Tag Archives: vitamin K

Don’t miss the window

Our skeleton starts off life as a delicate membrane-like template late in the second month of pregnancy but soon after the third month a primitive skeleton can be easily seen. Our bones form relatively early on because they are a key factor needed in the healthy growth and development of the growing baby. We tend to forget just how important a skeleton is but without it there would be nowhere for our muscles to attach and our vital internal organs would be extremely vulnerable to damage.

Throughout pregnancy, Mums-to-be are told to eat well and to get plenty of bone forming nutrients such as calcium. This advise extends to breast and bottle feeding and well into the weaning months and early years for good reason; the skeleton of a growing child is highly active and demands a plentiful supply or raw materials. However, there appear to be a gap somewhere between the early to mid teens and late 30’s where the focus of attention is taken away from skeletal health as other health priorities take the lime light and centre stage. For a growing number of people in this age bracket, weight management becomes an issue along with the trend for very restrictive diets in an attempt to drop the excessive weight. It’s not uncommon for levels of physical activity drop off especially in the school leaver population who either choose to avoid sports altogether or are forced into a more restrictive lifestyle that is so common in the digital workplace. Combine this with an increasing tendency to rely on processed and convenience foods and a lack of basic food, cooking and nutritional knowledge in many people and its quite easy to see how and why the early teen through to late 30’s are potentially hazardous to long term health. If we remain focused on the skeletal system, this phase of life is especially important considering that 90% of a girls skeletal mass is acquired by the age 18 and in boys by the age of 20. However, our bones keep developing reaching their lifetime peek mass by the age of 30 in both sexes. After this the skeleton remains quite stable until, in the case of women, the menopause starts when there can be a significant loss of bone mass. Men tend to loose bone mass slowly around the same phase of life but because of their greater skeletal size the effects are less noticeable in most cases. So, there appears to be window that can swing open for an opportunity to optimise skeletal health or slam shut, placing the maturing bone in jeopardy. Its rather like paying into a long term savers account or pension, you should have some reserves for later in life but it does mean you have to contribute early on and for many years to come with no real obvious outward signs of any benefit but in general you will be better off for the efforts.

The bare bones of skeletal nutrition We all know that calcium is important for bone health but it has been rather over played in the past. Our diets abound with calcium and the mature skeleton stores 99% of the bodies calcium reserves. In fact, our blood calcium levels are kept within such tight parameters that any fluctuation above or below the normal is considered a key sign of an underlying hormone disease rather than anything to do with dietary excess or deficiency. In saying that, calcium is still a vital bone mineral and one that is needed on a daily basis to maintain health. Despite many people having a problem in regards to sensitivity to allergy, milk and dairy products still provide a reliable and cost effective source of dietary calcium and protein. There have been some concerns raised about the intake of milk and an increased risk of thin bone disease but these claims have not been substantiated. In brief, the anti-milk theory suggests that the protein and phosphate naturally found in milk and dairy products make them ‘acid-producing’foods causing a shift in the bodies acid (pH) levels and triggering an accelerated loss of calcium from the bones and body; this process is not supported by any scientific evidence. Moreover, studies have confirmed that a higher phosphate intake was actually associated with decreased urine calcium and increased calcium retention. The theory then goes on to link this process with observations of thin bone related fractures in people from countries that consume a lot of milk and dairy foods; this is a case where correlation and causality can be misleading. Studies involving populations living and working in urban and rural environments yield quite different outcomes probably more related to their physical activity levels rather than to their milk and dairy food intake. While some people may find dairy foods a problem for those who do not a sensible level of intake would not appear to have any real detrimental effect on bone health and for some groups of people could be an important source of readily available protein and minerals. Check the tables below and see if you are getting enough calcium from your food (Table 1) compared to the recommended daily intake levels based on Western European, American and Canadian figures (Table 2).

