Table of Contents

In this blog post, I discuss Vitamin K2 and osteoporosis. Specifically, I cover the scientific research into the role of Vitamin K in improving bone health. I also list the foods high in Vitamin K2, provide the current recommended Vitamin K2 dosage for osteoporosis, discuss Vitamin K2 deficiency, differences between Vitamin K1 and Vitamin K2, and tell you about a Vitamin K2 food source rock star.

Below is a video summarizing a number of the main points on Vitamin K2 in this article.

Before I get too far into this blog post, let me share with you four important points:

  1. First, I prepared the article for my patients because many of them are confused by the mixed messages that they read on Vitamin K1 and K2 and its role in the treatment and prevention of osteoporosis.
  2. Second, I do not sell, promote, or have a financial interest in supplement products whether they be Vitamin K1, K2 or other dietary supplements.
  3. Third, as much as I could, I rely on published and peer-reviewed research as my source of information on Vitamin K.  I avoided sources (such as postings by supplement manufacturers) where I sensed a conflict of interest.
  4. Fourth, this article will help you have an informed conversation with your nutritionist regarding your dietary needs. I encourage you to direct any questions his or her way.

With that out of the way, let’s get into the detail on the relationship between Vitamin K, osteoporosis and your bone health.

 

Summary

Here is a summary of the key points of this article:

  • Some, but not all research, demonstrates that people with osteoporosis can use Vitamin K2 to improve both bone density and bone strength.
  • Vitamin K2 is more effective than Vitamin K1 for improving bone health.
  • The main sources of Vitamin K2 are animal products and fermented foods. A Japanese fermented dish called Nattō is particularly abundant in Vitamin K2.
  • Unless you are actively increasing your Vitamin K2 levels through diet or supplementation, you are likely deficient and have inadequate levels for your bone and heart health needs.
  • Vitamin K2 MK7 dosage recommendation is 150 to 180 µg per day. This is based on the dosage used in most recent research studies.
  • Recommended daily dosage for Vitamin K2 MK4 is 45 mg in Asia and Japan. Other jurisdictions do not provide guidance.
  • Consult with your physician and a Registered Dietitian Nutritionist before starting a Vitamin K2 protocol. This advice is particularly appropriate for people taking anticoagulants.

Vitamin K2 for Osteoporosis Treatment

Menaquinone or Vitamin K2 is critical for osteoporosis treatment and prevention (1). It helps strengthen bone in two ways:

  • Activates the osteocalcin (a protein produced by osteoblasts) so that it can help calcium bind to your bones.
  • Keeps the calcium (which is essential for maintenance of bone health) out of our blood vessels and targets it at our skeleton.

A paper by Myneni and Mezey in Oral Diseases (2) identifies several additional benefits of Vitamin K2 when it comes to bone health:

  • Promotes bone marrow stem cell proliferation.
  • Stimulates osteoblast differentiation.
  • Inhibits adipocyte differentiation.
  • Protects osteoblasts from apoptosis.
  • Inhibits osteoclast formation by inhibiting expression of RANKL, and promotes osteoclast apoptosis.

Myneni and Mezey conclude that “overall, [Vitamin K2] has an anabolic effect on bone.”

The Vitamin K2 initiative by the International Science and Health Foundation provides the following explanation:

“Osteoblasts produce a Vitamin K2-dependent protein called osteocalcin, which helps bind calcium in the bone matrix, leading to increased bone mineral content. Consequently, the skeleton becomes more resistant and less susceptible to fracture. But osteocalcin needs Vitamin K2 to function optimally.”

Several studies challenge the claim that Vitamin K2 enhances bone health. I discuss these later in this article.

Vitamin K, Heart Health, Cancer Prevention and Alzheimer’s

While this article is focused on Vitamin K and osteoporosis, Vitamin K has a beneficial effect on your health beyond your bones, namely:

  • Cardiovascular Health. Researchers believe that Vitamin K helps shuttle calcium out of your arteries, thereby reducing the build up of calcium deposits in your cardiovascular system. A long term study of a group of people taking high levels of Vitamin K2 (menaquinone) showed a significant reduction in the incidence of artery calcification and death from heart disease. (3)
  • Cancer Prevention. Several research projects indicate that Vitamin K2, in particular, can play a role in reducing the risk of several cancers, including prostate and liver cancers.
  • Neurodegenerative Disease Prevention. There are indications that Vitamin K can prevent Alzheimer’s disease. (4)

Vitamin K1 vs Vitamin K2

Although both Vitamin K1 and K2 are fat-soluble vitamins, there are a number of important differences between Vitamin K1 and Vitamin K2.

The topic of Vitamin K can be a little confusing and hard to understand. One source of confusion is that there are two major families of Vitamin K — a Vitamin K1 family and a Vitamin K2 family.

First, Vitamin K1 is given its name because it is a single molecule called phylloquinone. It is found mostly in plant foods such as leafy greens. Vitamin K1 is composed of a single member and participates in blood clotting.

The Vitamin K2 family, on the other hand, is the bigger of the two and is divided into a number of subgroups which include MK-4, MK-7 and MK-9.

Vitamin K2 is mostly found in animal foods and fermented foods (more on this in the next section of this post). Menaquinone (or Vitamin K2) is a group of essential fat-soluble vitamins. These compounds are labelled by their number.

Only two of the group ever get meaningful attention and these are the MK-4 and the MK-7. Both are common supplements that I will cover, in some detail, in the section dedicated to Vitamin K2.

Exercise Recommendations for Osteoporosis

Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?

A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.

free-osteoporosis-course-melioguide

I cover important topics related to osteoporosis exercise including:

  • Can exercise reverse osteoporosis?
  • Stop the stoop — how to avoid kyphosis and rounded shoulders.
  • Key components of an osteoporosis exercise program.
  • Key principles of bone building.
  • Exercises you should avoid if you have osteoporosis.
  • Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
  • Core strength and osteoporosis — why is core strength important if you have osteoporosis?

Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.

  • This field is for validation purposes and should be left unchanged.

Vitamin K Food Sources

I will cover food sources of Vitamin K by starting with Vitamin K1.

Foods That Have Vitamin K1

Vitamin K1, or phylloquinone, is a compound present in all plants that are photosynthetic. Green, leafy vegetables contain the highest known phylloquinone concentrations. Vitamin K1 food sources include:

  • Spinach
  • Collards
  • Kale
  • Swiss Chard
  • Parsley
  • Romain
  • Brussel sprouts
  • Broccoli
  • Cabbage

In general, plants with dark leaf colour have substantially higher concentrations of phylloquinone compared to plants with lighter leaves (such as iceberg lettuce).

Plant oils are also a good source of Vitamin K1 (phylloquinone):

  • Soybean.
  • Canola or rapeseed.
  • Cottonseed.
  • Olive.

In addition, spreads and salad dressings made from soybean, canola, cottonseed and olive are also excellent dietary sources of phylloquinone.

Sarah Booth, Ph.D, Director of the USDA Human Nutrition Research Center on Aging at Tufts University has published a comprehensive overview of the best sources of Vitamin K1. (5) If you want more detail on this subject, I suggest you read her publication.

Foods High in Vitamin K2

Unlike Vitamin K1, that is found in plants, Vitamin K2 is principally synthesized by bacteria. Before I identify the foods high in Vitamin K2, we need to spend a bit of time on the two most popular forms of Vitamin K2, namely MK-4 and MK-7 and explore their food sources.

Vitamin K2 MK-4 Food Sources

The MK-4 form of Vitamin K2 principally comes from grass-fed animals and can be found in:

  • Butter.
  • Meat.
  • Dairy products such as milk.
  • Egg yolks.

Here is how MK-4 is produced by grass-fed animals (cows, pigs, chickens, for example): the animal consumes plant food containing Vitamin K1 and converts, in its gut, to the MK-4 form of Vitamin K2. It should be noted that, although humans can convert K1 to K2 in their gut, we are not near as efficient as grass-fed herbivores.

If you prefer to get your Vitamin K2 from animal-based sources, then you will need to consume their product. It is unlikely that you will generate enough MK-4 in your gut flora to meet the needs of your bones.

A few more points about MK-4:

  • The half-life of MK-4 is substantially less than that of its family member, MK-7, and as a result will stay in your body a shorter time.
  • Because of its short duration, you will likely have to take three daily doses of MK-4. One dose is adequate for MK-7.
  • The MK-4 you will find in dietary supplements is likely synthetic, whereas the MK-4 found is food is produced naturally by nature.

Vitamin K2 MK-4 Food Examples

One of the side benefits of getting your Vitamin K2 through natural food sources, as opposed to dietary supplements, is that you will, at times, get several sub-groups of Vitamin K2 mixed into the food. That is not always the case because some foods only have one of the sub-groups.  Here are some food examples to chew on.

