Sunshine Superman

“If I had to give you a single secret ingredient that could apply to the prevention — and treatment, in many cases — of heart disease, common cancers, stroke, infectious diseases from influenza to tuberculosis, type 1 and 2 diabetes, dementia, depression, insomnia, muscle weakness, joint pain, fibromyalgia, osteoarthritis, rheumatoid arthritis, osteoporosis, psoriasis, multiple sclerosis, and hypertension, it would be this: vitamin D.”

During the whirlwind that has been my life of late, I managed to make my way through Dr. Michael Holick’s terrific book The Vitamin D Solution from which the above quote comes.  Before I get started on my review, in the interest of full disclosure, I’ve got to tell you that of all the books I’ve reviewed on this blog since its inception, this is the first and only one that I’ve been sent gratis by the publisher.  It was strange how it came about.  I learned of this book long before it was published and had pre-ordered it through Amazon.  A few weeks or so after my pre-order, I received an email from the publisher’s PR agent for this book asking if I would like a pre-publication copy for possible review.  I sure would, said I, and promptly canceled my Amazon order.

I’ve been a fan of Dr. Holick’s for years now, reading every paper he publishes, which is a considerable job given his prolific output.  I’ve corresponded with him a time or two on a few issues and he has always been very generous with his advice.  I consider him THE authority on vitamin D.  So, I was eager to dig into his book.

I wasn’t disappointed.

I figured that somewhere along the way, Dr. Holick had gotten intrigued with vitamin D, had pursued his interest and had become sort of a guru.  But in reading his book, I learned that he is much more than that.  He began studying vitamin D as a graduate student and ended up being the person who actually discovered 1,25 (OH)D, the major circulating form of vitamin D in humans.  This was back in the early 1970s, and he’s been studying vitamin D without letup since.  His book is the most up-to-date source of all the science available about this amazing nutrient.

Dr. Holick sums up the importance of vitamin D to human well being in this single sentence from early in the book:

The sun is as vital to your health and well-being as food, shelter, water and oxygen.

Which seems reasonable since every morsel of energy we consume originates with the sun.  No sun, no plants.  No plants, no animals.  No plants and animals, no us.  As Sir Karl Popper noted, we eat the sun. We evolved in the sunlight, so it makes sense that the sun offers other benefits as well food.

Dr. Holick begins his book with a fascinating comparison of a ten-year-old girl growing up somewhere along the equator to a ten-year-old girl growing up in the United States or Europe.  The former will probably never learn how to use a computer, never go to a mall, never learn to drive a car and will probably end up spending most of her life outside tilling the soil as did her parents and grandparents.  She will probably experience periods in her life of poverty and poor nutrition.  By contrast, her US or European counterpart will always have plenty to eat, will learn to shop, order pizza, operate a computer, Game Boy, Wii, and God only knows what other kinds of electronics.  She will have her doting parents slather sunscreen on her to protect her skin from birth until she’s old enough to do it herself.  She will come of age in a different world, filled with the latest in medical technology.

And she will pay for it with her health.

Her equatorial counterpart will be only half as likely to get cancer in her lifetime.  She will have an 80 percent reduction in risk of developing type I diabetes before the age of 30.  And she will live longer.  If she can avoid trauma or an untreated severe medical condition, the girl growing up in the more primitive but sunny circumstances will have an overall 7 percent greater longevity than her US/European counterpart.  She will have stronger bones, lower blood pressure, fewer cavities in her teeth, a greatly reduced risk for heart disease, type II diabetes, obesity, arthritis and most of the other diseases that will plague her more Westernized sisters.

Why the difference?  According to Dr. Holick, the equatorial girl has vastly more exposure to natural sunlight over her lifetime than does the other.

But, you might ask, why don’t the children in the US and Europe play outside more in the sunshine and reap its many benefits?  A couple of reasons.  Most of the US and Europe are too far north to get enough sun exposure to generate the production of adequate vitamin D during a large part of the year.  And, second, most parents are so fearful of sunburn that they slather their kids with sunscreen if and when they let these children play outside during the part of the year they can make adequate vitamin D.  Since a sunscreen with an SPF of only 8 reduces the synthesis of vitamin D by 95 percent, think of how little vitamin D children with sunscreens of SPF 30 or 45 are making.  Zero.

Why?

Heliophobes.

Readers of this blog know that I refer to people who have an unreasoning fear of fat as lipophobes, fat fearers.  Well, since Helios was the Greek god of the sun, I’ll call those who have an unreasoning fear of the sun heliophobes.

Why do people become heliophobes?  Same reason they become lipophobes: they refuse to think.

Just as lipophobes see a heart attack in every morsel of fat, heliophobes see skin cancer in every ray of sunshine.

To give them their due, the heliophobes have at least a smidgen of data to bolster their point of view.  Unlike the lipophobes, who have no reliable data demonstrating that saturated fat causes heart disease, the heliophobes can point convincingly at the data showing sun exposure causes problems for the skin.

Unquestionably, excess sun exposure causes premature aging of the skin and a couple of types of skin cancer.  Of this there is no doubt.  But, lack of adequate vitamin D appears to be related to an entire host of serious problems including melanoma, the most dangerous and deadly form of skin cancer.  The most common type of skin cancer from overexposure is basal cell carcinoma, which is just about the least malignant of all cancers, and if treated (by removal) results in virtually no mortality.  The same can’t be said for prostate, breast and colon cancers, all cancers thought to be sun (or, more correctly, lack of sun) related.  These cancers are much more prevalent the farther north one goes and almost non-existent at the equator.

The trade off, in my opinion, is well worth it.  Especially when it’s possible to have the best of both worlds and avoid both the premature aging, minor skin cancers AND the breast, prostate and colon cancers (not to mention multiple sclerosis, osteoporosis, and the host of other disorders laid at the doorstep of too little vitamin D) by sensible sun exposure.

Dr. Holick tells you how.  He provides charts and tables telling you how much sun exposure you require for adequate vitamin D synthesis depending upon where you live in the world.  And he describes how you can make up any difference by taking vitamin D supplements.

Why not just take the supplements and forget about the sun?

Vitamin D made in the skin lasts at least twice as long in the blood as vitamin D ingested from the diet.  When you are exposed to sunlight, you make not only vitamin D but also at least five and up to ten additional photoproducts that you would never get from dietary sources or from a supplement.

Old Mother Nature is pretty parsimonious with her creations, and I suspect she wouldn’t have five to ten photoproducts circulating around if they didn’t do something good for us.  Just because we aren’t advanced enough yet to figure out what it is they do, doesn’t mean they don’t do something.  Thus Dr. Holick’s recommendation to hit the sun if at all possible instead of the supplement bottle.

Plus, there are some downsides to indiscriminately throwing back the supplements without monitoring your 25 (OH)D levels.  See here and here, for example.

One of the few criticisms I have of this exceptional book is that Dr. Holick goes way overboard in his obvious worry about the opinion of the heliophobes.  Throughout, he repeatedly warns against overexposure as if getting a little too much sun from a day at the beach could lead to one’s body becoming wrinkled and having skin cancers the size of buboes popping out all over within a week.  But we can’t be too hard on the poor Doc because the water in which he swims professionally has a high SPF indeed.  His colleagues are primarily dermatologists and Dr. Holick works hard not to gain their total opprobrium.  As cardiologist wage their misguided war against fat, dermatologist wage theirs against the sun.  And just as many cardiologists haven’t figured out that fat can be a good thing, dermatologists apparently haven’t learned of the good sunshine can do.  Or if they have learned it, they’ve chosen to ignore it to their patients’ detriment.

The dermatologists are a pretty vocal group and are constantly issuing press releases about the dangers of sun exposure.  So sun phobic are dermatologists that in their minds, the perfect place to vacation would be inside a cave.  I’m not really exaggerating – they are heliophobes of the deepest dye.  And they don’t tolerate dissent.  Ask Dr. Holick.

In 2004 I was forced to give up my position as a professor of dermatology at Boston University Medical Center, a position I had held for nearly ten years.  My stalwart support of sensible sun exposure just didn’t jibe with the views of the chair of the department.

Since this time the scientific literature has exploded with articles about the benefits of vitamin D and the widespread epidemic of vitamin D deficiency.  (I just ran a PubMed search for vitamin D and found 48,552 citations.) I wonder if this silly woman who fired him and was so pompous and cocksure now feels any sense of remorse?  Especially since she still labors in obscurity while Dr. Holick is an academic rock star.

Another point I would take issue with is Dr. Holick’s statement in the book that there is no difference between vitamin D2 and vitamin D3.  He says he’s performed studies looking at these two versions of vitamin D and found both of them to maintain vitamin D levels in the appropriate range.   Since he’s done the studies and seen the data, I don’t have any reason to disagree with him on his findings.  But, there have been a number of anecdotal reports showing that people with problems due to vitamin D deficiency seem to have better symptomatic improvement if they take vitamin D3 (the real vitamin D) than if they take equivalent doses of vitamin D2.

Since these are anecdotal reports, we can’t put absolute faith in them, but I would still recommend vitamin D3 over vitamin D2.  In these situations where one supplement is supposed to perform better than another, usually the one that allegedly performs better, costs more.  So you end up in a risk reward situation: Do I want to pay more to get a better effect or do I want to pay less and hope for adequate results?  In the vit D3 versus vit D2, we don’t have this circumstance.  Both are dirt cheap, and, if anything, vitamin D3 is less expensive.  So if they both create the same blood levels, but one engenders more anecdotally positive reports, why not go with it.  My advice is to buy vitamin D3 and avoid the D2.

One more criticism I have of the book (might as well get ‘em out early) is Dr. Holick’s aligning with the mainstream in criticizing saturated fat.  I’m sure he hasn’t looked at the literature on saturated fat, because if he had, he wouldn’t have written what he did.  But I can’t really hold that totally against him since he is, after all, a mainstream guy (in all but his defense of sunshine), and, as such, would be expected to be marinated in the mainstream biases.

Unfortunately, for a century now, the American diet has been getting higher in fat–especially in the extra-unhealthy saturated fats.  This may partly explain why skin cancer rates have gone up, as well as diabetes and heart disease.  The average American diet is about 16 percent saturated fat, whereas most qualified dieticians [sic] will tell you it should be no more than one third of that.  To make matters worse, there has been a trend toward fad weight-loss programs advocating high fat content (the Atkins diet is probably the best known of these).

Leaving aside whether these diets actually work in the long term to help people keep weight off, diets high in saturated fat may cause a variety of life-threatening health problems and probably contribute to skin cancer, not to mention all other types of cancer.  But you don’t necessarily have to go on a traditional ‘diet’ to achieve the results you’re looking for.  You just need to start moving toward foods lower in saturated fat and try to limit or evict those foods that contain excessive amounts of fat–which is typically found in processed products (which also usually contain lots of salt and sugar) and marbled meats.  There are several excellent eating plans out there that advocate eating this way.

It’s beyond the scope of this book to offer specifics on the perfect diet, but I’ll say that a healthy eating regimen calls for plenty of fresh fruits and vegetables, high-quality proteins (“high-quality” meaning they are low in saturated fat but can be high in healthy monounsaturated fats, as is the case with wild salmon), and whole grains.

Jesus wept.

Fortunately, aside from a few small mentions here and there, this is about the extent of his saturated fat bashing.

For a while now, I have been worried about the long-term effects that will come about from the heliophobes and their constant sunshine bashing. (In fact, MD and I wrote a whole chapter about it in The Protein Power LifePlan back in 2000.)  But after reading The Vitamin D Solution, I’m greatly concerned.  Conscientious parents have no idea of the future damage they may be causing by never letting their children play outside without slathering them with sunscreen.  Today’s children have weaker bones are are much more prone to fracture than children of a few decades ago.  As Dr. Holick reports

Even more alarming is a new epidemic in which bone formation in children appears normal but is actually much softer than is should be.  Girls today break their arms 56 percent more often than did their peers forty years ago.  Boys break their arms 32 percent more often.

I’m sure the girls and boys of forty years ago were much more rough and tumble than the ones of today, yet the kids of today suffer more fractures.

