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2006年05月03日

某カップ麺のコマーシャルは非常に上手ですね。

アニメを使って、若者が商品をつい手に取りたくなるような印象的なCMを作っています。

若者の栄養状態をわざわざ悪くするような商品を、莫大な宣伝費用をかけて広告することは決して犯罪行為でも何でもないですし、どんな食べ物を食べるかは選ぶ消費者に責任があるのはもちろんですが、私たちはそういった宣伝広告にいかに大きな影響を受けているか(私が言いたいのは悪いほうですが)を認識する必要があります。

正しい知識を持ち、TVコマーシャルの奴隷にはならないことが必要です。

 

 

さて、日産婦のシンポジウムの続きです。

 

 

演題2 妊娠女性・若年女性における葉酸栄養状況とその効果に関する研究

演者 横浜市立大学付属市民総合医療センター 母子医療センター 石川浩史先生

 

 

要約する前に、まず葉酸と妊婦の関係についての背景を書いておきましょう。

 

日本における神経管閉鎖障害(Neural tube defect : NTD)の頻度が増加していることから、厚生省(現厚労省)は2000年に、「妊娠を計画している女性はバランスが取れた食事とサプリメントで1400μgの葉酸の摂取をすべきである」とし、その旨を患者に指導するよう都道府県や医師会などに勧告しました。

 

NTDとは、二分脊椎症や脊髄瘤、脳瘤、無脳症など、先天性の脳や脊椎の癒合不全を指します。

最も多いのは二分脊椎症で、胎生期に左右離れて発生した脊椎(背骨)がくっついて1本の脊柱管(背髄が入っている管)ができるのですが、それがうまくくっつくことができないという状態です。

症状が強い場合は、髄膜に包まれた脊髄が飛び出した状態(髄膜瘤)で生まれてきます。

髄膜瘤は大体は腰部にできるので、下肢や直腸・膀胱の神経麻痺を伴うことが多く、歩けなかったり、排尿・排便が自分でコントロールできない、などの障害を持つことになります。

私が大学病院の母子センターにいた時も、年に一人くらいはこういう赤ちゃんが入院したように記憶しています。

 

日本でのNTDの発生率は、19741979年で出産1万(死産を含む)対2.0程度だったのが、1998年には1万対6.0で、先進国では最も高い数値になっています。現在はもっと高くなっている可能性があります。

NTD葉酸というビタミンB群の仲間が不足していることが主な原因とされており、西欧諸国では妊娠可能年齢の女性の葉酸摂取量を増やすことで、NTDの発生率を低下させることに成功しました(ちなみにそのような政策を行う以前に最も高かったのは英国の1万対15でした)。

その反対に日本では増加の一途をたどり、結果的に先進国でNo.1というありがたくない現状になってしまったのです。

 

かつて西欧諸国に比べると格段に低かった日本におけるNTDの発生率は(人種による影響については不明ですが)、葉酸が十分足りていたことを意味しており、日本の食生活がそれだけ豊かであったことを示唆していると思います(もちろん葉酸の欠乏のみがNTDの原因とは言えないのですが)。

しかしこの数十年で、日本人の食生活は激変しました。その結果葉酸の摂取量が減少し、NTDがじわじわ増えると言う事態が起きているのです。

 

たかだか1万人に6人と言えど、そのような赤ちゃんが生まれた場合、本人はもちろん家族の負担は相当なものです。一生涯の医療費も相当かかるでしょう。

葉酸自体は廉価なものですから、それを補ってNTDが減らせるのなら、個人としても国家としてもメリットがあるというわけで、アメリカなどでは19911992年にすでに摂取を勧告し、小麦粉やシリアルなどに強制的に添加することを義務付けています。

 

ところが日本では、産婦人科によっては葉酸のサプリメントを推奨しているところもありますが、まだそれほど徹底した指導が行われているとは言えません。

これには根本的な問題があって、まず現場の医師に対する通達が不十分であるということと、妊娠が発覚して産婦人科にかかる頃にはもうその形成期(妊娠7週までが臨界期と言われています)を過ぎている場合が多いので、NTDを予防するという意味では、時すでに遅いわけです(もちろん葉酸自体はNTDの予防以外にも必要なビタミンなので、妊娠7週を過ぎてから摂取しても母体には有用で、無駄ではありませんが)。

 

ですから理想を言えば、妊婦に限らず妊娠可能年齢の女性にすべからく葉酸を十分量摂取して欲しいわけですが、そのためにはどのような対策をとるべきなのか、というのが、石川先生のご発表の要旨です。

 

長いので次に続きます。

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原因不明の体調不良、月経前症候群、うつ症状、パニック障害、過食症、肥満…、あなたのその症状は、低血糖症が原因かもしれません!


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Optimal Health オプティマル・ヘルスとは、「最高の健康状態」を意味する言葉です。
「病気ではない」という消極的な意味での健康ではなく、エネルギーに満ちた快適な状態でいられること。
その人らしい人生を思う存分過ごすこと。
すべての患者様にOptimal Healthを得ていただくことが、私達の願いです。


未来の医者は薬を使わず、食事を重視し、病気の本来の原因を探し、予防するという、人間の基本を大切にして治療をするであろう。
トーマス・エジソン
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