More Fat-Soluble Vitamin Musing

If vitamin A, D and K2 deficiency are important contributors to the characteristic pattern of chronic disease in modern societies (the 'disease of civilization'), we should see certain associations. We would expect to find a lower fat-soluble vitamin status along with the most prevalent chronic diseases: cancer, cardiovascular disease, diabetes, osteoporosis, tooth decay, etc. We would also expect that improving vitamin status could reduce the incidence or recurrence of these diseases, which would be more convincing than a simple association.

Let's start with cancer. This one is like shooting fish in a barrel. There are consistent associations between low vitamin D status and numerous cancers, most notably breast and colon. And it doesn't just stop at associations. Here's a double-blind, placebo-controlled trial showing a 60% reduction of internal cancers in 1,179 American women taking 1,100 IU of D3 (and calcium) per day for 4 years. I won't go through the rest of the mountain of data linking low vitamin D to cancer, but if you want to see more science go here.

Vitamin K2 has been less well studied in this respect, but preliminary evidence is promising. Cancer patients are often vitamin K deficient. Supplementation with menatetrenone (K2 isoform MK-4) may reduce the recurrence of liver cancer. There's a strong inverse association between K2 intake and advanced prostate cancer, with the effect coming mostly from dairy.

In my post on K2 last week, I mentioned a study in which investigators found a strong inverse association between K2 consumption and cardiovascular as well as all-cause mortality. Patients with severe arterial calcifications tend to be K2 deficient, and K2 deficiency can induce arterial calcification in rodents. Marcoumar, a drug that interferes with K2 status, also causes calcification in humans. There's a mechanism behind K2's effect on CVD. There are several K2-dependent proteins that may protect the arteries from calcification, lipid accumulation and damage: matrix Gla protein, gas6, and protein S.

There is also a compelling association between vitamin D status and cardiovascular disease. Here's a quote from one study that struck me:

The adjusted prevalence of hypertension (odds ratio [OR], 1.30), diabetes mellitus (OR, 1.98), obesity (OR, 2.29), and high serum triglyceride levels (OR, 1.47) was significantly higher in the first than in the fourth quartile of serum 25(OH)D levels (P<.001 for all).

In other words, the 25% of people with the lowest D status are more likely to have hypertension and high triglycerides, and much more likely to be obese and/or have diabetes than the 25% with the highest D status. Keep in mind it's just an association, but that is nevertheless an impressive list of problems that are linked to low D status. Here's a large study that looked specifically at the association of vitamin D status and heart attack risk, and found a strong association even for people who are only mildly deficient. Supplementing elderly women with a modest amount of D3 improves hypertension.

The link between fat-soluble vitamins and bone/dental health is very strong. Vitamins D and K2 are required for proper formation and mineralization of the bones and teeth, and proper development of the cranium and face (this is exactly what Weston Price saw). K2 supplementation has a major protective effect on osteoporosis and fractures, according to several controlled trials. The salivary glands have the highest concentration of K2 MK-4 of any organ, and they secrete it into saliva along with K2-dependent proteins. Weston Price documented the dramatic protective effect of cod liver oil (A and D) and butter oil (A and K2) against tooth decay.

I couldn't find any consistent associations between vitamin A status and chronic disease. This may be because, as opposed to D and K2, few people in the US or Europe are deficient. It's interesting to note that grain-fed dairy is still a good source of vitamin A, while it loses most of the vitamin D and K2 that's found in grass-fed dairy.

Osteoporosis and arterial calcification are not due to a lack or an excess of calcium. In fact, the two problems often come hand-in-hand. Calcium supplements are unnecessary at best. The Japanese, who eat far less calcium than the average American, have a lower risk of osteoporosis and fracture. The problem with both osteoporosis and arterial calcification is that the body is not using its calcium effectively. The studies mentioned above show that the fat-soluble vitamins are critical for proper calcium use by the body, among other things.

