1. ЗОЖ

Все говорят о важности витамина D, он защищает от морщин и рака: вот полный расклад - как работает, как выявить дефицит и чем его восполнять

Татьяна Черникова
Татьяна Черникова
15.09.2020

Витамин D, как звезда, которая только что зажглась в шоу-бизнесе: все о нем говорят, но мало что знают. Вроде бы врачи советуют пить, но зачем? Детям он нужен для предотвращения рахита, а взрослым? Ладно еще, если вы живете на Крайнем Севере, где полярная ночь длится по три месяца и необходимо как-то компенсировать нехватку солнца. Но если все лето провели на юге?

Оказывается, это вещество - серый кардинал в научном мире. Во-первых, никакой он не витамин, а стероидный гормон, который влияет почти на все органы и системы. Во-вторых, его нехватка грозит массой заболеваний: от простуды до онкологии. В-третьих, даже если вы живете в городе Юма в Аризоне, самом солнечном на планете, это еще ничего не гарантирует.

BeautyHack с помощью врачей и ученых составил досье на D и инструкцию по его применению.

T
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D

В

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И

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Т

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А

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M

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И

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Н

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Почему его называют витамином?

Почти 100 лет назад биохимик Элмер Макколум выяснил, что у собак, которых кормят рыбьим жиром, не бывает рахита, и задумался: «Может, это спасет от болезни и детей?». Сначала медик решил, что все благодаря витамину А. Но нейтрализовав его в продукте, получили тот же результат. Так он открыл новое вещество. Поскольку это был четвертый витамин, известный науке, его назвали четвертой буквой латинского алфавита.


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D1

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D2

D3

почти не используется в медицине


D4

(эргокальциферол) поступает в организм с растительной пищей: грибами, маслами, орехами, дрожжами 


D5

(холекальциферол) образуется под действием ультрафиолета и содержится в животных продуктах питания: жирной рыбе, сливочном масле, сыре, икре, печени, мясе

тоже вырабатывается в эпидермисе под воздействием солнечных лучей и переходит в D3


найден только в масле пшеницы, сейчас врачи проводят исследования – есть надежда, что он помогает предупредить онкозаболевания


Холекальциферол может синтезироваться в организме, а это свойственно только гормонам. Но нашли его позже остальных, поэтому за всей группой закрепилось название «витамины».


Чем грозит его дефицит?


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ослабленным иммунитетом и частыми простудами


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ранними морщинами, потерей упругости кожи


Уровень витамина D

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судорогами и слабостью мышц

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болями в суставах, артритом

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хрупкостью костей, остеопорозом, частыми переломами

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увеличением веса

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проблемами с сахаром в крови

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выпадением волос

перепадами настроения, утомляемостью, депрессией

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повышенным риском возникновения диабета (1 и 2 типов), сердечных и аутоиммунных заболеваний (как рассеянный склероз, например)

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замедленным обменом веществ

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бесплодием, развитием эндометриоза и синдрома поликистозных яичников

меньшей сопротивляемостью организма к онкозаболеваниям

Из-за последнего пункта уже не первый год спорят ученые со всего мира. Одни уверены, что витамин D может помочь предотвратить рак. Другие считают, что это ему не под силу, при этом он помогает снизить смертность от онкологии. В любом случае, сходятся они в одном: витамин D продлевает жизнь.

Джон Уайт

профессор, заведующий кафедрой физиологии Государственного исследовательского университета Макгилла в Монреале


Гиповитаминоз витамина D подавляет защитные механизмы организма, открывая путь к развитию опухолей - особенно в желудочно-кишечном тракте и костном мозге. Он способен замедлить переход клеток из предракового состояния в злокачественное и умеет контролировать их размножение. Причем можно принимать его не только внутрь, но и наружно: доказано на лабораторных мышах.


