98 Bich khoa todn thurvé Vitamin, Mui Khodng va Cac yéut6 viluomg Ngoai ra, c6 mot bénh béim sinh khong phai vi thiéu biotin, nhung 18 thudc vao vitamin ndy, do thiéu nhiéu carboxylase. Ching thiéu ny duge mo ta lin dau tién yao nim 1979. Khi bénh duge phat hign, n6 o6 thé chira dé dang. Nguy co qué liéu Hign nay, chia tim thay dtu higu ngo ddc B8 do qua liéu Ké don Chi dinh dau tign 1a thigu nhiéu carboxylase, biotin se chita khdi va bao dim cho doi sng bimh thuong ciia benh nhan (B8 phai duoc udng sudt dai). Ding B8 dé diéu tri rung long-cding nhong bat thudng vé lng va mong hose viém da nhon & mat va da du, tring ca, viem loi. Nhung & ngudi, thigu BS [a mot ngoai Ie va nhng clil dinh nay khong durge xéc nhan béi cic nghién ctu. Bénh due nudi duéng ahdn tao kéo dai ho’e an long tring tring kéo dai, Nhung khi tré lai ché 4 an binh thudng s@ thigt lap duge ean hing Nhiing nghién citu méi day do thay ring, biotin c6 Kha nang Jam gidm ting dudng mau. No due ding boi ligu phap dinh dudng, két hop voi cic vitamin nhom B khic va magesi dé h6 tro diéu tri benh dai théo dudng, [Bich khoa todn thu vé Vitamin, Mu6i Khodng va Céc yéui6 viluong 97 < Ngndn goe Nam 1940, thuat ngtr ACGNOHCMUGe Mau eHOMMOnenae) lien cau Ruud, né duge tim thiy trong 14 rau bi na, Thuat ng folat 1a chung va dit tén cho mot ho hop chat ma acid folic dé xem Ia phite hop co ban, Dac tinh Pha hiy nhanh béi nhigt va oxy héa: ‘vitamin BO rat nhay cim voi niu nudng vi nhigt dO nau lim phi hdy trung binh 90% B9. Ti lé phan trim thay di nhiéu ty theo thuc phim, folat e6 trong gan hay thit gd bén voi néu nudng hon folat duge chifa trong rau. Cang c6 su khéc nhau vé B9 trong khd aug hap thu cfa co thé. Mite do hip thu B9 cia long dé trimg hay nude cam rit st trong khi d6 dau haricots, chudi, gan hay nau men duge hap thu tot. Doi véi folat c6 wong sia, nhang céch thitc nau khic nhau hay xit ly cong nghi¢p lam mat di rat nhieu.28 Bich khoa todn thuvéVtemin, M6 Khodng va Céc y6ut6 viluong —_________ Nhang thay déi cia ham Ingng Folat trong sta bi Cach xt ly/ndtu mg/lit Sta tuoi 55 Sua gt tring 34 Sua bot 36 Sita ndu tuoi duge niu 5 phit 31 Sita tigt trang duge néfu 5 phiit 15 Sita bot duge nau 5 phit 10 Vai tro ‘Acid Folic 1a co sé chinh cia nhiéu coenzym. Trong nhiéu phan tng t6ng hop, nhng coenzym nay tham du vio qué trinh trudng thinh va phan chia t€ bao. N6 ¢6 vai tr quan trong & nhiéu mac khéc nhau: > Tao ra nhang (€ bao mau, thiGu acid folic din dén thiéu mau hong cdu (ging nhw thiéu B12). > He thin kinh trung wong, vi folat tham qua vao qué trinh téng hop nhiéu chat din trayén thin Kiuh ube > Dopamin, adrenalin, noradrenalin. > Roi loan thai 46, tinh thin cham chap xdy ra 12 do sai Kim cia chuyén héa folat. Nguén gée ca hing r0i loan nay van chua duge sing (3, nhung ngudi ta biét ring: tinh toan b> cia cic phan ing ma vitamin B9 1a co’ sé rat cn thiét cho qué trinh phat trién binh thuong cing nhu cho hoat dong hip nhing oa tit c& he thin kinh. NO cdn thiét trortg nhiéu trudng hop: ‘Bich khoa toan thu-vé Vitamin, Mudi khodng va Cac yéut6 vilugng 98 > Téng hop acid nucleic (ADN, ARN) tao nén gen. > Trong methyl héa acid nuclec, digu may dudng nh quan trong trong ngan ngira