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Σχετικά με την Βιταμίνη D.

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anastaziogr:
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή ΕίσοδοςΗ Uni-pharma ( Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος ) έχει βγάλει πρόσφατα δύο σκευάσματα βιταμίνης D3 (cholecalciferol).

Το Tabl. D3fix  1.200 IU x 60 που σήμερα (19/11/2012 κοστίζει 9,5 ευρώ)

και το

Tabl. D3fix extra  2.000 IU x 60 που σήμερα κοστίζει 12 ευρώ.

Τα φάρμακα αυτά δεν καλύπτονται από τα ασφαλιστικά ταμεία.

Τα δισκία και της μιας και της άλλης συσκευασίας είναι διχοτομούμενα.

Προτεινόμενη δοσολογία και για τα δύο σκευάσματα είναι ένα δισκίο την ημέρα συνήθως μαζί με κάποιο γεύμα, αλλά γράφει ότι το δοσολογικό σχήμα μπορεί να τροποποιηθεί με τη συμβουλή του Ιατρού.

Σε ένα διαφημιστικό σελιδοδείκτη των σκευασμάτων γράφει επίσης ότι δεν περιέχουν ζάχαρη ή αλάτι.

Ο τοπικός αντιπρόσωπος της εταιρείας μου είπε ότι η εταιρεία σχεδιάζει να βγάλει βιταμίνη D3 και σε σταγόνες.

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Τα παραπάνω σκευάσματα, τα οποία από όσο γνωρίζω είναι τα μόνα φαρμακευτικα σκευάσματα "σκέτης" βιτ D3 που κυκλοφορούν στην Ελλάδα (αν εξαιρέσουμε το Solgar, το οποίο υποτίθεται οτι είναι διατροφικό συμπλήρωμα) και όντως, δυστυχώς, δε καλύπτονται από τα ασφαλιστικά ταμεία. Σε αντιθεση καλύπτονται τα ανάλογα της βιτ D (αλφακαλσιδόλη κλπ) καθώς επίσης και οι συνδυασμοί ασβεστίου και βιτ D3.

Παρόλα αυτά όλες (τουλάχιστον όλες όσες ξέρω) οι κατευθυντήριες οδηγίες (Ελληνικές, Βρεττανικές, Αμερικανικές) για την αντιμετώπιση και θεραπεία της μετεμμηνοπαυσιακής οστεοπόρωσης καθώς και υποβιταμίνωσης D (εξαιρουμένων ειδικών περιπτώσεων όπως νεφρικής ή ηπατικής ανεπάρκειας ή  ραχίτιδας ανθεκτικής στη βιτ D) συνιστούν απλή βιτ D (και μάλιστα κατά προτίμηση D3) και όχι αλφακαλσιδόλη.
Παρόλα αυτά στην Ελλάδα, πολλοί "ειδικοί" της οστεοπόρωσης (ορθοπαιδικοί, ενδοκρινολόγοι, παθολόγοι, γενικοί ιατροί, γυναικολόγοι) πιστεύοντας ότι χορηγόντας την "μισοενεργοποιημένη" μορφή της βιτ D θα κάνουν καλύτερη δουλειά...προτιμούν την  άλφακαλσιδόλη....

Loumakis:
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

People with diabetes often develop clogged arteries that cause heart disease, and new research at Washington University School of Medicine in St. Louis suggests that low vitamin D levels are to blame.

In a study published Nov. 9 in the Journal of Biological Chemistry, the researchers report that blood vessels are less likely to clog in people with diabetes who get adequate vitamin D. But in patients with insufficient vitamin D, immune cells bind to blood vessels near the heart, then trap cholesterol to block those blood vessels.

“About 26 million Americans now have type 2 diabetes,” says principal investigator Carlos Bernal-Mizrachi, MD. “And as obesity rates rise, we expect even more people will develop diabetes. Those patients are more likely to experience heart problems due to an increase in vascular inflammation, so we have been investigating why this occurs.”

In earlier research, Bernal-Mizrachi, an assistant professor of medicine and of cell biology and physiology, and his colleagues found that vitamin D appears to play a key role in heart disease. This new study takes their work a step further, suggesting that when vitamin D levels are low, a particular class of white blood cell is more likely to adhere to cells in the walls of blood vessels.

Vitamin D conspires with immune cells called macrophages either to keep arteries clear or to clog them. The macrophages begin their existence as white blood cells called monocytes that circulate in the bloodstream. But when monocytes encounter inflammation, they are transformed into macrophages, which no longer circulate.

