علوم پزشکی

ارتباط ویتامین D و لوپوس؛ لوپوس موجب کاهش سطح ویتامین D می‌شود.

لوپوس موجب کاهش سطح ویتامین D می‌شود.

کمبود ویتامین D در میان بیماران SLE بیشتر از جمعیت عمومی است. طی دهه گذشته، مطالعات زیادی در سراسر جهان برای بررسی نقش ویتامین D در SLE از زوایای مختلف بالینی انجام شده است.
شواهد قانع کننده ای برای اثبات ارتباط بین سطح ویتامین D و فعالیت بیماری SLE وجود دارد.
اگر مبتلا به لوپوس هستید، احتمالاً به شما توصیه شده است که ویتامین D را به عنوان مکمل سایر روش‌های درمانی خود مصرف کنید. از آنجا که مبتلایان به لوپوس اغلب باید از تابش مستقیم نور خورشید یعنی راه اصلی تولید طبیعی ویتامین D، خودداری کنند؛ بنابراین یک کمبود شایع است که می تواند منجر به ضعف در سلامت استخوان شود. البته تحقیقات در مورد اینکه آیا مکمل های ویتامین D واقعاً به لوپوس کمک می کنند، روشن نیست.
طی چندین سال گذشته، جوامع علمی و پزشکی ارتباط بین سطح ویتامین D (25-هیدروکسی ویتامین D) و پاسخ ایمنی بدن را آغاز کرده اند. ما بر آن نیستیم که برای استفاده از ویتامین D به عنوان یک درمان لوپوس دفاع کنیم، بلکه بر آنیم که اطلاعات برخی از تحقیقات مهم را به شما ارائه دهیم که آشکار کننده ارتباط بین لوپوس و کمبود ویتامین D است.

برخی مطالعات نشان داده اند که ۶۷% (حتی برخی مطالعات دیگر درصد بیشتری) افراد مبتلا به لوپوس اریتماتوی سیستمیک (SLE) دارای کمبود ویتامین D هستند.

مبتلایان به لوپوس ویتامین D و امگا ۳ بخورند!

نتایج مطالعه‌ای نشان می‌دهد مواد غذایی حاوی ویتامین D و امگا ۳ برای بیماران مبتلا به لوپوس ضروری است و علایم بیماری را در آنها کاهش می‌دهد.

مدیکال ساینس نوشت: مطالعات جدید محققان دانشگاه جان هاپکینز در بالتیمور، دانشگاه ایالتی اوهایو و دانشگاه میشیگان نشان می‌دهد کمبود ویتامین D و امگا۳ موجب تشدید عوارض بیماری لوپوس می‌شود و علایم را حادتر می‌کند.

در ادامه این مطالعه آمده است عملکرد کلیه بیماران مبتلا به لوپوس به ویتامین D مرتبط است و این بیماران در صورت کمبود ویتامین D با مشکلات جدی کلیوی مواجه می‌شوند. از طرفی بیمارانی که از مواد غذایی حاوی امگا استفاده می‌کنند، کیفیت خواب بالایی دارند و با علایم خفیف‌تری مواجه می‌شوند.

برخلاف شایعات اینترنتی، هیچ رژیم غذایی تاییدشده‌ای برای بهبود لوپوس وجود ندارد، ولی این مطالعه نشان می‌دهد با مصرف ویتامین D کافی و امگا ۳ می‌توان علایم بیماری را کاهش داد.

لوپوس یک بیماری خودایمنی است که ۹۰ درصد مبتلایان را زنان تشکیل می دهند؛ بیماری های خود ایمنی به بیماری هایی گفته می شود که در آن سیستم ایمنی، بافت های سالم بدن را به عنوان یک عامل خارجی فرض می کند و به آن ها حمله می کند.

این بیماری به دو نوع DLE و SLE تقسیم بندی می شود. نقطه هدف DLE معمولا پوست است و روی ارگان های دیگر بدن تاثیر نمی گذارد. نوع SLE جدی تر است و علاوه بر پوست، اندام های حیاتی را نیز تحت تاثیر قرار می دهد. در نوع شدید بیماری، بافت مفاصل و عضلات و غشای ریه، قلب، کلیه ها و مغز آسیب می بیند. تشنج، افسردگی، گیجی و سکته مغزی، از عوارض لوپوس هستند.

