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vitamin D
維生素 D 是一種「陽光」維生素,我們可以在陽光下免費獲得。
​但維生素 D 有什麼用呢?除了曬太陽,我怎麼攝取它? 
維生素D是一種脂溶性維生素,可促進鈣的吸收,調節骨骼生長,在免疫功能中起重要作用。
維生素 D2(麥角鈣化醇)和 D3(膽鈣化醇)是最常見的兩種形式。[1][2]
Vitamin D is a ‘sunshine’ vitamin that you get it for free under sunlight. But what is vitamin D for? Apart from sunlight, how can I get it? 
Vitamin D is a fat-soluble vitamin that promotes the absorption of calcium, regulates bone growth and plays an important role in immune function. Vitamin D2 (ergocalciferol) and D3 (cholecalciferol) are the two forms that most seen. [1][2]
function vitamin D enhance efficiency innate immunity
當有害細菌、真菌和病毒進入我們身體時,我們的身體擁有自然殺傷細胞和巨噬細胞,以及其他免疫細胞,能夠識別、吞噬和破壞病原體。他們就像是為了摧毀敵人的營地而戰鬥的士兵。
當先天免疫系統被激活時,維生素D與某些細胞結合,增強它們表達、轉化和促進殺滅病原體的效率,從而幫助先天免疫系統殺死病毒。 [3][4][5]
When facing harmful bacteria, fungi and viruses that enters us, our body has natural killer cells and macrophages, along with other immune cells, recognize, engulf and destroy pathogens. They are like soldiers that fight to destroy the enemy’s camp.
When the innate immune system is activated, Vitamin D binds to certain cells to enhance the expression, transformation and promote the efficiency in killing pathogens, thus helping the innate immune system to kill viruses. [3][4][5]
function vitamin D calm adaptive immune anti-inflammation
後天免疫系統的細胞產生細胞因子—是種吸引更多免疫細胞並引發炎症的小蛋白質。但有時,細胞因子可能會變得過多而產生「細胞因子風暴」。發生細胞因子風暴時,免疫細胞會擴散到受感染的身體部位並攻擊本是健康的組織。
維生素 D 能結合後天免疫系統的細胞來提供抗炎作用。維生素 D 可以鎮靜後天免疫系統,使細胞產生更少的細胞因子,減少炎症和發生細胞因子風暴的可能性。 [3]
Cells of the adaptive immune system produce cytokines – small proteins that attract more immune cells and trigger inflammation. But sometimes, cytokines may become too abundant and create a cytokine storm – when immune cells spread beyond infected body parts and attack healthy tissue.
Vitamin D provides anti-inflammatory effect by binding to the cells of the adaptive immune system and turns some genes on while switching others off. Vitamin D calms the adaptive immune system, causing cells to produce fewer cytokines, reducing inflammation and the possibility of cytokine storm. [3]

新冠肺炎 和 維生素 D
COVID-19 & Vitamin D

insufficient vitamin D higher risk of COVID infection and severe disease
COVID-19 (SARS-CoV-2) 新冠肺炎病毒會誘導細胞因子產生和發炎反應。高水平的細胞因子風暴綜合症可能是 COVID-19 疾病嚴重程度的關鍵標誌之一,如上所述,維生素D可以降低細胞因子風暴的可能性。有充分證據表明,維生素 D 對於正常的免疫和肺功能、對抗病原體和預防自身免疫性疾病至關重要。[6]
最新研究發現,維生素 D 水平與感染 SARS-CoV-2 和感染者患嚴重疾病的風險之間存在負相關關係,即維生素 D 水平愈低,感染新冠肺炎及患嚴重疾病的風險愈高。 [7]
缺乏維生素 D 的人患 COVID-19 (SARS-CoV-2) 重症或危重症的可能性要高出 14 倍。 維生素 D 水平不足的患者死亡率為 25.6%,而維生素 D 水平充足的患者死亡率只為 2.3%。 [8][9][10]
而維生素 D 補充劑則可透過保持免疫系統平衡來預防急性呼吸道感染,就像體操運動員在平衡木上行走一樣。 [6][11]
COVID-19 (SARS-CoV-2) viruses induces cytokine production and pro-inflammatory responses. High levels of cytokine storm syndrome may be one of the critical hallmarks of COVID-19 disease severity. As mentioned above, vitamin D can reduce the possibility of cytokine storm. Vitamin D, with ample evidence, is essential for normal immune and lung functions to fight pathogens and prevent autoimmune diseases. [6]
An inverse correlation was demonstrated between the level of vitamin D and the risks of COVID-19 infection and of severe disease in those infected. This means the lower level of vitamin D will have higher risk of COVID-19 infection and severe disease. [7]
Studies found that people with vitamin D deficiency were 14 times more likely to have a severe or critical case of COVID-19. The mortality rate for those with insufficient vitamin D levels was 25.6%, compared with 2.3% among those with adequate levels. [8][9][10]
The latest research suggested the potential of vitamin D supplementation to prevent acute respiratory infection by keeping the immune system balanced, just like a gymnast walking on a balance beam. [6][11]

