Food sources of vitamin K2



Vitamin K2 is emerging as an exciting player in the control and possible regression of coronary atherosclerotic plaque. Only about 10% of dietary vitamin K intake is in the K2 form, the other 90% being the more common K1.

The ideal source of K2 is natto, the unpalatable, gooey, slimy mass of fermented soybeans that Japanese eat and has been held responsible for substantial decreases in osteoporosis and bone fractures of aging. Natto has an ammonia-like bouquet, in addition to its phlegmy consistency that makes it virtually inedible to anyone but native Japanese.

I say that the conversation on vitamin K2 is emerging because of a number of uncertainties: What form of vitamin K2 is best (so-called MK-4 vs. MK7 vs. MK-9, all of which vary in structure and duration of action in human blood)? What dose is required for bone benefits vs. other benefits outside of bone health? Why would humans have developed a need for a nutrient that is created through fermentation with only small quantities in meats and other non-fermented foods?

Much of the developing research on vit K2 is coming from the laboratories of Drs. Vermeer, Geleijnse, and Schurgers at the University of Maastricht in the Netherlands, along with several laboratories in Japan, the champions of K2.

MK-7 and MK-8,9,10 come from bacterial fermentation, whether in natto, cheese, or in your intestinal tract; MK-4 is naturally synthesized by animals from vitamin K1. While natto is the richest source of the MK-7 form, egg yolks and fermented cheeses are the richest sources of the MK-4 form.

Chicken contains about 8 mcg MK-4 per 3 1/2 oz serving; beef contains about 1 mcg. Egg yolks contain 31 mcg MK-4 per 3 1/2 oz serving (app. 6 raw yolks). Hard cheeses contain about 5 mcg MK-4 per 3 1/2 oz serving, about 70 mcg of MK-8,9; soft cheeses contain about 30% less. Natto contains about 1000 mcg of MK-7, 84 mcg MK-8, and no MK-4 per 3 1/2 oz serving.











Feta cheese

Thanks to the research efforts of the Dutch and Japanese groups, several phenomena surrounding vitamin K2 are clear, even well-established fact:

--Vitamin K2 supplementation (via frequent natto consumption or pharmaceutical doses of K2) substantially improves bone health. While K2 by itself exerts significant bone density/strength increasing properties in dozens of studies, when combined with other bone health-promoting agents (e.g., vitamin D3, prescription drugs like Fosamax and calcitonin), an exaggerated synergy of bone health-promoting effects develop.



--The MK-4 form of vitamin K2 is short-lived, lasting only 3-4 hours in the body. The MK-7 form, in contrast, the form in natto, lasts several days. MK-7 and MK-8-10 are extremely well absorbed, virtually complete.

--Bone health benefits have been shown for both the MK-7 and MK-4 forms.

--Coumadin (warfarin) blocks all forms of vitamin K.





Interestingly, farm-raised meats and eggs do not differ from factory farm-raised foods in K2 content. (But please do not regard this as an endorsement of factory farm foods.)

Another interesting fact: Since mammals synthesize a small quantity of Vit K2 forms from vitamin K1, then eating lots of green vegetables should provide substrate for some quantity of K2 conversion. However, work by Schurgers et al have shown that K1 absorption is poor, no more than 10%, but increases significantly when vegetables are eaten in the presence of oils. (Thus arguing that oils are meant to be part of the human diet. Does your olive oil or oil-based salad dressing represent fulfillment of some subconscious biologic imperative?)

If we believe the data of the Rotterdam Heart Study, then a threshold of 32.7 micrograms of K2 from cheese yields the reduction in cardiovascular events and aortic calcification.

It's all very, very interesting. My prediction is that abnormal (pathologic) calcium deposition will prove to be a basic process that parallels atherosclerotic plaque growth, and that manipulation of phenomena that impact on calcium depostion also impact on atherosclerotic plaque growth. Vitamins D3 and K2 provide potential potent means of at least partially normalizing these processes.

As the data matures, I am going to enjoy my gouda, Emmenthaler, Gruyere, and feta cheeses, along with a few egg yolks. I'm going to be certain to include healthy oils like olive and canola with my vegetables.


All images courtesy Wikipedia.

Copyright 2007 William Davis, MD

Comments (46) -

  • MAC

    12/28/2007 5:58:00 PM |

    Is not magnesium also a regulator of calcium?

    NIH link on magnesium: http://www.ods.od.nih.gov/factsheets/magnesium.asp
    though they really don't spell out magnesium's role in regulating calcium, just that it "keeps bones strong".

    Dr. Eades blog on magnesium and it's deficiency and role in inflammation: http://www.proteinpower.com/drmike/uncategorized/magnesium-and-inflammation/

    BTW Dr. Davis, Dr. Eades recently posted a comment on your TYP book as the best source regarding CT heart scans.

  • Anonymous

    12/28/2007 7:05:00 PM |

    Fascinating! Perhaps K2 is one factor that contributes to the so-called French paradox. It might make sense to eat imported cheeses produced by traditional methods in European countries that have the lowest rates of CHD -- France, Portugal, Italy, Spain, and Switzerland.

    In addition to vitamin K, many other fat-soluble nutrients (lycopenes, carotenoids, etc.) in plant foods simply aren't absorbed unless accompanied by fat, which, ironically, renders those "healthy" fat free salad spritzes downright hazardous to health.

  • Anonymous

    12/28/2007 7:33:00 PM |

    Great blog, enjoyed reading about vitamin K2.  