Bovine Liver

Bovine liver is one of the few foods with representation of most of the Vitamin K2 sub-groups. A 100 gram serving of bovine liver has the following:

  • MK-4: 6.8 µg
  • MK-5: no trace.
  • MK-6: 9.44 µg
  • MK-7: 25.6 µg
  • MK-8: 13.8 µg
  • MK-9: 9.8 µg
  • MK-10: 14 µg
Chicken Liver

Chicken liver, on the the hand, only has MK-4 and there are no traces of the other Vitamin K2 sub-groups. A 100 gram serving of chicken liver has the following:

  • MK-4: 14.1 µg
Butter

A 100 gram serving of butter from grass-fed animals has only MK4 in the following quantity:

  • MK-4: 13.5 to 15.9 µg
Curd Cheese

Curd cheese is another food with representation of most of the Vitamin K2 sub-groups; although the quantities are low in many of the sub-groups with the exception of MK-8 and MK-9. This is likely an indication of the importance of production from bacteria fermentation as compared to production by the grass-fed animal.

A 100 gram serving of curd cheese has the following

  • MK-4: 0.3 to 0.6 µg
  • MK-5: 0.0 to 0.2 µg
  • MK-6: 0.1 to 0.3 µg
  • MK-7: 0.2 to 0.5 µg
  • MK-8: 4.8 to 5.4 µg
  • MK-9: 18.1 to 19.2 µg
  • MK-10: no trace
Edam (Semi-hard Cheese)

Like curd cheese, Edam cheese is another food with representation of most of the Vitamin K2 sub-groups; although the quantities are low in many of the sub-groups with the exception of MK-8 and MK-9. This is likely an indication of the importance of production from bacteria fermentation as compared to production by the grass-fed animal.

A 100 gram serving of curd cheese has the following

  • MK-4: 3.3 µg
  • MK-5: 1.0 µg
  • MK-6: 0.6 µg
  • MK-7: 1.3 µg
  • MK-8: 10.5 µg
  • MK-9: 30.0 µg
  • MK-10: 0.9 µg
Egg Yolk

Egg yolk is an excellent source of MK4 but not much else. A 100 gram serving of egg yolk from grass-fed chickens has MK4 in the following quantity:

  • MK-4: 29.1 to 33.5 µg
vitamin k2 • osteoporosis • spinach

Vitamin K2 MK-7 Food Sources

As I mentioned earlier in this blog post, MK-7 is derived from fermentation — but not all fermentation is the same! Some foods as simply far better than others when it comes to MK-7 and a number of fermented foods cannot be counted on to provide adequate levels of MK-7.

The superstar in Vitamin K2 density and specifically, MK-7, is a Japanese fermented soy dish called Nattō.

Vitamin K2 Nattō

The MK-7 form of Vitamin K2 is principally produced through fermentation and can be found in:

  • Fermented foods like cheese and yogurt.
  • A Japanese fermented soybean dish called Nattō is a particularly generous source of Vitamin K2 as menaquinone-7 (MK-7). In fact, one could consider it a rock star in the world of Vitamin K2 sources!

A research study out of Japan in 2001 demonstrated that “in those regions in Japan where women consumed the most Nattō, the women generally have shown low rates of fractures.” (6)

In her publication (5), Dr. Booth compares the content of Vitamin K2 from Nattō and two types of cheese.

Nattō has almost 20 times the concentration of Vitamin K2 compared to hard cheeses and over 25 times the concentration found in soft cheeses.

  • Nattō: 998 µg/100g of menaquinone-7 (MK-7).
  • Hard Cheese: 51.1 µg/100g of menaquinone-9 (MK-9).
  • Soft Cheese: 39.5 µg/100g of menaquinone-9 (MK-9).

I have never tasted Nattō, however, it turns out Nattō is an “acquired taste”. The bad news is that most people will find Nattō has a disagreeable flavour. The good news is that you don’t need much to achieve your daily Vitamin K2 target because of its concentration.

The know of only one person who consumes Nattō on a regular basis.  She eats it exclusively for its health benefits — not because of its taste!

A reader on my YouTube channel shared her experience on how to make Nattō more palatable. She states:

Nattō is very easy to make with an Instant Pot or you can buy it frozen from asian groceries. I find that the best way to enjoy eating it is by adding 1/2 teaspoons of strong mustard and some soya sauce.

