Die Bedeutung der Sonne für die Multiple Sklerose

Zu viel Sonnenschein in direkter Exposition kann für einen MS-Patienten die Auslösung eines MS-Schubes bedeuten. Zu wenig Sonne hingegen vermindert die Vitamin D Synthese und führt ebenfalls zu einer Immunsituation, welche den Ausbruch der Multiplen Sklerose begünstigen kann.

In den Regionen nördlich des Äquators ist die Sonnenexposition deutlich geringer als in den sonnenreichen südlich gelegenen Gebieten.

Die Reiselust der Menschen in wärmere Regionen führt daher nicht selten bei hohem UV-Index zu einer ungünstigen übermäßigen Strahlenexposition. Das Leben im Norden wiederum lässt insbesondere in den Wintermonaten die körpereigene Vitamin D-Synthese zusammenbrechen.

Das richtige Maß an Vitamin D könnte hier hilfreich sein.

Insbesondere bei autoimmunologischen oder chronisch entzündlichen Erkrankungen ist die regelmäßige Einnahme von Vitamin D Präparaten sinnvoll.

Durch die Einnahme der rezeptpflichtigen Präparate nach Vorschrift  könnte ein positiver Krankheitsgewinn bei der Multiplen Sklerose erreicht werden.

Einzelheiten hierzu im folgenden Artikel.

„Zitat“

 

 

Prophylaxe gegen Krebs und chronische Krankheiten?

Von Marion Hofmann-Aßmus / Kann man mit ausreichender Vitamin-D-Versorgung chronischen Krankheiten wie Krebs, Morbus Parkinson oder Multipler Sklerose vorbeugen? Dies wird unter Experten derzeit lebhaft diskutiert – vor dem Hintergrund, dass in der Bevölkerung ein eklatanter Vitamin-D-Mangel herrscht.

Der Körper produziert Vitamin D mithilfe von Sonnenstrahlen. Daher ist der Begriff »Vitamin« streng genommen falsch. Denn definitionsgemäß kann der Körper Vitamine nicht selbst herstellen, sondern muss sie mit der Nahrung aufnehmen. Die von der Niere gebildete und ins Blut abgegebene aktive Form von Vitamin D ist das 1,25-Dihydroxy-Colecalciferol, auch Calci­triol oder 1,25[OH]2D3 genannt (Kasten 1). Es entspricht seiner Wirkung nach eher einem Hormon: So stimuliert Calcitriol die Aufnahme von Calcium in den Dünndarm und reguliert den Calciumstoffwechsel im Knochen. Zudem ist es über die Kontrolle des Renin-Angiotensin-Systems an der Regulation des Blutdrucks beteiligt.

Interessanterweise hat man in letzter Zeit jedoch herausgefunden, dass nicht nur die Niere in der Lage ist, den metabolisch aktiven Metaboliten herzustellen, sondern auch fast alle anderen Organe. »Dieser in den übrigen Organen gebilde­te aktive Metabolit hat nichts mit dem Knochen- oder Calciumstoffwechsel zu tun und wird auch nicht ins Blut abgegeben, sondern reguliert lokal gewebespezifische Zellfunktionen«, erklärte Professor Dr. Jörg Reichrath aus Homburg auf dem Deutschen Krebskongress in Berlin 2010.

Bis zu 200 Gene soll 1,25[OH]2D3 etwa in Darm-, Prostata-, Nerven- oder Brustdrüsenzellen beein­flussen können. Dies macht das Hormon neuer­dings so spannend. Denn diese Gene kontrollie­ren beispielsweise die bei der Tumorentstehung so wichtige Proliferation und Apoptose (program­mierter Zelltod) sowie die Differenzierung der Zellen. Die neu gewonnene Erkenntnis, dass viele Organe den aktiven Metaboliten selbst herstellen und dieser an Ort und Stelle wirkt, stellt die Basis für das Verständnis der möglicherweise vielfältigen Auswirkungen eines Vitamin-D-Mangels dar.

