{"id":13275,"date":"2024-11-18T12:03:00","date_gmt":"2024-11-18T11:03:00","guid":{"rendered":"https:\/\/www.sciencepharma.com\/blog\/whats-the-deal-with-vitamin-d\/"},"modified":"2024-11-22T14:14:07","modified_gmt":"2024-11-22T13:14:07","slug":"whats-the-deal-with-vitamin-d","status":"publish","type":"blog","link":"https:\/\/www.sciencepharma.com\/pl\/blog\/whats-the-deal-with-vitamin-d\/","title":{"rendered":"What&#8217;s the deal with vitamin D?"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"><strong>What is vitamin D?<\/strong><\/h2>\n\n\n<p style=\"text-align: justify;\"><strong>Vitamin D<\/strong> is a series of organic chemical compounds, the most important of which are <strong>cholecalciferol<\/strong> (vitamin D3) and <strong>ergocalciferol<\/strong> (vitamin D2). They differ chemically only in their side-chain structures, but both play the same role in the body. Both vitamin D3 and D2 are inactive, and only in the body are they transformed into biologically active forms: <strong>calcitriol<\/strong> and <strong>ercalcitriol<\/strong> [6,9,23].<\/p>\n<p style=\"text-align: justify;\">The biologically active form is a hormone that affects most of the physiological processes in the human body and mainly controls the body&#8217;s calcium and phosphate metabolism.<\/p>\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">Vitamin D promotes<strong> calcium<\/strong> <strong>absorption<\/strong> in the gut and maintains adequate serum calcium and phosphate concentrations to enable normal bone mineralization and prevent hypocalcemic tetany (involuntary muscle contractions leading to cramps and spasms). It is also needed for bone growth and remodeling by osteoblasts and osteoclasts. Bones can become thin, brittle, and misshapen without sufficient vitamin D. Vitamin D sufficiency prevents rickets in children and osteomalacia in adults. Together with calcium, vitamin D also helps protect older adults from <strong>osteoporosis<\/strong> [22,24].<\/span><\/p>\n<p style=\"text-align: justify;\">In addition to the most well-known ones described above, vitamin D also has several other functions, including reduction of inflammation as well as modulation of cell growth, neuromuscular and immune function, and glucose metabolism. Many genes encoding proteins that regulate cell proliferation, differentiation, and apoptosis are modulated in part by vitamin D. Furthermore, vitamin D is an important factor in muscle protein synthesis. This vitamin, due to its <strong>antioxidant<\/strong> and <strong>anti-inflammatory<\/strong> properties and activity in brain tissue, is essential for mood disorders preventions or treatments, such as <strong>depression<\/strong> and <strong>anxiety<\/strong>. There are also reports that vitamin D has <strong>anti-cancer<\/strong> properties regarding some types of cancer. Such a diverse functionality of vitamin D results from the fact that there are receptors for this vitamin in the cells of many tissues [2,4,18].<\/p>\n\n\n<div style=\"height:31px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>How much vitamin D do we need for proper functioning?<\/strong><\/h2>\n\n\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">Given that vitamin D is involved in many processes in the body, and its need depends on many factors, it is difficult to provide a precise and universal recommendation for a daily dose. Organizations issuing clinical guidelines, however,<\/span><span data-preserver-spaces=\"true\"> make some estimates, although it should be noted that these often differ from one another.<\/span><\/p>\n<p style=\"text-align: justify;\">The Panel on Dietetic Products, Nutrition, and Allergies (EFSA 2016) defined an adequate vitamin D intake of 600 IU per day for healthy individuals over one year of age, including pregnant and lactating women. The dietary reference values for healthy infants aged 7-11 months have been set at 400 IU per day.<\/p>\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">In turn, the upper safe limit of vitamin D is 4000 IU \/day for adults (including pregnant and lactating women) and adolescents aged 11\u201317\u2009. For children aged 1\u201310\u2009, the upper safe limit is 2000 IU.<\/span><\/p>\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">The extensive range between the appropriate intake and the maximum safe dose may be because vitamin D is relatively safe. Also, the demand for this vitamin varies, depending on many factors, which <\/span><span data-preserver-spaces=\"true\">will be discussed<\/span><span data-preserver-spaces=\"true\"> later.