Table 1: Calcium in common foods (apporoxamate)
Food Serving size Calcium (mg)
Milk, whole 236 ml 278
Milk, semi-skimmed 236 ml 283
Milk, skimmed 236 ml 288
Goats milk 236 ml 236
Yoghurt, low fat, plain 150 g 243
Yoghurt, low fat, fruit 150 g 210
Yoghurt, Greek style, fruit 150 g 189
Cheese, cheddar 40 g 296
Cheese, cottage 112 g 142
Tofu, soya bean, steamed 100 g 510
Soya drink 236 ml 31
Soya drink, calcium enriched 236 ml 210
Broccoli, cooked 112 g 45
Curley kale, cooked 112 g 168
Apricots, raw 160 g (1 fruit) 117
Orange 160 g (1 fruit) 75
Figs, ready to eat 220 g (4 fruits) 506
Almonds 26 g (12 whole) 62
Brazil nuts 20 g (6 whole) 34
Sardines, canned in oil 100 g (4 fish) 500
Pilchards, canned in tomato sauce 110 g (2 fish) 275
Whitebait, fried 80 g 688
Bread, white sliced 30 g (1 slice) 53
Bread, wholemeal, sliced 30 g (1 slice) 32
Pasta, plain, cooked 230 g 85
Rice, white, basmati, boiled 180 g 32
Table 2: Recommended daily intake of dietary calcium
Age Calcium (mg/day)
0-6 months 300-400
7-12 months 400
1-3 years 500
4-6 years 600
7-9 years 700
10-18 years 1300
Women
90 years to menopause 1000
Post menopause 1300
During pregnancy (1st trimester) 1200
Lactation 1000
Men
19-65 years 1000
65 + years 1300

As you can see from Table 1, getting adequate dietary calcium is not difficult but you need to know what too eat! A strict vegetarian who also avoids dairy foods will find it much harder to meet the minimum requirements for calcium without consuming specialist foods such as Tofu or taking a calcium supplement. Equally, someone following a strict weight loss may also fall short especially if they choose to follow the diet over a long term basis rather than modify their intake level across a balanced diet. Calcium is important but it is by no stretch of the imagination is it the key nutrient. What needs to be kept in mind is the fact that bone is a living tissue, its not simply a hard calcified mass. If it was it would be very prone to fracture because there would not be any flexibility or ‘give’in the skeleton when we jumped or ran. Proteins give bone its flexibility as well as a framework onto which the minerals (calcium, magnesium, phosphorous) can be deposited. A diet low in dietary protein is also detrimental to bone health. Fad diets that restrict proteins and poor general eating habits can that rely heavily on processed foods and carbohydrates starve the body of the essential protein building blocks of life known as amino acids. Key proteins from meat, fish, and eggs generally form the corner stone to human protein intake in Europe. In essence, there is nothing wrong with animal protein but there is no need to over consume from this food group since there are many great vegetable protein sources as well. Vegetarians and those seeking to rely less on animal proteins need to choose carefully but can increase their vegetable protein intake easily by eating more lentils, kidney beans and broad beans as well as soya, tofu, grain, nuts and seeds. By increasing the intake of vegetable proteins you will also be increasing the levels of other key bone nutrients including magnesium, zinc, B-vitamins (such as folic acid) and vitamin A generating beta carotene especially if you regularly eat the coloured vegetables such as orange, yellow and red peppers.   Absorb it or loose it In order to benefit from the calcium in your diet or from your supplement adequate levels of vitamin D are required. Over the past few years vitamin D has become a hot-topic in the press where it has been associated with many health problems ranging from MS through to certain types of cancers and even depression and psoriasis when levels are grossly deficient. The situation involving vitamin D and it’s involvement in such a variety of health problems is complex, poorly understood and undoubtedly linked to genetic susceptibility but when it comes to bone health the cause and effect relationship is very well understood and established. Vitamin D is not an easy vitamin to get in Northern European countries simply because of the lack of intense sunlight (more specifically the ultraviolet-B rays) needed to stimulate its production within the skin. Here we hit another controversy, by recommending sun exposure are we now putting people at risk of skin cancer? The simple answer is no! Just remember that sun exposure is healthy, sun burn is not. Getting 15-20 minutes of sun light per day, best between 10am and 2pm when the sun is at its peek, is all that is needed to boost natural vitamin D levels. For those of us at work stuck inside, shift workers or people confined to inside living some vitamin D can be obtained from a few foods (for example; salmon, mackerel, tuna, sardines, egg and liver) but to get enough you will need to eat quite a lot of it and on a very regular basis to meet the requirements for health let alone optimal health and there is no real vegetarian food option that delivers any vitamin D. In regards to vitamin D the only real option is a supplement especially over the winter periods. Intake recommendations for vitamin D vary greatly but supplements should be in the vitamin D3 form and need to be between 400iu (10mcg) to 1000iu (25mcg) in strength per day unless you have had a vitamin D blood test and need to significantly boost your levels under supervision. If you can’t get a blood test from your own GP we can always arrange this for you but the private lab will carry a lab fee of around £60 per test for a calcium and vitamin D test. You can take your own blood sample at home (a finger prick) and posted off to the lab for analysis. Another vital vitamin for bone health is vitamin K. This is required for the formation of specific bone proteins that actively help to build and strengthen the framework needed a healthy skeleton. Vitamin K is obtained from dark green leafy vegetables such as kale, cabbage and spinach as well as from lettuce. There are more specialist foods made from fermented soybeans that deliver high amounts of vitamin K. A good bone supplement should supply vitamin K but this needs to be avoided in anyone taking anticoagulant medication such as warfarin. Those on warfarin should not increase their vitamin K containing foods form the same reason.

