What You’ll Discover in this Ebook

What is Vitamin K2?

Types of Vitamin K and Why You Need Two of Them in Your Diet
Does Your Body Produce Enough Vitamin K2?

The Best Food Sources of Vitamin K2

Natto: One of the Best Sources of Vitamin K2
Why You Need More Vitamin K2 in Your Diet

Is Vitamin K2 the Missing Link for Bone Health?

How Vitamin K2 Impacts Bone Health
What Research Shows about Vitamin K2 and Osteoporosis

A Natural Way to Prevent Osteoporosis?

Vitamin K2 and Vitamin D: Is There a Link?
Vitamin K2 and Heart Disease

How Vitamin K2 Affects Blood Vessel Health

Vitamin K2 and Dental Health

Vitamin K2 and Cancer

Vitamin K2 and Metabolic Health

Can Vitamin K2 Keep Your Skin Looking Youthful?
Risk Factors for Vitamin K Deficiency

Vitamin K2 and Vitamin D – The Dynamic Duo

Are Vitamin K2 Supplements Safe?
Another Way to Add Vitamin K2 to Your Diet

Forms of Vitamin K2
Can Vitamin K2 Be Toxic?
In Conclusion

Take-Away Points
References:
About the Authors
You don’t hear a lot about vitamin K. That’s unfortunate since there’s growing evidence that this under-appreciated vitamin plays an important role in bone and heart
health. As physicians, we became intrigued with vitamin K2 after research showed vitamin K2 dictates where calcium goes in your body – whether it travels to your bones to
keep them strong and healthy or whether it lodges inside blood vessels leading to your heart. The first is a definite benefit while the latter you want to avoid.

When calcium deposits inside the walls of blood vessels or in the valves of the heart, it can lead to heart disease, a heart attack or stroke. If you’ve been keeping up with
medical research, you may have heard about studies linking calcium supplements to a greater risk for heart disease. Considering how many people take calcium as a
supplement, this is concerning. No one wants to take a supplement that puts them at risk for a heart attack!

Assuming these calcium studies are confirmed by further research, this puts men and women, especially women, in a dilemma. Women (and men) need calcium for healthy
bones but not at the expense of harming their heart. What if there was a vitamin that directs calcium to your bones, where you want it, and away from the walls of blood
vessels where it could stick and put you at greater risk for heart disease? Preliminary research suggests vitamin K2 might have this ability.
What You’ll Discover in this Ebook

First, we want you to understand vitamin K2 – what it is, where you get it, what it does inside your body, how it may lower your risk for health problems and how you can
make sure you’re getting enough of it. After talking about dietary sources of vitamin K2, we’ll discuss vitamin K2 supplements.

Many people are confused about vitamin K2 supplements and the various forms vitamin K2 comes in like MK-4, MK-7 etc. We’ll try to cut through the confusion and help you
decide whether you need a supplement and, if so, what kind to look for when choosing one.

Be aware, we aren’t affiliated with any brand of K2 supplements and we don’t sell them ourselves, so any recommendations we make are unbiased. In fact, we don’t
mention specific brands for that reason. We’re not out to sell a product. As physicians, we want to keep you informed about the latest medical science and help you make
the best choice for your own health.
What is Vitamin K2?

With so much focus on nutrition these days, you’d think you’d hear more about vitamin K, in general, including vitamin K2. That’s likely to change in the future as more
information comes out about its potential benefits. We won’t dig TOO deeply into the science of K2 and bore you with chemical structures etc., but we do want you to have
a basic understanding of vitamin K2. We promise you don’t have to have a science degree to follow along. Hopefully, we won’t make your eyes glaze over with boredom
either!

You may already know vitamin K is important for helping your blood clot or “coagulate.” Coagulation is a protective mechanism your body uses to keep you from bleeding to
death when you have a cut or an injury. When you have a cut, platelets and proteins in your blood called coagulation factors work together to create a gelatinous material
that plugs the opening in the blood vessel to stop the bleeding.

If you lacked these coagulation factors or they didn’t work properly, you could potentially bleed to death when you’re injured or after having surgery. Vitamin K activates
these super-important coagulation factors so they can stop the bleeding in a timely manner.

At one time, it was believed the only function of vitamin K was to help blood clot. Not to undermine the importance of blood clotting, but we’re now discovering vitamin K
has other benefits as well, as you’ll soon see and many of these benefits come from the K2 form.
Types of Vitamin K and Why You Need Two of Them in Your Diet

There are thirteen different types of vitamin K. The three main types are – vitamin K1, vitamin K2 and vitamin K3. Vitamin K1 is called phylloquinone. Vitamin K1 is the type
of vitamin K most closely tied to blood clotting. It’s found in plants and is the form of vitamin K most abundant in a standard Western diet.

One of the best sources of vitamin K1 is green, leafy vegetables. When you eat a big bowl of spinach, kale, collard greens, turnip greens or mustard greens, you’re supplying
your body with vitamin K1. Brussels sprouts and broccoli are other good sources of vitamin K1.

One thing you should know about vitamin K1 from green, leafy vegetables - you only absorb 5 to 10% of the K1 from these foods. Not very impressive! You can increase the
amount your body absorbs by eating vitamin K-rich foods along with a source of fat. All forms of vitamin K dissolve best in fat and are absorbed better when there’s fat
around. That’s because they’re fat-soluble vitamins.

