Endorsement
This book is a tour de force for health effects of exposure to the sun. It explains and provides evidence of the immense benefits of the sun for human health that have been sadly neglected since the previous century. It is written simply enough and in such a light-hearted vein that any intelligent fifth grader can and should read it. Actually, every literate man, woman and child age 12 and older should have this book and should read it thoroughly. It is the best single source on the many positive yet neglected roles of sunlight in human health. It also should be required reading for every upcoming doctor in training and all health care professionals.
Cedric F. Garland, Dr.P.H. F.A.C.E. Epidemiologist. La Jolla, California
Authors: Marc B. Sorenson, Ed.D, and William B. Grant, Ph.D.
Editorial Directors: Marc Sorenson, Ed.D, William B. Grant, Ph.D. and Adiel Tel-Oren, MD, DC, CCN, LN © 2017 by Marc Sorenson, Ed.D. and William B. Grant, Ph.D. First published in 2018.
All rights reserved.
Reproduction or translation of any part of this work beyond that permitted by Section 107 or 108 of the 1976 United States Copyright Act without permission of the copyright owner is unlawful. Requests for permission or further information should be addressed to Marc B. Sorenson, Ed.D. megamarc79356@gmail.com or William B. Grant, Ph.D. wbgrant@infionline.net
DISCLAIMER: This book is not meant to substitute for the counsel of a qualified health professional or to diagnose or treat any disease. Improper use of sunlight or other ultraviolet light exposure may result in various types of skin cancer, as well as aging of the skin. Some persons may also have skin types or conditions that preclude sun exposure or other ultraviolet light exposure, and certain diseases may also preclude exposure to ultraviolet light. The reader takes full responsibility for any action taken after reading this material. The reader is advised to consult a health professional before making any changes in sunlight exposure.
ISBN: 978-0-692-07600-2
Printed in the United States of America
Embrace the Sun

Just as the sun is the principal of all life, so it is the source of all healing. It is the Sun, and uniquely the Sun, that sick people seek in winter on our coast. It is the Great Doctor, Doctor of the Faculty of the Sky, to whom the suffering come to demand a cure for their ills.1
—J. Orgeas, L'hiver a Cannes.
By Marc B. Sorenson, Ed.D. William B. Grant, Ph.D.
i
Dedication
By Marc B. Sorenson, Ed.D.
This publication is dedicated to the billions of people worldwide whose health has been compromised by indoor lifestyles, misguided advice from medicine, deliberate sun avoidance, and the use of (most) sunscreens. It is our hope that by reading this work, those billions may cease hiding in the shadows and step outdoors again, without fearing the lies promulgated by the anti-sun industries—industries making millions by frightening men and women away from the salubrious effects of sun and fresh air—thereby diminishing the joy which could be theirs by safely enjoying their most faithful friend, the Sun.
A further dedication is given to the men and women, including my coauthor Dr. Grant, who have worked sedulously to uncover the facts about sun exposure. They have improved the world with their research and dispersed the mists of darkness, which have hidden the sun's golden rays. Now, through their efforts, those who read their works no longer need to see through a glass, darkly, but rather view clearly and delightfully, their shining friend, illuminating the pathway to transcendent human health. I salute them for their work.
I would also like to dedicate my gratitude to Dan and Micheline Smith and to Dr. Adiel Tel-Oren for their help in reading and editing. Their assistance was invaluable.
Finally, I dedicate my portion of this book to my wife, Vicki, who brings sunshine to my life each day.
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Dedication
By William B. Grant, Ph.D.
I dedicate my portion of the book first of all to my mentors and colleagues through the years who guided my development as a scientist. These include my physics thesis advisors at UC Berkeley, Professors Carson D. Jeffries and Linn F. Mollenauer, who patiently guided me in learning the ways of experimental physics and showed that one can enter any field one wants as long as one prepares properly.
Also, Professor Eugene D. Cummins who pointed out that many major advances in science are made by people who enter new fields and do not accept the paradigms of the field.
Also, my NASA Langley Research Center colleagues Drs. Edward V. Browell and Jack Fishman who guided me in the ways of atmospheric sciences and remote sensing where I learned that combining two data sets can be more important than presenting one data set for others to use.
Also, the late Professor Orie L. Loucks (Miami University, Oxford, OH), who introduced me to the ecological study approach, which we used in studying the effect of acid rain and ozone on eastern hardwood forests.
Also, the vitamin D researchers who have contributed their efforts to uncovering and elucidating the epidemiology of health benefits with respect to sun exposure and vitamin D status and to understanding of the roles of sun exposure and vitamin D in maintaining optimal health.
In particular to Cedric F. Garland, D.P.H. and Michael F. Holick, Ph.D., M.D., Johan E. Moan, Ph.D., and Barbara J. Boucher, M.D. for mentoring and many helpful discussions through the years, as well as to my many coauthors and editors and reviewers of the journal papers.
Also, to the advocates of beneficial sun exposure and optimal vitamin D status, in particular those individuals and non-profit organizations leading these efforts including Carole Baggerly, Grassroots Health; John J. Cannell, M.D., The Vitamin D Council (US); Perry Holman, The Vitamin D Society (Canada); and Henry Lahore, VitaminDWiki.com (US).
III
Also, to those journals willing to publish papers on sun exposure and vitamin D to expand the boundaries of knowledge such as Dermato-Endocrinology and Nutrients.
Finally, to Dr. Sorenson for synthesizing for the general public much of the information on the health benefits of sun exposure through production of vitamin D and numerous other mechanisms.
Acknowledgements
I am happy to acknowledge the following organizations that have funded my research and various research or writing projects during the past decade: the UV Foundation (McLean, VA), the Sunlight Research Forum (Veldhoven), the Vitamin D Council (San Luis Obispo, CA), the Vitamin D Society (Woodstock, ON, Canada), Grassroots Health (Encinitis, CA), and Bio-Tech Pharmacal, Inc. (Fayetteville, AR).
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Endorsements
No sun - no fun! This is the clear message of Marc B. Sorenson and William B. Grant, both outstanding experts in solar radiation and vitamin D. And they leave no room for any doubt that the full range of solar radiation has to offer much more than just vitamin D for our health.
Unfortunately, at least half of the nation lost this precious resource due to our lifestyle in a modern technical environment. What can we do? As modern society will not be able to move back to the age of hunter and gatherer, we will have to look for compensation. With regard to the lost physical activity fitness centers are well accepted as replacement. Pharmaceutically produced vitamin D and sunbeds should be accepted as well - even though a visit to Mother Nature cannot be topped by any technical means.
Prof. Dr. JOrg Spitz, Akademy of Human Medicine and Evolutionary Health Schlangenbad/Germany
Our culture today is one of sun avoidance, which has negatively impacted our health. I am delighted that Marc Sorenson and William Grant have worked together to create an almanac of information on healthy sun exposure - based on research. "The healing power of the sun and its use in medical treatment (heliotherapy) have roots extending back into antiquity," from a public health seminar we did in 2014 The sun's impact is far greater than vitamin D. Sorenson and Grant have provided us information about how to make our own choices regarding sun exposure, to manage our health, to help others. We can use this for informed action by us all to help set effective policy for our society's health. A special thank you to these gentlemen for leading this health cause.
Carole Baggerly, Director Grassroots Health - non-profit dedicated to moving research into practice with nutrients.
I have read and thoroughly enjoyed, "Embrace the Sun" by Dr. Marc Sorenson and Dr. Bill Grant. It has information that every person and every medical practitioner in the world should know and embrace.
The sun has been the life-giver to all life on the Earth, and all life has lived in balance with solar rays for all the time that life existed on this world. We have avoided the sun now for many years and the health of humans has suffered as a consequence. The ill effects of sun exposure are miniscule compared to the health benefits of prudent sun exposure. It is time to go out and become reacquainted with the much-maligned sun and re-discover the health benefits. I give this masterpiece an A+ grade.
V
Maurice Henry Van Strickland, M.D. FACP, FAAAAI, FACAAI, FAAP, Clinical Associate Professor of Medicine, University of Kansas School of Medicine, Wichita, Kansas.
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Foreword
Michael F. Holick, Ph.D., M.D.
Marc Sorenson and Bill Grant take us on a delightful journey to better understand the health benefits of our magnificent sun at a time when our sun has been demonized by various health organizations, including the dermatology community, which has been essentially unchallenged for the past 50 years. As noted by the authors, the world-wide sun phobia is based on the misconception that any exposure to direct sunlight increases the risk of developing the most common cancer, i.e., skin cancer. However, the most common skin cancer, non-melanoma skin cancer, is caused by chronic excessive exposure to sunlight. These cancers when detected early are easy to treat and are often cured. The most deadly skin cancer, melanoma, occurs on the least sun-exposed areas and the authors present compelling evidence that regular or habitual sun exposure impedes or prevents the development of this highly malignant cancer rather than causing it. What is true about melanoma is that major risk factors include being red headed, thus having fair skin and being prone to sun burning, number of sun-burning experiences during childhood and early adulthood, number of moles on the body, and a genetic predisposition for developing this malignancy.
The authors put into perspective the voluminous research over the past Century relating the many negative health consequences associated with sun avoidance, or to put in another way, to remarkable health benefits from sensible sun exposure. In the early 1900s it was first observed that indoor workers were at much higher risk of dying of cancer compared to outdoor workers. This was followed by a study by Apperly reporting that adults living at higher latitudes in the United States had a much higher risk for dying of cancer than adults who live in the southern states. A study in Canada reported that women who had the most sun exposure as teenagers and young adults reduced their risk of developing breast cancer by almost 70% when compared to women who had minimum exposure during these periods of time in their lives. It's also recognized that autoimmune disorders including multiple sclerosis, type-one diabetes, rheumatoid arthritis and Crohn's disease are much less common for those who are born and live closer to the equator. Those living at lower latitudes have not only lower blood pressure but also are at reduced risk for developing a heart attack. At the turn of the last Century tuberculosis was a major killer of children and adults. It was found that exposure to sunlight could help fight the infection. Solariums and outdoor treatment centers were established to help fight this deadly infectious disease. Finsen in 1903 received the Nobel Prize in Medicine for his observation that when the skin that was infected with tuberculosis was exposed to sunlight that it was effective in treating this disorder.
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How is it that exposure to the sun can have all of these health benefits? Dr. Sorenson and Dr. Grant acknowledge that the well-documented beneficial effect from exposure to sunlight is the cutaneous production of vitamin D. They also describe in detail various mechanisms by which vitamin D can have such global health benefits in reducing risk for more than 50 chronic illnesses including approximately 18 major cancers including melanoma. Sun deprivation and vitamin D deficiency have also been associated with not only depression but also neurocognitive decline in older adults with increased risk for developing Alzheimer's disease.
But this is only part of the story of the health benefits from sun exposure. They explain how the sun is able to elicit a wide variety of photochemical and biologic processes in the skin that provide additional health benefits above and beyond the beneficial effects provided by vitamin D. This is due to the fact that the sun is emitting packets of various energies including ultraviolet B, ultraviolet A, visible and infrared radiation. These packets of energy are absorbed in the skin cells causing a plethora of biologic effects. Of the many described in this book, most notable are the production of beta endorphin, which is responsible for improving the feeling of well-being and is also associated with the runners high, and nitric oxide, which is a natural skin product that when released during exposure to sunlight causes dilation of blood vessels, thereby reducing blood pressure.
The authors also nicely put into perspective what happens to the DNA in the skin when it absorbs ultraviolet A and ultraviolet B radiation and how the body develops repair mechanisms to help overcome these radiation insults. In other words, over millions of years, life forms including humans were exposed to sunlight and not only took advantage of the many health benefits, but they also adapted to the potential negative consequences by developing repair mechanisms to overcome the damaging effects from sensible sun exposure.
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Embrace the Sun is an easy read that is chock-full of valuable information about the health benefits of sensible sun exposure. It provides a very practical guide on how to take advantage of our Magnificent Sun.
Michael F Holick, Ph.D., M.D.
Professor of Medicine, Physiology and Biophysics and Molecular Medicine
Director of the Heliotherapy Skin and Light Research Center Director of the Vitamin D Skin and Bone Research Laboratory Director of the Bone Healthcare Clinic Boston University Medical Center
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Preface—Embracing the Sun
Dr. AdieL Tel-Oren (“Dr. T”)
MD, DC, LN, CCN, DACBN, DABFM Founder & President, Ecopolitan Community
This book touches every fiber within the matrix of human health, just as ubiquitous sunrays have touched the fabric of our complex existence since ancient times. The sun's entire spectrum of irradiated wavelengths has enabled the development of all life on Earth, and life will be terminated without it. This book's Appendix 6 proposes that the salubrius sun is "the conductor in the symphony of living:" Numerous crucial compounds are manufactured by our skin and brain in response to full spectrum visible, ultraviolet and infrared sunrays, all of which change in intensity throughout the day, causing various hormones, neurotransmitters, and immune messengers to crescendo and diminuendo-maintaining our metablic harmony. The skin and brain are intimately interconnected since our earliest embryonic life, and together they orchestrate our responses to external stimuli. Solar energy, the initiator of life, is the most fundamental external stimulus, and the skin-the largest organ to absorb the entire spectrum of that energy-suddenly becomes an organ of great importance, once we understand the countless metabolic pathways stimulated within it whenever it is touched and penetrated by solar particles.
As a practitioner who has trained many physicians internationally to eliminate various skin lesions aesthetically and non-surgically, I have learned to appreciate the skin's most obvious functions and traits, but only in the last decade I've realized the skin's unique ability to keep us healthy, happy, and protected from disease, including skin cancer, with the indespensible assistance of the sun, as proven by science! Just read on to see for yourself. And if you're interested in the subject of skin cancer and skin health from a holistic, comprehensive, scientific perspective that will both surprise and empower you, just email clinic@ecopolitan.com to receive an article dedicated to the unorthodox skinny about skin growths and other skin conditions.
Whether you are a health seeker, scientist, layperson, academician, student, or doctor - you're embarking upon the most comprehensive and up-to-date scientific book ever written about the sun's health benefits. It's also the most holistic book about the sun. Dr. Sorenson and Dr. Grant have demonstrated their truth-seeking and pioneering spirit, and succeeded in restoring the sun to its ancient level of prominence as a resource for wellness and healing.
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When my good friend Dr. Marc Sorenson introduced me to this new book and asked me to edit it scientifically and write a preface, I was intrigued, for two reasons:
First - the authors: Marc Sorenson, Ed.D. is an innovative educator, who has mastered the processes of teaching and learning; he is intimate with the necessity of repetition without excess, with the tools that sustain the reader's interest, and with the importance of attacking complex topics from multiple angles to successfully instill them in a student's mind. Marc truly embodies the term "doctor" -which derives from "teacher" in Latin. He has written several books, including a large compendium about general health and nutrition (Mega Health, 1993), written with wit and utilizing allegories and parables to penetrate the reader's mind; as well as a large book designed to enhance a person's vocabulary (I Want to Have Words with You, 2007), which is imbued with grace and humor, negating the drudgery and tedium we typically associate with memorizing word lists. To Dr. Sorenson, education is serious business! His descriptive, logically unfolding style creates a memorable educational experience. William B Grant, PhD is also a friend I greatly admire: For many years he has been swimming indefatigably and courageously against the mainstream's current perceptions of proper nutrition, diet, and vitamin D. As a scientist among scientists, he stands out for his original research and numerous contributions to our knowledge about vitamin D's benefits. His additions to this book elevate its scientific standing.
I am honored to support Marc and Bill's educational efforts.
Second, the book's topic resonated with my scientific respect toward Nature's complexity. Marc's excellent previous book, Vitamin D3 and Solar Power for Optimal Health (2008), described vitamin D's benefits as a photoproduct of solar UVB exposure. It focused on the recent progress within academic circles, documenting vitamin D's incredible importance to our health. Yet, those circles may have relegated the sun itself, despite its temporal primacy, to a secondary entity whose main job is the production of vitamin D3 within the skin's epidermis.
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This oversimplification might create the impression that vitamin D supplements equate with natural sun exposure and can replace it!
The study of nutrition has taught us to be humble: Nature is too complex and its myriad components too interrelated for any human to fully comprehend its nuances. A big mistake made by scientists has been the reductionist approach to natural systems, whereby a single element was isolated, synthesized, and sold as a replacement for the "real thing." Vitamin C, beta carotene, d-alpha-tocopherol, and other vitamins are all examples of this oversimplification of Nature: It took many years before we realized that all the bioflavonoids escorting vitamin C; all the other carotenoids; and all the isomers of vitamin E are crucial to health. Thus, they cannot be ignored to appease the vitamin manufacturers and scientists who have isolated just one of each family of nutrients, given it a name, and promoted it. Until we realized our errors and learned to respect Nature's complexity, we were bewildered by the inconsistencies in the performance of these single molecules. Today, vitamin D joins these isolated nutrients: The "Vitamin D decade"—that served as a catapult propelling us toward recognizing the importance of ultraviolet B radiation to health—is now giving way to the "solar decade." Soon we will all realize that isolating vitamin D for the purpose of "sun supplementation" can only benefit those who are D-deficient, and that the holistic approach is far more scientific: Enjoying the entire spectrum of solar radiation gives us many exciting benefits that were stolen from us by the health authorities, which have been admonishing us to hide from the sun.
This book illuminates many of the crucial benefits we reap from the sun, above and beyond vitamin D production: Solar UVA, UVB and visible irradiation stimulates the release of cytokines (important immune modulators); it inhibits disorders associated with inflammation, thereby reducing the progression of most degenerative diseases; it supports cardiovascular health via nitric oxide release; and improves emotional and behavioral health by inducing serotonin and endorphin production. Full spectrum and infrared rays have always interacted with skin cells, triggering mitochondrial ATP (energy) production within them! Existence has evolved around the dance between the cycles of light and darkness— (Continued on the back cover)
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Embrace the Sun
Introduction and Overview
"Keep your face to the sun and you will never see the shadows."
—Helen Keller
Marc B. Sorenson, Ed.D.
The assault on the sun, which has increased in intensity for several decades, is one of the most heinous crimes yet perpetrated on humanity. It is another example of how humans—some misguided and others motivated by profit—often grasp a certain idea they believe will either protect the human race from a particular malady, or produce a tidy profit. Unfortunately, by promulgating such ideas to the exclusion of all others, they cause a disruption of balance leading to death and destruction. The pendulum regarding sun exposure has swung so far to one side that many "health professionals" are now suggesting all people protect themselves completely from every single ray of sunlight and wear sunscreen all day, 365 days per year. This is, according to "balanced" scientists, contributing to the deaths of at least 336,000-400,000 Americans every year (references found in the main manuscript). This book will present the truth and thereby restore the balance for those suffering from the deception.
The sun has always been the giver of life. Unfortunately, an assault on the sun began many decades ago. Little by little, the myopic views of the anti-sun movement, which considered only the negatives of sun exposure, began to prevail, turning much of mankind against their friend, the sun. In the early 1900s sun exposure was considered very beneficial. Now, due to the money machine of sunscreen promoters, the sun has become "public-enemy number 1."
In 1936, sunscreens began to appear in the marketplace, which started the negative message regarding the sun, especially the portion of sunlight called ultraviolet light or UV light, which consists primarily of UVB and UVA spectra. But these chemical sunscreens blocked only the UVB portion of sunlight, the light responsible for vitamin D production; it did not block UVA light. UVB light also performs another important function: when the body has had enough sun exposure, it produces a feeling of heat on the skin, thereby warning us of the danger of overexposure. It tells us when to seek the shade.
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Consequently, those who use sunscreen have been overexposed to UVA light by no fault of the sun. The sun gave us the perfect balance of light for good health, but mankind in his "wisdom" took that balance away. New research has shown that researchers were wrong in their theories, believing in the need to artificially control both UVB and UVA, which is exactly what happens naturally when we seek the shade or cover up! We never needed sunscreen to accomplish what nature guided us to do. It is interesting that the anti-sun argument, for decades, has become almost exclusively about skin health. This theory wholly neglected the myriad healthful effects of sun exposure on other organs of the body, which benefits include, among others, cancer prevention, heart-disease prevention and mood enhancement. Now, the truth about the sun's healthful effects, including better skin health:
Did you know that as sunscreen sales have increased spectacularly, melanoma has also increased by about 3,000%? We must realize that the onslaught of advertising, designed to produce profits for sunscreen companies and their co-conspirators, have warped our perceptions. The health benefits of sun exposure are now well known among many scientists, but largely unknown for the general populace. This book will serve as a tool to take the truth to the world. The pendulum has swung too far to the negative, anti-sun side; we will now begin to bring it back to its rightful place, producing a balance, which will save millions of lives worldwide.
Sun exposure has profoundly decreased among the populace in the past century, while there has been an enormous increase in melanoma incidence. This fact alone should cause any rational person to rethink the message of sun avoidance. It also refutes the idea that humans should use sunscreen 365 days per year. This treatise will examine the aforementioned statements and accentuate this positive message: Sun exposure saves lives by preventing, mitigating and in many cases reversing diseases.
This is not another book on the benefits of vitamin D; that subject has been treated thoroughly by many authors and will continue to be researched. Nevertheless, vitamin D will often be mentioned, though little will be said about vitamin D supplementation. Supplementation detracts from the message that sun exposure is superior to any of its photoproducts. No one should erroneously assume, however, that this work is in any way meant to diminish vitamin D, since it is an exceptionally important photoproduct produced when the ultraviolet B (UVB) portion of sun exposure stimulates the skin. It is vital to human life, and when sunlight or sun lamps are not available to produce it, supplementation is a must, especially when a person is vitamin D deficient. Vitamin D supplementation can substitute for the vitamin D-producing aspect of sun exposure. However, there are additional health benefits of sun exposure that Vitamin D supplementation does not address, such as the production of nitric oxide, serotonin, endorphin and BDNF (a neuron growth factor and preventer of nerve death). Therefore, we have elected to omit reference to any studies regarding vitamin D supplementation.
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As stated above, Vitamin D is certainly not the only beneficial photoproduct of the sun. However, there has been an unfortunate tendency for many writers and researchers to assume the only benefit of sun exposure is the production of vitamin D—an idea which is in error. We will expand upon the direct and remarkable benefits of sun exposure for various diseases and will consider other photoproducts, such as nitric oxide and endorphins, which are produced by human skin in response to sun—photoproducts that may reduce the risk of heart disease, cancer, multiple sclerosis and myriad other disorders.
As an example, even erectile dysfunction may be relieved by nitric oxide.
Overview
In the first chapters of this work, we belie the idea that regular or habitual sun exposure is the cause of melanoma, and instead we present evidence that regular or habitual exposure impedes or prevents the development of that disease. In subsequent chapters, we will present the facts respecting other curative and preventive powers of the sun.
But first, to capture the reader's attention, we will present "headlines" which should have been written, based on overwhelming evidence from scientific research freely available to the world. We will then list many of the diseases associated with sun deprivation.
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The Headlines:
Voluminous research in the past few years has proved the truth
about the remarkable health benefits of the Sun. Why haven't
you read these Headlines?
•	Sun exposure in the U.S. has been reduced by 90% in the last 70-100 years, while the risk of melanoma has increased by at least 3,000%. Then how can anyone believe sun exposure causes melanoma?
•	As in the US, while sun exposure in Europe has profoundly decreased, there has been a spectacular increase in melanoma.
•	Many melanomas occur on the parts of the body that seldom or never see the sun, including inside and around sex organs, in the armpits, in the mouth, on the soles of the feet and on areas nearly always covered by clothing.
•	Women who completely avoid the sun have an increased risk of breast cancer of 1,000%, compared to those regularly exposed to sun.
•	Women in Spain who actively seek the sun have a reduced risk of hip fracture of 91%.
•	Sunbathing can often reduce both systolic and diastolic blood pressure within an hour, and the effect lasts for about two more hours.
•	Multiple Sclerosis is most prevalent in the northern part of the Northern hemisphere, but its prevalence virtually disappears in sunny equatorial climes.
•	Selective serotonin reuptake inhibitors (SSRI) such as Prozac work by keeping serotonin in circulation. Sun exposure can increase the amount of serotonin in the circulation by 800% in one day without toxic side effects, and the sun is free.
•	Regular, habitual sun exposure without sunscreens REDUCES the risk of melanoma.
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•	Outdoor workers obtain 3-10 times the annual sunlight exposure as indoor workers, yet they have lower incidences of melanoma. Why?
•	Women with active sunbathing habits live longer.
•	Women who avoid sun exposure have twice the risk of allcause death over 20 years, compared to those who are actively in the sun.
•	Chronic sun exposure is associated with a reduced risk of colorectal, breast, and prostate cancer.
•	Regular exposure to UV leads to an almost complete disappearance of DNA damage where skin cancer has been initiated.
•	There are 324 deaths associated with diseases of low sun exposure for every 1 death related to diseases of high sun exposure.
•	UV radiation, from sunlight, is the best natural source of vitamin D. Vitamin D supplements alone are not an effective substitute for adequate sun exposure.
•	Public health messages in the past 50 years, urging avoidance of sun exposure and the use of chemical sunscreens, have likely contributed to the rise in melanoma incidence.
•	Chemical sunscreens have unbalanced Mother Nature, which is one reason why melanoma has INCREASED exponentially, accompanying the exponential increase in sunscreen sales during the past 30 years.
•	DNA damage is reduced with a tan.
•	Low blood leves of vitamin D are a major indicator of sunlight deficiency.
•	If sunscreen is not re-applied every hour it creates more skin damage than if one used nothing at all.
•	Women who used sunbeds for 20 years had a 23% decrease in the risk for all-cause death.
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To better understand this book, the reader should be familiarized with the different types of solar radiation:
Sunlight is the visible portion of the radiation emanating from the sun, with wave lengths extending from about 400 to 700 nanometers (a nanometer is one billionth of a meter). The invisible ultraviolet portion of the sun's radiation is called ultraviolet radiation (UVR) or ultraviolet solar radiation and is also known as UV. Its wavelength is shorter than the visible part of the sun spectrum, and extends between 100 and 400 nanometers (nm), although solar UV reaching the earth's surface stops at 290 nm. That places it beyond the visual capacities of the human eye.
UVR is available year-round in the tropics and during part of the year farther north and south. UVR is also produced by artificial sources such as sunlamps, and phototherapy lamps. A photon of light is the same no matter whether produced by the sun or an artificial source. This means there is no such thing as "artificial UV light"—a term you may often hear from the media.
To understand the history and function of the sun, one should know the differences between the types of ultraviolet light that are components of solar radiation. There are three main varieties of UVR: UVA, UVB and UVC. These are determined by wavelengths, measured in nanometers.
UVA has a wavelength of 315-400 nanometers and when contacting the skin can penetrate beyond the epidermis, or outer layer, into a deeper layer called the dermis. UVA does not stimulate vitamin D production, but it does stimulate the production of nitric oxide, which is vital for human health.
UVB has a wavelength of 280-315 nanometers, but solar UV reaching the earth's surface stops at 290 nm. UVB penetrates only the epidermis when it contacts the skin. UVB stimulates the epidermis to produce vitamin D.
UVC light has a wavelength of 100-280 nanometers and is filtered out by the Earth's outer atmosphere, including the ozone layer.
The following is a list of diseases and disorders diminished by regular, non-burning sun exposure:
• Approximately eighteen major types of cancer, including melanoma
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•	Acute lower respiratory infection
•	Anaphylaxis
•	Anemia
•	Anxiety
•	Arthritis
•	Asthma
•	Athero-sclerosis
•	Autoimmune diseases
•	Bipolar disorder
•	Breast-tissue density
•	Chronic pain
•	Cognitive decline
•	Colds
•	Craniotabes
•	Crohn's disease
•	Chronic obstructive pulmonary disease
•	Cystic fibrosis
•	Dental caries
•	Eczema
•	Electric light disease
•	Epilepsy
•	Erectile dysfunction
•	Fibromyalgia
Flu
Heart disease
Heart failure
High cholesterol
Hypertension
HIV/AIDS
Compromised Immune system
Infectious mononucleosis
Infertility
Inflammation
Inflammatory bowel disease
Insomnia
Intermittent
claudication
Kidney disease
Leprosy
Leukemia
Low-back pain
Metabolic
Syndrome
Migraines
Mood disorders
Low muscle strength
Multiple Myeloma Myopia
Nursing home risk Obesity
Osteoporosis and fractures
Parasites
Parkinson's disease
Periodontal disease
Peripheral artery disease
Pre-eclampsia
Psoriasis
Rickets
Schizophrenia
Seasonal affective disorder (SAD)
Sepsis, Septicemia
Soft-tissue injury
Stroke
Tuberculosis
Ulcerative colitis
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Vitamin D—a secondary focus of this book:
Please note: The term, "25(OH)D" refers to the circulating form of vitamin D, which has been created in the liver by converting either vitamin D produced in the skin by sunlight, or vitamin D from foods or supplements. It is also the form of vitamin D that is measured by standard vitamin D testing.
Our magnificent sun is a miraculous source of health for humans! It is the great healer and mood elevator, and can produce benefits in the physical, mental and psychological realms when used as God (or Nature, if you prefer) intended it.
There are many photoproducts produced in the human body due to sun exposure. Vitamin D is only one of those photoproducts. Although it is not the focus of this book, vitamin D is an exceptionally important product of sun exposure, and a short discussion of its relationship with the sun is in order.
Sunlight is the natural source of vitamin D, and it is the most important source. For most people, exposure of the skin to the sun provides approximately 90% of vitamin D production.2
Vitamin D from sunlight can be synthesized in the skin mostly around midday, from 10 am - 2pm, when the UV index is above 3 and the shadow of an object is shorter than its height. The UV index is a measure of the intensity of ultraviolet radiation B (UVB) from the sun, and is expressed as a number on a scale of 0-11, a higher number indicating a higher intensity. Exposure to the ultraviolet UVB portion of UVR is necessary to cause the skin to produce vitamin D.
When it comes to sun exposure, shorter exposures more frequently are best, and the more skin exposed, the greater the amount of vitamin D produced before burning. People should know their skin types to understand and determine how long they can be outside in direct sun before risking sunburn under different conditions.
Vitamin D produced in the skin from solar UVB exposure does not lead to vitamin D toxicity and is considered safe, as the body limits its own production.3 This is not true for vitamin D supplementation. However, when sun exposure is not available, supplementation will be necessary for those whose blood levels are deficient.
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In the North American winter, due to the low angle of the sun, vitamin D cannot be produced through UVB sun exposure north of 35° latitude. The reason is that UVB rays are at an angle and are filtered out through the atmosphere. This is the same for the Southern winter, south of 35° latitude.
This also means you cannot produce vitamin D effectively during early morning or late afternoon/evening, even in summer or at low latitude locations (close to the equator) because the angle of the sun is too low at those times. The UVB rays should fall from a high angle and penetrate the atmosphere to reach earth (and your skin!). As stated, shadow length relative to height is the best way to determine if the angle of the sun is high enough. In addition, UVB does not penetrate glass;4, 5 therefore you cannot make vitamin D in your skin by exposing yourself to sunshine coming through windows.
According to the UK consensus statement, "Time required to make sufficient vitamin D varies according to a number of environmental, physical and personal factors, but is typically short and less than the amount of time needed for skin to redden and burn. Enjoying the sun safely, while taking care not to burn, can help to provide the benefits of vitamin D without unduly raising the risk of skin cancer."6
Full-body UV exposure of 1 MED (minimal erythema dose), or the equivalent of being slightly pink 24 hours after exposure, will provide between 10,000 and 25,000 IU of vitamin D.7
The amount of exposure needed to achieve adequate vitamin D status depends on latitude, altitude, time of year and day, weather, other aspects of the environment, age, skin pigmentation type, clothing, activity, and the amount of skin irradiated.8
The surface area of skin exposed will influence the amount of vitamin D made after UVB sun exposure, and lying down exposes more skin than standing up.
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Caveat
Now that we have presented information on vitamin D and sun exposure, we will add a caveat: Please do not conclude that just because vitamin D cannot be synthesized by the skin during winters, or during early morning or late afternoon, one should not try to obtain sunlight during those periods. The sun has marvelous effects at all times of day and at all seasons, and one should safely take advantage of it whenever it is available. In this book, we will cover extensively the benefits of sun exposure beyond vitamin D.
What is a tan?
A tan, or natural photoprotection, is a darkening of the skin in response to sun exposure. The darker the skin, the more it absorbs light in the outer skin layer, and thereby protects the deeper layers. It is the body's natural response to sun exposure or other UV radiation such as that from tanning lamps. It is also the body's defense against skin damage. Tanning has been much maligned by those who want the population to avoid sunlight at all costs. Yet, a tan is highly protective against excessive sun exposure and subsequent DNA damage,9 especially when tanning is done regularly.10, 11 Tanning serves to acclimatize the skin to reduce risk of overexposure, but the inability to tan is a risk factor for skin cancer.12
To help readers understand their skin types and keep them safe from overexposure to the sun, the following chart is presented. You will note that a skin-type 1 does not tan, and should dramatically limit sun exposure. A key to being safe is to leave the sun at the first sign of pinkness.
		Skin Type Fitzpatrick Chart		
Skin Type	Skin Colour	Hair Colour	Eye Colour	Description
1	White or very pale	Blonde	Blue, Grey, Green	Always burns, never tans
II	Pale white with beige tint	Chestnut or Dark blond	Blue	Always burns, sometimes tans
III	Beige to light brown	Dark brown	Dark Brown	Sometimes burns, always tans
IV	Light to moderate brown	Black	Brown	Rarely burns, always tans
V	Medium to dark brown	Black	Brownish black	Rarely burns, tans more than average
VI	Dark brown to black	Black	Black	Never burns
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Contents
Chapter 1. Does Sun Exposure Cause Melanoma?	1
Chapter 2. Other Diseases Related Positively or Negatively
to Sun Exposure	17
Chapter 3. Estimating the Incidence of Deadly Diseases
Associated with a Lack of UVR Exposure	21
Chapter 4. Boning Up: Sun Exposure Maintains and Increases
Bone Strength and Joint Health	39
Chapter 5. Cancer Prevention: Sun Exposure Is Essential	53
Chapter 6. Preventing Diseases of the Heart, Brain and Vascular
System: The Vital Need for Sun Exposure	85
Chapter 7. The Protective Affect of the Sun on Type-Two Diabetes,
Type-One Diabetes and Other Autoimmune Diseases	101
Chapter 8. Sun Exposure and Infectious Diseases	121
Chapter 9. Mental and Neurological Conditions Influenced by the Sun 139
Chapter 10. The Influence of Sun Exposure on Other Disorders	167
Chapter 11. Sun Exposure, Pregnancy, Lactation and other
Reproductive Issues	197
Chapter 12. Racial Disparities Related to Differences in UVB Exposure
and Vitamin D Status	205
Chapter 13. How Did the Sun So Quickly Change From Friend To Foe?
A brief History of the Rise and Fall of Heliotherapy	211
Appendix 1. The Magnificent Sun	219
Appendix 2. Balancing the Messages about Sunbeds	227
Appendix 3. Sunscreens: Dangerous At Best and At Worst Potentially
Deadly	241
Appendix 4. Understanding Proper Circadian Rhythms and the Critical
Importance of Sunlight in Maintaining Them	251
Appendix 5. The Assault on the Sun: Dishonesty, Duplicity and Dollars	255
Appendix 6. Salubrious Solar Solutions: Photo-Nutrient Supplements
vs. Civilization's Sun-Deficiency Epidemic	271
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XXIV

Chapter 1.
Does Sun Exposure Cause Melanoma?
Turn your face to the sun and let the shadows fall behind you.
—Maori Proverb
Melanoma is a skin cancer, which can become deadly if not treated or removed in its early stages. The Melanoma International Foundation (MIF) states that ultraviolet radiation (UVR) from the sun causes melanoma and should be avoided as a detriment to human health.13 That message is primarily disseminated by (some) dermatologists and their governing bodies, which conveniently ignore the voluminous research associating sun exposure to profoundly better healthperforming its miracles by reducing risk for such maladies as breast and prostate cancer, heart disease, osteoporosis and sundry others. The MIF message does not differentiate between strong, intermittent exposure, which can lead to sunburn, and regular, non-burning exposure, such as that received by those who routinely work and recreate outdoors. The latter are protected against melanoma.14 As an example, during my (MBS) youth as a farm boy, my friends and I, both young and old, were exposed to enormous quantities of UVR while we worked all day in the summer sun. We drove tractors and
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rode horses with our shirts off, irrigated land under the full sun and rounded up cattle and other animals in the sagebrush deserts and the mountains of Nevada and Utah. Never did I see anyone develop a melanoma in spite of often overdoing sun exposure and getting sunburned (which we don't recommend). We never even heard of the word melanoma. So, when I later heard that this terrible disease was caused by the sun, I was stunned. It certainly never happened in our farm and ranch country.
Concomitantly, an opposing message is rapidly emerging: Sun avoidance, by reducing the body's production of vitamin D and other beneficial photoproducts, is responsible for a dramatic increase in both degenerative and communicable diseases.15 In addition, a third view is drawing adherents who believe the increase in melanoma incidence is an illusion and an artifact produced by incorrect assessment: the misdiagnosis of benign skin lesions as melanoma.16
Nevertheless, melanoma, once allowed to progress into an advanced form, is nothing to trifle with, and a physician should immediately assess any unusual and notably evolving skin lesion. However, since many lesions are benign, yet may nonetheless be misdiagnosed as melanoma, a major surgical excision should not be taken lightly. Proceeding with a deep and invasive surgery for a harmless lesion is something no one should experience, and the most harmful part of the surgery may be the needless fear that one could have died from a deadly cancer—a cancer which really never existed. Dr. Adiel Tel-Oren states the following: "Preventive medicine is generally appreciated as the best approach to healthcare. This is the reason you're told to "have your skin checked." However, when a physician suspects a melanoma is present—usually by observing a rapidly changing or an obviously abnormal "textbook appearance" of melanoma—the condition has been allowed to become far too advanced, justifying the fear, risks, and disfigurement of invasive surgery. Real prevention would involve a gentle, nonsurgical, nonscarring destruction of every small lesion that might become a melanoma in the future, while it's still superficial enough to eliminate easily without pain and without injection of anesthetics. This approach, practiced by many physicians, may essentially eliminate the risks of advanced melanoma (or a scary misdiagnosis) and deep, disfiguring surgery altogether."17
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Melanoma accounts for about 9,940 cancer deaths per year in the US, making up only a small portion of the total number of cancer deaths per year in the US, estimated to be 589,430.18 Interestingly, melanoma is most common among men over 50,19 which makes one wonder why sunbeds are being targeted for extinction by the dermatological societies. Men over 50 hardly fit the demographic population using sunbeds! This demographic is young women. Already we begin to see there is deception within the organizations promoting the avoidance of sunbeds and of the sun. Their mantra continues to be "we are killing our young women with tanning-bed use and sun exposure." Does no one care for the 50-year-old men who are dying from melanoma and do not use sunbeds? Does anyone even mention there are more than twice as many men as women who die from melanoma?20
As you will shortly see, what most people believe about sun exposure and melanoma is egregiously wrong, and campaigns waged against the sun by many medical and business entities have ulterior motives. These are campaigns of misinformation, each having in direct object the establishment of large sales of anti-sun products for "protection," or frightening people into often-unnecessary medical visits and procedures. Regrettably, no amount of research appears capable of dissuading them from their deception.
Rethinking the Connection between the Sun and Melanoma
It has been ingrained in the consciousness of educated people throughout the world that the ultraviolet portion of solar radiation (UVR) is the cause of melanoma. To determine if sun exposure really does increase the risk of melanoma in most of the population, the following information should be considered: The world population, as it "progresses," spends increasingly less time exposed to direct sun. This is due to (1) an increase in indoor activities and decrease in outdoor activities, and (2) the increased use of sunscreens to prevent sun exposure when outdoors. Nevertheless, the rate of melanoma is believed to be increasing at an alarming rate, as evinced by the aforementioned statement by the MIF, which also stated in 2007 that "melanoma is epidemic: rising faster than any other cancer and projected to affect one person in 50 by 2010, currently it affects 1 in 75. In 1935, only one in 1,500 was struck by the disease." This prediction was correct as reported by the American Cancer Society in 2014: one in 50 now contracts the disease.21 The MIF, then, if one accepts the statistics reported by medical organizations, was accurate regarding the increase in melanoma. However, they were wrong, perhaps "dead wrong," in stating that the sun is at fault. As we will see, blaming the sun contradicts reason.
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Let's take another look at the mathematics. According to the MIF, people had about 30 times the risk of contracting melanoma in 20102014 as they did in 1935, representing a 3,000% risk increase. One
might surmise that sun exposure must have increased spectacularly, during the time frame discussed, to have caused the exponential increase in melanoma, assuming the statement by the MIF—that melanoma is caused by sun exposure—is correct. But is it?
Let's consider five pertinent questions:
Question 1. Has sun exposure increased as melanoma has increased?
If melanoma has indeed increased exponentially since 1935, and if such increase is due to sun exposure, then sun exposure must also have shown a parallel or at least significant increase during the same time. To determine the veracity of that idea, we analyzed data from the Office of Occupational Statistics and Employment Projections, Bureau of Labor Statistics (BLS), to determine if there was an increase or a decrease in human sun exposure during the years from 1910 to 2,000.22 We closely considered changes since 1935, the year the MIF used as a baseline for measuring increases in melanoma incidence.
The data from the BLS showed that indoor occupations such as "professional, managerial, clerical, sales, and service workers (except private household service workers) grew from one-quarter to three-quarters of total employment between 1910 and 2000." The BLS also stated that during the same period, the outdoor occupation of farming declined by 96%, from 33% to 1.2% of total employment. The data also show that approximately 66% of the decline in the occupation of farmers and 50% of the decline in the occupation of farm laborers occurred after 1935.
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Further information, this time from the Environmental Protection Agency (EPA), determined that as of 1986, only about 5 percent of adult men worked mostly outside, and about 10 percent worked outside just part of the time. The proportion of women who worked outside was thought to be even lower.23 These data demonstrate a dramatic shift from outdoor, sun-exposed activity to indoor, nonsun-exposed activity during the mid-to-late 20th Century. This change, nonetheless, has been accompanied by a 30-times increase in melanoma risk since 1935, the MIF-baseline year. So, if sun exposure is really responsible for the pandemic of melanoma, it has achieved that dubious distinction during a time of profound decrease in sun exposure! To us, this is wholly counterintuitive. The data just presented really suggest that sun exposure is not responsible for the increase in melanoma, and we submit instead, that the profound decrease in sun exposure may be a causative factor in the purported exponential melanoma increase. That concept is illustrated graphically below.