如何攝取維生素 D
How to get vitamin D

sunlight
當我們的身體在陽光下時,來自陽光的紫外線 B (UVB) 輻射會觸發皮膚形成維生素 D3,我們的身體懂得自我平衡,不會因曬太長時間導致累積過量的維生素D。 [1][2]
注意: UVB是不能穿透玻璃進入室內的,所以曬太陽不可留在室內。而塗防曬乳也會阻擋 UVB 進入皮膚,所以建議大家只塗臉部好了,手腳留些空間讓皮膚為你製造維生素D吧!
​​When our body is under the sun, ultraviolet B (UVB) radiation from sunlight triggers the formation of vitamin D3 in skin, and our body knows how to balance itself so that it doesn't accumulate excess vitamin D from prolonged exposure. [1][2]
But note that UVB cannot penetrate glasses and enter indoor, so we have to get out and enjoy the sunlight! Applying sunscreen will also block UVB from entering the skin, so it is recommended that you only apply it to your face, leaving some space on your hands and feet to allow your skin to make some vitamin D for you!
eat meal
除了走出室外暴露在陽光下,我們還可以通過飲食獲得維生素D。 維生素 D3 僅存在於動物源性食物中,而 D2 主要來自植物源食物。
​Apart from exposing to sunlight, we can obtain vitamin D through our diet. Vitamin D3 is only found in animal-sourced foods, whereas D2 mainly comes from plant sources.

每日基本攝取量
Essential Daily Intake

最好攝取維生素 D的方法當然是從天然的食物和曬太陽。
一個澳洲的研究建議,在未塗抹防曬品的情況下,於上午 10 點到下午 3 點日照較強的時段,每週 3 至 4 次將臉部、手臂及手掌日曬 10 至 15 分鐘,即可獲得足夠的維生素D。如果曝曬超過15分鐘之後,陽光就會把皮膚底下已生成的維他命D轉化成其他的物質,然後代謝掉,所以有效吸收時間為15分鐘。[12][13]
每日建議從食物中攝取維生素 D 的量為每天800 IU (20 mcg)。若你不可得到足夠的陽光,你的攝取量可能要增加至每日 1,000 IU (25 mcg)。 [2][14]
It is best to get vitamin D from food and exposing to sunlight. 
An Australian study found around 10–15 minutes of sun exposure at around 10:00 or 15:00 three to four times per week should be enough for fair-skinned people to produce recommended vitamin D levels. Longer the exposure time, more the vitamin D produced? Sorry no. If exposed to the sun for more than 15 minutes, the sunlight will convert the vitamin D that has been generated under the skin and metabolize them into other substances. The effective absorption time is found to be 15 minutes. [12][13]
The recommended daily value is 800 IU (20 mcg) of vitamin D per day from foods. If you don’t get enough sunlight, your intake should likely be closer to 1,000 IU (25 mcg) per day. [2][14]
vitamin D rich food chart
由於維生素 D 是脂溶性的,因此最好與含有一些脂肪的膳食或食物一起進食。
若你正在考慮進食維生素 D補充劑,也要必須注意不要過量攝取。最好的方法是先抽血檢查自己血液裡的維生素D水平才決定進食補充劑的分量。 [15]
Since vitamin D is fat-soluble, it is best absorbed when taken with a meal or snack that includes some fat.
However, for those that look for vitamin D supplementation, you have to be aware of overdosage. It is recommended to test the level of vitamin D in your blood before you take any supplementation. [15]