So, add a little olive oil or butter to your greens to maximize absorption of the vitamin K. As long as you’re not vegetable-phobic and aren’t eating a very low-fat diet, you
probably are getting enough vitamin K1 in your diet.

Vitamin K2 is structurally different from vitamin K1. It contains a different side chain or “tail” as part of its chemical structure. Vitamin K2 is called menoquinone. Research
shows menoquinone has some unique and beneficial functions. What’s surprising is how little you hear about vitamin K2.

When was the last time your doctor asked if you’re getting enough vitamin K2 in your diet? Chances are they’ve never asked you about it at all.

Most doctors are more focused on the blood clotting function of vitamin K and don’t differentiate between vitamin K1 and vitamin K2. We’re hoping this will change and
more doctors will acknowledge the role nutrition plays in health and disease prevention.

Back to vitamin K2. To confuse matters, different forms of vitamin K2 called isoforms exist. These isoforms have numbers like MK-4 and MK-7. We’ll talk about the different
isoforms and which ones are most important shortly. Suffice it to say, most people get little vitamin K2 through diet, at least in Western countries.

As you’ll soon see, the Japanese get more vitamin K2 because they eat natto, a food that has some interesting characteristics. Chances are you don’t have natto hiding in
your refrigerator. If you do, good for you! Assuming you eat it, you’re far ahead of the game when it comes to keeping your bones and heart healthy. Natto has an
impressive amount of vitamin K2, almost 1,000 micrograms per serving.

Vitamin K3 is the third form of vitamin K, also called menadione. Menadione is a synthetic form of vitamin K3. Menadione has no benefits from a health standpoint. In fact,
high doses of mendadione can be harmful. The FDA even banned menadione for use as an over-the-counter supplement but it’s still available as a nutritional supplement in
some third world countries.

If you choose to take a vitamin K2 supplement, buy it from a reputable source and make sure it’s not a synthetic form of vitamin K3.
Does Your Body Produce Enough Vitamin K2?

If you eat your veggies, especially green leafy ones, you’re getting enough vitamin K1, the form involved in blood clotting. You might wonder whether your body can convert
vitamin K1 from your diet to vitamin K2? Yes, it can – but there’s a lot of variability in how much humans and other animals do this. Research shows K1 to K2 conversion isn’t
very efficient in most people.

Bacteria in your intestinal tract can make vitamin K2 but much of the K2 produced by intestinal bacteria isn’t readily absorbed. That’s why you need preformed vitamin K2
from dietary sources to get the maximal benefits this vitamin offers.

Most people get enough vitamin K1 by eating a normal diet with the possible exception of the elderly. This amount is enough to ensure your blood clots normally but it’s not
enough to get the unique benefits that vitamin K2 offers.
The Best Food Sources of Vitamin K2

Where do you get vitamin K2 in your diet? Foods that contain significant amounts of vitamin K2 include meat and dairy products from grass-fed animals. Another excellent
source of vitamin K2 is a food called natto.

Natto is a popular breakfast food in Japan made from fermented soybeans. Although the Japanese enjoy it, in the United States, natto rarely tops the list of anyone’s
favorite foods. That’s because natto has a slimy texture and pungent aroma.

Natto may not top the list of culinary delights but it has its strong points. Natto is one of the best natural sources of vitamin K2. It has another benefit as well. Natto
contains an enzyme called nattokinase. Nattokinase has “anticoagulant” properties, meaning it helps prevent blood clots.

A blood clot can lodge in a blood vessel and block blood supply. If a blood clot blocks a vessel leading to your brain, this could lead to a stroke. If it’s a blood vessel that
supplies your heart with blood, it results in a heart attack. As a result, some people consume natto to lower their risk for stroke and heart attack.

Of course, you don’t want to eat natto if you’re taking a blood-thinning medication without consulting your doctor first. In addition, natto also lowers blood pressure. A
2008 study found the nattokinase in natto had a significant blood-pressure lowering effect. That could be of benefit if you have borderline high blood pressure.

If you’d like to try natto, most oriental food markets sell it. Some health food stores also carry it in frozen packages. How is this unusual food made? Cooked soybeans are
mixed with bacteria and allowed to ferment at a temperature of around 120 degrees F. After fermentation, the beans are placed in a cool environment until they’re ready
to eat.
Natto: One of the Best Sources of Vitamin K2

You’ll probably hear lots of negative things about natto – and some of them are justified. It has a rather pungent smell and slimy texture but don’t knock it until you try it.
Some people enjoy it once they get used to its texture and aroma.

Natto really doesn’t have a distinct taste. Rather it takes on the flavor of whatever you put on it. It’s very similar to tofu in that respect, although the texture and odor are
entirely different. Some people genuinely enjoy eating it. We had a 65 year old patient who ate it every morning for breakfast. When her bone-density study came back, her
bones were perfect!

Some people tell us natto tastes better with a little mustard or soy sauce. You can also add it to miso soup or eat it over brown rice. The best way we’ve found to eat natto
is mixed with low-carb pasta noodles along with a little garlic and olive oil. To be honest, it’s not our favorite food but it’s tolerable enough to eat. We just keep reminding
ourselves of its health benefits!

We’ve eaten natto a number of times and agree that it’s “okay” once you get past its slimy texture and pungent aroma. Let’s just say it’s an acquired taste and not
something the average person wants to eat every day, although you’d have no problems meeting your vitamin K2 requirements if you did. Natto is also a good source of
calcium, iron, magnesium, vitamin C and fiber.

