Supplements that are not Optional for Vegans

January 1, 2017 / Tracey Porter Nelson, MALC, M.Ed.

requiredI am not one to advocate taking a lot of supplements. Not like I used to in the past. But there are some nutrients that are just not an option. This is particularly true for those nutrients that our diets just do not provide enough of and we cannot live without.

Not Enough in the Diet

Vitamin D3 and K2 doesn’t really exist in any great quantity in our common food supply, particularly for those who are trying to eat a more plant-based, less fatty, or vegan diet. Consequently, a deficiency of these nutrients usually exists. Even if you eat plenty of dairy food, you really can’t get an adequate amount of either Vitamins D3 and K2 from your diet.not-optional

Deficiencies in calcium and magnesium are also common. However, you can get plenty of both of these along with crucial life-extending antioxidants like A and C simply by taking in several cups of leafy greens every day. Nevertheless, many people fail to partake in green smoothies or eating salads or cooked greens on a daily basis (as they should).

To get enough of these two nutrients and others eat 7 cups of greens per day (measured in the raw form). For example, 3 cups of kale in your morning protein smoothie, 3 cups of romaine lettuce in a salad for lunch, and 1 cup canned spinach for dinner provides a whopping 760 mg calcium!

This amount of calcium is enough for the whole day as it comes from a vegetable source which is much more bioavailable than dairy sources. Therefore, calcium that come from greens only requires half as much as the recommendation for dairy and supplement sources.

You also get over 100% of the following nutrients: Iron and vitamin K1, an excess of vitamin A (excess is safe in vegetable form) and 400% of vitamin C. You also get 89% of the RDA of manganese, 62% of your folate, 50% of your potassium and magensium, and a whole lot more. Greens don’t bog us down, give us energy, fiber, and are low calorie.

For decades, the usual “go to” food suggested for calcium has been dairy, thanks to the sustained efforts of the Dairy Council. But people are often sensitive to dairy or they don’t partake because they don’t like dairy products, are dieting, or have chosen to abandon eating animal products. In studies, dairy is particularly disease-promoting. So why not go to leafy greens as they have so many other benefits?

However, if you are fighting inflammation which causes several major problems including automimmune diseases, cancer, joint and muscle pain, exhaustion, osteopenia, and osteoporosis, you need to pay particular attention to your level of all of these nutrients just mentioned. The only time you may want to consider taking supplements for calcium and magnesium is if you can’t manage to get enough in your diet or when your health is bad enough that you need quick intervention. Warning: If you have atrial fibrillation, you will want to work with your doctor while taking magnesium supplements. Apparently this is because magnesium can restore normal rhythm to the heart. So, “a sudden ‘conversion’ of your heart to it’s normal rhythm COULD cause dangerous blood clots to be released. You MUST involve your cardiologist before you begin taking magnesium!” [Read more: http://www.easy-immune-health.com/atrial-fibrillation-cause.html#ixzz4UYXHfBQL.%5D

Still, since there is often already a magnesium deficiency in those who have A-fib, magnesium can potentially be of great help. But I wouldn’t take supplements without medical supervision as the doctor will likely have some specific instructions to help make it safer.[see reference, above]

I will cover a few specifics about each of these nutrients. However, the main focus of this article is on Vitamin K2.

Bone Building, Inflammation Blocking, Cancer Preventing Nutrients

Vitamin K2

  • Tips (for taking and purchasing K2):
    • There are two forms of this vitamin:
      • MK-4 is the synthetic form. More of the successful scientific trials have been conducted with this form but requires higher dosing multiple times per day because MK-4 has a very short biological half-life of about one hour.
      • MK-7 is the natural form. Studies show that MK-7 tends to stay in the blood longer and is more bioavailable only requiring a single dose. However, most of the successful studies used MK-4.
    • Vitamin K2 is nontoxic.
    • It is best taken with food or drink containing fat.