Седрик Гарланд


профессор кафедры эпидемиологии в Калифорнийском университете Сан-Диего, автор 150 статей и книг о раке


Есть статистика: онкологическая смертность зависит от широты проживания. Чем ближе к экватору, тем меньше людей умирает от рака. Отличной профилактикой может стать прием витамина D и кальция: по данным 200 исследований, это примерно на 50% снижает риск заболеть раком простаты, груди, кишечника, поджелудочной железы, легких, яичников, предстательной железы и меланомы.

Коллега из Америки согласна с ними только частично.


Джоан Мэнсон

руководитель отделения превентивной медицины в Женской больнице Бригама, профессор медицины и почетный профессор в области женского здоровья при Гарвардской медицинской школе


Наше исследование почти с 26 тысячами добровольцев старше 50 лет показало: уровень витамина D не влияет на риск возникновения рака или серьезных проблем с сердцем. Но его прием действительно снизил смертность от рака на 25%, если пациент употреблял его как минимум два года после постановки диагноза.



Кому и из-за чего его не хватает?

В Федеральном исследовательском центре питания, биотехнологии и безопасности пищи говорят, что дефицит витамина D есть у 23%-97% населения. В зависимости от региона. Дело в том, что большая часть России расположена в северной широте выше 35 параллели. Из-за этого солнечный свет падает тут под более острым углом и сильнее рассеивается. С ноября по март наша кожа вообще почти не вырабатывает холекальциферол.




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Александра Швец

Невролог, диетолог Клиники Екатерининская



Но это далеко не единственная причина. Дефицит «солнечного» витамина есть даже в Индии, Пакистане и Иране - странах, где загорать можно почти круглый год. С чем еще это может быть связано?



Люди почти не выходят на улицу днем, а ведь холекальциферол в коже вырабатывается только с 10 до 14 часов




Используют солнцезащитные кремы, снижающие синтез витамина D в коже на 95-98%




Страдают воспалительными заболеваниями кишечника (СРК), болезнью Крона, целиакия и другими, из-за которых питательные вещества усваиваются хуже




Имеют непереносимость лактозы и исключают из рациона сыры, молоко, сметану




Придерживаются строгой вегетарианской диеты




Употребляют витамин D в небольших количествах длительное время, в результате нарушается образование его активной формы в почках или он недостаточно усваивается в ЖКТ




Долго принимали холестирамин, глюкокортикоидные гормоны, противовирусные, противогрибковые и противоэпилептические препараты



В зону риска также входят беременные, кормящие и женщины в период менопаузы, люди с темным цветом кожи, заболеваниями сердца, лишним весом и пенсионеры: холекальциферол в их организме синтезируется хуже. Например, в коже 70-летнего человека производится на 50-75% витамина D меньше, чем в коже 20-летнего. А из-за избыточной массы тела он откладывается в жировой ткани и становится недоступным для центрального кровотока и усвоения.

После карантина, когда все просидели дома несколько месяцев, ситуация точно не стала лучше. А ведь впереди - осень и зима.




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Как часто нужно сдавать анализы на содержание витамина D в крови?

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К сожалению, дефицит витамина D является «тихой эпидемией». Симптомы обычно незаметны и на выявление проблемы уходят годы и даже десятилетия. Поэтому скрининг рекомендуется делать 1 раз в 6-12 месяцев. Это обычный забор крови из пальца. Цена - около 1300 рублей. Приходить нужно натощак. Если принимаете БАДы с витамином D, исключите их за 3-4 дня до похода к врачу.





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Если анализ показал значение меньше 20 нг/мл (50 нмоль/л) - у вас дефицит витамина D

от 20 до 30 нг/мл (от 50 до 75 нмоль/л) ) - недостаточность


более 30 нг/мл (75 нмоль/л)  - норма

Поскольку осенью и зимой солнца совсем мало и уровень витамина неизбежно падает, к концу лета его значения должны превысить 80 нмоль/л, чтобы хватило на зиму.

При коррекции дефицита витамина D его должно быть в организме не меньше 30-60 нг/мл (75-150 нмоль/л).






