Suntanning is healthy?

After reading an article on vitamin D that proclaimed High-Dose Vitamin D - One of the Best Nutritional Supplements on the Market, I was a little confused. I thought high dose vitamin D was toxic. But even more controversial, the author advises fullbody suntanning in real sunlight 20 minutes per day with no sunscreen. He does not even mention the issue of skin cancer once in his article. I was immediately reminded of an article I read many years ago in Mother Jones magazine about the apparent epidemiological correlation between sunscreen use and malignant melanoma (I abstracted two studies from medline that share this concern below). Thanks to the wonders of technology, you can see that Mother Jones article.

If melanoma is not prevented by sunscreen, then the only benefit is against the nonmalignant skin cancers, which are mainly cosmetic problems. There are several reasons why sunscreen would promote melanoma. One is that Caucasians spend much more time in the sun when they are not burning quickly. This ability to withstand the pain of the sun may be a major factor in melanoma. Since sunscreen blocks vitamin D formation and Vitamin D deficiency may predispose to cancer, the double whammy of increased sun with no vitamin D protection may be a key variable here. As the author of the MJ article notes, most Caucasians just do the sensible thing. They cover up. In fact, if you have ever traveled to hot places around the world, the locals always try to AVOID the sun, regardless of skin color. Only tourists lie about nude in the sand. Is it possible that if one tries to avoid the sun in general, but does get that 20 minutes per day fullbody exposure or the equivalent, then sunscreen is not only unnecessary, but actually unhealthy.

Caucasians who like to tan for hours may be defying evolution. But the same is probably true for those who get no directly absorbed UV. Humans evolved in subsaharan Africa on what was likely a vitamin D deficient diet. While they ate meat, early humans were scavengers, not hunters, and could not depend on steady supplies of foods like liver. Thus, they evolved powerful mechanisms for creating vitamin D from sunlight. Light skin absorbs more sunlight to create this vitamin due to this racial feature evolving in cold northern climates where sun was scarce. So while Caucasians need a good shot of sunlight, they really must be careful to get what they need and no more. Darker skin folks like Mediterranean, Jews, Arabs, Africans can tolerate much more. A nice tan is at least some reward after the centuries of oppression, no doubt. :-)

According to an article in Clin Exp Dermatol. 2000 Sep;25(6):459-63, entitled Epidemiology of melanoma (Marks R, University of Melbourne, Department of Medicine, St Vincent's Hospital Melbourne and Skin and Cancer Foundation of Victoria, Austrialia).

Melanoma incidence and morality rates are increasing in most countries throughout the world where they are being recorded. The annual incidence rates have increased in the order of 3-7% in fair-skinned populations in recent decades. The mortality rates have increased at a rate lower than for incidence. This has been attributed to educational programs designed to improve the early detection of melanoma, as the treatment of melanoma has not changed substantially in recent decades. There has been a decrease in the thickness of melanoma with an increasing proportion of thin melanomas at diagnosis. Causation of melanoma is a combination of constitutional risk factors of which skin colour is the major factor. The presence and number of common acquired and dysplastic melanocytic naevi is also a major constitutional risk factor in fair-skinned people. The only environmental risk factor that has been shown consistently is exposure to sunlight, particularly large doses of sunlight sufficient to cause sunburn in childhood that will be remembered many years later. However, recreational activity leading to sunburn in adulthood is also associated with risk. To date, no other environmental factors have been shown epidemiologically to be clearly associated with risk of melanoma. Recent epidemiological data from some studies suggesting that there is an increased risk of melanoma in sunscreen users requires further explanation.

Another in Br J Dermatol. 2002 Apr;146 Suppl 61:24-30, entitled Cutaneous malignant melanoma, sun exposure, and sunscreen use: epidemiological evidence (Bastuji-Garin S, Diepgen TL, Public Health Department, Paris XII University, Henri-Mondor Hospital, 51 avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France), states,

Cutaneous malignant melanoma is the most serious form of skin cancer and accounts for about three-quarters of all skin cancer deaths. Over the last few decades the incidence and mortality rates of melanoma have been increasing worldwide. The risk of melanoma is higher in individuals with both phenotypic susceptibility and a history of sun exposure. Therefore, recommended sun protection behaviours include wearing long-sleeved clothing, seeking shade, avoiding the sun when it is strongest, and using sunscreen lotion with a sun protection factor of 15 or higher. It has been reported, however, that the use of sunscreens does not protect against melanoma and seems to increase the duration of recreational sun exposure. These results are controversial. Two case-control studies show a protective effect of sunscreen use, while three studies showed a significant risk associated with sunscreen use. However, the discordant results, the low relative risks, the lack of dose-effect relationship and the numerous biases, especially the uncertainty that exposure (sunscreen use) preceded melanoma do not suggest a causative association between sunscreen use and melanoma. Several hypotheses could partly explain these contradictory results.

