Voeding als medicijn tegen longziektes
Voeding als medicijn tegen longziektes.
‘Laat uw voeding uw medicijn zijn en uw medicijn uw voeding’. Het is een citaat van Hippocrates dat al meer dan 2000 jaar oud is. Zelfs bij de oude Grieken was de relatie tussen een gezond dieet en een goede gezondheid bekend. Toch is het zo dat vandaag de dag voeding en medicatie in de medische wereld grotendeels gescheiden worden gehouden. Naar een diëtist gaan omdat je lijdt aan een longziekte klinkt dan ook niet heel voor de hand liggend. Toch is het al langer bekend dat zelfs de gezondheid van je longen afhankelijk is van de voedingsstoffen die je binnenkrijgt. Daarom werd in deze thesis onderzoek gedaan naar de mogelijkheden om met voedingsinterventies “interstitiële” longziektes tegen te gaan.
Interstitiële longziektes zijn longziektes die het interstitium oftewel de ruimte tussen de longblaasjes en de bloedvaten aantasten. Het merendeel (65%) van dit type longziektes is idiopathisch, dit wil zeggen dat de oorzaak onbekend is. Het is dan ook lastig om hiervoor een doeltreffende geneesmiddelen te vinden. Bijgevolg hebben twee van de meest voorkomende interstitiële longziektes, IPF (idiopathische longfibrose) en sarcoïdose nog geen effectieve behandelmethodes. Zo heeft iemand met IPF slechts een mediane levensverwachting van 2 tot 5 jaar. Er zijn slechts twee medicijnen bekend die de ziekte kunnen afremmen, echter hebben deze medicijnen ook hun bijwerkingen en blijft de kwaliteit van leven achter. Sarcoïdose daarentegen verdwijnt na verloop van tijd in de meerderheid van de gevallen. In 30% van de gevallen blijft het echter aanhouden en in 1-4% van de gevallen is het zelfs fataal.
Omdat behandelopties voor deze ziektes zo gelimiteerd zijn, terwijl de last voor de patiënten zo hoog is. Daarom is het van belang de ziekte op zoveel mogelijk manieren tegen te gaan.
Welke rol kan voeding spelen?
Ondanks het feit dat interstitiële longziektes een groot begrip is dat meerdere longziektes betreft, is het zo dat ze ook veel gemeen hebben. Zo zijn ontstekingen, oxidatieve stress en het risico op fibrose (littekenvorming) veel voorkomende verschijnselen bij deze ziektes Van verschillende voedingstoffen zoals antioxidanten is al bekend dat ze oxidatieve stress kunnen tegengaan. Ook hebben veel voedingsstoffen ontstekingsremmende effecten.
Er zijn al veel experimenten gebeurd met individuele voedingsstoffen en de invloed die ze uitoefenen op deze longziektes. Het merendeel van deze data is echter nog losstaand en gebaseerd op studies in het lab of op proefdieren. In dit onderzoek werd(en) al deze data samengelegd om een overzicht te creëren over welke voedingsstoffen nu positieve resultaten vertoonden. Op basis hiervan werd een dieet en een voedingsmiddel opgesteld waarmee mensen die lijden aan deze longziektes geholpen kunnen worden.
Welke voedingsstoffen zijn belangrijk
Een van de meest geteste voedingsstoffen is vitamine D, dat voorkomt in bjivoorbeeld vette vis. De associatie tussen tekorten aan vitamine D en het voorkomen van longziektes is al langer bekend Toch zijn hier ook risico’s aan verbonden. Zo zou vitamine D goed zijn in het voorkomen van IPF en sarcoïdose, maar indien de longziektes reeds aanwezig zijn kan het de situatie verergeren. Zo bleek dat het supplementeren van vitamine D aan muizen met fibrose cellulaire veroudering stimuleerden en werd bij patiënten met sarcoïdose een hoger risico op hypercalcemia en hypercalciuria gevonden indien vitamine D gecomplementeerd werd.
Ook Vitamine K, een vitamine die voornamelijk voorkomt in groene groente kan een rol spelen. Deze voedingsstof is een klasse apart, vroeger dacht men immers dat longfibrose tegengegaan kon worden met vitamine K remmers zoals warfarine. Dit werd bijgevolg geruime tijd als medicatie gebruikt. Toen deze behandeling echter onderzocht werd vond men echter dat het de ziekte net verergerde. Sindsdien gaan er steeds meer stemmen op om ook te kijken naar de potentie van vitamine K om de ziekte tegen te gaan.
Verder is er melatonine, een hormoon voornamelijk bekend voor zijn rol in het slaapritme. Melatonine komt voor in bijvoorbeeld noten en kan verder opgewekt worden door andere voedingsstoffen. Van melatonine werd aangetoond dat het effectief wastegen oxidatieve stress, ontstekingen en fibrose in muizen met longfibrose. In sarcoïdose werd het ook reeds op mensen getest, hier zorgde het voor herstelling van het functioneren van de longen en het tegengaan van oxidatieve stress.
Ook Omega 3, een voedingstof aanwezig in bijvoorbeeld vette vis, toonde longfibrose bij muizen tegen te gaan door het remmen van oxidatieve stress, fibrose en ontsteking. Het werd echter nog niet getest bij mensen met longfibrose. Het is wel al eerder bewezen dat omega 3 ontstekingsremmend kan zijn bij mensen die lijden aan andere ontstekende longziektes.
Tot slot zijn zijn er nog de zogenaamde polyfenolen, dit zijn heel kleine voedingsstoffen. De meest getest polyfenolen zijn quercetine, resveratrol en curcumine. Ook deze waren in dierproeven actief tegen ontsteking, oxidatieve stress en fibrose. Quercetine werd ook getest bij mensen met sarcoïdosis waar het oxidatieve stress tegen ging. Bovendien toonde resveratrol en quercetine in eerder onderzoek aan ontsteking tegen te gaan in andere ontstekende longziektes.
Hoe ziet het dieet/voedingsschema eruit.
Wat opvalt is dat de voorgestelde manier waarop deze voedingsstoffen werken nogal verschillen. Het zou dan ook kunnen dat de gecombineerde werking ervan nog extra effect geeft.
Daarom werd het volgende voedingsschema opgesteld. Het is een dieet voor een week waarbij voedingsstoffen in grote mate aanwezig zijn.
(afbeelding 1)
Ook werd er een smoothie ontwikkeld die rijk is aan de voedingsstoffen die een positieve werking blijken te hebben. Door de integratie van deze voedingsstoffen in een goede behandeling, zou het mogelijk zijn mensen beter te ondersteunen in hun ziekteproces. In de volgende afbeelding wordt een behandelproces gesuggereerd
(afbeelding 2)
De toekomst
Ook al is er al veel onderzoek verricht naar de effecten van voedingsstoffen, op interstitiële longziektes, toch blijft verder onderzoek bij mensen van essentieel belang. Het is al langer geweten dat een gezond dieet bijdraagt tot een betere gezondheid. Daarom is het van belang om voeding en medicatie niet altijd strikt te scheiden. Zeker bij ernstige ziektes waarbij behandelopties gelimiteerd zijn is het nodig in te zetten op alle mogelijke factoren waarmee de patiënt geholpen kan worden. Zo zou een integrale behandeling als IPF er als volgt uit kunnen zien.
(afbeelding 3)
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