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Although it has been theorized that the decreasing thickness of the ozone layer may be responsible for the increasing incidence of melanoma, research from Norway reported that yearly melanoma incidence increased 350% in men and 440% in women between 1957 and 1984—a period when there was absolutely no thinning of the ozone layer in that country.24
Therefore, the answer to question 1 is "no." Sun exposure has not increased as melanoma has increased. Exactly the opposite has occurred.
Question 2. Do outdoor workers have a higher incidence of melanoma than indoor workers?
If melanoma is increasing due to increased sun exposure, it is clear that outdoor workers, being exposed to far higher quantities of sun rays, would also have a far higher incidence of melanoma. Nevertheless, Dianne Godar and colleagues25 presented evidence that outdoor workers, while receiving 3-9 times the sun exposure as indoor workers,26,27 have had no increase in melanoma since before 1940, whereas melanoma incidence in indoor workers has increased steadily and exponentially.
Godar and colleagues also published irrefutable evidence of the protective influence of sun exposure against melanoma in a landmark study in 2015,28 entitled Dramatic Increases in Melanoma Correlate to Low Annual Sun Exposure in Europe.
Published in the scientific journal Dermato-Endocrinology, the paper makes some very interesting comments, all based on excellent research:
1.	Melanoma has steadily increased in fair-skinned indoor working people around the world. Increasing melanoma incidence significantly correlates with decreasing personal annual UVdoses [emphasis ours]. UV, or ultraviolet radiation, is the spectrum of sunlight that stimulates the skin to produce vitamin D3 and some other protective photoproducts.
2.	People are more susceptible to melanoma when they have larger numbers of moles, light skin and hair, and poor tanning ability.
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3.	There is a paradox between indoor and outdoor workers' melanoma incidences and their annual UV (ultraviolet light) exposure. [She repeats here, her earlier observation.]
Outdoor workers receive 3-10 times the annual UV doses indoor workers receive, but have only 50% of the risk for contracting melanoma.
4.	Although most scientists believe intermittent UV exposures— resulting in sunburns—initiate melanoma, the creation and use of sunscreens DID NOT [emphasis ours] reduce the incidence of the disease. One of the reasons may be that sunscreens dramatically reduce vitamin D synthesis in the skin.
5.	Sunburns are probably not [emphasis ours] involved in the initiation or growth of melanoma. Outdoor workers do get numerous sunburns but still have dramatically lower risk of contracting melanoma. [We do not advocate sunburning since, although it may not cause melanoma, it will certainly damage the skin.]
6.	Many melanomas occur on areas of the body where the sun never shines.
The authors go on to theorize that a lower level of vitamin D, among those who receive inadequate sun, could be a major reason for the exponential increase of melanoma in European countries where the UV (sun) exposure is minimal. Another reason they suggest is infection with human papilloma virus (HPV).
Whatever the theories propose, regarding the cause of high melanoma incidence accompanying low sun or UV exposure, the equation remains the same: FOR THE VAST MAJORITY OF THE
population, the greater the regular exposure to sun, the
LESSER THE RISK OF MELANOMA. Nevertheless, such information sells neither sunscreens nor melanoma surgeries, so don't stand on one leg until the public becomes correctly educated by dermatology associations. However, you can learn the facts and become a soldier in the "sun army" by promoting the evidence.
Other research corroborates the idea that outdoor workers experience less melanoma than indoor workers.29 One investigation30 demonstrated that melanoma was more common among indoor office workers and other indoor workers than among outdoor workers, and another showed a lifetime of sun exposure correlated to a reduced risk of melanoma. Dr. Cedric Garland and his colleagues showed that those who worked indoors had a 50% greater risk of melanoma than those who worked both indoors and outdoors,31 and still another study demonstrated that children who engage in outdoor activities are less likely to develop melanoma than those who do not.32 Many other papers in the scientific literature show that both incidence and death rate from melanoma are reduced with increasing exposure to sun.33, 34, 35, 36, 37, 38, 39, 40, 41 42, 43, 44 None of these findings is surprising when one considers the following: Whereas non-melanoma skin cancers such as SCC are easily produced in experiments using excessive ultraviolet radiation (UVR) from sunlamps, the same is not true for melanoma and BCC, which are difficult to produce with UVR alone.45 The ability to tan is associated with a reduced risk for all skin cancers,46 probably because it reduces the risk of overexposure/sunburns.
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Finally, from 2016, research reported in the journal Anticancer Research demonstrates UVR exposure to be inversely associated with melanoma:47 The researchers had set out to study whether the annual UVR quantity, estimated on a county level, was associated with incidence rates of oral, pharyngeal, and cervical cancers and melanoma. They found that all of these cancers were inversely associated with sun exposure. (The word "inverse" means "reversed in direction or tendency." Therefore, these researchers found that sun exposure was associated with a reduction in the appearance of all these cancers in the population.) Interestingly, the authors, in their introduction to the research, said that UVR exposure is a well-demonstrated risk factor for melanoma. Then, at the end of their paper, they concluded just the opposite: "Ourfindings are in agreement with several other published studies reporting no positive correlation between UVR exposure and the incidence rates of oral, pharyngeal, and cervical cancer and melanoma." Those two statements are contradictory, but the conclusion was correct: Those cancers are inversely correlated to UVR. Do you believe the anti-sun organizations will admit their errors and embrace the sun? Don't bet your life savings on it.
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This data indicate again that sun exposure is not responsible for the increase in melanoma, and that the decrease in sun exposure may be a causative factor in the reported dramatic melanoma increase.
The answer to question 2 is "no." Outdoor workers do not have a higher incidence of melanoma than indoor workers. The opposite is true!
Question 3. Do many melanomas occur on areas of the body that receive the greatest sun exposure?
If sun exposure were indeed the reason for the increase in melanoma, then we would reasonably expect that areas of the body receiving the most exposure would also be the areas of greatest occurrence of the disease. This is not the case. The aforementioned research by Garland,48 when assessing the incidence of melanoma occurring at various sites, found higher rates of melanoma on the trunk (seldom exposed to sun) than on the head and arms (commonly exposed to sun). Other research has shown that melanomas in women occur primarily on the upper legs, and in men more frequently on the back-areas of little sun exposure.49 In blacks, melanoma is more common on the soles of the feet and on the lower legs.50 Based on this data, it would be difficult to make the case that sun exposure is responsible for the increase in melanoma.
We have previously mentioned that intermittent bursts of intense sun, causing sunburn, are believed by some to increase the risk of melanoma, whereas regular exposure reduces the risk.51 Even on chronically sun-damaged skin, mutations leading to melanoma are rare.52 Further, the idea espousing sunburn as the cause of melanoma is inconsistent with the fact that most melanomas do not occur at burn sites.53, 54 The aforementioned paper by Godar55 hypothesizes that lack of sun reduces the quantity of vitamin D in the skin, then cites research showing that the potent hormone form of vitamin D, calcitriol, reduced the incidence, size and number of skin tumors and also reduced invasiveness and metastasis of melanoma in mice. Since regular sun exposure correlates to higher vitamin D production and higher levels in the blood, this evidence is plausible and would explain the reasons for reduced melanoma rates among those who are regularly exposed to sun. Finally, research from as far back as 1981 has demonstrated that approximately 75% of melanoma tumors occurred on relatively unexposed body sites.56
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Since most melanomas occur on areas of the body receiving little sun exposure, the indication is that sun exposure is not the cause of melanoma.
The answer to question 3 is "no." Most melanomas occur on areas of the body receiving little sun exposure. Melanoma on the face, where most sun exposure occurs, is very rare.
Question 4. Is there a co-morbidity of melanoma with common skin cancers, some of which are known to be associated with high sun exposure?
There is general agreement among scientists that sun exposure is one of the causal factors for squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), also known as non-melanoma skin cancers (NMSC). However, researchers have never demonstrated any increase in NMSC risk from non-burning sun exposure or from gradual tanning. If it were true that melanoma rates increase with solar exposure, then we would expect NMSC occurrence rates to parallel those of melanoma (in other words, we would expect a co-morbidity of melanoma and NMSC). However, SCC and BCC do not demonstrate co-morbidity with melanoma, according to research.57, 58, 59 Additionally, Dr. Grant has analyzed data from the Atlas of Cancer Mortality in the United States, and noted that death rates from NMSC in the period 1970-1994 were lower by 31% for white males and by 47% for white females than in 1950-1969. However, between those same periods, melanoma death rates increased by 89% in white males and 42% for white females.60 These changes may partially be explained by people spending less time in the sun (more time indoors) in 1970-1994, since NMSC death rates are partially related to total cumulative UV exposure. Despite this reduction in exposure, death rates from melanoma have dramatically increased!
Therefore, the answer to question 4 is "no." There is no co-morbidity of melanoma with common skin cancers, some of which are known to be associated with high sun exposure.
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Question 5. Has an increase in sunscreen use resulted in a decrease in melanoma?
Sunscreens block solar UV rays and are intended to decrease sun damage to the skin-damage said to increase the risk of melanoma. Sunscreen use has increased considerably in the past few decades. Therefore, if sun exposure is the cause of melanoma as stated by the MIF, there should be a concomitant decrease in melanoma as sunscreen use has increased. According to Kline & Company, a research group, sales of sunscreens in the U.S. in 1972 were $33 million; in 2008, sales were $650 million.61 In addition, according to the Fredonia Market Research Group Company, the sale of sunscreens used in cosmetics in 2007 in the U.S. was $130 million.62 Thus, the total sales of sunscreens as of 2008 were $780 million. Considering a dollar's value is only about 20% of what it was in 1972, the adjusted 2008 sunscreen expenditures are approximately $156 million, or about 4.7 times the 1972 figure. In other words, sunscreen use has increased by about 4.7 times. The U.S. population also has grown from 210 million in 1972 to 305 million in 2008-a 45% increase. Adjusting for population growth, it can be concluded that per capita sunscreen use has at least tripled in the time frame being considered. Those figures, however, may be exceptionally low! More recent information shows that as of 2013, the global sun care market generated $5.6 billion US dollars from its sun-protection products segment, which includes sunscreens.63
To be fair, and to our knowledge, there are three studies concluding that there is a decrease in melanoma risk with sunscreen use.64 The first showed that sunscreen with an SPF greater than 15 led to an 18% reduced risk of melanoma. Also interesting was the fact that sunscreen users in that study reported significantly more sunburns (which, as we've concluded before, would be a cause for reduced risk, unrelated to the sunscreens!). The second study, from Australia, showed that sunscreen use probably reduced all skin cancers, including melanoma, by 10-15%65 (since melanoma is rare in comparison with NMSC, the results of a study of all skin cancers may misrepresent melanoma rates specifically, thereby its conclusions are questionable). The third study, also from Australia showed a 50% decrease in the risk of melanoma over ten years.66 Australia has the combination of very high UVB doses and people with very fair skin, so what happens in Australia is not likely to be what happens elsewhere. The US Center for Disease Control argues that "there is insufficient research to conclusively state sunscreen will reduce your risk of Melanoma or BCC."67 Also, it is interesting to note that one paper suggests sunscreens may increase the risk of melanoma in high-latitude countries.68
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Nevertheless, as discussed, melanoma has increased steadily and exponentially since 1935. As also discussed, sunscreen use has also increased exponentially and sun exposure has decreased profoundly. Therefore, the data on increasing sunscreen use does not indicate that sun exposure increases the risk of melanoma. Rather, it indicates that sunscreen use, by reducing vitamin D production, may contribute to the reported increase in melanoma. Also, sunscreen never allows the body to acclimatize to a higher UV index as farmers have done for years. It has been shown that an SPF 15 sunscreen will decrease sun-stimulated vitamin D production by 99.5%,69 and it has been suggested that blocking only UVB light (which stimulates the production of vitamin D in skin) while leaving UVA unblocked, may lead to higher UVA exposure (overexposure) and damage of DNA, leading to melanoma.70, 71 Increasing melanoma rates, coupled with increasing sunscreen use, lends credence to that hypothesis.
The answer to question 5 is "no." The increase in sunscreen use has not resulted in a decrease in melanoma (on the contrary, melanoma rates have increased!). Regular sun exposure, without sunscreens, therefore does not increase the risk of melanoma.
All 5 questions demonstrate clearly that sun exposure is NOT the cause of melanoma, and that contrary to what the public has been led to believe, the sun actually reduces melanoma risk.
Now let's ask one more very important question: Is it possible that the reported increase in melanoma is at least partially due to excessive diagnosis of benign lesions?
Writing in the British Medical Journal in 2008, Dr. Sam Shuster, a dermatologist, argued that the purported increase in melanoma is not really an increase, but an artifact due to non-melanoma lesions being misdiagnosed as melanoma.72 In 2009, another study by dermatologists— Shuster and his colleagues—this time published by the British Journal of Dermatology, came to a similar conclusion and called the "increase" in melanoma a "midsummer night's dream."73 They determined, after tracking the reported increase in melanoma in the Eastern region of the UK between 1991 and 2004, that benign lesions were being classified in increasing numbers as stage-one melanoma. No other stages of the disease increased, and the increase in mortality due to melanoma was either miniscule or non-existent. This was true even though all grades of tumors were diagnosed at first presentation. They also noted that "the distribution of lesions reported did not correspond to the sites of lesions caused by solar exposure," a finding similar to that discussed in question #3 above. These dermatologists concluded: "the large increase in reported incidence is likely due to diagnostic drift which classifies benign lesions as stage-1 melanoma." They further stated, "These findings inevitably challenge the validity of epidemiology studies linking increasing melanoma incidence with UV radiation, and suggest the need for a search for other ways in which the disease may be caused."
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Another celebrated dermatologist, Dr. A. Bernard Ackerman, wrote a monograph entitled Sun and the "Epidemic" of Melanoma: Myth on Myth.74 In it he reviewed extensive research and concluded that melanoma had nothing to do with sun exposure; and like the authors of the aforementioned BMJ article, he indicated that excessive diagnosis of benign lesions is responsible for the purported epidemic of melanoma. Also mentioned in his book are the advancements in detection equipment between the 1930s and today. Most of the lesions today would not have been detected in the 1930's. This would also create the diagnostic drift stated above.
The skin cancer awareness campaign would also increase the number of the diagnosed melanoma cases without increasing mortality. This is probably why mortality has not increased since the mid-80's based on population. The number of dermatologists per capita has also increased dramatically in the US, which may be the reason why the US has more skin cancers than any other country.
Stunningly, a worldwide study of melanoma diagnosis and accuracy, published by the American Academy of Dermatology (AAD), showed that most melanoma diagnoses might be incorrect.75 Approximately 44 different authors from many different clinics and countries,
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including the US, contributed to the report. They made an accuracy-in-detection analysis based on the actual number of melanomas that were excised during a period of ten years, compared with the number that really needed to be excised. A total of 300,215 cases were found where excision took place. Of those cases, there were 17,172 melanomas, which really required excision, and 283,043 were excised but were later diagnosed as benign. The AAD research showed that only about 3.5% of melanoma diagnoses in non-specialized clinics, and 14.7% in specialized clinics, resulted in actually being melanoma. From this information, it is evident that many melanoma surgeries are bogus and may inflate the incidence of melanoma. The above-mentioned Drs. Shuster and Ackerman were correct.
Other research corroborates the ideas of Shuster and Ackerman. Dr. E.
J. Glusac wrote a paper in the Journal of Cutaneous Pathology, entitled, The melanoma 'epidemic', a dermatopathologist's perspective, in which he makes the case that death from melanoma has not really increased very much, if at all.76 A graph based on his paper is presented above, and shows that although the diagnosis of melanoma, from 1986 through 2011, skyrocketed, the death rate from melanoma remained flat.
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It is obvious that the business of removing benign lesions (and sending them to be analyzed by pathologists, resulting in additional visits and procedures) is lucrative for doctors. As the authors of the aforementioned AAD study stated in introductions to their research, "Early excision is the only strategy to reduce melanoma mortality, but unnecessary excision of benign lesions increases morbidity and healthcare costs." It is hard to believe the AAD published the report, but we are thankful it was done.
Therefore, the answer to the final question is "yes." It is possible that the reported increase in melanoma is at least partially due to excessive diagnosis of benign lesions.
Conclusion: From the research thus far presented, it could be concluded either that melanoma is increasing dramatically and is directly correlated to decreasing sun exposure, or that melanoma is not increasing much. In either case, the statement by the MIF, that sun exposure causes melanoma, has no validity. (Even If melanoma rates are not increasing, the location of melanomas in areas of little or no sun exposure, and the fact that outdoor workers have significantly reduced occurrence of melanoma, indicate that the sun is not the culprit).
What have we learned?
1.	Sun exposure has decreased profoundly as melanoma incidence has increased remarkably.
2.	Outdoor workers have a significantly lower incidence of melanoma than indoor workers.
3.	Many melanomas occur on areas of the body receiving little or no sun exposure.
4.	There is no co-morbidity of melanoma with common skin cancers, some of which are known to be associated to high sun exposure.
5.	An increase in sunscreen use has been associated with an increase in melanoma incidence.
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6.	It is possible that the reported increase of melanoma is partially due to excessive diagnosis of benign non-melanoma lesions.
7.	The idea that regular sun exposure leads to melanoma is counterintuitive and unreasonable considering the available scientific data.
8.	These facts should be presented to everyone who defames the sun as a carcinogen (cancer causer) for melanoma.
9.	Along with the decrease in sun exposure, 25(OH)D levels have also decreased profoundly, since 90% of 25(OH)D levels are produced by solar UVB (and sunscreens may eliminate 99.5% of the skin's vitamin D production).
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Chapter 2
Other Diseases Related Positively or Negatively to Sun Exposure
"To love and be loved is to feel the sun from both sides."
—David Viscott
A spate of negativism regarding sunlight has inundated the press in the past several decades in an attempt to make the sun "public enemy number one." The repetition of these falsehoods has made most of the public believe them. As Lee Atwater said, "perception is reality." Sad, but true. However, we must remember that the declaration of lies, even in the billions of repetitions, does not make them anything more than lies. In the case of sun exposure, those who have financial interests in attacking the sun have not only spread their false message regarding melanoma, but have obfuscated, through their neglect, the beneficial influence the sun might have had on many of our most virulent diseases. This chapter will cover the maladies associated with increased sun exposure and define the number of deaths caused by those diseases. Then, in Chapter 3, we will present the diseases associated with decreased sun exposure and likewise determine the number of deaths caused by those diseases. At that point, it will become clear that embracing the inclination toward habitual, nonburning sun exposure might prevent or mitigate those diseases, with the lives saved by sun exposure far exceeding the minuscule number of deaths caused by diseases discussed in this chapter. By so doing, we will shine a ray of light through the murky mists disseminated by the powers of perfidy, otherwise known as the "sun-scare science."
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Diseases associated directly with sun exposure:
Dr. Robyn Lucas and colleagues77 performed research to determine which diseases had a sufficient relationship to sun exposure [UVR] to warrant their inclusion as diseases caused, wholly or in part, by such exposure. The diseases listed as at-least-partially-caused by UVR were squamous-cell carcinoma of skin (SCC), basal-cell carcinoma of skin (BCC), actinic keratosis, sunburn, cortical cataract, pterygium, SCC (squamous-cell carcinoma) of the cornea and conjunctiva, and RHL (recurrent herpes labialis). Melanoma was also included in the list—a conclusion not corroborated by the evidence presented in Chapter 1. An increase in death rate was listed only for melanoma and the common skin cancers, SCC and BCC, also known collectively as nonmelanoma skin cancer (NMSC).
The American Cancer Society estimates that NMSC is responsible for 1,500 deaths per year, many among people with compromised immune systems.78 It is also estimated that every year in the USA there are more than one million cases of reported NMSC, which the American Cancer Society describes as highly curable.79 Therefore, the risk of death from these mostly innocuous NMSC lesions is approximately 0.0015, mostly occurring in highly-immune-compromised hosts.
Sun exposure is not the only factor correlated to NMSC. Smoking also predicts a higher risk of SCC.80 After adjustment for sun exposure, age and sex, smoking predicts a doubling of the risk for SCC, and there is a dose/response relationship between the number of cigarettes smoked and the risk of SCC. Such a relationship also exists among those whose diets lack green, leafy vegetables and whose consumption of meat and fat are very high.81 Obesity is also an important risk factor for NMSC. A recent paper suggested that being obese changes the tumor microenvironment, including aberrant cell signaling and genomic instability, due to the chronic inflammatory state that generally accompanies obesity.82 Inspection of data in the cancer mortality maps from the National Institutes of Health83 indicates that NMSC mortality rates are highest in the South from Texas to Virginia, which is also the region of the U.S. with the highest obesity rates but not the highest UVB doses.84
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In addition, factors such as radiation therapy, scarring and physical or thermal trauma are factors more likely to promote NMSC among people of African descent, and NMSC in that group occurs more frequently on areas of the body not generally exposed to sun.85 Therefore, it cannot be said that all NMSC is caused exclusively by sun exposure, though there is little doubt that it is a factor in the disease for those whose nutrition habits are poor (including most of the population of "Western" societies such as the US, UK and most of Europe).
Although not mentioned by Dr. Lucas, there are diseases beyond NMSC correlating to higher sun exposure, that do in some cases result in death. These diseases are all minor cancers:
Salivary gland cancer (SGC). There are an estimated 700 yearly deaths.86 A study in 1988 demonstrated a link between SGC and sun exposure.87
Lip cancer (LC). There are 72 yearly deaths.88 Research has shown that LC increases with increasing sun exposure.89
Myeloid leukemia (ML). There are 1403 yearly deaths. An investigation in Sweden showed high sun exposure to be associated with an increased risk of ML.90
Lymphocytic leukemia (LL). There are 1,450 yearly deaths.91 The same Swedish study showed high sun exposure to be associated to an increased risk of LL.
Cervical cancer (CC). There are 4,074 yearly deaths.92 In some research, CC has been shown to be directly correlated with sun exposure in the US.93 However, later research from 2016, reported in the journal Anticancer Research, demonstrated UVR exposure was inversely associated with CC.94 Therefore, we will not include CC as a cancer that correlates to high sun exposure and rather place it in the list of cancers correlated to low sun exposure.
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Pharyngeal cancer (PC). There are 2,330 yearly deaths. As with cervical cancer, PC has been shown to be directly correlated with sun exposure in the U.S.95 Again, as with cervical cancer, the research from 2016 shows UVR exposure was inversely correlated with PC. (See the footnote from the cervical cancer paragraph above.) Therefore, we will not include PC as a cancer which correlates to high sun exposure.
From the above-mentioned numbers, we see that in the USA there are 5125 yearly deaths from diseases partially related to sun exposure, including NMSC. Considering that cancer kills 589,430 Americans yearly,96 these cancers comprise a minuscule portion of the whole. Next, we will consider the deadly diseases closely associated with sun deprivation, a condition becoming more prevalent by the year.
What have we learned?
1.	There are few deaths associated (at least partially) with regular sun exposure, and melanoma is not one of them.
2.	The deaths caused by these sun-associated cancers is a tiny fraction (under 1%) of the total cancer mortality in the USA.
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Chapter 3
Estimating the Incidence of Deadly Diseases Associated with a Lack of Sun Exposure.
"Whoever wishes to pursue the science of medicine in a direct manner must first investigate the seasons of the year and what occurs in them."
—Hippocrates
Extensive research since 2000 has incriminated low UVR exposure (sun exposure) as a contributing factor in the cause of major degenerative diseases such as osteoporosis, cancer, heart disease, Parkinson's and diabetes. In addition, there are numerous other diseases and disorders, which correlate to UVR/vitamin D deficiency.97 Here we consider only the death-causing diseases, or those correlating to death from other causes. Please note: The research presented in Chapter 3 is, in most cases, only a small part of that which is available for each disease. The remainder will be fully presented in the succeeding chapters of the book, beginning with Chapter 4.
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Burden of disease from sun avoidance
In the previously mentioned research from Chapter 2, Dr. Robyn Lucas and colleagues set out to compare the global burden of disease, measured in disability-adjusted life years (DALY's), caused by complete sun avoidance—with the resultant vitamin D deficiency— and compared it to the burden caused by maintaining regular sun exposure.98 They determined that excessive sun exposure was a minor contributor to disease burden, causing an estimated loss of 1.6 million DALY's annually (worldwide). On the other hand, sun avoidance - resulting in severe vitamin D deficiency - was predicted to cause 3.3 billion DALY's annually. These figures suggest that for each case of death and disability caused by sun exposure, there would be at least 2,000 cases caused by sun avoidance. However, these researchers used only bone diseases—specifically rickets, osteomalacia and osteoporosis—to calculate the burden of disease due to sun avoidance. And of course, if total sun avoidance were the case, the whole world would shortly collapse from osteoporosis, unless vitamin D were replaced. Quite simply, the world's population would quickly die. And if the other lethal diseases associated with sun deficiency were included in the assessment, a total lack of sun exposure and vitamin D would logically cause people to die even faster. (Life as we know it would not be possible since vitamin D is essential for life, not only of humans but also for all mammals.)
If melanoma had been omitted from the Lucas calculations—as we believe it should have been based on the materials presented in chapter 1—the burden of disease due to total sun avoidance would have been much higher. It is also worth noting that many diseases— besides bone diseases—are correlated to vitamin D deficiency. Sorenson99 has listed and discussed research indicating that over 100 diseases and disorders correlate closely to low sun exposure and/or vitamin D deficiency. Had these diseases been taken into consideration in the analysis by Lucas, the DALY's ratio would have been several times greater than 2000:1.
This chapter will consider deaths from diseases associated with sun deficiency (not total avoidance) and will assess the comparison between those diseases and those we have heretofore discussed.
Since we have discussed the impressive calculations of Lucas, we will begin with the profound importance of sun exposure in preventing, mitigating, and even reversing bone diseases.
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Osteoporosis, fractures and arthritis
1.	Osteoporosis
Osteoporosis, a bone-thinning disease characterized by low bone mass and structural deterioration of bone tissue, leads to bone fragility.100 It often leads to fractures and death and is pandemic in Western societies. Other bone diseases such as osteopenia, osteomalacia and rickets are known to correlate to lack of sun exposure, but the number of deaths related to these diseases is so small (though the suffering is immeasurable), we decided to consider only osteoporosis for the purposes of this analysis.
The last available statistic from the National Osteoporosis Foundation estimates that osteoporosis was responsible for more than 2 million fractures in 2005 in the USA, including 297,000 hip fractures, 547,000 vertebral fractures, 397,000 wrist fractures, 135,000 pelvic fractures and 675,000 fractures at other sites. The Foundation also estimates that the number of osteoporotic fractures is expected to rise to more than 3,000,000 by 2025, with an average of 24% of hip-fracture patients aged 50 and over, dying within one year following the occurrence of their fractures.101 We therefore conservatively estimate the number of deaths from osteoporosis at 71,280 per year.
2.	Osteoarthritis(OA)
OA is also known as wear-and-tear arthritis or degenerative joint disease, and is characterized by bone and cartilage degeneration in joints, which leads to pain and joint stiffness. In the USA, the number of deaths per year from OA is estimated at 500,102 although the Centers for Disease Control and Prevention (CDC) state that this estimate may be very low.103
Research has shown that those whose vitamin D measurements fell in the middle to lowest thirds had a threefold progression of OA of the knee during a one-to-two year period as those in the highest third, and low blood levels of vitamin D also predicted greater loss of cartilage in the joints.104 It is important to remember here, that since 80-90% of 25(OH)D levels derive from of sun exposure, OA is associated with sun deficiency.
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3.	Rheumatoid arthritis (RA)
RA is an autoimmune disease, characterized by chronic inflammation of the joints and the tissues around the joints. It also affects certain organs in the body.105 As of 1998—the last year for which we could find statistics—rheumatic diseases were responsible for 9,367 deaths,106 2 2% of which were from RA,107 or a total of 2060.
One of the more recent studies on RA has demonstrated that at high latitudes, where sun exposure is considerably reduced, the rate of RA is much higher than at lower latitudes.108 In a subsequent study, it was found that older women who lived where there was more solar UVB, had a lower risk of developing RA. This was not true of younger women.109 The proposed reason was that younger women were more likely to use sunscreen (or sunblock), including in their cosmetics. RA is also more severe in winter,110 a time of reduced sun exposure. Therefore, sun deficiency is a likely factor in causing or exacerbating this disease.
Internal Cancers (all cancers mentioned in this section will be discussed at length in Chapter 5.)
Note A: The following cancer statistics are derived from the most up-to date figures available, from Dr. R. L. Siegel and colleagues: Cancer Statistics 2016 CA Cancer J Clin 2016 Jan;66(l):7-30.
Note B: Two exceptionally important cancer papers, known as ecological studies—the first by Dr. William B. Grant and the second by Dr. Grant and Dr. Cedric Garland—are cited often throughout this section on cancer. You may use the following references whenever these two studies are mentioned in the text:
(Grant WB. An estimate of premature cancer mortality in the US due to inadequate doses of solar ultraviolet-B radiation. Cancer. 2002 Mar 15;94(6):1867-75.)
(Grant WB, Garland CF. The association of solar ultraviolet B (UVB) with reducing risk of cancer: multifactorial ecologic analysis of
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geographic variation in age-adjusted cancer mortality rates. Anticancer Res. 2006 Jul-Aug;26(4A):2687-99.)
The following cancers have been shown to have an inverse correlation to sun exposure (lower sun exposure is associated with greater cancer occurrence):
1.	Breast Cancer (BC)
There are 40,890 BC deaths annually in the United States.111 Dr. Grant's ecological studies utilized data from 466 state economic areas for the period 1970-94, and demonstrated that for white Americans (including Hispanics), breast cancer mortality rates had the second highest inverse correlation with July UVB doses.112, 113 (the highest inverse correlation being colorectal cancer). In other words - the greater the sun intensity, the lower the rates of BC.
Several other studies, which demonstrate a protective effect of sun exposure against breast cancer, will be discussed within the breast cancer section in chapter 5. One of these studies has analyzed the sun-exposure habits of 5,000 women: The scientists determined that those who lived in the sunniest areas and who also had the highest sun exposure, had a 65% reduction in breast cancer risk compared to those who had the least exposure.114 A subsequent study by the same scientists concluded that "a high sun exposure index was associated with reduced risk of advanced breast cancer among women with light skin pigmentation."115 The BC risk was reduced by 47%.
Based on the preceding information, it seems reasonable to recommend sun exposure as a preventive measure against breast cancer. It would be ill-advised to recommend sun-avoidance to prevent a mild cancer (NMSC) that takes about 1,500 lives per year in the USA, while increasing the risk of breast cancer, which takes about 41,000 American lives per year.
2.	Ovarian Cancer
There are 22,280 new cases of ovarian cancer and 14,240 deaths annually.116 Ovarian cancer mortality rates were found strongly inversely correlated with solar UVB doses in the 2002 and 2006 ecological studies by Dr. Grant. And, Dr. Tran and colleagues have demonstrated that women in the highest third of average daily sun exposure, over their lifetimes, were at a 30% lower risk of all epithelial ovarian cancers than women in the lowest third of average daily sun exposure.117 Also, an observational study found that women living in regions with UVB doses in the top third had a 16% reduced risk of ovarian cancer compared with women living in the lower third.118
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3.	Endometrial Cancer
There are 60,050 new cases yearly from uterine corpus cancer, which is also called endometrial cancer. There are 10,470 deaths every year.
Endometrial cancer mortality rates were found to be strongly inversely correlated with solar UVB doses in Dr. Grant's aforementioned 2002 and 2006 ecological studies. Additionally, a 15.5-year study in Sweden showed a 20% decrease in the risk of endometrial cancer among women who sunbathed in the summer, and a 40% decrease in risk among those who used a sunbed more than three times per year.119 When the data were adjusted for confounding factors such as body-mass index and physical activity, the risk of endometrial cancer among sunbed users was further reduced to 50%, comparing with women who did not use sunbeds.
4.	Prostate cancer
There are 180,890 new prostate cancer cases and 26,120 deaths annually. Researchers compared the lifetime sun exposure of 450 white men with advanced prostate cancer to that of 455 white men who did not have cancer.120 The men were divided into quintiles according to the amount of exposure they had received. Subjects in the highest fifth of sun exposure had only 51% of the risk of prostate cancer as did those in the lowest fifth.
5.	Colon and rectal cancer
There are 95,270 new cases of colon cancer, 39,220 new cases of rectal cancer and 49,190 deaths from colon and rectal cancer combined annually.
Among all cancers, colorectal cancer has the strongest link to solar UVB exposure. It was the first type of cancer identified as being reduced by solar UVB exposure and was the basis for the UVB-vitamin D-cancer hypothesis when that study was published in 1980.121 Colon and rectal cancer mortality rates have demonstrated a strong inverse correlation with solar UVB doses in Dr. Grant's two aforementioned ecological studies of 2002 and 2006.
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The following is only one of several studies demonstrating the correlation between high sun exposure and low colon cancer rates:
Dr. Mizoue, conducting research in Japan, has demonstrated that people in the areas of highest solar radiation exhibit the lowest rates of colon cancer; those living in the areas of highest sun exposure had about half the colon cancer rate as those living in the lowest.122
6.	Pancreatic cancer
There are 37,680 new cases of pancreatic cancer and 34,290 deaths annually. Here are two of several research studies indicating a protective effect of sun exposure on pancreatic cancer: Dr. Grant, studying Spanish cancer rates compared to UVR exposure, has demonstrated that greater sun exposure predicted lower rates of pancreatic cancer.123 He also found that higher sun exposure, based on work occupation in Nordic countries, was associated with reduced risk of pancreatic cancer.124
7.	Bladder cancer
There are 76,960 new cases of bladder cancer and 16,390 deaths annually. Bladder cancer mortality rates were found to be strongly inversely correlated with solar UVB doses, in Dr. Grant's ecological studies of 2002 and 2006. However, smoking had a stronger direct association with bladder cancer mortality rate than UVB's inverse association.
The Nordic cancer study, cited in number 6 above, also found that the risk of bladder cancer was inversely associated with the amount of time spent outdoors, demonstrating a protective effect of sun exposure.
8.	Brain cancer
There are 23,770 new cases of brain cancer and 16,050 deaths annually. Adults born in the months of January and February have especially high rates of brain cancer compared to those born in July and August,125 which could be due to low 25(OH)D levels in pregnant mothers, as a result of insufficient sun exposure.
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9.	Kidney Cancer
There are 62,700 cases of kidney cancer and 14,240 deaths annually. Kidney cancer mortality rates were found to be strongly inversely correlated with solar UVB doses in Dr. Grant's ecological studies of 2002 and 2006.126, 127
Additional research has found that those in the highest quarter of occupational sun exposure have a 26% decrease in the risk of kidney cancer compared to those in the lowest quarter.128 A similar finding was made in the Nordic study.129
10.	Leukemia
There are 60,140 new cases of leukemia and 24,400 deaths annually. Research shows a very close relationship between sun deprivation and acute myeloid leukemia.130 The researchers stated, "During the light season, the incidence decreased by 58% per 1,000 kJ/m2/d incremental increase of solar radiation."
11.	Lymphoma
There are 81,080 new cases of lymphoma yearly and 21,270 deaths annually. Both Hodgkin's and Non-Hodgkin's lymphoma mortality rates were found to be strongly inversely correlated with solar UVB doses in Dr. Grant's ecological studies of 2002 and 2006.
Other research also demonstrates that greater sun exposure correlates to a diminished risk of lymphoma. A European study has shown that sunbathing four times weekly correlated to a 30% decrease in Non-Hodgkin's lymphoma (NHL) risk, compared to no sunbathing.131 However, at high European latitudes, the ratio of long wave UVA to UVB is higher than at lower latitudes, and since UVA can impair the immune system, UV exposure was found to be less protective against NHL at higher latitudes than at lower latitudes.132
12.	Gallbladder cancer
There are 11,420 new cases of gallbladder cancer and 3,710 deaths annually. One study, using NMSC as a marker for sun exposure, demonstrated that gallbladder cancer diminished as sun exposure increased, and listed this cancer as one of ten cancers showing highly significant reductions when correlated to sun exposure.133 Gallbladder cancer risk was also lower for occupations with higher sun exposure in Nordic countries.134
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13.	Multiple Myeloma
There are 30,330 cases of multiple myeloma yearly and 12,650 deaths. Dr. Grant's analysis in Spain, using NMSC as a marker for sun exposure, listed multiple myeloma as a cancer inversely correlated to
135
sun exposure.135
14.	Thyroid cancer
There are 64,300 cases of thyroid cancer yearly and 1,980 deaths. This is another cancer Dr. Grant's analysis in Spain (cited above), using NMSC as a marker for sun exposure, listed as being inversely correlated to sun exposure.
15.	Lung Cancer
There are 224,390 new cases of lung cancer and 158,080 deaths annually. In a geographical study of lung cancer mortality in China, a strong inverse correlation with sun exposure was revealed, with an estimated 12% decline in mortality for each incremental increase (of 10 millwatts-per-meter-squared-per-nanometer) in UVB intensity, even after adjusting for smoking habits.136
16.	Oral and Pharyngeal cancer
There are 9,750 deaths annually from these cancers. One study indicates that sun exposure has an inverse association with the diseases.137
Cardiovascular diseases (CVD), including coronary heart disease, heart attacks, and heart failure
CVD prevalence in the US
CVD is a major killer. The American Heart Association (AHA) reported in 2015, based on 2013 statistics, that more than 801,000 Americans die of CVD each year. This number is approximately 2,194 per day, or about 182 per hour. In other words, one of every three deaths is caused by CVD.138
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1.	Coronary heart diseases and heart attacks.
In the United States, someone has a heart attack every 43 seconds.139
A study on seasonal variations in heart attack rates in Brazil demonstrated a 30% higher risk in winter than summer in those aged 75 years and older.140
2.	Heart Failure
According to AHA statistics, in 2005, one in eight deaths in the US has heart failure listed on the death certificate and was identified as the "underlying cause" in 58,933 deaths.141
In France, deaths from heart failure are 20% higher than average in January and 15% lower than average in August.142 These findings could be due to higher sun-stimulated 25(OH)D levels in summer, or they could be due in part to nitric oxide production by the skin as a result of sun exposure—a subject we will discuss in chapter 6.
Diabetes
Diabetes is a disease of chronically high blood glucose, which can lead to blindness, nerve damage, heart disease and numerous other maladies. The American Diabetes Association (ADA) has stated that diabetes killed 69,071 people in the US in 2010, the last year for which statistics were available. The ADA also stated that diabetes contributed to a total of 234,051 deaths from other diseases in 2010.143
1.	Type-two diabetes
Ishii and colleagues found that blood-sugar levels were lower during the summer.144
2.	Type-one diabetes (an autoimmune disease)
In Newfoundland, Canada, an extremely strong inverse correlation exists between sun exposure and the incidence of type-one diabetes.145
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Other Autoimmune Diseases
1.	Asthma
Asthma is a disorder characterized by inflammation of the air passages. Such inflammation narrows the airways, which transport air from the nose and mouth to the lungs. According to the Asthma and Allergy Foundation of America (AAFA), each day 40,000 people miss school or work due to asthma; 30,000 people have an attack; 5,000 people visit the emergency room (25% of all emergency room visits are due to asthma) and 1,000 people are admitted to the hospital.146 In addition, there are about 4,000 asthma-related deaths every year.
A study from Spain showed that children exposed to the most sunlight have much lower risks of asthma than those who are least-exposed, with each hour of sun exposure added per day predicting a decreased risk of the disease.147
2.	Crohn's disease and ulcerative colitis (UC)
Crohn's disease and UC are inflammatory autoimmune bowel diseases causing abdominal pain, inflammation and fibrous tissue buildup. These diseases cause about 825 deaths yearly in the U.S.148
Crohn's disease is closely correlated to vitamin D deficiency and winter season,149 indicating an inverse relationship with sun exposure and vitamin D production.
A study of female nurses in the US found that "compared with women residing in northern latitudes at age 30, the multivariate-adjusted risk for UC for women residing in southern latitudes was less than half."150
Infectious diseases
Vitamin D production, stimulated by exposure to the UVB portion of solar radiation, may improve immune system response, and thereby reduce the risk of infections. One of the mechanisms by which this is accomplished is the production of antimicrobial peptides (AMPs), which can help to negate the effects of bacteria, fungi and viruses.151 One of the most important AMPs is cathelicidin, which is under control of the vitamin D receptor (VDR), whose activity is regulated by the presence of the potent hormone form of vitamin D: 1,25-dihydroxyvitamin D (1,25(OH)2D).
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Research demonstrates that when disease-causing microbes breach physical barriers, a class of proteins called toll-like receptors (TLRs) recognizes the invading pathogens and triggers the body's immune cells (white blood cells, such as macrophages) to respond in various ways, including the activation of the immune cell's vitamin D receptors (VDR). This response prompts the stored form of vitamin D, 25(OH)D, to be taken from the blood and hydroxylated to form 1,25(OH)2D (the potent hormone), which binds to the VDR of the immune cell. The cathelicidin gene is then activated and the human cathelicidin, LL-37, is synthesized within the immune cell in order to destroy the pathogen after the immune cell engulfs it. This reaction is totally dependent on the availability of the stored form of vitamin D.152 The cathelicidin also acts by destroying the integrity of the lipoprotein membranes of the pathogens, rendering them harmless.153 It also has a chemotactic effect, acting as a chemoattractant for immune cells in the immediate vicinity of the pathogen breach.154
Based on these facts, it would therefore be expected that sun exposure or other forms of UVB light would correlate to a lessened risk of infection. The following diseases have been identified as being correlated to low sun exposure or low serum levels of vitamin D:
1.	Influenza
The Center for Disease control (CDC) estimates that there are 36,000 yearly deaths from Influenza in the US.155 Dr. Hope-Simpson showed that cold and flu outbreaks are almost completely seasonal.156 Dr. John Cannell hypothesized that seasonal changes in solar UVB doses and vitamin D levels result in the seasonal changes in flu outbreaks:157 In the northern hemisphere, they occur in December through March. In the southern hemisphere, outbreaks occur June through September—almost exclusively in winter in both hemispheres. The outbreaks in each case occur in times of lowest sun exposure.
2.	Pneumonia
According to the CDC, there are about 1.1 million yearly hospitalizations and approximately 53 thousand deaths due to pneumonia.158 Pneumonia is often a result of influenza and is also highly seasonal, with the lowest rates in summer, an increase in fall, and a peak in winter.159, 160, 161
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Other research has established that low UVB exposures (resulting in low levels of photoproducts including vitamin D) correlate directly to periods of low solar radiation, and has indicated that such a correlation may be responsible for the seasonal variation in pneumonia and for the spike in winter cases.162
A study found that case-fatality rates, due to pneumonia arising from the influenza pandemic in the US in 1918-19, were much lower in communities with higher solar UVB doses in summer and winter.163 The effects of vitamin D in fighting infections and reducing inflammation were proposed to explain the findings.
3.	Septicemia/Sepsis
Septicemia is a severe and often deadly blood infection, and it is also a form of sepsis, defined as an infection of tissues by bacteria. Noxious bacteria do damage by attacking tissue or blood, but when they die or when their cell walls rupture, they release a poison (endotoxin), which may do more harm than the bacterial attack itself.
Sepsis is now one of the top-ten causes of death in the USA and the second leading cause of hospital-associated deaths outside of coronary intensive care units. In North America, sepsis and its related disorders kill more hospitalized people than heart attacks, colon cancer, breast cancer or AIDS. The annual cost of care is about $17 billion, and in the case of severe sepsis, antibiotics have not improved survival. In fact, antibiotics may produce molecules that exacerbate it.164
Dr. Grant has hypothesized that vitamin D deficiency, due to inadequate UVB exposure, is a risk factor for septicemia.165 He points out that septicemia incidence is highest in the winter and lowest in the autumn, while rates are also generally highest in the Northeast and lowest in the Southwest,166 and that African Americans (who are much more likely to be vitamin D deficient) have 1.7 to 4.3 times higher incidence rates than do Caucasians.167 There is also a rapid increase in septicemia risk with age, and several other chronic and infectious diseases are closely associated with such increase.168 All of these factors point to sun deficiency and/or vitamin D deficiency. Therefore, such a deficiency could play a strong causal role in septicemia, especially since deficiency inhibits the production of cathelicidins. As stated above, these are antimicrobial peptides which facilitate the destruction of pathogenic germs' cell walls, leading to their death. These peptides also help inactivate the endotoxins released as a result of that destruction.169, 170, 171 Septicemia/sepsis causes about 35,000 deaths per year in the US.172
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4.	Necrotizing fasciitis (flesh-eating bacteria)
Necrotizing fasciitis (NF) is rare and caused by virulent strep bacteria. It is estimated by the Necrotizing Fasciitis Foundation that 500-1500 people contract NF yearly in the USA.173 About 20% of patients with necrotizing fasciitis die.174 Using 1,000 as the midpoint for the estimated number of yearly cases, we estimate a total annual death number of 200. The disease is most common in seasons of low sun exposure, with the highest incidence in winter.175
5.	HIV infection
HIV infection was responsible for 6,995 deaths in 20 13.176 There is a 61% increase in death risk among children born to women with low 25(OH) D levels,177 indicating that low sun exposure is a factor.
6.	Tuberculosis (TB)
TB is an infectious disease affecting most tissues but especially the lungs. There were 555 deaths from TB in the U.S. in 2013.178
Sun therapy (heliotherapy) was used in the early 20th Century to effectively treat TB patients. Dr. Aguste Rollier's records of 1,129 surgical TB cases showed that heliotherapy cured 87% of "closed cases" and 76% of "open cases. " Among 158 patients with tuberculosis of the hip, 125 were cured and 102 "regained complete recovery of articular function."179
7.	Chronic obstructive pulmonary disease (COPD)
COPD is defined as a heterogeneous collection of conditions affecting various structures within the lung in a number of ways.180 In 2013, there were 145,575 deaths in the US from COPD, which included deaths from bronchitis, emphysema and other chronic lower respiratory diseases.181
Though there are multiple contributors to COPD-such as tobacco smoke, occupational dusts, chemicals and air pollution-vitamin D deficiency due to lack of sun exposure may also play a role. The severity of the disease has been demonstrated to correlate inversely to serum levels of vitamin D:182 The higher the levels of vitamin D, the lower the risk of COPD.
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Risk-benefit calculation
The following chart summarizes information presented in the first three chapters: All cancer figures come from Siegel's paper on cancer statistics (Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016 Jan; 66(1):7-30.)
Diseases associated with low sun exposure in the USA
Disease	Year	Deaths
Osteoporosis	2005	71,280
Osteoarthritis	2004	500
Rheumatoid arthritis	1998	2,060
Bladder cancer	2016	16,390
Brain cancer	2016	16,050
Breast cancer	2016	40,980
Cervical cancer	2016	4,074
Colon cancer	2016	49,190
Endometrial cancer	2016	10,470
Gallbladder cancer	2016	3,710
Kidney cancer	2016	14,240
Lung cancer	2016	158,080
Leukemia	2016	24,400
Lymphoma	2016	21,270
Multiple Myeloma	2016	12,650
Oral and pharyngeal	2016	9570
Ovarian cancer	2016	14,240
Pancreatic cancer	2016	34,920
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Prostate cancer	2016	26,120
Thyroid Cancer	2016	1,980
Cardiovascular	2015	801,000
Diabetes	2010	69,071
Crohn's disease	2004	825
Asthma	2010	4,000
Influenza	2010	36,000
Pneumonia	2016	53,282
Septicemia	2012	35,000
HIV—Aids	2013	6,995
Necrotizing fasciitis	2010	200
Tuberculosis	2014	555
COPD	2009	145,575
Total annual deaths, approximated		1,684,677
Risk/benefit analysis and conclusion:
There are, according to our calculations, approximately 1,684,677 yearly deaths caused by diseases associated with low sun exposure compared to 5125 deaths from diseases correlating with high sun exposure, producing a ratio of approximately 328.7:1. Based on this analysis, we conclude that it defies common sense to continue the anti-sun campaigns prevalent today. This ratio proves beyond doubt that regular, non-burning sun exposure (without sunscreens) should be encouraged as a prudent precaution, to yield a highly beneficial effect on health statistics. The ratio is presented graphically below, and should make anti-sun advocates think twice about suggesting that sun exposure should be avoided.
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RATIO OF YEARLY DEATHS FROM DISEASES ASSOCIATED WITH LOW SUN EXPSOURE VS. YEARLY DEATHS FROM DISEASES ASSOCIATED WITH HIGH SUN EXPOSURE
■	Deaths from diseases associated with low sun exposure
■	Deaths from diseases associated with high sun exposure
i
We also conclude that in seasons when the sun is available, it is in the interest of public health to replace sun-avoidance campaigns with recommendations for frequent, unscreened, non-burning sun exposure over as much of the skin surface as the weather and social context allow. The appropriate amount of exposure is easily calculated: when the skin begins to redden, cease sun exposure.
Dr. Richard Weller is a dermatologist who understands that sun exposure, used properly, has an exceptionally positive effect on human health. In a recent paper, he stated the following: All-cause mortality should be the primary determinant of public health messages.183 We agree. Much of the public has no idea of the sun's beneficial effects and believes that sun exposure's only effect is to create cancer. If the anti-sun message is the only one people hear, they may avoid the sun, and thereby succumb to the diseases the sun helps prevent. Avoiding the sun to reduce the risk from diseases associated with 5125 deaths in the U.S. while increasing the risk of death from diseases associated with 1,684,677 deaths per year, is highly illogical. And when we factor into the equation all the suffering, destroyed quality of life, and loss of productivity caused by long-term chronic diseases (before death) associated with insufficient sun exposure, the magnitude of the error of sun-avoidance becomes unimaginable!
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From this point forward, our discussions will focus on diseases and disorders for which sun exposure provides important benefits. Many of these conditions have been touched on in this chapter, but the discussions will be amplified as we move forward.
What have we learned?
1.	High sun exposure is associated with an increase in diseases known to cause approximately 5125 deaths per year.
2.	Low sun exposure is associated with an increase in diseases known to cause approximately 1,684,677 deaths per year.
3.	There are approximately 328.7 deaths associated with low sun exposure for every one death associated with high sun exposure.
4.	Sun exposure should not be avoided; it should be encouraged in a non-burning, controlled manner. Moderation is the key.
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Chapter 4.
Boning Up: Sun Exposure Maintains and Increases Bone Strength and Joint Health
"Every day, the moment you open your eyes and pull off your blankets, that's what you hope for:
The sunshine on your face, warm enough to make your heart sing."
—Sarah Ockler
Vitamin D deficiency, due to sunlight deficiency, leads to rickets, osteoporosis, osteomalacia, and other bone diseases. Yet, as the world modernizes, the population is moving indoors. And in both rural and urban population areas, which are sunny throughout the year, vitamin D deficiency is increasing. For example, a study in tropical Ethiopia showed that 42% of the children there are vitamin D deficient,184 with the prevalence of deficiency being significantly higher among urban children and in children who were less exposed to sun. Researchers made the following observations regarding their findings: "Behavior change communication to enhance exposure to ultraviolet light is critical to prevent vitamin D deficiency in a tropical country like Ethiopia. Further study is required to assess the deleterious effect of its deficiency on bone mineral homeostasis of growing children in Ethiopia during their most critical period of bone development."
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These researchers understand that the primary method of optimizing 25(OH)D levels in tropical areas is not to supplement vitamin D, but to get out in the sun. Research demonstrates that sun exposure maintains or increases bone mineral density and impressively strengthens bone. This will be discussed below.
Sun exposure prevents osteoporosis and fractures, mitigates arthritis and prevents rickets.
The title of this section should not be construed to indicate that sun exposure can restore the height of a person who has lost several inches due to deteriorating bones. It can, however add bone mineral density, preventing additional loss and dramatically reducing the risk of fractures.
Osteoporosis (brittle bones) and osteomalacia (soft bones)
This crippling disease of brittle bones leads to fractures, and often those fractures are fatal, particularly among the elderly. The mother of an acquaintance of mine (MBS)—a woman who avoided the sun—simply turned over in bed one night and broke her hip. Osteoporosis often destroys all quality of life for those who suffer it.
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Both sunbeds and sun exposure enhance 25(OH)D levels in the skin by introducing UVB light, which converts cholesterol in the skin to vitamin D. Remember, 90% of vitamin D produced in the US population is due to sun exposure when the UV Index is above 3 and your shadow is shorter than your height.185
In high latitude areas, where there is far less sun availability than lower latitude areas, we would expect rates of hip fracture to be high, and such is the case. Sweden is a country with large differences in latitude. An investigation there has shown that the higher the latitude and the lesser the sun exposure, the greater the risk of hip fracture.186 In other words, significantly more hip fractures occurred in the northern part of the country, where there was less sun exposure, compared to the middle and southern parts. Another Swedish study has demonstrated that in men, hip fracture risk was 37.5% lower in summer than in winter, whereas women had a reduced risk of 23.5% in summer.187 A study from Norway showed similar results: Hip fracture risk in men was 40% higher in winter than in summer, and in women it was 25% higher.188 These fluctuations in seasonal hip fractures demonstrate a loss of bone mass during periods of low UV index sun exposure (winter) and an increase in bone mass during periods of high UV Index sun exposure (summer). In other words, sun exposure (UVIndex above 3) is able to reverse bone loss, or osteoporosis. Other studies show similar patterns of bone strength based on sun exposure or lack thereof.189
The importance of sun exposure in maintaining and producing strong bones has been known since antiquity. Dr. Richard Hobday, author of The Healing Sun, wrote the following comments along with a history in an online article:190 "Traditionally, sunlight deprivation has been linked with weak or brittle bones. One of the earliest references to this conclusion was made more than two thousand years ago by the Greek historian Herodotus (480-425 BC), who noted a marked difference between the remains of the Egyptian and Persian casualties at the site of battle of Pelusium, which took place in 525 BC:
'At the place where this battle was fought I saw a very odd thing, which the natives had told me about. The bones still lay there, those of the Persian dead separate from those of the Egyptian, just as they were originally divided, and I noticed the skulls of the Persians were so thin the merest touch with a pebble will pierce them, but those of
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the Egyptians, on the other hand, are so tough it is hardly possible to break them with a blow from a stone. I was told, very credibly, the reason was Egyptians shave their heads from childhood, so the bone of the skull is indurated by the action of the sun—this is why they hardly ever go bald, baldness being rarer in Egypt than anywhere else. This, then, explains the thickness of their skulls; and the thinness of the Persian's skulls rests upon a similar principle: namely that they have always worn felt skull-caps, to guard their heads from the sun.' Herodotus, 'The Histories'"
And here is perhaps the transcendent study on hip fracture and sun exposure: research in Spain showed that women who were sun-seekers had only about one-eleventh the risk of hip fracture as those who stayed indoors 191 (See the graph below).

This is very powerful evidence of the efficacy of sun exposure in preventing weak bones. In stark contrast to this research are studies done on women who completely avoid the sun and suffer from osteomalacia. Osteomalacia is a soft-bone disease known as adult rickets, resulting from severe vitamin D deficiency that prevents bone from properly mineralizing. Women who seldom go outdoors, or who are nearly always fully covered with clothing, have an extremely high incidence of osteomalacia at a very young age, even if they live in geographical areas with abundant sunlight.192, 193 If one is never exposed to the available sun, the sun will not be able to produce its beneficial effects on the body, so one may as well live at the North Pole.
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But, when a sun-exposure program is undertaken, the results can be impressive. In a study on bone mineral density (BMD) in children with severe disabilities, it was shown that all of them had a significant increase in BMD after the start of a sun-exposure program, which lasted a year.194 It is also notable that none of these children had a fracture after the start of the sun-exposure program.
Sunbed use also is associated with stronger bones and higher 25(OH)D levels. An excellent study compared 50 people who used sunbeds regularly with 106 who did not.195 The sunbed users had 90% higher vitamin D, significantly higher bone density and lower PTH levels (high PTH levels are associated with lower bone mass). On average, the sunbed users had healthful 25(OH)D levels of 46 ng/ml [115 nmol/L], compared to an average of only 24 ng/ml [60 nmol/L] in those who did not regularly use sunbeds.
Some might ask, "why not just drink extra milk to prevent the bone loss?" The answer: It doesn't work. In a 20-year Swedish study involving 61,433 women and 45,339 men, it was shown that among women who drank three glasses of milk per day, there was a 93% greater risk of death, and a slight increase in fracture risk, when compared to women who drank less than one glass daily. A similar increase in the risk of death was seen in men who drank more milk, although the increase in fracture risk was smaller and not considered significant.196
Calcium supplementation is also touted as a way to prevent bone loss, but research is not conclusive, and supplementation may carry its own risks regarding heart disease. A five-year study compared postmenopausal women who supplemented 1,000 mg of calcium daily, with a control group who did not supplement calcium.197 At the end of the study, more than twice as many of the calcium-supplemented group members experienced heart attacks when compared to those who did not supplement. Other research showed similar findings, but it has been determined that these adverse effects occurred primarily among people whose diets were already replete with calcium.198 Our opinion: If we eat plenty of green vegetables, we
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have more than sufficient calcium (particularly when we have regular UVB exposure to produce the vitamin D needed for proper calcium absorption). Good nutrition, sun exposure, exercise and an antiinflammatory lifestyle are the real answers to preventing bone loss. Think carefully before using calcium supplements.
Here are two more pieces of sun (UVR)/bone research worth mentioning: A. an interesting Okinawan study measured heel-bone stiffness (a measurement of bone strength) and various lifestyle factors among Okinawan men with and without type-two diabetes.199 In the non-diabetic (control) group, a significant positive correlation was shown between heel-bone stiffness and two other factors: (1) sun exposure and (2) consumption of small fish. Of these two factors, sun exposure predicted greater bone strength. B. Research has revealed that cumulative ultraviolet radiation exposure (sun exposure) is an important determinant of long-term skeletal health:200 The researchers determined that only recent low levels of vitamin D are associated with increased fracture risk, whereas data linking cumulative lifetime vitamin D status with skeletal outcomes are lacking (due to insufficient vitamin D testing). They stated "...increasing cumulative sun exposure was associated with higher bone mineral density in younger males and protective against fractures in females independent of current vitamin D." Sun/UVR exposure is important to bone strength because of vitamin D production and perhaps even has its own independent protective influence against bone weakness.
Association between obesity and bone loss
The obesity pandemic, brought about by horrendous eating patterns, food-manufacturing technologies, destruction of gut health and microbial balance, lack of exercise and (in our opinion) lack of sun exposure, has spawned millions of nutritionally bizarre diet programs and numerous strange medical procedures. One of the strangest is gastric bypass surgery, a procedure that reduces ingestion and absorption of calories by bypassing parts of the stomach and small intestine. Similar to open-heart bypass, this surgery also "bypasses" the real problem: Outrageous lifestyle habits, poor food quality, and excessive reliance on medical drugs.
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Any thinking person would realize that surgery to reduce absorption of calories also reduces absorption of calcium and dietary vitamin D. It is a recipe for osteoporosis and hip fractures. These nutrients are essential for optimal bone health. Research has shown that only one year after gastric bypass, there was an 8% loss of hip bone density.201 The risk of fracture increases 2-3 times for every 10 percent drop in bone density.202 Also, for every loss of 0.12g (0.043 oz.) per square centimeter (0.15 square inch) of bone mass, the risk of a fracture increased by 360% in women and 340% in men.203 Bone density or bone mineral density (BMD) is the amount of bone mineral within bone tissue, described as mineral mass per volume of bone, although clinically it is measured indirectly—using 2-D imaging—by recording the optical density per square centimeter of bone surface. Remember, this bone loss was reported only one year after bypass surgery. If this rate of bone loss continued for several years, it would weaken the skeleton to a point where the slightest movement would cause a fracture. The bypass procedure is a horror, and bone loss brought on by the lack of absorption of calcium and vitamin D is even worse.
In the case of decreased absorption of vitamin D after stomach bypass surgery, increased dietary intake of vitamin D may or may not work to improve bone strength: It is likely that only a very small quantity of the increased intake would be absorbed into the system, and the only way to ensure adequate 25(OH)D levels in the blood would be to expose the skin to the sun around midday in summer or to light from sunlamps in winter. Vast quantities of vitamin D are produced in this manner, and the entire quantity is delivered to the blood, where it can work to increase calcium absorption in both the intestine and the bone. According to research, calcium absorption in the intestine is 65% higher in people whose 25(OH)D levels are at the high end of "normal," in comparison with those who are at the low end of normal.204
Osteoporosis is not inevitable, and is to a certain extent reversible. It is a problem caused by sun deficiency, excessive animal protein consumption, inflammation, smoking, and lack of activity. Now we have added another revolting cause: The doctor's scalpel. How many gastric bypass surgeons advise their patients about bone loss,
UVR/sun exposure, and vitamin D before performing this atrocity? Interestingly, however, sun exposure has a positive influence on the health of gastric bypass victims: Adverse effects of these surgeries are directly associated with the season and latitude in which they occur.205 Seasons or latitudes of low sun availability were inversely correlated to prolonged stays in the hospital (39% longer stay), increased dehiscence (bursting open of a surgically closed wound) and wound infection. This surgery is hideous to begin with, but if a person thinks he or she must have it, it appears that it should be done in a sunny season of the year, or at a sunny latitude.
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Armed with this knowledge about osteoporosis, do you now believe it might be worth a daily sunbath to save the lives of 71,000 people per year? Do you now believe that daily sun exposure (unprotected by sunscreen) is worth your while to reduce your own risk of fracture? Then why don't we know about these statistics and about the marvelous prophylactic effects of the sun against fractures? The answers to this question are simple: (1) This information doesn't sell any Fosamax or Boniva (osteoporosis drugs). (2) It doesn't sell any noxious, deadly sunscreens. (3) It would be unthinkable for most dermatologists to admit, after years of misinformation and resultant profits, that soaking up a little sunshine (or sunlamp radiation in winter) each day might be good for us. It has been said, "And ye shall know the truth and the truth shall make you free."206 Now you have boned up on bone strength and the sun, and you know the truth. Our fervent hope is that all may be free from the deceptions of those who would ignore the truth in favor of making another dollar.
Arthritis
Arthritis is an acute or chronic inflammation of a joint, often accompanied by pain and structural changes. It has diverse causes, including auto-immunity, infection, inflammatory foods, crystal deposition, and injury. It is a very serious disease, which according to the Centers for Disease Control (CDC), costs about $128 billion per year and causes approximately 9,500 deaths per year.
In 2010-2012, 49.7% of adults 65 years or older reported doctor-diagnosed arthritis.207 By 2030, an estimated 67 million Americans, ages 18 years or older, are projected to have doctor-diagnosed arthritis.208 And tragically, an estimated 294,000 children under age 18 have some form of arthritis or rheumatic condition. This represents approximately 1 in every 250 children in the US.209 An article from the Express,210 a UK online newspaper, describes research published in the scientific journal, Annals of the Rheumatic Diseases,211 stating: "Millions of people could protect themselves from crippling arthritis by getting a regular dose of sunshine. Scientists found that women with the highest levels of exposure to the sun - specifically ultraviolet B (UVB) light - were 21 percent less likely to develop the disease."
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Osteoarthritis (OA)
OA is also known as wear-and-tear arthritis and is characterized by bone and cartilage degeneration in joints, which leads to pain and joint stiffness.
Research has shown that those in the middle and lowest thirds of serum 25(OH)D levels had a threefold progression of osteoarthritis of the knee during a one-to-two year period as those in the highest third, with low blood levels of vitamin D also predicting greater loss of cartilage in the joints.212 Other research shows that in patients with arthritis of the knee, those with blood levels of vitamin D lower than 20 ng/ml [50 nmol/L] have more disability and more pain and are weaker than those with higher levels.213, 214 Low 25(OH)D levels also correlate closely to greater knee pain and walking difficulty.215 Remember, unless it is stated that 25(OH)D levels are a result of supplementation or dietary sources, those levels are dependent on UVB exposure from the sun (unless sun lamps are utilized). The research discussed above, therefore, is about sun exposure.
Rheumatoid arthritis (RA)
RA is a disease caused by chronic autoimmune-related inflammation of the joints, the tissue around the joints and certain organs in the body.216
A paper by Dr. Viera and colleagues demonstrated that at high latitudes, where sun exposure is considerably less available, the rate of RA is much higher than at lower latitudes.217 RA is also more severe in winter,218 a time of reduced sun exposure. A report from researchers in Ireland (a northern country with little sun exposure due to overcast conditions), has shown that approximately 70% of RA patients had low 25(OH)D levels and 26% were severely deficient.219 In an investigation using data from the Nurses Health Study, women in the highest category of UVB exposure (from the sun or other sources) had a 21% decrease in RA risk, when compared with women at the lowest category of UVB exposure.220
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As mentioned, RA is an autoimmune rheumatic disease (ARD), and seasonal vitamin D declines may trigger flares in ARD.221 Such declines, of course, are a result of decreasing sun exposure in colder seasons.
Arthritic joints carry another devastating side effect. Hip replacement surgery is often prescribed for arthritic conditions, and those people who go through total-hip-replacement procedures are 4.7 times as likely to have an ischemic stroke, and 4.4 times as likely to have a hemorrhagic stroke in the first two weeks post surgery.222 Those stroke risks remain elevated for 6-12 weeks. The term "ischemic" refers to a local deficiency of blood and oxygen supply to important tissues and cells (in this case, in the brain), resulting from obstruction of blood flow.
Rickets, making a comeback
After a century of knowing how to easily prevent this disastrous children's disease of soft and malformed bones, it is returning, and cases of rickets are reported as far south as Texas, Georgia and North Carolina,223 Not surprisingly, 83% of cases occur in black children. And 96% of the cases were breast-fed, demonstrating a lack

of vitamin D in their mothers' milk. We must educate expectant mothers to get out in the sun during their pregnancies, whenever possible, (or use sunlamps when the sun is not available.) Before and after giving birth, these mothers should ensure that both they and their babies maintain optimal serum levels of vitamin D. Even women who take prenatal vitamins are often woefully deficient in vitamin D, as are their newborns.224 So what is the most natural way for a mom to ensure that she and her nursing baby have sufficient vitamin D? If infants do not receive sun (or
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sunlamp) exposure when it is available, serum vitamin D may be deplorably inadequate.225
An excellent scientific paper regarding the incidence of vitamin D deficiency in breastfeeding women was published in the journal Nutrients.226 The research was particularly interesting in that the investigators measured the serum 25(OH)D levels in breastfeeding mothers from three different geographic areas: Shanghai, China; Cincinnati, Ohio; and Mexico City, Mexico. Their infants' vitamin D levels were also measured. Although there was considerable variance in vitamin D deficiency among the three areas, a large number of mothers and their offspring were deficient. Factors closely related to deficiency were obesity, season, and geographical location. Among the infants, predictors of higher vitamin D status were formula feeding [probably with added vitamin D] and higher UVB index.
The authors concluded "vD [vitamin D] deficiency appears to be a global problem in mothers and infants, though the prevalence in diverse populations may depend upon sun exposure behaviors and vD supplementation. Greater attention to maternal and infant vD status, starting during pregnancy, is warranted worldwide."

It is critically important that pregnant mothers be vitamin D replete during their entire pregnancies, because the fetus depends on the mother as the only source of nutrients, including vitamin D. For example, if infants are born to vitamin D deficient mothers, they may have such maladies as craniotabes,227 a softening of the skull, which is a predictor of fullblown rickets. One such instance occurred on a sunny Greek island and involved severe vitamin D deficiency in a pregnant mother [obviously resulting from not going out in the sun]. Her male infant suffered from congenital rickets: weak muscle tone, craniotabes, episodes of tremor,
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hypocalcaemia, elevated serum alkaline phosphatase, secondary hyperparathyroidism and decreased 25(OH)D. Like all other wonderful health tools, the sun is all around us, yet many refuse to use it. So, of what use is it to them?
Rickets is also associated with destruction of dental health. In the medical journal Pediatrics, an interesting report discussed the plight of two young girls who suffered from severe tooth decay related to rickets.228 This illness is characterized by defective bone growth and horribly deformed bodies, and, as we will see, it may also be characterized by teeth without enamel.
In research on rickets and tooth decay, the authors make the following statement: "Deficiency during pregnancy can cause enamel hypoplasia of primary teeth. Enamel regeneration is currently impossible; hypoplasia [an abnormal deficiency of cells or of structural elements] is therefore irreversible, and once affected, teeth are prone to fast caries development. Deficiency during early childhood can affect permanent teeth and ensuing caries can sometimes lead to tooth loss at a young age."
In other words, lack of sun exposure in pregnancy leads to lack of vitamin D in the serum of the fetus, which leads to rickets—and in some cases—teeth without enamel. What a horrible way to begin life! Women have become so frightened of the sun that they try to avoid it completely. By so doing, they rob themselves and their fetuses of vital vitamin D and pass on myriad complications to their offspring, whose bodies and brains cannot develop properly in the womb without sufficient vitamin D. Regular, non-burning sun exposure (or sunlamp use when the sun is not available) would completely prevent this horrid disease and the dental disasters which may accompany it. The sun-scare movement, including many dermatologists and the drug companies selling sunscreens, have blood on their hands. No one ever needs to have rickets. Pregnant mothers, get out in the sun for a few minutes around midday and make certain your children play in the sun regularly. Just take care not to burn. If all mothers and children would follow this advice, rickets would cease to exist.
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Sun exposure and growth
her baby to have robust health should
In the 1930s, when the medical community had not yet bought into the sun phobia of today, the Department of Labor printed a pamphlet called Sun for Babies in which they made this statement: "Every mother who wishes
give him regular sun baths from early infancy until he is old enough to play in the sun himself. If the sun's rays are to help the baby grow properly and to prevent rickets, they must fall directly on the skin and tan it." That would not be popular advice today, and it is likely that any parent practicing "baby tanning" would be arrested for child abuse. Since the 1930's the dermatological profession has come a long way... in the wrong direction.
Other research related to bone growth in children shows that those who are growth-hormone deficient, and are being treated for that deficiency, grow more rapidly during summer months:229 In a one-year study published in 2015, which used 118 children from 14 countries as subjects, growth was measured and compared to the amount of sun received by the children. Those who were exposed to more sun had faster growth. The investigators also demonstrated a role for circadian-clock pathways in influencing growth.
Although this study was claimed to be the first to demonstrate the influence of sun exposure on accelerated growth among children being treated with growth hormone, another investigation from 2013 came to the same conclusion.230 Others have also observed that children seem to grow more rapidly in summer.231, 232, 233
We want our children to have reasonable rates of growth, and the vitamin D produced by sun exposure may produce larger and stronger bones. Vitamin D may also be accompanied by other factors such as nitric oxide, serotonin, endorphins or other less studied
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photoproducts. Whatever the mechanisms, we now know that the sun has one more critically important effect on human health: accelerated growth among our children.
What have we learned?
1.	Osteoporosis-related fractures are generally least common in populations with higher sun exposure and are most common in populations with lower sun exposure.
2.	Sunlight exposure has the ability to build bone mass and profoundly reduce the rate of fractures. In other words, sun exposure can reverse osteoporosis.
3.	Sun exposure stimulates the production of vitamin D, absolutely necessary for the absorption of calcium in the intestine. Without it, no amount of calcium consumption will halt osteoporosis and subsequent fractures.
4.	Women who seek the sun in Spain have less than 10% the risk of a fracture compared to those who spend most of their time indoors.
5.	UVB exposure from sunbeds impressively increases 25(OH)D levels and bone strength.
6.	Calcium supplements (when the diet is not calcium-deficient) may increase the risk of heart attacks. It is far better to obtain calcium from lots of green, leafy vegetables (grown on calcium-rich soil), and then get plenty of sun (or sunlamp if necessary) exposure.
7.	Osteomalacia (soft bones) is common in women who seldom go outdoors, or who are nearly always fully covered with clothing, even when they live in geographic areas of high sunlight availability.
8.	Sun exposure inhibits the progression of various types of arthritis and decreases the loss of joint cartilage.
9.	Rickets, a totally preventable disease, is making a comeback due to sun deprivation.
10.	Gastric bypass for obesity results in bone loss, and sun (or sunlamp) exposure may be the only way for bypass patients to receive sufficient vitamin D to maintain bone strength.
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Chapter 5
Cancer Prevention: Sun Exposure is Essential.
Sunshine is a marvelous health-giving and healing power in the world. While sunshine is death to disease-producing agencies, it is life and health to all natural forms of life. Sit in the sun, recline in the sun, walk on the sunny side of the street, avoid parasols, and ever recognize the sun as a friend, not an enemy, a promoter of health, and a destroyer of disease.
—Frederick M. Rossiter, M.D. The Practical Guide to Health, 1913
In this chapter, as in Chapter 3, we will refer often to two exceptionally important cancer papers, which are known as ecological studies. These two studies—the first by Dr. William B. Grant and the second by Dr. Grant and Dr. Cedric Garland—are cited often throughout this section on cancer. You may use the following references whenever these two studies are mentioned in the text.
• Grant WB. An estimate of premature cancer mortality in the US due to inadequate doses of solar ultraviolet-B radiation. Cancer. 2002 Mar 15;94(6):1867-75.
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• Grant WB, Garland CF. The association of solar ultraviolet B (UVB) with reducing risk of cancer: multifactorial ecologic analysis of geographic variation in age-adjusted cancer mortality rates. Anticancer Res. 2006 Jul-Aug;26(4A):2687-99.
Sun exposure produces vitamin D, and vitamin D has various anticancer properties. Nevertheless, we will show that sun exposure by itself may have anti-cancer properties unrelated to vitamin D. Here are some of the anti-cancer properties of vitamin D:
Vitamin D inhibits angiogenesis around cancer cells.
Angiogenesis is the formation of blood vessels to provide blood and nutrients to newly formed tissue. If angiogenesis in cancer cells can be stopped, the cells die. Vitamin D acts as a selective angiogenesis inhibitor—it retards the growth of new, undesirable "feeder" blood vessels into cancer tissue while not affecting angiogenesis in normal tissue.234, 235, 236
Vitamin D promotes apoptosis in old or abnormal cells.
Apoptosis is defined as natural cell death or "cell suicide." When a cell has grown old or unhealthy, it needs to be replaced. Apoptosis is a beneficial programmed sequence of events leading to death and elimination of old or abnormal cells. When apoptosis does not take place, cells may become "immortal," multiplying out of control. This, of course, is the definition of cancer—the uncontrolled growth of abnormal cells. Vitamin D promotes apoptosis.237, 238, 239, 240
Vitamin D promotes differentiation of cancer cells.
Differentiation is the process by which cells take on the characteristics of the tissue surrounding them. In other words, they become a specific type of tissue: Breast tissue, heart tissue, bone tissue, etc. Cancer cells exhibit out-of-control growth, cell division and multiplication (proliferation) and they do not resemble the cells surrounding them. Vitamin D helps cancer cells differentiate.241, 242
Vitamin D inhibits invasiveness of cancer cells.
Invasiveness is the spreading of cancer cells into healthy tissue.
Normal cells respect borders and do not pass into other tissue, but cancer cells invade healthy tissue. Vitamin D inhibits the invasiveness of cancer cells.243, 244, 245
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Vitamin D inhibits metastasis.
Metastasis is the spreading of cancer cells from the initial location of the disease to another location, usually by way of blood vessels or the lymphatic system. For example, breast cancer cells may be transported to bone and create a new tumor. Vitamin D inhibits metastasis, thereby keeping cancer localized and rendering it less dangerous.246, 247, 248, 249, 250
Vitamin D inhibits proliferation.
Proliferation is the rapid growth and multiplication of cancer cells. If proliferation can be stopped, then cancer is stopped. Vitamin D retards proliferation, thereby slowing cancer growth.251, 252, 253, 254, 255
Sun exposure has been shown to exhibit a protective effect against the following cancers:
Breast cancer (BC) and other female reproductive cancers
The influence of sun exposure on breast cancer may start early in life. Research has demonstrated that girls who had the greatest sun exposure during the ages of 10-19 had a 35% decrease in the risk of breast cancer as adults, compared to those who had the least sun
Why don't the dermatologists tell us about research like this?
Decreasing Breast-Cancer Risk with Increasing Sunlight Expo sure in High Solar Radiation Areas. Expressed in Relative Risk (RR)

n Low exposure □ Mednim exposure High exposure^
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exposure.256 Another study of the relationship between breast cancer rates, sun exposure and dietary vitamin D was similarly impressive. The scientists analyzed the data from a large national study called HANES 1 (H1). The study subjects were 5,000 white women who had completed a health survey between 1971 and 1974, then reassessed in 1992. When assessing sun-exposure habits, it was determined that those who lived in the sunniest areas, and who also had the highest exposure to the sun, had a 65% reduction in breast cancer risk compared to those who had the least sun exposure.257 The graph above demonstrates the remarkable association between high sun exposure and reduced risk of breast cancer as demonstrated by that research.
A subsequent study by the same scientists found that "a high sun exposure index was associated with reduced risk of advanced breast cancer among women with light skin pigmentation."258 The risk was reduced by 47%. Since we know that sun exposure contributes to production of nitric oxide, serotonin, endorphins and other important photoproducts beyond vitamin D, it is likely that at least some of these substances were partially responsible for lowering the cancer risk. However, please remember: Whenever vitamin D deficiency is blamed for causing poor health, sun-exposure deficiency—the main reason for vitamin D deficiency—is the actual culprit.
Breast cancer was the second type of cancer (colon cancer being the first type) for which an inverse correlation between mortality rates and solar UVB doses was identified in the United States by the Garland Group in 1990.259 To do this, the scientists assessed cancer data from 87 regions of the US and compared that data to the quantity of sun exposure in each region.
In 2002, Dr. Grant analyzed ecological data from 466 USA state economic areas for the period 1970-94, finding that for white Americans (including Hispanics), breast cancer mortality rates had the second highest inverse correlation with UVB doses in the month of July (rectal cancer had the highest inverse correlation).260
In a 2006 study by Dr. Grant and Dr. Garland, cancer mortality rates in the 48 contiguous states were averaged by state, for the periods 1950-69 and 1970-94. These rates were compared with July UVB doses as well as other cancer risk-modifying factors: Alcohol consumption, Hispanic heritage, poverty status, smoking, and urban/rural residence.261 Again, in this ecological study, breast cancer mortality rates were strongly inversely correlated with solar UVB doses (sun exposure) as well as directly correlated with urban residence. People who live in urban centers generally receive less UVB radiation since they are more likely to work indoors, and tall buildings block the sun.
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Recently, a profoundly important piece of research emerged regarding breast cancer and sun exposure, although it received little fanfare: An investigation from Iran on the association between cancer risk and vitamin D showed that low vitamin D predicted only a slightly increased risk of breast cancer. However, among women who totally covered themselves and thereby had no sun exposure, there was a 10-fold increase in the risk of the disease.262 In other words, there was a 1,000% increase in breast-cancer risk due to sun deficiency (see the graph below).

