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ויטמין D

עודכן בתאריך 22/09/2022
 

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כללי

ויטמין D הינו ויטמין מסיס בשומן המתפקד הן כויטמין והן כהורמון. 

הויטמין מצוי בתרכובות שונות כאשר אלו החיוניות לגוף האדם הינן (D3 (Cholecalciferol 

המופק בבעלי חיים ומיוצר בתאי עור באמצעות חשיפה לקרני השמש ו-(D2 (Ergocalciferol המופק בצמחים. 

תפקידו העיקרי של הויטמין כולל בקרה, ספיגה והטמעה של מינרלים ובעיקר סידן וזרחן בעצמות. 

כמו כן, הוא חיוני לתפקוד תקין של מערכת החיסון, חלוקה תקינה של תאי הגוף, בקרה על רמות אינסולין ועוד. 

חוסר בויטמין עלול להיווצר בעיקר עקב חשיפה מועטה לקרני השמש ולהתבטא בתסמינים שונים כגון אובדן מסת עצם. 

עודף בויטמין עלול להיווצר עקב שימוש במינונים גבוהים ולגרום לעודף של סידן בדם(היפרקלצמיה).  

 

 

מקורות תזונתיים לויטמין D:

מרבית הויטמין בגוף נוצר באמצעות חשיפה לשמש. עם זאת, קיימים מזונות אשר מכילים את הויטמין בכמויות מסוימות:

מקורות מן הצומח (בצורת D2): פטריות שיטאקי מיובשות.

מקורות מן החי (בצורת D3): שמן כבד דגים, דגים (סלמון, הרינג, טונה, מקרל, סרדינים), חלב ומוצריו וביצים.

 

תפקידו של ויטמין D:

  • חיוני למאזן של סידן – ויטמין D מגביר את ספיגתו של סידן במעיים (מגביר את הייצור של חלבון קושר סידן במעיים), מווסת את ספיגתו מחדש בכליה, מונע את הפרשתו דרך השתן ובשילוב עם הורמון בלוטת יותרת התריס מבקר את כניסתו ויציאתו של סידן מן העצם.

  • חיוני לספיגת מינרלים וויטמינים - ויטמין D חיוני לייצור ולפעילות של חלבונים אשר תפקידם לספוג מינרלים וויטמינים במעיים.

  • חיוני למבנה ולחוזק של העצמות והשיניים.

  • חיוני לחוזק ולפעילות תקינה של השרירים.

  • מסייע לחלוקה תקינה של תאים בגוף.

  • מגביר את פעילות מערכת החיסון – חיוני לגדילה והתפתחות של תאי דם לבנים (תאי מערכת החיסון) ותאים ריריים (תאי אפיתל) אשר משמשים כקו הגנה ראשון בפני מזהמים.

  • חיוני לתפקוד עצבי תקין.

  • מווסת את רמות האינסולין בדם ובכך מסייע לחילוף חומרים תקין של סוכרים.

  • מסייע במניעת סרטן – מונע היווצרות תאים סרטניים ותורם להרס של תאים חריגים.


תכונות נוספות של ויטמין D:

  • קיים בכמה תרכובות כאשר אלו החשובות לגוף הינם D3 (Cholecalciferol) ו- D2 (Ergocalciferol). 

  • D3 מיוצר בתאי העור באמצעות חשיפה מבוקרת לקרני השמש (כ- 10 דקות ביום) ומופק גם בבעלי חיים, D2 מיוצר בצמחים (כגון פטריות).

  • אנשים בעלי עור כהה זקוקים לחשיפה ארוכה יותר (כ- 30 דקות) לקרני השמש על מנת לקבל כמויות נאותות של ויטמין D.


ספיגה והפרשה של ויטמין D:

תהליך הספיגה של ויטמין D המגיע מן המזון (D2) נעשה במעי הדק בנוכחות מיצי מרה. 

ייצורו של ויטמין D3 נעשה בתאי העור באמצעות חשיפה מבוקרת לקרני השמש 

אשר גורמות להמרה של מולקולה דמוית כולסטרול (7-dehydrocholes) ל- D3

לאחר ספיגתו מועבר הויטמין באמצעות כילומיקרונים (רכיבים אשר תפקידם להוביל שומנים) דרך הלימפה שם נקשר לחלבון נשא ומועבר לכבד. 

