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Health

Vitamin K2 – the Link Between Heart Disease and Osteoporosis

A hen and her chicks in the garden at our apartment building in Spain

Well, some of our family have gone home to Canada, and I’m finding a bit more time to read these days. I’m into a book about the tie between heart disease and osteoporosis. Who would have thought there is a connection? I certainly didn’t. But the book’s explanation of why we are seeing too much of these chronic diseases makes sense…

The connection is calcium – too little of it leads to thinning of bones and risk of osteoporosis – and too much can result in calcification (or “hardening”) of the arteries and blockages that can cause heart disease when they occur in arteries that supply the heart muscle. While this seems to present a paradox… too much calcium in one case and too little in the other… the link is a nutrient that controls where calcium goes in the body.

That nutrient is vitamin K2, a vitamin that was not widely studied until the last 20 years. It’s sister vitamin, K1, was researched more thoroughly as it was thought to be the only active form of vitamin K in the body. K1 is needed for blood clotting and is the vitamin whose action is blocked by the blood thinner, warfarin.

Vitamin K2, on the other hand, controls where calcium goes once it’s absorbed from the digestive system. It does this by activating two substances: osteocalcin and matrix gla protein (MGP). Once activated by vitamin K2, osteocalcin attracts calcium to bones and teeth making them stronger. Activated MGP, on the other hand, sweeps excess calcium away from soft tissues, including arteries and veins, preventing and removing dangerous plaque from inside arteries. A lack of vitamin K2 means that osteocalcin and MGP cannot be activated and therefore cannot perform these important functions.

Vitamin D is important too. You likely already know that this vitamin is needed to absorb calcium from your digestive system. This makes it an important factor in preventing osteoporosis. You may have taken calcium supplements with vitamin D added right into the tablet and probably have learned that it’s called the “sunshine vitamin” because we make it when the sun shines on our skin.

But vitamin D is also needed to make the MGP protein that removes calcium from soft tissues, preventing and reversing hardening of the arteries. So, vitamins D and K2 work together to prevent both osteoporosis and heart disease – vitamin D helps to get calcium into your system, and both vitamins K and D are needed to make sure the calcium goes to the right place.

Recommendations for calcium and vitamin D supplements have recently changed. Although recommended for many years for prevention and treatment of bone loss, recent studies suggest there may be more harm than benefit, especially in healthy adults and that there’s more to having healthy bones than just swallowing lots of calcium.

This information about vitamin K addresses several “paradoxes” in our explanation of causes of heart disease: Why do 50% of people who have a heart attack have normal cholesterol? Why do the French, with their rich, fatty diet, have less heart disease than us in North America? This is often called the “French Paradox”, and could be explained by different farming practices. How could there be so much osteoporosis (a disease of too little calcium) and heart disease (a disease of too much calcium) in a single population eating a similar diet?

Both heart disease and osteoporosis increased when farming practices changed in North America. Grass contains the precursor to vitamin K2 that animals convert for us. When animal feed was changed to grains to simplify production, the animals no longer ate chlorophyll, the green substance in plants with the pre-ingredient needed to produce K2. Without realizing the difference, we dramatically changed the content of our diet. Not only are you what you eat, you are what your food eats!

Vitamin K1 is found in green leafy vegetables, the broccoli/cauliflower family of vegetables, and small amounts in meat, fish and eggs. Animals and some bacteria can convert K1 into K2 but humans cannot. We need to consume it regularly in our diet as we don’t store this nutrient.

Choosing grass-fed meat and pastured eggs (from hens that feed in a pasture) can correct a vitamin K deficiency. Since betacarotene (a yellow nutrient) and chlorophyll (the green stuff in plants that animals make into vitamin K2) usually occur together, butter and egg yolks that contain vitamin K tend to be darker yellow. I’ve noticed that egg yolks here in Spain are a deep golden colour, so I suspect that hens here must be allowed to feed in pastures. Perhaps that’s one reason that the Spanish are one of the healthiest populations with a longer life span than us in North America!

Cheese is produced by bacterial action on milk, and some of these bacteria produce vitamin K2 at the same time. So some cheeses also contain vitamin K2. Some of us also have bacteria in our digestive systems that can convert small amounts of K1 to K2, but these bacteria can’t produce enough K2 to satisfy our needs.