    With recent findings on the importance of bone strengthening supplements and drugs for heart health, would weight lifting be helpful at bringing about plaque regression?

  • Carl H

    12/28/2007 8:14:00 PM |

    What about Miso?  Another fermented soy product.  Not bad + not natto.

  • Dr. Davis

    12/28/2007 11:06:00 PM |

    Hi, Mac--

    Yes, magnesium is among the three nutrients that I fuss about for bone and arterial health, along with K2 and D3.

    Thanks for the heads up on Dr. Eades blog. I've only recently stumbled across his Blog and found it wonderful, full of unique and refreshingly candid comments.

  • Dr. Davis

    12/28/2007 11:07:00 PM |

    No, not specifically. K2 improves bone health and possibly arterial health. Weight lifting improves bone health. But that's as far as the intersection goes.

  • Dr. Davis

    12/28/2007 11:08:00 PM |

    I love miso and was raised on it. But to my knowledge it is not a significant source of K2.

  • Cindy Moore

    12/29/2007 8:29:00 AM |

    "--Coumadin (warfarin) blocks all forms of vitamin K."

    Do you know if there is any evidence that long term (20 yrs+) warfarin use may increase risk?

  • Anonymous

    12/29/2007 8:58:00 AM |

    My research shows that CoQ10 has a structure very similiar to vitamin K.  Perhaps supplementation with CoQ10 may help provide Vitamin K2.

  • Dr. Davis

    12/29/2007 1:21:00 PM |

    Yes. Unfortunately, now several studies have shown that there is greater heart valve and artery calcification with prolonged Coumadin usage. Although the data are very preliminary, there may be benefit to K1 and K2 supplementation, though your doctor's cooperation is required to do this.

  • Harry35

    12/30/2007 1:38:00 AM |

    Here's a list of fermented and unfermented cheeses that I compiled by googling around. Not sure how to tell which of the fermented cheeses have the most K2, though.

    Fermented:

    Aged goat cheese
    Bleu Cheese
    Brie
    Cambozola
    Camebert
    Cantal
    Cheddar
    Cheshire
    Cultured dry cottage cheese
    Edam
    Emmenthal
    Feta
    Gorgonzola
    Gouda
    Gruyere
    Muenster
    Parmesan
    Port du Salut
    Roquefort
    Romano
    Stilton

    Unfermented

    Farmer cheese
    Mescarpone
    Most cottage cheese
    Mozzarella
    Pot cheese
    Processed cheese
    Provolone
    Provatura
    Quark
    Ricotta
    Scamorza

  • Dr. Davis

    12/30/2007 2:07:00 PM |

    Wow! Thanks, Harry.

    I didn't realize that provolone and ricotta were unfermented.

  • chickadeenorth

    12/30/2007 4:37:00 PM |

    Wow great info and timely article...thnx.
    I eat those fermented cheeses that  and have eggs, I use only olive oil though. I read somewhere that any oil that gets sticky on outside of the jug gets sticky inside the body and since canola is one of those I quit using it, wish I could find that article, ( Eades maybe?)what do you folks think.
    So having some oil on veg and salad is great, I don't use those low fat or spritz things are they seem too processed and full of chemicals.

    Thnx Dr D for the excellent info as always.

    So do you eat those slimy soybeans, are they pretty icky or do you think a person could get used to them. Lots of my Japanese guests ( from Japan not North America) bring some of their own food and I have seen these before. Looks kind of like eatin the foods off Fear Factor....j/k.

  • MAC

    12/30/2007 4:48:00 PM |

    Seem to remember reading somewhere recently that if the cheese has the word "culture" in the ingredient list then it is a fermented product. This could mean yogurt and kefir may have K2. Web sources seem to indicate this but didn't find any I consider reliable.

  • Dr. Davis

    12/30/2007 10:54:00 PM |

    I don't think that there's anything wrong with actually eating natto. It's just that it is quite difficult to stomach. I had it several times as a kid and found it thoroughly unappetizing, despite having tried some really exotic stuff like raw octopus and seaweed. Natto was the one thing I simply could not eat.

    The stick oil thing has me stumped. Our bodies digest foods like oil before they make it into the blood stream. Why its behavior in a bottle would have any bearing on its behavior in the body is beyond me.

  • Cindy Moore

    12/31/2007 12:08:00 AM |

    Mary Enig is an excellent source of information about oils. Her general belief is that processed oils (like corn, cannola and soy) are heat treated during the processing and this heat damages the fat molecules, so these fats are essentially spoiled when they are bottled. These oils are also polyunsaturates, which are the least stable of oils, so they should be stored properly and protected from heat, light, etc. (Flax and fish oils are "good" polys, but care should be used to keep these fresh and prevent oxidation)

    I only use virgin olive oil, virgin cocount oil and butter, and I rarely (if ever) use olive for cooking. (I want to try the nut oils, but haven't given them a shot yet).

  • chickadeenorth

    12/31/2007 8:20:00 AM |

    Cindy why don't you use olive oil to cook in at low heat,curious, I thought that was ok if it didnt get too hot. I just got some walnut and almond oil and have to try them.I also use coconut oil to cook in and grapeseed for salads.

    I cannot get vit k 2 in Ca and have a friend going to Florida in 2 days who will buy me some, what is a good name brand and dose,  also a good name brand and dose for DHEA thanks for feedback.

