Vitamin K and the Calcium Paradox 2 How a Little-Known Vitamin Could Save Your Life Kate Rhéaume-Bleue Contents Cover Title Page Dedication Acknowledgments Chapter 1: The Calcium Paradox Chapter 2: The Undiscovery and Rediscovery of Vitamin K 2 Chapter 3: How Much Vitamin K Do We Need, and How Do We Get It? 2 Chapter 4: Vitamin K : The Ultimate Antiaging Vitamin 2 Chapter 5: Even More Health Benefits of Vitamin K 2 Chapter 6: Measuring Your Vitamin K Levels 2 Chapter 7: Vitamins K , A and D: Better Together 2 Chapter 8: Toward a New Definition of Nutritious Endnotes Copyright About the Publisher To Sterling, I hope by the time you are grown up, this will all be common knowledge. Acknowledgments First of all I'd like to thank my amazing literary agent, Rick Broadhead. Rick immediately recognized the value of my idea, helped me shape the proposal, found a home for my book at Wiley and supported me in every step of the publishing and marketing process. Thanks, Rick. Thank you to my family for their support and patience throughout the writing process and beyond. I'm especially grateful to my husband, Chris, for his encouragement and analogies, and to my in-laws, Linda and David, for frequent babysitting and dog walking. To my own Mum and Dad, thanks for instilling in me a sense of curiosity, an appreciation of language and determination. Also to my sister, Robin, thanks for being in my corner. Thank you to my many dear friends who supported me along the way— whether you knew it or not. I'm particularly appreciative of you, Rahima, Paula, Jenny, Cher, Lynn, Lara, Lisa and Joyce. Just in case I don't get a chance to say it elsewhere, I'm deeply appreciative of every member of my “Factors Family”—you know who you are—for support and inspiration. I'm especially thankful to Joanne Aldridge. Jo, thanks for keeping me organized, putting out fires and making things happen. I'd like to gratefully acknowledge cardiologist and author Dr. William Davis, who generously contributed the case study featured in Chapter 6. Thanks, Bill. It's been a real pleasure and honor working with every member of the team at John Wiley & Sons, Canada. I feel like my book and I belong here, and I'm thankful for that. Finally, I'd like to express my humble gratitude to the many brilliant researchers and true scientific experts whose names appear in the endnotes of this book. This book would not have been written without your efforts and I hope it does justice to your work. Chapter 2 The Undiscovery and Rediscovery of Vitamin K 2 Even though most of the world is just hearing about vitamin K , it isn't new. 2 Scientists discovered K 70 years ago; they just didn't know what it was, or— 2 more accurately—they thought it was something else. Misconceptions about this vital nutrient persisted for decades, and we failed to recognize its unique actions, food sources and deficiency symptoms. Confusion about the nature of K persists to this day, in large part because of the lingering effects of its 2 botched discovery. This chapter explores that story, and reveals that vitamin K is the answer to a 70-year-old mystery. I'll also set the record straight 2 about the difference between K and its sister molecule, vitamin K . But first, 2 1 in order to clarify what K is—and what it isn't—it's helpful to understand 2 how we came to know about it at all. A Brief History of Vitamin K: A Tale of Two Nutrients Vitamin K was discovered in the early 1930s by Danish biochemist Henrik Dam (1895–1976). Dam was studying another fat-soluble nutrient, cholesterol, and working with laboratory chickens on very-low-fat diets. Mysteriously, some of the chicks in the study became ill, developing severe internal hemorrhages because their blood was unable to clot as usual. Dam found that the problem could be prevented by giving the chicks specific foods, particularly greens and liver, yet the clotting problem did not match up to any known nutrient deficiency. Eventually, the factor required for clotting was identified and named vitamin K because, in Dam's own words, “the letter K was the first one in the alphabet which had not been used to designate other vitamins, and it also happened to be the first letter in the word ‘koagulation’ according to the Scandinavian and German spelling.”1 Almost a decade later, American researcher Edward Doisy (1893–1986) succeeded in isolating vitamin K and thereby positively identified the nutrient and its structure. In 1943, Dam and Doisy shared the Nobel Prize in physiology and medicine for the discovery of the “coagulation nutrient,” vitamin K . And this is where things went 1 sideways for vitamin K . 