Increase Vit D-25 blood levels to 50 to avoid cancer

[Guest guest]

Sorry to post so much in one day but just found this news release:

Since colon cancer and cholangiocarcinoma are in the same family, it

would make sense to boost Vit D levels

Vitamin D Appears to Cut Breast and Colorectal Cancer Risk CME

News Author: Gandey

CME Author: Vega, MD, FAAFP

Disclosures

Release Date: February 12, 2007; Valid for credit through February

12, 2008 Credits Available

Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for

physicians;

Family Physicians - up to 0.25 AAFP Prescribed credit(s) for

physicians

February 12, 2007 — Researchers say that raising vitamin D levels may

prevent up to half of all breast and two thirds of colorectal cancer

cases in the United States. Based on the results of 2 separate

studies, the investigators recommend a daily intake of 2000 IU of

vitamin D3 and, when possible, moderate sun exposure.

" The results are pretty straightforward, " Glanz, PhD, director

of Emory University's Prevention Research Center at the Rollins

School of Public Health in Atlanta, Georgia, said in a news release.

However, changing behavior on the basis of these studies may be

premature, she noted. The analyses found an association between

vitamin D levels and lowered risk, not a definite link, Dr. Glanz

said, but adding vitamin D to the diet or taking a supplement would

probably not do much harm and there could be a benefit.

During an interview with Medscape, lead author Cedric Garland, DrPH,

of the University of California at San Diego, agreed that future

consensus is needed, but he recommended no delay in raising vitamin D

levels. " We shouldn't hold up implementation, " he said. " Inadequate

photosynthesis or oral intake of vitamin D is associated with high

incidence and mortality rates of breast cancer. "

Published in the January 30 Article in Press issue of the Journal of

Steroid Biochemistry and Molecular Biology, the researchers pooled

dose-response data from 2 previous studies — the Harvard Nurses

Health Study and the St. 's Hospital Study. They found that

patients with the highest blood levels of 25-hydroxyvitamin D had the

lowest risk for breast cancer.

Dr. Garland and his team divided the more than 1700 records in the

studies into 5 groups from the lowest blood levels of 25-

hydroxyvitamin D (< 13 ng/mL) to the highest (approximately 52

ng/mL). These data also included whether the patient had developed

cancer.

The investigators found that patients with serum 25-hydroxyvitamin D

of approximately 52 ng/mL had a 50% lower risk for breast cancer than

those with serum measuring less than 13 ng/mL. This level corresponds

to a vitamin D intake of 4000 IU per day, which exceeds the National

Academy of Sciences upper limit of 2000 IU per day. " Leading

researchers are building a case to have this level increased, " Dr.

Garland told Medscape, " but in the meantime, we are recommending a

daily intake of 2000 IU. "

The group is also calling for an additional 10 to 15 minutes of daily

sun exposure when appropriate — an amount estimated to be equivalent

to an oral intake of 3000 IU of vitamin D3.

But What About the Risk for Skin Cancer?

As previously reported by Medscape, the American Academy of

Dermatology has voiced concern about the vitamin D literature

prescribing the health benefits of sunlight. " While many health

issues are complex and involve multiple factors, we know that

ultraviolet light is the primary cause of skin cancer, and avoiding

excessive exposure to the sun and other forms of ultraviolet

radiation is the solution, " Clay Cockerell, MD, president of the

academy said in a news release.

During an interview with Medscape, Dr. Garland emphasized that his

group is advocating prudence and moderation, including the use of a

broad-brimmed hat. " I think most physicians will see this as a well-

controlled and reasonable approach, " he added.

The article points out that sun exposure is inadvisable for patients

with primary photosensitivity disorders, people taking

photosensitizing medications, and anyone with a personal or close

family history of skin cancer or actinic keratosis.

Evidence Stacking in Favor of Vitamin D

Dr. Garland was also a coauthor of a second study examining the

effect of vitamin D levels on colon cancer risk. Published in the

February issue of the American Journal of Preventive Medicine, the

researchers conducted a meta-analysis of 5 studies examining serum 25-

hydroxyvitamin in colorectal cancer.

The investigators combined the findings of the 5 studies using

standard methods for pooled analysis. There were 535 cases and 913

controls or 1448 participants in total. The researchers divided the

results into quintiles with median 25-hydroxyvitamin values of 6, 16,

22, 27, and 37 ng/mL.

Previous studies had shown that lower blood levels of vitamin D did

not protect against colorectal cancer, but in the current study, the

researchers came to a different conclusion. " Through this meta-

analysis we found that raising the serum level of 25-hydroxyvitamin D

to 34 ng/mL would reduce the incidence rates of colorectal cancer by

half, " lead author Gorham, MPH, PhD, a research epidemiologist

with the Naval Health Research Center in San Diego told

reporters. " We project a two-thirds reduction in incidence with serum

levels of 46 ng/mL. "

The amount of dietary vitamin D needed to reach the serum levels that

appear to be protective against colorectal cancer — 1000 to 2000 IU

per day — would not pose any risk, Dr. Gorham said. " The Institute of

Medicine has set a 'No Adverse Effect Level' of 2000 IU per day for

vitamin D intake, so this recommendation would be safe for most

people. "

J Steroid Biochem Mol Biol. Published online January 30, 2007.

Am J Prev Med. 2007;32:210-216.