  • Cindy Moore

    12/31/2007 5:51:00 PM |

    chickadeenorth, I don't often us olive in cooking because I've read (Enig I believe) that if it smokes it shouldn't be eaten....and I've had too many instances of the heat getting ahead of me and the oil ending up burned. I just find it easier to use coconut....and then I add butter and/or olive oil at the end to give it flavor, if needed. Mostly I just use the coconut oil.

    I use Source Naturals K, but am also interested in hearing some recommendations. I bought this because I'm told Source Naturals is a good company.

  • Dr. Davis

    12/31/2007 6:10:00 PM |

    We've used Source Naturals, Life Extension, and Jarrow. All seem like the real thing.

  • chickadeenorth

    12/31/2007 8:40:00 PM |

    ..thnx...is this in dry tablet form, what dose of tablet should I get her to pick up, what about DHEA?? name brand and dose.

    Ya I cook with natural gas so keep flame very low and don't over heat anything,I don't use allot as have good pots, maybe should use coconut more often, its adds a nice flavor especially to chicken and pork.

    I think some guests from Japan bought some of those soybeans once in a can, is that how they come, they ate something that looked familiar to your picture.

  • g

    1/1/2008 6:35:00 AM |

    Apparently the ADA have new guidelines coming soon!  AND guess what they advise now!  LOW CARB diets!!

    This is funny...
    http://thefitnessinsider.menshealth.com/2007/12/apparently-hell.html

  • chickadeenorth

    1/1/2008 5:13:00 PM |

    Hmm wonder what pushed their buttons, the powers at be in USA are also supposedly going to recommend a higher dose of Vit D too.
    http://articles.mercola.com/sites/articles/archive/2008/1/1/experts-starting-to-agree-more-vitamin-d-is-better.aspx

  • brassman

    1/1/2008 6:04:00 PM |

    Vitamin K is fat soluble. Will a tablet be absorbed well or do I need a soft gel as with vitamin d?

  • chickadeenorth

    1/1/2008 9:06:00 PM |

    Is this the right DHEA I am looking for, if so I found a source in Canada but still no Vit k 2.Sorry I can't log onto the forum.Smile

    http://www.nutrichem.com/Phosphatidyl-Serine-Complex-23.html

  • Dr. Davis

    1/2/2008 12:10:00 PM |

    The label and info says phosphatidylserine, not DHEA.

  • Dr. Davis

    1/2/2008 12:11:00 PM |

    The data would suggest that, unlike vitamin D, even tablets of K2 are well absorbed.

  • Anonymous

    1/31/2008 1:02:00 AM |

    Hello Dr. Davis,
    Thank you for this great post. We've recently learned that K2 was probably what Weston Price had  called Activator-X, since he had not been in contact with other researchers who were learning about vitamin K at the time.

    Anyway, I can help with the "sticky oil" comment. Oils that oxidize easily become sticky (basically like varnish drying) when exposed to oxygen. This means that canola oil and other less-saturated fatty acids can oxidize (producing free radicals) in the bottle (and MAYBE in the blood - there is oxygen in the blood, but I'm not an expert in blood chemistry). We don't know how long the oil was exposed to air before it was bottled. X-virgin olive oil, on the other hand, has a lot of anti-oxidants built in (and numerous phyto-nutrients), so probably has a longer shelf life. Most Canola oil is a highly processed modern hybrid. The Mediterranean people never lived on Canola oil. The fact that both are monounsaturated is largely irrelevant.  -David

  • Dr. Davis

    1/31/2008 1:33:00 PM |

    Thanks for the help, David.

  • donny

    7/1/2008 6:23:00 PM |

    I hate to comment on an article this old, but I've been reading a lot of stuff online about vitamin k lately. I found this article recently. Really, it looks like an attempt to denigrate food sources of vitamin k in comparison to supplementation.
    First they compared spinach consumption to a vitamin k supplement called konakion, and showed that konakion raised serum levels of k1 maybe seven to eight times as much as 227 grams of boiled spinach with butter. Then, they did a bait and switch, comparing the spinach and butter to a milligram of k2 mixed with 5 grams of butter, and they have a chart with that showing that the k2 with butter raised serum levels of k2 twice as much as the spinach with twenty five grams of butter.
    I'm just wondering if green vegetables, with butter, might be a good way to raise k2 levels after all?

    http://journals.cambridge.org/download.php?file=%2FBJN%2FBJN76_02%2FS0007114596001304a.pdf&code=2e2d0ca6a4129581d36eebf438633b36

  • Anonymous

    12/2/2008 3:05:00 PM |

    "Why would humans have developed a need for a nutrient that is created through fermentation with only small quantities in meats and other non-fermented foods?"

    Perhaps this is an example of how our "sterile" environment is killing us.  Before refrigeration, I am sure humans were subject to much more fermented food.

  • Dane Miller

    4/20/2009 5:58:00 PM |

    I , too hate commenting on an article so old.  Great stuff but canola as a healthy oil?  I think not.  Canola is terrible for you.  Or should I said rapeseed oil.

  • jpatti

    5/25/2009 1:05:39 AM |

    I understand there's a good bit of K2 in unpasteurized milk.  Apparently, grass-fed animals do produce a lot of A, D and K2, but much is destroyed through pasteurization.

    I've recently added raw milk to my diet.  Decided it was worth taking extra insulin for the health benefits.  Can't get raw butter or cream in my state, but am getting it from the same dairy, so it's grass-fed if not raw.

