We analyzed how magnesium supplementation affects the biology of rheumatoid arthritis (RA) in mice. By feeding one group a diet rich in magnesium and another a standard diet over 15 days, we examined changes in their tissue responses.
Our findings revealed that increased magnesium intake may alter gene expression linked to oxidative stress and cellular aging, processes that are significant in RA development. This suggests that magnesium could be beneficial for managing RA and potentially other autoimmune disorders by reducing disease severity and joint damage.
Read More
9
Magnesium may reduce lupus severity
Revised version with tracked changes oral Magnesium reduces levels of pathogenic autoantibodies and skin disease in murine lupus.
We investigated how magnesium (Mg) affects the severity of autoimmune lupus in mice. By feeding MRL/lpr female mice a standard or high magnesium diet for nine weeks, we measured impacts on skin lesions and pathogenic autoantibodies.
The results were encouraging: mice on the high magnesium diet showed significant reductions in skin issues and harmful anti-dsDNA antibodies. Plus, their immune systems displayed more regulatory T cells. However, there were no notable differences in other measured health indicators.
Overall, magnesium supplementation may be a cost-effective and safe complementary treatment for lupus.
Read More
8
Magnesium shows promise for NMOSD
Effects of long-term magnesium L-threonate supplementation on neuroinflammation, demyelination and blood-brain barrier integrity in mice with neuromyelitis optica spectrum disorder.
Our investigation focused on how magnesium L-threonate might help those with neuromyelitis optica spectrum disorder (NMOSD).
We examined both mice and cultured human cells to see if long-term magnesium treatment could reduce neuroinflammation, demyelination, and strengthen the blood-brain barrier.
The results were promising; magnesium supplementation appeared to alleviate damage linked to NMOSD by improving blood-brain barrier integrity and dampening inflammation.
This suggests magnesium could be a novel approach to treating NMOSD.
Read More
Most Useful Reviews
9
Strong nails improvement
94 people found this helpful
Very high-quality calcium combined with magnesium. I’ve been using NowFoods products for a while, and this calcium to magnesium blend did not disappoint. My nails, which weren't strong naturally, became noticeably stronger and shinier. I also had issues with tooth enamel, but now I don’t feel sensitivity to acids or temperature. Magnesium has helped me manage stress, making me calmer. I confidently recommend this supplement for strengthening nails, teeth, and supporting bone health and the nervous system.
Read More
9
Improved joint health
7 people found this helpful
This calcium has been wonderful! I started taking it regularly six months ago on my doctor’s advice, primarily for my rheumatoid arthritis. Among many brands I've tried, this one has no side effects and is well absorbed. My nails no longer separate, and I no longer have stomach aches. I've also been sleeping better, which I attribute to magnesium. This is now a regular purchase for my family and me, as I believe daily calcium is essential for health.
Read More
9
Joint pain relief
4 people found this helpful
This is my first product from iHerb. I noted various symptoms like joint pain and fatigue after childbirth due to a calcium and magnesium deficiency. I have been taking it for over ten days, and I feel none of those symptoms now! I am quite pleased with the results.
We investigated how calcium, specifically in the form of two-dimensional layered calcium disilicide nanoparticles (CSNs), can play a role in treating rheumatoid arthritis (RA). Unlike typical RA treatments that primarily focus on reducing inflammation, we observed that CSNs have multifunctional properties that can address the inflammatory aspect while also promoting bone health and repair.
Through a process called hydrolysis, CSNs release several beneficial components, including hydrogen gas, calcium hydroxide, and silica. Each of these components contributes uniquely: hydrogen helps reduce harmful radicals and aids in adjusting surrounding immune cell behavior; calcium hydroxide counters the acidity that can worsen bone loss; and dissolved calcium works with phosphates to encourage bone formation.
We found that the application of CSNs had promising results in tests conducted on both mouse and rabbit models of arthritis. This approach not only targets inflammation but also fosters a healthier bone environment, showing potential as a strong therapeutic option for those living with RA. With high biocompatibility and prospects for clinical transformation, this research suggests a new direction in handling autoimmune disorders using calcium-based therapies.
Read More
9
Magnesium shows promise for RA treatment
Magnesium Supplementation Modifies Arthritis Synovial and Splenic Transcriptomic Signatures Including Ferroptosis and Cell Senescence Biological Pathways.