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參考資料 References:
[1] Vitamin D2 vs. D3: What’s the Difference?, Healthline, https://www.healthline.com/health/high-cholesterol/statins-vitamin-d-connection#takeaway Accessed March 12, 2022.
[2] Vitamin D - Fact Sheet for Consumers. NIH website. https://ods.od.nih.gov/factsheets/VitaminD-Consumer/ Published March 22, 2021. Accessed March 12, 2022.
[3] Karina Zaiets, Ramon Padilla, Veronica Bravo, Can vitamin D help with symptoms of COVID-19? Possibly, it's key to helping your immune system function, USA Today website https://www.usatoday.com/in-depth/news/2020/06/09/vitamin-d-and-covid-19-could-low-vitamin-d-levels-affect-coronavirus/5274331002/  Published Jun. 11, 2020, Accessed Mar 26, 2022.
[4] Small, A.G., Harvey, S., Kaur, J. et al. Vitamin D upregulates the macrophage complement receptor immunoglobulin in innate immunity to microbial pathogens. Commun Biol 4, 401 (2021). https://doi.org/10.1038/s42003-021-01943-3
[5] Lagishetty V, Liu NQ, Hewison M. Vitamin D metabolism and innate immunity. Mol Cell Endocrinol. 2011;347(1-2):97-105. doi:10.1016/j.mce.2011.04.015 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200473/
[6] Bayraktar, N, Turan, H, Bayraktar, M, Ozturk, A, Erdoğdu, H. Analysis of serum cytokine and protective vitamin D levels in severe cases of COVID-19. J Med Virol. 2021; 94: 154- 160. https://doi.org/10.1002/jmv.27294
[7] Israel, Ariel et al. “Vitamin D deficiency is associated with higher risks for SARS-CoV-2 infection and COVID-19 severity: a retrospective case-control study.” Internal and emergency medicine, 1–11. 9 Jan. 2022, doi:10.1007/s11739-021-02902-w https://pubmed.ncbi.nlm.nih.gov/35000118/
[8] Dror AA, Morozov N, Daoud A, Namir Y, Yakir O, et al. (2022) “Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness”, PLOS ONE 17(2): e0263069, 3 Feb 2022 https://doi.org/10.1371/journal.pone.0263069
[9] Study: Vitamin D Deficiency Linked to Severe COVID, https://www.webmd.com/lung/news/20220208/vitamin-d-deficiency-tied-to-severe-covid Accessed March 12, 2022.
[10] Nathan Jeffay, Israeli study offers strongest proof yet of vitamin D’s power to fight COVID, https://www.timesofisrael.com/israeli-study-offers-strongest-proof-yet-of-vitamin-ds-power-to-fight-covid/ Published Feb 3 2022, Accessed March 12, 2022.
[11] National Institutes of Health. Low Vitamin D Levels Associated with Colds and Flu. NIH website. https://www.nih.gov/news-events/nih-research-matters/low-vitamin-d-levels-associated-colds-flu.  Published March 9, 2009. Accessed March 12, 2022.
[12] 江坤俊醫師, 狂曬太陽補充維他命D?醫師說要這樣做才不會白曬, https://health.udn.com/health/story/6008/3062366 , Published Apr 2, 2018. Accessed March 31, 2022.
[13] Samanek, A. J., Croager, E. J., Gies, P., Milne, E., Prince, R., McMichael, A. J., … & Slevin, T. (2006). Estimates of beneficial and harmful sun exposure times during the year for major Australian population centres. The Medical Journal of Australia, 184(7), 338-341. https://www.mja.com.au/journal/2006/184/7/estimates-beneficial-and-harmful-sun-exposure-times-during-year-major-australian
[14] Lu Z, Chen TC, Zhang A, et al. An evaluation of the vitamin D3 content in fish: Is the vitamin D content adequate to satisfy the dietary requirement for vitamin D?. J Steroid Biochem Mol Biol. 2007;103(3-5):642-644. doi:10.1016/j.jsbmb.2006.12.010 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2698592/
[15] 維生素D這樣吃,才不會中毒!| 林侑融 美國自然醫學醫師 EP.22 https://www.youtube.com/watch?v=cWukzfvIRPw
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