Take Two on K2

When I posted previously about Vitamin K2 I knew enough to say that if we’re not eating natto, we all need a K2 supplement. But how much? What kind? I really didn’t know.

A few months later an exciting new book caught my eye: Vitamin K2 and the Calcium Paradox: How a Little-Known Vitamin Could Save Your Life, by Canadian naturopath Dr. Kate Rheaume-Bleue.

The apparent contradiction the title’s referring to is that a calcium deficiency in the bones often exists at the same time there’s a calcium excess in the arteries of the same people, as osteoporosis and heart disease frequently show up together. There’s really the right amount of calcium, it’s just in the wrong places. The incidence of both these conditions has increased dramatically in the past century. What’s going wrong, and what’s changed?

Rheaume-Bleue points to a deficiency in Vitamin K2 in our modern diet. K2 is very different from the K1 that’s known for clotting. The function of Vitamin K2 is to move calcium around the body, guiding it into the bones and teeth where it belongs, and out of our arteries, where it causes problems.

What does K2 deficiency look like? Osteoporosis, heart disease, cancer, diabetes, varicose veins, wrinkled skin, dental cavities, Crohn’s disease, kidney disease, narrow crowded dental arch, alzheimer’s, arthritis, MS, infertility – all these and more point to a K2 deficiency. And the author goes on to conclude that essentially everyone who eats a standard North American diet is deficient; how the deficiency manifests is the only question.

So what’s changed to cause such a widespread shortage? It was largely the shift from pasture-feeding to grain-feeding animals that happened in the middle of the last century. Until then, farm animals grazed on grasses that were high in Vitamin K1, which they converted to K2 for us, and we then consumed. We can get our own K1 from greens, so a deficiency of K1 is rare in humans, as long as they eat vegetables; but our bodies don’t effectively convert it to K2. Our best sources of Vitamin K2 used to be meat, eggs, and butter from pasture fed animals, but now most animals eat grain, so they are deficient and so are we.

If you’ve ever come across the work of Dr. Weston Price – he was a dentist in the early 20th century who studied the diets of isolated primitive cultures – he identified an ingredient that he named “Activator X” that was responsible for keeping people in those cultures healthy until they left their traditional ways and adopted processed diets. That ingredient is now known as Vitamin K2.

So if you think you’re deficient in Vitamin K2, what can be done? The high road would be to source all your meat, eggs, and butter from pasture-raised animals, thus eating the way our ancestors did. That may be outside your budget.

There is one more food option, the traditional Japanese superfood called natto made of fermented soybeans. In the eastern part of Japan where it’s commonly eaten the incidence of hip fractures is much lower than in the rest of the country, pointing to natto’s major impact on K2 supply. Unfortunately, though, not everyone can get used to natto. It has a strong smell that has been likened to gym bags, and a stringy slimy texture that some people call mucousy.  It’s actually not hard to make – it cultures something like yogurt, with a particular inoculant. I learned to eat it to be polite when I lived in Japan. There it’s said to be the one food a foreigner can never love, and I don’t love it; but I make it and eat it.

If trying new foods with foul smells and disturbing textures is not for you, then Dr. Kate Rheaume-Bleue strongly recommends a Vitamin K2 supplement. It turns out there are two main forms of K2, which are abbreviated MK4 (menatetrenone) and MK7 (menaquinone). MK4 is the form in meat sources, and its supplements are synthesized from a tobacco extract. MK7 is extracted from natto, the soybean food. If you’re sensitive to soy, you won’t want to take MK7. (UPDATE: A reader has informed me that MK7 made from chickpeas is now available!)