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The message of the Iranian study is that sun avoidance, as promulgated by the sunscreen industry and dermatological societies, is one of the biggest frauds ever perpetrated. Coupled with our pitiful nutritional habits, sun avoidance guarantees that breast cancer will remain rampant. Women (and men), please take care of yourselves by obtaining regular, non-burning sun exposure. That habit reduces the risks of breast cancer, prostate cancer and about 17 other major cancers. The sun—used wisely—is not your enemy!
Other investigations have indicated that disruption of the circadian rhythm due to night-shift work may lead to increased breast-cancer risk (as well as colorectal cancer risk) in women.263, 264 Such a disruption, compounded by another disruption caused by dim light at night—reduced melatonin production—also leads to resistance to chemotherapy in breast-cancer patients.265 Melatonin supplements at night, however, have increased the effectiveness of chemotherapy back to normal. Of course, night-shift work, and staying up at night, are lifestyles that shun the sun, making it very difficult to maintain a proper circadian rhythm (see Appendix 4 for a discussion of circadian rhythm). Further, a study on mice showed conclusively that circadian rhythm disruption, through unnatural light cycles, increases the risk of breast cancer development.266
One of the dreads associated with breast cancer may be the mammogram, considered by many to be the best diagnostic tool for breast cancer. One paper reported that in women screened regularly for breast cancer by mammogram, the risk of the cancer was 22% higher than among those who were not screened regularly.267
Nevertheless, mammography did lead to an interesting paper on 25(OH)D levels and high breast-tissue density, which is a risk factor for breast cancer. In an investigation into the relationship of vitamin D to breast-tissue density, as measured by mammography, it was found that there was a strong inverse correlation; the higher the density, the lower the 25(OH)D levels.268 Since vitamin D supplementation was not a factor in this study, sun exposure, which stimulated vitamin D production, was the operative factor.
Based on the preceding information, it seems reasonable to recommend sun (or sunlamp) exposure as a preventive measure against breast cancer.
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Ovarian cancer
The National Cancer Institute's Cancer Mortality Map clearly shows that ovarian cancers are much less common in sunnier Southern and Southwestern States than in the North and Northeast,269 demonstrating a protective effect of sun exposure. Other research has also demonstrated an inverse relationship between sun exposure and ovarian cancer: An Australian investigation showed that women in the highest third of sun exposure, over a lifetime, had a 30% reduced risk of all endothelial ovarian cancers, a 53% reduced risk of borderline tumors, and 22% reduced risk of invasive tumors. Ovarian cancer mortality rates were also found to be strongly inversely correlated with solar UVB doses in the aforementioned 2002 and 2006 ecological studies by Drs. Grant and Garland.
And, in one piece of research using the Nurses' Health Study ll, sun exposure was associated with a 33% decrease in the risk of ovarian cancer.270
A study of African-American women living in 11 states in the US, involving 490 women who developed ovarian cancer and 656 women who did not, investigated the roles of milk consumption, calcium intake, vitamin D intake, and sun exposure in the risk for developing the disease. They found that whole milk consumption was an important contributor to ovarian cancer risk while calcium intake and sun exposure reduced that risk and vitamin D intake had no effect (however, vitamin D intake in this study was minimal, ranging from 130 IU to 524 IU per day, much lower values than can be generated from solar UVB exposure). Women who spent over 23 hours per week in the sun in summer had about 30% lower risk of ovarian cancer than women who spent under 6 hours per week in the sun.271 Thus, even among African Americans, who make vitamin D from solar UVB exposure at about one-third the rate of white Americans, regular sun exposure in summer can significantly reduce the risk of ovarian cancer.
Endometrial cancer
Endometrial cancer mortality rates were found to be strongly inversely correlated with solar UVB doses in Dr. Grant's 2002 and 2006 ecological studies.272, 273 Other research, using Spanish data, found an inverse correlation between endometrial cancer mortality and sun exposure assessed by using latitude as an index of sun exposure.274 Corroborating this finding was research from Sweden: This 15.5-year study showed a 20% decrease in the risk of endometrial cancer among women who sunbathed in the summer, and a 40% decrease in risk among those who used a sunbed more than three times per year.275 When the data was adjusted for confounding factors such as body-mass index and physical activity, the decrease in the risk of endometrial cancer was 50%.
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Colon cancer
In 1980, Cedric and Frank Garland published a seminal paper showing a relationship between colon cancer and geographical location.276 They observed dramatically higher rates of colon cancer in the Northeast, where there is a paucity of sun, compared with the South and West where sun exposure is more prevalent. They hypothesized that vitamin D, stimulated in the skin by sun exposure, reduced the risk of colon cancer. They noted the correlation between colon cancer and UVR exposure, stating particularly: "New Mexico and Arizona had the highest statewide mean solar radiation values (500 gm-cal/cm2).
In these two states, white males experienced colon cancer at rates of 6.7 and 10.1 per 100,000 population, respectively, over the period 1959-61. New York, New Hampshire, and Vermont had the lowest statewide mean solar radiation values (300 gm-cal/cm2).
In these three states, white males experienced colon cancer rates of 17.3, 15.3, and 11.3 per 100,000 population, respectively, during the same period."
Very recently, Dr. Cedrick Garland and his colleagues performed a meta-analysis of the studies on serum 25(OH)D level (a measure of sun exposure) and colon cancer-studies done since his first seminal paper. Upon analyzing the different blood levels of vitamin D and dividing them into quintiles (fifths) of vitamin D, they found that those in the highest quintile had a 33% lower risk of colorectal cancer, when compared to those in the lowest quintile.277 Individuals with a 25(OH)D level of 50 ng/ml [125 nmol/L] had an approximately 60% lower risk of colorectal cancer than those with a concentration of 5 ng/ml [12.5 nmol/L]. Those with 25(OH)D level of 30 ng/ml [75 nmol/L] had a 33% lower risk than those with a concentration of 5 ng/ml [12.5 nmol/L].
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We expect that sun exposure had everything to do with the higher 25(OH)D levels, and it makes one wonder: Was high sun exposure, beyond vitamin D itself, responsible for the protective effect, or was vitamin D (produced by sun exposure) the only protective factor? Likely, it was a combination of both vitamin D and the other photoproducts of sun exposure. The graph below, based on the Garland study, illustrates the dramatic correlation of different vitamin D/sun exposure levels to the risk of colorectal cancer.

Colon and rectal cancer mortality rates were also found to be strongly inversely correlated with solar UVB doses in Dr. Grant's 2002 and 2006 ecological studies previously discussed.
Other studies have corroborated the correlation between high sun exposure and low colon cancer rates. Japanese research demonstrated that people in the areas of highest solar radiation exhibit the lowest rates of colon cancer, with those living in the areas of highest sun exposure having about half the colon cancer rate as those living in the lowest.278 A significant aspect of this research is that sun exposure correlated to a reduced risk of cancer even where vitamin D consumption was high, indicating that sun exposure (as noted with breast cancer, above) may have beneficial influences on cancer beyond its stimulation of vitamin D production, or that vitamin D produced in the skin by UV radiation may have advantages over that consumed through food or supplements.
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This study is not the only investigation that differentiated between the effects of UV light exposure and vitamin D on colon cancer. Another study used mice with intestinal tumors—tumors which often progress to cancers.279 It was shown that mice given either UV radiation or vitamin-D supplementation reduced the tumor load when compared to mice receiving no treatment. However, only the UV treatments prevented the tumors from progressing to cancer.
These studies demonstrate again that we cannot simply substitute vitamin D supplements for sun exposure while assuming that we are getting all the benefits provided by the sun.
Bladder cancer
Bladder cancer mortality rates were found to be strongly inversely correlated with solar UVB doses in Dr. Grant's previously mentioned 2002 and 2006 ecological studies. Also, a study of cancer incidence with respect to occupation in Nordic countries found that the higher the amount of UVB exposure, the lower the risk of bladder cancer.280
Brain cancer
Research into the relationship between season of birth and subsequent risk of brain cancer demonstrates a higher risk among children born in colder seasons,281, 282 when UVR exposure would be far less than in warmer seasons. Similarly, adults born in the months of January and February have especially high rates of brain cancer compared to those born in July and August,283 which could be due to low 25(OH)D levels in pregnant mothers (from insufficient UVR exposure), or due to a serious need for vitamin D in the newborn.
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Esophageal Cancer
To our knowledge, only two investigations have correlated the risk of esophageal cancer with sun-exposure level. One study compared estimated lifetime residential ambient sunlight, called ultraviolet radiation (UVR) to three different types of esophageal cancer.284 Those with esophageal cancer of all types had about 60% less sun exposure when compared to a control group with no cancer.
However, UVR was not associated with reduced risk of esophageal squamous cell carcinoma, which comprised 28% of the esophageal cancer cases studied.
Gallbladder cancer
Using non-melanoma skin cancer (NMSC) as a marker for sun exposure, researchers have demonstrated that gallbladder cancer diminished as sun exposure increased, and listed this cancer as one of ten cancers with highly significant reductions in rate when correlated to increased solar (UVR) exposure.285 Dr. Grant, using cancer incidence statistics from Spain and also using NMSC as a marker for sun exposure, listed gallbladder cancer as one of the cancers that was inversely correlated to sun exposure.286 Also, a study of cancer incidence with respect to occupation in Nordic countries found that the higher the amount of UVB exposure, the lower the risk of gallbladder cancer.287
Kidney (renal) cancer
There is a strong inverse correlation between sun exposure and kidney cancer. For example, a study that utilized NMSC as a measure of sun exposure, has determined that sun exposure reduced the risk of several cancers, including kidney cancer, by 35% to 42%.288 Kidney cancer mortality rates were found to be strongly inversely correlated with solar UVB doses in Dr. Grant's 2002 and 2006 ecological studies.289, 290 Recent research, conducted by Dr. Sara Karami and colleagues, has demonstrated that high levels of sun exposure in women significantly reduce the rate of kidney cancer.291 Those women with the highest fourth of sun exposure showed a 33% reduction in risk. Interestingly, the data was adjusted for vitamin D intake, and the results still showed sun exposure to have a standalone protective influence on kidney cancer—another indication that sun exposure has protective effects beyond the benefits of vitamin D.
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These same researchers had demonstrated similar outcomes previously: In 2010, they showed that among European men with highest levels of sun exposure, there was a 24-38% reduction of renal cancer risk.292
Other studies on kidney cancer, using different designs, have produced comparable effects: A study of Swedish construction workers showed a significant 30% decrease in risk among men with the highest sun exposure;293 and in a study of approximately 451,000 adults, followed for nine years, increasing sun exposure was associated with a significant reduction in the disease.294
Leukemia
The risk of leukemia, a cancer of the bone marrow preventing the normal manufacturing of red and white blood cells and platelets, is influenced by sun exposure. An investigation showed a close relationship between sun deprivation and acute myeloid leukemia.295 The researchers stated: "During the light season, the incidence decreased by 58% (95% confidence interval, 16-79%) per 1,000 kJ/m2/d increase of solar radiation." In Finland, it has also been shown that deficiency of sunlight (or perhaps cold weather) was associated with increased rate of diagnoses when compared to diagnoses in the warm, sunlit season. Other research indicates that sun exposure in expecting mothers has reduced the risk of leukemia and other cancers in their children.296
Finally, in a laboratory study using UVA irradiation of leukemia cells, it was determined that such radiation caused rapid apoptosis (natural cell death) in the exposed cancer cells.297 UVA, of course, is the major ultraviolet component of the solar radiation reaching the earth. In another study, UVA has been shown to also cause a marked decline in the proliferation of leukemia cells.298 Proliferation, as we explained earlier, is the process of rapid growth and multiplication of cancer cells. So it appears that exposure to UVA rays has two positive attributes for preventing cancers: It has the ability to hasten the death of cancer cells, and to retard the tendency of cancer cells to grow and multiply out-of-control.
Sun exposure is a natural protector against leukemia. What more need we say?
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Lymphoma
Research by Dr. Karen Smedby and her colleagues demonstrates that greater sun exposure correlates to a diminished risk of lymphoma.299 The study showed that sunbathing four times weekly correlated to a 30% decrease in the risk for Non-Hodgkin's lymphoma (NHL) compared with no sunbathing. Two or more sunburns per year before age 20 correlated to a 40% reduction NHL risk compared to not having any sunburns, and regular "sun vacations abroad" also correlated to a 30-40% reduction in the risk for NHL.
Although sun exposure had been shown in that study to correlate strongly to a reduced risk of numerous cancers, including NHL, the results with Hodgkin's lymphoma (HL) were mixed. However, the most recent research shows there is an inverse correlation between HL and the total lifetime exposure, as well as childhood or adulthood exposure, to one of the following three factors: Sun exposure, sunlamp exposure and sunburn.300 The combined analysis, comparing the highest with lowest exposures, demonstrated an average reduction of 44% in the risk of contracting Hodgkin's Lymphoma. Two items particularly stand out in this research: (1) Sun-lamp use correlated to a reduced risk of the disease—a positive result for the much-maligned tanning industry. (2) Past sunburns have also correlated to a reduced HL risk. Of course, no one would recommend sun-burning; sunburn simply serves a surrogate measurement representing a high degree of sun exposure. A person can easily benefit from high quantities of sun exposure without burning, simply by moving out of the sun when the skin begins to redden and then returning to the sun after the skin has adjusted and started to tan.
The mortality rates of both Hodgkin's and Non-Hodgkin's lymphoma were found to be strongly inversely correlated with solar UVB doses in Dr. Grant's 2002 and 2006 ecological studies previously discussed. In other words, the greater the sun exposure, the lesser the risk of lymphoma. This research once again demonstrates the efficacy of sun exposure in reducing many types of cancer. Don't expect the American Academy of Dermatology to mention this vital information in its next newsletter!
An analysis of 10 studies done on the correlation between UVR exposure and NHL has concluded that increasing recreational sun exposure correlated with a 24% reduction in NHL risk.301
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Also, the season of diagnosis has a significant influence on survival rate among lymphoma patients: Those who were diagnosed in early autumn (after the high sun exposure of summer) had a 20% increase in survival rate, on average, compared to those diagnosed in winter.302 However, among those who were diagnosed in early autumn and whose average age was below 30, there was an impressive 64% increase in survival rate!
Children also benefit from sun exposure's protection against NHL risk. A seven-year investigation in Greece demonstrated that an increment of 15 days of sunbathing at Greek seaside resorts was associated with a 40% decrease in the risk for non-Hodgkin's lymphoma, but the sunbathing had no affect on Hodgkin's lymphoma.303 Our children need to play in the sun and enjoy sunbathing for optimal health. Good parents will ensure that their children participate in sunny activities regularly and safely, without using sunscreens (see Appendix 3). To protect against overexposure, simply return indoors, seek shade, cover up with hats and other clothing, and develop a good tan—as intended by nature.
Additional research, published in the journal Blood, has demonstrated a remarkable risk reduction of a group of cancers known as lymphoid malignancies, i.e. Non-Hodgkin's Lymphoma, multiple myeloma and classical Hodgkin's Lymphoma: The researchers measured exposure to the sun among residents in different geographic areas and compared the categories different categories of exposures to the risk of contracting these cancers.304
Those residents living in the areas with the highest quartile (fourth) of sun exposure, when compared with those in the lowest quartile, had a 43% decrease in the risk of Non-Hodgkin's lymphoma and a 64% decrease in the risk of one of its subcategories, known as diffuse large B-cell lymphoma. The risk of another subcategory, chronic lymphocytic leukemia, was reduced by 54%. Multiple myeloma was also associated with a reduced risk of 43% among those living in areas with the highest quartile of sun exposure. Interestingly, dietary vitamin D was not associated with the risk of these cancers. The researchers stated, "These results support a protective effect of routine residential UVR exposure against lymphomagenesis through mechanisms possibly independent of vitamin D."
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In perusing the research on many of the diseases we have discussed, we noted, as in the study above and as mentioned throughout this book, that vitamin D was effective for some diseases but only minimally effective, or not effective, for others. However, exposure to the sun or to other UV sources (such as sunlamps) was usually profoundly effective. Instead of just focusing on vitamin D as the main beneficial product of UV exposure, the authors of many of these studies could have also mentioned the effect of UV exposure on vasodilation, mediated by the skin's production of nitric oxide. They could also have discussed the influence of sun exposure on the production of beneficial serotonin and endorphin. Vitamin D is an exceptionally important product of sun, but it is not the only product. We predict that a whole new field of research, regarding other photoproducts of sun exposure, will soon emerge and will provide impressive new knowledge regarding the life-and-health-giving benefits of our most precious friend, the sun.
These findings are doubly important, since they indicate that sun exposure may have protective effects against cancers independent of its stimulation of vitamin D production in the skin, or that the type of vitamin D produced through sun exposure is superior to that obtained through food or supplements. It appears "Mother Nature knows best," and the sun's rays, one of God's greatest gifts to mankind, should not be ignored as powerful therapeutic and preventive therapy.
Melanoma and other skin cancers
This subject has been covered in the first section of this book, but bears repeating here in the cancer section for review. Sun exposure does associate with non-melanoma skin cancers which are rarely fatal, but regular sun exposure shows an inverse association to melanoma, the deadly skin cancer which takes many lives yearly: the more nonburning sun exposure, the less the risk of melanoma. Remember also the fact that was mentioned in the first section of this book: approximately 75% of melanoma tumors occur on relatively unexposed body sites.305
Research from the Netherlands states that a shift from daily sun exposure to intermittent exposure has correlated to an increase in skin cancer, including melanoma, and suggests that the best advice for preventing skin cancer is moderate, frequent sun exposure.306
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Interestingly, the paper mentions that circadian rhythm is affected by light and postulates that excessively low levels of light in the daytime, as well as excessively high levels of light in the evening and at night, can weaken and disrupt that rhythm, which could be a risk factor for some types of cancer and for metabolic syndrome. Such ideas have been studied previously, and have indicated that disruption of the circadian rhythm, due to night-shift work, may lead to increased risk of breast-and/or-colorectal cancer in women.307, 308 This disruption, compounded by another disruption due to dim light at night, results in reduced melatonin production, which leads to resistance to chemotherapy in breast-cancer patients.309 Melatonin supplements at night, however, increase the effectiveness of chemotherapy to normal.
From Australia's University of Sydney comes some of the latest research that contradicts one of the biggest lies of the past several decades—that melanoma is caused by sun exposure. The results of the investigation were recently published in the International Journal of Cancer, and demonstrated conclusively that regular sun exposure was not associated with either overall melanoma risk or with risk at various particular different body sites.310 To the contrary, the highest sun exposure predicted a 44% decrease in melanoma risk on the head and neck when compared to areas of the lowest exposure. In addition, when sun exposure to the upper limbs was assessed, the area exposed the most was associated with a 34% decrease in melanoma risk. The authors stated, "Our results suggest occupational sun exposure does not increase risk of melanoma, even of melanomas situated on the head and neck."
The authors would have been more accurate (but politically incorrect) had they stated that sun exposure is actually protective against the risk of contracting melanoma (rather than just saying that it doesn't increase the risk). In reading this research, I (Sorenson) was reminded of a statement by Dr. Frank Garland, during his presentation at a vitamin D conference I attended several years ago. He said, "Melanoma is a disease of sedentary, indoor office workers." He was absolutely correct.
It is also interesting that two older investigations demonstrated that UV exposure was associated with a dramatic reduction of skin cancer. One of these studies was done in 1988 and involved mice given a chemical protocol designed to induce skin cancer.311 Half of the mice were also given ultraviolet B (UVB) irradiation during that protocol. After 20 weeks of a cancer-initiation-promotion protocol, with two carcinogenic
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chemicals, there were 75% fewer cancerous tumors per mouse in the mice irradiated with UVB, compared with the non-irradiated mice.
The second study was reported in 1992. It demonstrated that 12 weeks of UV radiation, applied either before or during chemical initiation of skin cancer, resulted in 61% less skin cancer in mice irradiated before the chemical treatments, and in 50% less skin cancer in mice irradiated during the treatments.312
The message is this: Exposure to UV light from sunlamps or sunshine may actually protect against skin cancer development. These two older studies show that there's nothing new under the sun: Many of us have been promulgating that message for years, yet this research indicates that we were not the first to realize the cancer-preventive influences of the sun.
Another exceptionally important piece of research, conducted by Dr. Julia Newton-Bishop and her colleagues and reported in 2011, demonstrated that the greater the number of hours spent in the sun during weekends, the lesser the risk of melanoma.313 The researchers showed that people who spent 4-5 hours in the weekend sun had a 28% decrease in melanoma risk compared with those spending less than four hours in the sun. People who spent more than 5 hours in the sun had a 33% decrease in risk. It appears that the more sun one can soak up on the weekends, the greater is the protection against melanoma. The results of this

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Finally, and perhaps amazingly, the American Academy of Dermatology (AAD) has produced a paper on a seven-year study of vitamin D and melanoma.314 It compared serum 25(OH)D levels at the beginning of the study (also called baseline levels) with the risk of melanoma seven years later. After the seven-year period, those people whose baseline serum D levels were the lowest had a 500% increase in the risk of melanoma, compared with those whose levels were the highest. Of course, the high levels or low levels of vitamin D were due to sun exposure, which means that the AAD had suggested with its own research that sun exposure was prophylactic against melanoma. Imagine that! The AAD contradicting its own anti-sun propaganda by showing that sun exposure is marvelously effective in preventing melanoma! Unfortunately, this message is still largely ignored by most dermatologists, who are scaring people into buying sunscreen products that eliminate vitamin D production! The graph below illustrates the decreasing risk of melanoma with increasing levels of vitamin D.
Regardless of the mechanism by which sun exposure reduces the risk of melanoma, the evidence for the health benefits of safe sunbathing becomes clearer by the day. We believe that millions of lives could be saved yearly by recommending regular, non-burning sun exposure for the entire population (appropriate sunlamp exposure is needed when the sun is not available or insufficient - see Appendix 6: Practical Sun Replacement).

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Another benefit of moderate sun or sunlamp UVR exposure is that it actually reduces DNA damage in the skin: A 2016 article in Cancer Research Frontiers states that "regular exposure to UV leads to an almost complete disappearance of DNA damage in the basal and suprabasal layers of the epidermis, where the initiating of skin cancer occurs.”315 Another 2016 study, published in the British Journal of Dermatology, reviewed the impact of repeated low-level sunlight exposures on vitamin D status and DNA damage and repair in light-and brown-skinned individuals.316 The UVR doses were equivalent to 13-17 minutes of midday exposure in the UK. The study reported that these repeated low-level exposures did not result in any accumulated DNA damage, indicating that any damage was quickly repaired. Also, it showed that these exposures led to sufficient 25(OH)D levels in the participants. No wonder regular sun exposure is associated with less melanoma! However, there is another factor necessary for reducing both types of skin cancers, and that factor is nutrition.
Skin cancer and nutrition-stop blaming the sun!
In the rush by dermatologists and sunscreen companies to demonize sun exposure as the universal cause of skin cancers, there has been a total disregard for nutrition as an element that can strongly protect against skin damage, or strongly promote damage (leading to cancer development). What we eat, according to whether it is healthful or noxious, can have either profoundly positive or negative influences on the skin.
As an example, polyphenols are antioxidant phytochemicals that prevent free-radical damage and thus protect the skin. Polyphenols are prevalent in foods such as nuts, seeds, onions, green tea, pomegranates, apples, berries, cherries and other fruits. They are also found in grape seeds, vegetables and dried legumes and exist in such nutrients as resveratrol and silymarin (milk thistle extract). These nutritional superstars are able to reduce inflammation and quench oxidative stress. Therefore, they prevent free-radical damage to DNA, inhibit suppression of the immune system, and maintain the regulation of cellular signaling pathways, thereby reducing the potential for skin cancers.317, 318
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Particularly interesting is the fact that green tea extract, and other polyphenol-containing products such as grape-seed proanthocyanadins, have been shown to inhibit the formation of skin tumors. Two researchers, writing in the Archives of Dermatological Research, made the following conclusion after a thorough review of the literature regarding polyphenols and skin cancer: "Based on the epidemiological evidence and laboratory studies conducted using in vitro and in vivo systems, it is suggested routine consumption or topical treatment of these polyphenols may provide efficient protection against the harmful effects of solar ultraviolet radiation in humans."319
We might conclude that protective nutrition would include the consumption of green tea, some dark green vegetables such as broccoli, spinach and other deep greens, and the daily habit of eating dark berries, cherries, grapes and other such fruits. But there are other vegetables involved in the fight against skin cancer:
Some of the best skin protectants are tomatoes, which contain the antioxidant lycopene. One investigation showed that among individuals who consumed forty grams of tomato paste daily for ten weeks, sunburn-resistance time increased by 40%,320 and other research demonstrated that eating other tomato-based products correlated to significantly reduced risk of sunburn after exposure to ultraviolet radiation from sunlamps.321 It has also been shown that individuals with the lowest intake of alpha-carotene, beta-carotene, cryptoxanthin, lutein, and lycopene (all are carotenoid antioxidants found in such vegetables such as dark leafy greens, carrots and tomatoes) had a 50% increased risk for melanoma.322
There are several other scientific investigations demonstrating that high fruit and vegetable consumption predicts a lesser risk of skin cancer.323, 324, 325, 326 (The references cited here are just a few of those available).
One of those investigations studied the relationship between melanoma survival and fruit consumption.327 Melanoma patients who had their cancers removed—and who had a predicted death rate of 40% within 10 years—were assessed for consumption of fruit and red meat. Daily fruit consumption correlated to a 46% reduction in death risk. Those who ate red meat at least once weekly showed an 84% increase in death risk!
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Percent risk of skin cancer during 10 years, based on fruit and meat consumption
WEEKLY MEAT CONSUMPTION

-100	-50	0	50	100
Risk of skin cancer according to dietary intake
Voluminous research on many other cancers shows the same relationship between fruit, vegetable, and meat consumption and cancer: the higher the meat consumption, the higher the risk of death from cancer; the higher the consumption of fruits and vegetables, the lower the risk of cancer. Melanoma is no exception. Regular, nonburning sun exposure, coupled with the consumption of large quantities of fruits and vegetables, are the very best protection against cancers, although those are certainly not the only protective factors. Here are a few others with a protective influence:
Fish and vitamin consumption. A systematic review of case-control and cohort studies of dietary factors found a trend towards reduced risk of melanoma with consumption of fish and vitamins A, C, D, and E.328 These findings are in general agreement with many other studies regarding risk of various types of cancer and other chronic diseases. As with the other research mentioned above, fruit and vegetable consumption also showed a trend toward reduced risk. A case-control study on vitamin C alone, conducted in northern Italy, found that higher dietary vitamin C intake was associated with reduced risk of melanoma for women under the age of 60 years, especially for those with Fitzpatrick skin phototypes II and III.329
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Coffee. Certain kinds of coffee may also reduce the risk of melanoma. Higher coffee intake was associated with a 10-25% reduction of melanoma risk in the large cohort study conducted by the National Institutes of Health and the AARP.330 A meta-analysis of two case-control studies and five cohort studies found that the highest intake of caffeinated coffee was associated with a 19% reduction of melanoma risk in comparison with the lowest intake; but no effect was found for decaffeinated coffee.331 However, a large cohort study in the US, analyzing the effects of both caffeinated and decaffeinated coffee, has reported similar (beneficial) findings for overall mortality and most chronic diseases, but not for cancer.332 The authors suggested that coffee might reduce mortality (but not cancer rates) through effects on inflammation, lung function, insulin sensitivity, and depression.
We have presented the information on coffee and melanoma risk because it exists in sufficient volume in the scientific literature to warrant attention. Nevertheless, we do not believe that drinking coffee is healthful in all cases and would suggest that consuming coffee and other stimulants should be reduced or avoided. Similarly, there is also some indication that smoking reduces the risk of melanoma (because of its damage to collagen, aging the skin and making it resistant to the expansion of melanoma), but we would certainly not suggest that everyone start smoking to protect against melanoma. If that were to happen, the risk of lung cancer and other diseases would increase exponentially. Use the coffee information presented above as you and your medical professional see fit.
Grape seeds. Animal studies have found that grape seed proanthocyanidins can reduce the risk of skin cancer by inhibiting inflammation, rapidly repairing damaged DNA, and stimulating the immune system.333 Additionally, a narrative review published in the Journal of the American Academy of Dermatology found that "Grape seed proanthocyanidins, epigallocatechin-3-gallate, resveratrol, rosmarinic acid, lycopene, and fig latex have demonstrated clear anticancer effects toward melanoma."334
And what are dietary factors that increase the risk of skin cancer?
Alcohol consumption is one such factor. In one investigation, those persons who were in the highest quintile (fifth) of alcohol
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consumption were shown to have a 65% increase in melanoma risk.335 Another study showed a 250% increase in melanoma risk among those who consumed two or more alcoholic drinks per day.336
There are at least two other negative dietary habits correlating to increased skin-cancer risk: first, the highest dairy-product consumption has been shown to correlate to a 2]4-times increase in the risk of developing a non-melanoma skin cancer.337 Second, the types of fats we consume are exceptionally important:338 Fats we consume in junk foods (and even in cheap oils found within prepackaged foods sold in supermarkets and health-food stores) are deadly, both for overall health and for skin cancer. They are filled with free-radical molecules, which wreak havoc on the skin. If we eat such fats without ingesting massive quantities of colorful fresh fruits and veggies, we will be much more susceptible to skin damage and potential cancer.
To summarize: To the extent that sun exposure causes skin damage, it does so due to lack of proper nutrients in the diet. There is little doubt that some damage will be caused by sun exposure in the absence of proper nutrition. Since the nutrients that protect against so many cancers (including skin cancer) might not be able to completely overcome the deleterious effect of the "suicide diet" most of us consume, it behooves us to change our nutrition.
Additional factors which may increase melanoma risk:
PCB exposure
Polychlorinated biphenyls, or PCBs, are noxious, man-made chemicals used in insulating materials, lubricants, adhesives, paints and many other products. They have been banned or restricted in many countries because of risks to the environment and human health.339 Those with the highest levels of blood PCBs have 7-times the risk of melanoma compared to those who have the lowest levels.340
Moles (naevi)
Some very important research by Dr. Adele Green found that the strongest risk factor for both limb melanoma and trunk melanoma was the presence of more than 10 naevi (moles) on the arm, which predicted a 42-times increased risk of melanoma.341
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As we have seen previously, there are many possible causes for melanoma, including nutritional status, alcohol use, and toxicity. Excessive sun exposure, while the skin is nutritionally unprotected and/or attacked by toxic agents and free radicals, can result in cumulative skin damage that might develop further into carcinoma, but usually not melanoma (the highly exposed face, where carcinoma is very common but melanoma is uncommon, is a good example of that). The same cumulative skin damage, in addition to genetic tendency, may be responsible for the formation of moles, which increase melanoma risk statistically because of the high concentration of melanocytes within them.
Sildenafil, a surprising newcomer to the melanoma equation
Sildenafil, also known as Viagra, is a drug used for erectile dysfunction (ED). Sildenafil increases the invasiveness of melanoma cells, which may raise the risk of melanoma's morbidity and mortality, according to a prospective study beginning in 2000 and reported in 2014.342 This investigation found that recent use of Viagra was associated with an 84% increase in melanoma risk, while long-term use of the drug was associated with a 92% risk increase. Among those who had no major chronic diseases at the beginning of the study, melanoma risk was 124% higher in those who had recently used the drug and 177% higher among those who had used the drug long-term.
Noxious chemicals have many side effects, but who would have guessed that a drug for ED would increase the risk of melanoma? Remember, we have previously presented information showing that melanoma is not caused by regular sun exposure, and that UVR actually reduces melanoma risk. Solar exposure has also been found to prevent ED.343 Therefore, sunbathing, and sunlamps where necessary, are better choices for both melanoma prevention and ED prevention.
Human Papillomavirus
Human papilloma virus (HPV) may cause a skin infection leading to both melanoma344, 345 and common skin cancers.346
Obesity
Obesity causes inflammation in many body systems, and inflammation is known to correlate closely with various cancers.347,
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348 It has now been shown that there is an association between melanoma and obesity,349 and it is interesting that the increases in both diseases have progressed in unison.350
Important thoughts on melanoma by Dr. Arthur Rhodes
Dr. Arthur Rhodes, a professor of dermatology at Rush Medical College, states that blaming the sun as the only cause of melanoma can be a deadly misconception.351 He also states that the dermatology profession's message—that sun exposure is the only cause of melanoma—is killing many people. He gives several examples of death resulting from that deadly misconception:
1.	A dermatology trainee died of melanoma at age 28. He watched a mole change in his armpit for years, but because the area had never received UV light, he assumed it was not melanoma and delayed seeking help.
2.	A 40-year-old woman had a sore on the bottom of her heel, but believing that only sun exposure caused melanoma, she had no idea she was at risk. She died three years later.
3.	A Harvard-trained lung specialist ignored a sore on his upper back. He and his fiancee, a Harvard-trained pediatric resident, observed the change for several years without having it examined. They didn't know that melanoma could occur in an area that was never exposed to the sun. He died six months after diagnosis at age 29.
Here is a quote from this enlightened dermatologist:
"If a medical resident can misinterpret public health messages about sun exposure and melanoma, and two Harvard-trained physicians were ignorant about the most important risk factors for developing melanoma, then the general public will tend to make the same potentially fatal mistakes. Those mistakes lead to delayed diagnosis of this potentially lethal cancer—particularly when we pound out the message that the culprit in melanoma is sun, sun, sun, and are not sufficiently emphasizing the most important risk factors for developing melanoma."
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Continuing with other cancers:
Multiple Myeloma
Multiple Myeloma is a cancerous proliferation of plasma cells in the bone marrow, causing numerous tumors, and characterized by the presence of abnormal proteins in the blood.
The aforementioned analysis in Spain, using NMSC as a marker for sun exposure and demonstrating the sun's protection against multiple types of cancer, also listed multiple myeloma as a cancer inversely correlated to sun exposure.352 In other research, the risk of multiple myeloma was reduced by 43% among those living in areas with the highest quartile (fourth) of sun exposure.353
Oral cancer
Although little is known about the relationship of sun exposure to oral cancer, one investigation shows an inverse association between sun exposure and this disease.354
Pancreatic Cancer
Australian researchers demonstrated that for each 10% increase in sun exposure there was a 1.5% decrease in risk for pancreatic cancer.355 Other investigators also showed an increased risk of pancreatic cancer in subjects who had low estimated annual residential sun exposure compared to those with moderate to high exposure.356 Still others showed an inverse correlation between higher "predicted" 25(OH)D levels and pancreatic cancer.357 Predicted 25(OH)D levels are related to oral vitamin D intake plus geographical location, recreational time spent out of doors, and skin pigmentation.
A pooled analysis of five prospective cohort studies found that 25(OH)D levels were inversely correlated with pancreatic cancer incidence. Those with 25(OH)D levels above 57 nmol/L [23 ng/ml] had about a 30% lower incidence of pancreatic cancer compared to those with 25(OH)D levels lower than 46 nmol/L [18.4 ng/ml].358
A recent paper examined whether vitamin D could be considered causally linked to reduced risk of pancreatic cancer using Hill's criteria for causality in a biological system.359 The criteria important for vitamin D include strength of association, consistent findings in different populations, temporality, biological gradient, plausibility (e.g., mechanisms), experiment (e.g., clinical trial), and analogy.360 Using these criteria, the authors of the paper determined that low vitamin D levels contribute to pancreatic cancer.
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Subsequently, a paper from Turkey presented findings regarding overall survival rates for patients diagnosed with pancreatic cancer in two regions: Antalya state-with more sunlight and warmer climate, and Alyhon state-with lower sunlight and colder climate. The difference in sunlight duration was about an hour per day. Those in Antalya had significantly better survival probabilities, especially when diagnosed with stages I, II, or III pancreatic cancer.361
Dr. Grant, in research conducted on Spanish cancer rates compared to UVR exposure rates, also found that greater sun exposure predicted lower rates of pancreatic cancer.362 Similarly, Dr. Grant found that higher sun exposure-based on geographic regions at lower latitudes—correlated to a lower risk of pancreatic cancer and several other cancers.363 In a paper from Japan, which employed climatic data from the Japan Meteorological Agency, it was shown that low sun exposure was significantly related to decreased risk of pancreatic cancer.364 Additionally, a study of cancer incidence with respect to occupation in Nordic countries found that higher UVB exposure was associated with a reduced risk of pancreatic cancer.365 Finally, in an impressive study from Queensland, Australia, researchers used several measures to determine sun exposure and then compared it to pancreatic cancer risk.366 The results showed that being born in or living in areas of higher ambient ultraviolet radiation (sun rays), was associated with about 30-40% lower risk of pancreatic cancer.
Pharyngeal Cancer
Although an early study showed that pharyngeal cancer incidence was higher in areas of high sun exposure (see Chapter 2), the latest research demonstrates that it has an inverse association with sunlight exposure;367 the higher the exposure, the lower the risk of the cancer.
Prostate Cancer
Dr. Esther John and colleagues compared the lifetime sun exposure of 450 white men with advanced prostate cancer to that of 455 white men without the cancer.368 The men were divided into quintiles (fifths) according to the amount of sun exposure they had received.
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Subjects at the highest quintile of sun exposure had only 51% of the prostate cancer risk found in subjects at the lowest quintile. Similar results were obtained in a much earlier study by Schwartz and colleagues.369 Several additional studies have shown that high sun exposure over a lifetime relates to a considerably lower rate of death from prostate cancer.370, 371, 372
Other researchers used childhood sunburn as a measure of UVR exposure and determined that men who experienced sunburns as children had only about one-fifth the risk of contracting prostate cancer as those who had not sunburned!373 A note of caution: We are not recommending for anyone to sunburn as a method to prevent prostate cancer or other types of cancer (but it's nice to help people relax and eliminate the fear they've been induced into about their childhood sunburn!). Sunburn was used in this research to predict higher 25(OH)D levels, but sunburn is not necessary to achieve those levels, since non-burning sun exposure achieves at least the same results. This research also demonstrated that men with the lowest UVR exposure had more than three times the risk of prostate cancer, while the onset of the disease was delayed more than four years in those who had the greatest exposure compared to those who had the least exposure. A follow-up to this study, mentioned within the same paper, showed that men in the lowest quartile of sunbathing had a 5.3-fold greater risk of prostate cancer compared with men in the highest quartile. Still other research has indicated that "higher levels of cumulative sun exposure, adult sunbathing, childhood sunburn and regular sunny holidays in hot climates were each independently and significantly associated with a reduced risk of this [prostate] cancer."374
Norwegian researchers have also demonstrated an inverse correlation between prostate cancer and sun exposure when they compared death rates from prostate, breast and colon cancer in relation to the season in which these cancers were diagnosed.375, 376 Over a period of 36 months, study subjects whose cancers were diagnosed during summer and fall (times of the greatest sun exposure and vitamin D production) had much lower death rates than those diagnosed in winter and spring.
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Another indication of the sun's influence on prostate cancer is research done on prostate specific antigen (PSA). Generally, the higher the PSA level in the blood, the greater is the risk of prostate cancer. When the prostate gland is undergoing changes leading to cancer, PSA levels usually rise. Men with the lowest levels of lifetime sun exposure have higher PSA levels than those with the highest levels of sun exposure.377
However, a recent meta-analysis of previous studies of serum 25(OH)D levels and prostate cancer showed no relationship between prostate cancer and vitamin D.378 The reason for the discrepancy (a significantly lowered risk of prostate cancer with higher sun exposure, but not with a high serum vitamin D level) is yet unknown. Science is always evolving—and we have seen that updated research methods have changed the results obtained in older studies. It is probable that the beneficial influence of sun exposure on prostate cancer goes beyond its stimulation of vitamin D production in the skin. From the above research, it appears that sun exposure is the safest and surest way to reduce the risk of prostate cancer. However, some research indicates that too much sun exposure may be counterproductive, thereby clouding the picture. The paragraph below, by Dr. Grant, provides the details and explains the dilemma. For our purposes, the term UV exposure means sun exposure.
Thoughts on prostate cancer and UV exposure by William B. Grant
There is confusion over whether UV exposure reduces the risk of prostate cancer (PC). Gary Schwartz hypothesized that UVB exposure reduced the risk of PC after looking at the geographical variation of PC mortality rates in the US for white and black Americans; rates were higher in the north and blacks had higher rates than whites.379 His paper was followed by a more detailed analysis.380 However, UVB doses increased from northeast to southwest while prostate cancer rates increased from southeast to northwest. This was not the same as colon cancer, the type of cancer with the strongest reduction by solar UVB radiation.381 Hanchette and Schwartz noted that a possible confounder was age, but did not consider it important. Schwartz began to have some doubts about his hypothesis in 2013, stating that "Prospective studies of serum 25(OH)D do not support a protective role for higher levels of 25(OH)D on prostate cancer risk overall, but a role for vitamin D deficiency is supported by several studies."
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Indeed, a growing body of evidence implicates low levels of 25(OH)D with an increased risk of fatal prostate cancer."382 Schwartz also suggested that there might be critical periods in life when UV exposure is more important, and that calcium intake and serum levels might play important roles. The most likely explanation for a beneficial effect of UV exposure would be vitamin D production. However, prospective studies indicate that both low and high 25(OH)D concentrations are associated with increased risk of PC incidence.383, 384 It's important to note that low 25(OH)D concentrations seem to be associated with increased risk of advanced PC, rather than localized PC.385 In one case-controlled study, the high UV doses of New South Wales, Australia, were associated with increased risk of PC in that region.386
Also, observational studies of prostate cancer incidence do not find any significant difference in prostate cancer incidence between men with high and low vitamin D levels, an index of solar UVB exposure.387 A reason for this finding may be that calcium is a risk factor for prostate cancer.388
It was recently realized that the effect of age in the form of life expectancy had been overlooked in the ecological analyses by Schwartz.389 A paper published in 2006 shows that the average life expectancy for white males in 1997-2001 was 65-73 years in the southeast and 76-80 years in the northwest.390 Normally cancer mortality rates are given in age-adjusted form by five-year groupings, but since PC death rates rise so rapidly with increasing age, this approach does not give accurate values. The conclusion is that moderate regular solar UV exposure may reduce the risk of PC, but too much may increase the risk of localized (non-advanced) PC.
Does shift work play a part in increasing prostate cancer?
In a letter to the editor of the International Journal of Cancer, Dr. Grant summarizes research indicative of the deleterious effects of shift work on prostate cancer and suggests that low UVB exposure may be a reason for the association.391 He points out, as we have in this section on prostate cancer, that exposure to UVB (primarily sun exposure) is associated with a lower risk of the disease. Obviously, shift workers often sleep during the day when the UVB portion of solar radiation is available, and they are otherwise exposed to very little sunshine. They therefore are deprived of the cancer-preventive influence of the sun, which would otherwise be available. Shift workers should be sure to find a time during the day to safely enjoy the sun, not only for prevention of prostate cancer, but for several other types of cancer closely associated with night-shift work.392
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Moderate, regular sun exposure is a protector against prostate cancer.
Thyroid Cancer
This is another cancer that Dr. Grant's analysis in Spain, using NMSC as a marker for cumulative solar irradiation of the skin, listed as being inversely correlated to sun exposure.393 Another study compared sun exposure with cancer incidence and deaths in the US, and found an inverse relationship with thyroid cancer in women (the greater the sun exposure, the lower the rate of thyroid cancer).394
Lung Cancer
Research on African Americans has demonstrated a lower risk of lung cancer in the southern states than northern states, even though smoking habits are similar in both geographic locations.395
Further confirmation of a preventive effect of sun exposure on lung cancer was found in studies by Dr. Zhou and colleagues, who compared survival rates of lung-cancer patients with the season of cancer diagnosis or surgery. It was found that lung cancer patients whose surgery or diagnoses occurred in summer, when sunlight is more prevalent, had better survival rates. The researchers stated, "Patients who had surgery during summer had better recurrence-free survival (RFS) than patients who had surgery during winter."396 The same relationship exists when lung-cancer season of diagnosis is compared with the fatality rate: Those diagnosed in the fall have a lower death rate than those diagnosed in winter.397
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What have we learned?
1.	There are 19 major cancers listed in this chapter, all of which are associated with insufficient sun exposure:
a.	Breast cancer
b.	Ovarian cancer
c.	Endometrial cancer
d.	Colon cancer
e.	Bladder cancer
f.	Brain cancer
g.	Esophageal cancer
h.	Gallbladder cancer
i.	Renal (kidney) cancer
j.	Leukemia
k.	Lymphoma
l.	Melanoma
m.	Multiple myeloma
n.	Oral cancer
o.	Pancreatic cancer
p.	Pharyngeal cancer
q.	Prostate cancer
r.	Thyroid cancer
s.	Lung cancer
2.	Many of these cancers also have a close association with low 25(OH)D levels. However, a few others don't seem to have such an association.
3.	It is a mistake to think that either optimal sun exposure or optimal 25(OH)D levels are the answers to curing cancer. Nutrition is vitally important and there are other environmental factors playing a part. Sun exposure, however, is a vital factor in helping to prevent the cancers discussed in this section.
From the information presented in this chapter on cancer, it appears regular sun exposure is one of the best cancer prophylactics available. But can it also reduce the risk of heart disease, our number 1 killer?
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Chapter 6.
Preventing Diseases of the Heart, Brain and Vascular System: The Vital Need for Sun Exposure.
"You can make the pathway bright; fill the soul with Heaven's light, if there's sunshine in your heart."
—Church Hymn
Ischemic Arterial Diseases (also called vascular diseases):
These diseases are caused by atherosclerosis, a blockage of arterial blood flow, which is brought on by a poor diet, lack of exercise, and inflammation due to disease conditions. These problems are worsened by a lack of sun exposure. However, no one should misconstrue that a paucity of sun exposure is responsible for ischemic diseases. These diseases are primarily caused by the consumption of too much detrimental fat, including rancid vegetable oils and hydrogenated fats,398, 399 and dietary sugar,400, 401 and they are exacerbated by inflammation due to infectious diseases.402, 403, 404 Sun exposure simply acts as an antidote for the poisons consumed.
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Ischemic diseases can occur in all arteries, although they are often thought of as a heart or brain malady due to the inordinate number of heart attacks and strokes caused by atherosclerosis. There are other diseases of atherosclerosis, however, which we will cover in this section. Ischemic heart disease, stroke and peripheral artery disease are atherosclerotic disorders of the arteries and are also known as cardiovascular diseases (CVD).

