Körperliche Bewegung – ein Heilmittel gegen Müdigkeit?

Bewegung bei Darmkrebspatienten während der Behandlung

Autor: Vivien Gireg

Fuß, Abstandhalter, Der Pfad, Senior, Zusammen

Das kolorektale Karzinom gehört zu den drei häufigsten Krebsarten weltweit. Allein 2018 gab es über 1,8 Millionen neu diagnostizierte Fälle (Global Cancer Observatory, 2019). Der Darmkrebs beginnt als ein verstärktes Gewebswachstum in der Innenschicht des Kolons oder des Rektums. Dieses Gewebswachstum, auch Polyp genannt, kann bösartig werden und folglich in Blut- oder Lymphgefäße einwachsen und sich dadurch im Körper verteilen und metastasieren (Marley & Nan, 2016). Die Überlebensrate ist zwar durch die medizinischen Fortschritte gestiegen, jedoch erleben die Patienten dabei schwerwiegende Symptome (Macleod et al., 2017, S. 1).

Eines der häufigsten Symptome, die Patienten mit dieser Art von Krebs erleben, ist die Fatigue (Aapro, Scotte, Bouillet, Currow & Vigano, 2016). Anders als die Müdigkeit, die eine gesunde Person verspürt, lässt sich die Krebs-assoziierte Erschöpfung oder Fatigue durch Schlaf nicht verbessern und kann von der Erstdiagnose bis Jahre nach Behandlungsabschluss persistieren, wobei sie meistens während der Behandlungszeit am stärksten vorhanden ist (Bower, 2014). Das konstante Gefühl der Müdigkeit reduziert die Qualität des Lebens dieser Patienten stark. In einem qualitativen Review beschrieben Patienten mit Krebs die Krebs-assoziierte Fatigue als überwältigend und allumfassend, als ob jemand das Ladekabel aus der Steckdose gezogen hätte oder der Sprit ausgegangen wäre. Ganz einfache Tätigkeiten wie Essen zu sich zu nehmen, zu gehen oder ganz einfach den Fernseher einzuschalten sind durch die Müdigkeit zur Herausforderung geworden. Am häufigsten erwähnten die Patienten den emotionalen Frust den sie durch die Limitationen in körperlichen, kognitiven und sozialen Aspekten verspürten (Scott, Lasch, Barsevick & Piault-Louis, 2011). 

Es gibt Möglichkeiten, diesem Symptom entgegenzuwirken und dadurch die Qualität des Lebens dieser Menschen zu verbessern. Vor allem in der Behandlungszeit, in der die Patienten am meisten unter der Fatigue leiden, ist eine Hilfestellung besonders wichtig. Auch wenn es paradox scheint, stellte sich durch die Forschung in den letzten drei Jahrzehnten Bewegung als ein effektives und sicheres Mittel gegen Krebs-assoziierte Fatigue heraus (Nyrop et al., 2016, Rock et al., 2012). In meiner Abschlussarbeit für den Bachelor in Pflegewissenschaft habe ich eine Literaturrecherche zu diesem Thema in den Datenbanken Medline (via PubMed), Cochrane Library und CINAHL complete (via Ebsco Host) in Deutsch und in Englisch im Zeitraum von April bis Juni 2019 durchgeführt. Ich habe insgesamt acht Studien gefunden, die die Auswirkung einer Bewegungsintervention bei Darmkrebspatienten auf deren Fatigue erforschten. Ich schloss nur Studien ein, bei denen die Darmkrebspatienten noch eine Behandlung erhielten, entweder eine Chemo- oder Strahlentherapie, da die Fatigue in der Behandlungszeit am Stärksten sein soll. 

In allen Studien übten die Teilnehmer Aerobic- und Widerstandsübungen aus, jedoch variierte die Intensität von niedrig bis hoch. Bewegungsübungen von niedriger Intensität sind Übungen mit einem Intensitätslevel von 12-14 auf der Borg Skala (van Waart et a., 2018). Das bedeutet, dass die Betroffenen sich für das Training ein wenig anstrengen müssen, sie sich dabei jedoch gut in der Lage fühlen, die Bewegungsübungen fortzusetzen und nicht außer Atem kommen (Williams, 2017). Ein Beispiel dafür wäre Brisk Walking. Die Übungen mittlerer Intensität haben in den Studien ein Intensitätslevel bis 15, und die der hohen Intensität bis 16 auf der Borg Skala (Lin et al., 2014; van Waart et al., 2018). Übungen hoher Intensität bedürfen einer enormen Anstrengung, Herz- und Atemfrequenz sind sehr hoch. Beispiele dafür sind Fahrradfahren oder Schwimmen (Borg, 1982). 

Die Patienten, die Bewegungsübungen niedriger Intensität durchführten, erzielten die besten Ergebnisse, vor allem auf die körperliche und mentale Fatigue bezogen (Shariati et al., 2010, van Waart et al., 2018). Ein Bewegungsprogramm mit mittel-intensiven Übungen machen in den Studien von Lin et al. (2014) und Singh et al. (2018) einen mäßigen bis gar keinen Unterschied auf das Fatigue-Level der Patienten. Intensive Bewegungsübungen können laut der Studie von van Waart et al (2018) zu einer Verbesserung der körperlichen Fatigue führen, jedoch die bereits reduzierte Aktivität der Patienten noch stärker reduzieren.

Außerdem trainierten die Teilnehmer in den Studien unterschiedlich lange, die Trainigsdauer reichte von vier Wochen bis 18 Wochen. Je länger die Patienten Sport betrieben, desto eher verbesserte sich ihre Müdigkeit (Lu et al., 2019, van Vulpen et al., 2015). Das Verhältnis der Patienten mit einer milden, moderaten und starken Fatigue veränderte sich bei den Patienten, die trainierten, signifikant (p<0,01) (Lu et al., 2019). Jedoch variiert nicht nur die Anzahl der Wochen, sondern auch die Bewegungsdauer pro Woche. Drei Studien erforschten Bewegung von bis zu 120 Minuten pro Woche. Zwei Studien befassten sich mit 150 Minuten an Bewegung pro Woche und drei weitere mit über 180 Minuten an wöchentlicher körperlicher Aktivität. Zwei Stunden an Bewegung pro Woche erzielte nur in einer von drei Studien eine signifikante Verbesserung der Fatigue (Brunet et al, 2017; Lin et al., 2014; Shariati et al., 2010). Eine von zwei Teilnehmergruppen konnte Verbesserungen der Müdigkeit bei bis zu 150 Minuten an Sport pro Woche erreichen (Singh et al. 2018; van Waart et al., 2018). Jedoch stellten die Patienten aller drei Interventionsgruppen, die mehr als 180 Minuten an Sport pro Woche betrieben, signifikante Verbesserungen der Müdigkeit fest (Lu et al., 2019; van Vulpen et al., 2015; van Waart et al, 2018).