We analyzed how magnesium supplementation affects the biology of rheumatoid arthritis (RA) in mice. By feeding one group a diet rich in magnesium and another a standard diet over 15 days, we examined changes in their tissue responses.
Our findings revealed that increased magnesium intake may alter gene expression linked to oxidative stress and cellular aging, processes that are significant in RA development. This suggests that magnesium could be beneficial for managing RA and potentially other autoimmune disorders by reducing disease severity and joint damage.
Read More
9
Magnesium may reduce lupus severity
Revised version with tracked changes oral Magnesium reduces levels of pathogenic autoantibodies and skin disease in murine lupus.
We investigated how magnesium (Mg) affects the severity of autoimmune lupus in mice. By feeding MRL/lpr female mice a standard or high magnesium diet for nine weeks, we measured impacts on skin lesions and pathogenic autoantibodies.
The results were encouraging: mice on the high magnesium diet showed significant reductions in skin issues and harmful anti-dsDNA antibodies. Plus, their immune systems displayed more regulatory T cells. However, there were no notable differences in other measured health indicators.
Overall, magnesium supplementation may be a cost-effective and safe complementary treatment for lupus.
Read More
9
Magnesium-based therapy for RA
Anti-Acidification and Immune Regulation by Nano-Ceria-Loaded Mg-Al Layered Double Hydroxide for Rheumatoid Arthritis Therapy.
We explored the potential of a new magnesium-aluminum layered double hydroxide combined with nano-ceria in treating rheumatoid arthritis (RA). This innovative therapy targets the unhealthy immune environment and the harmful buildup of hydrogen ions associated with RA. By neutralizing excess acidity, we observed improved immune responses, encouraging the body to heal damaged bones. This approach showed promising results in mice models, indicating it may be a viable future treatment for managing RA effectively.
Read More
9
Magnesium aids arthritis through immunity
Magnesium increases numbers of Foxp3+ Treg cells and reduces arthritis severity and joint damage in an IL-10-dependent manner mediated by the intestinal microbiome.
We explored the effects of a high magnesium diet on rheumatoid arthritis using two mouse models. Our findings suggest that magnesium can significantly reduce arthritis severity and joint damage, while also promoting immune cell types that help combat inflammation.
Interestingly, these benefits seem to hinge on an immune mediator called IL-10 and changes in the gut microbiome, such as increased beneficial bacteria. While our results are promising, it is important to recognize that the protective effects depend on sufficient levels of IL-10, indicating that the relationship between magnesium and immune regulation is quite intricate.
Very high-quality calcium combined with magnesium. I’ve been using NowFoods products for a while, and this calcium to magnesium blend did not disappoint. My nails, which weren't strong naturally, became noticeably stronger and shinier. I also had issues with tooth enamel, but now I don’t feel sensitivity to acids or temperature. Magnesium has helped me manage stress, making me calmer. I confidently recommend this supplement for strengthening nails, teeth, and supporting bone health and the nervous system.
Read More
9
Improved joint health
7 people found this helpful
This calcium has been wonderful! I started taking it regularly six months ago on my doctor’s advice, primarily for my rheumatoid arthritis. Among many brands I've tried, this one has no side effects and is well absorbed. My nails no longer separate, and I no longer have stomach aches. I've also been sleeping better, which I attribute to magnesium. This is now a regular purchase for my family and me, as I believe daily calcium is essential for health.
Read More
9
Joint pain relief
4 people found this helpful
This is my first product from iHerb. I noted various symptoms like joint pain and fatigue after childbirth due to a calcium and magnesium deficiency. I have been taking it for over ten days, and I feel none of those symptoms now! I am quite pleased with the results.
Read More
9
Osteoporosis relief
3 people found this helpful
I periodically order these for my 71-year-old mother. She no longer experiences hand numbness while sleeping, and her sleep has improved. With an osteoporosis diagnosis, we alternate courses of glucosamine/chondroitin with calcium/magnesium, resulting in significantly better health and less joint pain.
Read More
9
Improved sleep quality
3 people found this helpful
Best sleep! I previously struggled with anxiety and superficial sleep, waking up constantly and feeling exhausted. Now, I sleep through the night without waking. I used to experience issues like flattening of my toes, but that's no longer a problem. Initially, I took magnesium citrate without much change, but this product has proven to be effective.
