which is only strong in most temperate zones in the middle of the day, and in most of more northern North America, may not be sufficient to trigger Vitamin D synthesis even in midday during winter months.

I'm in Florida, which has strong sun. I had been avoiding sun for years due to a family history of skin cancer and all the dire dermatologist warnings, and I'm not sure that has been all that healthy - frankly I'd rather have skin cancer than MS. Conversely, I don't think sunburns or baking for hours in the sun are healthy either, or necessary to get a lot of Vitamin D, as jimmylegs noted. I am pretty pale, but am able to sit in the sun for a just a few minutes around midday this time of year without burning or noticably tanning. I try to do this at lunch, if only for five minutes, recognizing this to be against any dermatological recommendation. If I am going to be out in sunlight for more than that, I would cover up and/or put on sun screen to avoid burning. On weekends I work in my yard and follow the shade around with no sunscreen on - I'm getting some diffuse UV doing that and yet don't burn or tan. Unfortunately it gets too hot to keep that up here in the summer. At very high European latitudes (my ancestral home), even as pale as I am I can be out in the sun for more than an hour in summer and not burn, although much more than that would probably burn. I now believe people were meant to have sun exposure.

Here is a recent Norwegian study, perhaps relevant to Canadian conditions:

*****

Tidsskr Nor Laegeforen. 2006 Apr 6;126(8):1048-52. Related Articles, Links


[The photobiology of vitamin D--a topic of renewed focus]

[Article in Norwegian]

Moan J, Porojnicu AC.

Avdeling for stralingsbiologi, Rikshospitalet-Radiumhospitalet, 0310 Oslo. johan.moan@labmed.uio.no

The sun is our most important source of vitamin D. Exposure to solaria, in sub-erythemogenic doses, also gives large amounts of this vitamin. The ultraviolet radiation in these sources converts 7-dihydrocholesterol to previtamin D3 in the skin. Furthermore, heat isomerization to vitamin D3 takes place, then transport to the liver and hydroxylation to calcidiol, which is transported to the kidneys and hydroxylated to the active hormone calcitriol. The vitamin D3 status of the body is supposed to be reliably imaged by calcidiol measurements. Calcidiol levels above 12.5 nmol/l prevent rickets and osteomalacia, but optimal levels are probably higher, in the range 100-250 nmol/l. A daily food intake of 100-200 microg vitamin D3 (50-100 g cod-liver oil), or a weekly exposure to two minimal erythemal doses of ultraviolet radiation (20 to 40 minutes whole body exposure to midday midsummer sun in Oslo, Norway), will give this level. An adequate supply of vitamin D3 seems to reduce the incidence rates or improve the prognosis of several cancer forms, including prostate, breast and colon cancer, as well as of lymphomas. Several other diseases are related to a low vitamin D3 status: heart diseases, multiple sclerosis, diabetes, and arthritis. The action mechanisms of vitamin D are thought to be mainly related to its known cell-differentiating and immuno-modulating effects. Even though most of the 250 annual death cases from skin cancer in Norway are caused by sun exposure, we should, in view of the health effects of ultraviolet radiation, consider modifying our restrictive attitude towards sun exposure and use of solaria.

Publication Types:
Review

PMID: 16619064 [PubMed - indexed for MEDLINE

The Australians have been working hard on this question of sun exposure and Vitamin D - here's an Australian paper, probably more similar to southern US in terms of UV radiation, except, of course, the seasons are reversed. THe observations for time for fair-skinned people to burn during summer is similar to what I experience in Florida.

Med J Aust. 2006 Apr 3;184(7):338-41. Related Articles, Links


Estimates of beneficial and harmful sun exposure times during the year for major Australian population centres.

Samanek AJ, Croager EJ, Giesfor Skin Cancer Prevention P, Milne E, Prince R, McMichael AJ, Lucas RM, Slevin T.

Genomics Directorate, WA Health, Perth, WA.