Кому и из-за чего его не хватает?

Есть тесты на витамин D3, витамин D2 и комплексный 25-ОН (D2 + D3). Первые два нужны только по показаниям врача, если необходимо оценить баланс разных метаболических вариантов веществ. А показатель 25-ОН - общий, он отражает количество витамина D, синтезирующегося кожей под действием ультрафиолета и получаемого организмом из еды и добавок.







Допустим, у вас нехватка. Что делать: есть одну рыбу или бежать в солярий?

Солярий делу точно не поможет: многие лампы дают другой УФ-спектр, не такой, как у солнца. Увы, но и во время отпуска невозможно впрок запастись витамином, проводя дни напролет на пляже. К тому же все мы знаем: это опасно.

Что же до еды, то обогатить рацион полезными веществами никогда не помешает. Ешьте дикий лосось, сельдь, сома, консервированные сардины, макрель и тунца, грибы, сливочное масло, молоко, сметану, яичный желток, сыр, говяжью печень, устриц, петрушку, крапиву, пейте соевое молоко и апельсиновый сок. И рыбий жир в капсулах.

Но имейте в виду, если у вас уже выявили дефицит D, то нормализовать его уровень только с помощью питания, увы, не удастся. Или же придется съедать по 10 кг сыра бри или 18 яиц в день. Плюс при глубокой заморозке и термической обработке пищи некоторый процент витамина теряется, поэтому лучше размораживать продукты медленно, не вымачивать мясо или рыбу в воде, готовить все на пару, гриле или в фольге. И принимать витамин в качестве добавки.








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Какой врач должен назначить необходимую дозу? И в какой форме лучше ее употреблять: масляных капсулах, водных растворах, таблетках?

Терапевт, эндокринолог и диетолог имеют право выписывать профилактическую дозу. Лечебную дозу при некоторых заболеваниях должен выписывать эндокринолог после дополнительных исследований: паратгормон, фосфор, кальций общий и кальций ионизированный, креатинин, кальций в моче.

А вот форма выпуска абсолютно не важна, они все эффективны, главное - правильно рассчитанная доза. Помните только, что D3 усваивается лучше, чем D2.






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Когда принимать?

Желательно в первой половине дня во время еды. Холекальциферол - жирорастворимое вещество, поэтому усваивается он лучше с пищей, а не натощак. А вот алкоголь препятствует его всасыванию, поэтому лучше сделать между их приемами перерыв.







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Говорят, из-за витамина D может повыситься уровень кальция в крови и он отложится на стенках сосудов...


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Если принимать токсические дозы, то уровень кальция действительно станет очень высоким и может повреждать почки и сосуды. При терапевтических и профилактических дозировках такой опасности нет. Кальций откладывается на стенках сосудов независимо от уровня витамина D, и этот процесс связан с системным воспалением, которое имеет место при метаболическом синдроме.








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Стоит ли вместе с D пить другие витамины?

Только если установлены их недостаточность или дефицит. Принимать в качестве профилактики можно, главное - внимательно изучить упаковку: вдруг комплекс тоже содержит витамин D, это может привести к передозировке.

Чем она грозит? Потерей аппетита, тошнотой, рвотой; головными, мышечными и суставными болями; запорами; сухостью в полости рта; увеличенным мочеобразованием; слабостью; депрессией; потерей массы тела; нарушением сна; повышением температуры; кальцинозом почек, кровеносных сосудов, легких.









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«Солнечный витамин» нельзя употреблять тем, у кого


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- гипервитаминоз D










гипервитаминоз D










- гиперкальциемия










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гиперкальциемия










- гиперкальциурия










гиперкальциурия










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мочекаменная болезнь









саркоидоз










- саркоидоз










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активная форма туберкулеза легких









острые и хронические заболевания печени и почек









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повышенная чувствительность к компонентам препарата (особенно к бензиловому спирту).












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