It turns out that Nattō is not only an amazing source of MK-7, it also has a number of the Vitamin K2 subgroups. A 100 gram serving of Nattō has the following:

  • MK-5: 7.1 to 7.8 µg
  • MK-6: 12.7 to 14.8 µg
  • MK-7: 882 to 1,034 µg
  • MK-8: 78.3 to 89.8 µg
One Reader’s Experience with Nattō

Since publishing this post on Vitamin K2, a reader contacted me and shared her personal experience with Nattō . Here it is:

“Both of my parents broke hips in their senior years and I have small bones. I’ve had regular DEXA scans and my bone mineral density (BMD) is decreasing. I am not interested in going on osteoporosis drug therapy and have chosen to use resistance and agility training to help build bone strength and to avoid falls. I am 67 years of age.After reading the book Vitamin K2 and the Calcium Paradox, I started making Nattō at home.The commercial Nattō comes in a single serving styrofoam package that I cannot bring myself to buy regularly for environmental reasons.I buy just enough of the commercial Nattō to use as a starter — it takes only 1/9 of the single serving package to make 1 kilogram of dried soybeans into Nattō. I am considering using the dried spores (bacillus subtilis) in place of the commercial Nattō and will then be independent of the commercial styrofoam-packaged Nattō entirely.It took some effort to get used to the flavor and texture but I was motivated to succeed because of its bone health benefits and also because my diet is on the low side for protein and the soybeans help with that.”

A reader on my YouTube channel shared her experience on how to make Nattō more palatable. She states:

“Nattō is very easy to make with an Instant Pot or you can buy it frozen from asian groceries. I find that the best way to enjoy eating it is by adding 1/2 teaspoons of strong mustard and some soya sauce.”

vitamin k2 • osteoporosis • natto
Vitamin K2 Cheese

Dr. Booth identified dairy products and in particular cheese as a Vitamin K2 food source. Hard cheeses are the highest with 51.1 µg/100g of menaquinone-9 (MK-9) per 100g of cheese. Vitamin K2 hard cheese sources include:

  • Gouda
  • Edam
  • Gamalost (a Norwegian cheese)

One more thing, it is important to note that when cheese is processed, such as in cheese slices, the Vitamin K2 is eliminated.

Since Dr. Booth’s report, a new piece of research published in the June 2017 edition of Current Developments in Nutrition, “indicate that the amount of vitamin K contents in dairy products is high and proportional to the fat content of the product.”  (7)

Registered Dietitian Nutritionist, Nancy Robinson, points out in her blog article that the research “found that low and full fat dairy products contain more Vitamin K2 than previously reported.” She also recommends that “Vitamin K is a fat soluble vitamin so fat free dairy is not a good source.”

Is MK-4 Better Thank MK-7 for Bone Health and Osteoporosis?

A common question is whether you should use MK4 or MK7 for bone health and to treat osteoporosis. This article focused on MK7 more than MK4 because the most current research (for example, the three year 2013 Dutch study by Knapen, et al) was on the effects of MK7. There is research available on MK4, but it is more dated.

MK4 and MK7 are menaquinones (Vitamin K2) and both appear to be beneficial to bone health. Both seem to do the job Vitamin K2 was designed to do, that is, act as an usher and direct calcium away from the arteries and assist in the binding of calcium to bone.

I searched for a validated research report that compared MK4 to MK7 to see which was the better candidate for the prevention and treatment of osteoporosis but was not successful.

In her published study, Vitamin K: food composition and dietary intakes, Dr. Sarah Booth of Tufts University states: “The menaquinones are poorly understood in terms of vitamin K absorption and utilization.” In other words, researchers have more to learn about menaquinones so expect more information in the future.

If you spend enough time, you will find sites that state MK4 is better than MK7 and other sites that argue the opposite. Some people preferred animal-based products; others fancy fermentation.

Both sub-groups appear beneficial to bone health. The critical thing is get adequate levels of Vitamin K2 and some of the MK-7 sources, particularly Nattō, are hard to beat on that count.

In the end, the choice is yours to make.

vitamin k2 cheese melioguide

Does Vitamin K2 Help Bone Health?

As I mentioned earlier in this post, Vitamin K2 is active in the metabolism of calcium by activating the calcium binding action of several proteins (the carboxylation of osteocalcin). A number of studies show that Vitamin K2 does help bone health, although the evidence is not conclusive.

Vitamin K2 Helps Osteoporosis

Several studies support the role of Vitamin K2 in improving bone health. A three year study from the Netherlands (7) looked into the effect of Vitamin K2 supplementation — in the form of low dosage of Mk7 (180 μg MK-7/day capsules) — and it’s affect on the bone mineral density (BMD) and bone mineral content (BMC) of the lumbar spine, total hip and femoral neck. The research team also measured bone strength at the femoral neck.

[Note: 180 μg or 180 micrograms is only 0.18 milligrams.]

The findings showed that Vitamin K2 intake significantly decreased age-related decline of both BMC and BMD in areas with the most trabecular bone: the spine and the femoral neck. It also showed an improvement in bone strength in the femoral neck and a decreased loss of height in the lower thoracic vertebra.