In the new study, researchers looked at vitamin D levels in 43 people with type 2 diabetes and in 25 others who were similar in age, sex and body weight but didn’t have diabetes.

They found that in diabetes patients with low vitamin D — less than 30 nanograms per milliliter of blood — the macrophage cells were more likely to adhere to the walls of blood vessels, which triggers cells to get loaded with cholesterol, eventually causing the vessels to stiffen and block blood flow.

“We took everything into account,” says first author Amy E. Riek, MD, instructor in medicine. “We looked at blood pressure, cholesterol, diabetes control, body weight and race. But only vitamin D levels correlated to whether these cells stuck to the blood vessel wall.”

In one of those studies, the researchers are giving vitamin D to people with diabetes and hypertension to see whether the treatment may lower blood pressure. In the second study, African Americans with type 2 diabetes are getting vitamin D along with their other daily medications, and the research team is evaluating whether vitamin D supplements can slow or reverse the progression of heart disease.

Sometime in the next several months, the scientists hope to determine whether vitamin D treatment can reverse some of the risk factors associated with cardiovascular disease.

“In the future, we hope to generate medications, potentially even vitamin D itself, that help prevent the deposit of cholesterol in the blood vessels,” Bernal-Mizrachi explains. “Previous studies have linked vitamin D deficiency in these patients to increases in cardiovascular disease and in mortality. Other work has suggested that vitamin D may improve insulin release from the pancreas and insulin sensitivity. Our ultimate goal is to intervene in people with diabetes and to see whether vitamin D might decrease inflammation, reduce blood pressure and lessen the likelihood that they will develop atherosclerosis or other vascular complications.”

Loumakis:
  Αφιερώνω το παρακάτω άρθρο σε φίλο και συνάδελφο του φόρουμ, που πληροφορήθηκα οτι η γυναίκα του ειναι έγκυος, για να της μετρήσει τα επίπεδα βιταμίνης D και να της δωσει έγκαιρα θεραπεία υποκαταστασης, εάν χρειάζεται. Με βάση την παρακάτω εξαιρετικά πρωτότυπη εργασία, υψηλότερα επίπεδα βιταμίνης D στην εγκυμοσύνη σχετίζονται με καλύτερη διανοητική και ψυχοκινητική ανάπτυξη των βρεφών. Στη γυναίκα του εύχομαι καλή λευτεριά και στους δύο ένα γερό και έξυπνο μωράκι.

Circulating 25-Hydroxyvitamin D3 in Pregnancy and Infant Neuropsychological Development απο το Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

OBJECTIVE: To investigate whether circulating 25-hydroxyvitamin D3 [25(OH)D3] concentration in pregnancy is associated with neuropsychological development in infants.

METHODS: The Spanish population-based cohort study INfancia y Medio Ambiente Project recruited pregnant women during the first trimester of pregnancy between November 2003 and February 2008. Completed data on 1820 mother-infant pairs were used. Maternal plasma 25(OH)D3 concentration was measured by high-performance liquid chromatography in pregnancy (mean 13.5±2.1 weeks of gestation). Offspring mental and psychomotor scores were assessed by trained psychologists at age 14 months (range, 11–23) by using the Bayley Scales of Infant Development. β-Coefficients with 95% confidence intervals (CIs) of mental and psychomotor scores associated with continuous or categorical concentrations of maternal plasma 25(OH)D3 were calculated by using linear regression analysis.

RESULTS: The median plasma value of 25(OH)D3 in pregnancy was 29.6 ng/mL (interquartile range, 21.8–37.3). A positive linear relationship was found between circulating concentrations of maternal 25(OH)D3 concentrations in pregnancy and mental and psychomotor scores in the offspring. After adjustment for potential confounders, infants of mothers with 25(OH)D3 concentrations in pregnancy >30 ng/mL showed higher mental score (β = 2.60; 95% CI 0.63–4.56) and higher psychomotor score (β = 2.32; 95% CI 0.36–4.28) in comparison with those of mothers with 25(OH)D3 concentrations <20 ng/mL.

CONCLUSIONS: Higher circulating concentration of maternal 25(OH)D3 in pregnancy was associated with improved mental and psychomotor development in infants.