While writing this post I got an email notifying me of a recent study showing that melanoma, a virulently malignant form of skin cancer is occurring with frighteningly high frequency in today’s teens.  These are the adolescents at the leading edge of the great heoliophobe movement, the very ones whose parents, in an effort to protect them, coated these kids liberally with sunscreen every time they walked out of doors.  Did their well-meaning parents set them up for this terrible disease?  Are the chickens coming home to roost?  It’s difficult to say for sure, but, in my opinion, it’s more than likely.  Here’s what happened.

When I was a kid, I played outside all the time.  So did all my friends.  We were outside, especially during the summer, from the time we got up until it was dark.  Since we played outside most all the time, as summer approached and the suns rays became more direct, we had already developed the base of tan from being outside all during the spring when it was difficult to get sunburned.  Our tans protected us from the effects of the sun, blocking both UVA and UVB light.

UVB rays are those that burn the skin and the ones that drive the synthesis of vitamin D.  UVA rays are those that mobilize the melanin (the pigment in the skin) and bring it to the surface.  When enough melanin comes to the surface, our skin gets darker, i.e., we develop a tan.  The tan then protects us from the harmful effects of the sun, allowing us to stay out all day without getting a sunburn and without getting too much UVA, which is important since excess UVA exposure is thought to be the cause of melanoma.

Although many sunscreens available today claim to block both UVB and UVA, when today’s teens were young children, virtually all of the sunscreens on the market then blocked UVB only.  Which is probably the root cause of the increase in melanoma in adolescents today.  Here’s what happens.

People who don’t use sunscreens and who have good sense get out of the sun when they begin to burn.  Avoiding the sun limits the exposure to both UVB, the burning rays, and UVA, the melanoma-stimulating rays.  When people slather on sunscreen that blocks UVB only, they can then stay out in the sun for a long time without burning.  The price they pay for this is that they end up with an extremely large dose of UVA, which doesn’t cause pain but sows the seeds for later melanoma development, a fate that has in the past befallen many a vacationer to the sunny areas of the world.

Many people labor away in offices for 50 weeks of the year then escape for a couple of weeks of fun in the sun.  Since they have limited time, they don’t want to spend it with graduated sun exposure while they develop a tan.  They pile on the sunscreen in copious amounts, hit the beach and stay out all day, stopping only long enough to put on more sunscreen.  During this process, they accumulate the effects of huge exposure to UVA and often pay the price years later by developing melanoma.  Those hardy folk who work outdoors all year long and have constant sun exposure almost never develop melanoma.  Why?  Because they develop a tan that blocks the UVA.  Plus, thanks to their constant sun exposure, they receive the benefit of plenty of vitamin D synthesis, which has been shown to be protective against melanoma.  The poor schmucks on vacation who broil in the sun while basting themselves with sunscreen get way too much UVA and don’t get any vitamin D because sunscreen blocks virtually all of the vitamin D synthesizing rays.  They are the victims of a true double whammy.

And that is what I suspect is driving the increase in melanoma in teens today: their poor misguided parents attempting to do the right thing.  Very sad, indeed.

Along with the increase in melanoma, the huge epidemic of fibromyalgia we are seeing today is in great measure a consequence of vitamin D deficiency.  Without enough vitamin D, bone doesn’t harden as it should.  It grows, but is softer and mushier and less supportive than it should be.  The body continues to make more bone to try to remedy the problem and the bones actually enlarge.  This enlargement presses against the periosteum, the fibrous sheath that surrounds the bone and through which the nerves run.  As the pulpy bony growth presses against the periosteum, it stimulates the nerves in the periosteum and causes the deep bone pain common to sufferers of fibromyalgia.  Doctors who are up to date on their vitamin D knowledge will press the breastbone to try to elicit pain.  And if they do, their patient is probably suffering from a vitamin D deficiency.  If that’s what the blood test shows, then the fibromyalgia can be treated with a course of sunshine and/or vitamin D supplementation.

A couple of weeks ago, I was reading The Vitamin D Solution on a plane, and the guy sitting across the aisle from me was reading Predictably Irrational, which I had read and enjoyed a while back.  I kept looking to see where he was in his book, and he kept glancing at mine.  After we had landed and were taxiing in, he asked me if I had ever known anyone who had responded medically to vitamin D.  He then told me that he had been experiencing severe, debilitating pains in the bones in his chest, back and legs.  He went to his doctor, who checked his vitamin D levels, found them way low, and started my new friend on a course of vitamin D supplements, which, in due course, had gotten rid of his problem.  He was a pretty tan guy, so I asked him about his sun exposure and wondered why he would be vitamin D deficient.  He then told me he was a kidney transplant patient, which explained everything.  As you will learn when you read Dr. Holick’s book, the kidney converts the inactive form of vitamin D circulating in the blood to the active form.  This gentleman’s transplanted kidney obviously wasn’t doing it for him.  Vitamin D supplements did the trick, however, and his pains had vanished.

The subject matter I’ve covered in this post barely scratches the surface of what’s there in Dr. Holick’s new book.  I heartily recommend it to all.

Before I sign off here, though, I want to relate a funny story.  Funny to me at least.  It involves a character who was a running dog of mine back when I was in medical school.  Any of you who read The Protein Power LifePlan already met this guy in another humorous adventure of his I related in the section on iron overload.  He’s the guy who dated the pig lady.

This guy was, in Billy Bob Thornton’s memorable words to Woody Harrelson in the movie Indecent Proposal, a “real poon hound.”  This guy would relentlessly go after anything with a skirt.  And, as often happens with those types, he came down with a bad case of herpes.  As soon as he got his diagnosis he went into a depression for about a week and then began reading everything he could read on herpes.  He discovered that herpes was typically a local infection but that in some patients (mainly immunocompromised ones) herpes could go systemic, which means it could spread through the bloodstream and and create a hellish infection everywhere, often with fatal consequences.  His affliction was never far from his mind, which led to the tale that follows.

In those days Zovirax hadn’t been developed, so the only remedies for this loathsome disorder were OTC products that didn’t really work.  At that time the main OTC med was Stoxil, which my friend purchased by the car-load lot and coated himself (or at least his infected parts) with at the least sign of an outbreak.

One day he came down with some kind of upper respiratory infection and called me to get something for it.  He was prone to these infections, which responded well to minocycline, a tetracycline-derivative drug.  I called him in a course of the drug and forgot about it.

Unbeknownst to me, my friend was planning a day at the lake with his latest inamorata.   Complexion-wise, he was lily white and usually avoided the sun.  A day at the lake was not his typical recreation, so I can be excused from not telling him not to go out in the sun; it would have never occurred to me that he might do so. The sun can be a problem because tetracycline drugs have a propensity to give people who take them a photosensitivity reaction when they get too much exposure.  These photosensitivity reactions cause the skin to swell and become discolored and blistered.

My friend took his meds as prescribed, had a great day at the lake, came home with the girl and hit the sack.  After he had been asleep for a few hours, he woke up needing to relieve himself.  On his walk to the toilet, he passed the bathroom mirror and glanced at the mirror wherein he saw the Elephant Man staring back at him.  His face red, blistered and swollen, eyes just slits.  He had obviously had a bad photosensitivity reaction (obviously that is to those who knew about such things) after his day in the sun while on minocycline.  But he didn’t know this.  He flew into a blind panic because the first thing that sprang to his mind was that his herpes was swarming on him: that he had developed systemic herpes.  He immediately grabbed the Stoxil and practically bathed in it.  Then he put in an emergency call to his dermatologist, whom, I’m sure, found it strange since dermatologists rarely — if ever — get emergency calls.

When he told me about it later in the day, I burst out laughing and have laughed about it any time I thought of it up to this moment.  In fact, I’m having trouble typing these words because I’m still laughing so hard remembering.  Who says doctors are humorless?  My friend even laughed about it later, though admittedly not to the same degree I did.  What I found so funny was not his condition but the fact that he was so obsessed with his herpes that the first thought that jumped to his mind was that his disfigurement was his herpes going wild.  Maybe you just had to be there.

Don’t let my semi-off-topic detour make you forget about picking up a copy of Dr. Holick’s book.  Despite my few minor criticisms, it is an excellent book that provides a wealth of useful information.  Just the Q&A is worth the price of the book because in that section Dr. Holick answers all the questions anyone might think of about vitamin D, including the one I’ve been asked numerous times: If you shower after sunbathing, does it wash away the vitamin D.  The answer is No.  Then he explains why.

There is something for everyone in this book, from studies showing sun bathing works as well (if not better) than medications for lowering blood pressure to discussions of vitamin D and its effects on obesity and leptin secretion.  It doesn’t matter if you’re depressed, have multiple sclerosis, psoriasis, osteoporosis or even PMS, you can learn how vitamin D will help you out. Grab a copy and start reading.

Since the last time I posted (which, admittedly, was a while ago), I’ve flown about 8 billion miles, so I’ve had plenty of time to read while in the air.  Here is a list of the books  on my nightstand right now.

Pandora’s Seed: The Unforeseen Cost of Civilization by Spencer Wells.  I’m about a forth of the way through this book describing the problems we hunting/gathering humans have had in adapting to agriculture.  So far, so good.  A couple of medical missteps already, but nothing major.  But I haven’t gotten to the real meat of the part on disease, so I’ll reserve my judgment until then.

The Upside of Irrationality: The Unexpected Benefits of Defying Logic at Work and at Home by Dan Ariely.  This is the follow up book to Predictably Irrational, which I posted about earlier.  While the first book explained how predictably irrational we humans really are, this second one teaches us how to benefit from it.

Manthropology by Peter McAllister.  A fun book written by an Australian anthropologist discussing what wimps modern men (and women) are compared to their Paleo ancestors.  According to McAllister, today’s elite athletes would have trouble competing with our ancient predecessors in any events requiring speed or strength.  Unfortunately this book won’t be available in a US edition until Oct 2010.  If you want it before then, you can get it on Amazon, but you’ll have to pay through the nose for it like I did. I couldn’t resist the title.

The First Cut, Cut to the Quick, and The Deepest Cut all by Dianne Emley.  The careful reader can probably detect a theme in these books, which are are police procedural mystery novels set in Pasadena, CA.  The protagonist, Nan Vining, is a single mom and has recovered from a near death experience after having been stabbed in the throat while on duty.  These have been my escapist books over the past couple of weeks.  I’m running out of mysteries to read because it seems that I have read everything written by US and UK (and even Australian) authors.  Help!  Any and all suggestions will be appreciated.

36 Arguments for the Existence of God: A Work of Fiction by Rebecca Goldstein.  A literary novel if there ever were one.  Probably not everyone’s cup of tea, but I enjoyed it immensely.  It has so many moving parts that it’s hard to describe.  Read the Amazon review if you’re interested.

The Rational Optimist: How Prosperity Evolves by Matt Ridly .  I was curious to see how Matt Ridly, an excellent science writer, would approach a more soft science than usual.  His thesis is that collective human intelligence will save us from the fates all the Erhlich’s and Malthusians fear await us.

Decoding Reality: The Universe as Quantum Information by Vlatko Vedral. Another book that is no doubt not everyone’s cup of tea, but I’m a physics/quantum mechanics geek so I enjoy this kind of book.  It explores the idea that information is the basic element making up the universe.

Cro-Magnon: How the Ice Age Gave Birth to the First Modern Humans by Brian Fagan.  Dr. Fagan is an Emeritus Professor of Anthropology at the University of California, Santa Barbara and a fellow member of the Santa Barbara Yacht Club. This book, his latest, explores the time that Cro-Magnon man and Neanderthals co-existed in Europe and how the superior intellect of the former allowed them to survive the Ice Age.  Until I read this book, it hadn’t occurred to me that the Cro-Magnons, who were identical to us genetically, roamed Europe for about 30,000 years, a length of time vastly longer than all of recorded history.  And yet it seems we know less about them than we do most of the other primitive beings.

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218 thoughts on “Sunshine Superman

  1. I suspect when Dr. Holick refers to high quality protein he is not referring to protein assiciated with low saturated fat but protein of high biological value such as egg and whey protein. as opposed to proteins of low biological value such as those found in grains and pulses

    • Sarcoidosis is one of the few conditions where D supplementation could aggravate the condition.
      Trevor Marshall suffers from the condition and has suggested that Chronic disease is not caused by D deficiency but vitamin D deficiency is a result of chronic disease. He has developed the Marshall protocol, requiring strict avoidance of sunlight, supplements, and D-rich foods. He has a surprisingly strong following.
      http://bacteriality.com/about-the-mp/

      • I wrote Dr. Holick about the Marshall Protocol a couple of years ago, and he wrote me back saying (in a nice sort of way) that he thought is was BS.

