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    維他命D在以往的的認知是用來幫助鈣吸收，調節鈣平衡。從最近這幾年一直有新的研究報告，維他命D作用在體內的非常多器官，因此已經漸漸被視為一種賀爾蒙。

 

一、認識維他命D：

    維他命D是一群脂溶性且結構像類固醇的維生素，目前已經發現的是從D2到D7，人體除了可以從食物攝取外，還可以自行合成，利用體內的類固醇當原料，經由陽光中的UVB照射皮膚後產出。(就像植物光合作用一樣)VIT D1.jpg

    D2主要存在真菌類(菇類)與酵母中，如果經陽光照射也會產出D3。D3來自動物性食物，例如魚肝油、鮭魚、沙丁魚等。

    體內的維他命D需被活化成賀爾蒙才有生理作用，維他命D必需由肝臟中的25-羥化脢(25- hydroxylase)產生25-羥膽鈣醇（25-hydroxycholecalciferol）通過血液運送到全身，這是血中濃度最高的化合物。最後再由腎臟的1α-羥化脢轉化為（1,25-dihydroxycholecalciferol），也稱作鈣三醇（Calcitriol）<活性維他命D>，這才是身體真正能夠吸收及使用的分子。

    在上一篇提到藉由日曬可以增加維他命D，但根據衛生署所做調查，國人攝取維他命D不足，居然高達9成以上。主要是日照不足，照錯時間，不愛運動或者使用太多防曬用品，因此想只靠自然陽光合成維他命D，有相當的難度。


二、維他命D的作用

A、輔助鈣吸收
    體內缺乏的維他命 D，就無法産生足夠的合成活性維他命D，會導致人體無法從飲食中取得足夠的鈣。在這種情況下，身體不得不消耗身體骨骼中儲存的鈣，以保持血中的鈣濃度。這種消耗會使骨骼變得脆弱，妨礙新骨骼形成，易罹患骨質疏鬆症，最常見者為髖骨骨折。另外，鈣質和憂鬱、焦慮症狀有高度相關，因此維他命 D 對於憂鬱、失眠或各種慢性疾病病人，有很大的幫助。

 

B、免疫系統調節
     維他命 D 能加強免疫力，主要是因為維他命 D 在體內會和細胞中維他命 D 受體 (Vitamin D receptors，簡稱 VDR) 結合。VDR 普遍存在於體內先天的及後天的免疫細胞中，例如：單核球（monocytes），巨噬細胞 (單核球演變來的)、樹狀細胞、自然殺手細胞等。研究顯示 VDR 配位體能夠增加自然殺手細胞的活性，進一步讓巨噬細胞吞噬外來致病原的活性。

 

    事實上維他命 D 本身也能幫助免疫調節，對一些免疫功能太強導致的身體問題，維他命 D可適度調節免疫過強的功能，對於一些發炎疾病：如風濕性關節炎、紅斑性狼瘡、多發性硬化症甚至癌症等等，都有正面的助益。研究顯示，懷孕的婦女服用維他命 D，明顯減少小孩日後發展成多發性硬化症或是過敏的機率。

 

C、癌症
    一個 2006 年的研究，發現低日照會增加罹患一些癌症的風險，並且資料中也發現維他命 D 濃度與癌症的發生率有相關性。研究者建議，每天補充 1,000 IU 的維他命 D 可減少罹患大腸癌的風險達 50%，以及乳癌、卵巢癌的罹患率降低 30%。而血清中低濃度的維他命 D 與乳癌進程和轉移也有關聯。 

    另一個研究是多倫多大學的研究小組對 512 名剛被診斷為乳癌的病人，檢測她們的血液中維他命 D 的含量，並且追蹤長達 12 年，發現大約有 38% 婦女血液中維他命 D 含量太低，被認為是「維他命 D 缺乏」， 並且 39% 有「維他命 D 不足」的現象，只有 24% 的婦女顯示有「足夠的」維他命 D。維他命 D 缺乏的婦女在她們的病情進展上，風險幾乎是加倍的，和攝取足量維他命 D 的婦女相較，則多了 73% 的死亡率。

 

D、心血管疾病
    許多證據顯示血中 25(OH)D 之濃度偏低會不利於心血管之健康情況。維他命 D 缺乏症會活化腎泌素、升壓素之活性並且容易導致高血壓及左心室肥厚。並且維他命 D 缺乏會增加副甲狀素荷爾蒙，這個現象會增加胰島素抵抗，並且與高血壓、糖尿病、慢性發炎、心血管疾病風險上昇有密切關聯。流行病學研究顯示，血中 25-(OH)-D3 之濃度與冠心症及心血管疾病有密切關聯性。

 

E、心智及神經健康
    血液中維他命 D 濃度較低的年長人士，在記憶、學習和思考上出問題的可能性較大，缺乏維他命 D 可能是失智風險的早期警示。英國 Exeter 大學的 David J. Llewellyn 博士在 1998~2006 年之間，收集了 858 位 65 歲以上老人的心智方面的資料，並且測量他們血中維他命 D 的濃度，之後每三年，再度測量參與者的心智能力。結果發現維他命 D 濃度最低的人群 (小於 25 nmole) 比維他命 D 濃度正常的人心智退化的比例增加了 60%。芬蘭 2010 年的研究也指出維他命 D 含量較低的人，罹患帕金森氏症的機率比一般人高出 3 倍。

 

三、到底該攝取多少量呢?

    不同族群攝取的量不同，根據美國IOM (Institute of Medicine美國國家學院)建議的每天攝取量，每日最高補充量為4000IU，衛生福利部國民健康署第7版，每天攝取量最高為2000 IU(1 ug=40 IU)。

    建議(1)一般人，每天攝取200~2000IU；(2)停經後的健康婦女，每天最少攝取800IU；(3)停經後，經診斷缺乏維他命D的婦女，每日攝取4000IU以上。(4)癌症或是正在接受化療者，每日攝取2000IU。(正在做免疫療法者勿服用維他命D)(5)洗腎病患：需同時補充活性維他命D與非活性維他命D。

    就目前研究顯示，每日服用10000IU達兩個月，尚未有中毒現象。所以維生素D的補充，相當的安全。

    

四、那到底是補充維他命D(Cholecalciferol)<非活性維他命D>還是直接補充鈣三醇（Calcitriol）<活性維他命D>?

    肝腎功能正常的健康朋友，建議直接服用非活性維他命D即可，因為直接補充活性維他命D，容易導至高血鈣的發生。如果有肝腎功能異常，請詢問醫師。

 

五、目前維他命D的以證實等級之作用分類

    目前維他命D已經被廣泛用來做很多疾病的預防以及治療，但依實證醫學來看很多作用還沒有很明確的被證實。以下就實證的分級來分類

A、已有相當多實證證實(確定有效)

(1)佝僂病：缺乏磷酸鹽；(2)范可尼氏症候群(Renal tubular Fanconi syndrome)：磷酸鹽過低導致的腎臟疾病；(3)軟骨症(Osteomalacia)；(4)牛皮癬；(5)甲狀腺切除後的低血鈣或是低維他命D；(6)維他命D低下(跟很多疾病有關，例如：骨質流失、腎臟病、肺功能異常、糖尿病、心血管疾病等)

B、有一些實證證實(有效)

(1)肌肉痠痛；(2)骨質酥鬆；(3)腎性骨病變；

C、沒有明確的實證證實(可能有效，還在確認中)

(1)氣喘；(2)免疫系統；(3)癌症預防；(4)幫助懷孕以及安胎(較不會流產)；(5)纖維肌痛；(6)骨折；(7)高血壓；(8)腎臟病；(9)改善情緒；(10)減少失智；(11)改善失眠

D、目前無實證(可能無效)

(1)異位性皮膚炎；(2)前列腺癌；(3)心臟病；(4)高膽固醇

從上述資料來看，很多療效都還在證實階段，因此也不要一味的大量補充；但是體內很多組織器官都需要維他命D來幫助身體健康，加上很多人很少曬太陽，或是防曬做的相當好，要靠曬太陽達到體內血液25(OH)D濃度提高至30 ng/mL以上，有相當的難度，因此還是建議大家多補充些維他命D。

 

六、總結與建議：

    維他命D不再是以往認知的單純維他命而已，維他命D也是一種賀爾蒙，參與身體內鈣質穩定、免疫調節、預防及治療癌症、降低血壓等，即使目前還欠缺很多大型試驗來證實，但是由於現代人飲食不均、防曬做的太好或是日曬不足的情況下，加上維他命D的安全性相當高，建議每日可以補充到800IU~2000IU。

VIT D2.jpg

 

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