OBJECTIVE: To examine the influence of geographical and seasonal factors on duration of solar ultraviolet (UV) radiation exposure of skin to produce recommended vitamin D levels without producing erythema. DESIGN AND SETTING: An ecological study using daily Ultraviolet Index (UVI) data collected in major population centres across Australia for 1 year (1 January - 31 December 2001) to calculate sun exposure times for recommended vitamin D production and erythema. MAIN OUTCOME MEASURES: Sun exposure times to produce either serum vitamin D concentrations equivalent to an oral intake of 200-600 IU/day or erythema for people aged 19-50 years with fair skin (Fitzpatrick type II skin) exposing 15% of the body. RESULTS: In January, across Australia, 2-14 minutes of sun three to four times per week at 12:00 is sufficient to ensure recommended vitamin D production in fair-skinned people with 15% of the body exposed. However, erythema can occur in as little as 8 minutes. By contrast, at 10:00 and 15:00, there is a greater difference between exposure time to produce erythema and that to produce recommended vitamin D levels, thereby reducing the risk of sunburn from overexposure. From October to March, around 10-15 minutes of sun exposure at around 10:00 or 15:00 three to four times per week should be enough for fair-skinned people across Australia to produce recommended vitamin D levels. Longer exposure times are needed from April to September, particularly in southern regions of Australia. CONCLUSION: Our study reinforces the importance of existing sun protection messages for the summer months throughout Australia. However, fair-skinned people should be able to obtain sufficient vitamin D from short periods of unprotected sun exposure of the face, arms and hands outside of the peak UV period (10:00-15:00) throughout Australia for most of the year. The greater variability in sun exposure times during winter, means that optimal sun exposure advice should be tailored to each location.

PMID: 16584368 [PubMed - indexed for MEDLINE]

LisaBee, I think you have become de facto the resident authority on Vitamin D. (Maybe that is a function of living in Florida.) As I read all the info here on sunlight and Vitamin D, some questions come to me: The two (sunlight and Vitamin D) are almost spoken of as the same thing; but are they? I understand that sunlight makes our D (skin, D-precursor, rickets, etc.), but doesn't sunlight do other good things in our bodies? Although I take D, I'm not sure it does anything for me in respect to MS.

Perhaps it's not the D connection that does anything, but something else about sunlight?

Just wondering if anyone knows.

Sunshine would affect melatonin levels as well as vitD levels. I've always assumed sunlight had "healing" properties, being somewhat disinfectant. I try to leave road burn/other messy scrapes from cycling etc uncovered and in the sun. My GP recommended sunlight for a case of (gross) persistent plantars warts, when nothing else worked. I haven't found anything on google to support latter however...

Just a comment....We would vacation every year in Florida. I found that when we came to Florida after I had been diagnosed (lived in Ohio) I felt quite a bit better. I attributed it to the sunshine. I felt so much better that we made the decision to move to Florida. I have not had a relapse (hopefully didn' jinx myself!) since we've been here. That's not to say there haven't been some odd symptoms come and go but I do believe that the natural source of Vit D (sun) has a lot to do with the way I feel. I think it (Vit D) has helped me tremendously.
Lori

LisaBee,

frankly I'd rather have skin cancer than MS.

You must have read my mind.

I now am much less bothered about slapping on high factor suncream.

We live in the UK and because of my wife's job had to holiday in December (winter). We ended up going to places such as Australia and got exposed to sun big time. When our first child came along we ened up taking holidays in the Summer. Three years later and I'm dx with RR at 39 with no previous symptoms. Of course - a sample of one but seems to link

As usual more research required. But as I mentioned before - do a piece of research on those who do not get exposure to the sun. Good populations are nuns and prisoners. If Vit D was protective then the incidence among these populations should be higher than the norm.

But I am coming to the conclusion that with many things in life, it all boils down to luck (or bad luck).

