Bring me sunshine ... and health

Can avoiding the sun be damaging our health? And why is author Oliver Gillie on a mission to improve the health of Scots? By Lesley Morrison.

Advice from cancer charities to stay in the shade and always cover up in the sun may have had damaging effects, according to the man who first warned about Scotland's sunshine shortage.

In September Oliver Gillie wrote Scotland's Health Deficit: An Explanation and a Plan, claiming that lack of sunlight could be contributing to health problems in the nation. His report argued that being deprived of daylight - and the vitamin D which it helps the body make - could contribute to a range of conditions including depression, cancer and multiple sclerosis.

Now Gillie says cancer charities have been "embarrassed" by the unforeseen impact of their advice to cover up in the sun - which has led to soaring rates of vitamin D deficiency. Messages have included the suggestion that there is "no such thing as a healthy tan", which Gillie says is misguided and unfounded in science.

So what lies behind Gillie's determination to go against the tide of public and professional opinion and bring the Scottish health effects of lack of vitamin D, the vitamin manufactured in sun-exposed skin, to public attention?

Gillie has long-standing links with Scotland. Brought up in Tynemouth, his father was educated in Scotland and Gillie himself studied at Edinburgh University, where he obtained a BSc and then a PhD in genetics.

He talks of having a "sentimental attachment to Scotland", which is demonstrated by his choice of a photograph of himself tossing the caber to help illustrate his report.

He studied at the Institute of Animal Genetics and says that time spent with distinguished fellows of the Royal Society in Edinburgh helped him hone his ability to ask questions and to constructively criticise. Since then he has worked with national newspapers for 25 years as a medical correspondent and editor, winning 16 awards for his journalism and the Royal Jubilee medal from the Queen for his work in science and health journalism. Nowadays he describes himself as an investigative health journalist.

In 2004 he first addressed the vitamin D issue in Sunlight Robbery, a report on UK public health policy published by the Health Research Forum. This outlined some of his concerns about Sunsmart, a campaign that advised people to reduce their risk of skin cancer by avoiding the sun between 11am and 3pm.

It has led to unannounced changes, Gillie argues. "Cancer Research UK is embarrassed. They took a strong position on sun exposure and it is now clear the benefits outweigh the risks. They have quietly changed their advice without really telling anyone. In Europe, public health authorities were slower to tell people to avoid the sun, so they have not so far to retreat".

These days most healthy people only get about 5% of the vitamin D they need from their diet. But lack of sunshine is an especially Scottish problem: Scots are twice as likely as people in southern England to have low vitamin D levels while, in winter, 92% of Scots fail to reach the optimum level.

Gillie isn't alone in expressing concern. Dr Faisal Ahmed is a paediatrician in Glasgow who estimates he sees 25 to 30 new cases a year of rickets, with the typical features of swollen joints and bow legs.

"In the 1970s, it was south Asians who presented with it. While people with dark skin pigmentation are still at higher risk, I am now seeing a more ethnically diverse group. The main risk factors are not socio-economic,"

he says, adding that other factors playing a part include prolonged breastfeeding and little or no advice about vitamins.

He describes how in the 1970s, his predecessors examined who the risk groups were, administered vitamin D and got rid of rickets.

What should happen today? "Every child should get vitamin D".

Gillie agrees. In his latest book he presents the evidence for the association between insufficient vitamin D and the risk or severity of other chronic diseases including cancer, heart disease, multiple sclerosis, hypertension, stroke, diabetes and rheumatoid arthritis, and makes the case for supplementation. The association wasn't hard to find, he says, giving the example of multiple sclerosis: "I collected data about birthday clusters of MS and it showed a higher incidence in babies born in spring and summer after a vitamin D-deprived pregnancy".

One of the aims of the UK Government's Healthy Start programme, which also operates in Scotland, is to address the problem of vitamin deficiency. Children in families on certain benefits are entitled to free vitamin supplements from the age of six months until their fourth birthday. Qualifying mothers are entitled to free vitamins during pregnancy and until their baby is one year old, but the debate continues about whether free vitamins should be available to all babies and children.

Gillie claims: "The government has made a mess of it and they are not widely available. They could give advice on vitamin D without controversial advice on sunshine".

In the meantime, GPs can prescribe the vitamins but few do. One who does is Dr Helga Rhein, a German doctor working now as a GP in Edinburgh. "In Germany, vitamin D supplementation for breastfeeding babies is routine.

From a public health point of view, it borders on negligence not to give vitamin D to dark-skinned people, especially babies. GPs look for guidance to public health on this but, since the 1970s Glasgow rickets scare, attention to it seems to have fizzled out".

Rising concern about rickets among Asian children in Glasgow in the early 1970s, linked to diet and lack of sunlight, led doctors at Yorkhill to produce a film about sun exposure aimed at Asian families. It is credited with contributing to the reduced rates of rickets among Scots Asians.

At a UK level NICE (National Institute of Clinical Excellence) guidance on antenatal care, which appeared only to be based on two small studies, recommends that vitamin D not be routinely given, contradicting the advice of the 2007 report of the Scientific Advisory Committee on Nutrition.

But Gillie is delighted that Rhein is now applying for funding for a randomised controlled trial to establish optimum dosages for the Scottish population and he himself is currently planning a controlled trial of vitamin D treatment with Professor Julian Peto, Cancer Research UK Professor of Epidemiology at the Institute of Cancer Research in Surrey.

This major piece of work is to cost £8.3million, closely following a huge cohort of elderly patients. "10,000 people over the age of 65 will be treated, with 10,000 controls," Gillie says.

But with the current policy gap, there is an urgent need for more research and guidelines across a range of specialisms, he adds.

Allan Struthers, Professor of Cardiovascular Medicine at Dundee University, also thinks we should take a closer look at Scotland's vitamin D issue: "There are more cardiovascular events in Scotland in winter than summer. The time is ripe to conduct research into whether vitamin D administration might reduce this peak."

Any of these lines of research may end up helping to vindicate Gillie, who a track record of being in the forefront of public health policy change, especially in regard to nutrition.

He is a trustee of the Caroline Walker Trust, set up in memory of the campaigning nutritionist Caroline Walker, one of the first to draw attention to the need for food labelling. Politicians and policy makers were forced to pay attention to that agenda, and Gillie hopes they will now take on board the messages in his latest book, for the benefit of the people of Scotland. www.healthresearchforum.org.uk

Vitamin D: the facts

Vitamin D helps the body produce and maintain strong bones. It is produced naturally in response to UV rays from the sun.

Vitamin D deficiency can cause bones to soften, and in extreme cases this can cause rickets in children and related conditions in adults.

Sunburn can double the risk of skin cancer, but anyone should be able to get enough sunshine to produce vitamin D without exposing themselves to tanning or burning.

Most people can't make enough vitamin D in winter because of low levels of UV in the sun, but our bodies can cope on reserves stored through the summer.

People who are most likely to be lacking in vitamin D include those with naturally darker skin, people whose clothing fully conceals them, some babies and pregnant women.