Ischemic heart disease—this is the number-one killer in the USA.
Most heart diseases and other vascular diseases are due to a gradual occlusion (closing) of the heart arteries by calcium and a substance called oxidized cholesterol, which forms a deposit called a plaque. A plaque may burst, blocking the narrowed area, or fat-laden blood may clot in that area, halting blood flow and preventing oxygen delivery to the tissue. When this happens in the coronary arteries of the heart, a heart attack, or myocardial infarct, occurs, cutting off the oxygen supply to the heart. If the infarct is too large and not cared for immediately, death ensues.
Stroke: If this same scenario occurs in the brain, a stroke results.
As we have already presented, UVB is a spectrum of sunlight with many effects, including the suppression of inflammation in the skin, and thus has been used to very successfully treat skin diseases such as psoriasis and eczema (see the sections on those diseases).
Since inflammation is necessary to produce the condition of atherosclerosis, it would be interesting to know whether UVB light might also have the same anti-inflammatory effects in the arteries. If so, the UVB light could inhibit or reduce atherosclerosis, and by so doing provide an entirely new treatment and prevention against heart disease and other vascular events such as stroke and intermittent claudication.
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The idea that UVB could prevent atherosclerosis by reducing inflammation in arteries was recently studied by Japanese researchers.405 Using a mouse model, they demonstrated that UVB light irradiation, applied once a week for 14 weeks, leads to an increase in the action of T-regulatory cells, thereby inhibiting inflammation. In addition, UVB exposure reduced the production of another type of T-cell which is pro-inflammatory, and thereby proatherogenic (leading to the production of atherosclerosis). These two effects of UVB light reduce the development and progression of atherosclerosis. Stated differently, the research shows that sun exposure is a critically-important therapy to reduce and prevent diseases of the heart and blood vessels. Protect vour heart bv being sure to obtain sufficient non-burning UVB light from sun exposure or
other sources such as UVB lamps, which were used bv the researchers. It is also important to note that neither skin cancer nor skin inflammation were observed following UVB exposure in this breakthrough study, which again emphasizes the importance and safety of UVB exposure for human health.
Peripheral arterv disease: If the arteries of the limbs are occluded, the disease is called peripheral artery disease (PAD), which can result in a condition known as intermittent claudication, causing terrible pain during walking-due to oxygen deprivation in the muscles.
Numerous papers have demonstrated a correlation between inadequate UVB exposure or inadequate 25(OH)D levels and coronary heart disease and strokes, which are here considered together. 25(OH)D levels, of course, are usually a surrogate measurement for sun exposure.
Researchers found that those below the median level of serum vitamin D suffered 57% more heart attacks than those whose levels were above the median.406 They also noted that the greatest number of heart attacks occurred in winter and spring, times of lowest serum 25(OH)D levels due to lack of vitamin D-producing UVB light. Others compared the risk of stroke and heart attack with serum-25(OH)D levels and found a 62% risk increase in those with the lowest levels compared to those with the highest levels,407 and still others determined that men whose serum levels of 25(OH)D were less than 15 ng/ml [38 nmol/L] had nearly 2.5 times the risk of a heart attack as those whose levels were above 30 ng/ml [75 nmol/L].408
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A report presented at an American Heart Association (AHA) conference in Orlando, Florida regarding a two-year study on the effects of serum 25(OH)D levels in CVD patients at a hospital in Utah, was enlightening.409 It showed that patients whose levels were the lowest were 77% more likely to die during the two-year study period, 45% more likely to develop coronary artery disease, 78% more likely to have a stroke, and twice as likely to suffer heart failure. Remember, when discussing people who have the highest levels of 25(OH)D, we
are speaking of those who have the highest exposure to the sun.
Other research indicates that sun exposure in summertime among gardeners correlates to lower cholesterol levels and decreased risk of heart attack.410 HDL cholesterol is considered to be protective against heart disease, and LDL cholesterol is considered to be a risk factor. A study in Chile showed that HDL decreases in the winter, and LDL is significantly higher in winter/spring than in summer.411 A study on seasonal variations in heart attack rates in Brazil demonstrated a 30% higher risk in winter than summer in those 75 and older.412 Many other research papers are indicative of an increase in heart disease death in the winter.413
A Canadian investigation revealed that during the month of January there was an 18.6% higher death rate from myocardial infarction and a 19.9% higher death rate from stroke, in comparison with the month of September.414 Another investigation of sun exposure and stroke demonstrated that those who were least exposed to the sun were 61% more likely to experience a stroke.415
Outdoor temperature, which is usually another surrogate for sun availability, has been shown to associate to CVD as well. A Chinese study of 23,000 individuals found that when temperatures were below 5°C, for each 10° centigrade decrease in outdoor temperature, there was a 6.2 mm/hg higher systolic blood pressure.416 Further extrapolating their results to CVD, they found that each 10mm/hg increase in SBP predicted a 21% increase in the risk for CVD death.
CVD death was also 41% higher in winter than summer, again indicating that a lack of sun exposure could have been a major player in increasing the death rate. It might be thought that winter flu epidemics were responsible for the higher CVD death in winter, but other research clearly shows that the relationship between cold weather and CVD mortality remains valid regardless of whether flu epidemics occur.417
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Research done in New York State reveals an association between the winter season and hospitalizations for ischemic heart disease, especially heart attacks:418 25(OH)D levels are lower in the winter, which could be one cause, and the lack of nitric oxide production as a result of staying indoors could be another cause.
A study in Buenos Aires investigated the monthly frequencies of diverse diseases, including CVD, which led to emergency calls. The researchers compared these disease frequencies with the season and with several meteorological variables. They found that season, rather than temperature, was the apparent explanation for the winter peaks in emergency calls.419
In higher latitudes, there is a shorter season during which sun exposure is available.420 A review of latitudes and rates of CVD in the British Isles demonstrates that CVD occurs much more frequently at higher latitudes:421 Those who live in northern Scotland have twice the rate of CVD as those who live in southern England. Those who live in the more central Midlands, Wales and northern England have intermediate rates. All of this research points to a major prophylactic effect of sun exposure on cardiovascular disease, whether wholly mediated through vitamin D production in the sun-exposed skin, or whether partially mediated through other beneficial influences of the sun such as nitric-oxide production. In some regions, at higher latitudes there is increased cloudiness, which may also have an effect.
Altitude also has an influence on the quantity of UVB (the portion of the sunlight spectrum that stimulates vitamin D production) arriving from the sun, with high altitudes receiving more UVB. For example, The National Weather Service in Flagstaff, Arizona states that there is a 4%-5% increase in UVB per 1,000 feet elevation gain.422 UVB increases about 4% per 1,000 feet elevation gain near sea level, but it increases 8-10% per 1,000 feet elevation gain at altitudes over 8,000 feet. Also, higher altitude leads to increased UVB availability in late fall and winter.423 In one study, it was found that as altitude increased, CVD in men decreased.424 Men who lived at less than 4,000 feet altitude suffered most from CVD. Those who lived in the 5,000 foot range had 98% of the CVD rate of those living at 4,000 feet or below; for those living in the 6,000 foot range the CVD rate decreased to 90%; in the 7,000 foot range it decreased to 86%, and it was further decreased to 72% at 8,000 feet. Other research showed similar results, with higher altitudes correlating to a 14% reduction in the risk of stroke.425
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In a large study of dialysis patients, comparing the risk of cardiovascular events to altitude, it was found that patients living at an altitude greater than 6,000 feet had a 31% decrease in the risk of myocardial infarction (heart attack), a 27% decrease in the risk of stroke, and lower risk of CVD death when compared to those living at sea level.426 Other investigations have showed similar results among dialysis patients.427 And a Swiss study demonstrated an impressive decrease in mortality (death) from coronary heart disease and stroke with increasing altitudes:428 Mortality from heart disease decreased by 22% for each 1,000 meters of altitude gain, whereas stroke mortality decreased by 12% for each 1,000 meters gained. The researchers also stated that being born at high altitude had an additional and independent beneficial effect on coronary heart disease mortality.
There is, however, another reason for the association between altitude and decreasing disease. Particulate aerosol loading of the atmosphere also decreases with increasing altitude, and small particles, called PM 2.5 (diameter <2.5 microns), are an important risk factor for CVD.429, 430 The mechanism seems to be that PM2.5 increases inflammation.431
Sun exposure protects against heart attacks even when vitamin D is not increased. Researchers analyzed the records of first-time heart-attack patients and found that their chance of survival varied according to whether they were placed on the north (dark) side of the hospital or on the south (sunny) side-survival rate on the sunny side was about 25% higher!432 It is unlikely that the positive relationship between sun exposure and survival of heart disease patients in this study was facilitated by vitamin D, since vitamin D-producing UVB is filtered out by window glass.433 Nitric oxide, a vasodilator, is the likely photoproduct that provided the most protection against heart attacks. The production of nitric oxide is stimulated by UVA, which is not filtered by window glass.
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A word about statin drugs: Cholesterol-lowering drugs known as statins are some of the most popular drugs in the world, and their use is a $20 billion per year industry. But they have a problem: Their side effects are legion, and these drugs are associated with an increased CVD risk in women. A recent paper summarized the problems with statins: "There is a categorical lack of clinical evidence to support the use of statin therapy in primary prevention. Not only is there a dearth of evidence for primary cardiovascular protection, there is ample evidence to show that statins actually augment cardiovascular risk in women, patients with diabetes mellitus and in the young. Furthermore, statins are associated with triple the risk of coronary artery and aortic artery calcification"434
Common sense and science agree that instead of statins, it's better to use sun exposure and a good diet to prevent CVD.
Chronic high blood pressure (hypertension)
Blood pressure is determined by the amount of blood the heart pumps and the amount of resistance to blood flow in the arteries. The more blood the heart pumps and the tighter the arteries, the higher the blood pressure.435 Chronic high blood pressure, or hypertension, can damage arterial walls and can eventually lead to an increased risk of heart disease, heart failure, other arterial diseases, kidney disease, irregular heart rhythms, osteoporosis, cognitive dysfunction, painful intercourse and stroke.436 Conventional textbook theory holds that blood pressure is regulated by the brain, blood vessels, or kidney, but recent evidence suggests it could be regulated in the skin, and sun exposure plays a role in controlling the condition.437 Hypertension is defined as having a blood pressure greater than 140/90 mm/Hg, and 31% of US adults are hypertensive.438
One of the earlier studies of hypertension and sun exposure showed that hypertension increased linearly at increasing distances from the equator.439 One study of hypertensive subjects shows that blood pressure levels average 165/90 in winter but 134/74 in the summer, and both stroke and heart attack rates double in the winter.440 Even in children, blood pressure is higher in winter than summer.441 This, of course, is indicative of a protective role of sun exposure on hypertension.
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UVB light treatments with sun lamps have also been shown to substantially lower blood pressure within 24 hours, and to raise serum 25(OH)D levels by 162% within six weeks, while lowering both systolic and diastolic pressure by six points.442
The sun's rays stimulate the production of vitamin D, and vitamin D lowers blood pressure by blocking the action of the enzyme renin, which if unblocked, profoundly raises blood pressure.443 Research dramatically showed that men who had the lowest levels of serum vitamin D also had 6.1 times the risk of developing hypertension. In women, the lowest vitamin D levels related to a 2.7 times increased risk.444 Of course, we already know that nitric oxide (NO), produced by the skin after exposure to the UVA, reduces blood pressure as well, so another important agent of protection in this study was probably NO, and the higher blood pressure was likely a surrogate for sun deprivation (see the discussion on nitric oxide below).
Blood pressure rises with age almost worldwide, although there are exceptions. The blood pressure of the Kuna Indians, who live in isolated islands off the coast of Panama, does not rise with age445 unless they move to the city—in which case the rate of hypertension in elderly Kunas is greater than 60%.446 In their native islands Kunas have absolutely no hypertension whether they were 20, 30 or 60 years old. Urban living takes people indoors and puts them in an area of greater pollution—pollution which filters out the sun's rays. Of course, diet tends to change when people become urbanized, but considering UVR exposure is proven to maintain healthful blood pressure levels, it is a safe assumption that a significant part of the change for urbanized Kunas is reduced sun exposure. Urban vs. rural dwelling has correlated to a rise in both CVD and blood pressure in several other research projects studying subjects from Africa447 and India.448 Also, when researchers studied other relevant factors—such as the amount of clothing worn, type of work done, and amount of time spent indoors—they found that all these support the idea that lack of sun exposure is a strong risk factor for hypertension.449
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It is important to again mention that aside from vitamin D, there is another significant player in the relationship between hypertension, CVD and sun exposure. Ultraviolet A (UVA) radiation stimulates the skin to release nitric oxide (NO) from pre-formed stores of NO in the skin. NO is a potent vasodilator, and when released into the arteries by UVA stimulation, it causes increased blood flow in the blood vessels. This lowers blood pressure.450, 451 Dr. Oplander and his colleagues wrote the first paper on UVA, NO and blood pressure in 2009,452 and Dr. Richard Weller has been a leader in doing research and granting interviews on NO since that time. He has made two interesting statements: (1) "We suspect the benefits to heart health of sun will outweigh the risk of skin cancer. The work we have done provides a mechanism that might account for this, and also explains why dietary vitamin D supplements alone will not be able to compensate for lack of sun."453 ( 2) "Although the benefits of sun are often attributed to vitamin D, a gas called nitric oxide is also important. Made when the sun hits our skin, nitric oxide lowers blood pressure when it enters the bloodstream. Although the reduction is small, it could make a big difference."454
A recent study from China demonstrates that sun exposure correlates to a lowered risk of hypertension:455 In a randomly selected population of Chinese residents from Macau (where the rate of hypertension is very high), the following risk factors for hypertension were assessed: Lack of sun exposure, low intake of fish, smoking, obesity and lack of exercise. An average of more than one-half hour of sun exposure per day, as compared to no sun exposure, predicted a 40% reduced risk for hypertension. Oily fish consumption more than four times per week, compared with less than four times per week, predicted a 60% reduced risk; daily moderate physical activity-compared to no physical activity-predicted a 20% reduced risk; being obese compared to normal weight predicted 4.6 times the risk of hypertension, and heavy smoking predicted 1.4 times the risk.
Hypertension is a major risk factor for heart and other vascular diseases, which are the number-one killers in western societies. Isn't it time we made a few lifestyle changes to profoundly reduce the risk of these diseases? Frightening the people out of the sun, along with the move to indoor living, has been an unmitigated disaster. We need to once again learn to enjoy safe, non-burning sun exposure.
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Having discussed the relationship of major cancers and heart disease to sun deprivation, it is important to mention a paper by Dr. Grant estimating that by doubling the dose of sun exposure, 400,000 lives could be saved yearly in the USA, with most of the reduction in mortality due to lives saved by lesser incidence of cancer and cardiovascular disease.456 In addition, Carole Baggerly and her colleagues have estimated that approximately 336,000 lives could be saved annually by bringing 25(OH)D levels to 40 ng/mL [100 nmol/L].457 Their analysis listed the following diseases as those which would be most profoundly reduced by increased levels of 25(OH)D:
Cardiovascular disease (CVD)-reduced by 180,000; colorectal cancer-by 20,000; breast cancer-by 12,000; other cancers-by 70,000, and Alzheimer's disease-by 15,000. This is a good assessment, provided that UVR exposure and not just vitamin D supplements would be enhancing the levels of 25(OH)D. As discussed in the section on CVD, it appears that nitric oxide is the primary photoproduct that reduces CVD.
Erectile dysfunction (Ed) Part 1 (see part 2 under sexual performance and fertility)
ED is considered one of the major predictors of CVD,458, 459, 460 and although some experts consider it to be of psychological (and therefore neurological) origin,461 erection is a mostly a vascular event462 and ED is, to a great extent, an ischemic vascular disease similar to heart disease. Nevertheless, it also is associated with a higher risk of other maladies such as respiratory, gastrointestinal, endocrine and inflammatory disorders.463 ED is no laughing matter, as recent research has demonstrated that the condition predicts a profoundly increased risk not only of CVD, but of death in general:464 A 12-year study showed that men with ED had a 70% increase in allcause mortality, compared to men without the condition. We believe that (as in many other degenerative diseases) the consumption of junk food ends up plugging the arteries and wreaking havoc on all body systems. At our former health resort, we have had several men report that after using our nutrition program and obtaining sun exposure, their ED problems disappeared. Based on the science available, it is our opinion that ED originates predominantly with noxious nutrition, and sun exposure can offer a partial solution for the condition. As important as the sun is, it should not be considered a cure. Only a healthful diet (as well as addressing the other possible causes) can reverse the disease. Nevertheless, let's delve into the helpful effects the sun brings—effects provided by NO stimulation to the arteries.
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The vascular part of the ED problem lies in two cylindrical arteries or chambers called the corpus cavernosa. When these chambers become occluded and inflexible, they do not allow blood flow into the penis, making erection impossible. Nitric Oxide (NO), upon stimulation by the nervous system, causes vasodilation in the cavernosa, allowing them to open and receive blood. As stated in the online journal, Concepts in Biochemistry, "Achievement of a penile erection in males is largely an application of basic principles of hydraulics. Stimulation of the nerves innervating the penis causes the dilation of the deep arteries supplying blood to the penis. The large amount of blood entering the penis engorges the corpus cavernosa blood sinuses comprising much of the penis volume. This engorgement in turn acts to compress the veins draining blood from the penis. The increased inflow and decreased outflow of blood causes an erection. Cessation of nervous impulses to the penis acts to abolish the erection."465
An early study assessed the effect of ultraviolet light (UV) exposure on cavernosal strips, which were obtained from men during penile prosthetic surgery.466 The strips showed relaxation in response to UV, and the relaxation increased with the duration of exposure. We expect that sunbathing, which would profoundly increase NO in the circulation, would also allow erection. The same nitric-oxide mechanism that lowered blood pressure, as discussed in the previous section,467 would seem to be a good method to treat ED.
Another indication that sun exposure can play an important role in treating ED, is the fact most men with ED have low 25(OH)D levels.468, 469 But we already know that low 25(OH)D levels are a surrogate measurement for low sun exposure, and therefore a large part of the problem may be a lack of nitric oxide production!
Peripheral Artery Disease (pad)
Most research assessing PAD in relation to sun exposure is, in fact, research on 25(OH)D levels, which are surrogate measurements for sun exposure, as previously mentioned. The most recent research at the time of this writing shows that in vitamin D-deficient diabetics, the risk of PAD is about 70% higher than among those with normal levels.470 Other research has determined that those with serum-25(OH)D levels lower than 18 ng/ml [45 nmol/L] have twice the risk of PAD as those with levels over 29 ng/ml, [73 nmol/L] and that each 10 ng/ml [25 nmol/L] decrease predicts a 29% increase in PAD.471 More sunlight = more vitamin D = less PAD. Of course, NO may also be a player in this equation due to its vasodilatory effects.
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Cardiovascular disease (CVD): The role of UV exposure and vitamin D: A summary statement by Dr. Grant
Despite the fact that higher 25(OH)D levels are nearly always found to be associated with reduced risk of cardiovascular disease472 and associated diseases such as diabetes mellitus,473 randomized controlled trials have not found that vitamin D supplementation reduces risk of cardiovascular disease.474 Therefore, 25(OH)D levels may be a surrogate measurement for sun exposure, meaning other photoproducts such as nitric oxide (NO) may be responsible for the lowered risk of CVD. A pair of recent papers reported that leisure-time or recreational outdoor physical activity was significantly associated with reduced risk of cardiovascular disease. In a study in the US, both frequency and intensity of outdoor activities were associated with reduced risk, as was higher 25(OH)D level.475 When 25(OH)D levels were removed from the equation, an inverse association was found between outdoor recreational activity and mortality. The authors stated the following: "The underlying mechanism for this association may not involve 25(OH)D. Hence, further studies are warranted to confirm and investigate the underlying mechanism." However, it may be that the randomized controlled vitamin D trials were not properly designed and conducted with respect to factors such as baseline 25(OH)D concentration, vitamin D dose, and trial duration.
Similar findings have been found for hypertension, diabetes mellitus, heart failure, stroke, and myocardial infarction (heart attack). In a study in Finland, older adults who had moderate leisure-time activity outdoors had a 30-40% reduction in mortality and cardiovascular disease rates, compared with those who had low activity levels; while those with high outdoors activity levels had 50% lower mortality and CVD rates.476 These findings are also supported by a study of death rates related to sun exposure in Sweden: Those who had the lowest sun exposure had life expectancy reduced by 0.6-2.1 years compared to those with the highest sun exposure.477 These researchers stated:
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"Nonsmokers who avoided sun exposure had a life expectancy similar to smokers in the highest sun exposure group, indicating that avoidance of sun exposure is a risk factor for death of a similar magnitude as smoking."
Remember, sun exposure produces vitamin D, which is sometimes the vital product to enhance health. In other cases, even when vitamin D is raised, it may not have an influence on the disease being investigated (but it may have a profound, positive effect on other diseases that are not being investigated). That is the reason sun exposure is always superior to any of its photoproducts, and why it is dangerous to think that a vitamin D supplement all by itself can somehow take the place of our friend, the Sun. Try to obtain your share of healthful sun exposure whenever possible, and thereby reap the entire package of benefits. (However, if your vitamin D level remains deficient or insufficient, or if you are not sufficiently exposed to the sun or to sun-lamps, you will need to take a vitamin D supplement until the deficiency is reversed, and then maintain a healthful level.)
Heart Failure (HF): A non-ischemic (non vascular) heart disease
Heart failure occurs when the heart's function as a pump is inadequate to meet the body's need for oxygen and nutrients. As with heart attacks and strokes, there is a correlation between season and risk of HF. In France, deaths from heart failure are 20% higher than average in January but 15% lower than average in August,478 very likely as a result of higher UVB-stimulated 25(OH)D levels in summer, or partly because of nitric oxide liberation by the skin due to sun exposure. A study done in Spain found similarly that heart-failure hospital admissions were 25% higher than average in January and 33% lower than average in August.479 Such results have also been reported in Scotland, especially among individuals 75 years of age and older.480 As mentioned earlier, dark-skinned people in northern latitudes have lower 25(OH)D levels than light-skinned people. This is due to the fact that more exposure time is required for dark skin to produce vitamin D when exposed to UVB.481 Consequently, African Americans suffer higher rates of vitamin D deficiency than do white Americans.482 It might therefore be expected that the rate of heart failure among dark-skinned people would be higher than among light-skinned people, and such is the case: The incidence of HF in black people is 40% higher in men and more than 100% higher in women, compared to white people.483 However, HF is related to low vitamin D in all races, and most HF sufferers have serum levels below 20 ng/ml [50 nmol/L],484 which is considered dangerously deficient. Adults with HF also show a history of sedentary, indoor living,485, 486 with much less exposure to sun.487
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In addition, cold temperature has an influence on HF, and cold temperature is also associated with low sun exposure. Cold weather predicts an increased risk of cardiovascular diseases, as measured and documented by hospital admissions for those diseases in Korea.488 Also, a Canadian study showed that periods of cold weather were "linearly" associated with HF.489 High blood pressure (hypertension) is higher in winter as has been discussed, and hypertension may have an adverse effect on HF, which provides another possible link between sunlight and the disease.490
Tragically, newborns also suffer from HF, and until lately studies had not considered vitamin D deficiency as a possible cause. However, in a study conducted in southeast England, sixteen infants were identified who had suffered from heart failure and hypocalcaemia between 2000 and 2006.491 All were dark-skinned. Six of them were of Indian origin, and ten were of African ethnicity. Six suffered cardiac arrest, three died, eight were placed on lung machines, and two were referred for heart transplants. The average serum 25(OH)D level of these children was only 7 ng/ml [18 nmol/L], and some of the infants had undetectable levels of the vitamin. It is likely, due to dark skin and the northern latitude of England, that the mothers of these infants were vitamin D deficient prior to giving birth, which would have resulted in the life-threatening deficiency in their newborns. Regular sunbathing at noon without sunburning, or regular sunlamp exposure, could have prevented this catastrophe.
Those who fear the vascular and non-vascular diseases discussed here should provide themselves with safe and habitual sun exposure (or sunlamp therapy, whenever sunlight is insufficient), as an antidote to lifestyle habits (such as poor nutritional choices), which are the real causes of these diseases.
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To complete this chapter, another statement from Dr. Richard Weller is in order:
"Sunlight may have beneficial cardiovascular effects, independently of Vitamin D production. Vitamin D could, in these circumstances, act as a marker for sunlight exposure and its postulated beneficial effects. These recent human data show the physiological relevance of photorelaxation. High blood pressure is the leading cause of disability-adjusted life years lost worldwide and as a risk factor underlies 18% of all deaths." Weller further noted: "The action spectrum of nitrite release shows ultraviolet B is also involved in nitrite reduction to Nitric Oxide, and thus sunlight may be more effective than a pure UVA source." He concluded: "the prevalence of cardiovascular and cerebrovascular deaths is around 100 times higher than those from skin cancer. Interventions leading to small changes in the incidence of cardiovascular disease are thus of greater benefit to the health of the public even than large changes in skin cancer incidence."492
Safely embrace the sun, and your heart, brain and blood vessels will love you for it!
What have we learned?
1.	a poor diet is the primary cause of diseases that occlude the arteries (ischemic diseases). Such diseases include heart disease and cerebrovascular disease leading to heart attack and stroke, and peripheral artery diseases such as intermittent claudication.
2.	Infectious diseases leading to inflammation in the vascular system may also lead to heart disease and stroke. In future chapters, we will present evidence that the risk of infectious diseases is profoundly reduced in areas with high sunlight availability.
3.	Although sunlight deprivation does not cause ischemic diseases, UVR exposure plays an important role as an antidote, and lessens the damage caused by those diseases.
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4.	Numerous investigations have shown an impressive reduction in the risk of heart attacks, strokes and high blood pressure (hypertension) during summer as compared to winter.
5.	At higher latitudes in the same countries, sun exposure is not as available, and the risk of ischemic diseases and their resultant complications increases.
6.	At higher altitudes, where the sun is more intense, cardiovascular health is considerably better than at low altitudes.
7.	Sun exposure protects against heart attacks even when vitamin D is not produced.
8.	Sun exposure reduces the risk of high blood pressure by stimulating the production and release of nitric oxide.
9.	Erectile dysfunction (ED) may be temporarily reversed, through nitric oxide production, thanks to sun exposure.
10.	Heart failure, a non-ischemic disease, is profoundly more prevalent in areas of low sun exposure.
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Chapter 7
The Protective Effect of the Sun on Type-two Diabetes, Type-one Diabetes and other Autoimmune Diseases
"Sunlight could save your life"
—Dr. Zane Kime
Diabetes
Diabetes is a disease of chronically high blood glucose leading to blindness, nerve damage, heart disease, kidney disorders and numerous other maladies. Diabetes comes in two forms: (1) Type-one, usually caused by an autoimmune response, which damages the insulin-producing islets of the pancreas. This reduces the production of insulin, which is responsible for removing glucose from the blood and storing it in the cells. (2) Type-two, in which insulin is produced, but blood glucose remains high due to insulin resistance. As with heart and vascular disease, we must realize that a paucity of sunlight is not the cause of either type of diabetes; rather it is caused, to a
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large extent, by deleterious nutrition habits, primarily high meat
..	493 494 495	.■	496 497	498
consumption,493 494 495 sugar consumption,496 497 egg consumption,498 low consumption of fruits and vegetables, and too many fried foods.499 In the case of type-one diabetes, milk consumption may be the most important nutritional factor.500 However, sunlight may act as a prophylactic against both types of diabetes. With either type, it is not usually the diabetes itself that kills, but other diseases resulting from it.
Type 2 diabetes mellitus
Most diabetics are type-two. We will begin this discussion with that form.
There are several studies showing a relationship between type-two diabetes mellitus (DM) and sun or UVB exposure. One paper showed that blood-sugar levels were lower during the summer,501 and another demonstrated that exposure to sun lamps increased insulin secretion.502, 503
In addition, a meta-analysis produced moderate evidence that recreational sun exposure is associated with a reduced risk of type-two diabetes.504 The study was undertaken because the researchers have observed that higher 25(OH)D levels were consistently associated with lower diabetes risk, yet vitamin D3 supplementation was not. They hypothesized sun exposure could have influences not related to vitamin D, and such seems to have been the case.
One of the more important investigations showed that women who had "active sun exposure habits" had a 30% decrease in the risk of type-two diabetes.505
Diabetes type 2 is growing very rapidly and may someday overwhelm the health-care system. In our experience, it is the most easily reversed of all degenerative diseases, so this is a tragedy. Proper nutrition, exercise, clean environment, and safe sun exposure can prevent almost all type-two diabetes. At our former health resort, about two-thirds of type-two diabetics were free of all medication within two weeks. It is a largely a reversible disease, and can easily be prevented. If you don't have it, prevent it. If you have it, reverse it. Start today.
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Type-one (insulin dependent) diabetes mellitus (IDDM)
There was a 30.5% increase in the rate of type-one diabetes (IDDM) between 2001 and 2009506 and there are many theories as to the cause, including improper hygiene, viruses, and vitamin D deficiency.507 Type-one diabetes results when the pancreas ceases to produce insulin. Type-one is a disease afflicting many babies and young people and is sometimes known as "juvenile diabetes." It is an autoimmune disease such as multiple sclerosis or rheumatoid arthritis, and is totally different in its cause from type-two DM, which is due to atrocious eating habits and obesity. Australian research shows that the incidence of IDDM correlates closely with latitude. The southernmost part of the country, which has far lesser availability of UVB from the sun, has about three times the incidence as the northernmost part.508 And in Newfoundland, Canada, an exceptionally strong inverse correlation exists between UVB exposure and incidence of type-one diabetes,509,510 supporting the concept that sun exposure reduces the risk of the disease.
As with type-two DM, type-one DM results in dramatically increased risk of heart disease, stroke, blindness, neuropathy, amputation, high blood pressure, kidney disease, and erectile dysfunction. Here are additional facts about the relationship between sun exposure and type-one diabetes:
1. Children born in northern climes, where vitamin D
production through sun exposure is very limited, have the highest risk of type-one DM. In Finland, where the risk of type-one DM is the highest in the world, it has been shown that children who were not supplemented with at least 2,000 IU of vitamin D daily had five times the risk of type-one diabetes compared to children who were given 2,000 IU per day or more.511 However, 25(OH)D concentrations are nearly the same globally,512, 513 (likely because of dietary variations), therefore those residing at high latitude do not have lower vitamin D. Sun exposure, however, is certainly lower in the far north, and may be an important reason for the higher risk of type-one diabetes. Nutrition is probably contributing to the increased risk at high latitudes, considering the types of foods that are traditionally available there (insufficient amounts of fresh vegetables and fruits).
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2.	The above statement is impressive, but consider this: A child in Finland is about 400 times more likely than a child in
Venezuela to acquire tvpe-one DM. Across the globe there is a marked geographic variation in incidence of the disease, with high-latitude countries having the highest incidence and equatorial countries having the lowest incidence.514 Sun exposure stimulates the skin to produce vitamin D, so it might be surmised that high 25(OH)D levels in Venezuela are responsible for the exponentially lower risk. High vitamin D is obviously an important factor in preventing type-one diabetes. Nonetheless, vitamin D is not likely to be the only factor: A 400:1 ratio of disease risk (comparing Finland to Venezuela) is far beyond what was accomplished in the supplement research in Finland.515
3.	Between these two countries there are considerable differences in nutritional habits, which are likely to be no less important!
4.	Another consideration: As you will see in the next page, high sun exposure has a far greater beneficial effect on multiple sclerosis (MS), another autoimmune disease, than does vitamin D alone. It is likely that the sun has its own independent effects in preventing or improving type-one diabetes, as it does with MS. Immunosuppression is a good thing for preventing autoimmune diseases, and sun exposure selectively suppresses the autoimmune attacks. Some of these effects may be due to nitric oxide, endorphins and serotonin, all of which are produced by the body when exposed to sun.
The latest impressive study on type-one diabetes and sun exposure is one from Denmark by Dr. Ramune Jacobsen and colleagues.516 They assessed the association between sun exposure during gestation (pregnancy) and the risk of type-one diabetes in Danish children at the age of 15 years. The results were that more sunshine during the third
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gestational trimester was associated with a 40% reduction in the risk of contracting the disease by age 15.
The bottom line is this: to prevent type-one diabetes in yourself and your children, get plenty of non-burning sun exposure (or appropriate sunlamp treatment whenever sunlight is not sufficient), which will not only produce marvelous effects due to vitamin D, but likely will go far beyond vitamin D in exerting its own independent effects.
Other Autoimmune Diseases:
Autoimmune diseases are caused by a disordered immune reaction in which antibodies are produced against the body's own tissues and thereby destroy those tissues. Researchers have stated, "Autoimmune diseases are the third leading cause of morbidity and mortality in the industrialized world, surpassed only by cancer and heart disease."517 Many of these diseases have been found to associate with low solar radiation and vitamin D.518 The mechanism of autoimmune disease prevention by sunlight may be the suppression of certain immune cells called "T-cells" in a manner which impedes the immune system's attacks on its own tissues.519, 520
Multiple Sclerosis (MS)
MS is an autoimmune disease in which T-cells initiate an inflammatory response against myelin, the protective cover of nerves.521, 522 This process, known as demyelination, leaves the nerves bare and susceptible to "short circuiting." From 85 to 170 people per 100,000 in the USA suffer from MS, and the rate among women, during the period from 1991 through 1994, has increased by 50% compared to the period from 1982 through 1986.523 As of 2010, the last year for which we could find statistics, there were 350,000-400,000 cases of diagnosed MS in the USA.524 (There may be many more yet-undiagnosed cases of MS in the population, or mild cases that aren't yet considered MS).
Vitamin D has a direct influence on the degree of suffering among MS patients: A sudden worsening of MS symptoms is known as a "relapse" or "exacerbation," and research shows that these events are profoundly related to serum 25(OH)D levels.525 Mowry and colleagues, in correlating serum vitamin D to the rate of relapse, have reported that for every increase in serum levels of 10 ng/ml [25 nmol/L], there is a 34% decrease in the risk of relapse in young people.526 Remember, 90% of serum 25(OH)D levels is derived from sun exposure. As we will see toward the end of this section on MS, sun exposure has protective effects on MS beyond vitamin D,527 and in the above research on vitamin D, which is very impressive, high 25(OH)D levels may really be acting as a surrogate measure for sun exposure.
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Sunlight stimulates the production of vitamin D in the skin as previously discussed, and it would be expected that MS incidence might be lessened in areas of higher sun exposure, and increased in areas of lower exposure. It would also be plausible that the severity of the disease would be greater among those with lower sun exposure, who would therefore have lower 25(OH)D levels. Indeed, among people living in geographical locations where there are 3,000 hours of available sun yearly, MS rates are quite low.528 The same relationship exists when latitudes are correlated with rates of MS: The risk of MS in far northern areas is more than 100 times greater than it is in equatorial areas, where sunlight is intense, and the rate of MS approaches zero.529, 530, 531 The same has been seen in France, where a geographical study found that MS rates were higher in the north, where solar UVB doses were lower than in the south.532 It has been known for decades that those who live closer to the equator had a lower risk of multiple sclerosis (MS), 533 and in various pieces of research, vitamin D produced by sun exposure has been suggested as the factor responsible for the decreasing risk of MS based on proximity to the equator. However, there may be factors beyond vitamin D, as we shall discuss.
This latitude pattern persists within the USA, where there is far higher MS incidence in northern states.534 In Australia, there is a seven-fold increase in MS incidence between the tropical Northern Queensland and Southern Hobart, located in the less sunny part of the country.535 Even in small countries like Ireland, MS incidence is greater in the north than in the sunnier south.536 And, even in sunny countries such as Kuwait, those who have the highest sun exposure have a lessened risk of the disease.537 It has also been demonstrated that for each increase of one degree latitude in the northern hemisphere (indicating lower sun exposure), the odds of moderate disability from MS increased by 2%, and the odds of high disability increased by 3%. 538 A similar relationship was noted in relapse rate: Each degree of latitude increase was associated with a 1% increase in the odds of having relapses over the previous year. A 1% increase may not seem impressive, but in a country with a 30% higher latitude, the increased risk of relapse would be 30%, and the increased risk of disability would be 60-90%.
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Many, but not all, MS patients experience periods of remission and then relapse,539 and the damage to the cerebral cortex is more severe during the relapse phase.540 Research has found a latitude-dependent increase in the risk of relapse, with higher latitudes in the northern hemisphere, and lower latitudes in the southern hemisphere, associating with a greater risk.541 This would indicate that sun exposure reduces the risk of the disease. That same study also showed that the variation in risk was correlated to seasonal sun exposure, with the relapses occurring more frequently in seasons when ultraviolet radiation [from sun exposure] was at its lowest point.
Childhood sun exposure also appears to confer resistance to contracting MS. Australian research compared the numbers of daily hours subjects spent in the sun when they were six to fifteen years of age.542 Adults who were in the lowest "childhood sun-exposure" category were three times as likely to develop MS as those in the highest category. It has also been shown that children with MS, born during seasons and in areas of greatest sun exposure, experienced their first symptoms of the disease about two years later than those born in times and areas of little sun exposure.543 Those with the greatest numbers of actinic keratosis and common skin cancers (NMSC) were also much less likely to develop MS: It has been demonstrated that adults in England with NMSC have about half the risk of developing MS as those without NMSC.544
Further information regarding the relationship between latitude and MS is furnished in a study of the first appearance of demyelinating events (deterioration of the myelin sheath—an indication of MS), correlated to latitude in Australia.545 The researchers' conclusions were, "Age and sex adjusted MS incidence rates increased by 9.55% (95% confidence interval (CI) 7.37-11.78, p < 0.001) per higher degree of latitude."
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Altitude also correlates to MS. In Switzerland, MS rates are higher at low altitudes than they are at high altitudes, where sunrays are more intense.546
Sun, immigration and MS
A study of immigrants born in the sunny West Indies, but who later moved to the United Kingdom (UK), showed they had only one-eighth the rate of MS as their own children born in the UK.18 Another study assessed MS among people in the West Indies, showing that the rate of MS was higher among people who had emigrated to Europe but returned to the islands after many years. The increase was especially obvious in those who had arrived in Europe prior to age 15.19 They developed more than four times the rate of MS than others their age.
When mature adults from England—an area of high risk for MS— immigrate to South Africa (a low-risk area), their high risk is maintained:547, 548 They develop MS at about six times the rate seen in native South Africans. Children who accompany the migrants, however, become highly protected against the disease. This research indicates that in order to effectively prevent future development of MS, sun exposure (or sunlamp use where sunlight is insufficient) in childhood is important. However, other research shows that adults also benefit from sun exposure: Researchers in Australia have found that "the prevalence of multiple sclerosis among those migrating before the age of 15 years from the high-risk UKI (England and Ireland) to lower-risk Australia was not significantly different among those migrating at or after that age. Obviously, the best advice would be to keep sun exposure high regardless of age."
It is not possible, of course, for all English children to spend their formative years in South Africa or Australia and then move back to England. They can, however, be encouraged to play outdoors during the summer months (and get a few minutes of sunlamp exposure during winter). It is also important for expectant mothers to keep sun exposure high. Children in northern countries born in May (at the end of winter) develop significantly more MS as they become adults than those born in November.549 The reason could be that the expectant mother, during the fetal stage, influences the development of future MS in her children. In the southern hemisphere—in Argentina for example—this relationship to birth month has also been observed, but in reverse order due to the seasonal flip. Most MS patients there are born in September, the last month of winter in the country.550
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Those who mount campaigns against childhood sun exposure are setting children up to become victims of MS. These campaigns are misguided and demonstrate the harm perpetrated by ignorance.
Military research corroborates the inverse relationship between sun exposure and MS.
In 1922 Dr. Charles Davenport wrote a paper entitled, "Multiple Sclerosis from the standpoint of geographic distribution and race."551 He analyzed the MS rate of military draftees and compared it to their states of origin. The highest rates were found in men who grew up in Michigan, Wisconsin, and the extreme northwest—all areas with low sun availability. There were few cases of MS among those who grew up in southern states, where sun availability is abundant. Dr. Davenport also noted that draftees from urban areas, where sun availability is lower than in rural areas, had 50% higher MS rates than those who came from rural areas. Similar studies confirm that relationship.552, 553 In 1979, assessments of the MS rates of USA military personnel were again compared to their states of origin, with nearly identical results.554
As with certain other diseases, sun exposure may have a positive influence on MS, independent of vitamin D production: Researchers used animals with experimental autoimmune encephalomyelitis (EAE) (an experimental form of MS deliberately induced in animals in a laboratory setting) to determine the relative influences of UVR and vitamin D on the disease. They concluded, "These results suggest UVR [sun] is likely suppressing disease independent of vitamin D production, and vitamin D supplementation alone may not replace the ability of sun (UV) to reduce MS susceptibility."555 Later on, some of these same researchers investigated the mechanism by which sun exposure suppressed the disease and determined that UV light selectively inhibits spinal cord inflammation and demyelination.556 In another study, scientists performed an investigation in which UVR— the same radiation emitted by the sun and sunbeds or sunlamps—was administered to animals with EAE.557 The researchers found that UVR treatments stopped inflammation and demyelination of the spinal cord by inhibiting a chemical known as a chemokine, also known as a cytokine. Cytokines are specialized proteins that are either inflammatory or anti-inflammatory in their nature. Inflammatory cytokines or chemokines are the cause of inflammation and autoimmune attacks resulting in MS. The MS-ameliorating effects in the study were directly initiated by UVR, independent of vitamin D.
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Stunningly, some of these same investigators have determined, in yet anther study, that vitamin D was actually necessary for EAE to take place.558 Mice lacking the vitamin D receptor had a markedly lower risk of developing EAE. In mice that were simply vitamin D deficient, the development of EAE was also partially suppressed. We do not view this research as showing that vitamin D sufficiency leads to MS, but it certainly indicates that sun exposure, independent of vitamin D (and perhaps in conjunction with it), is absolutely critical to prevent and ameliorate this frightening disease.
Another study showed that sun exposure, while obviously being critical in the production of vitamin D, had its own profound influence in lessening the degeneration of nerves (neurodegeneration) in those with MS.559 By measuring whole brain volume (WBV) and grey-matter volume (GMV) utilizing magnetic resonance imaging (MRI), the scientists determined that greater summer sun exposure predicted greater WBV and GMV in MS patients. Interestingly though, when 25(OH)D levels were measured, they had no influence on the positive effects of sun exposure with WBV or GMV. The researchers concluded: "Sun exposure may have direct effects on MRI measures of neurodegeneration in MS, independently of vitamin D."
Still another investigation has also determined that low sun exposure and vitamin D were independent risk factors for demyelination. 560 And another study showed that sun exposure, by controlling circadian rhythm, may be protective against high severity of MS.561
Unsurprisingly, recent research demonstrates that teenagers who have the greatest exposure to the sun have a delayed onset of MS as adults.562 The study involved 1,161 Danish patients with MS who were given questionnaires regarding their sun-exposure habits and body-mass index (BMI) as teenagers. Besides sun exposure, other factors that influence vitamin-D levels were also used to determine the probable cause of MS. Interestingly, only sun exposure and lower BMI were associated with later age at the onset of the disease. Other serum vitamin D predictors such as fish consumption did not show any association with MS. The authors still seemed to feel that vitamin D was the reason for the extended time before disease onset. That is unlikely, however, since other predictors of higher 25(OH)D levels showed no association with MS. This research again shows that the sun has positive effects in preventing and mitigating MS, independent of vitamin D.
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One of the most compelling papers on sun exposure and MS was produced by Dr. Robyn Lucas and colleagues.563 Here are the salient points in their report called Ultraviolet radiation, vitamin D and multiple sclerosis: (the scientific terms will be explained below)
•	There is strong evidence from observational studies showing that low past sun exposure is associated with an increased risk of developing multiple sclerosis (MS).
•	Lower sun exposure or lower vitamin D status have been linked to more severe MS, that is, more frequent relapses and more rapid progression to disability.
•	Vitamin D supplementation trials for people with MS have shown improvement in immunological and MRI parameters, but with little convincing evidence of clinical benefit.
•	Higher levels of sun exposure may benefit MS-related immune parameters through both vitamin D and non-vitamin D pathways.
•	Exposure to ultraviolet radiation may result in immune tolerance beneficial for MS sufferers, through the upregulation of T and B regulatory cells, enhanced levels of cis-urocanic acid, alterations in dendritic cell trafficking, as well as release of a range of other cytokines and chemokines.
To elucidate the last paragraph it is necessary to understand the vocabulary used. T-cells are an integral part of the immune system that helps to rid the body of invading microorganisms. The regulatory T-cells (or suppressor T-cells) are a subpopulation of T-cells, which modulate the immune system and help prevent the body from attacking itself.564
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As previously stated, MS is an autoimmune disease in which the immune system attacks and destroys the myelin sheath of the body's own nervous system. The regulatory, or T suppressor cells suppress these attacks, thereby preventing, abrogating or ameliorating the disease. B regulatory cells are also a part of the immune system and can, through their suppressive functions decrease inflammation, possibly through the production of anti-inflammatory cytokines.565 Cis-urocanic acid is a chemical that is significantly lower in MS patients, but when it is stimulated by sun exposure it significantly reduces many indicators of MS.566, 567 Dendritic cells are immune cells that are present in the tissues near the outside environment, such that they are the first to recognize foreign elements and process them to present them to other immune cells. Upon activation, they communicate with and regulate the responses of B cells and T cells within the lymphatic system. They are essential in decreasing the immune responses that promote the formation of autoimmune diseases.568
This research is important because it shows how sun exposure works against MS in several different ways, only one of which may be the stimulation of vitamin D production.
As the Lucas report states: "Recognition of multiple pathways whereby exposure to UVR may affect the development of MS could mark the beginning of prevention activities through modulation of an environment risk factor and the development of new therapeutic compounds. The vitamin D star seems to be waning, despite considerable genetic evidence vitamin D plays an important role in MS risk. Perhaps it is only one part of a more complex picture. New intervention trials, undertaken in parallel, of vitamin D supplementation and UV-B phototherapy, should provide more definitive evidence. A finding for sun exposure, through the entirety of its effects, does have clinical significance as an immunomodulator for the development of MS, offers one of the few opportunities to modify disease risk for MS."
So how much difference could sun exposure make in preventing this devastating disease? Dr. Grant has estimated, "half of the 400,000 people with MS would not have MS if all Americans had the UVB/vitamin D status as those living in the southern states."569
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We might surmise that perhaps MS would not exist in America if all Americans had the same sun exposure status enjoyed by people living in equatorial countries.
When we consider the causes of MS and the potential preventative and ameliorative effects of sun exposure on the disease, it becomes obvious that nearly everyone should take advantage of the beneficial effects of non-burning sun exposure (or at least use sunlamps where necessary). There is blood on the hands of those organizations promoting sun avoidance at all costs. Help spread the word around the world!
Asthma
According to the Centers for Disease Control and Prevention (CDC), "about one in every 12 people in the United States now has asthma— a total of 24.6 million people and an increase of 4.3 million since 2001."570 This disease, like diabetes and melanoma, is spiraling out of control and showing no sign of abating.
The Scientific American, on April 14, 2011, published an article entitled: Why are Asthma Rates soaring?571 In this article, they lamented the fact that for the last three decades asthma rates have been surging, and offered differing theories to explain this increase, only to be disproven and discarded. One of those theories was the hygiene hypothesis, which states that modern civilization has become excessively "clean" or sterile, such that youngsters are not subjected to infectious organisms and thereby do not develop strong immune systems capable of fighting off pollens, dust, etc. Another theory was that those who had allergic reactions to various environmental pollutants had inherent weaknesses, which predisposed them to asthma. According to the article, both of these ideas have failed the test and are no longer in vogue. Neither allergy nor early-life "cleanliness" leads to an increase in asthma (however, some scientists have recently implicated lower diversity in human microbiota -resulting from insufficient contact with soil, "dirt", plants, and animals - as one of the key causes of asthma, atopy, contact dermatitis, allergies, and other immune challenges). The latest theory to surface expounds that the pandemic of obesity is to blame, because it causes inflammation throughout the body. However, there are many obese people who are not asthmatics.
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Asthma is a disorder characterized by inflammation of the air passages causing narrowing of the airways transporting air from the nose and mouth to the lungs.572 The mechanism by which sun exposure may reduce asthma and its symptoms could be the antiinflammatory properties of vitamin D, which is produced in the UV-stimulated skin. Inflammation is often caused by the aforementioned messenger proteins called cytokines, which are either pro-inflammatory or anti-inflammatory elements of the immune system.573 Vitamin D has the ability to inhibit pro-inflammatory cytokine production while stimulating production of antiinflammatory cytokines.574 However, there are likely other beneficial effects of sun exposure, beyond the stimulation of vitamin D production in the skin.
Risk of contracting asthma. 1.0 = lowest risk
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'	increa£;no nek of Asthms; l.Q — lowsst risk
One of the most recent studies on factors contributing to asthma showed that living in a room without windows was associated with a 930% increase in the risk of asthma (see the graph above), and living in an area without adequate sunlight was associated with a 220% risk increase.575
Since windows filter out the UVB light that stimulates the production of vitamin D, the presence of windows in the room could not have reduced asthma through vitamin D—it had to be some other factor. Obviously, window glass allowed something else to enter the room and protect the people inside it from the remarkable increase in asthma risk they would have otherwise endured. We know that UVA light, which does pass through windows, stimulates the production of nitric oxide, a potent vasodilator. Could it also be a bronchodilator? This explanation, of course, is a hypothesis.
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A recent study from the University of Kansas demonstrates that children born to women who receive more sun exposure during the second trimester of pregnancy have a considerably lowered risk of asthma as they develop.576 The researchers did not compare sunny geographical areas with non-sunny ones to make their assessments. Instead, they compared the amounts of sunlight occurring in the same areas during different years. They found that in areas experiencing high quantities of sunlight in a given year, the risk of asthmatic children being born in that year was reduced. This was noted whenever the mothers experienced sun exposure during the second trimester of pregnancy. The researchers theorized that higher levels of vitamin D during sunny times accounted for the protective effects of sunlight. This may be true, but as we have explained in the previous paragraph the protection may have been due to sun exposure per se, independent of vitamin D.
Other research also shows the profound influence sun exposure has on asthma. In Qatar, researchers measured serum 25(OH)D levels in asthmatic children and compared those levels to levels of healthy non-asthmatic controls.577 Deficiency was defined as having levels below 20 ng/ml [50 nmol/L]. Many other factors were also evaluated, such as nutritional practices, and various serum parameters such as calcium, phosphorus, alkaline phosphatase, magnesium, creatinine and parathyroid hormone were measured. The results: Asthmatic children had a 67% reduction in sun exposure compared with nonasthmatics, as well as a 71.3% reduction in physical activity.
An investigation by Hart and her colleagues showed that controlled exposure to ultraviolet light (UVR) in mice markedly limited the development, incidence, and severity of asthma signs such as inflamed airways and lungs.578 These researchers exposed mice to allergens generally known to bring on asthma attacks, then exposed them to sun lamps for 30 minutes. After sunlamp exposure, the allergens caused no asthma attacks. The researchers also stated that sunlamp exposure stimulated in the mice the production of a certain cell type, which when it was transferred into other mice, suppressed the immune reactions and halted asthma symptoms. This is another indication that sunlight has a healthful effect on asthma beyond vitamin D production.
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Drs. Litonjua and Weiss noted that the prevalence of asthma and allergic diseases had began to increase worldwide in 1960. They hypothesized that since people have increasingly spent more time indoors, there has been lesser exposure to the sun, leading to decreased vitamin D production579 and deficiency in pregnant women, resulting in greater incidence of asthma in their offspring. But was vitamin D deficiency the cause or was it simply sun deficiency?
A study from Spain showed that children exposed to the most sunlight have much lower risk of asthma, with each hour of sun per day predicting a decreased risk of the disease.580 Still another study demonstrated that among children who had prolonged vitamin D deficiency as babies, there was a clear link between that condition and an earlier onset of asthma.581 (Of course, vitamin D deficiency is a surrogate measurement for sun exposure as mentioned many times previously). The researchers stated: "We've also shown for the first time [that] babies deficient in vitamin D have higher levels of potentially harmful bacteria in their upper airways and are more susceptible to severe respiratory infections."
We find it amazing that the 2011 article about asthma in Scientific American (mentioned above) has never even considered the possibility of asthma being caused by lack of sunlight. Now with this latest research, it is our hope they will correct the mistake and use their considerable prestige to promulgate the vitamin D/sunlight/asthma connection. It is time to return to the sun.
At the health resort previously owned by the Sorenson's, we often noticed that asthmatics ceased using their inhalants after a week or two of hiking in the sunshine. One of them decreased the dosage from 6 inhalants per day to zero in about a week. The resort was located in sunny Saint George, Utah, where the elevation is 3,000' and the sun shines an average of about 260 days per year. Could it have been that sun exposure helped reduce the symptoms of asthma? We believe the combination of a nearly-plant-based diet and sunlight made the difference, and the aforementioned research provides reasonable support for that opinion.
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Inflammatory Bowel Diseases (IBD)
IBD consists of two primary diseases, ulcerative colitis (UC) and Crohn's disease (CD). UC is a chronic inflammatory condition characterized by relapsing and remitting episodes of inflammation limited to the mucosal layer of the colon.582 Crohn's disease, however, can involve any part of the gastrointestinal tract from the mouth to the anus, but most commonly affects the small intestine or the colon, or both.583 In a 12-year investigation of hundreds of thousands of IBD patients, hospitalizations and prolonged hospitalizations for both UC and CD were higher among those who had low sun exposure compared to those with very high sun exposure.584 The same relationship was shown between sun exposure, bowel surgeries and deaths: more surgeries were needed for those patients who experienced the lowest sun exposure compared to those who had the highest sun exposure, and more deaths occurred among those with low exposure. An interesting side note to this investigation was the large number of non-IBD patients analyzed for sun exposure levels: The same relationship existed as with the IBD patients—low sun exposure was associated with prolonged hospitalizations and more deaths when compared with high exposure. Other research involving the association of Crohn's disease to sun exposure has also found that surgery for the disease was significantly reduced among patients who received more sun exposure.585
French research has shown that high residential sun exposure is associated with a low risk of CD,586 but not UC: Women who were in the highest third of sun exposure had only half the risk of CD compared to those in the lowest third, but UC was increased 21% by high sun exposure. This study is one of only a few we have seen— other than studies on non-melanoma skin cancer—demonstrating a positive association of sun exposure with disease risk. None of the other studies mentioned here showed this relationship with UC. Another interesting side note to this research was that vitamin D intake was not associated with decreased risk of CD.
It has also been shown that in the US there is a north-south gradient for IBD risk,587, 588, 589, 590 which means that the risk of developing IBD is significantly lower in southern latitudes (where sun exposure is greater). And finally, another French study has demonstrated that low sun exposure is associated with an increased incidence of Crohn's disease.591
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It is important to understand that IBD causes malabsorption of nutrients in the gut, leading to diseases of malnutrition.592 Vitamin D is one of the "nutrients" that may not be absorbed efficiently, and therefore sun exposure (or sunlamps) may be the only viable source of vitamin D for a person with IBD.
To summarize, sun exposure plays a vital role in the quest for a healthy gut.
Rheumatoid arthritis (RA)
RA is an autoimmune disease, which is characterized by chronic inflammation of the joints, the tissue around the joints, and of certain organs in the body.593
One paper demonstrated how, at high latitudes where sun exposure is considerably less available, the rate of RA is much higher than at lower latitudes.594 RA is also more severe in winter,595 a time of limited sun exposure. A report from researchers in Ireland (a northern country with little sun exposure due to overcast conditions) showed that 70% of RA patients had low 25(OH)D levels and 26% were severely deficient.596 In an investigation using data from the famous nurses health study, those women who were in the highest category of UVB (ultraviolet light exposure from sun or other sources), had a 21% decrease in RA risk compared with those in the lowest category.597 In this paper, the authors proposed that younger women do not show the effect of sunlight since they are more likely to use cosmetics or sunscreens to block UVR.
RA is an autoimmune rheumatic disease (ARD), and seasonal vitamin D declines may trigger flares in ARD.598 Such declines, of course, are a result of decreasing sun exposure in the colder seasons.
Arthritic joints carry a devastating potential side effect: Hip replacement surgery is often prescribed for arthritic conditions, and those people who go through total-hip-replacement procedures are 4.7 times as likely to have an ischemic stroke, and 4.4 times as likely to have a hemorrhagic stroke in the first two weeks post surgery.599 Those stroke risks remain elevated for 6-12 weeks. Eat correctly and
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safely soak up the sun. It's a better option than hip replacement and potential stroke.
What have we learned?
1.	Women who have "active sun exposure habits" have a 30% decrease in the risk of type-two diabetes.
2.	The southernmost part of Australia, which has far less availability of sunlight, has about three times the incidence of type-one diabetes as the sunny northern area.
3.	The risk of multiple sclerosis (MS) is more than 100 times greater in far northern areas of the globe than in equatorial areas, where sun exposure is intense, and the rate of MS approaches zero.
4.	A study from Spain showed that children exposed to the most sunlight have much lower risks of asthma. Each hour of sun predicts a decreased risk for the disease.
5.	In a 12-year investigation of hundreds of thousands of IBD patients, hospitalizations for both UC and CD were higher among those who had low sun exposure compared to those with very high sun exposure.
6.	One paper demonstrated how, at high latitudes where sun exposure is considerably less available, the rate of RA is much higher than at lower latitudes.
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Chapter 8
Sun Exposure and Infectious Diseases
"I think you might dispense with half your doctors if you would only consult Dr. Sun more."
—Henry Ward Beecher
Relatively new and very important research shows that sunlight boosts the effectiveness of T-cells, an integral part of the immune system.600 T-cells are a type of lymphocyte, which recognizes and binds to foreign invaders, thereby rendering them harmless. This important new finding demonstrates another beneficial effect of sun exposure-one with no relationship to vitamin D.
The key player in this action is the UV spectrum of sunlight, which stimulates hydrogen peroxide production. The hydrogen peroxide (HP) causes T-cells to move to the site of infection, and kills noxious bacteria. Dr. Gerard Ahern, one of the primary investigators, stated it in this way: "T-cells, whether they are helpers or killers, need to move to do their work, which is to get to the site of an infection and orchestrate a response. This study shows sunlight directly activates key immune cells by increasing their movement."
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Also interesting is the fact the skin has a large share of the total T-cells in humans, about twice the number circulating in the blood. Think about this magnificent body of ours! It is programmed to immediately respond to any invasions occurring in the skin. And sun exposure, if we take full advantage of it, immediately accelerates the process. Then, when T-cells are activated by blue light, they move rapidly to other body areas where they can be utilized.
However, vitamin D production, stimulated by exposure to solar UVB, also improves immune system responses and thereby reduces the risk of infections. One of the mechanisms by which this is accomplished is the production of antimicrobial peptides (AMP's), which can help to negate the effects of bacteria, fungi and viruses.601 One of the most important AMPs is cathelicidin, which is under control of the vitamin D receptor (VDR), whose activity is regulated by the presence of the potent hormone form of vitamin D: 1,25(OH)2D.
Research demonstrates that when disease-causing microbes breach physical barriers, proteins called toll-like receptors (TLRs) recognize the invading pathogens and activate immune cell responses, which include the activation of vitamin D receptors (VDR). This reaction causes the stored form of vitamin D, called 25(OH)D, to be taken from the blood and become hydroxylated to form 1,25(OH)2D, which binds to vitamin D receptors (VDR). The cathelicidin gene is then activated and the human cathelicidin, LL-37, is synthesized in order to destroy the pathogens, once they have been engulfed by macrophages or certain white blood cells. This reaction is totally dependent on the availability of the stored form of vitamin D.602 Cathelicidin acts by destroying the integrity of the lipoprotein membranes of the pathogens, rendering them harmless.603 It also has a chemotactic effect, acting as a chemo-attractant for immune cells in the immediate vicinity of the pathogen breach.604 To repeat a common theme throughout this book: Lack of vitamin D, also known as hypovitaminosis D, is caused by insufficient conversion of vitamin D precursors by sun rays.605
Based on these facts, we would expect sun exposure or other forms of UVB light to correlate with a lessened risk of infection. The following diseases have been identified as being associated with low sun exposure or low serum levels of vitamin D.
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Influenza
Dr. Hope-Simpson showed in 1981 that influenza is seasonal. Based on this report and observing how institutionalized men, taking vitamin D supplements, had a reduced risk of developing influenza, Dr. Cannell proposed that seasonal cold and flu outbreaks are related to lower solar UVB doses. In the northern hemisphere, influenza occurs in December through March. In the southern hemisphere, outbreaks occur June through September—almost exclusively in winter in both hemispheres. The outbreaks in each case occur in times of lowest sun exposure.
Aside from vitamin D production, it is also possible that solar radiation has virucidal effects, reducing influenza infections by eliminating the virus before it can be transmitted by aerosol from host to host.606 In addition, in records from an 'open-air' hospital in Boston, Massachusetts during 2008-2009, Hobday and Cason have commented on the H1N1 flu outbreak—suggesting that some patients and staff were spared the worst of the outbreak. They stated: "A combination of fresh air, sun, scrupulous standards of hygiene, and reusable face masks appears to have substantially reduced deaths among some patients and infections among medical staff."607
A personal note (by Sorenson): Colds and flu tend to occur in the same seasons, and the influence of seasons on my tendency to contract colds had a highly significant influence on my interest in sunlight. Until the age of thirty-five, too much of my life was spent fighting flu and colds. My first head cold would occur in autumn around mid-November and would keep me in bed two or three days. The illness would then subside over several weeks. Then I would contract whatever flu was making the rounds. These ailments took a toll on my school work and social life. Most of my friends would suffer one cold in a year while I was blessed with up to half-a-dozen. Winter was an unhappy time, and I dreamed of leaving the cold weather of the central Nevada-Utah border and moving to warmer climes. My winter experiences convinced me that colds and flu were caused by the weather. This, of course, was only partially true—a fact which didn't occur to me until years later. Cold temperature can be a risk factor, but nothing like lack of sunlight. Acute cooling of the feet does bring on common cold symptoms608 and one study showed that cold temperature, coupled with low humidity, increased the number of respiratory infections.609 However, much of the earlier research dismisses a connection between acute cooling of the body surface and the common cold.610 Either way, it should be remembered that during seasons of higher sun exposure the temperatures are warmer. No doubt, summer was my healthy season. The sun blazed from dawn to dusk and I soaked it up. The work on our ranch was intense, and the days were long, starting with morning feeding of animals followed by irrigating, hauling hay and performing other outdoor tasks. Despite the long hours, I loved the sun, and it made the hard work worthwhile. Whenever possible, my shirt came off, and because of my deep tan, my friends called me "brown man." Those were my halcyon days—I was happy and healthy and enjoyed a vigor that was lacking in winter. I now realize I had never been ill under the summer sun. Hence, my interest in spreading the sun gospel to the world.
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It is now generally believed, and rightfully so, that the increased incidence of the common cold during winter is related, in part, to decreased sun exposure.611 This was brought home to me several years ago when an elderly friend of mine, after listening to one of my presentations, asked if I knew a way to reduce the number of colds he was having each winter. I suggested regular tanning-bed use during winter. He followed the advice and the following winter had no sign of a cold. Either the UV light somehow protected him against his usual respiratory infections, or it was just luck. The research suggests it was the former, via increased 25(OH)D levels or due to other factors.
Obviously, sun exposure is essential to human health, so when we read articles about how harmful the sun is, we need to consider who is paying to promote this negative perception. Myopic or biased research is the most harmful type of research, because journalists generally love a controversial story. They might not realize that they promote illness, death and destruction to the world, while ignoring the research-supported benefits of sun exposure.
Leprosy
Leprosy is considered to be an eradicated disease, but in India it still exists. An article in an Indian paper shows it to be much more prevalent in highly urbanized areas (areas of less sun) than in rural or less polluted areas612 (areas of more sun). Ultraviolet light has also been shown experimentally to kill half of the leprosy-causing bacteria.613
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Pneumonia
Pneumonia is often a result of influenza and is also highly seasonal, with the lowest rates in summer, an increase in fall and a peak in winter.614, 615, 616 Researchers have established that low UVB exposures correlate directly to periods of low UV radiation (sunlight), and indicate that such a correlation may be responsible for the seasonal variation in pneumonia and for the spike in winter cases.617 They state, "The mechanism of action of diminished light exposure on disease occurrence may be due to direct effects on pathogen survival or host immune function via altered 1,25-(OH)2-vitamin-D metabolism." Another study found that case-fatality rates due to pneumonia arising from the 1918-19 influenza pandemic in the US were much lower in communities with higher solar UVB doses in summer and winter.618 The effect of vitamin D in fighting infections and reducing inflammation were proposed to explain the findings.
Interesting research from the Philippines associated meteorological conditions (rainy days, sunshine, relative humidity, temperature) with the likelihood of contracting childhood pneumonia:619 The researchers found that lack of sunshine was most closely associated with the disease, and that each one-hour increase in sun exposure per day lowered the risk of contracting pneumonia by about 33%. Why would people keep their children out of the sun and increase the risk of this killer disease?
Acute lower respiratory infections (ALRI) in children
ALRI are a leading cause of sickness and mortality both in children and adults worldwide. Unfortunately, acute lower respiratory infections are not uniformly defined and this may hamper a true appreciation of their importance. From an epidemiological point of view, the definition of acute lower respiratory infections usually includes acute bronchitis and bronchiolitis, influenza and pneumonia.620
According to the World Health Organization, about 20% of all deaths in children 5 years old or younger are due to ALRI,621 and several studies indicate that sun exposure has a protective effect against the disease.
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In one piece of research, children who were placed outside in the sun, uncovered, were less than half as likely to suffer ALRI, and those who had the lowest levels of vitamin D were ten times more likely to contract this infection than those with the highest levels.622
Newborns with ALRI have serum levels of vitamin D 79% lower than those of non-infected newborns, and their mothers have levels 70% lower than those of the mothers of non-infected newborns.623 Considering cathelicidins are present in the lungs and provide the first line of defense against invading organisms,624 these findings are not surprising. High 25(OH)D levels in most populations are caused by high sun exposure and therefore represent a measurement of that exposure, which may have positive influences on ALRI independent of vitamin D. In fact, a very recent investigation on sunlight and vitamin D, conducted in Nigeria, has compared the 25(OH)D levels and sun exposure habits in children with and without ALRI.625 There was virtually no difference in 25(OH)D levels between the sick and healthy groups, but those children who had a higher percentage of the body exposed to sunlight were less likely to have ALRI, reinforcing the fact that sun exposure has many healing effects beyond its ability to stimulate the production of vitamin D.
Sepsis
Sepsis is the presence of various infectious organisms or their toxins in the blood or tissues, and septicemia is sepsis of the blood, also known as "blood poisoning." Sepsis accounts for 500,000 emergency-room hospital visits per year in the USA. It is followed by a typical stay of 6 to 9 days,626 making it one of the most deadly medical conditions— conditions often resulting in multiple organ failure and death. There are about 750,000 cases of sepsis per year, and about 3% of all hospital admissions result in a case of sepsis.
Hospitals are hotbeds of antibiotic-resistant "superbugs" and other infectious agents. In cases of severe sepsis, antibiotics have not improved survival. In fact, antibiotics may produce molecules that exacerbate sepsis.626, 627 Therefore, the health system must urgently find and implement non-antibiotic approaches in order to overcome sepsis.
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This quote from Tufts University puts the problem of superbugs in perspective. "Hospitals treat sick people. As a result, they have a larger number and diversity of disease-causing microorganisms than is typically found in the community. Furthermore, hospitals regularly use medicines to kill disease-causing microorganisms, creating an environment favoring microbes resistant to these medicines. Finally, while the skin is an excellent barrier against microorganisms, it is often broken in hospitals where many patients arrive with open wounds, and it is further punctured by needles and cut with medical implements."628
Dr. Grant has hypothesized that vitamin D deficiency, due to inadequate sun/UVB exposure, is a risk factor for septicemia.629 He presents five lines of reasoning in support of his hypothesis:
1.	Septicemia rates are highest in winter and lowest in fall.
2.	Rates are generally highest in the Northeast and lowest in the West.
3.	Incidence rates in African Americans are higher than in white Americans.
4.	There is a rapid increase in incidence with age. Older people tend to have lower sun exposure and lower vitamin D levels.
5.	Several infectious and chronic diseases are associated with an increased risk for septicemia. These same diseases are associated with low sun exposure.
Periodontal Disease (Pd)
PD is an infectious disease characterized by inflammation and subsequent destruction of the supporting structures of the teeth, including the bone,630 and is the number-one cause of tooth loss.631, 632
We have already established in Chapter 4 that osteoporosis can be prevented by sun exposure. The bone holding the teeth in place is called the alveolar ridge. PD is exacerbated whenever the alveolar ridge degenerates as a result of an inflammatory process and reduced bone density. Several studies show that osteoporosis is closely related to alveolar ridge bone loss and loss of teeth.633, 634, 635, 636
Research shows that low 25(OH)D levels predict a greater risk of PD in pregnant women.637 Since higher 25(OH)D levels are predicted by high sun exposure, the efficacy of sun exposure for PD prevention has been established in this research.
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Sun exposure may also have other direct effects on PD beyond high serum vitamin D, but at this time we don't have the research to prove it (although we have already established that solar radiation fights infection and inflammation that cause bone loss).
Bacteria that live in dental plaque cause a response by immune cells, which release pro-inflammatory cytokines in an attempt to destroy the bacteria. Unfortunately, these cytokines cause gum and bone inflammation and destroy gum tissue.638 Vitamin D decreases the action of inflammatory cytokines—proteins which cause inflammation in tissue—and increases the action of anti-inflammatory cytokines.639, 640 Importantly, there are studies establishing a positive correlation between severe PD and diabetes, cancer, and Alzheimer's disease.641 A study of people with PD, diagnosed via dental examination between 1971-76 and reassessed between 1982-1992, has concluded that severe PD correlated to a 2.26 times increase in diabetes risk compared with moderate PD or no PD.642 This may or may not indicate that PD is one of the causes of diabetes in individual patients.
Researchers looking for the causes of PD have demonstrated that subjects who lacked vitamin D receptors (necessary to stimulate absorption of calcium) suffered from greater severity of
PD and earlier appearance of the disease.643, 644, 645, 646 Other researchers have twice demonstrated that periodontal disease correlates with low serum 25(OH)D levels,647 caused by insufficient sun exposure.
Another indication of the relationship between sun exposure and PD is that attachment loss (a disorder where bone loss and inflammation cause teeth to become loose and potentially fall out) is greater in persons with lower 25(OH)D levels.648 Also, the gums of persons who suffer from gingivitis (gum inflammation) were shown to have a lower tendency to bleed upon probing, if their serum 25(OH)D levels were high, indicating that the inflammation was reduced.649 Plenty of sun exposure is recommended for good dental health.
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Dental caries (cavities)
Studies on sun exposure and dental cavities were first reviewed by Dr. Zane Kime in his book, Sunlight Could Save Your Life. These studies are older but are very valuable.650 One finding showed a direct correlation between hours of available sun per year and the number of dental caries in Caucasian boys 12 to 14 years of age: In geographic areas with less than 2,200 hours of available sunlight, there were, on average, 486 cavities per-year in each group of 100 boys. In areas where there were 3,000 or more hours of sunlight, there were only 290 cavities per year per hundred boys. The frequency of cavities was also higher in winter than in summer months.651
It is likely that the reason for better dental health in areas of greater sun availability is the higher serum levels of vitamin D among those with greater sun exposure. More recently, in 2008, it was found that pregnant women who were deficient in vitamin D gave give birth to children whose tooth enamel was weak and who were at much higher risk of dental caries.652
Dr. Grant wrote an exhaustive paper on sun exposure, vitamin D and dental caries in 2011.653 In it, he noted that early researchers from the 1920s through the 1940s had analyzed the prevalence of dental caries in armed services personnel relative to their home states. Dental health was far superior among the personnel from the southern states (with greater sun exposure, of course) compared to the northern states. He also shows that dental health among those personnel improved in a nearly linear fashion based on increasing levels of sun exposure from state to state. From these data, it is easy to conclude that sun exposure is protective against dental caries. In his summary statement, Dr. Grant laments the unfortunate fact that when water fluoridation was being proposed to reduce the risk of dental caries in the 1950s, these UVB and vitamin D findings were not given any consideration.
Necrotizing fasciitis (flesh-eating bacteria)
Necrotizing fasciitis (NF) is rare and caused by virulent strep bacteria. The disease is most common in seasons of low sun exposure, with the highest incidence in winter.654 It is possible that sun-stimulated vitamin D produces the cathelicidins necessary to keep the disease at bay during the summer.
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HIV infection (AIDS)
Research has shown that 86% of AIDS patients had lower serum levels of vitamin D than a control group of healthy males.655 In addition, research conducted on HIV-infected women showed that those with the lowest 25(OH)D levels in the initial stages of infection were 25% more likely to progress to stage 3 or worse, and had a 46% higher risk of developing severe anemia, in comparison with women who had higher serum levels. Women in the highest quintile (fifth) of vitamin D had a 42% reduced risk of all-cause mortality when compared to those in the lowest quintile.656 Other researchers have demonstrated that HIV-positive pregnant women with the lowest 25(OH)D levels had a 50% greater risk of vertical transmission of HIV to their children and a two-fold increase of HIV transmission by breast feeding. There was also a 61% increased risk of death among children born to women with low 25(OH)D levels.657 The best protection for these women and children would be regular exposure to the sun or to other sources of UVB light to ensure adequate levels of vitamin D. With regard to the anemia mentioned above, it has been demonstrated that high-dose vitamin D supplementation has reduced HIV-1 replication caused by vitamin D deficiency (resulting from low sun exposure). Vitamin D supplementation has also reversed winter-associated anemia, which usually accompanies HIV replication.658 The key to preventing vitamin D deficiency is, of course, sun exposure—always the best choice when available. And sun lamps may be the second-best choice, as they produce vitamin D and many more healthful substances.
Infectious Mononucleosis (IM)
IM is an acute form of mononucleosis, which is a disease associated with Epstein-Barr virus and characterized by sudden fever and a benign swelling of lymph nodes. It is also known as glandular fever659 and is sometimes called the kissing disease, since the virus causing mono is transmitted through saliva. However, the disease can also be spread through coughing or sneezing, or by sharing food utensils with someone who has the condition.660
Recent research has shown that in Scotland, the disease is less frequent in summer and peaks in the winter,661 suggesting that sun exposure may be protective against it. Additionally, as we have pointed out in the section on multiple sclerosis, there is a strong association between low sun exposure and MS. This is an important point since MS and IM are closely linked.662,663 In Norway and Italy, the incidence of MS is highest in spring, again indicating that low 25(OH)D levels, resulting from low sun exposure during winter, play an important role.664
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Tuberculosis (TB)
TB is a disease affecting most tissues, but especially the lungs. TB has decreased dramatically since the early 20Th century, but there were still 644 deaths from TB in the USA in 2006.665
In the early 20th century, sun therapy (heliotherapy) was used to treat TB patients effectively. Dr. Aguste Rollier's records of 1,129 surgical TB cases showed heliotherapy cured 87% of "closed cases" and 76% of "open cases." Among 158 patients with tuberculosis of the hip, 125 were cured and 102 "regained complete recovery of articular function."666 And according to one source, "During one period of time just following World War 1,1,746 of the 2,167 tubercular patients who were under Rollier's care completely recovered health. The only failures were among those who had allowed their tuberculosis to enter its most advanced stages."667 (See the following graph)
Efficacy of Sun Exposure for complete Recovery from ^Tuberculosis