Auch der Betreuungsgrad der Interventionen wurde in den Studien unterschiedlich gewählt. Eine Interventionsgruppe von Cheong et al. (2018) und van Waart et al. (2018) wurde von Krankenpflegern oder Physiotherapeuten professionell beraten, bei den Übungen jedoch nicht persönlich betreut. Die Fatigue der Patienten verbesserte sich in beiden Studien nach der Intervention. Betreute sowie teilweise betreute Bewegungstrainings wirkten sich im Vergleich dazu nicht in allen inkludierten Studien, die diese Interventionen durchführten, positiv aus (Brunet et al., 2017; Lin et al., 2014; Singh et al., 2018). Bei Patienten mit Darmkrebs, die sich einer Chemotherapie unterziehen, wird aufgrund ihres höheren Alters und der Toxizität der Chemotherapie eine geringere Einhaltung eines herkömmlichen Programms erwartet (Cheong et al., 2018). Aus diesem Grund kann es sein, dass ein Programm mit viel individuellem Management besser für Darmkrebspatienten geeignet ist. Zudem erhöht ein zuhause durchführbares Trainingsprogramm auch die Compliance der Krebspatienten (Windsor et al., 2004).

Schlussfolgerung

Die Bewegung ist ein sicheres und effektives Mittel gegen das belastende Symptom Fatigue und die Patienten sollten von den Ärzten, Pflegern und anderen Mitarbeitern in der Gesundheitsbranche darüber informiert werden. Auf den onkologischen Stationen werden die Patienten von dem Gesundheitspersonal jedoch eher selten zu körperlicher Aktivität motiviert (Nyrop et al., 2016). Dabei ist die Fatigue vor allem in der Behandlungszeit, in der sich die Patienten dort ambulant oder stationär aufhalten, am schwerwiegendsten (Bower, 2014). Oftmals liegt es daran, dass das Personal die Patienten als zu alt, unsportlich oder ungeeignet für ein Bewegungsprogramm erachtet, da Darmkrebspatienten häufig ein hohes Alter und mehr postoperative Komplikationen als zum Beispiel Brustkrebspatienten haben (van Waart et al., 2018). Doch nachdem Sie diesen Artikel nun gelesen haben, haben Sie einige Quellen zur Hand, bei denen Sie sich noch ins Detail informieren können, um Ihren Patienten in dieser schwierigen Lage professionelle Hilfe zur Selbsthilfe geben können. Die Zeit und Motivation für Bewegung aufzubringen ist vor allem für Patienten, die berufliche und familiäre Verpflichtungen haben, schwierig. Gerade deswegen ist es wichtig, dass diese von ihren professionellen Betreuern über Mittel informiert werden, mit denen sie sich selber helfen können und welche die Qualität ihres Lebens steigern (Nyrop et al., 2016). 

Literaturverzeichnis

Aapro, M., Scotte, F., Bouillet, T., Currow D., & Vigano, A. (2016).  A Practical Approach to Fatigue Management in Colorectal Cancer. Clinical Colorectal Cancer, 16(14), 275-285.

Borg, G. A. (1982). Psychophysical bases of perceived exertion. Medicine and Science in Sports an Exercise, 14(5), 377-381.

Bower, J. E. (2014). Cancer-related fatigue: mechanisms, risk factors, and treatments. Nature Reviews Clinical Oncology, 11(10), 597-609.

Brunet, J., Bruke, S., Grocott, M. P. W., West, M. A., & Jack, S. (2017). The effects of exercise on pain, fatigue, insomnia, and health perceptions in patients with operable advanced stage rectal cancer prior to surgery: a pilot trial. BMC Cancer, 17(1), 153-163.

Cheong, I. Y., An, S. Y., Cha, W. C., Rha, M. Y., Kim, S. T., Chang, D. K., & Hwang, J. H. (2018). Efficacy of Mobile Health Care Application and Wearable Device in Improvement of Physical Performance in Colorectal Cancer Patients Undergoing Chemotherapy. Clinical Colorectal Cancer, 17(2), 353-362. 

Global Cancer Observatory (2019). Colorectal Cancer, http://gco.iarc.fr/today/data/factsheets/cancers/10_8_9-Colorectum-fact-sheet.pdf (11.06.2019).

Lin, K. Y., Shun, S.-C., Lai, Y.-H., Liang, J.-T., & Tsauo, J.-Y. (2014). Comparison of the Effects of a Supervised Exercise Program and Usual Care in Patients With Colorectal Cancer Undergoing Chemotherapy. Cancer Nursing, 37(2), 21-29.

Lu, Y., Qu, H.-Q., Chen, F.-Y., Li, X.-T., Cai, L., Chen, S., & Sun, Y.-Y. (2019). Effect of Baduanjin Qigong Exercise on Cancer-Related Fatigue in Patients with Colorectal Cancer Undergoing Chemotherapy: A Randomized Controlled Trial. Oncology Research and Treatment, 42, 431-438. 

Macleod, M., Steele, R. J. C., O’Carroll, R. E., Wells, M., Campbell, A., Sugden, J. A., Rodger, J., Stead, M., McKell, J., & Anderson, A. S. (2018). Feasibility study to assess the delivery of a lifestyle intervention (TreatWELL) for patients with colorectal cancer undergoing potentially curative treatment. BMJ Open, 8(6), 1-11.

Marley, A. R., & Nan, H. (2016). Epidemiology of colorectal cancer. International Journal of Molecular Epidemiology and Genetics, 7(3), 105-114.

Nyrop, K. A., Deal, A. M., Williams, G. R., Guerard, E. J., Pergolotti, M., & Muss, H. B. (2016). Physical Activity Communication Between Oncology Providers and Patients With Early-Stage Breast. Colon, or Prostate Cancer. Cancer, 122(3), 470-476.

Rock, C. L, Doyle, C., Denmark-Wahnefried, W., Meyerhardt, J., Courneya, K. S., Schwartz, A. L., Bandera, E. V., Hamilton, K. K., Grant, B., McCullough, M., Byers, T., & Gansler, T. (2012). Nutrition and Physical Activity Guidelines for Cancer Survivors. A Cancer Journal for Clinicians, 62(4), 243-274.

Scott, J. A., Lasch, K. E., Barsevick, A. M., & Piault-Louis, E. (2011). Patients’ Experiences With Cancer-Related Fatigue: A Review and Synthesis of Qualitative Research. Oncology Nursing Forum, 38(3), 191-203.

Shariati, A., Haghighi, S., Fayyazi, S., Tabesh, H., & Kalboland, M. M. (2010). The effect of exercise on the severity of the fatigue in colorectal cancer patients who received chemotherapy in Ahwaz. Iranian Journal of Nursing and Midwifery Research, 15(4), 145-149. 

Singh, F., Galvao, D. A., Newton, R. U., Spry, N. A., Baker, M. K., & Taaffe, D. R. (2018). Feasibility and Preliminary Efficacy of a 10-Week Resistance and Aerobic Exercise Intervention During Neoadjuvant Chemoradiation Treatment in Rectal Cancer Patients. Integrative Cancer Therapies, 17(3), 952-959.

van Vulpen, J. K., Velthuis, M. J., Steins Bisshop, C. N., Travier, N., van den Buijs, B. J. W., Backx, F. J. G., Los, M., Erdkamp, F. L. G., Bloemendal, H. J., Koopman, M., de Roos, M. A. J., Verhaar, M. J., Ten Bokkel-Huinink, D., van der Wall, E., Peeters, P. H. M., & May, A. M. (2015). Effects of an Exercise Program in Colon Cancer Patients undergoing Chemotherapy. Medicine & Science in Sports & Exercise, 48(5), 767-775.

van Waart, H., Stuiver, M. M., van Harten, W. H., Geleijn, E., de Maaker-Berkhof, M., Schrama, J., Geenen, M. M., Meerum Terwogt, J. M., van den Heiligenberg, S. M., Hellendoorn-van Vreeswijk, J. A. J. H., Sonke, G. S., & Aaronson, N. K. (2018). Recruitment to and pilot results of the PACES randomized trial of physical exercise during adjuvant chemotherapy for colon cancer. International Journal of Colorectal Disease, 33(1), 29-40.