Here’s where it’s particularly helpful that the author’s Canadian: She explains a dose discrepancy that I hadn’t been able to resolve between studies I’ve read and what’s on the shelves of stores. It seems that Health Canada doesn’t know there is a Vitamin K2, so the limit they’ve put on Vitamin K1 supplements – 120 mcg per dose – also applies to Vitamin K2 sold in Canada. This works quite well if you’re taking the MK7 form, as 120 mcg is an effective daily dose according to many studies. But with MK4, it would take about 38 of the legal Canadian dose pills per day to have a measurable impact on our bodies. The price alone is prohibitive. For those who are sensitive to soy, MK4 is the only form you’ll be able to tolerate, so it might be worth a drive across the border to where you can buy MK4 in therapeutic doses at a reasonable price.

There are some other potential issues with MK7 that the author doesn’t identify. Some people develop heart palpitations when they take it. Personally, I stopped sleeping well after taking it for a while, and the problem went away when I gave up the supplement. Natto doesn’t seem to bother me, though. Of course, as with all these things, your experience may be very different from mine.

The book contains a wealth more information on the interactions between nutrients.  The author firmly believes, as I do, that no one nutrient can solve all our problems, and that supplements can’t take the place of a healthy diet and lifestyle. She devotes a fair bit of time to discussing the interaction between Vitamin D, Vitamin A, and Vitamin K2, as none of these fat-soluble vitamins can work if there’s a shortage of one of the others. She also has sections on magnesium and Vitamin E.

For me, my particular interest in Vitamin K2 has to do with turning around osteoporosis, but my family line is riddled with the other conditions that are linked to a K2 deficiency. I’d started taking a lot more Vitamin D for the sake of my bones, but it’s very helpful to know that all this extra D is useless with inadequate K2.

The author presents an enticing statistic, in case you still need convincing: She quotes studies that showed a 50% reduction in arterial plaque after only six weeks of taking Vitamin K2 as menaquinone (MK7). That’s impressive! Also, she says that K2 supplementation seems to reduce hip fracture rates more than increases in bone density can explain. That is, it appears to improve the strength or flexibility of bones.

You don’t have to have osteoporosis or heart disease to learn something useful from this book. I suggest you read the book. But if you aren’t going to do that, then buy some Vitamin K2 and start taking it.

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I passed the test!

