Sunshine prevents and cures cancer (and a healthy tan makes you look good too!) Print
Health
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By Oliver Gillie

How many times have you heard it: “There’s no such thing as a
healthy tan.” Second only to “smoking kills”, avoiding the sun is
the health advice that has most permeated our conciousness.
Young and old, rich and poor, everyone knows that exposure to
the sun puts us at risk of skin cancer. But does it? What if the
advice we’ve been given to avoid the sun is wrong? What if
hiding your skin from those seductive rays is putting your health
in danger?

While every summer cancer charities and skin experts launch
their annual campaign to persuade people, against their natural
inclination, to cover up and stay out of the sun, there is growing
evidence that lack of exposure to sunlight is responsible for a
multitude of diseases from multiple sclerosis and diabetes to
several types of cancer and schizophrenia. And it's all down to a
deficiency of vitamin D – some 90 per cent of which we get
from sunlight.

Most medical researchers have been slow in recognising the
potentially lethal consequences of vitamin D deficiency. In part
this is because vitamin D is not the only trigger for these
diseases. However in the British Isles with our long winters and
cloudy summers, it seems that insufficient exposure to the sun
can make the difference between illness and health, between life
and death.

Dr Peter Selby, lecturer in medicine at Manchester Royal
Infirmary, says: “Reducing exposure to solar radiation, far from
preventing cancer, may have the opposite effect.” He points out
that a 10 per cent decrease in exposure to sunlight would not
greatly reduce skin cancer but could lead to a 6 per cent increase
in certain other cancers. And these extra cancer deaths, he points
out, would exceed all the deaths from skin cancer put together.

In the UK about 14,000 women a year die of breast cancer –
some 40 per cent of these may be caused by deficiency of
vitamin D, estimates William Grant, a NASA scientist who has
become an expert in vitamin D epidemiology. He calculates that
12-15% of all cancers in the UK, apart from lung cancer, are
linked to vitamin D deficiency. That adds up to some 20,000
cancer deaths a year in the UK resulting from too little exposure
to the sun, compared with only 2,000 deaths per year from skin
cancer of all kinds – not all of which are caused by too much
sun. Melanoma, the commonest skin cancer (1,600 deaths per
year) may also be caused by diet, overweight and lack of
exercise.

MULTIPLE SCLEROSIS is almost unknown in Europeans who
are born in South Africa and so in the old days, when doctors
worried about the rigours of weather, people with MS were
often advised to move to a sunnier climate. Many studies have
since shown that MS is more common in cold northern latitudes
than it is in sunnier places. In a pioneering study in the 1960s,
Professor Sir Donald Acheson, now Dean of Southampton
Medical School, found that MS in US war veterans was most
closely related to the amount of December sunlight in their place
of birth. Winter sunshine, which we now know can make a
crucial difference to vitamin D stores, was implicated.

But Acheson’s ideas fell on stoney ground. “Sunshine? More
like moonshine, what absolute poppycock,” one senior colleague
remarked in a public put down. It was an idea before its time
and the work remained a curiosity, largely forgotten until now.

Over the next 40 years several quite different diseases were
found to be linked geographically with MS. Deaths from cancer
of the colon and cancer of the prostate were found to be most
frequent in the same countries where deaths from MS are most
often seen. These were the least sunny northern countries of
Europe and the least sunny northern states of the US. Dental
decay and rickets were also found to be most common in these
areas. And strangest of all, schizophrenia, an extremely
disabling mental illness, was found to be more common in the
colder northern states of America and in colder northern districts
of Italy. While Parkinson’s disease, another nervous
disorder (causing primarily tremor and stiffness), had a similar
geographical distribution.

Theories abounded. Sunlight was too obvious an answer for
many researchers. Nor did anyone dare suggest that such
different nervous diseases as schizophrenia, Parkinson’s disease
and MS might all have the same ultimate cause. Perhaps, they
proposed, the diseases were caused by viruses? People in the
north eat more fat, perhaps that was causing these diseases?
Maybe it was all a matter of heredity. The research was like a
giant jigsaw puzzle with thousands of pieces. But many
important pieces were missing, and thousands of pieces from
other jigsaws were muddled up in the same box. Nevertheless,
piece by piece connections were made and the jigsaw began to
fit together.