Vitamin K2 Has no Effect on Bone Density

Several research studies dispute the efficacy of Vitamin K2 in improving bone health. In one study (9) of Vitamin K and bone health the authors concluded “there were no differences in changes in bone mineral density measurements at any of the anatomical sites measured between the two groups (the control and study groups).”

The other study (9) found “no effect of phylloquinone or MK4 on lumbar spine or proximal femur BMD or proximal femur geometric parameters was observed.” The authors stated that “this study does not support a role for vitamin K supplementation in osteoporosis prevention among healthy, postmenopausal, North American women receiving calcium and vitamin D supplementation.”

Vitamin K1 vs Vitamin K2 for Osteoporosis?

Vitamin K1 is processed in the liver and plays a larger role in the coagulation of our blood, whereas Vitamin K2, on the other hand, is processed in the intestine.  This makes it more available to different tissues than Vitamin K1.

A large meta-analysis published in 2006 in the Archives of Internal Medicine demonstrated that while both Vitamin K1 and Vitamin K2 were beneficial for osteoporosis and bone health, Vitamin K2 was more effective than Vitamin K1. (10)

The meta-analysis found that high levels of Vitamin K2 were associated with reduced:

As mentioned before, it has been shown that Vitamin K2 is also beneficial for your cardiovascular system.

Is Vitamin K2 an Effective Osteoporosis Treatment?

Several scientific studies confirm that Vitamin K2 is an effective way to treat osteoporosis and should be part of your health regimen, however, the results are not conclusive.

Let’s tackle what could cause Vitamin K2 deficiency.

Causes of Vitamin K2 Deficiency

Vitamin K2 deficiency tests are hard to come by. However, you can probably assume that you are Vitamin K2 deficient unless you are actively increasing your levels through food or supplementation. Some health professionals estimate that 80% of the US population has only 10% of their required Vitamin K2 levels.

Several causes of Vitamin K2 deficiency (11) are:

  • Poor nutrition. Not consuming adequate levels of either food from grass-fed animals or specific fermented foods.
  • Antibiotics that negatively affect our gut microbiome.
  • Poor absorption of Vitamin K2 from the gut due to aging or chronic gastrointestinal (GI) infections.
  • Age-related compromised bioavailability of Vitamin K2.
  • Bariatric surgery

Individuals with malabsorption issues my have inadequate levels of Vitamin K. These syndromes include:

  • Cystic fibrosis.
  • Celiac disease.
  • Ulcerative colitis.
  • Short bowel syndrome.

Vitamin K2 and Calcium

Studies found that when people take lots of calcium, the calcium coated their arteries and caused potential heart problems. Researchers have since determined that Vitamin K2 reduces the calcium level in the bloodstream (thereby reducing the risk of coating the arteries) and redirects it to the skeleton for bone building (by activating the osteocalcin protein).

Vitamin D3 and K2

What is the relationship between Vitamin D3 with K2, and does the combination of Vitamin D3 and K2 improve bone health? A meta-analysis study published in 2017 looked into this issue. (12)

In the study, the researchers stated: “Vitamin D promotes the production of vitamin K-dependent proteins, as shown in rats. These findings cannot be explained by our current understanding of the biochemical role of vitamin K, but suggest that vitamin D may influence vitamin K-dependent proteins.”

Most of the studies to date have been on rats. Studies on humans have been of a small scale. According to the authors: “Human evidence for the role of 1,25(OH)D in stimulating vitamin K-dependent proteins is scarce”. However, the researchers identified studies in Japan and Norway where a low 25(OH)D and vitamin K1 levels were associated with Bone Mineral Density (BMD), hip fractures and hop fracture risk.

Vitamin D3 and K2 and Bone Mineral Density

The authors review a groups of studies that looked at the effects of Vitamin D3 and Vitamin K2 and go on to state: “These findings indicate that combined administration of vitamin D and vitamin K appears to be useful in increasing BMD in postmenopausal women. It should be noted that these studies found beneficial effects at some but not all BMD sites measured. Furthermore, treatment with vitamins D and K with calcium increased BMD in older female patients with Alzheimer’s disease.”

The authors conclude by stating that “animal and human studies suggest that optimal concentrations of both vitamin D and vitamin K are beneficial for bone and cardiovascular health as supported by genetic, molecular, cellular, and some human studies.”

But they share words of caution, particularly as they relate to overuse of Vitamin D: “However, vitamin D and calcium supplementation along with vitamin K deficiency might also induce long-term soft tissue calcification and CVD, particularly in vitamin K antagonist users and other high-risk populations. At this moment, we should be careful about supplementing high-dose vitamin D, unless indicated differently.”

Should You Take Vitamin D3 with K2?

Vitamin D3 and K2 are fat-soluble vitamins and compete for uptake if taken together. Later in this blog I get into some detail about the nature of this competition and identify the research (13) that supports these findings.