Special situations The window for optimising bone health can be significantly helped by diet and lifestyle choices but there are a few occasions when other health issues can complicate things. People with certain digestive problems that adversely affect nutrient absorption, such a Coeliac disease and some inflammatory bowel problems, need special individualised attention and advise. This may also extend to the long term use of steroid based medications because of its adverse impact on bone health.

Dietary supplements While we have placed great emphasis on food, diet and what can be achieved through lifestyle adjustment, the use of a specific dietary supplement aimed at optimising bone specific nutrition may be appropriate in many cases. The bone specific supplement Calci-D-min delivers a highly absorbable plant calcium known as Aquamin (derived from red algae) that’s easy on the stomach and quickly absorbed and assimilated by the body. Aquamin also delivers magnesium and 74 other naturally occurring trace elements contained in the red algae. The Calci-D-min supplement has been formulated to supply effective levels of vitamin D3, K1 and K2 along with boron selenium and zinc. Depending on the diet, as food supplement two to four capsules are recommended taken with food. Because of the vitamin K ingredient, Calci-D-min is not recommended for anyone taking the anticoagulant drug warfarin. The product is 100% vegetarian and fully approved by the Vegetarian Society.

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Vitamin K – a key nutrient for strong bones

Vitamin K is required for the production of the bone protein osteocalcin – a key component in the matrix of bone. Osteocalcin’s role is to anchor calcium molecules and hold them in place within the bone.

A deficiency of vitamin K leads to impaired bone health due to inadequate osteocalcin levels. Despite some studies showing that the lower the level of circulating vitamin K, the lower the bone density,more recent studies indicate that while low dietary vitamin K levels are linked to fractures due to osteoporosis, they do not appear to correlate to low BMD. Vitamin K prevents fractures probably by increasing the tensile strength of bone without affecting BMD.

Background:

Various forms of vitamin K supplements have been used in human trials examining its effects on bone health: vitamin K1 (phylloquinone), menaquinone-4 (MK4, a form of K2) and menaquinone-7 (MK7, another form of K2 ). The results with vitamin K supplementation on bone health have been mixed.

Most of the double-blind studies with vitamin K1 have shown only modest or mainly no effect on bone density and while studies with MK4 have shown positive results in reducing bone loss and fracture rates, the dosage used (45 mg/day) was well beyond a nutritional effect and more likely the positive results are due to a drug-like effect at such high dosages.

Menaquinone-7, or MK-7 (a longer-chain form of vitamin K2), is found in high concentrations in natto (a fermented soy food popular in Japan). MK-7 has been found to be more potent and more bioavailable as well as to have a longer half-life than MK4. MK-7 is also more effective than K1 in activating osteocalcin and stays in the blood circulation much longer.

New Data:

In a major clinical trial, MK-7 supplementation at relatively low dosage levels (180 mcg per day) produced tremendous effects on improving bone health. In the study, 244 healthy postmenopausal women took either the MK-7 or a placebo for 3 years. Bone mineral density of lumbar spine, total hip, and femoral neck was measured by DXA; bone strength mesures of the femoral neck were also calculated. Vertebral fracture assessment was performed by DXA and used as measure for vertebral fractures.

Product link:

Calci-D-Min: formulated for bone health and high in vitamin K1 and K2

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Is there a risk between Calcium and getting a heart attack?