I hope you can see that a deficiency of fat-soluble vitamins could well be a major contributor to the characteristic pattern of diseases that afflict industrialized nations. There are two more facts that we need to complete the picture. First of all, some research suggest a high prevalence of vitamin D and K deficiency (or insufficiency). A, D and K are synergistic. A and D have their own nuclear receptors that alter the transcription of hundreds of genes, while K activates many of these genes once they are translated into proteins. Thus, you'd expect that giving them together would have a much larger effect that giving them alone. This suggests that the studies using single vitamins may be falling far short of the protection afforded by optimal status of all three.

Meditation

Meditation is the single most effective tool I've ever found for cultivating calmness, positivity and self-acceptance. It's an ancient technique that's simple and free. In fact, it's so simple, I'm about to teach it to you in five minutes over the internet. I personally practice Zen meditation
several times a week, by myself and with a sitting group. Meditation is not fundamentally a religious practice, although it has been used by spiritual people in every major religion. Don't think you're patient enough for meditation? That's exactly why you should be doing it!

Let's start with posture. The main purpose of the meditation posture is to allow you to remain still for long periods of time without discomfort. I'll discuss two postures: cross-legged and kneeling. Before you elevate your mind though, you have to elevate your backside. Find something you can sit on- a firm cushion or a folded blanket will work well. Your pelvis should be at least four inches above the ground. Now cross your legs. Your knees should be lower than your pelvis. Adjust your posture until you can maintain a straight back without any muscle tension. You'll have to rotate the top of your pelvis forward slightly, curving your lower back in toward your stomach.

Now put your hands together so that your left fingers rest on top of your right ones, just above your lap. Your palms should face up. Now touch your thumbs lightly together. That's it! You are now sitting in a very nice meditation posture. It will get more comfortable over time as you adjust to it.

The kneeling posture is the same except you kneel and put the support under your pelvis, between your legs. Wooden 'seiza' benches work well for this, but are not necessary. Your pelvis should be at least six inches off the ground so that you don't hurt your knees. This is my preferred posture, but I'm admittedly in the minority.

Now that you know the posture, face a blank wall three or four feet away. You can also look at the floor (while keeping your head and neck straight) or anything else that isn't likely to capture your interest.

Try breathing 'into your stomach'. To do this, breathe using only your diaphragm, in such a way that it makes your stomach rise and fall rather than your chest. Breathe slowly and deliberatley, pausing after each exhale. Bring your full attention to the rise and fall of your stomach. That's it, you're meditating! Really. Don't get fancy: it's counterproductive to try to actively relax yourself or achieve some different mental state.

In Zen, we call meditation 'sitting'. We use such a simple word because that's all it is: paying full attention to the moment, while you sit. Just bring your attention to your breath. If your mind drifts, gently bring it back. Don't try to stifle your thoughts, just acknowledge them and come back to your breath. If you can't focus, that's normal.

Try this for 15 minutes at first. Every day is best, but do what you can. When you're more comfortable with the technique, increase your time to 30 minutes. Meditation is a practice that changes and ripens with time.

The Dhamma Brothers

I saw a movie a few nights ago called 'The Dhamma Brothers'. It's about a meditation program at Donaldson correctional facility in Alabama, one of the most violent prisons in the country. Two Bhuddist teachers of Vipassana meditation led a 10-day silent retreat for a volunteer group of inmates. They got up at dawn and meditated for several hours each day. Some of the inmates went through an amazing transformation.

They were forced to confront and accept the horrible crimes they had committed. When you aren't allowed to talk for 10 days, and all you have are your thoughts to keep you company, it's hard to ignore your feelings. Many of them had breakdowns as they felt the full force of their own suffering for the first time.

At first, the warden was skeptical that the prisoners were just acting to get parole; "fake it 'til you make it". Then he started noticing major changes in the inmates' behavior. They became less violent and easier to deal with. Some of them left their gangs. Even after the program was discontinued thanks to an overzealous chaplain, many of the "Dhamma brothers" continued meditating on their own.

It's hard to doubt a grown man's sincerity when you see tears running down his cheeks. These men were hardened criminals, most of them serving life sentences for murder, who rediscovered perspective and humanity simply by spending focused time with themselves.

Meditation is a powerful tool. There are two types of knowledge: intellectual and visceral. You can read books until you're cross-eyed and you will never connect with the fundamental, animal, visceral side of living. We like to think of ourselves as rational, conscious beings. It's reassuring to us. We're in control of our minds and therefore our lives. But that's more illusion than reality.