به گزارش بنیاد لوپوس آمریکا، خستگی و ناتوانی از مهمترین و اولین نشانه های لوپوس است. در مراحل بعدی علایمی مانند سر درد، درد مفاصل، تب، کم خونی، ریزش مو، تورم در ناحیه دست و پا و اطراف چشم، لخته شدن غیر طبیعی خون، سفید شدن یا آبی شدن انگشتان در سرما، حساسیت پوست نسبت به نور خورشید و زخم های پروانه ای شکل روی بینی و گونه دیده می شود.

تحقیقاتی که به تازگی صورت گرفته نشان می دهد که یک سازوکار مرتبط با کروموزوم X، با بیماری های خودایمنی و لوپوس در ارتباط است. دلیل اینکه اغلب زنان در معرض لوپوس قرار می گیرند این است که کروموزوم X نسبت به کروموزوم Y، ژن های مرتبط با ایمنی بیشتری را حمل می کند و همانطور که می دانیم زنان دو کروموزوم X و مردان یک کروموزوم X و یک کروموزوم Y دارند؛ بنابراین زنان بیشتر در معرض بیماری های خود ایمنی هستند.

لوپوس هیچ عامل شناخته شده ای ندارد و ترکیبی از عوامل ژنتیکی، محیطی، هورمونی، ایمنی بدن و زیست محیطی است. عفونت های باکتریایی و ویروسی، استرس عاطفی شدید، قرار گرفتن در معرض نور شدید خورشید و استفاده از داروی های فشار خون و منظم شدن ریتم قلب، می توانند سبب بروز علایمی شبیه لوپوس شوند. افزایش هورمون استروژن در دوران بارداری نیز می تواند لوپوس را تشدید کند.

Vitamin D Deficiency and Lupus

If you have lupus, it is likely that you have been advised to take vitamin D as a supplement to your other therapies. Since those with lupus often must avoid direct sunlight, the primary way that vitamin D is produced naturally, it is a common deficiency that can lead to poor bone health – among other conditions. Yet, the research is not clear on whether vitamin D supplements really help with lupus. Read on to explore the facts about this important nutrient and the latest lupus research!

Introduction

Over the past several years, the scientific and medical communities have begun to make a connection between Vitamin D (25-hydroxyvitamin D or [25(OH)D]) levels and the body’s immune response. We are writing this blog, not to promote the use of vitamin D as a lupus treatment, but rather to help inform you as to some of the important research and information that is currently available on vitamin D deficiency and its role in lupus. Some studies have shown that as many as 67% (and even a higher percentage in other studies) of individuals with Systemic Lupus Erythematosus (SLE) are vitamin D deficient which makes this research all the more relevant to gaining more understanding about the connection between vitamin D levels and lupus disease activity.

It is also common for those with lupus to have poor bone health and are twice at risk for having a bone fracture than those without SLE. Since vitamin D is necessary for the body to absorb calcium – a primary building block of bones – it is something for lupus patients to pay close attention to!

What is vitamin D and how does it affect the body?

What is vitamin D?

  1. Vitamin D is a nutrient (specifically a steroid hormone) that helps the digestive system absorb calcium and a few other things.
  2. It is the only vitamin that the body can produce on its own – though that requires the skin to be exposed to sunlight. The body needs to get all other vitamins from the foods you eat or by taking supplements.
  3. Once your the body absorbs vitamin D, it turns it into a hormone (called either activated vitamin D or calcitriol). It is the ONLY vitamin that does this.