vitamin-k-heart-bone-fb

  • Benefits:
    • Vitamin K2’s most significant and well known role is in transporting calcium back into the bones.
    • It is also effective at removing calcium from the soft tissues. This is vital because we don’t want calcium lodged in our arteries because it can cause a blockage leading to a heart attack and/or stroke. When it is in our tissues, it hurts causing pain in joints and kidneys (kidney stones).
      • It can remove the calcium already present within those tissues or arterial blockages. Here is some of the evidence:
        • There have been lots of studies supporting the conclusion that people who consume the highest levels of vitamin K have healthiest hearts, such as the Rotterdam Heart Study; a large-scale, well-controlled clinical trial that tracked 4,800 subjects for seven years.
        • Other studies have shown that higher vitamin K levels correspond to less calcium deposits in the aorta and can even cause a 37% regression of preformed arterial calcification.[1,2]
      • K2 has been found to decrease inflammation in several studies. Here is why that is so terribly important:
        • Inflammation is like a fire burning out of control in our bodies. The way the body tries to extinguish the fire is to steal calcium from our bones (if there is none available in the diet) to put it out, much like a fire extinguisher will do. This is one of the mechanisms responsible for osteoporosis.
        • Inflammation has also be shown to be the toxic environment needed for many cancers and other disease processes such as obesity to get a foothold in the body.
        • Inflammation causes damage to the lining of our arteries. When this happens, both calcium and cholesterol come to the rescue to repair the damage (thereby creating a blocked artery).
        •  Because inflammation is the precursor to many disease processes like osteoporosis and heart disease, those seeking better health need to do all they can such as taking Vitamin K2 (including making key lifestyle changes) to prevent inflammation whenever they can.
        • Here are the findings of some studies:
          • In a study of patients with Rheumatoid Arthritis (RA), after three months of taking 100 mcg of MK-7, “. . .the MK-7 treated group showed a marked decrease in RA biochemical markers compared to controls, including significantly lower CRP, ESR, and DAS28-ESR. This suggests improved disease activity in RA patients. . .”[3] This is significant because RA is a chronic inflammatory disease affecting multiple joints. Both MK-4 (the synthetic form) and MK-7 were helpful, but MK-7 was better as it was more bioavailable.
          • According to Dr. Mercola, “The study from the Czech Republic evaluated the role of MK-7 in inflammation and found that it prevents inflammation by inhibiting pro-inflammatory markers produced by white blood cells called monocytes. NattoPharma reported:2
            • The novel finding in our study supplements our three-year clinical study showing MK-7’s ability to slow down cardiovascular aging and osteoporosis, and it should further serve as the catalyst to create the urgency of daily consumption of MK-7…
            • We know that in Western populations, most people do not obtain enough due to modern diet. Our food is increasingly deficient in vitamin K2 in particular, and up to 98% of the general healthy population may be vitamin K2 insufficient with long-term detrimental impact on bone and cardiovascular health.”[4]

Why it Works So Well

Sometimes it helps to understand the mechanisms behind how a nutrient works in order to appreciate its value. According to Dr. Mercola,

“There’s a complex biochemistry that occurs with K2 involving two enzymes: Matrix Gla-protein (MGP) Osteocalcin ‘Gla’ is short for glutamic acid. Glutamic acid is imported into the cells in the wall of your arteries, where it binds to calcium and removes it from the lining of your blood vessels. Once removed from your blood vessel lining, vitamin K2 then facilitates the intergration of that calcium into your bone matrix by handing it over to osteocalcin,. The osteocalcin then helps cement the calcium in place. Vitamin K2 activates these two proteins. Without it, this transfer process of calcium from your arteries to your bone cannot occur, which raises your risk of arterial calcification.”[5]

Mercola quotes health guru, Dr. Goodman, as follows:

“Vitamin K2 is like a light switch—it switches on MGP and osteocalcin, which takes calcium out of the arterial wall and keeps it in the bone. There’s so much information showing this relationship between osteoporosis (not having enough calcium in your bones) and having an increased incidence of heart disease. What’s actually happening, I think, a lot of patients are vitamin K2-deficient,” Dr. Goodman says. “So now, I tell all patients – especially when they have risk factors for calcification – ‘You’ve got to get vitamin K2 when you take your vitamin D, and your calcium, and magnesium.’ Because we need to make sure that the calcium is going where it’s supposed to go.”[6]