        • Did Dr. Holick also have sarcoidosis? I don’t think the explanation Trevor Marshall gives is 100% accurate but his protocol has kept his own sarcoidosis in remission and it has helped my husband’s case as well. I also used it successfully to reduce my migraines and autoimmune symptoms. Cancer cells and cells that are infected with cell wall deficient bacteria have the ability to make the enzyme that activates vitamin D into hormone D. The uproar about D deficiency is actually reflecting that the body’s supply of the vitamin is being quickly converted into the hormone. Endocrinologists seem to think that checking the hormone level is unimportant because of the “careful control by the kidneys” (there is the BS – the placenta makes the enzyme but it is not elevated in breast milk so why is it elevated in infant formula?).

          D is a short term solution like Prednisone – there is an temporary reduction in symptoms because of the flush of nutrients being released from the bones. Those nutrients run out however leaving us children at risk for fractures. It has been misunderstood and if you consider native garb from equatorial regions you might notice a trend toward covering up the skin.

          So BS kind of depends on your viewpoint. I have five years of my own vitamin D levels (posted) and my husband’s (private) that reflect chronically depressed vitamin D and chronically elevated hormone D (1,25-D). D is part of the answer but it is not a magic bullet solution that seems to be envisioned. Our paleolithic ancestors did not have soil full of bromide, fluoride and perchlorates. Their soil had iodine and magnesium – unfortunately flooding over the centuries washed much of into the sea and brine pits.

          We still make vitamin D in the north and there are not tons of bow legged people or babies hobbling around like rodeo cowboys. In my fifteen years of working with northern families in the WIC program, I met only one infant with early rickets. He was very dark complected like his mom. She had a severe dairy allergy and he was completely breastfed. He took right to sardines when I met them around 18 months old and his legs grew nice and straight.

          So I have to say I agree with Dr Barbara Gilchrist – there is a much larger body of evidence pointing towards sensible sun protection then excessive sun-tanning (not sun avoidance though).

  2. As you’ve said Professor Holicks book is really worth the read. The heliophobe issue is a major concern and is right up there with hi carb, low fat diets, long term sedentary lifestyle etc. The dermatologists and anti-cancer organisations (& many in the scientific community) are so brain washed by the belief that sun exposure is demonic they are in denial regarding vitamin D. I’d been doing the paleo diet\protein power diet since 2001 and had still been having some problems. I’d tried altering individual variables for a month (12 experiments a year for 5-6 years). Then around in mid2007 I discovered some software that let me enter all food and gave me a readout of macro and micronutrients- the only thing I couldnt get enough of was Vitamin D. The horrible thought occurred. I might need to engage in …… sun exposure. I’m at around 40 deg Latitude S and spent that spring and summer systematically tanning myself and taking supplements. Felt increasing good to great as time progressed. Requested a D3 blood test done in Autumn, Dr reluctantly agreed, and managed to exceed the lower limit of normal (just)! Wish I’d known 20 years earlier but I work in OHS where zero sun exposure is pushed hard and I practiced what I preached (and was taught at University). Many OHS people think I’m barmy (stupid) when I mention the need for balance ie zero or too little sun exposure is harmful, a bit is good, too much is harmful.
    OB

  3. I’m still trying to convince my wife to ditch the sunscreen. My father had skin cancer (Irish and grew up in New Mexico), so he goes out only slathered now, I imagine he’s short on D.

    As far as mystery/crime novels, Robert Wilson is a recent discovery of mine (he’s British and rather famous so you probably know him already), closest I’ve seen a modern novelist come to Chandler and Arturo Perez-Reverte when he was on his game like ‘The Club Dumas’ (the Capt Alatriste novels are dismal in my opinion).

  4. It’s nice to see you back! This is just in time for our trip to the beach with extended family—and I’m the whacko who won’t be slathering her kids with sunscreen. I’ve never been a big fan, but I have used it on occasion when they want to go out from 10-2 if they don’t have a base tan. But we’ve generally been on a different schedule from everyone else and done early a.m. and late afternoon.

  5. A new friend of mine mentioned that he suffers from fatty liver disease, and I was telling him about your 6 Week Cure book and the benefits of eating saturated fat in clearing the liver. However, he eats a high carb diet, and junk fats like margarine (yuck). Would it do him harm to eat more saturated fat if he didn’t cut his carb intake? I eat a lot of saturated fat along with a lower carb diet.. and I’m always telling people to eat more butter and less vegetable oils. Should I include a caveat to lower carb intake at the same time, or is sat fat consumption good even with high carb intakes? Been wondering about this.

    • I, myself, would prefer saturated fat even in the presence of a lot of carbs over vegetable fat and carbs. The human studies that I’ve seen showing rapid reversal of fatty liver, however, used low-carb diets.

      • Hi,
        Very glad to see you back. How much low carb (how many grams) to reverse fatty liver disease drastically?
        Regards,
        Ram

  6. The IOM (Institute of Medicine in the U.S.) is considering revising its vitamin D recommendations within the next year. If they do so in an upward direction (as expected), it will be at least partially in response to Dr. Holick’s work.

    Hadn’t heard about sternal pressure as a screening test for vitamin D deficiency. I’ve read that the place to press is the shin bone – and a safer place to apply pressure if you’re a male physician examining a female patient without a chaperone.

    -Steve

    • You can put pressure on a lot of bones and get pain. They guy I met on the plane had severe pain in his scapulae that was greatly exacerbated by even gentle pressure.

  7. The fact is vitamin d is an essential component of health the increase in melanoma mentioned which corresponds quite nicely with the increasing use of sunscreen is perhaps the tip of the iceberg cancer and MS and heart disease increases await all will ,in my opinion, rise as the first totally sunscreen generation ages those perhaps approaching 30 . In my opinion that group will actualy be the first generation to experience a shorter life span. ‘The Lord looked at the sun and said it is good’ The dermatologist disagreed.

  8. Mike….great meeting you and Mary at the NRA. (I’m the guy that ribbed you for not selecting me as subject for last book).

    I hope it was worthwhile for you guys.

    Cheers!
    Steve

  9. Added this one to my wishlist, hopefully will get it for Father’s Day/birthday coming up.

    Since you’ve had a “gentle” introduction to information theory, I’d recommend Jaynes’ book (http://amzn.to/bpLzP0). More “AHA!” moments in this book than any other I’ve read.

  10. So nice to see you back Dr Eades ! Straight after I read this blog I put Dr Hollick’s book in my Amazon basket – I’ve watched his video lecture on the grassroots vitamin D website – very amazing speaker but a mystery as to why he thinks D2 is as good as D3, but I’ll take that with a pinch of salt as well as his criticism of saturated fat. I’ve also put Brian Fagan’s Cro-Magnon book in my basket – thanks for the recommendation :-)

  11. So happy to see a new post from you! Jam-packed with info; thanks!. For high-interest thrillers, have you read the Steig Larsson trilogy yet (starting with The Girl with the Dragon Tattoo)?

    BTW, your paragraph about the role of UVB and UVA (starting, “UVB rays are those that burn the skin”) is missing any mention of a link between UVA and melanoma–its role sounds positive. Thus, two paragraphs later when you refer to “UVA, the melanoma-stimulating rays” it comes out of the blue. Eventually one figures it out but another sentence in the first paragraph would clarity it up front. [Sorry; it’s the editor in me screaming to get out…]

  12. Yes, I’ve read the Steig Larsson trilogy. Too bad there won’t be more.

    Thanks for the editorial advice. I always appreciate it, especially when it’s free. :-) I can see how the paragraph in question could be confusing. I’ve made a stab at fixing it.

    • Try Redbreast by Jo Nesbo, a Norwegian writer. It is one of the best mysteries I’ve read in a loing time, blending some fascinating histroy along the way. The follow up, Nemisis, is nearly as good. Redbreast was voted the best Scandanavian crime novel of all time (or something like that) and is the best of the recent vogue for Northern Eurpeon mysteries.

    • Dr. Eades, a couple of months ago I stopped taking the 40 mg a day of Lovastatin I had been taking for about three years and started taking 5000 iu of Vitamin D daily. I hoped the Vitamin D would help raise my HDL levels from 63 (last test in September) and that the loss of the statin wouldn’t result in a drop in my LDL levels. BTW, I’ve been no sugar/very low carbs for about a year now and consistently taking one gram a day of Enduracin and two grams a day of fish oil.

      Well, just got new test results back. My HDL has dropped to 52 and my triglycerides and LDL levels are double what they were before with the Lovastatin (Trig now 243, LDL 152). My D level was 56.

      So — where do I go from here? I had a stroke about 5 years ago and various poor cardiac tests thereafter. I loved having my HDL above 60 since low-carbing/niacin/fish oil — but now I’m thinking I need to get back on the statin and that the D just isn’t jacking up my HDL like I hoped it would. Any guidance would be greatly appreciated.

      • I can’t possibly advise on any of this over the internet. You need to discuss the situation with your own physician, and if your don’t trust your physician’s advice, you need to determine if you should find another.

        I can tell you that there is a rebound effect on lipids when statins are discontinued. If that is what you are experiencing, it should normalize. But, again, you need to check with your physician on this.

  13. I bought Holick’s book as soon as it came out. You should read his book. And, if you choose not to, you should check out his lectures, videos of which are available in all the usual places. They are a riot. I usually avoid watching videos, since I can get a lot more information in the same time by reading. But his lectures are both informative and wickedly entertaining.

    I have been trying to find out from him, thus far unsuccessfully, what his thoughts are on narrow-band versus broad-band UVB lamps. From what I’ve read, UVB-NB has distinct advantages. But I haven’t been studying this stuff since grad school. In his book he does suggest that tanning beds and Sperti lamps (UVB-broadband) are fine.

    Although they can be expensive, UVB lamps seem to offer the advantage of producing those 5-10 photoproducts that supplements don’t offer. Of course, the sun is best, but some of us have jobs which make regular sun exposure hard to obtain.

    • I have the same problem! I have a day job and I would like to develop a tan, but I’m fearful that if I go to a tanning salon I will be:

      1) Irradiated 5 ways to Sunday
      and
      2) Die of a cancer variety pack

      Are tanning salons safe? Should I watch out for dangerous bulbs or something?

  14. It seems unnatural to avoid the sun when our ancestors lived outdoors. But I wonder whether those of us of northern European stock need as much sunlight as others. I for one can’t be in the Denver sunshine very long without feeling myself start to burn. So I’m not throwing out the sunscreen, but I don’t slather it on as much as I used to.

    Not everyone who works in outdoors benefits from it. My uncle, a lineman in California, developed melanoma and very sensitive skin. His ancestors were Scandinavian and English.

    I wonder how much our ancestors were helped by a layer of dirt. They surely weren’t as squeaky clean as we are now. Elephants give themselves a dirt spray–a bit like mineral makeup, which is SPF 8.

    My skin really improved after I started eating a low-carb, high-fat diet. I used to exfoliate and moisturize like crazy, but now I hardly do either even though I live in a dry climate.

  15. Love your book reviews and “reading list.” But, you are missing an opportunity for those of us who follow you to help support your blog … you should be linking to the books with your proteinpowerc-20 associates ID to get your small commission from Amazon! At least we know you really like the books and aren’t linking to them for the commission!

    (No need to publish this comment, as its mainly “off-topic”. Just wanted to express my thanks for the reading tips — your choices are much better than Oprah.)

    • I think I am linking to them through my Amazon associates account, but who knows, maybe I’m not. That’s not why I put them up, though. Enough people have asked me what I’m reading, so I’ve tried on the last few posts to list whats currently on my nightstand.

      • The link itself will have the code in it … hover over the link for your books on the site and you’ll see they end with (or have embedded in them):

        &tag=proteinpowerc-20

        If the link doesn’t have a “-20″ code like that in it you are not getting credit for it.

        You can add the Amazon “site stripe” to your browser and use it to create links any time you have Amazon on screen.

        Anyway, I do enjoy the reading lists. For your mystery/thriller reading list, have you read the Gabriel Allon series by Daniel Silva? The protagonist is a bit different from the American Spy thrillers from Vince Flynn or Brad Thor, but the books are similar in tone. “Allon” is a Mossad agent who is also an accomplished art restorer, so the locales are a bit more international in scope.

