Does Vitamin K remove calcium from arteries? Is it a good idea to supplement Vitamin K for heart health? What is the evidence on Vitamin K and heart disease?
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References:
1-https://www.mdpi.com/2072-6643/12/10/2909
2-https://link.springer.com/article/10.1007/s00394-019-01998-3
3-https://www.acpjournals.org/doi/abs/10.7326/0003-4819-159-12-201312170-00011
4-https://www.frontiersin.org/articles/10.3389/fnut.2023.1115069/full
5-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682995/
6-https://onlinelibrary.wiley.com/doi/full/10.1002/clc.22842
7-https://www.sciencedirect.com/science/article/pii/S0167527315001990
8-https://europepmc.org/articles/pmc2988224/bin/mmc1.pdf
9-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103514/
10-https://www.sciencedirect.com/science/article/pii/S0140673612603122
11-https://www.ahajournals.org/doi/pdf/10.1161/circulationaha.121.057008
12-https://www.jacc.org/doi/10.1016/j.jacadv.2023.100643
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0:00 Vitamin K and calcium
2:16 Should we try to reduce calcium?
5:19 Vitamin K and heart disease
7:38 My view on Vitamin K supplements
9:20 Side effects
10:12 Potential danger
Is it true that vitamin K2 removes calcium from our arteries and is it a good idea to supplement K2 for heart health? today we’re going to be focusing on cardiovascular disease but if you have other questions regarding vitamin K, bone health or glucose metabolism or any others,
Ask below and we can make more content. also, I don’t have any conflicts of interest in this area, I don’t sell vitamins or any supplements or medications. so there are two main forms of vitamin K: K1, which mainly comes from green leafy vegetables, and K2, which comes from animal
Products and fermented foods like natto and hard cheeses. so where does this idea come from that vitamin K2 affects calcification in our arteries? there are some factors in our artery walls that can suppress calcification and that require vitamin K for their activation. something called
Matrix GLA protein, or MGP for short, inhibits calcification in artery walls but if people don’t have enough vitamin K in their system, if they’re vitamin K deficient for example, then this MGP can’t get activated and can’t do its job. also, people who eat more vitamin K in their
Food seem to have less calcium in their arteries and lower risk of heart disease. this is a really interesting observation but by itself it doesn’t necessarily mean that it’s the vitamin K causing these effects and above all we can’t assume that taking a pill with purified, isolated Vitamin K
Is going to do the same thing. we have a number of examples where consuming a food high in a vitamin is associated with good outcomes but supplementing the purified vitamin did not have the same effect,
Or in some cases even caused harm. so we have to test it, as always in science we can’t assume, if we want to know the effect of a vitamin K supplement we have to actually give it to to humans and see what happens. fortunately for us, scientists have run this experiment several times,
And there are some published randomized trials suggesting that vitamin K supplementation may indeed help slow down calcium deposition in the arteries. but is that a good thing? this is a question that we should always ask and we should get used to asking these questions,
Does this change actually help me in the end? the thinking process goes that if a high calcium score tends to be bad news, and that’s not unreasonable at all, then it would seem to follow that it’s a
Good idea to take calcium out of the arteries and try to reduce that calcium score. but actually the reality is this logic misses the whole point. some of you may have seen our past video on the calcium
Score and might be familiar with all of this, but the bottom line is that the calcium in the artery wall is not the problem itself, it’s not the cause of risk, it’s an indicator. calcification is a pretty late occurrence in plaque progression, plaque growth, so by the time we have detectable
Calcium, it’s telling us that this individual probably has a lot of plaque and it’s been growing for a long time, usually decades. that’s why it’s a sign of concern, not because the calcium itself causes harm. in fact, there’s some evidence that the calcification is part of the
Regeneration of the artery, of the stabilization of the plaque. the plaque that’s most vulnerable and most likely to rupture, to break and cause problems like heart attacks, is the soft plaque, not the calcified portion. there are even some contexts where the calcium score can go up,
The number can increase, while the risk of a heart attack actually goes down. when people have a high calcium score usually they’re given lipid lowering treatment, often a statin. and it’s a very normal expectation for a patient who starts a statin to think everything is going to get better now and
My calcium number is probably going to get better, it’s going to improve, it’s going to decrease. but actually it often goes up even more and this is thought to be part of the stabilization of the plaque that statins help induce. so this is a common question that people have, well,
The statin increased my calcium so what’s the point? Statins are prescribed because trials have shown they lower actual events like heart attacks in people who have indication, so it’s a really interesting example of actual risk of heart disease going down while the calcium score goes
Up. so we’ve covered all this in past content, but just this concept that overinterpreting the calcium score and forgetting that it’s not the cause of harm can be misleading. it’s a little bit reminiscent of HDL-cholesterol. people with higher HDL-cholesterol tend to have lower risk of
Heart disease, so this created this idea that we want to raise our HDL-cholesterol, how do I raise my HDL-cholesterol? but we now know from a lot of evidence that raising HDL-cholesterol doesn’t necessarily do anything to risk of heart disease. so it’s focusing on the wrong thing, it’s treating
A marker instead of treating the causes of the disease. same thing with calcium. so bottom line, I want to know if a diet or a treatment or a supplement raises or lowers my actual risk of events. heart attacks and strokes and things like that. and just slowing down calcium progression
Doesn’t necessarily tell me that. so we need trials that focus on actual rate of events. now, there are some trials published looking at Vitamin K supplementation that report events. there’s one from 2009 for example, and they find that there’s no statistically significant difference in event
Rates between the participants supplementing and those on a placebo, but the problem is it’s a very small number of events. this trial is not statistically powered for events so it’s not really that conclusive. fast forward to the last chapter of this novel. there’s a newer
Trial looking at Vitamin K supplementation and calcification in the arteries and they randomized over 300 participants and they gave half of them vitamin K2. pretty high dose, 720 micrograms a day. and also some vitamin D. and the other group got a placebo. and they followed them for 2 years.