<\/span><\/p>\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Sources of vitamin D<\/strong><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">FOOD<\/h3>\n\n\n<p><span data-preserver-spaces=\"true\">Food products rich in vitamin D are primarily:<\/span><\/p>\n<ul>\n<li><span data-preserver-spaces=\"true\"><strong>Oily fish<\/strong> \u2013 such as eel, salmon, sardines, herring, and mackerel<\/span><\/li>\n<li><strong>Cod liver oil<\/strong><\/li>\n<li><strong>Red meat<\/strong><\/li>\n<li><span data-preserver-spaces=\"true\"><strong>Egg yolks<\/strong> and cheddar <strong>cheese<\/strong><\/span><\/li>\n<\/ul>\n\n\n<div style=\"height:17px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"319\" src=\"https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon9-1024x319.jpg\" alt=\"\" class=\"wp-image-13240\" srcset=\"https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon9-1024x319.jpg 1024w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon9-300x93.jpg 300w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon9-768x239.jpg 768w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon9-1536x478.jpg 1536w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon9-2048x637.jpg 2048w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n<\/div>\n\n\n<div style=\"height:18px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">The richest source of vitamin D is <\/span><strong>fresh eel<\/strong><span data-preserver-spaces=\"true\">, whose content can reach up to 1200 IU\/100 g, or <\/span><strong>cod liver oil<\/strong><span data-preserver-spaces=\"true\">, which contains up to 1000 IU\/tbs. This vitamin is found negligible in other foods, such as cow milk, vegetables, and fruits. Vegetable oils do not contain it at all [21]. <\/span><\/p>\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">The average person&#8217;s<\/span> most varied diet is <strong>not enough<\/strong> to provide the body with optimal doses of vitamin D<span data-preserver-spaces=\"true\">. Even in people who do not follow an elimination diet, vitamin D absorption may be <strong>insufficient<\/strong>. People who do not eat fish or meat are particularly vulnerable to vitamin D deficiencies, as a plant-based diet is extremely poor in this vitamin [20]. <\/span><\/p>\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"319\" src=\"https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon4-1024x319.jpg\" alt=\"\" class=\"wp-image-13210\" style=\"width:718px;height:auto\" srcset=\"https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon4-1024x319.jpg 1024w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon4-300x93.jpg 300w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon4-768x239.jpg 768w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon4-1536x478.jpg 1536w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon4-2048x637.jpg 2048w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n<\/div>\n\n\n<h3 class=\"wp-block-heading\">SUN<\/h3>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p style=\"text-align: justify;\">It is also possible to obtain sufficient amounts of vitamin D through exposure to sunlight. Vitamin D is produced endogenously when <strong>sunlight ultraviolet type B<\/strong> (UVB) rays strike the uncovered skin and trigger its synthesis. Cutaneous 7-dehydrocholesterol turns into previtamin D3, which becomes inactive vitamin D3. It is then metabolized in the body into its active form [20].<\/p>\n<p><span data-preserver-spaces=\"true\">For this reason, <\/span>moderate sun exposure is recommended.<\/p>\n<\/div>\n<\/div>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"319\" src=\"https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon12-1024x319.jpg\" alt=\"\" class=\"wp-image-13237\" srcset=\"https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon12-1024x319.jpg 1024w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon12-300x93.jpg 300w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon12-768x239.jpg 768w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon12-1536x478.jpg 1536w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon12-2048x637.jpg 2048w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n<\/div>\n\n\n<div style=\"height:27px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">But what does moderate mean? It is estimated that about <strong>30 minutes<\/strong> of <strong>sun exposure per day<\/strong> (particularly between 10 a.m. and 4 p.m.) covering the face, arms, hands, and legs <strong>without sunscreen<\/strong> usually leads to sufficient vitamin D synthesis, i.e., 2000-4000 IU [21,22].