        I had high hopes for Michael Palmer’s medical mysteries after reading “The First Patient”, but his follow up effort “Second Opinion” wasn’t as good. I have not read his new one, “The Last Surgeon”; I’ll probably wait for the paperback or clearance sale to try it out again.

  16. bloglines lost my account and now I can’t find your comments feed again, not the individual post comments but the one I was subscribed to before that gave me all the comments no matter what post they were on.

  17. I have seen the subligual version of viatmin D3 at the health store. Is there any difference in the efficacy of taking D3 supplements in gel form or sublingual?

  18. So nice to see you again!

    I was wondering how to refute those people out there (lay folk and doctors alike) who say that the sun is far more dangerous today than it ever was before in history because of the hole(s) in the ozone. These people usually cite Australia.

    Usually I just let these people talk on, spewing their ignorance of the facts, but I’d sure like a comeback to this one about the ozone.

    I even had someone try to tell me that the sun is now much closer to the earth than it was when we were kids! Sheesh.

    So what about this ozone nonsense?

    • I’m guessing it’s not that big a deal. Dr. Holick doesn’t mention it at all in his book, and I would imagine that he would be on top of the situation.

    • For a while there was an annual thinning of the ozone layer over Antarctica commonly called the “ozone hole”. I think that’s where the story comes from. If anyone lived in Antarctica, they might be getting more UV than they used to.

  19. Quote: ” As Dr. Holick reports

    Even more alarming is a new epidemic in which bone formation in children appears normal but is actually much softer than is should be. Girls today break their arms 56 percent more often than did their peers forty years ago. Boys break their arms 32 percent more often.”

    I’m sure the girls and boys of forty years ago were much more rough and tumble than the ones of today, yet the kids of today suffer more fractures. (end quote)

    Please, before publishing this nonsense, do a little research on this. It is as simple as asking any orthopedic surgeon the REASON for all the the broken arms. It’s simple: SNOWBOARDING!!!

    Snowboarding was not around forty years ago. It is a relatively new sport, and it’s biggest problem is that it causes forearm fractures, because of the position your body is in when you fall. There have been many critics of snowboarding just for that reason.

    I have children/teenagers, and once they started snowboarding, two out of three of them broke their forearms within the first two days. Before that, my rough-and-tumble kids had never had a broken bone in their lives, despite some pretty crazy experiences such as falling out of trees and jumping off roofs into piles of hay, etc.

    It’s likely that my own children have contributed to the statistics a little bit: both of the broken forearms were in my girls.

    We live in the mountainwest, where kids snowboard all winter long, and it is very common to see kids with their forearms in casts during the snowboarding season. Our orthopedic surgeon jokes that he loves the sport of snowboarding: it has enabled him to buy a new boat, new jet skiis, etc. He said that kids’ bones haven’t changed…just the sports they participate in, and the fact that girls participate in snowboarding as much as the boys…forty years ago, fewer girls would have been playing sports. Oh, and incidentally, not too many adults snowboard…most adults stick with skiing, which is much safer. That’s why there is not an increase in adult forearm fractures. Most kids think of skiing as being an “old person” sport and prefer to snowboard.

    If we outlawed the sport of snowboarding, the rates of forearm fractures in children would go right back to baseline.

    • I think you are extrapolating events in your local situation incorrectly. Where you live, snowboarding may cause a lot of forearm fractures, but nationwide, I doubt that it makes a blip. The vast majority of kids in the country have never been on a snowboard.

  20. I went to Dr. Hollick’s web site and listened to his video’s. I was surprised to see that he only recommends 1000-2000 IU of Vitamin D per day. I assume that he is following the NIH’s recommendation of Serum 25(OH)D of 20-50 ng/ml? How does this square with the Vitamin D Council’s recommendation of 4000-8000 IU of Vitamin D daily and 25(OH)D of 50-80 ng/ml?

    Personally I took 8000 IU of Vitamin D all winter and was tested this spring with 25(OH)D of 67 ng/ml. I’m getting sun exposure this sprint/summer/fall, cutting back on the Vitamin D supplements and getting retested at the end of the year. Hopefully I can come up with a winter/summer recipe to keep my Vitamin D levels high.

    I’m also curious about your opinion of Vitamin A and its potential cancellation of Vitamin D’s positive effects against cancer. I see that Dr Hollick wants a maximum dose of 3500 IU of Vitamin A. I believe that the Vitamin D council wants something far less and thinks that Cod Liver Oil is evil. The Weston Price Foundation has an opposite view of Vitamin A citing that the studies done on it were incorrectly performed because they used minimal Vitamin D.

    • Don’t forget Dr. Hollick also advises some sun exposure If a recall correctly about 30 minutes or so a day. I believe he views about 50 ng/ml as a target. His views on tanning beds have been noted

  21. After testing low for Vit D over the past year, I recently threw out all my sunscreens which I used diligently for the past 20+ years. I now sunbathe for 30 minutes each midday, if my schedule permits. I couldn’t believe how quickly I developed a tan in this short amount of time. It is a nice reprieve in the middle of the day – a sort of meditation – and the sun just feels so good – I highly recommend it.

    Isn’t it interesting how dermatology has split into two specialties – one treating diseases of the skin and the other all about beauty enhancement. Perhaps the dermatologists of yesteryear struggled with an identity crisis, wanting to be respected as serious MDs treating serious diseases and not just superficial skin annoyances such as acne and wrinkles. Today you can forget about getting botox and a cancer screening at the same time.

    Funny how karma has handed the rock star baton to the pimple poppers though. http://www.youtube.com/watch?v=mGFoAX2Rf6g

  22. I finally found a local doctor here in Denver who has a clue about all of the most recent science. She used to be an ER physician and now has an anti-aging practice. She spends a good percentage of her presentations to new patients espousing the benefits of Vit D (and the problems with its’ lack). First thing she does is test Vit D levels (along with hormone and thyroid panels). Even though I’ve been supplementing with about 4000 iu for over a year, I still only came in at a 38. She wants a minimum of 40, and preferably well over. I don’t slather sunscreen anymore, but must be unbelievably cautious about my amount of sun exposure. I got a severe burn at 9am after only an hour in May! Going to increase the supplements and try to get more regular exposure. She also puts patients on strictly limited grain diets and uses bioidentical hormones, as well as T3 supplementation. Yay for me, finally.

    I have to say, I’m saddened that the authority on Vitamin D has to venture into the non-science supported realm of throwing saturated fat out as the cause of increasing skin cancer rates (and all of our other health woes). Seems to me that’s how the US wound up in this mess to begin with, a la “We just *know* saturated fat is bad! Eventually we’ll get a study to confirm our belief…” from every different direction. Why can’t an author simply stick to what they know the science proves, and skip the guessing? It almost sounds like he’s throwing out the saturated fat bone to obfuscate the dilemma of contradicting all the dermatologists’ sunscreen recommendations. “It’s not the increasing use of sunscreen causing all these problems, it’s that damned saturated fat we just won’t stop eating.” It’s like a gigantic game of Whack-A-Mole trying to suppress each erroneous reference to saturated fat. I’ve all but given up talking about it in polite conversation, because the conversations never end politely. Depressing.

    @Lindy – I tend to agree with your comment, but not just the snowboarding. Think of the toys our kids have: trampolines (yikes!), scooters, ripsticks, rollerblades, heeley’s, etc. The only thing I had as a kid was a bike, and that was in the 70’s. My kids don’t often play outside without being on a device of some sort, and invariably do something extreme on it besides like ramps or jumps. FWIW, I supplement my kids with D3 and krill oil. Maybe it’ll even the odds!

    p.s. Missed your posts Doc!

    • What kids do today that they didn’t do 40 years ago is spend inordinate amounts of time playing video games. Sitting on a couch playing video games for hours on end engenders little risk for broken bones. I would venture that the time spent in non-activity (playing VGs) more than compensates for the extra ‘devices’ that can cause kids to break bones.

    • When I was a kid in the late 50’s and 60’s we had very unsophisticated skateboards which we road down any hill we could find, we had trampolines, we had bikes. We also played neighborhood tackle football games in vacant lots with no pads, baseball with hardballs and fast overhand pitching. No one wore helmets or pads for any of this. My brother had a go-cart he made from a piece of plywood and a lawn mower engine. You steered it with a rope and it was virtually impossible not to wreck it or come flying off. Kids got hurt all the time, but broken bones were few. We were outside all summer.

  23. My kids daycare has a policy of slathering all the children in SPF 50 (school provided) before they go outside. Of course, the parents must sign a consent form for this, which I of course refused. So I got to sign a special wavier stating that the parents had requested sunscreen not be used at anytime. (The kids all nap in the heat of the day anyway, and rarely stay out for more than 20 minutes if its at all warm. The risk of sunburn is really zero for any of them).

    The downside is my 2 year old loves to slather herself in lotions, and I think is envious of all the other kids getting coated in creams everyday. She gets really excited on the rare occasions when she does wear sunscreen, like at the pool, like it’s some sort of special treat.

    Sigh.

  24. Dr. Holick’s previous book, The UV Advantage, is also excellent, but the new book takes off where TUVA left off, with updated research and recommendations. I had the same thoughts as you about his D2/D3 advice and dietary fats. A nutrition expert Dr. Holick isn’t, so I took that with a grain of salt.

    As a person who developed brown “liver” spots on the back of my hands in my 20s (when I was avoiding sat fats and consuming more PUFA oils and my midday sun exposure was limited to weekends and holidays) and a basal cell skin cancer and skin graft on my nose in my 30s, I have been very interested in the hazards and benefits of sun exposure for a number of years. After the MOHS and plastic surgery almost 12 years ago to remove and repair the basal cell carcinoma I was advised I had a 50% chance of another skin cancer on my nose. The pimple sized nodule removal required a dime sized skin graft and it was almost a year before the repair was fully healed, so I can appreciate that basal cell carcinoma removal, while not typically life threatening, is certainly not minor. So I don’t take it lightly.

    But now in my late 40s and a little wiser, I regret the many years I completely avoided the sun or slathered on high SPF lotions daily as instructed by my dermatologist. It was like living in a cave sometimes. now I still avoid burning, and still don’t tan very much, but my health and well-being is much improved when I get some regular midday sun exposure and keep my Vit D level at a certain level with supplements (sun exposure without any supplementation dropped my Vit D level too much). I check my Vit D status and adjust my D3 dose via twice yearly finger prick blood drop mail-in 25 (OH)D tests through http://www.grassrootshealth.net ( a University of California Vit D study) in late winter/early fall and via my HMO whenever I’m having blood drawn for other purposes – I just ask the doc to add it with the other lab orders).

    These days my skin seems to be far less prone to burning than when I was younger and using Jane Brody’s cookbooks (sorry to say), even though I’m not much of a tanner. I have no new brown “liver” spots on my hands, though the older spots are still there, though they have slightly faded. I can’t help but think the switch from veg oils to butter and other saturated fats about 5-6 years ago is part of the improved ability to withstand more midday sun exposure (plus my exposure is no longer just on weekends and holidays). I may develop more wrinkles and probably will increase cosmetic but relatively minor sun damage, but I think that’s a fair trade-off and I’m willing to accept that. What good is it to keep one’s face as smooth as a baby’s bottom if it also means developing a more serious and perhaps life-threatening disease?

    I also like listening to Dr. Holick’s lectures on UCTV (links available on the http://www.grassrootshealth.net website and iTunesU). He’s a dynamic speaker.

  25. You may have answered the following but I didn’t see it: Just how much time should one spend in the sun to get “enough” Vitamin D? I walk/jog with my arms and legs exposed to the sun for about an hour each day. Is this enough? Should I lay in the sun for X minutes per day, exposing most, if not all, of my skin?

    • It depends upon where one lives. The closer the equator, the less time one needs to spend in the sun. Dr. Holick’s book has all kinds of charts and maps that let you calculate how much time you need to spend in the sun to promote adequate vitamin D synthesis.

  26. This post reminded me of an advert I laughed at a couple of weeks ago. It was boasting about how their fish-product now had lower saturated fat content than ever before. Sounds like Dr. Holick is a genius, but eats swill out in the sun, and probably gets burnt to buggery for not having enough Sat Fat in his skin.

