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clear search termsPreventing Arterial Plaque
You would think that if a specific vitamin had actually been shown in clinical study to be associated with a 50% reduction in cardiovascular disease risk (yes, half!) that it would be a major news headliner, right? Right up there with the latest drug? Not so much! But I expect we will start to hear much more from the mainstream about the power of Vitamin K2 in the next few years.
In the body, many vitamins serve as cofactors for enzymes and thus play major roles in catalyzing (that is, speeding up or increasing) key biochemical processes. Vitamin K is a cofactor. Most of my clients haven’t even heard of Vitamin K. Or if they have, it’s about the high level of Vitamin K1 (phylloquinones) found in green leafy vegetables vs. Vitamin K2 (menaquinones). Unfortunately, Vitamin K2 is prevalent mostly in foods that many of our clients have shied away from due to nutritional myths. Foods such as butter (but only if it’s grass-fed), cheeses, fatty red meats (e.g. ribeye steak), liver, and egg yolks. The food containing the highest amount of Vitamin K2 is a highly fermented soy food called natto, which very few people can tolerate given its strong odor and flavor.
Bacteria in the human gut can produce Vitamin K forms, but this appears to be not in sufficient quantity to prevent calcification in a Vitamin K-deficient diet. While it appears that animals can easily convert Vitamin K1 into Vitamin K2, this has not been well demonstrated in humans (one of few human studies). And our modern epidemics of osteoporosis and heart disease may be evidence of this combined K1-to-K2 impairment and our overall poor intake of foods high in Vitamin K1. Unlike other fat-soluble vitamins, the body does not store Vitamin K, so it must be taken in regularly.
Among other functions, Vitamin K is responsible for carboxylating (a simple biochemical adjustment) and thus activating a class of proteins in the body called Gla proteins. These proteins play a variety of functions such as blood clotting and managing calcium in the body. There are still many medical practitioners who rely on “old school”, outdated know-how that Vitamin K is only key for blood clotting and thus should be minimized in cases of high-risk for (or diagnoses of) cardiovascular disease. Indeed, Vitamin K1 is preferentially used by the liver which is where clotting proteins are made. However, the rest of the body preferentially uses the K2 form which is where it is needed to keep bones, arteries, kidneys, brain, etc. healthy. Insufficient Vitamin K2 can dramatically increase the risk of cardiovascular disease, specifically via calcification of arteries, especially the aorta.
In blood vessels, Vitamin K2 is necessary to carboxylate MGP, a protein which strongly inhibits vascular calcification. But only Vitamin K2, not Vitamin K1! And Vitamin D also plays a synergistic role in this activation. In the famous Rotterdam study, sufficient Vitamin K2 intake was shown to prevent both cardiovascular disease and aortic calcification more than 50% of the time! As many of us well know, our cardiovascular disease myths are often focused on the wrong factors! Sudden death from heart attack is even much more highly correlated with calcification of the aorta than with cholesterol. I expect in the next decade we will at least see widespread availability of conventional labwork that measures uncarboxylated MGP, given it has already – repeatedly – been shown to be highly correlated with the level of arterial calcification and Vitamin K nutritional status.
Get confident about using functional medicine know-how to help your clients with concerns about atherosclerosis and/or arteriosclerosis. I typically recommend a combination of MK-7 and MK-4 forms of Vitamin K2 in supplement (e.g. Pure Encapsulations’ Synergy K). If you want to do a deeper dive, this article by Chris Masterjohn is very well done and also includes an excellent info-graphic.
Vitamin K2 is powerful! But of course many other key factors must be considered in cardiovascular concerns. If you’d like to delve into root causes at a confidence-building depth, consider our clinical course on Cardiovascular Myths & Truths . It’s one of many clinical courses you may choose from to customize your SAFM Semester. Unlike most advanced, clinical training programs, SAFM offers you the opportunity to dive deeply into the topics you are most passionate about (vs. just getting cursory knowledge in a wide array of topics, training that can leave you feeling informed but ultimately ineffective in helping your clients get truly breakthrough results).