Vitamin D3

I don’t plan to get into depth about vitamin D3 or the other minerals I mentioned simply because a lot has already been written about them. With regard to vitamin D3, it is commonly know to be the vitamin responsible for preventing rickets in children (a disease causing bone deformity). The only way to really get enough vitamin D3 is either through year-round sun exposure or supplementation. It is such an important nutrient and so hard to obtain through out diet that the government started the practice of supplementing our milk with the nutrient. Nevertheless, even when we drink three or four glasses of milk a day, we are not getting enough. Maybe enough to prevent rickets, but not enough to prevent other diseases or to provide optimal health.

vitamindsunshinechart

Of course, being a co-factor to support calcium absorption, this vitamin is essential to maintain strong bones. It also prevents or treats 76 diseases.[7] That is because vitamin D3 also plays a role in preventing inflammation, the environment produced in the body by our modern lifestyle that promotes cancer and many other diseases.

Getting your vitamin D3 level tested may help you chart your progress and provide you with a baseline but it is no longer recommended ever since a study found that the same samples sent to different labs can come back with dramatically different results. Nevertheless, unless it is a problem for you financially, it might be a good idea especially if you are using the same lab each time.

As proven in the test below, Vitamin D3 intake is one of the key co-factors to the absorption of the calcium needed in the strengthening of bones. For example, the higher score on the participant’s D3 blood test, i.e., the 25(OH)D score, and amount of calcium intake, the higher the Bone Mineral Density (BMD) of the hip bone.

vitamin-d3-intake-chart

Total hipbone mineral density by quartiles of calcium intake, stratified by 25(OH) vitamin D. Vitamin D status strongly modifies the bone building effects of oral calcium intake. Image Credit – Open Heart.

Studies also show that a vitamin D deficiency is a predictor of reduced survival in patients with heart failure whereas vitamin D supplementation improves outcome.[8] Other studies indicate that vitamin D supplementation at 4,000 IU reduces C-reactive protein by 64% and insulin resistance by 24% in women with type 2 diabetes mellitus.[9]

On a Personal Note: I and many doctors and nutritionist are not in favor of eating fatty foods like fatty fish, cod liver oil, and dairy products to get vitamin D3, calcium, or K2 because fat increases insulin resistance and heart disease. See the following with regard to dairy foods from a paper by Open Heart which made recommendations to “keep bones hard and hearts soft”:

Consumption of cow’s milk has been inconsistently associated with cataracts, ovarian and prostate cancers, and Parkinson’s disease, and it has been implicated in certain autoimmune diseases, such as type 1 diabetes and multiple sclerosis. Overall, the evidence for dairy-induced human disease appears to be most consistent for prostate cancer and for type 1 diabetes.

A recent study of over 106 000 adults followed for 20 years showed that drinking three or more glasses of milk per day was associated with increased risks for bone fracture and higher mortality rates compared with drinking not more than one glass of milk per day.20 By contrast, for the women in that study, each daily serving of cheese and/or other fermented milk products such as yogurt was associated with a 10–15% decrease in the rates of mortality and hip fractures (p<0.001).

The sugar in milk, lactose, is broken down in the gastrointestinal tract to d-galactose and d-glucose. d-Galactose has been found to increase inflammation and oxidation in adult humans, and in adult animals this sugar triggers accelerated ageing, neurodegeneration, and a shortened life span.[10]

How to Take

Take all of these supplements with food containing fat.

vitamin-k2Vitamin K2

The suggestions on dosages vary. But by in large, the studies for vitamin K2 are showing best results for the restoration of bone and removal of plaque build up in the arteries is with the synthetic form MK-4:

15 mg taken three times per day

However, MK-7 only requires:

From 45-150 mcg per day once per day

If I wanted enough of both types of vitamin K2 so I could obtain the proven benefits from each, I’d only take 45 mcg of MK-7 (so as not to over do it) replacing one of the doses of the MK-4 with that taking only two of the 15 mg MK-4 doses. That is what I would do if I wanted to be conservative about it. But there is no known level of toxicity. That would strategy would allow the K2 stays in the blood longer and it would provide me with all the benefits from the studies. However, it is worth noting that not all vitamin K supplements are created equal. Vitamin MK-7 is measured in micrograms (mcg) which is a fraction of what you need from the MK-4 which is measured in milligrams (mg). I was not able to find that quantity of MK-4 except for at Amazon.com.