<\/span><\/p>\n<p style=\"text-align: justify;\">This amount of sun exposure may seem easy to achieve, but many factors influence the ability to produce vitamin D in the skin. The season, time of day, day length, cloud cover, smog, melanin content in the skin, and sunscreen are some factors that affect UVB exposure and vitamin D synthesis. <strong>Older people<\/strong> and <strong>people with dark skin<\/strong> have a <strong>lower<\/strong> ability to produce vitamin D from sunlight. Significantly, UVB radiation <strong>does not penetrate glass<\/strong>, so exposure to sunlight indoors through a window does not produce vitamin D [20].<br \/>On the other hand, excessive sun exposure will not be beneficial. UV radiation is a carcinogen, and the use of photoprotective agents to reduce the risk of skin cancer is necessary. Creams with high SPF factors are highly recommended &#8211;&gt;<a href=\"https:\/\/www.sciencepharma.com\/pl\/blog\/sunny-solutions-unmasking-the-uv-filters\/\">click to see our article about UV filters<\/a>.<\/p>\n<p style=\"text-align: justify;\">Unfortunately, the very same UVB wavelengths (290-320 nanometers, or nm) that make the body synthesize vitamin D also produce sunburn and genetic mutations that can lead to <strong>skin cancer<\/strong> [20].<br \/>Is this already an impasse? While the sun&#8217;s vitamin D synthesis is beneficial, we should use sunscreens with a high SPF. Let&#8217;s take a closer look at this.<br \/>Sunscreens with an SPF of only eight block the UVB rays that produce vitamin D. However, this is a purely theoretical situation that may occur under ideal laboratory conditions rather than in real life. Studies have never found that everyday sunscreen use leads to vitamin D insufficiency.<\/p>\n<p style=\"text-align: justify;\">In fact, people who use sunscreen daily can maintain their vitamin D levels. One of the explanations for this may be that no matter how much sunscreen you use or how high the SPF is, some of the sun&#8217;s UV rays reach your skin. An <strong>SPF 15<\/strong> sunscreen filters out 93 percent of UVB rays, <strong>SPF 30<\/strong> keeps out 97 percent, and <strong>SPF 50<\/strong> filters out 98 percent. This leaves anywhere from <strong>2 to 7 percent<\/strong> of solar UVB <strong>reaching your skin<\/strong>, even with high-SPF sunscreens. And that&#8217;s if you use them perfectly all over your skin &#8211; an appropriately thick layer of cream for every centimeter of exposed skin [19]. However, covering the entire body with a suitably thick layer of sunscreen is not very realistic. Moreover, sunscreen can wear off during the day, for example, when sweating or touching the skin. Either way, vitamin D production is still going on!<\/p>\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"319\" src=\"https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon5-1024x319.jpg\" alt=\"\" class=\"wp-image-13213\" style=\"width:687px;height:auto\" srcset=\"https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon5-1024x319.jpg 1024w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon5-300x93.jpg 300w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon5-768x239.jpg 768w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon5-1536x478.jpg 1536w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon5-2048x637.jpg 2048w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n<\/div>\n\n\n<div style=\"height:28px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h3 class=\"wp-block-heading\">SUPPLEMENTATION<\/h3>\n\n\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">So, is there a chance we can get as much vitamin D as we need without supplementation? For healthy people who eat a balanced diet and spend time outdoors during spring and summer, this should not be a problem. However, <\/span><strong>vitamin D supplementation<\/strong> is highly recommended<span data-preserver-spaces=\"true\"> in the<strong> fall<\/strong> and <strong>winter<\/strong>. It is also recommended that<strong> young children<\/strong> and the <strong>elderly<\/strong> take supplements <strong>all year round<\/strong>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">Many products containing vitamin D are available on the market, and manufacturers are competing with each other by offering increasingly higher doses. But is the highest over-the-counter dose the best?<\/span><\/p>\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">Remember that <\/span>supplementation for a healthy person is intended to <strong>PREVENT<\/strong> deficiencies and should not be based on high doses<span data-preserver-spaces=\"true\">. High doses of vitamin D are intended for people with diagnosed deficiencies or diagnosed diseases in which a high supply of vitamin D is particularly necessary.