First, I should apologize for the long gap between posts. My writing time has been absorbed into 1400 square feet of gardening bliss, which legitimately counts as bone-building activity. But now that we’ve had our first heavy frost, I’m down to a couple of short rows of greens under covers, and it’s time to get back to my desk.
It’s also time to announce that my bones passed their big test – the one that really counts: They held together beautifully when I had a bad fall. The scene was the garden, and the accident involved me recklessly trying to move an oscillating sprinkler while outrunning it to stay dry. I scrambled onto the half-meter high stile to get over a fence, but when my wet feet met the slick top step I crashed down – very hard – my entire weight on my hip onto the packed path. There I lay, stunned and wetter, but suddenly very excited: Nothing broke!!!  I wore a mammoth bruise for a long time, yet wasn’t even stiff the next day. Despite my doctor’s dire warnings, and the High Risk of Fracture on my chart, my bones were able to do their job and absorb the impact.
Now, a year after my bone density T-score of -4, I can reflect on the approach I’ve taken, as my bones seem to be serving me well:
  • Exercise: I changed my gym workout, now choosing the treadmill over an elliptical trainer. This causes more impact to my bones, which should challenge them to grow stronger. I’ve continued using weight machines to work my lower body, but now choose free weights for upper body work, and do those exercises standing up so my spine can carry the extra weight. On days I don’t get to the gym I go for a brisk walk. Keep moving.
  • Supplements: I added strontium citrate (680 mg per day), Vitamin K2 (100 mcg per day of the MK7 or menaquinone form), silica, and 3 mg per day of boron. I was already taking B complex, a balanced mineral supplement, fish oil, magnesium, Vitamin D, and Vitamin C.
  • Diet: I gave up most dairy products. Yup, to improve my bones I stopped drinking milk. I found out through testing that I’m sensitive to milk (not that I noticed any symptoms) which means it would have tended to cause inflammation, and that is bad for bone health. Also, dairy products metabolize to form acidic residue, which increases bone loss. I get my calcium from leafy greens, nuts, and salmon, with about 600 mg per day from a supplement. (The 1500 mg per day supplement my doctor recommended is way too much!) I put more emphasis on making and drinking mineral-rich bone broths. I already ate a lot of vegetables, and that hasn’t changed. I had already given up gluten, and any foods that contain it. Since lower body weight is one of the major risk factors for osteoporosis, I gave myself permission to abandon my life-long pursuit of weighing a little less. That must have been effective, as I have gained about 3 kg, and mostly feel fine with that :).
  • Reading: I devoured some excellent books that helped form my understanding. My favourites are Your Bones by Lara Pizzorno, The Whole Body Approach to Osteoporosis by R. Keith McCormick, The Myth of Osteoporosis by Gillian Sanson, and Vitamin K2 and the Calcium Paradox by Kate Rheaume-Bleue.
  • Support: I joined an online community of people who share what they’re learning about osteoporosis. I also continue to meet with a local Health Pursuits Reading/Study Group where lots of wise people have spurred me on with their insights into natural approaches.
  • Drugs: I have not taken any. I don’t plan to take any. Since I haven’t needed to return to my nice well-meaning doctor who told me I had no choice but to take Actonel, she doesn’t know. I have a choice, and I’m exercising it by venturing into realms that are beyond her training.
  • Followup bone density test: Although I was told I would get an automatic recall, that hasn’t happened. I considered initiating the appointment  myself, but then wondered: What would I do differently if I got a worse test result? I’m already doing everything I know how to improve my bones. Since I’m very numbers-oriented, I know I’d obsess over the new scores, way beyond their accuracy or their ability to predict fractures. So I’ve let it go, and I’ve stopped having bad dreams in which I’m about to get my retest scores. One day, if the test centre calls, I’ll go for a repeat test. But I am more than a test score.
Still, I made a note to myself to avoid risky activities like outrunning sprinklers in wet obstacle courses. Instead I should focus on developing true superpowers that will allow me to leap over garden stiles in a single bound.

Calcium Supplements: After the Scary Story

Calcium supplement use may raise heart attack risk

Did you catch this headline? Last week all the media outlets reported the results of a German nutrition study that tracked 24,000 people over an 11-year period. Participants who took calcium supplements had almost double the heart attacks of those who didn’t take calcium. The authors concluded that we should ditch the supplements and meet our calcium needs from food sources. While that is generally a very good approach with most nutrients (a handful of supplements can’t atone for a junky diet!), there’s some missing information here: How much calcium were the un-supplemented participants getting from their diets? How much of what forms of calcium were the others taking, and how much were they also getting from their diets? What were their bodies able to absorb?

More important, were they taking vitamin K2? As I mentioned before, it’s responsible for directing calcium to our bones, and away from our arteries. Although bacteria in our intestines can convert some vitamin K1 (the renowned blood-clotter) into K2, even if we ate several cups of leafy greens a day, without a good serving of Japanese natto or a supplement, we’d still be deficient. If the calcium-popping participants weren’t also taking K2 then it’s not surprising their arteries were overloaded.

And what were the participants’ vitamin D levels? There’s an important partnership between vitamin D and vitamin K2; too little of one prevents the other from doing its best work. If the supplementing group had vitamin D levels in any way typical of people in Germany’s northern latitude – their calcium may well have wandered into their hearts.

And what were they all eating? Adding calcium supplements to a highly-processed diet might well have compounded other issues.

In the absence of definitive answers, how is a diligent bone-lover to respond? It was just months ago that my own doctor advised me to take 1500 mg per day of calcium supplements, with no discussion of how I eat or any other supplement than magnesium; I don’t feel at all inclined to go back and ask for her updated advice, especially since she also insisted I take bisphosphonate drugs!

