Vitamin D3 Avoiding a Minimum Mindset

posted by on April 27th, 2017

Most practitioners agree there is a combination of approaches that can be taken when addressing bone mineral density, endocrine dysfunction and autoimmunity.  Probably surprising to many is the impact both Vitamin D3 (cholecalciferol)  and Vitamin K2 (menaquinone) have on these age and immune related complaints.  More surprising is the benefit of their combination in our therapeutic plan.

When it comes to bone mineral density, several interventions including dietary intake of nutrients and the addition, if not a part of lifestyle, exercise.  In addition to lifestyle changes proper supplementation is a necessity, including minerals like calcium, magnesium, boron, strontium as well as fat-soluble supports of bone health like vitamin D, soy isoflavones, and vitamin K.

Vitamin D is indispensable for the development and conservation of bone tissue because it regulates both calcium and phosphorus.  Two minerals whose bone “respiration” is necessary proper bone density.  Due to poor dietary habits or lack of sufficient green and colorful vegetables, many individuals may leech these essential minerals.  Vitamin D is also necessary to supplement for bone health because when Vitamin D levels are insufficient, parathyroid hormone may increase activating bone breaking cells- osteoclasts bringing calcium to the blood.  Over time, this leads to a weakening of bone density and progressive risk for osteoporosis. Lastly, Vitamin D is present in bone health to stimulate calcium-binding proteins that initiate absorption of calcium in the blood.

Vitamin D3 is more effective than Vitamin D2 and is a better supplement choice for most individuals.  Often practitioners want to know “ how much is too much”. We see more and more evidence to raise the RDA/RDI for Vitamin D, already we see many practitioners looking to experts in this field and recommending much higher doses.  Higher doses are commonly recommended when pharmaceutical interventions deplete vitamin D status.

The estimated recommended minimum daily dosage of vitamin D for those aged 1 – 50 is 600IU or 15mcg daily. However, higher levels of 2000 IU/d for children 0–1 yr, 4000 IU/d for children 1–18 yr, and 10,000 IU/d for children and adults 19 yr and older may be needed to correct vitamin D deficiency Swiglo ;J Clin Endocrinol Metab  93:666–673

Besides higher amounts of Vitamin D3 in addition to calcium (and likely more important), magnesium) supplementation is the pairing of K2 with Vitamin D3.  A potential recommendation flub with Vitamin D3 is supplementing it with calcium alone.  There is a reason dietary intake of calcium with vitamin d supplementation has improved BMD outcomes than when calcium is simply supplemented next to Vitamin D3 in the lab. Dark green “leafies” are not just a great source of calcium but also of Vitamin K.  Vitamin K has multiple derivatives including blood thinning Vitamin K1 and bone building vitamin k2.  K2 is converted from k1 in the intestine with the help of the microbiome.  While dietary intake is always a first line therapy for health, vitamin K doesn’t have a long storage in the body, as such it is necessary to replenish vitamin K through diet. Common food sources of K2 are often missed by a large percentage of the population.  While this is not an issue for those in good health, it becomes a particular concern from those that are at risk for poor bone mineral density, or immune dysfunction if dietary intake is not taken seriously.  Many individuals with poor gut health or poor dietary habits may struggle with production of K2 as a result of their poor gut environment, making supplementation all the more prudent.  In addition, many individuals find the simplicity of supplementation of benefit due to its ease of use.

One of Vitamin K2’s super powers is its ability to direct bone to increase its production of osteocalcin.  Osteocalcin is a part of bone building and supports the body’s movement of calcium into the bone, instead of into soft tissue. Both Vitamin D and K2 are responsible for its synthesis. In addition, Vitamin K2 also plays a role in collagen production and is a natural antioxidant making it hugely impactful with Vitamin D3 for cardiovascular protection of the vessels and heart.

Vitamin D deficiency has traditionally only been linked to low levels of adequate sunlight, poor bone health and osteoporosis. However, there have been many studies conducted over the recent years explaining why vitamin D has been proven to be much more important in an individual’s overall body and heart health.

Dr. Peter Brondum-Jacobsen conducted a study linking low levels of vitamin d to a higher risk of mortality and heart-related problems. The study, published in Arteriosclerosis, Thrombosis and Vascular Biology followed 10,170 individuals over the course of 29 years. Through this research Dr. Brondum-Jacobsen and his team were able to link inadequate vitamin D levels to a higher risk of heart disease and higher mortality rates among those with insufficient vitamin D levels.

Dr. Brondum-Jacobsen compared those with these lower levels (or less than 15 nanomal vitamin per litre serum) to those with adequate levels of vitamin D (or more than 50 nanomol vitamin per litre serum), which accounted for about 50% of the study population.

“We observed that low levels of vitamin D compared to optimal levels are linked to 40% higher risk of ischemic heart disease, 64% higher risk of heart attack, 57% higher risk of early death, and to no less than 81% higher risk of death from heart disease.”

Vitamin K2 is available as both M-4 and M-7 as a dietary supplement. MK-7 is a form of vitamin K2 that has greater bioavailability than MK-4 after oral administration.  MK-7 appears to offer a number of practical benefits over MK-4 in terms of lower dosing and single daily dosing instead of multiple doses.

 

 

 

Wasserman, RH, Brindak, ME, Mayer, SA, Fullmer, CS. Evidence for multiple effects of vitamin D3 on calcium absorption: response of rachitic chicks, with or without partial vitamin D3 repletion, to 1,25-dihydroxyvitamin D3. Proc Natl Acad Sci USA. 1982;79(24):7939-7943.

Swiglo BA , Murad MH , Schünemann HJ , Kunz R , Vigersky RA , Guyatt GH , Montori VM 2008 A case for clarity, consistency, and helpfulness: state-of-the-art clinical practice guidelines in endocrinology using the grading of recommendations, assessment, development, and evaluation system. J Clin Endocrinol Metab  93:666–673

Schurgers LJ, Teunissen KJ, Hamulyák K, Knapen MH, Vik H, Vermeer C. Vitamin K-containing dietary supplements: comparison of synthetic vitamin K1 and natto-derived menaquinone-7. Blood. 2007;109(8):3279-3283.

Rheaume-Bleue K. Vitamin K2 and the Calcium Paradox. Reprint. New York: Harper; 2013.

Okamoto H, Shidara K, Hoshi D, Kamatani N. Anti-arthritis effects of vitamin K(2) (menaquinone-4)—a new potential therapeutic strategy for rheumatoid arthritis. FEBS J. 2007;274(17):4588-4594.

Ebina K, Shi K, Hirao M, et al. Vitamin K2 administration is associated with decreased disease activity in patients with rheumatoid arthritis. Mod Rheumatol. 2013;23(5):1001-1007.

Suzuki K, Tsuji S, Fukushima Y, et al. Clinical results of alendronate monotherapy and combined therapy with menatetrenone (VitK2) in postmenopausal RA patients. Mod Rheumatol. 2013;23(3):450-455.

Schurgers LJ, Teunissen KJ, Hamulyák K, Knapen MH, Vik H, Vermeer C. Vitamin K-containing dietary supplements: comparison of synthetic vitamin K1 and natto-derived menaquinone-7. Blood. 2007;109(8):3279-3283.

Nakamura E, Aoki M, Watanabe F, Kamimura A. Low-dose menaquinone-4 improves γ-carboxylation of osteocalcin in young males: a non-placebo-controlled dose-response study. Nutr J. 2014 Aug 27;13:85.

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