If you buy natto, look for an organic version. Most soybeans have been genetically modified. Although there’s no firm evidence that genetically-modified foods or GMOs
cause health problems, we try to avoid them. Why take a chance with something not proven to be safe?

Other food sources of vitamin K2:

Natto – the best source. It gets a gold star for being so rich in natural vitamin K2

Goose liver
Hard cheeses. Gouda is an especially good source
Soft cheeses. Brie is an excellent source.

Egg yolks
Butter from grass-fed animals (commercial butter is NOT a good source)
Fermented foods. Sauerkraut is a good source as long as it’s raw and unpasteurized. So is kefir and kimchi (pickled cabbage)

Chicken livers and chicken breast

Ground beef

Looking at this list, it’s not hard to see how people who eat a vegan diet without meat or dairy products would be deficient in vitamin K2. It’s also easy to see why a person
who eats an omnivorous diet would also not get enough vitamin K2 through diet alone. How much of these foods do you eat every day?

The Japanese are more open to eating natto, the richest source of vitamin K2, and are much less likely to be deficient in this vitamin. Interestingly, the Japanese have a
lower rate of hip fractures related to osteoporosis and heart disease compared to Western countries. Could it be the natto they eat?
Why You Need More Vitamin K2 in Your Diet

We’ve already mentioned vitamin K2 is different from vitamin K1, the phylloquinone form of vitamin K you hear the most about. Vitamin K2 has health benefits that are
distinct from vitamin K1. These benefits are gradually being recognized and acknowledged.

The two areas where vitamin K2 shows the most promise is for heart health and bone health. According to some studies, vitamin K2 also has anti-cancer properties too.
We’ll talk about each of these benefits and the research that supports them shortly. Ready to get started?
Is Vitamin K2 the Missing Link for Bone Health?

Osteoporosis is a devastating disease that leads to fractures, including hip fractures, the most painful and debilitating kind. It robs some people of the best years of their
life and makes it difficult for them to do the things they enjoy. In clinical practice, you see so many post-menopausal women with problems due to osteoporosis, including
hip fractures. Hip fractures have a high rate of disability and often result in either disability or death.

With osteoporosis, you can also have compression fractures involving the bones in the spine that lead to pain and loss of mobility. Have you ever seen an older person whose
head is forced into a downward position so they are always looking at the ground? It’s called a Dowager’s hump and it’s the hallmark of advanced osteoporosis.

We’ve seen lots of women who have taken their calcium and vitamin D and still developed significant osteoporosis and fractures as a result. You can blame some of it on
genetics or other lifestyle factors but we believe lack of vitamin K2 may be a contributing factor as well.

As you might expect, we’re big advocates of preventing osteoporosis but getting enough calcium and vitamin D is just one part of the equation. There’s growing evidence
vitamin K2 is important for bone health.

The role vitamin K2 plays in maintaining healthy bones has already been identified. Research shows vitamin K2 activates proteins involved in forming healthy bone tissue.
One of these proteins is called osteocalcin. Osteocalcin plays an essential role in building strong, healthy bones.
How Vitamin K2 Impacts Bone Health

Osteocalcin is produced by cells called osteoblasts. Osteoblasts have the important job of making new bone tissue. When bone is first laid down, it lacks hardness. To
become firm enough to support your body and resist breakage, bones need calcium. You’ve heard that before, haven’t you?

Osteocalcin draws calcium into the newly-formed bone to mineralize it and make it hard – but it needs a little assistance. Before it can properly do its job, osteocalcin
needs vitamin K2 to activate or turn it on. Unless osteocalcin is activated by K2, it can’t draw calcium into bone tissue to harden it. As you know, calcium is the most
important mineral for maintaining healthy bones.

Vitamin K2 activates osteocalcin through a process called carboxylation – a chemical process that involves adding a carboxyl group to the molecule. Promise we won’t delve
into chemistry any deeper than that!

One way you can check for vitamin K2 deficiency is to look for under-carboxylated osteocalcin, or poorly activated vitamin K2, in the blood. Studies have shown a link
between undercarboxylated osteocalcin and low bone mineral density. No wonder! When osteocalcin isn’t carboxylated, it can’t draw calcium into newly formed bone
tissue.

Unfortunately, a test for undercarboxylated osteocalcin isn’t readily available at the current time. A test that measures the amount of total vitamin K in your blood is
available but it doesn’t differentiate between vitamin K1 and K2.

Doctors usually only order this test when someone has a problem with blood clotting. Fortunately, taking a K2 supplement or eating foods rich in natural vitamin K2 like
natto reduces levels of under-carboxylated osteocalcin. This ensures osteocalcin can pull calcium into your bones properly.

Did you know bones are active, living tissue? They’re constantly undergoing turnover. Old bone is broken down and replaced by new bone. As mentioned, osteoblasts make
bone but another group of bone cells called osteoclasts break it down. Vitamin K2 has benefits here too. Research shows vitamin K2 blocks the activity of osteoclasts and
promotes their destruction, thereby preventing bone breakdown.