P.S. If you are passionate about transforming healthcare through the power of functional medicine, we encourage you to learn more about SAFM’s practitioner training programs. Enrollment for our next cohort is now open!
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32 Questions for “Preventing Arterial Plaque”
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17.1
Indeed that particular study seems to be missing the results.
https://clinicaltrials.gov/ct2/show/results/NCT01002157
However, there are other studies that have been completed and the results published:
https://pubmed.ncbi.nlm.nih.gov/28756183/
https://clinicaltrials.gov/ct2/show/NCT00642551
https://clinicaltrials.gov/ct2/show/NCT02976246
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Anonymous says:
I’m 55, menopausal and developing osteoporosis and macular degeneration. I was taking high dose D3 with MK7. Macular degeneration is linked to cardiovascular disease. Should I take an MK4 and MK7 combo, MK4 for osteoporosis and MK7 for cardiovascular benefits? I’m not sure if I should combine this with vitamin D3 either? I know when I was taking high-dose D3 with MK7 and calcium, I developed an accute kidney stone attach. When I take low-dose D3 with MK7, I have a thin urine stream. This is why I question whether a combo of the vitamin K without D3 would be better…
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16.1
Thank you for your question. Alas, as much as we might wish to further support individuals such as yourself, we are unable to share personal health guidance in a public format such as this, as it wouldn’t be responsible. You will need to work with a practitioner who can thoroughly understand your unique health situation, help you with designing an appropriate regimen, and also monitor and support your journey over time. People can have notably different levels of response to berberine and metformin, especially in combination. You are welcome to check our practitioner directory to see if you wish to pursue working with one of them. https://practitioners.schoolafm.com/
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Heather Williams says:
I have multiple clients with MTHFR mutations, and one recently asked about the relationship between taking Vitamin K (in her vitamin D supplement) and her already increased risk for blood clotting with the mutation. Has there been any research done that you have seen about whether or not people with MTHFR mutations should be careful about vitamin K intake?
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Lydia says:
Can one continue to take MK-4 and MK-7 while on a statin? Don’t they work at cross-purposes — the former decalcifying plaque, the latter calcifying it? Thanks.
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14.1
Yes, one can use MK4 and MK7 while on a statin. They don’t work at cross-purposes. In fact, this type of combo supplementation may offset some of the negative effects of statins as they are known to inhibit the synthesis of vitamin K2 – this is a good study that talks about this relationship:
https://www.ncbi.nlm.nih.gov/pubmed/25655639
It is true that statins stabilize plaque by promoting its clacification. That being said, MK4 and MK7 have a normalizing effect on the calcification process; they won’t deplete calcium from the bloodstream but rather prevent excessive or inappropriate calcification that may be a result of statin use.
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Varun B says:
Hello Tracy,
My mother has diabetes and has undergone multiple stenting in two primary arteries over the last 8-9 years. She has started taking Vit D3+K2 combo which has 115mcg K2 and 3000 unit D3. My question is, how long does it take before seeing any benefit of K2 like a reversal of blockage? I need to know if 115 mcg dose is enough for her condition so that the blockage does not become worse and if any reversal will happen in a stable way.Thanks
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13.1
Alas, we cannot give specific case advice nor recommendations in the SAFM Q&A forums. However, your question is raising an important overarching point and it is the fact that no amount of vit D3+K2 will be able to fully address the blockages that are likely a result of high cholesterol levels due to diabetes that your mother is struggling with. In this case, insulin resistance and the oxidative stress that is the detrimental consequence of this dynamic is a root cause that needs to be addressed if you want to see progress in artery health. Therefore, one should prioritize dietary intervention, possibly along with berberine, chromium, and magnesium. Also, you may want to look into other agents that were shown to help with arterial plaque reversal such as pomegranate, aged garlic, and essential fatty acids EPA and GLA. Hope this helps.
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Tracey says:
One of the article stated that the test results would be completed at the end of 2017. Would you provide me a direct link to the results if they are out. And available Thank you ????
