Tag Archives: vitamin K2

More on Crumbly Bone Prevention

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My husband saw another adolescent athlete with surgically soft bones. (Back in 2019, I wrote my first post on “crumbly bones.” You can read that post here: Crumbly Bone Alert.) He has to drill holes and put anchors, screws, nails, and pins into bone for what he does, so he sees first-hand whether someone has good bone integrity or not. And increasingly he is seeing normal-appearing, healthy-looking kids with soft bones. Even more distressing is that these kids are high school athletes. They should have strong bones, not soft, flimsy bone.

It’s bad enough when he sees middle-aged women with soft bones, but even more ominous when it’s active kids with no known risk factors. Once, when probed about diet, the mom of one of these youths with weak bones frustratedly replied that her child would only eat two very specific processed, boxed foods. The mom had encouraged other foods to no avail.

Kids Bones are Suffering

“Crumbly bones” are increasing in our kids. In 2003,  a study out of Rochester, Minnesota (USA) looked at the occurrence of forearm fractures in youth and found that boys were 32% more likely to have a fracture when compared to the past 30 years, and girls were 56% more likely (Khosla, 2003). Often-times, these changes of “soft” bone cannot usually be seen with the classic DEXA scan, so it’s not even seen readily with our normal bone density evaluations (Kalkwarf, 2011). And since a broken bone here or there is considered somewhat a normal right of passage for kids, unless the break occurred with exceptionally little incidence, there will be no medical instruction on unhealthy bones and how to take care of the skeletal system with diet and exercise. Doctors and parents aren’t thinking about “crumbly” bones in an otherwise normal, healthy kid.

I guess what I’m trying to say is that this is probably a silent epidemic. That lots of youth probably have poor bone integrity, and we just aren’t catching it.

It’s Not too Late to Start Strengthening Bones at Any Age

But this post isn’t just about kids. Yes, it’s better to play “keep up” with bone integrity than “catch up,” but I have read reports of osteoporosis improvement in elderly patients, either with regard to bone mineral density or with decreased fracture risk (Iwamoto, 2014; Shanb, 2014). There are things you can do now to make bones better.

Today I will touch on vitamin K2, which I mentioned in the first post linked to above.

VITAMIN K2

Bones need vitamin K2 to be healthy. You may also see vitamin K2 referred to as MK-4 (menaquinone-4) or MK-7 (menaquinone-7), the different numbers identify slightly different chemical forms of the same vitamin. (There are even more numbers/forms than this, eg MK-9 or MK-11, which may or may not be important. There are not enough studies yet to know.)

Vitamin K1 and Vitamin K2 Have Different Roles So Don’t Think of Them as the Same

Vitamin K2 should NOT be confused with vitamin K1. (And neither vitamin should be confused with potassium, an important electrolyte whose symbol is a simple “K” on the periodic table.) Vitamin K1 and vitamin K2 are both very, very important, but the expanse of their jobs differ. When you read, you will undoubtedly see vitamin K1 and vitamin K2 lumped together, which is a real travesty. They have different roles and both are needed.

Vitamin K2 Helps Hearts, Blood Vessels, Brains, and Bones

Vitamin K2 is a vitamin which scientists somewhat recently recognized–or at least recognized the significance of. Many American doctors will not even know about it, even though in Japan they have been using high dose vitamin K2 supplementation for osteoporosis treatment for years. (Iwamoto, 2014) Vitamin K2 has profound effects on our blood vessels, brains, bones, immune system [Linneberg (2021) even showed it affected Covid outcomes], and skin.

With regard to bone, Vitamin K2 helps take calcium and put it in bones and teeth. It keeps calcium out of the lining of our blood vessels (think of cardiovascular disease with the calcified plaques blocking blood flow) and tissues and puts it where it belongs.

How Does the Body Get Vitamin K2?

You can get vitamin K2 through different mechanisms. The really confusing thing about vitamin K2 is that its content in foods is unreliable and unpredictable. And some foods might have MK-4, while others have MK-7. And still others might have some of the lesser studies forms of vitamin K2 like MK-9 or MK-10.