Calcium pills increase the risk of heart attacks” was the latest worrying headline for many a little while ago. As if we don’t have enough to worry about now our trusted and protective calcium dose is out to get us! However, this is not really new news. Taking pure elemental calcium has always been questioned in connection with unwanted calcification of soft tissues and potentially associated with the calcium-based plaques seen in the walls of diseased blood vessels. The current study, published in July issue of the BMJ, took this a stage further by suggesting that those who took elemental calcium in doses of 500mg or more were increasing their risk of a heart attack. The BMJ study analysed 11 previous studies covering some 11,921 people over 4 years. Out of these people 296 had heart attacks of which 166 were taking calcium (over 500mg/day) and the rest (130) were on placebos. The trial participants were mostly female, and the trial only involved elemental calcium, not calcium combined with vitamin D or any other nutrient. In fact, studies that used calcium and vitamin D combinations were actively excluded from the analysis. When the numbers were statistically crunched elemental calcium appeared to increase the risk of a heart attack by roughly 30%. Oddly enough in 2008 the BBC reported on research conducted at the University of Minnesota that showed owning a cat appears to reduce the risk of a heart attack by 40%; could buying a cat be an antidote to the problem?

On a more clinical note, the reassuring aspect of this story is that pure elemental calcium, taken in isolation, appears to be the issue. Personally, I can’t remember the last time I came across a patient that was taking pure calcium in the absence of other key factors such as vitamin D or vitamin K or as part of a multiple bone complex, such as OsteoPrime. I feel reassurance is needed in these cases where the benefits clearly outweigh the risks for bone health.