Health professionals recommend that you take these fat-soluble vitamins three hours apart to reduce the competitive interaction between them and improve the absorption of the individual vitamins.

Exercise Recommendations for Osteoporosis

Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?

A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.

free-osteoporosis-course-melioguide

I cover important topics related to osteoporosis exercise including:

  • Can exercise reverse osteoporosis?
  • Stop the stoop — how to avoid kyphosis and rounded shoulders.
  • Key components of an osteoporosis exercise program.
  • Key principles of bone building.
  • Exercises you should avoid if you have osteoporosis.
  • Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
  • Core strength and osteoporosis — why is core strength important if you have osteoporosis?

Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.

  • This field is for validation purposes and should be left unchanged.

Vitamin K2 Side Effects and Cautions

A few words of caution before you integrate Vitamin K2 into your diet. There are several situations where Vitamin K2 could cause you health problems. Let’s start with soy allergies and then discuss blood thinners (anticoagulants).

Vitamin K2 and Soy Allergies

Menaquinone-7 (MK-7) is derived from fermented soy. If you have a soy allergy, Vitamin K2 in menaquinone-7 could be problematic.

Vitamin K2 and Anticoagulants

The other word of caution is for individuals who are on anticoagulants or blood thinners such as warfarin (Coumadin). Both Vitamin K1 and K2 support blood clotting and might counteract the effects of an anticoagulants.

If you are on or plan to take an anticoagulant, you should speak with your physician about adding the recommended Vitamin K2 dosage for osteoporosis.

For example, one of our readers shared her story about working with her doctor to optimize her level of MK-7 so that did not interfere with the medication she was on for blood clotting.

How Should You Take Vitamin K?

The absorption of the whole family of Vitamin K is greatly increased when you consume it with a meal rich in fats. This point is important and can greatly increase the absorption. Another important point is discussed below.

Vitamin K and Other Vitamins/Supplements

Vitamin K is one of four fat soluble vitamins. The other fat soluble vitamins are A, D and E. Fat soluble vitamins are not absorbed from the stomach walls. The absorption takes place in the intestines.

A 2015 study (13) looked at absorption in mice to see whether consuming more than one fat soluble vitamin at a time increased or decrease the absorption of the others. The study showed “significant competitive interactions for uptake” between Vitamin D, E, A and K. It seems that the only fat soluble vitamin that did not lose out was Vitamin A when taken with vitamin E.

The recommendation on Consumer Lab is that if you want to benefit from maximum absorption on your Vitamin K that you take it at least 3 hours apart from other fat soluble Vitamins (D, E and A). To learn more about this listen to my interview with ConsumerLab’s CEO, Dr. Tod Cooperman on Calcium Supplements for Osteoporosis.

Vitamin K2 Dosage for Osteoporosis

The Vitamin K2 dosage recommendations differ for MK7 and MK4 — the two most common Vitamin K2 subgroups.

Vitamin K2 MK7 Dosage Recommendations

The 2013 study in the Netherlands discussed above (8) used a dosage of 0.18 mg/day (180 µg/day) of Vitamin K2 Mk7 supplements.

In his book, Vitamin K2: The Missing Nutrient for Heart and Bone Health, Dr. Dennis Goodman, a cardiologist in New York City, also recommends between 150 to 180 µg/day of MK-7 Vitamin K2 (16).

If you are not getting that level in your diet, you might consider supplementing. However, you should be cautious about the type of Vitamin K2 you take. Discuss your needs with your physician and take into account your health status and medical history.

How to Achieve Your Vitamin K2 Dosage with Food Sources

If your goal is to achieve your Vitamin K2 MK-7 dosage target of 180 µg/day using food sources you will be looking at consuming one of the following food quantities per day:

  • Nattō: 18 grams or 0.63 ounces.
  • Hard Cheese: 352 grams or 12.4 ounces.
  • Soft Cheese: 456 grams or 16 ounces.

Please note that I am not advocating you eat that quantity of cheese everyday. I know I couldn’t eat that much! If you can get your hands on Nattō, you will be in a good position to have adequate levels of Vitamin K2. Consider supplementing the Nattō with a Vitamin K2 efficient cheese like gouda or cheese curds.

Vitamin K2 MK4 Dosage Recommendations

Recommended daily dosage for Vitamin K2 MK4 is 45 mg. Because Vitamin K2 MK4 has a shorter half life than MK7, health professionals recommend that you consume Vitamin K2 MK three times throughout the day.

