» Näring & Hälsa
Täby Kiropraktorklinik: En helhetssyn på hälsa

Näring & Hälsa

Alla i Sverige behöver D-vitamin tillskott under höst, vinter och våren

Time for Vitamin D Supplementation
Beginning in September the sun is far enough away that we are no longer able to produce D vitamin when our skin is exposed to sunlight. This means everyone (EVERYONE) living in The Nordic latitudes (even in SCANDINAVIA) should supplement with D vitamin beginning now until May. This recommendation comes from one of many sources: the Vitamin D council is a nonprofit organization working to educate the public about D vitamin. It was started by a medical doctor whose ideas was to create a center for evidence-based vitamin D research and is a reliable source for the general public. Read the most recent research at: vitamindcouncil.org

Hur påverkar D-vitamin brist oss som bor i Skandinavien?

Flera studier har publicerats nyligen som tittar närmare på hur brist på vitamin D gör oss känsligare för att utveckla allergi, astma eller atopiskt eksem. I Skandinavien är risk för D vitamin brist ovanligt hög på grund av främst latituden sedan den långa mörka vintern. Brist på D vitamin är också kopplat till en del autoimmuna sjukdomar som förekommer oftare i norden. Tillskott under vintern har rekommenderats för att minska risk för influensa samt andra kroniska sjukdomar i många länder. De som bor i Skandinavien behöver tillskott under höst, vinter och vår. Vitamin D Council forskar kring D vitamin och publicerar råd och information i ett brev alla har tillgång till via vitamindcouncil.org. The Vitamin D Council is a nonprofit organization in California, United States founded by a Doctor of Medicine concerned about the increasing deficiency of vitamin D and the consequences associated with it. The goal is to educate patients, families, doctors and health professionals on vitamin D and safe, sensible sun exposure to improve the quality and longevity of lives.

Ni som inte tål mjölkprodukter har högre risk att drabbas av både D-vitamin och kalciumbrist, vilket gör det ännu viktigare för er med tillskott. Här är en länk till mjölkfri och soyfri alternativ Sammanfattning mjölk produkter och mjölkfria alternativ

Om du har invandrat till Sverige eller har lätt att bli brun i solen, har du nog behov av extra D vitamin. Vi hittar D vitamin i sardiner, lax, sill, hälleflundra, tonfisk i olja och makrill. Mindre mängder hittas i ägg, griskött, räkor, kycklingkött och lamm. Bästa källorna för kalcium är oskalade sesamfrön, ost, persilja, hasselnötter, grönkål och mjölk.

Intake of magnesium has an important impact on the uptake and utilization of D vitamin.

Magnesium, vitamin D status and mortality: results from US National Health and Nutrition Examination Survey (NHANES) 2001 to 2006 and NHANES III

When is D-vitamin too much or too little?

Experts in Endocrinology express the following opinion ” vitamin D deficiency is very common in all age groups — essentially everyone is at risk”.  Our main source of D vitamin is through sunlight exposure directly to the skin during the spring, summer and fall. Vitamin D is otherwise available in only a few foods and as a supplement. In northern latitudes, particularly Scandinavia, there is a risk for not meeting your daily requirements depending on the weather. From September through April D vitamin needs to be supplemented due to the northern latitude and lack of exposure to the sun.  Vitamin D is most well know for its role with calcium for skeletal health, building strong bones! Vitamin D has other important functions including enhancing the immune system, regulating cell growth and proliferation, reducing inflammation, supporting the immune system and neuromuscular health. There are a wealth of studies focusing on the link between D vitamin deficiency and cancer, depression, high blood pressure, MS, infections, inflammatory diseases and diabetes.

The best way to measure D vitamin in the body is under discussion, but experts agree that a serum 25(OH)D level of 50 nmol/L is adequate for healthy inidviduals. What is confusing is how different articles discuss different measurements of D vitamin: IU is the international unit while μgm (mcg) is microgram. (400 IU = 10 μgm  = 10 mcg)

A vitamin D deficiency can occur when usual intake is lower than recommended levels over time, exposure to sunlight is limited, the kidneys cannot convert 25(OH)D to its active form, or absorption of vitamin D from the digestive tract is inadequate.  Fish liver oil and fatty fish are the best sources of foods with D vitamin.  Vitamin D-deficient diets are associated with milk allergy, lactose intolerance, ovo-vegetarianism, and veganism. Other groups at risk for D vitamin deficiency include:

  • breastfed infants
  • infants of mothers who have D vitamin deficiency
  • the elderly (due to reduced capacity to absorb D vitamin)
  • people who do not get outside regularly
  • dark skinned people
  • people covering their bodies
  • people with Crohns disease, liver disease, cystic fibrosis, kidney disease
  • children and adults who are obese or have had gastric bypass surgery
  • people with fat malabsorption problems
  • people taking medications: anticonvulsants,  glucocorticoids, antifungals or cholesterol reducing medications

The infants D vitamin status is dependent on the mothers D vitamin status at birth. The pregnant mother with vitamin D deficiency will have an infant that is deficient in D vitamin.  Low infant levels are associated with increased risk for RS virus, as well as developing asthma and diabetes 1 later in life. Besides supplementing the infant, the breastfeeding mother is recommended to take a dose of 4000 IU so the infant gets adequate levels.

Children with a low vitamin D present with a higher incidence of fractures from normal activities.

Recommended Dietary Allowances (RDAs) for Vitamin D and tolerable upper intake levels are all far below the dosages considered to be harmful. The tables below show these doses. These are doses recommended for healthy people. Taking the lower limit is sufficient during the summer fall and spring for healthy individuals not in a risk group. The upper intake levels are appropriate for risk groups. Individuals who have already a deficiency, require in some cases even higher levels to correct, treat och prevent D vitamin deficiency and should be monitored by a physician.

The following table shows the range of vitamin D which can be safely taken based on age. The list shows different alternatives for strength depending on how the manufacturer measures the D vitamin. Vitamins should be taken always from late september through April, and earlier if the summer is rainy and cloudy.

0 -6 months the daily dosage should be between 400-1000 IU or 10-25 μgm (mcg)

7 months to 1 year: 400-1500 IU or 10-38 μgm (mcg)

1-3 years 600-2500 IU or 15-63 μgm (mcg)

4-8 years 600-3000 IU or 15-75 μgm (mcg)

9-18 years 600-4000 IU or 15- 100  μgm (mcg)

adults 2500-4000 IU or 63 – 100 μgm (mcg)

women who are pregnant or lactating 600-4000 IU or 15-100 μgm (mcg).

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/539596/SACN_Vitamin_D_Press_Release_July_2016.pdf

Can patients get too much vitamin D?

Too much vitamin D can be toxic, but is very rare. Studies investigating toxicity all involved daily consumption of over 40000 IU (1000 mcg) per day. Immediate symptoms of toxicity are abdominal cramps, nausea and vomiting. Symptoms can otherwise be due to an underlying magnesium deficiency. Vitamin D toxicity can be determined by a blood test. The first sign is hypercalcemia, a high level of calcium in the urine.  There are some health conditions which affect how the body metabolizes vitamin D and calcium, particularly hyperparathyroidism or kidney disease. People with these health conditions should be under supervision when taking D vitamin supplements.

Överdosering.

Tillskott med D-vitamin har länge hämmats av en rädsla för överdosering. Denna rädsla har nu visat sig vara kraftigt överdriven. Omvandlingen till den aktiva formen sker i flera steg vilket är en inbyggd säkerhetsmekanism. I studier har dosbehov och säkerhet undersökts. Dessa talar för att 100 mikrogram (=4.000 IE) vitamin D3/dag ger tillfredsställande nivåer utan biverkningsrisk. Jämför detta med livsmedelsverkets rekommendation på 400 IE per dag som alltså bara utgör 10% av optimal dos. Referens: www.lakartidningen.se/engine.php?articleId=6

EXPONERA HUDEN FÖR SOLEN

Äntligen har Svensk forskning visat hur viktig det är att exponera huden för solen! Studien jämförde riskerna med att undvika solen med riskerna av att röka. Studien följde kvinnor i Sverige över 20 år och kunde visa ett samband mellan att undvika att sola sig med en ökad risk att dö förtidigt i olika sjukdomar. Detta råd gäller även de som har haft malignt melanom. Lagom exponering minskar risken för aggressiva förändringar som följd av malignt melanom. Samtidigt som man ska exponera kroppen till solen, ska man inte ta på sig solskydds faktor och vara ute alldeles för länge. Det är bara under månader maj, juni, juli och augusti som vi har tillräckligt med sol på våra norra breddgrader för att kroppen skall kunna tillverka D-vitamin, förutsatt att man är ute i solen och armar och ben exponeras. Årets andra månader behöver vi ta D-vitamin för optimal hälsa (Lindqvist, 2016).

