The Missing Link between Bone & Cardiovascular Health: A Comprehensive Overview

Partha Mahendra Panna
Heart Health, Medicine, Patient

19

Mar 25

Overview

Before the advent of processed foods, diet was a strong source of nutrients. Maintaining a balanced intake of calcium, Vitamin D3 and Vitamin K2 is vital for reducing and preventing certain disease risks. But over time, we have been deprived of the essential vitamins and minerals that drive bodies to peak performance and growth. RDA (Recommended Daily Allowance) recommends 1000mg/day of calcium. 1 out of every 2 Bangladeshi consume <50% of RDA. Another key nutrient our diets have created a deficiency in is vitamin K2.  Another key nutrient is vitamin D3 which we cannot get from our diets. 

Unfortunately, research has revealed that most people are deficient in vitamin K, particularly children who have the most intense need to promote bone and cardiovascular health so that they can grow into thriving adults. It has also been demonstrated that the majority of healthy adults including pregnant women are vitamin K-insufficient, resulting in a substantial fraction (about 30%) of osteocalcin and MGP being synthesized as inactive proteins- meaning that they are just literally ‘there” not doing anything. This fraction increases with age. Adding vitamin K2 to your diet switches on these powerful proteins, so they can do their good work. 1

Figure 1: Calcium Deficiency in all of life’s stages in Bangladesh

Interconnection between Calcium, Vitamin D3 and Vitamin K2:

Calcium, Vitamin D3 and Vitamin K2 are the three major nutrients for healthy life including bone and cardiac health. We are only well aware of Calcium and vitamin D3 in bone health but lack of knowledge about menaquinones known as vitamin K2. In Bangladesh, the recommended daily doses of calcium and vitamin D3 generally align with international guidelines, though it’s always best to consult a healthcare provider for personalized recommendations. 2,4

  • Bone Health: The synergy between calcium, vitamin D3 and vitamin K2 is critical for optimal bone health. While calcium provides the building blocks for bones, vitamin D3 enhances calcium absorption, and vitamin K2 ensures that calcium is correctly utilized and deposited in the bones rather than in arteries or other soft tissues.
  • Cardiovascular Health: Adequate levels of vitamin K2 help prevent calcium from depositing in arteries, thus playing a protective role against cardiovascular disease.
  • Supplementation Considerations: Combining these nutrients in supplementation is often recommended, especially for individuals at risk of osteoporosis or cardiovascular diseases. However, excessive intake should be avoided as it can lead to hypercalcemia (high blood calcium levels) or unwanted calcification of soft tissues.

1. Calcium

[WHAT WE’VE ALWAYS HEARD -WE NEED MORE CALCIUM IN OUR DIETS.]

Calcium is essential for normal growth and development of the skeleton and for adequate bone mineralization. Moreover, calcium is the first supplement of choice to prevent osteoporosis. Calcium is essential for the functional integrity of the nervous, muscular, and skeletal systems. The major fraction (99%) of calcium is in the skeletal structure.

For decades doctors routinely recommended calcium supplements to prevent and treat osteoporosis. However, this is only part of the story as the need for other nutrients specifically Vitamin K2, was not yet known. Recent research shows that a high intake of calcium from supplements is correlated with an increased risk for cardiovascular events!

• Role in the Body: The safety and efficacy of calcium supplements in preventing bone loss is now being questioned and there is increasing concern that calcium supplements may be doing more harm than good.

But calcium has a dark side. The recent studies show that calcium supplements – which are commonly taken to reduce the effect of osteoporosis may increase the risk of cardiovascular events by up to 30 percent.

Recently, a ground-breaking three-year study proved the bone-building/preservation and bone-strengthening benefits of vitamin K2, confirming observational studies. And importantly, vitamin K2 was also shown in this study to prevent excess calcium from depositing in the arteries. Arterial calcification promotes dangerous arterial stiffening, exacerbating poor heart health.

In a nutshell, here’s how: calcium (with or without vitamin D) without adequate Vitamin K2 cannot be properly utilized for bone health. The calcium accumulates in soft tissues, including cardiovascular arteries, which create damage.

• Sources: Dietary sources include dairy products such as milk, cheese, yogurt, leafy green vegetables, fortified foods (like some cereals and juices) and supplements.

• Deficiency: Insufficient calcium intake can lead to weakened bones, increasing the risk of fractures and conditions like osteoporosis, especially in older adults.

