D is for Debacle - The Sun, Vitamin D, 25(OH)D and Health

“D” is for DebacleThe Crucial Story of 25(OH)D

www.thefatemperor.com2014 Ivor Cummins BE(Chem) CEng MIEI

A Thank-You to Some Experts:Prof. Michael HolickEndocrinologist and Professor of Medicine, Physiology and Biophysics. Currently director at Boston University Medical Center. Internationally recognized expert on all aspects of vitamin D.

Dr. Edward GorhamAssociate Professor in the Department of Family and Preventive Medicine at the University of California

Prof. Robert P Heaney Clinical Endocrinologist, Professor of Medicine and John A. Creighton University Professor Emeritus, Creighton University School of Medicine. Internationally recognized expert on vitamin D.

Dr. Cedric F Garland Adjt Prof. Family and Preventative Medicine, Division of Epidemiology, University of San Diego. Internationally recognized expert on the disease implications of vitamin D.

Dr. Chris MasterjohnPhD in Nutritional Science and Assistant Professor of Health and Nutrition Sciences at Brooklyn College.

Dr. Bruce Hollis PhDProfessor of Pediatrics, Biochemistry and Molecular Biology at The Medical University of South Carolina as well as the Director of Pediatric Nutritional Sciences. Vitamin D research for the past 35 years and has published >200 peer reviewed articles.

Prof. Reinhold ViethProfessor in the Department of Nutritional Sciences, and the Department of Laboratory Medicine and Pathobiology, University of Toronto. Internationally recognized expert on the clinical nutrition of vitamin D as well as its pharmacology and safety.

Dr. David Grimesconsultant Gastroenterologist at Blackburn Hospital in the UK. Expert in Vitamin D for the developing foetus and the implications for infections, diabetes, heart disease, liver disease and Crohn's disease.

Prelude

1. The Centrality of the Sun2. 25(OH)D – The Creation3. 25(OH)D – The Power4. 25(OH)D – The Human Cost5. Anatomy of a Debacle6. The Solution

Epilogue

The “D”ebacle Content:

2014 Ivor Cummins BE(Chem) C(Eng) MIEI

Prelude1. The Centrality of the Sun2. 25(OH)D – The Creation3. 25(OH)D – The Power4. 25(OH)D – The Human Cost5. Anatomy of a Debacle6. The Solution

Epilogue

The Literature is Exploding

Prelude – Critical Human Hormone

D3 – The Hormone Precursor

2014 Ivor Cummins BE(Chem) CEng MIEI

• “Vitamin” D3 (Cholecalciferol) is the hormone-precursor molecule required to synthesize 25(OH)D

• This is the crucial element provided mostly by UVB light on skin, but can be taken in supplement form & diet

• 25(OH)D is the pre-hormone substrate.

• Is produced in the Liver from D3 Cholecalciferol

• Enabled us to leave the seas, and a lot more besides

• Is used all over the body for critical functions

• An analogy might be “Ammunition Pack”

25(OH)D – The Pre-Hormone

• 25(OH)D is the pre-hormone substrate.

• Is produced in the Liver from D3 Cholecalciferol

• Enabled us to leave the seas, and a lot more besides

• Is used all over the body for critical functions

• An analogy might be “Ammunition Pack”

• 1,25 (OH)2 D is the active Hormone

• Is produced in the Kidney and elsewhere from 25(OH)D

• Is at 1000x lower concentration than 25(OH)D

• An analogy might be “precision bullet”1,25 (OH)2 D – The Active Form

25(OH)D – The Pre-Hormone

Prelude – The Implications of Low…

USA25(OH)D

Distribution(NHANES III Seasonal Sampling)

~70% of US Population Insufficient ( 15 Years Previously was ~50% )

USA25(OH)D

RequiresEngineering

USA25(OH)D

RequiresEngineering

RICKETS

USA25(OH)D

Prelude

1. The Centrality of the Sun2. 25(OH)D – The Creation3. 25(OH)D – The Power4. 25(OH)D – The Human Cost5. Anatomy of a Debacle6. The Solution