<\/span><\/p>\n<p><span data-preserver-spaces=\"true\">Recommendations for vitamin D supplementation according to the current <strong>Polish guidelines<\/strong> issued last year are as follows [22] :<\/span><\/p>\n\n\n<div style=\"height:23px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Group<\/strong><\/td><td><strong>Age and recommended dose<\/strong><\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Neonates born at term and infants<\/strong><\/td><td>Age 0\u20136 months: 400 IU of vitamin D3\/day<br><br>Age 6\u201312 months: 400\u2013600 IU of vitamin D3\/day<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Children (1\u201310 years)&nbsp;<\/strong><\/td><td>Age 1\u20133 years: 600 IU of vitamin D3\/day<br><br>Age 4\u201310 years: 600\u20131000 IU of vitamin D3\/day (starting from May until the end of September; supplementation is not necessary, although still recommended and safe)<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Adolescents (11\u201318 years) and adults (19\u201365 years)<\/strong><\/td><td>1000\u20132000 IU of vitamin D3\/day (starting from May until the end of September; supplementation is not necessary, although still recommended and safe)<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Pregnancy and lactation<\/strong><\/td><td>Women planning pregnancy should receive adequate cholecalciferol supplementation &#8211; the same as in the general adult population.<br>When pregnancy is confirmed until the end of breastfeeding, cholecalciferol supplementation should be carried out under the control of serum concentration to achieve and maintain optimal concentrations within the ranges of >30\u201350 ng\/mL OR 2000 IU of vitamin D3\/day.<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Younger seniors (>65\u201375 years)<\/strong><\/td><td>1000\u20132000 IU of vitamin D3\/day<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Older seniors (>75 years)<\/strong><\/td><td>2000\u20134000 IU of vitamin D3\/day<br>These guidelines are designed for the general population without an increased risk of significant vitamin D deficiency. People with significant deficiencies are usually under medical care and often require much higher doses of vitamin D.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<div style=\"height:22px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p>These guidelines are designed for the general population without an increased risk of significant vitamin D deficiency. People with significant deficiencies are usually under medical care and often require much higher doses of vitamin D.<\/p>\n\n\n\n<div style=\"height:29px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>How do we recognize symptoms of vitamin D deficiency?<\/strong><\/h2>\n\n\n\n<div style=\"height:9px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Condition<\/strong><\/td><td><strong>Reason<\/strong><\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Elderly people<\/strong><\/td><td>Both synthesis and metabolism of vitamin D change with aging due to <strong>reduced synthesis capacity<\/strong> of the skin (aged skin produces approximately 40% less vitamin D than younger skin) and age-related renal function reduction [11].<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Vegans, vegetarians<\/strong><\/td><td>Reduced dietary intake [10].<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Overweight and obese people<\/strong><\/td><td>Vitamin D is fat-soluble, so in obese people, it <strong>accumulates<\/strong> in large quantities in <strong>adipose tissue<\/strong>, which is not available to the body.<br>During effective weight loss, vitamin D is released from adipose tissue [1].<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Depression<\/strong><\/td><td>Serum vitamin D levels inversely correlate with clinical depression; the association appears to be driven by the <strong>homeostatic, trophic<\/strong>, and <strong>immunomodulatory<\/strong> effects of vitamin D [16,28].<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Diabetes type 1 and 2<\/strong><\/td><td>Vitamin D alleviates the course of the disease. There is a significant relationship between vitamin D deficiency and the development of type 1 and type 2 diabetes. <strong>Inflammation<\/strong> has a significant role in the pathogenesis of <strong>type 1 diabetes<\/strong>, and vitamin D acts as an immunomodulator. <strong>Low <\/strong>vitamin D is associated with <strong>insulin resistance<\/strong>, and so with <strong>type 2 diabetes<\/strong> [3,22].<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Atopic dermatitis<\/strong><\/td><td>Vitamin D alleviates the course of the disease. Atopic dermatitis is a chronic inflammatory skin disease that involves a dysregulated immune response. Vitamin D is an immunomodulator but is also associated with the proliferation and differentiation of keratinocytes and the production of <strong>antimicrobial peptides<\/strong>-endogenous antibiotics [12,17].