Embora não exista um tratamento efetivo para prevenção e combate ao resfriado, não faltam métodos alternativos que prometem aliviar os sintomas, acelerar a recuperação e até mesmo prevenir o resfriado. Você já ouviu que vitamina C é bom para gripes e resfriados? Entenda como isso funciona, se é que funciona.
O resfriado comum pode ser causado por mais de uma centena de vírus diferentes. Já a gripe é causada pelo vírus influenza, em suas inúmeras formas. Embora o resfriado comum e a gripe compartilhem sintomas semelhantes, os dois quadros apresentam diferenças importantes. Primeiro, a gripe tende a ser mais severa do que os resfriados; os sintomas tendem a ser mais intensos e o tempo para se recuperar é geralmente mais longo. Além disso, a gripe pode trazer riscos importantes à saúde, pois em casos graves pode vir acompanhada de infecções bacterianas (ex.: infecção do ouvido, pneumonia ou até mesmo miocardite), rabdomiólise, falência renal e até falência de múltiplos órgãos.
O tratamento da gripe inclui controle dos sintomas e o uso de medicamentos antivirais. Já para o resfriado, parece não haver uma droga que combata o vírus de modo suficientemente efetivo que justifique seu uso. Além disso, trata-se de uma condição de baixo risco que se “resolve sozinha” na imensa maioria das vezes; portanto, o tratamento é tipicamente focado no controle dos sintomas (ex.: uso de descongestionantes nasais, antitérmicos e medicamentos contra a dor). Ainda que não exista um tratamento efetivo contra suas causas, não faltam tratamentos alternativos que prometem reduzir a incidência do resfriado comum, minimizar seus sintomas ou até mesmo acelerar a recuperação. Dentre eles, a suplementação de superdoses de vitamina C (acima de 200 mg/dia) é certamente um dos mais populares. Mas até que ponto é um tratamento eficaz?
Um pouco sobre a vitamina C
A vitamina C, ou ácido ascórbico, desempenha importantes funções em nosso organismo. Dentre elas, destaco a participação na síntese de colágeno (uma das proteínas mais abundantes em nosso organismo), na síntese de carnitina e sua ação antioxidante. A deficiência de vitamina C sabidamente resulta em escorbuto, uma doença cujos sintomas incluem fraqueza muscular e fadiga (em razão da deficiente síntese de carnitina) e problemas em tecidos conectivos diversos, onde o colágeno é essencial. Já sua ação antioxidante tem alimentado hipóteses de propriedades antienvelhecimento da vitamina C. As evidências para isso, no entanto, são fracas. A despeito dos papeis fundamentais exercidos pela vitamina C, nosso organismo não é capaz de sintetizá-la, o que nos torna absolutamente dependentes de sua ingestão via dieta.
O brilhante cientista Linus Pauling e a popularização da vitamina C
Linus Pauling foi, sem dúvidas, um dos mais importantes cientistas de todos os tempos. Contemporâneo de muitos que leem este blog (1901-1994), Linus foi um dos fundadores da química quântica. Seus trabalhos sobre ligações químicas lhe renderam um prêmio Nobel em química. Linus também trabalhou com biomoléculas e, dentre elas, a vitamina C parecia lhe chamar a atenção em especial. Em 1971, Linus publicou a 1ª edição do livro “Vitamina C e o resfriado comum” (tradução livre), onde defendia a suplementação de altas doses de vitamina C para, entre outros benefícios, ter mais resistência contra o resfriado comum. Anos depois, ele publicou outro livro “Como viver mais e sentir-se melhor” (tradução livre), em que defendia que o consumo de superdoses de vitamina C combateria o desenvolvimento não apenas de resfriado e gripe, mas também de doenças cardiovasculares, câncer, e inúmeras outras condições. Entretanto, poucas evidências apoiam tais alegações. Por exemplo, uma meta-análise verificou que a suplementação com antioxidantes (incluindo a vitamina C) não afeta a progressão da aterosclerose. Outra meta-análise observou que a vitamina C não apresenta efeito positivo na prevenção e tratamento de doenças cardiovasculares.
Ainda que as evidências em favor das alegações de Linus a respeito dos benefícios da vitamina C sempre foram bastante controversas, seu prestígio, sua popularidade e a lógica clara em seus argumentos certamente ajudaram a popularizar o uso da vitamina.
Radicais livres, antioxidantes, vitamina C e sistema imune
As propriedades antioxidantes da vitamina C fazem com que ela também desempenhe papeis na regulação da função imune. Isso porque a geração de radicais livres é indispensável para a resposta do hospedeiro quando infectado por agentes invasores. Os radicais livres não apenas constituem uma ferramenta que células do sistema imune usam para matar microrganismos, mas também participam da regulação da quimiotaxia e da fagocitose. Se você não está seguro acerca da importância da capacidade de neutrófilo ou macrófago de se locomoverem para “caçar” um agente invasor e depois de fagocitá-lo para matá-lo, assista este vídeo. Os radicais livres gerados para matar microrganismos fagocitados podem, por outro lado, danificar as membranas das células do sistema imune; uma vez que essas células dependem muito da integridade de suas membranas para reconhecer patógenos e “conversar” com outras células, o dano causado pelos radicais livres pode comprometer a competência da resposta a agentes invasores.