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A Bony Issues

Did you know that you get a new skeleton every eight years? (for more information on bone turnover and what influences it click here) Just like your skin, bone is a living tissue and is constantly being renewed and replaced. Our commonly held view is that bone is a hard brittle material that does not change needs to be revisited in light of ongoing research into bone health and the new ways it can be improved and influenced. The fact is that bone is an incredibly changeable tissue explains how it is able to adapt to different stresses placed upon it (click here for some background on this aspect of bone biology). Indeed its very shape and thickness can alter in response to different stimuli. For example, a professional tennis player will place so much stress through his right arm bones that in time the bone cells become more active and remodel the architecture of the forearm bones making them thicker and stronger. The skeletons ability to change and adapt is a key factor in maintaining bone health and an equally important aspect in certain diseases. This has been dramatically illustrated in certain extreme environment. Studies performed by NASA clearly show that space flight had severe complications on the skeleton. Due to the weightless nature of the body in space, gravity cannot act on the skeleton, with an end result of a rapid thinning and weakening of bone. Special bone loading exercises and equipment have to be used to help those living and working in zero gravity maintain their bone and muscle health as this image shows keeping bone health in top form on the International Space Station is not without its complications and fuss! Otherwise ultrafit Astronauts develop osteoporosis, the thin bone disease commonly associated with older or menopausal women! Interestingly this is no news to the Russians who have been working with manned space stations for years. The Russian Cosmonauts (click on the manual download option if you follow this link) routinely take vitamin K supplements. This nutrient is known to boost bone health by stimulating the growth of the bone proteins needed to support the calcium and other minerals found in the skeleton. For those interested in the nutritional demands and requirement in zero gravity click here for an abstract on the subject, if you click on the option “PDF 334 KB” on the right side of the new screen that pops up you can get a fascinating download on this subject.
Vitamin K has only relatively recently become a hot topic in the osteoporosis world outside Russia. Despite it’s potential interaction with blood thinning drugs such as warfarin (those on blood thinners should avoid vitamin K) vitamin K is a very safe and well tolerated nutrient. Studies indicate that taking certain forms of vitamin K are associated with a 77% reduced risk of hip fracture and an 60% reduction in vertebral fractures. The mechanism behind this dramatic finding appears to involve the bone protein osteocalcin. Without a good framework to act as a guide minerals simply cannot bind on to strengthen the bones.
Feeding the bones
Bones demand feeding in a special way for a lifetime of optimal health. Certain dietary factors are known to have a bad effect on bone health and may actually increase your risk of developing thin bones in later life. Processed foods, excessive sugar, alcohol, fizzy drinks, cigarettes, coffee all can have a detrimental effect on the bones. Many pre-made ready meals come loaded with added salt. Salt has the effect of making food tasty but the extra salt (sodium) not only plays havoc with your blood pressure and fluid balance but it can also increase the calcium loss significantly. Estimates have this loss in the region of 52grams of calcium if your sodium intake jumps from 1000mg per day to 4000mg. Eating a healthy and balanced diet is such a common phrase we tend to forget how important it is to tissues we don’t normally think about; be honest, when was the last time you thought about the health of your hip bone?
When it comes to foods there is a great deal of controversy. Many authorities list milk and dairy products as key sources of calcium needed for healthy bones while some raise the worry that dairy derived calcium may actually have a detrimental effect on the skeleton. The Vegan society has some interesting information on this rather controversial subject, click here. Protein is another potential point of confusion. We need adequate protein for bone to make the basic scaffolding onto which minerals are deposited. High protein intakes, however, are associated with an increased los of calcium from the body, click here for come additional background information. Beans and pulses may offer a solution in this situation. A 100g portion of beans (dry weight) has a neutral effect on calcium balance while a similar amount of animal derived protein may cause a loss of calcium from the body. Increasing your intake of beans and pulses will boost your protein intake and have no adverse effect on calcium balance. To reassure you though, a moderate intakes of animal products, as part of a balanced diet, will not cause a drastic enough loss when off set against the additional calcium intake of that meal. Most balanced diets offset losses with the gains.
While we are on the subject of absorbing calcium it would be a good idea to mention the importance of vitamin D, or specifically vitamin D3. Acting in a hormone-like way, this key vitamin not only boosts the immune systems ability to keep us fit and well, it plays a pivotal part in the absorption of calcium from the gut. Many of us simply don’t get enough vitamin D3 from sunlight exposure and there is a negligible amount on offer from the diet. Contrary to the commonly accepted idea, milk offers no vitamin D. This confusion may have originally come from America where milk is fortified with added vitamin D, but this is not the case in the UK. Taking extra vitamin D3 would appear to be the answer for all of us, especially over the dark winter months.
To appreciate how important it is to keep bones well fed it is worth understanding how the nutritional needs change with age. During infancy our bodies are very efficient at absorbing calcium, especially from breast milk. A baby can absorb 66% of the available calcium from breast milk compared to less than a 40% absorbency rate from infant formula milk. During childhood (between one and ten years of age) the efficiency of calcium absorbency reduces to about 35%, but by adolescence it rises again to 40% to match the growth spurts associated with this phase of life. Crash diets and eating fads can seriously reduce the nutrient intake over this crucial phase of skeletal development. By the time adulthood is reached much of the final skeletal form is set. The peak bone mass is achieved by 35 years of age. Calcium absorption reduces slightly to about 30%. Adulthood also brings with it other natural diversions as far as calcium goes. It has been suggested that during the first three months of pregnancy, maternal bone density reduces as well as during lactation. During the menopause a complex interaction between hormones, calcium and other trace elements occur. Increasing calcium alone appears to be pointless. There are in fact 22 nutrients associated with the maintenance of optimal bone health. All must be in the correct balance for the benefit to be seen.
When it comes to exercise it is the load bearing, bone stressing forms that boost strength. Keep those fit astronauts in mind. Take away gravity and you take away the stimulus for bone health. If you don’t feel that your joints are up to a pounding work out there are other options. Consider balance exercises that strengthen your legs and challenge your balance, such as Tai Chi, can decrease your risk of falls. There are also posture exercises that can improve your posture and reduce rounded or “sloping” shoulders can help you decrease the risk of fractures, especially in the spine. Finally there are a range of functional exercises designed to improve how well you move can help you in everyday activities and decrease your risk of falls and fractures. For example, if you have trouble getting up from a chair or climbing stairs, you should do these activities as exercises, simply try standing up and sitting down several times until you are tired – it’s a start! There is a growing interest in both Yoga and Pilates. Both these methods can also improve strength, balance and flexibility; however people with low bone density or osteoporosis should avoid certain positions to prevent fractures.
All in all, there is a lot you can do to protect and build your bone health.
• Eat well and choose from a variety of foods.
• Move towards a more vegetarian style of eating and rely less on meats for protein.
• Stop smoking and curb any regular excessive alcohol intake.
• Start an exercise plan aimed at loading bones or improving posture and balance.
• Take extra vitamin D3 along with a good all-round bone nutrient such as OsteoPrime or Osteo Factors.
• If you think your bones may be at risk get a heel scan or bone density scan to be on the safe side.

Further Reading: Preventing and Reversing Osteoporosis by Dr Alan Gaby MD.

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