■ Sun exposed, recovered from TB
Sun exposed, not recovered from TB(advanced cases only)
Sun-lamp therapy was also used by Niels Finsen, who received the Nobel Prize in Medicine in 1903 for successfully treating 800 patients afflicted with lupus vulgaris—tuberculosis of the skin.668 In addition,
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Russian research has shown that extracorporeal ultraviolet radiation of blood for chronic bronchitis associated with pulmonary TB, halved the clinical symptoms of the chronic bronchitis and lessened the number of TB bacteria present in the body.669 More recently, researchers observed that among persons who had been exposed to TB, those with the lowest 25(OH)D levels were five-times more likely to progress to the fully developed disease. Women, who were more likely to have low serum 25(OH)D levels, were also more likely to develop the disease.670
In 2009, the first case of drug-resistant TB arrived in the US from Peru.671 It was nearly 100% resistant to antibiotics, which does not bode well for the country, since it could cause an immense killer epidemic. There seems to be no answer to the "superbug" causing it. Or is there an answer? Could the sun provide a solution to this health threat? The superbugs are upon us like a bad horror movie, and when they start to take over the earth, there will be one remedy: UV light from the sun or sun lamps. We would be well-advised to have our defenses set up in advance by enjoying daily UVR exposure.
In Switzerland sun exposure helped prevent and cure TB long before the advent of antibiotics!
I recently happened across research that should be of interest to those who love the Sun. It gave a historical perspective of TB, showing how the city of Bern, in Switzerland, wiped out most of its TB problems by using lifestyle changes, including greater access to sun exposure.672 The authors studied the TB incidence in Bern during the period from 1856-1950. There were three areas of the city assessed for their historical TB problems. One was known as the Black Quarter, where during 1911-1915 there were 550 cases of TB per 100,000 people; the second was the City Center with 327 cases per 100,000 people. The third area was the Outskirts, with 209 cases per 100,000 people. There were three living conditions correlating closely to TB:
1.	The number of persons per room. A higher number predicted a greater risk of TB.
2.	A greater number of rooms without sunlight predicted a greater risk of TB.
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3.	A greater number of windows per apartment predicted a diminished risk of TB
As the country worked to address these problems by improving living conditions, reducing room crowding, building open-air schools and building sanatoria, TB risk dropped from 330 cases per 100,000 in 1856 to 33 per 100,000 in 1950—0 90% drop! Sanatoria, by the way, were secluded hospitals specializing in healing through good food, fresh air and sunlight.
The researchers concluded their paper with this statement:
"Improved living conditions and public health measures may have contributed to the massive decline of the TB epidemic in the city of Bern even before effective antibiotic treatment became finally available in the 1950s."
This is an important paper. It shows how natural methods, including sun exposure, were highly effective in decimating TB. Sanatoria may be needed again, as the superbugs, including TB superbugs, are now highly resistant to antibiotics.673
When people avoid the sun, they set themselves up for disease. Instead, embrace the sun but don't burn. Sun exposure is one of the best methods for disease prevention known to man, and it doesn't produce any superbugs; in fact, as you will see below, it kills them!
Sunlight as an antiseptic and antibiotic
The German microbiologist Robert Koch, who isolated TB bacteria in 1882, showed that sunlight could kill bacteria. However, even earlier, in 1877, other researchers discovered that sugar water left in the shade became cloudy, indicative of bacterial growth. But if exposed to sunlight, it remained clear.674
Solar radiation is a potent bactericide. Dr. Kime, in his book, Sunlight Could Save Your Life, reviewed the results of research conducted between 1886 and 1909. It showed that the following bacteria were killed by ultraviolet light: Anthrax, plague, streptococci, tubercle bacillus, cholera, staphylococcus, colon bacillus and dysentery bacillus. Sunlight was virtually forgotten with the advent of antibiotic drugs, but now the interest has returned. While watching a newscast,
I (Sorenson) noticed the news ticker announcing, "Sunshine is the most effective anti-infection therapy." But is this really news? Dr.
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Kime cites several early studies on sunlight and infectious diseases, performed at about the same time as the advent of antibiotics.
Reports in the scientific literature in the 1940s showed that sunlight killed infectious bacteria or viruses. Kime states ..."a number of patients, having such various infections and diseases as blood poisoning, childbirth infections, peritonitis, viral pneumonia, mumps, and bronchial asthma were treated very successfully with ultraviolet light therapy to their blood."675, 676, 677, 678, 679, 680, 681, 682, 683, 684 The interest in blood irradiation for infectious diseases is now kindling new interest, due to the resistance of the "superbugs" to conventional antibiotic therapy. An example of this interest is found in a scientific book chapter from 2017. It is entitled, Ultraviolet Irradiation of Blood: "The Cure That Time Forgot?''685 The paper reviews the history of blood irradiation in the cure for infectious diseases. The author makes the following observation: "No resistance of microorganisms to UV irradiation has been reported, and multi-antibiotic resistant strains are as susceptible as their wild-type counterparts." Obviously, the answer to the superbug dilemma is known, but will it be used?
Perhaps not. It could cost the pharmaceutical industry a fortune. (For more information on this subject, see Dr. John Cannell's web site: Vitamin D Council.org)
Dr. Kime also cited research showing that UV therapy killed flu virus outside the body686 and destroyed cancer-producing viruses.687 He reported good results in his own practice in treating fungal infections with sunlight therapy. Other early research showed that all bacteria within eight feet of low-intensity UV lights were killed in ten minutes.688
While visiting in Mexico, a friend invited me (Sorenson) to tour a bottled-water plant in a town called Juchipila. Interestingly, the water was exposed to UV as a means of purification, an inexpensive method used in many countries. Sunlight also kills E. coli bacteria in twelve feet of seawater and in waste stabilization ponds.689 It is also interesting that the Sonicare electric-toothbrush company now sells a sanitizer based on UV. The brush, after use, is placed in the UV sanitizer, and the company claims it kills millions of germs in 10 minutes.
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Nursing pioneer Florence Nightingale insisted that hospitals for wounded troops be constructed to allow free entry of sunlight. How many hospitals today follow her brilliant advice? In the USA, nosocomial infections (those acquired in a hospital) occur two million times a year and claim 90,000 lives.690, 691 Hospital construction returned to the "dark ages" after the advent of antibiotic drugs. Meanwhile, the solution to most nosocomial infections is right outside the building, and no one will let it in! At the very least, hospital rooms should be cleansed daily with UV of sufficient strength to kill surrounding bacteria. Even hospital profits would improve since they are businesses, after all.
The University of Pennsylvania's Center for Health Transformation states, "Nosocomial infections create terrific problems by prolonging hospital stays, occupying scarce bed-days, requiring a greater number of diagnoses, more medication, and a greater burden on doctors and nurses." They estimate, "If a 300-bed hospital with 10,000 admissions yearly had a 5 percent annual infection rate (500 infections) with costs of $600 to $50,000 depending on the type of infection, the total costs for these infections could be as high as $7.6 million."692 Multiply that by the number of hospitals. Imagine the savings if they let the light in! The patients in such rooms would also be happier and have a more positive outlook.
Given the reality of the superbugs, it makes sense to return to a sanitation method used successfully for millennia. The antibiotic drug revolution destroyed the successful and promising use of UV lamps and sun exposure as antiseptic, pro-immunity treatments. With the current increase in the failure of antibiotics, the interest in UV must be renewed. We have become so obsessed in our pursuit of new antibiotics that we walk in darkness (or under artificial light) and fail to see the brilliant source of healing that awaits us outside.
Serendipitously, I (Sorenson) happened on an article called Natural Alternatives to Bleach for Disinfecting.693 It discussed pros and cons of such disinfectants as bleach, vinegar, hydrogen peroxide and yes, sunlight. The article stated that bleach could be dangerous, causing irritation to the eyes, mouth, lungs and skin, and when mixed with ammonia can result in the release of toxic fumes.
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The authors suggested three alternatives: vinegar, which is non-toxic; hydrogen peroxide, which can cause burns at high concentrations, but when diluted is reasonably safe; and sunlight, which like vinegar is nontoxic. The article states "In fact, scientists have found that exposing a bottle of water to sun for 6 hours is an economical way to provide developing countries with safe drinking water. The disinfecting properties of sun can also be useful around the house. If you have an object you can move outside, the sun's rays can help disinfect it. A stained piece of white laundry can be effectively brightened and disinfected by spraying the stain with lemon juice or vinegar, then hanging it in the sun."
The authors also mentioned that exposing the armpits to the sun would kill odor-causing bacteria. There is little I (Sorenson) enjoy more than sunbathing with my hands behind my head and my armpits exposed to the sun. Lots of vitamin D, nitric oxide and endorphins produced, and later on I am more popular with my friends—without using deodorants!
Also on this topic, research has shown that sunlight may be good for your socks and feet: Scientists tested socks contaminated with the fungus causing tinea pedis ("athlete's foot"), a chronic skin disease. The objective of the research was "to evaluate the effectivity of sun exposure in reducing fungal contamination in used clothing." Fifty-two socks, proven by fungal culture to be contaminated by patients with tinea pedis, were studied. The samples were divided into two groups: Group A underwent sun exposure for 3 consecutive days and Group B remained indoors. At the end of each day fungal cultures of the samples were performed.694 The researchers reported that elimination of the fungal cultures was significant in the sun-exposure group, but not the indoor group.
I (Sorenson) won't forget how fresh the clothing (including the socks) smelled after my mother had laundered and hung it outside in full sunshine to dry, during my childhood. I expect that any fungi or bacteria were eliminated, along with the resultant odor, which would have occurred if the clothing had been allowed to stay inside in a dark place.
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What have we learned?
1.	Influenza and most colds occur in winter season, when sun exposure is not very available. This is true in both the northern and southern hemispheres, and is indicative of a protective effect of sunlight, probably due to higher 25(OH)D levels in summer.
2.	Leprosy, where it still exists, is most common in urban areas of little sun exposure. Ultraviolet light has been shown experimentally to kill half of the bacteria causing the disease.
3.	Pneumonia is closely associated with lack of sunshine. Each one-hour increase in sun exposure per day lowered the risk of contracting pneumonia by about 33%.
4.	Acute lower respiratory infections (ALRI) in children is less prevalent among those who have ample amounts of sun exposure.
5.	Sepsis rates are highest in winter and lowest in fall, demonstrating a protective effect of sun exposure, possibly mediated by increased 25(OH)D levels in fall.
6.	Periodontal disease is closely associated with low 25(OH)D levels, indicating that inadequate sun exposure could lead to loss of teeth.
7.	The greater the sun exposure among children, the less is the risk of dental caries (cavities), and summer season is inversely associated with dental caries.
8.	Necrotizing fasciitis (flesh-eating bacteria) is most common in seasons of low sunlight, with the highest incidence in winter, indicative of a possible protective effect of sun exposure.
9.	HIV infection (AIDS) and its severity are associated with low 25(OH)D levels, indicating a low level of sun exposure.
10.	Infectious Mononucleosis (IM) is less frequent in summer and peaks in the winter, demonstrating the protective influence of sunlight.
11.	Tuberculosis (TB) has been completely cured by the use of regular, direct sunlight.
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12.	Sunlight is an exceptionally effective antiseptic and
antibiotic and was used since 1940 to cure various bacterial and fungal diseases.
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Chapter 9
Mental and neurological Conditions influenced by the Sun
"Sunshine on my shoulders makes me happy."
—John Denver
It seems like almost everyone is taking pharmaceutical drugs in an attempt to eliminate disease symptoms or to improve mental functioning and mood. That is such a shame, when God (or Nature if you prefer) has furnished the best natural pharmacopoeia that has ever existed or will ever exist. Clean, natural foods, sun exposure and regular exercise are the doctors we need so badly. Let's take a look at what Dr. Sun can do for our mentality.
ADHD (attention deficit hyperactivity disorder)
ADHD is the most prevalent of all mental disorders in children and causes significant problems with executive functions (e.g., attentional control and inhibitory control) causing attention deficits, hyperactivity, or impulsiveness not appropriate for a person's age.695 Insufficient sun exposure may be one of the major causes of ADHD. Researchers have found that sun exposure correlates to a decreased risk of attention deficit hyperactivity disorder (ADHD). They assessed the relationship between the prevalence of ADHD and the intensity of the sun in various nations and in US states,696 and after adjusting for birth weights, infant mortality and other relevant factors, the findings were not altered. It is obvious that sun deprivation by itself was associated with a higher risk of ADHD.
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Interestingly, the authors suggested that the mechanism by which sunlight accomplishes this improvement could be a positive change in the circadian rhythm, a factor previously associated with ADHD. Surprisingly, the researchers rejected the idea that vitamin D production stimulated by solar UVR could be the reason for the close association between sun exposure and ADHD. Dr. Grant has suggested this rejection was premature,697 since vitamin D receptors are present in all cells of the brain, and research has shown an association between low vitamin D and diseases such as autism. In addition, Alzheimer's, brain development in baby rats, anxiety and depression are correlated to 25(OH)D levels. Rats born to vitamin D-deficient mothers also have permanently damaged brains into adulthood698 and exhibit hyperactivity.699 In addition, recent research shows that adult vitamin D deficiency leads to behavioral and brain alterations in mice.700
A 2015 study of pregnant women showed that vitamin D deficiency, which determines the prenatal vitamin D status of the fetus during brain development, has a profound influence on the risk of ADHD in childhood:701 For each increase of 10 ng/ml [25 nmol/L] of vitamin-D concentration in the serum of the pregnant woman, the number of ADHD symptoms in their children decreased by 11%. This means that pregnant women need plenty of sun exposure during midday, when vitamin D production is at its peak (or utilize sunlamps if sun availability is low).
Of course, serotonin, endorphins and nitric oxide are also produced in the body due to sun exposure, and morning sun works to reset circadian rhythms.
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A 2016 study in Australia found that higher 25(OH)D level in umbilical-cord blood at the time of birth was associated with a lower rate of ADHD between the ages of 1.5 and 5.0 years. Each 10 nmol/L increase in 25(OH)D level was associated with an 11% reduction in ADHD using the Child Behavior Checklist.702 In Australia, the primary source of vitamin D is solar UVB exposure.
Considering the aforementioned effects of vitamin D deficiency on the brain, it is not surprising that solar radiation, which stimulates the skin to produce vitamin D, correlates to a reduced risk of ADHD. It is likely that the sun exerts its benefits through several different mechanisms.
Alzheimer's disease (AD) and non-Alzheimer's dementia
One of the fears of aging is that memory will fade and full-fledged AD will develop. Amyloid plaques, consisting of tangles of amyloid protein (a complex protein resembling starch) in nervous tissue, are pathological markers of AD that are found in spaces between the brain's nerve cells. Recent research indicates that vitamin D and omega 3 fatty acids may help in removing these plaques and thereby they reduce the risk or severity of AD.703 The research, described in a press release from UCLA, compared immune system parameters and inflammatory markers in the blood of two different groups, one with AD and the other without it. The researchers showed that both vitamin D and omega 3 fatty acids improved the ability of macrophages (large white blood cells) to clear amyloid plaques in those with AD. Macrophages work by engulfing foreign particles and then disposing of them—a process known as phagocytosis. Cell death caused by Alzheimer's disease was also diminished, and inflammatory markers diminished in those who suffered from excessive inflammation. This study demonstrates the beneficial effects of both vitamin D and omega 3 fatty acids on the immune system.
When people fail to be in the sun, low levels of vitamin D result. The message is clear: You need sun exposure (or use sunlamps if necessary) to avoid "losing your marbles."
Non-melanoma skin cancer (NMSC), a marker for sun exposure, is associated with reduced AD risk. Whereas melanoma, the deadly skin cancer, is inversely correlated with sun exposure the (more sun exposure, the less melanoma), NMSC directly correlates with sun exposure. NMSC has been associated with lower risk for melanoma and many other cancers. NMSC can be easily removed and is rarely fatal, unless the immune system is compromised due to other diseases, anti-rejection drugs or invasive medical procedures. Melanoma, however, can often be deadly. We are not suggesting that people contract NMSC in order to prevent melanoma; in addition to regular non-excessive sun exposure, it is best to adopt correct nutritional habits to reduce the risk of melanoma and other skin cancers.704
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Since sun exposure directly correlates to NMSC, the latter is often used as a sun-exposure indicator and compared with various diseases to evaluate the relationship between them and sun exposure. A 2013 article, published in the journal Neurology, reveals that among people with NMSC, the risk of Alzheimer's disease (AD) is profoundly decreased:705 Those with NMSC had a 79% reduction in AD risk. Stated another way, those without NMSC had about five times the risk of AD! Of course, this demonstrates the importance of sun exposure in reducing AD risk.
All tissues in the body have vitamin D receptors, and the brain and central nervous system must have vitamin D to function properly. If memory is fading fast, it may be time to spend more time in the sun. Remember, sun exposure is the direct, natural way to obtain significant amounts of vitamin D, a vitally important hormone. As much as 20,000 IU of vitamin D can be produced with whole-body exposure at midday, in addition to beneficial serotonin, endorphin, anti-inflammatory messengers, hydrogen peroxide, and nitric oxide.
As impressive as the correlation between low vitamin D and Alzheimer's disease is, it pales in comparison with the potential of vitamin D to reduce the risk of non-Alzheimer's dementia. A seven-year study showed that the risk of non-Alzheimer's dementia was 19.7 times higher in people who had vitamin D levels less than 10 ng/ml [25 nmol/L] (severely deficient), compared to those who had higher levels.706 When people do not get enough sun, low levels of vitamin D are a result. The message here: To keep your brain functioning, plenty of sun (or sunlamp) exposure is a necessity.
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Autism
Is autism a sun-deficiency disorder?
Autism rates are increasing exponentially and are related to vitamin D deficiency, which, of course, is related to sun deficiency. The Autism Society of America defines autism as "a complex developmental disability typically appearing during the first three years of life and is the result of a neurological disorder affecting the normal functioning of the brain, impacting development in the areas of social interaction and communication skills. Both children and adults with autism typically show difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities."707
The cost of autism is about $35 billion annually, and the societal cost for each case is about $3.2 million.708 The most alarming increase in the prevalence of autism has been observed over the past few decades, and its incidence is growing at the rate of 10-17% per year.39 Dr. John Cannell wrote a compelling paper on how autism could be caused, at least in part, by lack of vitamin D during brain development.709 The rest of this section discusses his primary arguments.
Dr. Cannell points out that in 1989, about the time autism began its most rapid increase in incidence, the American Medical Association Council on Scientific Affairs first warned of the perceived dangers of sun exposure and advised to keep infants out of the sun as much as possible.710 In 1999, when autism risk began to really skyrocket, the American Academy of Pediatrics advised to keep infants out of direct sun and to make sure that activities minimized sun exposure.711 It is quite possible that the results of all of this "protection" has been an increase in autism. The increase in the incidence of autism has closely paralleled the increase in sun-avoidance efforts. Tourette's syndrome (another nervous-system disorder) has also increased, parallel to the growth in autism.712
It is obvious that vitamin D is essential for brain development,713, 714 and children are deficient because of sun "protection" measures that lower 25(OH)D levels. Could this be one of the reasons for the surge in the rate of autism?
Here are more of Dr. Cannell's autism/vitamin D-deficiency links:
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1.	Both autism and vitamin D deficiency are associated with abnormally high inflammation.715, 716
2.	Dark-skinned people are far more likely to be vitamin D deficient because they require more sun exposure to produce it. If autism is linked to vitamin D insufficiency, the rate of autism among black children is expected to be higher than among white children, due to maternal and/or infant insufficiency of the vitamin influencing brain development. This is exactly the case; children of mothers who have emigrated from Uganda to Sweden, for example, have an autism rate of 15%, which is 200 times that of the general population.717
3.	There is a close correlation between latitude and autism among countries. The higher the latitude, the higher the rate of autism.718 High-latitude countries have higher rates of vitamin D deficiency due to a shorter season in which UVB is available to stimulate its production in the skin (see Chapter 2). The same relationship of latitude to autism exists within the states of the USA, with northern states having higher rates of autism.719
4.	In winter, when sun exposure is low, birth rates of autistic children peak.720
5.	Rickets and autism show similar urban/rural distribution rates. Rickets is an accepted vitamin D-deficiency disease, and urban children have significantly higher rates of both diseases.721 Pregnant rural women and their children tend to be outside in the sunshine more than their urban counterparts, and in urban settings, more air pollution blocks out UVB light. Poor air quality is directly correlated with autism722 and with profoundly lower serum levels of vitamin D.723 Finally, where precipitation rates are high, rates of autism are also high,724 suggesting a link to sun deprivation.
Several years after Dr. Cannell's hypothesis on autism and vitamin D, the evidence continues to mount as to the correlation between sun exposure and vitamin D and a lessened risk of autism. In 2013, Dr. Grant, with Dr. Cannell, published a paper in which they state, "Evidence is mounting that vitamin D deficiency is intimately
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involved in autism."725 In their analysis, they compare sun exposure to autism rates among several areas and races in the US. They make a

compelling case, in which autism correlates to vitamin D deficiency due to insufficient sun exposure. And, in research from 2016, a study sample of 4,229 children found that gestational 250HD deficiency, assessed either at mid-gestation or at birth, was associated with an increase in autism-related traits in 6-year-old children.726 Although these researchers concluded that vitamin D supplementation was the way to treat or reduce autism, this investigation really indicates that sun exposure (whenever and wherever it is available), the cause for vitamin D production, may be superior to supplementation in reducing disease prevalence.
If vitamin D deficiency is related to autism, symptoms should improve in summer. A case study reported by Dr. Cannell revealed improvements in autism-related sleep and behavioral problems during summer.727 The graphs above show the difference in autism characteristics in a 15-year-old. The first graph shows monthly changes in sleep disturbances; the second shows the frequency of autistic traits: crying, excitability, hyperactivity and pounding objects. Indications of autism decrease dramatically in summer months.
In addition, low serotonin levels combined with low vitamin D during pregnancy have been hypothesized to contribute to autism.728
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This hypothesis is based on the fact that sun exposure contributes to the production of both substances, and on the fact that vitamin D is necessary in the synthesis of serotonin, on which the brain is dependent for mood enhancement.
Bipolar disorder
Bipolar disorder (BPD), also known as manic-depressive illness, is a brain disorder causing unusual shifts in mood, energy, activity levels, and the ability to perform day-to-day tasks. Symptoms are severe and can result in damaged relationships, poor job or school performance and even suicide.729
Sun exposure resets the body's circadian rhythms, which are variations in physiology and behavior persistent with a cycle length close to 24 hours.730 This system is contained in the hypothalamus and stimulated by nerve cells in the retina of the eye in response to light.731 Research indicates that environmental conditions early in life may imprint the circadian system and influence mental function later in life:732 Increased number of hours of daylight at the location of birth during the first three months of life are associated with a significantly older age of onset of BPD. (For more on circadian rhythms, see Appendix 4.) In spite of research such as this, we are still told to protect our children from the sun, thereby setting them up for earlier onset of myriad diseases. When will we learn?
Another investigation about sunlight showed that depressed bipolar inpatients who had windows in their hospital rooms, allowing direct sunlight to enter the room in the morning, stayed in the hospital 3.7 days less, on average, than patients whose rooms were not illuminated in the morning.733 In this study there was no correlation between the length of hospital stay and the exposure to afternoon sunlight on the west side of the building, where the light entered windows during the afternoon. This demonstrates the importance of morning sun in resetting the circadian clock. Morning light is also important to the prevention of obesity (see that section), and sunny hospital rooms are also associated with decreased risk of death and shorter hospital stays among heart-attack patients who stay at the sunny side of the hospital (see the section on CVD).
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Considering this research on the life-saving and health-enhancing influences of sunny hospital rooms, it is important to note that these influences could not be due to vitamin D production, since windows block the UVB light that stimulates the production of vitamin D in the skin.734, 735 It is likely that UVA light and visible morning light—which stimulate the production of nitric oxide and serotonin—are the factors that save lives. The lesson to be learned is this: We need both UVA and UVB, as well as visible light, for optimal health, as intended by Mother Nature.
Cognitive disorders
Can you think as well as you used to? Does sun deprivation lead to intellectual disabilities? The preponderance of evidence suggests that higher 25(OH)D blood levels correlate to better cognitive ability (ability to think), so if you want a higher IQ, it behooves you to regularly expose yourself to sun around midday, or to use sunlamps in winter. Another alternative is to use a sunbed two or three times a week, or to take frequent tropical vacations (unless you have type-one skin, which does not tan). The key is to be safe. Remember, 90% of 25(OH)D measured in the blood of Americans, is produced by exposure to sun.
A study of cognitive abilities as they relate to 25(OH)D levels shows that persons who have the lowest levels are more than twice as likely to be cognitively impaired as those with the highest levels.736 Since vitamin D is absolutely essential to proper nerve function and development, 737, 738 and since there are vitamin D receptors throughout the central nervous system, it stands to reason that mental abilities would be compromised by poor vitamin D status. We would also expect depression rates to be higher in people whose vitamin D levels are low. Therefore, sun exposure may make you both smarter and happier.
Research from the British Journal of Psychiatry makes this point: "People with intellectual disabilities have a high risk of osteoporosis and fractures."739 Since it is well-known that vitamin D is absolutely essential to optimal bone health, the authors theorized that vitamin D deficiency could have an influence on intellectual shortcomings as well. To test their theory, they measured the 25(OH)D levels of 155 patients with intellectual disabilities and compared them to 192
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controls who had no such disabilities. The results were compelling: nearly twice as many patients with intellectual disabilities were vitamin D deficient when compared to normal controls. The
researchers noted that they were able to normalize 25(OH)D levels with supplementation, but did not report whether the supplementation abated the intellectual problems. They concluded: "Vitamin D deficiency is highly prevalent in people with intellectual disabilities, partly because of insufficient exposure to sun. Screening and treatment strategies, aiming to reduce these patients' high fracture risk, should be introduced. Similar strategies may be required in other psychiatric populations at risk for fractures and with a tendency to spend excessive time indoors."
These researchers obviously understood that the best method to obtain vitamin D is through sun exposure. However, the phrase they used, "partly because of insufficient exposure to sun," is probably not accurate, since most serum vitamin D is due to sun exposure. The term "partly" should simply be replaced with "mostly."
One of the most persuasive studies on fractures showed that women in Spain—those who regularly enjoyed sun exposure-had about one-eleventh the risk of hip fractures as women who had little exposure740 (see the chapter on osteoporosis). We have seen no research demonstrating such profound protection by vitamin D supplementation alone, although high levels are essential for the absorption of calcium. Solar radiation has many effects on the human body beyond producing vitamin D—effects which may also lessen the risk of fracture and osteoporosis. Based on the studies on cognitive function mentioned above, we would theorize that Spanish women who were continually in the sun, probably had only a small fraction of the intellectual disabilities experienced by those who had little sun
exposure. Is it not a very smart action to preserve and strengthen our bones while simultaneously increasing our mental capacity? It can be done simply by exposing ourselves to regular, non-burning sun.
In a study published at the American Journal of Geriatric Psychiatry, researchers investigated the association between 25(OH)D levels (produced of course, by sun exposure) and the risk of poor cognitive performance and mood disorders in the elderly. The results were impressive: Regarding cognitive ability, the researchers found that in two of four tests, those with vitamin D deficiency exhibited cognitive performances 5.22 times and 3.22 times poorer than those who were not deficient. Regarding mood disorders, it was found that those whose 25(OH)D levels were deficient-defined as less than 20 ng/ml [50 nmol/L—had 11.7 times the incidence of depression when compared to those whose 25(OH)D levels were higher.741 It is known that vitamin D (working together with omega-3 fats) is involved in the conversion of the amino acid tryptophan to synthesize serotonin and modulate its release and function in the brain.742 By producing vitamin D, sun exposure therefore contributes to cognitive health as well as works as an anti-depressant.
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Results of more recent research, based on a 15-year residential history of varying degrees of sun exposure, have shown that cognitive impairment in persons who were below the median exposure to sunlight was 88% greater than in those who were above the median.743 The researchers mentioned vitamin D as a possible mechanism by which sun exposure could positively influence cognition, but they also remarked that regulation of the circadian rhythm by the sun could be a factor. These same investigators had previously shown that lower levels of sun exposure resulted in a 2.6-times higher incidence of cognitive impairment.744
Depression and seasonal affective disorder (SAD)
The section on cognitive disorders above mentioned an exceptionally important study on depression, sun exposure and vitamin D. This section will present more corroborating information on how sun deficiency associates with a greater risk of depression.
Few people realize how prevalent depression is in our society, representing a huge drain on the economy. According to Steven Genuis, in an editorial in Canadian Family Physician, "The World Health Organization estimates depression costs the American economy about $44 billion annually, equal to the total cost of all cardiovascular diseases."745 He also stated that in one decade, there was a 300% increase in the sales of antidepressants, making these medications the top-selling pharmaceuticals in the world.
What does the sun do to relieve "the blues?" The answer lies in a chemical responsible for transmitting impulses between nerve cells. This "neurotransmitter/' serotonin, is a natural "upper," working in synchronization with the natural "downer," melatonin. When we awake to sunshine, light enters the eye and stimulates serotonin production. We then quickly become awake and invigorated, and melatonin is suppressed. At day's end, however, the bright light disappears (or at least that is how nature intended it), melatonin levels rise, and serotonin levels diminish. We begin to feel sleepy and ideally retire for a good night's rest. It is a perfect system for our needs—unless we stay up far beyond biologically natural hours, by using artificial lighting. Lack of serotonin is believed to cause depression, and current antidepressant drugs attempt to keep serotonin at high levels. There is bad news about these drugs, however, and good news about the sun and its influence on depression.
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First of all, sunlight can dramatically increase serotonin levels in the brain. Dr. Gavin Lambert and his colleagues in Australia measured serotonin levels in response to varying degrees of bright light.746 To do so, they drew blood samples from the internal jugular veins of 101 men and compared the serotonin concentrations of the blood to weather conditions and seasons. The results were remarkable; Men who were measured on a very bright day produced eight times more serotonin than those who were measured on a cloudy, dismal day (see the graph below).

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They also observed that the effect of bright light was immediate, and that there was no holdover from day to day. Serotonin levels were also seven times higher in summer than winter. There we have the answer to seasonal affective disorder (SAD), a form of mood disorder occurring especially in winter, and characterized by depression, irritability, aggression, weight gain, fatigue, and inability to concentrate. A 2015 report from Proceedings of the Royal Academy B, demonstrated that female rats with the least sun exposure per day displayed the most aggression.747 An increase in melatonin was given as the reason for the aggression, since when winter approaches, sunlight decreases and melatonin increases. Melatonin acts on the adrenal glands, causing the release of a hormone called DHEA, which has been consistently linked to aggression in both mammals and birds. Therefore, to avoid troubles with your loved ones, make sure they get plenty of sun or other form of UV light every day of the year!
It has also been shown that depressed psychiatric patients residing in sunny rooms stayed in the hospital 2.6 fewer days, on average, than those who had "dull" rooms.748 The sunny rooms had windows, so it is likely that endorphins, created by the sun's rays entering through the windows, were responsible for making the patients felt better. It could not have been vitamin D, since as aforesaid, the UVB light necessary to produce Vitamin D is filtered out by window glass.
Speaking of "dull" rooms (rooms with minimal windows or with window covers reducing lighting)—these are typically the rooms housing television sets (including darkened bedrooms). An interesting study from the University of Pittsburgh has found that the more TV teenagers watch, the more likely they are to be depressed as adults. For each hour of TV watched, the rate of depression increased significantly. The author's theory was that preponderance of depressing news and programming on TV, internalized by the viewers, was the main cause.749 Is this theory correct, or could it be that hours of sedentary life in front of the TV, watching junk food commercials, lead to obesity and poor health as the teenager ages? We have another theory, which may supplant, or at least add to those ideas: Is it possible that years of unnatural indoor habits create insufficient levels of vitamin D, nitric oxide, endorphins, serotonin, and/or Brain-Derived Neurotropic Factor (BDNF), leading to long-term mood disorders? When these deficiencies combine with the other deleterious influences of excessive TV watching, we may have a perfect recipe for depression. Sun exposure and vitamin D are absolutely necessary for human health and happiness. An indoor lifestyle is unnatural and damaging to the human body and psyche.
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Brain-Derived Neurotropic Factor (BDNF)
Our brain's structure and function are influenced by a naturally produced protein called BDNF, which is a part of a cascade of proteins promoting growth of neurons and preventing nerve death.750 Researchers have shown that BDNF has an effect on behavior, mood (e.g. depression), and brain adaptation (e.g. plasticity) and that its levels fluctuate seasonally in correlation with the amount of ambient sunlight:751 BDNF levels increase in spring and summer and decrease in fall and winter. The authors of this research summed up their findings thusly: "This finding is important for our understanding of those factors regulating BDNF expression and may provide novel avenues to understand seasonal dependent changes in behavior and illness such as depression."
Correct levels of BDNF, however, have many other important and positive affects in the body,752 including the promotion of long-term memory, regulation of mood and perception of pain, reduction of Alzheimer's disease and Huntington's disease, and control of epilepsy, depression, anxiety, bipolar disorders, schizophrenia and addiction. In addition, BDNF has positive affects on type-two diabetes, cardiovascular disease and colorectal cancer.
BDNF levels have been shown to increase significantly after bright light exposure.753 In what we would consider to be a remarkably important study, both light exposure and treadmill exercise increased the expression of BDNF in rats.754 And—as the researchers showed— exercise and/or bright light promoted neurogenesis (new nerve cell growth) in the adult rat brain. How important is this finding for adults who are worried about cognitive decline? We are actually seeing an example of new brain cells being built by bright light and exercise. But the researchers were not through with their recommendations. They stated in their summary: "In view of these findings, we propose that moderate exercise or exposure to sun during childhood can be beneficial for neural development." Other research has similarly indicated that physical activity is positively associated with BDNF levels.755 So now we can add one more natural chemical inversely associated with depression, memory loss, and nervous system degeneration, and directly associated with sun exposure. We now have vitamin D, serotonin, endorphins, and BDNF. And to that list we will soon add the important neurotransmitter—dopamine.
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Should we grow an outdoor garden?
Dr. Diane Godar and her colleagues have presented evidence showing that outdoor workers, while receiving 3-9 times the sun exposure as indoor workers, have had no increase in melanoma since before 1940, whereas melanoma incidence in indoor workers has increased steadily and exponentially.756, 757, 758 while thinking about this fact, I ran across an article entitled A senior moment: Get'down and dirty'
Gardening is good for you!759 It discussed all the benefits of gardening and related some research regarding its therapeutic use. What are those benefits?
1.	Provides exercise to strengthen both the upper and lower body muscles, especially improving hand strength
2.	Reduces arthritis
3.	Promotes circulation
4.	Reduces heart rate
5.	Lowers blood pressure
6.	Burns calories
7.	Improves sleep
8.	Exposes the body to the sun to reset the circadian rhythms and combat depression
9.	Promotes better nutrition (from freshly picked vegetables)
10.	Increases self-esteem (it is an accomplishment to produce one's own food)
11.	Gives a better sense of time (outdoor work keeps us aware of the earth's time)
Of course, some of these benefits of gardening are really benefits of sun exposure as mentioned in the article. However, there may be another factor at play: when we connect with the earth, it improves our health,760 including heart health761 and mood762 through a transfer of electrons from the earth to our bodies. Also, when we spend time outdoors we inhale volatile (airborne) plant molecules in the relatively unpolluted fresh air. According to scientific studies, these bioactive plant molecules provide powerful immune support and are naturally anti-inflammatory and anti-microbial.763, 764, 765 In Nature, prior to the construction of enclosed or airtight homes and cities, we would inhale several types of health-giving bioactive plant molecules throughout our entire life cycle.
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What have we lost when we adopted our sedentary, indoor lifestyle? Among other things, we have lost our good nutrition, our inhaled plant molecules, our sun exposure, and our contact with the earth and its healthy microbes. It is no wonder working in a garden has such beneficial effects on our health! It gives us back at least some of our basic human health needs. So, if you don't have a garden, find one and get out in the sun!
Beware the anti-depressant drugs!
The most popular anti-depressant drugs are intended to perform their task by keeping serotonin levels higher, but there are problems. The Food and Drug Administration (FDA) indicates that antidepressant medications, known as selective serotonin re-uptake inhibitors (SSRI), may increase depression in some cases and lead to suicidal thoughts. Some of the brands involved are Paxil, Lexapro, Prozac, Effexor, Zoloft, Wellbutrin, Luvox, Celexa and Serzone, although the FDA listed 34 drugs. The entire list can be found online at
fda.gov/cder/drug/antidepressants/. The FDA states the following: "The Food and Drug Administration asks manufacturers of all antidepressant drugs to include in their labeling a boxed warning and expanded warning statements alerting health care providers to an increased risk of suicidality in children and adolescents being treated with these agents, and additional information about the results of pediatric studies."
The FDA lists several additional warnings and instructions about these drugs for children:
• Antidepressants increase the risk of suicidal thinking and behavior (suicidality) in children and adolescents with major depressive disorder and other psychiatric disorders.
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•	Anyone considering the use of an antidepressant in a child or adolescent for any clinical use must balance the risk of increased suicidality with the clinical need.
•	Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior.
•	Families should be advised to closely observe the patient and to communicate with the prescriber.
Missing are two important facts: first, SSRI drugs increase bone loss.766 Research shows that women who used SSRI lost nearly 80% more bone per year than non-users! And as expected, later research shows that SSRI use is correlated to a 75% greater likelihood of sustaining a fracture.767 Second, SSRI don't work very well. A metaanalysis of data on SSRI's submitted to the FDA indicates that placebos (sugar pills) are as effective as SSRI's in reducing depression;768 in other words, only drug companies benefit from SSRI's—not depression sufferers who endure all the risks.
What about other mood-altering drugs? It has been shown that antianxiety drugs, such as valium and Xanax, and sleep aids like Ambien, Sonata and Lunesta lead to increased risk of death:769 During 7.6 years, and after controlling for other factors such as sleep disorders, anxiety disorders and other psychiatric illnesses, the risk of dying was found to be 3.46 times higher in those who took the drugs compared to those who did not. Considering the material we have covered so far concerning brain disorders, insomnia, and sun exposure, it seems reasonable to believe that a better and less dangerous option would be regular sun or sunlamp exposure.
Research from Denmark has shown that morning light, made to mimic daylight, relieves anxiety by reducing the activity of the brain's fear center.770 The efficacy of light treatment was based on the intensity of the light: the greater the intensity, the greater the effect.
A scientist named Dr. Klaus Martiny has commented on the above study, noting that morning light improves sleep: "A lack of daylight disrupts some hormonal processes in our bodies regulating our circadian rhythm. This can result in a shift in circadian rhythm, so people go to sleep later and later in the evenings, and this shift is associated with an increased risk of depression."771 Martiny suggested a good rule of thumb is to go to sleep before midnight and awaken before 8:00 AM. However — as we will discuss in the section on obesity — the earliest morning sun, which was responsible for resetting the circadian rhythm, was also associated with a remarkably lower risk of obesity. We therefore suggest a better rule of thumb is to be outside for a half-hour when the sun rises each morning. (For more information on circadian rhythms, see Appendix 4.)
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Other "uppers"
Although the brain produces serotonin in response to the sun's rays entering the eye, there is another class of "feel-good" hormones— endorphins—that are secreted within the brain and nervous system, but are also produced by the skin in response to sun or UVB exposure.772 Endorphins elevate mood while producing a sense of wellbeing. Additionally, Dr. Michael Holick, an expert on the benefits of solar radiation, has reported that the important neurotransmitter dopamine, another "upper," also increases with exposure to ultraviolet light.773 The assertion about dopamine was corroborated by other scientists.774,775 This further supports our statement that stimulating the skin with solar radiation works its "magic" in many ways beyond the production of vitamin D.
Do you want to feel good without reaching for toxic prescription drugs? Get away from the TV, video games, and other sedentary, sunless activity, and get outdoors. And stop eating highly processed and toxic foods that are devoid of nutrients, and/or rich in artificial stimulants.
Epilepsy
According to a medical hypothesis proposed in a paper about epilepsy, light therapy may be an effective treatment to prevent epileptic seizures.776 Here are a few of the authors' interesting observations: (1) Sun exposure is important in the endogenous production and regulation of melatonin and vitamin D, both of which influence seizure thresholds. (2) Seizure frequencies increase in winter and on overcast days. (3) Some studies demonstrate a lower prevalence of epilepsy in southern Europe—where sun exposure is greater—compared to northern Europe; (4) Light therapy is an established treatment for depression, and some forms of epilepsy and depression are related.
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According to one researcher, both melatonin and vitamin D influence seizure thresholds in epilepsy.777 He also states that seizure frequency increases in winter, and that epileptic seizures are known to occur more frequently on dull days than on bright, sunny days, regardless of time of year.778 Interestingly, this researcher also reports that epidemiological studies reveal a lower prevalence of epilepsy in southern Europe compared to Scandinavia and northern Europe. The mechanism of action may be similar to that of anti-depressant drugs [but without the risks]. He recommends high-intensity light treatments for the disease, but suggests that this treatment is likely to be palliative rather than curative. If sun therapy can effectively reduce the frequency of seizures as these reports indicate, it is a terrific boon to sufferers of epilepsy, even if the research has not established whether it is curative or just palliative. [After all, risky drug treatments are also just palliative].
Additionally, other papers have suggested that vitamin D deficiency, caused by sun deprivation, could increase the risk of sudden death in epilepsy.779 Therefore, for people with epilepsy, safe and regular sun exposure (or sunlamp use in winter) may be the best therapy.
Mood
Anyone who works in natural light experiences enhanced mood, performance, behavior and psychological health. Very few things improve our wellbeing like arising early in the morning and walking outside on a bright, sunny day: Our attitude improves, our serotonin and endorphin levels increase, and there is an almost immediate feeling of exhilaration. We also become less confrontational, and our minds seem to click on all cylinders. Later on, around midday, if we are fortunate enough to have time to safely sunbathe (with a lot of our skin exposed), we produce large quantities of vitamin D, and our nitric oxide levels increase. This gives us a delicious feeling of relaxation and an almost instantaneous lowering of blood pressure as the cares of the day melt away.
Regrettably, most of us live in a society robbed of the sun, being confined to artificially lighted buildings and to poor little cubicles— which are like prison cells that won't allow our happiness to manifest itself in the light.
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More scientists are recognizing that modern humans suffer from artificial, insufficient light in their lives. These scientists are advocating a return to natural light. One of the best studies on the subject of light and mood measured the impact of windows and daylight on the physiological, psychological and behavioral health of nurses.780 The study used biological measurements, behavioral mapping and analysis of archival data in a nursing unit with two wards exhibiting similar conditions—except that one ward had more windows and more natural lighting than the other. In the ward with more windows and natural light, the nurses had lower blood pressure and higher body temperature, less sleepiness and a better mood. Communication and laughter also increased. Heart rates were shown to be lower with greater exposure to natural light, and caffeine intake was reduced as well. Also, there was a decrease in the frequency of medication errors by the nurses, although this difference was not considered statistically significant.
Rana Zedeh, the lead researcher of that study, made the following statement:781 "Research has shown a range of different outcomes are impacted by sun, including regulation of the circadian rhythm, shorter length of stay for patients, reduced perception of pain for patients, and reduced anxiety and agitation among elderly patients with dementia. Improved outcomes for patients also help staff manage their patients better."
One can only imagine the potential benefits that could be realized if unencumbered sun rays had been allowed to flow into the building: Vitamin D production would have increased, and it is likely that patients as well as nurses would have improved their health. Dr.
Zadeh also made this declaration: "Intelligently designed clinical workspaces could lead to higher safety and quality levels... By default, when we think of a healthcare workspace, we may think of a large, deep building with no windows for staff, little access to greenery or outdoors, an institutional feel, complex way-finding, and monotonous color and lighting. Knowing how the human brain receives stimuli from the environment and constantly changes neural hormonal responses controlling cognitive performance and alertness, we might be able to improve outcomes by creating more vigilant and restorative elements in environments."782
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Our plain-English translation of the above statement is "get out of little dark boxes and get back into the sun."
Another interesting study supports the findings of the above nursing unit study: By comparing two treatments for depression—sun exposure vs. visiting a doctor—it corroborated what almost every human being knows instinctively: That sunshine brightens the mood. Twenty people with depressive symptoms were divided into two groups. One group was asked to spend more time in the sun, while the other group was asked to see a doctor. The experiment lasted for seven weeks and showed that those who spent more time in the sunlight had fewer symptoms of depression than those who visited a doctor.783
It was suggested that vitamin D status caused the differences between the two groups, but all the evidence we have discussed this far indicates that it was the influence of sun exposure, with its increased production of endorphins and serotonin. People who have lived in northern climes have all experienced immediate mood elevation when going outside on a cold but clear sunny day during winter, following several days or weeks of cloudy winter weather. Vitamin D is not produced by the skin during winter in high-latitude countries, so winter sunshine must be the factor making the difference. Also, we cannot raise 25(OH)D levels fast enough to make such an immediate difference in mood.
Some authors express their concerns that since the sun stimulates endorphins and serotonin production—resulting in people feeling happy, relaxed and positive—this might lead to a "sun addiction" or tanning addiction. They therefore liken tanning to substance abuse.784, 785 However, recent research disagrees with this assumption that the sun meets the criteria for producing addiction. Yet, a popularized 2015 report maintains that ultraviolet light is addictive.786 Well, if they are correct, then it is a good thing. That report is obviously meant to be a hit piece regarding sun exposure and tanning, as demonstrated by its factually misleading opening statement: "Despite widespread awareness UV exposure is a major risk factor for all common cutaneous malignancies, skin cancer incidence relentlessly increases by ~3% per year." The "all common cutaneous malignancies" portion of this statement, of course, is patently false, as we have shown unequivocally in Chapter 1 noting that regular sun exposure is protective against melanoma. These researchers conducted various experiments on mice, which demonstrated that a behavior choice, such as desiring lighter rather than darker environments, were increased by regular exposure to UV light. These behavior choices were mediated by P-endorphins, peptide hormones which are similar to opiates. The Researchers summarized their paper with the following: "While primordial UV addiction, mediated by the hedonic [pertaining to pleasure] action of P-endorphin and anhedonic effects of withdrawal, may theoretically have enhanced evolutionary vitamin D biosynthesis, it now may contribute to the relentless rise in skin cancer incidence in man." This summary statement is claptrap, as can be seen by the research on melanoma and sun exposure presented in Chapter 1. Other research from January 2016—this time using humans as subjects—demonstrates that UVB induces the expression of P-endorphins in human skin, and concludes this is likely the reason for addiction to ultraviolet radiation.787
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So, is this a bad thing just because the word "addiction" was chosen? This marvelous product, P-endorphin, is one of the feel-good hormones decreasing pain and increasing a sense of well-being. The case the researchers make regarding addiction to sun is compelling, and why not? Sun exposure causes vitamin D production in the skin, which is essential to human health. It also stimulates the production of nitric oxide, which relaxes our vessels and lowers our blood pressure. It stimulates production of serotonin in the brain, which is another feel-good hormone necessary for a happy mood and wellbeing. And considering the myriad additional effects of sun exposure on health, including the prevention of cancer, the prevention and reversal of bone diseases and the reduction of heart disease, could it not be part of God's (or Nature's) master plan to develop a positive addiction to the sun in order to keep us healthy and prevent disease?
I (Sorenson) am a sun addict and expose myself to it regularly for two reasons: (1) It makes me feel good and marvelously improves my mood, and (2) it protects me from disease and weakness.
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If sun is addictive and helps me prevent melanoma, heart disease, bone loss and other maladies, I'll take the opiate high and say, "Thank God for the addiction!"
Do you want to feel better, laugh more, improve your health, escape the monotony and be more alert and intelligent? Bring sunshine back into your life!
Parkinson's disease (Pd)
In a 1988 study comparing four northern US regions with three southern regions, death rates from PD were found to be significantly higher in the northern regions,788 suggesting a possible protective effect of sun exposure. Later research corroborated those findings, demonstrating a strong north-south decreasing gradient for PD among white Americans.789
A study of the association between outdoor activity, vitamin D intake and the risk of Parkinson's disease, has demonstrated that both total vitamin D intake and outdoor activity were associated with a reduced risk of PD.790 However, the researchers stated that outdoor activity was more significantly associated with decreased PD risk than was vitamin D intake. Another study similarly revealed that outdoor work correlated with a 26% reduction in the risk of PD,791 but for some bizarre reason, the authors concluded that occupational sun exposure was not likely to have a substantial role in the etiology of PD. Yet, in an impressive 29-year study in Finland, those who were at the highest quartile of serum 25(OH)D levels at the beginning of the study had an impressive 67% reduction in the risk of contracting PD at the end of the 29 years.792 The highest levels of 25(OH)D were probably due to more time in the sun, although fish consumption could have had some impact. Another study from Finland, this time conducted over a period of 22 years, demonstrated that those subjects who participated in vigorous physical activity had a 73% reduction in the risk of PD.793 Again, one can only surmise that sun exposure was responsible for the reduced risk of PD among the active subjects (who spend more time outdoors).
An article on Parkinson's disease was published in Nature Reviews Neurology, entitled "Could sun offer protection from Parkinson's disease?"794 The article reported that according to research, when
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25(OH)D levels are low there is a tripling of the risk of Parkinson's
disease.795 The report emphasized that vitamin D is obtained through diet and sun exposure, but indicated that little vitamin D comes from food, whereas massive quantities can be provided through sun exposure in a short time. The following chart shows that relationship:

The latest research, from China, demonstrates that sun exposure is dramatically protective against Parkinson's disease (PD).796 This study compared 201 newly diagnosed PD patients with 199 controls who were free of PD, by collecting data on vitamin D intake, blood 25(OH)D levels and sun exposure in both groups, using a self-report questionnaire. Those who had the highest levels of blood 25(OH)D had a 48% decrease in PD risk. Those receiving the greatest sun exposure had about 47% decrease in PD risk. Whereas a significant positive correlation existed between elevated blood levels of vitamin D and sun exposure, vitamin D intake from supplements and food did not correlate with blood levels of vitamin D.
This is a particularly interesting study demonstrating that vitamin D levels should be raised mostly by exposing the skin to the sun (or sunlamp) whenever possible rather than by dietary intake. It appears that dietary intake in the amounts most Chinese people receive is not effective for raising the blood levels of vitamin D.
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Schizophrenia
There is a significant association between the month of birth and schizophrenia in men:797 In men born during seasons of little sun, the rate of schizophrenia is higher. This relationship exists in both the northern and southern hemispheres. Schizophrenia is also more common in dark-skinned migrants to cold climates, and increased rates of schizophrenia are observed in those who are born in urban compared to rural settings.798 Migrants to colder climates are 4.6 times more likely to develop schizophrenia than are natives.799
Dr. Grant800 and others 801have observed the possible correlation between influenza occurring during women's pregnancies and dramatically increased schizophrenia rate in their children. Such a finding could be at least partially due to brain damage in the embryo, resulting from the high fevers commonly seen during influenza. There is a very close relationship between fever of a pregnant mother and the risk of later schizophrenia in her child.802 A meta-analysis of studies regarding gestational influenza and its influence on psychosis in adults shows that influenza is a factor for psychosis, with those adults born to women with the flu having an increased risk.803 Schizophrenia is considered to be a psychotic disorder.
But what does this relationship have to do with the sun? We have established earlier that during seasons of high sun exposure flu is nearly non-existent.804 Higher 25(OH)D levels stimulate the production of cathelicidins, which destroy the cell walls of viruses, thereby keeping the flu at bay in summer. It follows that higher blood levels of vitamin D, by preventing flu in pregnant women, also help reduce the risk of schizophrenia in their children. In addition to this indirect effect of vitamin D, it is also possible that this vitamin has a direct affect on the brain, reducing the risk of schizophrenia.
A possible method to prevent schizophrenia has been proposed: The use of bright light therapy for pregnant mothers during the second trimester of pregnancy, if it occurs around the winter solstice. The bright light would make up for the lack of sun exposure at that time of year. The hypothesis is that bright light would protect against circadian pacemaker problems in the child. This would be accomplished by several mechanisms, including the control of melatonin secretions in the mother.805
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The research, therefore, indicates that sun exposure protects against schizophrenia through several possible mechanisms.
Electric light disease and the sun
Recently we became aware of two scientific papers that are related, probably without the authors' knowledge of each other. Both papers had to do with circadian rhythms, which are biological cycles recurring in approximately 24-hour intervals: Upon awakening at sunrise, there should be an increase in the blood levels of the chemical serotonin—a natural mood enhancer. At night, when the sun sets, melatonin—a natural relaxer—must take over to help us sleep soundly.
Other circadian rhythms operate throughout our daily life, helping us function better and feel healthier and happier.
The first of the two papers was called "Electric light, particularly at night, disrupts human circadian rhythmicity: is that a problem?"806 In
this study, the authors make the point that almost all life forms on earth have developed circadian rhythms (daily oscillations in physiology), and that disruptions of those rhythms can result in depression, cancers, obesity, and diabetes. Our physiology, they report, is meant to work on a sunrise to sunset cycle, and this cycle is becoming increasingly disrupted by electric lighting, which may be responsible for subsequent disease.
The second paper was called "Circadian clocks optimally adapt to sun for reliable synchronization."807 In it, the authors explain that circadian rhythms are best synchronized by the sun. It therefore becomes clear that to escape the ravages of electric light disease, it would be a good idea to reset our biological clocks daily by being out in the morning sun when possible, and avoiding long hours of electric light exposure at night. This could be one of the best therapies possible when we feel "out of synch." Catching some sun throughout the day would also keep serotonin levels higher and keep our moodiness in check. We generally feel better when we are in the sun. This, coupled with enhancement of health, demonstrates how our friend, the sun, is an essential companion for optimal living. Another paper pointed out how artificial nighttime light also increases sleep onset latency and increases alertness at night, disrupting sleep.808
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Other research has expanded upon the above papers, stating that our
nighttime use of computers, phones, tablets and TV—habits which suppress melatonin synthesis and alter the circadian rhythm— increases the risk of breast, prostate and other cancers as well as psychiatric, hypertensive, and cardiac disorders. These habits are associated with an almost complete lack of daytime sunlight, whose blue-light spectrum is responsible for synchronization of the biological clock.809 Of course, the lack of sun exposure also leads to vitamin D deficiency.
Don't lose your marbles ... instead, find the sun!
What have we learned?
1.	ADHD (attention deficit hyperactivity disorder) is associated with low sun exposure levels, probably due to vitamin D deficiency and desynchronized circadian rhythms.
2.	Alzheimer's disease is inversely associated with nonmelanoma skin cancer, suggesting that sun exposure lessens the risk of the disease.
3.	Autism is much more prevalent among children whose mothers received little sun exposure during their pregnancies. Vitamin D production during sun exposure appears to be the mechanism by which autism is prevented.
4.	Bipolar disorder is associated with lack of sunlight, particularly morning sunlight, which has the ability to reset the circadian rhythm.
5.	Cognitive impairment is closely related to sun deprivation and 25(OH)D levels.
6.	Depression and seasonal affective disorder (SAD) are more common in winter, when sun exposure is low. Light therapy is often effective in mitigating or preventing these disorders. The mechanisms may be an increase in serotonin, endorphin and BDNF and proper levels of melatonin at the right time of day.
7.	It is unlikely that vitamin D plays a major role in depression or SAD; rather, lack of sun exposure is the key.
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8.	Epilepsy, based on geographical and seasonal variations in incidence of the disease, may be caused by lack of sun exposure. Vitamin D production by sun exposure may be the mechanism for protection against the disorder.
9.	Mood is marvelously enhanced by sun exposure, likely by resynchronization of the circadian clock and by production of serotonin and endorphins.
10.	Parkinson's disease is associated with both low sun exposure and vitamin D deficiency.
11.	Schizophrenia is more common in men born in seasons of low sunlight, and may also be influenced by winter flu, which is also associated with low sun exposure.
12.	Electric light at night may lead to a mood disorder called "electric light disease." Resynchronization of the circadian rhythms by sunlight may help to overcome the disorder.
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Chapter 10
The Influence of Sun Exposure on Other Disorders
"The windows of my soul I throw wide open to the sun."
—John Greenleaf Whittier
Until now we have discussed disorders occurring in groups, such as cancers, infectious diseases, cardiovascular diseases and others. This chapter will discuss a miscellany of maladies with no grouping. All of these disorders benefit from sun exposure.
The diseases discussed will be anaphylaxis and allergies, chronic obstructive pulmonary disease (COPD), eczema, insomnia, fatty liver disease, myopia, obesity, pain, psoriasis, sexual dysfunction and infertility, premature aging (shortened life span), soft tissue injury, suboptimal athletic performance and uterine fibroids. These diseases lead to thousands of deaths and untold suffering. Sun exposure may help mitigate the suffering and decrease the risk of death, so read and take action!
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Anaphylaxis and other allergic reactions
Anaphylaxis, or anaphylactic shock, is an extreme allergic reaction, whereby antibodies are massively manufactured against a protein that is recognized as a threat by the immune system, as a result of prior exposure to the same protein. It is characterized by a profound drop in blood pressure, severe itching and hives, and breathing difficulties. Untreated, it can be lethal. A common cause is bee sting, although many drugs and foods trigger reactions in individuals. Although there are many causes for anaphylaxis, one of the major associations with the reaction is low sun exposure, anaphylaxis being much more prevalent in areas with less sun.810, 811, 812, 813 Interestingly, the frequency of hospital admissions for the condition has increased 5-7 fold in the last 10-15 years, although death from anaphylaxis has not increased.814 This incongruence could be explained by increased availability of self-treatment (epinephrine injection) and faster, more efficient response to the disease by medical personnel.
When geographical location in the USA is compared to the number of prescriptions for the anti-anaphylaxis drug EpiPen, a strong north-south gradient is apparent,815 with the highest prescription rates in Massachusetts and the lowest in Hawaii. People residing in southern states are prescribed this drug 70-75% less then those residing in New England. Similar statistics are observed in Australia, where EpiPen prescriptions are more frequent in the south than the north,816 as are hypoallergenic formula prescriptions817 (since Australia is in the
Southern hemisphere, the south is colder and has less sun). A similar gradient in the US is seen with visits to the emergency room for acute allergic reactions, including anaphylaxis, especially food-induced anaphylaxis:818 There were more emergency room visits in the northeast region in comparison with the south.
These studies indicate that sun exposure may be protective against this life-threatening immune reaction. Additional research papers demonstrate the same latitudinal influence on anaphylaxis rates, with higher frequencies recorded in areas of little sun exposure.819 An example is a study showing higher rates of this condition in children residing in northern countries.820
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Food Allergy
In a review of the research on sun exposure, vitamin D and food allergy-dated August 15, 2015—the following interesting statements were made:821 First, the reviewers state that since 2007, most epidemiological studies have demonstrated that low sun exposure, as measured by season of birth and latitude, is a risk factor for food allergy. Second, they noted that studies looking directly at vitamin D status as measured by serum 25(OH)D levels are not nearly as consistent as studies evaluating sun exposure levels. They wrote: "Although conflicting, the vitamin D studies suggest a more complicated association than a linear dose response in all individuals, with some studies indicating different associations based on host characteristics (e.g. concomitant eczema, genetic polymorphisms, and country of birth)."
Their summary is telling: "Many studies have linked sun with the development of food allergy but whether this is directly related to vitamin D status or a myriad of other sun-derived, seasonal and/or geographic factors remains uncertain. More studies are needed to investigate the role of sun and vitamin D status in food allergy because of their potential for primary prevention and disease modification."
Another review paper has also shown that studies on vitamin D and allergy are disappointing, yet it suggests to conduct randomized clinical trials of vitamin D supplementation for the prevention of food allergy during early life.822 This paper illustrates again that in scientific studies, sun exposure is nearly always protective against a disease, but this is not always the case when vitamin D supplements are used.
Our takeaway? Get sufficient sun exposure on a regular basis (or use quality sunlamps if sun availability is low), to lower your risk of food allergies. Sun exposure provides plenty of vitamin D when needed, but also provides nitric oxide, endorphins, serotonin, dopamine, BDNF and other photoproducts yet to be named. We must cease equating sun exposure only with vitamin D production, and committing a disservice to other healthful effects of the sun.
Get outdoors, into the sunshine. It may be the most important thing you can do if you suffer from allergies!
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Chronic obstructive pulmonary disease (COPD)
COPD is defined as a heterogeneous collection of conditions affecting various structures within the lung in a number of ways.823 One of the more recognized forms of COPD is emphysema, which results in extreme difficulty in breathing. In 2005 there were 126,005 deaths in the US from COPD.824 Although there are multiple contributors to COPD—including tobacco smoke, occupational dusts, chemicals, and air pollution—vitamin D deficiency may also play a role. Research has demonstrated that the severity of the disease correlates inversely to serum levels of vitamin D,825 and that the disturbances in lung and peripheral muscle function are more pronounced in COPD patients with vitamin D deficiency.826
We have already established that sun exposure can prevent and even reverse osteoporosis (see that chapter). Studies have also established that osteoporosis associates closely with COPD:827 There is a high prevalence of COPD in patients with osteoporosis, and COPD is also more severe in patients with osteoporosis compared to patients with normal bone mass.828 One may intelligently conclude, based on this information, that a part of the cause for both diseases is a lack of sun-derived vitamin D (and perhaps other sun-stimulated photoproducts).
Eczema
Eczema is an inflammatory condition of the skin characterized by redness, itching, and oozing vesicular lesions, which become scaly, crusted, or hardened.829 Atopic dermatitis is the most common form of many types of eczema. UV radiation has been used successfully for decades for its treatment.830, 831 The most recent review of studies, performed by Dr. A. Patrizi, concludes that phototherapy [UV light from sunlamps, sunbeds etc.] is an effective and safe method of controlling the condition.832 An excellent paper by Dr. D.J. Palmer mentioned the following regarding the use of UV light as a treatment:
1.	UV therapy was first used in the 1970s, when UVA radiation was used to treat atopic dermatitis and other skin conditions.833 The results were considered poor to fair, but created optimism going forward.
2.	In the 1980s, a combination of UVA and UVB therapy was used to treat atopic dermatitis, and in one investigation, it was shown that of 107 patients treated, 93% had good results, and the need for steroidal skin treatments decreased in half of the patients. A second experiment followed, in which 94% of the patients had good results and 85% of them had a decreased need for the steroid treatments.834
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3.	A 12-country European study, reported in 2004, found that the prevalence of eczema symptoms increased with higher latitudes (indicative of reduced sun exposure).835
4.	In 2009, Italian researchers showed that seaside holidays led to complete resolution of atopic dermatitis in 91% of patients,836 demonstrating the positive effects of sun exposure on the disease. The study also indicated that the condition improved during summertime and deteriorated in the other seasons.
5.	A 2013 study of more than 91,000 American children found that significantly increased prevalence of eczema was associated with several measures of lower solar UVB dose.
Another study on sun exposure in children aged 0-17 years has also established that sun exposure was associated with lessened prevalence of eczema:837 Children in the highest quartile (fourth) of exposure were about 20% less likely to experience eczema than children in the lowest quartile.
Research done on 415 young people directly measured sun exposure in the first 16 years of life and compared it to the risk of contracting atopic allergic diseases.838 It showed that those who spent more than 4 hours per day in the sun during summer had a significantly reduced risk of eczema and hay fever. However, as the researchers stated, "Increased sun exposure during summer holidays in adolescence was associated with reduced eczema and rhinitis (inflamed nasal cavities) risk, independently of measured 25(OH)D levels." This indicates again that sun exposure produces salubrious effects beyond its ability to stimulate vitamin D production.
Further research shows that eczema is dramatically improved by UVB treatment839 without the use of steroids,840 which are often recommended for the condition. Researchers could not pinpoint the reason for the protective effect of the sun, but surmised it could be due to a change in the immune system.
The message is this: Get plenty of regular, safe sun (or use quality sunlamps if sun availability is limited) and don't rely on vitamin D supplementation alone to furnish all of the sun's healing powers—it can't. Remember also that when vitamin D is needed to improve health, sunlight is the most natural source.
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Fatty liver disease
Fatty liver disease is an inflammatory disease, which has been recently associated with lower brain volume.841 It is associated closely with high consumptions of fructose,842 soda843 and a high-cholesterol, high-alcohol, high-protein diet (in men).844 Sun exposure may, however, act as a prophylactic for these nutritional habits.
Sun exposure may prevent liver inflammation in non-alcoholic fatty liver disease (NAFLD), the most prevalent liver disorder in western countries, according to a paper published in the May 2015 issue of the journal Nutrients.845 The authors of this paper state that "Following exposure to sun-derived ultraviolet radiation (UVR), the skin releases anti-inflammatory mediators such as vitamin D and nitric oxide."
Although there has been no conclusive proof that solar radiation works against human NAFLD, according to these authors, animal studies suggest that sun exposure (UVR), can prevent the development of NAFLD. The authors noted that these positive results were attributed mostly to vitamin D, but remarked that clinical trials have yet to demonstrate a clear, beneficial effect of vitamin D supplementation in NAFLD. Therefore, they suggest that other mediators such as nitric oxide may be important. Again, this demonstrates that the sun provides benefits independently of vitamin D. Future research may clarify this idea. Until then, regular sun exposure (or the use of sunlamps if the sun is not available) may provide good insurance for a healthier liver.
Insomnia
Insomnia is an inability to sleep, and too little sleep can be deadly. Forbes Magazine online printed an excellent article on sunlight and sleep,846 in which the following horrendous statistics were mentioned: "In 2012, 60 million Americans filled prescriptions for sleeping pills, up from 46 million in 2006." The article discusses the potential dangers of sleep medications, showing that those who take 18 sleeping pills per year have a tripling of the risk of death compared to those who take fewer than 18.847 It then describes the results of recent research showing that people whose workplaces have windows are able to sleep about 46 minutes per night more on average, than those who have no natural light access.848 Also, those who had more sun exposure were generally happier, had fewer ailments, and experienced better vitality than their window-less counterparts.
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This research is particularly interesting because the effects of sun exposure in this case probably had nothing to do with vitamin D, since the solar rays came through windows, which block the vitamin D-producing UVB light. It is likely that the positive effects of the sun were produced by increasing serotonin levels (a natural mood enhancer) in the brain during sun exposure, and then by allowing melatonin (a natural relaxer) to take over during the night.
It is becoming increasingly obvious that lack of sleep is a major risk factor for human health, as reported in the journal Sleep Medicine, regarding metabolic syndrome (Met S).849 Met S is a group of metabolic disorders (high blood pressure, abdominal obesity, high cholesterol, high triglyceride levels, low HDL levels and insulin resistance) linked to increased risk of cardiovascular disease and type 2 diabetes. The study assessed 2579 adults without Met S for sleep habits during a 2.6-year period to determine their risk of developing the disorder. The participants' age ranged between 40 and 70 years.
Those who slept an average of 6 hours or less daily were 41% more likely to develop Met S than those who slept 6-7.9 hours. The parameters considered particularly disconcerting were a 30% increased risk of high blood glucose and excess belly fat (both indications of future diabetes), and a 56% increase in high blood pressure risk. The researchers concluded: "Short sleep duration is an independent risk factor for incident metabolic syndrome in a population-based longitudinal study."
Many elderly individuals have difficulty sleeping long and soundly enough to feel refreshed. A study by Dr. Julie Gammack exposed test subjects to 30-60 minutes per day of direct sun, and according to the Saint Louis University health web site, "Nursing home patients exposed to natural light had improved sleep quality. They had less difficulty falling asleep, fewer episodes of wakefulness during the night and greater satisfaction with the amount of sleep they got."850
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A 2014 study from Egypt reveals several factors associated with insomnia among elderly people:851 Having five or more chronic diseases was associated with a 7.5 times increased insomnia risk; anxiety was associated with a 1.9 times increased risk; and depression with a 1.7 times increased risk. There was only one factor, sun exposure, which was associated with reduced insomnia risk—a 43% reduction! Likely, this was due to the sun-related production of serotonin and melatonin (see the section on depression). And indeed, sun exposure in daily life is positively associated with melatonin excretion in the elderly.852 Another study has shown that sleep disturbances are more common in sub-arctic areas during the dark time of the year.853
Another factor influencing the ability to sleep is the proper function of the circadian rhythm (CR), also known as the "biological clock."854 CR are variations in physiology and behavior consistent with a cycle length close to, but not exactly, 24 hours. It is necessary to synchronize the rhythms on a regular basis to maintain them, and such synchronization is achieved through regular exposure to light and darkness.855, 856 Researchers have shown that nocturnal light pollution and underexposure to daytime sunlight are both factors in disruption of CR.857 The blue region of the sunlight spectrum regulates circadian rhythm858 by causing an interesting photopigment called melanopsin to be produced in the eye. This photopigment is probably the prime circadian regulator.859 For more information on circadian rhythms, see Appendix 4.
Sleep deprivation is a common and perhaps deadly malady. If one
wants to sleep well, sun exposure during the day is imperative. The
sun may be our best hope for reversing this pandemic.
Myopia
Among the many other horrors associated with lack of sun, myopia (nearsightedness) is now becoming of scientific interest. The disease is caused by refractive error which prevents the correct focusing of light by the eye. The light, rather than focusing directly and precisely on the retina, focuses in front of it, causing the perceived object to be out of focus.860
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You may not realize that sun exposure is critical for good vision in children, but in our opinion, the science provides incontrovertible evidence. Recent research has corroborated the findings of a number of earlier investigations of this subject.
The Daily Mail, a UK newspaper, reported, "Too much time indoors damages children's eyes: Lack of natural sun is thought to be driving up rates of short-sightedness among the young."861 The article also mentions that Chinese children are now being sent to schools built with translucent walls in order to prevent the nearsightedness associated with lack of sunlight.
Other interesting statements in that article:
1.	Nearsightedness is rising, now affecting around 40% of the population.
2.	Yet, in hunter-gatherer societies living mainly outdoors, the incidence of nearsightedness is only 0.5% of the population.
3.	Spending an extra 40 minutes per day in the sun has been shown to improve children's sight dramatically.
It doesn't take a rocket scientist to determine that myopia is caused by lack of sun exposure. The evidence has been building for years. For example, already in 2008 researchers had demonstrated that the lowest risk of myopia among 12-year-old students was found among those who reported the highest levels of outdoor activity.862 Some might surmise that the key ingredient was exercise, but the researchers have refuted this idea by showing that indoor exercise did not reduce myopia risk. Something besides exercise had to be leading to the lower risk of myopia among children who were active outdoors-sunlight is the most likely cause: The lower risk of myopia persisted even after adjusting for genetic factors, ethnicity and the amount of "near work" (long hours of study, staring closely at books). This is important, because for many years there was an assumption that long hours of near work-almost never focusing on distant objects-led to myopia. This study debunks that assumption.
This same research showed the prevalence of myopia among Chinese children living in Singapore was 29.1%, whereas its prevalence among Chinese children living in Sydney, Australia was only 3.3%. The children in Sydney spent about 13.8 hours per week outdoors
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compared to 3.1 hours in Singapore. In other words, the children who spent most of their lives indoors had 9.5 times the risk of developing myopia!
Percent risk of myopia based on sun exposure in Chinese children living in Singapore or Sydney