Williams, N. (2017). The Borg Rating of Perceived Exertion (RPE) scale. Occupational Medicine, 67(5), 404-405

Windsor, P. M., Nicol, K. F., & Potter J. (2004). A randomized, controlled trial of aerobic exercise for treatment-related fatigue in men receiving radical external beam radiotherapy for localized prostate carcinoma. Cancer, 101(3): 550-557.

 

Why Do Plant-Based Diets Help Rheumatoid Arthritis?

Rheumatoid arthritis is a chronic systemic autoimmune disease affecting millions, characterized by persistent pain and stiffness, and progressive joint destruction—particularly in the hands and feet, leading to crippling deformities. What can we do to prevent it and treat it?

In a famous 13-month long randomized controlled trial of plant-based diets for rheumatoid arthritis, patients were put on a vegan diet for three and a half months, and then switched to an egg-free lactovegetarian diet for the remainder of the study. Compared to the control group, who didn’t change their diet at all, the plant-based group had a significant improvement in morning stiffness within the first month, cutting the number of hours they suffered from joint stiffness in half. Pain dropped from five out of ten down to less than three out of ten. A drop in disability; they reported subjectively feeling better, significant improvement in their grip strength, fewer tender joints, less tenderness per joint, and less swelling, with the added benefit of losing about 13 pounds and keeping most of that weight off throughout the year. They also had a drop in inflammatory markers in their blood, sed rate, C-reactive protein, and white count. The question is why. What does diet have to do with inflammatory joint disease?

Well, rheumatoid arthritis is an autoimmune disease in which your body attacks the lining of your own joints. Why would it do that? Well, there’s a different autoimmune disease called rheumatic fever, in which your body attacks your own heart. Again, why would your body do that? It appears to be a matter of friendly fire.

Rheumatic fever is caused by strep throat, which is caused by a bacteria that has a protein that looks an awful lot like a protein in our heart. So when our immune system attacks the strep bacteria, it also attacks our heart valves, triggering an autoimmune attack by “molecular mimicry.” The protein on the strep bacteria is mimicking a protein in our heart, so our body gets confused and attacks both. That’s why it’s critical to treat strep throat early to prevent our heart from getting caught in the crossfire.

So researchers thought maybe rheumatoid arthritis might be triggered by an infection as well. A clue to where to start looking was the fact that women seem to get rheumatoid arthritis three times more frequently than men. What type of infection do women get more than men? Urinary tract infections, so researchers started testing the urine of rheumatoid arthritis sufferers, and lo and behold found this bacteria called Proteus mirabilis. Not enough to cause symptoms of a UTI, but enough to trigger an immune response. And indeed, there’s a molecule in the bacteria that looks an awful lot like one of our own molecules in our joints, so anti-Proteus antibodies against the bacteria may inadvertently damage our own joint tissues, leading eventually to the joint destruction. Therefore, therapeutic interventions aimed at the removal of this bacteria from the bodies of patients, with consequent reduction of antibodies against the organism, should lead to a decrease in inflammation.

Well, as we saw before, urinary tract infections originate from the fecal flora; the bugs crawl up from the rectum into the bladder. And so, how might one change the bugs in one’s colon? By changing our diet. Some of the first studies over 20 years ago on trying to fundamentally shift people’s gut flora were done using raw vegan diets, figuring that’s about as fundamental a shift from the standard Western diet as there is. And indeed, within days one could significantly change someone’s gut flora. And you put rheumatoid arthritis sufferers on that kind of diet, and they experienced relief, and the greater improvements were linked to greater changes in their gut flora. But the diet was considered so intolerable that half the patients couldn’t take it and dropped out–perhaps because they were trying to feed people things like buckwheat-beetroot cutlets buttered with a spread made out of almonds and fermented cucumber juice.

Thankfully, regular vegetarian and vegan diets work too, changing the intestinal flora and improving rheumatoid arthritis, but we didn’t specifically have confirmation that plant-based diets brought down anti-Proteus antibodies, until now. Those who responded to the plant-based diet showed a significant drop in anti-Proteus mirabilis antibodies compared to the control group. Maybe it just dropped immune responses across the board? No, antibody levels against other bugs remained the same, so the assumption is that the veg diet reduced urinary or gut levels of the bug.

A shift from an omnivorous to a vegetarian diet has a profound influence on the composition of the urine–for example, higher levels of lignans in the urine of those eating vegetarian. Up until now, it was just thought that lignans protected people eating more plant-based from getting cancer, but now we know lignans can also have antimicrobial properties as well, so may be helping to clear Proteus from the system. Either way, this suggests a new type of therapy for the management of rheumatoid arthritis. This new treatment includes anti-Proteus measures such as dietary manipulations in the forms of vegetarian diet.

Source:https://nutritionfacts.org/video/why-do-plant-based-diets-help-rheumatoid-arthritis/

Top 5 Foods That Help You Fight Coronavirus

corona_virus

Despite our best efforts, we may not be able to prevent getting the novel (new) SARS coronavirus that leads to COVID-19. The good news is, it’s a lot like the common flu and for most healthy people, recovery is quick and it’s not a big deal.  The bad news is, it spreads easily, it has at least 10 times the mortality rate of the regular flu, and we don’t have a vaccine yet.

So, if you are immunocompromised, older, working with the sick, or just interested in boosting your immune system, you might be interested to know about a study back in 2005 that found that the presence of nitric oxide significantly inhibited the replication cycle of SARS coronavirus. In other words, nitric oxide disrupts the virus’ ability to grow.

What Is Nitric Oxide?

Nitric oxide is used by the body for cell signaling, blood vessel dilation to promote better blood flow and there’s evidence that it helps lower blood pressure and improve brain function. How can we get more nitric oxide? We can boost our nitric oxide simply by the foods we eat.

Top 5 Nitric Oxide Sources

Here are the top 5 sources of plant-based nitric oxide, so you can better defend against coronavirus if it ever enters your body. Why wait for a man-made vaccine when we can have, as Hippocrates put it, “food be [our] medicine.”