Epilogue

Skin Pigmentation Hypotheses – to ~40kYrs ago

EvolutionaryDrivers

LOSS OF BODY HAIR (~1M Yrs ago)• Striding Bipedalism• Sweat Gland System• Whole Body Cooling• Critical Brain Cooling

~1 million years…

EvolutionaryDrivers

• Skin generally non-pigmented

• Hairless areas pigmented

• Sun Protection Robust Overall

• Vitamin D accessed via Grooming, as for dogs etc

• Captive animals require D Supplementation!

~1 million years…

EvolutionaryDrivers

Hair Loss – Key Downside:• Human Origin had Equatorial Sun • Ubiquitous powerful UV penetrates to Blood Vessels

and damages Folate (photolysis) • Lack of folate causes Neural Tube Birth Defects• Other Reproductive Impacts from excessive UV• Also need to protect hugely increased Sweat Gland

System from damageAnd 25(OH)D Synthesis?

• Equatorial Sun still provides adequate amounts of UV in spite of pigmented skin

• Engineering “Tradeoff” thus achieved

~1 million years…

EvolutionaryDrivers

and damages Folate (photolysis) • Lack of folate causes Neural Tube Birth Defects• Other Reproductive Impacts from excessive UV• Also need to protect hugely increased Sweat Gland

System from damageAnd 25(OH)D Synthesis?

~1 million years…

EvolutionaryDrivers

and damages Folate (photolysis) • Lack of folate causes Neural Tube Birth Defects• Other Reproductive Impacts from excessive UV• Also need to protect Homo Sapiens’ hugely

increased Sweat Gland System from damageAnd 25(OH)D Synthesis?

~1 million years…

EvolutionaryDrivers

~1 million years…

EvolutionaryDrivers

• Engineering “Trade-off” thus achieved

~1 million years…

Skin Pigmentation Hypotheses –~30-40k Yrs to present

EvolutionaryDrivers

Migration from Equator• Increasing weakness of UVB• Use of Clothing increases• Adaptive Pressure Deployed• Fishing Ability Offsets

<40k years…

EvolutionaryDrivers

• Skin Heavily Pigmented

• Protection Robust Overall

• Vitamin D synthesis adequate

• Trade-off Optimised

<40k years…

EvolutionaryDrivers

Trade-offs change with Latitude:• Studies strongly link available UV on Earth’s surface

to indigenous Skin Coloration• Increasing Loss of Vitamin D Synthesis as we leave

Equator – combined with poor nutrition, Rickets and many other issues ensue – we’ll look at those shortly

• In Northern Hemisphere particularly severe effect• Acknowledgement: alternative hypotheses suggest

many things: “simply lost pigmentation because unneeded” etc)

<40k years…

EvolutionaryDrivers

<40k years…

EvolutionaryDrivers

• In Northern Hemisphere particularly severe effect• Acknowledgement: alternative hypotheses suggest

many things: “simply lost pigmentation because unneeded” etc)

<40k years…

EvolutionaryDrivers

• In Northern Hemisphere particularly severe effect• Note: alternative hypotheses suggest many things:

“simply lost pigmentation because unneeded” etc

<40k years…

EvolutionaryDrivers

• In Northern Hemisphere particularly severe effect• Note: alternative hypotheses suggest many things:

“simply lost pigmentation because unneeded” etc• But Timeframe and Logic indicate Key Driver, &

emerging hypotheses suggest Sun is critical beyond D

<40k years…

Human Evolutionary Environment:

Assmann G, Schulte H. Am J Cardiol. 1992;70:733–737.