An autoimmune disorder occurs when the body's immune system mistakenly attacks its own healthy cells and tissues, believing them to be foreign invaders, such as bacteria or viruses. This reaction can lead to inflammation, tissue damage, and impaired function of the affected organs. There are over 80 known autoimmune diseases, including rheumatoid arthritis, lupus, multiple sclerosis, and type 1 diabetes, each with its own specific symptoms and treatment options. The exact cause of these disorders is still unclear, but a combination of genetic, environmental, and hormonal factors is believed to play a role in their development.
Diagnosis of autoimmune disorders often involves a combination of physical examinations, assessment of symptoms, blood tests, and imaging studies to evaluate organ involvement. Treatment typically focuses on managing symptoms and controlling the immune response using medications such as corticosteroids, immunosuppressants, and biologics. In addition to medication, lifestyle modifications, such as stress management and a balanced diet, can be beneficial in managing symptoms. If you suspect you have an autoimmune condition, it's important to consult a healthcare professional for proper evaluation and tailored treatment options.
Calcium magnesium refers to a dietary supplement that combines two essential minerals, calcium and magnesium, which play critical roles in maintaining various bodily functions. Calcium is vital for building and maintaining strong bones and teeth, while magnesium supports muscle function, energy production, and the regulation of calcium levels in the body. Together, these minerals work synergistically to promote overall health, particularly in areas such as bone density, cardiovascular health, and muscle function.
Supplements that contain both calcium and magnesium can be particularly beneficial for individuals who may be deficient in these minerals due to dietary restrictions or health conditions. They are available in various forms, including tablets, capsules, and powders. When considering a calcium magnesium supplement, it's essential to choose a product with the right ratio of these minerals, as well as other supporting vitamins and minerals like vitamin D, which enhances calcium absorption. Always consult with a healthcare provider before starting any new supplement regimen to ensure it aligns with your health needs and goals.
Calcium and magnesium are essential minerals that play vital roles in various bodily functions, including immune system regulation. While they contribute to overall health, the evidence supporting their use specifically for autoimmune disorders is limited. Some studies suggest that adequate levels of magnesium may help reduce inflammation and support immune function, which could be beneficial for individuals with autoimmune conditions. However, it's important to note that these minerals are not a cure for autoimmune disorders and should not replace conventional treatment methods prescribed by healthcare professionals.
If you're considering calcium and magnesium supplementation, it's essential to consult with a healthcare provider to ensure it fits within your overall treatment plan. They can help assess your individual needs, potential interactions with medications, and the appropriate dosages. Remember, managing autoimmune disorders typically involves a comprehensive approach including medications, lifestyle changes, and sometimes dietary adjustments. While minerals like calcium and magnesium can support your overall health, they should be viewed as part of a broader strategy rather than a primary solution for autoimmune issues.
Based on user reviews, the time it typically takes to see results from calcium and magnesium supplements for autoimmune disorders varies. Some users report experiencing significant benefits after just a few weeks. For instance, one user mentioned feeling relief from symptoms like fatigue and joint pain after only ten days of use Read Review. Another reviewer stated that they felt improvements in sleep and overall well-being after a month Read Review.
However, results can also take longer to manifest. A user shared that they noticed effectiveness after four months, which included a reduction in leg cramps and anxiety Read Review. Ultimately, while some individuals may see positive results in as little as a week, others might require several months of consistent use to experience noticeable changes in their autoimmune symptoms.
The research surrounding supplements, particularly magnesium and calcium-based therapies, provides compelling insights into their potential for treating autoimmune disorders. A study focusing on calcium nanosheets indicates that this form of calcium can not only target inflammation but also enhance bone health in patients with rheumatoid arthritis (RA), which could represent a significant advancement in treatment options [1]. Furthermore, other studies highlight magnesium's promising roles in various autoimmune conditions, including its ability to reduce disease severity and joint damage in RA, as well as its beneficial effects on immune regulation and inflammatory response [10].
In addition to RA, research also suggests magnesium supplementation may alleviate symptoms in other conditions like neuromyelitis optica spectrum disorder (NMOSD) and lupus, showcasing its multifaceted therapeutic potential [4][6]. These findings collectively suggest that both calcium and magnesium supplements are well-supported by scientific research as viable options for managing various autoimmune disorders, offering patients new hope for treatment strategies tailored to their specific conditions.