2. Vitamin D3

[WE NEED MORE VITAMIN D3 FOR BONE AND BEYOND]

Cholecalciferol or Vitamin D3 is produced within the skin under the influence of UV radiation including sunlight. Vitamin D3 promotes intestinal uptake and transport of calcium ensuring sufficient blood calcium levels for normal mineralization of collagen matrix in the skeleton.5

• Role in the Body:  Beyond bone health, vitamin D3 has immunomodulatory effects, influencing the function of immune cells.

• Sources: Sun exposure is the primary source of vitamin D3. It is also found in fatty fish (like salmon and mackerel), fortified foods, and supplements.

• Deficiency: A deficiency in vitamin D3 can lead to poor calcium absorption, resulting in rickets in children, osteomalacia (soft bones) in adults, and an increased risk of osteoporosis.

3. Vitamin K2

[THE QUINTESSENCE OF LONGEVITY]

Two vitamins are involved in the regulation of calcium metabolism: whereas vitamin D stimulates intestinal uptake of calcium, vitamin K2 is required for the synthesis of two regulatory proteins: osteocalcin in bone and matrix Gla-protein (MGP) in the vasculature. Vitamin K2 is required for the biological activity of both proteins.

In addition to its function as an enzymatic cofactor, vitamin K2 has a dual role in mediating bone homeostasis-it acts in an anabolic manner to stimulate the synthesis of osteoblastic markers and deposition of bone, while also decreasing bone resorption by inhibiting the formation of osteoclasts as well as their bone resorptive activity.3

• Sources: Vitamin K2 is found in fermented foods (like natto, a traditional Japanese dish), cheese, and animal products. Supplements are also available.

• Deficiency: Low levels of vitamin K2 can result in poor bone health and an increased risk of arterial calcification, potentially leading to heart disease.

Clinical Recommendations and Use:

  • Dosage and Safety: The dosages of calcium, vitamin D3, and K2 should be balanced. Excessive intake of calcium without adequate vitamin K2 can increase the risk of calcification in arteries. It’s crucial to tailor supplementation based on individual needs assessed by a healthcare provider.
  • Monitoring Levels: Regular monitoring of blood calcium and vitamin D levels is essential for those on supplements to avoid toxicity and ensure optimal health outcomes.

Conclusion:

Emerging research continues to highlight the importance of vitamin K2 intake for optimizing calcium transport. While vitamin D has long been known to facilitate calcium absorption, it is vitamin K2, through its carboxylation of osteocalcin that guides calcium into bones and prevents its absorption into arteries. Vitamin K2 also activates matrix Gla-protein (MGP), a protein in blood vessels that keeps calcium out of arteries.6 Maintaining a balanced intake of calcium, vitamin D3, and vitamin K2 is vital for bone health, reducing the risk of osteoporosis, and preventing cardiovascular issues related to calcification. This combination will be signified as the First Line treatment for osteoporosis.7 Vitamin k2 & D3 will help our bones draw calcium out of our bloodstream and deposit it into bone tissue which helps prevent calcium paradox.

Author of this article:

  1. Partha Mahendra Panna, B.Pharm, M.Pharm (DU), AGM, Radiant Nutraceuticals Limited

Reference:

  1. MenaQ7 is the Optimal Vitamin K2. (2024, June 3). Menaq7. https://menaq7.com
  2. Adriana J. van Ballegooijen, Stefan Pilz, Andreas Tomaschitz, Martin R. Grübler and Nicolas Verheyen. (2017). The Synergistic Interplay between Vitamins D and K for Bone and Cardiovascular Health: A Narrative Review. International Journal of Endocrinology, p 1-12.
  3. NattoPharma ASA (2015). Vitamin K2 Argument [Brochure]
  4. Why K2D3? – For healthy bones and vital joints. (2022, February 22). K2D3. https://k2d3.com
  5.  Kappa Bioscience AS. (2021). K2Vital Facts & Figures [Brochure]
  6.  Wasilewski, G. (2022). The calcium paradox: the role of vitamin K in the bone-vascular axis. [Doctoral Thesis, Maastricht University]. Maastricht University.
  7. Lundberg, H. E., Glasø, M., Chhura, R., Shukla, A. A., Austlid, T., Sarwar, Z.,  & Larsen, S. E. (2022). Effect on bone anabolic markers of daily cheese intake with and without vitamin K2: a randomised clinical trial. BMJ Nutrition, Prevention & Health, 5(2), 182.