    My bp has dropped about 30/30 without the Lisinopril I was on before.  As hubby says, if it's placebo, it's one worth sticking to.  ;)

    Besides raw milk, I've also about tripled my intake of butter and eggs.  

    And btw, fermenting raw milk yourself is wicked easy.  Take a quart of milk, heat it to around 100-110 degrees (I do this with a quart jar in my crockpot in an inch of water with the lid off).  Remove about a half cup of warmed milk and stir in about 1/4 cup yogurt.  Pour this back into the main container, turn off the crockpot (so it doesn't overheat and kill the culture), and cover with a blanket or such to insulate it.  

    I do this while fixing dinner, in the morning I have yogurt - fermented raw milk, yummy stuff, chockful of K2.  It's not thick like store-bought, more like a drink.  I add blueberries to it most often.

    The point is, with a source of raw milk it takes about 5-10 minutes of "work" to make your own fermented dairy.  You need a quart sized jar, a source of heat, a thermometer, some insulation and some culture (store-bought plain yogurt works fine) - fermented dairy just happens overnight.

  • robbyn

    9/27/2009 9:44:19 AM |

    I know that sauerkraut contains vit k2, but do not know how much per 100g. Has anyone been able to find the figures?

  • Anonymous

    1/5/2010 5:13:32 PM |

    Dear Dr. Davis
    Hello
    Is there a special food diet for patients with aortic valve calcification. How many milligrams
    of vitamin CaLaughing:K2:K:Mg, are recommended for patients.
    Thanks
    Lev

  • Sharon

    2/17/2010 6:56:22 AM |

    Serious question Dr.Davis:    Fibrinogen can create calcification, K2 reduces calcification, natto reduces fibrinogen but is there any clottin risk and conflict in using both agents for a patient with the two dysfunctions?

    Thank you Sharon

  • Anonymous

    3/15/2010 8:46:14 PM |

    Recently had a CT.  After the CT, got up off table and had no pain for 2 weeks.  In constant pain due to significant cervical and lumbar radiculopathy, fibromyalgia, osteoarthritis, etc.  Has anyone ever had a CT with contrast who was in pain and pain gone after the contrast CT?  My doctor told me to blog to see if could find others who drank a liquid and had an IV during the CT.  Was wonderful to have no pain for 2 weeks, and interesting it happened immediately upon rising from the table where the CT was performed.  Anyone exeriencing this, please blog

  • ea

    3/25/2010 1:35:56 AM |

    In http://www.westonaprice.org/On-the-Trail-of-the-Elusive-X-Factor-A-Sixty-Two-Year-Old-Mystery-Finally-Solved.html it says:
    Since the amount of vitamin K1 in typical diets is ten times greater than that of vitamin K2, researchers have tended to dismiss the contribution of K2 to nutritional status as insignificant. Yet over the last few years, a growing body of research is demonstrating that these two substances are not simply different forms of the same vitamin, but are better seen as two different vitamins: whereas K1 is preferentially used by the liver to activate blood clotting proteins, K2 is preferentially used by the other tissues to place calcium where it belongs, in the bones and teeth, and keep it out of where it does not belong, in the soft tissues.
    In other words, to properly use the Calcium in your diet, you need vitamin K2 (as well as A & D) ~ and, since K2 is fat soluble, also fat so that you can absorb the K2.  With K2 the Calcium will be used to strengthen bones and teeth. Without K2 the Calcium will be deposited in joints leading to osteoarthritis, in blood vessels leading to heart attacks and strokes, in eyes leading to cataracts, and in other soft tissues.

    In http://www.westonaprice.org/On-the-Trail-of-the-Elusive-X-Factor-A-Sixty-Two-Year-Old-Mystery-Finally-Solved.html there is also a table of K2 content of various foods.

  • bed frame

    7/6/2010 7:09:17 AM |

    Before I don't know what is vitamin K2 is. But after reading and analyzing your post. Now I know that it is important. I thank you for sharing this very helpful post.

  • Yogi Sinzapatos

    7/29/2010 3:50:33 PM |

    Mixing jpatti's home made raw milk yogurt with flaxseed oil = Dr. Johanna Budwig's cure for cancer (and many other diseases).

  • dermatology laser

    9/30/2010 3:23:32 AM |

    Vitamin K2 might be, for instance more relevant in the form of a supplement or in low-fat dairy.

  • Chuck

    10/21/2010 3:38:37 AM |

    As far as Warfarin blocking the absorption of vitamin K, I am not a big fan of people taking rat poison. Warfarin is the active ingredient in rat poison.

    It is worse than the urine of a pregnant horse. Premarin-- pregnant mare urine. I am American and natto does not taste that bad. Of course it is better to add it to something else. For example no one eats sugar by itself.

    Now raw garlic by itself is painful to eat. But I add it to other foods and it is OK. Raw ginger by itself is also painful to eat.

  • buy jeans

    11/3/2010 4:53:24 PM |

    MK-7 and MK-8,9,10 come from bacterial fermentation, whether in natto, cheese, or in your intestinal tract; MK-4 is naturally synthesized by animals from vitamin K1. While natto is the richest source of the MK-7 form, egg yolks and fermented cheeses are the richest sources of the MK-4 form.