ung thu. > Téng hop methionin, acid amin déng thoi loc homocystein, gay ra huyét khoi va xo voa dong mach. > Téng hop protein Nobu cau Nhimg ude tinh thay d6i ty theo ting te gid. Nhung theo nhing cOng b6 méi day thi nhu cdu duge dénh gid 300mg/ngay, trung binh cho ngudi trudng than, gia ting rit 16 hie ¢6 thai va cho con bi. Co thé it dy tri B9, n6 ans du tro chit ; su gan, KhMeheiagiaaikhongaal se Ham Iugng vitamin B6 duge khuyén cung ip Loai me/ngily ‘Yre con bi 50 Tre thr 1-3tudi 100 Tre tie 4-12 tdi 200 ‘Thanh nign ter 13 dén 19 wi 300 Nguoi trudng thank 300 Phy nit c6 thai hay cho con ba 500100. Bach kinoa tan thu vé Vitamin, Mu6i Khodng va Cae yéu 16 viluong Nguén cung cdp “ Nguén cung cap tu nhién vitamin B9 Thyo phém Nong 4 Tinh én din Nim 100 dén 250 mg/t00g ‘80% bj pha hy kh nd Ca rot 10 dén 40 mg/t00g_ 80% bi pha hily khi nu Mam tia mi 150 dén mg/1009 180% bi pha hy Khi ndu ‘Haricots 10 én 40mg/100g (80% bi pha hiy khi nau Khoa tay: 5 dén 10mg/100g (80% bi pha hiy khi ndu Same 52 mgt 0% bj pha hy ‘SGa b6 tuoi ‘Sémgflit 50% bj pha hiy ua bot Gegfit 50% bi pha hiy Nam men 2000 dén 5000 mg/100g (chit xudt 6 dae) Thit, b6, Jon, be 10 dén 50mg/100g it bi pha hdy béi nu Ga, trang 40 dén 90mg/100g it bj pha hoy b6t nd |Gan (bd, heo, bé) 30 dén 35 mg/1009 it bj pha hiy bdi niu ‘Trong thy phdm cé nguén g6c dong vat va thyc vat. N6 bj lugng B9 rat manh pha hiy nhanh bdi Oxy héa va nhigt. Vi khudn chi dudng mot tao nén mot nguén géc cung edip phy thém nhung rit it, Nguén g0c cung cap tot nat 1a: gan (gan be dé, paré gan Vit...) tring, néim. Thigu B9 sé di kém voi thigu vitamin C hode sit, kém. Khi d6 giim tinh sinh hoc c6 sin cha B9. Dic bigt bénh bd dién khign cho nguoi st dung gan bd cén than, cfing anh hudng dén B9. ‘ ‘Bich khoa toén thu vé Vitamin, Musi khong va Cac yéu 6 viluong 101 Dau bigu thiéu vitamin BY ‘Thiéu B 1a mot trong ahdng thigu vitamin thudng gap nhat, Tai cdc nude phat trién 15 dén 30% dan ching bi. Dau bieu lam sang Nhong diu higu lam sang it hay nbiéu trim trong tay theo thigu nhanh cham, > Thigu cap: dén dot ngot sau khi ding thude khang folic nhw methotrexat, hay khéng sinh diéu tri benh dudng (iét nigu. (Bactrim, Eusaprim). Dac biét nguy hiém 6 nhong dita tr8, Ide c6 thai, khi dé biéu hign bling ri loan tiéu h6a (di chay, chdn an, budn ndn), benh da, chiy mau hay ban xudt huyét. > Thigu min tinh: xudt hién mét mdi ting dan, rdi loan gidie nga va tri nhé, dé bj kich thich, doi khi gidm ngon migng cing nhing dau ching ging nhu thigu B12. O thanh nién thigu B9 c6 thé gay ra cham phat trién. > Trigu ching lam sing cita tré em bj ri loan chuyén hoa B9 bao gém: Nhtng r6i loan than kin khic nhau cing voi co gift, roi loan thdi 49 tw ky va cham chap vé tinh than. Dau bieu sinb boc Nhang trigu chting sinh hoc bao gém: > Gidm folat cia héng céu > Tang kich thude cia héng clu > Thigu mau héng cdu lén102 Bach khoa toa thurvé Vitamin, Mui kinodng va Cae yéu t6vilupng Chin dodn bang cach loai trir thigu vitamin B12 vi tigu ching lam sang gidng nhau, Nbing nbém ngny co Thiéu folat c6 thé bat ngudn tir nguyén nhan: > Thiéu ti thée an duge mang vao co thé, > Thigu hap thu do mac phai hay di truyén. > Tang nhu céu (hay bai