Vitamin-D-Synthese im Körper

Die Haut spielt bei der Herstellung von Vitamin D eine wichtige Rolle: Mithilfe von UVB wird in den Keratinozyten aus 7-Dehydrocholesterol (Provitamin D3), das die Leber aus Cholesterol bildet, das Prävitamin D3 und anschließend das Colecalciferol (D3) gebildet. Letzteres verwandeln die Leberzellen dann in die Speicherform Calcifediol (25[OH]D3). Die Niere stellt die biologisch aktive Form Calcitriol (1,25-Dihydroxy-Colecalciferol oder 1,25[OH]2D3) her und gibt sie ins Blut ab. Calcitriol reguliert unter anderem den Knochen- und Calciumstoffwechsel. Zudem weiß man heute, dass 1,25[OH]2D3 nicht nur in der Niere, sondern in fast allen Organen gebildet wird und dort gewebespezifische Zellfunktionen ausübt. Im Unterschied zum tierischen oder menschlichen Vitamin D3 bezeichnet man das pflanzliche Pendant als Vitamin D2.

Diskutiert wird ein Zusammenhang mit:

Krebserkrankungen, zum Beispiel Kolon- und Mammakarzinom,
Rachitis und Osteomalazie,
kardiovaskuläre Erkrankungen, zum Beispiel arterielle Hypertonie,
Autoimmunkrankheiten, zum Beispiel Diabetes mellitus Typ 1, Morbus Crohn oder Multiple Sklerose,
Infektionserkrankungen wie Tuberkulose,
psychiatrische Erkrankungen wie Schizophrenie oder endogene Depressionen.

Aussagekräftige Studien fehlen

Ob man mit Vitamin D einem Tumor vorbeugen kann, ist nicht abschließend geklärt. Einige epidemiologische Studien sowie tierexperimentelle und molekular­biologische Untersuchungen stützen die Hypothese, wonach das D3-Hormon anti­kanzerogenes Potenzial hat.

Das Problem ist aber, dass aussagekräftige, randomisierte placebokontrollierte Studien bislang fehlen«, bemängelte Reichrath. Die vorhandenen Studien seien zu kurz und die Probanden hätten Vitamin D in zu niedriger Dosis bekommen. »Nötig wäre eine Gabe von mindestens 1000 I. E. täglich über mindestens fünf bis zehn Jahre«, so der Dermatologe. Hinzu komme mangelndes Studiendesign, etwa bei der viel diskutierten Lappe-Studie (1).

In dieser randomisierten placebokon­trollierten Studie erhielten postmenopausale Frauen zwar relativ hohe Dosen Vitamin D (1100 I. E. täglich), zugleich jedoch Calcium. »Es zeigte sich eine signifikante Reduktion des Krebsrisikos unter Vitamin D plus Calcium gegenüber Placebo und verglichen mit einer alleinigen Calciumgabe. Die Studie deutet also auf einen positiven Effekt von Vitamin D hin. Sie ist aber nicht aussagekräftig, da es keine Gruppe gab, die ausschließlich Vitamin D erhielt«, erklärte Reichrath.

Weniger Sonne, mehr Krebs

Die wichtigsten Hinweise auf eine antikanzerogene Wirkung liefern bislang epidemiologische Studien. So ermittelte eine Untersuchung ein um 50 Prozent niedri­geres Risiko für Kolonkarzinom bei Menschen mit einem 1,25[OH]2D3-Spiegel über 33 ng/ml, im Vergleich zu unter 12 ng/ml (2). Gleichzeitig weisen weitere Autoren darauf hin, dass die Einnahme von Vitamin D das Krebsrisiko erheblich verringern könne. So soll nach einer Metaanalyse die tägliche Einnahme von 1000 I. E. Vitamin D das Risiko für Brust- und kolorektales Karzinom etwa halbieren (3).

Auch der schon länger bekannte Zusammenhang mit der Region oder der Intensität der UV-B-Strahlen bestätigte sich. Laut einer Studie von Grant ist die UV-B-Stahlung invers korreliert mit der Krebsmortalität. Demnach starben zwischen 1970 und 1994 aufgrund unzureichender UV-B-Exposition in den USA jährlich 21 700 weiße und 1400 farbige Einwohner vorzeitig an Krebs (4).

Die erhöhte Mortalitätsrate durch zu geringe UV-B-Strahlung geht nicht allein auf das Kolonkarzinom zurück. Eine Vielzahl weiterer Tumoren scheint mit dem Mangel an Sonnenlicht und dem daraus resultierenden Vitamin-D-Status assoziiert, etwa Brust-, Eierstock-, Prostata-, Nieren-, Lungen-, Pankreas-, Blasen- oder Magenkarzinom.

