Vitamin D

A nutrient that the body requires in percentages to function and remain healthy. Vitamin D assists the body usage calcium and phosphorus to make strong bones and teeth. It is fat-soluble (can dissolve in fats and oils) and is discovered in fatty fish, egg yolks, and dairy products. Skin exposed to sunshine can likewise make Vitamin D. Inadequate Vitamin D can cause a bone illness called rickets. It is being studied in the avoidance and treatment of some kinds of cancer. Likewise called cholecalciferol. (1 )

Overview

Vitamin D is a necessary nutrient and hormone with multiple functions in the body consisting of bone health, guideline of serum calcium and phosphate levels, along with functions in immune function, cell expansion, differentiation, and apoptosis. Accordingly, Vitamin D deficiency has actually been connected with a variety of health results such as bone illness, diabetes, hypertension, heart problem, cancer, and autoimmune and infectious illness. Research has turned to investigating whether particular hereditary variations in Vitamin D metabolism are associated with Vitamin D status or Vitamin D– related health outcomes. Significantly, not least because of advances in technology and method, a number of massive genetic association research studies or prospect gene studies investigated associations between the Vitamin D-related genes dhcr7, nadsyn1, gc, cyp2r1, cyp27b1, and cyp24a1, and Vitamin D receptor and serum levels of Vitamin D.

Vitamin D can be manufactured in the skin, and it helps to help with digestive ca++ absorption. Ergosterol, which occurs in plants, is a Vitamin D precursor. The active form of Vitamin D (1,25( oh) 2d) is a steroid hormone. Kidney activation of Vitamin D is managed by numerous endocrine elements. Liver and/or kidney disease can lead to a 1,25( oh) 2d shortage. Parathyroid hormone shortage can be dealt with through Vitamin D supplementation. Cholecalciferol rodenticide poisoning can trigger signs of Vitamin D toxicity. Glucocorticoids and calcitonin can be utilized to reverse symptoms of Vitamin D toxicity. (2 ).

History

The modern history of Vitamin D started in the mid-1800s, when it was noticed that city children were more likely to have rickets than rural children. Half a century later on, palm reported that children raised in warm environments practically never ever established rickets. Mccollum isolated Vitamin D, and windaus its precursors, getting the nobel prize. Other researchers later on observed that individuals with skin cancer had lower occurrence of nonskin cancers, which lower general death rates from all internal cancers integrated existed in sunnier locations. These observations went mostly unnoticed, and the field stagnated up until 1970, when maps were produced of cancer mortality rates. Through study of these maps, cedric and frank garland of johns hopkins university reported a strong latitudinal gradient for colon cancer mortality rates in 1980, and hypothesized that greater levels of Vitamin D compounds in the serum of people in the south were accountable, and that calcium consumption also would decrease occurrence. Edward gorham and coworkers performed cohort and embedded research studies, including the first research study that discovered an association of a serum Vitamin D compound with minimized cancer danger. William b. Grant then carried outnumerous ecologic research studies that extended the Vitamin D-cancer theory to other cancers. (3 ).

Working mechanism

Vitamin D is carried through the blood to the liver, where it is converted into the prohormone calcifediol. Distributing calcifediol may then be converted into calcitriol– the biologically active form of Vitamin D– in the kidneys.

Whether manufactured in the skin or consumed, Vitamin D is hydroxylated in the liver at position 25 (upper right of the molecule) to form 25-hydroxycholecalciferol (calcifediol or 25( oh) d). This reaction is catalyzed by the microsomal enzyme Vitamin D 25-hydroxylase, the product of the cyp2r1 human gene, and expressed by hepatocytes. As soon as made, the item is launched into the plasma, where it is bound to an α-globulin carrier protein named the Vitamin D-binding protein.

Calcifediol is transferred to the proximal tubules of the kidneys, where it is hydroxylated at the 1-α position (lower right of the molecule) to form calcitriol (1,25-dihydroxycholecalciferol, 1,25( oh) 2d). The conversion of calcifediol to calcitriol is catalyzed by the enzyme 25-hydroxyVitamin D3 1-alpha-hydroxylase, which is the product of the cyp27b1 human gene. The activity of cyp27b1 is increased by parathyroid hormonal agent, and likewise by low calcium or phosphate.

Following the last converting step in the kidney, calcitriol is released into the flow. By binding to Vitamin D-binding protein, calcitriol is transported throughout the body, consisting of to the intestinal tract, kidneys, and bones. Calcitriol is the most powerful natural ligand of the Vitamin D receptor, which mediates most of the physiological actions of Vitamin D.