Vitamin K2 positively influences bone health in two ways – by activating proteins like osteocalcin, involved in bone formation, and by blocking the activity of osteoclasts,
cells that break bone down. Osteocalcin also draws calcium into another “bony” structure, your teeth. We’ll talk more about how vitamin K2 may benefit your teeth
shortly.
What Research Shows about Vitamin K2 and Osteoporosis

A Japanese study compared vitamin K2 to prescription for preventing bone fractures due to osteoporosis. One group of post-menopausal women took vitamin K2 in MK-4
form (we’ll talk more about forms of vitamin K later). Another group took an osteoporosis drug called etidronate. The group who took vitamin K2 had a slightly lower risk of
developing a vertebral (spinal) fracture compared to women taking the medication.

Just think – vitamin K2 was more effective than an established osteoporosis medication for preventing spinal fractures. The risk of fractures dropped dramatically when they
combined the vitamin K2 with etidronate.

Another study carried out in Japan showed vitamin K2 (in the MK-4 form) reduced the incidence of vertebral bone fractures by 52%. Vitamin K2 was more effective than an
established osteoporosis medication for preventing spinal fractures. The risk of fractures dropped dramatically when vitamin K2 was combined with etidronate. Vitamin K2
may help osteoporosis medications work better.

In animals, the MK-4 form of vitamin K2 increases bone density and builds stronger, more resilient bones. It even enhances the fibrous protein tissue called collagen that
holds everything together. In addition, diets low in vitamin K have been linked with a greater risk for hip fractures. One study involving almost 73,000 women showed higher
vitamin K intakes were associated with a lower risk for hip fractures.

The landmark Framingham Heart Study also found a link between vitamin K and bone health. It showed older men and women with the lowest intakes of vitamin K were at
65% higher risk for developing a bone fracture relative to those who ate a vitamin K-rich diet. This study looked at vitamin K as a whole. Unfortunately, it didn’t distinguish
between vitamin K1 and vitamin K2.

Although not all studies show vitamin K2 supplements produce large improvements in bone health, these studies were short term, lasting a year or less. In a study involving
244 post-menopausal women, women received either 180 micrograms of a K2 supplement or a placebo for a full three years.

The women on the placebo experienced a 1.5% loss of bone density in their lumbar spine over a three year period. The women that took the vitamin K2 supplement showed
only a minor loss of 0.5%. Based on this study, it appears you have to get enough vitamin K2 longer term to get the full bone health benefits.
A Natural Way to Prevent Osteoporosis?

Why is the possibility of preventing osteoporosis with vitamin K2 so exciting? Many of the drugs used to treat osteoporosis have significant side effects. For example, a
popular group of osteoporosis drugs called bisphosphonates, have three potentially serious side effects. Some research shows they may actually weaken the structure of
bones. Ironically, this can lead to fractures, exactly what you’re trying to prevent.

Secondly, there’s a possible link between bisphosphonates and cancer of the esophagus, a form of cancer with a poor prognosis. Lastly, there’s a rare side effect called
jawbone necrosis where the jawbone begins to weaken and die. Cases have been seen even in people using bisphosphonates for a short period of time. These are all
uncommon side effects; however, they are serious should they occur. It would be nice to have a safe, well-tolerated alternative.
Vitamin K2 and Vitamin D: Is There a Link?

Vitamin D and vitamin K2 are “best buddies.” Vitamin K2 works synergistically with vitamin D to maintain bone density. Synergism is when two things work better together
than separately. You may already know vitamin D is important for healthy bones. Vitamin D helps maintain bone density by boosting the synthesis of osteocalcin while
vitamin K2 converts osteocalcin to its active form. It’s a team effort!

Vitamin K2 and vitamin D are a “dynamic duo” that work together for bone health. Plus, vitamin D increases calcium absorption from the intestinal tract. With so much
focus on vitamin D and calcium, vitamin K2 gets doesn’t get the attention it deserves, yet it’s a necessary element to complete the bone-building process.
Vitamin K2 and Heart Disease

Heart disease is the number one killer in industrialized countries and we’re seeing heart disease at younger and younger ages due to the obesity epidemic. Anything we can
do to lower the risk of dying prematurely of heart disease is important. There’s growing interest in the role vitamin K2 may play in keeping the walls of blood vessels, called
arteries, free of plaque.

You may have read about a 2012 German study that linked calcium supplements to heart disease. The link was compelling enough that the United States Preventive Services
Task Force recommended that women past menopause stop taking calcium supplements.

With so many women at high risk for osteoporosis, this study raised a lot of questions and created tremendous uncertainty. No one knew whether to take calcium
supplements or not. It’s a classic case of the “double-edged sword.” Heart attacks versus broken bones. Not a choice you want to have to make.

Women, in particular, need enough calcium to keep their bones healthy. Not all women get enough calcium through diet alone, especially those who eat a vegan diet or
can’t tolerate dairy products. We fielded a number of calls from women, after the studies came out, wondering whether they should toss their calcium supplements and risk
the health of their bones to protect their hearts.

Since the initial 2012 study showing a link between calcium and heart disease, other research has reached a similar conclusion while other studies have not. It’s possible
that the different outcomes, whether calcium supplements are harmful or not, could be explained by variations in vitamin K2 consumption.

In other words, if you get enough vitamin K2 in your diet, you get the benefits of calcium without the potential heart risk due to vitamin K2’s ability to direct calcium to
bones so it’s less available to deposit in blood vessels.
How Vitamin K2 Affects Blood Vessel Health

Research suggests vitamin K2 acts as a “gatekeeper,” activating hormones like osteocalcin that bind to calcium and make it less available for attaching to the walls of
arteries. You certainly don’t want calcium sticking to your arteries. When calcium does lodge in the inner lining of vessels it mineralizes.