tiét) * Thiéu tir thie an: N6 [a dich t& trong cic nude 6 tinh trang thiéu dinh dudnig, biéu hign cap hic c6 thai, va & tré nhd. Tré em duge nudi bing sta dé. Thiéu B9 tram trong (do néng do B9 @ sia dé thip hon so véi sita me). + Trong s6 nhéng ngudi gia, 10 dén 30% trong sho bj thigu mau do thiéu folate, Diéu tri bing céch cung cp them B9 sé cdi thigia nhanh myc d9 16 Hin tuéi gia. + Nguoi nghién man tinh, thiéu ti thite an mang vao duge két hgp véi kém hap thu va kém phan phdi trong nhiéu té chic khac nhau. * Thiéu do hap thu kém: Bat thudng vé hap thu folat cé thé mic phai hoac do bam sinh. * Nhaing bat thuong mac p SPRUE, benh nhigt d6i, diye dac tumg béi tigu chay man, viém Ludi va thiéu mau, ket hop: voi kém hap thu ‘Bach khoa tan thu vé Vitamin, Mudikhodng va Céc yéut6 viluong 103, folat, vitamin B12 va sit. Phuong phip digu tr} chi yéu bing khang sinh. Bénh co dia (khong dung nap gluten) anh hudng dén rut non, bénh Crohn va ct mot non dua dén kém hip thu két hop. * Nhang bat thudng do bam sinh: Mo ta lan dau tién vé bénh bam sinh cia hp thu folat duge cong be vao nam 1961. Nguén g6c vin chwra duye xéc.dinh, n6 c6 thé do thiéu bam sinh mot protein cn thiét cho van chuyén acid folic va cic din xudt cla ching. Khi quan st céc bénh nhan cho phép ta hiéu ring. Vitamin B9 that cn thiét cho qué trinh phat trién va hoat dng binh thudng cia hé thin kinh, > Sir dung kéo dai hay lap lai mot vai thude doi hai phai cung ciip them mot cach hé thong. Tiéu bidu la: > Thude ngira thai > Aspirin (tic dong véi vitamin C) > Khang sinh dé chia nhiém tring duong tiéu hay sida: bactrim, eusoprim > Thuée chéng dong kinh (phenobarbital, phenytoin) > Methotrexat (diéu tj chdng ung thu) > Thudc loi tiéu (triamteren) > Sulfasolazin duge sir dung trong bénh tigu héa ging nhu bénh crohn va viém dai trang - trye trang chay mau, tao digu kign thuan Igi cho thiu plate104 Bach khoa toan thr vé Vitamin, Mu6i khodng va Cée yéu 16 viluyng > Pyrimethamin, dye ké don dé diéu tri toxolasmose, hay sot rét. ste Nhu cw cing duge ting mot cach ding ké & tr8 sor sinh, tré sinh non, nhdt 1a tr8 duge nudi dudng bang sta bo hay sta me thigu B9. Noi khae hon, kha nang cung edip B9 te thie an hing ngay la khong di. Nhiéu tinh hudng ting nhtng HGR SMBSMESHAAM inh non, tré nid, phat trién nhanh, tudi gia, c6 kinh nhiéu, ung nhiéu rwou, sit dung kéo dai mot vai loai thudc, mOt sO bénh tiéu hoa, SIDA... Nguy co qua lieu Negay nay chua thay trugng hop nao bi ngd dc do qua ligu, Bénh ung the méu bi chdng chi dinh ding B9. ‘Thigu BO két hop véi B12 thung xy ra, Khi d6, ngudi ta khuyén-nén bé sung vitamin B12 trude. Ke dou * Thiéu vitamin B9 06 nhiéu dau higu bao dong: Lugng B9 6 trong héng cdu thap, cham hon, khi thé tich héng cdu duge ting én, thiéu mau héng cfu Ién cau phai cung cp liéu cao (10 dén 20mg tren ngay) dé diéu chinh, Bach khoa oan thu vé Vitamin, Mudi hoding va Cc yéut6 viluong 105 Ngan ngita Liéu thay di tay theo nguy’co, tir 400mg dén 4mg trong ngay. Nhumg nhu cdu, cung edp thudng it duge thie hign & nhng nguy co, phat hign thiéu dinh lung folat & dng céu it duge thyc hién, Danb gid cde nguy co Dé dinh gid nhong nguy co thigu vitamin BY, edn phai dit ra mot vai cu ho > C6 thude nh6m 6 nguy co khong? > C6 ché d6 an duge thay déi va gidu folat khong? > C6 nhing dau ching co nang lién quan voi thigu BO, dic bigt la giém kéo dai tri thong minh, kia ning chi ¥, tap trung,tri nhé, khong? bj rdi loan, tinh tinh hay dé kich thich? * Chi dinh cho nhiing nguoi gia tudi: Hiéu chinh thigu folate khong chi quan trong dé 10i uu kha nang tri tue, ma cdn rat edn thiet dé duy tri kha nang nay, dic biét, d nhing ngudi gid. Monique Ferry, chuyén gia ngudi Phap vé vitamin & ngudi gid cho thiy ring: Mot sé ngudi gia duge chén dodn bénh Alzheimer * fa nan nan cia thiéu folat va thudng két hop v6i thigu vitamin B12. Nhing roi loan tam than c6 thé xudt hitn trude khi thiéu mau. Néu tinh trang folat duye diéu chinh sém thi nhang 161 Joan sé bién mat. Néu diéu chinh, bénh khong thé thodi Tui duge,106 __ Bide kina todn thr vé Vitamin, tuoi knodng va Cae y6u 6 vilupng Do dé, cin cho ngudi gia biét duge tim quan trong Khi dang gan va cic thie in giau folat. N6 6 thé bé tro théin folat, vitamin B12 va la nhung thie an cin thigt dé duy ti chite nang ti tue. * Chi dinh B9 6 ngudi tré tudi: Voi ngudi tré, thigu dinh duong cong thuong gap, nhung khong cling nhong hu qua nhu wen. a nghién ctu ca Smithells va schorah, duge xéc dinh b6i nhiéu nghién ctfu, da chi ra ring: Thiéu folat & nguoi me sé tao thudn loi bién dang cho tré so sinh nh khong dong kin Ong song. Thude ngita thai, lam tang thigu folat. Vi vay FDA cia Hoa Ky, dé nghj bé sung them vao banh mi va bot nga cdc B9, dé cung cap cho cae phu n& tong tudi 6 thai, © Phép nguoi ta cang dé nghi nhing phy n& muda co thai phdi ding thém folat ba thang truéc khi thu thai. * O phy ne n6i chung: MOt tinh hudng khéc cia thigu folat 43 din dén nhing hau qui ding ké cho sie khée va cing cdn ngin nga mot cich e6 he thong. Néu khong d€ xay ra’bénh ung thir 6 ti cung, Nhigu nghign citu chi ra rang Papilloma virus va thiéw folat, beia - caroten cing vitamin C sé ting nguy co di sin c6 tir cung va ung thu. ‘ach Khoa toén thu vé Vitamin, Mudi khong va Cée yéu t6vilupng 107 Luan diém nay duge cling e6 bai Butterworth, Ong da cho thay ring phu ng mang Papitloma virus, c6 folat héng cdu gidm va ting nguy co Ién 5 Idn so véi nhing ngudi chi bj nhiém don thudn virus. Do dé, nhu céu BO can cung cap cho phu nd néi chung rat dang ké. Dac diet, doi voi nhang ngudi c6 phigy dé am dao bat thuémg phi tuin theo nhing Ii khuyén vé thye phim cing nhu cain bo Sung them mot cach thich hap. Mudn biét nhung thong tin chi tit them, hay xem phan "nguyén téc b6 sung mudi khoding - vitamin", *Benh tim- mach Folat cng git vai tro ngan ngita bénh tim mach, thiGu chiing, gidng nhw thiéu vitamin B6 va B12 st dus dén gia ting homocystein. Mgt nghién ctu duge thye hign num 1995 6 Irlande cho thay ring nhang ngui dong thém vitamin nhém B gidm 64% nguy co chét do ahéi mau co tim, VITAMIN B12 HAY COBALAMIN Nguén géc Nhang dau higu dic uung cia bénh duge.md té & the ky 19 béi Addison va Anton Biermer Ja thiéu héng céu vao teo niém mac da day. Déa nam 1920, mot bac st nguoi My, nho khém pha ra vitamin da két luan ring: nguyén nhan ciia thigu mau c6 thé 1a thigu vitamin. Tir 46, Ong bat dau tién hinh nghién edu cia minh bang cach