Det är dags att exponera huden för solen så att du kan producera D vitamin. Det är avgörande för din hälsa inte minst benhälsa. I Skandinavien har vi det relativt högsta antalet personer i världen som drabbas av benskörhet. Det är tragiskt med tanke på att man kan förebygga med tillskott av D vitamin och kalcium från september tom april. Detta råd gäller båda kvinnor och män. Observera att man ska sola med förstånd. Risken för malignt melanom ökar om man solar allt för mycket och bränner sig.

Har du pollenallergi? Vet du vilken mat du ska undvika???

Många i Sverige drabbas av pollenallergi.

Korsallergen eller ”Cross-Allergens” är mat som har en liknande kemisk struktur som pollen och gör att kroppen reagerar som om den var allergisk. Till exempel ska de som har gräsallergi undvika apelsiner, tomater, kiwi samt melon. Det är extra viktigt att undvika korsallergener under allergisäsongen samt när man är sjuk. Under övriga delar av året, ska man sparsamt äta mat som är kopplat till ens allergi. Detta gör att man minskar en ständig belastning av immunförsvaret. Många patienter upplever en signifikant förbättring av hälsan när de under året undviker mat som skapar en allergisk reaktion. När man kokar mat, ändrar man proteinstrukturen. En del allergiker upplever då mindre besvär av maten de annars är känsliga för, men kan istället få en fördröjd reaktion på huden, som eksem.

Länk till Pollen kalender från Naturhistoriska Riksmuseet här:http://www.nrm.se/sv/meny/faktaomnaturen/vaxter/pollen/pollenkalender.14260.html

Här har du en lista med korsallergener till björk, gräs, gråbo och latex. A list in English: In English

Björk:
Vete, potatis, äpple, morot,päron, aprikos, tomater, hasselnöt, mandel, valnöt kiwi, koriander, körsbär, plommon, nektarin, palsternackor, paprika, selleri, solrosfrön, spenat.

Gråbo:
Melon, vattenmelon, selleri, morot, äpple, Anis, fänkål, hasselnötter, kamomill, koriander, kummin.

Latex:
Avokado, banan, kiwi, jordnötter, kastanj, majs, morot, potatis, tomat.

Gräs:
Apelsin, tomat, potatis, jordnötter, kiwi, körsbär, melon, vattenmelon.

Osteoporosis, Calcium and Atherosclerosis

Osteoporosis is a disabling condition which can be prevented with supplementation of calcium and D vitamin. Scandinavians, both men and women have the highest risk for this disease. In most areas of the world it is only postmenopausal women who are at risk for developing this disease. Calcium supplementation is particularly important for reducing the risk for osteoporosis and its painful disfiguring consequences. The question has been raised whether supplementation of 1200 mg per day in the postmenopausal woman is associated with an increased risk for for atherosclerotic vascular disease. More simply, the question is, does taking a dose of calcium (1200 mg) which prevents ostoporosis increase the chance that the calcium is deposited in the arteries. Researchers have studied this and their are two important findings. The first is that taking calcium supplements as a postmenopausal women does not increase the risk for vascular disease and second, patients with pre-existing vascular disease reduce their risk for hospitilization and mortality by taking a calcium supplements. Calcium should be taken together with D vitamin to ensure strong bones. Men, particularly smokers, should not take extra calcium supplements. Men who are at risk for osteoporosis should consult their physician for advice about calcium supplement, but taking D vitamin of at least 800 IU is important for bone health.

What does this mean? Taking calcium supplements (1200 mg) does not increase the risk for vascular disease and may even be protective for the patient who already suffers from it.

Referenser:

Lindqvist P, Epstein E, Nielsen K, Landin-Olsson M, Olsson H. 2016. Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the Melanoma in Southern Sweden cohort. Journal of Internal Medicine;doi: 10.1111/joim.12496.

Deng X, Song Y, Manson J, Signorello L, Ahang S, Ness R, Sediner D, Dai Q. 2013. Magnesium, vitamin D status and mortality: results from US National Health and Nutrition Examination Survey (NHANES) 2001 to 2006 and NHANES III; BMC Medicine, 11:187 doi:10.1186/1741-7015-11-187.

Bohle B. 2007. The impact of pollen-related food allergens on pollen allergy. Allergy.;62(1):3-10.

Brot C, Jørgensen N, Madsen OR, Jensen LB, Sørensen OH.1999. Relationships between bone mineral density, serum vitamin D metabolites and calcium:phosphorus intake in healthy perimenopausal women. J Intern Med.;245(5):509-16.

Bågenholm G, Sääf M, Barenvik-Olsson M, Kristiansson F, Gustafsson S, Fernell E. 2010. Alla förskolebarn i Sverige behöver vitamin D-berikad kost. Läkartidningen;41(107)2471-3.