  27. It seems that the more I read the more confusing it gets. You would think that if you drank enough milk, which wouldn’t be much, you would get your required Vitamin D. In fact I have to wonder; if we went back a little in time we would come to a point where people just ate. They ate and lived -much like the example given in the above article about the girl with no malls or pizza etc- and they survived just fine. I know that even our supposedly fresh vegetables today have less nutrients in them than those of old but is it that bad that we can’t even just eat healthy meals without supplementing “extra?” 4000-8000 IU of Vitamin D? What happened to the RDA of 400? Is this only in America? Is there no such thing as a healthy diet anymore “without supplementation? I’m lost. I thought I was healthy….the more I read the more others are trying to convince me I’m not.

    • At one point people did just eat, but they also spent a lot of time in the sun. When they didn’t spend the time in the sun, they got rickets.

  28. Nice review of the book! One thing though, about the girl at the equator: she is eating a very different diet. First off, she likely doesn’t get much wheat. The 1-30% (depending who you ask) of people who get an immune reaction to wheat, are also the people who are very low on vitamin D, even when they DO get enough sun. I was one of those: grew up in Southern California, had a nice tan, didn’t wear sunscreen, and still had osteopenia. Which resolved after going GF, even though now I don’t get near as much sun.

    Second, the girl at the equator likely has low ferritin levels. She doesn’t get iron-supplemented food, and the food she DOES eat tends to be the kind that blocks iron absorption. She may even have parasites. She is probably at risk for iron-deficiency. But high iron levels — such as are found in the US — are very much associated with diabetes and other metabolic problems, as you explained nicely in Protein Power. Excess iron gets deposited in the skin, and cancer eats iron. My own feeling is that the melanoma results partially because of the excess iron deposits.

    Thing is, all these nutritional issues are very much tied together. In writing books it is way easier to concentrate on one nutrient or one food, but they all interconnect.

  29. Very interesting read. I have pretty fair skin (Irish descent) so I’ve always burned easily. I’ve noticed that my forearms however – which are the most tan part of my body – don’t get burned with a fair amount of sun exposure.

    Regarding the bone fractures in children, I’ve read that a better way to increase bone strength is to lift weights (rather than rely on calcium supplements). Is there any correlation between inactivity in kids and bone strength aka increased bone fractures? I suppose this lack of inactivity would also include less sun exposure if kids are playing outside.

  30. kris,

    I don’t think dermatologists have really split into two specialties – I think they all really prefer to be cosmetic dermatologists as exclusively as possible – no insurance to deal with and lots of cash -paying customers seeking the fountain of youth. They see patients with skin ailments and diseases because they have to, if for no other reason than to still feel like a “healer”.

    Perhaps I’m become jaded living in the center of the Youth Seekers in So California, but it’s telling when I call for an appt for a skin cancer checkup and am told that it’ll be a 3+ month wait, but when I mention that I’d like to discuss having some enlarged facial capillaries laser zapped (not covered by insurance), I can be seen for a consult in as little as 2-3 days or whenever is convenient.

  31. Howdy Doc!

    I’m wondering if Dr. Holick mentions anything about tanning beds? Do we produce vit. D from fake sun exposure? Is it a good idea to get a base tan that way when you know you spend all your time in the office and you’re headed to Brazil in a few weeks?

    For what its worth, I still use sunscreen – if I don’t I end up with a nasty burn when I go out surfing once a week. I guess I can try easing off as the summer progresses…

    btw, got a grass-fed hangar steak in the SVS right now, it’s almost grillin time!

    • Dr. Holick spends a fair amount of time discussing tanning facilities. He does believe that indoor tanning is a reasonable substitute for those who can’t get out in the sun.

  32. OT- I was reading about the latest diabetes/cancer risk findings in women in this article at physorg (http://www.physorg.com/news195390635.html) when the last sentence just about bowled me over… “Of course, wherever possible, the best approach is to avoid diabetes entirely, says Dr. Chodick, with the help of a high-fiber, low-carbohydrate diet combined with exercise.”

    Mainstream, no qualifiers or explanations. Now they just have to replace “fiber” with “fat”, but they’re halfway there!

  33. Well, since you asked for book recommendations I’ll put in my two cents. These are in the fiction/escapism department. Neither of them is terribly new so maybe you’ve already read/decided not to read them.

    1. The Eyre Affair by Jasper Fforde. This is the first in a series involving Thursday Next, a literary detective. It’s set in an alternate history where literature is highly valued. It’s good to know the plot of Jane Eyre for this one, but this book is nothing like Jane Eyre. It’s part mystery, part sci fi, part government conspiracy. Hard to categorize this one. He’s also written a “Nursery Crime” series that I enjoyed.

    2. The Sweetness at the Bottom of the Pie by Alan Bradley. This is a mystery that includes some fun chemistry, and an interesting plot centered around the Penny Black stamp.

    • Haven’t read the Jasper Fforde stuff, but have read a lot about it. It just doesn’t seem to be for me, but as I run out of new mysteries to read, I may have to give it a whirl.

      I have a copy of The Sweetness at the Bottom of the Pie on my nightstand, but I haven’t opened it yet.

  34. I was in my mother’s dermatologist’s waiting room a few months back, picked up a trade mag from, IIRC, The Skin Cancer Institute. Something like that. Chock full of fear. But was really interesting was that EVERYsingle “supporter,” i.e., $$$$$$$ donor, was either a maker and retailer of sunscreens, or the maker of the ingredients!

    “Follow the money!”

    (I do use a sticky white base kid’s sunscreen on my nose because of my rosacea.)

    I “grew up” in Florida, summer month after month living in my Speedo, sailing, swimming, aquatics counselor, city lifeguard. I returned a few years ago to take care of my dying father and, of course, bought sunscreen. But as I got into the Primal/Paleo living last summer, I did my own research and concluded I was going for the D. Better a basal cell carcinoma than colon cancer!

    I had a blood workup done last October and my Vit D level was 54. (I was age 63, so that might have something to do with it not being higher.) To the lab’s credit, they actually insert a line about levels needing to be above 32 “for optimal health.”

    I get, most days now in the summer, a few hours or more of bare torso sunlight and add about 5,000 IU’s as supplements.

    BTW, sun does not cause “premature aging.” That’s the normal aging. Lack of sunlight just slows the process.

  35. I think I remember reading that you can’t absorb the vitamins and minerals from dairy without dietary fat. I was wondering if the fat free dairy currently being recommended would contribute to weaker bones, more breaks and lower vitamin D levels as well.

  36. How would one treat a patient with sarcoidosis who has a serum 25(OH)D of 14 ng/ml? I have a such a patient with recurrent uveitis secondary to sarcoidosis.

    • Without going back and hitting the texts about sarcoidosis, off the top of my head, I would recommend 10,000 IU vit D3 daily until levels get up to at least 40 ng/ml.

      • Isn’t there an increased risk of hypervitaminosis D and hypercalcemia with Vitamin D supplementation in sarcoidosis?

        • That’s why I prefaced my recommendation by saying I can’t remember much about sarcoidosis. But if what you say is true (I still haven’t gone to the texts about it), I would think that a careful titration of vitamin D wouldn’t hurt. I especially don’t think sunbathing would hurt. But, again, I can remember almost nothing about sarcoidosis.

  37. Hey Mike,

    Great to see you back from the ‘whirlwind’ however briefly.

    I am a Holick (and Cannell) fan, although there is a Holick lecture online somewhere, where he was specifically asked to use “the minimum number of slides” – what followed was an entertaining lecture, but Powerpoint nightmare which would leave most viewers in need of a quiet lie down in a darkened room! (before of course taking on board and following his sensible sun exposure advice).

    Two predictably pedant points.

    “These cancers are much more prevalent the farther north one goes and almost non-existent at the equator.”

    You of course mean the farther north and south of the equator – and I’m sure those of us who know which way is really ‘up’ understand that ;).

    Heliophopbes of the darkest dye? Hmm, I’m sure a true heliophobe would be proud to be, in the words of a laundry powder commercial, “whiter than white”! – but I guess ‘of the lightest dye’ doesn’t really convey the message either.

    Cheers,

    Malcolm

    • My mistake on the direction from the equator. Yes, I meant farther north OR south from the equator… Thanks for taking me to task.

      Good to hear from you.

  38. What about air pollution in large cities? Won’t that block UVB sunlight? I’ve wondered about just how much is blocked. I looked for websites to find out how much of UVB is going through but all I ever got was UV of both. It’s always “high” or “extreme” UV level in Texas during summer.

    • Probably not the pollution levels in large US cities at this point, but in the past, many children living in polluted American and European cities did developed rickets, a severe, disfiguring disease of vitamin D deficiency. This situation is discussed in detail in Dr. Holick’s book.

  39. Great post, thank you, I’ve broken out a bunch of quotes to pass along in my blog. This Vitamin D thing is fascinating. I read a post by Dr. Davis in October and started supplementing – results were palpable in days, especially wrt CrossFit workouts. Of particular value in this post was all of the folks I know who could benefit from knowing this – much less from reading the book. Thanks again. Paul

    • Thanks for the excellent book recommendation. I have already downloaded it to my Kindle and am a good way into it (had to put it down to spend my requisite “sun time” in the garden).

      This Vit D discussion made me remember a program on Dr. Radio (Sirius) that I was listening to awhile back. The doctor was talking about the fact that many people are deficient in Vit D and he specifically said that it was a fat-soluble vitamin. Then he went on to recommend SKIM milk or other fat-free dairy products as a the best dietary source. Jesus wept…

  40. Lately, I have been enjoying the Scandinavian mysteries that are suddenly available in English. They are very moody and in the police procedural style. Some writers are Maj Sjowall and Per Wahloo (the Martin Beck series), Hakan Nesser, Henning Mankell, Helene Thursten, and Johan Theorin. I suspect they would all benefit from more Vit D supplementation during the long winter months. :-)

  41. So showering after sun exposure doesn’t wash away the vitamin D? What about swimming? Will I still benefit from vitamin D production if my sun exposure is while in the water? And wondering what effect the water has on UV radiation, does it pass through water (three or four feet deep)?

    • I wouldn’t think it would matter. I doubt that much UV radiation passes through three or four feet of water, but, presumably, you’re not under water for the entire time you’re swimming…unless you have gills.

  42. Dr. Eades,

    Did the book mention anything about vitamin d absorbed through the eyes? My sunglasses broke a few months ago and I’ve theorized that unfiltered sunlight is better and haven’t replaced them. I’m definitely picking up the book.

  43. Detective fiction: among my favourites are the brilliantly plotted police procedurals of the British writer Jill McGown, who died two or three years ago. She did write a couple of regrettably experimental novels later in her career, but the bulk of her output is first rate.

  44. Anna,

    Here in CT, dermatologists have been divided into these two groups for some reason. I have had the same experience as you though, waiting months for an appointment with a dermatologist for a skin cancer screening. While there I inquired about rosacea and a prescription anti-aging face cream and was told to see a different dermatologist. This has happened to me several times. Even my present dermatologist that I see for rosacea treatments would not even look at a suspicious mole I had. I had to make an appointment with a different md. Ironically, the only dermatologist I have been to that never made this distinction was Dr. Perricone; he was my dermatologist before he wrote his books and became a rock-star. Although, try to get an appointment with him today to get a wart removed. ☺

    On a more serious note, I forgot to mention in my previous comment, that possibly the lack of sun exposure might be contributing to the stunning increase of illnesses such as anxiety, depression and addiction. Am I imagining this? There are an increasing amount of tv shows related to these illnesses: OCD, Hoarding, Addiction, Celebrity Rehab, Intervention and Sober Living. It is so sad and frightening. I am sure the amount of garbage in our food sources doesn’t help.

  45. Hi Dr. Eades,

    Loved the article! Great commentary about Vit. D and total health. Chris Masterjohn has a lot of great references about this as well.

    Just one comment about fractures. I would argue that girls today are more active than they were 40 years ago due to a dramatic increase in their participation in sporting events. Womens sports have increased dramatically over the last few decades. This may, along with a lack of D and a healthy diet, be why they have the increased fracture rate. No studies to back this up, just conjecture.

    Thank you for writing a great blog.

    In health,
    Brandon

  46. Great to see you back. Hope you get some well deserved rest. I’m loving this post. I’ve been diagnosed with low Vitamin D.