  1. Beetroot Juice – Beets are the king of raising nitric oxide levels. Beets have a lot of nitrates, which the body converts to nitric oxide. According to one study, consuming a beetroot juice supplement raised nitric oxide levels in the subjects by 21% in 45 minutes. Another study showed drinking just 3.4 ounces of beetroot juice every day significantly raised nitric oxide levels in men and women. 3.4 ounces is about what TSA lets you take on the plane for carry-on liquids so it’s definitely not much.
  2. Garlic – Maybe this is why people have taken garlic for colds for centuries. Garlic boosts levels of nitric oxide by activating nitric oxide synthase, the enzyme involved in the conversion of nitric oxide from the amino acid L-arginine. So if you’re taking arginine supplements, garlic will help turn more of it into nitric oxide. One study showed that aged garlic extract temporarily increased blood nitric oxide levels by up to 40% within an hour and another study found that aged garlic extract also helped maximize nitric oxide absorption by the body.
  3. Leafy Greens – Green leafy vegetables like kale, broccoli, cabbage, spinach, arugula, and celery are packed with nitrates, which are converted to nitric oxide in your body. One study found that regularly eating green leafy vegetables was associated with healthy levels of nitric oxide in the body so this is the single best way to keep elevated levels of nitric oxide in your body. Time to start eating more salads!
  4. Citrus Fruits – Or anything high in vitamin C. But of course oranges, lemons, limes and grapefruit are all excellent sources of vitamin C. Vitamin C plays a critical role in health and raises levels of nitric oxide by increasing its bioavailability and maximizing absorption. Research also shows that it may increase levels of nitric oxide synthase, the enzyme necessary for the production of nitric oxide.
  5. Nuts and Seeds – Almonds, cashews, walnuts, chia seed, flax seed, pumpkin seed, and sunflower seeds have a lot of arginine, a type of amino acid that assists in the production of nitric oxide. Research suggests that getting arginine from foods like nuts and seeds in your diet can help increase nitric oxide levels in your body. For example, a large study involving 2,771 people showed that a higher intake of arginine-rich foods was associated with higher levels of nitric oxide in the blood. Another study found that supplementing with arginine increased levels of nitric oxide after just two weeks.

Now here’s our natural drug disclaimer (just like the one’s on TV). Warning: Eating more of the foods listed in our Top 5 Foods to Fight Coronavirus is not only going to help with coronavirus, but elevated nitric oxide levels may lower your blood pressure, improve circulation, and improve mental cognition.

Effects of weight-control on Typ 2 Diabetes

 

 

 

 

 

 

 

Diabetes Type 2 is a common and widespread disease and it is clearly related to overweight and obesity. The clinical manifestation of diabetes is also related to age. While only 2-3% of people under the age of 50 are afflicted, the prevalence of diabetes is rising continually with the progress of age. At an age of over 70 years, almost 20% are afflicted. So if we speak of a typical Person with diabetes, we think of an elderly person with long-time overweight. But in the last decades also younger people showed an increasing prevalence of diabetes. This may be due to an incline of obesity in our society and due to altered eating habits and less activity today.

While patients with diabetes often suffer under symptoms like chronic fatigue, polyuria and an increase of their thirst, diabetes itself can lead to other secondary illnesses in the long run. It weakens the immune-systems and makes the afflicted person more susceptible for systemic and local infections. It reduces the body’s capacity of healing, so that often time’s chronic wounds are prevalent. Furthermore Diabetes multiplies the risk of developing severe illnesses like stroke, heart-attack, kidney-failure and blindness.

This makes clear how essential it is, to treat the disease well and prevent further damage to the body. While older people often are treated with pills and if necessary also with insulin, especially younger people should be encouraged to change their lifestyle which can improve and in some cases even reverse their diabetes.

A recent study in England addressed the question, to what extend the loosing of weight can influence the diabetes. For this study they recruited 149 people at an age between 20 and 65 and a Body-Mass-Index between 27 and 45 that were diagnosed with non – Insulin – dependent Diabetes in the last 6 years. They gave them a special Formula-low-calorie-Diet which helped them to loose weight. Afterwards they got support in not gaining weight again. The participants of the study got no Diabetes-Medication at all. The results are astonishing: After 1 year 7% of 89 Persons that lost 0-5 kg decreased their diabetes, but already 34% of 56 Persons that had lost 5-10 kg completely reversed their diabetes! 28 people that lost 10-15 kg, 57% of them reversed their diabetes and with the 36 people that lost over 15 kg even 86% of them diabetes was completely reversed. The interesting thing was, that these effects were the same no matter how high the starting-level of obesity was. For example a person that lost from 130 to 115 kg had the same positive effects like a person that lost from 110 to 95 kg.

Altogether almost half of the participants of the study did not only reverse their diabetes, they also felt much better and gained more quality in life.  These results are really encouraging and they shall activate us to motivate Patients in their efforts to adapt to a healthy lifestyle. We should support them in losing weight which by itself can lead to an improvement or even a reverse of diabetes. It will make them feel much better and prevent the emergency of secondary diseases. All together it is the healthiest, cheapest and most natural medication we can offer. Patients should be taught that it is worth it to take responsibility for your life and become active.

 

Source: Lean MEJ, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol 2019;7:344–55.

 

By Faith Alone – Effects of Faith in a Loving God on the Human Body and Soul

Effects of faith

Does your faith impact not only your thinking, but also your mental and physical health? Several studies have examined the question, how faith influences our health. Professor Harold Koenig is leading the Centre for the Study of Religion/Spirituality and Health in Durham, North-Carolina. In a meta-study he and his team collected more than 1.200 scientific articles that were published after 1871 and that analysed the connection between faith and health*. 80% of the studies dealt with the question how faith afflicts the soul. He found out, that in most cases believers had a better psychological health compared to none-believers. The majority of believers could handle disappointments better, had a higher self-esteem and more confidence, and were more optimistic. To trust in a higher power can relieve the soul. Even if a person was affected by psychological illnesses, faith in God helped to deal with the situation. 70% of 444 studies showed, that faith can ease depression and can provide help for anxiety-disorders. In addition, believers were more likely to succeed in overcoming addictions than non-believers. With God at their side it was easier for patients to become free from alcohol than without him. So far the vast majority of the studies showed the positive effects of Christian faith on mental health. But Koenig also found out, that believers have advantages concerning their physical health. People who were believers had a lower blood-pressure, a better immune system, less heart diseases and – they lived longer. This was shown in over 82 studies! So this huge meta-study of 1200 studies showed significant positive effects of faith on human health – mental and physical health.

So even from a “worldly perspective” it is beneficial to believe in an almighty, loving God who is in control of our life. And beyond that, how much more hope and confidence brings the thought about God‘s promise to be with us and to provide a new heaven and a new earth for us.

But you may say “Wait a minute” – didn‘t Herold Koenig just speak of the effects of faith in general, no matter what you believe in? Does it matter, what I believe in?

The nature of faith

Nowadays many people think, that it doesn‘t matter what you believe, as long as you believe something. But is this really true? Let me give you an illustration: Imagine you are standing at the shore of a frozen lake and you want to cross the lake to get to the other side. The ice is only very thin, but your faith is very big! You have no doubt, that you can cross that lake and you feel very good about it! You are 100% sure, that you will make it and so you start running across the thin ice – but you don’t get very far until you crash through the ice and sink into the water. Now imagine you are standing at the shore of a frozen lake one more time, but this time it had been colder and the ice is two meters thick. But you are very fearful. You have only little faith. You don’t know if the ice will carry you. You can’t imagine how in the world you shall cross this lake. With trembling knees you put one foot in front of the other and you are sweating and praying to reach the other side. It almost seems like a miracle to you, that you finally crossed the lake and reached the other shore. – But the truth is: The ice was so thick, you could have crossed the lake in an 70 tons Abrams M1A2-battle-tank without any problem! So we see, that it does make a difference, what we trust in. It is important to build our faith on the truth and that is why Jesus said, that if we study his teachings, we will discover the truth and the truth will set us free. So faith and truth must be united. Jesus said, he is the one who shows the truth and he is the truth.

So, how does Jesus describe the essence of faith that he asks us to have?