According to Paul Bergner, a respected nutrition expert from medherb.com, in response to an interview question from me:

The safe upper limit is now considered to be 2000IU per day for adults, 1000 iu per day or infants. Vitamin D is big news this year, as it was discovered how many people in temperate latitudes are deficient, and how it contributes to depression, cancer, and other conditions. Vitamin D should probably be called a pro-hormone, and contributes to the endocrine and immune systems. 20 minutes of sunlight in a sunbathing-like situation gives you -a lot- more vitamin D than the upper limit above, but they say you can get toxicity only from taking too much orally. The chief risk in modern days is taking too much cod liver oil. I'd also like to point out that hunter gatherers eating animal fat got vast amount of vitamin D in their diet too. Anyway the big news is that a great majority of north Americans become deficient in vitamin D during the winter months, and that we are essentially in the midst of a mini-vitamin-D-deficiency-epidemic.

The situation has attracted the attention of the public health establishments, and the National Academy of Sciences recently upped the RDA for Vitamin D from 400 iu to 1000 iu per day. Raising the RDA that much is the equivalent of an earthquake at the NAS. I know a practitioner in Portland who runs serum vitamin D on all patients with depression, because of the possibility of winter depression being a major factor there. Then he supplements if deficient. He said he has seen the 2000iu a day dose improve but not completely cure winter depression in some patients. In one clinical trial, they compared vitamin D supplementation versus bright light for winter depression, and the vitamin D did better in the whole group, but did best in those who were D deficient in their blood work (see a similar study).

So that;'s just the depression. It would take a longer time for supplementation to affect cancer rates, but in light of our oil-and-D rich hunter-gatherer past, when we -also-walked around naked in the sun a lot, I think most modern people ought to be getting 1000-1500 oral vitamin D, and, more important, making an effort to get out in the sunlight. BTW one researcher some years ago calculated the benefits of avoiding sunlight to avoid relatively rare skin cancers, versus the number of serious internal cancers that would then be caused by vitamin D deficiency, and about 10 times as many people would diet from the serious cancers as would die from skin cancer if sunlight were avoided completely (see a supporting study). Here is a link to the best up to date and official info on vitamins.

If we are indeed experiencing a mini epidemic of vitamin D deficiency, studies such as these below may have significant ramifications, particularly for people with dark skin who live in cold northern climates:

From Am J Phys Anthropol. 1975 Nov;43(3):409-16, The evolutionary significance of vitamin D, skin pigment, and ultraviolet light (Neer RM),

Vitamin D is essential for normal growth, calcium absorption, and skeletal development. Vitamin D deficiency can cause death, immobilization, or pelvic deformities which prevent normal childbirth. In the past these problems were extremely common in North America and Europe, and were only eliminated by adding vitamin D to food. Prior to that, variations in available vitamin D affected health, survival and reproductive efficiency sufficiently to have evolutionary significance. Vitamin D is naturally present in few foods; most comes from the photo-conversion of 7-dehydrocholesterol in skin. The limiting factor in this conversion is the availability of ultraviolet light less than 310 nm. Seasonal and geographic variations in natural ultraviolet radiation cause parallel variations in blood vitamin D levels, intestinal calcium absorption, and clinical vitamin D deficiency. These physiological variations can be abolished by exposure to comparable artificial ultraviolet radiation, or by dietary vitamin D supplements. Ultraviolet radiation less than 310 nm is absorbed by skin pigment, but is also increases skin pigmentation. This has led to the hypothesis that skin pigment regulates skin vitamin D production. Little direct evidence exists to test this reasonable hypothesis, but necessary and sufficient conditions for establishing it can be outlined. Until this hypothesis is experimentally tested, it is impossible to evaluate the corollary hypothesis: that racial variations in the efficiency of cutaneous vitamin D production restricted the evolution of dark-skinned peoples to tropical latitudes and thereby caused the geographic distribution of the races.

