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 There are still many medical practitioners who rely on “old school”, outdated know-how that Vitamin K is only key for blood clotting and thus should be minimized in cases of high-risk for (or diagnoses of) cardiovascular disease.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 know that healthcare must be transformed to be sustainable and effective, and you believe strongly that Functional Medicine is key to making that happen, we urge you to learn about our semester program.
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