Adding to the confusion is that you’ll see some researchers swear by MK-7, while others say MK-4 is fine. It’s often quoted that MK-7, which is found in plant sources of vitamin K2, has a longer half-life and sticks around longer, so it’s better. Others argue that MK-4 is what is present in all animals (so, of course, that’s what we should use), and that it does not stay in the blood because it is “sucked up” by our tissues.

I don’t know. My consensus is to look at the vitamin K2 food list and try to add those foods in. Try to eat more vegetables. And supplement as needed.

Your body gets vitamin K2:

By eating egg yolks, butter, certain cheeses, organ meats, fish eggs, and fermented foods (like sauerkraut or a Japanese food called natto). The problem here is that a food type can have differing levels of vitamin K2 amounts, depending on what an animal is eating or how a cheese is made. So “Brand A” of butter may have less vitamin K2 than “Brand B.” And “Brand A” may have a different vitamin K2 in May than it does in August because the cow is grazing on different grass quality. Vermeer (2018) has a great article with vitamin K2 levels of various foods. Check it out. Chris Masterjohn, PhD, has an extensive page on vitamin K2 and has a spot where you can type in the food to see how much vitamin K2 is in it. Check it out.

By converting excess vitamin K1 to vitamin K2: The human body can convert excess vitamin K1 to vitamin K2. The problem with this is that most humans do not eat enough vegetables and leafy greens to even get enough vitamin K1 for optimal health, so there isn’t much, if any vitamin K1 leftover to turn into vitamin K2. A second confounder is that different people have different processing capabilities, so some people might have “good” genes for vitamin K1 conversion while others do not. A third confounder is that vitamin K1 is best absorbed with fat, and many health-conscious people are low fat.

By your gut bacteria: Your gut bacteria can make vitamin K2. The problem here is the disrupted gut bacterial flora that is very common now, contributed to by antibiotics and poor diets.

By vitamin K2 supplementation: Different formulations can degrade over time, leaving uncertain vitamin K2 levels (Orlando, 2019).

What’s a Person to Do?

So if vitamin K2 is that important, and yet our available sources are that unpredictable, then what’s a person to do? Throw hands up in the air and say, “Life sucks. This is stupid. I can’t do this anymore?” NO! Regularly include the sources you can food-wise. Do what you can! If you can’t eat these things, look at lists and see what you can eat to get K2. If you can’t eat anything, then supplement. Read all about vitamin K2 (the Masterjohn site I linked to above is exceptionally extensive and easy to read).

Eat more egg yolks.

Use butter.

Eat more vitamin K1-rich leafy greens and vegetables. Cook them with butter or olive oil to absorb more vitamin K1 to potentially convert to vitamin2.

Order sushi with salmon roe or some other roe.

Use cheese. Different cheeses have different K2 levels, so check out the lists.

Eat fermented foods like sauerkraut or kimchi.

FInd some vitamin K2-rich foods and eat some daily for your bones. Feed them to your kids for their bones. Every choice. Every day. Adds up.

Terri F

NOTE: Those on warfarin (Coumadin) should not increase their vitamin K2 (including from foods) without a doctor monitoring them closely.

Citations:

Khosla, S., Melton, L. J., Dekutoski, M. B., Achenbach, S. J., Oberg, A. L., & Riggs, B. L. (2003). Incidence of Childhood Distal Forearm Fractures over 30 Years: A Population-Based Study. Journal of the American Medical Association, 290(11), 1479-1485. https://doi.org/10.1001/jama.290.11.1479

Kalkwarf HJ, Laor T, Bean JA. Fracture risk in children with a forearm injury is associated with volumetric bone density and cortical area (by peripheral QCT) and areal bone density (by DXA). Osteoporos Int. 2011;22(2):607-616. doi:10.1007/s00198-010-1333-z

Iwamoto J. Vitamin K₂ therapy for postmenopausal osteoporosis. Nutrients. 2014 May 16;6(5):1971-80. doi: 10.3390/nu6051971. PMID: 24841104; PMCID: PMC4042573.

