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Edward Napke, B.Sc., M.D., D.P.H., Queen Elizabeth's Anniversary Medal (QEAM) This is a remarkable book that could be helpful in lowering the risk of prostate cancer and its progression in individuals subject to deficient circulating concentrations of vitamin D3 and its biologically active metabolites. The deficiencies are mainly the result of insufficient exposure to solar short wavelength ultraviolet-B radiation, without which vitamin D3 cannot be photosynthesized. Reinforcing this are inadequate intakes of supplementary vitamin D3 and the foods that contain it.
After acknowledging that many factors are implicated in prostate cancer, the author cites approximately 100 studies reported in scientific journals and reproduces geographically significant disease-specific statistics of mortality extracted from publications of the WHO and its affiliate, the IARC (International Agency for Research into Cancer).
The information thus assembled indicates that in countries in the northern and southern hemispheres, vitamin D3 deficiency is an overlooked environmental risk factor of major importance, particularly in middle-aged and elderly men whose place of residence is in the middle and higher latitudes (40 degrees and higher). Bibliographic references are given for all of the sources cited.
Despite the importance of the work in drawing attention to the dangers of vitamin D3 deficiency, not only with respect to prostate cancer but also to breast cancer, colorectal cancer, multiple sclerosis, type 1 diabetes, a variety of bone diseases and a growing list of other disorders, little is said about the author's personal experience with prostate cancer and bladder cancer, diagnosed in 1984 and 1986.
We sense that a gripping story has been left untold and must remain in the dark until this is done. There is a "hole in the narrative" that lessens the human and personal appeal of the book. I have brought this to the attention of the author, who is willing to rectify the omission in any subsequent edition.
My main criticism, however, is that he fails to distinguish consistently between the so-called "sunshine vitamin," namely vitamin D3 (cholecalciferol), the history of which is summarized, and vitamin D2 (ergocalciferol), a substance derived from yeasts and plants. All too often readers are expected to make do with the non-specific term vitamin D, when what is actually being discussed is D3.
It is from vitamin D3 that minute quantities of a short-lived, powerful steroid hormone, 1 alpha,25-dihydroxyvitamin D3 (calcitriol), are repeatedly metabolized from the body's limited store of calcidiol, (25-hydroxyvitamin D3), its major circulating reservoir of the vitamin. The book shows that when the blood supply of calcidiol begins to wane, which tends to occur in the elderly in the late winter and early spring, there is a corresponding decrease in the concentration of calcitriol.
That is why residents of countries in the middle and high latitudes, particularly those where the winters are long and cold, need to build up a supply of calcidiol during the warm season sufficient to last the whole of the coming winter.
When circumstances prevent this, ensuring adequate daily intakes of vitamin D3- rich foods and supplements can be crucial. Readers are informed that their daily requirement of vitamin D3, expressed in international units, may be greatly in excess of the quantities they are actually obtaining, from sun exposure and nutrition.
African-North Americans and Afro-Caribbeans are shown to be at exceptionally high risk of deficiency. It is in these populations that the incidence and mortality rates of prostate cancer are reported to be the highest in the world.
The benefits derivable from adequate circulating concentrations of calcitriol in another common cancer are strikingly apparent in the results of a six-months long in-hospital study of female breast cancer patients. Some of the findings of that study are included in the closing pages of the book (Appendix D). The information we are given is compelling. - Edward Napke, B.Sc., M.D., D.P.H.,
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