2 Both Dam and Doisy, as well as other researchers around the world, recognized that vitamin K appeared in two distinct forms, designated K and 1 K . However, although both forms were discovered and characterized over 2 the course of the 1930s, three fundamental misunderstandings about these nutrients persisted for the next 70 years. First, K and K were considered to 1 2 simply be structural variations of the same vitamin and not unique nutrients with discrete properties. Second, blood clotting was thought to be their only role in the body. Third, vitamin K deficiency was assumed uncommon and obvious, since it would manifest as some kind of bleeding disorder. These last two assumptions are accurate when it comes to K , but highly inaccurate 1 when it comes to K . 2 Although it was not pursued, there must have been at least a notion among scientists studying vitamin K that the nutrient somehow had health impacts beyond coagulation. In his 1946 Nobel lecture, Henrik Dam made a passing reference to early inklings that vitamin K might play a role other than blood clotting, but then dismissed the idea: “It . . . seems unlikely that vitamin K, as such, should play any role in the prevention of caries.”2 If by “as such” Dam meant vitamin K , then he was right: phylloquinone (K ) does not play any 1 1 direct role in preventing dental cavities. But K , menaquinone, plays a big 2 one. Incredibly, the discovery of the first vitamin K–dependent activity unrelated to blood clotting didn't occur for almost another 30 years—and it was a major milestone in changing the fundamental perception of vitamin K. In 1975, researchers at the Harvard Medical School discovered the vitamin K – 2 dependent protein osteocalcin, which we now know to be a critical factor in drawing calcium into bones and teeth to prevent osteoporosis and dental cavities.3 Despite this radical discovery, it would be yet another 20 years until the scientific community realized that vitamin K is “not just for clotting anymore.”4 In 1997, researchers reported that the nutrient was required for two critical physiologic processes unrelated to coagulation: ensuring healthy calcium deposition in bones and preventing calcification of arteries that leads to premature death. The implications of this finding were astounding. For the first time, scientists had identified a single nutritional compound that governed the appropriate deposition of calcium in the body. The puzzle of two widespread but seemingly unrelated diseases, osteoporosis and atherosclerosis, was being solved. So why didn't you hear about this 15 years ago? Although K 's role in preventing these major diseases is now obvious, in 2 the 1990s we still didn't quite get the relevance of this nutrient. After all, even though K was clearly necessary for optimal bone and heart health, little 2 evidence existed to suggest that a lack of this nutrient was a common problem. The most surprising revelation of all was finally made in 2007: vitamin K deficiency is, in fact, very widespread, and this is having a major 2 impact on human health.5 Scientists are still grappling with the full ramifications of this plight. We know that osteoporosis, atherosclerosis, cancer and other serious health conditions are implicated. Research about the amazing benefits of K is still pouring in. 2 The Mysterious Activator X There's a little more to the history of vitamin K than its bungled and delayed 2 discovery by the mainstream scientific community. An astounding body of evidence that illuminates our modern understanding of menaquinone was actually published in 1939, four years before Dam and Doisy accepted their Nobel Prize. For decades, this wealth of knowledge sat right under the collective nose of scientists and nutrition experts, undiscovered because its author, who didn't know the identity of the vitamin he was studying, simply referred to the nutrient as “X.” Furthermore, the author's formal training made him an unexpected source of groundbreaking nutritional research. He was, after all, a dentist. Dr. Weston A. Price was not your average dentist. He has been called the “Charles Darwin of nutrition” thanks to his discoveries about the causes of dental cavities and chronic disease. Dr. Price's work, which took him around the world in search of the origins of illness, resulted in the discovery of a new fat-soluble nutrient that he named “activator X.” Price demonstrated that the nutrient clearly played a critical role in health and a lack of it would produce illness in a very predictable pattern. For decades, the identity of activator X remained a mystery and the subject of debate in the realms of medicine and nutrition. Now we know it is vitamin K . The fascinating life and work of Dr. 2 Weston Price provide an abundance of original, evidence-based information about the actions and health benefits of vitamin K to which modern research 2 is just catching up. Understanding his findings provides a framework for appreciating the full spectrum of remarkable healing properties of vitamin K . 