שתי הצורות של הויטמין מאוחסנות בכבד שם הן עוברות המרה ל- Calcidiol לאחר מכן נישאות אל הכליות ועוברות המרה נוספת ל- Calcitriol

מהכליות עובר הויטמין בצורתו הפעילה דרך הדם אל השרירים ואל רקמות שומן בגוף. 

הספיגה של D3 יעילה יותר מזו של D2 כאשר חשיפה לקרני שמש מספקת כ- 80-90% מסה"כ הויטמין בגוף.

 

גורמים לחוסר בויטמין D:

חשיפה מועטה לקרני השמש – חשיפה מועטה לקרני השמש כמו במקרים של עבודה משרדית או לבוש צנוע (דתיים).

השמנת יתר – השמנת יתר גורמת לאגירה של הויטמין ברקמות השומן ומונעת את יציאתו אל זרם הדם.

בעיות עוריות – אצל אנשים אשר סובלים מהפרעות עוריות שונות עלול להיפגע ייצור של ויטמין D.

מחלות – אנשים הסובלים מהפרעות ספיגה (כגון מחלות מעי דלקתיות, צליאק, סיסטיק פיברוזיס ועוד), 

תפקוד לקוי של כבד וכליות ומיתר או תת פעילות של בלוטת התריס עלולים לסבול מחסר של ויטמין D.

גיל מבוגר – ככל שקיימת עלייה בגיל כך תפקוד המעיים פוחת וישנה ספיגה לקויה של ויטמינים ומינרלים רבים וביניהם ויטמין D

כמו כן, בעיות שונות הקשורות לתפקודי הכבד והכליות גם הן שכיחות בגיל המבוגר ועלולות להשפיע על רמות הויטמין בגוף.

 

הפרעות ותסמינים הנגרמים עקב חוסר בויטמין D:

חוסר בויטמין D גורם להפרעות במשק הסידן והזרחן (רמות סידן וזרחן נמוכות בדם) בגוף המשפיעות בעיקר על מסת העצם. התסמינים השכיחים כוללים:

בילדים – רככת, עצירה בגדילת העצמות ושיניים לא חזקות.

במבוגרים – רכות עצמות (אוסטאומלסיה), עיוות בעצמות, שברים ופגיעה במבנה העצם עקב ספיגה לקויה של סידן ואצירה של זרחן.

תסמינים נוספים עקב חוסר של ויטמין D עלולים להתבטא בעוויתות או התכווצויות של השרירים והפרעות במערכת הלב וכלי הדם.

בנוסף, חוסר בויטמין D עלול להעלות את הסיכון להתפתחות סוגי סרטן שונים ובעיקר סרטן הערמונית וסרטן השד.

 

עודף של ויטמין D (רעילות): 

רמות גבוהות של ויטמין D גורמות לעלייה ברמות הסידן בדם (היפרקלצמיה) אשר יכולות להביא לתסמינים כגון 

הפרשת סידן בשתן, בריחת סידן מהעצמות, שקיעת סידן בכליות (אבנים בכליות), הפרעות במערכת הלב וכלי הדם, ורטיגו, טינטוןים באוזניים ועוד.

רעילות של ויטמין D הינה נדירה אך עלולה להופיע עקב צריכה ממושכת (בתזונה או דרך תוספים) הגבוהה מ- 25000 יחב"ל (625 מק"ג) ביום.

חשוב לציין, כי אנשים הסובלים מהפרעות בתפקודי כליות עלולים לסבול מתסמיני רעילות עקב צריכה של תוסף ויטמין D גם במינונים נורמאליים.

רעילות של ויטמין D עלולה להתבטא בתסמינים כגון בחילות, הקאות, אובדן תיאבון, צמא מוגבר, שלשולים, גירויים עוריים ועוד.

 

מינון יומי מומלץ של ויטמין D לפי ה- RDA (RECOMMENDED DAILY ALLOWANCE):

  • מלידה ועד גיל שנה – 10 מק"ג (400 יחב"ל).

  • גילאים 1-70 שנים – 15 מק"ג (600 יחב"ל).

  • גילאים 70 ומעלה – 20 מק"ג (800 יחב"ל).

