Cover letter to Scientists' Letter on Vitamin D
for Cancer and other Disease Prevention

CEDRIC F. GARLAND, Dr. P.H., F.A.C.E.
PROFESSOR
DEPARTMENT OF FAMILY AND PREVENTIVE MEDICINE
9500 GILMAN DRIVE, 0631
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LA JOLLA, CALIFORNIA 92093-0631
(619) 980-2965/ (858) 534-0520

October 17, 2007

A number of biomedical scientists have just completed an urgent letter to professional organizations in public health summarizing the preponderance of new evidence supporting a preventive role of adequate intake of vitamin D and serum levels of 25-hydroxyvitamin D, the main vitamin D metabolite, for prevention of several diseases. These include cancers of the colon and breast (1), Type I diabetes (2), and multiple sclerosis (3). We are asking for your organization's adoption of this recommendation. Our letter is enclosed.

The scientists and physicians who have coauthored this letter are aware that the American Public Health Association is strongly interested in the prevention of disease. Intelligent and informed use of vitamin D for disease prevention is now a mature field and provides the American Public Health Association an unusual moment in medical history to help prevent cancer and other serious diseases, with very small, if any, risk. Many of these diseases are notably difficult to treat, and produce considerable suffering and premature loss of life.

More than 1,000 scientific articles are indexed in PubMed supporting the role of vitamin D in prevention of chronic diseases, including most of the nation's most prominent epidemiological cohort studies, a wide range of preclinical studies, and a recent randomized, placebo-controlled, double-blinded clinical trial that assigned subjects to 1,100 IU per day of vitamin D3 with 1450 mg per day of calcium, calcium alone or placebo (4).

Lower intakes of vitamin D, such as the designated adequate intake in US adults through age 70 years of 400 IU per day (5) are far too low to prevent or substantially reduce incidence of cancer (6), Type I diabetes (7) or multiple sclerosis (8). Actual median adult oral intake of vitamin D in the US is 250-300 IU per day (1).

We recognize that adopting new vitamin D recommendations may be a change from current standard care for most physicians. The coauthors have addressed some of the reasons for the need for change in the enclosed letter. (We have attached PDF files of three recent papers supporting the conclusions of the letter regarding prevention of cancer (4, 6 and 9). An additional seven key papers can be downloaded or linked to from http://www.grassrootshealth.org/references.htm (1-3, 5 and 7-12).

Three components of proposed sample statements for a position statement from the American Public Health Association are shown below:

• The American Public Health Association recognizes that a large and increasing body of biomedical research now supports a role of greater vitamin D adequacy in prevention of colon cancer, breast cancer, Type I diabetes and multiple sclerosis.
• Therefore we recommend an increase in the daily intake of vitamin D3 to the range of 1000-2000 IU per day for adults and teenagers, and 1000 IU for children from 1-12 years.
• As information for use by health care professionals who may choose to monitor the vitamin D status of their patients with a laboratory test, we support measurement of serum 25-hydroxyvitamin D, during late winter or early spring (January-March). The target level should chosen by the health care professional in consultation with the patient, considering individual characteristics of the patient. A rough guideline would be to maintain the early springtime (annual minimum) serum 25- hydroxyvitamin D target level at 40 to 60 nanograms per mL. Higher serum target levels might be appropriate for some patients, based on clinical assessment.

These examples are provided for your adoption, editing, or for you to use as a nucleus for your organization to develop similar statements. For your information, the Canadian Cancer Society on 6/8/2007 recommended intake of 1000 IU per day of vitamin D during fall and winter, and the Canadian Pediatric Society on 9/24/2007 recommended that physicians consider recommending intake of 2000 IU per day for women who are pregnant or breastfeeding, with monitoring of serum 25-hydroxyvitamin D and calcium. Both organizations have published their recommendations on the Internet (web addresses below). While most of Canada is located at higher latitudes than the US, vitamin D deficiency is highly prevalent in fall, winter and spring in both countries due to lifestyle.*

Carole Baggerly, director of GrassrootsHealth, a public health promotion organization, is the authors' contact on this request. Carole has access to detailed supporting data on the role of vitamin D in prevention, and will promptly send you whatever further information you may need to support consideration of a statement on vitamin D by the American Public Health Association. Please let her know any information you need. She can be reached at
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Telephone 619-823-7062

There is urgency in seeking this statement from your organization. Thousands of new cases are diagnosed, and hundreds die, each week from serious diseases whose incidence could be substantially reduced by intake of adequate amounts of vitamin D, according to a substantial body of evidence from numerous published studies.

There is no strong commercial involvement in this initiative, since vitamin D is a natural compound, any patents that may have existed on its isolation expired decades ago. The cost of 1000-2000 IU of vitamin D3, now 5 cents per day, could be as low as 1-2 cents per day with economies of scale. The estimated annual national cost of providing essentially universal vitamin D supplementation would be approximately $6M. In contrast, the estimated annual economic cost of cancer in the US is $78 billion in direct costs of medical care and $122 billion in lost productivity, a total of $200 billion (13). If eliminating vitamin D inadequacy in the US prevented only 10% of cancer incidence, that action would provide a 3,000/1 return on investment. The evidence indicates that the percentage of cancer incidence that would be prevented is substantially higher (4, 6, 9, 12).

The sooner physicians and other health professionals become aware, through the American Public Health Association, of the value of adequate vitamin D status, the sooner the incidence of new cases of cancer and other serious illnesses may be reduced. We look forward to the opportunity to work with you on any aspect of this request. You also may contact me directly at any time with questions or suggestions.

If the information you have received with this letter is sufficient for approval of the sample statements in the text of the letter (above) by the American Public Health Association, kindly contact Carole ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).

Since there is considerable urgency to this request, Carole will be following up with you within the next week to see what other assistance we can provide for your consideration of this request for a statement. Thank you for your prompt attention.

With all good wishes,

Cedric F. Garland, Dr. P.H. F.A.C.E.
Professor
Department of Family and Preventive Medicine
Member, UCSD Moores Cancer Center
University of California San Diego
9500 Gilman Drive 0631
La Jolla, California 92093-0631
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Telephone (619) 980-2965

Frank C. Garland, Ph.D.
Professor (Adj)
University of California San Diego
Department of Family and Preventive Medicine
9500 Gilman Drive 0631
La Jolla, California 92093-0631

Edward D. Gorham, M.P.H., Ph.D.
Assistant Professor (Adj)
University of California San Diego
Department of Family and Preventive Medicine
9500 Gilman Drive 0631
La Jolla, California 92093-0631

*Several US cities, including Rochester, New York (43.2°), Madison, Wisconsin (43.1°), Minneapolis, Minnesota (45.0°), and Medford, Oregon (44.0°) are at a higher latitudes than the southernmost Canadian city, Windsor, Ontario (42.6°).

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