Clinical Context

Higher levels of metabolites of vitamin D have been associated with

lower risks for cancer in some observational research, although data

regarding the effectiveness of vitamin D supplementation and cancer

prevention has not all been positive. In a study of the Women's

Health Initiative cohort by Wactawski-Wende and colleagues, which

appeared in the February 16, 2006, issue of the The New England

Journal of Medicine, supplementation with vitamin D at a dose of 200

IU twice daily failed to reduce rates of colon cancer compared with

placebo.

The dose of vitamin D in the Women's Health Initiative was modest,

and subjects were followed up for a mean of only 7 years. It is not

clear if there is a threshold for serum 25-hydroxyvitamin D levels,

the best serum marker of vitamin D levels, in reducing the risk for

cancer. Two current analyses address this issue.

Study Highlights

Vitamin D and Prevention of Breast Cancer: Pooled Analysis

Researchers searched PubMed for articles published between 1966 and

2006 that related quantile of serum 25-hydroxyvitamin D level to the

risk for breast cancer.

The authors created a summary odds ratio for the development of

breast cancer for each quintile of serum 25-hydroxyvitamin D.

2 studies involving 1783 patients were included in the analysis. One

study found an inverse relationship between levels of serum 25-

hydroxyvitamin D levels and the risk for breast cancer, whereas the

other study found no relationship. Again, study methods in the 2

studies were fairly homogeneous.

Serum 25-hydroxyvitamin D levels were divided into quintiles of 6,

18, 29, 37, and 48 ng/mL. Again, there was a negative linear

relationship between levels of serum 25-hydroxyvitamin D and the risk

for breast cancer, with odds ratios of 1.00 (referent group in the

lowest quintile of serum 25-hydroxyvitamin D), 0.90, 0.70, 0.70, and

0.50 for increasing quintiles of serum 25-hydroxyvitamin D

concentration.

Compared with a serum 25-hydroxyvitamin D level less than 10 ng/mL, a

level of 50 ng/mL reduced the risk for breast cancer by 50%. This

level of serum 25-hydroxyvitamin D would require an average intake of

4000 IU of vitamin D per day, although the authors note that intake

of 2000 IU per day combined with sun exposure of approximately 12

minutes per day with 50% of the skin exposed could also help patients

achieve a serum 25-hydroxyvitamin D level of 50 ng/mL.

Optimal Vitamin D Status for Colorectal Cancer Prevention

Researchers searched PubMed for articles that related quantile of

serum 25-hydroxyvitamin D level to the risk for colorectal cancer. 5

studies published between 1966 and 2005 met inclusion criteria.

The authors created a summary odds ratio for the development of

colorectal cancer for each quintile of serum 25-hydroxyvitamin D.

All included studies were case-control analyses with follow-up

between 2 and 25 years. 3 studies reported a reduction in the risk

for colorectal cancer with higher levels of serum 25-hydroxyvitamin D

level, although 2 studies failed to demonstrate a significant

protective effect of serum 25-hydroxyvitamin D level. However, the

authors of the current study state that the methods of the 5 studies

were fairly homogeneous.

There was a linear trend toward reduced risk for colorectal cancer as

levels of serum 25-hydroxyvitamin D increased. The odds ratios for

colorectal cancer for each increasing quintile of serum 25-

hydroxyvitamin D level were 1.00 (referent group), 0.82, 0.66, 0.59,

and 0.46.

Compared with a serum 25-hydroxyvitamin D level less than 12 ng/mL, a

level of at least 33 ng/mL or more was associated with a 50%

reduction in the risk for incident colorectal cancer.

Despite the fact that women are more likely to use vitamin D

supplementation vs men, there was no report of a difference between

sexes regarding the protective effect of levels of serum 25-

hydroxyvitamin D.

The authors conclude that vitamin D intake of 1000 to 2000 IU per day

would confer an appropriate balance between protection against

colorectal cancer and adverse events related to hypervitaminosis.

Pearls for Practice

The current review suggests that the risk for breast cancer may be

reduced by 50% through consumption of 4000 IU/day of vitamin D.

Alternatively, individuals may consume 2000 IU of vitamin D per day

and spend approximately 12 minutes per day in the sun.

The current review suggests a linear, negative relationship between

levels of serum 25-hydroxyvitamin D and the risk for colorectal

cancer. Based on these data, vitamin D intake at an average of 1000

to 2000 IU per day should provide significant protection against

colorectal cancer.

[Guest guest]

Thanks for the interesting Vitamin D information - I would caution

everyone, though, that transplant patients have an increased risk of

skin cancer, so it's especially important for anyone who expects to

need a transplant at some point to wear sunscreen at all times, and

probably try to take Vitamin D supplements instead of sun exposure.

tx,

nina

> But What About the Risk for Skin Cancer?

> As previously reported by Medscape, the American Academy of

> Dermatology has voiced concern about the vitamin D literature

> prescribing the health benefits of sunlight. " While many health

> issues are complex and involve multiple factors, we know that

> ultraviolet light is the primary cause of skin cancer, and

avoiding

> excessive exposure to the sun and other forms of ultraviolet

> radiation is the solution, " Clay Cockerell, MD, president of the

> academy said in a news release.

>

> During an interview with Medscape, Dr. Garland emphasized that his

> group is advocating prudence and moderation, including the use of

a

> broad-brimmed hat. " I think most physicians will see this as a

well-

> controlled and reasonable approach, " he added.

>

> The article points out that sun exposure is inadvisable for

patients

> with primary photosensitivity disorders, people taking

> photosensitizing medications, and anyone with a personal or close

> family history of skin cancer or actinic keratosis.