Vitamin D Deficiency Behind Many Western Cancers?

twilight30 wrote us with a link to an article in the Globe and Mail. If further study bears out the findings, new research into the causative agents behind disease and cancer may have a drastic impact on the health of citizens in Canada and the US. According to a four-year clinical trial, there's a direct link between cancer and Vitamin D deficiency. "[The] trial involving 1,200 women, and found those taking the vitamin had about a 60-per-cent reduction in cancer incidence, compared with those who didn't take it, a drop so large — twice the impact on cancer attributed to smoking — it almost looks like a typographical error. And in an era of pricey medical advances, the reduction seems even more remarkable because it was achieved with an over-the-counter supplement costing pennies a day. One of the researchers who made the discovery, professor of medicine Robert Heaney of Creighton University in Nebraska, says vitamin D deficiency is showing up in so many illnesses besides cancer that nearly all disease figures in Canada and the U.S. will need to be re-evaluated. 'We don't really know what the status of chronic disease is in the North American population,' he said, 'until we normalize vitamin D status.'"

Comments

60% reduction in risk?

[aschoff_nodule]

I believe that Vitamin D might protect against some cancers.

However, I do not agree that Vitamin D deficiency can be responsible for about 60% cancers.

Here are my reasons why:

1) The process of carcinogenesis (initiation of the first DNA mutation/ adduct required to form cancer to the stage of clinically overt disease) in most cases takes more than 4 years. This clinical trial is only 4 years and too premature to reach to conclusions.

2) I have yet to read the paper, but it is necessary to know whether this trial was truly randomized meaning that the those who got the Vitamin D pill and those who got the placebo were similar to each other in all other ways. It is possible that if it is not randomized, a healthier cohort of people chose to take Vitamin D for a long time.

3) It is also important to know how they treated those people who dropped out of taking the Vitamin D pills. It is possible that unhealthier people dropped out and then we were comparing all subjects in the placebo group to the "healthier" people in the Vitamin D group.

4) A risk reduction of 60% (= relative risk of 0.4) is epidemiologically very strong and if that was the case, we would have already found such a role of Vitamin D much earlier (like 30 years before or so). There is something called Bradford Hill's criteria for causation in epidemiology which has strength of association as one of the criteria. The rationale for that is if we had a confounder which is actually responsible for the effect, we would have known it before because it is more likely to have a stronger effect. The same principle goes here. We do not know anything that could prevents so many types of cancer with such great attributable fraction. The magnitude of effects of like 2.5 or reduction of risk to 0.4 were the strengths we used to see in the papers of 1970s. Hence I think there could be some issues with the study design and data analysis of this study if they found such a great magnitude of effect.

Having said that I think that Vitamin D might prevent many cancers, but I expect a lower magnitude of the effect.

Quick Physiology Lesson

[mrbluze]

I think I'll head off to the pharmacy.

Not so fast ;)

Vitamin D is a fat soluble vitamin and is present in meat products. Deficiency in Vitamin D causes rickets. Vitamin D is so-called, and many would think it was not available without a dietary source, but it is produced in the skin under the influence of UV light. It then gets processed by the liver, then 'activated' in the kidneys and off it goes and does good things.

Because it is fat soluble, it is unlike Vitamin C in that stores are steady and no Vitamin D production only starts to cause problems after several months.

Whilst Vitamin D requirements increase with age, sun exposure commonly decreases with age, especially in the elderly. Much of this is simply a lifestyle issue.

Importantly, Vitamin D is already known to have immunomodulatory activities (a well functioning immune system is critical in preventing cancer over time). It is also known to induce some cancers to self-destruct.

Tanning Industry Hoax!

[reversible physicist]

The "controversy" about the health benefits of sun exposure is fueled mainly by the tanning industry. All of the large studies on which the health benefit claims are based (including the one cited here) used oral vitamin D, not sun exposure. To quote from the abstract of a recent article in The Journal of steroid biochemistry and molecular biology (B. Gilchrest, March 2007),

Ultraviolet (UV) radiation is a proven carcinogen, responsible for more than half of all human malignancies. It also compromises skin appearance and function. Since the UV action spectra for DNA damage, skin cancer and Vitamin D(3) (vit D) photosynthesis are identical and vit D is readily available from oral supplements, why has sun protection become controversial, now that some data suggest conventionally "sufficient" levels of vit D may be less than optimal for at least some population groups? First, the media and apparently some researchers are hungry for a new message. Nevertheless, after 50 years, UV exposure is still a major avoidable health hazard. Second, the controversy is fueled by a powerful special interest group: the indoor tanning industry. They target not the frail elderly or inner-city ethnic minorities, groups for whom evidence of vit D insufficiency is strongest, but rather fair-skinned teenagers and young adults, those at highest risk of UV photodamage. Third, evolution does not keep pace with civilization. When nature gave man the appealing capacity for vit D photosynthesis, the expected lifespan was far less than 40 years. Long-term photodamage was not a concern, and vit D was not available at the corner store. The medical community should avoid sensationalism and instead rigorously explore possible cause-and-effect relationships between vit D status and specific diseases while advocating the safest possible means of assuring vit D sufficiency.