Again, take calcium for a week or two prior to starting this vitamin as a precaution just in case you don’t have enough in your blood to prevent problems. And always take it with enough calcium, magnesium, and vitamin D3 daily.

Potential Problems

Not everyone is without problems taking this vitamin, such as myself. If there are problems, usually it is because you are already low in calcium, just as I was when I got started. When I had problems I just had to be patient and persistent in order to persevere. What learned was that because vitamin K2 is such an effective nutrient that is meant to be shuttling calcium from your blood into your bones. It is powerful. So if there isn’t much calcium in your diet, it may cause you some discomfort or other symptoms. I had joint aches. I strongly suggest whether you have problems or not:

  • Take a full dose of plant-based or bovine-sourced calcium (microcrystalline hydroxyapatite or MCHC also called calcium hydroxyapatite) for a full week or two along with at least these other co-factors, vitamin D3 and magnesium, before you start taking vitamin K2. (Strong suggestion: For those with bone disease to use MCHC rather than a plant-sourced supplement due to reasons that will become evident in one of the charts near the end of this article).
  • Continue taking these after you begin taking vitamin K2.
  • If you still have problems, build up your good gut bacteria. Your body can make some vitamin K2 in your bowel on its own.[11]
    • NOTE: Having gut flora out of balance is going to cause you painful joints when you take just about any supplement as these particles are slipping through the holes in your permeable gut directly into your bloodstream without being fully digested into their molecular form.
  • Of course, as always with any food, medicine, supplement, skin product, or other substances that come in contact with your body, assess if your problems are allergy related. If so, try switching to the other form

Vitamin D3

The suggestion for vitamin D3 intake appears to vary depending on whether you are deficient or not, your size, etc. Of course the RDA is quite low, to help prevent rickets, they have raised their recommendations quite significantly recently.

The general recommendation for optimal health seems to fall anywhere between 2,000 IU to 10,000 IU per day. Some scientific studies are giving 50,000 IU per week to their deficient patients for up to ten weeks to build up their vitamin D levels. Another suggested 100,000 IU per week for four weeks then 100,000 IU per month for six months. That study was for lupus sufferers. they didn’t have a single inflammatory flare. The recommendation by Dr. Mercola is 5,000 IU per day. Although vitamin D can reach toxic levels, apparently because we get between 3,000 to 20,000 IU from sun exposure per day and that can accumulate over time, none of the previous recommendations are of concern. Some suggest that enough exposure during the summer, such as 80 days fully exposed to the sun for 30 minutes, will last you through the winter. However, I have not seen any studies that prove that.

As Mercola stated, in his opinion, there is no way to know for sure what is optimal for us without testing because it takes time to bring levels up to an optimal range.

Potential Problems: 

Some people break out in hives or itching when ever they take vitamin D3 supplements. That is likely because it is made of lanolin which comes from wool. I never do well when I wear wool. So it makes sense why I might not do well taking D3. So you will want to take a vegan plant-source of this vitamin if you find that you are having this problem, too.

I hear that taking some magnesium for a week prior also helps prevent any potential problems that may creep up with taking vitamin D3.[12] I am not sure why this is because the website, Vitamin D Wiki, does not explain. But when I was having problems with leaky gut and pain in my joints with every supplement I ever took, I was willing to try anything just to keep from being deficient in these nutrients. So if you are having problems and a plant-based supplement is not helping, this is worth a try. Otherwise, you may end up having to eat a great deal of fatty or bad for you dairy, eggs, fish or purchase one of those UV producing lamps for the winter months.

I would also suggest taking plant-based or bovine-sourced calcium and eat calcium rich greens ahead of time for a week prior as well.

What about Calcium?

The whole point for taking the co-factors vitamin K2, D3 and the mineral magnesium is to increase the uptake and effectiveness of calcium in our bones. For some, getting enough calcium through diet is not going to be a problem. Nevertheless, deficiencies often exist in women who are dieting, or anyone who is either allergic to dairy products or a vegan especially if they do not eat seven cups of leafy greens every day.