Calcium build-up reduces blood flow and increases the risk for a blood clot to form and a heart attack to occur if it’s an artery within the heart and a stroke if it’s a vessel
within the brain. Vitamin K2 helps keep this from happening. It does this by activating a protein in the walls of blood vessels called matrix Gla protein or MGP.

MGP blocks the attachment of calcium to blood vessel walls. This keeps calcium away from the blood vessel wall where it shouldn’t be. In simple terms, vitamin K2 acts as a
“traffic cop,” directing calcium to bone and away from the walls of blood vessels.

This all sounds good in theory, but is there experimental evidence that vitamin K2 prevents coronary heart disease? The 2004 Rotterdam Heart Study tracked the dietary
habits and health outcomes of 4,800 men and women for 7 years. At the end of the 7 year period, they found men and women with the highest intakes of vitamin K2 in their
diet were 57% less likely to develop coronary heart disease.

What they didn’t find was an association between vitamin K1 intake and a lower risk for heart disease. This is additional scientific support for the idea that you need
vitamin K2 independently of vitamin K1.

In this study, could the cardiovascular benefits have come from eating a healthy diet rather than the effects of K2? Probably not. When you look at the list of foods high in
vitamin K2, most are high in fat. People who eat lots of these foods are less likely to be healthy eaters.
Vitamin K2 and Dental Health

Another bony structure in your body, your teeth, may benefit from vitamin K2. In the 1940s, a dentist named Weston Price from Cleveland, Ohio spent almost two decades
studying the dentition of human skeletons from a variety of areas of the world. He was amazed by the beautiful teeth of people from cultures that ate a high-fat diet. He
was convinced some unidentified dietary factor was responsible for the excellent dental health of these cultures, something that is missing from our diet today.

Dr. Price discovered two vitamins – vitamin A and vitamin D - were present in higher quantities of the diets of these cultures - but there was a third element he couldn’t
identify. He called it “activator X.” It wasn’t until almost 60 years later that the activator X was identified as vitamin K2. That vitamin K2 would be important for healthy
teeth isn’t surprising. It helps direct calcium to bones AND teeth.

Dr. Weston Price used a combination of cod liver oil and butter oil (from grass-fed animals) to reverse dental decay in his dental practice with apparent success. Although
we aren’t dentists, some of the patients we know who are taking a vitamin K2 supplement tell us their teeth have improved significantly – they have less tartar and more
cavity-free dental check-ups.

Can’t say for sure if vitamin K2 is responsible but it’s interesting how often we hear this story. We believe adequate amounts of vitamin K2, vitamin D and calcium are
important for healthy teeth AND bones.
Vitamin K2 and Cancer

While far from being conclusive, a number of intriguing studies show vitamin K2 may slow the growth of some types of cancer. If there’s one disease that frightens people,
it’s cancer. No surprise about that! Although more people are living longer lives with cancer, it’s still best to prevent it.

Sadly, one in three people will be diagnosed with cancer at some point in their life. You may wonder whether vitamin K2 has cancer-fighting properties. Some studies have
looked at this issue and the preliminary findings are encouraging.

Several research studies carried out in Japan show vitamin K2 could protect against both lung and liver cancer, diseases that are frequently fatal. Vitamin K2 may also offer
protection against prostate cancer, one of the most common cancers in men. A European study found a diet low in vitamin K2 was linked with a greater risk for prostate
cancer. A good thing since prostate cancer is one of the most common cancers men develop as they age.

It’s premature to say vitamin K2 can prevent or treat any kind of cancer. Research in this area is still in its infancy. Still, there are plenty of reasons to get more vitamin K2
in your diet – for your teeth, bones and heart.
Vitamin K2 and Metabolic Health

A common problem in Westernized countries is insulin resistance; a condition where cells don’t respond as well as they should to insulin produced by the pancreas. Cells
need insulin to take up glucose. Without it, glucose stays in the bloodstream and cells that need it “starve” in the midst of plenty.

When cells become insulin resistant, the pancreas has to pump out more insulin and you have more insulin circulating in your bloodstream. At the same time, insulin doesn’t
do its job of sending glucose into cells as well as it should. Over time, your pancreas “tires” of pumping out insulin and your blood sugar begins to rise because glucose can’t
get into cells. The result is type 2 diabetes. Insulin resistance, also known as metabolic syndrome, is common, especially among people who are overweight or obese.

How does this relate to vitamin K2? A 2011 study published in Diabetes Care conducted in young, healthy men showed supplementing with vitamin K2 for one month
increased insulin sensitivity. If these studies are confirmed by future research, getting more vitamin K2 could be a way to reduce your risk of type 2 diabetes.

It’s too soon to say that vitamin K2 prevents type 2 diabetes but it certainly can’t hurt to add more vitamin K2 to your diet. We tell patients that vitamin K2 in combination
with a healthy diet and regular exercise may lower the risk for type 2 diabetes.

With so many people being at risk for type 2 diabetes, every healthy lifestyle change counts. Taking vitamin K2 probably won’t make up for a diet high in processed carbs
and refined sugar – but no supplement can do that!
Can Vitamin K2 Keep Your Skin Looking Youthful?