According to one school of thought, MS is a hereditary disease
of northerners, possibly borne round the world by Vikings.
Researchers rushed to find the MS gene. But now Australians,
who over the years have received the most dire warnings to keep
out of the sun, have found that MS is six times less common in
tropical Queensland than it is in Tasmania which has much less
sun, particularly in winter. Genetics could not explain the
difference: the people of Tasmania and Queensland have the
same Anglo-Irish and European ancestors. Children in Tasmania
who did not develop MS were more likely to have spent two to
three hours a day playing outdoors in summer during weekends
and holidays. Maybe these diseases can be prevented by playing
in the sun. Fun in the sun, could the answer be so simple?
Then came a breakthrough. MS is caused by patches of damage
in parts of the brain and spinal cord leading to severe disability
and eventually paralysis. The symptoms come and go. People
with MS may improve for a while and then relapse for no
apparent reason, until now. Brain scans of people with MS
investigated by a team of scientists in Germany have shown that
the number of MS lesions increase during winter when the
amount of vitamin D in the body declines.

And other pieces of the jigsaw were falling into place. In 1992
Gary Schwartz, a researcher at the University of Pittsburg,
suggested that the common factor linking MS and prostate
cancer could be vitamin D. Schwartz showed that consumption
of cod liver oil (a good source of vitamin D) in youth reduces
the risk of prostate cancer in old age. Finally evidence
linking prostate cancer directly with sunlight came two years
ago from Professor Richard Strange and colleagues at Keele
University. They found that men in North Staffordshire with
prostate cancer had had substantially less exposure to the sun
than men who did not have prostate cancer. On average, men
who had least exposure to the sun developed prostate cancer
four years earlier than men who had more exposure. Regular
foreign holidays and sunbathing were found to protect against
the disease.
 

NORTHERN EUROPE is not man’s natural environment.
Recent studies of human DNA tell us that man evolved in
Africa. Small bands of people left the African continent some
80,000 years ago following the southern coast of Asia, and
eventually colonising what is now Iraq and Iran. These people,
who were almost certainly dark skinned, moved into Europe via
Turkey, the Black Sea and the Mediterranean as the northern ice
cap retreated some 50,000 years ago. The story of this epic
human journey has been reconstructed from modern DNA
studies and is told by Oxford professor Stephen Oppenheimer in
his authoritative book “Out of Eden”.

The virgin territory of Europe must have supplied plentiful food
in summer but in winter not only was food in short supply, low
levels of vitamin D must have increased the susceptibility of
these pioneering bands of people to disease and reduced their
fertility. Dark skin takes six to 10 times as long as white skin to
make a given quantity of vitamin D and so those with lighter
skins would have had an advantage as the pioneers moved north.
The importance of skin colour for human survival outside the
Tropics has been shown by Dr Nina Jablonski of the California
Academy of Sciences in San Fransisco and George Chaplin of
Manchester Metropolitan University. They found that skin
colour of 180 different indigenous peoples is linked closely to
the amount of autumn and winter sunlight where they live. Not
only do native peoples everywhere have paler skins the further
they live from the equator, but women and children in the
human groups studied by Dr Jablonski always had paler skins
than men, a neat adaptation to provide the maximum vitamin D
that is needed for fertility in women and growth in children.

Northern Europe was the end of the line for the successive
waves of people travelling through Turkey and the Balkans after
the ice age. It was further north than man had ever lived before
and the cloudy maritime climate of the British Isles and other
countries bordering the North Sea have reduced sunlight even in
summer. And so Europeans evolved a pale skin that enables the
first weak rays of spring sun to be used to make vitamin D. This
enables body stores of the vitamin depleted during winter to be
replaced at the earliest opportunity, while tanning provides some
protection as sunlight becomes stronger over the summer. For
thousands of years into historic times, Europeans living an
outdoor life in the countryside do not seem to have suffered
from obvious vitamin D deficiency.

But in the past 400 years, when large numbers of people began
to congregate in towns and cities a severe problem of vitamin D
deficiency developed. In 1650, treatises were written on rickets,
the bone deforming disease of children that became known as
the English disease. The disease was most common in cities,
where narrow streets and air pollution prevented the penetration
of the sun. Children developed deformities of the legs which
made it difficult for them to walk and women suffering from
the disease had flat deformed pelvises which caused difficulty in
childbirth.

The link between rickets and lack of sunlight was not made until
1822 when a Polish doctor noted that children living in Warsaw
frequently suffered from the disease while children living in the
surrounding countryside did not. He recommended fresh air and
sunlight. In 1889 the British Medical Association reported that
rickets, common in cities, was unknown in rural areas. A year
later another British doctor reported in the Practitioner that
rickets did not occur among the poor living in the city slums of
China and India and concluded that exposure to sunlight would
prevent the disease. It would be another 30 years before these
ideas began to be accepted.