    I have many of the symptoms you quoted at the beginning of the post. My endocrinologist has put me on Vitamin D 50000 units once a week (ergocalciferol? – does that sound right?) and has repeatedly asked me about my sun exposure, as in why don’t I get more.

    In the past three weeks it does seem that much of my feet and low back pain has subsided. I suffer from chronic sinus infections but haven’t felt the need to see the doctor since the winter. No real infections. Thankfully, my bone density is normal. But I grew up in your generation and my childhood was much as you described yours.

    I took some advice from The 6 Week Cure and have been sleeping in strict darkness, no lights and no TV, curtains drawn (only one dim street light outside) going to bed earlier. Maybe that’s been helping my immune system too.

    One downside to the tropical sun can be cataracts. My wife, who is originally from Trinidad, suffered from them. Proper shielding can go a long way towards mitigating that effect though, I believe. Just wearing a hat should help.

    As for mysteries, try Tony Hillerman. “Skin Walkers” was a great read.

    Cheers. Jim

  47. “Unfortunately, for a century now, the American diet has been getting higher in fat–especially in the extra-unhealthy saturated fats. This may partly explain why skin cancer rates have gone up, as well as diabetes and heart disease.”

    Dr. Eades, you let Dr. Holick off too easy. He not only has his diet data wrong, he has the science wrong. The rise in skin cancer has coincided, most recently, with a decrease in saturated fat consumption. His advocating a diet of 55% carbs (as indicated by his championing the advice of dietitians) shows a lack of knowledge of current nutrition science and/or a lack of understanding of biochemistry. So while the majority of his book may be advocating a change of thought that could help prevent disease, the nutrition suggestions are a roadmap to the very diseases Vit. D could help prevent. This fact should not be glossed over.

  48. Brilliant.
    Let me just put in a word for the natural sunscreens; tocopherols and carotenoids. Studies have shown that eating a can of tomatos every day for 14 weeks before the sunny season offers protection against sunburn. Astaxanthin has also shown similar effects. I have a great anecdote about vitamin E (tocopherols). One summer my mate and I went hitching on Christmas day. The roads were packed bumper to bumper but no-one stopped for two days. The weather was so hot that we got next to no protection on our shoulders, chests, necks and faces, as we had no hats and didn’t feel like over-dressing. The only food we had was spirulina tablets (supplying carotenoids), a bottle of wheatgerm oil, and some dried poppy heads (we needed them to keep going after a while). We ate the sprulina with a little wheatgerm oil as we went. By the time we got a ride our burned parts were tingling and stinging. From experience I knew that pain and long peeling would follow. In desperation I suggested rubbing the wheatgerm oil on every burnt area. So we did. And what do you know, we never burnt or peeled. The pain went away and our skin stayed good as new.
    Nowadays I take vitamin E as a matter of course, and supplement mixed carotenoids or astaxanthin in summer, as well as eating a carotenoid-rich diet. I am paleskinned and have freckles and some red hairs. I rarely use sunscreen; only on the most exposed parts of the body at the height of the day, and not always then. Not only do I not burn; I don’t even tan much.
    Do carotenoids inhibit vitamin D conversion? I doubt the effect, if any is significant, except perhaps in very low sun areas and low vitamin D cases. It could account for the CARET study results. But I reckon nature took into account both diet and sunlight when designing us. She’s not stupid.

      • If you put carotenoids in a sunscreen, they will block UV A&B. But if you have them in tissues, maybe they trap the UV energy – and pass it on. This is how they work in chloroplasts; the pigments, including carotenoids and tocopherols, form a big net that traps solar energy and passes it into the chlorophyll, from whence energy is generated. If they have the same characteristic in human cells they ought to be able to increase photoconversion of vitamin D, by increasing the area able to catch the UV. It looks like some lipophilic antioxidants can feed escaped electrons back to Co-Q10 in the mitochondrial membrane in this way. The interaction between plant antioxidants, UV radiation, and desirable photoproducts in mammal tissues needs more study, methinks. The general effect of a high vege antioxidant intake is consistent with good photoproducts increasing and bad ones decreasing.

    • George,

      The CARET, HATS and ATBC used Lurotin as the beta carotene. Umm.. that is a synthetic derivative of benzene from petroleium and not bioidentical to what our mammalian receptors which ligand and bind too.

      Synthetic, patentable hormones and vitamins RARELY work in clinical trials. Yes they are profitable for the manufacturers but they case physiological havoc apparently with appropriate reason — we cannot metabolize or eliminate and there are receptor-ligand issues.

      One really has to be prudent — poor quality multivitamins can hurt/maim/kill.

      -G

      • I didn’t know it was synthetically sourced, but it was all-cis beta carotene, which is just one of the isomers of beta carotene, itself just one the carotenoids found in food. Not generally known, but fat-soluble antioxidants once oxidised, if not recycled, are excreted conjugated in bile; so good liver and gall-bladder function is handy if you want to take lots of them. On the other hand, to fix a bad liver or GB, you might need to supplement AOs; and also to quit the gluten, as this is a hepatic and gall badder poison.

  49. Also, it’s not just sunburn; vitamin E, and probably other lipid-soluble or lipid related (selenium) antioxidants also protect against burns from hot objects. When I am taking vitamin E and my hand brushes the element, I don’t get a blister or scar. The same accident when I’m not taking E, or only taking 100iu, results in a burn and scarring. There is two types of protection; prevention by daily consumption of c. 1,000iu, and post-burn protection by smearing the contents of the E-plus oil caps onto the area. Both work, and the combination of the two is most effective.
    I can see two principles at work; a burn causes a chain reaction, where lipid peroxides from burnt cells kill other cells, destroy capilliary bood vessels and trigger fibroblasts. Vitamin E, by blocking the peroxide chain, prevent the damage spreading, and the anti-inflammatory effect inhibits the fibroblasts and protects the microciculation. In the case of cuts and grazes, vitamin E also seems to be able to spread healing and reduce scarring, while lessening the risk of infection. It probably improves the function of some immune cells, such as NKs and macrophages, while lessening the need for fibroblast activity; by protecting collagen, for example, it reduces the triggers for collagen remodelling, which otherwise causes scarring and fibrosis and damages microcirculation, increasing the damaged area.

  50. Dr Eades,
    Have you read Colin Wilson’s crime fiction? It is early (1960’s) work in the profiler genre. Ritual in the Dark, his first novel, and The Killer (AKA Lingard), his personal favourite, are what I’d recommend. His book on Rasputin is excellent too. If you like Ayn Rand, you ought to love Colin Wilson; his main riff is human potential; and The Killer (1969 I think) has an interesting link to Omega-3 behavioural research (as a child, Lingard hated and never ate fish; as we might predict, he becomes a seriously sick puppy). The books, especially The Killer, are based on Wilson’s research and true crime writing; they ring true in a way modern profiler books don’t. Compared to Lingard, Hannibal Lecter is about as realistic as Shrek.

    • I am a huge fan of Colin Wilson. Got started on him when I read his autobiography, Dreaming to Some Purpose, after I read a review of it in The Spectator. I’ve really enjoyed some of his stuff and have found some of it to be dreck. Haven’t read any of his fiction yet, though. I’ll give your recommendations a whirl. Thanks.

      • Sometimes Colin Wilson has such an open mind that his brain falls out. At other times he’s been the great philosophical genius of our times. And other times he has been editing dreck to put food on the table. I think the philisophical genius (and creator of some unputdownable fiction) will be the Colin Wilson for the ages. Time buries a great writer’s mistakes, which is why it buries most writer’s collected works.

  51. Hmm, the Weston A Price link you provided was a little disturbing. Between sun and supplements, my D levels are now somewhere around 70, and they seem to be suggesting that this is about twice the optimal level, and possibly dangerous. What do you think?

    It’s not exactly a mystery, per se, but my first novel (a thriller) was published a while back by Macmillan in the UK, and later picked up by Pan in paperback. Easy to find in England, hard to find in the US, but if I had your snail mail I’d be happy to send you a free copy.

    • If you’re out in the sun a lot, I would cut back a bit on the supplements. Supplements are just that: supplements. Meant to be taken if you can’t or won’t go out in the sun. If you do spend time in the sun at the proper latitude, you shouldn’t need them.

  52. Dr. Holick has a good video on UCTV on vitmain D. It is available on youtube.

    UCTV has a lot of good info on their “Mini Medical School For the Public” series. A lot of current thoughts on CAM.

    One question I have regarding vitamin D synthesis is whether of not it has an appreciable effect on circulating cholesterol levels. Has anyone ever studied whether sun exposure – vitamin D synthesis reduces any cholesterol numbers?

    BTW, I enjoy you website.

    • I have read in a few places that increased sun brings about decreased cholesterol because the synthesis of vitamin D uses cholesterol and therefore removes some of it from the circulation.

      • Hmm. According to Dr. Willams at Heart Scan Blog, 50-60 ng of vitamin D level increases HDL significantly. If you really want to reduce sLDL, cut out refined carbohydrates. That’s what he has seen in his patients over and over. He has not really said anything about Vitamin D reducing cholesterol number (totally useless if you don’t look at HDL, lLDL, sLDL). Another thing, I’ve read that saturated fat also increase HDL significantly. Some had over 100, perhaps 120 or 140? I don’t recall exact number but that’s what happens when you do things like that. Free the animal website had several articles over that. Interesting stuff.

      • So, I’ve been wondering lately if the connection between cholesterol and vitamin D works the other way. Does the body sense a lack of vitamin D and pump out cholesterol in an effort to make more D?

  53. Thanks for your timely review of Dr. Holick’s book. I owe you extra thanks since I’ve posted on Vitamin D repeatedly over the last couple months and didn’t know this book was out (he says sheepishly)

    While it may seem a little off-topic, your “Rational Optimist” and “Quantum Information” references made me think of the work of Rupert Sheldrake (“New Science of Life,” “Presence of the Past”). Offers an entirely new perspective on how organisms (of which w are one) come to be.

      • Hello Dr. Eades,

        I have noticed for myself and sometimes other an increase in HDL with monotherapy of vitamin D3. Mine personally increased from 60s to 89 mg/dl with only D3 getting the 25OHD to 60-80 ng/ml. I was already mod sat fat, low carb and jogging same intensity/freq. Personally the increase perhaps in ?? testosterone, estrogen and lean mass from vitamin D may have boosted HDLs?? I dunno… big jump for me though!

        Like you I have to commend Holick for standing up against ‘mainstream’ and the critics over the years. Truth does prevail. On the other hand, I do not understand fully Holick’s embrace of synthetic chemical steroidal hormone derivatives of like D2…??! Hopefully the outcomes will not be poor like Progestins (oral contraceptives/stroke risk; Provera/WHI, etc)

        Here are some ancedotal observations from a research physician who practices in Canada and other published accounts that I could find:

        Dr.Schwalfenberg ‘vitamin D2 has metabolites with unknown functions’
        http://www.cfp.ca/cgi/reprint/54/6/864
        http://www.cfp.ca/cgi/reprint/53/9/1435-a
        http://www.cfpc.ca/cfp/2007/may/vol53-may-clinicalreview-schwalfenberg.asp

        http://jcem.endojournals.org/cgi/content/full/93/8/3015
        Cholecalciferol is almost twice as potent as ergocalciferol in increasing serum 25(OH)D, when administered either by mouth or im.

        Different effects of D2 V. D3 on calcium metabolism and vit D metabolites incl Calcitriol:
        Serum concentration of vitamin D metabolites during treatment with vitamin D2 and D3 in normal premenopausal women.
        Rødbro P et al. Bone Miner. 1986 Oct;1(5):407-13.

        Review article PharmD:
        http://www.gnjournal.com/article/S0197-4572(08)00041-4/abstract
        The value of vitamin D(3) over vitamin D(2) in older persons.
        Zarowitz BJ. Geriatr Nurs. 2008 Mar-Apr;29(2):89-91.

        The case against ergocalciferol (vitamin D2) as a vitamin supplement. Vieth et al Am J Clin Nutr. 2006 Oct;84(4):694-7.
        http://www.ajcn.org/cgi/content/full/84/4/694

        Thank you for highlighting this great book! I like your new summer reading list!