Doch soll nicht unerwähnt bleiben, dass einige epide­miologische Studien auch eine negative Wirkung beziehungsweise keinerlei Effekte von Vitamin D ermittelten. So stellten Forscher des amerikani­schen National Cancer Instituts bei umfangrei­chen Studien (mehr als 12 000 Blutproben) fest, dass ein höherer Serumspiegel keine protektive Wirkung auf die Entwicklung seltener Tumoren hat. Dazu zählten die Forscher beispielsweise das Non-Hodgkin-Lymphom, Ösophagus-, Magen-, Nieren-, Ovarial-, Pankreas- oder Endome­triumkarzinom (5).

Tierexperimente zeigen eindrucksvoll, dass der Vitamin-D-Stoffwechsel eine große Bedeutung für die Tumorentstehung hat«, sagte Reichrath. So würden Versuche mit Hamstern belegen, dass sowohl die Häufigkeit als auch die Größe von Karzinomen, die man durch Karzinogene induziert hat, durch den Vitamin-D-Status modifizierbar sind. »Das heißt, Vitamin-D-defiziente Tiere entwickeln schneller und auch größere Tumore als Tiere, die ausreichend mit Vitamin D versorgt sind«, berichtete Reichrath beim Krebskongress.

Dilemma um die Sonne

Der Schutz vor Sonnenlicht galt lange Zeit auch als Schutz vor Krebs – zumindest vor Hautkrebs. Hier tritt ein Dilemma zutage, das Dr. Rüdiger Greinert, Leiter der Abteilung Molekulare Zellbiologie am Dermatologischen Zentrum Buxtehude beim Deutschen Krebskongress in Berlin auf den Punkt brachte: »Es gibt keine Vitamin-D-Synthese ohne DNA-Schädigung in der Haut, denn die UV-Spektren, die zu Sonnenbrand, Bräunung, Hautkrebs oder aber der Vorstufe des Vitamin D führen, überlappen nahezu.« Die Grafik zeigt die relative Wirksamkeit der UV-Spektren bezüglich Hautschäden und Vitamin-D-Synthese.

Doch sollte man bezüglich der Dauer der Sonnenbestrahlung hellen Hautkrebs und malignes Melanom differenziert betrachten. Für die Entstehung des hellen Hautkrebses macht man die lebenslange Akkumula­tion von UV-Strahlen verantwortlich.

Nicht so eindeutig ist die Datenlage beim malignen Melanom: Strittig ist etwa, ob kurze intensive Sonnenbäder, zum Beispiel im Urlaub, eher protektiv oder eher risikosteigernd wirken. Auch assoziieren einige Untersuchungen die stärkere (längere) Sonneneinstrahlung in der Nähe des Äquators und an Küsten mit einem höheren Risiko für malignes Melanom. Dagegen scheint eine dauerhafte, weniger intensive Sonnenbestrahlung in gemäßigteren Breiten eher schützend zu wirken, etwa bei beruflich exponierten Personen. Weitgehend einig ist man sich darin, dass Sonnenbrände (insbesondere in der Kindheit) das Risiko für ein malignes Melanom deutlich erhöhen.

Als optimaler Zeitpunkt, um Vitamin D zu synthetisieren, gilt die Mittagszeit, also genau der Zeitpunkt, an dem das Risiko für eine Hautschädigung am höchsten ist. Reichrath empfiehlt daher »einen regelmäßigen, aber maßvollen Aufenthalt im Sonnenlicht.

Bei einer Beratung sollte das Apothekenteam erwähnen, dass die individuell verträgliche Strahlendosis vom Hauttyp und der Sonnenintensität abhängt. Für den in Mitteleuropa vorherrschenden hellen Hauttyp reichen laut Weltgesundheitsorganisation während der Sommermonate bereits dreimal wöchentlich 5 bis 15 Minuten Sonnenstrahlung auf Gesicht, Hände und Arme aus, um ausreichend Vitamin D zu bilden.