The demonstration in 1919 that ultra-violet light from a mercury
arc lamp could cure rickets in children provided dramatic
scientific "proof" that rickets was caused by lack of sunlight. At
about the same time it was shown that cod liver oil (which is
now known to be rich in vitamin D) could cure rickets in dogs
raised exclusively indoors. It took a few more years for
scientists to chemically identify vitamin D and show that it was
responsible for the ability of cod liver oil to cure rickets. By the
1930s vitamin D was being added to foods such as margarine
and rickets became relatively rare.

The discovery of vitamin D was an early triumph of modern
science which caught the public imagination and fed the craze
for city people to seek health in the open air. Cycling, rambling
and youth hostelling all became immensely popular between the
two world wars - a movement which reached a summit of sorts
with the invention of the bikini by a French engineer in 1946.
The full delight of sun on naked skin was re-discovered and
forty years of carefree sunbathing followed before the spectre of
skin cancer cast its pall over summer fun.

NICOLAI GOGOL’S short story Dairy of a Madman (1834) is
one of the earliest and most complete descriptions of
schizophrenia. Brief accounts of the disease had appeared in
Paris and London in 1809 but, with the possible exception of
the character Poor Tom in Shakespeare's King Lear, earlier
descriptions of schizophrenia do not seem to exist.
Schizophrenia appears to have been virtually unknown before
1800 while most other psychiatric and nervous diseases such as
epilepsy are described in the Old Testament or other early
historical works.

These literary observations made by Dr Eric Altschuler of the
Brain and Perception Laboratory at the University of California
provide historical support for a theory that schizophrenia may be
caused by a deficiency of vitamin D during pregnancy.
Schizophrenia, it seems, emerged as a new disease with the
great expansion of modern European cities, at much the same
time as rickets began its most devastating phase.
 For many years geneticists claimed that schizophrenia was an
inherited disease and poured scorn on other ideas. But they were
at a loss to explain why people with schizophrenia had winter
birthdays more often than would be expected. Extra vitamin D is
required in the last three months of pregnancy to support the
rapid growth of the baby. When the level of the vitamin is low,
as occurs most frequently in winter, there may not be enough to
provide for normal development of the brain or other organs
causing more winter births of people with schizophrenia.
The nervous system of the developing baby may be damaged in
other ways by vitamin D deficiency. Other diseases which occur
more frequently than would be expected in babies born in winter
or early spring are autism, Alzheimer's disease, Parkinson's
disease, and MS. The cause of these diseases is still being hotly
debated by experts but vitamin D deficiency is one theory that is
gaining increasing support. Like schizophrenia, these diseases
may appear to be more strongly inherited than they really are
because family members influence each other in the way they
seek or avoid the sun.

Schizophrenia is one of several diseases that has been found to
be more common among dark-skinned people than among
whites in Britain. Diabetes, multiple sclerosis, autism and rickets
have also been reported to be more frequent among immigrant
families who came to Britain from Tropical countries. First
generation immigrants born in the Tropics are no more
vulnerable to schizophrenia than native British whites, but the
disease is more frequent among their children than among white
British people, according to several research studies led by
Professor Glynn Harrison at the University of Nottingham, Dr
Dinesh Bhugra at the Institute of Psychiatry, London, and
others.

Many explanations, including prejudice, psycho-social stress
and inheritance have been considered, but they do not explain
the facts. Investigators have repeatedly pointed to the
consistency of their findings and concluded that an
environmental factor must be responsible. Now in the light of
other research it seems obvious that deficiency of vitamin D,
caused by the slow absorption of ultra-violet light by black skin
and low levels of sunlight in northern climates, is the most likely
explanation for the increased incidence of these diseases in
immigrant families.

Not only are more people with schizophrenia born in winter, the
number of people born each year who later develop the disease
varies from year to year in a way that cannot be explained by
chance. Investigations by Dr John McGrath and others at the
University of Queensland have linked this variation in births of
schizophrenic people with the amount of sunlight around the
time of their birth. The observations fit in neatly with new
findings that show the importance of vitamin D for growth of
cells and for the development of the brain.

Dr McGrath, an Australian who is currently working at Harvard
University, says: “Queensland, where I live, is in the Tropics so
we get strong sun all the year round. I try to sit out in the sun
every day and when I go to the beach with the children we have
a half hour of exposure to the sun before we put on any
suncream. Sunlight is specially important for pregnant and
nursing mothers.”