<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Rheumatoid arthritis<\/strong><\/td><td>Vitamin D alleviates the course of the disease; rheumatoid arthritis manifests with chronic inflammation of synovial joints, and vitamin D concentration is lower in these patients than in healthy individuals. Vitamin D is important for <strong>immunomodulation<\/strong>, as its active form suppresses autoimmunity by inhibiting the production of pro-inflammatory cytokines [13,15].<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Hyperthyroidism, hypothyroidism and parathyroidism<\/strong><\/td><td>Poor absorption of vitamin D from the <strong>intestine<\/strong> and the body may not activate vitamin D properly [7,14,25].<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Renal failure<\/strong><\/td><td>Reduced amount of active form of vitamin D in serum [24].<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Liver failure, hepatic steatosis<\/strong><\/td><td>Reduced amount of active form of vitamin D in serum [24].<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\"><strong>Inflammatory bowel diseases<\/strong><\/td><td>Reduced absorption from the gut [24].<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<div style=\"height:19px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">Vitamin D levels that are too low are quite common-<strong>about 50%<\/strong> of the population has <strong>vitamin D insufficiency<\/strong>. Unfortunately, recognizing it is not easy because most patients with vitamin D insufficiency (or even deficiency) are <strong>asymptomatic<\/strong>, and routine testing of serum vitamin D levels in healthy populations is not recommended [20,24].<\/span><\/p>\n\n\n<div style=\"height:18px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"319\" src=\"https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon14-1024x319.jpg\" alt=\"\" class=\"wp-image-13257\" style=\"width:646px;height:auto\" srcset=\"https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon14-1024x319.jpg 1024w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon14-300x93.jpg 300w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon14-768x239.jpg 768w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon14-1536x478.jpg 1536w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon14-2048x637.jpg 2048w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n<\/div>\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<p style=\"text-align: justify;\">Only patients with prolonged and severe vitamin D deficiency can experience symptoms associated with secondary <strong>hyperparathyroidism<\/strong>, including bone pain, arthralgias, myalgias, fatigue, muscle twitching (fasciculations), and weakness. Fragility fractures may result from chronic vitamin D deficiency, leading to osteoporosis. In children, irritability, lethargy, developmental delay, bone changes, or fractures can be vitamin D deficiency symptoms [24].<br \/>It means that significantly low vitamin D levels become noticeable only in the long term, but the effects on the body may be <strong>severe<\/strong> and<strong> irreversible<\/strong>.<\/p>\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"319\" src=\"https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon11-1024x319.jpg\" alt=\"\" class=\"wp-image-13234\" srcset=\"https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon11-1024x319.jpg 1024w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon11-300x93.jpg 300w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon11-768x239.jpg 768w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon11-1536x478.jpg 1536w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon11-2048x637.jpg 2048w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n<\/div>\n\n\n<div style=\"height:18px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<p style=\"text-align: justify;\">This data shows us that vitamin D <strong>supplementation is extremely important<\/strong>. It is important, however, to use it wisely. As with everything, you can overdo it in this area too.<\/p>\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"319\" src=\"https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon6-1024x319.jpg\" alt=\"\" class=\"wp-image-13217\" style=\"width:663px;height:auto\" srcset=\"https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon6-1024x319.jpg 1024w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon6-300x93.jpg 300w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon6-768x239.jpg 768w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon6-1536x478.jpg 1536w, https:\/\/www.sciencepharma.com\/wp-content\/uploads\/2024\/11\/baner_www_szablon6-2048x637.jpg 2048w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n<\/div>\n\n\n<div style=\"height:24px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>How to approach vitamin D supplementation?