Characteristics of biblical faith

At one point, when his disciples were struggling with disappointment and discouragement, Jesus told them very plainly: “I tell you the truth, if you have faith as small as a mustard seed, you can say to this mountain, ‘Move from here to there’ and it will move. Nothing will be impossible for you.” (Mt 18:4)

So Jesus said, if you have faith, nothing that you ask will be impossible for you. If it is God‘s will, he can even move mountains for us! So biblical faith is believing in the utter power of God and his possibility to act in our lives! But what is special about the faith Jesus wants us to have? You have to believe in something, that you can’t see right now. The mountain is there. It is as big and as steady as before, but you believe that God can move this mountain. Additionally, you haven’t ever heard of something like this before! You believe in something, you can’t see now. The book of Hebrews gives us a definition of faith that expresses this fact. Hebrews 11:1 says: “Now faith is being sure of what we hope for and certain of what we do not see.” And in verse 6 it says: “And without faith it is impossible to please God, because anyone who comes to him must believe, that he exists and that he rewards those who earnestly seek him.”

So the nature of faith is, that we put our trust in the promises of God, although we cannot see their fulfilling today! It is like walking with your eyes closed, but hand in hand with a person that you trust. Even though you can’t see the way that is ahead of you, you trust in your companion, and that he is leading you right as he is telling you where to go. As we look back on our experiences with God and on how we took little steps of faith, we can win confidence for the future, although it may be unclear to us. But God has promised, that he will lead us to the end. In Hebrews it also says very clearly, “that anyone who comes to God, must believe, that he exists and that he will reward the ones, who earnestly seek him.” Of course, it only makes sense to believe, if we are sure, that God exists, but the text says, that it is equally important, that we believe in a God who is good and who will reward the ones that seek him. Many people are not sure, if God is good or not, but it is essential to believe in a gracious and loving God! We have the promise, that if we seek, we will find him (Mt 7:7). If we search for truth with all our heart, we will find it! Jesus said, God is like a father who is waiting for us to come home and for this reason he was willing to give his most precious gift for us.

But what does this faith in God‘s promises look like? How does it influence our lives?

Examples of faith

I am so glad, that there are many examples of people in the bible that show us how to grow in faith. We can read many exciting stories, that tell us the experiences, the fortitude and the weaknesses of men and women of faith, and that show how gracious God was with those people and how he led them in their lives. We will notice, that their challenges were in essence oftentimes very similar to ours and that they gave us an example from which we can learn many lessons for our own lives.

One of those examples is Joseph. First he was sold as a slave to Egypt and then he was put into prison because of his loyalty to God and to his master. Surely, it wouldn‘t have been easy for me, if I had been in his position. But the real test came, when the cupbearer in prison promised Joseph to help him to get out of prison as soon as he was free – but then nothing happened. Joseph had to wait in prison for two more years. I‘m sure, that this was a very hard test of faith. Probably Joseph was tempted to give up. I would have asked myself: Why does nothing happen? But Joseph didn’t lose his faith! And God rewarded his loyalty. After many years of endurance, none other than the pharaoh himself called him out of prison and Joseph found himself to become the second most powerful man in Egypt! We also see, that Joseph‘s character changed throughout his life for the good through endurance and trust in God’s guidance, and that God prepared him through all the years for the work he wanted him to do. There are many other examples of faith in the bible: David, who was fighting Goliath, the giant, with just a slingshot and five stones. Or Daniel‘s three friends, who were rather willing to be thrown into the oven, than to worship the golden image of Nebukadnezar. But in the fire Jesus was with them and only their chains burned up. I‘m sure most of you will remember a person in the bible, that is a shining example of faith for you personally.

One outstanding example for me is the widow, that was willing to give her last bread to the prophet Elijah, although she and her son had nothing left for themselves. And even though she only knew very little about God, God rewarded her faith and worked a miracle: bread and oil in her house multiplied from that day on and God provided for her needs. But before this happened, she was tested whether she was willing to give the last thing she had to God. For me this is a good example of living faith. God can only put something into our hands, if we are willing to let go and open our hands first. Only then God can refill them. If the widow hadn’t given Elijah her last bread, probably no miracle would have taken place. If the disciples hadn’t decided to follow Jesus and leave their work and family, they wouldn’t have changed like they did. I think faith always requires to put our life into God’s hand no matter what and to take the risk to obey him.

The greatest example of such faith is found in the life of Jesus. His whole life was a ministry for God and mankind. I am especially astonished by the scene in Gethsemane, when Jesus prayed three times: “My father, if it is possible, may this cup be taken from me. Yet not as I will, but as you will.” (Mt 26:39). Jesus was terrified when he thought of the sacrifice that he was about to bring, especially that the sin of the whole world should be laid upon him. But he was putting the will of his father first, entrusting his own life entirely to him! Even though his feelings were totally contrary, he was willing to do his father‘s will and to trust him, that his way is the best. I think this simple prayer shows what faith in summary is like – submitting our will to God‘s will:  “Father your will be done!” A modern author puts it this way: “Faith means, to lay our plans into God‘s hands” (EGW).  – Are we willing to do that today?

We have been looking at the benefits of faith for body and soul at the beginning of this article. As I write I can even feel the benefit of thinking about the principles of biblical faith. It is encouraging to see, that the people in the bible also started with little steps of faith and that their faith grew through persistence, despite of the personal weaknesses they had. And so it is with us: by acting out faith it will grow and show its positive effects in our lives today.

 

* Harold G. Koenig, “Religion, Spirituality, and Health: The Research and Clinical Implications”, ISRN Psychiatry Volume 2012, Article ID 278730, 33 pages

 

Beer Phytoestrogens

The Most Potent Phytoestrogen is in Beer


Image Credit: Quinn Dombrowski / Flickr. This image has been modified.

Why do alcoholic men develop so-called man boobs and other feminine traits? We know estrogens produce feminization, and our liver clears estrogens from the body. As such, the original theory was that alcohol-induced liver damage led to the retention of excess estrogens. The problem was that when researchers measured estrogen levels, they weren’t elevated. What’s more, even those with cirrhosis of the liver appeared to clear estrogens from the body normally, and men’s testicles started shrinking even before serious liver disease developed.

So, alternative explanations were considered. If it’s not due to estrogens produced endogenously, meaning within the body, maybe alcoholics are being exposed to “exogenous estrogenic substances from dietary sources”—perhaps from phytoestrogens in the plants that alcoholic beverages are made from. The discovery that plants could contain hormonal compounds was made back in 1951 by two Australian chemists charged with finding out the cause of an “epidemic of infertility in sheep that was ravaging their nation’s wool industry.” It took them ten years, but they finally figured out the cause: a compound called genistein, present in a type of clover, and the same phytoestrogen found in soybeans.

You can read about the dreaded clover disease on scare-mongering websites, but you’ll note they never talk about the difference in dose. To get as much as the sheep were getting from clover, you’d have to drink more than 1,000 cartons of soymilk a day or eat more than 8,000 soy burgers or about 800 pounds of tofu a day.

This is not to say you can’t overdo it. There are two case reports in the medical literature that describe feminizing effects associated with eating as few as 14 to 20 servings of soy foods a day. But at reasonable doses, or even considerably higher than the one or two servings a day Asian men eat, soy phytoestrogens do not exert feminizing effects on men.

