Vitamin D and the Risk of Cancer - "Disappoints"November 19, 2018
Vitamin D and the Risk of Cancer - "Disappoints"
It was all over the news last week, "Vitamin D Doesn't Help Reduce Your Risk of Cancer". Published in the prestigious New England Journal, (lead article, no less) this smacks of credibility. It was randomized with 25,871 Americans from all over the country and intentionally designed to include 20 percent African-Americans. Folks were given 2,000 IU of Vitamin D or placebo for a median range of 5.6 years. The results were "disappointing" in that there was no statistical reduction in cancer.
What's my take on this? Wow, there are so many flaws, I'm just stunned that this made it into the NEJM. This reflects all the classical problems of nutritional research. Let me give it a try to see if I can convince you with a reasonable argument. First, cancer is not a 5 year disease. It is a 15-20 year disease. Here is why. A 1 cm nodule, big enough to be seen on an x-ray is about 1 billion cells. That is about 2 to the 30th power, or 30 generations, or 30 doublings. If a doubling takes 6 months, you have 15 years for that cancer to grow from one cell to its current size. The time you want to be affecting cells is at the very beginning of their life.
Vitamin D's core function is to tell immature cells to mature. A mature cell is programmed to die at the end of its "time". Cancer cells don't grow wildly as much as they don't die. A five year study is way too short. And if I were to do the study, I would first do the new generation blood testing studies that can show cancer cells circulating 5-7 years before clinically apparent. We'll talk about those next week.
The key problem with this study is then that the cancers that do show up in 5 years will already be 10 years down the road from getting started and no longer modulated by vitamin D levels. As cancers progress from generation 1 to generation 30, they add more mutations to allow them to grow with their primary genetic defect in their mitochondria. They are now autonomous and on the road to aggressive disease. Any study that looks at generation 22-30 is looking at inevitable disease. Vitamin D is going to work at generation 1-10.
Second problem. Way too low a dose. We know that you have Toll Receptor Proteins that are sensitive to Vitamin D and they are not activated until your D level is 32. Since that research study by Liu in Science came out there has been an explosion of research all linking low Vitamin D to a sluggish immune response to TB and just about everything else. You need enough Vitamin D to fight cancer, or anything else. 2,000 IU of Vitamin D will get you to a blood level of 30. Just. We've shown that with a study in Antarctica over winter where you get NO Vitamin D for 6 months, guaranteed.
Worse, African Americans have pigment which keeps Vitamin D out. They start with levels of 5.5 ng - 15 ng, whereas Caucasians start with 20. This study didn't get blood levels. Arrghhh. Two thousand units of D is what a healthy young Caucasian will make in 2 minutes of sun exposure in June. Get their blood level to 50, for goodness sakes!
And go read Garland's study in PLOS1, that showed a 67% reduction in cancer when your blood level gets closer to 50 than 20. This study likely had folks D levels around 25, way, way, way too low. If you look at folks who live on the Equator in Africa, the Masai and the Hadzabe, both who are very dark skinned, wear very little clothing and have abundant sunshine, you find a D level of 45-55 range. That's what we should aim for. And by the way, they have very little cancer. I can go on....finally. Any new dose of D takes about a year to reach a new homeostasis without a starting loading dose. This wasn't a four-year study at a stable dose, it was a three-year study. Your body thinks of D's "volume of distribution" of D as about 1,000 gallons, not the 20 gallons you think of yourself representing. That is because D dissolves into fat. And D isn't a vitamin in isolation. It is critically linked to K2. You can't do foods in isolation. You need ecosystems......I can rant on and on. But this study doesn't help me much. It just gets me steamed up.
WWW: What will work for me. Just out of pique, I went and took my monthly dose of 100,000 a few days early. My blood level runs around 50 ish when I take 100,000 a month. But the war on cancer is just getting wound up. I want to learn all the technology of advance warnings on cancer and show that lifestyle can reduce your risk when we catch those early cancer cells when they are still capable of being modulated.
- Cancer cells that you find by physical exam are usually at least 1 cm in size. How many cells does that represent? Answer: about a billion, which is 30 generations of cancer cells, which is about 7-15 years of disease.
- Humans have toll receptor proteins on immune cells regulated by Vitamin D. They are activated by what level of D? n Answer: above 32
- Two thousand units of D is the equivalent of how much sunshine in a middle European young person? Answer: 2 minutes. (Africans need 12 minutes to get the same amount. Arabs and South Asians need about 6 minutes to make that much D. Finns, Russians and Celts need less than a minute, and then they burn.
- A study of Vitamin D and cancer should run for how long? Answer: At least 15 years and then you are just getting started. And throw in some K2 while you are at it.
- It's possible to weed out folks who might be getting cancer in the next 7 years by what? Answer: read next week. The science of circulating cancer cells is coming soon.