<\/strong><\/h2>\n\n\n\n<div style=\"height:21px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h5 class=\"wp-block-heading\">Follow the current guidelines for vitamin D<\/h5>\n\n\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">Healthy people<strong> do not need<\/strong> to use too high doses &#8211; vitamins can also be <strong>overdosed<\/strong>. Although vitamin D is quite safe, in very high doses used for a long time, it may be <strong>toxic <\/strong>[24].<\/span><\/p>\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">Acute intoxication can lead to acute<strong> hypercalcemia<\/strong> that can cause confusion, anorexia, vomiting, polyuria, polydipsia, and muscle weakness. Chronic intoxication can lead to <strong>nephrocalcinosis<\/strong> and <strong>bone pain<\/strong> [20].\u00a0<\/span><span data-preserver-spaces=\"true\">How high doses are we talking about? It is worth being careful when using vitamin D in doses<strong> higher than 10\u00a0000 IU\/day<\/strong> for a<strong> long time<\/strong> &#8211; then the concentration of calcium in the serum should be monitored [20].\u00a0<\/span>Currently, many products on the market contain this vitamin, sometimes even in very high doses &#8211; remember, you may not need the highest dose.<\/p>\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h5 class=\"wp-block-heading\">Vitamin D3 is more efficacious than vitamin D2<\/h5>\n\n\n<p><span data-preserver-spaces=\"true\">At raising serum concentrations, and thus, <strong>vitamin D3<\/strong> is the preferred choice for supplementation [26].<\/span><\/p>\n\n\n<div style=\"height:18px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h5 class=\"wp-block-heading\">Vitamin D cannot be metabolized without adequate magnesium level<\/h5>\n\n\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">Ensure you get enough <strong>magnesium<\/strong> from food or products containing magnesium &#8211; magnesium lactate has one of the best absorption rates. Taking recommended doses of vitamin D may not be beneficial if magnesium levels are too low [27].<\/span><\/p>\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">Vitamin D may be harmful in the presence of magnesium deficiency; then, the use of high doses of vitamin D may lead to a dangerous depletion of magnesium resources in the body, which may lead to arterial calcification or atherosclerosis.<\/span><\/p>\n\n\n<div style=\"height:19px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h5 class=\"wp-block-heading\">The presence of zinc is also important<\/h5>\n\n\n<p style=\"text-align: justify;\"><span data-preserver-spaces=\"true\">Zinc deficiency inhibits processes related to the activation of vitamin D in the kidneys [5].<\/span><\/p>\n\n\n<div style=\"height:17px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h5 class=\"wp-block-heading\">Calcium Intake in Vitamin D Deficiency Prevention<\/h5>\n\n\n<p style=\"text-align: justify;\">During the prevention of vitamin D deficiency, an appropriate dietary calcium intake should be assured [22].<\/p>\n<p><strong><span data-preserver-spaces=\"true\">Vitamin D supplementation is <\/span><span data-preserver-spaces=\"true\">very important<\/span><span data-preserver-spaces=\"true\">, but <\/span><span data-preserver-spaces=\"true\">it should be approached<\/span><span data-preserver-spaces=\"true\"> responsibly<\/span><\/strong><span data-preserver-spaces=\"true\">.<\/span><\/p>\n\n\n<div style=\"height:90px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<\/p>\n<p>References:<\/p>\n<ol>\n<li><em>Abdullah Thani NSI, Khairudin R, Ho JJ, Muhamad NA, Ismail H. Vitamin D supplementation for overweight or obese adults. Cochrane Database Syst Rev. 2019 May 23;2019(5):CD011629. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6532760\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6532760\/<\/a><\/em><\/li>\n<li><em>Abiri B, Vafa M. Vitamin D and Muscle Sarcopenia in Aging. Methods Mol Biol. 2020;2138:29-47. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32219739\/\">https:\/\/pubmed.ncbi.nlm.nih.gov\/32219739\/<\/a><\/em><\/li>\n<li><em>Abugoukh TM, Al Sharaby A, Elshaikh AO, Joda M, Madni A, Ahmed I, Abdalla RS, Ahmed K, Elazrag SE, Abdelrahman N. Does Vitamin D Have a Role in Diabetes? Cureus. 2022 Oct 18;14(10):e30432. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9671203\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9671203\/<\/a><\/em><\/li>\n<li><em>Akp\u0131nar \u015e, Karada\u011f MG. Is Vitamin D Important in Anxiety or Depression? What Is the Truth? Curr Nutr Rep. 2022 Dec;11(4):675-681. doi: 10.1007\/s13668-022-00441-0. Epub 2022 Sep 13. PMID: 36097104; PMCID: PMC9468237. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9468237\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9468237\/<\/a><\/em><\/li>\n<li><em>Amos A, Razzaque MS. Zinc and its role in vitamin D function. Curr Res Physiol. 2022 Apr 30;5:203-207. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/35570853\/\">https:\/\/pubmed.ncbi.nlm.nih.gov\/35570853\/<\/a><\/em><\/li>\n<li><em>Courbebaisse M, Cavalier E. Vitamin D in 2020: An Old Pro-Hormone with Potential Effects beyond Mineral Metabolism. Nutrients. 2020 Nov 3;12(11):3378. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7692961\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7692961\/<\/a><\/em><\/li>\n<li><em>Czarnywojtek A, Florek E, Pietro\u0144czyk K, Sawicka-Gutaj N, Rucha\u0142a M, Ronen O, Nixon IJ, Shaha AR, Rodrigo JP, Tufano RP, Zafereo M, Randolph GW, Ferlito A. The Role of Vitamin D in Autoimmune Thyroid Diseases: A Narrative Review. J Clin Med. 2023 Feb 11;12(4):1452. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/36835987\/\">https:\/\/pubmed.ncbi.nlm.nih.gov\/36835987\/<\/a><\/em><\/li>\n<li><em>Vitamin D: EFSA sets dietary reference values. October 2016. <a href=\"https:\/\/www.efsa.europa.eu\/en\/press\/news\/161028\">https:\/\/www.efsa.europa.eu\/en\/press\/news\/161028<\/a><\/em><\/li>\n<li><em>Ellison DL, Moran HR. Vitamin D: Vitamin or Hormone? Nurs Clin North Am. 2021 Mar;56(1):47-57. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33549285\/\">https:\/\/pubmed.ncbi.nlm.nih.gov\/33549285\/<\/a><\/em><\/li>\n<li><em>Garc\u00eda-Maldonado E, Gallego-Narb\u00f3n A, Zapatera B, Alcorta A, Mart\u00ednez-Su\u00e1rez M, Vaquero MP. Bone Remodelling, Vitamin D Status, and Lifestyle Factors in Spanish Vegans, Lacto-Ovo Vegetarians, and Omnivores. Nutrients. 2024 Feb 2;16(3):448. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC10857037\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC10857037\/<\/a><\/em><\/li>\n<li><em>Giustina A, Bouillon R, Dawson-Hughes B, Ebeling PR, Lazaretti-Castro M, Lips P, Marcocci C, Bilezikian JP. Vitamin D in the older population: a consensus statement. Endocrine. 2023 Jan;79(1):31-44. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9607753\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9607753\/<\/a><\/em><\/li>\n<li><em>Kim G, Bae JH. Vitamin D and atopic dermatitis: A systematic review and meta-analysis. Nutrition. 2016 Sep;32(9):913-20. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27061361\/\">https:\/\/pubmed.ncbi.nlm.nih.gov\/27061361\/<\/a><\/em><\/li>\n<li><em>Kostoglou-Athanassiou I, Athanassiou P, Lyraki A, Raftakis I, Antoniadis C. Vitamin D and rheumatoid arthritis. Ther Adv Endocrinol Metab. 2012 Dec;3(6):181-7. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3539179\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3539179\/<\/a><\/em><\/li>\n<li><em>Mackawy AM, Al-Ayed BM, Al-Rashidi BM. Vitamin d deficiency and its association with thyroid disease. Int J Health Sci (Qassim). 2013 Nov;7(3):267-75. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3921055\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3921055\/<\/a><\/em><\/li>\n<li><em>Meena N, Singh Chawla SP, Garg R, Batta A, Kaur S. Assessment of Vitamin D in Rheumatoid Arthritis and Its Correlation with Disease Activity. J Nat Sci Biol Med. 2018 Jan-Jun;9(1):54-58. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5812075\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5812075\/<\/a><\/em><\/li>\n<li><em>Menon V, Kar SK, Suthar N, Nebhinani N. Vitamin D and Depression: A Critical Appraisal of the Evidence and Future Directions. Indian J Psychol Med. 2020 Jan 6;42(1):11-21. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6970300\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6970300\/<\/a><\/em><\/li>\n<li><em>Mesquita Kde C, Igreja AC, Costa IM. Atopic dermatitis and vitamin D: facts and controversies. An Bras Dermatol. 2013 Nov-Dec;88(6):945-53. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3900346\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3900346\/<\/a><\/em><\/li>\n<li><em>Mu\u00f1oz A, Grant WB. Vitamin D and Cancer: An Historical Overview of the Epidemiology and Mechanisms. Nutrients. 2022 Mar 30;14(7):1448. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/35406059\/\">https:\/\/pubmed.ncbi.nlm.nih.gov\/35406059\/<\/a><\/em><\/li>\n<li><em>Neale RE, Khan SR, Lucas RM, Waterhouse M, Whiteman DC, Olsen CM. The effect of sunscreen on vitamin D: a review. Br J Dermatol. 