ANTIOXIDANTS

How to obtain vitamin K?

No fat / No K

Low fat diets are a bad idea if you want to obtain vitamin K - Eat vitamin K or take K2 supplements with fat such as olive olive oil and butter to enable effective K absorption

-Fats act as carriers of the fat-soluble vitamins (A, D, E, and K) and the carotenoids - thus enabling their absorption.

-Low fat processed foods have less naturally occurring vitamin K - since K is removed with the fats.

Balance intake of K with the rest of the bone and heart health “Team"

K2 works in synergy with:

-Vitamins A

-Vitamins D

-Magnesium and  Calcium

Recommended Daily dose of K?

The Institute of Medicine Recommended Dose of Vitamin K -  was recently increasedto 90 microg/d for females and 120 microg/d for males (an increase of ~ 50% from previous recommendations). However, this dose is much lower than study doses that increased carboxylation of OSTEOCALCIN for bone mineralization and increased MGP to prevent calcium crystallization where it doesn't belong.

Vitamin K1 (Phylloquinone)

K1 is easily obtained in our diet - and is important for producing clotting factors, but did not seem to influence study results that helped CVD or cancer.

*EVM, 2003. Safe Upper Levels for Vitamins and Minerals. Risk Assessment: Vitamin K. Report of the Expert Group on Vitamins and Minerals; London, Engl., pp. 154-161. Available from: <http://www.food.gov.uk/multimedia/pdfs/vitmin2003.pdf>.

^# Data from Several US studies^@ Mean average intake from food

Vitamin K2 (Menaquinones)

K2 form is many times more effective than K1

K2 effective aganst heart disease and cancer, but not K1 - A 2004 study published in the "Journal of Nutrition" studied the effects of vitamin K1 and K2 ingestion on heart disease. A high dietary intake of menaquinone, mostly in the form of cheese, was correlated with a lower risk of heart disease.

• MK-4 produced by animal tissue, the rest are produced by bacteria during fermentation

• After eating, MK-4 survives 3-4 hours, MK-7 survives several days in body

• Soft cheeses contain 30% less K2 than hard cheeses

Most table data calculated from ng/g values at:

Vermeer, C., Knapen, M.H., Schurgers, LJ., 1998. Vitamin K and metabolic bone disease. J Clin. Pathol. 51(6), 424-426.

Ikeda Y., Iki M., Morita A., Kajita E., Kagamimori S., Kagawa Y., Yoneshima H. (2006). Intake of fermented soybeans, natto, is associated with reduced bone loss in postmenopausal women: Japanese Population-Based Osteoporosis (JPOS) Study. J. Nutr. 2006 May; 136(5):1323-8.

Schurgers, L.J., Vermeer, C., 2000. Determination of phylloquinone and menaquinones in food. Effect of food matrix on circulating vitamin K concentrations. Haemostasis 30(6), 298-307.

Who needs to Supplement K?

Those with K-deficient symptoms / conditions:

•  Excessive bruising and bleeding (blood type O's have this tendency )

•  Digestive system problems, especially malabsorption -pancreatic disease, celiac disease, irritable bowel syndrome (IBS), ulcerative colitis, Crohn's disease or those who have had intestinal bypass surgery; since vitamin K is a fat-soluble nutrient, these conditions increase the likelihood of fat malabsorption.

•  Liver disease (interferes with K storage)

•  Gallbladder problems (lack of bile salts interferes with the break-down/absorption of all fat-soluble vitamins)

•  Older individuals (over age 70)

Those with or who want to prevent:

•  CVD

•  Osteoporosis or those > 65 yrs(who are at risk of osteoporosis/hip fractures)

•  Bone spurs

•  Leukemia or cancer of the lung, liver,orprostate

•  Heart attack / Stroke

•  Heavy menstrual flow/menstrual pain

•  Hemorrhagic disease

•  Kidney stones

•  Nausea and vomiting during pregnancy

•  Osteoporosis and Osteopenia

•  Pulmonary embolism

•  Rheumatoid arthritis

Supplementing K

Low-dose* Vitamin K supplementation has been shown to stabilize fluctuations in INR** of those taking warfarin

*Low-dose = 50-150 mcg/day; ** INR is a standard measuement for the time it takes for blood to clot;

Sconce E, Khan T, Mason J, et al. Patients with unstable control have a poorer dietary intake of vitamin K compared to patients with stable control of anticoagulation. Thromb Haemost. 2005 May;93(5):872-5.

However, If on cholesterol-lowering or blood-thinning medication, do not supplement K without seeking medical supervision

Supplement K2 not K1 -K1 is usually supplied in the diet and K2 is more effective against the health problems listed above;

MK-7 form extracted from natto is longer acting/better absorbed than MK-4 (synthetic supplemental form supposedly identical to natural MK-4),MK-8 or MK- 9 supplements -CHOOSE MK-7 EXTRACTS from NON-GMO SOY;

You don't need to take a K2 supplement if you can eat ½oz of relatively cheap natto daily -which provides ~154 mcg of K2. Unfortunately, most Westerners find natto unpalatable (not only slimy, it also smells pretty bad)

K2 supplement Dosage?- Vitamin K expert Dr. Vermeer recommends between 45 mcg and 185 mcg daily for adults. This author's suggested recommendation is:

Take 150 mcg K2 /day WITH FAT (to enable its absorption).

K -Toxicity

Although allergic reaction is possible, there is no known toxicity associated with high doses of vitamin K1 or K2 forms of vitamin K

Food and Nutrition Board, Institute of Medicine. Vitamin K. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, D.C.: National Academy Press; 2001:162-196. (National Academy Press). It has been found to be safe even at 45 mg or more per day - up to a thousand times greater than generally occurring in the daily diet.

Synthetic menadione (vitamin K₃) and its derivatives have resulted in several health problems - as such, it is no longer used.

Drug / Nutrient Interactions

Drug Interactions

•   Anticoagulants (E.g. Warfarin/Coumarin) - interfere with vitamin K activity, reducing available K by

•   Cholesterol lowering bile acid sequestrants (E.g. Cholestyramine, Colestipol) - may reduce the intestinal absorption of the fat-soluble vitamins A, D, E, and K

Nutrient interactions

-Large doses of vitamin A and vitamin E (~1000 IU or more) have been found to antagonize vitamin K.

Olson RE. Vitamin K. In: Shils M, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore: Lippincott Williams & Wilkins; 1999:363-380.

Testing for K-sufficiency

The usual prothrombin test only tests for clotting activity - and does notindicate whether enough K is present to maintain vascular matrix-GLA protein or bone OSTEOCALCIN activity.

OSTEOCALCIN test - measures how much uncarboxylated OSTEOCALCIN is present in the blood.High levels indicate insufficient vitamin K present to promote optimal bone health.

Matrix-GLA protein ( MGP) test - High levels of undercarboxylated MGP indicate that insufficient vitamin K is present to protect against vascular calcification.