The daily recommended dosage of MK-4 varies depending on jurisdiction, as well as the Dietitian Nutritionist you consult with. In the 2006 publication from Cockayne, the dosage level varied from trial to trial. MK-4 dosages were at either 15 mg/day (1 trial) or 45 mg/day (6 trials).

In parts of Asia and specifically, Japan, the daily recommended dosage of MK-4 is 45 mg. The European Food Safety Authority approved the health claim for Vitamin K but has not offered a dosage recommendation. In the United States, the FDA has not validated a health claim for vitamin K.

Given the complexity surrounding Vitamin K2 and your unique circumstances (your bone health, potential Vitamin K inadequacies, etc) your best route is to consult with a Registered Dietitian Nutritionist for guidance.

Vitamin K2 Supplements

One of the challenges with Vitamin K2 supplements is the efficacy of the claims on the package label.

Analysis of Menaquinone-7 Content

A 2018 study (15) looked at MK-7 supplements for content and impurities in both oil and no-oil dietary supplements. This study used MK-7 from Swiss, British and Polish producers.

The researchers found many of the hard tablet dietary supplements had concentrations of MK-7 below the level listed on the bottle. In the case of the oil capsule supplements, the MK-7 vitamin content was significantly higher than listed.

According to the published report, “moreover, it was revealed that there were large quantities of the cis/trans vitamin isomers (menaquinone-6 and -7), which most likely do not have vitamin K activity or it is significantly lower.”

This study highlighted the significant problem within K2 supplements quality “resulting from the lack of appropriate requirements and controls.”

MK-4 Synthetic Production

A number of dietary supplement providers prefer MK-4 supplements over MK-7. This is because they can produce MK-4 using a synthetic production while MK-7 requires fermentation. Also keep in mind that the dietary supplement may only contain the single sub-group and, unlike food sources, not have other related Vitamin K2 sub-groups.

ConsumerLab Vitamin K Report

ConsumerLab, an independent testing organization, tested eight K2 supplements for purity, accuracy in labelled amount and absorbency.

In their report, they identified two products that offered 100 µg dosage of Vitamin K2/Mk-7 in isolation. They also identified several “combination” supplement products where Vitamin K2 was one of the ingredients.

To learn more about their report, visit ConsumerLab.

Exercise Recommendations for Osteoporosis

Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.

But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?

A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.

free-osteoporosis-course-melioguide

I cover important topics related to osteoporosis exercise including:

  • Can exercise reverse osteoporosis?
  • Stop the stoop — how to avoid kyphosis and rounded shoulders.
  • Key components of an osteoporosis exercise program.
  • Key principles of bone building.
  • Exercises you should avoid if you have osteoporosis.
  • Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
  • Core strength and osteoporosis — why is core strength important if you have osteoporosis?

Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.

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Vitamin K2: The Missing Nutrient for Heart and Bone Health

If you are interested in learning more about Vitamin K2 and its affect on your heart and bone health, I recommend you read Vitamin K2: The Missing Nutrient for Heart and Bone Health (16) by Dr. Dennis Goodman. You can find the book on Amazon.

In his book, Dr. Goodman presents the latest and most impressive research studies, as well as insights on diet, exercise, and stress reduction, as a conversation between doctor and patient.

Another good read available on Amazon is Vitamin K2 and the Calcium Paradox by Canadian Naturopathic Doctor Kate Rheaume-Bleue.

[Disclosure: Please note that I receive a small commission from Amazon if you purchase either Dr. Goodman’s or Dr. Rheaume-Bleue’s book after clicking either of the links above.]

Below is a video from several years ago where I discuss Vitamin K2 and bone health.

Vitamin K2, MK-9, Jarlsberg Cheese and Bone Health

A recent study (19) published in the Nutrition, Prevention and Health section the British Medical Journal (BMJ) identifies another of the MK (menaquinone) versions of Vitamin K2 may yield bone benefits. In the study, conducted by a group from Norway, “66 healthy female volunteers were recruited. Of the group, 41 women were allocated to daily intake of 57 g Jarlsberg (J-group) and 25–50 g Camembert (C-group) in 6 weeks. After 6 weeks the C-group was switched to Jarlsberg. The study duration was 12 weeks with clinical investigations every 6 weeks.”

The Jarlsberg cheese contains MK-9. The researchers found that blood samples of the Jarlsberg women showed that the key biochemical markers of bone turnover, including osteocalcin, and vitamin K2 increased significantly after 6 weeks.