Neuroscience and meditation have shown us that the human mind is like a monkey riding an elephant. The monkey is our conscious and the elephant is our subconscious. The monkey can tell the elephant where to go, but ultimately the elephant is going to do what it wants. The monkey likes to be in charge however, so it retroactively decides it was the one that chose the direction.

To illustrate the point, imagine doing a simple algebra problem. Do you have to go over everything you ever learned about algebra in your head to solve that problem? No, your subconscious navigates the strata of accumulated knowledge and practically hands you the answer. What happens when you decide on an entree at a restaurant? Do you make a pro/con list for each item and weigh them accordingly? Or do you decide based on a feeling? Where does that feeling come from?

Meditation is plugging back into the vastness of human experience. It's acknowledging that your conscious, declarative mind is only a small slice of the pie.

Vitamin Deficiency

I'm going to do some speculating today. More than usual. What are some of the deficiency symptoms of A, D and K2? Another way of putting the question is, what problems can you prevent or cure by giving people the right fat-soluble vitamins? If you read my last post, you know that cardiovascular disease, osteoporosis (and resulting fractures) and tooth decay are all linked to fat-soluble vitamin status, perhaps in a causal way. There's also a suggestion that they could be involved in diabetes, kidney stones, resistance to infection and cancer. Well, we've just about covered all the major modern health problems, haven't we?

What if the 'disease of civilization' is simply a deficiency of fat-soluble vitamins? What if the only reason we haven't realized it yet is because we haven't understood the critical importance of K2 MK-4, and its synergy with A and D? I'm not totally convinced it's true, but it does make sense. I'm interested to hear other peoples' opinions on this.

There are two mechanisms that could cause deficiency. The first is the obvious: reduced intake. In general, we have a lower intake of A, D (from sunlight) and K2 than non-industrial populations past and present that did not suffer from the disease of civilization. Most Westerners fall short of optimal serum vitamin D, and K2 insufficiency may be common (this will require further research).

Reading Nutrition and Physical Degeneration, as well as other accounts of non-industrial groups transitioning from their traditional diets to a more Westernized one, it struck me how badly these people were being affected. Even when they were still eating some nutrient-dense traditional foods, their development and health suffered tremendously. I asked myself this question: could the Western food they were eating have actively interfered with their vitamin status, and could it be doing the same to us?

The most common foods that replaced traditional diets in Weston Price's studies were white wheat flour and sugar. Wheat contains a lot of gluten, which in some people causes celiac disease. Celiac is an immune response to gluten that causes the degeneration of the intestinal lining, which is responsible for absorbing nutrients, among other things. Celiac patients are often deficient in many nutrients, including fat-soluble vitamins. So there's a potential link between gluten damage and fat-soluble vitamin status.

The interesting thing about celiac is it may actually be a spectrum, with many people showing some degree of gluten damage, but only severe cases being diagnosed. The diagnosis involves looking for antibodies against gluten, but there is evidence that some people may mount an immune response without producing antibodies (through the innate immune system). Peter pointed this out a while back.

So the hypothesis goes: the disease of civilization is caused by a deficiency of fat-soluble vitamins, due to both a lower intake and inefficient absorption through a damaged intestinal lining. Comments?

Vitamin K2, menatetrenone (MK-4)

Weston Price established the importance of the MK-4 isoform of vitamin K2 (hereafter, K2) with a series of interesting experiments. He showed in chickens that blood levels of calcium and phosphorus depended both on vitamin A and K2, and that the two had synergistic effects on mineral absorption. He also showed that chickens preferred eating butter that was rich in K2 over butter low in K2, even when the investigators couldn't distinguish between them. Young turkeys fed K2-containing butter oil along with cod liver oil (A and D) also grew at a much faster rate than turkeys fed cod liver oil alone.

He hypothesized that vitamin A, vitamin D and vitamin K2 were synergistic and essential for proper growth and subsequent health. He particularly felt that the combination was important for proper mineral absorption and metabolism. He used a combination of high-vitamin cod liver oil and high-vitamin butter oil to heal cavities, reduce oral bacteria counts, and cure numerous other afflictions in his patients. He also showed that the healthy non-industrial groups he studied had a much higher intake of these fat-soluble, animal-derived vitamins than more modern cultures.