        Kindly, G

  54. Hey Dr. Mike!

    I’ve posted a few times touting my “almost zero” carb lifestyle (18 months into it now….doing great)

    I just recieved my latest lipid profile from my semi annual physical (42 yr. old white male) and my HDL in the last 5 years has steadily increased from an abysmal 34 to now an outstanding 67!!

    My question pertaining to the subject of this blog, was is there any evidence (or is it mentioned at all in Dr. Holik’s book) that sunshine/vitamin D levels benefit the levels of HDL? The reason I ask, was this has been my first physical when I was “super tan”, and was just curious as to a possible causation.
    Thanks in advance.
    George

  55. BTW… thank you for your insightful books and recommending the POWER of SUNLIGHT > 10-15 yrs ago in ProteinPower, which I read 2 yrs ago.

    Wish I had your and MD’s book earlier…!! Sunlight and routine walking semi-cured my undiagnosed hypothyroidism when I was age 21. Was forced to do a lot of walking on the Cal campus after moving a mile away from my classes in Nutritional Science!

  56. I came across a whole series of lectures on Vit. D over at uctv.tv .

    Here are the search results for “Vitamin D”: http://www.uctv.tv/search-moreresults.aspx?keyword=vitamin+d&x=0&y=0

    So far I’ve only watched the one about sunscreens. Absolutely damning: http://www.uctv.tv/search-details.aspx?showID=15770

    Dr., my 93 year old mother is in increasing musco-skeletal pain as time goes on. She was diagnosed with fibromyalgia years ago, but dealt with it with occasional analgesics. Now, it hurts her to move at all, which then results in not moving, and gelling of her joints. She eats a fairly good diet – I’m the cook – but gets no sunlight and only a multivitamin, which may or may not be a source.

    I’d like to put her on maybe 3,000 IU’s, but I have the hurdles of my siblings and her doctor…..great guy, luv him, but…….

    What do you think?

  57. Loved “The Sweetness at the Bottom of the Pie”
    “Chasing Vermeer” by Blue Balliett is a young teens’ book, but really good. More ‘Vermeer inspired mysteries are “The Girl with the Pearl Earring” by Tracy Chevalier and “The Girl in Hyacinth Blue” by Susan Vreeland.
    I liked to say, before Taubes and Eades, that I was so light-skinned that I could get a sunburn in a full moon. I was an SPF 95 (j.k.) devotee. Now I know a lot more and better. Somewhere I heard a wise dermatologist mention that we need sun, but do put sunscreen on your face!

  58. My Bad, it is Dr Holick that said wear suncreen on your face. The NYTimes mag’s Deborah Soloman interviewed him for a March 15, 2010 piece. Here is the question and answer quote:
    DS: “What if you would rather be dead than walk around New York in gym shorts? Why is exposing your legs so important?
    MH:There’s the rule of 9s. You have about 18 percent of your skin surface on each of your legs. Your face is only 9 percent; we never recommend you expose your face. You should always protect it with either sunscreen or an appropriate hat.”

  59. I’ve never been a fan of sunscreen. I can taste the stuff in my mouth for hours after putting it on but I’ve always been a bit sun shy until this fall when my labs showed up with a low low level. After some supplements and a bout with vitamin d toxicity I’ve become a sun worshiper.

    I get my 15 minutes of fame on each side each day the sun peaks out even a little bit.

    So far so good. I feel much better all the way around. Don’t know what I’ll do in the winter months yet. Will cross that bridge when I get to it.

    Good to see you back!

    Ressy
    Sweet Evil Fabric Queen

  60. Nice review, Doc, Thank you.

    I became a fan of D3 supplementation after buying and implementing 6WeekCure – that ‘bought’ me the final 3 kgs of a 10 kg drop from 82.5 to 72.5. Thank you even more for that.

    On the D3 front, I have been supplementing 5,000 IU per day over this winter, going up to 10,000 IU if I felt a cold coming on. I believe I’ve suffered significantly fewer ‘coughs ‘n sneezes’ this year. Thanks again!

    In the comments in this post I was intrigued by Dave Dixon’s reference to the Jayne’s Probability text, so I ended up downloading and reading the ‘free intro’. This consists of the 1st 3 Chapters plus the Introduction. Really quite Cool, for those of us interested in Scientific Method and Statistics. In particular, the introduction discusses Safety and the Linear Response Model with and without Threshold. I was even more impressed by the Serendipity of having a few day’s earlier reading about a Co-60 study mentioned in stan-heretic’s blog of May 21 ,2010 – Gamma radiation protects against cancer, in low doses? Cancer mortality reduction by 97% – huge! Is it true? Hormesis?.

    A blow to the Linear No Threshold Model, I trust.

    Today, 15th June, I saw your Twitter reference to HDL and Cancer. There may be some Correlation, but until someone produces a biochemical,enzymatic or hormonal mechanism a la Krauss’ fructose/DNL/liver damage proposal, I will pay no attention.

    I say this, as one who has HDL of 3.3 mmol/L (127 mg/dl)!!!!

    Wishing you and Mary: ” All Success with Sous Vide Supreme”

  61. Dr. Eades great review and GREAT to have you back 😉

    you said “If you’re out in the sun a lot, I would cut back a bit on the supplements. Supplements are just that: supplements. Meant to be taken if you can’t or won’t go out in the sun. If you do spend time in the sun at the proper latitude, you shouldn’t need them”

    I live in SW Florida and get a good amount of sun (I love the sun)…but I’m also stuck in my office a lot. So I supplement during the week and not on the weekends when I spend a lot of time outside. I take anywhere from 4-6 thousand IU’s a day. Just got my results back from the lab. Came in at 63. So even with sun…(unless you’re a lifeguard) I think you still need to supplement.

    Don’t know if you remember this, but my son had to get tested for growth hormone….just wanted to follow up and let you know all is well with him. No GH needed, he’s just a late bloomer (like his dad). But thank you again for your kind and sincere response a few years back.

    Marc

  62. Some time ago I read an article in Discover about skin color and the balance between vitamin D production and folate destruction (oh, found it!)

    http://www.pbs.org/wgbh/evolution/library/07/3/text_pop/l_073_04.html

    Seems that large amounts of sun exposure can lead to folate deficiency. Did Holick’s book mention that? Not really a concern for me – I live north of 40 degrees, but for fair women of childbearing age in tropical climes, this may be a real issue…

    • Keep in mind that liver is just about the best source of folate; it blows vegetables out of the water. I’m guessing our hunter-gatherer ancestors didn’t have a problem with folate deficiency running around in the sun. Eat some liver!

  63. “Dr. Hollick instead recommends getting sun exposure as a way of increasing blood levels of vitamin D. Just 10-15 minutes in the sun is the equivalent of taking between 15,000 and 20,000 IU’s of Vitamin D, but without the potential for toxicity that is becoming more common as people take larger doses of it orally.”
    Does anyone know why these large doses from sunlight are not toxic? Does vit D play a role in sunstroke?

    • Check out Barry Groves’ “Second opinion” website, and look for the “sunlight” link. But basically, sunlight is self-limiting, as far as Vitamin D production is concerned.

  64. No one has commented on the doctor’s explanation of the cause of fibromyalgia. He doesn’t give any sources for his theory about the over-growth of bones. It sounds silly to me. I’ve had fibromyalgia syndrome since I lived in Southern California and knew others who lived there who had it too. If the cause was vitamin D deficiency, wouldn’t it be more common in the North than in the South?

    I’ve been taking a vit D supplement since I moved to the Seattle area, and it helps with a lot of things, but I still have FMS in spite of having a great vit D level. Dr. Paul St. Amand, an endocrinologist at UCLA, has a more reasonable explanation for what causes FMS. His treatment protocol is not easy, but I can testify that it works.

    • Judy, can you post a link to Dr. Amand’s info re FMS. I have a family member who suffers a great deal from this disorder and am interested in what he has to say.

      I haven’t read Dr. Hollick’s book but I know there is some thought that people with FMS may be prone to immune related illnesses. The family member of mine who has FMS also has scleroderma. Perhaps the immune dysfunction is what causes some to look at vitamin D deficiency. BTW, my family member also has vitamin D deficiency.

      Thanks in advance.

      • k,
        Sorry to be so late with a response to your request, I just found it. If you type “fibromyalgia” into the search bar on Amazon, Dr. St. Amand’s book will usually be at the top of the list. Check out the reviews to see what his patients say about his protocol. The book is called “What Your Doctor May Not Tell You About Fibromyalgia.” (He has other books as well, but start with this one.)

        The doctor’s website is: http://fibromyalgiatreatment.com/. It is well worth a trip to CA to see him in person for those who can manage it, but many people are getting well just from the information in his books and on his website. I have more information and all the links on my blog at carbwars.blogspot.com. Just type “We Need a Hero” or “fibromyalgia” in the search bar to find all the posts. You can e-mail me there if you want to continue the discussion.

  65. I got my copy of Dr Holick’s book yesterday and am nearly finished reading…but oh I am so scared of skin cancer now ! I go in the sun sensibly these days now that I’m in my 50s and have been sensible for many years, but when I was a teenager and in my 20’s I definitely overdid it, and according to Dr Holick that is when the most damage leading to melanoma is done ! And I’m one of those blue eyed fair types :-( So it’s too late for me and many others and I may wake up one day and find some dreadful mole or something…..I’m so scared :-( I can’t even concentrate on the book properly now, I’ve been on the internet looking up nevi and moles and skin blemishes and examining my skin more critically than ever :-( :-(

  66. Your statement: “Which seems reasonable since every morsel of energy we consume originates with the sun.” reminded me of one of my favorite quotes by physicist Richard Feynman:

    “The World looks so different after learning science. For example, trees are made of air, primarily. When they are burned, they go back to air, and in the flaming heat is released the flaming heat of the sun which was bound in to convert the air into tree. [A]nd in the ash is the small remnant part which did not come from air, that came from the solid earth, instead.”

  67. @ Marc
    do you know that silent celiac disease (gluten sensitivity) is a common reason for short stature in children with normal GH levels? Ron Hoggan’s webpage has good discussions of the stats. This is very hypothetical, but if you had the same trait it would explain poor absorption of vit D, which may be cause of low levels. Maize and milk have similar prolamines to gluten and should also be considered.

    Re: Ozone hole; at its peak, the ozone hole covered Australia and New Zealand. Since restriction of halogens (fridges, propellants etc) it is repairing and is back over Antarctica. Climate change skeptics ought to consider the ozone hole; there is no doubt that this was due to man-made pollution of the upper atmosphere, and restriction of the relevant pollutatants has allowed the upper atmosphere to start recovering.

    Desmondo – there may be good reasons why some radiation can protect against cancer; at low levels, free radicals (including pro-oxidant phase vitamins) promote upgrading of SOD, GPx, catalase, etc., and this protects against sudden increases in oxidative stress. This has been shown in research using preperation with low-dose menadione (K3) to protect against high-dose K3 toxicity (molpharm.aspetjournals.org/content/52/4/648.full). At high levels of ionisation (or oxidative stress), ions (or free radicals) cancel one another out to some extent (only at high levels are they likely to collide much by chance, before they can collide with lipids and proteins). This is called the Petkov effect (or, the Three Stooges syndrome, from The Simpsons).
    I should point out that doses of radiations and toxins are still being studied, meanwhile there are less toxic ways to boost antioxidant enzymes; cruciferous vegetables (isothiocyanates), astragalus (polysaccharides), abalone mushroom (polysaccharides), and other medicinal herbs and fungi (also by ensuring optimal intake of selenium, zinc, manganese, copper and iron – and, of course, protein – the raw materials of these protective enzymes). One can get hormetic effects without any Mithridatic risk.

  68. I believe that you recommended taking 400 mg of magnesium along with the Vitamin D in the past. What about calcium supplements?

  69. Not so panicky today about skin cancer – I can only do my best today to undo any sun damage from my youth.

    I also want to say, the book is highly interesting and I found it thrilling to discover that Dr Holick was the man responsible for the first isolation and identification of the active form of vitamin D3 or 1,25-dihydroxyvitamin D3 ! Wow !

  70. I live in a very sunny climate, and would love to soak up some sun every day. However, as soon as I spend any time in the sun, I get more age spots.

    I’ve often wondered if this is really normal aging or if it’s a by product of our diet and lifestyle. In other words, does that girl living near the equator get age spots when she grows up, too ?