So, back in 1951, we realized plant compounds could be estrogenic. Two German researchers realized that perhaps that’s why women who handle hops start menstruating, and, indeed, they found estrogenic activity in hops, which is the bittering agent used to make beer. They found trace amounts of the soy phytoestrogens, but in such tiny quantities that beer would not be expected to have an estrogenic effect. In 1999, however, a potent phytoestrogen called 8-prenylnaringenin was discovered in hops, which I discuss in my video The Most Potent Phytoestrogen Is in Beer. In fact, it’s the most potent phytoestrogen found to date, fifty times more potent than the genistein in soy, “provid[ing] an obvious explanation for the menstrual disturbances in female hop workers in the past.” Today, we have machines to pick our hops, so our only exposure is likely via beer consumption, but the levels in beer were found to be so low that they shouldn’t cause any concern.

Then in 2001, a study on a hops-containing “dietary supplement for breast enhancement” raised the concern that another phytoestrogen in hops called isoxanthohumol might be biotransformed by our liver into the more potent 8-PN, which would greatly augment the estrogenic effect of hops. This study was conducted on mice, though. Thankfully, a study using human estrogen receptors found no such liver transformation, so all seemed fine…until 2005. “[T] he liver is not the only transformation site inside the human body.” The human colon contains trillions of microorganisms with enormous metabolic potential. It’s like a whole separate organ within our body, with a hundred livers’ worth of metabolizing power. So, let’s effectively mix some beer with some poop and see what happens.

Indeed, up to a 90 percent conversion was achieved. Up to then, “the concentration of 8-PN in beer was considered too low to affect human health. However, these results show that the activity of the intestinal microbial community could more than 10-fold increase the exposure concentration.” This can explain why you can detect 8-PN in the urine of beer-drinkers for days: Their gut bacteria keep churning it out. Obviously, the amount of straight 8-PN in beer is not the only source of estrogen effects given this conversion. So, a decade ago, the question remained: Might drinking too much beer cause estrogenic effects and feminize men? See my video What Are the Effects of the Hops Phytoestrogen in Beer? for the update.

Source: https://nutritionfacts.org/2019/06/04/beer-phytoestrogens/

Endurance-training but not resistance-training is keeping our cells young

As the days are getting longer and warmer, more and more people feel attracted to go out and enjoy nature. You can also see more people out there bicycling or jogging and it seems that together with nature our drive to sports is awakening. The positive effects of sport are widely known. Activity is strengthening our cardiovascular system and it is able to prevent us from many kinds of various diseases. People who are doing sport are healthier, more balanced and live longer than people who are not active.

Just recently I was reading an article about the effects of sport on our cells that was very interesting to me. Professor Laufs from the University of Leipzig in Germany was examining the effects of different types of sport on the cells of our body and he found out, that it makes a great difference, what kind of sport we are doing! If you want to do sport, you have principally two choices: Either you can do endurance-training like swimming, running or cycling, or you can do resistance-training, and strengthen your muscles. You would typically do this with dumbbells or other fitness-devices in a gym. It was astonishing to me, that Professor Laufs found out, that endurance-training had a much greater benefit on the health of our cells, than resistance-training!  

Professor Laufs and his team were examining 266 inactive young people and putting them basically into 3 different groups. The first group was starting with endurance-training (running) 3 times a week, the second group was doing resistance-training (pumping iron) 3 times a week and the third group was continuing their inactive lifestyle from before. After six months blood-examinations were taken from the participants and their Leukocytes were examined for length of telomeres in the cell nucleus. Now Professor Laufs found out, that the length of telomeres in the “running-group” was increased, while resistance-training did not show these effects! But what does this mean?

The DNA contains our genetic information in the cell nucleus. It is packed in 46 Chromosomes. Now each Chromosome is “protected and sealed” by a special cap on each end, which is called “telomere”. The problem is, that this cap is shortening with each replication of the cell and that this shortening of telomeres is viewed to be an important mechanism of cellular aging. But there is one enzyme in our body, called “Telomerase” that can reverse this shortening of Telomeres. Now Professor Laufs found out, that the length of Telomeres and the activity of Telomerase was increased in the “running-group” compared to the “inactivity-group”, but that resistance-training (pumping) did not show the same effects! That means, that endurance-training like running, cycling or swimming has an outstanding potential of keeping our cells young!

To my knowledge this was for the first time, that it could have been scientifically shown, that sport can keep our cells young on a molecular level! The reason for the increased activity of telomerase in the running-group may be due to an increased level of nitric-oxide in the blood-vessels during endurance-training, which is acting like a hormone and providing different cellular changes. You can say, that we are made for moving outside and that by doing so, we can do our part for “healthy aging”. It was very interesting to me also, that sport is not all the same, but that endurance-training seems to be more healthie for our body than resistance-training! Resistance-training can be an addition or complement to endurance-training, but it can never replace it.  Another advantage of endurance-training is, that you can easily do it outside and get an additional extra-portion of fresh air and sunlight! And you can practice it in a group together with other people! So why don’t use the warmer and brighter days of springtime to go out and do some exercise? Your cells will love it!    

Source: “Endurance but not resistance training has anti-aging effects”, European Society of Cardiology, 27.11.2018 (ESC Press Office)

Link: https://www.escardio.org/The-ESC/Press-Office/Press-releases/endurance-but-not-resistance-training-has-anti-aging-effects

Sanddorn-pflanzliche Vitamin B12 Quelle

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Sanddorn ist eine der ganz wenigen pflanzlichen Vitamin B 12-Quellen

Lange Zeit ging die Ernährungsphysiologie als Wissenschaft davon aus, dass die besten Quellen für die Vitamin B12-Versorgung Nahrungsmittel tierischer Herkunft wie Milch, Leber und Fleisch seien. Sanddorn könnte die Ausnahmeerscheinung unter den Pflanzen sein. .Sanddorn kann jedoch aufgrund der Symbiose mit dem Mikroorganismus „Actinomyces“ in seinen  Samenschalen Vitamin B12-Konzentrationen bilden.
Durch eine Konzentration von bis zu 60 µg Vitamin B12 pro 100 g ist der B12-Gehalt in manchen Sanddorn-Pflanzen extrem hoch. Der Nachweis des B12-Gehaltes wurde mit dem ELISA-Test gemacht, welcher als zuverlässig gilt. Einiges spricht dafür, dass diese Analyseresultate zutreffend sind.

Vitamin B12: Versorgung bei vegetarischer und veganer Ernährung

Vitamin B12

Vitamin B12 wird von Mikroorganismen gebildet. Werden bei veganer Ernährung keine Nahrungsergänzungsmittel verwendet, droht schwerwiegende Unterversorgung. Vegetarisch-vegan lebende Menschen sollten ihre Vitamin-B12-Versorgung regelmäßig überprüfen lassen.

SOURCE: VEGETARIERBUND DEUTSCHLAND

Vitamin B12 wird von Mikroorganismen gebildet

Vitamin B12 wird auch Cobalamin genannt. Cobalamine können nur von Mikroorganismen (z. B. Bakterien) gebildet werden. In manchen Lebensmitteln kommen ähnliche chemische Verbindungen vor, die als Analoga bezeichnet werden. Auch diese werden von Mikroorganismen gebildet, haben jedoch keine Vitaminfunktion für den Menschen.