Optimal refraction of light is the key to good vision. Refraction is the change of direction of a ray of light as it passes from one medium into another. In the case of vision, it is necessary for the eye to refract light entering it in a manner which forms a clear image on the retina. One of the mechanisms by which lack of sunlight leads to myopia may be an improper elongation of the eyeball's shape, resulting in poor refraction of light. It has been shown, in young adults with myopia, that refractive error is inversely associated with ocular sun exposure,863 indicating that incorrect eye development results from sun avoidance. Obviously, the eyes need sunlight stimulation to develop perfect vision (but this does not mean we should ever stare at the sun). We simply need to be outdoors during sunny hours.
An article by Robin Wuffson, MD, demonstrates that eye deterioration, which leads to myopia in children aged 8-14, is more common in the winter months than in the summer months.864 It supports the conclusion that "the eyes need regular sunlight stimulation to develop perfect vision."
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Dr. Kathryn Rose, a leading international researcher of visual disorders at the University of Sydney's Faculty of Health Sciences, said this about one of her studies on myopia and sun exposure: "Many epidemiological studies have examined the issue of computer, video and television based activities on the eye health of children and have found no association between time spent using digital media and the development of myopia. While it is an intuitive association to make, it simply has not been confirmed. There are some studies finding an association between time spent doing near-work activities such as reading and studying, but results are inconsistent and marginal. There may be an indirect link where children have substituted large amounts of time spent outside with these activities." Doctor Rose has determined that lack of sunlight is the culprit.865 Researchers also found scientific evidence suggesting that small children under six years of age should spend at least three hours per day outdoors in the sunshine.866, 867 Another investigation assessed the likelihood of developing myopia in children who participated in outdoor recess activities vs children who stayed indoors during recess. After one year, about 18% of the children who stayed indoors developed myopia while only about 8.5% of the "outdoor" group developed the disorder.868 (In our opinion, outdoor recess does not provide sufficient time in the sun for young children; more time in the sun might have provided even better results than those seen with the outdoors group.) A related study demonstrated that actual exposure of the eye to the sun was protective against myopia in people aged 15 to 50 years.869
Other researchers studied the influence of vitamin D on myopia to determine if the protective effects were mediated by vitamin D levels.870 Their conclusion: "there was no evidence they [vitamin D levels] were independently associated with future myopia." This is another disease requiring the full benefit of sun exposure for prevention and improvement, and demonstrating the profound importance of the sun for children, beyond the production of vitamin D. However, there are others who still believe vitamin D is a factor.871, 872
Additional researchers have revealed that children with the lowest fourth of conjunctival autoflorescence (i.e. sun exposure to the cells covering the visible part of the eyeball) had double the prevalence of myopia as those in the highest fourth.873 They stated, "This further supports the inverse association between outdoor activity and myopia." One of the researchers, Dr. McKnight, also stated, "Myopia affects over a billion people worldwide, and is becoming increasingly more frequent. In some areas of South-East Asia as many as 80% of people have myopia. The cost of treating myopia (with glasses, contact lenses or laser) is high, and doesn't fix the underlying structural problem with the eye. Severe myopia can result in retinal detachment and blindness."
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Myopia in children also leads to a higher risk of both glaucoma and cataracts in adulthood.874, 875 Therefore, the common "expert advice" to avoid sun exposure in order to prevent eye diseases is misguided.
In general, this promotion of sun avoidance should be considered criminal, in light of the scientific data, since it causes not only problems with vision, but a host of other chronic, debilitating diseases.
Not surprisingly, monkeys also suffer a greater risk of myopia when they are deprived of natural outdoor light.876
In our opinion, the link is irrefutable: Sunlight deprivation can now be added to the list of environmental and nutritional mistakes leading to blindness. Other investigators obviously feel the same way. Here we quote from Dr. Hobday, writing in Perspectives of Public Health: "A century ago, it was widely believed high levels of daylight in classrooms could prevent myopia, and as such, education departments built schools with large windows to try to stop children from becoming short-sighted. This practice continued until the 1960s, from which time myopia was believed to be an inherited condition. In the years following, less emphasis was placed on preventing myopia.
It has since become more common, reaching epidemic levels in East Asia. Recent research strongly suggests the amount of light children get as they grow determines whether they will develop short sight. However, evidence showing that daylight in classrooms prevents myopia is lacking. Given the rapid increase in prevalence among school children worldwide, this should be investigated."877 Others are also concerned and state that eye elongation and progression of myopia decrease in periods with longer days and increase in periods with shorter days.878 According to these researchers, "children should be encouraged to spend more time outside during daytime to prevent myopia."
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Let's all return to regular, sensible and safe sun exposure. Human beings did not evolve in a sunless box!
Obesity, or the fat of the land. Can sun exposure lead to a slimmer figure?
Here we have another benefit of sun exposure-morning sun specifically! A recent study from Northwestern Medicine demonstrates that timing and intensity of light correlate with body mass index (BMI).879 BMI is a numerical computation comparing height and weight, and is a commonly used method to assess obesity or the lack thereof. A high BMI usually means a person is obese or at least approaching obesity. Optimal BMI is 18-25. Below 18 is considered underweight, above 25 is overweight, 30 is obese and 40 and above is morbidly obese. However, BMI does not work for heavily-muscled people, who may have minimal fat but whose BMI puts them in an obese category.
This study showed that exposure to bright morning light was directly related to BMI. After adjusting for confounders such as diet, exercise and timing of sleep, it was determined that very early exposure to morning light correlated remarkably to lower BMI. Even when light intensity was equal at different times of the day, those who received the earliest bright light had lower BMI. In fact, for each hour later in the day when light exposure occurred, BMI increased by 1.3 units.
This fact is exceptionally important, since a person who has a BMI of 25 (upper ideal range) could approach 30 (obesity), over time, simply by the habit of receiving sun exposure later in the day, e.g. 10:00 AM rather than 6:00 AM.
The authors suggested that the mechanisms by which early light exposure could influence weight control could be the following: (1) resetting the circadian rhythm (internal clock), (2) the greater quantity of blue light in morning sun and (3) effects on melatonin production. Whatever the mechanisms, we now know that early-morning sun is important to weight control. It may also be important to other health issues. But before we begin to think sun exposure is the cure-all for obesity, we must realize that poor nutritional habits and lack of exercise are much more important. Nevertheless, sun exposure can furnish one more arrow in the quiver.
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Since we know that the greatest sun-related vitamin D production occurs around noon, we would suggest enjoying some early sun exposure to begin the day and then to engage in moderate, nonburning sunbathing at midday to optimize 25(OH)D levels. These habits should produce the greatest benefit possible.
The incessant advice to stay out of the sun at midday has been incorrect, as science has now proven. We should enjoy sun at any time, but for vitamin D production, midday is best. Dr. J. Moan and colleagues have explained that vitamin D production by the skin is much greater at midday than in early morning or late afternoon, and that the risk of developing melanoma is also much lesser at midday.880 This is because a greater percentage of healthful, anticancer UVB-stimulated vitamin D production is available at midday, leading to the least potential for damage. The researchers stated it thusly: "To get an optimal vitamin D supplement from the sun at a minimal risk of contracting cutaneous malignant melanoma (CMM), the best time for sun exposure is noon. Thus, common health recommendations given by authorities in many countries, that sun exposure should be avoided for three to five hours around noon and postponed to the afternoon may be wrong and may even promote CMM." Although sun exposure at midday protects against melanoma, we're not convinced that sun exposure in the afternoon (or early morning) actually contributes to melanoma. This is because of the established fact that people who are regularly enjoying the sun (at any time of the day) develop fewer melanomas than those who are cloistered indoors. Let's face it: nearly everything we have been told by the sunscare/sunscreen industry is false.
Sun exposure is far superior to vitamin D supplements in preventing weight gain.
Another scientific paper "sheds more light" on the subject of obesity.881 This research was conducted on mice with shaved backs that were placed on a high-fat diet and then exposed to non-burning ultraviolet radiation (UVR) during a three-month experiment. The mice, without the benefit of UVR, would have been expected to gain weight rapidly on that diet, but when they were exposed to UVR, the weight gain was impressively reduced. The UVR treatment achieved a 30-40% reduction in weight gain, compared to the expected weight gain with the high-fat diet.
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Other benefits included: significant reductions in glucose intolerance, insulin resistance and fasting insulin levels (all markers and predictors of diabetes), nonalcoholic fatty liver disease, and cholesterol. All of these factors, including obesity, are part of a cluster of maladies known as the metabolic syndrome, or MetS, which is indicative of deteriorating health and susceptibility to heart disease and diabetes.
Other interesting findings:
Supplementation with vitamin D actually reduced the aforementioned beneficial effects. Dr. Shelley Gorman, one of the authors, made the following three interesting observations:882
1.	"These findings were independent of circulating vitamin D and could not be mimicked by vitamin D supplementation."
2.	"It looked like the presence of vitamin D in mice on the high fat diet prevented the [beneficial] effect of UV radiation on weight gain."
3.	She also mentioned the mechanism of weight loss may be dependent on nitric oxide (NO), which originates from diet and can be mobilized by UV radiation to become bioactive. This was due to the fact that in another part of the experiment, skin induction of nitric oxide (NO)—also a product of skin exposure to the sun—reproduced many of the positive effects of UVR, something vitamin D supplements could not do.
The authors concluded their research thusly; These studies suggest UVR (sun exposure) may be an effective means of suppressing the development of obesity and MetS, through mechanisms independent of vitamin D but dependent on other UVR-induced mediators such as NO."
Blue light: another reason to stay active in the sun
A study published in 2017 showed that the blue-light spectrum of sunlight, a spectrum that can penetrate the skin, can cause subcutaneous fat tissue to decrease in size.883 In other words, it can cause fat loss. Thus, the action of sunlight may help one to stay slim or become slim. The researchers showed that daily exposure of differentiated adipocytes [fat cells] to blue light resulted in decreased lipid droplet size and increased basal lipolytic [fat breakdown] rate. These scientists had been doing research on light and diabetes, and they serendipitously found that the light could be an asset in maintaining (or producing) a slim body. Additional information about the health benefits of blue light can be found in Appendix 6.
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It has been suggested that since low 25(OH)D levels correlate to obesity, those low levels are a possible cause of obesity. However,
vitamin D is stored in fat tissue, and therefore an increase in fat will lower the quantity of 25(OH)D circulating in the blood. Hence, low vitamin D is a consequence of obesity, and not the cause.884
Research continues to mount about the positive effects of sun exposure, independent of vitamin D production. This should in no way be construed to diminish the vital importance of vitamin D. Rather, it is to make a point that sun exposure works in many ways, including stimulating the production of vitamin D, NO, serotonin and endorphins. Why should we be satisfied with any one of these marvelous health aids when the sun is available? With sun exposure, we can enjoy the benefits of the entire package.
Pain
We are experiencing a pandemic of pain in the US, and Dr. Tom Frieden, director of the Centers for Disease Control (CDC), referred to prescription painkillers as "a growing epidemic gripping our country."885 For example, a new study, conducted by the National Safety Council and the state of Indiana, showed that 80% of Indiana's employers have been impacted by prescription drug abuse, and the economic burden may be as high as $60 billion. However, the CDC states that the non-medical use of prescription painkillers costs health insurers up to $72.5 billion annually.886
Certainly, there must be a better way to relieve pain, and that better way is sun exposure.
There are many indications that sun exposure reduces pain. For example, spinal surgery patients with postoperative discomfort were studied for the quantity of pain medication they required.887 The hospital had a bank of rooms on the sunny side and another on the dark side, referred to respectively as the "bright" and "dim" rooms. Patients in the bright rooms had 46% greater sun exposure than those in the dim rooms. Patients in the bright rooms experienced less pain and took 22% less pain medication than those in the dim rooms, regardless of age. Also impressive was the additional finding that bright-room patients reported feeling far less stress. This study demonstrates again the sun's health effects beyond the production of vitamin D, since UVB light, which stimulates the skin to produce vitamin D, cannot penetrate window glass. Therefore, pain reduction in this study could not have been attributed to Vitamin D. Optimal levels of vitamin D are also important for reducing pain, but in this case, the sun had to work through other mechanisms, such as serotonin, endorphins, or nitric oxide. Endorphins are produced by the body after sun exposure888 and are effective at reducing pain by binding to opioid receptors in the same manner as Vicodin, Morphine and other opioid medications.889
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Low-back pain (LBP) is pandemic in much of the world, but especially in Muslim countries where most women wear clothes that prevent skin exposure to the sun.890 One of the first studies to show an association between LBP and reduced sun exposure was done in England:891 It concluded that those who lived in northern towns were 3-4 times as likely to have consulted their doctors about low-back pain as those living in southern towns.
Research done in southeast Asian countries shows an impressive increase in the rate of LBP from southern to northern latitudes, starting at 5° North (Malaysia - 8.8% LBP rate), continuing to 23° N (10.2% LBP rate), then 32° N (13%), and finally to 40° N (Beijing — 15.8%).892 A study by Dr. Lofti and colleagues showed that vitamin D deficiency was common among those suffering from LBP, and three-times more common than among those who did not suffer from LBP.893 The researchers stated, "The major determinant of hypovitaminosis D in our patients is limited sun exposure." Similar findings have been reported in Saudi Arabia894 and Pakistan,895 where a study was done on undergraduate medical students from different universities to assess their awareness regarding vitamin D deficiency associated with lack of sun exposure. These subjects often suffered from fatigue and muscular pain. Researchers concluded that many of them were acquainted with vitamin D deficiency, and some used a supplement to try to address the problem, which researchers seemed to feel was not sufficient for their needs, sun exposure being the best method to maximize vitamin D levels. They concluded that the role of the sun, and the proper time and duration of exposure, could not be ignored if students were to help effect a healthy and active society. They also indicated that since these students would be medical care givers in the future, their habits should be similar to the habits they intended to recommend to their future patients.
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It appears that sunlight, whether or not accompanied by vitamin D production, is effective for relief. Try a few minutes of non-burning sun exposure daily to ease the pain.
Vitamin-D deficiency correlates quite closely to chronic pain, and pain is usually reduced or eliminated by optimizing blood levels of vitamin D. An interesting case study on vitamin D and pain discusses a woman suffering from Crohn's disease, a condition which tends to be closely associated with vitamin D deficiency.896 The woman complained of bone pain and muscle weakness and had critically low 25(OH)D levels (only 7 ng/ml [18 nmol/l]), which will do little more than sustain life. As treatment, the woman was put in a sunbed, three times weekly for ten minutes, over a period of six months, wearing a one-piece bathing suit. After the six months of treatments, she was "free of muscle weakness and bone and muscle pain." In all likelihood, this woman was suffering from fibromyalgia, a common ailment characterized by chronic muscle and joint pain, fatigue, and tenderness in multiple areas. Myalgia (muscle pain) is a similar disease, which has been shown to be relieved by optimizing 25(OH)D levels caused by lack of sun exposure.897 Additional studies have also shown the efficacy of tanning-bed treatments in reducing chronic pain.898, 899 And in a study by dermatologists, who evaluated persons with fibromyalgia symptoms including pain, those who used UV-producing sunbeds experienced a reduction in pain compared to those who did not receive UV treatment. Feelings of well-being and relaxation were also reported among the tanners.900
It is difficult to find anyone outside the tanning industry who has anything good to say about sunbeds. Dr. Grant, Dr. Tel-Oren and I are exceptions, and I use one in my home in winter when I cannot obtain any vitamin D from sun exposure. I am careful not to burn just as I am careful not to burn in the summer sun. We hope that this book will bring a much-needed change of attitude toward UVB and other sunlamps, which can (at least partially) replace the absent sun, providing some of the health benefits it would have bestowed upon us in nature.
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Psoriasis
Psoriasis is a skin disease in which cells proliferate rapidly, causing patches of scaly, itching skin. Interestingly, sun exposure is the best therapy. The National Psoriasis Foundation recommends brief, frequent exposures to the sun as a therapy and reports that 80% of those who do it improve or totally clear psoriasis.901 Research demonstrates that home UVB lamps are also a very cost-effective method to control psoriasis.902 Other sources of UV therapy are used by dermatologists, who state that UV is safe and effective for psoriasis. UV treatments also help in curing other skin diseases such as parapsoriasis, atopic dermatitis (a form of eczema), cutaneous T-cell lymphomas, morphea, and vitiligo vulgaris.903 Narrow-band ultraviolet B (UVB) light from sun lamps has also been shown to improve psoriasis.904, 905 In one research review, sunbed therapy was recommended for several dermatological conditions, including psoriasis and eczema.906
Julie Moore, a dermatologist at Gottlieb Memorial Hospital, says, "The sun is one of the best treatments for psoriasis, so in summer I encourage my patients to sit out on the deck and give their affected areas a good sun bath."907 Obviously, Dr. Moore is an honest dermatologist who has the best interests of her patients at heart.
Very recently my wife, Vicki, and I received a message from a friend who had psoriasis. She went to a dermatologist who told her to immediately start using a sunbed. Her psoriasis cleared up very quickly, and she is very happy. It is good to know there are some dermatologists who advise their patients correctly. To learn about dermatologists who favor sun therapy or are against it, see Appendix 2 and Appendix 5.
Sexual dysfunction and infertility
Can the sun make a difference in sexual behavior or fertility? There are certainly indications that sun exposure does influence hormones and sexual behavior. Since we now have your undivided attention, let's take a look at the evidence.
In 1939, Dr. Abraham Myerson measured initial levels of circulating testosterone in men and then exposed their various body parts to UV light.908 After five days of chest exposure sufficient to cause reddening, circulating testosterone increased by 120%. After eight days without additional UV exposure, testosterone returned to initial levels. When the genital area was exposed, testosterone levels increased by 200%! Considering our sex-obsessed society, it is surprising no studies followed up on Myerson's work. Testosterone, after all, is important in sexual behavior, since it is the "love" hormone for both sexes.
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Sunlight may also have a positive effect on the unfortunate condition called erectile dysfunction (ED). ED rates have dramatically increased, creating a pandemic, as evidenced by numerous advertisements for various "curative" ED products. Since it is a vascular disease, ED was covered in the cardiovascular section; nevertheless, we are repeating the information here since it is connected to sexual performance: ED is considered one of the major predictors of CVD.909 It is caused by the inability of the corpus cavernosa—two cylindrical chambers which run the length of the penis—to become engorged with blood that is necessary for an erection. During normal, healthy conditions, the cavernosa are stimulated by nitric oxide (NO), which is a potent vasodilator. The cavernosa then relax, and blood flows into the penis, allowing erection to take place. Therefore, erection is a vascular event.910
An early study assessed the effect of ultraviolet (UV) light on cavernosal strips, obtained from men during penile prosthetic surgery.911 The strips showed relaxation in response to UV light, and the relaxation increased with the duration of exposure. We expect that sunbathing, which would profoundly increase NO in the circulation, would also promote erection. The same nitric oxide mechanism that lowered blood pressure, as discussed in the cardiovascular section, should provide benefit to ED sufferers. After all, drugs for ED, such as Viagra and Cialis, work by enhancing the effects of nitric oxide.912 These drugs, as previously mentioned, carry many health risks. Sunlight is free and is a much better, safer choice.
Sunshine, Blueberries, Nitric Oxide and Peak Sexual Function: Better than Viagra and Cialis?
Let's delve into this unusual title.
It is well-known high blood pressure contributes to erectile dysfunction (ED) by inhibiting the relaxation of the erectile arteries, thereby preventing blood flow into the cavernosa.913
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So where do blueberries enter this equation? Blueberry consumption dramatically increases NO in the blood. In fact, in an eight-week experiment, blueberry powder (22 gm/day) increased the serum levels of NO 60% when compared to a placebo.914 Blueberries, of course, are among the world's most healthful fruits, ranking at the top with tart cherries, pomegranates, and raspberries, probably due to their exceptionally high levels of antioxidants. These fruits also protect the skin and the arteries.
Women may also suffer from erectile dysfunction of the female sex organ. Therefore, this is important information for both you and your spouse. Wouldn't it be wonderful to participate daily in two (or three) of our favorite activities, eating blueberries and sunbathing, and as a bonus-increasing our physical health and adding new excitement to our love life? Does it get any better than that?
Infertility
Sun exposure may also increase fertility. If this is true, we would expect conception rates to be higher in summer than winter. And so it is. In higher latitude countries, where sun availability varies dramatically during the year, conception rates are indeed highest in late summer and birth rates are highest the following spring.915 The Daily Mail, from the UK, posted an article regarding the sun and fertility, which should attract interest.916This article discussed the fact that Infertility is a problem causing some couples to seek help from in vitro fertilization (IVF). New research shows that sun exposure for a month prior to the procedure increases the odds of success by 35%.917 Dr. Frank Vandekerckhove, who authored the study, looked at the IVF results of about 6,000 women and compared dates of their treatment with weather conditions, finding that the more sunshine, the greater likelihood of becoming pregnant. Dr. Vandekerckhove indicated that sun exposure a month before conception probably helped a woman's eggs to mature. He also mentioned there is every reason to think that a burst of sunshine will also help women trying to get pregnant naturally. Sunshine may also help men, since sperm seem to function best in late summer.918 In an article posted on Emax Health, entitled Sex in the Sun May Increase Your Fertility, it is noted that approximately 15% of couples who want to conceive are plagued by problems of infertility.919 Sunlight may be the answer they seek, and it is much less expensive than IVF!
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Considering this information, it might seem that sun deficiency would be an effective method of birth control (please don't adopt this as sound medical advice, nor should you try this at home...), if one were willing to accept an increased risk of sexual dysfunction, depression, cancer, heart disease, MS, diabetes and osteoporosis.
Sunshine and longevity.
Impressive research by Dr. Pelle Lindqvist indicates that greater exposure to the sun results in longer life:920 During a 20-year period,
the subjects in the study who avoided sun exposure were twice as likely to die of any cause compared to those who had the highest sun
exposure. There was also a dose-dependent inverse relation between
sun exposure and all-cause death. In other words, the greater the
sun exposure, the lesser the risk of death.
Risk of death during twenty years based on amount of sun exposure