The approach that makes sense to me is to continue with a non-processed  diet, based largely on a wide variety of fresh vegetables, with some meat, fish, nuts, fruit, eggs, yogurt, cheese, healthy fats, and non-gluten grains. Consistent with the COMB study I mentioned before I also take K2, D, magnesium, and fish oil. (That report recommended strontium citrate, which I took for a month. However, I figured out it was the cause of some daily headaches that developed, so stopped. I’ll try strontium again soon, as other support nutrients may be better balanced now.) I also take silica, boron, a multi-mineral supplement that includes 500 mg calcium,  a vitamin B complex, and vitamin C.

When new information comes out it can be hard to make sense of it. Personally, after reflecting on this news I don’t find it too scary after all.

Vitamin D for Young People

Children don’t spend any time thinking about their bones. So here’s some news for those who care for children: Make sure they get enough vitamin D. A recent study published in the Archives of Pediatrics and Adolescent Medicine found that low vitamin D levels were associated with stress fractures.

The study followed 6,712 athletic girls aged nine to sixteen for seven years, monitoring dairy, calcium, and vitamin D intakes. Over the seven years, 3.9 % developed stress fractures. Those with the highest vitamin D intake, though, suffered the fewest fractures.

This agrees with the correlation that many researchers are finding between bone health and vitamin D levels, and points to the need to protect bones even in childhood.

I recently listened to a fascinating lecture by Dr. Stasha Gominak on vitamin D. She’s a neurologist who has identified a most interesting connection between low vitamin D levels and poor sleep quality. She makes so many fascinating comments on the subject that I recommend you listen to all four parts of the lecture. However, something she brought to my attention that particularly relates to this post about children is the extent to which our vitamin D intake from sun exposure (the optimum kind of D) has dropped in one generation.

When I was growing up in the 60s and 70s no one in my suburb had central air conditioning; we played outdoors, and when the house got really hot we even ate outside, with no gazebo. We hadn’t yet heard of sunscreen, so our skin was fully exposed to the sun. Kids walked or biked to their destinations, and we were free to wander the neighbourhood. Our favourite activities involved a lot of moving around, usually with others, especially since there was nothing to watch on TV for most of the day. At least for the summer, we got all the vitamin D we needed (as well as a good bit of bone-building exercise).

By contrast, when my children came along in the late 80s the house was pleasantly cooled, so they stayed indoors a whole lot more to keep comfortable. Whenever they were outside we made sure they were slathered in sunscreen, effectively preventing their skin from making that essential vitamin D. Furthermore, since the world had grown much more aware of predators and other nasties, we drove them around as much as we could. And by then VCRs and video games gave them a lot of indoor entertainment. All told, in the name of improving their lifestyle, we deprived them from what’s proving to be a vital vitamin in preventing a dizzying number of diseases.

My conclusion from reading about vitamin D? When possible I must get 15 minutes per day of sun exposure on bare skin, no sunscreen. If I had children now I’d make sure they did, too. The rest of the year, supplements are essential.

Now back to the study I mentioned above. To the surprise of researchers, those with the highest dairy and calcium intakes also suffered the most fractures:

“In contrast, there was no evidence that calcium and dairy intakes were protective against developing a stress fracture or that soda intake was predictive of an increased risk of stress fracture or confounded the association between dairy, calcium or vitamin D intakes and fracture risk,” the authors comment.

The authors also note that in a stratified analysis that high calcium intake was associated with a greater risk of developing a stress fracture, although they suggest that “unexpected finding” warrants more study.”

Yup, calcium is not the key bone-builder. Make sure you get your vitamin D.