Shanb AA, Youssef EF. The impact of adding weight-bearing exercise versus nonweight bearing programs to the medical treatment of elderly patients with osteoporosis. J Family Community Med. 2014;21(3):176-181. doi:10.4103/2230-8229.142972

Linneberg A, Kampmann FB, Israelsen SB, Andersen LR, Jørgensen HL, Sandholt H, Jørgensen NR, Thysen SM, Benfield T. The Association of Low Vitamin K Status with Mortality in a Cohort of 138 Hospitalized Patients with COVID-19. Nutrients. 2021; 13(6):1985. https://doi.org/10.3390/nu13061985

Orlando P, Silvestri S, Marcheggiani F, Cirilli I, Tiano L. Menaquinone 7 Stability of Formulations and Its Relationship with Purity Profile. Molecules. 2019;24(5):829. Published 2019 Feb 26. doi:10.3390/molecules24050829

Vermeer C, Raes J, van ‘t Hoofd C, Knapen MHJ, Xanthoulea S. Menaquinone Content of Cheese. Nutrients. 2018;10(4):446. Published 2018 Apr 4. doi:10.3390/nu10040446

Nutrition for a Gymnast

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Ten Nutrients Every Gymnast Needs and How to Get Them

Recently a college gymnastics coach asked me if I knew one of the best in-practice (or in-meet) pick-me-up foods. I made a few naïve, idealistic stabs. “Nope,” he grinned. “Fruit Loops.” I didn’t know whether to cry at my innocence or to promptly squeeze his grin between my right thumb and forefinger, giving him a verbal lashing and the full weight of my academic condescension. I was so frustrated!

Faulty Nutrition Advice

I’m disappointed in the common gymnastics nutrition advice I encounter. It’s worthy of censorship. I don’t want anyone to touch my daughter’s nutrition without her running it by me first. Often the advice encourages exceptionally high carbohydrate counts and very low fat intakes. (How are they ever to absorb the vitamin D and vitamin K2 they need for their bones as grandmas?) Other times it advocates for highly processed cereals and granola bars loaded with sugars. (What nutritional punch does sugar pack?)

What’s a mom to do? Well, I like the gymnast in our family to focus on the nutrients her body needs to make strong bones, to keep muscle cramping to a minimum, and to protect her head in case of a bad fall. We focus on real, whole, and deeply nutritious foods. Focusing on these foods also encourages her immune system to fight off colds, helps keeps her tendons and ligaments well-supplied, and allows her hormonal system to have a chance to function properly.

Doesn’t She Need Carbohydrates?

As far as macronutrients (carbohydrates, fats, and proteins) go, I ask her to try figure out the best carbohydrate to protein to fat ratio for herself– using her hunger, energy, and mental clarity and focus to help guide her. (I firmly believe that each athlete is an individual with unique macronutrient needs. It is not “one-diet-fits-all.”) I explain that carbohydrate foods, although fast-acting, will not stick around very long, but that fats and proteins digest more slowly and can help her feel full longer. She includes carbohydrates for their quick pay-off of energy, and then she plays with the fat and protein amounts to determine the amounts (and kinds) which keep her feeling full– but still energetic and light and springy on her feet (or hands).

Reality Checks and Hard Talks

Food never goes away and our relationship with it really colors our whole life! So, periodically we talk about eating disorders, and I’ll ask her how she’s feeling about what we’re eating. We have talked in the past about the weight of muscle mass versus fat mass (muscle weighs more) and how weight is not a good indicator of health, fitness, or gymnastics capabilities. We talk about avoiding junk food but how to let loose and enjoy them comfortably when we want to.

Since competitive gymnasts often want to stay “little,” we talk about the changing body and the fact that a female gymnast’s skills will ebb and flow, progress and flop, as the physical body changes– and that will just require her to train smarter (to understand the physics of strength, power, vertical jump advantage, and quickness) and show off what a woman can do!

Competitive gymnastics has been suppressing the growth of competitive gymnasts for a long time, and I want none of that garbage for my precious one. I want her to embrace fully what it feels like to be an empowered woman, never afraid of food or eating–or actually of anything or anyone. I want bold, confident, and intelligent-minded women who will leave their sports behind one day but transfer everything they learned into a new path.