Arten von Vitamin B12

Alle Cobalamine haben eine bestimmte Grundstruktur, das Corrin mit einem zentralen Kobaltatom. Vitamin B12 ist die einzige bekannte biologische Substanz, die das Spurenelement Kobalt enthält. Je nachdem, welche Moleküle an das Kobaltatom gebunden sind, unterscheidet man u. a. die folgenden Cobalaminarten:

  • Adenosyl-Cobalamin (5′-Desoxyadenosylcobalamin, Coenzym B12)
  • Methyl-Cobalamin
  • Hydroxy-Cobalamin
  • Aquo-Cobalamin
  • Cyano-Cobalamin

Die ersten vier Cobalaminarten kommen natürlicherweise vor. Cyanocobalaminist die synthetische Form, die in den meisten Vitamin-B12-Präparaten verwendet wird. Die eigentliche Vitamin-B12-Wirksamkeit entfalten Adenosyl- und Methylcobalamin. Jedoch können die anderen genannten Cobalamine im Körper in die beiden aktiven Formen umgewandelt werden. Liegen weitere Veränderungen am Corringerüst vor, wie zusätzliche Seitenketten und fehlende Komponenten, handelt es sich um inaktive Vitamin-B12-Analoga.

Funktion von Vitamin B12

Vitamin B12 ist im menschlichen Körper an drei biochemischen Reaktionen beteiligt: dem Abbau der Aminosäure Homocystein, der Umwandlung von Methylmalonsäure sowie von Leucin. Vereinfacht gesagt spielt Vitamin B12 dadurch eine wichtige Rolle bei der DNA-Synthese und Zellteilung, der Blutbildung sowie der Funktion des Nervensystems (die Bedeutung der Leucinumwandlung ist bisher unklar).

Aufnahme von Vitamin B12

In vom Tier stammenden Lebensmitteln ist Vitamin B12 an Proteine gebunden. Aus diesen wird es im Magen unter Einwirkung der Magensäure herausgelöst. Nahrungsergänzungsmittel enthalten Cobalamin in freier Form. Damit das Vitamin anschließend vom Körper aufgenommen werden kann, muss es an den sogenannten „Intrinsic Factor“ gebunden werden. Dabei handelt es sich um ein Protein, das in den Zellen der Magenschleimhaut gebildet wird. Die eigentliche Aufnahme findet dann im unteren Dünndarm statt. Wird Vitamin B12 in sehr großen Mengen zugeführt, kann es aufgrund der Konzentrationsunterschiede auch ohne die Bindung an den Intrinsic Factor über den Magen-Darm-Trakt ins Blut gelangen. Der menschliche Körper verfügt über Vitamin-B12-Speicher, die gefüllt eine Reservekapazität von drei bis fünf Jahren aufweisen.

Zwar wird Vitamin B12 auch von Bakterien im menschlichen Dickdarm hergestellt. Da die Aufnahme jedoch in höheren Darmabschnitten, nämlich dem unteren Dünndarm, erfolgt, ist dieses „humane“ Cobalamin nicht nutzbar und somit auch keine Vitamin-B12-Quelle.

Vorkommen und Bioverfügbarkeit von Vitamin B12 in Lebensmitteln

In den meisten tierischen Lebensmitteln ist Vitamin B12 reichlich enthalten (Tabelle 1). Das mögliche, sehr geringe Vorkommen in Wurzel- und Knollengemüse sowie vergorenen Lebensmitteln wie Bier, Sauerkraut und fermentierten Sojaprodukten reicht nicht aus, um einen signifikanten Beitrag zur Vitamin-B12-Versorgung zu leisten. Zudem sind die von einigen Herstellern sowie in der Laienpresse behaupteten angeblichen Vitamin-B12-Gehalte dieser Lebensmittel durchweg nicht belegt. 1

 

Einzelne Meeresalgen, die traditionell in der asiatischen Küche verwendet werden (z. B. Nori), sowie die Süßwasser-Mikroalge Chlorella weisen in einzelnen Untersuchungen erhebliche Vitamin-B12-Mengen auf. Über die tatsächliche Nutzbarkeit des enthaltenen Vitamin B12 für den Menschen liegen jedoch bisher keine Ernährungsstudien vor. Die meisten Nahrungsergänzungsmittel auf Algenbasis enthalten ausschließlich oder überwiegend Analoga ohne Vitaminwirksamkeit.

Vitamin-B12-Gehalt verschiedener Lebensmittel 2

Lebensmittel Vitamin B12 (µg/100 g)
Rinderleber 65,0
Rindfleisch 5,0
Rotbarsch 3,8
Camembert (30 % Fett i. Tr.) 3,1
Emmentaler (45 % Fett i. Tr.) 3,0
Frischkäse, körnig 2,0
Hühnerei 1,9
Brie (50 % Fett i. Tr.) 1,7
Joghurt (3,5 % Fett i. Tr.) 0,4
Kuhmilch (3,5 % Fett i. Tr.) 0,4

Mit Vitamin B12 angereicherte Nahrungsmittel reichen nicht aus

Einige Lebensmittel werden mit Vitamin B12 angereichert. Dazu zählen verschiedene Sojaprodukte, Müsli und Cornflakes, Fruchtsäfte sowie Fleischalternativen. Vegan lebende Menschen können mit diesen pflanzlichen Lebensmitteln, abhängig vom Vitamin-B12-Gehalt, ihre Cobalaminzufuhr verbessern. In Deutschland enthalten die angereicherten Produkte jedoch meist zu geringe Vitamin-B12-Mengen, um dadurch den Tagesbedarf vollständig zu decken. Außerdem ist zu beachten, dass Bio-Produkte im Gegensatz zu konventionellen Produkten nicht mit Vitamin B12 angereichert werden dürfen. Vegane Lebensmittel aus ökologischer Erzeugung enthalten demnach kein Cobalamin.

Vitamin-B12-Bedarf

Die Deutsche Gesellschaft für Ernährung (DGE) empfiehlt eine tägliche Zufuhr von 3 µg Vitamin B12. 3 Ein Mangel an Cobalamin hat Störungen der Zellteilung im gesamten Organismus zur Folge. Betroffen sind vor allem Zellen, die rote Blutkörperchen bilden sowie Zellen der Mund- und Rachenschleimhäute und des Nervensystems.

Vitamin-B12-Mangel

Typisches Symptom des Vitamin-B12-Mangels ist eine bestimmte Form der Blutarmut, bei der die roten Blutkörperchen abnorm vergrößert sind (megaloblastäre Anämie). Charakteristische Anzeichen sind blasse Haut und Schleimhäute, Rückbildungen der Mund-, Zungen- und Darmschleimhäute mit nachfolgender Beeinträchtigung der Nährstoffaufnahme sowie unspezifische Symptome wie allgemeine Schwäche, Ermüdbarkeit und Schwindel.

Wesentlich schwerwiegender als die gestörte Blutbildung ist die zweite Symptomgruppe des Cobalaminmangels. Hier kommt es zu Schädigungen des zentralen Nervensystems, was sich in Sensibilitätsstörungen (z. B. „Ameisenkribbeln“ an Händen, Füßen und anderen Körperteilen), Appetitmangel, Schwäche von Reflexen und Bewegung, Störungen der Bewegungskoordination sowie psychiatrischen Störungen, wie Verwirrung, Halluzinationen, Gedächtnisstörungen bis hin zu Psychosen, äußern kann.