As already discussed, vitamin K2 activates (by carboxylation) a protein called MGP. MGP keeps calcium from sticking to elastin fibers inside the walls of blood vessels. Once
there, it can calcify and harden, leading to heart disease.

Healthy elastin fibers are also important for keeping your skin youthful because it helps skin “bounce back” rather than become lax and saggy. By blocking calcification of
elastin in the deeper layer of your skin, vitamin K2 may slow down the skin-aging process.

Research shows people who can’t metabolize vitamin K properly develop premature skin wrinkling. We wouldn’t recommend taking a vitamin K2 supplement for preventing
wrinkles at this point, but if you take one for other reasons, keep an eye on your skin. You may notice it looks a little younger!
Risk Factors for Vitamin K Deficiency

Although most people get enough vitamin K1 through diet, it’s vitamin K2 most of us are lacking. Still, it’s possible to be deficient in both forms of vitamin K. You’re at
greater risk for vitamin K deficiency if you have certain intestinal conditions that reduce absorption of nutrients like celiac disease or inflammatory bowel disease or if
you’ve had a portion of your intestinal tract removed.

People who have cystic fibrosis also more commonly lack vitamin K. Taking antibiotics also increases the risk for vitamin K deficiency since gut bacteria produce a small
amount of vitamin K. Older people are also more likely to be deficient in vitamin K.
Vitamin K2 and Vitamin D – The Dynamic Duo

Recently, tons of information has come out about the importance of vitamin D for good health. Vitamin D is essential for bone health and plays a role in immune health as
well. With regards to bone health, vitamin D boosts calcium absorption from the intestinal tract. Once you absorb calcium, it enters your blood stream and makes its way to
the tissues that need it, teeth and bones. Without vitamin K2 to point it in the right direction, calcium can go anywhere in your body, including the walls of blood vessels
where you don’t want it.

Vitamin K2 “directs” calcium to teeth and bones and keeps it from depositing in the walls of blood vessels or other tissues. Taking vitamin D or calcium without “balancing
things out” with vitamin K2 in food or supplement form increases the risk of sending calcium to places it shouldn’t be. A significant number of people have low or marginally
low vitamin D levels and are taking supplements to correct this problem.

If you’re taking a vitamin D supplement, we recommend adding more vitamin K2 to your diet or taking a K2 supplement. When you’re absorbing more calcium because of
vitamin D, you want it to go to the right place –your bones. If you’re taking prescription medications, particularly blood thinners, talk to your doctor before taking K2 in
supplement form.

We think it’s equally important to get enough vitamin D. Vitamin K2 and vitamin D work together, along with calcium, to keep bones healthy. We see so many patients who
are low or borderline-line in vitamin D. The best source of vitamin D is sunlight. When sunlight hits your skin, it converts a compound on the surface of your skin to a vitamin
D precursor. Once that precursor is formed, your liver and kidneys convert it into active vitamin D.

If you spend a lot of time indoors, live in an area with little direct sunlight in the winter, or consistently wear a sunscreen, you may have a low vitamin D level and not know
it. To make matters worse, there are few natural food sources of vitamin D, with the exception of fatty fish like wild-caught salmon.

Some foods like milk and cereal are fortified with D. Still, unless you’re consuming these foods every day, you may not be getting enough vitamin D for optimal health. If
you’re over the age of 60, eat a vegan diet, have intestinal conditions that reduce fat-soluble vitamin absorption or have dark skin, you’re at greater risk for vitamin D
deficiency.

Fortunately, you can check your vitamin D status through a simple blood test. We believe everyone should check their vitamin D level and know where they stand. It’s even
more important if you have a risk factor for vitamin D deficiency. Yes, this book is about vitamin K2 but vitamin K2 works closely with vitamin D. It’s important that you get
enough of both!
Are Vitamin K2 Supplements Safe?

We would prefer that you get vitamin K2 from food sources rather than supplement form. We advocate food sources of vitamin K2 over supplements for a number of
reasons. For one, you get the benefits of the other components in the food. For example, Gouda cheese, a good source of vitamin K2, also contains protein and calcium.
Plus, the FDA doesn’t regulate nutritional supplements. As a result, you can’t always be sure you’re getting what’s on the label.

That being said, we take a vitamin K2 supplement ourselves. Despite eating a healthy diet, we don’t always consume enough foods high in vitamin K2. Unfortunately, most
people don’t. You may discover you can benefit from a supplement too, unless, of course, you develop a fondness for natto.

If you’re taking a blood thinning medication like warfarin, don’t take a vitamin K2 supplement without talking to your doctor. In fact, it’s a good idea to consult with your
doctor before taking ANY supplement. At high doses, vitamin K2 can interfere with the activity of warfarin. Interestingly, a small study showed consuming modest amounts
of vitamin K helps stabilize daily fluctuations in warfarin levels. This could actually help people get the full benefits of their blood thinner.

More research is needed in this area. Until more is known, we discourage taking supplemental vitamin K in any form if you’re on a blood-thinning medication, if you
have a history of stroke or heart attack or if you’re pregnant or nursing.

Other than the possibility of vitamin K affecting warfarin, supplemental vitamin K2 has few risks or side effects – assuming you DONT use the synthetic form, vitamin K3.
Vitamin K3 is known to cause side effects including destruction of red blood cells, sweating flushing and chest tightness.