Lowest sun exposure Highest sun exposure
RISK OF DEATH: 1.0 = LOWEST RISK
The study seemed to give vitamin D most of the credit for increased life spans among those who had high sun exposures, but also mentioned the possibility that nitric oxide production by sun-exposed skin may have been a factor. Regrettably, no mention of endorphin or serotonin was made. Perhaps one of the most intriguing findings in this study was that women who used sunbeds were 23% less likely to die from any cause than women who did not use them at all. (See Appendix 2).
Although we were impressed with the study's findings, one of the authors' interpretive remarks presents a grave unscientific error, unrelated to the study itself: They state, "Ultraviolet (UV) radiation from the sun is known to heighten the risk of developing malignant melanoma (MM) of the skin. This condition is primarily responsible for increased mortality due to UV radiation exposure." Their own research showed that mortality rates decreased with more sun exposure! As we have already discussed, no such MM risk is proven. If anything, sun exposure has profoundly decreased as melanoma has exponentially increased. It is counterintuitive and anti-scientific to suggest that regular, moderate sun exposure causes melanoma, and the researchers' remarks unfortunately repeat that misleading mistake! It appears that many good researchers fall in the trap of adopting common misconceptions, without spending the time to check the evidence. And the evidence refutes these common beliefs, including research by Dr. Grant that clearly corroborates the inverse association between sun exposure and melanoma.921
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Another paper by Dr. Lindqvist showed that sun exposure was protective not only against all-cause death, but also associated with impressively diminished risks of all cardiovascular diseases (CVD) and cancer.922 The charts below show the reduction of death over time among those who avoided sun exposure, those who engaged in moderate sun exposure and those who had the most active sun exposure over a 20-year period. There is little doubt sun exposure is a good prescription for a long and healthy life!
Avoiding sun exposure	in ■ * ■ c. i ■o («> .	Moderate sun exposure	in . a «
	"8 2	Alive	■5 2
^CVP	I-		1 Q.
	£	^CVD	
	r ■	Cancer	r ■
Other	o ■	Other	o ■
Most active sun exposure
Time since inclusion
Time since inclusion
Time since inclusion
There are other studies showing that lack of sufficient sunlight and low 25(OH)D levels are risk factors for earlier death. In a study of Asian women, low levels of vitamin D correlated to a doubling of the risk of death over 6.9 years.923 And why are those levels low? Because of sun deficiency. Osteoporosis and cancer, which pre-existed when the study of Asian women began, were also predictive of early death, which would be expected. Both osteoporosis and cancer are closely associated to low 25(OH)D levels and lack of sun exposure, as previously stated in the cancer and osteoporosis sections of this book. Therefore, it is plausible that low levels of vitamin D were not only directly responsible for a higher death rate, but also indirectly, by increasing the risk of these two deadly diseases.
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Sun exposure and the elderly
A 2007 investigation of vitamin D levels and telomere length indicates that vitamin D can reduce a major predictor of aging.924 The sections of DNA found at the ends of chromosomes are known as telomeres, and the shortening of telomeres is considered an indicator of the aging process—the faster the shortening, the faster the aging. The study found that higher 25(OH)D levels [caused by sun exposure) correlate to longer telomeres and a reduced aging process. Interestingly, osteoporosis, another disease of sun deprivation and vitamin D-deficiency, also correlates closely to shortened telomeres.925
In 2015, Dr. Richard Weller published a paper together with Dr. Fiona Wright, promoting sun exposure for older people. In it, they make several important points that further dispel the myths regarding sun exposure:926
1.	"Intermittent sun exposure is a risk factor for the more dangerous melanoma but chronic sun exposure and outdoor occupation may be protective."
2.	"Public health advice has tended to concentrate on the dangers of sun exposure despite the absence of any data showing increased sun exposure correlates with raised allcause mortality."
3.	"Inadequate sun exposure carries its own risks, and the older population are particularly sun-deprived as recorded by low serum 25(OH)D levels and lack of outdoor activity."
4.	"Sun exposure has health benefits dependently and independently of vitamin D synthesis. Low serum 25(OH)D levels correlate with increased morbidity and mortality but the direction of association is not always clear. Vitamin D has a causal role in calcium and phosphate metabolism, in skeletal health and probably reduction of colorectal cancer."
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5.	"	mobilization of nitric oxide by UVA radiation from nitrate
stores in skin, with consequent reduction in BP, may account for the observed reduction in cardiovascular disease and allcause mortality with increased sun exposure."
6.	"Advice on healthy sun exposure needs to be reconsidered, with reduction in all-cause mortality and morbidity as the primary end point."
It is refreshing to follow Dr. Weller's scientific papers, since he is a dermatologist who has not succumbed to the mantra of the various anti-sun organizations. He tells the truth, and this truth will help free those who labor under the falsehoods perpetrated by the "sun-scare" industry. Elderly people desperately need regular sunbathing to sustain their health. My wife and I know this, because we conduct church meetings at an assisted-care facility. Our hearts bleed to know that the suffering of the facility's residents need never have happened if they had done two things: (1) engaged in regular sun exposure during their lifetimes and (2) practiced good nutrition. In my opinion, most of them would never have been admitted to the facility in the first place, had they known and practiced these two guidelines. Published research supports this idea: In one investigation, those whose serum 25(OH)D levels were in the deficient category had three-and-one-half times the risk of being admitted to a nursing home as those whose levels were in the highest category.927
Embrace the sun to increase both the quantity and quality of life!
Soft-tissue injury: Too many dancers dance in the dark.
Could low sun exposure lead to injuries in professional dancers? Research published in the Journal of Science and Medicine in Sport, found that professional ballet dancers were much more likely to injure themselves during winter.928 The objective of the study was to ascertain whether lack of sun exposure among dancers during winter might correlate to lowered 25(OH)D levels and thereby increase injury. Elite, classical ballet dancers, 19 in all, were chosen for the investigation and were monitored during a six-month period for 25(OH)D levels, serum markers for bone turnover, and frequency of injuries. It was found that 25(OH)D levels averaged 15 ng/ml [37 nmol/L] in winter and 24 ng/ml [60 nmol/L] in summer. Soft tissue injuries were nearly twice as frequent in winter (24) as in summer (13).
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It is significant that soft-tissue injuries correlated so closely to low vitamin D, since vitamin D is generally thought of as a bonestrengthening hormone. Also interesting is the fact that in both summer and winter, 25(OH)D levels were too low. Yet in winter, the dancers were approaching critically low levels. Vitamin D levels would be expected to be higher in summer, of course. Still, it was not nearly high enough, and we presume that levels around 60 ng/ml [150 nmol/L] would have correlated to an even lower risk of athletic injuries among the dancers.
Perhaps it is time for dancers to leave the darkness and practice routines outdoors during summer. This would help optimize vitamin D and muscle strength. Then, in the winter, sunlamps could be used for vitamin D production and for other benefits of UVR, or at least regular vitamin D supplementation would provide some protection against winter injuries.
Suboptimal athletic ability
Almost no one realizes the dramatic improvement sun exposure can make on athletic performance. I (Sorenson) helped Dr. John Cannell obtain translations of many esoteric and decades-old studies that were long forgotten—perhaps because sun lamps were used to create improvements in athletics, and have fallen out of favor due to the "sunscare" movement. I co-authored a paper with Dr. Cannell and other colleagues, called Athletic Performance and Vitamin D.929 This paper is the source of much of the material covered here, and demonstrates the remarkable, positive effect of sun or other ultraviolet (UV) exposure on human performance. I would also strongly suggest readers avail themselves of Dr. Cannell's book on the subject, called The Athlete's Edge, which discusses in far greater detail the materials introduced here.
One of the salient studies on UV exposure took place in 1957 and assessed the influence of sun exposure on strength and performance over a two-year period.930 During this time, six subjects were able to increase athletic performance and muscle trainability through systematic UV exposure. But when vitamin D3 was used, it not only did not work, it inhibited the performance-enhancing effect of the UV exposure. I sometimes fear the public is beginning to believe that if sun exposure is proven to enhance human health, one needs only to take a vitamin D pill. Don't get pulled into this idea. Sun exposure will always be more important than any of its individual photoproducts.
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Here are some of the other salient studies on sun exposure and performance: In 1938, Russian researchers demonstrated that a series of four UV treatments to a group of students improved speed in the 100-meter dash compared to a group of non-irradiated students, when both groups were undergoing daily physical training.931 Average times improved from 13.51 seconds to 13.28 seconds in the non-irradiated group and from 13.63 to 12.62 seconds in the irradiated group. In other words, the UV-treated group improved by three-fourths of a second more than the non-UV group. This finding may seem like a relatively small improvement, but three-fourths of a second better time in a 100-meter dash could be the difference between first and last place!
In 1944, German research involving 32 medical students showed that UV exposure twice weekly, over six weeks, was associated with a 13% improvement in endurance, whereas performance of a control group was unchanged.932
Other German research demonstrates that the ability of a muscle to gain strength (trainability) is much better in summer than winter, and peaks in September.933 In fact, the trainability in September was 2% times higher than the average monthly trainability for the entire year.
Reaction time has also been shown to improve significantly in sunnier months.934, 935
When we consider reaction time, muscle and bone strength, speed and endurance, we should realize these measurements are not only important for athletes, they are important for all aspects of living for all people. Everyone wants to be stronger, quicker, and faster, as well as have more endurance in daily activities. Therefore, we should all embrace the sun.
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Uterine Fibroids
Hysterectomy, or the removal of the uterus, is an all-too-common surgery among women in the United States, second only to childbirth by cesarean-section.936 Dr. Stanley West and other experts believe that as many as 90% of these operations are unnecessary, as they are usually done in response to the presence of non-cancerous uterine fibroids.937
Nevertheless, if uterine fibroids lead to hysterectomies, anything preventing the fibroids from forming would lead to a dramatic decrease in this procedure.
Once again we see the power of the sun in reducing the risk not only of a benign fibroid, but also the risk of unnecessary surgery and the resultant strain on the health-care system. According to a recent research report, women who spent at least an hour outdoors daily, had a 40% reduction in the risk of uterine fibroids.938 Dr. Donna Baird, the leader of the research team, stated, "It would be wonderful if something as simple and inexpensive as getting some natural sunshine on their skin each day could help women reduce their chance of getting fibroids."
Since the sun is free, it seems irrefutable that a daily dose of sunlight would be far superior to an expensive, painful and unnecessary surgery. Wouldn't you agree?
After reading about the preceding miscellany of diseases associated with sun deprivation, we hope you are convinced of the vital necessity of sun exposure to your health. Keep on sunning!
What have we learned?
1.	Anaphylaxis and allergies occur much more commonly in areas of low sunlight exposure.
2.	Chronic obstructive pulmonary disease (COPD) is associated with low 25(OH)D levels, which are caused by low sunlight exposure.
3.	Eczema can be treated with sun exposure, which may produce up to a 90% cure.
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4.	Insomnia can be mitigated by sun exposure, probably due in part to circadian-rhythm adjustments.
5.	Fatty liver disease is associated with lack of sun exposure.
6.	Myopia (nearsightedness) in children is directly correlated to lack of sun exposure. In one study, children who spent most or their lives indoors had 9.5 times the risk of developing myopia as those who spent the most time outdoors!
7.	Part of the obesity problem may be a lack of sun exposure, especially in the morning.
8.	The pain pandemic may be caused in part by lack of sun exposure and/or vitamin D. Of the two, sun exposure is more important.
9.	Psoriasis has been cured by using sun exposure or ultraviolet lamps for decades. Sunbeds are also effective tools to use for the disorder.
10.	Sexual performance and fertility are influenced by sun exposure, which has beneficial effects on erectile dysfunction, sperm structure and function, and egg maturation.
11.	Shortened life spans are closely correlated to sun exposure insufficiency, which may double the risk of death during a 20-year period. Indicators (markers) of aging are also closely associated with lack of sun exposure and/or low 25(OH)D levels.
12.	Soft-tissue injury is directly correlated to low 25(OH)D levels, which are markers for sunlight deficiency.
13.	Suboptimal athletic performance can be overcome in some cases by sunlight exposure, which has been shown to increase muscle and bone strength, decrease reaction time, improve sprint times and increase endurance.
14.	Uterine fibroids, which may lead to hysterectomy, are 40% less common among women who enjoy at least an hour of outdoor activity daily.
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Chapter 11
Sun Exposure, Pregnancy, Lactation and Other Reproductive Issues
"There is a muscular energy in sunlight corresponding to the spiritual
energy of wind."
—Annie Dillard
The period encompassing preconception, pregnancy and lactation is, most likely, the most important time in a woman's life to have regular sun exposure and high vitamin D status. For one thing, expression of hundreds of genes are regulated by the active form of vitamin D, 1,25-dihydroxyvitamin D [1,25(OH)2D],939 and gene regulation is very important during fetal development.940 It is well-known that 1,25(OH)2D concentrations rise during pregnancy and that these concentrations depend on 25(OH)D (the circulating form of vitamin D).941 Moreover, rates of conception, pregnancy and birth outcomes, and infant health are better when women have higher 25(OH)D concentrations during their reproductive period. These outcomes are described in this chapter.
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Adverse pregnancy and birth outcomes associated with low sun exposure/vitamin D status
Since vitamin D is very important for general health and controlling gene expression, it would be expected that lower vitamin D status would be associated with poorer fetal development, pregnancy outcomes and early-life health. In fact, these expectations have been confirmed in a number of studies.
The following adverse pregnancy and birth outcomes are linked to low sun exposure or low vitamin D levels.
Preeclampsia
Preeclampsia is a disorder in pregnant women, characterized by edema (fluid accumulation), hypertension (high blood pressure) and excessive urine protein. Pre-eclampsia can progress to eclampsia, which can cause convulsions, coma and death. Ten percent of pregnant women have high blood pressure, and preeclampsia complicates 2% to 8% of pregnancies.942
Preeclampsia can lead to problems in the liver, kidneys, brain and the clotting system. Risks for the baby include poor growth and prematurity. Overall, 10% to 15% of direct maternal deaths are associated with preeclampsia and eclampsia.943 The prevalence of preeclampsia is highest in winter and early spring,944 implicating sunlight deficiency as a possible cause, and low 25(OH)D levels also predict a doubling of the risk of preeclampsia.945, 946 Additionally, newborn children of women at risk for pre-eclampsia were twice as likely as other children to be vitamin D-deficient. This is important, because vitamin D-deficient newborns are likely to develop rickets and suffer from convulsions.947 Pregnant women, obviously, should be sun-seekers, or at least make sure they get other safe UV exposure when the sun is not available.
Primary (first-time) cesarean section (C-section)
Primary cesarean section can result from several conditions, including failure of delivery to progress, fetal distress, malpresentation such as breech position, and fetal head-maternal pelvis mismatch, etc.948 A
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study conducted in Boston between 2005 and 2007 found that 17% of 253 women studied had a primary C-section delivery.949 Women with a 25(OH)D level less than 15 ng/ml [38 nmol/L] were almost 4 times as likely to have a cesarean as women with higher levels. This shows how crucial sun exposure is to prevent C-section delivery! 25(OH)D levels are lower in black women, because dark skin produces vitamin D more slowly than light skin, when exposed to the sun. In this Boston study, black women were more likely than white women to undergo C-section delivery due to fetal distress and related indications. This would demonstrate the absolute necessity for black women to get ample sun exposure (or safe sunlamp use when sun is not available) in order to produce sufficient vitamin D for a healthy pregnancy. In 2010, 33% of births in the US were by C-section; 23% of deliveries among those with no previous C-section delivery were considered primary C-section deliveries.950 Obviously, the relationship of sun exposure/vitamin D to cesarean section must be considered vitally important, and pregnant women should be informed of this relationship in order to take prophylactic action.
The major problem associated with C-section delivery is that the
newborn does not pass through the birth canal, and as a result it does not acquire the vaginal and fecal bacteria it needs to establish the proper gastrointestinal microbiota. This failure to pass through the birth canal may help explain the increasing trend of autoimmune diseases such as type-one diabetes, Crohn's disease, and multiple sclerosis as well as allergic diseases such as asthma, allergic rhinitis, and atopic dermatitis.951
Preterm Delivery
Babies born prematurely have an increased risk of problems later in life, such as brain injury and abnormal brain development, sometimes resulting in cerebral palsy, mental retardation, sensory impairments and cognitive deficits, as well as academic underachievement and grade failures.952, 953 Additionally, preterm delivery costs much more than term delivery.954 Low 25(OH)D levels predict a 50% increase in the risk of preterm birth compared to high levels,955 and maternal 25(OH)D concentrations at or above 40 ng/mL were associated with substantially reduced preterm birth risk in a large, diverse population of women.956
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Gestational Diabetes
Gestational diabetes (GD) is characterized by high blood-glucose levels, especially during the third trimester of pregnancy, and is related to insulin resistance. The risk of GD is increased by diets high in saturated animal fat (e.g., meat and eggs), refined grains and added sugar, and low in fruit, vegetables, whole grains, and fish.957, 958 Low 25(OH)D levels also predict a 50% increase in the risk of GD.959, 960
Anemia
Anemia is a deficiency of functioning red blood cells, resulting in weariness because the blood carries less oxygen to the cells. A study in New York involving 158 pregnant adolescents (under 18 years of age) found that the risk of anemia was 8 times higher in those with 25(OH)D levels lower than 20 ng/ml [50 nmol/L], than it was with higher 25(OH)D levels.961
Pregnancy outcomes and adverse effects later in life
Pubmed.gov was searched for papers reporting adverse effects on pregnancy outcomes and health of the baby, with respect to vitamin D status. Low vitamin D status during pregnancy leads to adverse effects that are diagnosed in the resultant baby later in life. Since most of the vitamin D is derived from sun exposure, and since there are likely health benefits associated with sun exposure other than vitamin D production, we consider vitamin D status to be merely an index of UV exposure.
Low vitamin D status is almost always a surrogate measurement for sun deprivation. This section discusses some adverse effects of sun deprivation, predicted by 25(OH)D levels.
Dental health:
A study in Canada found that maternal vitamin D status predicted adverse infant tooth conditions at 1-year: Low vitamin D levels were associated with thinner tooth enamel.962 This can predispose the teeth to cavities and result in multiple dental surgeries with a host of long term complications and side effects, and toxic exposure to dental materials.
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Lung development, neurocognitive function, eating disorders and bone mass:
A study in Australia involving 901 mother-offspring pairs with offspring born in 1989-91, for whom 25(OH)D levels during pregnancy were available, found that "After adjusting for relevant covariates, maternal vitamin D deficiency (less than 20 ng/ml [50 nmol/L]) during pregnancy was associated with impaired lung development in 6-year-old offspring, neurocognitive difficulties at age 10, increased risk of eating disorders in adolescence and lower peak bone mass at 20 years."963
Rickets:
This disease is still found in children born to mothers who had limited exposure to UVB-containing sunshine during pregnancy and lactation, especially darker-skinned mothers.964 Future mothers at risk must be informed about the importance of UV exposure (sunlight or sunlamps) before and during pregnancy, as an easy prevention of rickets.
Bone mineralization and size:
A study in England, involving 7,000 children approximately 10 years of age, found that both bone mineral content and bone surface area, and thus bone size, were positively related to sun exposure during their mothers' pregnancies.965
Food allergy emergency:
Research from Boston states that children younger than 5 years, who were born in fall or winter (times of low sun exposure), had about 50% increase in the risk of emergency room visits for food allergies, compared with children born in spring or summer. The authors suggested this finding was related to differences in UVB exposure during their mother's pregnancies.966
Muscle development and insulin resistance:
A study in India found that children born to mothers who had vitamin D deficiency during the 28th to the 32nd weeks of pregnancy had smaller arm-muscle area at age 5, and at age 9.5, they had higher fasting insulin resistance—a cardiovascular-disease risk factor.
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Multiple sclerosis (ms):
Research from Finland found that maternal vitamin D deficiency during early pregnancy is associated with a nearly two-fold risk increase of MS in the offspring, compared to the offspring of women who had normal vitamin D levels.967 Similar research from Denmark demonstrated that babies born with the lowest quintile (fifth) of 25(OH)D levels had twice the risk for future multiple sclerosis as infants born in the highest quintile.968
Vitamin D [25(OH)D] levels during pregnancy
A search of pubmed.gov was conducted to get a sense of 25(OH)D levels during pregnancy around the world. The highest 25(OH)D levels were found among indigenous women of East Africa, who had an average value of 52 ng/ml [130 nmol/L].969 This value is representative of what spending considerable time in the sun provides, and it was also likely the case in pre-historic times. For the rest of the world, levels varied from 10 ng/ml [25 nmol/L] in Tokyo, Japan970 to 36 ng/ml [90 nmol/L] during the third trimester of pregnancy in Thailand.971 In the United States, blacks were found to have much lower 25(OH)D levels than whites in the period 1996-2008 (18 ng/ml) [45 nmol/L] vs. 30 ng/ml [75 nmol/L] in winter, 23 ng/ml [58 nmol/L] vs. 36 ng/ml [90 nmol/L] in summer.972 Globally, the mean 25(OH)D level for all people is near 22 ng/ml [55 nmol/L].973 25(OH)D levels increase from the first to the third trimester of pregnancy as found in both Thailand974 and China.975
Nursing
In order for a mother to deliver 400 IU per day of vitamin D to the nursing infant via breast milk, she has to produce or consume 6,400 IU per day of vitamin D.976 A study of breastfeeding women in Cincinnati, Mexico City and Shanghai found that 25(OH)D levels for mother and infant were strongly related to season, maternal obesity, vitamin D supplementation and a high sun index.977 Thus, nursing mothers should try to spend a reasonable amount of time in the sun daily, if possible (if not possible, they should use vitamin D-producing sunlamps).
Recommendations
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Based on the above, pregnant and nursing mothers should spend enough time in the sun (or use sunlamps) to make several thousand IU of vitamin D per day. Whether it is the vitamin D or vitamin D in combination with other health benefits of UV exposure, measuring 25(OH)D concentrations is a convenient way to determine whether sufficient time has been spent in the sun. Since 25(OH)D levels are mentioned as being critical for pregnant women and their offspring, it is important to know that the skin, in response to peak summer sunlight, can produce and release up to 20,000 IU of vitamin D in a period of only 10-15 minutes.978
One minor problem with UV exposure during pregnancy is a slight decrease in folate due to destruction by UV irradiation.979 Folate reduces risk of spina bifida. Thus, pregnant women getting more UV exposure might want to take a bit more folate or eat more green leafy vegetables than otherwise.
Pregnant and nursing women face several obstacles to obtaining adequate sun exposure. These obstacles include living and working indoors, wearing too much clothing for the season and location, and covering up for religious reasons. Other obstacles include using sunscreen or wearing cosmetics containing sunscreen, and believing pale skin is better than tanned skin, especially in ethnic groups with darker skin pigmentation. Some of these obstacles can be overcome by using sunlamps safely, at the convenience and privacy of home.
What have we learned?
1.	Low 25(OH)D levels predict a doubling of the risk of preeclampsia.
2.	It is absolutely imperative for black women to have ample time in the sun to avoid the risk of primary caesarian section. Of course, it is also important for women of other races.
3.	Low 25(OH)D levels predict a 50% increase in the risk of preterm birth.
4.	Low 25(OH)D levels predict a 50% increase in the risk for Gestational Diabetes.
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5.	The risk of anemia in pregnant adolescents is 8 times higher when 25(OH)D levels are low rather than high.
6.	Among children ten years of age, bone mineral content and bone area, and thus bone size, were positively related to sun exposure during their mothers' pregnancies.
7.	Other adverse effects of low vitamin D status during pregnancies, diagnosed in the children produced by those pregnancies later in life, are the following: Poorer dental health, impaired lung development, neurocognitive difficulties, increased risk of eating disorders, lower peak bone mass, rickets, food allergies, smaller arm muscles, multiple sclerosis and metabolic/cardiovascular disorders.
8.	Pregnant as well as nursing mothers should try to spend a reasonable amount of time in the sun daily, if possible. If not, sunlamps should be used safely.
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Chapter 12
Racial Disparities Related to Differences in UVB Exposure and Vitamin D Status
Keep your sunny side up!
-- Judy Garland
Since the primary source of vitamin D is solar UVB exposure, it would be expected that darker-skinned individuals would have lower serum 25(OH)D levels than lighter skinned individuals living in the same place. This is indeed the case. In the US, during the period of 2001 to 2004, white Americans had average serum 25(OH)D levels near 26 ng/ml [65 nmol/L]. Hispanic Americans had values near 21 ng/ml [53 nmol/L], and black Americans had values near 16 ng/ml [40 nmol/]980 Since higher solar UVB exposure and serum 25(OH)D levels have been linked to better health outcomes, it would be expected that darker skin would, therefore, predispose people to poorer health outcomes (disparities).981 In fact, a cross-sectional study of 12,505 Americans (3402 non-Hispanic blacks, 2143 Mexican Americans, and 5960 non-Hispanic whites) has determined that, while socioeconomic factors were the strongest determinant of skin-color based health disparities in the US, serum 25(OH)D levels also played an important role.982
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This section reviews findings on racial disparities linked to UVB exposure and serum 25(OH)D levels.
Cancer
The role of sun exposure and vitamin D in reducing the risk of cancer has already been discussed in Chapter 5. Thus, this section will discuss only the evidence relating to darker-skinned individuals, primarily African Americans, who have increased risk for cancer. A geographical ecological study published in 2002, reported that for white Americans residing in over 400 US regions, there were 15 types of cancer, for which mortality rates were inversely correlated with solar UVB doses in the month of July.983 For black Americans, there were only six cancers—of the bladder, breast, colon, lung, pancreas, and rectum. The two main reasons for the different findings: there are fewer black Americans than white Americans and black Americans produce less vitamin D from solar UVB. Both reasons made it more difficult to find the effect of UVB on cancer in black Americans. In a subsequent study using UVB doses averaged by state and including other risk-modifying factors, higher UVB doses were found to be protective against lung, breast, colon, gastric/stomach, lung, and rectal cancer.984
An analysis of colorectal cancer mortality rate, using data from the US from 1988 to 2006, found that African Americans had twice the risk for the disease. However, when serum 25(OH)D levels were factored in, the effect of skin color was reduced by about 40% and low serum 25(OH)D level was associated with a doubling of risk.985
A review of cancer survival disparities between blacks and whites found (after consideration of stage at time of cancer diagnosis, type of treatment, and socioeconomic status) that blacks had significantly reduced cancer-specific survival rates and all-cause survival rates.986 This reduction in survival was at a rate of anywhere from zero to 50%.
A paper published in 2013 reported that that vitamin D deficiency may have a stronger effect on the risk of more aggressive breast cancer, particularly in women of African ancestry.987 Another paper, published in 2015, reported that higher vitamin D status was associated with lower risk of aggressive prostate cancer in African-American men with high calcium intake.988 (Note: high calcium intake may lead to increased risk of prostate cancer. The study indicates that high vitamin D levels protected against higher prostate-cancer risk due to the high-calcium intake.)
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A report from the Black Women's Health Study, which involved 59,000 African-American women, found that those with the lowest cumulative predicted serum 25(OH)D level had about a 23% increase in the risk of breast cancer compared to those in the highest level.989 Predicted serum 25(OH)D level was based on taking vitamin D supplements (with or without calcium, at least twice a week); multivitamin use (at least twice a week, not specified whether they included vitamin D or how much); body mass index (BMI); vigorous exercise; walking for exercise; current cigarette smoking; current alcohol consumption; use of female hormones; use of oral contraceptives; and menopausal status.
Cardiovascular disease (CVD)
There is mounting evidence that higher serum 25(OH)D levels are associated with lower risk of cardiovascular disease (see Chapter 10).
A paper published in 2011 noted that African Americans have higher rates of type 2 diabetes (T2D) and some forms of cardiovascular disease (CVD) than do European Americans. African Americans also have much higher rates of vitamin D deficiency.990 At that time, there was only evidence from observational studies showing that higher serum 25(OH)D levels were associated with lower rates of cardiovascular disease. Nonetheless, the author suggested that raising serum 25(OH)D levels of African Americans might help reduce racial disparities for these diseases.
A review of data in the US for the years 2001-2004 has found that lower serum-vitamin-D levels explained nearly one-third of the excess risk of peripheral arterial disease in black compared to white adults.991
A prospective study in the Southern USA found that African-Americans and non-African-Americans with the lowest serum 25(OH)D levels had the same increase in CVD mortality rates comparing with the highest levels, indicating that vitamin D status, not skin color or racial origin, was the culprit.
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Diabetes mellitus
One of the adverse effects of diabetes mellitus is retinopathy (deterioration of the retina due to blood vessel damage, which can eventually lead to blindness). Based on an analysis of data from 906 Caucasians and 433 African Americans, higher serum 25(OH)D levels were associated with significantly reduced risk of diabetic retinopathy: the risk in those with 25(OH)D over 30 ng/ml [75 nmol/L] was about 60% lower than in those under 12 ng/ml [30 nmol/L].992
Pregnancy and birth outcomes
A study based on data from the years 1988-1994 found that about
40% of African-American women of childbearing age had hypovitaminosis D (serum 25(OH)D level below 15 ng/ml [38 nmol/L] compared to about 4% for white women.993
A study involving 178 African-American women found that for every 2.7 ng/ml [6.8 nmol/L] increase of 25(OH)D level, the risk of clinical depression after giving birth decreased by about 16%.994
A study involving 1067 white and 236 black mother-infant pairs in Massachusetts found that the risk of having a small baby relative to gestational age was about three times higher for mothers with serum 25(OH)D level under 10 ng/ml [25 nmol/L] compared to mothers above 10 ng/ml [25 nmol/L].995 In addition, this risk of having a small baby was twice as high in black participants as in white participants. Vitamin D disparity between blacks and whites was responsible for about one-third of this difference.
A study in the US, using data from 1959-1965, found that in nonwhite mothers, serum 25(OH)D levels higher than 12 ng/ml [30 nmol/L] were associated with a 20-30% reduction in spontaneous preterm births.996 The proposed mechanism was increased inflammation due to lower vitamin D levels. No relation between serum 25(OH)D level and preterm birth was found in white women.
Autism
There is mounting evidence that vitamin D deficiency is an important risk factor for development of autism. Science has not determined what is more important-maternal vitamin D deficiency during pregnancy or deficiency during early childhood. A geographical ecological study of autism prevalence among American children between ages 6-17 found that solar UVB exposure was more protective against autism among black Americans compared to white Americans.997
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Mortality rate
A study conducted in Memphis, TN and Pittsburgh, PA found that African Americans with low serum 25(OH)D had a higher risk of death compared to white Americans with low levels.998 If serum 25(OH)D levels under 20 ng/ml [50 nmol/L] were raised to above 20 ng/, the mortality rate was expected to decrease by about 15%.
However, if levels were raised to above 30 ng/ml [75 nmol/L], there was about a 40% reduction in the mortality rate! Reductions in mortality rates are equivalent to higher life expectancy, i.e., increasing the age at the time of death.
Summary
African-Americans have similar health outcomes as white Americans with respect to serum 25(OH)D levels. There is, however, some confusion in the literature regarding the importance of higher serum 25(OH)D levels for African-Americans since they can have very strong bones even with low serum 25(OH)D levels.999 This finding is likely due to more efficient retention and utilization of calcium and phosphate by African-Americans, comparing with white Americans.1000 Since African-Americans and other dark-skinned people require 2-5 times the sun exposure in order to equal the vitamin D-producing capacity of white Americans, it is imperative they soak up the sun at midday for an hour or so whenever possible. Sunbed or sunlamp exposure is also an efficient method of increasing 25(OH)D levels. We do not usually recommend vitamin D supplementation when UVB is available (via sun exposure or sun lamps), but supplementation is vital for African-Americans (or others) when there is no other way to optimize serum levels of vitamin D. Always choose the sun when possible. Remember, sun exposure causes production of nitric oxide, serotonin and endorphin, which are vital substances not available by simply taking a vitamin D supplement.
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What have we learned?
1.	African Americans have twice the risk for colon cancer as other Americans, but when serum 25(OH)D levels were factored in, the effect of skin color was reduced by about 40% and low serum 25(OH)D level was associated with a doubling of risk.
2.	Vitamin D deficiency may have a stronger effect on the risk of more aggressive breast cancer, particularly in women of African ancestry.
3.	Higher vitamin D status is associated with lower risk of aggressive prostate cancer in African-American men with high calcium intake.
4.	Lower serum-vitamin-D levels explained nearly one-third of the excess risk of peripheral arterial disease in black compared to white adults.
5.	African-Americans with the lowest serum 25(OH)D levels have the same increase in CVD mortality rates comparing with the highest levels, indicating that vitamin D status, not skin color or racial origin, is the culprit.
6.	Raising vitamin D levels in African Americans reduces the risk of all-cause death profoundly.
7.	Since African-Americans and other dark-skinned people require 2-5 times the sun exposure in order to equal the vitamin D-producing capacity of white Americans, it is imperative they soak up the sun at midday for an hour or so whenever possible. Sunbed or sunlamp exposure is also an efficient method of increasing 25(OH)D levels.
8.	When there is a choice, sun exposure or sunlamp exposure is always the best method to ramp up vitamin D levels, regardless of race.
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Chapter 13
How Did the Sun So Quickly Change from Friend to Foe? A Brief History of the Rise and Fall of Heliotherapy
"Love comforteth like sunshine after rain."
-- William Shakespeare
Whereas vitamin D has been accepted as absolutely essential to human health, the source stimulating its production (sun exposure) certainly has been condemned, at least for the past forty years. The sun, in the view of many misguided health professionals and the patients they serve, is an enemy. Because of the injudicious (and in some cases deliberately misleading) attack on sun, hundreds of thousands of people each year are afflicted with a host of completely avoidable diseases. These victims have vitamin D-depleted bodies because they live in sunless homes and work in sunless offices. As shown in the cartoon, we have become, for the first time in human
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history, artificial cave dwellers. Our caves are our homes and offices. And when we do go outside, we dutifully cover ourselves with clothing and pour sunscreen on any exposed areas. Unfortunately, sunscreens block up to 99.9% of vitamin D production by the skin in response to sun exposure. How did this vilification of the sun develop? A brief history of the sun and its relationship to health will shed some light on this question.
The following history of sun therapy is partially a compendium of Dr. John Fielder's exceptionally well-written paper, History of Heliotherapy.1001 From this history, one can easily see the stark contrast between the disparagement of sun exposure at present, vs. the wide acceptance sun therapy enjoyed in the past.
Many ancient peoples were sunbathers. The Egyptians, Babylonians, and Assyrians had sun gardens and gave the sun the status of a god. Hippocrates, the Greek physician known as the "father of medicine," recommended sunbathing and had his own large solarium—an enclosed area for sunning. This was also true of ancient Romans, whose thermae (hot tubs and baths) were equipped with solaria. The Roman writer Pliny wrote, "Sun is the best remedy."
In the early 19th Century, scientists began to experiment with sun as a healer and were so impressed with their results they attempted to build a new system of therapeutics based on heliotherapy. In 1857 Madame Duhamel of France exposed children with TB to sunshine because it hastened their recovery. Many doctors used heliotherapy with great success, and as Dr. Fielder states, "As a general rule, the experience of all the hygienists in their use of sunbathing was so successful all question of doubt as to its place in the hygienic system was ensured."
Madame Duhamel was correct about sunbathing healing tuberculosis (TB). Later on, a disillusioned physician, Dr. Rollier, gave up a promising surgical practice and moved to the mountains of the Swiss countryside to practice medicine there. However, he discovered people there needed little help, as they were seldom sick. People were always telling him, "Where the sun is, the doctor ain't [sic]." In fact, Dr. Rollier's fiancee had TB and would have died without intervention. He brought her to the Alpine area, exposed her regularly to sunshine, and she completely recovered. Dr. Rollier opened a sanatorium in 1903 which was really just an extremely large solarium with patient living quarters. There were 2,167patients under Dr. Roller's care for TB following World War One. Of these, 1,746 completely recovered their health. Only those in the most advanced stages of the disease failed to recover.
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In 1895, Dr. Niels Finsen made use of the first artificial UV light in treating patients with a particularly virulent form of TB known as lupus vulgaris (a skin disease). Though the disease was considered incurable, 41 of every 100 patients under his care recovered. Finsen's work earned the Nobel Prize in Medicine in 1903.
These researchers and physicians were not alone in their observations of the therapeutic power of the sun. In 1877 two scientists, Arthur Downes and Thomas Blunt, discovered that sunlight was bactericidal. In 1890, the German microbiologist Robert Koch (who had isolated and described the tuberculosis bacterium in 1882), showed that sunlight killed TB bacteria.1002 The legendary humanitarian Florence Nightingale also observed the sun's ability to help heal wounded soldiers and insisted that hospitals must be constructed to allow the free entry of sunlight.1003
For many years afterward, heliotherapy was the treatment of choice for bacterial infections. Unfortunately for heliotherapy, however, penicillin was discovered in 1928 and sulfanilamide in 1939. Sulfanilamide in particular was effective against TB, so the era of antibiotic drugs was born and heliotherapy virtually forgotten. People still loved the sun, however, and sun tanning became popular for several decades. Then, as some evidence regarding the appearance of common (non-threatening) cancer in skin areas excessively exposed to the sun, the attitude toward sunshine began to change.
Dr. Michael Holick states, "In the 1920s it was recognized that farmers in Europe developed [common] skin cancer on their most sun-exposed parts—their ears, face, nose, and backs of their hands."1004 This news was the beginning of the war on the sun. Still, there was also early research indicating that sunlight might have anticancer properties, and in 1932 an editorial in the British medical journal "Lancet" suggested that since sunlight was so effective in promoting health, the government should set aside public areas for nude sunbathing!1005
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In 1936 and 1937, Dr. Sigmund Peller demonstrated that solar UV radiation reduced the risk of internal cancer but not lip cancer or common skin cancer. In the first paper, he demonstrated how in outdoor occupations and surroundings where lip cancer or common skin cancer was prevalent, other cancers diminished.1006 In the second paper, he showed that sailors—individuals who spent long hours in the sun—had about eight times the expected rate of common (non melanoma) skin cancer, but only about 40% of the expected rate of the deadly internal cancers.1007
Peller was impressed with the reduced mortality from deadly cancers, experienced by those who had previously had common skin cancers— cancers which were easily removable or "cured." He felt he had found the answer to reducing deadly cancers by 60% [he was correct], but he erroneously concluded that skin cancer itself, rather than sun exposure, had triggered a protective mechanism preventing the deadly internal cancers. He went so far as to suggest that UV light be used to induce common skin cancer as a method of vaccination to prevent internal cancers! The name of his first paper was "Carcinogenesis as a means of reducing cancer mortality." His methods would probably have worked, but it would have been trading a greater evil for a lesser evil—a tradeoff that was not necessary. He would have indeed saved many lives from major cancer while creating a pandemic of common skin cancer. He was, however, completely wrong about immunity. Skin cancer provides no immunity to major cancers. But, as we know, sun exposure and vitamin D do indeed lessen the rate of major internal cancers, which is what Peller was really observing.
In 1941, Dr. Frank Apperley stated that Peller was wrong to suggest inducing common skin cancer as a method of preventing the more deadly cancers.1008 Apperley's research showed it was sun exposure— not skin cancer—which was responsible for reducing the risk of deadly cancers. He studied cancer incidence at different latitudes and demonstrated the following: North American death rates resulting from major cancers, among the inhabitants of cities located between latitudes 30° and 40° north, were 85% higher than death rates among inhabitants of cities between 10° and 30°. Inhabitants of cities between latitudes 40° and 50° north latitude had cancer death rates 118% higher than those between 10° and 30°. Inhabitants of cities
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between 50° and 60° had death rates from internal cancers 150% higher than those between 10° and 30°. The following graph shows Apperley's findings:
Increasing Cancer Incidence with Increasing Latitude in North America
-i-»
</>
O
c	10 to 30	30-40	40-50	50-60
co
O
Degrees north latitude
Apperley did not know how the sun reduced the incidence of the major cancers, but stated, "The presence of skin cancer is really only an occasional accompaniment of relative cancer immunity in some way related to exposure to ultraviolet light." He suggested that a higher degree of common skin cancer was the price to be paid for the decreased death rate from the major cancers. Apperley was incorrect on that point. Dr. Homer Black's research makes it clear that higher incidence of common skin cancer is not necessary if people make moderate changes in the quantity and type of fats they consume, and if they eat foods rich in antioxidants.1009, 1010, 1011
Apperley and Peller demonstrated the sun's ability to reduce the incidence of the major "killer" cancers, but the fear of skin cancer began to sweep all other considerations aside, and the sunscreen industry was born. Sunscreen sales in 1972 were about $18 million per year,1012 and the total USA market for sunscreens in 2005 had climbed to $640 million a year.1013 In 1972 dollars it is equivalent to $320 million, an almost 18-fold increase. However, those figures pale by comparison with figures from 2013, which showed the global sun care market generated $5.6 billion US dollars from its sun-protection products segment, which includes sunscreens, many of which are ingredients in women's cosmetics.1014 Sales increased despite the fact that as early as 2003, it was known that sunscreens may have been partially responsible for increasing the deadliest of skin cancers, melanoma.1015 The "Powers of Darkness" as Dr. Grant calls them, are not easily overcome, especially when large amounts of money are at stake.
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An interesting aside regarding the Chinese appreciation for the Sun
The Chinese, whose experience in healing goes back thousands of years,1016 have always seemed to understand the power of natural healing better than we who live in the Western world. They would not need to read the first three chapters of this book to appreciate the benefits of unobstructed sun for human health. An article from Shanghai emphasized this concept:1017 A real-estate developer there had to pay a family the equivalent of $15,650.00 for robbing them of their sun. One of the developer's skyscrapers exceeded the legal height, and partially blocked the sun, preventing the family from obtaining their government-mandated sun allotment during the coldest time of the year. The allotment was two hours per day, but the skyscraper allowed only 1-2 hours of sun.
The judge in the case said, "We can't live without sunshine" and told the developers they had to respect the rights of the people to enjoy the sun.
This is in stark contrast with the US in the 1990s, where a president of the American Academy of Dermatology (AAD) made this statement: "In some vision as I grow older I see us moving to more shelters and perhaps underground living because of these hazards" (meaning sun exposure).1018 She also said that melanoma would cause more cancer deaths than any other cancer by about 2010. Fortunately, we are not yet living underground, and melanoma is nowhere near the top of the cancer-deaths charts, though it will probably increase in incidence as more people are convinced by the ADD to avoid the sun.
It appears that the Chinese are a whole lot smarter than the AAD! The AAD's insistence that people avoid the sun is much more likely to destroy the health of the American public than soaking up some unobstructed sunshine. So please, PLEASE enjoy some safe, nonburning sun, winter and summer while you improve your health!
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Final Thoughts:
So there you have it. The Magnificent Sun gives us life, and all spectrums of light are synergetic to each other and must ALL be used as nature intended, in the correct variety and amounts. The sun is one of our greatest friends for health, as you have learned throughout this book. It's only when research divides the sun's rays, or when profits are prioritized over science, that we find problems. We need all spectrums of light for health. God (or Nature if you prefer) did not make any mistakes.
There will always be risks and benefits in anything we do. The sun gives us life when used correctly and not excessively. Chemical sunscreens and sun avoidance around midday have unbalanced the sun for decades and destroyed many of its positive effects. Whether this has resulted from misguided or myopic research, or from the desire for profit, you'll have to decide for yourself.
Be safe and remember: Embracing the Sun is one of the golden rules of health. However, it is not a cure-all. People who believe that sun exposure can negate the deleterious effects of a junk food diet, the use of drugs and alcohol, polluted air and water, inactivity, absence of nature, or a nasty attitude, are sadly mistaken. Sun exposure will act as an antidote for some of these poisons, but it can never take the place of clean living, a natural environment, kindness and positive thoughts.
Best wishes in your pursuit of health and happiness.
Marc Sorenson and Bill Grant.
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Appendices
Appendix 1.
The Magnificent Sun
"Pleasant the sun when first on this delightful land he spreads his orient beams on herb, tree, fruit and flower."
—John Milton
Do we appreciate the sun, or do we simply take it for granted? Hopefully, after reading the information presented in this book, you, the reader, have an entirely new appreciation of its health benefits. As we bring the book to a close, however, we would like to provide a bit more information about our life-giving friend, whose awe-inspiring attributes extend far beyond its value to human health. May your appreciation grow, and may you add wonder and amazement to your life, each time you view our beautiful, fiery orb.
The sun's mass is comprised of hydrogen (71.0%), helium (27.0%), oxygen (0.97%), carbon (0.40%), iron (0.14%), silicon (0.099%), nitrogen (0.096%), magnesium (0.076%), neon (0.058%), sulfur (0.040%) and additional minor elements.1019
The sun is essentially a massive fusion reactor, converting hydrogen to helium in the core, which extends from the center to about 25% of the sun's radius. The energy produced at the core heats the next zone, the
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radiative zone—to 7 million °K at near the core, dropping to 2 million°K at the outer edge of the radiative zone. This heats the next zone—the convective zone—which is near the sun's surface (from 0.7 radii, or 200,000 km below the sun's surface, to almost the visible surface). The outer layer is the visible surface of the sun—the photosphere—which is heated to between 4500°K and 6000°K.1020
The sun is the primary source of life on earth. Without the sun, there would be no light, no heat, and no life. Visible radiation permits plants to grow through the action of photosynthesis. Chlorophyll "a" is the most abundant pigment in plants and is generally found in the leaves where energy production occurs. Its peak absorption regions are near 430 nm (blue) and 662 nmol (red). Chlorophyll b is less abundant and has peak absorptions near 453 nm and 642 nm. Having two types of chlorophyll permits plants to absorb sunlight more efficiently. Thus, most plants appear green since blue and red are absorbed but green radiation is not.1021
The photosynthetic reaction is; carbon dioxide plus water plus light convert to glucose plus oxygen:
6CO2 + 6H2O	>C6Hl2O6 + 6O2
Sunlight energy
Thus, photosynthesis removes carbon dioxide from the atmosphere, makes glucose (an important carbohydrate), and releases oxygen to the atmosphere. All these actions are essential for life on Earth.
Hemoglobin in animals has a similar structure to chlorophyll in plants.1022 Hemoglobin carries oxygen in the blood. Chlorophyll consumption increases the number of red blood cells. In hemodialysis patients with anemia, sodium ferrous chlorophyll treatment was found to increase hemoglobin and hematocrit significantly.1023
All food consumed by animals was originally plant based, whether eaten in plant-based form, in animal-based form, or in fungi (mushroom)-based form. Thus, without plants, there would be no animals.
The sun is also the source of energy that heats the Earth's atmosphere, its surface, and its water. Due to the daily rotation of Earth, we have day and night. Due to the tilt of the Earth's axis by 23.4° about the elliptical orbit around the sun, there are seasons. This can be demonstrated by holding a ball with a tilted axis and rotating it in front of a flashlight, seeing that the top of the ball gets more light with the tilt in one direction, and the bottom of the ball gets more light with the tilt in the opposite direction. Additionally, due to the elliptical path of earth around the sun, the earth-sun distance is shortest near January 1 (perihelion), 0.983 astronomical units, and longest around July 1 (aphelion), 1.017 astronomical units. Thus, the Earth is 3.5% closer to the sun in the austral (southern hemisphere) summer than in the boreal (northern hemisphere) summer. Since radiation intensity falls off by the inverse proportion of the square of the distance, the sun's intensity is 7.0% higher in the austral summer than in the boreal summer, and 7.0% higher in the boreal winter than in the austral winter.
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Weather is also controlled in large measure by the sun. Heating by the sun evaporates water vapor from the surface and from plants by the process of transpiration. When water vapor condenses, clouds and fog develop. Heating causes the atmosphere to expand and have lower density and pressure. Increased water vapor content of the atmosphere also lowers its density and pressure, since the molecular weight of water vapor is lower than the two main constituents of the atmosphere, molecular nitrogen and molecular oxygen. Differential heating by the sun, due to the Earth's rotation affecting the daily variation in temperature and formation of clouds, produces variations in pressure which result in winds that try to equalize pressure. Seasonal variations in solar heating result in seasonal variations in weather and climate. An interesting slide show on how the sun affects weather is found at http://www.slideshare.net/tamjohns/suns-effect-on-weather.
Astrology used the positions of the constellations in the nighttime sky to guide planting of crops in ancient times. These favorable positions for crop plantings were extended by humans to other realms, including the association between birth dates and compatibility with others, depending on their astrological sign. These associations were never proven by science. However, there are scientifically proven effects of birth season on physical and developmental attributes, mental disorders, and health. Examples: higher mean birth weight, later pubertal development, and taller adult height were found in
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those born during summer in the UK, relative to those born in winter.1024 Additionally, there are excess birth rates for schizophrenia and bipolar disorder in those born during winter/spring compared to summer/fall.1025 Ten percent of the risk of schizophrenia is attributed to being born in winter/spring.1026 Preterm birth rates in the UK peak in the period November-December-January.1027 Also, winter birth is associated with increased risk of multiple sclerosis.1028
Ancient societies worshiped the sun. Egyptians had a sun god, Ra. Romans had a sun god, Sol Invictus. Aztecs had two sun gods, Huitzilopochili and Tonatiuh. Incas had a sun god, Inti, who was also the god of agriculture. Japanese had a sun goddess, Amaterasu.
The Egyptian peoples honored Ra, the sun god. For people in ancient Egypt, the sun was a source of life. It was power and energy, light and warmth. It was what made the crops grow each season, so it is no surprise that the cult of Ra had immense power and was widespread. Ra was the ruler of the heavens. He was the god of the sun, the bringer of light, and patron to the pharaohs. According to legend, the sun travels the skies as Ra drives his chariot through the heavens.
Although he originally was associated only with the midday sun, as time went by, Ra became connected to the sun's presence all day long. The Greeks honored Helios, who was similar to Ra in many aspects. Homer describes Helios as "giving light both to gods and men." The cult of Helios celebrated each year with an impressive ritual that involved a giant chariot pulled by horses off the end of a cliff and into the sea.
It seems that modern industrial/technological society has forgotten how much we owe the sun.
Aside from the physical properties of the sun and the sun-earth distance, the other most interesting property is the emission spectrum. The spectral output of solar radiation is essentially that of a black-body (perfect absorber and radiator of energy with no reflective power) with a temperature of 5,525°K. The spectrum is shown in the graph below. While the visible spectrum is what we see, the invisible
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UVB spectrum produces vitamin D and the invisible infrared spectrum delivers most of the heat to the earth. Note that there are some wiggles on the spectrum. These are due to absorption by some of the atoms/ions in the sun's outer layer, the photosphere, which is about 340 miles thick.1029
Molecular constituents of the Earth's atmosphere absorb much of the solar radiation before it reaches the Earth's surface. The species that absorb most of this radiation are ozone (in the UVB and UVC region), water vapor, carbon dioxide, and oxygen. The graph shows how the molecular atmosphere affects solar radiation reaching the earth's surface.1030
The distance to the sun is about 93 million miles. The speed of light is 300,000 m/s (186,000 miles/sec). Thus, it takes an average of 8 min, 20 sec. for radiation leaving the sun to reach the earth.
Plants and animals are dependent on the Sun.
Animals are generally plant eaters (herbivores), animal eaters (carnivores) or plant and animal eaters (omnivores). Thus, plants are the basis for most life on Earth since animals cannot make carbohydrates from sunlight and sunlight. Carbohydrates are an important source of energy for animals and also serve several other important functions.
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Both plants and animals are also dependent on other effects of sunlight. An obvious role for the sun is providing the light that allows animals to see objects around them, in addition to regulating circadian rhythms and the wake-sleep cycle. For animals, sunlight is important for the production of vitamin D as well as other photoproducts discussed in this book.
Radiation, Earth, sky and color
As shown by the graph above, the sun's radiation that reaches the Earth's surface is affected by the atmosphere. Wavelengths shorter than 290 nm are blocked by both oxygen and ozone. The ozone UV absorption band peaks at 250 nm and ends at about 340 nm. When it was announced in 1974 that chlorofluorocarbons (CFCs) used in refrigeration systems might destroy the stratospheric ozone layer, the main concern was the increased risk of skin cancer.
The color of the sky and clouds are affected by molecules, aerosols, and the sun's elevation angle (the angle between the horizon and the center of the sun's disc). Molecules scatter light in proportion to the inverse fourth power of wavelength, called Rayleigh scattering, named after the physicist who figured this out. Thus, shorter wavelengths scatter much more than longer wavelengths. That is why the sky looks blue on a clear day. UVB (and UVC), being the shortest solar wavelengths, are scattered the most. Thus, much of the UVB we receive comes at us from all directions, so it is possible to burn as well as make vitamin D while sitting in the shade on a sunny day. At sunrise and sunset, the path of sunlight through the atmosphere is much longer than during midday. As a result, much of the blue light is filtered out, so clouds can appear orange or red at sunrise or sunset. Aerosols, which can be particulates or small drops of water, scatter light via what is called Mie scattering, especially if they are about the same diameter as the wavelength of light. Mie scattering is largely independent of wavelength, and stronger in the forward direction than in other directions. Thus, if looking in the direction of the sun, but blocking the sun, there will be a glow of sunlight around the sun.
The infrared rays of the sun give us the warmth we need to live and the visible spectrum of sunlight enables us to see.
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The sun also has an effect on our mood and emotional well-being. Research shows that too little exposure to sunlight can lead to seasonal affective disorder (SAD) - a type of winter depression.
Sunlight also helps our bodies to form vitamin D underneath the skin. This vitamin helps us to build and maintain teeth and bones and helps the body to absorb calcium.
The Sun is the brightest and most familiar object in the sky. Life on Earth would not be possible without it:
•	The food we eat exists because of sunlight falling on green plants, and the fuel we burn comes either from such plants, or was accumulated by them (in the forms of coal, oil and natural gas) long ago.
•	The Earth would probably not be fit for life if it did not have water. Life as we know it needs liquid water, and Earth is the only planet in our solar system to have it. Without the Sun, Earth would be an icy rock in space. Even now, Earth is probably the only place in our solar system fit for life: any water on Venus and Mercury would become steam, and water on Mars or on more distant planets would freeze.
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Appendix 2
Balancing the Messages about Sunbeds
The sun does not shine for a few trees and flowers but for the wide
world's joy.
—Henry Ward Beecher
This section is meant neither to promote sunbeds nor to discourage their use. Seldom is anything positive said about sunbeds, although there is research which shows many benefits. Such research is usually ignored because it does not conform to a preconceived notion. We therefore want to present research to demonstrate that there are other opinions providing some balance to typically negative messages about sunbeds.
Sun exposure and tanning have been vilified by many (but not all) dermatologists, which is not surprising, considering that 73% of all dermatologists have a share in the $34 million distributed to them by pharmaceutical companies.1031 Sunbeds have been demonized to an even greater degree and are called "cancer machines" by many in the medical profession and in the popular press, and there are movements afoot to make it illegal for those under the age of 18 to even use them. Many beneficial effects of vitamin D and other photoproducts produced by sun exposure are also produced by the use of high-quality sunbeds.
However, there are caveats to be considered.
While indoor tanning provides benefits such as increased production of vitamin D and other photoproducts, there are some concerns that indoor tanning might also increase the risk of skin cancer and melanoma. Here are a few considerations regarding indoor tanning:
1. The relative amounts of UVA and UVB can vary by the type of lamp used. The ratio of UVB to UVA in mid-latitude, mid-day summer sun is about 3-5%: 95-97% of the UV spectrum. However, the times of day recommended for sun exposure by health organizations—early morning or late afternoon—will receive substantially more UVA and less UVB than what is received at noon. Low-pressure sunbeds are typically in the range of 2-3% UVB, and Dr. Grant's recent investigations show that nearly all sunbeds now have lamps that emit 2% UVB, which is lower than outdoor sun at midday.1032 However, the UVB component emitted by indoor tanning lamps can vary from 1-6%. Also, the intensity is higher than sunlight, yet this is a controlled environment compared to sunlight. Aside from these issues, UV light from a sunbed is exactly the same as UV light from sun exposure.
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However, some sunlamps have higher UVB emissions, while other lamps have only UVA. For example, high pressure mercury lamps, such as those used near the head in some sunbeds, produce only UVA (we do not recommend this type of sunbed). UVB stimulates production of melanin while UVA tans melanin by oxidizing it. A study in the Netherlands found tanning three times a week at a sub-sunburn level for eight weeks was sufficient to raise 25(OH)D concentrations from 62 to 109 nmol/L, which was somewhat better than the 58 to 93 nmol/L for those taking 1000 IU/d vitamin D3.1033
Both UVA and UVB radiation are involved in the tanning process. UVB stimulates melanocytes (pigment-producing cells) to produce more melanin and increase pigmentation coverage while UVA photo-oxidizes existing melanin and redistributes some of the pigment-producing cells.1034 While both UVA and UVB can give the same visual tanning appearance, the UVB-induced tan results in greater protection against UV damage than the UVA-induced tan.
2. Another thing to consider is that UV-visible (existing in the visible range, but still considered to be ultraviolet light) intensities that are higher than the skin can tolerate may increase free radical production and cause damage greater than the skin can easily repair.1035 Sunbeds restricting the intensity to that of sunlight are less likely to produce too many free radicals. Since free radicals can alter DNA, they can increase the risk of skin cancer and melanoma. The proper use of the equipment is key. When using a sunbed, an industry-certified operator should be in control. Research has shown that there is very little risk when using a commercial unit compared to a home/selfserve unit. The reason is that the trained operator will skin-type a person (not allowing a Skin Type 1 [always burn/never tan] to sunbathe), use the correct exposure schedule for the specific unit based on skin type, and gradually increase the person's exposure so it remains below sun burning levels. Proper education and setting a time limit on sunlamp use at home (for example, just 3-5 minutes every morning depending on Skin Type) can eliminate this concern while promoting independence and inexpensive self-care.
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According to research, melanoma risk is higher for occasional sunbed UV exposure than it is for habitual exposure, but there are elements that confound the validity of this research: Sun burning episodes prior to sunbed use, skin type, and the identity of the person controlling the sunbed equipment.1036 It is likely that a number of factors combine to reduce risk of melanoma in those chronically exposed to UV radiation, including vitamin D production,1037 tanning, and thickening of the outer layer of the skin (stratum corneum). Thus, occasional indoor tanning might not give the same benefits as long-term and frequent indoor tanning that provides sufficiently high UVB component.
In conclusion, there are some health benefit associated with indoor tanning, related to vitamin D production and other photoproducts such as nitric oxide and endorphins. However, there also appears to be some modest risk of melanoma, due to the lower UVB to UVA ratio in tanning lamps and the lamps' higher intensity. Therefore, it is wise to educate oneself and choose the sunbed that most closely mimics sunlight and is controlled by an industry certified operator (or, when tanning beds are not easily available for frequent use, to build a protective tan and receive the sun's benefits by utilizing high-quality sunlamps at home, frequently, in a judicious, educated manner — see appendix 6). Now that we have covered the caveats, we present the following materials, which demonstrate the remarkably positive health effects of tanning-bed use—effects far out-weighing any small risks.
Sunbed benefits
1. Vitamin D production and bone strength. Many so-called
experts have stated that sunbeds do not create higher 25(OH)D levels, but several studies have disproven this falsehood: In a study comparing 50 subjects who used a sunbed at least once a week to 106 control subjects who did not use sunbeds, it was shown that tanning-bed users had 90% higher 25(OH)D levels than non-users, and that they also had significantly higher bone-mineral density, indicative of stronger bones.1038 Parathyroid hormone (PTH) levels were also measured and were 18% lower among the tanners. High PTH levels are often associated with weak bones and low 25(OH)D levels. Another study (mentioned in the caveat section above), also showed an increase in 25(OH)D levels with sunbed use;1039 and whereas a daily 400 IU vitamin D supplement did not maintain healthful 25(OH)D levels, sunbed use increased 25(OH)D levels by 150% in only seven weeks.1040
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We are members of an email group of scientists, researchers and writers who are intensely interested in sun-related research, and who share articles on sunlight, sunbeds and vitamin D. We received a most interesting email from Rufus Greenbaum, who lives in the UK and who organizes vitamin D symposiums. He recounted how he had met a man who had used sunbeds twice weekly since 1970, and who had just completed a bone densitometer test, known as a DEXA scan. His doctor stated, "You have the strongest bones that I have ever seen." That news certainly came as no shock, since conventional sunbeds produce large quantities of vitamin D in short periods of time, and vitamin D is absolutely essential for optimal absorption of calcium in the gut and for maintaining calcium in the bones.1041, 1042, 1043 Without calcium absorption and retention in bone tissue, consuming vast quantities of calcium makes little difference to bone strength, since much of the calcium will be flushed down the toilet, and bone calcium will be mobilized toward the blood.
2. Sunbeds can control psoriasis and eczema. They are often recommended by dermatologists as a way to overcome these diseases. Some common-sense scientists have investigated the literature and stated that UV light is nearly 100% effective for many dermatologic conditions, and that sunbeds are very convenient sources of UV rays for patients who cannot otherwise afford the rigorous travel and time commitments necessary to visit the dermatologist.1044 Their investigation involved an arduous search of PubMed and Google Scholar for papers reporting on sunbeds and their salutary effects on different skin diseases. These scientific internet searches showed convincingly that sunbeds were a valid treatment for psoriasis, but also indicated that sunbeds could be useful "as a
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treatment option for atopic dermatitis [eczema], mycosis fungoides, acne, scleroderma, vitiligo, and pruritus, as well as other UV sensitive dermatoses."
The conclusion they reached was amazing, considering the negative reports regularly touted by the press. They stated:
"Unsupervised sun exposure is a standard recommendation for some patients to obtain phototherapy. Selected use of commercial sunbeds in the treatment of dermatologic conditions may be another useful and effective treatment for those patients with an inability to access office-based or home-based phototherapy"[emphasis ours].
One of the dermatologists who recommends unsupervised sun exposure as stated above is Dr. Julie Moore of Gottlieb Memorial Hospital. As previously mentioned, she states that the sun is one of the best ways to treat psoriasis, so she recommends for her patients to "sit out on the deck and give their affected areas a good sun bath.1045"
Hallelujah! Common sense is beginning to penetrate the dermatology profession, as more dermatologists are climbing on the sun bandwagon each year.
3.	Sunbed use reduces chronic pain.1046' 1047 A study of pain in fibromyalgia patients, conducted by dermatologists, revealed that those who used UV-producing sunbeds experienced a decrease of 0.44 points on a 10 point scale (Likert scale) determined by subject questionnaire, when compared to those who did not receive UV light. Feelings of well-being and relaxation were also reported among the tanners.1048
4.	Sun lamps may help unborn children. They are now being recommended for use by pregnant women who will give birth in a winter month, in order to protect the unborn child from osteoporosis during adulthood.1049
5.	Sunbeds may reduce endometrial cancer. Research from Sweden demonstrated that women who use sunbeds more
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than three times yearly had a 40-50% reduction of the risk for endometrial cancer.1050 The authors surmised that the effects observed were likely due to stimulating higher 25(OH)D levels in winter.
6.	Sunbed use reduces the risk of clots. In an eleven-year study of the sun-exposure habits of 40,000 women, venous thrombotic (clotting) events were measured. It was found that women who sunbathed during the summer, on winter vacations, or when abroad, or used a sunbed, were at 30% decrease in the risk of clots compared to those who did not sunbathe.1051 The authors again speculated that increased vitamin D, which has anticoagulant properties, had provided these positive results.
7.	Sunbed use is associated with lower breast-cancer risk.1052
8.	It is likely that many benefits of sun exposure can be provided by sunbeds (or home-based sun lamps), including increased resistance to cancer, osteoporosis, heart disease, diabetes, periodontitis, arthritis, infection and other maladies.
9.	Sunbeds may be used regardless of outside weather.
10.	Sunbeds (or sunlamps) may be used during "vitamin D winter." This is especially important at higher latitudes lacking sufficient UVB from winter sun to stimulate adequate vitamin D production by the skin.
11.	Perhaps the most important research on sunbeds was a 20-year study in Sweden by Dr. Pelle Lindqvist and his colleagues,
who showed that women who used sunbeds were 23% less likely to die from any cause than women who did not use them.1053
The truth about sunbeds and melanoma
As we have shown, it is impossible to establish the sun as the cause of melanoma; yet through chicanery and dishonesty, as established by Dr. Ackerman (see appendix 5), we continue to see that the desire for profit leads to the continuing mantra of the anti-sun movement—that melanoma is caused by our friend, the sun. This mantra is preposterous, and the purveyors of the message are beginning to sound silly. We expect that since their sun/melanoma message is ready to crash and burn, these same people are now attacking the tanning industry. And, while incorrectly used sunbeds, or the wrong type of sunbed, may slightly increase melanoma risk as we have established in the caveat section above, there is hardly any science to indicate that proper sunlamp use is dangerous.
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One of the claims regarding tanning and melanoma is that since the advent of sunbeds—in about 1970—melanoma has increased dramatically. While this statistic is true, it has nothing to do with sunbeds. Melanoma rates were increasing steadily long before sunbeds hit the scene, and this rate of increase was not influenced by sunbeds. Dr. Diane Godar has produced a graph showing that sunbeds made no difference at all in the increase of melanoma. You will note the rate of increase in melanoma is exactly the same now as it was since 1940. Dr. Godar's graph is presented below.
Those who oppose the use of sunbeds can conveniently ignore the rate of increase prior to the first sunbeds to make it appear that the sunbed is the culprit. This is intellectual dishonesty, reminiscent of the
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old saying, "There are lies and damn lies, and then there are statistics." Twisting the facts or ignoring them does not change them.
There is also a difference in between home-use and professional-use tanning, as explained in the caveats section above. A 2016 study provides the following: "The tanning salon meta-analysis estimate of 1.05 essentially shows no increased melanoma effect, while the home tanning estimates a significant increase in melanoma risk (1.53). We therefore see there is an important underlying difference between commercial tanning and "do it yourself" home tanning, which may involve increased sun burns and the known risk for melanoma." It concluded: "When professional sunbed usage is considered independent of home and medical exposures there is no association with melanoma."1054
Several studies have investigated the relationship of tanning-bed use to melanoma. A review of 22 investigations done from 1979 through 2002 showed that only four of these studies have indicated that sunbeds increased melanoma risk, while eighteen studies have shown no such increase.1055 One of the studies showing an increased melanoma risk was conducted by Dr. Philippe Autier and colleagues in Belgium in 1991.1056 However, in 2002 Dr. Autier conducted another study in which no association between sunbed use and melanoma was found.1057 This later report stated, "No result suggested a dose-response curve, and no association was even present for subjects who reported more than 35 hours of cumulated tanning-bed use at least 19 years before the interview. Our study doesn't support the possibility sunbed use could increase melanoma risk."
We looked for other studies which might have come to contrary conclusions and found one from 2007.1058 It was a meta-analysis of 19 studies, concluding that sunbeds do increase melanoma risk.
However, when Dr. Grant assessed the meta-analysis, he noted that the studies failed to take skin type into consideration.1059 He reanalyzed the data and determined: "These results indicate when studies largely influenced by inclusion of people with skin phenotype 1 [light-skinned non-tanners] without adjustment for skin phenotype are removed from the meta-analysis, no significant relation is found between sunbed use and risk of CMM [cutaneous malignant melanoma]."
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Several studies between 2003 and 2008 showed mixed results. One showed no significant increase in melanoma with sunbed use.1060 Another study of five European countries showed that in France, where 20% of the population used sunbeds, their use was associated with a 19% increase in melanoma risk.1061 In Sweden, where 83% of the population used sunbeds, there was a 38% decrease in melanoma. Overall, the risk of melanoma was reduced by 10% in tanning-bed users, although individuals with fair skin and a high number of moles were at increased risk. Clearly, studies indicting sunbeds, without taking into consideration skin type (or the sunlamp type and intensity) are flawed; and, if they do not also differentiate between tanning and burning, they are doubly flawed. For example, it is possible that the French excessively burn their skin during their tanning-bed use, resulting in increased risk, whereas the Swedes may be using a better type of sunlamp, in moderate amounts, just to improve vitamin D status without burning, thereby lowering their melanoma risk.
Remember, excessive ultraviolet light exposure, whether it comes from the sun or from tanning lamps, causes burning. We have clearly established that burning may correlate to an increased risk of melanoma. Unfortunately, most of the studies associating sunbed use with increased melanoma did not control for burning. Exposure to either the sun or to sunbeds must be done prudently, so it is best to become fully educated about your sunlamp type and intensity, as well as your skin type, or use professional tanning salons with trained personnel who assess skin type and make recommendations for the maximum time clients should tan.
Dr. Grant also reminds us that UVB is one of the most beneficial wavelengths. UVA does have health benefits, including stimulating the production of nitric oxide, but excessive UVA is harmful in that it penetrates more deeply and generates free radicals leading to skin aging and DNA damage, as several studies have shown.1062, 1063, 1064 This is not true of UVB. However, the tan produced by UVA serves as a protection against damage by further UVA. It is important to use sunbeds with outputs mimicking the midday, mid-latitude spring-and-summer UVB portion of total UV—roughly 3.5-5%. European countries limit UVB emitted from sunbeds to 1.5% of total UV radiation1065, 1066—a huge mistake. Sunbeds in the USA emit a much higher percentage of UVB, about 2% on average.1067 Prior to 1983, sunbeds used in Norway and Sweden were rich in UVB and with no association between tanning-bed use and melanoma. Both the lamps and the acrylic sheet between the lamps and the person affect the UVB/UVA ratio. The acrylic, as it ages, decreases the UVB transmission more than UVA, leading to increased UVA exposure relative to UVB. As you have already seen, however, the healthful effects of sunbed use, even if such use is imperfect, far exceed the slightly increased potential for common skin cancer—a condition which is easily rectified when action is taken early.
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Personally, we have no qualms about using sunbeds, but we are neither asking nor telling you to do the same. Read all the facts, then make up your own mind. Considering the numerous health benefits from high serum 25(OH)D levels and the production of endorphins, nitric oxide and other photoproducts, the slight risks do not concern us. A very light skin which does not tan, or a skin condition sensitive to UV, may preclude tanning-bed use by some individuals. Those with freckles and red hair do not generally tan well, and should avoid sunbeds or limit themselves to very short exposures. In addition, it is a good idea to cover the face and genitals as those areas may be excessively sensitive to ultraviolet light. Others who may have adverse effects to sunbed exposure are organ transplant recipients, those with many nevi (moles) or those taking photosensitive prescription drugs.1068 If you do not know if your drug is photosensitive, ask a pharmacist. Avoid even the least amount of burning.
In some cases, sunbeds may help the physical and mental health of people residing in the far north. For example, sunbeds for Canadian military personnel may be essential to survival: The most remote outpost of the Canadian armed forces is also the northernmost community on Earth, where its purpose is to gather radio signals and other electronic intercepts from Russia and pass them to military analysts in the South.1069 The sun in that location disappears on October 14 and does not reappear until February 28. During this time, temperatures drop to 50 degrees below zero, and if the wind blows, the chill factor is incredibly low. The facility is built with most of the comforts of home, including gym facilities and tanning machines where increasing 25(OH)D levels are considered essential to life. We expect that if anyone were to try to take away those machines, it would cause an insurrection.
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As we go to press, there is new research that lends credence to the benefits of sunbeds:
Bad Science. Should we fear using sunbeds? Two recent scientific analyses say "no." The World Health Organization (WHO) messages regarding the dangers of sunbeds are unbalanced, biased and inaccurate.
We live in a world where governments and political parties have run amok in their desire to tell the people how to think, and where the goal (supposedly to help the people avoid mistakes) justifies the message. The truth—the whole truth—is not important as long as the sheeple conform to the dogma being promoted. Even the heads of government, heads of justice departments and heads of investigative bureaus have now made decisions in advance of investigations rather than basing their decisions on the facts that they should be gathering. This is an alarming trend, since truth should govern our world to maintain freedom and knowledge. Fortunately, there are those stalwarts who stand for truth, and who oppose falsehoods and chicanery with every fiber of their beings.
Sadly, some "science" follows the aforementioned paths of deception. Many writers have let a bias toward a particular outcome color their judgement and even misinterpret their results. You can find many examples of bad science by doing an internet search for that term. Because a result was printed in a scientific journal, or stated by a multinational organization, it does not necessarily denote truth.
Two reports on sunbeds, one by the World Health Organization (WHO) and another by a European SCHEER report, concluded that sunbeds were dangerous and would lead to cancer. The research compiled to reach this conclusion was of poor quality and biased. It also left out relevant information—information that would have completely changed the result. Obviously, these results were born of a need to produce the result they wanted, not a need to find the truth.
However, other scientists, interested in truth, read these reports and were alarmed. They expressed their concerns by authoring two journal articles, both published in Anticancer Research.1070 1071 They noticed glaring inconsistencies in the manner that had been used by WHO and SCHEER to make their "scientific" pronouncements. They also noted that the quality of the research cited by WHO and SCHEER was poor, and that the poor quality was known and admitted by the original researchers. None of this deterred WHO and SCHEER from using this tainted information.
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These researchers who challenged the WHO and SCHEER reports were an international team of dermatologists, epidemiologists, endocrinologists and vitamin D researchers from Canada, the U.S. and Europe. Having dermatologists involved in refuting lies about sunbeds makes their opinions remarkable, considering that their opinions on sunbeds are usually highly negative.
Here are the glaring errors the authors brought out regarding the WHO and SCHEER reports:
•	The reports were unbalanced, even neglecting to include some well-done studies showing no increase in melanoma risk with sunbed use. In other words, they selectively suppressed relevant information that would have changed the outcomes that were critical of sunbed use. This is considered to be academic fraud, although that term was not used by the authors.
•	The reports ignored the consequences of vitamin D deficiency; it is well established that sunbeds are remarkably effective in stimulating the production of vitamin D in human skin.
•	The quality of the research that the WHO and SCHEER used to condemn the use of sunbeds was known to be poor, but the reports did not acknowledge that weakness.
•	The reports by WHO and SCHEER concluded falsely that "a large proportion of melanoma and nonmelanoma skin cancer is attributable to sunbed use, and that there is no need to use sunbeds as there are no health benefits and they are not needed to achieve an optimal vitamin D level."
The last statement, that there is no need to use sunbeds, as there are no health benefits, is an egregious misstatement of the facts, as we have already pointed out.
The authors of the first paper in Anticancer Research concluded their findings regarding the WHO and SCHEER thusly: "The stance taken by
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both agencies is not sufficiently supported by the data and in particular, current scientific knowledge does not support the conclusion sunbed use increases melanoma risk."
The authors of the second paper came to a similar conclusion after doing their analysis of the reports: "Current scientific knowledge is mainly based on observational studies with poor quality data, which report associations but do not prove causality. At present, there is no convincing evidence that moderate/responsible solarium [sunbed] use increases melanoma risk." We couldn't agree more.
Sunbeds and other sources of ultraviolet light can be of great value to human health if they are used safely. The same can be said about the sun.
So please, look at the research and make up your own mind. Know the truth and the truth will set you free.1072
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Appendix 3
Sunscreens: Dangerous at Best and at Worst Potentially Deadly
Palm trees, ocean breeze, salty air, sun kissed hair,
That endless summer, take me there.
—quotesideas. com
Despite research discussed in the melanoma chapter, if sun burning might participate in causing melanoma, shouldn't we use sunscreens? The answer is "no," although many disagree. Be sure to consult a well-informed, unbiased physician before making any changes to your habits, and give him or her a copy of this book. Caution is the best prevention for sunburn. You should never stay out until the skin turns red, and in the beginning stages of sun exposure, gradually increase it until a tan develops. A tan is a sign the skin is protecting itself against burning. In a landmark paper published in 1993 in the journal Preventive Medicine, Dr. Gordon Ainsleigh stated, "As melanoma research has demonstrated, the best prevention is regular exposure, thereby maintaining a protective tan and high vitamin D blood and tissue levels."1073 Up to 99% of vitamin D production is stopped by sunscreen,1074 voiding many of the health benefits of sun.
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Sunscreens also provide little free-radical protection:1075 Sunscreen manufacturers have claimed a free-radical protection factor ten times greater than any afforded by their product! Such overblown claims have led to lawsuits. Furthermore, some sunscreens protect only the outer layers of the skin from burning while leaving the inner layer (where melanoma is initiated) vulnerable to damage.1076 Sunscreen use increased because governments and physicians promoted it. Unfortunately, the rate of melanoma increased concomitantly,1077 and there is even a possibility that the estrogenic compounds and other chemicals found in sunscreen may actually themselves be carcinogenic.1078
Queensland, Australia has vigorously promoted sunscreen for decades, and Queensland now has one of highest rates of melanoma in the world,1079 along with a rate of vitamin D deficiency which is becoming critical.1080 In the period between 1980 and 1987, skin cancers doubled. Sunscreens, as explained below, remove the warning signal for excessive sun exposure.1081 Therefore, sunscreens (ironically) promote melanoma. Research was conducted in Italy on sunscreen use among children:1082 The researchers interviewed parents to determine if sunscreen use, protective clothing and other precautions were used to prevent sun damage. They counted the moles on the children, since high mole count is correlated to a high risk of melanoma. Protective clothing was associated with a 41% reduction in the number of moles when compared to the average, but sunscreen use was associated with a 68% INCREASE in mole count, regardless of skin type or eye color. Interestingly, the number of sunburns was not correlated to mole number, and the children who had the highest mole counts had never had sunburns. The probable explanation is that children who wore the most sunscreen never felt the hot sensation produced by UVB on the epidermis (outer layer of skin), because UVB was blocked by sunscreen. The children missed nature's warning signal for excessive sun exposure. In other words, sunscreen use causes unbalanced exposure. Meanwhile, UVA light penetrated deeply into the dermis (the lower layer of skin), causing damage that may have resulted in moles.
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It is worth repeating that sunscreens may prevent external burning by UVB but permit UVA to burn the lower layers of skin and initiate melanoma. The body's protective mechanism may be rendered useless by sunscreens, which lull users into a false sense of security while UVA wreaks havoc with their skin. This is more than conjecture. Research on sunscreen use and the amount of time spent in direct sun clearly shows: The stronger the sunscreen's rating, the longer people using it tend to expose themselves.1083
Taking vacations to sunny areas correlates to increased melanoma incidence,1084 and higher accessibility to air travel correlates strongly with the increasing incidence of melanoma, presumably due to sunny vacations leading to sunburn.1085 Most of those vacationers are probably applying plenty of sunscreen to block UVB. They therefore stay out in the sun too long, especially if they have not built up a protective tan. Others may simply stay out too long and burn themselves, which might lead to melanoma. Occasional orgies of sun exposure damage the skin, so the key is to carefully and regularly enjoy the sun. Several studies make a case that UVA penetration allowed by sunscreens may lead to melanoma.1086, 1087, 1088 The following graph shows a cross section of skin, and the way it is affected by UVA and UVB.
A comprehensive review done between 1966 and 2003 revealed absolutely no correlation between sunscreen use and Melanoma risk.1089 In other words, sunscreens don't work for this disease. It seems like the authors were mainly interested in proving that
sunscreens are safe to use "just because they are not correlated with melanoma." (One of the authors concluded that it's still safe to continue "protecting" our skins with sunscreens, as if
Figure 1
Skin cross section
and penetration
UVB light heats the epidermis.
warning of overexposure.
Hair
Hair follicle
Melanocytes
Fat cells
Sebaceous gland
UVA light penetrates to the Dermis
and may damage the skin if the
UVB warning system is destroyed
by sunscreen
Epidermis
Dermis
Subcutaneous
layer
Sweat glands
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his real concern were that the public would stop using these important and valuable skin-protective products). This is a bizarre stance, considering that the sunscreen industry has been utilizing the fear of melanoma to push its products, by pretending that they can reduce its risk. Yet what this study has shown inadvertently is that sunscreens had absolutely no beneficial effect on melanoma risk. It is also possible that these authors somehow missed an important study from the International Journal of Cancer in 2000, which compared 571 people with a first diagnosis of melanoma with 913 healthy control subjects. Those who used sunscreens were 1.8 times more likely to contract melanoma than those who did not, and among those who always used sunscreens so they could stay out longer in the sun, the risk of melanoma was 8.7 times greater than those who did not use them.1090 Also, other research has shown that above 40 degrees north latitude, the use of sunscreen was associated with a 60% increase in the risk of melanoma.1091 In this research, however, a slight reduction in melanoma risk was associated with sunscreen use below 40 degrees. Aside from melanoma, other investigations have compared sunscreen use with the risk of the common skin cancers. They show limited or no benefit of using sunscreen to reduce risk of basal cell carcinoma, and a slight benefit for squamous cell carcinoma.1092, 1093, 1094 Remember, these cancers are rarely fatal, compared to melanoma, which can be deadly if not taken care of in its incipient stages.
To be fair, there are three studies, to our knowledge, showing a decrease in melanoma risk with sunscreen use.1095 The first showed that sunscreen with an SPF greater than 15 led to an 18% reduction in the risk of melanoma. Interestingly, sunscreen users in this study reported significantly more sunburns. The second study showed that sunscreen use probably reduced all skin cancers, including melanoma, by 10-15%,1096 and the third showed a 50% decrease in melanoma risk over ten years.1097 These 3 studies appear to support the claims made by the multi-billion dollar sun care industry, but they are no match for the voluminous research exposing the harm done by their products to human health and to the environment.
Nevertheless, if we analyze the data from a different perspective, we indeed see that more sunscreen use equals more melanoma. We need only compare the increasing sales of sunscreens during three decades with the change in melanoma incidence. Sunscreen sales increased from $18 million to $640 million between 1972 and 2005. If sunscreens really helped prevent melanoma, we would have observed a drop in melanoma rates rather than the tripling which occurred. And
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the increase in sales has continued. As of 2013, the global sun care market generated $5.6 billion US dollars from its sun-protection products segment, which includes sunscreens.1098
The lifetime risk of developing melanoma in 1935 was 1 in 1500. It climbed to 1 in 75 in 2000, and the risk increased by 5% to 7% per year.1099 Melanoma rates among Caucasians more than tripled between 1980 and 2003 alone.1100 Did this increase not parallel the mammoth and successful advertising blitz by the sunscreen industry?
It is likely that as sunscreen use continues to rise, melanoma incidence will rise too. People were outside in the sun much more in 1935 than they are today because we have moved from outdoor jobs into offices and we have been scared out of the sun.
Despite contrary evidence, many bloggers and even "scientists" continue to repeat the mantra stating that exposure to UV rays causes melanoma. If so, then why has melanoma increased dramatically as we have moved indoors? And why does increasing sunscreen use have such a direct correlation to increasing melanoma rates? Don't sunscreen buyers use the product they purchase? Isn't it peculiar that the conclusion reached by many in the "scientific" community is "therefore, we need to avoid the sun even more?" There is no science at all in this counterintuitive conclusion.
Here is a summary of the argument they are trying to sell us: "As we have moved out of the sun and learned to cover ourselves with sunscreen when we go outside, the rate of melanoma has dramatically increased. And, those who receive the greatest sun exposure have profoundly lowered risks of major cancers, multiple sclerosis and heart attacks (see Chapters 1-3). Therefore, we must continue to avoid the sun and increase our use of sunscreen." They are defending the indefensible.
So what is the result of the "sunscare" tactics and the claimed "protection" against melanoma? Melanoma has profoundly increased. Can it be that health policies regarding sun exposure have not only been ineffective, but profoundly counterproductive? One could conclude that sunscreens are a complete waste of money at best and at worst they may cause melanoma!
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Some people are awakening. Reuters News Service reported a lawsuit filed in the Los Angeles Superior Court accusing sunscreen manufacturers of exposing millions to cancer and other dangers through false and misleading product claims.1101 The class-action suit stated sunscreen makers "inflate claims about their products' qualities, lulling consumers into a false sense of security over prolonged sun exposure." The defendants include some very big names: Johnson & Johnson, Schering-Plough Corp, Playtex Products, Tanning Research Laboratories and Chattem. The lawsuit further stated that sunscreens "may protect against harmful UVB rays with shorter wavelengths, but the skin remains exposed to harmful UVA rays with longer wavelengths penetrating deep within the skin."
Also quoted in the Reuters article: "The suit also alleges parents have been misled into believing their children are protected as a result of claims in labels for products aimed specifically at children, such as Coppertone Water Babies. Schering-Plough misled... the general public by representing that their Coppertone Water Babies UVA/UVB sunblock Lotion provided 45 times a child's natural protection against both UVA and UVB rays," according to the suit. It says the product only provides a level of protection against UVB, and cites scientific studies showing sunscreen ingredients do not provide the same level of UVA protection." The defendants were in for a rough ride since, as mentioned above, the stronger the sunscreen, the longer the users will stay out in the sun.1102
The FDA, amazingly, has gotten in on the sunscreen act. After reviewing sun-protection comments and claims made by manufacturers, it stated: "available evidence fails to show sunscreen use alone helps prevent skin cancer or premature skin aging. Thus, the anti-aging, skin cancer, and sun damage claims proposed by the comments would be false or misleading due to lack of sufficient data in support of these claims. For example, the statement proposed by one comment, claiming sunscreen use 'may help prevent sun-induced skin damage such as premature skin aging,' would be inherently misleading to consumers by suggesting sunscreen use alone may help prevent premature skin aging."1103
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Backing up this FDA statement is an important study from Europe, demonstrating again that sunscreens do not help prevent melanoma.1104 By comparing melanoma rates vs. sunscreen sales in 24 countries in Europe, during the period of 1997-1999 to 2008 and 2012, the researchers' goal was to determine the efficacy of sunscreens in preventing melanoma. They found that higher income people had significantly higher melanoma incidence, and increased sunscreen sales had not prevented higher income populations from being at higher risk of melanoma. In other words, we see this equation: Higher sunscreen use=higher melanoma risk! Even with all the research done and the lawsuits filed, many in the pharmaceutical and medical fields still just don't get it.
A pharmaceutical company laments that in spite of all the information about skin cancer, people are still "baking themselves in the sun." Another preaches, "The disease is largely preventable when sun protection is consistently practiced." Is the medical/pharmaceutical industry so harebrained as to ignore the simple correlation between increasing sunscreen use and increasing melanoma? Could it be that dollars are involved? That must be the case, because as we have demonstrated, we as a society are not baking ourselves in the sun. We have lost about 90% of our sun exposure compared to our recent history. The latest research at the time of this publication demonstrates that sunscreens, because of their ability to shut down vitamin D production,1105 are leading to widespread vitamin D deficiency, which may be affecting millions worldwide.1106 Children may be the most negatively influenced, according to research showing that vitamin D deficiency in that age group has increased 83-times (8,300 % increase) since 2000.1107
Other dangers of sunscreens
In 2008, The Centers for Disease Control and Prevention (CDC) in 2008 released a study showing that 96.8% of Americans at age six are contaminated with a major sunscreen ingredient called oxybenzone and that women were 3.5 times as likely to have high concentrations as men.1108 The authors suggest that women's greater use of personal-care products, most of which contain sunscreens, is the reason for their higher degree of contamination. Oxybenzone is used in 588 sunscreens and in 567 other personal-care products.1109 One investigation showed that up to 8.7% of oxybnezone is absorbed1110 and accumulates in the body.1111 It is still found in the urine 5 days after application. Other research papers confirm that sunscreen chemicals are highly absorbed and then detected in urine and breast milk, where they may cause systemic effects, including disruption of the endocrine system.1112, 1113
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Pregnant mothers exposed to oxybenzone gave birth to babies with low birth weights, 1114 which “programs" the developing child for greater risks of heart disease, hypertension, type-two diabetes and other diseases in adulthood.1115 Furthermore, sun causes the chemical to become a potent allergen1116, 1117 and to form free radicals.1118, 1119, 1120, 1121 One study concluded, “The surprising result is UV filters applied to the skin surface not only lose their screening capability after a period of incubation, but also may lead to enhanced ROS [free radicals] generation in nucleated epidermis through photogeneration."1122 In fact, after one hour, more free radicals were created by sunlight contacting sunscreen, than sunlight on skin." To us, this is another indication sunscreens cause more damage than no sunscreens! An interesting investigation regarding extreme cases of recreational sun exposure during a two-week sunbathing vacation, as compared to a series of ten sunbed sessions, came to a very interesting conclusion:1123 Sunscreen use during the vacation resulted in high cumulative UV exposure-higher than the series of 10 sunbed sessions. These researchers concluded their paper with this statement: "In extreme cases of recreational sun exposure where sunscreens providing suboptimal broad-spectrum protection are used, the UV insult to the skin is likely to result in higher cumulative exposures than commonly employed sunbed practices." Of course, UV is no insult to the skin unless it is excessive, whether it is from sun exposure or sunbeds. Non-burning, regular exposure is the key.
Sunscreen chemicals also have potential "gender-bending" characteristics by increasing estrogen and decreasing testosterone in men1124, 1125 and may be partly responsible for the nearly 50% reduction of sperm count in the last few decades.1126 Sunscreen chemicals are also known to cause the feminization of fish,1127 and environmental pollution by these and similarly-structured chemicals is now thought to cause feminization in alligators and the gradual extinction of Florida panthers due to failure to breed.1128 Sunscreens also increase the absorption of pesticides through the skin.1129, 1130
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Non-chemical metallic sunscreens (zinc oxide and titanium dioxide) blocking UV light are also intended to protect against skin cancer, although there is little indication that they are effective in their protection.1131, 1132 These metallic sunscreens do not penetrate the skin to the same extent as chemical sunscreens, but they do generate free radical damage after sun exposure and may contribute to cellular damage, resulting in cancer.1133, 1134, 1135 Microscopic particles of these products are also used for aesthetic reasons, but unfortunately they may accumulate in hair follicles or penetrate deep into the dermis, which may result in a variety of harmful effects.1136, 1137, 1138
In addition to adverse effects on human health, chemical sunscreens have potential deleterious effects on the environment. A study from the Archives of Environmental Contamination and Toxicology, regarding the detrimental effects of Oxybenzone, stated that Oxybenzone is a photo-toxicant, meaning its adverse effects are exacerbated in the light.1139 Does this toxic chemical sound like something you'd like to apply to your skin or your children's skin while out in the sun?
The researchers also stated: "Oxybenzone is an emerging contaminant of concern in the marine environment." They found that a small dollop of sunscreen in six Olympic-sized pools caused a disruption of coral growth. Such disruption leads to a whitening and killing of the marine activity of coral reefs. This is accomplished by ossification of a free-swimming larva called a planula, which kills the growth of coral reefs. Think carefully about this information when you next see a sunscreen ad.
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Appendix 4
Understanding Proper Circadian Rhythms and the Critical Importance of Sunlight in Maintaining Them
Far away there in the sunshine are my highest aspirations. I may not reach them but I can look up and see their beauty, believe in them and try to follow them.
—Louisa May Alcott
Since circadian rhythms are mentioned throughout much of the text, a short discussion will help the reader better understand how the sun, through regulation of the proper circadian rhythms, influences the health of the human body.
Circadian rhythms are variations in physiology and behavior persisting with a cycle length close to, but not exactly, 24 hours. It is necessary to synchronize the rhythms on a regular basis to maintain them, and such synchronization is achieved through regular exposure to light and darkness.1140 This is also known as "resetting the biological clock." Researchers have found that nocturnal light pollution and underexposure to daytime sunlight are the mechanisms of circadian-rhythm disruptions.
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Circadian rhythms include sleeping and waking in animals, flower closing and opening in angiosperms (plants with flowers and enclosed seeds), and tissue growth and differentiation in fungi.1141 Besides light and darkness, there are other factors that influence synchronization or desynchronization of the biological clock, but they play a small part. For the purpose of this book, we will consider the influence of light in sustaining proper circadian rhythms, and by so doing, enhance and maintain human health. Researchers have stated, "Mammalian circadian rhythms form an integral physiological system allowing for the synchronization of all metabolic processes [emphasis ours] to daily light/dark cycles, thereby optimizing their efficacy."1142 Anything with a profound effect on all metabolic processes is obviously important to the proper functioning of the human organism.
When circadian rhythms are disrupted (or de-synchronized), it upsets the physiology of the human body. People who take long flights across many time zones often feel "out of sorts" and many have a difficult time adjusting to the new time zone. We call this "jet lag," and it is a common manifestation of a desynchronized rhythm. Another cause of desynchronization is night-shift work. When the body expects bright light but gets dimness or darkness instead, it attempts to resynchronize—resulting in physiological and psychological damage, which might manifest as cloudy thinking, fatigue, and other conditions, which might lead to chronic disease and degeneration.
There are innumerable research papers demonstrating the health detriments of a desynchronized circadian rhythm. For example, research on rats shows that desynchronization leads to premature cellular aging,1143 as measured by telomere length (a DNA marker for life span). The shorter the telomeres, the shorter the life span. "Jet-lagged" young rats have aging characteristics of middle-aged rats.
It also appears that circadian disruptions change the structure of important proteins, which play a protective role in cancer—thereby increasing the risk of breast cancer.1144 Other research has demonstrated that disruption of circadian rhythms may lead to a profound increase in the risk of heart disease, metabolic syndrome, lung cancer1145 and other cancers;1146, 1147 even the risk of poor dental hygiene and dental caries may be increased by desynchronized circadian rhythms.1148
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One might ask why a book on the sun is making such an emphasis on circadian rhythms. Here is the answer: The sun can, and should, reset the circadian clock daily. It is the timing cue, also called a zeitgeber, which adjusts the internal rhythm of an organism to synchronize with an external cycle. This adjustment maximizes the efficiency of many metabolic processes in relation to the changing daily environment, thereby optimizing human physiology, reducing stress, and preventing critical illness.1149, 1150
This is another positive benefit of the sun, occurring apart from vitamin D production. As you have seen throughout this book, there is almost no end to the health-promoting effects of the sun.
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Appendix 5
The Assault on the Sun: Dishonesty, Duplicity and Dollars
He who has light within his own clear breast May sit in the centre and enjoy bright day; But he who hides a dark soul and foul thoughts, Benighted walks under the mid-day sun, Himself in his own dungeon.
—John Milton
Attacking the sun makes billions, and there is a war going on. The combatants are The Sun vs. the Powers of Darkness.
As discussed earlier, the American Academy of Dermatology (AAD) published a report showing that most melanoma diagnoses may be incorrect, since only about 6% of melanoma diagnoses resulted in actually being melanoma.1151 The AAD also published information on a vitamin D/melanoma study demonstrating that the lowest 25(OH)D levels were associated with a 500% increase in the risk of
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chapters of this book, we have not only
presented incontrovertible evidence that habitual sun exposure is associated with a profoundly reduced risk of melanoma, but we have also shown that sun
exposure reduces the risk of numerous other maladies. Yet, the AAD and other organizations in the Power-of-Darkness cabal continue to repeat the tiresome advice to
s DERMATOLOGY WORLD
Sun, surf, and CME: San Diego
host to ACADEMY 06
Fig. IA
SUNNY SAN DIEGO PLAYED HOST to the American Academy of Dermatology's summer scientific meeting, ACADEMY '06, July 26-
DERMATOLOGY WORLD
San Antonio shines with
stellar meeting program
THE
AMERICAN
ACADEMY
OF
Dermatology (AAD) held its 66th
Annual Meeting Feb. 1-5, in sunny
San Antonio, attracting dermatol
ogists from 80 countries. At the
melanoma.1152 Of course, they would never admit that sun derived vitamin D would help. In the first three
completely avoid any direct sun exposure.1153 The Surgeon General may have even joined this cabal. In 2014, he issued recommendations to completely abstain from sun exposure unless protected.1154 Meanwhile people die, while the AAD has fun in the sun, which is the height of hypocrisy. Here (above) are two pages, touting their meetings, from Dermatology World, the organ of the Association, taken from the respected dermatologist Dr. Bernard Ackerman's marvelous and massive monograph against his own profession, entitled Sun and the "Epidemic" of Melanoma: Myth on Myth.1155
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We find it strange that San Diego and San Antonio, with their abundant sun, would be chosen for their "scientific meetings." Don't they believe in or heed their own messages? We've heard that Seattle and Anchorage have great "dermatology weather," especially in winter! Whatever the answer is, they promulgate those healthdamaging, anti-sun messages, which help line their pockets—while they enjoy the "sun and surf."
•	Dr. Ackerman made the following statement in his monograph: "...the sun, now incriminated as the major culprit responsible for an 'epidemic' of melanoma, will be rehabilitated from its status current of pariah, our worst enemy, to its place rightful, all things considered, namely, humankind's best friend."
Dr. Ackerman also exposed the influence money plays among the purveyors of the anti-sun movement and the makers of sunscreens. He states, "The American Academy of Dermatology, the Skin Cancer Foundation and the American Cancer Society sold their seals of recommendation to manufacturers of sunscreen, the price being substantial in terms of dollars but incalculable in regard to tarnish of honor."
•	He adds, that "for an application fee of $10,000 (now reduced to $5,000) and an annual fee of $10,000, a sunscreen manufacturer can boast approval of its product in the form of the "Seal of Recognition" of the American Academy of Dermatology, decorating the front of each tube. The Skin Cancer Foundation has done the same for many years, while sunscreen companies pay it many thousands of dollars annually in the hope of gaining many millions of dollars in return." Dr. Ackerman tells us that the "vaunted American Cancer Society (ACS) displays its logo on the front of tubes of Neutrogena for $300,000 annually."
One of the greatest examples of this duplicity is displayed in an ad (see below), which was run in women's magazines, and ostensibly paid for by the American Cancer Society (ACS). You will note that the ACS logo appears in the lower right corner of the ad, creating the appearance that the ad was purchased by the ACS. This ad also serves as a sales pitch for sunscreens by saying "use sunscreen, cover up and watch for skin changes." Additionally, the ad shows a young woman stating that her sister accidentally killed herself when she died of skin cancer. Now let's examine the truth about this ad, as uncovered by the New York Times.1156
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This ad was neither sponsored nor paid for by the ACS. It was paid for by Neutrogena—a convenient way to sell sunscreens without letting the public even know that the ad is anything more than a commercial "public-service announcement." And shame on the ACS for selling their souls for filthy lucre. The picture being held by the young lady is not a picture of her sister, and the young woman herself is a model hired to pose for the ad.
More deception and more dollars changing hands.
Neutrogena is also in other countries. It is one of the largest corporate funders of the Canadian Cancer Society (CCS), which receives funding based on annual sales—the number of Neutrogena sunscreen bottles sold in Canada—$1.00 per bottle up to $200,000.00 per year. 1157 The CCS is therefore financially motivated to promote sunscreen-containing products. The Canadian Dermatology Association (CDA) also receives funding from pharmaceutical industries making chemical sunscreens.1158
More about the American Cancer Society (ACS)
From their mission statement, we learn: "The American Cancer Society is the nationwide, community-based, voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and service."
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Given the mounting evidence that UVB exposure and vitamin D reduce the risk of many types of cancer and increase survival after cancer develops, and given the American Cancer Society's mission statement, one would expect that they would encourage sensible sun exposure. However, inspection of their website (www.cancer.org) reveals a different point of view:
First, there is information on the risk of skin cancer from UV rays, with a set of measures to reduce UV exposure. At the end of that section is a statement regarding vitamin D:
“A word about sun exposure and vitamin D: Doctors are learning vitamin D has many health benefits. It might even help lower the risk for some cancers. Your skin makes vitamin D naturally when you are in the sun. How much vitamin D you make depends on many things, including how old you are, how dark your skin is, and how strong the sunlight is where you live.
At this time, doctors aren't sure what the optimal level of vitamin D is. A lot of research is being done in this area. Whenever possible, it's better to get vitamin D from your diet or vitamin supplements rather than from sun exposure because dietary sources and vitamin supplements do not increase skin cancer risk, and are typically more reliable ways to get the amount you need." As previously discussed and proven in this book, this statement is hogwash.
Second, additional misinformation promulgated by the ACS is focusing on UV exposure avoidance:
J. Leonard Lichtenfeld, MD, MACP: Dr. Lichtenfeld currently serves as Deputy Chief Medical Officer for the ACS in the Society's Office of the Chief Medical Officer located at the Society's Corporate Center in Atlanta. He has posted a series of blogs regarding UV exposure. This one from May 20, 20151159 says, “It's that time of year again, those months we all look forward to when life (sometimes) gets a little bit slower, the days a bit longer, and many of us take (yes!!!!!) A vacation. It's also time for Don't Fry Day, which is the Friday before Memorial Day. That's the day when organizations including the American Cancer Society and led by the National Council on Skin Cancer Prevention remind you to be sun safe, and know what to do to protect the skin you are in."
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From an ACS perspective, the rules are pretty straight forward and easy to remember:
Slip! (on a shirt)
Slop! (on the sunscreen)
Slap! (on a wide brimmed hat), and Wrap! (on a pair of UV protective sunglasses)
The ACS then goes on to give their suggestions for avoiding sunlight, particularly UV rays:
"How do I protect myself from UV rays?"
"People who get a lot of exposure to ultraviolet (UV) rays are at greater risk for skin cancer. Sunlight is the main source of UV rays, but you don't have to avoid the sun completely. And it would be unwise to stay inside if it would keep you from being active, because physical activity is important for good health. But getting too much sun can be harmful. There are some steps you can take to limit your exposure to UV rays."
"Some people think about sun protection only when they spend a day at the lake, beach, or pool. But sun exposure adds up day after day, and it happens every time you are in the sun.
Simply staying in the shade is one of the best ways to limit your UV exposure. If you are going to be in the sun, "Slip! Slop! Slap!® and Wrap" is a catchphrase that can help you remember some of the key steps you can take to protect yourself from UV rays:
•	Seek shade
•	Protect your skin with clothing
•	Use sunscreen
•	Wear a hat
•	Wear sunglasses to block UV rays
•	Avoid sunbeds and sun lamps
•	Protect children from the sun
These materials from the ACS demonstrate its nearly 100% bias against sun exposure and a 100% approval of sunscreens. Have they not read the research? Do they not pay any attention to the FDA, who has stated, "Available evidence fails to show sunscreen use alone helps prevent skin cancer or premature skin aging. Thus, the antiaging, skin-cancer, and sun-damage claims proposed by comments [of the sunscreen industry] would be false or misleading due to lack of sufficient data in support of these claims."1160 A recent study corroborates this FDA statement. It investigated sunscreen use and its usefulness in preventing NMSC, and it came to the following conclusion: "We did not find evidence for the effectiveness of daily sunscreen for preventing BCC or SCC compared with the occasional use of sunscreen."1161
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Remember; whenever you see the ACS promoting sunscreen, there is little to back up their biased opinions.
Are phototherapy sessions safe?
As we have indicated, dermatologists and their organizations, with certain refreshing exceptions, promote the idea that both sunbeds and natural sun exposure are detrimental to health. Yet, thousands of dermatologists use UV radiation (UVR) to reduce the risk of many skin diseases. They claim that their UVR exposure is totally safe. This is an egregious example of duplicity. Recently, Dr. Anne Haas, President of the California Dermatology Society, made an obviously false statement at a regulatory hearing regarding UVR devices, saying that whereas sunbeds were cancer causers, the UVR devices used in the dermatologists' offices had never been shown to cause any cancer problems.
Her statement, that there is no evidence UV devices in the dermatologist's office cause cancer, is ludicrous.
Here is the truth:
1.	The light used by dermatologists is the same type of light used in sunbeds.1162, 1163 The light, however, is given in a very high dosage—exactly what they warn against.
2.	Researchers have demonstrated that phototherapy in the dermatologist's office definitely does lead to an increase in skin cancer.1164 And some skin cancer was sufficiently noteworthy that other researchers concluded their study with this warning: "A noteworthy number of NMSC were diagnosed in this Mediterranean population of patients exposed to high-dose UV treatment. A thorough risk-benefit evaluation should always be done before UV treatment and patients should be carefully monitored for skin cancer during and after treatment discontinuation."1165
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3.	Many honest dermatologists recommend tanning-bed use to their patients to clear psoriasis. Obviously, it is effective for this disease, and if phototherapy in the dermatologist's office causes skin cancer, what seems to be the problem with tanning beds?? Both UVR therapies (tanning bed and phototherapy at a dermatology clinic) work very well. Therefore, why should anyone with psoriasis be denied the benefits lower-cost treatments and easier accessibility,1166 which are provided by sunbeds or home-based sunlamps? So why the deception? The answer lies in money. When scientists and doctors such as those in the last quoted paper advocate sunbeds or sunlamps for therapy, it could cost the dermatology industry a fortune.
As you will note in the graph below, melanoma incidence has increased nearly in lockstep with the increase in the number of dermatologists.1167 What a business! Is there any doubt why they don't want the tanning industry absorbing the money made from their lucrative and expensive office treatments? Think about it.
There are some honest and principled dermatologists who are aware of the truth, such as those we have mentioned. And there is nothing