The need for this nutrient for health is generally unquestioned. But with recent studies showing the increase incidence in cardiovascular (CV) events upon taking calcium supplements, there is a lot of confusion and fear surrounding whether one should even take a calcium supplement anymore. For the normal person, it is always best to get your calcium from food sources, particularly leafy greens. However, for the person with bone disease, I believe some supplementation, especially by one particular type indicated in the chart from the study, below, still may be called for (due to its incredible benefits for building bone).

most-effective-types-of-calcium

Change in cortical bone thickness among 64 women with osteopenia randomised to 14-month treatment with no mineral therapy (red bar), calcium gluconate (blue bar), or calcium hydroxyapatite (green bar). The control group showed bone loss (p

The optimal amount of calcium recommended to be taken is 1,000 mg per day, as indicated in this graph from the same study as the incidence of death increases when calcium intake is higher or lower than 1,000 mg.

optimal-calcium-intake

Relationship of daily calcium intake to risk of CV mortality during follow-up. Data were fully adjusted for confounding variables. The calcium intake for optimising CV longevity is about 1000 mg/day, with higher and lower calcium intakes associated with increased CV mortality. Image Credit – Open Heart.

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Copyright 2016 Tracey Porter Nelson, MALC, M.Ed.

You are free to share as long as a link to the article in this blog, Over 50 Diabetic Frutarian, and the author’s name is included. No reproductions can be made in print for the purpose of making a profit without obtaining permission first.

Sources:

1) Faloon, W. (2009, January). “Protection Against Arterial Calcification, Bone Loss, Cancer, and Aging!” Life Extension Magazine. [Website]. Retrieved from http://www.lifeextension.com/magazine/2009/1/vitamin-k-protection-against-arterial-calcification-bone-loss-cancer-aging/page-01?p=1

2) Super K with Advanced K2 Complex (2016). Description of Supplement. [Website]. Retrieved from http://www.lifeextension.com/vitamins-supplements/item01834/super-k-with-advanced-k2-complex?gclid=CjwKEAjwgo6_BRC32q6_5s2R-R8SJAB7hTG-2BP8xXQimqkHjmvIJItLwi1mS5kfqd_Ke7Ew25sOsBoCNV7w_wcB

3) Rhéaume-Bleue, K. (2015 October). “Choosing the Right Vitamin K2: Menaquinone-4 vs Menaquinone-7 Clinical considerations of different forms of vitamin K2.” Natural Medicine Journal, 7(10). [Website]. Retrieved from http://www.naturalmedicinejournal.com/journal/2015-10/choosing-right-vitamin-k2-menaquinone-4-vs-menaquinone-7

4) Mercola, J. (2013, October 13). “New Study Shows Evidence That Vitamin K2 Positively Impacts Inflammation.” Mercola.com. [Website]. Retrieved from http://articles.mercola.com/sites/articles/archive/2013/10/12/vitamin-k2-benefits.aspx

5) Ibid.

6) Ibid.

7) “Proven: Vitamin D prevents or treats 76 health problems.” (2016, December). Vitamin D Wiki. [Website]. http://www.vitamindwiki.com/tiki-index.php?page_id=1336

8) Gotsman I, Shauer A, Zwas DR, Hellman Y, Keren A, Lotan C, Admon D. (2012 April). “Vitamin D deficiency is a predictor of reduced survival in patients with heart failure; vitamin D supplementation improves outcome.” European Journal of Heart Failure, 14(4):357-66. doi: 10.1093/eurjhf/hfr175. Epub 2012 Feb 3. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22308011

9) Flores, M., Barquera, S., Macias, N., Salmeron, J., Greenberg, A., Wood, R., Long, K., Meydani, S. (2010, April). “Vitamin D supplementation reduces C-reactive protein and insulin resistance in women with type 2 diabetes mellitus.” The FASEB Journal, 24(1). Retrieved from http://www.fasebj.org/content/24/1_Supplement/342.1.short 

10) O’Keefe, J. H., Bergman, N., Carrera-Bastos, P., Fontes-Villalba, M., DiNicolantonio, J. J., & Cordain, L. (2016). “Nutritional strategies for skeletal and cardiovascular health: hard bones, soft arteries, rather than vice versa.” Open Heart, 3(1), e000325. http://doi.org/10.1136/openhrt-2015-000325 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809188/

