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Uncategorized / 7.18.2016 / No Comment

Non-Melanoma Skin Cancer (NMSC), other Cancers and Sun Exposure. What is the Truth?

By Marc Sorenson, EdD. Sunlight Institute…

A 2016 paper in the British Journal of Dermatology showed that NMSC (also known as common skin cancer) had a positive association with cancers such as breast cancer, lung cancer and lymphoma.[1] Since NMSC is also associated with increased sun exposure, one might be inclined to say that these cancers are caused by such exposure. This is troubling, as many research papers have showed a reduced risk of most internal cancer with greater sun exposure. For example, breast cancer was the second type of cancer for which an inverse correlation between mortality rates and sun exposure was identified in the United States.[2] And, when assessing sun-exposure habits in a study of 5,000 women, scientists determined that those who lived in the sunniest areas, and who also had the highest sun exposure, had a 33% reduction in breast cancer rates compared to those who had the least exposure.[3] A subsequent study by the same group found “that a high sun exposure index was associated with reduced risk of advanced breast cancer among women with light skin pigmentation.”[4] The reduced risk was 47%. Numerous additional studies have demonstrated a reduction of the risk breast cancer among women who are regularly exposed to the sun. A discussion or these studies will me available in the book, Embrace the Sun, which should be available before the end of the 2016.

As for lung cancer, a geographical study in China demonstrated that lung cancer mortality showed a strong inverse correlation of risk with sun exposure, with an estimated 12% fall per each 10 milliwatts per meter squared per nanometer (a measurement of sun intensity) increase in UVB irradiance (sun exposure) even if adjusted for smoking.[5]

Now let’s consider lymphoma. The most recent research shows that there is an inverse correlation between Hodgkin lymphoma (HL) and the highest vs. lowest lifetime, childhood and adulthood factors: sun exposure, sun-lamp exposure, and sunburn. [1] The pooled analysis showed an odds ratio of .56, or in other words, a 44% reduced risk of contracting the disease.^{^[6]} 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—and (2) sunburn also correlated to a reduced risk. Of course, no one would recommend sun-burning—it simply serves a surrogate measurement for a high degree of sun exposure. Sun exposure can easily be used in high quantities—without burning—by moving out of the sun when the skin begins to redden, and then coming back later, after the skin has adjusted and started to tan.

Therefore, there is an interesting dichotomy between the idea that sun exposure may contribute to the three mentioned cancers, and the fact that all of these cancers have been shown to associate with low sun exposure, and be protected against by higher sun exposure.

So what is the answer? Dr. Bill Grant has found it. When people contract NMSC, they are advised to avoid the sun, thus setting themselves up for increased cancer risk.[7] Thanks again to Dr. Grant for his immediate solution to this dilemma.

There is more than sufficient research to show conclusively that most major cancers are prevented by plenty of sun exposure. Don’t be misled. Be sure to obtain some safe sun exposure whenever possible.

[1] Ransohoff KJ, Stefanick ML, Li S, et al. Association of non-melanoma skin cancer with second non-cutaneous malignancy in the Women’s Health Initiative. Br J Dermatol. 2016 May 26. [Epub ahead of print]

[2] Garland FC, Garland CF, Gorham ED, Young JF. Geographic variation in breast cancer mortality in the United States: a hypothesis involving exposure to solar radiation. Prev Med. 1990 Nov;19(6):614-22.

[3] John EM, Schwartz GG, Dreon DM, Koo J. Vitamin D and breast cancer risk: The HANES 1 epidemiologic follow-up study, 1971-1975 to 1992. Cancer Epidemiology Biomarkers and Prevention 1999;8:399-406.

[4] John EM, Schwartz GG, Koo J, Wang W, Ingles SA. Sun exposure, vitamin D receptor gene polymorphisms, and breast cancer risk in a multiethnic population. Am J Epidemiol. 2007 Dec 15;166(12):1409-19.

[5] Chen W, Clements M, Rahman B, Zhang S, Qiao Y, Armstrong BK. Relationship between cancer mortality/incidence and ambient ultraviolet B irradiance in China. Cancer Causes Control. 2010 Oct;21(10):1701-9.

[6] Monnereau A, Glaser SL, Schupp CW, Ekström Smedby K, de Sanjosé S, Kane E, Melbye M, Forétova L, Maynadié M, Staines A, Becker N, Nieters et al. Exposure to UV radiation and risk of Hodgkin lymphoma: a pooled analysis. Blood 2013;122(20):3492-9.

[7] Grant WB. Increased risk of non-cutaneous malignancy after diagnosis of non-melanoma skin cancer may be due to sun avoidance. Br J Dermatol. 2016 Jul 15. [Epub ahead of print].

Uncategorized / 7.18.2016 / No Comment

Sun Exposure significantly decreases the Risk of invasive Cancers. Let’s get some sun.

Another important research paper on sun exposure and the risk of cancer was completed in March of 2016.[1] In it, the researchers showed once again that areas of greater sun exposure have lower rates of most cancers than areas of lesser sun exposure. To make their assessment, the investigators first obtained data from the North America Land Data Assimilation System daily average sunlight for the continental United States. They then compared that data to cancer incidence and mortality from the Centers for Disease Control.

They found that cancer incidence for all invasive cancers was significantly decreased with increasing solar radiation (sun exposure). Invasive cancer is cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues.[2] The same was true for 11 of 22 leading cancers. Interestingly, however, there was no correlation with mortality with increasing solar radiation when the invasive cancers were considered, although mortality from 7 of 22 leading cancers, including cancers of the uterus, leukemias, lung, ovary and urinary bladder did significantly decrease with increasing solar radiation. Liver cancer increased both in incidence and mortality with increasing sun exposure, and cervical cancer increased in incidence but not mortality. However, the adverse effect on liver cancer may be balanced by the very positive effects of sun exposure in decreasing liver inflammation.[3]

All-in-all, this research is very positive in presenting the anti-cancer effects of sun exposure on most cancers. Be sure to obtain your share of safe, non-burning sun exposure.

[1] Fleischer A, Fleischer S, Solar radiation and the incidence and mortality of leading invasive cancers in the

United States Dermatoendocrinol. 2016 Mar 28;8(1):e1162366

[2] http://www.cancer.gov/publications/dictionaries/cancer-terms?CdrID=45741

[3] Gorman S, Black LJ, Feelisch M, Hart PH, Weller R. Can skin exposure to sun prevent liver inflammation? Nutrients 2015 May 5;7(5):3219-39.

Uncategorized / 7.14.2016 / 1 Comment

Vitamin D Society recommends Summer Sun to build up D Levels.

By Marc Sorenson, EdD. Sunlight Institute…

Canada has a long season each year in which vitamin D from sunlight is not available. Due to the northern latitude of Canada, May through October is the only period when vitamin D can be produced in response to sun exposure to the skin. Therefore, a new press release from the Vitamin D Society recommends to protect health by building up vitamin D during the summer. Vitamin D from the summer sun helps to prevent serious diseases such as cancer, cardiovascular diseases, diabetes, multiple sclerosis and others.

Dr. Reinhold Vieth, the scientific advisor for the Society, states the following: We often assume that the health benefits of sunshine are solely due to vitamin D, but that is not proven yet. In other words, it is likely that sunshine does more for our bodies than just produce vitamin D.”

Dr. Vieth is correct. Vitamin D is only one of several products of sun exposure. Others are nitric oxide, which helps prevent vascular problems, and serotonin and endorphins that enhance mood. It is likely that there are many more products of sun exposure that enhance human health.

The Society recommends 6 guidelines for safely enjoying the sun and its health benefits:

Be moderate, and don’t burn.
Sun exposure can produce vitamin D only during the mid-day hours, so be outside between 10 AM and 4 PM.
Know your skin type and risk of burning. Red hair and very light skin predict a greater risk of burning. (Also remember that dark skin needs more sun exposure to produce vitamin D).
A gradual build-up of a tan protects the skin from burning.
When the skin begins to redden, it is time to stop the sun exposure.
Frequent but shorter sun exposure times are better for producing vitamin D.

Since about 35% of all Canadians do not meet suggested vitamin D requirements, sun exposure is essential to reverse that statistic.

So Canadians, safely enjoy the sun this summer!

To read the entire press release, go to this link: http://www.vitamindsociety.org/press_release.php?id=44

Uncategorized / 7.11.2016 / No Comment

Men, protect your Prostate!. Research demonstrates a positive influence of Sun Exposure on Prostate Cancer.

By Marc Sorenson, EdD. Sunlight Institute.

Regular sun exposure is one of the best ways to reduce the risk of many cancers. Although the relationship of sun exposure (and vitamin D) to the risk of prostate cancer is controversial, a study from Australia, published in 2011, showed that the less sun exposure, the greater the risk of the cancer.[1] The researchers investigated the relationship between prostate cancer incidence and solar radiation in non-urban Australia and found an inverse association. There are many other studies that indicate a protective effect of sun exposure. One of the earliest was conducted by Dr. Esther John and her colleagues: they compared the lifetime sun exposure of 450 white men with advanced prostate cancer to that of 455 white men who did not have cancer.[2] 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 quintile.

Another study on cancer that corroborated these observations was entitled: Is prevention of cancer by sun Exposure more than just the effect of vitamin D? A systematic review of epidemiological studies.^{^[3]} In their review, the authors noted that regular sun exposure correlated to a reduced risk of colorectal cancer, prostate cancer, breast cancer and non-Hodgkin’s lymphoma (NHL). However, vitamin D levels correlated to a reduced risk of colorectal, and to a lesser extent, breast cancer, but were not correlated to a significant risk reduction in prostate cancer and non-Hodgkin’s lymphoma. The authors concluded with this statement: “Particularly in prostate cancer and NHL, other sun-potentiated and vitamin D-independent pathways, such as modulation of the immune system and the circadian rhythm, and the degradation of folic acid, might play a role in reduced cancer risk as well.” These researchers did well to remind us, that as important as vitamin D is to the human body, other effects of sun exposure may be more important in some diseases. The authors could have also mentioned the effect of sun on vasodilation, mediated by the production of nitric oxide (produced by the skin after sun exposure). They could also have discussed the influence of sun on production of serotonin and endorphins, all of which may have contributed to their observations.

Other research used childhood sunburn as a measure of UVR exposure and determined that men who had sunburned as children had only about one-fifth the risk of contracting prostate cancer as those who had not sunburned.^{^[4]} A note of caution! We are not recommending that anyone sunburn in order to prevent prostate or other types of cancer. Sunburn was used in this research to predict higher vitamin D levels, but it is not necessary to achieve those levels, since non-burning sun exposure achieves the same results. This research also demonstrated that men with lowest level of UVR exposure had more than triple the risk of prostate cancer and that 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, reported that men in the lowest quartile of sunbathing were linked to a 5.33-fold greater risk of prostate cancer than those in the highest quartile. Still other research has indicated that “higher levels of cumulative exposure, adult sunbathing, childhood sunburn and regular holidays in hot climates were each independently and significantly associated with a reduced risk of this [prostate] cancer.^{^[5]}

So men, protect your prostate by regular, non-burning sun exposure. Don’t let the Powers of Darkness frighten you away from the sun.

[1] Loke TW, Seyfi D, Khadra M. Prostate cancer incidence in Australia correlates inversely with solar radiation. BJU Int. 2012 Apr;109 Suppl 3:75.

[2] John EM, Schwartz GG, Koo J, Van Den Berg D, Ingles SA. Sun exposure, vitamin D receptor gene polymorphisms, and risk of advanced prostate cancer. Cancer Res 2005;65(12):5470-79.

[3] van der Rhee H, Coebergh JW, de Vries E. Is prevention of cancer by sun exposure more than just the effect of vitamin D? A systematic review of epidemiological studies. Eur J Cancer. 2013 Apr;49(6):1422-36.

[4] Moon SJ, Fryer AA, Strange RC. Ultraviolet radiation: effects on risks of prostate cancer and other internal cancers. Mutat Res 2005;571(1-2):207-19.

[5] Bodiwala D, Luscombe CJ, Liu S, Saxby M, French M, Jones PW, Fryer AA, Strange RC.. Prostate cancer risk and exposure to ultraviolet radiation: further support for the protective effect of sun. Cancer Lett 2003;192:145-49.

Uncategorized / 7.8.2016 / No Comment

Dead Sea Sun Exposure heals Atopic Dermatitis in Children

By Marc Sorenson, EdD. Sunlight Institute…

Atopic dermatitis (AD) is the most common form of many types of eczema, an inflammatory condition of the skin characterized by redness, itching, and oozing vesicular lesions which become scaly, crusted, or hardened.^[1] UV radiation from sun exposure or sun lamps has been used successfully for decades for its treatment.^[2] ^[3]

In the latest study on AD, researchers studied 72 youth with AD who were given sun exposure of varying intensities at the Dead Sea in Israel.[4] The subjects were divided into three groups and were exposed to increasing sunlight amounts during 28-day periods in March 2014, October 2014 and March 2015.

Eighty-seven percent of the subjects showed good clinical results immediately, and after three months, 71% still showed good results. One very important result, as stated by the researchers, was this: “Higher cumulative exposure times correlated with better results and enhanced remission.”

Also noteworthy was the finding that no adverse effects occurred.

Chalk up one more victory for the sun in its battle against disease!

[1] Palmer DJ. Vitamin D and the Development of Atopic Eczema. J Clin Med. 2015 May 20;4(5):1036-50.

[2] Palmer DJ. Vitamin D and the Development of Atopic Eczema. J Clin Med. 2015 May 20;4(5):1036-50.

[3] Falk ES. UV-light therapies in atopic dermatitis. Photodermatol. 1985 Aug;2(4):241-6.

[4] Kudish A, Marsakova A, Jahn I, Gkalpakiotis S, Arenberger P, Harari M. Dead Sea ultraviolet Climatotherapy for children with Atopic Dermatitis. Photodermatol Photoimmunol Photomed. 2016 Jul 5. doi: 10.1111/phpp.12250. [Epub ahead of print]

Uncategorized / 6.30.2016 / No Comment

Cognitive Decline in the Elderly. Is it lack of Sun Exposure?

By Marc Sorenson, EdD. Sunlight Institute…

Lack of Sun Exposure: Does it cause mental decline? My wife and I conduct church meetings at an assisted-care center, also known as a rest home. In our almost two years at the facility, we note that many of the residents there have lost or are losing their cognitive abilities (abilities to think). It worries us that many of them do not get outdoors often, which probably contributes to both their physical and mental deterioration. It is likely that lack of sun exposure is a key factor, and research from Japan corroborates this view.[1] The researchers had previously reported that elderly individuals with cognitive impairment showed a low frequency of activity. This research assessed whether the type of activity (indoor of outdoor) had different effects on cognition.

The subjects were measured by a mental test known as the mini-mental state examination (MMSE), before being starting the study period. Then, for one year, their activities were measured by an infra-red sensor. At that time they were reevaluated and placed in one of two groups: (1) a cognitive decline group and (2) a normal group. Those whose cognition declined had very few outings away from the facility, compared to the normal group. Those who had 20 or more outings had no decline whatsoever.

The researchers summed up their findings thusly: “This study objectively evaluated the behavior of elderly individuals with infrared sensors and revealed that elderly people who have few occasions to go out tend to show a decrease in cognitive function.” The researchers should have mentioned that those who do not go out have no sun exposure.

It is also known that the risk of being admitted to a nursing home can be predicted by vitamin D levels. In one investigation, those whose serum vitamin 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.[2] Of course, people with low vitamin D levels are suffering from sun-exposure deficiency. Let’s take care of our elderly by being sure that they enjoy plenty of safe sun exposure.

Safely embracing the sun has so many positive benefits! Be sure your elderly parents and friends have sufficient sun exposure without burning.

[1] Suzuki T, Murase S. Influence of outdoor activity and indoor activity on cognition decline: use of an infrared sensor to measure activity. Telemed J E Health. 2010 Jul-Aug;16(6):686-90

[2] Visser, M. et al. Low serum vitamin concentrations of 25 hydroxyvitamin D in older persons and the risk of nursing home admission. Am J Clin Nutr 2006;84:616-22.

Uncategorized / 6.25.2016 / No Comment

More on Sun Exposure and Depression

Does sun exposure help fight depression? Of course!

By Marc Sorenson, EdD. Sunlight Exposure

Although this blog has discussed sun exposure and its affects on depression, there is some information that I may have neglected to mention. It has been shown that depressed psychiatric patients who resided in sunny rooms stayed in the hospital 2.6 fewer days than those who had “dull” rooms.[1] The sunny rooms had windows, so it is likely that endorphins and serotonin, created by the sun entering the windows, were the natural “uppers” by which the patients felt better. Nitric oxide, produced by UVA light exposure, could also have played a part.

Another of those dull rooms is the one that houses the TV. An interesting study from the University of Pittsburgh found that the more TV teenagers watched, the more likely they were to be depressed as adults.^{^[2]} The study author theorized that because there is so much depressing news and programming on TV, the more exposure, the more the internalizing or the depressing programming. For each hour of TV watched, the rate of depression increased significantly.

The researchers may be correct, or it could be that hours of sedentary life in front of the TV, watching commercials for junk food, leads to obesity and poor health as the teenager ages. We have another theory that may supplant, or at least add to those theories. It is possible that years of unnatural indoor habits create deficiency of the aforementioned vitamin D, nitric oxide, endorphins and serotonin, which may have long-term effects. Combined with the deleterious influences of excessive TV watching, that could be a recipe for depression and health disasters. 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.

Safely embrace the sun and obtain its “feel-good” effects.

[1] Beauchemin KM, Hays P. Sunny hospital rooms expedite recovery from severe and refractory depressions. J Affect Disord. 1996 Sep 9;40(1-2):49-51.

[2]Primack, B. Association between media use in adolescence and depression in young adulthood: a longitudinal study. Arch Gen Psychiatry. 2009 Feb;66(2):181-8

Uncategorized / 6.12.2016 / No Comment

Sun Exposure, artificial Light and Weight Control

Sun Exposure, artificial light and weight control. Marc Sorenson, EdD… Sunlight Institute

Sun exposure gives life and has so many positive effects, including anticancer, anti-heart disease, and anti-osteoporosis. Unnatural light, however can do exactly the opposite. In the case of obesity, artificial light at night (ALAN) can lead to weight gain, according to a study in the International Journal of Obesity.[1]

The hormone melatonin works in conjunction with serotonin during each daily physiological cycle, known as the circadian rhythm. Serotonin is a natural “upper” that awakens our senses and prepares us for our workday. Then, when the rhythms are properly synchronized, as evening comes, serotonin decreases and melatonin, a sleep inducer, takes over so that we can sleep soundly and awake refreshed as daylight and serotonin once more take over. However, a monkey wrench is often thrown into the works. It is called artificial light at night (ALAN), and it may be one of many factors that lead to obesity. ALAN inhibits melatonin production, a factor in both obesity and cancer.

The researchers looked at satellite images of 80 countries, assessed the amount of ALAN emitted from each country and then compared the rates of obesity in each. The data was adjusted to take into consideration the differing dietary patterns in each country, as well as the urban vs rural population and other factors that would influence obesity.

The results showed, that after all adjustments, ALAN emerged as a prominent predictor for obesity.

So how does this relate to sun exposure? One of my recent posts noted the results of research on early morning sun exposure and obesity, noting that early sun exposure inhibited obesity dramatically.[2] So not all light is good. Light at night is harmful; early morning sun exposure is wonderful. And if one wants to remain slim, it is imperative to eschew junk food, exercise and get plenty of non-burning sun exposure.

[1] Rybnikova NA, Haim A, Portnov BA. Does artificial light-at-night exposure contribute to the worldwide obesity pandemic? International Journal of Obesity. Int J Obes (Lond). 2016 May;40(5):815-23.

[2] Reid KJ, Santostasi G, Baron KG, Wilson J, Kang J, et al. Timing and Intensity of Light Correlate with Body Weight in Adults. PLoS ONE 2014 9(4): e92251. doi:10.1371/journal.pone.0092251

Uncategorized / 6.12.2016 / No Comment

Sun Exposure, Pneumonia, Influenza, Health. Embrace the Sun!

By Marc Sorenson, EdD Sunlight Institute…. Sun exposure and more

One of the more interesting research studies on sun exposure is one from the Philippines, It assessed the quantity of sun exposure as compared to the risk of childhood pneumonia.[1] Each one-hour increase in sun 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?

Research such as this is very impressive in that it provides a formula against this potentially fatal disorder. People who spend their lives working outdoors in the sun have protection against pneumonia. It is interesting to surmise that those who receive three hours of sun per day might have 100% protection. Is the same true for adults? No one knows, but I would bet that the results would be identical.

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,^{^[2]} ^{^[3]} ^{^[4]} indicative of an influence of sunlight as a prophylactic against the malady. Research has also established that low UVB exposures correlate directly to periods of low UV radiation, and indicate that such a correlation may be responsible for the seasonal variation in pneumonia and for the spike in winter cases.^{^[5]} The researchers state that, “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.”

Whatever the mechanism, we can be sure of one thing: sun exposure reduces the risk of innumerable diseases, and those who advise us to reject sun exposure are approaching criminality by setting us up for poor health and early death. Safe sun exposure (non-burning) is one of the master keys to success in health and in life. Don’t miss your share!

[1] Paynter S, Weinstein P, Ware RS, Lucero MG, Tallo V, Nohynek H, Barnett AG, Skelly C, Simões EA, Sly PD, Williams G; ARIVAC Consortium. Sunshine, rainfall, humidity and child pneumonia in the tropics: time-series analyses. Epidemiol Infect. 2013 Jun;141(6):1328-36.

[2] Dowell SF, Whitney CG, Wright C, Rose CE Jr, Schuchat A. Seasonal patterns of invasive pneumococcal disease. Emerg Infect Dis 2003;9:573-9.

[3] Talbot TR, Poehling KA, Hartert TV, Arbogast PG, Halasa NB, Edwards KM, Schaffner W, Craig AS, Griffin MR. Seasonality of invasive pneumococcal disease: temporal relation to documented influenza and respiratory syncytial viral circulation. Am J Med 2005;118:285-91.

[4] Dowell SF, Whitney CG, Wright C, Rose CE Jr, Schuchat A. Seasonal patterns of invasive pneumococcal disease. Emerg Infect Dis 2003;9:573-9.

[5] Alexander NJ White, Victoria Ng, C Victor Spain, Caroline C Johnson, Laura M Kinlin, and David N Fisman. Let the sun shine in: effects of ultraviolet radiation on invasive pneumococcal disease risk in Philadelphia, Pennsylvania. BMC Infect Dis 2009;9:196

Uncategorized / 6.3.2016 / 1 Comment

Does Does Sun Exposure have an Influence on COPD?

By Marc Sorenson, EdD. Sunlight Institute….

COPD is defined as a heterogeneous collection of conditions that can affect various structures within the lung in a number of ways,^[1] and usually cause difficulty in breathing. In 2005 there were 126,005 deaths in the US from COPD.^[2] Though there are multiple contributors to COPD such as tobacco smoke, occupational dusts, chemicals and air pollution, vitamin D and sun deficiencies may also play a role. Research has demonstrated that the severity of the disease is correlated directly to serum levels of vitamin D,^[3] and other research demonstrates that severe disturbed lung and peripheral muscle functions are more pronounced in COPD patients with vitamin D deficiency.[4] In addition, recent research shows that cardiopulmonary exercise capacity is increased remarkably in people with high vitamin D levels compared to those with low levels.[5] Of course, 90% of vitamin D blood levels are produced by sun exposure.

In other blogs, I have established that sun can prevent and even reverse osteoporosis, and it is also well-established that osteoporosis associates closely with COPD.[6] There is a high prevalence of COPD in patients with osteoporosis, and the disease is also more severe in patients with osteoporosis compared with patients with normal bone mass. [7] 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). It is surprising that little or no research has been done on the effects of sun exposure per se. I would think that in very sunny areas, the risk of the disease would be reduced profoundly.

Now doesn’t that make you breathe easier?

[1] Rennard, S. COPD: Overview of Definitions, Epidemiology, and Factors Influencing Its Development. Chest 1998;113(4)(Suppl 4):235s-241s.

[2] Deaths from Chronic Obstructive Pulmonary Disease—United States, 2000-2005. JAMA 2009; 301(13):1331-1333.

[3] Janssens W, Bouillon R, Claes B, Carremans C, Lehouck A, Buysschaert I, Coolen J, Mathieu C, Decramer M, Lambrechts D. Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene. Thorax 2010;65(3):215-20.

[4] Yumrutepe T, Aytemur ZA, Baysal O, Taskapan H, Taskapan CM, Hacievliyagil SS. Relationship between vitamin D and lung function, physical performance and balance on patients with stage I-III chronic obstructive pulmonary disease. Rev Assoc Med Bras. 2015 Mar-Apr;61(2):132-8.

[5] Kaul A, Gläser S, Hannemann A, Schäper C, Nauck M, Felix SB, Bollmann T, Ewert R, Friedrich N. Vitamin D is associated with cardiopulmonary exercise capacity: results of two independent cohorts of healthy adults. Br J Nutr. 2016 Feb 14;115(3):500-8

[6] Romme EA, Smeenk FW, Rutten EP, Wouters EF. Osteoporosis in chronic obstructive pulmonary disease. Expert Rev Respir Med. 2013 Aug;7(4):397-410.

[7] Silva DR, Coelho AC, Dumke A, Valentini JD, de Nunes JN, Stefani CL, da Silva Mendes LF, Knorst MM. Osteoporosis prevalence and associated factors in patients with COPD: a cross-sectional study. Respir Care. 2011 Jul;56(7):961-8.