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wrong with making money in business if integrity is the watchword for doing so. However, it is always important to check the facts before jumping on the bandwagon for media-driven trends. You should know at this point in the book that sun-exposure, in non-burning, habitual fashion will save millions of lives.
More on the Skin Cancer Foundation (SCF)
The SCF misstates facts about the Sun and vitamin D. Could it be a veiled effort to promote sunscreens for financial reward?
Please note: much of the research cited here was also cited previously. It is repeated here to refute the statements made by the SCF.
The Skin Cancer Foundation recently posted a press release on their website, stating that they have busted the "myths surrounding vitamin D and sun exposure." In this press release, they quote Perry Robins, president of the foundation, as saying, "The misconception. that exposure to UVB radiation is the optimal source of vitamin D, puts people at risk for potentially life-threatening skin cancer. Furthermore, in most cases the body stops producing vitamin D after just a few minutes of sun exposure."1168
Refutation: The idea that sun exposure is the optimal source of vitamin D is not a misconception. We have thoroughly covered this idea earlier in the book, and will reiterate it below.
In addition, the SCF press release states, "About 86 percent of melanomas (the most dangerous form of skin cancer) and 90 percent of non-melanoma skin cancers are associated with exposure to UV radiation."1169 They cite a 1996 article to support this fallacious statement. That citation, of course, comes from a dermatological journal, Archives of Dermatology. Here are a few facts the SCF should have considered: (a) Whereas common skin cancers such as basal- or squamous-cell carcinoma are more common among those who are regularly in the sun, the risk of the deadly melanoma is considerably reduced by regular sun exposure.1170 (b) In addition, it is well-known that many melanomas occur on areas of the body rarely or never exposed to sun.1171, 1172, 1173
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Another fact belying the aforementioned statements made by the SCF in their press release: Outdoor workers, while receiving 3-9-times the sun exposure as indoor workers, have had no increase in melanoma since 1940, whereas melanoma in indoor workers has increased steadily and exponentially during the same period.1174 Quite obviously, if sun exposure led to melanoma, outdoor workers would have the greatest incidence of the disease and indoor workers would have a lesser incidence. Numerous scientific papers show that the opposite is true: those with more regular exposure to the sun have a lesser risk of melanoma.1175, 1176, 1177, 1178, 1179, 1180, 1181 1182, 1183, 1184, 1185, U86, 1187, 1188, 1189, 1190 This is also confirmed by the World Health Organization in the 2012 IARC Monograph.1191
It should also be noted that sun exposure has profoundly decreased in the last hundred and ten years due to a population which has moved indoors. For example, indoor occupations such as "professional, managerial, clerical, sales, and service workers (except private household service workers) grew from one-quarter to three-quarters of total employment between 1910 and 2000,"1192 While the outdoor occupation of farming decreased by 96%.1193
Yet, the Melanoma International Foundation (MIF) has stated that ultraviolet radiation from sun causes melanoma and should be avoided as a detriment to human health. They also state that melanoma incidence has increased by 3,000% since 1935.1194 It is impossible to figure out their faulty logic! Considering that the population has moved indoors, it becomes obvious that there is a terrible disconnect between the facts and the statements of both the SCF and the MIF. Since the SCF is closely allied with sunscreen manufacturers, as we have shown, could their web site press release be anything more than a ploy to increase sunscreen sales?
And speaking of sunscreens, the increase in sunscreen sales is dramatic,1195, 1196 and the incidence of melanoma continues to skyrocket in spite of its use.1197 The blockage of sun by sunscreens correlates to an increased risk of melanoma, and yet the MIF and SCF continue to warn us to avoid the sun? Does this make sense to you? Furthermore, the SCF has stated, "for adequate protection against melanoma, non-melanoma skin cancers and photo-aging, everyone over the age of six months should use sunscreen daily year-round, in any weather." Yes, they are suggesting we use sunscreen even in cloudy weather in the winter! How convenient for an organization, which works closely with sunscreen manufacturers, to make such a statement. Could there be a conflict of interest here?
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Strangely, the SCF press release labels the following three statements as "myths:"
1.	UVB radiation is a good source of vitamin D.
2.	Sun exposure is the only source of vitamin D.
3.	Sunbeds are a healthy option for boosting 25(OH)D levels.
Let's take a look at each of these statement, to determine if they are really myths or facts:
1.	UVB radiation is a good source of vitamin D. This is a proven fact, not a myth! UVB radiation from 10-15 minutes of full-body exposure to peak summer sunshine can stimulate the production of up to 20,000 IU of vitamin D.1198 While the skin may cease producing vitamin D after 20 minutes of full-body exposure, it is because it has produced all the vitamin D the body needs. Since many multi-vitamin supplements contain only 400-600 IU, it is obviously best to make sun (UVB) exposure the primary, most effective source of vitamin D. Furthermore, the SCF press release also goes on to say that the limit of vitamin D production is reached after just 5-10 minutes of midday sun, and that sun exposure beyond 5-10 minutes leads to the breakdown of stored vitamin D and leads to lower levels of vitamin D.
There is absolutely no research to indicate that sun exposure or sunbed exposure leads to lower levels of vitamin D. Research available since 1971 has shown that lifeguards, who in 1971 probably had day-long unprotected sun exposure, had 25(OH)D levels 2.5 times the levels of the "normal" population, which were a group of asymptomatic individuals who volunteered for the research.1199 This "normal" population had average values of 27 ng/ml [68 nmol/L], whereas lifeguards had average values of 64 ng/ml [160 nmol/L]. In discussing this research, Dr. Bruce Hollis and colleagues suggest that the 25(OH)D levels in the sun-replete lifeguards were "true normal," levels, while the "normal volunteer population" actually exhibited varying degrees of vitamin deficiency.1200 Another, similar study showed that "normal" adults had 25(OH)D levels of about 68 nmol/L [27.2 ng/ml], whereas lifeguards had levels of approximately 175 nmol/L [70 ng/ml],1201 and still other investigations have shown that lifeguards not only have much higher 25(OH)D levels but have shown no sign of toxicity due to those high levels.1202 Yes, UVB from sun exposure is not only a good source of vitamin D, it is an excellent source!
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2.	Sun exposure is the only source of vitamin D. No such myth, to our knowledge, has been propagated previously, making this statement by the SCF exceptionally strange. A myth is an unproven or false collective belief. There is no false collective belief that sun exposure is the only source of vitamin D—people have been using UVB lamps for many years to make vitamin D, and many foods and supplements contain vitamin D. However, the sun is certainly by far the best source of vitamin D. For example, cod liver oil has about 400 IU per teaspoon; salmon, 400 IU per 3.5 oz. serving; fortified milk, 100 IU per 8 oz. glass; and fortified orange juice, 100 IU per 8 oz. glass. And vitamin D supplements range between 400 IU and 5,000 IU. Compare
Sources of Vitamin D	Vitamin D Content
Cod Liver Oil (1 tsp.)	400-1,000 IU
Salmon (fresh, wild, 3.5 oz.)	600-1,000 IU
Salmon (farmed, 3.5 oz.)	100-250 IU
Fortified Milk (8 oz.)	100 IU
Fortified orange juice (8 oz.)	100 IU
this to 20,000 IU from sun exposure. It's no contest.1203 Almost everyone knows that vitamin D can be obtained from many sources, and therefore no one believes that "sun exposure is the only source of vitamin D." See the chart above.
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3.	Sunbeds are a healthy option for boosting 25(OH)D levels. This is not a myth! An excellent study compared 50 people who used sunbeds regularly with 106 who did not. The sunbed group had 90% higher 25(OH)D levels and significantly higher bone density.1204 Other research has shown that (a) Women who use sunbeds have a 40-50% reduction in the risk of endometrial cancer.1205 (b) There is a significantly lowered risk of venous thrombotic events among women who use sunbeds when compared with those who do not.1206 (c) Tanning-bed use is inversely correlated to breast-cancer risk.1207 And, we have already discussed the fact that many studies demonstrate the Following: the use of carefully run tanning beds in commercial salons show either no increased risk of melanoma, or a negligible risk. Finally, a 20-year study has shown that women who use tanning beds have a 23% reduced risk of all-cause death.1208
Fortunately, organizations beyond the SCF are "seeing the light."
Cancer Research UK has joined with other health organizations to make a consensus statement regarding sun exposure and vitamin D.1209 Those organizations are the British Association of Dermatologists, Cancer Research UK, Diabetes UK, the Multiple Sclerosis Society, the National Heart Forum, the National Osteoporosis Society, and the Primary Care Dermatology Society. Here is the first part of their consensus statement: "Vitamin D is essential for good bone health, and for most people sun is the most important source of vitamin D. The time required to make sufficient vitamin D varies according to a number of environmental, physical and personal factors, but is typically short and less than the amount of time needed for skin to redden and burn. Enjoying the sun safely, while taking care not to burn, can help provide the benefits of vitamin D without unduly raising the risk of skin cancer."
It is irrefutable that the aforementioned dermatological and other health societies of the UK do not consider the health benefits of responsible sun exposure to be mythical. Why then does the SCF (an American organization) consider itself so much more intelligent than these British organizations? The following may be the clue: There are 69 corporate sponsors of the SCF, each of which pays at least $10,000 per year for the privilege of belonging to the SCF "Corporate Council.1210 If you look at the SCF Corporate-Council page, you will note that many of the members are involved in producing or selling products for skin protection, i.e. sunscreens. Is it any wonder the SCF suggests year-round sunscreen use, even in cloudy, wintry weather? It certainly smacks of quid pro quo, no? Some dermatologists, however are not buying this horrific silliness born of corporate greed: A 2017 paper from Spanish dermatologists suggests that people need their sun exposure and only the most severe skin problems should be accorded sun deprivation.1211
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More on sunscreens and the SCF
Should children over the age of six months use sunscreen year-round, even in sunless, cloudy weather? Of course not—but this idea certainly makes a lot of dollars for the sunscreen manufacturers.
How convenient for the Skin Cancer Foundation to state, "for adequate protection against melanoma, non-melanoma skin cancers and photo-aging, everyone over the age of six months should use sunscreen daily year-round, in any weather."1212 The Skin Cancer Foundation was founded in the USA by sunscreen manufacturers, which are forbidden by the FDA to claim that their products prevent melanoma. This following statement by the FDA, which we have used previously, belies the claims of the Skin Cancer Foundation: "available evidence fails to show sunscreen use alone helps prevent skin cancer
or premature skin aging. Thus, the anti-aging, skin cancer, and sun
damage claims proposed by the comments [of the sunscreen industry] would be false or misleading due to lack of sufficient data
in support of these claims.”1213
To repeat: Dr. Bernard Ackerman, a celebrated dermatologist, has further stated, "...the American Academy of Dermatology, the Skin Cancer Foundation and the American Cancer Society sold their seals of recommendation to manufacturers of sunscreen, the price being substantial in terms of dollars but incalculable in regard to tarnish of honor.” He continued, "Sunscreen companies pay it [the Skin Cancer Foundation] many thousands of dollars annually in the hope of gaining many millions of dollars in return.”1214
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Sunscreens block Solar UVB and are (supposedly) intended to decrease sun damage to the skin-damage that (supposedly) increases the risk of melanoma. Sunscreen use has increased profoundly in the past few decades. Therefore, if sun exposure were the cause of melanoma, there would have been an accompanying decrease in melanoma rates. Exactly the opposite has happened. As we discussed in Chapter 1, the US sales of sunscreens were $33 million in 1972 and $650 million according to Kline & Company, a research group.1215 In addition, the sale of sunscreens used in cosmetics in 2007 was $130 million according to the Fredonia Market Research Group Company.1216 Therefore, the total sales of sunscreens as of 2007 were about $780 million. Considering that a dollar's value was only about 20% of what it was in 1972, the adjusted 2008 sunscreen expenditures are approximately $156 million, or about 4.7 times the 1972 figure. In other words, sunscreen use has increased by about 4.7 times. The U.S. Population has also grown from 210 million in 1972 to 305 million in 2008-a 50% increase. Adjusting for this population growth, it can be concluded that per-capita sunscreen use has at least tripled in the time frame being considered-the figure may actually be much higher; and the growth of the industry shows no signs of abating. Research from 2013 states that the global sun care market generated $5.6 billion US dollars from its sun-protection products segment, which includes sunscreens.1217 Despite this significant increase in sunscreen use, melanoma incidence, according to the Melanoma International Foundation (MIF) has increased steadily and exponentially. It is therefore illogical to assume that sunscreens prevent melanoma when the data suggest that they may actually contribute to it!
Also, if solar UV rays were indeed a major cause of skin damage, then highly exposed populations (sailors, etc.) with extensive solar exposure, would have excessive melanoma rates. However, they have reduced melanoma rates,1218 thanks to the protection afforded by tanned skin and increased vitamin D levels. Then, there is the fact that most melanomas occur in poorly exposed body areas.1219 This further demonstrates the poor reasoning employed by the sunscreen industries and their associates.
Consider the following:1220 Sunscreen use, as we have explained, has increased parallel to the increasing rate of melanoma. Therefore, the data on increasing sunscreen use does not indicate that sun exposure increases the risk of melanoma; rather, it indicates that sunscreen use, by reducing vitamin D production, may contribute to the reported increase in melanoma. It has been shown that an SPF 15 sunscreen will decrease sun-stimulated vitamin D production by 99.5%,1221 and it has been suggested that blocking only UVB radiation (which stimulates the production of vitamin D in skin) while leaving UVA unblocked, may lead to higher UVA exposure (overexposure), which results in DNA damage, possibly leading to melanoma.1222, 1223 UVB, which causes discomfort when one has had enough exposure, lets the body know when to leave the sun. This warning signal is negated by sunscreen, leaving the body susceptible to overexposure. Increasing melanoma rates, coupled with increasing use of sunscreens, lends credence to this hypothesis. Vitamin D also provides protection against sun damage by facilitating DNA repair.1224 We gain nothing by eliminating vitamin D production through sunscreen use.
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As you can determine from the research presented, the sun has been much maligned by those who have a financial interest in frightening the populace and selling sunscreens. When money is involved, be very careful about what you believe!
Safely enjoy the sun. Do not burn and carefully consider your skin type. Your health will love you for it!
Scatter sunshine, everywhere you go.
—Church Hymn
For those who want to stay abreast of the latest information on the benefits of sun exposure, visit sunlightinstitute.org.
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Appendix 6
Salubrious Solar Solutions Photo-Nutrient Supplements vs. Civilization's Sun-Deficiency Epidemic
Adiel Tel-Oren, MD, DC, CCN, LN
Overview
This book repeatedly emphasizes the importance of getting daily exposure to sunlight for health, and describes the benefits of tanning beds as an alternative resource to obtain a portion of the ultraviolet (UV) segment of solar radiation. In an ideal and ancient world, it would be easier to follow the advice to go regularly under the sun without cover in order to expose most of our skin to its glorious rays. Unfortunately, the harsh reality discussed herein prohibits most people from enjoying sufficient year-round sun exposure. The magnificent sun—irradiating its full spectrum of rays—is our eternal life giver and most powerful energy source. The entire spectrum of sunlight has enabled the development of all life on Earth, and without it life would cease to exist. Everything we do revolves around the natural cycles of light and darkness. Our biological makeup has always been programmed to respond to the environmental cues of sunlight, which governs the flux of metabolic processes, behaviorism (mood) and internal clocks. Sunlight influences hormone secretion, libido, heart rate, alertness, sleep propensity, body temperature, and gene expression.13, 22 Therefore, it is not surprising that human physiology, well-being, immune response and productivity are all affected by the daily and seasonal changes in the solar spectrum. When you are with the rhythm of nature you sleep more soundly, cope more easily with stress, reduce anxiety & depression, and reduce the risk of autoimmune disorders.33, 58 Conversely, exposure to unnatural light sources at the wrong time of the day is highly detrimental to human health.18 Just review the cancer sections of this book to fully realize the severe effect of sun deficiency.
In Nature, humans (like all other life forms) would reside outdoors (structures with doors did not exist...). Since time immemorial, our ancestors would experience significant daily doses of full-spectrum solar radiation even when seeking intermittent shelter within shallow caves, shadows cast by trees and rocks, and (much later) primitive huts. They had to find and gather their food and create their tools during daylight, and benefitted from the scattering of solar rays even in the shade.3 As we've seen in this book, today's obsessions with technology, light-deprived life, altered light rhythms, and imbalanced light spectra severely compromise our health. We shun the sun, stay up well past dusk, spend much of our time indoors, cover most of our skin during the day, and bombard ourselves with artificial light at night. We alternate between deficiency of sunlight and excess of "junk" light, severely disrupting the natural clocks within us, creating confusion in the signaling within our bodies, and hampering our physiological functions, resistance to illness, and sense of well-being. Furthermore, the fear of sunshine created by orthodox medicine and the pharmaceutical industry (both harnessing the power of modern media) has caused individuals to avoid the sun or apply sunscreens, which block beneficial solar wavelengths. Certain populations hide their body from the sun because of religion or tradition, and others because of cold weather. Many societies today reside in unnatural geographical latitudes (far away from the tropical origins of humanity), thanks to technological advancements that allow humans to survive (but not thrive) in regions exhibiting harsh conditions (shorter days, cold climate) during several months of each year (see Appendix 1). Urban dwellers may suffer from blocked beneficial sunrays due to overcast skies or persistent pollution particles. As we have seen, these disturbances to vital light rhythms have contributed to depression, cancer, hormone imbalances, anxiety, sleeping disorders, autoimmunity, allergies, cardiovascular disease, and other chronic illnesses.18
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So how can we avoid solar deficiency, reset our clocks, regain our vitality, and prevent disease, if our lifestyle, work, location, clothing choices, traditions, pollution, or weather won't allow us to receive our daily dose of sunlight naturally? The answer proposed in this article is Sun Replacement Therapy (SRT).
SRT is a quick and practical home-based method to rebalance and resynchronize the body's essential biological clocks, while simultaneously providing the critical photoproducts manufactured during sun exposure. SRT uniquely incorporates the full solar spectrum (not just UVR), mimicking closely the composition of naturally occurring sunlight. A session of 5 - 15 minutes every morning will provide a multitude of benefits, whenever it's impractical or unlikely to perform the dual activity of exposing most of the skin to warm sunrays during midday as well as exposing the face to bright morning sunlight.
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The primary focus of this article is to convey a better understanding of light as a key influence on human health, to explain the severe impact of light-cycle desynchronization, and to show how Sun Replacement Therapy provides an intelligent novel system (for people who are not able to get "the real thing"), acting as a "solar supplement" of "photonutrients," to readjust circadian rhythm and provide all the essential photoproducts discussed in this book, including vitamin D.
The Sun - The Maestro in the Orchestra of Life
Sunlight is the conductor in the symphony of living. It governs our biological clocks, behaviorism and daily metabolic processes.
Existence has evolved around the dance between the cycles of light and darkness, also known as the circadian rhythm.1 The term circadian rhythm is derived from the Latin root circa diem, "about a day." These inner rhythms have a course of approximately 24 hours,11, 56 and provide a pattern that anticipates what we need to be healthy. They regulate our day-to-day biological routines, which are synchronized to our physical environment and are stimulated by various photic (visible spectra) and non-photic (invisible spectra) of solar radiation.16, 56 Circadian rhythms control the timing, quantity and quality of hormones and neurotransmitters the body produces, which regulate appetite, energy, mood, sleep and libido,33, 58 thus supporting health and maintaining disease resistance.
Responses to Light
Research has proven that our circadian rhythms are dependent upon light entering our eyes to regulate our body's master clock.16, 37, 44
This master clock is in the brain, at the suprachiasmatic nuclei (SCN) within the anterior hypothalamus.16, 34 The SCN synchronizes "clock cells" in peripheral tissues within the eye, brain, heart, lung, gastrointestinal tract, liver, kidney, and the skin.14, 35, 36, 42, 46 Based on signals of light and darkness, the SCN instructs the pituitary gland to secrete hormones, the chemical messengers of the body, in varying quantities depending on the time of day. These hormonal changes control and modify the sleep/wake cycle, blood pressure, digestion, metabolism, reproduction, and the immune response—regulating the physical and chemical processes involved in the overall maintenance of life.16
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Key hormones and neurotransmitters such as serotonin and melatonin are secreted by the nervous system to set our daily rhythms according to the quality and quantity of light received.6,44 A new day's light will cue the body to increase serotonin (impulse control), cortisol (stress), GABA (calm), dopamine (alertness), follicular stimulating hormone (FSH, reproduction), gastrin releasing peptide (GRP, eating), neuropeptide Y (NPY, hunger), causing a needed rise in blood pressure and body tern peratu re.7,13,29,41,53 As the su n goes down at su nset a nd I ight diminishes, the body produces melatonin, lowering blood pressure and temperature and preparing the body for sleep.13,29,36,38,50
Solar Rays - The Visible and Invisible Spectra
The spectrum of solar radiation that reaches the Earth's surface ranges from 290 nm to more than 1,000,000 nm, and consists of 6.8% UV, 38.9% visible light and 54.3% infrared radiation (Fig.l).23,26
UV photons fall between the wavelengths of visible light and gamma radiation. UV light is commonly divided into the following spectral regions; UV-A (315 nm - 400 nm), UV-B (280 nm - 315 nm) and UV-C (100 nm - 280 nm).45,55 95-97% of the UVR (UV-radiation) which reaches the Earth's surface is UV-A. UV-A rays are present throughout the day and can penetrate window glass. The remaining 3-5% is UV-B, also known as the "burn rays." Most windows and automobile glass block these rays. UV-C rays do not reach the Earth's surface as they are filtered by the ozone layer.4,13,23,52 Exposure to UV-B and UV-A radiation can alter human function by a skin-mediated response.18
Solar spectrum
290nm 320nm 400nm	760nm 14O0nm	3000nm	10*nm
| NIR |	| FIR
Fig 1. Solar spectrum composition. Red X over UVC means that thqy are blocked by the ozone layer (NIR: near infrared, FIR: far infraredf
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Every day we witness the metamorphosis of the visible spectrum, between 400 nm and 780 nm.23 At sunrise, a high intensity in the blue region (400-500 nm) is received. As the day goes by, this blue light is scattered and gradually diminishes. As a result, we perceive an orange-red hue (600-700 nm), a phenomenon called sunset.55 During the night, very limited amount of visible light emanates from the stars. A full moon emits approximately five times that amount, radiating significant light in the blue visible range.6, 48 Visible light can penetrate the epidermal and dermal layers of the skin and can directly interact with lymphocytes (white blood cells) and other immune cells to regulate immune function.38
There are three infrared (IR) spectral bands; IR-A, IR-B and IR-C. IR radiation can penetrate the epidermis, dermis and subcutaneous tissue. The degree of penetration depends on wavelength range. Exposure to IR is perceived a heat. IR-A (780 to 1400 nm), also known as near infrared (NIR), deeply penetrates into biological tissues and is used in diagnostic and skin treatments. IR-B (1.4 um to 3.0 um) penetrates only a few mm into the skin and ocular tissues. Lastly, IR-C (3.0 um to 1 mm), also known as far infrared (FIR), is absorbed very superficially (< 1 mm).4, 45, 55
Variations in Solar Exposure and Assimilation
Timing, intensity, and wavelength of light, as well as skin type, season and location are important aspects that need to be taken into account when discussing effectiveness and maximization of solar exposure/assimilation.
Timing is crucial. The human physiology oscillates with the spectral changes in light throughout the day. The spectra of light at dawn, late afternoon and evening are distinct. Hormonal and metabolic responses in humans are cued by the natural changes in the visible light spectra. Naturally occurring blue light exposure in the early morning has positive effects on humans, regulating alertness, cognition and mood. However, blue light exposure in the evening (typical with TV/Computer/Cellular screens and LED displays like alarm-clocks) is disruptive and detrimental to human health. It inhibits the production of melatonin needed for sleep, for correct body mass index, and for good cognition.49
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Skin type determines the amount of solar exposure required for synthesis of vitamin D (UVB). Dark skin requires about five to six times more solar exposure than pale skin for equivalent vitamin D photosynthesis.28 Thirty minutes in the summer sun with most of the skin exposed can produce 50,000 IU (1.25 mg) of vitamin D in a white person, 20,000-30,000 IU in a tanned individual, and 8,000-10,000 IU in a dark-skinned person.28 Even when these numbers differ among studies, they consistently demonstrate the skin's superiority in providing vast amounts of vitamin D relative to any other source. As this book emphasizes, both SRT and traditional sunbeds are excellent UVR sources that effectively produce vitamin D and other UV photoproducts like endorphins.
The sunlight spectrum varies greatly with latitude, time of the day, and season of the year. Near the equator, midday and midsummer are the times where sunlight is most intense. UV doses are higher close to the equator, at higher altitudes and in conditions of minimal clouds. UV dosing (essential for vitamin D and other photoproducts) depends on time spent outdoors, amount of clothing, body fat, skin pigmentation (melanin), shade and sun blocks. People typically living in equatorial locations tend to be more outdoors and wearing less clothing as it tends to be warmer, receiving higher ambient UV doses (associated with common, non-threatening skin cancer, but not with melanoma, as the scientific discussions in this book prove) than people inhabiting temperate climates.28, 30
Lack of natural circadian light in the winter leads to the damaging emotional and physiological effects associated with seasonal depression (SAD).40
The risk of autoimmune diseases (multiple sclerosis, asthma, type 1 diabetes mellitus, and others), cardiovascular diseases (hypertension and myocardial infarction), many cancers (bladder, breast, cervical, colon, endometrial, esophageal, gastric, lung, ovarian, pancreatic, rectal, renal and vulvar) and other serious conditions increases with latitude (decreasing UV dose) of residence.24 Generally, it is believed that this increased risk is at least partially due to insufficient UVB radiation, leading to vitamin D deficiency.13 This book reveals many other photoproducts of UVR that support the health of the immune system, nervous system, and cardiovascular system, in addition to synthesis of vitamin D.
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Traveling across multiple time zones also interferes with the normal circadian cycle, leading to the symptoms of jet lag. Constant change in the circadian cycle due to shift work has the most devastating health effects, increasing risk for cancer, obesity and type 2 diabetes.9 When the natural circadian cycle is disrupted, there is an increase in the risk of autoimmune and infectious diseases.18, 28, 30
Sun Replacement Therapy - How to Get Your Daily Dose of PhotoNutrients!
Using the sun as a therapy has been practiced over centuries in ancient Egypt, Greece, China and India,54 and more recently in Europe and the USA (see chapter 13). It is most effective with the proper combination of light intensity, duration and timing. Sun Replacement Therapy (SRT) is a system consisting of the full spectrum of UV and visible solar rays, with an enhancement of wavelengths that were scientifically proven to benefit human health, mood and circadian cycle, for use whenever sun exposure is insufficient in quantity, quality, and timing. SRT includes a full-spectrum lamp, a blue light (440-480 nm), and UV radiation lamp with an appropriate UVA/UVB ratio - all working together in a manner that allows most of the benefits of real solar radiation to be obtained within a practical 5-15 minutes morning session. Nothing can truly replace the complexity of Nature perfectly, but this approach is as close as it gets to mimicking the magnificent spectrum of rays generated by our friend, the lifegiving sun.
Healing Ultraviolet Rays
UV radiation (UVR) has been used for many years to treat skin diseases. UV exposure is an important environmental interface with immune function as it plays an essential part in the prevention of several diseases. As shown in chapter 13, it has been used as a popular medical treatment for TB, rheumatic disorders, diabetes, gout, chronic ulcers, and wounds.23, 28 As stated above, a low exposure to UVR increases the risk of autoimmune diseases, cardiovascular diseases, and many cancers.24 The levels of UV radiation from the sun vary with latitude, altitude, weather, time of day and season of year. For example, winter provides mostly UVA radiation and hardly any UVB,24 contributing to Seasonal Affective Disorder (SAD).
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A beneficial aspect of UV exposure is decreased risk of melanoma, as detailed in chapter 1. Studies have shown that melanoma is more frequently found among people with indoor occupations than those getting large amounts of UV exposure (e.g. farmers). Children who have more outdoor activities and thus more sun exposure have a lower risk of melanoma as well.24
Exposure to both UVA and UVB radiation can have direct immunosuppressive effects through upregulation of cytokines (TNF-a and IL-10) and increased activity of T regulatory cells that remove selfreactive T cells. These mechanisms may help prevent autoimmune diseases.28
Furthermore, UV exposure was shown to improve mood through the release of endorphins. UV radiation leads to production of an opioid P-endorphin, which is released into the bloodstream, and in sufficient concentrations it induces mood enhancement and relaxation.13 In addition to SRT, traditional sunbeds are an excellent source of UVR, as stated in appendix 2.
UVR therapy, also known as phototherapy, is divided into different types: Broadband UVB (290-320 nm), narrow band UVB (310-315 nm), monochromatic UVB (308 nm from an excimer laser), broadband UVA (320-400 nm), and UVA-1 (340-400 nm).13
UVA
An appropriate UVA dose provides great health benefits. UVA radiation penetrates more deeply into the skin than UVB, and reaches both the epidermis and the deeper dermis, where it affects blood vessels, dermal dendritic cells (the skin's antigen-presenting cells), dermal fibroblasts, endothelial cells, mast cells, and granulocytes.24 Thus, it has a direct impact on the immune system.
As we have seen in this book, UVA generates nitric oxide (NO) in our skin. NO reduces blood pressure by relaxing blood vessels, thus improving cardiovascular health. Moreover, it has antimicrobial effects, by disinfecting tissues and regulating inflammatory processes in acute and chronic wounds. It also acts as a neurotransmitter by stimulating the brain. When occurring in excess, nitric oxide acts as a potent free radical, so too much UVA exposure can be counterproductive and may lead to skin damage.24
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UVA exposure increases the production of cytokines and enzymes that protect cells and tissues against oxidative stress and tissue injury, by facilitating antioxidant, anti-inflammatory, anti-proliferative, and anti-apoptotic activities. A UVA exposure of 20-30 minutes protects the skin against damage induced by solar radiation and is thus an adequate exposure time.24
uvb
UVB radiation is the only portion of the solar spectrum able to photosynthesize vitamin D in the skin,28 modulating cell proliferation, differentiation, apoptosis, angiogenesis, immune and inflammatory responses.24 A metabolite of vitamin D influences bones, intestines, immune and cardiovascular systems, pancreas, muscles, brain, and control of cell cycles.30 Its primary physiological function is to maintain serum calcium and phosphorus levels in an adequate range to ensure metabolic functions, neuromuscular transmission and bone mineralization.13 The major form of vitamin D circulating through the bloodstream is 25-hydroxyvitamin D (25[OH]D). This is the "stored form," utilized in determining a person's vitamin D status. Conversion of skin-derived (or food/supplement-derived) vitamin D into 25(OH)D is primarily done in the liver although various cell types in the skin also carry out this transformation. 25(OH)D is transformed in the kidneys as well as in other tissues into the steroid-like hormone 1,25-dihydroxyvitamin D (1,25[OH^D), the active form of the vitamin, which regulates over 1,000 different genes in every tissue in the body. It is known to accumulate in intestinal cell nuclei, where it enhances calcium and phosphorus absorption, controlling calcium blood levels and regulating bone-calcium metabolism.13 It has a wide range of biological actions, such as inhibiting angiogenesis, cellular proliferation, and spread of cancer, inducing differentiation (anticancer effect), stimulating insulin production (diabetes), inhibiting renin production (hypertension), and stimulating the production of macrophage cathelicidin,30 which is a polypeptide that effectively combats both bacterial and viral infections.28
People living at high latitudes throughout the world are often found to be deficient in vitamin D. Sunscreen products dramatically reduce vitamin D synthesis in the skin, increasing the likelihood of deficiency.26 Deficiency is related to many downfalls in human health-hypertension, cardiovascular diseases, influenza, obesity, cancer, type 2 diabetes, and autoimmune diseases.28, 30 Research has shown that vitamin D supplementation is less efficient than UV radiation when observing the suppression of multiple sclerosis,11 and this book has described other instances whereby UVR/Sun exposure exhibited greater benefit than D-supplements. Therefore, it's wise to enjoy those healing rays every day, either through natural sunlight (if available in sufficient quantity and quality), or through Sun Replacement Therapy.
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UVB skin therapy owes its effectiveness to its anti-proliferative properties, obtained by inducing local and systemic immunosuppressive effects.24 Many skin diseases (e.g. psoriasis, vitiligo, atopic dermatitis, localized scleroderma) can be treated with solar radiation (heliotherapy) or artificial UV radiation (phototherapy).13 Many experts recommend daily exposure to the midday sun for a period of 15-30 minutes,28 but this recommendation is not practical for most people, as discussed above, and tanning beds, which provide UVR (but not the healing visible solar spectrum), are not always available on a daily basis. SRT can easily provide all the needed UVR by exposing the full body in the privacy of home daily!
The Healing Visible Light Spectrum
Visible light has a powerful effect on human health, because light entering the eyes affects circadian rhythms.12, 36 Visible light (400-780 nm) can also penetrate epidermal and dermal layers of the skin and may directly interact with circulating lymphocytes to modulate immune function.38 Full spectrum white light has been found to increase blood flow, increase antibody production, and decrease inflammation by reducing pro-inflammatory cytokines TNF-a, IL-6, interferon-gamma, and interleukin-12, while increasing antiinflammatory cytokines interleukin-10 and TGF-beta.57 Sufficient light intensity is necessary to provide all the crucial circadian effects described earlier and the immune benefits obtained through the skin. During high-latitude winters, daylight time is often too short, and overcast skies contribute to light deficiency, especially in dark mornings. This is compounded by the tendency of humans to cover most of their skin, as well as the insufficient indoor lighting at workplaces, schools, hospitals, factories, garages, banks, etc. SRT, applied to the entire body at the privacy of home, compensates for this deficiency.
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Blue Light
Blue light is an essential environmental cue which sets the circadian rhythm. It stimulates cognitive brain activity. It enhances alertness (wakefulness), performance (cognition) and mood. It takes less than a minute of blue light exposure to trigger the brain regions involved in regulating alertness and cognition.49 This is better than a cup of coffee in the morning! Research has shown that blue light consistently outperformed caffeine in visual reaction, decision making, alertness and cognition.5
Light regulates multiple non-image-forming (nonvisual) circadian, neuroendocrine, and neurobehavioral functions, by stimulating intrinsically photosensitive retinal ganglion cells (ipRGCs).49 ipRGCs mediate the entrainment of circadian rhythms, regulation of pineal melatonin synthesis, pupillary light constriction, and the regulation of sleep.32 These retinal cells relay photic information to non-imageforming centers of the brain, one being the hypothalamic suprachiasmatic nucleus (SCN), which is the master biological clock of the human body as previously discussed. Even blind individuals detect light through these non-image-forming centers, hence their ability to be influence by variations in solar radiation spectra.49
Melanopsin, a photo sensitive retinal pigment, is associated with mediation of non-image-forming retinal functions and has a crucial effect on sleep.32 Melanopsin projects into the SCN and synchronizes it with the solar day. It is highly sensitive to blue light. Melanopsin reactivity is based on a biochemical feedback loop: It gets activated by blue light in the early morning and starts producing an electrical signal, which regulates genes that affect the biological clock.32 Then, as the evening approaches, orange-red light switches it back into a less active biochemical state that will render it sensitive to blue light again, in the following morning. Excess blue light in the wrong time of the day (especially during dark hours) desynchronizes the innate clocks and disturbs the reactivity of melanopsin. This disrupts the cascade of events initiated by morning light. Individuals with a low level of melanopsin (especially in winter, but also resulting from the disruption related to blue light exposure during the evening and at night) are found to suffer from mood and sleep disorders, and possess a higher risk of seasonal affective disorder (SAD).40 A great way to reset the body's internal clock, restoring sleep-wake cycle and addressing mood issues caused by SAD (and many other related health problems) is to utilize Sun Replacement Therapy every morning: It contains abundant emissions in the blue region, triggering the non-visual photoreception needed for realignment of circadian rhythm, starting the morning correctly, with alertness and improved performance, as intended by Nature!
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Other functions of blue light as a therapeutic agent include the skin's production of singlet oxygen and the photo-inactivation of bacteria.24 A study has demonstrated successful eradication of MRSA (methicillin-resistant Staphylococcus aureus, a bacterium that has developed resistance to multiple antibiotics and usually leads to serious skin and soft tissue infections, which may be fatal if treatment is delayed), within a few minutes of exposure to blue light (470 nm).17 Blue light therapy was also shown effective against severe acne, premenstrual depression, bulimia and anxiety.22
As mentioned earlier, continuous blue light, especially when darkness is necessary (light pollution from phones, TV, computer screens, LED lights, etc.), is quite detrimental to our health as it interferes greatly with melatonin production, which is essential for good sleep quality, keeping a desirable waist line and a healthy heart:
Melatonin is a small indole-amine that is produced and secreted in a 24-h rhythm that peaks at night. It also aids in the entrainment of biological clocks, including influences on clock genes.6 Furthermore, melatonin suppresses UVR-induced skin damage.25 Melatonin concentration rises during the evening, promoting the onset of sleep. Importantly, it suppresses appetite, decreases blood pressure and lowers body temperature.13, 29, 36 Melatonin concentrations are closely linked with obesity. Studies have shown that melatonin stimulates brown fat, which burns calories instead of storing them, thereby helping regulate body weight and metabolism.8 Exposure to light at night strongly suppresses melatonin secretion and thus interferes with sleep duration and quality. Chapter 9 discussed the beneficial effect of longer sleep on general health and longevity.
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Health-Giving Visible Red and Near Infra-Red Rays
There are numerous benefits obtained from appropriate red and Near Infra-Red (NIR) exposure. Infra-red saunas and domes have become trendy tools in homes and clinics for detoxification via sweating, for treating skin diseases, and to reduce inflammation. 2 20, 43 Solar infrared radiation in excess (which can only occur with sunscreen use) can generate free radicals deep in the skin.4 But modest solar infrared exposure is beneficial, as are therapeutic infrared applications such as moist heat (hot bottles/heating pads) and hot baths. Non-burning heating sources are essentially infrared rays of varying wavelengths, which we experience as pleasant warmth.
One aspect of red light and infra-red solar rays that is not frequently discussed is the fact that they transfer energy to cells in the skin and the tissues below it. Studies have shown that respiratory enzymes are inhibited by blue light and activated by red light.31 Red light enhances mitochondrial function by activating the mitochondrial enzyme cytochrome c oxidase, which consequently enhances the production of ATP (chemical energy needed for cell functions).19, 31 It is used to speed up healing of wounds and stimulate hair growth.47 Infrared rays are not a part of SRT, since infrared devices, various heating sources, and saunas are found everywhere. Warm-blooded humans have always endeavored to surround themselves with comfortable warmth, finding ways to avoid long-term exposure to the cold weather (the absence of sufficient infrared rays) by recreating their original tropical warm (infrared rich) environment.3
At Night, "Come to the Dark Side" to Find Health
Our home and work environments are continuously bombarded with artificial light, even at night. We no longer live or sleep in natural darkness! This negates the natural cues given by nature, putting our health at risk on many levels: Circadian Rhythm Disruption (CRD) occurs when your body produces hormones, chemicals and neurotransmitters in the wrong amounts and at the wrong time of the day. It is linked to increasing cancer risks, metabolic dysfunction, and mood disorders.6 The body can no longer discriminate between day and night. No wonder so many of us feel "out of balance," lacking energy, feeling blue, and constantly seeking "healing" experiences.
We can learn from animals in their original, natural, nourishing environments: Energized, balanced, adaptable, nourished bodies can take "health" for granted, without the need for contemplating the concepts of "health and disease"—because their bodies have no reasons to ever get sick! Indeed, our imbalanced modern life requires a lot of corrections and adjustments in order to regain our health. Resetting our circadian rhythm is paramount among them, and a short SRT session every morning will bring us closer to our natural beginnings.
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As previously discussed, melatonin is produced solely at night and any exposure to light stops its production. It is a key element in countering infection, inflammation, cancer and auto-immunity.28
When people are correctly exposed to sunlight or bright artificial light in the early morning as occurs in Nature (and as in SRT), their beneficial nocturnal melatonin production will occur sooner with the arrival of darkness, helping them enter the restorative sleep phase more easily at night. Also, Serotonin production will be stimulated by the bright morning light of the sun (or SRT), providing a positive mood and a calm, focused mind. Serotonin is the precursor to melatonin: The pineal gland makes melatonin by acetylating and methylating serotonin.27 Normally produced during the day, serotonin is only converted to melatonin in darkness. This conversion naturally stops with morning light, thereby increasing serotonin levels.
Final Thoughts About Getting Your Full Spectrum of Photo-Nutrients
Humans have been programmed to reside in warm outdoors, exposed to the sun during the day, and to sleep during the night hours. Important pathways react to light and darkness cues. Many photoproducts are made during exposure to various parts of the solar spectrum at different times of the day. Humans, like plants, have soaked up the sun's energy and converted it into biological reactions since primordial times. Hence, the solar spectra must be considered "essential photo-nutrients." These solar-derived nutrients made life possible, and are no less important than food-derived ones. We can't fool with Nature's rules while expecting a life of marvelous metabolic balance.
If you are fortunate enough to dwell all year in a warm sunny latitude with open unpolluted skies, get your unclad body exposed to the midday sun for long enough time (which will depend on your skin type, tan, latitude, altitude etc.) without burning, as well as expose yourself to early morning sunlight, to receive all the scientifically proven benefits described in this book and this appendix! If you are not so fortunate, because of higher latitude, less sunlight, cold weather, clothing, work schedule, indoor or urban living and pollution, then treat yourself every morning to only 5-15 minutes (based on skin type and tan) of SRT—delivering all the essential photo-nutrients (UVR, full spectrum light, and additional blue light) that are critical to your body and mind, and are analogous to those bestowed upon us by the healing sun.
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clinic@ecopolitan.com
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References for Appendix 6
[1]	Albrecht U, Eichele G (2003) The mammalian circadian clock. Curr Opin Genet Dev 13(2): 271277
[2]	Avci P, Gupta A, Sadasivam M, Vecchio D, Pam Z, Pam N, Hamblin M.R, (2013) Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring. Semin Cutan Med Surg 32(1):41-52
[3]	National Academy of Sciences (2010) In the light of evolution: Volume IV: The human condition. Washington, DC: National Academies Press (US). (Jabloncki, N.G, Chaplin G. 9 Human skin pigmentation as an adaptation to UV radiation)
[4]	Barolet D, Christiaens F, Hamblin M.R (2016) Infrared and skin: friend or foe. J of Photochem and Photobio B 155: 78-85
[5]	Beaven C.M, Ekstrom J (2013) A comparison of blue light and caffeine effects on cognitive function and alertness in humans. PLoS One 8(10): e76707
[6]	Bedrosian T.A, Nelson R.J (2017) Timing of light exposure affects mood and brain circuits. Transl Psychiatry 7(1): e1017
[7]	Brainard G.C (1991) Photic parameters that regulate the neuroendocrine system and influence behavior in humans and animals. Photodermatol Photoimmunol Photomed 8:34-39.
[8]	Cipolla-Neto J, Amaral F.G, Afeche S.C, Tan D.X, Reiter R.J (2014) Melatonin, energy metabolism, and obesity: a review. J Pineal Res 56(4): 371-381.
[9]	Costa G (2010) Shift work and health: current problems and preventive actions. Saf Health Work 1(2):112-123
[10]	Cutolo M, Maestroni G.J, Otsa K, Aakre O, Villaggio B, Capellino S, Montagna P, Fazzuoli L, Veldi T, Peets T, Hertens E, Sulli A (2005) Circadian melatonin and cortisol levels in rheumatoid arthritis patients in winter time: a north and south Europe comparison. Ann Rheum Dis 64(2): 212216
[11]	Czeisler C.A, Gooley J.J (2007) Sleep and circadian rhythms in humans. Cold Spring Harb Symp Quant Biol 72: 579-597
[12]	Czeisler C.A, Shanahan T.L, Klerman E.B, Martens H, Brotman D.J, Emens J.S, Klein T, Rizzo J.F (1995) Suppression of melatonin secretion in some blind patients by exposure to bright light. N Engl J Med 332(1): 6-11
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1103	Proposed Rules. Federal Register # 165. 2007;72: 49070.
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Europe: A Population-Based Ecological Study. SAGE Open October-December 2014: 1-6.
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iio6	Pfotenhauer KM, Shubrook JH. Vitamin D deficiency, its role in heath and disease, and current supplementation recommendations. J Am Osteopath Assoc. 2017;117(5):301. 1107Basatemur E, Horsfall L, Marston L, Rait G, Sutcliffe A. Trends in the Diagnosis of Vitamin D Deficiency. Pediatrics. 2017 Mar;139(3).
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1112	Krause M, Klit A, Blomberg Jensen M, S0eborg T, Frederiksen H, Schlumpf M, Lichtensteiger W, Skakkebaek NE, Drzewiecki KT. Sunscreens: Are they beneficial for health? An overview of endocrine disrupting properties of UV-filters. Int. J. Androl. 35, 424436 (2012).
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About the Authors:
Marc B Sorenson. Ed.D.
Sunlightinstitute.org

Marc is a doctor of education (EdD) with a background in health. He and his wife, Vicki, founded one of the top health resorts in the world. During their 15 years at their health institute known as National Institute of Fitness, their clients lost approximately 110 tons of fat, two thirds of diabetic guests were free of medication in two weeks, and others recovered from high cholesterol, lupus, arthritis, migraines, hypertension, angina, arthritis, neuropathy, heart disease and allergies. The institute was ranked as one of the world's best destination spas and was featured in media throughout the U.S., and in Japan and Singapore.
His book Megahealth was a selection of the Literary Guild, Doubleday Book Club and Doubleday Health Book Club, where it was Book of the Month. He has also published several other books in the fields of health, human happiness, English vocabulary and vitamin D. He did meticulous research into hundreds of published papers on sunlight and health in order to write Vitamin D3 and Solar Power. It was published in the U.S. and in the Czech Republic and is now awaiting publication in Israel in Hebrew.
He was awarded the Money School of Boston recognition for Excellence in Nutrition writing—the only person so honored by the school.
He is a part-time professional speaker and has made presentations in many states in the U.S. and in cities in Japan, Canada, Mexico, and Italy. Dr. Sorenson has given more than 3,000 presentations on fitness, sunlight, nutrition and religion. His nutrition plan, like Dr. Grant's, is plant based.
He has appeared as a guest on many TV programs, and has conducted his own radio show.
His hobbies include reading classic English literature and attending theater. His favorite activities include studying scripture, sunbathing, traveling with Vicki in Europe and Mexico, playing with the grandchildren and hiking on 13,000 foot Mount Wheeler near their Nevada ranch. He also enjoys entertaining his friends, such as Dr. Grant, at the ranch.
On the recommendation of Senator Orrin Hatch, a flag was flown over the United States Senate Building in honor of his contributions to the health and fitness of the citizens of the USA.
William B. Grant, Ph.D.
Sunlight, Nutrition and Health Research Center

Bill has a Ph.D. in physics from the University of California, Berkeley. He had a 30-year career in atmospheric sciences with an emphasis on laser remote sensing of atmospheric constituents such as ozone and aerosols. In the early 1990s, while living in Virginia, he led a project for the Sierra Club to determine the effect of acid rain and ozone on eastern U.S. hardwood forests. In that project he learned how to use the ecological approach, where populations are defined geographically and both health outcomes and risk-modifying factors are averaged for each population. He applied this approach in 1997 in a multi-country study in the a seminal paper linking dietary factors such as fat and total calories to risk and cereals/grains and fish to reduced risk of Alzheimer's disease.
In 1999, after seeing the Atlas of Cancer Mortality Rates in the United States, 1950-94, U.S. National Cancer Institute, showing large geographical variations in cancer mortality rates, low for many types of cancer in the Southwest, high in the Northeast, he set about to try to explain the geographical variations. The seminal paper by the brothers Cedric and Frank Garland in 1980, proposing the UVB-vitamin D-cancer hypothesis based on the then map for colon cancer, provided the approach. The study raised the number of UVB/vitamin
D-sensitive types of cancer from five to 15 in a paper published in Cancer in 2002.
Dr. Grant retired from the NASA Langley Research Center in 2004 to pursue health studies full time, moving to San Francisco and forming the non-profit organization, Sunlight, Nutrition and Health Research Center (sunarc.org), for research and education regarding the roles of UVB, vitamin D, and diet in reducing the risk of chronic and infectious diseases. He has 260 publications on vitamin D listed at pubmed.gov, of which 93 also include ultraviolet exposure. He is a scientific advisor to GrassrootsHealth.net, VitaminDCouncil.org, and VitaminDSociety.org, and a frequent presenter at national and international vitamin D conferences.
He also has 36 papers on diet and chronic disease. His most recent papers on diet strengthened the evidence that animal products (meat, eggs, fish, and cheese and sometimes milk) are the most important dietary risk factors for many types of cancer as well as Alzheimer's disease. Based on his research on diet and chronic diseases, he strives to eat a whole-plant based diet with fish and some chicken. Due to limited solar UVB doses in San Francisco, he also takes vitamin D3 supplements to maintain his 25-hydroxyvitamin D concentration above 40 ng/mL, but also enjoys bird watching as a way to enjoy the out-of-doors and embrace the sun.