Team:KCIS NewTaipei/Human Practices

Human Practice

The Human Practice group coordinated with individuals in and out of our team. The human practice reached out to specialists and professionals to gain more insights into probiotics and vitamin D for our project.

We started off with a public opinion survey to investigate people’s current understanding of vitamin D and vitamin D deficiency in order to gain feedback on our project. The Human Practice team also arranged several educational forums where we presented to a wide range of audiences about the importance of vitamin D. According to our survey, very few people are aware of the importance of vitamin D. Therefore, we posted several posts on Instagram about vitamins in hopes to reach a larger audience to educate. Currently, Tik-Tok is a rising social media platform where people all around the world are using. Therefore, we decided to spread the importance of vitamin D by filming short educational videos on tik tok!
In June, we made a survey to collect data on the demand for our product and the public’s knowledge on vitamin D deficiency. The survey was sent out to different regions around the world, including Asia, North America, Europe, etc. We post an Instagram story to announce the survey and post the link in our account profile to welcome everyone to fill it out for us. Our members also sent it to our classmates, teachers, and relatives in different countries, asking them to share the survey to people around them. We received a total of 1355 anonymous responses in 12 days and collected the data in the following graph below.

The majority of our participants’ ages lie between 18 to 55, and only some participants are 0~17 years old or 56~75 years old. More than half of our participants(63.8%) are female, while the rest 35.5% being males and 0.7% of participants who are unable to disclose. As all of our team members are from Taiwan, we lived in a Taiwanese community. Thus, the majority of our participants currently live in Taiwan as well, the survey results are more likely to reflect the situation in Taiwan.
*Referring to Fig 1., 2., 3.
*Fig. 1 Age of Participants
*Fig. 2 Gender of Participants
*Fig. 3 Where did you take the survey?
Most of our participants (74.2%) responded that they are aware of their vitamin D intake, and know vitamin D is essential for their health. However, due to the pandemic, people tend to have fewer chances to go outdoors. Out of 1355 responses, 71.2% of the participants spent less than 3 day outdoors within the past 2 weeks, indicating how people have less exposure to sunlight, a vital source of vitamin D. Our survey also shows 36.0% of the participants rely on sunlight as their main vitamin D source; 18.3% of the participants, on the other hand, are unclear on how they receive vitamin D on a daily basis.
*Referring to Fig 4.,5., 6., 7.
*Fig 4. Have you ever paid attention to your intake amount of Vitamin D?
*Fig 5. On a scale of 1-10, how important do you think Vitamin D is for your body?
*Fig 6. Time spent outdoors in last 2 weeks
*Fig 7. How do you usually take in Vitamin D?
While most individuals take vitamin D on a regular basis, 58.9% of people are not sure whether or not supplements work, and only 26.6% of them think it does make a difference. We can infer from the results how a majority of individuals are unsure about vitamin D supplements’ utility, proving the necessity of our product. Since our product can be seamlessly incorporated into people’s daily diets, it can have a much greater impact than supplements and other current solutions.
*Referring to Fig 8. & 9.
*Fig 8. How often do you take Vitamin D supplements?
*Fig 9. Do you feel that Vitamin D supplements work?
86.9% of communities acknowledge vitamin D deficiency as a serious problem. For the following question in the survey, we asked for a free response answer on why vitamin D is a problem. Out of 1355 responses, more than half (51.7%) are unsure, while 43.3% focus on its negative impacts on bone growth.
*Referring to Fig 10. & 11.
*Fig 10. Do you think Vitamin D deficiency is a serious issue for human health?
*Fig 11. Why do you think Vitamin D is a problem?
Fermented foods are habitually eaten around the world. In Asia, there is kimchi for Korean, and miso for Japanese, while in western countries there is Greek yogurt for Greece, and pickles in America. Our survey reassured our assumption that fermented food is consumed on a global scale. More than half of the participants (51.5%) eat more than one kind of fermented food on a daily basis. The internationally spread culture assists our product to be used world-widely, helping to prevent the patient of vitamin D deficiency effectively.