Based on user reviews, many individuals have reported a range of improvements in their symptoms after taking calcium and magnesium supplements. A common theme among users is enhanced nail and tooth health; one reviewer noticed stronger, shinier nails and reduced sensitivity in tooth enamel after using the supplement Read Review. Others have experienced better sleep quality, with users noting they fall asleep more easily and stay asleep throughout the night, attributing these improvements to magnesium's calming effects Read Review.
In addition to sleep improvements, users have shared significant relief from joint pain and cramping. One user reported the disappearance of leg cramps after four months of use Read Review. Another noted that after a few weeks, symptoms of joint pain and fatigue postpartum were completely alleviated Read Review. While individual experiences do vary, these testimonials suggest that many have found notable benefits from this supplement in improving both their physical comfort and overall health.
Based on user reviews, many individuals have reported positive experiences when combining calcium and magnesium supplements with other supplements for managing autoimmune disorders. For instance, one user mentioned that they alternate their calcium and magnesium intake with glucosamine and chondroitin and have noticed significant improvements in joint health Read Review. Another reviewer highlighted that combining the supplement with vitamin D3 and omega oils enhanced the absorption of calcium, leading to better health outcomes overall Read Review.
However, not all experiences have been positive. A user reported adverse reactions resembling an autoimmune disorder, including painful knees after starting the supplement, prompting them to stop usage Read Review. Another individual faced severe side effects, including kidney pain, after using the product quickly without sufficient research Read Review. These mixed experiences suggest that while many find success in using these supplements with others for autoimmune support, it's essential for users to proceed with caution and consult healthcare professionals when considering new supplement combinations.
Users report varying experiences when it comes to the right dose of Calcium Magnesium for treating autoimmune disorders. Many find relief from symptoms like joint pain and fatigue, with some attributing improved bone health and sleep quality to the combination of calcium and magnesium. For instance, one user noted a significant reduction in joint pain and improved sleep after starting to take the supplement based on their doctor’s recommendation for rheumatoid arthritis Read Review. Another mentioned that her hand joints stopped hurting after taking the product in cycles, suggesting some users find periodic dosing effective Read Review.
However, others have reported negative effects, such as severe pain and discomfort after starting the supplement, which indicates that individual responses can vary widely Read Review. One review pointed out that the form of calcium and magnesium also matters, leading some to prefer more absorbable chelate forms after unsatisfactory results with other products Read Review. It’s clear from the reviews that while many users have found success with calcium and magnesium for autoimmune issues, they also emphasize the importance of finding the right formulation and dosage for individual needs.
9
Joint pain relief
4 people found this helpful
This is my first product from iHerb. I noted various symptoms like joint pain and fatigue after childbirth due to a calcium and magnesium deficiency. I have been taking it for over ten days, and I feel none of those symptoms now! I am quite pleased with the results.
9
Nervous system improvement
3 people found this helpful
This is my first order from iHerb. The large packaging impressed me, as I usually overpay for smaller sizes locally. I've been taking these vitamins for a month, and I’ve noticed a benefit in strengthening my bones and improving my nervous system. I felt an improvement after about three weeks and wish to continue taking them.
10
Cramps alleviated
1 people found this helpful
I waited a year to use this supplement and started after my daughter was born. Now, after four months, I can say it's effective. I no longer have leg cramps during sleep or exercise. I feel calm despite being home with my child. I also think it's helped maintain my teeth and nails in good condition.
9
Strong nails improvement
94 people found this helpful
Very high-quality calcium combined with magnesium. I’ve been using NowFoods products for a while, and this calcium to magnesium blend did not disappoint. My nails, which weren't strong naturally, became noticeably stronger and shinier. I also had issues with tooth enamel, but now I don’t feel sensitivity to acids or temperature. Magnesium has helped me manage stress, making me calmer. I confidently recommend this supplement for strengthening nails, teeth, and supporting bone health and the nervous system.
9
Improved sleep
2 people found this helpful
Awesome! I've had trouble falling asleep recently, but a colleague suggested calcium and magnesium for women. I found this product, and it really helps me fall asleep easier and I wake up less during the night. My husband takes it too, and we both sleep well now. I will definitely repurchase.