  • Heidi

    11/11/2010 5:34:36 PM |

    Earlier in the thread there was mention made on canola oil. Here's a link that explains the dangers:
    http://www.westonaprice.org/know-your-fats/559-the-great-con-ola.html

  • Jack C

    11/18/2010 3:03:20 AM |

    Somewhere in my files there is a study, from Japan I believe, that found that serum concentrations of MK4 increased after consumption of natto, which contains no MK4. It therefore appears that MK7, 8 and 9 will convert, to some degree, to MK4. Conclusion (mine): Aged cheese can provide all of the vitamin K2 needed. Aged raw milk cheese has most of the benefits of raw milk but is as pathogen free as pasteurized milk due to destruction of pathogens by low pH during aging.  

    While I can not quickly lay my hands on that study, I have found a couple of other related studies of interest.

    Vitamin K is required for activation of osteocalcin. Vitamin K deficiency is associated with low bone mineral density due to increased levels of uncarboxylated (unactivated) osteocalcin(ucOC). The plasma vitamin K2 concentrations required to minimize ucOC increases with age (PMID 16469998). Conclusion: (mine) Eat more aged raw milk cheese as you age to protect you bones.

    Rats readily convert vitamin K1 to K2 but humans do not.

    "Vascular calcification may be species specific to humans. As laboratory animals, such as the rat, grow old, they suffer from only mild arterial calcification" (PMID 18772323): Conclusion (mine): K2 is the answer: Eat more raw milk aged cheese as you get older to prevent calcification of arteries.

    Jack C.

  • Gillian

    1/17/2011 5:13:44 PM |

    Hi, Dr Davis
    I´ve read in some earlier comment of yours, that natto is not really a reliable source for K2, is that so and if, then why?
    I also wonder why I sometimes feel pain in my legs when eating cream.
    I have seen the famous photographer from Sweden that have filmed arteries and showed that cream supposedly block the arteries..
    What is your opinion??

  • Lobster bake

    2/18/2011 9:17:08 AM |

    Thanks, very well written post, found it through a random Google search and I shared it on my Facebook. This Vitamin K foods are very helpful to keep our body healthy and young.

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Estrogens and CT heart scan scores

A recent study from the Women's Health Initiative (WHI), the large study that originally showed no reduction in heart attack with use of estrogens in postmenopausal females, has just published a new study.

In this new effort, women who took Premarin (horse estogens) had up to 61% lower CT heart scan scores. This new study was confined to the women from the original WHI study who had entered the study between the ages of 50-59 years (average 55 years old), since this was the significant subgroup of women who actually showed a reduction in heart attack risk, whereas other groups showed no benefit or a slightly increased risk.

For a full discussion of this fascinating result, see the Track Your Plaque report, Can estrogen reduce CT heart scan scores? at http://cureality.com/library/fl_06-017estrogen.asp. (This report is open to both Track Your Plaque Members and non-Members.)

I truly wish that the issues surrounding female hormone replacement were clearer. This new perspective adds just another interesting twist on a strategy that too many people, in my view, dismissed too readily with the initial WHI results.

To add to an already confusing situation, the WHI study was sponsored by Wyeth Pharmaceuticals, the maker of Premarin, and many of the investigators participating in the study obtained financial compensation from Wyeth. On the one hand, we have to give credit to the company and the investigators for publishing the initial study that panned the effects of Premarin. On the other hand, it makes any positive data somewhat suspect, particularly since there is a far less costly and probably superior preparation called human estrogens.

Incidentally, Wyeth is also behind the maddening FDA petition to prevent "compounding" pharmacies from dispensing human hormones like estrogen unless made by a drug manufacturer. They hide behind claims of concerns over safety. Nonsense. This is pure profiteering and protection of their enormously profitable franchise and has nothing to do with public safety. If there were genuine concerns that the compounding pharmacies, around for decades with an excellent reputation, pose safety issues, why not just lobby for improved oversite?

If only we had data like WHI that used human estrogens and human progesterone. I suspect that we'd see bigger, better effects with less of the ill effects peculiar to the cross-species use of Premarin and the synethetic progestin, Provera.

The wheat-free life

"There's nothing else I can do with my diet," declared Whitney, a 53-year old university faculty member.

"I don't eat meat. I never eat fried foods. I can't remember the last time I used butter. My idea of having a treat is a handful of blueberries. What else can I do?"

Whitney was clearly frustrated. With a CT heart scan score of 264, she was worried that trouble was just around the corner. Her lipoprotein panel had demonstrated a severe small LDL pattern, with 70% of all LDL particles in the small category. HDL was also low at 41 mg/dl.

"What did you eat for breakfast?" I asked.

"Same as always: Either Fiber One cereal or Shredded Wheat. No sugar, just skim milk. Sometimes I have some orange juice, fresh-squeezed of course."

"How about lunch?"

"If I brown-bag it, I'll usually have a reduced-fat turkey breast sandwich on whole grain bread. About once a week, I'll have a whole wheat bagel--no cream cheese, of course."

"Dinner?"

"Sometimes I have chicken--skinless--with a vegetable, corn, or salad. I love pasta, but I always use whole wheat."

"How about snacks?"

"I try not to snack. But, when I'm desperate, I usually grab some Triscuits or pretzels."

The problem with Whitney's diet was clear: Too many sugar-equivalents, otherwise known as wheat. I suggested that her diet was far too heavily laden with wheat products. She seemed skeptical. "But this is as low-fat as I can get! Now you're going to take away wheat?"



What happens when you eliminate wheat from your diet?

Several predictable, consistent changes can be observed:


--HDL cholesterol goes up.

--Triglycerides go down.

--Small LDL particles are reduced.