And from Arch Dermatol. 1991 Apr;127(4):536-8, Racial pigmentation and the cutaneous synthesis of vitamin D (Matsuoka LY, Wortsman J, Haddad JG, Kolm P, Hollis BW. Department of Dermatology, Jefferson Medical College, Philadelphia, PA 19107)

The varying epidermal melanin content that produces racial pigmentation determines the number of photons that reach the lower (malpighian) cellular layers, where vitamin D3 synthesis takes place. We investigated the effect of racial pigmentation on vitamin D3 formation, stimulating the process with a fixed dose of UVB radiation. Following whole-body exposure to 27 mJ/cm2 of UVB, there was a significant racial group effect on serum vitamin D3 levels. Post-UVB levels were significantly higher in whites (31.4 +/- 4.4 nmol/L) than in Indians or blacks (12.8 +/- 2.9 and 9.1 +/- 2.1 nmol/L, respectively), while the levels in Orientals (27.8 +/- 4.4 nmol/L) differed significantly from those in blacks and Indians but not in whites. Race had only a marginal effect on serum 25-hydroxyvitamin D, with higher levels in whites than in blacks (69.9 +/- 12.7 vs 29.7 +/- 6.2 nmol/L). Serum 1,25-dihydroxyvitamin D and vitamin D binding protein levels were similar in all groups. We conclude that while racial pigmentation has a photoprotective effect, it does not prevent the generation of normal levels of active vitamin D metabolites.

Accelerating Ethics

If futurist Ray Kurzweil is right, then the rate of change in technology is itself accelerating logarithmically. This article on the advance in Korean stem cell research may be just one example. It may also foretell the fall of Rome; it's just not clear yet if Rome is America or Asia. Ten years ago, the British cloned a sheep after biologists said it was not possible. It took till last year to clone an embryo, this time in Korea, but the process was so onerous that it was not worth duplicating. Proof positive to many that what is technically called somatic cell nuclear transfer would never be viable. Yet, in less than one year, that "never" has turned into a reliable method of producing stem cells that are genetically identical to the adult donor. This therapy has raised a lot of issues surrounding bioethics, yet most of the rest of the world has reached a place of comfort, including most religious leaders in industrialized countries. From a report on NPR's The World

"Apparently, at least according to Rabbi Weiner, Petri dish embryonic stem cell research is in accordance with Halacha (Jewish law). Religious views play a large role in Israel's stem cell program. The World's Aaron Schachter concludes our stem cell series by examining how the Judaic duty to care for the sick trumps ethical concerns over the rights of embryos created in the laboratory.

When Rabbi Yaakov Weiner looks for guidance on the morality about embryonic stem cell research, he turns to the same place he usually goes for answers. Rabbi Yaakov Weiner: From the Bible, the first book of Genesis. Weiner heads the Jerusalem Center for Research in Medicine and Halacha, or Jewish law. He points to one relevant biblical passage. Genesis 9, verse 6. Most modern Bibles translate this verse as a prohibition against murder. But Orthodox Jewish tradition interprets it specifically as a prohibition against abortion. Weiner translates the passage as follows: If someone spills the blood of a human, when this human is within another human, he gets capital punishment. So, aborting a fetus violates Jewish law, or Halacha. But if an embryo is created outside the womb, that's another matter.

Rabbi Yaakov Weiner: The embryos, which are in the Petri dish, according to Halacha, have no halachic status and I can either throw them away or I can use them for medical research. In fact, Weiner says, using embryonic stem cells for medical research is not just acceptable, it's encouraged. A Jewish principle called "pikuach nefesh" mandates that people do all they can to save human life, and that includes medical research that could one day lead to cures for disease. Weiner's decision, along with similar findings of other rabbis, and Muslim clerics, paved the way for Israel's acceptance of embryonic stem cell research."

As was also reported on NPR, Chinese researchers are proceeding full steam ahead with stem cell research, as well. One might question their ethics in the use of embryonic tissue unless you actually understood their ethics. Confucian ethicists have decided that life begins at birth, not conception. Thus, it is considered unethical NOT to use aborted fetal tissue for medical purposes. Ethics is not black and white. Chinese molecular biologists trained in the US are actually returning to China because that is where they think they have a future. Foreign investors are dumping huge amounts of money into projects that are part of a national initiative to win China a Nobel prize in regenerative medicine. They will likely devote a lot of effort towards nanotech and nanomedicine as well. China really has no chance of feeding and growing its population without some of the promises of nanotech. Chinese clinics are already successfully applying some of the procedures only studied in animals or small groups elsewhere.