  • נשים בהריון – 15 מק"ג (600 יחב"ל).

  • נשים מניקות – 15 מק"ג (600 יחב"ל).

הערת מערכת: בשנת 2015 פורסמו מספר ניירות עמדה הטוענים כי חישוב המינון היומי המומלץ (RDA) הינו שגוי וכי עליו לעמוד על כ 7000-9000 יחב"ל. 

צאו לשמש!

 


טווח מינון לטיפול בחוסר ויטמין D:

  • חוסר של ויטמין D בדם – במקרים של חוסר ויטמין D בדם ניתן לתת מינון של כ- 50,000 יחב"ל לשבוע במשך 6-12 שבועות. לעתים קיים צורך במינונים גבוהים יותר או בתקופות ממשוכות. בכל מקרה, מומלץ לבצע את הטיפול תחת פקוח רפואי ומעקב אחר רמות הויטמין בגוף.

  • מניעה של דלדול עצם (אוסטאופורוזיס) ושברים - נמצא כי ויטמין D במינון של 400-2000 יחב"ל ביום ביחד עם סידן מפחית את הסיכון להתפתחות של אוסטאופורוזיס ושברים.

  • דלדול עצם (אוסטאופורוזיס) – ויטמין D במינון של 400-800 יחב"ל ליום ביחד עם סידן מפחית את אובדן מסת העצם אצל אנשים הסובלים מדלדול עצם. יש להתאים את המינונים בהתאם לגיל, לצריכת הויטמין במזון ולמידת החשיפה לקרני השמש.

  • הפרעות ספיגה – נמצא כי מינון של 1000-1200 יחב"ל אצל חולי קרוהן ומינון של 1000-2000 יחב"ל אצל חולי סיסטיק פיברוזיס עשוי למנוע חוסר בויטמין D וכתוצאה למנוע רככת עצמות (אוסטאומלציה) אשר מהווה תסמין נפוץ בחולים אלו.

  • שפעת נמצא כי מינון של 1200 יחב"ל למשך 15-17 שבועות עשוי להפחית את הסיכון להדבקות בנגיף השפּעת.

  • סוכרת מסוג 2 – ויטמין D מעלה את רמות האינסולין. נמצא כי מינון של 1300 יחב"ל ביום למשך 3 חודשים עשוי לשפר את הרגישות לגלוקוז אצל חולי סוכרת מסוג 2. עם זאת, יש לעקוב אחר רמות הויטמין בדם על מנת למנוע רעילות.

  • מניעת סרטן שילוב של ויטמין D במינון של 1100 יחב"ל ביום ביחד עם סידן במינון של 1500 מ"ג ביום נמצא כמפחית סיכון להתפתחות סוגי סרטן שונים בעיקר אצל נשים וגברים בגיל המבוגר.

  • מניעת נפילות – חוסר בויטמין D נמצא כמעלה סיכון לנפילות בגיל המבוגר. מינון של 700-1000 יחב"ל ביום עשוי להקטין את הסיכון לנפילות.

  • טרשת נפוצה נמצא כי ויטמין D במינון של 400 יחב"ל כחלק ממולטי ויטמין עשוי להפחית את הסיכון להתפרצות של טרשת נפוצה או למנוע את התקפיה.

 

תגובות הדדיות עם תרופות / צמחי מרפא / תוספי תזונה

המידע על האינטראקציות זמין למנויי האתר בלבד. לרכישת מנוי לחצו כאן.


התוויות נגד לשימוש ב ויטמין D1-6:

  • מומלץ שלא ליטול תוסף של ויטמין D או להגביר את צריכתו בתזונה במקרים הבאים:

  • רגישות או אלרגיה ידועה לויטמין.

  • היפרקלצמיה (עודף של סידן בדם).

  • פעילות יתר של בלוטת יותרת המגן (פרתירואיד).

  • Chronic granulomatous - קבוצה של מחלות גנטיות אשר גורמות לליקוי בתאי מערכת החיסון ומשפיעות על חילוף החומרים של ויטמין D בכליות. מחלות אלו עלולות לגרום לעודף של ויטמין D ולהיפרקלצמיה (עודף סידן בדם).