Reference: http://www.sciencedaily.com/releases/2012/03/120305173453.htm

Low Density History

My grandmother probably never heard of osteoporosis. For most of her life the disease was rare and largely unknown.  But in 1982, right around her 90th birthday (and by then she was too old to care) the word osteoporosis was suddenly thrust into the common vocabulary. A massive public information campaign began, warning post-menopausal women by every means possible of imminent danger and disfigurement from weakened bones. The pharmaceutical companies, pushing their lucrative hormone replacement therapy (HRT), sponsored the campaign that sent a generation of fearful women scurrying to their doctors for prescriptions. No one seemed concerned about the absence of studies that proved HRT could prevent or reverse osteoporosis. Soon, though, a problem did emerge: there was no easy way to test the strength of bones in living people. So the Dual Energy X-ray Absorptiometry (DEXA) machine was developed in 1988, and finally our bones could all be compared on the basis of density.

Subsequently, the World Health Organization established a large database of DEXA readings, and in 1994 they announced international standards for osteoporosis. They also changed its definition. It went from being a disease characterized by fragility fractures to a condition marked by low bone mineral density, no fracture needed. Suddenly half of all post-menopausal women – and quite a few other people – were painted with the ominous diagnosis.

But the 1994 definition has some obvious shortcomings. It doesn’t take into account the fact that bone mineral density alone can not adequately predict the quality of our bones or their tensile strength which are most significant predictors of fractures. Also, the standards compare my bones with those of young women on a normal curve, not considering what might be normal and healthy and perfectly suitable for me. Furthermore, the DEXA machine that set the standards has some serious limitations, typically rating larger bones higher than smaller bones of the identical density. (There are more details here.) In other words, being diagnosed based solely on a DEXA score should not be nearly as scary as our doctors tell us.
Of course, fragility fractures truly are a serious problem, and I don’t want any. So I’m taking charge of all the factors that are within my control. I’m optimizing my nutrition and exercise, and minimizing the risk of falling. To reduce stress I’m turning back the clock on history, and living like my grandmother did, letting my bones do their work.

Carry your weight and surprise your bones.

Aside from optimizing our nutrition through diet and supplements, the best gift we can give our bones is weight-bearing exercise. Study after study confirms that putting certain kinds of stresses on bones helps them to grow, or at least to resist shrinking.

So what exercise makes the difference for bones? Weight-bearing exercise includes almost any kind we do on our feet while working against gravity. Some examples are walking, jogging, hiking, dancing, and climbing stairs. Good news for me – gardening also counts! Swimming and biking are great for other reasons, but they are not weight-bearing because they don’t involve working our muscles and bones against gravity; therefore they aren’t the best for building bones.

If it were only as simple as going for a walk each day… But the problem is that our bones quickly adapt to the level of stress they usually encounter, then need new challenges to stimulate them to grow. So it helps to surprise them with new moves and greater intensities; for that reason it’s important to choose a variety of activities, and to alternate between lower and higher intensities. One study found that “inserting a 10-s rest interval between each load cycle amplifies bone’s response to mechanical loading”. That suggests that our bones are more stimulated to grow by a sequence of high intensity short bursts interspersed with 10-second rests, than by longer periods of sustained exercise. So digging the garden – as soon as I can get to it – will be better for my bones than a long run.

Exercise on our feet is vital for our vulnerable hip joints (femoral necks), as well as our spines and femurs. While those are the sites that the DEXA machines scan for density, we have other bones to consider: wrists and upper arms are also prone to fractures. So it makes sense to include a range of activities that stress those bones, like pushups, triceps dips, and carrying heavy groceries. Here’s a link to a site with lots of exercise suggestions.

Anything that improves our balance helps reduce the likelihood of falling. Lately I’ve opted to spend life’s less interesting moments standing on one foot, then switching to the other. It hasn’t taken long for me to develop impressive flamingo skills, which I practise while brushing my teeth, putting on socks, waiting in line, or talking on the phone. One day this should help me catch myself before falling.

