IJE Advance Access originally published online on September 19, 2006
International Journal of Epidemiology 2006 35(5):1359-1360; doi:10.1093/ije/dyl206
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Letter to the Editor |
Do sunlight and vitamin D reduce the likelihood of colon cancer? Time for a paradigm shift?
Department of Epidemiology and Biostatistics, University Medical Centre Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
E-mail: p.jongbloet{at}epib.umcn.nl
In your section ‘Reprints and Reflections’ of the Journal you present the original paper by CF Garland and FC Garland on the so-called ‘vitamin D-colon cancer’ hypothesis,1 published in 1980, followed by a series of six commentaries resuming the state of affairs 25 years later.2–7 Correlation studies between higher colon cancer rates and higher geographic latitude and, thus, less vitamin D have been extended to other cancer sites, including breast, bladder, corpus uteri, oesophageal, kidney, lung, ovary, pancreas, prostate, rectum, stomach, multiple myeloma, and non-Hodgkin lymphoma. And, if that was not enough, also to other diseases—including hypertension, type 1 diabetes mellitus, multiple sclerosis and osteoporosis—that are linked to vitamin D insufficiency. This hypothesis, therefore, has found adherence and has been tested in different ways. However, it is broadly accepted that there was no vitamin D deficiency in the US. Furthermore, the minimal dose required (and upper threshold) for colon cancer prevention is by no means established. The current health recommendations typically discourage high intakes of vitamin D as well as sun exposure, at least without use of sunscreen, which effectively blocks vitamin D production.
The most impressive argument in the original report was the indication of a strong inverse association between colon cancer mortality rates and the annual mean daily solar radiation compiled in both the Metropolitan (80% of the population residing in a metropolitan area) and non-metropolitan states in the US. It is our purpose to question the causal relation to vitamin D in the current discussion and to infer an up till yet neglected biological factor present in animals and humans, namely the South-to-North gradient of the seasonally bound conception and birth rates.8 This gradient in seasonality goes parallel with geographic latitude and solar radiation, apparent on both hemispheres. That is, the further away from the equator the stronger this birth seasonality. The seasonal preovulatory overripeness ovopathy (SPrOO) concept is based on this biological phenomenon and predicts that individuals conceived during the breakthrough and breakdown of the seasonally bound ovulatory seasons are at higher risk for being prone to developmental anomalies and deficiencies in different organs and organ systems, for example in the immune system.9,10 This ovopathy concept is backed by animal experiments on preovulatory and post-ovulatory overripeness ovopathy and in line with the disproportional excess rates of fatal neural tube defects11 and type 1 diabetes mellitus,12 which increase further away from the equator and diverge on both hemispheres.
This proposed causal relation of seasonally bound non-optimally matured oocytes to cancer, therefore, not only agrees with the geographical latitude effect under discussion but also with the disproportional month-of-birth deviations apparent in childhood leukaemia,13–15 premenopausal breast cancer,16–18 lung cancer,19 and brain tumours in children20,21 and adults.22 These deviations in general correspond with the major total birth peak or major ovulatory season.11,12 Further, it is in line with the enigmatic phenomenon of shorter life expectancy of people born in the first half of the year when compared with the second half, at least in Europe and upside down in Australia.23 Finally, this ovopathy concept clarifies the male bias in about all (non-gender specific) cancers10 and is in accord with many prenatal determinants, such as specific maternal and intrauterine factors in childhood leukaemia, breast cancer, and oesophageal cancers.
An analogous persistent paradigm regards the so-called Mediterranean diet allegedly protective for cardiovascular diseases.24 Olive oil in the diet has been argued to be a similarly confounding or indirect factor, which is associated with geographical latitude. Seasonally bound ovopathy and its pathophysiological consequences related to geographical latitude again explains the presumed association and needs a paradigm shift. ‘Not the olive is important, but where the olive grows’. A similar paradigm shift related to vitamin D might be necessary. It would discard some inconsistencies encountered, such as fortification or addition of vitamin D in the nutrition still under debate. The epidemiological findings do not prove that higher levels of vitamin D would lower risk of colorectal cancer, while overexposure to UVA is harmful.
References
1 Garland CF, Garland FC. Do sunlight and vitamin D reduce the likelihood of colon cancer? Int J Epidemiol 1980;9:227–31. Reprinted with permission. 2006;35:217–20.
2 Garland CF, C Garland FC. Commentary: Progress of a paradigm. Int J Epidemiol 2006;35:220–22.
3 Giovannucci E. Commentary: Vitamin D and colorectal cancer—twenty-five years later. Int J Epidemiol 2006;35:222–24.
4 Grant WB, Gorham ED. Commentary: Time for public health action on vitamin D for cancer risk reduction. Int J Epidemiol 2006;35:224–25.
5 Cross HS. Commentary: From epidemiology to molecular biology—vitamin D and colorectal cancer prevention. Int J Epidemiol 2006;35:225–27.
6 Egan KM. Commentary: Sunlight, vitamin D, and the cancer connection revisited. Int J Epidemiol 2006;35:227–30.
7 Armstrong BK. Commentary: Seeing the light. Int J Epidemiol 2006;35:231–32.
8 Roenneberg T, Aschoff J. Annual rhythm of human reproduction: I. Biology, sociology, or both? J Biol Rhythms 1990;5:195–216.
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20 Heuch JM, Heuch I, Akslen LA, Kvåle G. Risk of primary childhood brain tumors related to birth characteristics: a Norwegian prospective study. Int J Cancer 1998;77:498–503.[CrossRef][ISI][Medline]
21 McNally RJQ, Cairns DP, Eden OB et al. An infectious aetiology for childhood brain tumours? Evidence from space-time clustering and seasonality analyses. Br J Cancer 2002;86:1070–77.[CrossRef][ISI][Medline]
22 Brenner AV, Linet MS, Shapiro WR et al. Season of birth and risk of brain tumors in adults. Neurology 2004;63:276–81.
23 Dobblhammer G, Vaupel JW. Lifespan depends on month of birth. Proc Natl Acad Sci 2001;98:2934–39.
24 Jongbloet PH. Is the Mediterranean diet relevant to myocardial infarction? Olive oil consumption versus geographical latitude. Int J Epidemiol 2003;32:876–77.
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