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In Defense of Vitamin A

In the bone health world, vitamin A has a bad reputation. Some studies have suggested that it’s toxic to bones because it increases the activity of the osteoclasts. These are the cells that do the important work of cleaning away old bone. If they get carried away, though, there can be a net loss of bone if they outpace the osteoblasts that are working to build new bone.

But recent research has found that this isn’t actually the fault of vitamin A itself, but of a failed partnership. If there’s a shortage of vitamin D or vitamin K2, then A can’t do its job properly; the three fat-soluble nutrients are meant to work together for bone care. If we absorb too much of one of them, that creates a corresponding need for more of the others. Since a huge percentage of people are deficient in both D and K2, this means that for the bones of some people, taking preformed vitamin A can be detrimental.

Too little vitamin A, though, is also a problem. A deficiency can also cause bone loss, as well as impaired vision, dry eyes, and a pre-disposition to a host of diseases, including cancer. The key is having good nutritional balance.

As for my story, I was able to bring my vitamin D level into a healthy range with supplements. Check. And I added vitamin K2 to my diet by eating natto three times a week. Check. My vitamin A, though, persistently tested low, even though I eat a lot of foods with beta-carotene, which is supposed to convert to vitamin A. What was that about? Why couldn’t I raise my level of vitamin A?

It turns out that many people can’t process beta-carotene much or at all, for a variety of reasons. For some, the problem is a diet lacking the healthy fats needed to stimulate absorption. For others, it may be that they drink too much alcohol, or that they have inadequate bile flow. Or their gut ecology may be out of balance, perhaps because of low stomach acid levels, celiac disease, or parasites. And to complicate the issue, a large percentage of the population were just born with a genetic variation that prevents them from absorbing beta-carotene or converting it into the active form.

So what can we do to get enough vitamin A in our systems? First, get tested to determine whether you’re in the majority who need some more. If you are, then make sure you eat plenty of retinol foods. The top of this list is cod liver. The second, third, and fourth options are other kinds of liver. If this makes you shudder, then you may benefit from taking preformed vitamin A, or retinol, as a supplement. It often comes in tiny capsules made from cod liver oil, but you won’t taste a thing. It’s also available in dry tablets. But since vitamins A, D, and K2 are fat-soluble, which means they can build up in our tissues, it’s important not to overdo them.

And here’s a side note if you’re hoping to see your hundredth birthday: vitamin A sufficiency is now recognized as a key contributing factor to longevity.

Keep Those Facts Coming!

A fascinating new study in Aging reaffirms the benefits of appropriate micronutrients on bone density. In this one-year double-blind study, test subjects were given a combination of melatonin, strontium citrate, vitamin D3, and vitamin K2, then compared with a random group that received a placebo. Bone density, bone marker turnover, and health-related quality of life were compared at the start, six months through, and after 12 months.

Compared to the placebo group whose bones lost density, those who took the nutrient combination experienced significant bone density increases (4.3% at the lumbar spine), declines of bone turnover, and better mood and sleep.

What were they taking each day?

• 5 mg melatonin
• 450 mg strontium citrate
• 2000 IU vitamin D3
• 60 mcg vitamin K2 (MK7 form)

Previous studies referenced in the paper have shown bone benefits from all of these nutrients, although this is the first study that has combined them. Rather than uncomfortable side effects, those who took the micronutrients saw their quality of life improve.

How does this compare to the 2012 COMB study? Well, COMB didn’t include any melatonin, which generally helps with sleep. The same amount of vitamin D was used, but more strontium citrate (680 mg) and more vitamin K2 (100 mcg) in COMB. As well, COMB subjects consumed DHA and magnesium, and their bones improved even more: 6% at the lumbar spine. Here’s more about that research.

The new study used a statistically significant but much smaller test group (20 vs 114), made up of postmenopausal women with osteopenia, whereas the COMB study subjects began with worse density – already in the osteoporosis range.

My personal response to this? I will keep going with the approach I’ve committed to: my own combination of micronutrients along with a healthy diet and lifestyle. My bones are with me for the long haul!

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 20^th 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.

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.

The elusive K2

It turns out that K2 is an oft used name. I knew it applied to the second highest mountain peak in the world, located between Pakistan and China. And I’m telling the whole truth when I tell you that until just now I didn’t know it is a word whispered between illegal drug users. But did YOU know that it is also a vitamin that your bones must have?

Maybe you’ve heard of vitamin K. Have you wondered how it rated the 11th letter of the alphabet, when the previous vitamins were A-B-C-D-E? Why it isn’t vitamin F? Well, it turns out that the Danish scientist who identified it referred to it as the Koagulationsvitamin because of its role in coagulation, and that starts with a K. Eventually scientists figured out that there are several forms of this vitamin, and this initial variety was renamed K1

Without vitamin K1 we are prone to hemorrhaging because the blood doesn’t clot appropriately. It’s easy to get enough of this, though, because it’s abundant in leafy green vegetables. Kale is an excellent source of K1.

Another member of the family, vitamin K2, has a major effect on bone metabolism by regulating calcium. While directing the calcium to our bones, where it’s needed, it effectively transfers it away from our arteries, preventing arteriosclerosis. So the gain to our bones also benefits our hearts.

But here’s the problem: while some vitamin K2 can be formed in the body from vitamin K1, the most biologically active form can’t, so must be taken from food or a supplement. The best food source of K2 is a traditional Japanese fermented soybean food called natto.

As it happens, my husband and one daughter love natto, so every now and then I make a batch for them, a three-day process that involves soaking, cooking, then fermenting soybeans with a culture hand-carried from Japan. I can tell you more about this if you want to know. But most non-Japanese people have a very hard time eating natto. Whether it’s the smell reminiscent of stinky socks, the mucous-like threads that hang from a spoonful, or the overpowering taste – chances are it would take you some time to acquire the taste for this food.

So in the case of vitamin K2, for the sake of your bones I strongly suggest you buy a supplement. To help absorption, take it with a bit of fat because K is fat-soluble.