In addition to the kidneys, calcitriol is also manufactured by certain other cells, including monocyte-macrophages in the body immune system. When synthesized by monocyte-macrophages, calcitriol acts in your area as a cytokine, regulating body defenses against microbial invaders by promoting the natural body immune system.

Inactivation

The activity of calcifediol and calcitriol can be reduced by hydroxylation at position 24 by Vitamin D3 24-hydroxylase, forming secalciferol and calcitetrol, respectively.

Distinction between substrates

Vitamin D2 (ergocalciferol) and Vitamin D3 (cholecalciferol) share a similar system of action as outlined above. Metabolites produced by Vitamin D2 are called with an er- or ergo- prefix to distinguish them from the d3-based counterparts (often with a chole- prefix).

Metabolites produced from Vitamin D2 tend to bind less well to the Vitamin D-binding protein.

Vitamin D3 can additionally be hydroxylated to calcifediol by sterol 27-hydroxylase (cyp27a1), however Vitamin D2 can not.

Ergocalciferol can be directly hydroxylated at position 24 by cyp27a1. This hydroxylation likewise causes a greater degree of inactivation: the activity of calcitriol decreases to 60% of initial after 24-hydroxylation, whereas ercalcitriol undergoes a 10-fold decline in activity on conversion to ercalcitetrol.

It is contested whether these differences lead to a measurable drop in effectiveness.

Intracellular mechanisms

Calcitriol goes into the target cell and binds to the Vitamin D receptor in the cytoplasm. This triggered receptor goes into the nucleus and binds to Vitamin D response components (vdre) which are specific dna series on genes. Transcription of these genes is stimulated and produces greater levels of the proteins which mediate the impacts of Vitamin D.

Some reactions of the cell to calcitriol seem too quick for the classical vdre transcription pathway, causing the discovery of various non-genomic actions of Vitamin D. The membrane-bound pdia3 most likely acts as an alternate receptor in this pathway. The classical vdr might still play a role. (4 ).

Benefits of Vitamin D

Vitamin D– nicknamed the “sunlight vitamin” due to its capability to be absorbed by the body through sunlight– is a major player in keeping the body healthy. Its main task, according to the nationwide institutes of health’s workplace of dietary supplements, is to promote calcium absorption, making it required for bone development and bone improvement (when mature bone tissue is gotten rid of and new bone tissue is formed). Because of that, an absence of Vitamin D can cause thin, fragile, or misshapen bones. But Vitamin D provides a variety of other advantages too, ranging from positives for both physical and mental health. Here are 9 Vitamin D advantages you need to learn about– consisting of methods to get more of the vitamin in your everyday diet.

Vitamin D reinforces your bones

Vitamin D is well-known for its bone-building and strengthening powers. “Vitamin D promotes absorption of calcium in your gut, which ultimately permits regular mineralization of your bones,” jackie newgent, rdn, cooking nutritionist and author of the clean & easy diabetes cookbook, tells health. Essentially, the calcium that benefits your bones wouldn’t be able to do its job without Vitamin D. “you need Vitamin D for bone development– and to prevent bones from becoming fragile.” when teamed with calcium, it can assist avoid osteoporosis, a disease that signifies that the density and quality of bone are minimized, she includes.

Vitamin D can assist reinforce muscles

In addition to its bone-building abilities, Vitamin D is likewise influential in strengthening muscles. “absence of Vitamin D in the body can increase the risk of having weak muscles, which in turn increases the threat of falls,” lana nasrallah, mph, rd, clinical dietician at unc health, tells health. This is particularly crucial for the senior. “Vitamin D might help increase muscle strength hence preventing falls, which is a common problem that causes considerable impairment and death in older grownups.”.

Vitamin D can support the body immune system and battle swelling

Dr. Nasrallah includes that Vitamin D can likewise assist build immunity. “it can support the body immune system by eradicating harmful germs and infections,” she says. In fact, this function in possibly avoiding infections has become a vital concern during covid-19 pandemic, as researchers are interested in its prospective role in infection results. “there is particular interest in its function in viral infections such as influenza and coronavirus,” barry boyd, md, rdn, a yale medication hematologist, oncologist, and nutritionist, tells health. He points to a 2017 bmj analysis of 25 randomized control trials comparing Vitamin D supplements to placebos, which discovered that Vitamin D decreased the threat of severe respiratory infection.