  Με την ευκαιρία αυτή να κάνω και ένα σχόλιο σε προηγούμενη ανάρτηση του φόρουμ.
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή ΕίσοδοςΤα παραπάνω σκευάσματα, τα οποία από όσο γνωρίζω είναι τα μόνα φαρμακευτικα σκευάσματα "σκέτης" βιτ D3 που κυκλοφορούν στην Ελλάδα (αν εξαιρέσουμε το Solgar, το οποίο υποτίθεται οτι είναι διατροφικό συμπλήρωμα) και όντως, δυστυχώς, δε καλύπτονται από τα ασφαλιστικά ταμεία. Σε αντιθεση καλύπτονται τα ανάλογα της βιτ D (αλφακαλσιδόλη κλπ) καθώς επίσης και οι συνδυασμοί ασβεστίου και βιτ D3.

Παρόλα αυτά όλες (τουλάχιστον όλες όσες ξέρω) οι κατευθυντήριες οδηγίες (Ελληνικές, Βρεττανικές, Αμερικανικές) για την αντιμετώπιση και θεραπεία της μετεμμηνοπαυσιακής οστεοπόρωσης καθώς και υποβιταμίνωσης D (εξαιρουμένων ειδικών περιπτώσεων όπως νεφρικής ή ηπατικής ανεπάρκειας ή  ραχίτιδας ανθεκτικής στη βιτ D) συνιστούν απλή βιτ D (και μάλιστα κατά προτίμηση D3) και όχι αλφακαλσιδόλη.
Παρόλα αυτά στην Ελλάδα, πολλοί "ειδικοί" της οστεοπόρωσης (ορθοπαιδικοί, ενδοκρινολόγοι, παθολόγοι, γενικοί ιατροί, γυναικολόγοι) πιστεύοντας ότι χορηγόντας την "μισοενεργοποιημένη" μορφή της βιτ D θα κάνουν καλύτερη δουλειά...προτιμούν την  άλφακαλσιδόλη....

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   Συμφωνώ απόλυτα οτι δεν χρειάζεται να δίνει κανείς αλφακαλσιδόλη (One-Alpha κλπ.), αλλά απλή βιταμίνη D. Η προτίμηση για την αλφακαλσιδόλη ειναι αποτέλεσμα διαφημιστικης προώθησης απο τις μητρικες φαρμακευτικες εταιρείες. Η μόνη περίπτωση που χρειάζεται να δωσει κανείς αλφακαλσιδόλη ειναι προχωρημένη νεφρική ανεπάρκεια, όπου λόγω αδυναμίας υδροξυλίωσης της βιταμίνης D στη θέση 1 (υπενθυμίζω οτι το ηπαρ υδροξυλιώνει  τη βιταμίνη D στη θέση 25 και ο νεφρος στη θεση 1 για να παραχθεί η ενεργός ορμόνη 1,25-(OH)2-βιταμίνη D), χορηγούμε έτοιμη 1-OH-βιταμίνη D (αλφακαλσιδόλη)  παρακάμπτοντας τον νεφρό. Επιπλέον η αλφακαλσιδόλη εχει μικρό, αλλά υπαρκτό κίνδυνο υπερασβεστιαιμίας, που η απλή  βιταμίνη D δεν έχει (παρα μόνο σε τεράστιες δόσεις, υπερβολικά πανω απο τις συνιστωμενες).

Loumakis:
  Αυξανονται και πληθύνονται οι ερευνες οι σχετικες με την βιταμινη D, που αποδεικνύουν οτι ειναι πολλαπλα ευεργετική στην προληψη νοσηματων. Παραθέτω αλλες δύο. Η μια ερχεται να επιβεβαιωσει τη σημασια της βιταμινης D στην πρόληψη του σακχαρωδη διαβήτη τύπου Ι (στο πλαισιο της γενικότερης προληψης των αυτοάνοσων νοσηματων) και η δεύτερη αναδεικνύει μια πιθανή προληπτικη δραση στον τερηδονισμό των δοντιων, που όμως εκδηλωνεται μεχρι την ηλικια των 13 ετων. Και δύο μαζί αποδεικνύουν ποσο σημαντικό ειναι να μετριεται η βιταμίνη D και στην παιδική ηλικία (άραγε πόσοι παιδίατροι τη μετρανε στα πλαισια ενος προληπτικού τσεκ-άπ; )

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

 Low serum vitamin D concentration was associated with an increased risk of developing "insulin-requiring" diabetes in a nested case-control study of active-duty military service members.

The study, led by Edward D. Gorham, PhD, MPH, a research epidemiologist from the Naval Health Research Center, San Diego, and assistant adjunct professor in the Department of Family and Preventive Medicine at the University of California, San Diego, was published online September 7 and in the December issue of Diabetologia.