--LDL cholesterol drops (the amount dropped depends on the proportion of small LDL pattern)

--Blood sugar drops.

--Blood pressure drops.

--C-reactive protein (an index of imperceptible inflammation) drops.


In addition to these measurable changes, several perceptible improvements often develop: more energy, less afternoon "slump," better sleep, sometimes less rashes.

Since Whitney was skeptical, I suggested a simple 4 week "experiment": Eliminate wheat products entirely for 4 weeks and see for herself what happens. I also warned her that, while I believe that elimination of wheat is a great strategy, she could negate the benefits by indulging in candy, soft drinks, and other junk products. It would therefore be necessary to maintain an otherwise healthy diet.

So Whitney gave it a try for 4 weeks. To make up for the dropped calories, she increased her reliance on vegetables, fruits, lean proteins, nuts, seeds, and healthy oils.

After losing 6 lbs over the 4 weeks without otherwise trying, she was convinced. She was further convinced when we reassessed her laboratory work: HDL went up 10 mg/dl; triglycerides down 120 mg/dl; blood sugar dropped from 112 mg/dl (pre-diabetic) to 95 mg/dl (normal). Several months later, we checked her lipoproteins. Small LDL had dropped to around 30% of total LDL--a big improvement.

It's contrary to conventional wisdom. It's counter to the USDA Food Pyramid. It's certainly not what the American Heart Association says. It could potentially disrupt the economics and politics of the enormously powerful food industry.

But, more often than not, the results are impressive to phenomenal.

Death of a $7 billion industry

Vitamin D has taken its place as a crucial ingredient for coronary plaque control and control of CT heart scan scores.

Vitamin D replacement is also crucial for bone health, particularly the prevention of osteoporosis. But conversations about vitamin D replacement to true healthy levels is notably absent from the conversation on treatment and prevention of osteoporosis. Yes, you will find a small dose of vitamin D in calcium tablets and in multivitamins. Those of us who check blood levels of 25-OH-vitamin D3 in patients will tell you: They don't work. These are unabsorbable forms of vitamin D and at trivial doses. There was an attempt to give this issue a little cursory attention when a small dose of vitamin D was added to Fosamax (Fosamax D).

There are an estimated 50 million Americans with various degrees of osteoporosis. It's numbers like this that make the drug manufacturers salivate. Osteoporosis treatment is also chronic. This is among the holy grails of the drug industry: developing agents for widespread ailments that require long-term treatment that extends over years. That's a lot more profitable than 10 days of antibiotics that are over and done with in one treament course.

The osteoporosis market now stands at $7 billion per year and is expected to grow 6-7% per year, according to industry analysts. Drugs like Fosamax, Evista, and Actonel will eventually be replaced by Boniva, Eclasta, and bazedoxifene, and later by AMG-172 and balicatib. Monthly costs for these drugs can be $70 or more per month, sometimes several hundred dollars. (Experience has shown that the introduction of new drugs does not necessarily mean that other drugs will drop in price.)

Here's a clinical trial I'd like to see performed: Vitamin D restored to healthy levels of 50-100 ng/ml over an extended period and compared to a group treated with placebo. My prediction is that there will be dramatic differences in bone density. (Small studies have been performed, but no large, long-term trials of the sort that would yield real firepower.) Or, how about vitamin D to true therapeutic levels over 5 years compared head-to-head with one of the drugs. My prediction: little difference.

Vitamin D also provides an enormous panel of health benefits beyond restoration of bone density, like rise in HDL, drop in triglycerides, facilitation of control over CT heart scan scores, drop in fracture risk, drop in blood pressure and C-reactive protein, reduction in risk for colon, prostate, and breast cancer. None of the drugs can hope to provide any of these effects, except a drop in fracture risk.

Vitamin D usually costs around $2 per month. I doubt that such trials will be performed. If I were a manufacturer of osteoporosis drugs and my career success was dependent on the increasing revenues of these drugs, I would be quaking in my shoes, hoping that the public does not learn what a powerful tool good old vitamin D is. But if you are an individual just looking for health tools, vitamin D is, in my view, amongst the most powerful natural, nutritional tools you have available with outsized health benefits.

Lose weight and HDL goes . . . down

Steve started with a miserable HDL cholesterol of 27 mg/dl. As expected, the low HDL was associated with all its evil friends: small LDL, deficiency of healthy, large HDL, high triglycerides, VLDL, and a pre-diabetic blood sugar.

Steve committed to a strict diet of reduced processed carbohydrates like wheat products, reduced meat and saturated fats. He relied on vegetables, fruit, lean proteins, and healthy oils. Over a 6 month period, he lost an impressive 39 lbs. He proclaimed that he hadn't felt this good in 30 years.

We rechecked his HDL: 25 mg/dl.

"I don't get it!" Steve declared, understandably.

There's a curious phenomenon with HDL. If you lose weight, HDL goes up--but not right away. Steve had lost a substantial quantity of weight and was continuing to lose weight when the blood work was obtained. While HDL does indeed rise with weight loss, it doesn't do so immediately. In fact, in the first two or so months after significant weight lost, HDL goes down.

Why? I don't really have an explanation, but it is a very consistent effect.

Losing weight towards ideal weight is truly an effective strategy for raising HDL. But we need to be patient. If you've lost many pounds like Steve did, then waiting at least two months after weight has stabilized may be necessary to fully gauge the effect on raising HDL.