With either everyday or weekly Vitamin D supplements, particularly in people who were deficient in it. “research studies show that high latitudes and winter season are risk elements for both low Vitamin D, increased influenza, and other respiratory health problem and negative results,” he states. “we now are seeing a similar pattern with greater death rates in covid-19 infections,” though more research still needs to be done to figure out whether the link is causal or simply a connection.

Vitamin D can help enhance oral health

Because Vitamin D helps our body soak up calcium, it plays a vital role in supporting oral health, decreasing the risk of tooth decay and gum disease. A 2011 review in the journal of the tennessee oral association notes that while the research is little, there’s an “emerging hypothesis” that the vitamin is beneficial for oral health, due to its impact on bone metabolic process and “its ability to operate as an anti-inflammatory representative and promote the production of anti-microbial peptides.”.

Vitamin D can help prevent type 1 and type 2 diabetes

While research studies are not definitive, Vitamin D may be practical for avoiding both type 1 and type 2 diabetes, says newgent. One such study, released in 2006 in the journal diabetes care, discovered that while Vitamin D by itself did not effectively lower the threat of an oversupply of sugar in the blood, a combined daily consumption of >> 1,200 mg calcium and >> 800 iu Vitamin D might efficiently lower the danger of type 2 diabetes.

Vitamin D can help treat hypertension

According to a 2019 evaluation published in the journal present protein & peptide science suggests that Vitamin D may play a role in treatment of hypertension– one of the markers of cardiovascular disease– states newgent. According to authors of the review, “even short-term Vitamin D deficiency might directly raise bp [blood pressure] and promote target organ damage.” the scientists went on to add that, “due to the high connection between Vitamin D and high blood pressure, Vitamin D supplements therapy might be a new insight in the treatment of hypertension.”.

Vitamin D can help you slim down

Dr. Boyd mentions that obesity is a recognized threat aspect for low Vitamin D levels– which implies more Vitamin D may aid with weight loss. One 2009 study in the british journal of nutrition discovered that, in overweight or obese women with low calcium levels, those who took an everyday dose of calcium paired with Vitamin D were more successful shedding pounds than those who took a placebo supplement, due to an “appetite-suppressing result” of the combination.

Vitamin D can assist fight anxiety

The sun can illuminate your state of mind, therefore can Vitamin D. According to a 2017 review article in the journal neuropsychology, scientists discovered “a significant relationship between depression and Vitamin D shortage.” while they acknowledged that more research is required to specify the exact workings of it– such as, if low Vitamin D levels are a cause or effect of depression– the authors suggest “screening for and treating Vitamin D deficiency in subjects with depression” keeping in mind that it is an “simple, economical and might enhance depression outcome.”.

Vitamin D may help reduce the risk of certain cancers

Dr. Boyd indicates various studies– the majority of which are referenced on the national cancer institute’s (nci) site– that supply some proof that Vitamin D might have cancer combating powers. “proof.

Is increasing that Vitamin D supplements may enhance cancer outcomes,” he explains. The cancers for which the most human information are offered are colorectal, breast, prostate, and pancreatic cancer.

The nci particularly calls out a couple of reasons scientists are interested in a link in between Vitamin D and a lowered risk of cancer. The organization explains that some research study shows that incidence and death rates for certain cancers were lower among individuals residing in southern latitudes, where levels of sunlight direct exposure are relatively high, than among those living at northern latitudes, though extra research study needs to be done to discover a particular causal or correlational link between more sunshine exposure and a lower danger of cancer. More experimental evidence, per the nci, reveals, that cancer cells and of growths in mice, Vitamin D has actually been found to have numerous activities that may slow or avoid the advancement of cancer cells and growths in mice, consisting of promoting cellular differentiation, reducing cancer cell development, stimulating cell death (apoptosis), and decreasing growth capillary development (angiogenesis). (5 ).

Advantages of Vitamin D for males

There are a number of Vitamin D benefits for guys. Lately, Vitamin D has been the subject of much medical study. Research study reveals that Vitamin D is not simply important for bone health. this crucial nutrient also contributes in supporting healthy muscle development, testosterone levels, and psychological health. In this post, we provide information about Vitamin D and share three unexpected Vitamin D benefits for men.

Vitamin D is vital for muscle development.

Vitamin D plays a vital role in the advancement of skeletal muscle, which is the muscle attached to bones that assist move the body. Sufficient Vitamin D is likewise critical in enhancing muscle strength and efficiency.