Back to Nutrition

Okay. Back to nutrition. I made a chart for our fridge that I thought I’d share on-line here. It’s the table you see above as the image for this post. You can, I hope, pull up the PDF file for clear printing here:

Blog Gymnastics table

Addendum: I have updated the same table you see as the image to read “Ten Nutrients Athletes Can’t Be Without… And How to Eat Them!” That way it can also be printed off for non-gymnast athletes too. For the PDF to this version, click here:

Ten Nutrients Athletes Can’t Be Without and How to Eat Them

I could have added iron, vitamin B12, and folate to this list. But if the foods on this list are eaten, those nutrients are each covered too. Meat has iron and vitamin B12. Beans and green vegetables have folate.

Many experts do recommend supplementing with calcium, vitamin D, and omega 3 fatty acids for gymnasts. Talk to your doctor about that. Since we don’t eat a lot of dairy in our house due to some intolerances, I do rotate through bone supplements for the kids. But please, I prefer that you talk with your doctor about that. I am here to share our story and my thoughts, but you should not use it blindly as medical advice. Instead, use it to further your own research and discussions with your doctor. I love comments and would be happy to hear what you do for your gymnasts, concerns you have about gymnastics nutrition, or constructive discussion on what I have written and composed here in this post. Thanks!

Please, help your gymnast find his or her way to strength, dignity, courage, and long-lasting belief in his or her amazing self-worth as a person, not just an athlete.

Warmest wishes,

Terri F

Slow Guts Need Care

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“Colectomy rates for constipation are rising, are associated with significant morbidity and do not decrease resource utilisation, raising questions about the true benefit of surgery for slow transit constipation… (1)”

Whew!  From second chakras to acupuncture to triphala, I have been taking this alternative medicine front by storm to cure my slow gastrointestinal (GI) transit.  If all conventional medicine has to offer is a colectomy, then there is no shame in yoga and Squatty Potties.  Where do I stand?  Pretty good.  Pretty good.  Not yet cured.  Definitely have some ups and downs, but overall, my gut has totally reversed itself.  Knock on stinking wood.  Or incense sticks–or something–just so my gut doesn’t fall back again.  (Which those with this problem know is quite easily possible.)

Constipation isn’t talked about.  But it should be.  Colons are cut out because of it (seriously–see opening quote).  And people go to the ER for it (quite embarrassing, quite).  Not to mention hemorrhoids and anal fissures and horrible cramping (ouch).  Sometimes all it takes is simple diet maneuvers to get things back on track.  Other times, like in my case, it takes exploring your sanity and motivation.  (For the record, I am completely sane.  I ask my husband and friends every day.  Although I question some of my friends–so maybe you ought to wonder about me…Which brings me to the necessary disclaimer that this is only my story.  It is not medical advice.  You should absolutely discuss anything you try for your health with your doctor.  I am not your doctor.  I quit that jazz for Oz and its Munchkins.)

My History

I’m going to take a few posts to lay out what I do or have tried for my slow transit.  Let me briefly get you up to speed on my gut history.  I’ve had constipation all of my life.  As long as I can remember.  It worsened, just like the medical texts said it would, every decade of my life.  Until I was pooping once a month WITH Miralax, fiber, and a probiotic.  (Magnesium simply did not work at all.)  This was about age 35, and I had to start cranking on the stimulant medicines (which until this point I had only used as needed for the most part).  Not only was this ineffective, the high doses led to ouchy cramping.  I knew something else had to be done, so I turned to the halls of the internet clinic (because my doctors didn’t have any good answers for me–I mean, how could they?  I didn’t have any for myself!) after I quit working to homeschool my kids and I had “time.”

Now I must say, there have been three times, each lasting a mere few months, in my life where I have had what I feel are completely normal people bowel movements with little to no use of supplemental pills or powders. Once in my twenties after being treated for ulcer type symptoms with a PrevPac (involves amoxicillin and clarithromycin). Second time was two years ago just before getting pregnant.  Pregnancy and lactation proceeded to undo the hard-earned success I had achieved using diet, lifestyle changes, and focused supplementation. Finally, the third time I feel my gut has been reliable has been the last few months.  So, here I am with about daily Bristol 4 stools.  I’ll admit, I’m nervous going to bed each night, wondering, “Will I go tomorrow?”  Thinking the next day will be the beginning of the end of my GI success.  Unless you have a very bad problem with constipation, you may simply just not get this.   But I’m hoping if that’s you, I lost you at the first paragraph.