For those who think it is the beginning of the end, then the end will soon be upon us. Because rapidly accelerating changes build upon their own momentum. With exponential growth in bioengineering techniques predicted, a few years delay will put us FOREVER behind Asia. Because a few years of progress will be like more than a decade at current rates. A decade will be more like a century. I predict that the first reports of well documented and dramatic cures from stem cell therapy will be rolling in from Korea by this time next year, if not sooner. And then many of the naysayers will just jump on the bandwagon.

So perhaps the US alone will survive this moral crisis or perhaps it is really no moral crisis at all. Orrin Hatch, an ardent conservative, abortion foes, yet also a longtime friend to herbalists (he wrote DSHEA to prevent the FDA from destroying the market), is also a staunch proponent of stem cell therapy. He personally is into fitness, diet and exercise, uses herbs regularly, etc. Like the Christian, Jewish and Muslim clerics worldwide who have said that the torah or old testament only bans the removal of life from a woman's womb, Hatch put it more succinctly. He said ""I understand why this form of stem-cell research may troublesome," Hatch said. "However, after many conversations with scientists, ethicists, patient advocates and religious leaders and many hours of thought, reflection and prayer, I reached the conclusion that human life does not begin in a Petri dish."

In other words, if you take an egg from woman, there is no life there. Unfertilized eggs get sloughed and flushed every day. So they alone are considered garbage, waste, etc. by everyone. In the same article, Robert Bennett, a longtime abortion foe, released a statement reiterating his position. The junior Utah senator said his views on the issue were influenced by his daughter's experience that some lab-created human embryos never are capable of developing toward birth. He explained: "We are very close to this issue in our family; one of our daughters has used in-vitro procedures in an attempt to have additional children." While the attempt was unsuccessful, Bennett said her experience showed him "that all embryos are not created equal; some are healthy enough to have a chance of survival, and some are not."

If you take one of these eggs, which has not ever been fertilized and implanted and remove the nucleus from that egg and replace it with the nucleus from an adult somatic cell and do this all in a Petri dish, I don't think anyone can really argue that there is any individual life there, any more life than there is life in the small piece of flesh that I accidentally cut off my finger while grating carrots. That small piece of flesh contains living cells that contain my DNA. If I could take that tissue and culture about 100 so-called adult stem cells from it in a Petri dish and no one would have a moral objection. Yet take my same DNA from that cell and put it into a donated egg cell with no DNA (perhaps even donated from myself if I was an adult female patient) and grow about 100 embyronic stem cells and that is somehow fiddling with life just because these cells could possibly maybe grow into a fetus if placed in a woman's uterus.

As many of you know, 75% of in vitro fertilizations fail, yet somehow that is NOT murder (which is no doubt at the crux of Senator Bennett's point above). The embryos do not result in life. They die anyway or are frozen and eventually disposed of. Trying and failing to bring children to infertile couples when millions need adoption is somehow a morally defensible reason to destroy 75% of the embryos that are created through failed IVF, yet using these same bunches of cells (not little people) to save the lives of already living human beings is immoral. If it is OK to sacrifice these cells for IVF, it is OK for stem cells. For the record, all Asian governments ban the last step of implanting cloned somatic cell transfers into wombs to "farm" actual humans for organ harvest, etc. That of course is the real fear, but we currently have a thriving international market in black market organs already. There will always be some of us who will do evil, but that is no reason to stop progress. The more happy and healthy people there are, the less crime and sociopathic behavior we can expect, as many long term trends show (the main variable affecting crime rates has always been levels of unemployment and wages). So the longterm gains outweigh the risks.

The reason I mention this has do with the issue of accelerating change. After decades of what seemed like plodding changes in science and medicine, we have reached the asymptotic point in the curve, where things are probably gonna go straight up through the roof. If I am wrong, we shall soon see. If we resist these changes for too long, rather than figure out how to embrace them as a highly desirable part of modern integrative healthcare, then we will be left very far outside the mainstream in a very short period of time. Many in the field of clinical applications of stem cell therapy are proponents of alternative medicine. The two work together nicely. Patients being treated with stem cells need to eat right, exercise, take certain supplements, etc in order to get the best results.

I certainly can't think of anything more "natural" than using youthful versions of my own cells to regenerate the old decrepit ones. Using myself at my peak as my medicine. That's how we should really think of Somatic Nuclear Cell Transfer (SNTC), which is the scientific name for so-called cloned embryos. Since the likelihood of successful fullterm development of a human clone is less even than normal IVF, I think we can say unequivocally that LIFE requires an implanted embryo in a woman's uterus. Lets say there is a soul? Only a cruel god would condemn such a soul to live in a frozen Petri dish for all eternity. It would seem far more likely that any soul would wait till implantation before taking up residence.