Even elite athletes can gain from appropriate Vitamin D levels. In one research study, researchers took a look at the Vitamin D blood levels of more than 200 college football professional athletes. Almost 60% of these professional athletes had unusual Vitamin D levels, while 10% had a serious deficiency. Those professional athletes with lower levels of Vitamin D had a greater prevalence of muscle pressure and core muscle injury. Adequate levels of Vitamin D are important for high-level professional athletes and weekend warriors alike to enhance muscle strength.

Vitamin D supplementation might improve testosterone levels.

The male reproductive system is referred to as a target location for Vitamin D. Testosterone( a male hormonal agent) plays a vital role in bone mass, muscle strength, fat circulation, and even sex drive. One research study discovered that males taking Vitamin D supplements had greater testosterone levels than the placebo group.

Vitamin D supplementation might enhance mood.

Evidence for a link in between Vitamin D shortage and mental health is growing. Vitamin D receptors are widespread in the brain, including the hippocampus, and it is believed that this nutrient may be a key player in our general psychological wellness. (6 ).

Adverse effects of Vitamin D

Doctors tend to think about Vitamin D levels to be adequate if there are at least 20 nanograms (ng) of the vitamin per milliliter (ml) of blood. If levels rise above 50 ng/ml, an individual might experience unfavorable adverse effects.

However, the majority of research indicates that the toxicity threshold for Vitamin D is relatively high, around 200– 240 ng/ml.

A person with levels of Vitamin D in this range usually takes in between 10,000 and 40,000 global systems (ius) of the vitamin per day.

Below are some of the most major negative effects associated with too much exposure to Vitamin D.

Hypercalcemia

The majority of the significant adverse effects associated with Vitamin D toxicity are related to hypercalcemia.

Hypercalcemia is an excess of calcium in the blood. This happens when there are more than 10,4000 ng/ml of calcium in the blood.

Scientists often mention this limit as 10.4 milligrams (mg) of calcium per deciliter of blood or as 0.104 mg/ml.

There is a strong relationship between Vitamin D and calcium. When there are high levels of Vitamin D metabolites in the blood, this increases the amount of calcium that the intestinal tracts take in.

High levels of Vitamin D metabolites can also promote the release of calcium from the bones into the blood stream.

Having too much calcium in the blood can result in a large range of issues and symptoms. Some of the most severe consist of:.

• A loss of appetite
• Diarrhea and irregularity
• Confusion, disorientation, or trouble thinking
• Queasiness and vomiting
• Joint and muscle pain
• Continuous headaches
• Irritability and stress and anxiety
• Unexplained exhaustion
• Muscle weak point
• Increased thirst and more regular urination
• An irregular heart beat
• Decreased reflexes
• A metallic taste in the mouth
• Hypertension

Kidney damage

Excess calcium in the bloodstream can bind with phosphate and kind crystals that deposit in soft body tissues.

These crystals can cause tissue damage and ultimately organ damage, depending on their area, number, and size.

The kidney is especially susceptible to calcium deposits because of its function as a filter and its lots of little passageways.

When calcium deposits get stuck in kidney tissues, nephrocalcinosis can occur. If this condition is severe, it can cause irreversible kidney damage and, ultimately, kidney failure.

Signs of nephrocalcinosis consist of:.

• Queasiness and vomiting
• Fever and chills
• Extreme discomfort in the stomach, the sides of the back, or the groin location, including the testicles in men

Irregular heart beat and heart attack

Extreme hypercalcemia can decrease or alter the ability of the heart’s cells to operate, and individuals with serious hypercalcemia typically experience irregularities in the heart beat.

A person with significantly high levels of calcium or phosphate in the blood might also develop calcium deposits, or plaques, in the arteries or valves of the heart.

In 2012, medical professionals reported the case of a 70-year-old woman who received calcium injections in the equivalent of 80,000 iu/day over one month.

She experienced hypercalcemia and complete heart blockage, which needed a permanent pacemaker.

Some signs of heart issues connected with Vitamin D toxicity consist of:.

• An irregular heart beat, which might be momentary or consistent
• Chest discomfort
• Inexplicable exhaustion
• Hypertension
• Pain when working out
• Dizziness
• Chest discomfort

Breakable bones and bone pain

When there is too much calcium distributing freely in the bloodstream, the body might not have adequate hormones to bind the mineral to the bones efficiently.

Vitamin D toxicity can trigger hypercalcemia and subsequent issues with the bones. Some symptoms consist of:.