Ian

lc i think the medical community would agree that the prehormone vitamin d production of sunlight on skin is one of its most important health aspects, whatever else it may do. supplementing with vitamin d is the main recommendation as an alternative to actual sunlight.

even vitamin d and melatonin are inversely related, so does sunlight regulate melatonin production specifically in response to serum levels of vitamin d? i think it probably does.

there are probably a few other things happening but whatever they are aren't easy to look up because everyone talking about health and sunlight is talking about vitamin d.

vitamin d and its beneficial impact on ms are well researched. in my opinion, if it doesn't do anything for an individual with ms, then that person is likely not taking enough, or waited too long to start.

here's something else i think u'll find interesting:

http://www.mercola.com/2004/jul/3/vitamin_d_levels.htm
One-hour glucose and area under the glucose curve during a standard 75-g oral glucose tolerance test are inversely associated with the serum concentration of 25(OH)D. Extrapolation of recent graphic data for healthy young adults showed that improvements in 60-minute, 90-minute and 120-minute postprandial glucose levels and insulin sensitivity appeared to plateau when subjects reached vitamin D levels above 35 ng/ml.

jimmylegs, I certainly agree with your first sentence; but then comes the clause, "whatever else it may do." That's what I want to know!

It may well be that I am not taking enough D supplementation or waited too long to start. I am quite sure it is not helping me now.

My mission now is to learn more about sunlight! (By the way, I'll have to sit in the sun early each day this weekend--temps are forecasted to be around 90 degrees F!)

hi lc, i know you want to know what the whatever else is and as i said in my post, it is difficult to search for because everyone who looks at sunlight and health is talking about vitamin d!

so, now i have to ask, what is your daily supplementation of vitamin d? do you know your serum level of d3? is your supplement d2 or d3?

and yes do do do sit in the sun!

jimmylegs, I think you are definitely another Vitamin D authority. I hope you can comment on my D intake.

I am 57 years old. I take 1000 IU of Vitamin D (as Cholecalciferol, according to the bottle label) and a teaspoon of cod liver oil each day. I eat salmon twice a week. I do not know my serum level of D3. I am trying to sit in the sunshine more these days (although as a kid, I was out there ALL the time!).

hi there, ewww isn't CLO fun. blech!

ok. well cholecalciferol is D3, that's the one u want. most fortified foods and some supplements contain ergocalciferol (D2) which is not the same as what your skin makes in sunlight.

i will go through the info you gave...

cholecalciferol: 1000 IU is the recommended daily for normal people who are not D deficient, and it's probably WAAAAY to low according to a LOT of research. people with ms tend to be D deficient, therefore likely need more than the basic amount to get up to a decent level. i have been advised to take 4000IU per day. i've heard this is more like what your average temperate zone healthy person needs, not a deficient MS-er. we need more in the short term and then can drop back to 4000IU per day once at a healthy serum D concentration. this is of course to be established on an individual basis.

CLO: definitely a good idea. does the bottle say how many units of D3 are provided per teaspoon? this would be very good information to have. i was advised to take 2 Tbsp/day.

salmon: also a very good idea. do you make sure it's wild cold water caught? i told my doc i was having fish twice a week and she said, have it three times. i whined about bioaccumulation of toxins, and she said, pick your battles, you're ingesting toxins just by breathing and you need that vitamin D! LC you may want to alternate a smaller white fish in between the salmon meals.
(also, i had been having an egg three times per week - only for the last few months, didn't have any before - and she said to drop it back to two.)

serum d3: MONITOR, MONITOR, MONITOR!!! this is the only way you will know whether your efforts are resulting in levels that have a chance of being effective.

i am going to supplement and monitor my d3 saturation every 3 months until i can see an average level of about 140, and can understand how to deal with seasonal sun exposure. there are interesting articles describing seasonal offsets in peak serum values vs peak uvb exposure. googling and reading over such articles will help me understand what happens to my own serum vitamin d levels as i monitor. by the way, i read an article on outdoor workers in south india with unsupplemented levels over 450, so being over 100 is not a concern with regard to hypercalcaemia.

i believe that it is critical for people with ms or at risk of ms to monitor their serum d3 and keep it well above established adequate levels for bone health (only 80 nmol/l). you can read that say, 50% of people with MS are vitamin D deficient. does that mean deficient on a bone health scale? i think it does. i think vitamin d deficiency on a immune system health scale might be 100% of the MS population. and the ones who don't get ms get diabetes, cancers, arthritis, psoriasis, and/or alzheimers instead.