*Referring to Fig 12. & 13.
*Fig 12. What kind of fermented food do you eat?
*Fig 13. Do you eat any fermented food in your daily life?
In the survey, 28.7% of the population ate fermented products for more than one meal a week, while another 20.2% ate these products for more than four meals a week. Although 48.7% of them consume one meal or less of fermented food within a week, we still see most of all the participants take fermentation food as part of their diets.
*Referring to Fig 14.
*Fig 14. How often do you eat fermented food?
56.3% of the population does not take probiotic supplements. 54.4% of the population remains neutral about trying our probiotics, and 25.6% of them are eager to try them. 70.1% of total responses keep a reserved attitude of using our product, most of the population claim they need more information before trying our product. Thus, the certified documents for our final products are mandatory to gain trust from the public.
*Referring to Fig 15. & 16. 17.
*Fig 15. Do you take any probiotic supplements?
*Fig 16. Would you incorporate our probiotics in your meals as a source for Vitamin D?
*Fig 17. Why or why don’t you choose our product?
In our survey, 86.8% of the population agreed on the severity of vitamin D deficiency in regards to human health. But on the follow-up question, 51.7% were unsure, suggesting that the majority of individuals are still not sure what Vitamin D deficiency is and why it is an issue. Realizing this, our education plan aims to increase public awareness on the importance of vitamin D to human health. For more information, Click here.
To successfully promote our project to the public, we analyze market trends to determine what methods best fit today's markets. We researched and collected information from our survey,organized the results, and analyzed the data.
You can find more details on our entrepreneurship page found here.
Interviewing professionals not only increases the overall credibility of our project’s concept, but also ensures the solution’s feasibility. By discussing our experiment and implementation ideas for combating vitamin D deficiency with doctors, we can gain more constructive feedback with ways of possible improvements. For interviewing professionals, our team interviewed three professionals in medicine and nutritional science: Dr. Edward Huang, Dr. Michael F. Holick, and Dr. Joseph L. Napoli.
Dr. Edward Huang
Edward Huang, MD, MPH, is a physician at Palo Alto Medical Foundation's gastroenterology department. He has done research on gut microbiota and its relations with gastrointestinal (GI) conditions.
Through our interview with Dr. Edward Huang, MD, MPH, we learned valuable knowledge regarding probiotics, a key aspect of our project. We learned that in general, it takes 3 years for bacteria to reach a mature state in which the gut microbiome remains constant. Dr. Huang stated how the types of bacteria in one’s microbiome vary according to geographical location. For example, the microbiome of someone who lives in Uganda would look different from that of someone who lives in the United States. Furthermore, suggested probiotic intake depends on the treatment or disease of that patient. People should take probiotics regularly in order to maintain the positive benefits as most probiotic strains last 1-4 weeks in the GI tract after their consumption. In fact, when determining gut microbiome makeup, we can measure the amount from stool. Also, butyrate is found in stool since it is a short chain fatty acid which is the energy substrate for the whole colon. Finally, Dr. Huang concluded that our project solution is very interesting since utilizing probiotics to treat vitamin D deficiency is not a current strategy. He also informed us on the health issues that we should consider for our project. For example, if butyrate is being overexpressed then it can cause the bacteria to die or proliferate less.
Dr. Michael F. Holick
Michael Holick, Ph.D., M.D, a professor specializing in fields of medicine, physiology, and biophysics, has changed the old understanding of vitamin D. His work includes several papers regarding the topic of vitamin D, such as reemphasizing on the issue of vitamin D deficiency, warning against dangers of lacking sunlight exposure, and isolating active forms of vitamin D, 1,25(OH)2D (Holick Receives Linus Pauling Prize for Health Research, 2009).