    Any thoughts on how to take advantage of the sun without looking like a granny before my time?

  71. Count me as another pale-faced person of northern European heritage who wonders about adjusting the amount of sunlight to accommodate skin pigmentation. My Irish-American father never tanned. Working outdoors, his face, arms, and upper chest turned red with countless freckles. Two brothers inherited the same skin and they got red, freckled backs from swimming or playing outside shirtless. My skin tans only slightly and then reddens if I continue sun exposure, even regular sun exposure of 15-30 minutes a day. I have faint age spots on my forearms from years of unprotected, regular sun exposure and in the summer, a slight reddish hue. I wear crewneck shirts to protect my chest, but I see other women in their 30s-60s with freckled chests. A tan looks healthy. Red, freckled skin does not.

    Owing to concerns about chemicals in sunscreens, I quit using them years ago along with most other cosmetic products, including makeup.

    Is there a simple visual guide to determining how much sun is too much? Is semi-permanent or permanent reddish skin and age spots a sign of premature aging?

  72. Thank you for this; I just posted a link to this article at http://www.holdthetoast.

    Years ago, in an article in my old ezine, Lowcarbezine!, I said that along with my nutritional heresy of considering meat and eggs and cream and butter to be far more healthful foods than whole grains and fruits, I also held the heretical view that sun exposure was healthful, and that people were doing themselves an injury by slathering on SPF 4,682 every time they set foot out the door. I got several concerned emails from readers, telling me that about this I was wrong, sun was dangerous.

    I’m pleased to see my instincts were right.

  73. Hey Doc,
    Great review …thanks. I am enjoying the book.
    You have usually read everything I suggest but here’s a few.
    Brian Haig “The Hunted” and everything else by him. Gail Lynds “The Last Spymaster”. Ward Larsen ” The Perfect Assasin” and most stuff from Joseph Finder. Let’s see if there is any in there you haven’t read.

  74. Anyone out there NOT able to tan/butn? Growing up, I used to burn fairly easily (fair-skinned Dutch/German heritage). Now (at 55) I’m hard-pressed to tan. It all started about 8 years ago when hubby and I were in Florida deep-sea fishing. I had forgotten to bring along sunscreen, and so spent the entire day in the sun on the ocean. I ended up a little pink on the tops of my shoulders, but that’s it.

    The other day I was out on the riding mower cutting the grass for about 4 hours in 85-degree heat and full sun from about 11:00 am to 3:00 pm (in Maine, around 44 degrees latitude) WITHOUT sunscreen. Did I burn? Nope. Did tan? Not really. I have a slight tan that I’ve built up, but nothing too significant.

    Anyone else experience an inability to tan/burn? Is it something that happens with age?

    Also, why does Dr. Holick state repeatedly in his book that he’s not in favor of tanning? If a tan is protective, why not?

    And, who wants to use sunscreen only on their face and end up with a white face and tan body?

  75. Dr. Eades, could you post some day on oxaloacetate? In the book I am studying for my current nutrition class, the authors go on and on about how oxaloacetate is critical for the TCA cycle, and give its presence in the TCA cycle as the definitive reason why carbohydrates should be the bulk of the diet (45-65%) for good health. I know this has to be wrong, but I don’t know enough yet to elucidate why. I would love to get your thoughts.

  76. I stopped taking Vit D3 after I found that whenever I overdo it (over 2000 IU/day for me) I get acute immunosuppressieve reactions : herpes labialis (fever blisters), angina and painful saliva glands. I have heard similar stories on other blogs. I’m afraid that when taking it slow (2000 IU or less) it does not give me acute reactions but what about long term : kidney stones, bacterial growth, etc.. ?

    Some bloggers seem to think that when eating nutrient rich low-carb/paleo, your VitamineD3 requirement is minimal and easy to overdo (e.g. Peter at Hyperlipid, Jenny at Diabetes Update) .

  77. I know you maily concentrate in adult issues but I would like to know your input in ADHD: Drugs such as Ritalin, Addreall Stattera, Concerta, etc versus natural sipplents.
    Thanks,
    Cecilia

  78. Off topic.
    My nephew was just diagnosed with Carnitine Palmytol Transferase Syndrome. A quick Google and it seems to be a genetic inability of the mitochondria to use long chain fatty acids for energy.
    The thing is, the treatment (according to their MD) is a high carb low fat diet. This part of my family is pro low fat high carb, so am I just being overly skeptical? Or is this legitimate?
    One of the symptoms of this disorder is low levels of ketones… how can you increase ketones with a high carb diet? It just doesn’t make sense.

  79. Thanks Dr Eades, that was a nice review.

    I already have a Vitamin D book from David Grimes (Vitamin D and Cholesterol) on reading list, but I think Holick’s second book would be a nice next entry on Vit D. Grimes’ book is simply great:

    http://www.vitamin-d-deficiency.co.uk/index.php

    I got my Crohn’s pretty much totally controlled with Vit D (5000-8000 IU a day), even in absense of continuous supplementation. Simply amazing stuff – only real side effects I got was/is occasional sternal pain and I had a major drop in BP which gave(?) me some dizziness, but I’m fine now. I also think it helped me mentally – better concentration and less need for sleep. Incredible stuff really.

    Regarding supplements, it seems that the amount of Vit D provided varies tremendously:

    http://www.medpagetoday.com/MeetingCoverage/CMSC-ACTRIMS/20522

    According to this review (April 2010!), oil or oil capsules are more available to the body than tablet form:

    http://www.ncbi.nlm.nih.gov/pubmed/20425758

    Regarding D2 and D3 forms, there is this often cited review that proposes that D3 is much better and at least more consistent:

    http://www.ajcn.org/cgi/content/full/84/4/694

  80. Dr. Eades…I’m wondering if you are familiar with the results of any studies that might’ve been done on getting UV exposure from tanning beds for the purpose of Vitamin D synthesis. What about folks who live way up north and cannot get much sun exposure except maybe in the summer? Would the UV exposure from a tanning bed produce all the photo byproducts in the body as the sun would? Or would it be better to just take D3 supplements?

  81. Interesting article. I’m wondering if tanning in a tanning bed gives the same benefits. I’m in a far northern clime. Thanks!

  82. Hi, I’ve just discovered your web site – all very interesting. I live in Australia – a highly paranoid place as far as the sun goes. My daughter has brown skin [ white mother, black father] and is still instructed to wear sun screen by school teachers etc. I tell her that as a ‘brown’ person she probably needs more sun than I do to remain healthy and I don’t tend to put sunscreen on her at all. As for myself I only use it on my face and hands in summer. By the way, Robert Goddard is a fabulous British crime – suspence – mystery writer – always a good read.

  83. 1) The mainstream recommendation is to avoid the sun 2 or 3 hours either side of midday – should this be turned on its head?

    2) If you don’t have a tan but are forced to stay outside for whatever reason, are there any recommendations apart from covering up to avoid burning?

    3) I used a SPF 15 earlier this year that blocked out nearly all UVA (5 star) but I still tanned up – how?

    4) Does vitamin D creation depend on how tanned you are? If so, is it best to keep large areas of the body ‘white’ so that they work more efficiently when shown the sun for a short bathing period?

  84. I agree with previous blog re Daniel Silva Gabriel Allon series. We love Gabriel. Have you read Dave Stone the Echelon Vendetta, Venetian Judgement and Orpheus Deception? Great mystery thrillers set in Europe, Western US and Far East. Looking forward to more from Mr. Stone!! Enjoy.

  85. My husband and our two children are brown from May until October, and it never ceases to amaze me how many people will proffer their opinion on just how “dangerous” this is —I’ve even had friends offer to buy me sunscreen, as if the issue is one of finances and not our well-being—trying to explain the need for vit D to one of these misguided heliophobes is like reasoning with a potato.

  86. I used to be afraid of sunburn, as I have a fairly white skin. This year I had the opportunity to enjoy the first sun in the spring and many days after that. I have never before had the tan I have now. I never used a sunscreen. What I did do is eat a can of tomato paste every day. I read somewhere that it would help to protect against burning. And I didn’t burn. So my question : could tomato paste (lycopene!) be of any help?

    Kind regards,

    André
    Netherlands

  87. Huge fan of your blog. I’m looking forward to reading this book.

    I just read your post about the China Study and how observational studies can’t prove causation. Is not a study comparing % of people who develop cancer near the equator compared to people in northern climates–then announcing that this higher rate of cancer is caused by sunlight also committing the same sin? Couldn’t that at best only point us towards a hypothesis? I assume the author than goes into controlled experiments, but I was curious about your thoughts.

    Since I read this post I’ve been going in the sun a lot and it feels great—my mood and energy have improved considerably.

    Mystery Novels—I’m sure you’ve read this one if you’re a fan of the genre but I just read Raymond Chandler’s classic, Farewell My Lovely. Incredible! Definitely worth a reread if you haven’t picked it up in a while.

    Thanks again for the great articles!

  88. You mentioned Sarcoidosis; here is a theory – in some people who suffer low vit D levels, the body responds by increasing production of a vitamin D producing tissue. This is the sarcoidosis. It is triggered by low Vit D, and may end up over-producing it. Perhaps an example of genetic atavism.
    This is just a theory but explains why it affects mainly dark-skinned people in northern climes on gluten diets. If it’s right, then vit D supplements ought to stop the process.
    Vit K2 would help with the calcification; Inuit, who eat lots of vit D traditionally also ferment animals to produce K2.

    Does Horlick promote D2 because he is vegetarian? Just wondering.

    This winter I got several colds, flus, and pneumonia. The lady in the Health shop suggested I take high-dose vit D. I was already getting 1,000iu from cod liver oil and taking 3,000iu extra every other week, so I was sceptical. Eventually I got some D3 and started taking 8,000iu. Haven’t had a sniffle since, and some other symptoms have cleared up, nerve twitches. I’d say it worked.

  89. There is a tendency to believe that there is a correlation between sunscreen/sun-protection and increased risk of melanoma.
    I believe it is the other way around. The increased incidence of melanoma is the result of dermatologists getting “encouraged” by sunscreen-manufacturers to be more and more thorough in their screening and thus creating the fear that is the foundation of the sun-scare campaign. If we look at the history of the sun-scare (it is now soon 10 years since the “Slip-Slop-Slap” pelican started the crusade in Victoria, Australia) it has always started in each country with dermatologists advertizing free “skin-spot-screening” in womens glossy magazines. For more see this video:
    http://www.youtube.com/watch?v=F_CrPZLbkE8

  90. As I understand it, the fat in your body (cellwalls, lungs, skin etc) mirrors the fat profile in your diet. So eating a lot of PUF’s could change the fatlayer under the skin. Could it be that PUF’s going rancid in the skin – due to the light and warmth- are the cause of skincancer? Could heliophobism be the consequence of lipophobism?

  91. Wow, do I have a story to tell…

    I got basal cell carcinoma on my nose, some 10 years ago, and my dermatologist told me to stay out of the sun. Period. Little did I know then, what I know now.

    Some years later, as we were treating melanoma #2 on my body (both occurred where sun would never shine), I looked at her and asked, “Why would I be getting melanoma here? The sun has never touched this area.” I’ll never forget that she had NO ANSWER. Thank goodness for the internet. I set out to research this myself. By this time, it had been almost six years with NO sun exposure. And, I had never even heard of Vitamin D supplementation.

    Fast forward to today. I do get modest sun exposure. I do supplement with Vitamin D3. I do have a (naturopathic) doctor that has helped me change my health and life. My vitamin D levels are now in the 70-80 range, as opposed to 32, when she first tested my blood.

    I’ve learned a lot, and it’s not over yet. Excellent post, and I’m getting the book!

  92. Dr. Eades, for a truly entertaining guilty reading pleasure, I highly recommend ‘The Last Good Kiss’ by James Crumley. Some have called it the best hard-boiled, noirish detective novel of the last 30 years. I agree with them. IMHO, you can skip the rest of Crumley’s works, though. TLGK is his masterpiece and nothing else he did compares to it. Here’s the first sentence.

    “When I finally caught up with Abraham Trahearne, he was drinking beer with an alcoholic bulldog named Fireball Roberts in a ramshackle joint just outside of Sonoma, California, drinking the heart right out of a fine spring afternoon.”

    Yowsuh. That’s writing. It just keeps getting better from there, too.