Skin cancer is rampant. In an earlier blog, evidence was presented that a common drug for erectile dysfunction, sildenafil (Viagra), had a nasty side effect: Its use was associated with an increased risk of melanoma.
Now, another study from Denmark demonstrates that a popular drug for high blood pressure is dangerous. It substantially raises the risk of non-melanoma skin cancer (NMSC). The NMSC specifically studied was squamous cell carcinoma (SCC), which is easily treated and has a low mortality rate. Nevertheless, it is something we should try to avoid. Hydrochlorothiazide is the drug. It is popular in both the U.S. and Western Europe. Approximately 10% of all cases of squamous cell carcinoma may be caused by Hydrochlorothiazide. Especially relevant is this fact: In Denmark, the risk of developing squamous cell carcinoma is up to seven times greater for users of Hydrochlorothiazide. However, It should be noted that other types of blood-pressure medication did not show the same effects in promoting skin cancer.
Why do we post this information on skin cancer?
The reason for posting this information? To try to halt the idea that sun exposure is the cause of all skin cancers. In fact, there is a plethora of evidence against that idea. Furthermore, regular, non-burning sun exposure is protective against melanoma in most people. In previous blogs for Sunlight Institute, we have offered evidence that lack of foods such as nuts, seeds, tomatoes, greens and fruits increase skin cancer risk. Meat consumption has also been shown to increase the risk of melanoma. So has alcohol consumption. PCB exposure also increases the risk. Being obese is another risk factor. Hence, Hydrochlorothiazide has many partners in promoting skin cancer.
In conclusion: When you see that someone has a skin cancer, think! Is it due to drugs? Is it due to poor nutrition? While sunlight may have an influence on squamous cell carcinoma, we should definitely not immediately determine that it is caused by our friend, the Sun.
 Li WQ, Qureshi AA, Robinson K, Han J. Sildenafil use and increased risk of incident melanoma in US men: a prospective cohort study. JAMA Intern Med. 2014 Jun;174(6):964-70C.
 Arnspang S, Gaist D, Johannesdottir Schmidt SA, Hölmich LR, Friis S,
Pottegård A, Hydrochlorothiazide use and risk of non-melanoma skin cancer: A nationwide case-control
study from Denmark, Journal of American Dermatology (2017), doi: 10.1016/j.jaad.2017.11.04
 Popular blood pressure medicine linked with increased risk of skin cancer. Medical Express News, Nov. 5, 2017. https://medicalxpress.com/news/2017-12-popular-blood-pressure-medicine-linked.html;
In an impressive mouse study, it was shown that in animals that were exposed to high doses of radiation during a 35-week program, those that were fed a pre-radiation dose of tomato powder or tangerine powder had a higher level of the antioxidant lycopene than mice who were not fed the powders (control group). Lycopene is a potent antioxidant found in tomatoes, tangerines, watermelon and other fruits and vegetables.
Interestingly, the animals that consumed the tangerine powder had higher levels of lycopene than those consuming the tomato powder, but the results were not as impressive. The number of cancerous tumors that developed in the tomato-fed mice was about half the number that developed in the control group. Tomatoes obviously have anti-skin cancer attributes, but remember that lycopene may not be as effective as the whole tomato powder in reducing that disease. Whole foods are nearly always superior to the nutrients extracted from them, as all of the nutrients work in concert to help health whether for mice or men. There may be hundreds of nutrients besides lycopene in tomatoes, all having a positive effect in protecting against cancer. Why just take one nutrient from the tomato and put it in a pill? I’ll tell you why: It is a way to make money. In this case, the researchers discovered that important substances called glycoalkaloids were significantly higher in the skin after the ingestion of tomato powder, and seem to believe that these substances were responsible for the reduced risk of skin cancer.
It has actually been known for some time that some of the best skin protectants are tomatoes. One investigation showed that among individuals who consumed forty grams of tomato paste daily for ten weeks, sunburn-resistance time increased by 40%, and other research demonstrated that eating different tomato-based products correlated to significantly reduced risk of sunburn after exposure to ultraviolet radiation from sunlamps. It is also known that individuals with the lowest intake of alpha-carotene, beta-carotene, cryptoxanthin, lutein, and lycopene (all carotenoid antioxidants found in such vegetables such as carrots and tomato) had a 50% increased risk for melanoma.
There are few foods that taste better than a ripe, field-grown tomato. Eat your fill and enjoy some regular, non-burning sun.