Wichtig ist, die Haut langsam an die Sonne zu gewöhnen und Hautrötungen unbedingt zu vermeiden. Der Sonnenschutz sollte erst auftragen werden, wenn die individuell verträgliche Sonnendosis erreicht ist. Wissenswert ist zudem, dass viel UV-B nicht automatisch in viel Vitamin D(-Vorstufen) resultiert. Im Gegenteil. Zu viel UV-B-Bestrahlung induziert den Abbau der Vorstufen, während die DNA-Schädigung und weitere negative Effekte wie Hautrötungen weiter ansteigen. Gleiches gilt für eine künstliche Bestrahlung in Sonnenstudios.

Schutz vor Parkinson und Demenz?

Zwei kürzlich veröffentlichte Beobachtungsstudien stellen einen Zusammenhang zwischen niedrigen Vitamin-D-Spiegeln und Morbus Parkinson sowie einer geringeren kognitiven Performance (Leistungsfähigkeit) im Alter her.

Forscher in Finnland untersuchten im »Mini-Finland Health Survey« Blutproben von mehr als 3100 Personen. Während der 29-jährigen Nach­beobachtungszeit erkrankten im Quartil mit den höchsten Vitamin-D-Serumkonzentrationen 67 Prozent weniger Menschen an Parkinson als im Quartil mit den niedrigsten Werten (6). Auch wenn man daraus nicht folgern kann, dass eine Vita­min-D-Substitution die Krankheit verhindern oder bessern könnte, startete die US-amerikani­sche Emory Universität bereits eine klinische Pilotstudie, in der Parkinson-Patienten mit Vitamin D behandelt werden.

In der InCHIANTI-Studie, einer prospektiven Beobachtungsstudie, erfasste man die Vitamin-D-Spiegel von über 800 älteren Personen (über 65 Jahre) in Italien und testete sie gleichzeitig auf eine Demenzerkrankung. Dabei zeigte sich, dass Teilnehmer mit einer Vitamin-D-Insuffizienz (unter 25 nmol/l) im Standardtest (MMSE, Mini-Mental State Examination) häufig schlechter abschnitten. Auch bei der Prüfung auf mentale Schnelligkeit (Trail Making Test B) waren sie langsamer. Ihre mentale Flexibilität hingegen ließ keine Assoziation erkennen (7). Den Einfluss auf die kognitiven Leistungen führt man derzeit auf die antioxidativen Effekte des D-Hormons zurück.

Bei Alzheimer-Patienten beobachtete man ebenfalls eine Assoziation von niedriger Vitamin-D-Konzentration und schlechterem Abschneiden im MMSE. Insgesamt wiesen Patienten mit einer Alzheimer-Demenz einen geringeren Vitamin-D-Spiegel auf, verglichen mit Kontrollpersonen ohne Demenz.

Weniger MS in Äquatornähe

Die Multiple Sklerose (MS) ist eine neurodegenerative T-Lymphozyten-vermittelte Autoimmunerkrankung. Ihre Ursache ist noch nicht eindeutig geklärt; man vermutet aber, dass Umwelteinflüsse eine Rolle spielen. Für einen Einfluss des Sonnenlichts spricht etwa die Epidemiologie: Die Krankheit ist umso häufiger, je weiter der Wohnort vom Äquator entfernt liegt.

Eine ganze Reihe epidemiologischer Studien bestätigen eine Verbindung zwischen MS und Vitamin D. Beispielsweise zeigt eine aktuelle Fall-Kontroll-Studie aus den USA, dass Personen mit einer hohen D-Konzentration im Blut ein geringeres Risiko aufwiesen, MS zu entwickeln. Dieser Zusammenhang galt jedoch nur für Teilnehmer mit weißer Hautfarbe, für die Gruppe mit den höchsten Werten (1,25[OH]2D3 über 99,1 nmol/l) und insbesondere für unter 20-Jährige (8). Weitere Studien deuten darauf hin, dass niedrige Vitamin-D-Spiegel bei MS-Patienten mit schwererem Krankheitsgeschehen und häufigeren Schüben einhergehen.

Ob eine Supplementation das Krankheitsgeschehen positiv beeinflussen könnte, ist noch unklar. Überhaupt wird die Frage, ob eine Vitamin-D-Gabe bei Autoimmunkrankheiten generell sinnvoll oder auf Dauer sogar schädlich ist, kontrovers diskutiert.