Fernández-Rivas M, Benito C, González-Mancebo E, de Durana DA. 2008. Allergies to fruits and vegetables. Pediatr Allergy Immunol.;19(8):675-81.

Goetz DW. 2011. Idiopathic itch, rash, and urticaria/angioedema merit serum vitamin D evaluation: a descriptive case series.W V Med J.107(1):14-20.

Hofmann A, Burks AW. 2008. Pollen food syndrome: update on the allergens. Curr Allergy Asthma Rep.;8(5):413-7.

Larsen ER, Mosekilde L, Foldspang A. 2004. Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res.;19(3):370-8.

Mak G, Hanania NA. 2011. Vitamin D and asthma. Curr Opin Pulm Med.;17(1):1-5.

Meyer R. 2008. Review: The prevalence of allergic disease. The Journal Of Family Health Care;18 (1),27-30.

Michaelsen KF, Astrup AV, Mosekilde L, Richelsen B, Schroll M, Sørensen OH.1994. The importance of nutrition for the prevention of osteoporosis. Ugeskr Laeger.;156(7):958-60, 963-5.

Pelajo CF, Lopez-Benitez JM, Miller LC. 2010. Vitamin D and autoimmune rheumatologic disorders. Autoimmun Rev.;9(7):507-10.

Searing DA, Leung DY. 2010. Vitamin D in atopic dermatitis, asthma and allergic diseases. Immunol Allergy Clin North Am.;30(3):397-409.

Schmidt MH; Raulf-Heimsoth M; Posch A. 2002. Evaluation of patatin as a major cross-reactive allergen in latex-induced potato allergy; Ann Allergy Asthma Immunol;89(6)613-8.

Szodoray P, Nakken B, Gaal J, Jonsson R, Szegedi A, Zold E, Szegedi G, Brun JG, Gesztelyi R, Zeher M, Bodolay E. 2008. The complex role of vitamin D in autoimmune diseases. Scand J Immunol.;68(3):261-9.

Sørensen OH, Jensen JE. 1993. Osteoporosis treatment–state of the art. Nord Med.;108(11):289-92.

Thacher TD, Clarke BL. 2011. Vitamin D insufficiency. Mayo Clin Proc.;86(1):50-60.

Vieths S, Scheurer S, Ballmer-Weber B. 2002. Current understanding of cross-reactivity of food allergens and pollen. Ann N Y Acad Sci.;964:47-68.

Belderbos M et al. 2011. Cord Blood Vitamin D Deficiency is Associated With Respiratory Syncytial Virus Bronchiolitis. Pediatrics;127(6):e1513-20. doi: 10.1542/peds.2010-3054.

Brooks M. 2011. Endocrine Society Issues Practice Guideline on Vitamin D.  ENDO 2011: The Endocrine Society 93rd Annual Meeting. Presented June 6, 2011.

Clarke N. 2012. Vitamin D deficiency: a paediatric orthopaedic perspective. Current Opinion in Pediatrics,24(1):46-9. doi: 10.1097/MOP.0b013e32834ec8eb.

Marshall et al. 2012. Vitamin D in the maternal–fetal–neonatal interface: clinical implications and requirements for supplementation. Journal of Maternal-Fetal and Neonatal Medicine. J Matern Fetal Neonatal Med. Epub ahead of print.

Ross C. Et al. 2011. The 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D from the Institute of Medicine: What Clinicians Need to Know. J Clin Endocrinol Metab; 96(1): 53–58.

Vieth R. 1999. Vitamin D supplementation, 25-hydroxyvitmain D concentrations and safety. AM J Clin Nutr;69(5)842-56.

Koutkia P. et al. 2001. Vitamin D intoxication associated with an over-the-counter supplement. N Engl J Med;345(1)66-7.

Heaney R. 2008. Vitamin D: criteria for safety and efficacy. Nutr Rev;66(110 supple 2)S178-81.

Lewis JR, Calver J, Zhu K, Flicker L, Prince RL. 2011. Calcium supplementation and the risks of atherosclerotic vascular disease in older women: results of a 5-year RCT and a 4.5-year follow-up. J Bone Miner Res;35-41.

Frost M, Wraae K, Abrahamsen B et al. 2012. Osteoporosis and verebral fractures in men aged 60-74 years. Age Ageing;41(2)171-7.

Xiao Q, Murphy RA, Houston DK, Harris TB, Chow W, Park Y. Dietary and supplemental calcium intake and cardiovascular disease mortality: The National Institutes of Health-AARP Diet and Health Study. JAMA Intern Med. 2013;1-8

www.lakartidningen.se/engine.php?articleId=6279