We originally evolved in an intense UVB environment – part of our design

Migration over millennia drove commensurate skin pigmentation adaptation

Tradeoff: Between UV Excess (e.g. Folate), and adequate synthesis of 25(OH)D

Key Takeaways:

Luxwolda and Muskiet,Submitted Manuscript

MAASAI MEDIAN 25(OH)D = 42ng/ml

MAASAIBANTU

Wyoming Woman Athletes 25(OH)D

Why is Breast Milk now D Deficient?MIMIC EVOLUTIONARY SUN

Mother: 6400 IU/dayBaby: Only Breast Milk

MODERN REALITYMother: 400 IU/day Supplement

Baby: 300 IU/day Supplement

Why is Breast Milk now D Deficient?“MIMIC EVOLUTIONARY SUN”

V5=~620

V5=~70

Thus with Mediocre Nutrition in Northern Latitudes, we needed to rapidly devolvePigmentation to enhance D3 synthesis for Infant Needs

V5=~620

V5=~70

Evolution…….Matters.

Bone Mineral Density (g/cm2)

Fracture (RR)

Colon Cancer (RR)

8’ Walk Time (s)

Attachment Loss (mm)

Median 25(OH)D Concentration (ng/ml)

1612 20 24 3228 36 40 44

Adapted from :

And: Nutrients, Endpoints, and the Problem of Proof – Prof. Robert P. Heaney - 2008

Another Evolutionary View…

Fracture (RR)

Colon Cancer (RR)

8’ Walk Time (s)

1612 20 24 3228 36 40 44

Adapted from :

Fracture (RR)

Colon Cancer (RR)

8’ Walk Time (s)

1612 20 24 3228 36 40 44

Adapted from :

Prelude

1. The Centrality of the Sun

2. 25(OH)D – The Creation3. 25(OH)D – The Power4. 25(OH)D – The Human Cost5. Anatomy of a Debacle6. The Solution

Epilogue

How This Most Critical Hormone is Made

7 DeHydroxyCholesterol Primary Source is Sun UVB

(Sunscreen Prevents Synthesis)

7 DeHydroxyCholesterolCholecalciferol(“Vitamin” D3)

Primary Source is Sun UVB

Catalyzes “Cholesterol” to D3

7 DeHydroxyCholesterol

D3/D2Supplements

Cholecalciferol(“Vitamin” D3)

Dietary contribution is limited

Dietary Fatty Fish, Organ Meats, etc

D3/D2Supplements

Liver then makes 25(OH)D

21st Century Science:In-Cell Local 1,25 D

Production on Demand

25(OH)D !

D3/D2Supplements

25(OH)D !

25(OH)D is The KEY METRIC

D3/D2Supplements

25(OH)D !

1,25 D

Kidney then makes 1,25 Dihydroxy Vitamin D

D3/D2Supplements

25(OH)D !

1,25 D

1,25 is ACTIVE Form of D

Liver then makes 25(OH)D :

D3/D2Supplements

25(OH)D !

1,25 D

20th CenturyScience: Mainly Ca Regulation

D3/D2Supplements

25(OH)D !

1,25 D

1,25 does far more than Ca++ regulation !!!

20th CenturyScience: Mainly Ca Regulation

What the Most Critical Hormone Regulates

Valdivielso J M et al. Am J Physiol Renal Physiol 2009;297:F1502-F1509

Low 25(OH) D Invites in: Cancer (esp. Colon/Breast)

TB/Influenza/Infections General

Various Blood Disorders

T1 (and T2) Diabetes

Osteomalacia/Osteoporosis

Asthma / Autoimmune Diseases

Multiple Sclerosis

Heart Disease in General

Thyroid Issues / Chronic Fatigue

Inflammation

Obesity/Hypertension

Metabolic Syndrome

Pre & Post Natal Issues

Multiple Sclerosis

Inflammation

Metabolic Syndrome

Prelude

1. The Centrality of the Sun2. 25(OH)D – The Creation

3. 25(OH)D – Control System Criticality 4. 25(OH)D – The Consequences5. Anatomy of a Debacle6. The Solution

Epilogue

Central Control System of the Human MachineUNIQUE

DNACODE

Central Control System of the Human Machine

35TRILLION

UNIQUEDNA

35TRILLION

UNIQUEDNA

35TRILLION

BLOODSERUM

25(OH)D25(OH)D

UNIQUEDNA

35TRILLION

BLOODSERUM

25(OH)D25(OH)D

1,25 D

UNIQUEDNA

ONDEMAND

35TRILLION

VDRRXR

BLOODSERUM

25(OH)D25(OH)D

1,25 D

UNIQUEDNA

ONDEMAND

35TRILLION

VDRRXR

BLOODSERUM

25(OH)D25(OH)D

1,25 D + SAFETYSWITCH

UNIQUEDNA

ONDEMAND

35TRILLION

VDRRXR

BLOODSERUM

25(OH)D

1,25 D

VDRRXR

25(OH)D

UNIQUEDNA

ONDEMAND

35TRILLION

VDRRXR

BLOODSERUM

25(OH)D

1,25 D

VDRRXR

25(OH)D

UNIQUEDNA

ONDEMAND

35TRILLION

VDRRXR

BLOODSERUM

25(OH)D

Transcription!!

1,25 D

VDRRXR

25(OH)D

UNIQUEDNA

ONDEMAND

35TRILLION

VDRRXR

BLOODSERUM

25(OH)D

Transcription!!

1,25 D

VDRRXR

25(OH)D

SAFETYSWITCH

UNIQUEDNA

ONDEMAND

35TRILLION

VDRRXR

BLOODSERUM

25(OH)D

Transcription!!

1,25 D

VDRRXR

25(OH)D

SAFETYSWITCH

UNIQUEDNA

ONDEMAND

35TRILLION

VDRRXR

BLOODSERUM

25(OH)D

Transcription!!

1,25 D

VDRRXR

25(OH)D

SAFETYSWITCH

UNIQUEDNA

ONDEMAND

CRITICAL PROTEINSe.g. CATHELICIDIN

35TRILLION

VDRRXR

BLOODSERUM

25(OH)D

Transcription!!

1,25 D

VDRRXR

25(OH)D

SAFETYSWITCH

UNIQUEDNA

ONDEMAND

Replication!!

35TRILLION

VDRRXR

BLOODSERUM

25(OH)D

Transcription!!

1,25 D

VDRRXR

Blood Pressure

Cancer

Heart Disease

MS, TB, Flu

Asthma

T1 Diabetes

T2 Diabetes

Obesity

Met Syndrome

Alzheimers

25(OH)D

SAFETYSWITCH

UNIQUEDNA

ONDEMAND

Replication!!

SAFETYSWITCH↑↑CATHELICIDIN

Prelude

1. The Centrality of the Sun2. 25(OH)D – The Creation3. 25(OH)D – The Power

4. 25(OH)D – The Consequences5. Anatomy of a Debacle6. The Solution

Epilogue

Survival Outcome for low 25(OH)D reminiscent of Smokers Vs Non-Smokers

Doesn’t Prove Causality

Summary:

HEART and GENERAL MORBIDITY

Relation of Vitamin D Deficiency to Cardiovascular Risk Factors, Disease

Status, and Incident Events in a General Healthcare Population

Jeffrey L. Anderson, MDa,b,*, Heidi T. May, PhD, MSPHa, Benjamin D. Horne, PhD, MPHa,c,

Tami L. Bair, BSa, Nathaniel L. Hall, MDa,b, John F. Carlquist, PhDa,b, Donald L. Lappé, MDa, andJoseph B. Muhlestein, MDa,b, for the Intermountain Heart Collaborative (IHC) Study Group

(Am J Cardiol 2010;106:963–968)

Population 25(OH)D Levels

Adequate>30ng/ml

36.4% V. Low <16

Low16-30 ng/ml

Majority Population Insufficient

Remember D is a proxy for Sun(!)

Vitamin D and Cardiovascular Disease Carl J. Lavie, MD, John H. Lee, MD, Richard V. Milani, MD (J Am Coll Cardiol 2011;58:1547–56)

Survival trends stronger than Non-Smoker versus Smoker

Dose-Response Relationship with Accelerated Effect in lowest Quartile

Key Takeaways:

CVD and All Cause Death

Incidence Rate Average of 6 Studies, consistent association throughout

Key Takeaways:

COLON CANCER – Incidence Rate

55% reduction in ColonCancer Risk associated with 38ng/ml 25(OH)D

r P trend <0.0001

COLON CANCER INCIDENCE

10 20 4030

Incidence Rate Average of 6 Studies, consistent association throughout

Mortality strongly associated with 25(OH)D levels, but multi-factor phenomenon

Key Takeaways:

COLON CANCER – Incidence Rate

55% reduction in ColonCancer Risk associated with 38ng/ml 25(OH)DO

P trend <0.0001

COLON CANCER INCIDENCECOLON CANCER MORTALITY

RR = 0.28

RR = 0.44

10 20 4030

P trend =0.02

Strong, Linear association – & D mechanism directly tied to cell proliferation

Key Takeaways:

BREAST CANCER - Mortality

Vitamin D and prevention of breast cancer: Pooled analysis (2007)

Cedric F. Garland,, Edward D. Gorhama, Sharif B. Mohra, William B. Grant b,Edward L. Giovannucci,

Martin Lipkin, Harold Newmarke, Michael F. Holick, Frank C. Garland

Journal of Steroid Biochemistry & Molecular Biology 103 (2007) 708–711

P trend <0.001

R2 = 0.9

50% lower riskwith 48 ng/ml

Strong, Linear association – & D mechanism directly tied to cell proliferation

Key Takeaways:

Vitamin D and prevention of breast cancer: Pooled analysis (2007)

Cedric F. Garland,, Edward D. Gorhama, Sharif B. Mohra, William B. Grant b,Edward L. Giovannucci,

Martin Lipkin, Harold Newmarke, Michael F. Holick, Frank C. Garland

Journal of Steroid Biochemistry & Molecular Biology 103 (2007) 708–711

P trend <0.001

R2 = 0.9

P trend <0.002

R2 = 0.94

Association is Dramatic, and mechanism’s available.

Key Takeaways:

Where would you rather be?

BREAST CANCER MORTALITY

RR = 0.28P <0.05

Enormous body of evidence linking MS to 25(OH)D Status

MULTIPLE SCLEROSIS

Contribution of vitamin D

insufficiency to the

pathogenesis of Multiple Sclerosis

Ther Adv Neurol Disord(2013) 6(2) 81–116DOI: 10.1177/1756285612473513

Ireland53O N

Enormous body of evidence linking MS to 25(OH)D Status:

MULTIPLE SCLEROSIS

25(OH)D Interacts with risk of MS from conception thru life via different mechs

Contribution of vitamin D

insufficiency to the

pathogenesis of Multiple Sclerosis

Ther Adv Neurol Disord(2013) 6(2) 81–116DOI: 10.1177/1756285612473513

MULTIPLE SCLEROSIS

Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study

BMJ VOLUME 327 9 AUGUST 2003 bmj.com

N=136 MS Cases (in their 30’s) vs 273 Matched Controls

Summary:

MULTIPLE SCLEROSIS

Summary:

Consistent Dose-Response Benefit primarily for exposure age 6-10 and 10-16

P<0.01 for trend

MULTIPLE SCLEROSIS

Summary:

Even more marked when Actinic Damage was used as independent measure

P<0.01 for trend P<0.01 for trend

MULTIPLE SCLEROSIS

Summary:

Even more marked when Actinic Damage was used as independent measure

Conclusion: UVB and/or D critical for Adaptive Immune System Development

P<0.01 for trend P<0.01 for trend

Prelude

1. The Centrality of the Sun2. 25(OH)D – The Creation3. 25(OH)D – The Power

4. 25(OH)D – The Consequences5. Anatomy of a Debacle6. The Solution

Epilogue

Correctly executed, difference controlled to be primarily D and Ca.