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12.1
Thanks for checking in. Indeed we were disappointed to learn that it will be October of 2019 when the results will be posted.
You can continue to check the status of this particular clinical trial here:
https://clinicaltrials.gov/ct2/show/results/NCT01002157?view=results
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Morrie says:
Curious on information regarding bicuspid aortic valve stenosis (calcification of valve) – any nutritional advice on slowing down the calcification? Any studies?
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11.1
It is important to note that bicuspid aortic valve is an anatomical issue that some people are born with and it means that their valve may wear out quicker over time. Here’s a good explanation of what “bicuspid aortic valve” means:
https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-aortic-valve-stenosis
As for the nutritional guidance to prevent the calcification of this valve it would be quite the same as outlined in the write up above. In fact there is a promissing study under way that is looking into the efficacy of MK7 specifically for bicuspid aortic valve stenosis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946171/ but we need to wait for the final results.
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val wolf says:
I had been taking K2 for some time—then I saw a video about if there happens to be soft plaque in the arteries, K2 can conceivably remove the ‘cap’ and release the soft plaque, thus causing a clot. Have you heard of anything like this?
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10.1
Val, thank you for your question. I recommend going back to the video that you are referring to and checking the references if there are any. In our research, we couldn’t find evidence that K2 can indeed cause a removal of the ‘cap’ and release of the soft plaque. Vit K2 has been shown in many different studies now (some are cited throughout the above article) to prevent arterial plaque calcification. Calcification of the plaques occurs as atherosclerosis progresses, it is unclear whether calcification increases plaque instability and could predict the risk of rupture. However, calcification may be predictive of future cardiovascular events.
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Warren Cunningham says:
Regarding the study in the Netherlands that is supposed to be published at the end of 2017, I corresponded with the Dr. Abraham Kroon, the lead researcher, to ask about the study results. He responded that the study — unlike what is stated in the abstract — will not be available until the end of 2018.
Menaquinone-7 Supplementation to Reduce Vascular Calcification in Patients with Coronary Artery Disease: Rationale and Study Protocol (VitaK-CAC Trial)
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SAFM Team says:
Excellent. We appreciate the update!
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Neville says:
Hello, Is there anyway i can contact a functional medicine doctor who can help with VitK2 supplementation?
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8.1
At the moment, the easiest place to get connected with a local, functional medicine physician would be via IFM at http://www.FunctionalMedicine.org. You will see a link to search for a practitioner which you can do via distance from your zipcode.
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Pete says:
NCBI is conducting a test of Menaquinone-7 Supplementation to Reduce Vascular Calcification in Patients with Coronary Artery Disease. Results should be out by the end of 2017. Their dosage is 360 μg MK-7 daily.
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7.1
Yes, thank you for posting and sharing! I am very excited about seeing the outcome of this one (especially because, unlike so many other studies, the intervention dosage should be sufficient to show marked effects). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4663571/
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Michael says:
Have practitioners actually seen a decrease in calcium scores after supplementing with K2? I’d love to hear some anecdotal stories about this.
Also, from the research I’ve done, it appears that the Mk4 form of K2 might actually be more effective.
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6.1
I know anecdotally of reductions of coronary calcium scores over time, but definitely K2 can arrest the progression of CC scores over time and stabilize the value. Plaque can definitely be removed with K2, especially combined with other remedies (e.g. proteolytic enzymes, high-dose fish oil); I have seen this in a few clients myself. A great question re: MK-7 and MK-4. The studies I mention specifically reflect use of MK-7. I know that some people have uniquely beneficial responses with MK-4, especially with regard to bone building (e.g. countering osteoporosis). My concern with MK4 is the short half-life that really requires multi-dosing to be most effective (and the issue of compliance). I am concerned about bioavailability of these nutrients from supplement e.g. http://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-11-93 . Certainly I think combination formulas of MK-7 and MK-4 may be a good choice for those who have multiple concerns regarding not only calcium removal from undesired placement but calcium deposition where it is most needed e.g. Designs for Health Tri-K http://catalog.designsforhealth.com/TRI-K-60 .
