The American Academy of Dermatology (Academy) recently issued an updated position statement on vitamin D after an updated review of the increasing body of scientific literature on this vitamin and its importance for optimal health.
The Academy continues to recommend that the public obtain vitamin D from nutritional sources and dietary supplements, and not from unprotected exposure to ultraviolet (UV) radiation from the sun or indoor tanning devices, as UV radiation is a known risk factor for the development of skin cancer.
The Academy’s position statement on vitamin D now also states that individuals who regularly and properly practice sun protection, such as the daily use of sunscreen on exposed skin or the wearing of sun protective clothing, may be at risk for vitamin D insufficiency. A higher dose of vitamin D may be necessary for these individuals and others with known risk factors for vitamin D insufficiency, such as those with dark skin, the elderly, photosensitive individuals, people with limited sun exposure, obese individuals or those with fat malabsorption. Therefore, the Academy encourages those with concerns about their levels of vitamin D to discuss options for obtaining sufficient dietary or supplementary sources of vitamin D with their physician.
“The vitamin D position statement supports the Academy’s long-held conviction on safe ways to get this important vitamin – through a healthy diet which incorporates foods naturally rich in vitamin D, vitamin D-fortified foods and beverages, and vitamin D supplements,” stated dermatologist David M. Pariser, MD, FAAD, president of the American Academy of Dermatology. “The updated recommendation for individuals who practice daily sun protection acknowledges that while protecting the skin from the damaging rays of the sun is important, so is maintaining adequate vitamin D levels. Concern about vitamin D should not lead people to forego sun protection, but rather prompt a conversation with their physician about how to ensure adequate and safe vitamin D intake while guarding against skin cancer .”
The Academy’s new position statement notes that the National Academy of Sciences Institute of Medicine guidelines for vitamin D are the standard reference for advising patients on proper minimum intake levels. The currently recommended adequate intake levels established by the Institute of Medicine may be revised upward due to evolving research on the increasing clinical benefit of vitamin D. The statement also notes that the U.S. Department of Agriculture (USDA) Dietary Guidelines discuss a daily total dose of 1,000 IU (International Units) of vitamin D for supplementation of those at-risk for vitamin D insufficiency.
The Academy’s new position statement also asserts that there is no scientifically proven, safe threshold of sun or indoor tanning device exposure that allows for maximum vitamin D synthesis in the skin without increasing the risk of skin cancer. Also, while numerous studies suggest an association between low levels of vitamin D and an increased risk of certain types of cancers and diseases, the Academy emphasizes that the causal relationship of vitamin D to these disease outcomes has yet to be demonstrated with clinical trials.
“It is well documented in the medical literature that unprotected exposure to UV radiation from natural sunlight or indoor tanning devices causes skin damage. There is no current research available that provides a safe limit for sun exposure to maximize vitamin D production that does not put the individuals health at risk for developing skin cancer,” stated Dr. Pariser. “In addition, contrary to some reported information about vitamin D and the prevention of certain cancers and diseases--other than for bone health, we simply need more clinical data to determine what role, if any, vitamin D plays in these conditions.”
The Academy continues to recommend that individuals protect themselves from UV exposure when outdoors, such as seeking shade whenever possible, wearing sunscreen and covering up with a wide-brimmed hat, long sleeves, pants and sunglasses. Also, the Academy urges the public to avoid tanning beds.
For more information about skin cancer, please visit the SkinCancerNet section on www.skincarephysicians.com, a Web site developed by dermatologists that provides the public with up-to-date information.
To help the general public better understand the relationship between vitamin D and the sun, the National Council on Skin Cancer Prevention has issued a position statement on vitamin D, sun protection and skin cancer prevention. The Council recommends that vitamin D be obtained from a combination of dietary sources and supplements and not through intentional exposure to ultraviolet (UV) radiation.
“For those who are concerned about vitamin D insufficiency, diet and vitamin D supplementation are the most appropriate methods to obtain adequate vitamin D – it is not appropriate to seek exposure to ultraviolet radiation,” says dermatologist Henry Lim, MD, FAAD, Council co-chair and chairman of dermatology at Henry Ford Hospital, Detroit, MI.
UV radiation, a known carcinogen, can cause a range of health problems, including skin cancer, cataracts, premature aging, and immune suppression. With more than one million skin cancers diagnosed annually, skin cancer is the most common form of cancer in the United States. Each year, there are more new cases of skin cancer than the combined number of new cases of breast, prostate, lung and colon cancer.
While UVB radiation is one source of vitamin D, the benefits of exposure to UVB radiation cannot be separated from its harmful effects. For this reason, the safest way to obtain adequate vitamin D is through a combination of diet and vitamin D supplements.
According to the latest version of the U.S. Departments of Agriculture and Health and Human Services’ Dietary Guidelines for Americans 2005, adults with limited sun exposure (e.g., the housebound population) should ingest extra vitamin D from vitamin D-fortified foods and/or supplements. For this group of individuals, an intake of 1000 international units (IUs) of vitamin D per day for adults is recommended. For children under 18 years of age, including infants, the American Academy of Pediatrics recommends 400 IU of vitamin D per day.
Because sufficient vitamin D can be acquired through diet and vitamin supplements, the Council recommends that adults and children practice comprehensive sun-protection behaviors and avoid intentional exposure to natural sunlight and artificial UV radiation (tanning beds) as a means to obtain vitamin D.
Practicing a comprehensive sun-protection regimen to avoid the risk of skin cancer is essential. The National Council’s prevention guidelines include: seeking the shade between 10 am and 4 pm, generously applying sunscreen with a sun protection factor (SPF) of 15 or higher, and wearing sun-protective clothing, including wide brimmed hats and UV-protective sunglasses. For the full guidelines and the position statement, visit www.skincancerprevention.org . For a list of vitamin D sources in a typical diet, visit the National Institutes of Health Office of Dietary Supplements website: http://ods.od.nih.gov/factsheets/vitamind.asp.
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