Key Takeaways:

ALL CANCER MORTALITY (Experiment)

Baseline 25(OH)D = 29ng/ml

1100 IU Vitamin D + 1450 Ca / day

Randomized Control Trial

N = 1179 Healthy Women

2014 Ivor Cummins BE(Chem) Ceng MIEI

Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial

Correctly executed, difference controlled to be primarily D and Ca.

Key Takeaways:

ALL CANCER MORTALITY (Experiment)

Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial

Baseline 25(OH)D = 29ng/ml

1100 IU Vitamin D + 1450 Ca / day

Randomized Control Trial

N = 1179 Healthy Women

Clear impact on Cancer and Overall mortality, especially with 1st Year removed

TYPE 1 DIABETES

The most common serious chronic disease in children, esp. in Northern Latitude

TYPE 1 DIABETES - Finnish Study

Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study

THE LANCET • Vol 358 • November 3, 2001

N=12,055 Births in 1966, Supplementation 1st year of life, follow-up to 1997

Summary:

Note: Vitamin D known to prevent Type 1 Diabetes in animals

Summary:

Adjusted for Social Status, Birth Weight, Growth Rate etc.

Summary:

Conclusion Clear – Verified Vitamin D critical for Immune System Development

FINLAND GUIDELINE VIT D vs Type1 Diabetes Incidence in <15 Year Olds

Northern Latitude, very poor UVB. Supplement Strategy collapsed since 1950’s

Summary:

Incidence of Type 1 Diabetes in Finland

JAMA July 24/31, 2013 Volume 310, Number 4

TYPE 1 DIABETES - Supplementation History?IU

Summary:

Incidence Rate studied for 1978 onwards, & some Trend Messing about…

TYPE 1 DIABETES - Supplementation History?

Summary:

Conclusion: Not quite clear? Questioned. Supplemented Dairy acknowledged.

Incidence Rate studied for 1978 onwards, & some Trend Messing about…

D-fortifiedDairy

Remove the inappropriate inferences, and plot a natural curve

Engineering Style Summary:

D-fortifiedDairy

Add in the earlier historical data from another source that had it…

Diabetes December 2002 vol. 51 no. 12 3353-3361

The Rise of Childhood Type 1 Diabetes in the 20th Century

D-fortifiedDairy

Conclusion: - go figure.

Diabetes December 2002 vol. 51 no. 12 3353-3361

The Rise of Childhood Type 1 Diabetes in the 20th Century

Add in the earlier historical data from another source that had it…

D-fortifiedDairy

Strong Hypothesis that Flu Outbreaks are mediated by 25(OH)D levels

Summary:

INFLUENZA – Seasonal Triggering

Hypponen E, Power C:

Hypovitaminosis D in British

adults at age 45 y: nationwide

cohort study of dietary and lifestyle predictors

Am J Clin Nutr 2007, 85: 860–868

Strong Hypothesis that Flu Outbreaks are mediated by 25(OH)D levels

Summary:

Hypponen E, Power C:

Hypovitaminosis D in British

adults at age 45 y: nationwide

cohort study of dietary and lifestyle predictors

Am J Clin Nutr 2007, 85: 860–868

Latitude Simultaneity, Transfer Dynamics, etc

MonthSeason

Berry DJ, Hesketh K, Power C, et al. (2011) Vitamin D status has a liner

association with seasonal infections and lung function in British adults.Br J Nutr 106, 1433–1440

208 randomised individuals to placebo or 800 IU/day of D3 over 2 years

Key Takeaways:

INFLUENZA – Hospital Experiment

Re: epidemic Influenza and vitamin D

Aloia JF, Li-Ng M: Epidemic influenza and vitamin D. Epidemiol Infect 2007; 135: 1095–1096

Cannell et al. Virology Journal 2008 5:29 doi:10.1186/1743-422X-5-29.