Here are some of the systems and processes that vitamin D (and calcium) affect:

  • It is essential for strong bones because it helps the body takes the calcium from food and gets it into the blood. Without vitamin D, all of the calcium that is ingested would just pass through the digestive tract unabsorbed and leave the body.
  • It also encourages bone cells to create stronger bones by ensuring they have enough calcium.
  • Muscle function
  • Cellular growth and changes
  • The circulatory/cardiovascular system
  • Respiratory system
  • Brain development
  • Anti-cancer effects
  • The immune system’s T-cells and dendritic cells. Dendritic cells play an important role in protective immunity.
  • Vitamin D is also thought to have antibacterial and anti-inflammatory properties

What do the studies about vitamin D deficiency and lupus show?

Many studies have now shown that there is a link between vitamin D and lupus. Here are some fast facts based on these studies:

  • Individuals with lupus are more likely to have low levels of vitamin D.
  • Individuals with lupus who have higher levels of vitamin D tend to have fewer lupus symptoms.
  • The risk factors for heart disease in individuals with lupus increases if vitamin D levels are low.
  • The risk for high blood pressure and elevated lipids is higher in individuals with SLE and with a vitamin D deficiency.
  • Some studies have shown that giving vitamin D supplements to individuals with lupus can reduce the chances and occurrences of flares.
  • Adding vitamin D in vitro (test tube experiments performed with cells or biological molecules) has been shown to reverse abnormalities in the immune system characteristic of SLE.

There is some conflicting information as to the efficacy of vitamin D supplements in individuals with lupus, but for the most part the results looks promising.

Dr. Edie Vickers of the An Hao Natural Healthcare Clinic in Portland, Oregon believes that vitamin D supplements can provide benefits to individuals with lupus.

The results from several recent studies is a bit less clear. A study conducted by researchers from Universities of Medical Sciences in Tabriz and Urmia, Iran showed promise for supplementing diets with vitamin D to decrease disease activity. By contrast, however, a study conducted by researchers at the Department of Rheumatology at Al Zahra Hospital in Iran concluded there were no significant improvements in SLE symptoms for the individuals who were given vitamin D supplements. So, though promising, clearly, more research is needed‌

Symptoms and Diagnosis for Vitamin D Deficiency

The symptoms for vitamin D deficiency can be very subtle but can include fatigue, general aches and pains or frequent infections. Some people may have no noticeable symptoms at all. If you have pain in your bones or weakness that causes mobility issues (this can be a symptom of severe vitamin D deficiency), please seek medical attention immediately.

How is a vitamin D deficiency diagnosed?

According to the Vitamin D Council, a blood test is the only accurate way to test for a vitamin D deficiency. There are several ways to test for vitamin D:

  • Asking for the test at a doctor’s office: Ask your doctor to specifically give you the 25(OH)D blood test. FYI, there is another test called the 1,25(OH)2D test but the 25(OH)D is the only way to test whether or not a person is getting enough vitamin D. Sometime medical insurance will cover this test.
  • At-home blood test: It is actually possible to order an in-home vitamin D test kit from the Vitamin D Council through their website (https://www.vitamindcouncil.org) for around $60. In-home tests are easy to use and involve pricking a finger to get a small blood sample. This sample is sent to a laboratory for results. We cannot confirm the accuracy of this particular test, but The Vitamin D Council has very good information on a variety of issues regarding vitamin D health.
  • Ordering a test from a website: There are a few websites with labs recommended by the Vitamin D Council for sending tests: healthcheckusa.com, and privatemedlabs.com. All of these companies sell the 25(OH)D test. The price of these is a bit higher than the order-at-home blood test.

What is considered a good level for vitamin D?

According to Dr. Thomas, author of The Lupus Encyclopedia, a good level for vitamin D is 30ng/ml if on steroids, although he states that a Johns Hopkins study suggests around 40ng/ml. Here is a chart with information taken from The Vitamin D Council showing the recommended levels of vitamin D from other various organizations:*To reach and maintain the Vitamin D Council’s recommended levels of 50 ng/ml, a daily dosage of 5,000 IU/day of vitamin D supplement would be needed. To reach and stay above the 30ng/ml level recommended by the Endocrine Society, a supplement of around 2,000 IU/day would be advised. To read more on this and other guidelines for reaching certain levels of vitamin D.