11) Conly, J.M., Stein, K. (1992, October-December). “The production of menaquinones (vitamin K2) by intestinal bacteria and their role in maintaining coagulation homeostasis.” Progress in Food Nutrition Science, 16(4):307-43. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/1492156

12) “Overview: Rare Allergic Reaction to Vitamin D.” (n.d.). Vitamin D Wiki. [Website]. Retrieved from http://www.vitamindwiki.com/tiki-index.php?page_id=2433

Other Vitamin K2 studies also worth noting… 

Osteoporosis:

  •  https://www.ncbi.nlm.nih.gov/pubmed/10750566 – Findings:
    • Vitamin K2 (menatetrenone) effectively prevents fractures and sustains lumbar bone mineral density in osteoporosis.
  • https://www.ncbi.nlm.nih.gov/pubmed/19172219 – Findings:
    • Short-term menatetrenone therapy increases gamma-carboxylation of osteocalcin with a moderate increase of bone turnover in postmenopausal osteoporosis: a randomized prospective study.
  • https://www.ncbi.nlm.nih.gov/pubmed/24841104 – Findings:
    • Menatetrenone monotherapy decreased serum undercarboxylated osteocalcin (ucOC) concentrations, modestly increased lumbar spine BMD, and reduced the incidence of fractures (mainly vertebral fracture), and that combined alendronate and menatetrenone therapy enhanced the decrease in serum ucOC concentrations and further increased femoral neck BMD)
  • https://www.ncbi.nlm.nih.gov/pubmed/17012108 – Findings:
    • Positive effect of vitamin K2 treatment on carboxylation of osteocalcin in early postmenopausal women.
  • https://www.ncbi.nlm.nih.gov/pubmed/6287835 – Findings:
    • Women with primary biliary cirrhosis malabsorb calcium, phosphate and vitamin D, and develop accelerated cortical bone thinning. We have assessed the value of parenteral vitamin D, oral hydroxyapatite (HA), and calcium gluconate (CG) in the treatment of cortical bone thinning in primary biliary cirrhosis. . . .One group receiving no mineral supplements (control), one group receiving HA, and one group receiving CG. All patients received parenteral vitamin D2 (100,000 IU monthly). The HA group showed a significant gain in cortical bone thickness (p less than 0.01), while no significant change occurred in the CG group. This study indicated that vitamin D2 does not halt metacarpal cortical bone thinning in primary biliary cirrhosis. The addition of CG prevents bone thinning, and HA promotes positive cortical bone balance.

Cardiovascular Disease and Vitamin K2:

  • https://www.ncbi.nlm.nih.gov/pubmed/27494446 – Findings:
    • In a in a prospective cohort with 36,629 participants over 12 years, it was found that a high intake of menaquinones (K2) was associated with a reduced risk of Peripheral Artery Disease, at least in hypertensive and diabetic participants.
  • https://www.ncbi.nlm.nih.gov/pubmed/27437760 – Findings:
    • In blood vessels, vitamin K2 reduces the formation of hydroxyapatite, through the carboxylation of matrix Gla protein and Gla rich protein, inhibits the apoptosis of vascular smooth muscle cells, by increasing growth arrest-specific gene 6, and reduces the transdifferentiation of vascular smooth muscle cells to osteoblasts. The commonly used dosage of vitamin K2 in human studies is 45 mg/day and its application can be an interesting strategy in benefitting bone and vascular health, especially to osteoporotic post-menopausal women.

Diabetes Risk:

  • https://www.ncbi.nlm.nih.gov/pubmed/20424220 – Findings:
    • This study shows that both phylloquinone and menaquinones intakes may be associated with a reduced risk of type 2 diabetes. Dietary phylloquinone at baseline was significantly lower in subjects who developed type 2 diabetes during the study. After adjustment for potential confounders, risk of incident diabetes was 17% lower for each additional intake of 100 μg phylloquinone/d. Moreover, subjects who increased their dietary intake of vitamin K during the follow-up had a 51% reduced risk of incident diabetes compared with subjects who decreased or did not change the amount of phylloquinone intake.
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