But what about all the warnings for people with osteoporosis?  “BE CAREFUL. Don’t run, or jump, or twist, or hug anyone, or sneeze.” Yes, if you have osteoporosis it’s essential that you exercise appropriately for your condition, and with medical approval. Consulting a qualified trainer is a good idea. These warnings are particularly important:

  • Do NOT do any high impact exercises without medical approval. These can result in stress fractures.
  • Do NOT do exercises that involve bending forward at the waist, such as toe-touching. These can result in spontaneous crush fractures of the spine when coming back up from this position.

Personally, I’ve been able to continue hugging and sneezing without breaking anything. I also run gently on a treadmill (lower impact than on the road), and I might have mentioned that I plan to garden…soon. For anyone concerned about bone density – find some activities you can fit into your day and DO THEM. Life as you know it may depend on it.

Believable Good News

A new Canadian study has followed a group of people just like me: those who are responding to osteoporosis purely with lifestyle adjustments, without taking bisphosphonate drugs. Medical researchers from the University of Alberta and University of Calgary prescribed six micronutrients and an exercise program, then tracked the results. I’m delighted to see that over the year of the study the bone density of the participants increased more than it would have with the standard pharmaceutical drugs.

Of course, one reason I like this study is because it seems to validate my approach. Another is that no drug company funded the work, and for me that adds credibility. The authors appear to be squeaky clean with regard to conflicts of interest that may have skewed the results.

On the negative side, the sample wasn’t entirely representative of the low-bone-density population; the authors worked exclusively with people the doctors call “non-compliant”, who had already decided not to use the recommended drugs. Some had abandoned the drugs after experiencing continued decline of their density while taking them. Others had explored their options and just wanted a non-pharmaceutical approach. To me that suggests a cohort that is more health-aware than the average population, more likely to do their own critical investigations, eat a better diet, and resort to fewer pharmaceutical products in general. Really, though, I’m not concerned about the non-representative sample: when it comes right down to it, all I want to know is what will work for ME and the people I care for! And with that prescription I will comply.

Lifestyle adjustments in the study

So what did the participants do? Here’s the list:

Table 1: Combination of micronutrients (COMB) Protocol for Bone Health.


COMB protocol for bone health

(1) Docosahexanoic acid or DHA (from Purified Fish Oil): 250 mg/day
(2) Vitamin D3: 2000 IU/day
(3) Vitamin K2 (non-synthetic MK7 form): 100 ug/day
(4) Strontium citrate: 680 mg/day
(5) Elemental magnesium: 25 mg/day
(6) Dietary sources of calcium recommended
(7) Daily impact exercising encouraged

In earlier posts I’ve already talked about vitamins D and K2, strontium, magnesium, and calcium. Although I take fish oil containing DHA for general good health, I hadn’t heard that it’s particularly helpful for bones. According to the study: “Both DHA and vitamin D are involved in the regulation of many genes and…associated with improved bone strength.”

As for the exercise component, the authors said: “Patients were also instructed to commence and maintain a regimen of daily impact exercises such as jumping jacks or skipping where possible as impact has been associated with prevention of bone density loss.

How much did it help?

The mean improvement in BMD (bone mineral density) was impressive: 3% in the hip, 4% in the neck of the femur, and 6% in the spine. That was contrasted with a continued decline in BMD among the study dropouts, and substantially lower improvements using bisphosphonate drugs. Unlike the drugs, the study protocol delivers no side effects.

What will I change?

I’m already taking the micronutrients suggested by the study, although in different amounts. My calcium is not exclusively from food sources, as I consume very little dairy food, and I’m not confident that I can meet all my requirements all the time with my diet. These days I take 200 mg of DHA, 6000 IU of D3, 100 micrograms of K2, 340 mg of strontium citrate, 420 mg of magnesium citrate, and 1000 mg of a calcium supplement. I plan to leave those as they are for now. At the moment I get impact exercise three or four times a week at the gym, with some walking in between, and heavy gardening all summer. That didn’t prevent osteoporosis in my case, but adding some jumping jacks into my non-gym days is worth a try.
Combination of Micronutrients for Bone (COMB) Study: Bone Density after Micronutrient Intervention