Dr. Gorham and colleagues used prediagnostic serum taken as part of a US Department of Defense serological surveillance program between 2002 and 2008. They compared levels of 25(OH)D between 1000 consecutive patients who developed insulin-requiring diabetes and 1000 healthy matched control participants. Case and control participants had all been on active duty at the time of the initial blood draw. Individuals from the 2 groups were matched based on "date that the blood sample was drawn (±2 days), age (±3 months), length of military service (±30 days), sex, and whether the control was on active duty when the case was diagnosed," the authors write.

A median of 1 year (range, 1 month - 10 years) elapsed between the blood sample collection and diabetes diagnosis. More than two thirds of all the study participants were younger than 35 years.

Those in the lowest quintile of serum 25(OH)D levels (<43 nmol/L) had a 3.5-fold greater likelihood of developing insulin-requiring diabetes than those in the highest quintile of serum 25(OH)D levels (≥100 nmol/L). Those in the second-lowest quintile of serum 25(OH)D levels (43 - 59 nmol/l) had a 2.5-fold greater risk. Odds ratios for the next 3 serum 25(OH)D levels quintiles (60 - 77, 78 - 99, and ≥100 nmol/L) were 0.8, 1.1, and 1.0 (reference), respectively ( P trend < .001).

"Based on the present study, it may be that no further reduction in risk would be expected once a serum 25(OH)D concentration of >60 nmol/l has been attained," the authors note.

Those who developed diabetes had significantly lower mean 25(OH)D levels than the healthy control patients (62.2 nmol/L vs 72.5 nmol/L; P ≤ .0001).

Among racial groups, blacks were more likely to develop diabetes than other races, but the association between 25(OH)D levels and diabetes was seen in all racial groups.

After adjustment for race, those with the lowest quintile of 25(OH)D were at nearly 2-fold greater risk of developing diabetes compared with those in the highest quintile (odds ratio, 1.9; 95% confidence interval, 1.4 - 2.7; P < .0001). Compared with whites, the odds ratio for blacks was 1.6 (95% confidence interval, 1.2 - 2.0; P < .001).

As the researchers explain, worldwide rates of type 1 diabetes vary by latitude, with annual age-standardized incidences ranging from a low in the tropics (0.5 per 100,000 in Venezuela) to a high near the Arctic Circle (60/100,000 in Finland).

It is possible, the researchers state, that vitamin D affects immune function. "Vitamin D deficiency is associated with major effects on the innate immune system. This could potentially influence the risk of diabetes by reducing risk of infection of islet cells," the authors write.

A potential study limitation includes the possibility that a small number of patients may have had complicated type 2 diabetes. "Cases in the present study were included solely because they were dependent on insulin," the authors note.


Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

Dental professionals may want to consider whether their patients have adequate vitamin D levels when assessing them for caries, a new study suggests.

Vitamin D supplements were associated with a 47% reduction in risk for caries, according to a systematic review and meta-analysis published online November 9 in Nutrition Reviews.

However, the quality of the evidence amounted to ''low certainty'' by the standards of the US Preventive Services Task Force, according to the study's author, Philippe P. Hujoel, DDS, PhD, professor of oral health sciences, University of Washington, Seattle.

"There have been 3 studies conducted recently," Dr. Hujoel told Medscape Medical News. "They were very favorable, but they increased vitamin D levels by low amounts through full-spectrum lighting, making it unclear if the caries reduction was due to vitamin D or due to the pineal gland activation. Dentistry has emphasized fluoride and sealants, and vitamin D has fallen by the wayside."

Vitamin D has long been known to play a role in tooth formation, but some researchers have theorized that it might have additional benefits in reducing caries through either antimicrobial or immunological effects.

The decline in interest in the effects of vitamin D on caries is puzzling because even those studies done between World War I and World War II suggest that supplements and ultraviolet light treatments could reduce caries rates, Dr. Hujoel said.

The American Dental Association (ADA) initially endorsed that finding, and the American Medical Association (AMA) followed suit, but then the ADA reversed its position for reasons that are no longer clear, Dr. Hujoel said. He is exploring that history for a future article.

Dr. Hujoel did not find a big difference between the effects of ultraviolet therapy and nutritional supplementation with either vitamin D2 or vitamin D3.

Ineffective After Age 13 Years

According to his analysis, vitamin D supplementation was ineffective after the age of 13 years, particularly for girls, and he theorized that changes in body fat could influence the way vitamin D is stored and metabolized.