 Cooperstone JL, Tober KL, Riedl KM, Teegarden MD, Cichon MJ, Francis DM, Schwartz SJ, Oberyszyn TM. Tomatoes protect against development of UV-induced keratinocyte carcinoma via metabolomic alterations. Sci Rep. 2017 Jul 11;7(1):5106.
 Stahl W, Heinrich U, Wiseman S, Eichler O, Sies H, Tronnier H. Dietary Tomato Paste Protects against Ultraviolet Light–Induced Erythema in Humans. J Nutr 2001;131:1449-51.
 Aust O, Stahl W, Sies H, Tronnier H, Heinrich U. Supplementation with tomato-based products increases lycopene, phytofluene, and phytoene levels in human serum and protects against UV-light-induced erythema. Int J Vitam Nutr Res 2005;75:54-60.
 Millen AE, Tucker MA, Hartge P, Halpern A, Elder DE, Guerry D 4th, Holly EA, Sagebiel RW, Potischman N. Diet and melanoma in a case-control study. Cancer Epidemiol Biomarkers Prev 2004;13:1042-51
 Afaq F, Katiyar SK. Polyphenols: skin photoprotection and inhibition of photocarcinogenesis.Mini Rev Med Chem. 2011 Dec;11(14):1200-15.
 Afaq F, Katiyar SK. Skin photoprotection by natural polyphenols: Anti-inflammatory, anti-oxidant and DNA repair mechanisms. Arch Dermatol Res 2010;302:71.
 Stahl W, Heinrich U, Wiseman S, Eichler O, Sies H, Tronnier H. Dietary Tomato Paste Protects against Ultraviolet Light–Induced Erythema in Humans. J Nutr 2001;131:1449-51.
 Meyskens FL Jr, Farmer PJ, Anton-Culver H. Diet and melanoma in a case-control study. Cancer Epidemiol Biomarkers Prev 2004;13:1042-51.
The Vitamin D Society of Canada has just released one of the best articles on the relationship of sun exposure and its potential for vitamin D production. Sun exposure is the natural way to obtain your essential vitamin D, and of course provides other essential photoproducts such as nitric oxide, serotonin, endorphin and BDNF.
Here is the press release from the Vitamin D Society, in full:
For Immediate Distribution
TORONTO, Ont (April 4, 2017) – The daylight hours are getting longer, the sun is getting stronger and summer is just around the corner. Make this the year that you optimize your vitamin D levels through effective sun exposure. Enjoy the health benefits and disease prevention from optimal vitamin D levels and learn to control your risks from sun exposure.
Vitamin D is made naturally in your body when UVB rays from the sun convert cholesterol in your skin to pre-vitamin D3. We make about 90% of our vitamin D from UVB sun exposure. UVB rays are short and only reach the earth when the sun is directly above us. We can’t make vitamin D in the winter in Canada because the sun is at too low of an angle and the UVB rays are absorbed in the atmosphere.
You make vitamin D in Canada between the months of May and October. The best time for exposure is around midday, between 10am and 2pm, when the UV index is above 3 and your shadow is shorter than your height. The further you get from noon, the lower the amount of vitamin D you’ll make. The sun’s visible light may penetrate through glass, but UVB light will not; therefore you will not make vitamin D.
Full body sun exposure at non-burning levels can create between
10,000-25,000 IU of vitamin D in your skin. You can never get too much vitamin D from the sun as your skin self regulates, whereas ingesting vitamin D does not have the same control. In addition, vitamin D that you make from the sun lasts twice as long in your body as vitamin D taken through supplements or food.
Statistics Canada reports that Canadian vitamin D levels have dropped by 10% over the past six years. The root cause of this decrease is lower sun exposure. People are just not getting outside around midday in the summer and making vitamin D, and when they are outside they are using sunscreen, which if applied correctly prevents 95%+ of vitamin D production.
In Canada, 12 million Canadians (35%) have vitamin D blood levels below the recommendations from Health Canada. This puts these people at a higher risk for several diseases, including cardiovascular disease, cancer, osteoporosis, diabetes, multiple sclerosis, Alzheimer’s disease and many more. In fact, a study completed in 2016 reported that if Canadians increased their vitamin D levels to the recommended level of 100 nmol/L, we would save $12.5B in healthcare costs and 23,000 premature deaths annually.
A recent study reported that women who avoided the sun have twice the risk of all cause death. The authors said that “avoidance of sun exposure is a risk factor for death of a similar magnitude as smoking.”