A vitamina C tem a capacidade aumentar a mobilidade de neutrófilos, como mostra este estudo. No entanto, outros parâmetros da função dos neutrófilos não parecem ser influenciados pela vitamina C. Estudos mostram que infecções resultam em rápida redução da vitamina C presente no sangue e dentro de leucócitos, o que sugere sua participação nas respostas à infecção. Os efeitos imunomoduladores da vitamina C parecem estar associados a uma atenuação no dano causado por radicais livres, graças a sua ação antioxidante. Portanto, parece ser inquestionável a importância da vitamina C para uma boa resposta imune, o que obviamente inclui resistência a infecções diversas (incluindo gripe e resfriado) e capacidade de resolver tais infecções com rapidez. Não por coincidência, casos em que há deficiência de vitamina C são tipicamente acompanhados de imunossupressão. O que se questiona, todavia, é até que ponto pessoas saudáveis e que consomem vitamina C dentro das quantidades recomendadas precisam suplementar vitamina C em altas doses para evitar especificamente resfriados e gripes.
Afinal, devemos suplementar vitamina C?
Existem estudos que apoiam a hipótese de que suplementar com vitamina C reduz as chances de ser acometido por resfriado comum (estudos com gripe são muito mais escassos), de atenuar a severidade de seus sintomas, ou de se recuperar mais rapidamente. No entanto, a literatura no geral está longe de apresentar resultados consistentes; ao contrário, existe bastante disparidade. Meta-análises, no entanto, geralmente apontam para ausência de efeitos positivos da suplementação com doses acima de 200 mg/dia. Uma das mais recentes meta-análises, que contou com mais de 10.500 participantes em mais de 25 ensaios clínicos controlados por placebo não mostrou efeitos consistentes em reduzir a incidência, tampouco a severidade do resfriado. Nesse mesmo estudo, análises de subgrupo incluindo apenas ensaios com doses ≥1 g/dia ou ≥3 g/dia também indicaram não haver benefícios da suplementação na população em geral. No entanto, em subgrupos de indivíduos submetidos a treinamento físico ou estresse intensos, houve uma significativa redução da incidência de resfriados (cerca de 10% em atletas e soldados em condições extremas). Isso parece ocorrer apenas em condições de estresse que duram poucos dias, já que estudos em que os agentes estressores duraram 2-3 meses, nenhum benefício da suplementação foi observado.
Em relação ao tempo de acometimento, a mesma meta-análise mostrou que adultos que suplementam regularmente com vitamina C têm redução de ~10% no tempo de doença, o que pode chegar a ~15% em crianças. Apesar do efeito ser significativo, é preciso refletir sobre a necessidade de suplementar continuamente para uma redução tão pequena em uma doença cujo curso já é curto. Do ponto de vista clínico, o benefício não me parece muito importante.
E se as doses forem maiores?
Na meta-análise mencionada acima, não foi observada nenhuma associação entre a dose utilizada nos estudos e os resultados neles observados. Caso ainda paire uma dúvida, um estudo sobre a cinética de absorção de vitamina C após ingestão oral sugere que a dose máxima tolerável (3 g a cada 4 horas) não resulta em aumentos na concentração sanguínea de vitamina C muito superiores a doses de ~1 g.
Sendo assim,
quando não há deficiência de vitamina C, é pouco provável que a suplementação confira proteção contra resfriados, gripes e, por que não, infecções oportunistas em geral. Ainda que exista evidências sobre tempo reduzido de acometimento por resfriados, tal redução é pequena e provavelmente sem relevância clínica. Em situações específicas de estresse, no entanto, os benefícios parecem justificar o uso pontual. Megadoses provavelmente não serão mais efetivas do que doses mais baixas, já que a concentração plasmática de vitamina C parece ser muito bem regulada. Na dúvida, coma muitas frutas e fique tranquilo; afinal, atingir as doses recomendadas de vitamina C pela alimentação é relativamente simples.
Referências
Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2013 Jan 31;(1):CD000980.
Wintergerst ES, Silvia Maggini, Dietrich H. Hornig b. Immune-Enhancing Role of Vitamin C and Zinc and Effect on Clinical Conditions. Ann Nutr Metab 2006;50:85–94.
Jacob RA, Sotoudeh G. Vitamin C function and status in chronic disease. Nutr Clin Care. 2002 Mar-Apr;5(2):66-74.
Panush RS, Delafuente JC, Katz P, Johnson J: Modulation of certain immunologic responses by vitamin C. III. Potentiation of in vitro and in vivo lymphocyte response. Int J Vitam Nutr Res Suppl 1982; 23: 35–47. 35
Anderson R, Smit MJ, Joone GK, van Straden AM: Vitamin C and cellular immune functions: protection against hypochlorous acidmediated inactivation of glyceraldehyde-3- phosphate dehydrogenase and ATP generation in human leucocytes as a possible mechanism of ascorbate-mediated immunostimulation. Ann NY Acad Sci 1990; 587: 34–48.
M De La Fuente and V Victor. Anti-oxidants as modulators of immune function. Immunology and Cell Biology (2000) 78, 49–54
Anderson R, Oosthuizen R, Maritz R, Theron A, Van Rensburg AJ: The effects of increasing weekly doses of ascorbate on certain cellular and humoral immune functions in normal volunteers. Am J Clin Nutr 1980; 33: 71–76
Bleys J, Miller ER 3rd, Pastor-Barriuso R, Appel LJ, Guallar E. Vitamin-mineral supplementation and the progression of atherosclerosis: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2006;84:880-7
Shekelle P, Morton S, Hardy M. Effect of supplemental antioxidants vitamin C, vitamin E, and coenzyme Q10 for the prevention and treatment of cardiovascular disease. Evidence Report/Technology Assessment No. 83 AHRQ Publication No. 03-E043. Rockville, MD: Agency for Healthcare Research and Quality, 2003
Padayatty SJ et al. Vitamin C pharmacokinetics: implications for oral and intravenous use. Ann Intern Med. 2004 Apr 6;140(7):533-7.
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