Vitamin K3 is sometimes used in injectable form. K2 supplements from a reputable manufacturer shouldn’t contain vitamin K3 but always do your research to be sure and
buy from a reputable supplier.
Another Way to Add Vitamin K2 to Your Diet

Dr. Weston Price, the dentist who discovered vitamin K2 is important for dental health, used and recommended a combination of fermented cod liver oil (rich in vitamin D)
and butter oil (high in vitamin K2) for dental and bone health. What makes fermented cod liver oil unique is the fact that it’s cold processed. Cold processing, unlike heat,
doesn’t damage the omega-3 fatty acids in the oil. Fermented cod liver/butter oil is a good source of vitamin D, vitamin K2, vitamin A and omega-3 fatty acids.

At least one company makes a combination of fermented cod liver oil and butter oil with flavorings added to make it more palatable. We don’t take this combination
ourselves because cod liver oil has significant amounts of vitamin A.

Yes, vitamin A is important for health but high doses can have side effects including liver toxicity and loss of bone mass at higher doses. Some experts will argue that
vitamin A isn’t toxic unless you’re deficient in vitamin D but there’s not enough research to show vitamin D protects against vitamin A toxicity.

It may be true that vitamin A and D together reduce the risks of taking vitamin A as a supplement but we’d like to see more research to support this before recommending
fermented cod liver oil/ butter oil as a source of vitamin K2. Getting vitamin K2 from food sources or a vitamin K2 supplement, in our opinion, is safer.
Forms of Vitamin K2

We mentioned that vitamin K2 comes in different forms or “isoforms.” These isoforms are numbered MK-4 through MK-10. The two most important isoforms from a health
standpoint are MK-4 and MK-7. MK-4 is found primarily in grass-fed meat and dairy products including cheese.

MK-7 is abundant in fermented foods, the best source being natto. Cheese, especially Gouda cheese and brie, is also a good source of MK-7. MK-7 is produced by bacterial
fermentation of soy which means people with soy allergies should avoid it. MK-4 on the other hand is hypoallergenic.

Of MK-4 and MK-7, MK-4 is the most active form. MK-4 is the form of vitamin K2 used in the 1999 Japanese bone density and fracture trials. MK-4 has become an accepted
osteoporosis treatment in Japan. The problem with MK-4 is it has a short half-life, only about 4 hours. This means half of it is eliminated from your body in 4 hours. MK-7 has
a much longer half-life of around 3 days, so it stays in your system longer.

If you choose to take a vitamin K2 supplement, we currently recommend the MK-7 form. A small study carried out in Japan showed MK-7 in supplement form was much
better absorbed than MK-4 in supplement form as measured by blood levels.

After doing our research, we take the MK-7 form of vitamin K2 and believe this is the best choice if you choose the supplement route. Plus, MK-4 supplements are not
natural and aren’t from grass-fed animal products. Instead, they’re extracted from the tobacco plant.

When patients ask about vitamin K2, we usually tell them to buy grass-fed dairy products like grass-fed butter in place of the dairy products they’re currently using. Grass-
fed dairy and cheeses like Gouda and brie contain the MK-4 and MK-7 forms of vitamin K2. We also suggest they either add natto to their diet or take an MK-7 supplement.

Using this approach, they get both MK-4 and MK-7. Plus, vitamin K2 supplements that have both MK-4 and MK-7 are now readily available. Ideally, you should get some of
both, whether it’s through diet or supplements. Most of the bone studies were done using MK-4, although several studies show MK-7 also reduces bone loss in post-
menopausal women.

This brings up another question – what’s the best dosage of vitamin K2? Unfortunately, no one knows for sure. If you look at the “recommended” dose of vitamin K, the
amount is optimized for blood clotting, not bone or heart health. Current recommendations are for women to get 90 micrograms of vitamin K2 daily and men 120
micrograms.

Studies looking specifically at vitamin K2 for bone and heart health have used differing dosages. Based on the amount used in the various studies, we would recommend
getting around 200 micrograms of vitamin K2 daily to promote good health. This amount is dramatically less than the currently recommended dose of vitamin K2 used to
treat osteoporosis.
Can Vitamin K2 Be Toxic?

Vitamin K2 has no known toxicity. In fact, there’s no toxic level set for this vitamin. It doesn’t appear to be risky to your health even in large amounts, although we don’t
recommend going above 200 micrograms a day in supplement form until more is known.
In Conclusion

We hope we’ve increased your awareness and appreciation of vitamin K2, a vitamin most people know little about, much less get enough of in their diet. Research on
vitamin K2 is still in its infancy. There’s still so much to learn about this vitamin.

The exciting thing is vitamin K2 is non-toxic, although not something you should take as a supplement if you’re on a blood thinner. If you can get adequate amounts of
vitamin K2 through diet alone – that’s the best way to do it.

If you can’t, shop around for a non-synthetic K2 supplement. We recommend the MK-7 form. Do your research and only buy from a reputable company. When shopping for
supplements, we always prefer ones that have the United States Pharmacopeia (USP) seal as a verification of quality. Consumer Labs, accessible online, also does testing of
supplements and lists the ones they deem to be of high quality. Look for a supplement that’s free of synthetic colorings, flavorings and preservatives.

Look for a brand of MK-7 that is GMO free or be brave and try natto. We have a few patients who have developed a taste for it. It’s by far the best source of natural vitamin
K2 in the MK-7 form.
Take-Away Points

Vitamin K2 is important for heart and bone health, based on preliminary research. Some evidence also suggests it’s beneficial for dental health too.