Overall they found no significant change in the rate of calcium accrual, although there was a subset of patients that had high calcium at baseline where they did see slower calcium increase in the patients receiving the supplement. interestingly, this trial also looked at soft
Plaque, so non-calcified plaque, and they did not find a statistically significant difference between the patients receiving the supplement versus the placebo in terms of the increase, the growth rate of non-calcified plaque. and finally this trial also reported number of events.
And overall they found no significant difference between the two groups. and then in a subset of participants that had no history of heart disease, they report less events in the patients receiving the supplement, but same problem as before, tiny sample size. 13 events total so we really can’t
Do any compelling statistics on a sample size like that. and the authors say it themselves, this is more maybe hypothesis generating but needs to be confirmed in a properly powered trial. so bottom line, I don’t have a strong view either way on vitamin K supplements and heart health
Because we don’t have compelling evidence looking at actual rate of events. focusing exclusively on rate of calcium accumulation or reducing calcium isn’t necessarily informative. if properly powered trials show an event reduction with vitamin K supplements, then yeah, I think that’s going to
Put this supplement on the map in a big way. failing that, I don’t think it’s going to be widely recommended based on the evidence. another interesting tidbit is I recently did a live show with Dr Ford Brewer, who is a cardiologist formerly at Johns Hopkins, and he also has
A YouTube channel, you guys may be familiar with his content. so we did this joint live show recently and we talked exactly about this topic, vitamin K supplements and heart health, and it was interesting because I had this impression before we started, we hadn’t actually talked about
Our views on the subject but I had an impression that we were going to have some disagreements so I thought that would be interesting, to compare the evidence that we had seen, but it turned out
That on the show, and this was live so we’re doing this in real time, I think we kind of realized we have the exact same view and the exact, almost the exact same takes, and specifically this caveat of
The calcium score being something that needs to be taken with a grain of salt, not over relying on it and always bearing in mind it’s an indicator, not a cause of risk. so I’ll link that below, it’s a
1-hour show where we go over many of these trials on this topic in some detail for people who want a bit more depth. last thing I wanted to touch on is side effects, because some people might ask, very reasonable question, okay, there isn’t a lot of evidence of benefit but I’ll just gamble,
I’ll take the vitamin K, if it doesn’t work, whatever. right? what do I have to lose? so most published trials that I’ve seen have not reported a lot of side effects, including with substantial dosages of vitamin K supplements. there is one trial that suggests increased side
Effects specifically in an elderly population but overall in the literature that I’ve seen, not a strong signal of harm. although it should be said that when these large trials powered for events, which usually have to last several years and have to have a large number of people, it’s
Very possible, we can’t rule out that those might pick up side effects since it’s a larger sample size. my other concern is false reassurance, and I hear this logic, it’s not rare, where people will
Say in the comments or in a message, people will say well, I have a lot of plaque and I have all these risk factors and I have a bad family history but I’m not doing anything my doctor told me,
I’m ignoring everything, I’m taking vitamin K cuz this influencer told me about it so I’m safe. and I think that’s very dangerous logic because we’re betting our life on something that has next to no compelling evidence as far as actual events and we’re foregoing alternatives that have a
Monumental amount of evidence behind them. so just a little bit of caution with that social media logic. when somebody tells you, here, you have this problem, just take this pill, just take this herb, just take this natural thing or do this practice. very simple, ask for the evidence. can
You show me some evidence that people doing that, that people taking that, have a lower risk of disease? in this case of heart disease, of heart attacks or strokes. 99% of the time that question ends the conversation right there. here’s a lot more information on the calcium score and here’s
A conversation with a cardiologist going over these issues of the calcium score, the value, the caveats and these questions around statins as well. check those out, I’ll catch you next time