Addictive Foods

Kraft Foods, Inc. is manufacturer of Kool Aid, Oscar Mayer, Kraft Macaroni and Cheese, Velveeta, Honey Maid Grahams, and hundreds of other processed food products. Post cereals also falls under the umbrella of Kraft with products like Raisin Bran, Post Toasties, and Fruity Pebbles. Annual revenues in 2006 for Kraft: $34.4 billion. A big operation with enormous influence over our eating habits.

Nabisco is manufacturer of Oreos, Ritz Crackers, Chips Ahoy and many others. Like Kraft/Post, it is also a big player.

While Nabisco was owned for several years by tobacco giant RJ Reynolds, in 2000 it was acquired by Philip Morris, another big tobacco manufacturer.

More recently in Spring, 2007, Philip Morris (now called Altria--you'd change your name, too, if it was synonymous with dirt) spun off its Kraft subsidiary for a big profit. However, the management structures remain intertwined.

In other words, despite the shuffling of shares, the two industries, big tobacco and big food, are in many respects one and the same.

Is it any surprise that the same industry that made billions of dollars pushing addictive nicotine products responsible for the deaths of hundreds of thousands of people is now intimately involved with addictive products produced and marketed by the processed food industry?

If you believe that food manufacturers are innocently and honestly conducting their businesses, simply think back to the testimony provided in front of Congress during the tobacco industry hearings. Broad deception, concealed truths, and outright lies were commonplace. There was no conscience involved. This was about money--and lots of it.

Why should the processed food industry, intimate with the tobacco industry, be any different?

If you want control over heart disease and your heart scan score, buy produce and buy local. Spend your time in the produce aisle, not the cereal or chip aisle. Unprocessed food, unadorned by bright labels, cartoon animals, American Heart Association endorsements, that's what we should seek.

Heart Scan Curiosities #7




Here's a situation that crops up once in a while, occurring in perhaps 2% of heart scans.

The white within the circled area represents calcium, and thereby atherosclerotic plaque, situated immediately at the "mouth", or opening, of the the right coronary artery. What is somewhat unusual is that this plaque is not principally coronary, but aortic. That is, the plaque is mostly situated in the large vessel called the aorta. The three coronary arteries arise from the aorta.

In this instance, the aortic plaque involves the mouth of the right coronary artery. (In views not shown, the plaque also extends into the artery as well.) I call this a "double whammy" because the same plaque can post risk for heart attack and stroke.

Generally, aortic plaques pose risk for stroke. When aortic plaque fragments, little bits and pieces can travel upward to the brain and block an artery, thus a stroke.

In the coronaries, disrupted ("ruptured") plaques don't generally shower debris, but permit blood clot formation, resulting in heart attack.

This plaque, however, poses the theoretical risk of both heart attack and stroke because of its strategic location.

Should a plaque like this be handled any differently? I don't think so. But it does provide another reason to take atherosclerotic plaque in any artery seriously.

The nutrition counterculture

When we look back over our American nutritional history over the last 50 years, it's hard not to come to the conclusion that much of the innovation in nutrition did not come from official agencies like the Food and Nutrition Board of the Institute of Medicine, the National Academy of Sciences, the FDA, the USDA, or the AMA.

Instead, it came from the popular culture. It came from bold, extravagant claims made by maverick figures like Ancel Keys, Nathan Pritikin, Dean Ornish, and Robert Atkins. Of course, some ideas have now fallen by the wayside, dismissed in a broad American "experiment" as ineffective, impractical, or kooky. But it permitted experimentation on an extraordinary scale with millions of people following a particular strategy at a time.

The advice of the official agencies tended to be reactionary. When nutritional deficiencies (remember those?) of the early 1900s were prevalent, they issued advice on food choices to help alleviate deficiencies. When deficiency transformed into excess after World War II, "smart" food choices from food groups and "sensible eating" became the theme.

Unfortunately, the advice was always adulterated by the enormous influence of various special interests, anxious to protect their national franchise. Powerful groups like the meat industry, wheat producers, and the dairy industry all made sure they had a big hand in crafting and influencing what was told to the American people.

The result: the advice offered by official groups has always represented the compromise of what some agency wished to convey to the people and the very powerful input of industry. What if the government decided to advise us what automobile to buy? Imagine the uproar in the auto industry when Washington tells us to buy Toyota for fuel economy and reliability. How long would that advice last?

That's why almost no knowledgeable adult follows the advice of the USDA, the National Academy of Sciences, or the Food Pyramid. I believe that we all intuitively recognize that the advice is watered-down, sometimes silly, sometimes downright unhealthy.

Nonetheless, the national experiment in diet that has taken place since 1950 has led to a collective wisdom of what is good and what is bad. The most productive conversations on nutrition therefore take place outside of the USDA and Washington. It occurs, instead, in places like bookstores, websites, and the media. Of course, there's lots of misinformation and profiteering in these sectors, as well. But like the enormous force unleashed by the collective wisdom of those contributing to the Wikipedia phemonenon, we've zig-zagged to something closer to the truth than ever uttered by an official agency.

Prescription vitamin D

Niacin:

Over-the-counter: $2-5 per month
Prescription: $120 per month


Fish oil:


Over-the-counter: $3-6 per month
Prescription: $120 per month


Vitamin D:


Over-the-counter: $2 per month
Prescription: $70 per month



With vitamin D in particular, the prescription form is vastly inferior to the over-the-counter preparation. This is because the prescription form is ergocalciferol, or vitamin D2, not the effective human form, vitamin D3 or cholecalciferol.