After our interview with Dr. Holick, we gained a deeper insight into our project. According to Dr. Holick, most probiotics reside in the GI system, including the ileum, jejunum, and colon. Yet, as 1,25(OH)2D functions in the duodenum, the butyrate and VDR produced by engineered probiotics therefore, might not end up increasing activation efficiency of vitamin D as it is more likely to reside in a different place in the human body. Furthermore, unlike 25(OH)D that can be produced locally, 1,25(OH)2D is only synthesized in the kidneys raising another question mark towards our project’s feasibility. Through the interview, Dr. Holick also stated how while our project does consist of clever concepts, it does not cure the root cause of vitamin D deficiency as it only solves calcium absorption issues. This interview with Dr. Michael F. Holick brought our team new perspectives on the topic of vitamin D deficiency and raised new questions we need to explore further.
Further Research
How will butyrate produced by the engineered probiotic affect VDR expression in the duodenum?
Butyrate increases Vitamin D Receptor expression level in a time and dose manner (Gaschott & Stein).
Dr. Joseph L. Napoli
Joseph L. Napoli, Ph.D., a professor under the department of nutritional sciences & toxicology at University of California Berkeley, has done research in metabolism, fat-soluble vitamins, vitamin D, and vitamin A. He has done research on the topic of vitamin D throughout his career.
In the interview with Dr. Napoli, we confirmed on, discovered errors in, and gained deeper insights for our original research. Firstly, Dr. Napoli mentioned that the issue of overdose of vitamin D is overexaggerated and rarely happens in real life. As Dr. Napoli stated, 1,25(OH)2D induces the transcription of certain genes. Yet, as soon as transcription starts, a specific gene is expressed to inactivate 1,25(OH)2D. This helps the ethical and safety aspect of our final product of fermentation starter as we do not need to stress too much about problems with overexpressing vitamin D. Secondly, we realized a greater issue is that overproduction of calcium contributes to causes of gastric reflux diseases, kidney stones, and other diseases. Thirdly, we were able to get confirmation that sunlight and food products have no sufficient amounts of vitamin D the human body requires for proper regulations. Lastly, new questions arose about the metabolic pathways set up for our probiotic, the survival conditions of probiotics, the butyrate dose response curve, butyrate dosage, and certain safety margins we must consider for our project. By having this interview with Dr. Joseph L. Napoli, it allowed us to get one step closer to a more feasible project as we will continue to build on the research based on feedback given.
Further research
Does VDR increase impact on signalling?
Vitamin D is either activated by vitamin D receptors (VDR) or by heterodimers consisting of VDR and the retinoid-X-receptor-α (RXR-α)(Carlberg et al., 1993). All the genomic actions of 1, 25(OH)2D all are controlled by and dependent on transcription factor vitamin D receptors (VDR). Therefore, the signalling for any vitamin D most likely suggests molecular actions of VDR in the human body (Carlberg & Campbell, 2013).
Looking at all three interviews, not only did we gain professional feedback from different doctors specializing in different fields, but also gained more insight into probiotics, Vitamin D, and VDR. By connecting different information collected from the interviews, our team had a better understanding of how our project will process and what we need to improve on for a better solution to vitamin D deficiency.
Holick Receives Linus Pauling Prize for Health Research | School of Medicine. (2009).

Joseph L. Napoli | Research UC Berkeley. (2021).

Gaschott, Tanja, and Jürgen Stein. “Short-chain fatty acids and colon cancer cells: the vitamin D receptor--butyrate connection.” Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer vol. 164 (2003): 247-57. doi:10.1007/978-3-642-55580-0_18

Carlberg, C., Bendik, I., Wyss, A., Meier, E., Sturzenbecker, L. J., Grippo, J. F., & Hunziker, W. (1993). Two nuclear signalling pathways for vitamin D. Nature, 361(6413), 657–660.

Carlberg, C., & Campbell, M. J. (2013). Vitamin D receptor signaling mechanisms: Integrated actions of a well-defined transcription factor. Steroids, 78(2), 127–136.

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