  • הפרעות בתפקודי כליה – יש לנקוט זהירות בנטילת ויטמין D אצל אנשים הסובלים מהפרעות בתפקודי כליה. בנוסף, במקרים בהם קיים צורך בויטמין מומלץ ליטול אותו בצורתו הפעילה (Calcitriol), שכן הפגיעה הכליתית אינה מאפשרת את ההמרה של הויטמין לצורה זו.


מחקרים על ויטמין D:

 

 

בחלק זה תמצאו סקירות מחקרים על ויטמין D למידע השלם למנויים

 

מקורות:

 

מקורות כלליים לכל המידע מלבד התגובות ההדדיות

 

  1. Stargrove M B, Treasure J, McKee D. L, Herb, Nutrient, and Drug Interactions, Elsevier, 2008. pp 399-422.
  2. www.naturaldatabase.com – Vitamin D. found at - http://naturaldatabase.therapeuticresearch.com/nd/Search.aspx?cs=NONMP&s=ND&pt=100&id=929&ds=
  3. אודי בר, יפה שיר-רז, "המדריך הישראלי השלם לתוספי תזונה", כתר ספרים, 2005
  4. www. Naturalstandard.com – Vitamin D. found at - http://naturalstandard.com/databases/herbssupplements/vitamind.asp
  5. מוריי מייקל ט., פיז'ורנו ג'וזף א., "אנציקלופדיה לרפואה טבעית", אור-עם, 1995
  6. National Academy of Sciences. Institute of Medicine. Food and Nutrition Board
  7. DRI table for DRI tables for recommended dietary allowances (RDA). found at -  http://www.iom.edu/Activities/Nutrition/SummaryDRIs/DRI-Tables.aspx
  8. U.S. Institutes Of Health – Office Of Dietary Supplements – RDA tables. found at http://ods.od.nih.gov/Health_Information/Dietary_Reference_Intakes.aspx
  9. Patrick Holford, "Special Report: Supplements – Optimum Daily Allowances". found at - http://www.patrickholford.com/index.php/advice/betterhealtharticle/138/

 

מקורות לתגובות ההדדיות

 

  1. Lindh JD, Björkhem-Bergman L, Eliasson E. Vitamin D and drug-metabolising enzymes. Photochem Photobiol Sci. 2012 Dec;11(12):1797-801. https://pubmed.ncbi.nlm.nih.gov/22903070/
  2. Aloia JF, Li-Ng M, Pollack S. Statins and vitamin D. Am J Cardiol. 2007 Oct 15;100(8):1329–1329. https://pubmed.ncbi.nlm.nih.gov/17920383
  3. Ertugrul DT, Yavuz B, Cil H, Ata N, et al. STATIN-D study: comparison of the influences of rosuvastatin and fluvastatin treatment on the levels of 25 hydroxyvitamin D. Cardiovasc Ther. 2011 Apr;29(2):146–52. https://pubmed.ncbi.nlm.nih.gov/20370794
  4. Glueck CJ, Budhani SB, Masineni SS, et al. Vitamin D deficiency, myositis-myalgia, and reversible statin intolerance. Curr Med Res Opin. 2011 Sep;27(9):1683–90. https://pubmed.ncbi.nlm.nih.gov/21728907
  5. Liberopoulos EN, Makariou SE, Moutzouri E, Kostapanos MS, Challa A, Elisaf M. Effect of simvastatin/ezetimibe 10/10 mg versus simvastatin 40 mg on serum vitamin D levels. J Cardiovasc Pharmacol Ther. 2013 May;18(3):229–33. https://pubmed.ncbi.nlm.nih.gov/23288870
  6. Makariou SE, Liberopoulos EN, Agouridis AP, Challa A, Elisaf M. Effect of rosuvastatin monotherapy and in combination with fenofibrate or omega-3 fatty acids on serum vitamin D levels. J Cardiovasc Pharmacol Ther. 2012 Dec;17(4):382–6. https://pubmed.ncbi.nlm.nih.gov/22431864
  7. Ott C, Raff U, Schneider MP, Titze SI, Schmieder RE. 25-hydroxyvitamin D insufficiency is associated with impaired renal endothelial function and both are improved with rosuvastatin treatment. Clin Res Cardiol. 2013 Apr;102(4):299–304. https://pubmed.ncbi.nlm.nih.gov/23262496
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