• Aching or unpleasant bones
• Instability
• An increased rate of falling
• Bones that are prone to fracture or break
• Badly stooped posture
• Severe back or joint discomfort
• Loss of height or length of limb

Dehydration

Vitamin D toxicity might trigger dehydration.

Raised levels of calcium in the blood can hurt the kidney’s ability to focus urine.

This can result in a person producing and passing abnormally big quantities of urine, which is called polyuria.

Researchers are not totally sure why this takes place. One theory is that high calcium levels reduce the impacts of antidiuretic hormonal agents.

These hormones encourage the kidneys to retain water, and less hormones might lead to bigger amounts of diluted urine.

When a person passes a great deal of diluted urine, they lose big amounts of water and electrolytes. For this reason, a person with Vitamin D toxicity might be prone to dehydration.

Signs of moderate dehydration consist of:.

• A dry mouth and tongue
• Restlessness
• Irritation
• Sunken eyes
• Increased thirst
• Decreased urinary output
• Decreased tear production and dry eyes
• Skin that is sluggish to go back to typical after being pinched

Severe dehydration can lead to dangerous conditions. Other signs and symptoms of this condition consist of:.

• A weak or missing pulse
• Low high blood pressure
• Unusual exhaustion
• Really little or no urine output
• Unconsciousness

Pancreatitis

Hypercalcemia can trigger severe pancreatitis, which is the term for inflammation of the pancreas.

In 2017, researchers published a review of the functions and treatment of Vitamin D toxicity-induced acute kidney injury.

They studied the experiences of 19 individuals with the toxicity. Each had taken an average of 6,000,000 iu of the vitamin over 1– 3 months.

Two of the 19 people experienced severe pancreatitis as a problem.

Signs of pancreatitis consist of:.

• Upper stomach pain that reaches the back
• Queasiness and throwing up
• A rapid pulse
• Weight reduction
• Fever

Lung damage

When high levels of calcium and phosphate in the blood bind to form crystals, these deposit in soft tissues.

The crystals are specifically most likely to deposit in soft-tissue organs that act as filters, such as the lungs.

If much of these calcium salt deposits, or ectopic calcifications, are present in the lungs, they can hinder the organ’s function.

Some signs of the resulting lung damage consist of:.

• Coughing
• Problem breathing
• Chest discomfort (7 )

Dosing

Vitamin D is a necessary nutrient. Fish, eggs, and strengthened milk are good sources of Vitamin D. The quantity that ought to be taken in every day is called the suggested dietary allowance (rda). The rda is 600 iu (15 mcg) daily for individuals 1-70 years of age and 800 iu (20 mcg) daily for those 71 years and older. While pregnant and breastfeeding, the rda is 600 iu (15 mcg) daily. In kids, the rda depends upon age. Vitamin D is also made in the skin after sun exposure. Spending 15-30 minutes in the sun each day must be enough to keep normal Vitamin D levels for many people.

Many people must not take in more than 4000 iu daily unless under the care of a doctor. Speak to a healthcare provider to discover what dose might be best for a particular condition. (8 ).

Interactions

Possible interactions consist of:.

• Taking Vitamin D and aluminum-containing phosphate binders, which might be utilized to deal with high serum phosphate levels in people with chronic kidney disease, might trigger hazardous levels of aluminum in people with kidney failure in the long term.
• The anticonvulsants phenobarbital and phenytoin (dilantin, phenytek) increase the breakdown of Vitamin D and minimize calcium absorption.
• Atorvastatin (lipitor). Taking Vitamin D might affect the way your body procedures this cholesterol drug.
• Calcipotriene (dovonex, sorilux). Don’t take Vitamin D with this psoriasis drug. The mix might increase the risk of excessive calcium in the blood (hypercalcemia).
• Cholestyramine (prevalite). Taking Vitamin D with this cholesterol-lowering drug can decrease your absorption of Vitamin D.
• Cytochrome p-450 3a4 (cyp3a4) substrates. Usage Vitamin D meticulously if you’re taking drugs processed by these enzymes.
• Digoxin (lanoxin). Avoid taking high doses of Vitamin D with this heart medication. High dosages of Vitamin D can cause hypercalcemia, which increases the risk of deadly heart problems with digoxin.
• Diltiazem (cardizem, tiazac, others). Avoid taking high doses of Vitamin D with this blood pressure drug. High doses of Vitamin D can cause hypercalcemia, which might decrease the drug’s effectiveness.
• Orlistat (xenical, alli). Taking this weight-loss drug can lower your absorption of Vitamin D.
• Thiazide diuretics. Taking these blood pressure drugs with Vitamin D increases your danger of hypercalcemia.
• Taking steroid mediations such as prednisone can decrease calcium absorption and impair your body’s processing of Vitamin D.
• Stimulant laxatives. Long-term use of high dosages of stimulant laxatives can minimize Vitamin D and calcium absorption.
• Verapamil (verelan, calan sr). Taking high doses of Vitamin D with this high blood pressure drug can cause hypercalcemia, and might also reduce the efficiency of verapamil. (9 )