Osteocalcin “is among the most abundant proteins in bone and is produced exclusively by osteoblasts. Initially believed to be an inhibitor of bone mineralization, recent studies suggest a broader role for osteocalcin that extends to the regulation of whole body metabolism, reproduction, and cognition.” Further, “osteocalcin has routinely been used as a serum marker of osteoblastic bone formation and believed to act in the bone matrix to regulate mineralization.” (20)

Conclusion

Your osteoporosis health regimen should include an appropriate osteoporosis exercise program and the right nutritional combination. Vitamin K1 and K2 play an important role in your nutrition and should be part of your regular diet.

If you wish to delve deeper into this subject, I encourage you to read the Vitamin K section of the Institute of Medicine Panel on Micronutrients Dietary Reference Intakes. (17)

Osteoporosis Guidelines

For more information, check out my Osteoporosis Guidelines.

References

  1. Huang ZB et al. Does vitamin K2 play a role in the prevention and treatment of osteoporosis for postmenopausal women: a meta-analysis of randomized controlled trials. Osteoporosis Int. 2015 Mar;26(3):1175-86
  2. Myneni VD and Mezey E. Regulation of Bone Remodeling by Vitamin K2. Oral Diseases. 2017 Nov; 23(8): 1021-1028.
  3. Geleijnse JM, et al., Dietary intake of menaquinone is associated with a reduced risk of coronary heart disease: the Rotterdam Study., J Nutr. 2004 Nov;134(11):3100-5
  4. Presse N, et al., Low vitamin K intakes in community-dwelling elders at an early stage of Alzheimer’s disease., J Am Diet Assoc. 2008 Dec;108(12):2095-9. doi: 10.1016/j.jada.2008.09.013.
  5. Booth, S. Vitamin K: food composition and dietary intakes., Food Nutrition Research. 2012; 56: 10.3402/fnr.v56i0.5505.
  6. Kaneki et al. Japanese fermented soybean food as the major determinant of the large geographic difference in circulating levels of vitamin K2: possible implications for hip-fracture risk. Nutrition. 2001 Apr;17(4):315-21
  7. Booth SL, et al. Multiple Vitamin K Forms Exist in Dairy Foods. Current Developments in Nutrition, Volume 1, Issue 6, June 2017, e000638.
  8. Knapen M.H.J, et al. Three-year low-dose menaquinone-7 supplementation helps decrease bone loss in healthy postmenopausal women. Osteoporos Int. 2013 Sep;24(9):2499-507.
  9. Booth SL, et al. Effect of vitamin K supplementation on bone loss in elderly men and women. Journal of Clinical Endocrinological Metabolism. 2008 Apr;93(4):1217-23. doi: 10.1210/jc.2007-2490. Epub 2008 Feb 5.
  10. Binkley N, et al. Vitamin K treatment reduces undercarboxylated osteocalcin but does not alter bone turnover, density, or geometry in healthy postmenopausal North American women. Journal of Bone and Mineral Research. 2009 Jun;24(6):983-91. doi: 10.1359/jbmr.081254.
  11. Cockayne S, Adamson J, Lanham-New S et al. Vitamin K and the prevention of fractures: systematic review and meta-analysis of randomized controlled trials. Arch Intern Med 2006;166:1256–61.
  12. https://vitamink2.org/k2-pedia/myths-facts/
  13. van Ballegooijen A.J., et al. The Synergistic Interplay between Vitamins D and K for Bone and Cardiovascular Health: A Narrative Review, Int J Endocrinol. 2017; 2017: 7454376, Published online 2017 Sep 12
  14. Goncalves A, et al. Fat-soluble vitamin intestinal absorption: absorption sites in the intestine and interactions for absorption. Food Chem. 2015 Apr 1;172:155-60. doi: 10.1016/j.foodchem.2014.09.021. Epub 2014 Sep 16.
  15. Szterk A., et al. Analysis of Menaquinone-7 Content and Impurities in Oil and Non-Oil Dietary Supplements. Molecules. 2018 May 1;23(5). pii: E1056. doi: 10.3390/molecules23051056
  16. Vitamin K2: The Missing Nutrient for Heart and Bone Health, Dr. Dennis Goodman.
  17. Vitamin K2 • Vital for Health and Wellbeing. Chapter 4: Menaquinones, Bacteria, and Foods. Barbara Walther and Magali Chollet. March 22nd, 2017. Print ISBN: 978-953-51-3019-2
  18. Institute of Medicine Panel on Micronutrients. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. 2001. ISBN-10: 0-309-07279-4ISBN-10: 0-309-07290-5.
  19. Lundberg HE, et al. Effect on bone anabolic markers of daily cheese intake with and without vitamin K2: a randomised clinical trial. BMJ Nutrition, Prevention and Health. May 26, 2022
  20. Zoch, ML., et al. New Insights into the Biology of Osteocalcin. Bone. 2016 Jan; 82: 42-49.

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