9
Osteoporosis relief
3 people found this helpful
I periodically order these for my 71-year-old mother. She no longer experiences hand numbness while sleeping, and her sleep has improved. With an osteoporosis diagnosis, we alternate courses of glucosamine/chondroitin with calcium/magnesium, resulting in significantly better health and less joint pain.
9
Kidney function support
3 people found this helpful
This is an excellent supplement that I regularly take with brief interruptions. I combine it with vitamin D3 and omega to ensure that calcium is effectively utilized and not deposited in my kidneys. This is not my first order, and I plan to continue using it, as the tablets work wonderfully.
0
Discontinued use
12 people found this helpful
I regret not reading reviews before purchasing. I developed symptoms resembling an autoimmune disorder; my knees became red and painful after just a week. I stopped taking them, but they did provide relief. Now, I plan to order magnesium separately for my nerves.
0
Adverse reactions
5 people found this helpful
My first review here is a cautionary tale. After reading numerous forums, I ordered these vitamins quickly but faced serious side effects, including severe pain in my kidneys after starting them. Despite experiencing deep sleep, I had to stop taking them after a couple of days due to the discomfort.
9
Improved joint health
7 people found this helpful
This calcium has been wonderful! I started taking it regularly six months ago on my doctor’s advice, primarily for my rheumatoid arthritis. Among many brands I've tried, this one has no side effects and is well absorbed. My nails no longer separate, and I no longer have stomach aches. I've also been sleeping better, which I attribute to magnesium. This is now a regular purchase for my family and me, as I believe daily calcium is essential for health.
7.5
Joint pain reduction
4 people found this helpful
I ordered this calcium and magnesium for a friend after using it myself last spring. I have low calcium levels and take it in cycles. After completing a course, my hand joints stop hurting, and my husband's knee pain has also improved.
2
No improvement
2 people found this helpful
I took these supplements for calcium deficiency during pregnancy, but there was no noticeable effect on my health. I regret ordering such a large quantity. Next time, I will opt for a more absorbable chelate form of calcium based on better reviews.
9.5
Calcium's role in RA treatment
Hydrolysis of 2D Nanosheets Reverses Rheumatoid Arthritis Through Anti-Inflammation and Osteogenesis.
We investigated how calcium, specifically in the form of two-dimensional layered calcium disilicide nanoparticles (CSNs), can play a role in treating rheumatoid arthritis (RA). Unlike typical RA treatments that primarily focus on reducing inflammation, we observed that CSNs have multifunctional properties that can address the inflammatory aspect while also promoting bone health and repair.
Through a process called hydrolysis, CSNs release several beneficial components, including hydrogen gas, calcium hydroxide, and silica. Each of these components contributes uniquely: hydrogen helps reduce harmful radicals and aids in adjusting surrounding immune cell behavior; calcium hydroxide counters the acidity that can worsen bone loss; and dissolved calcium works with phosphates to encourage bone formation.
We found that the application of CSNs had promising results in tests conducted on both mouse and rabbit models of arthritis. This approach not only targets inflammation but also fosters a healthier bone environment, showing potential as a strong therapeutic option for those living with RA. With high biocompatibility and prospects for clinical transformation, this research suggests a new direction in handling autoimmune disorders using calcium-based therapies.
9
Magnesium aids arthritis through immunity
Magnesium increases numbers of Foxp3+ Treg cells and reduces arthritis severity and joint damage in an IL-10-dependent manner mediated by the intestinal microbiome.
We explored the effects of a high magnesium diet on rheumatoid arthritis using two mouse models. Our findings suggest that magnesium can significantly reduce arthritis severity and joint damage, while also promoting immune cell types that help combat inflammation.
Interestingly, these benefits seem to hinge on an immune mediator called IL-10 and changes in the gut microbiome, such as increased beneficial bacteria. While our results are promising, it is important to recognize that the protective effects depend on sufficient levels of IL-10, indicating that the relationship between magnesium and immune regulation is quite intricate.
8
Magnesium shows promise for NMOSD
Effects of long-term magnesium L-threonate supplementation on neuroinflammation, demyelination and blood-brain barrier integrity in mice with neuromyelitis optica spectrum disorder.
Our investigation focused on how magnesium L-threonate might help those with neuromyelitis optica spectrum disorder (NMOSD).
We examined both mice and cultured human cells to see if long-term magnesium treatment could reduce neuroinflammation, demyelination, and strengthen the blood-brain barrier.