Price found an inverse correlation between the levels of K2 in butter and mortality from cardiovascular disease and pneumonia in a number of different regions. A recent study examined the relationship between K2 (MK-4 through 10) consumption and heart attack risk in 4,600 Dutch men. They found a strong inverse association between K2 consumption and heart attack mortality risk. Men with the highest K2 consumption had a whopping 51% lower risk of heart attack mortality and a 26% lower risk of death from all causes compared to men eating the least K2! Their sources of K2 MK-4 were eggs, meats and dairy. They obtained MK-5 through MK-10 from fermented foods and fish. The investigators found no association with K1, the form found in plants.

Perigord, France is the world's capital of foie gras, or fatty goose liver. Good news for the bon vivants: foie gras turns out to be the richest known source of K2. Perigord also has the lowest rate of cardiovascular mortality in France, a country already noted for its low CVD mortality.

Rats fed warfarin, a drug that inhibits K2 recycling, develop arterial calcification. Feeding the rats K2 completely inhibits this effect. Mice lacking matrix Gla protein (MGP), a vitamin K-dependent protein that guards against arterial calcification, develop heavily calcified aortas and die prematurely. So the link between K2 and cardiovascular disease is a very strong one.

Mammals can synthesize K2 MK-4 from K1 to some degree, so dietary K1 and other forms of vitamin K may contribute to K2 MK-4 status. 

The synergism Weston Price observed between vitamins A, D and K2 now has a solid mechanism. In a nutshell, vitamins A and D signal the production of some very important proteins, and K2 is required to activate them once they are made. Many of these proteins are involved in mineral metabolism, thus the effects Price saw in his experiments and observations in non-industrialized cultures. For example, osteocalcin is a protein that organizes calcium and phosphorus deposition in the bones and teeth. It's produced by cells in response to vitamins A and D, but requires K2 to perform its function. This suggests that the effects of vitamin D on bone health could be amplified greatly if it were administered along with K2. By itself, K2 is already highly protective against fractures in the elderly. It works out perfectly, since K2 also protects against vitamin D toxicity.

I'm not going to go through all the other data on K2 in detail, but suffice it to say it's very very important. I believe that K2 is a 'missing link' that explains many of our modern ills, just as Weston Price wrote. Here are a few more tidbits to whet your appetite: K2 may affect glucose control and insulin release (1, 2). It's concentrated in the brain, serving an as yet unknown function.

Hunter-gatherers didn't have multivitamins, they had nutrient-dense food. As long as you eat a natural diet containing some vegetables and some animal products, and lay off the processed grains, sugar and vegetable oil, the micronutrients will take care of themselves.

Vitamin K2, MK-4 is only found in animal products. The best sources known are grass-fed butter from cows eating rapidly growing grass, and foie gras. K2 tends to associate with beta-carotene in butter, so the darker the color, the more K2 it contains (also, the better it tastes). Fish eggs, other grass-fed dairy, shellfish, insects and other organ meats are also good sources. Chris Masterjohn compiled a list of food sources in his excellent article on the Weston Price foundation website. I highly recommend reading it if you want more detail. K2 MK-7 is found abundantly in natto, a type of fermented soybean, and it may be partially converted to MK-4.

Finally, you can also buy K2 supplements. The best one is butter oil, the very same stuff Price used to treat his patients. I have used this one personally, and I noticed positive effects on my skin overnight. Thorne research makes a synthetic liquid K2 MK-4 supplement that is easy to dose drop-wise to get natural amounts of it. Other K2 MK-4 supplements are much more concentrated than what you could get from food so I recommend avoiding them. I am generally against supplements, but I've ordered the Thorne product for a little self-experimentation. I want to see if it has the same effect on my skin as the butter oil (update- it does).

Activator X

Activator X, the almost-mythical vitamin discovered and characterized by Weston Price, has been identified! For those of you who are familiar with Weston Price's book 'Nutrition and Physical Degeneration', you know what I'm talking about. For the rest of you, allow me to explain.