Increased to 2000 IU/day in 3rd Year

Key Takeaways:

25(OH)D acts via multiple mechanisms as discussed

Key Takeaways:

25(OH)D acts via multiple mechanisms as discussed

Very few studies done (and mouse/rat/dog lack the VDR for this mechanism, so much data is worthless…)

The Bottom Line: “Mechanisms From pre-Cradle to Grave”

Prelude

1. The Centrality of the Sun2. 25(OH)D – The Creation3. 25(OH)D – The Power4. 25(OH)D – The Consequences

5. Anatomy of a Debacle6. The Solution

Epilogue

Witness An Unfolding Catastrophe….

NHANES III (1988-1994)

NHANES (2001-2004)

The Literature is Exploding

European Journal of Clinical Nutrition (2012)

doi:10.1038/ejcn.2012.78

Vitamin D and the scientific calcium dogma: understanding the ‘Panacea’ of the sun

doi:10.1038/ejcn.2012.78

USA25(OH)D

Distribution

< 32ng/ml > 32ng/ml

Recall Where We Are Now…..

doi:10.1038/ejcn.2012.78

Recall Where We Are Now….. P

The Skin Cancer / Melanoma Hysteria

J Am Acad Dermatol. 2006 Feb;54(2):301-17 2014 Ivor Cummins BE(Chem) CEng MIEI

330 340 350 360 360 370 380 390 400

Blue is UV-B zone that enables Vitamin D Synthesis (and Cholesterol Sulphate)

330 340 350 360 360 370 380 390 400

Red is zone that enables tan protection, and warning Erythema (Sunburn) Blue is UV-B zone that enables Vitamin D Synthesis (and Cholesterol Sulphate)

330 340 350 360 360 370 380 390 400

Green is zone that theoretical modelling suggests “Cosmetic” Skin Cancers Red is zone that enables tan protection, and warning Erythema (Sunburn) Blue is UV-B zone that enables Vitamin D Synthesis (and Cholesterol Sulphate)

330 340 350 360 360 370 380 390 400

UV-A is currently deemed the primary driver of Cutaneous Malig. Melanoma Green is zone that theoretical modelling suggests Squamous Skin Cancer Red is zone that enables tan protection, and warning Erythema (Sunburn) Blue is UV-B zone that enables Vitamin D Synthesis (and Cholesterol Sulphate)

~95% of Terrestrial UV Energy is from UVA. And it sails thru

Ozone, and even Glass

330 340 350 360 360 370 380 390 400

Green is zone that theoretical modelling suggests Squamous Skin Cancer Red is zone that enables tan protection, and warning Erythema (Sunburn) Blue is UV-B zone that enables Vitamin D Synthesis (and Cholesterol Sulphate)

UV-A is currently deemed the primary driver of Cutaneous Malig. Melanoma

Squamous and Basal cell Skin Cancers?

- <0.5% Mortality)USA: ~2k deaths/yr

Melanoma Zone – Serious Stuff

USA: ~9k deaths/yr

So who’s the idiot? (a) Evolution Itself, or (b) how humans have interpreted it??

330 340 350 360 360 370 380 390 400

Green is zone that theoretical modelling suggests Squamous Skin Cancer Red is zone that enables tan protection, and warning Erythema (Sunburn) Blue is UV-B zone that enables Vitamin D Synthesis (and Cholesterol Sulphate)

UV-A is currently deemed the primary driver of Cutaneous Malig. Melanoma

Squamous and Basal cell Skin Cancers?

- <0.5% Mortality)USA: ~2k deaths/yr

Melanoma Zone – Serious Stuff

USA: ~9k deaths/yr

Sunscreens Effective Most Sunscreens Not Effective

MELANOMA Versus Sun Exposure History