2 Born in 1870 near the village of Newburgh, Ontario, Weston Andrew Price moved to Ohio in the 1890s, settling in Cleveland, where he practiced dentistry for the next 50 years. But, right from the beginning, something bothered Dr. Price about his practice: it was too busy. It didn't seem right to him that so many people had such bad teeth. Price reckoned that this wasn't natural. He suspected that something about people's modern, industrialized lifestyle was having a seriously negative impact on dental health and general well-being. And so, in 1925, after three decades of treating people whose teeth and bodies were plagued with the common maladies of the modern day, Dr. Price and his wife, Florence, embarked on a series of extensive and often hazardous expeditions to find people around the world who were truly healthy and to determine what made them so. Using Indiana Jones–era modes of transportation, the Prices made their way to remote corners of the globe: frigid Alaska, the most primitive regions of Africa, faraway Australia and New Zealand, the idyllic archipelagos of the South Pacific, the windswept Outer Hebrides (an isolated chain of islands off the west coast of Scotland), barely accessible mountain villages of Switzerland, the deserts of the Andean Sierra and the jungles of the Peruvian Amazon. There Dr. and Mrs. Price found groups of people who, cut off from the influence of the modern world and without toothbrush or paste, were, simply put, healthy. The world over, the Prices found communities of traditional people who had no need for dentists—indeed, had little need for doctors of any kind. Instead, they displayed exceptional immunity to the serious afflictions that plagued the modern world. Dr. Price noted that they were able to maintain this vibrant health for a lifetime, “so long as they were sufficiently isolated from our modern civilization” and followed the ancestral diet that had sustained their people for generations. If, instead, individuals from the tribe lost this isolation and began to consume foods of modern civilization, things changed. Without exception, Price found that when these previously healthy people adopted a modern diet—either because they left their isolated home to live in more urban areas or trade route developments brought the modern foods to them—they experienced a predictable and specific pattern of decline in their health. First, dental decay would set in. Where cavities had been unknown before, people would develop one, then several, and sometimes mouths full of rotting teeth. Then came the gum disease. Although today dental health is primarily considered an issue of dental hygiene, tooth and gum disease emerged in these individuals even though there had been no change in dental hygiene habits. Dental hygiene as we know it had not previously been necessary. More seriously, there is a predictive relationship here that was, it seems, better appreciated in Price's time and that is only now being rediscovered: tooth decay and gum disease are harbingers of heart disease.6 What was even more disturbing than the emergence of dental disease where it had not existed before was the equally predictable pattern of chronic disease seen in the offspring of those who adopted the modern diet. Where the parents had broad, beautiful faces, the first generation born after the introduction of modern foods had narrowed dental arches that housed crowded, crooked teeth. These children were also prone to a number of other now-common ailments, including increased susceptibility to infections, and even behavior issues. In many groups the process of birthing became much longer and more difficult as well. Price remarked that most cultures he studied observed special feeding practices and reserved sacred foods for both men and women approaching their childbearing years, as well as for growing children. Almost every culture also had customs or taboos around how often children should be born. They practiced the spacing of children so that mothers could replenish their nutrient stores for subsequent children. Apparently, traditional wisdom had a prescription for producing healthy kids. When this wisdom was abandoned in favor of the modernized diet, problems set in. In the photos on page 31 you can see the typical broad, well-proportioned faces of healthy indigenous people. The strikingly beautiful teeth and square jaws in both men and women are now only seen in supermodels, some professional singers and elite athletes. The relative facial proportions are similar in healthy people around the world. Upper, middle and lower thirds of the face are approximately equal. The width of the jaw is about the same as the width of the forehead. Facial symmetry is the norm. Wherever indigenous people were sufficiently isolated from industrialized society and consuming only traditional foods, Dr. Price encountered villages full of adults and children with perfectly straight, healthy teeth and wide, attractive faces to match. The next set of photos show the typical facial changes caused by a