Skin cancer is a concern and risk of sun exposure must be managed and balanced with the benefits from vitamin D and other photoproducts. Research has shown that people with higher sun exposure such as outdoor workers, who have 3-10 times the sun exposure as indoor workers, have a lower incidence of melanoma. The National Cancer Institute reports that
melanoma risk is increased as a result of intermittent acute sun
exposure leading to sunburn. People who are a skin type 1, with white or very pale skin colour, red or blonde hair colour and who always burn and never tan, should severely limit their sun exposure.
The Vitamin D Society offers the following tips:
– Know your own skin and skin type. Don’t burn. Never overexpose yourself.
– Acclimatize or condition your skin for sun exposure by gradually
building or lengthening exposure times as your skin begins to tan to reduce your risk of burning
– Prevent burning and overexposure when required through the use of hats, clothing, shade and sunscreens.
– For vitamin D, get sun exposure at midday, between 10 am and 2 pm, when the UV index is above 3 and your shadow is shorter than your height.
– Expose more skin for a shorter period of time to generate more vitamin D while reducing your risk of overexposure.
It’s important to manage the risk and enjoy the rewards of moderate sun exposure for good health. Cancer Research UK, through the Consensus Vitamin D Position Statement, offers the following recommendation:
“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.”
“This advice may go against what current health organizations
recommend,” says Perry Holman, Executive Director of the Vitamin D Society. “They typically recommend you stay out of the sun at midday and use sunscreen when outdoors. But this would reduce your potential vitamin D production and does not consider the benefits as well as the risks of sun exposure on overall health. You need to have balance.”
About the Vitamin D Society:
The Vitamin D Society is a Canadian non-profit group organized to increase awareness of the many health conditions strongly linked to vitamin D deficiency; encourage people to be proactive in protecting their health and have their vitamin D levels tested annually; and help fund valuable vitamin D research. The Vitamin D Society recommends people achieve and maintain optimal 25(OH)D blood levels between 100 –
150 nmol/L (Can) or 40-60 ng/ml (USA).
To learn more about vitamin D, please visit www.vitamindsociety.org
For more information, please contact:
Melissa Andrade, Enterprise Canada 905-346-1230
THIS PRESS RELEASE CONTAINS MUCH OF WHAT YOU NEED TO KNOW ABOUT VITAMIN D, SUN EXPOSURE AND HEALTH. Please read it carefully, as it could save your life.
By Marc Sorenson, EdD, for sun exposure…
A new research paper on sun exposure and cancer has some interesting observations and some errors. It is entitled, Does Sunlight protect us from cancer? Here is the abstract of the article, verbatim.
“The Ultraviolet (UV) radiation contained in sunlight is a powerful mutagen and immune suppressant which partly explains why exposure to solar UV is the biggest risk factor for the development of cutaneous tumors. Evidence is building that sunlight may be protective against some internal malignancies. Because patients with these tumors are often vitamin D deficient, this has led some to propose that vitamin D supplementation will be beneficial in the treatment of these cancers. However, the results from already completed trials have been disappointing which has given weight to the argument that there must be something else about sunlight that explains its cancer-protecting properties.”
The first sentence, of course, is false. The idea, that sun exposure is the biggest risk factor for skin cancer, is erroneous. We have presented materials many times, proving that melanoma is not caused by sun exposure, and that sun exposure is protective against that disease. And as regards common skin cancers, we have shown that high-fat nutrition, lack of antioxidants, meat consumption and alcohol intake are all risk factors. Search the blogs on this site to read the different articles.
The statement is correct, of course, that sunlight is protective against many internal cancers. Dr. Bill Grant and I are finishing our book, Embrace the Sun, where we present nearly all of the research on the protective influence of sun exposure against cancer.
The statement that vitamin D research has been disappointing is both true and false. Randomized controlled studies (RCTs) have shown the vitamin D supplements do have a protective effect against internal cancers, contrary to the statement by the researchers.
Finally, let’s look at the statement that there is something beyond vitamin D that explains the cancer-protecting properties of sun exposure. That is partially true. Beyond vitamin D, the sun causes the production of nitric oxide, serotonin, endorphin and BDNF, all of which are vital to human health, and may have their own cancer-protective properties.
The bottom line? Eat correctly (avoid junk), REGULARLY soak up some sun around midday and get plenty of exercise. That advice will be a boon to your health in myriad ways.
UVB exposure benefits by Marc Sorenson, EdD. Sunlight Institute…
UVB is a spectrum of sunlight that is responsible for stimulation of vitamin D production in the skin. It also has many other 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.   