IMPORTANT NOTE: Nobody with lupus should attempt to take high doses of vitamin D to control their disease activity, and as always, please speak with your treating physician before starting or stopping any medication or supplement. There is no study as to the long term effects of high dosages of vitamin D. Currently the recommended daily allowance is 600IU a day until age 70, please consult with your physician before taking more than the recommended daily allowance.

Are certain people more likely to develop a vitamin D deficiency?

The answer is yes. Here are a several groups of people who are more likely to develop this deficiency:

  • People with darker skin tones: Melanin protects the skin from UV rays. People with darker skin have more melanin and therefore absorb fewer UV rays. This means that people with more melanin make vitamin D much more slowly than those with lighter skin after sun exposure.
  • People who spend a lot of time indoors during the day: Naturally, these people will have the least amount of UV exposure.
  • The elderly: With thinner skin, the ability to produce vitamin D is reduced.
  • Infants who are breastfed and not given a vitamin D supplement: If the mother takes a supplement, this can help.
  • People who cover their skin all of the time or wear sunscreen to block out UV rays: This often includes many individuals with lupus who suffer from photosensitivity and need to avoid UV rays. Wearing sunscreen is still recommended but can limit your body’s ability to produce vitamin D.
  • People who live in the Northern US, Canada or other locations in the upper Northern hemisphere: This has to do with the reduced number of hours of sunlight as you get further from the equator.
  • During times of year where there is less sunlight (winter, for example): Interestingly, individuals with lupus often suffer higher incidence of flares during these months as well.
  • Women who are pregnant
  • People who are very overweight or obese

Where can you get more vitamin D?

There are only three ways to get vitamin D:

  • By exposing the bare skin to the sun
  • By taking supplements
  • Dietary intake from foods

Vitamin D has long been known as the “sunshine vitamin” because it is produced by the body in response to ultraviolet light exposure from the sun. Therefore, exposure to sunlight is one way to get more vitamin D, with 20-25 minutes per day being a helpful amount to affect vitamin D levels positively. If you have photosensitivity or live in a climate with less available sunshine, this may not be an option for you. Ultraviolet lamps and bulbs are also available for indoor use. Vitamin D supplements are commonly prescribed to raise vitamin D levels. With supplements dosage can be controlled to meet the individual’s needs. Please speak with a doctor about finding the right dosage of vitamin D supplements. Do not begin taking any supplements without first speaking to a physician. Taking too much vitamin D may lead to hypercalcemia and can cause a feeling of sickness, loss of appetite, being thirsty, frequent urination, pain in the abdomen, muscle pain or weakness, fatigue and/or confusion. Special care should be taken when taking vitamin D supplements for those who have the following conditions:

  • Kidney disease
  • Kidney stones
  • Liver disease
  • High blood calcium levels
  • Hyperparathyroidism
  • Hodgkin’s or non-Hodgkin’s lymphoma
  • Granulomatous disease
  • Hormonal disease
  • If you are taking certain medications: This can include high blood pressure medications, medications for irregular heartbeat, and other drugs that may interfere with vitamin D and may require more than the usual dosage of vitamin D.
  • Let your doctor know all medications and supplements that you are currently taking.

Vitamin D can also be found in certain foods as well. Some foods that contain high amounts of vitamin D are fatty fish (such as mackerel, trout, salmon, tuna and eel) and fish oils, egg yolks, cheese, fortified– meaning vitamin D has been added- cow’s milk (contains 100 IU’s in one 8 ounce glass), fortified cereals, fortified orange juice, and beef liver.

In Conclusion

While the research is certainly interesting and even promising, there is no conclusive research that shows that low vitamin D levels cause lupus nor can the physiological and clinical significance be confirmed. It is also difficult for researchers to determine whether low levels of vitamin D cause lupus or whether the lupus causes the low levels of vitamin D. Overall, more research and experimentation is needed to determine a more clear answer about the helpfulness of vitamin D to help manage and treat lupus. What we do know is that, given its relative safety in combination with the beneficial effects on the immune system, there is optimism that correcting a vitamin D deficiency in individuals with SLE may lead to better outcomes. We will keep reading and watching for any developing studies and information on this topic and, as always, keep you informed.

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