Beide Symptomgruppen können unabhängig voneinander auftreten. Das Problematische bei einer Vitamin-B12-bedingten Blutarmut ist, dass sie durch eine hohe Zufuhr von Folat – etwa bei vegetarischer oder veganer Ernährung – verzögert oder „maskiert“ werden kann, da beide Vitamine bei der Zellteilung zusammenwirken. Gleichzeitig schreiten aber die neurologischen Veränderungen fort, sodass es zu bleibenden Schäden am zentralen Nervensystem kommen kann.

Eine Unterversorgung mit Vitamin B12 führt außerdem zu erhöhten Blutkonzentrationen an Homocystein, die einen Risikofaktor für die Entstehung von Atherosklerose und Herz-Kreislauf-Erkrankungen darstellen.

Vitamin-B12-Mangel bei älteren Menschen

Im Alter bedingt ein Vitamin-B12-Mangel einen schnelleren Abfall der Gedächtnisleistungen und damit möglicherweise ein höheres Demenzrisiko. Ältere Menschen sind unabhängig von der Ernährungsweise häufiger von einem Vitamin-B12-Mangel betroffen. Ursache ist meist eine chronische Gastritis (Magenschleimhautentzündung), die dazu führt, dass weniger Magensäure gebildet wird und somit Vitamin B12 nicht ausreichend aus den Nahrungsproteinen herausgelöst werden kann.

Bestimmung der Vitamin-B12-Versorgung

Aufgrund der großen Körperspeicher kann es Jahre dauern, bis sich klinische Symptome eines Vitamin-B12-Mangels zeigen. Der Versorgungszustand mit Vitamin B12 lässt sich jedoch frühzeitig anhand von Blutanalysen bestimmen. Dabei sollten verschiedene Messwerte des Cobalaminstoffwechsels, insbesondere das Holo-Transcobalamin II (Holo-TC), untersucht werden (Tabelle 2).

Die alleinige Bestimmung des Vitamin-B12-Gehalts im Blut ist nicht geeignet, um den Versorgungszustand sicher zu beurteilen. Auch bei Personen mit Vitamin-B12-Spiegeln im unteren Referenzbereich (≥ 156-400 pmol/l) können klinische Zeichen eines Vitamin-B12-Mangels auftreten. Zudem kann auch bei normalen Vitamin-B12-Werten im Blut bereits in den Körperzellen ein funktioneller Vitamin-B12-Mangel vorliegen. Der früheste Indikator für einen Mangel sind erniedrigte Holo-TC-Werte. Dieses Transportprotein bindet Vitamin B12 und macht es den Körperzellen verfügbar.

Blutmarker zur Bestimmung der Vitamin-B12-Versorgung 4

Marker Mangel bei
Holo-Transcobalamin II (Holo-TC) < 35 pmol/l
Methylmalonylsäure (MMA) > 271 nmol/l
Homocystein > 12 μmol/l

Vitamin-B12-Versorgung bei Vegetariern und Veganern

Mit einer lakto-(ovo-)vegetarischen Ernährung kann ausreichend Vitamin B12zugeführt werden. Vegetarier nehmen mit durchschnittlich 1,7 bis 2,5 μg täglich jedoch deutlich weniger Cobalamin auf als Fleischesser (5-7 μg pro Tag). 5, 6Werden bei veganer Ernährung keine Nahrungsergänzungsmittel oder mit Vitamin B12 angereicherte Lebensmittel verwendet, liegt die rechnerische Vitamin-B12-Zufuhr bei 0 μg pro Tag.

Entsprechend weisen Veganer in vielen Studien eine unzureichende Vitamin-B12-Versorgung auf. 7, 8, 9 Aber auch viele Lakto-(Ovo-)Vegetarier sind nicht ausreichend mit Vitamin B12 versorgt. In einer Studie wiesen 65 % der lakto-(ovo-)vegetarisch und 83 % der vegan lebenden Teilnehmer einen erheblichen Cobalaminmangel auf. 10 Die Deutsche Vegan-Studie zeigte, dass mit zunehmender Dauer der veganen Ernährung die Blutkonzentrationen an Vitamin B12kontinuierlich sanken. 11

Entsprechend sollten Veganer die ausreichende Zufuhr von Vitamin B12 über angereicherte Lebensmittel und Nahrungsergänzungsmittel, z. B. Tabletten oder Tropfen, oder Vitamin-B12-Zahncreme sicherstellen. Schwangere Veganerinnenund stillende Veganerinnen sollten besonders auf eine adäquate Zufuhr achten, um die Vitamin-B12-Versorgung ihrer Kinder zu sichern.

Empfehlung der Vegan Society

  • 2–3-mal täglich mit Vitamin B12 angereicherte Lebensmittel zu essen, die insgesamt 3 μg Vitamin B12 liefern oder
  • 1-mal täglich ein Vitamin B12 Supplement mit mindestens 10 μg Vitamin B12einzunehmen oder
  • 1-mal wöchentlich ein Vitamin B12 Supplement mit 2.000 μg Vitamin B12einzunehmen

Fazit

  • – Lakto-(Ovo-)Vegetarier können ihren Bedarf an Vitamin B12 durch den Verzehr von Milch, Milchprodukten und Eiern decken.
  • – Veganer können mit herkömmlichen pflanzlichen Lebensmitteln keine ausreichende Zufuhr von Vitamin B12 erreichen.
  • – Der Verzehr von fermentierten Produkten, Algen und Lebensmitteln, die mit Bodenbakterien kontaminiert sind, kann eine sichere Vitamin-B12-Versorgung nicht gewährleisten.
  • – Zur Sicherstellung einer bedarfsgerechten Vitamin-B12-Zufuhr bei veganer Ernährung ist die regelmäßige Verwendung von Nahrungsergänzungsmitteln (und/oder angereicherten Lebensmitteln) oder Vitamin-B12-Zahncremenotwendig.
  • – Veganer, aber auch Lakto-(Ovo-)Vegetarier, sollten ihre Vitamin-B12-Versorgung regelmäßig untersuchen lassen.

Dr. Markus Keller (unter Mitarbeit von Franka Schmidt)

Cover Vegetarische Ernährung - Claus Leitzmann und Markus Keller

Quelle

Claus Leitzmann und Markus Keller
Vegetarische Ernährung
Ulmer 2013 (3. aktualisierte Auflage), 380 Seiten, 22,99 €
ISBN 978-3-8252-3873-5

Literatur

1 Berger I (2009): Vitamin-B12-Mangel bei veganer Ernährung: Mythen und Realitäten aufgezeigt anhand einer empirischen Studie. Ibidem, Stuttgart, S. 34-55

2 Elmadfa I, Aign W, Muskat E, Fritzsche D (2007): Die große GU Nährwert Kalorien Tabelle. Neuausgabe 2006/07. Gräfe und Unzer, München

3 DGE (Deutsche Gesellschaft für Ernährung), ÖGE (Österreichische Gesellschaft für Ernährung), SGE (Schweizerische Gesellschaft für Ernährungsforschung), SVE (Schweizerische Vereinigung für Ernährung) (Hrsg) (2008): Referenzwerte für die Nährstoffzufuhr. Neuer Umschau Buchverlag, Neustadt a. d. Weinstraße, 3. korr. Nachdruck, S. 131

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11 Hahn A, Waldmann A (2004): Gesund mit reiner Pflanzenkost? Unimagazin Hannover, Forschungsmagazin der Universität Hannover 1/2, 6-9

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