Since inflammation is also necessary to produce the condition of atherosclerosis (arterial plugging or occlusion) in arteries, it would be interesting to know whether UVB light might also have the same anti-inflammatory effects in those arteries. If so, the UVB effect could inhibit or eliminate atherosclerosis, and by so doing provide an entirely new treatment for heart disease and other vascular events such as stroke and intermittent claudication.
The idea that UVB could prevent atherosclerosis by reducing inflammation in arteries was recently studied by Japanese researchers.  Using a mouse model, they demonstrated that UVB light irradiation, once weekly for 14 weeks, leads to an increase in the action of T-regulatory cells that inhibit inflammation. In addition, UVB exposure also reduced the production of another type of T-cell that 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. Or stated differently, the research shows that sun exposure is critically-important therapy to reduce and prevent heart and other vascular diseases.
Protect your heart by being sure to obtain sufficient non-burning UVB light from sun exposure or other sources such as the UVB lamps used by the researchers. It is important to note that neither skin cancer nor skin inflammation were observed following UVB exposure.
This is another breakthrough study that emphasizes the necessity of sun exposure for human health.
 National Psoriasis Foundation web site Oct. 2005.
 Yelverton CB, Kulkarni AS, Balkrishnan R, Feldman SR. Home ultraviolet B phototherapy: a cost-effective option for severe psoriasis. Manag Care Interface 2006;19:33-36, 39.
 Situm M, Bulat V, Majcen K, Dzapo A, Jezovita J. Benefits of controlled ultraviolet radiation in the treatment of dermatological diseases. Coll Antropol. 2014 Dec;38(4):1249-53.
 Gupta A, Arora TC, Jindal A, Bhadoria AS. Efficacy of narrowband ultraviolet B phototherapy and levels of serum vitamin D3 in psoriasis: A prospective study. Indian Dermatol Online J. 2016 Mar-Apr;7(2):87-92.
 Naoto Sasaki, Tomoya Yamashita, Kazuyuki Kasahara, Atsushi Fukunaga, Tomoyuki Yamaguchi, et al. UVB Exposure Prevents Atherosclerosis by Regulating Immunoinflammatory Responses. Arterioscler Thromb Vasc Biol. 2016;36:00-00.
 Hafid Ait-Oufella, Andrew P. Sage. Editorial. The Sunlight. A New Immunomodulatory Approach of Atherosclerosis. (Arterioscler Thromb Vasc Biol. 2017;37:7-9. DOI: 10.1161/ATVBAHA.116.308637.)
By Marc Sorenson, EdD, Sunlight Institute…..
Before proceeding with the discussion on sunlight addiction, it is important to review the truth about sunlight and melanoma, to understand why sunlight addiction may be a good thing.
A recent report on ultraviolet light and addiction is obviously meant to be a hit piece regarding sunlight exposure and tanning, as seen in the opening statement: “Despite widespread awareness that 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. Whereas the relatively benign common skin cancers are increased by exposure to sunlight, melanoma is increased by avoiding the sun. If the dramatic increase in melanoma over the past century were due to sunlight exposure, then sunlight exposure must also have increased dramatically during that time. To determine whether that has happened, 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 decrease in human sunlight exposure during the years from 1910 to 2,000. The statistics showed that indoor occupations such as “professional, managerial, clerical, sales, and service workers grew from one-quarter to three-quarters of total employment between 1910 and 2000.” BLS also stated that during the same period, the outdoor occupation of farming declined from 33% to 1.2% of total employment, a 96% reduction. The data also showed an approximately 66% decline in the occupation of farmers and 50% of the decline in the occupation of farm laborers.
The Environmental Protection Agency also determined that as of 1986, about 5 percent of adult men worked mostly outside, and that about 10 percent worked outside part of the time. The proportion of women who worked outside was thought to be even lower. These data demonstrate a dramatic shift from outdoor, sun-exposed activity to indoor, non-sun-exposed activity during the mid-to-late 20th Century.
Despite these facts, the Melanoma International Foundation (MIF) has stated that melanoma has increased by 30 times (3,000%) just since 1935! Here is the statement by the MIF: “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.” Indeed, the American Cancer Society in 2014 reported that one in 50 now contracts the disease. That exponential increase in melanoma has been accompanied by a profound decrease in sunlight exposure, yet sunlight or other UV exposure is blamed for the melanoma increase—a totally counterintuitive argument! I submit that not only is sunlight not responsible for the exponential increase in melanoma, but that the decrease in sun exposure may be a major cause of that increase.
Here are other facts that belie the idea that melanoma is caused by sunlight exposure:
- Outdoor workers, while receiving 3-9 times the UVR exposure as indoor workers,  have had no increase in melanoma since before 1940, whereas melanoma incidence in indoor workers has increased steadily and exponentially.
- Most melanomas occur on areas of the body that are seldom or never exposed to the sunlight.  
- The use of sunscreen, which has increased steadily, has not resulted in a decrease in melanoma. In fact, melanoma has increased as sunscreen use has become more widespread. Since sunscreens block sunlight, it is evident that at best they are a waste of money and at worst may be contributing to the increase in melanoma.
Now, let’s discuss the research on the aforementioned addiction to sunlight. The researchers conducted various experiments on mice that showed behavior choices, such as desiring lighter rather than darker environments, were increased by regular exposure. These behavior choices were mediated by β-endorphins, peptide hormones which are similar to opiates. So is this all bad? This marvelous product, β-endorphin, is one of the feel-good hormones that decreases pain and increases a sense of well-being. The case the researchers make regarding addiction to sunlight is compelling, and why not? Sunlight 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 the 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 sunlight 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 sunlight so than our health could be enhanced? I am a sunlight addict, and expose myself to it regularly for two reasons: (1) It marvelously improves my mood and (2) it protects me from disease and weakness. I am a light-skinned, blue-eyed Caucasian who has spent much of my seven decades on this earth seeking the sun. Yet, there have been no melanomas or even common skin cancer.
Nevertheless, the researchers summarize their paper on sun addiction with the following: “While primordial UV addiction, mediated by the hedonic [pertaining to pleasure] action of β-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.”
That summary statement is claptrap, as can be seen by the research on melanoma and sunlight presented above. If sunlight is addictive and helps me to avoid melanoma, heart disease, bone loss and other maladies, I can only say, “hooray for the addiction!”
 Gillian L. Fell, Kathleen C. Robinson, Jianren Mao, Clifford J. Woolf, and David E.
Fisher. Skin β-endorphin mediates addiction to ultraviolet light. Cell. 2014 June 19; 157(7): 1527–1534.
 Ian D. Wyatt and Daniel E. Hecker. Occupational changes in the 20th century. Monthly Labor Review, March 2006 pp 35-57: Office of Occupational Statistics and Employment Projections, Bureau of Labor Statistics
 U.S. Congress, Office of Technology Assessment, Catching Our Breath: Next Steps for Reducing Urban Ozone, OTA-O-412 (Washington, DC: U.S. Government Printing Office, July 1989).
 Melanoma International Foundation, 2007 Facts about melanoma. Sources: National Cancer Institute 2007 SEER Database, American Cancer Society’s 2007 Facts and Figures, The Skin Cancer Foundation, The American Academy of Dermatology.
 American Cancer Society. Melanoma Skin Cancer Overview 9/16/2014. Accessed on 9/23/2014 at http://www.cancer.org/cancer/skincancer-melanoma/overviewguide/melanoma-skin-cancer-overview-key-statistics
 Godar D. UV doses worldwide. Photochem Photobiol 2005;81:736–49.
 Thieden E, Philipsen PA, Sandby-Møller J, Wulf HC. UV radiation exposure related to age, sex, occupation, and sun behavior based on time-stamped personal dosimeter readings. Arch Dermatol 2004;140:197–203.
 Garland FC, White MR, Garland CF, Shaw E, Gorham ED. Occupational sunlight exposure and melanoma in the USA Navy. Arch Environ Health 1990; 45:261-67.
 Rivers, J. Is there more than one road to melanoma? Lancet 2004;363:728-30.
 Crombie, I. Racial differences in melanoma incidence. Br J Cancer 1979;40:185-93.
 Phillippe Autier. Do high factor Sunscreens offer protection from melanoma? West J Med. 2000 Jul; 173(1): 58.
By Marc Sorenson, EdD, Sunlight Institute
Let’s revisit the need for appropriate nutrition in preventing melanoma death.
It has been well-established that melanoma is not caused by sunlight exposure, despite the sunphobes’ protestations to the contrary. There are numerous research papers that indicate melanoma is considerably less frequent among those who are regularly exposed to sunlight than among those who avoid it.     (The references cited here are only a few of the many papers that corroborate the fact that melanoma is less common among those who embrace the sun.)