Vitamin K2 plays a role in where the calcium you get from your diet goes. It directs it toward bone and away from other tissues like the inside of blood vessels where you
don’t want it.

Vitamin K1 and vitamin K2 have different functions. Vitamin K1 is mostly involved in blood coagulation, while vitamin K2 helps direct calcium to teeth and bones and keep it
from sticking to blood vessels.

Bacteria in your gut can convert vitamin K1 to vitamin K2 but the amount is limited. There’s evidence that you need both vitamin K1 (which most people get enough of
through diet) and vitamin K2 (diet or supplement).

Most people don’t get enough vitamin K2 through diet alone. Dietary options for getting vitamin K2 are somewhat limited.

A variety of “isoforms” or types of vitamin K2 exist. If you choose to take a supplement, we recommend either the vitamin MK-7 isoform due to its longer half-life OR a
vitamin K2 supplement containing both MK-4 and MK-7.

If you take a vitamin D or calcium supplement, it’s critical that you get enough vitamin K2 in your diet for balance.

You shouldn’t take vitamin K2 or any type of vitamin K supplement without consulting your doctor if you’re on a blood thinner like warfarin. Vitamin K at higher doses can
interfere with the effects of blood thinners.

If you decide not to take a supplement, add more fermented foods to your diet and consume butter and dairy products from grass-fed animals. We recently started eating
fresh sauerkraut, a good source of vitamin K2. Canned sauerkraut is NOT a good source since it’s pasteurized.

We have also added kimchi, a form of fermented cabbage that’s popular in Korean cuisine. Look for a brand in a glass not a metal container. Many natural food stores and
some mainstream supermarkets carry kimchi these days. It’s not hard to find. Kimchi has another health benefits as well – it has more probiotics than yogurt! Probiotics are
important for gut and immune health.

We always believe you should get vitamin, mineral and nutrients from food sources whenever possible. We try to do that too but, in the case of K2, we ended up adding
a supplement. We think vitamin K2 is too important to risk not getting enough of.

We hope, however you choose to do it, you’ll get more of this under-appreciated and misunderstood form of vitamin K. With the medical community finally recognizing the
health benefits of vitamin K2 we suspect you’ll be seeing much more about it in the near future!

Finally, we hope you’ve enjoyed reading this e-book and have a better understanding of the important role vitamin K plays in your body. If you have any suggestions about
how we could have better presented this information we would love to hear from you. Please visit our blog “heathylifestyledocs.com”. Here’s to your good health!
References:

U.S. Pharmacist. “The emerging Role of Vitamin K2” (1/20/2012)

Hypertens Res. 2008 Aug;31(8):1583-8. doi: 10.1291/hypres.31.1583.

Curr Pharm Des. 2004;10(21):2557-76.

J Bone Miner Res. 2000 Mar;15(3):515-21.

Medscape.com. “Vitamin K in the Treatment and Prevention of Osteoporosis and Arterial Calcification”
Adv Nutr March 2012 Adv Nutr vol. 3: 158-165, 2012.
American Cancer Society. “Vitamin K”

Life Extension. “Protecting Bone and Arterial Health with Vitamin K2” (2008)
Clin Calcium. 2012 Jun;22(6):797-803. doi: CliCa1206797803.
Nutraingredients-USA.com. “Vitamin K2: Study Unlocks Which Forms Have Higher Bioavailability” (2012)

Am J Clin Nutr. 2000 May;71(5):1201-8.

WebMD. “Vitamin K2”

Longevity Medicine Review. “Vitamin K”

Nutraceuticals World. 16.10 (Dec. 2013): p101

Atherosclerosis. 2009 Apr;203(2):489-93. doi: 10.1016/j.atherosclerosis.2008.07.010. Epub 2008 Jul 19.
Nutraingredients-USA.com. “Vitamin K2 Shows Extremely Important Improvements in Clinical Outcomes for Bone Health” March, 2013.

Nutraingredients-USA.com. “Vitamin K May Benefit Both Elderly Men and Women” March 29, 2011.
The Merck Manual Professional Edition. “Vitamin K”

Disclaimer: The information covered in this ebook is for educational purposes only. It should never be used as a substitute for diagnosis and treatment by a medical doctor.
The authors make no representations with respect to the completeness of the books contents. Please discuss this information with your doctor before using it as self-
treatment.
About the Authors

Kristie Leong M.D. is a family practice physician and medical writer. She retired from medical practice 14 years ago to pursue a career as a health, fitness and nutrition
writer. Since that time, she has published over 4,000 medical articles online. She has a strong desire to help people prevent health problems through lifestyle changes, and
she prefers medicine-free solutions to medical problems when possible. She plans on publishing more ebooks in the area of health, nutrition and fitness in the future.

Apollo Leong M.D., her husband, currently practices family medicine full time in Virginia. He is a founding member and senior partner in a large independent multi-specialty
medical group. Despite having nearly 25 years of experience as a board certified physician his patients continue to teach him new things on a regular basis. He and Kristie
attend medical conferences to stay abreast of what’s going on in the medical field. Like Kristie, Dr. A, as he’s fondly called, enjoys using medication-free approaches,
including diet, supplements, and exercise, to help patients live fuller, healthier lives. They live in Virginia with their pack of rescue dogs.