Warnings

This medication consists of Vitamin D. Do not take drisdol, calciferol, cholecalciferol, 1,25-dihydroxycholecalciferol, or ergocalciferol if you dislike Vitamin D or any ingredients consisted of in this drug.

Keep out of reach of kids. In case of overdose, get medical help or get in touch with a toxin control center right away.

Cautions

• Ergocalciferol: use with care in kidney impairment (strong caution), heart problem, kidney stones, arteriosclerosis.
• Acquire serum calcium two times weekly during titration.
• Stop if the patient ends up being hypercalcemic.
• The presence of tartrazine in some products might trigger allergies.
• Vitamin D toxicity may last >> 2 months after treatment is ceased.
• Limit consumption in infants with idiopathic hypercalcemia.
• Concurrent use of heart glycosides.
• Sufficient scientific action to Vitamin D therapy is dependent on adequate dietary calcium.
• Keep normal serum phosphorous concentrations in clients dealt with for hyperphosphatemia to prevent metastatic calcification.
• When treating hypoparathyroidism, concomitant treatment with intravenous calcium, parathyroid hormone, and/or dihydrotachysterol might also be needed.
• Grownups with a body mass index (bmi) greater than 30 kg/m ² are at high risk for Vitamin D shortage due to storage of Vitamin D in fat; dosages higher than recommended everyday allowance may be needed however must be carefully kept track of to prevent toxicity.
• In kidney problems, supplementation with ergocalciferol might be necessary; display closely.
• In clients with rickets, the range between therapeutic and toxic dosages is narrow in Vitamin D– resistant patients; change dosage based upon scientific action to avoid toxicity.

Pregnancy and lactation

Use Vitamin D with caution during pregnancy if the advantages outweigh the threats. Animal research studies show threat and human studies are not offered, or neither animal nor human studies are done. Vitamin D is distributed into breast milk; use with care while breastfeeding. (10 ).

Conclusion

It is commonly accepted that Vitamin D is essential for the maintenance of skeletal health and collecting evidence suggests that Vitamin D deficiency is an independent risk element for different extra-skeletal diseases consisting of cancer. Whether Vitamin D is just a marker of risk or has in fact some beneficial impacts on non-skeletal illness remains to be illuminated. Therefore, current suggestions concerning preventive medicine must be based upon skeletal results of Vitamin D. While rdas have actually recently been released for Vitamin D, it is also evident that there is a huge gap between these suggestions and the authentic Vitamin D consumption and Vitamin D status in the basic population. Health experts and public health authorities are, for that reason, motivated to position even more emphasis on combating Vitamin D shortage. Potential methods include food fortification for the basic population, Vitamin D supplementation in at-risk people such as the senior, and by advocating lifestyle adjustments such as outdoor exercise for the avoidance of obesity with careful and balanced sunshine direct exposure, and a healthy diet. Though, in addition, studies developed to figure out the most ideal and efficient methods in achieving a physiologic and healthy Vitamin D status are urgently needed. (11 ).

References

1. Https://www.cancer.gov/publications/dictionaries/cancer-terms/def/vitamin-d
2. Https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/vitamin-d
3. https://www.sciencedirect.com/science/article/abs/pii/S1047279708003190
4. Https://en.wikipedia.org/wiki/vitamin_d#mechanism_of_action
5. Https://www.health.com/nutrition/vitamins-supplements/vitamin-d-benefits
6. Https://blog.theralogix.com/vitamin-d-benefits-for-men/
7. Https://www.medicalnewstoday.com/articles/322602#side-effects
8. Https://www.webmd.com/vitamins/ai/ingredientmono-929/vitamin-d
9. Https://www.mayoclinic.org/drugs-supplements-vitamin-d/art-20363792
10. Https://www.rxlist.com/consumer_vitamin-d/drugs-condition.htm
11. Https://ar.iiarjournals.org/content/35/2/1161