Getting to the Details

I have tried A LOT of stuff.  Since pregnancy and nursing, it has been focused on things that are safe to my baby.  I am still nursing, so I am still careful about what I try.  Let’s get started with more of my story.  There is a lot to write, and I will break it up.  If you have severe constipation and you expect a quick-fix, you may need to reset your expectations.

I am going to start with the supplements I take or have taken.  Some I don’t even take for the constipation, but I have to wonder about the role they play in my gut progress.  I only have room to cover vitamin K2 in this post.  MUCH more to come.  And, please, supplements really need to pass the approval of your doctor.

Vitamin K2

Briefly about:  Vitamin K2 is a relatively recent health-related discovery. It helps shuttle calcium where it’s supposed to go, whether we’re talking about shuttling it TO the bones or shuttling OUT of the heart blood vessels where it doesn’t belong. Getting enough vitamin K2 in our modern diet is tough for anyone because our meat, egg and dairy sources are not eating what they would eat if turned out of the pen. Vitamin K2 is present in the egg yolks of birds who eat worms, seeds, and other things they peck at in nature; the fat of grass-grazing animals; liver; and the milk-fat products of grass-grazing animals (butter and full-fat milk). It is also formed by bacterial action on milk-fat when cheese is being made or by bacterial action when natto (from soybeans) is being made. One last rich source is fish eggs. Vitamin K2 is a fat-soluble vitamin, and therefore likes to be in fat and is best absorbed when eaten with fat.

My story:  I started taking vitamin K2 because I realized with my dairy and egg intolerance, I was not getting any K2 to support my bones, blood vessels, and gums/teeth. (Vitamin K2 plays a large role in the structure and health of the oral region.) (Aside:  Vitamin K2 is supplemented in conventional chickens and so it is a source of vitamin K2; I strangely can’t eat chicken either.) I don’t know if vitamin K2 has helped my STC or not as an individual agent. However, it is a supplement I have taken daily for the last four months or so.

Is there research that may lend itself to the idea that vitamin K2 may be helping my gut move forward? I found an abstract in which bone morphogenetic protein 2 (BMP2) helped improve slow transit constipation. Vitamin K2 does impact BMP 2:

Mol Med Rep. 2015 Nov;12(5):6547-54. doi: 10.3892/mmr.2015.4297. Epub 2015 Sep 7. Bone morphogenetic protein 2 regulates the differentiation of nitrergic enteric neurons by modulating Smad1 signaling in slow transit constipation. Liu X1, Liu S2, Xu Y3, Liu X4, Sun D1.

 

And then here is a connection linking vitamin K2’s effect on BMP 2, a vitamin K dependent protein:

Oman Med J. 2014 May; 29(3): 172–177. doi: 10.5001/omj.2014.44PMCID: PMC4052396. Vitamin K Dependent Proteins and the Role of Vitamin K2 in the Modulation of Vascular Calcification: A Review. Margueritta S. El Asmar,1 Joseph J. Naoum,2 and Elias J. Arbid2,*

Bottom line for me: Vitamin K2 modulates BMP2. BMP2 may help slow transit constipation. MAYBE my vitamin K2 supplement is helping my slow transit. (Big question mark.)

Closing

Next post will have lots more.  It’s a long, long story.  Eat right.  Sleep right.  Look up the second chakra.  Love your gut.  Question your sanity.  Keep going.  🙂

Terri

 

 

  1.  Aliment Pharmacol Ther. 2015 Dec;42(11-12):1281-93. doi: 10.1111/apt.13415. Epub 2015 Oct 1. Colectomy for constipation: time trends and impact based on the US Nationwide Inpatient Sample, 1998-2011. Dudekula A1, Huftless S2, Bielefeldt K1,3.