Weston Price was a dentist and scientist in the early part of the 20th century. Practicing dentistry in Cleveland, he was amazed at the poor state of his patients' teeth and the suffering it inflicted. At the time, dental health was even worse than it is today, with some children in their teens already being fitted for dentures. Being a religious man, he could not bring himself to believe that 'physical degeneration' was what God intended for mankind. He traveled throughout the world looking for cultures that did not have crooked teeth or dental decay, and that also exhibited general health and well-being. And he found them. A lot of them.

These cultures were all considered 'primitive' at the time, and were not subject to the lifestyles or food choices of the Western world. He documented, numerically and with photographs, the near-absence of dental cavities and crooked teeth in a number of different cultures throughout the world. He showed that like all animals, humans are healthy and robust when occupying the right ecological niche. Price had a deep respect for the nutritional knowledge these cultures curated.

He also documented the result when these same cultures were exposed to Western diets of white flour, sugar and other industrially processed foods: they developed rampant cavities, their children grew with crooked teeth due to narrow dental arches, as well as a number of other strikingly familiar health problems. I think it's worth mentioning that Price's findings were universally corroborated by doctors in contact with the same cultures at the time. They are also corroborated by the archaeological record. Many of his findings were published in respected peer-reviewed journals. 'Nutrition and Physical Degeneration' is required reading for anyone interested in the relationship between nutrition and health.

Naturally, Price wanted to understand what healthy diets had in common besides the absence of white flour and sugar. Having studied cultures as diverse as the carnivorous Inuit, the dairy-eating Masai and agricultural groups in the Andes, he realized that humans are capable of thriving on very diverse foods. However, he did find one thing in common: they all ate some amount of fat-soluble, animal-derived vitamins. Even the near-vegetarian groups ate insects or small animals that were rich in these vitamins. He looked for, but did not find, a single group that was entirely vegetarian and had the teeth and health of the groups he described in 'Nutrition and Physical Degeneration'.

There were three vitamins he found abundantly in the diets of healthy non-industrialized people: A, D, and an unknown substance he called 'activator X'. He considered them all to be synergistic and critical for proper mineral metabolism (tooth and bone formation and maintenance) and general health. He had a chemical test for activator X, but he didn't know its chemical structure and so it remained unidentified. He found activator X most abundantly in grass-fed butter (but not grain fed!), organ meats, shellfish, insects, and fish eggs. Many of these foods were fed preferentially to pregnant or reproductive-age women in the groups he studied.

Price used extracts from grass-fed butter (activator X), in combination with high-vitamin cod liver oil (A and D), to prevent and reverse dental cavities in many of his patients. 'Nutrition and Physical Degeneration' contains X-rays of case studies showing re-calcification of severe cavities using this combination.

After reading his book, I wasn't sure what to make of activator X. If it's so important, why hasn't it been identified in the 60+ years since he described it? I'm happy to say, it finally has. In the summer of 2007, Chris Masterjohn wrote an article for the Weston Price foundation website, in which he identified Weston Price's mystery vitamin: it's vitamin K2, specifically the MK-4 isoform (menatetrenone).

It occurs exactly where Weston Price described it, and research is beginning to find that it's also critical for mineral metabolism, bone and tooth formation and maintenance. Its function is synergistic with vitamins A and D. To illustrate the point, where do A, D and K2 MK-4 all occur together in nature? Eggs and milk, the very foods that are designed to feed a growing animal. This is true from sea urchins to humans, confirming the ubiquitous and critical role of these nutrients. K2 has not yet been recognized as such by the mainstream, but it is every bit as important to health as A and D. The scientific cutting edge is beginning to catch on, however, due to some very tantalizing studies.

In the next post, I'll go into more detail about K2, what the science is telling us and where to get it.

Foraging

A friend and I went hunting for morels today in the Wenatchee forest. There was only one on the entire mountain, but we managed to find it:


We also found two "spring kings": spring-fruiting boletus edulis, also known as porcini or cepe. Firm and nutty, without a trace of bugs:


Raw is my favorite way to eat a good spring king. Here's an older one that was 6" across. Too old for me so I left it for the amateurs: