The Best Source of Vitamin D

If one is going to make an evolutionary argument for what a “natural” vitamin D level may be, how about getting vitamin D in the way nature intended—that is, from the sun instead of supplements? I run through the pros and cons in my video The Best Way to Get Vitamin D: Sun, Supplements, or Salons?. Though supplements may only cost about 10 dollars a year, sunlight is free. We never have to worry about getting too much vitamin D from sunlight, since our body has a way to regulate production in the skin, so if we get our D from the sun, we don’t have to trust poorly regulated supplement companies not to mislabel their products. Indeed, only about half the supplement brands that researchers tested came within 10 percent of their labeled amount.

Sunlight may also have benefits beyond vitamin D, such as how our body may use the sun’s near-infra-red rays that penetrate our skin to activate chlorophyll by-products in our bloodstream to make Co-Q10. (See my video How to Regenerate Coenzyme Q10 (CoQ10) Naturally for more on this.) There’s another way our body appears to use the sun’s rays to maximize the effects of the greens we eat: Within 30 minutes of exposure to the ultraviolet (UV) rays in sunlight, we can get a significant drop in blood pressure and improvement in artery function, thanks to a burst of nitric oxide-releasing compounds that flow into our bloodstream. We can even measure the nitric oxide gas coming straight off our skin. Of course, we have to eat greens or beets in the first place, but that combo of greens and sunlight may help explain some of the protection that plant-based eaters experience.

Morning sun exposure may help those with seasonal affective disorder, as well as improve the mood of wheelchair-bound nursing home residents. Previously, I’ve talked about the benefits of avoiding light at night—see my video Melatonin and Breast Cancer if you’d like to know more—but underexposure to daytime sunlight may also affect our melatonin levels, which don’t only regulate our circadian rhythms but may also be helpful in the prevention of cancer and other diseases. Older men and women getting two hours of outside light during the day appear to secrete 13 percent more melatonin at night, though we’re not sure what, if any, clinical significance this has.

The downsides of sun exposure include increased risk of cataracts, a leading cause of vision loss, though this risk can be minimized by wearing a brimmed hat and sunglasses. Sunlight also ages our skin. In my The Best Way to Get Vitamin D: Sun, Supplements, or Salons? video, you can see a dramatic photo of a truck driver who spent decades getting more sun on the left side of his face—though his driver’s side window. “The effects of sunlight on the skin are profound, and are estimated to account for up to 90% of visible skin aging”—that is, wrinkles, thickening, and loss of elasticity. Things like sun exposure and smoking can make us look 11 years older. Cosmetic surgery can make us look up to eight years younger, but a healthy lifestyle may work even better. Doctors don’t preach about sun protection for youthful facial looks, though, but because of skin cancer. Medical authorities from the World Health Organization, the American Cancer Society, to the Surgeon General warn about excess sun exposure and for good reason, given the millions of skin cancers and thousands of deaths diagnosed every year in the United States alone.

The UV rays in sunlight are considered a complete carcinogen, meaning they can not only initiate cancer, but promote its progression and spread. Melanoma is the scariest, which “makes the rising incidence of melanoma in young women particularly alarming.” This increase has been blamed on the increased usage of tanning salons. Tanning beds and UV rays in general are considered class 1 carcinogens, like processed meat, accounting for as many as three quarters of melanoma cases among young people and six times the risk of melanoma for those who visited tanning salons ten or more times before the age of 30.

The tanning industry is big business, bringing in billions of dollars. There may be more tanning salons than there are Starbucks, and they use those dollars like the tobacco industry: to downplay the risks of their products. Laws are being passed to regulate tanning salons, from complete prohibitions, like in the country of Brazil, to age restrictions for minors. But, unlike tobacco, tanning isn’t addictive. Or is it?

Have you heard of “tanorexia”? Some people tan compulsively and report a so-called tanner’s high. Describing tanning behavior like a substance abuse disorder might seem a little silly—that is, until you stick people in a brain scanner and can show the same kind of reward pathways light up in the brain, thanks to endorphins that are released by our skin when we’re exposed to UV rays. In fact, we can even induce withdrawal-like symptoms by giving tanners opiate-blocking drugs. So, tanning is potentially addictive and dangerous. Harvard researchers suggest that we should “view recreational tanning and opioid drug abuse as engaging in the same biological pathway.” But there’s a reason sun exposure feels good. Sunlight is the primary natural source of vitamin D, and, evolutionarily, it’s more important, in terms of passing along our genes, not to die of rickets in childhood. Unlike natural sunlight, tanning bed lights emit mostly UVA, which is the worst of both worlds: cancer risk with no vitamin D production. The small amount of UVB many tanning beds do emit, however, may be enough to raise vitamin D levels. Is there a way to raise D levels without risking cancer? Yes: vitamin D supplements.

Indeed, we can get some of the benefits of sun exposure without the risks by taking vitamin D supplements. But, for the sake of argument, what if such supplements didn’t exist? Would the benefits of sun exposure outweigh the risks? That’s the subject of my video The Risks and Benefits of Sensible Sun Exposure.

For other videos in this vitamin D series, see:

I also explore Vitamin D as it relates to specific diseases:

Here’s the video about that amazing chlorophyll activation: How to Regenerate Coenzyme Q10 (CoQ10) Naturally.

What do greens and beets have to do with artery function? Check out some of my latest videos on the wonders of nitrate-rich vegetables:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

How Much Water Should We Drink Every Day?

More than 2000 years ago Hippocrates (460–377 BCE) said, “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” What does that mean when it comes to water? Water has been described as a neglected, unappreciated, and under-researched subject, and further complicating the issue, a lot of the papers extolling the need for proper hydration are funded by the bottled water industry.

It turns out the often quoted “drink at least eight glasses of water a day” dictum has little underpinning scientific evidence . Where did that idea come from? The recommendation was traced to a 1921 paper, in which the author measured his own pee and sweat and determined we lose about 3% of our body weight in water a day, or about 8 cups (see How Many Glasses of Water Should We Drink in a Day?). Consequently, for the longest time, water requirement guidelines for humanity were based on just one person.

There is evidence that not drinking enough may be associated with falls and fractures, heat stroke, heart disease, lung disorders, kidney disease, kidney stones, bladder and colon cancer, urinary tract infections, constipation, dry mouth, cavities, decreased immune function and cataract formation. The problem with many of these studies is that low water intake is associated with several unhealthy behaviors, such as low fruit and vegetable intake, more fast-food, less shopping at farmers markets. And who drinks lots of water? People who exercise a lot. No wonder they tend to have lower disease rates!

Only large and expensive randomized trials could settle these questions definitively. Given that water cannot be patented, such trials seem unlikely; who’s going to pay for them? We’re left with studies that find an association between disease and low water intake. But are people sick because they drink less, or are they drinking less because they’re sick? There have been a few large prospective studies in which fluid intake is measured before disease develops. For example, a Harvard study of 48,000 men found that the risk of bladder cancer decreased by 7% for every extra daily cup of fluid we drink. Therefore, a high intake of water—like 8 cups a day—may reduce the risk of bladder cancer by about 50%, potentially saving thousands of lives.

The accompanying editorial commented that strategies to prevent the most prevalent cancers in the West are remarkably straightforward in principle. To prevent lung cancer, quit smoking; to prevent breast cancer, maintain your ideal body weight and exercise; and to prevent skin cancer, stay out of the sun. Now comes this seemingly simple way to reduce the risk of bladder cancer: drink more fluids.

Probably the best evidence we have for a cut off of water intake comes from the Adventist Health Study, in which 20,000 men and women were studied. About one-half were vegetarian, so they were also getting extra water by eating more fruits and vegetables. Those drinking 5 or more glasses of water a day had about half the risk of dying from heart disease compared to those who drank 2 or fewer glasses a day. Like the Harvard study, this protection was found after controlling for other factors such as diet and exercise. These data suggest that it was the water itself that was decreasing risk, perhaps by lowering blood viscosity (blood thickness).

Based on all the best evidence to date, authorities from Europe, the U.S. Institute of Medicine, and the World Health Organization recommend between 2.0 and 2.7 liters (8 to 11 cups) of water a day for women, and 2.5 to 3.7 liters (10 to 15 cups) a day for men. This includes water from all sources, not just beverages. We get about a liter from food and the water our body makes. So this translates into a recommendation for women to drink 4 to 7 cups of water a day and men 6 to 11 cups, assuming only moderate physical activity at moderate ambient temperatures.

We can also get water from all the other drinks we consume, including caffeinated drinks, with the exception of stronger alcoholic drinks like wines and spirits. Beer can leave you with more water than you started with, but wine actively dehydrates you. However, in the cancer and heart disease studies I mentioned above, the benefits were only found with increased water consumption, not other beverages.  

I’ve previously touched on the cognitive benefits of proper hydration here: Does a Drink Of Water Make Children Smarter?

Surprised tea is hydrating? See my video Is Caffeinated Tea Dehydrating?

Surprised that the 8-a-day rested on such flimsy evidence? Unfortunately, so much of what we do in medicine has shaky underpinnings. That’s the impetus behind the idea of evidence-based medicine (what a concept!). Ironically, this new movement may itself undermine some of the most effective treatments. See Evidence-Based Medicine or Evidence-Biased?

How else can we reduce our risk of bladder cancer? See Raw Broccoli and Bladder Cancer Survival.

What kind of water? I recommend tap water, which tends to be preferable from a chemical and microbial contamination standpoint. What about buying one of those fancy alkalizing machines? See Alkaline Water: a Scam?

It’s so nice to have data on such a fundamental question. We have much to thank the Adventists for. You will see their studies cropping up frequently. See, for example, Plant-Based Diets and Diabetes, The Okinawa Diet: Living to 100, and Evidence-Based Eating.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: