Do all children need vitamin D and which is better - oil or water: the pediatrician answered the most popular questions from parents

Vitamin D successfully participates in thirty biochemical reactions that occur during human metabolism. Its presence is necessary in sufficient quantities throughout the entire calendar year, so a person who wants to stay healthy no longer has to wonder why vitamin D3 is needed.

There are two most useful forms:

• D2 (ergocalciferol), which enters the body with food (fatty fish, animal liver and kidneys, egg yolks, dairy products, butter, hard cheeses);
• D3 (cholecalciferol). It comes from food and is also synthesized in the body independently.

The importance of vitamin D plays an important role starting from birth, or rather, from the moment a person is conceived. The direct participation of the element in the metabolism of calcium and phosphorus, which, like “bricks”, build the child’s bone skeleton, is extremely important during the period of growth and formation. This is a real “protector” that prevents the risk of developing rickets in premature and weak newborn babies.

By taking vitamin D3, a child is almost 100% able to meet the need for the microelement in the body. This is especially important in the absence of breastfeeding (before complementary feeding). With the help of vitamin D, metabolic processes in cartilage, joint and bone tissues are supported throughout the entire period of life, and losses during menopause and with the onset of old age are compensated. The need for vitamin D is vital for both children and adults, pregnant and lactating women. This rule especially applies to regions with reduced solar activity and a small number of clear days.

The mechanism of formation of vitamin D3 is closely related to the absorption and production of ultraviolet radiation by human skin and exposure to air in open clothing.

Important! Exposure of an adult to the sun for about 6 hours in open clothing provides a daily dose of vitamin D of 10 mcg.

What causes vitamin D deficiency?

Vitamin D deficiency in many Russian residents is due to:

• location in the northern temperate zone (above 42 degrees north latitude)
• limited exposure to the sun (office work, driving cars)
• eating meat from animals that have not been exposed to the sun (farm)
• use of sunscreens
• chronic diseases (obesity, intestinal pathology, taking a large number of medications)

You can determine the level of vitamin D in your body by taking the following test:

25-OH vitamin D (25-hydroxycalciferol) (amount)

Indications for use

Let's consider the main conditions in which it is necessary to replenish vitamin D3 for preventive or therapeutic purposes.

In children:

1. Disturbances in the growth and development of bones and joints, skeleton.
2. Risk of rickets.
3. Signs of vitamin deficiency.

Important! Before taking it, it is recommended to take a blood test to confirm the level of the substance. Based on the results of the examination, the doctor will make an individual prescription, taking into account the patient’s age, indications, place of residence, type of activity, concomitant pathologies, etc.

In adults:

1. Presence of signs of vitamin D deficiency.
2. Pregnancy and breastfeeding (to prevent pathologies of fetal development).
3. Complaints of muscle cramps, spasms.
4. Osteoporosis, joint damage, bone fractures.
5. Calcium and phosphorus deficiency, poor absorption.
6. Bone marrow diseases.
7. Complex treatment of cardiovascular system, gastrointestinal tract.
8. Enterocolitis.
9. Comprehensive treatment of systemic lupus erythematosus, skin tuberculosis, type 2 diabetes, psoriasis.
10. Prevention of occupational diseases (in metallurgy).
11. Hypoparathyroidism.
12. Prescription of glucocorticosteroids.
13. Decreased immunity, frequent seasonal diseases.

Important! The use of vitamin D without tests and doctor's prescription is possible only for preventive purposes.

For the curious

Vitamin D

combines a group of vitamins (D1, D2, D3, D4, D5), of which only two forms (D2 and D3) have important biological significance.

The main biological role of calcitriol

(1,25-OH-vitamin D) is to maintain a constant level of calcium in the blood (vitamin D enhances the absorption of calcium in the intestines and, if there is not enough calcium in the blood, ensures the flow of calcium from the bones into the blood).

Over time, receptors for calcitriol, in addition to the intestines and bones, were found in the kidneys, genitals, pancreas, muscles, cells of the immune and nervous systems. Thus, it became clear that vitamin D performs a large number of different functions in the human body:

• regulates the expression of 3% of the human genome (several thousand genes)
• increases the sensitivity of the insulin receptor (prevention of insulin resistance, obesity, diabetes)
• strengthens the skeletal system
• reduces the level of parathyroid hormone in the blood
• promotes the synthesis of sex hormones (testosterone, estrogens, progesterone)
• improves reproductive function
• affects innate and acquired immunity
• prevents the development of tumors, depression, Parkinson's disease

Overdose of the drug

Let's consider the possible risks of excessive use of dietary supplements:

1. Indigestion, nausea, vomiting, upset stomach.
2. Headaches, dizziness.
3. Convulsions, breathing problems.
4. Loss of appetite.
5. Changes in mood, nervousness.
6. Rashes on the body.
7. Loss of consciousness.

It should be noted that taking the drug is cumulative. The body creates a kind of reserve, which it spends when you stop using dietary supplements or as needed. If the dosage is followed correctly and the period is not exceeded, then, as a rule, no side effects are observed.

Vitamin D deficiency

A lack of vitamin D in the body can lead to the development of:

• diseases of the cardiovascular system
• immunodeficiency, allergies, psoriasis, bronchial asthma, rheumatoid arthritis
• periodontal disease
• tumors of the large intestine, mammary glands, ovaries, prostate
• chronic fatigue, depression, insomnia
• decreased muscle strength leading to a risk of falls
• decreased motility and number of morphologically normal sperm (male factor infertility)
• risk factor for premature birth, fetopathies (less than 20 ng/ml)

Achieving a vitamin D level of 50 ng/ml (125 nmol/l) reduces the risk of developing:

Vitamin D is important during pregnancy.

Its deficiency is associated with the risk of developing gestational diabetes mellitus, premature birth, preeclampsia, and various intrauterine developmental defects.

There is not a single case of teratogenic (leading to the development of tumors) effect of vitamin D in the world.

Complivit Aqua D3

Pharmacological properties

Pharmacodynamics
Vitamin D3 is a natural form of vitamin D, which is formed in humans in the skin under the influence of sunlight. Compared to vitamin D2, it is characterized by 25% higher activity.

Vitamin D binds to the specific vitamin D receptor (VDR), which regulates the expression of many genes, including the ion channel genes TRPV6 (ensures the absorption of calcium in the intestine), CALB1 (calbindin; ensures the transport of calcium into the bloodstream), BGLAP (osteo-calcine) ; ensures bone tissue mineralization and calcium homeostasis), SPP1 (osteopontin; regulates osteoclast migration), REN (renin; ensures regulation of blood pressure, being a key element of the renin-angiotensin-aldosterone regulatory system), IGFBP (insulin-like growth factor binding protein; enhances the effect insulin-like growth factor), FGF23 (fibroblast growth factor 23; regulates the levels of calcium, phosphate anion, processes of cell division of fibroblasts), TGFB1 (transforming growth factor beta-1; regulates the processes of cell division and differentiation of osteocytes, chondrocytes, fibroblasts and keratinocytes), LRP2 (LDL receptor-related protein 2; mediates the endocytosis of low-density lipoproteins), INSR (insulin receptor; ensures the effects of insulin on any cell type).

Vitamin D3 is an active antirachitic factor. The most important function of vitamin D3 is to regulate calcium and phosphate metabolism, which promotes proper mineralization and skeletal growth.

Colecalciferol plays a significant role in the absorption of calcium and phosphates from the intestine, in the transport of mineral salts and in the process of bone calcification, and also regulates the excretion of calcium and phosphates by the kidneys. The concentration of calcium ions in the blood determines the maintenance of muscle tone of skeletal muscles, myocardial function, promotes nervous stimulation, and regulates the process of blood clotting.

Lack of vitamin D in food, impaired absorption, calcium deficiency, as well as insufficient exposure to the sun leads to: in children during periods of intensive growth - to rickets, in adults - to osteomalacia, in pregnant women, symptoms of tetany may occur - disruption of the processes calcification of newborn bones.

An increased need for vitamin D occurs in women during menopause, as they often develop osteoporosis due to hormonal imbalances.

Vitamin D has a number of so-called. extraskeletal effects.

Vitamin D is involved in the functioning of the immune system by modulating cytokine levels and regulating the division of T-helper lymphocytes and the differentiation of B-lymphocytes. A number of studies have noted a decrease in the incidence of respiratory tract infections with vitamin D supplementation.

It has been shown that vitamin D is an important part of the homeostasis of the immune system: it prevents autoimmune diseases (type 1 diabetes, multiple sclerosis, rheumatoid arthritis, inflammatory bowel diseases, etc.).

Vitamin D has antiproliferative and prodifferentiating effects, which determine the oncoprotective effect of vitamin D. It has been noted that the incidence of certain tumors (breast cancer, colon cancer) increases against the background of low levels of vitamin D in the blood.

Vitamin D is involved in the regulation of carbohydrate and fat metabolism by influencing the synthesis of IRS1 (insulin receptor substrate 1; participates in the intracellular pathways of the insulin receptor signal), IGF (insulin-like growth factor; regulates the balance of adipose and muscle tissue), PPAR-δ (activated receptor peroxisome proliferators, type δ; helps process excess cholesterol).

According to epidemiological studies, vitamin D deficiency is associated with the risk of metabolic disorders (metabolic syndrome and type 2 diabetes mellitus).

Vitamin D receptors and metabolizing enzymes are expressed in arterial vessels, the heart, and virtually all cells and tissues relevant to the pathogenesis of cardiovascular disease. Animal models show anti-atherosclerotic effects, renin suppression and prevention of myocardial damage, etc. Low levels of vitamin D in humans are associated with unfavorable risk factors for cardiovascular pathology, such as diabetes mellitus, dyslipidemia, arterial hypertension, and are associated with the risk of cardiovascular accidents , incl. strokes.

Studies in experimental models of Alzheimer's disease showed that vitamin D3 reduced amyloid accumulation in the brain and improved cognitive function. Non-interventional human studies have shown that the incidence of dementia and Alzheimer's disease increases with low vitamin D levels and low dietary intake of vitamin D. Cognitive function and the incidence of Alzheimer's disease have been impaired with low vitamin D levels.

Pharmacokinetics.

An aqueous solution of vitamin D3 is absorbed better than an oil solution. In premature babies, there is insufficient formation and flow of bile into the intestines, which interferes with the absorption of vitamins in the form of oil solutions. After oral administration, colecalciferol is absorbed in the small intestine. Metabolized in the liver and kidneys. The half-life of colecalciferol from the blood is several days and may be prolonged in cases of renal failure. The drug penetrates the placental barrier and into mother's milk. Vitamin D3 has the property of cumulation. It is excreted from the body by the kidneys in small quantities, most of it is excreted in bile.

Vitamin D standards

Considering the different units of measurement, the recommended level is:

60 - 100 ng/ml

150 – 250 nmol/l

To convert from ng/ml to nmol/l you need ng/ml * 2.5 = nmol/l

Example: 30 ng/ml * 2.5 = 75 nmol/l

Russian Association of Endocrinologists

considers
the optimal concentration
of vitamin D in the blood of an adult to be 30-100 ng/ml,
deficiency is
20-30 ng/ml,
deficiency
is less than 20 ng/ml.

According to data presented at the 10th European Congress on Menopause and Andropause (Madrid, 2015), vitamin D levels in obese patients in Russia:

less than 20 ng/ml - 35%

20-30 ng/ml - 30%

more than 30 ng/ml - 35%

Daily Values ​​for Vitamin D

according to the recommendation of the American Society of Endocrinology (2011).

Prophylactic dose

vitamin D (when you can not detect it in the blood and take it calmly) is considered to be 4,000 IU per day.

Without medical supervision, it is not recommended to take vitamin D at a dose of 10,000 IU for more than 6 months. (Russian Association of Endocrinologists)

It is almost impossible to overdose on vitamin D. For example, in Holland, an elderly couple (90 and 95 years old) accidentally took a single dose of cholecalciferol 2,000,000 IU each.

Doctors monitored them for 2 months and did not identify any symptoms of overdose or toxicity. The maximum blood concentration of its form of 25-OH-vitamin D on day 8 was 210 and 170 ng/ml, respectively, which is slightly higher than its target values.

How to take vitamin D correctly and which is better - oil solution or water solution

Pharmacies and stores offer a large selection of different forms of vitamin D: drops and capsules, dragees, ampoules, chewable tablets. Oil and water solutions are fundamentally different in composition and consistency. These are the questions parents most often ask about. It is a very popular opinion that the only effective form of vitamin D is an oil solution, since the vitamin itself is fat-soluble. However, this is not quite true. It all depends on the age of the patient.

To assimilate the oil solution, full functioning of the enzyme systems of the gastrointestinal tract is required. Therefore, for example, an aqueous solution is better suited for children in the first year of life - it is absorbed faster. It is convenient and safe to give to babies and can be drunk at any time of the day without being tied to a specific meal.

The disadvantage of water-based drops is that their main component begins to degrade in the oral cavity and stomach under the influence of hydrochloric acid, while vitamin D is absorbed in the small intestine. Therefore, adults are recommended to choose capsules - they are more effective. An oil solution is also good, but it is better absorbed if taken at the same time as food. The same applies to capsules, so the ideal time to take vitamin D is in the morning during breakfast.

And, of course, be sure to include in your diet foods high in this essential vitamin: fatty fish, cod liver, egg yolk, butter, goat milk, hard cheeses. And in the summer, try to spend more time outdoors, not forgetting about sun safety rules.

Health to you and your children!

This material summarizes evidence-based medicine studies from different years. However, it is for informational purposes only and cannot be used as a direct guide to action. Before consuming vitamin D, you should consult a specialist.