one of my docs said aim for 125 nmol/l - 150 nmol/l. this is low compared to say, a lifeguard working somewhere along the equator. i've been supplementing at well over 3000IU/d, plus fish, eggs, and CLO, for three months and i'm still only up to 72 nmol/l. i am looking into the method suggested at macmaster for boosting people into a new range quickly. usually they would use this to get someone from say, 30 to 80nmol/l. you take 50,000 IU/d for 10 days. i have an appointment with my doc next week to discuss getting a prescription.

i've read that full body exposure to the sun in clear conditions for half an hour can generate up to 20,000 IU of D, and the body destroys excess. from a table provided to me by a dietitian, vitamin d toxicity appears to occur when high potency prescription d3 supplements beyond the body's means to process, are taken for periods of months to years.

i think the original article in this thread pointed out that vitamin d processing depends on skin pigment and age so the darker you are the less efficient your skin is at making d3. the older you are, the less efficiently cholecalciferol gets hydroxylated (mainly in the liver and kidneys) to calcitriol, the good steroid you want in your system for immune health.

the drug info centre at mac told me that those people whose liver and kidneys do not hydroxylate vitamin D properly can get a prescription for calcitriol, that is, pre-hydroxylated cholecalciferol. there are also new analogs that apparently don't carry the same risk of hypercalcaemia as prehydroxylated calcitriol.

all that said, i see a sunbeam outside with my name on it! ttfn!

d

Hey, Legs! I don't find the CLO too bad--brand is Garden of Life, Olde World Icelandic Cod Liver Oil (Lemon Mint Flavor); maybe among other problems my tastebuds are shot now; I've heard stories of some pretty bad ones.

Serving size is 1 teaspoon, which supplies 200 IU of Vitamin D. After hearing of your intake, maybe I will increase mine.

I have not eaten eggs for years. My husband doesn't like them; I avoid them because the yolks are rich in arachidonic acid which promotes inflammation (and I continue to believe it--in the form of my sinus drainage--is deeply involved and I still work, tho unsuccessfully, to reduce it!).

I will contact my doctor about monitoring my serum D3. He's pretty accommodating about my requests. I still urge you to request a fasting serum insulin test when your blood is drawn next time. Then we could have LOTS of numbers to compare!

I thank you for all your time and information; it's nice to feel that others understand.

lyndacarol wrote:I don't find the CLO too bad--brand is Garden of Life, Olde World Icelandic Cod Liver Oil (Lemon Mint Flavor); maybe among other problems my tastebuds are shot now; I've heard stories of some pretty bad ones.

Serving size is 1 teaspoon, which supplies 200 IU of Vitamin D. After hearing of your intake, maybe I will increase mine.

Just for comparison, I buy cod liver oil capsules (Nature Made brand). The label indicates that they contain 130 IU vitamin D, 1250 IU vitamin A, and 67 mg omega-3 fatty acids (45 mg EPA & 22 mg DHA)/500mg. Just for fun I determined that it would take about 8 capsules to make up a teaspoon. This quantity would provide 1040 IU of vitamin D. However, it would also provide 10,000 IU of vitamin A. While the vitamin D content is desirable, the vitamin A content is likely too high. The Mayo Clinic states that 3000 IU/day is the recommended dosage. I have also read that doses higher than 10,000 IU/day should be avoided due to toxicity problems. Some supplement manufacturers make a vitamin D oil supplement where the vitamin D has been separated from the vitamin A, e.g., Jarrow Formulas. A high dosage vitamin D (1000 IU/tablet) supplement is also available from Now Foods. Anyways, I hope that this information has been helpful.

NHE

ok lc, i will ask my doc for an insulin test,and u ask for a d test! best wishes!!!!

nhe i too worry about vitamin a. bugger. however i heard you can get 10000 iu of A from a freakin carrot, ie beta carotene, which does the same deal as d, ie your bod makes what it needs and offs the remainder.

it all makes u think, dammit i am going to have to get my d from sunligt!!!

or overdose on a. boo!!

ttfn