Auch Rheumatiker weisen häufig einen Vitamin-D-Mangel auf. Bei Patienten mit rheumatoider Arthritis scheint die Krankheitsaktivität zudem mit der Unterversorgung zu korrelieren. Auch hat man heraus­gefunden, dass bei diesen Patienten die »gewöhnliche« Vitamin-D-Supplementation von täglich 800 bis 1000 I. E. nicht ausreicht, um den Spiegel zu normalisieren. Unklar ist, ob höhere Dosierungen effektiver wären.

Nur günstig fürs Immunsystem?

Dem Colecalciferol schreiben viele Experten immunmodulatorische Eigenschaften zu, etwa die Stimulierung verschiedener antimikrobieller Funktionen in Makrophagen oder die Beeinflussung der Zytokinexpression von Monozyten und aktivierten T-Lymphozyten.

Eine aktuelle Untersuchung kommt zu dem Schluss, dass der Einfluss von Vitamin D noch grundlegender ist als bislang angenommen (9). Denn nur, wenn eine naive (nicht aktivierte) T-Zelle nach Kontakt mit einem Erreger verfügbares Vitamin D registriert, könne sie ihre Aktivierungskaskade starten, in deren Verlauf sich die nun aktivierte T-Zelle massenhaft vervielfältigt und Bakterien oder Viren gezielt angreift. Diese neue Erkenntnis könnte nach Meinung der Autoren bei der Behandlung von Infektionen oder der Unterdrückung von Autoimmunreaktionen künftig eine Rolle spielen.

Dass ein hoher Vitamin-D-Spiegel bei Autoimmunerkrankungen hilfreich sei, steht im Widerspruch zu der von einigen Experten vertretenen »alternativen Hypothese«. Diese geht davon aus, dass Colecalciferol aufgrund seiner Steroid-ähnlichen Struktur Immunprozesse eher inaktiviert als aktiviert. Dadurch würden zwar einerseits Entzündungsreaktionen gehemmt, andererseits aber die Immunantwort langfristig unterdrückt. Somit könne der Körper chronisch persistierende Infektionen schlechter bekämpfen. Diese werden jedoch als mögliche Ursache bei der Entstehung von Autoimmunkrankheiten diskutiert. Die niedrigen Vitamin-D-Spiegel vieler Patienten wären dann ein Schutz des Körpers gegen chronische Infektionen. Vertreter dieser Hypothese raten daher von einer unkritischen Substitution bei Patienten mit Autoimmunkrankheiten ab.

Mangelland Deutschland

Angesichts der vielfältigen Krankheiten, mit denen der Vitamin-D-Status derzeit assoziiert wird, macht das weit verbreitete Defizit vielen Fachleuten große Sorgen. Schätzungsweise mehr als eine Milliarde Menschen leiden weltweit an einer Vitamin-D-Defizienz oder -Insuffizienz. »Der Mangel an Vitamin D stellt ein gravierendes Gesundheitsproblem auch für unsere Gesellschaft dar«, betonte Reichrath.

Über den optimalen D-Serumspiegel besteht bislang kein Konsens. Derzeit bezeichnet man Werte unter 20 ng/ml als Defizienz und zwischen 20 und 30 ng/ml als Insuffizienz. Erst Konzentrationen ab 30 ng/ml gelten als ausreichend (Suffizienz). Vielen Experten erscheinen diese Normwerte jedoch viel zu niedrig, sie fordern höhere Grenzwerte. In Deutschland weisen laut einer Studie 57 Prozent der Männer und 58 Prozent der Frauen zwischen 18 und 79 Jahren eine Vitamin-D-Defizienz auf (10). Auch die Nationale Verzehrsstudie II, die im Auftrag des Bundesministeriums für Ernährung, Landwirtschaft und Verbraucherschutz das Ernährungsverhalten von 20 000 Deutschen untersuchte, kommt zu dem Schluss, dass die Versorgung mit Vitamin D unzureichend ist. Bei Männern und Frauen aller Altersgruppen liegt der Median der Zufuhr deutlich unter der empfohlenen Aufnahmemenge (Grafik). Diese beträgt laut DGE 5 μg/Tag und ab 65 Jahren 10 μg/Tag (zur Prävention der Osteoporose). Zur Umrechnung: 25 µg entsprechen 1000 I. E., 1 µg dann 40 I. E.

Jedoch erreichen 82 Prozent der Männer und 91 Prozent der Frauen die empfohlene tägliche Zufuhr nicht. Bei Jugendlichen und jungen Erwachsenen liegt der Anteil sogar noch höher, mit mehr als 86 Prozent bei den Männern und mehr als 96 Pro­zent bei den Frauen. Ebenfalls schlecht schneiden die Senio­ren ab: 94 Prozent der Männer und 97 Prozent der Frauen sind unterversorgt (11).

Wer ist gefährdet?

In den meisten Fällen beruht ein Vitamin-D-Mangel auf einer un­zureichenden Synthese in der Haut. Die Ursachen sind vielfältig und liegen auch im Lebensstil begründet. Die meisten Menschen verbringen den Tag größtenteils in geschlossenen Räumen. Glas jedoch lässt nur einen geringen Prozentsatz der für die Synthese wichtigen UV-B-Strahlen passieren. Dazu kommt die geringe UV-B-Strahlungsintensität in nördlichen Breiten während der Wintermonate: Von November bis einschließlich Februar geht die Vitamin-D-Produktion nahe null.

Eine weitere Ursache ist die Anwendung von Sonnenschutzmitteln. So reduziert etwa ein Mittel mit Sonnenschutzfaktor 8 die Vitamin-D-Synthese der Haut um über 95 Prozent. Daneben können intrinsische Faktoren einen Mangel auslösen: etwa eine verminderte intestinale Absorption oder eine erworbene oder angeborene Störung des Vitamin-D-Metabolismus.

Dunkelhäutige Menschen, die in nördlichen Breiten leben, zählen zu den Risikogruppen, da sie im Vergleich zu Hellhäutigen eine wesentlich längere Lichtexposi­tion benötigen, um die gleiche Menge an Vitamin D herzustellen. Adipöse Menschen sind ebenfalls häufig betroffen, denn sie speichern einen Teil des Vitamins irreversibel im Bauchfett.

Im Alter nimmt das Synthesevermögen ab, weil sich die Konzentration der Vorstufe in der Haut verringert. So kann ein 70-Jähriger unter gleichen Bedingungen nur etwa 25 Prozent der Konzentration an 1,25[OH]2D3 herstellen wie ein 20-Jähriger. Bettlägerige Menschen oder solche, die sich aufgrund einer Immunsuppression vor Sonnenstrahlung schützen müssen, sind ebenfalls gefährdet. Gleiches gilt für Patienten, die langfristig Medikamente wie Antiepileptika, Glucocorticoide, Rifampicin, Orlistat, Colestyramin oder Laxanzien einnehmen.

Vitamin D findet sich auch in der Nahrung, allerdings nicht in ausreichend hoher Konzentration, um etwa in Mitteleuropa das Sonnenlicht als Quelle ersetzen zu können. Enthalten ist es insbesondere in fettem Fisch und Fischöl sowie in geringerer Menge in Eiern, Innereien, Käse, Milch und pflanzlicher Nahrung (Tabelle).

Supplementierung von Vitamin D

Wie viel Vitamin D »gesund« ist oder womöglich vor Krankheiten schützt, kann noch nicht abschließend beantwortet werden, zumal eine große individuelle Variabilität besteht. Einig ist man sich, dass Vitamin D supplementiert werden sollte, falls der Mensch es nicht ausreichend herstellen kann. Zuvor sollte jedoch der Serumspiegel gemessen werden.

Vitamin D in Nahrungsmitteln

Lebensmittel Vitamin D (I. E.) pro 100 g
Lebertran 12 000
Hering 1000
Sardinen 450
Lachs (wild, frisch) 800
Lachs (gezüchtet, frisch) 200
Eier 120
Shitakepilze (getrocknet) 1600
Shitakepilze (frisch) 100
Champignons 80
Butter 50
Kalbsleber 10
Vollmilch 5
Schmelzkäse (45 % Fett i. Tr.) 120
Gouda (45 % Fett i. Tr.) 50

Angegeben sind ungefähre Werte, da der Vitamin-D-Gehalt von Faktoren wie Fütterung, Herkunft und Sorten abhängt. Aus (12).