The results were promising; magnesium supplementation appeared to alleviate damage linked to NMOSD by improving blood-brain barrier integrity and dampening inflammation.
This suggests magnesium could be a novel approach to treating NMOSD.
9
Magnesium may reduce lupus severity
Revised version with tracked changes oral Magnesium reduces levels of pathogenic autoantibodies and skin disease in murine lupus.
We investigated how magnesium (Mg) affects the severity of autoimmune lupus in mice. By feeding MRL/lpr female mice a standard or high magnesium diet for nine weeks, we measured impacts on skin lesions and pathogenic autoantibodies.
The results were encouraging: mice on the high magnesium diet showed significant reductions in skin issues and harmful anti-dsDNA antibodies. Plus, their immune systems displayed more regulatory T cells. However, there were no notable differences in other measured health indicators.
Overall, magnesium supplementation may be a cost-effective and safe complementary treatment for lupus.
References
Ji P, Qiu S, Huang J, Wang L, Wang Y, et al. Hydrolysis of 2D Nanosheets Reverses Rheumatoid Arthritis Through Anti-Inflammation and Osteogenesis. Adv Mater. 2025;37:e2415543. 10.1002/adma.202415543
Toaima DN, Abdel-Maksoud KS, Atef HM, Salah NY. Magnesium, fibrinolysis and clotting interplay among children and adolescents with type 1 diabetes mellitus; potential mediators of diabetic microangiopathy. Nutr Diabetes. 2025;15:13. 10.1038/s41387-025-00368-9
Laragione T, Harris C, Gulko PS. Magnesium Supplementation Modifies Arthritis Synovial and Splenic Transcriptomic Signatures Including Ferroptosis and Cell Senescence Biological Pathways. Nutrients. 2024;16. 10.3390/nu16234247
Fu C, Huang L, Lian C, Yue J, Lin P, et al. Effects of long-term magnesium L-threonate supplementation on neuroinflammation, demyelination and blood-brain barrier integrity in mice with neuromyelitis optica spectrum disorder. Brain Res. 2025;1846:149234. 10.1016/j.brainres.2024.149234
Yan Y, Yao C, Zhang B, Yang Z, Xie J, et al. Olanzapine vs. magnesium valproate vs. lamotrigine in anti-N-methyl-D-aspartic acid receptor encephalitis: a retrospective study. BMC Neurol. 2024;24:331. 10.1186/s12883-024-03811-z
Verlato A, Laragione T, Bin S, Kim RH, Salem F, et al. Revised version with tracked changes oral Magnesium reduces levels of pathogenic autoantibodies and skin disease in murine lupus. BMC Immunol. 2024;25:58. 10.1186/s12865-024-00650-y
Liu H, Zhang K, Xiong L. Dietary magnesium intake and rheumatoid arthritis patients' all-cause mortality: evidence from the NHANES database. J Health Popul Nutr. 2024;43:112. 10.1186/s41043-024-00597-1
Fu H, Guo Y, Fang W, Wang J, Hu P, et al. Anti-Acidification and Immune Regulation by Nano-Ceria-Loaded Mg-Al Layered Double Hydroxide for Rheumatoid Arthritis Therapy. Adv Sci (Weinh). 2024;11:e2307094. 10.1002/advs.202307094
Fang J, Cao T, Liu C, Wang D, Zhang H, et al. Association between magnesium, copper, and potassium intakes with risk of rheumatoid arthritis: a cross-sectional study from National Health and Nutrition Examination Survey (NHANES). BMC Public Health. 2023;23:2085. 10.1186/s12889-023-16906-y
Laragione T, Harris C, Azizgolshani N, Beeton C, Bongers G, et al. Magnesium increases numbers of Foxp3+ Treg cells and reduces arthritis severity and joint damage in an IL-10-dependent manner mediated by the intestinal microbiome. EBioMedicine. 2023;92:104603. 10.1016/j.ebiom.2023.104603
Li Z, Chen K, Shao Q, Lu H, Zhang X, et al. Nanoparticulate MgH ameliorates anxiety/depression-like behaviors in a mouse model of multiple sclerosis by regulating microglial polarization and oxidative stress. J Neuroinflammation. 2023;20:16. 10.1186/s12974-023-02696-y