2019 Nov;181(5):907-915. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30945275\/\">https:\/\/pubmed.ncbi.nlm.nih.gov\/30945275\/<\/a><\/em><\/li>\n<li><em>Vitamin D Fact Sheet for Health Professionals. 2024. <a href=\"https:\/\/ods.od.nih.gov\/factsheets\/VitaminD-HealthProfessional\/\">https:\/\/ods.od.nih.gov\/factsheets\/VitaminD-HealthProfessional\/<\/a><\/em><\/li>\n<li><em>P\u0142udowski P, Karczmarewicz E, Bayer M, Carter G, Chlebna-Sok\u00f3\u0142 D, Czech-Kowalska J, D\u0119bski R, Decsi T, Dobrza\u0144ska A, Franek E, G\u0142uszko P, Grant WB, Holick MF, Yankovskaya L, Konstantynowicz J, Ksi\u0105\u017cyk JB, Ksi\u0119\u017copolska-Or\u0142owska K, Lewi\u0144ski A, Litwin M, Lohner S, Lorenc RS, Lukaszkiewicz J, Marcinowska-Suchowierska E, Milewicz A, Misiorowski W, Nowicki M, Povoroznyuk V, Rozentryt P, Rudenka E, Shoenfeld Y, Socha P, Solnica B, Szalecki M, Ta\u0142a\u0142aj M, Varbiro S, \u017bmijewski MA. Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe &#8211; recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency. Endokrynol Pol. 2013;64(4):319-27. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24002961\/\">https:\/\/pubmed.ncbi.nlm.nih.gov\/24002961\/<\/a><\/em><\/li>\n<li><em>P\u0142udowski P, Kos-Kud\u0142a B, Walczak M, Fal A, Zozuli\u0144ska-Zi\u00f3\u0142kiewicz D, Sieroszewski P, Peregud-Pogorzelski J, Lauterbach R, Targowski T, Lewi\u0144ski A, Spaczy\u0144ski R, Wielgo\u015b M, Pinkas J, Jackowska T, Helwich E, Mazur A, Rucha\u0142a M, Zygmunt A, Szalecki M, Bossowski A, Czech-Kowalska J, W\u00f3jcik M, Pyr\u017cak B, \u017bmijewski MA, Abramowicz P, Konstantynowicz J, Marcinowska-Suchowierska E, Bleizgys A, Karras SN, Grant WB, Carlberg C, Pilz S, Holick MF, Misiorowski W. Guidelines for Preventing and Treating Vitamin D Deficiency: A 2023 Update in Poland. Nutrients. 2023 Jan 30;15(3):695. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/36771403\/\">https:\/\/pubmed.ncbi.nlm.nih.gov\/36771403\/<\/a><\/em><\/li>\n<li><em>PubChem Ercalcitrol 2024. <a href=\"https:\/\/pubchem.ncbi.nlm.nih.gov\/compound\/Ercalcitriol\">https:\/\/pubchem.ncbi.nlm.nih.gov\/compound\/Ercalcitriol<\/a><\/em><\/li>\n<li><em>Sizar O, Khare S, Goyal A, Givler A. Vitamin D Deficiency. StatPearls Publishing; 2024 Jan-. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK532266\/\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK532266\/<\/a><\/em><\/li>\n<li><em>Talaei A, Ghorbani F, Asemi Z. The Effects of Vitamin D Supplementation on Thyroid Function in Hypothyroid Patients: A Randomized, Double-blind, Placebo-controlled Trial. Indian J Endocrinol Metab. 2018 Sep-Oct;22(5):584-588. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6166548\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6166548\/<\/a><\/em><\/li>\n<li><em>Tripkovic L, Lambert H, Hart K, Smith CP, Bucca G, Penson S, Chope G, Hypp\u00f6nen E, Berry J, Vieth R, Lanham-New S. Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis. Am J Clin Nutr. 2012 Jun;95(6):1357-64. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22552031\/\">https:\/\/pubmed.ncbi.nlm.nih.gov\/22552031\/<\/a><\/em><\/li>\n<li><em>Uwitonze AM, Razzaque MS. Role of Magnesium in Vitamin D Activation and Function. J Am Osteopath Assoc. 2018 Mar 1;118(3):181-189. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29480918\/\">https:\/\/pubmed.ncbi.nlm.nih.gov\/29480918\/<\/a><\/em><\/li>\n<li><em>Wang R, Xu F, Xia X, Xiong A, Dai D, Ling Y, Sun R, Qiu L, Ding Y, Xie Z. The effect of vitamin D supplementation on primary depression: A meta-analysis. J Affect Disord. 2024 Jan 1;344:653-661. <\/em><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/37852593\/\"><em>https:\/\/pubmed.ncbi.nlm.nih.gov\/37852593\/<\/em><\/a><\/li>\n<\/ol>\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>What is vitamin D? Vitamin D is a series of organic chemical compounds, the most important of which are cholecalciferol (vitamin D3) and ergocalciferol (vitamin D2). They differ chemically only in their side-chain structures, but both play the same role in the body. Both vitamin D3 and D2 are inactive, and only in the body [&hellip;]<\/p>\n","protected":false},"featured_media":13225,"template":"","meta":{"inline_featured_image":false},"class_list":["post-13275","blog","type-blog","status-publish","has-post-thumbnail","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>- SciencePharma<\/title>\n<meta name=\"description\" content=\"Vitamin D is crucial for calcium absorption, bone health, immune function, and more. 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