Entgegen der viel niedrigeren Empfehlungen der Deutschen Gesellschaft für Ernährung (DGE) (täglich 200 I. E. für Kinder, Erwachsene und Schwangere, 400 I. E. ab 65 Jahren) raten verschiedene Experten zu 800 bis 1000 I. E. täglich für gesunde Erwachsene und Kinder jeden Alters. Zur Prophylaxe der Osteoporose empfiehlt die DVO-Leitlinie 2009 mindestens 30 Minuten täglich eine Sonnenlichtexposition von Armen und Gesicht. Wenn dies nicht erreicht wird, raten die Experten zur Supplementierung mit 800 bis 2000 I. E. Vitamin D3 oral täglich oder einer äquivalenten Dosis mehrwöchentlich.

Vitamin-D-Test

Zur Bestimmung des Vitamin-D-Status dient nicht der aktive Metabolit im Serum, da dieser nur eine Halbwertszeit von unter vier Stunden aufweist. Geeigneter ist die Speicherform 25-Hydroxy-D3 mit einer Halbwertszeit von etwa zwei Wochen. Ein Selbsttest ist nicht möglich, weil der Arzt Blut abnehmen und dieses an ein Labor schicken muss. Die gesetzlichen Krankenkassen übernehmen die Kosten für die Laboruntersuchung von etwa 25 bis 35 Euro nicht.

Auch Reichrath empfiehlt täglich 1000 bis 2000 I. E. zur Sicherstellung einer ausreichenden Versorgung; zur Behandlung eines Vitamin D-Mangels solle man einmal wöchentlich 50 000 I. E. über acht Wochen geben. Die amerikanische National Osteoporosis Foundation rät neuerdings allen Frauen nach der Menopause, täglich 800 bis 1000 I. E. Vitamin D einzunehmen. Üblich ist eine Vitamin-D-Rachitisprophylaxe von 400 bis 500 I. E. bei gestillten und nicht gestillten Säuglingen bis zum Ende des 1. Lebensjahres.

Literatur

  1. 1.    Lappe, J. M., et al., Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 85 (2007) 1586-1591.
  2. 2.    Gorham, E. D., et al., Optimal Vitamin D Status for Colorectal Cancer Prevention A Quantitative Meta Analysis. Am J Prev Med 32 (3) (2007) 210-216.
  3. 3.    Garland, C. F., et al., The role of vitamin D in cancer prevention. Am J Public Health 96 (2006) 252-261.
  4. 4.    Grant, W. B., An estimate of premature cancer mortality in the U.S. due to inadequate doses of solar ultraviolet-B radiation. Cancer 15 (2002) 1867-1875.
  5. 5.    Helzlsouer, K. J., et al., Overview of the Cohort Consortium Vitamin D Pooling Project of Rare Cancers. Am J Epidem 172 (2010) 4-9.
  6. 6.    Knekt, P., et al., Serum Vitamin D and the Risk of Parkinson Disease. Arch Neurol 67 (2010) 808-811.
  7. 7.    Llewellyn, D. J., et al., Vitamin D and Risk of Cognitive Decline in Elderly Persons. Arch Intern Med 170 (2010) 1135-1141.
  8. 8.    Munger, K. L., et al., Serum 25-Hydroxyvitamin D Levels and Risk of Multiple Sclerosis. JAMA 296 (2006) 2832-2838.
  9. 9.    Rode von Essen, M., et al., Vitamin D con­trols T cell antigen receptor signaling and activation of human T cells. Nature Immunology 11 (2010) 344-349.

10. Hintzpeter, B., et al., Vitamin D status and health correlates among German adults. Eur J Clin Nutr 62 (2008) 1079-1089.

11. Nationale Verzehrsstudie II: Ergebnisbericht Teil 1. Max Rubner-Institut, Karlsruhe 2008.

12. Worm, N., Heilkraft D., Systemed Verlag Lünen, 2009.

13. Gilchrest, B. A., Am. J. Clin. Nutrition 88 (2008) 570-575.

 

Die Autorin Marion Hofmann-Aßmus absolvierte eine Ausbildung als veterinärmedizinisch-technische Assistentin (VMTA) und studierte anschließend Diplom-Biologie an der Ludwig-Maximilians-Universität München. Promoviert wurde sie 1999 mit einer Arbeit im Bereich der molekularen Kardiologie an der Chemischen Fakultät der LMU München. Seither ist sie freiberuflich in verschiedenen Redaktionen und als Fachjournalistin tätig.

Dr. Marion Hofmann-Aßmus

Abt-Führer-Straße 9a

82256 Fürstenfeldbruck

hofmann_assmus@t-online.de

 

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