Babies in Finland often used to be given very large doses of
vitamin D in the first year of life and now Dr McGrath, working
with Finnish doctors, has shown that men who were given these
large supplements as babies are less likely to develop
schizophrenia than men who were not given the supplement.

This same group of men given vitamin D as babies have been
found to be less likely to develop diabetes before the age of 30.
And in the UK people with this type of juvenile diabetes (known
as diabetes type 1) are more likely to be born in the winter or
early spring months when vitamin D is in short supply.
In juvenile diabetes the beta cells in the pancreas that normally
produce insulin do not develop properly and are attacked by the
body’s own immune system. Deficiency of vitamin D is
probably what causes these cells to develop abnormally,
triggering the assault. Now a dramatic demonstration that
vitamin D can rescue beta cells that are being attacked in this
way is likely to sway scientific sceptics. Two independent trials
conducted in Rome and Munich have shown that giving vitamin
D to children when diabetes is first diagnosed can save the beta
cells, at least temporarily, and delay development of the disease.
But these trials of the health benefits of vitamin D supplements
are exceptional. Few trials have been made of vitamin D for
treatment of diseases other than bone disease because the
vitamin cannot be patented and drug companies cannot justify
expensive trials which will not lead to profits. However trials of
several compounds similar to vitamin D have begun recently for
treatment of cancer because these compounds can be patented.

Crucial pieces of the jigsaw puzzle now seem to be in place and
a consistent picture has emerged although many researchers
remain sceptical, especially those who have spent most of their
lives committed to other theories. The sceptics point to technical
difficulties in the scientific evidence and the lack of final proof
that vitamin D is the cause of most of these diseases. But the
weight of so many different studies demonstrating or suggesting
the health benefits of sunbathing and vitamin D supplements can
no longer be overlooked.
 

Yet every year doctors repeat the mantra: “There is no such
thing as a healthy tan,” words which are enshrined in a
Consensus Statement of the UK Skin Cancer Prevention
Working Party and endorsed by more than a dozen health
charities as well as by UK government health departments. And
every year doctors complain about the large number of people
who ignore their advice by sunbathing and tanning.
The advice of the Skin Cancer Working Party has of course been
given in good faith with the very best of intentions but it is
based on a mistaken Consensus. It can no longer be defended.
The stark truth is that advice to avoid the sun has put more lives
at risk than it can possibly have saved and, it must be faced, is
responsible for many thousands of deaths.

Dr Neil Walker, chairman of the UK Skin Cancer Prevention
Working Party, says: “The phrase ‘no such thing as a safe tan’ is
one way of getting the message across that sun damage can lead
to the development of potentially fatal skin cancers. I think we
need to look at this again. Personally I advise my patients not to
bake and not to burn. I think telling people to avoid the sun
entirely is draconian and unnecessary.”
In fact, there is much scientific evidence showing that regular
exposure to the sun does not necessarily carry any increased risk
of skin cancer. Heavy occupational exposure to the sun such as
is seen in farmers and construction workers is associated with a
reduced risk of melanoma, the worst type of skin cancer. When
care is taken not to burn, intermittent exposure to the sun
probably carries relatively little risk of skin cancer, and provides
a very great benefit from the vitamin D it gives.

This much has been clear since at least 1997 when Mark
Elwood, a distinguished scientist at the University of Otago,
New Zealand, published a review of 50 studies of melanoma and
sun exposure in the International Journal of Cancer. The
Consensus should have been redrafted then, but its momentum,
financed by government and World Health Organisation funds,
has proved to be unstoppable. Until recently, few skin cancer
experts were prepared to recognise the probable role of vitamin
D in preventing other cancers, there was little understanding of
how important vitamin D is for prevention of other diseases, nor
were skin experts prepared to concede that regular sunbathing or
use of supplements is needed to provide adequate levels of
vitamin D in our climate.

“It is safe to say that the cost of vitamin D deficiency is billions
of dollars. How many billions is the issue,” says Professor
Robert Heaney of Creighton University, Omaha, Nebraska, who
has made many studies of vitamin D and disease.
The cost of disease believed to be caused or exacerbated by
vitamin D deficiency has been estimated by Wiliam Grant to be
some 50 billions of dollars in the United States. The cost to the
UK National Health Service of just one disease, diabetes type 1,
which can probably be prevented by vitamin D supplements,
runs to £500m a year or about 1 per cent of the NHS budget.
The total cost of D deficiency disease to the UK must certainly
be calculated in billions of pounds.

“This is money that really could be saved if people generally
took supplements of vitamin D or sunbathed regularly,” says
Professor Heaney.

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