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I am delighted to see that a gold-standard clinical study began in late 2015 will be looking over two years specifically at the effects of Vitamin K2 supplementation on coronary calcium scores. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4663571/. Unfortunately human studies in this area to date have been largely limited to case studies or those with less rigid control e.g. http://www.fasebj.org/cgi/content/meeting_abstract/22/1_MeetingAbstracts/1092.15 .
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Mary Meagher says:
Many Vitamin D supplements are now also containing Vitamin K, though in a combination of K1 and K2. Thoughts on these K combos for people with Factor V Leiden? Is there a safe amount of K1 supplementation for Factor V? Or should they avoid K1 altogether?
Thanks-
4.1
Indeed, I too have seen several Vitamin D/K combination formulas that are now including both K1 and K2. Alas, I don’t think the question you raise (a wise one given the Factor V Leiden concern) has been overtly studied clinically in any way. Given the inherent risks, I would not recommend Vitamin K1 for patients/clients with this diagnosis. I also believe it would be important for these individuals to seek fairly consistent intake of foods high in Vitamin K1 (e.g. dark leafy greens) so that appropriate medication adjustments (or other protective measures) can be managed optimally. A great question – and a good reminder of the need to consider carefully the whole person and the potential risk of supporting one wellness goal without considering the potential downsides in another area.
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Subhashini Katumuluwa says:
Hi Tracy. Thanks so much for this informative post. For someone on coumadin, it is recommended that they limit (or keep stable) the amount of Vit K they are consuming in food. That recommendation is regarding Vit K1, right? So is it ok for such people to be taking Vit K2 supplements if they have CAD? Thank you!
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3.1
You are very welcome! Correct: we are learning that K1 is the more important nutrient for controlling blood clotting, while K2 is particularly important for controlling calcium sequestering. For individuals using coumadin on an ongoing basis (vs. for acute or short-term needs), research points to the intelligence of using Vitamin K2 supplements (perhaps with a modified coumadin dose after a new PT-INR baseline has been identified) to stabilize the effect of the coumadin. I have spoken to many functional physicians who do just that, usually using a moderate (~90 mcg) dose of the MK-7 form of Vitamin K2. Of course, it’s critical that the prescribing physician be involved, and alas most of them are not educated on the finer points of various forms of Vitamin K (and the ways in which ongoing use of a medication like coumadin can increase the risk of arteriosclerosis) and may need some education. This more detailed write-up points to some of this research, gives references for further follow-up, and might be helpful to you. http://www.lifeextension.com/magazine/2007/6/report_vitamink/page-01
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This is exciting Tracy. I most likely need to review; but what test do you need to take to get the Cornary Calcium score?
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A heart scan (an EBT, essential a type of CT scan) gives technicians the data they need to calculate a coronary calcium score. This article by Dr. William Davis (author of “Wheat Belly” by the way, one of my favorite client giveaways) will give you some more information: http://www.healthcentral.com/cholesterol/c/7986/111036/coronary-score/ ).
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Mary Meagher says:
Great article to concisely explain the interconnectedness and importance of D, K2, Mg, and Ca! Personal thoughts…Mercola offers K2 @ 150 mcg, a little too high for daily dosing?
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1.1
Thanks! For daily, preventive dosing in a healthy individual, I think a much smaller dose is sufficient (e.g. ~45 mcg). However, for those with known high risk of cardiovascular disease I do think a higher dose is merited in order to not only prevent escalation but also reverse the existing dynamic. In this latter case, I will typically recommend more like (~90 mcg/day), not quite as high as what Mercola promotes however. I do think we need more research in finding the “optimal” daily dosing in the case of active disease. I am not aware of any research specifically showing the need for levels that high, though the next decade of research may show otherwise.
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Thank you for all the information.
I have been trying to find out the results of the 2015 vit K2MK7 CAC trial on CAD with patients but apparently is not available or perhaps I can’t find it . The study was scheduled to end in 2 years.