When you're exposed to sun, what form of vitamin D is activated in the skin? It's all vitamin D3, no vitamin D2 whatsoever. Vitamin D3 is also far more effective than D2. People taking D3 (as long as it's oil-based) easily obtain healthy levels of vitamin D in the blood. People taking 50,000 units per day of D2 (the recommended quantity) remain miserably deficient, with minor increases in vitamin D blood levels. In short, D2 barely works at all. D3 works easily and effectively.

Moreover, D2 is the plant-based form. It is a form not found naturally in humans. D3 is the mammalian form, the same found in humans that exerts all its biologic benefits.

Then why is the prescription form of vitamin D2 (brand names Driscol and Calciferol) more expensive?

It's the same old pharmaceutical industry scam: Look for something patent protectable, regardless of whether it's superior to the non-patent protectable product, then sell it for exagerated profits. Though it is inferior and the science and clinical experience prove that it's inferior, you can still fool lots of people, including prescribing physicians. So what if you only make $50 or $100 million?

Don't fall for it. Prescription doesn't necessarily mean superior. In fact, the prescription form may be significantly inferior, as with vitamin D2. But the pharmaceutical industry carries such power and persuasion, who's going to know?

Nutrition activist Mike Adams













I borrowed the above comic from the website of nutritionist, more properly nutrition activist and author, Mike Adams. His website, www.newstarget.com, was a pleasant surprise.

I was actually looking for some thoughts on pharmaceutical advertising and its pervasive and destructive effects and came across one of Adam's reports, Pharmaceutical television advertising is a grand hoax at http://www.newstarget.com/021526.html. The piece is a rant against the pharmaceutical industry's constant bombardment of the media, who have also been co-opted into their service, enticed by the enormous advertising revenues the drug industry brings.

But I was surprised to find an insightful, informative website on health issues, particularly healthy eating that rejects the manufactured food industry's intensive effort to persuade us to eat their products. While I don't agree with everything Adams has to say, his website provides some great food for thought. He also provides lots of downloadable information.

There's also some great laughs at his poke at the pharmaceutical industry with his Disease Mongering Engine at http://www.newstarget.com/disease-mongering-engine.asp, in which you get to create your own diseases. I got a real kick out of this.

CT scans and radiation exposure



The NY Times ran an article called

With Rise in Radiation Exposure, Experts Urge Caution on Tests at

http://www.nytimes.com/2007/06/19/health/19cons.html?_r=1&adxnnl=1&oref=slogin&adxnnlx=1182254102-vQpytpx6W/Z9gvAaNPDZvA



“This is an absolutely sentinel event, a wake-up call,” said Dr. Fred A. Mettler Jr., principal investigator for the study, by the National Council on Radiation Protection. “Medical exposure now dwarfs that of all other sources.”


Where do CT heart scans fall?

Let's first take a look at exposure measured for different sorts of tests:



Typical effective radiation dose values

Computed tomography Milliseverts (mSv)

Head CT 1 – 2 mSv
Pelvis CT 3 – 4 mSv
Chest CT 5 – 7 mSv
Abdomen CT 5 – 7 mSv
Abdomen/pelvis CT 8 – 11 mSv
Coronary CT angiography 5 – 12 mSv

Non-CT Milliseverts (mSv)

Hand radiograph Less than 0.1 mSv
Chest radiograph Less than 0.1 mSv
Mammogram 0.3 – 0.6 mSv
Barium enema exam 3 – 6 mSv
Coronary angiogram 5 – 10 mSv
Sestamibi myocardial perfusion (per injection) 6 – 9 mSv
Thallium myocardial perfusion (per injection) 26 – 35 mSv

Source: Cynthia H. McCullough, Ph.D., Mayo Clinic, Rochester, MN


If you have a heart scan on an EBT device, then your exposure is 0.5-0.6 mSv, roughly the same as a mammogram or several standard chest x-rays.

A heart scan on a 16- or 64-slice multidetector device, your exposure is around 1.0-2.0 mSv, about the same as 2-3 mammograms, though dose can vary with this technology depending on how it is performed (gated to the EKG, device settings, etc.)

CT coronary angiography presents a different story. This is where radiation really escalates and puts the radiation exposure issue in the spotlight. As Dr. Cynthia McCullough's chart shows above, the radiation exposure with CT coronary angiograms is 5-12 mSv, the equivalent of 100 chest x-rays or 20 mammograms. Now that's a problem.

The exposure is about the same for a pelvic or abdominal CT. The problem is that some centers are using CT coronary angiograms as screening procedures and even advocating their use annually. This is where the alarm needs to be sounded. These tests, as wonderful as the information and image quality can be, are not screening tests. Just like a pelvic CT, they are diagnostic tests done for legimate medical questions. They are not screening tests to be applied broadly and used year after year.

Always be mindful of your radiation exposure, as the NY Times article rightly advises. However, don't be so frightened that you are kept from obtaining truly useful information from, for instance, a CT heart scan (not angiography) at a modest radiation cost.



Detail on radiation exposure with CT coronary angiograms on multidetector devices can be found at Hausleiter J, Meyer T, Hadamitzyky M et al. Radiation Dose Estimates From Cardiac Multislice Computed Tomography in Daily Practice: Impact of Different Scanning Protocols on Effective Dose Estimates. Circulation 2006;113:1305-1310, one of several studies on this issue.