He notes that the better trials he found were more likely to show evidence for the success of the treatment. "Regardless of whether trial quality was defined by an overall quality score, by individual study design characteristics, by the pivotal nature of a study, or by the time era in which the studies were conducted, higher study quality translated into higher vitamin D effectiveness," he writes.

For example, the studies in which the treatment groups were more similar showed a significantly larger vitamin D benefit than those studies in which investigators assigned vitamin D on the basis of health awareness or caries experience.

In addition, the trials with the biggest funding, scope, and sample sizes reported more pronounced beneficial effects. Finally, 2 studies published in 1975 and 1989 with more contemporary design, caries scoring methods, and settings showed more effectiveness than the 22 controlled clinical trials conducted between World War I and World War II.

Dr. Hujoel also researched whether the caries reduction associated with vitamin D was a result of "vehicle effects" (the benefits of whatever was administered along with the vitamin D). For example, some trials used cod liver oil, which also included vitamin A, iodine, and marine fats.

Other trials used ultraviolet light therapy, which could have activated the participants' pineal glands, increasing salivation. That effect might have been more important than stimulating their skin to produce vitamin D precursors.

However, these alternative explanations cannot easily account for the consistent benefit across trials that used a variety of vitamin D therapies.

Falls Short of Proof

The meta-analysis falls short of proving that vitamin D protects against caries, Dr. Hujoel acknowledged. Although some of the studies done decades ago were sophisticated for their time, with control groups, randomization, and statistical analysis, they did not entirely meet contemporary standards of study design.

In a few, investigators also appeared to have conflicts of interest. For example, he writes, "[a] pathologist involved with patenting vitamin D3 extraction was described as cooperating 'heartily' with caries trials and coauthored a report suggesting that vitamin D3 was superior to vitamin D2."

In addition, Dr. Hujoel pointed out, populations have changed since the early 20th century, when the bulk of the research was done. Diets were lower in carbohydrates and phosphate, rickets was common, fluoride was less widely used, and sun exposure was considered essential to health.

Finally, Dr. Hujoel notes that he did not find evidence of a dose response. For this reason, he does not think that patients who have adequate serum vitamin D levels are likely to get any benefit from supplements.

"I'm not at all in favor of supplementing," he said. "Children should play in the sun or get vitamin D through their diet."

Still, it would not hurt to recommend that patients with caries make sure they are getting adequate vitamin D, as they will likely benefit in more ways that just the narrow issue of caries prevention, he said.

That recommendation might particularly pertain to patients found to be at high risk for recurring caries, according to Michael Rethman, DDS, an associate clinical professor at the University of Maryland in Baltimore and former chair of the ADA's Council on Scientific Affairs. Dr. Rethman was not involved in the study.

"I agree with [Dr. Hujoel's] analysis that this is a topic that ought to be looked at with well-designed prospective clinical trials," Dr. Rethman told Medscape Medical News.

Μαρία Χόρτη:
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος   Μία πρακτική συμβουλή σε όσους θελουν να μετρησουν τα επίπεδα της βιταμίνης D στους ασθενεις τους, ασφαλισμένους του ΕΟΠΥΥ. Με δεδομένο ότι στη λίστα εξετασεων του ΕΟΠΥΥ (e-diagnosis) δεν περιλαμβανεται η 25-ΟΗ-βιταμίνη D (που τα επίπεδα της αποτελούν μέτρο της επάρκειας σε βιταμίνη D του οργανισμού), αλλά η 1,25-(ΟΗ)2-βιταμίνη D (που μας είναι σχεδόν άχρηστη, γιατί τα επίπεδα της πέφτουν μόνο σε πολύ βαρειά έλλειψη βιταμίνης D), προτείνω να επιλέγετε τη δεύτερη και να λέτε στον μικροβιολόγο να μετρήσει την πρώτη (έχουν το ίδιο κόστος).

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Σε δυο μικροβιολογικα της περιοχης μου παρολο που στο παραπεμπτικο που εκδιδω ειναι γραμμενο όπως λέτε (επιλεγω 1,25-ΟΗ-D3 αλλά στα σχολια ζηταω την 25-OH-D3) ο ασθενής επιβαρύνεται με 10 ευρω επιπλέον. Οι μικροβιολόγοι ισχυριζονται ότι είναι εξέταση που δεν την κάνουν αυτοι αλλά την στέλνουν Αθήνα, και το κόστος της ειναι 2πλάσιο απο την 1,25... οπότε παιρνουν τα χρηματα απο τον ΕΟΠΥΥ για την 1,25 και ζητανε 10 ευρω επιπλεον απο τον ασθενη.

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