If you can’t find grass-fed food or fermented products with the vitamin, you can take a vitamin K2 supplement. But supplements may not all be created equal. K2 is also called menaquinone or MK and, just to make it complicated, there are several different types of MK, depending on whether they are produced by animals or bacteria. MK-4 comes from animal sources. It works well but is cleared from the blood stream very quickly, so could require dosing several times a day to maintain activity. Menaquinone-7 (MK-7) comes from plant sources, and some feel it’s a better choice as it stays in the blood stream with once a day dosing. Of course, nutrients can continue to have their health effects after leaving the blood and moving into the tissues, so there are two schools of thought on which is better. The bottom line is that any vitamin K2 supplement is likely better than having none at all but, as always, it’s best to get your nutrients from food if possible.

So, I plan to buy my eggs from local farmers whenever I can in the future and will be asking whether they let them out of the coup once in a while. And I’ll be looking for an MK supplement for the days when I don’t have nice yellow-yolked eggs or grass-fed meat! What about you?

If you want to know more, here are some of the references I used:

Vitamin K2 and the Calcium Paradox by Kate Rheaume-Bleue, BSc, ND

Vitamin K2 – A little known nutrient can make a big difference in heart and bone health

Globe and Mail: Are Calcium Supplements Helping or Harming Your Health

Categories
Health

Could calcium pills be risky?

In the past decade, a debate has developed over calcium and vitamin D supplements–should everyone older than 50 take them to prevent osteoporosis (weakened, porous bones)? The amount of calcium in our diet, the quantity of vitamin D we make in response to sunlight, and the amount of exercise we get are important factors in preventing bone loss.

Lots of questions…

Can calcium and Vitamin D supplements take the place of a healthy diet and exercise? Can we get enough of these nutrients without supplements? How much is enough? Can too much be dangerous?

Here’s the controversy:

Several years ago, the US Preventive Services Task force issued a statement saying there was not enough evidence to support a need for calcium supplements in older adults who did not have osteoporosis or vitamin D deficiency.

In December 2017, the Journal of the American Medical Society published an analysis of 33 trials on older adults not living in nursing homes. It found no clear benefit from these supplements.

Another concern with supplements is the large “bolus” of calcium that floods the blood stream after a tablet is taken. Studies suggest that this could increase the risk of heart disease, with some showing up to 30% increased risk in those taking calcium supplements. Recommendations now suggest dividing calcium supplements over the day if they are being taken to avoid a spike in blood calcium. However, the problem is that researchers did not design these studies to look for potential heart problems, so we cannot completely trust these results. We need more research to confirm this.

Vitamin D–more controversy

The official recommended daily amount (or “RDA”) of vitamin D is 400iu per day, but this is the quantity needed to avoid Rickets, a disease of softening of the bones. As discussed in an earlier blog, we now know that we need larger amounts of vitamin D for a healthy immune system. Experts suggest 800 to 1000iu daily for those who are not making their own vitamin D due to lack of sunlight exposure, but researchers are still trying to decide how much is ideal. If you missed that article, click HERE to link to it.

And,a new concern…

This week, a new study published in the journal “Gut” suggests calcium supplements may increase the risk of polyps in the colon after 6 to 10 years of therapy… and polyps are important “precursors” to colon cancer (meaning: polyps are a stage in the development of cancer). Again, researchers said that more research is needed to confirm their results—being the first study to suggest this connection—but are concerned since millions of people take them.

Supplements versus food

One difference between getting calcium from a supplement rather than food, is that most common supplements contain calcium carbonate. Even when taken with food, this form of calcium is only 20% absorbed. The other 80% remains in the bowel where it causes constipation and, perhaps, also polyps.

Calcium in food, on the other hand, can be much more highly absorbed, especially when you have adequate vitamin D. I have read studies that found as little as 300mg of absorbed calcium a day in the diet can keep bone healthy, compared to 1000 to 1200mg recommended in supplement form. The difference, however, is likely due to the low level of calcium absorption from tablets.

A broken bone, like a hip or the spine, can devastate the life of an elderly person. And drugs for osteoporosis are expensive, difficult to take and have serious side effects. The best way to prevent osteoporosis and bone fractures is to exercise at least 3 times a week, don’t smoke, get adequate sunshine (or supplement vitamin D in a northern winter), and eat calcium-rich foods. Examples of these foods are dairy products, vegetables, fish (especially with dissolved bones), mineral water, and even tap water! See the reference “Calcium in food information” below for more details.

If you’re curious about your bone health, you can calculate your risk of a fracture here. (Note: conversion tool on the right to change pounds and inches to kilograms and centimeters)

References:

JAMA article

Gut online

Calcium in food information

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