Welcome to the Evolution of Medicine podcast! On this episode, James sits down with biochemistry professor and prolific researcher Dr. Leon Schurgers of the University of Maastricht. Much of Dr. Schurgers’ research has centered on vitamin K and cardiovascular risk. In this half hour, James and Dr. Schurgers talked about calcification of the heart and the role of vitamin K2 in reducing cardiovascular risk. The conversation also covered vitamin K2 supplementation, and what to look for in the products available. This is a must-listen for any practitioner on the front lines of functional integrative medicine! Highlights include:

  • Dr. Schurgers’ research journey and how he has helped shape the role of K vitamins in functional integrative medicine
  • The causes of calcification and how vitamin K2 affects this process
  • Where the research stands on vitamin K2 and cardiovascular risk
  • Best practices for testing vitamin K levels
  • And so much more!

Resources mentioned in this podcast:

James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs and health technology as well as practical tools to help you transform your practice and the health of your community. This podcast is brought to you by the Lifestyle Matrix Resource Center who provide a range of options to help you deliver successful, effective, functional, and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.

James Maskell: Hello, and welcome to the podcast. This month, we are diving deep into really important clinical information, specifically around vitamin K and vitamin K2. Dr. Leon Schurgers is a professor of biochemistry all around vascular calcification. He is from the University of Maastricht. I had the first chance to see him back at the Integrative Health Symposium a few years ago. In this incredible half an hour, we talked about calcification of the heart. We talked about the role of vitamin K2 as it comes to reducing cardiovascular risk. And then, we also talked about why vitamin K2 supplementation’s important, what the best form is, how to test for it. Really, really interesting half an hour. I think a must-listen for any practitioner on the front lines all functional and integrative medicine. Enjoy! Welcome to the podcast, Dr. Schurgers. Welcome, Doc.

Leon Schurgers: Welcome. Nice to be on your show.

James Maskell: Actually, the first time we connected, I was actually at your lecture at the Integrative Health Symposium a few years ago, and it was very difficult for me to get in through the door because there were that many people lining up to learn about vitamin K2. You must’ve made quite an impression.

Leon Schurgers: I don’t know. I didn’t see that because there were so many people there.

James Maskell: Let’s just start with this. Vitamin K, probably the least known of the vitamins. What got you started into vitamin K research?

Leon Schurgers: That’s actually a good question. As with many things, I think it was serendipity. I was doing an internship at the University of Maastricht in the Netherlands, and I came in a lab that was working on vitamin K-dependent proteins. Actually, that was my starting moment. I felt directly attached to this topic, so I stayed there.

James Maskell: What were some initial discoveries that you found with vitamin K that got the juices flowing and made you want to participate fully in this research area?

Leon Schurgers: It was actually the start of my PhD project. After my internship, I got a PhD position offered, PhD trajectory, so doing my PhD in that same lab, and I was working on the difference between vitamin K1 and vitamin K2. We can dive a little bit more into the details of the two different vitamins. Actually, that was really the starting moment that I felt, “Okay. There is so much to learn about vitamin K and it’s not just one vitamin, but it’s a flavor of different K vitamins.” That was really the start, and because I also worked on newly discovered vitamin K-dependent proteins. That was really something that I really got intrigued into this topic.

James Maskell: Can you do a quick summation of K1 and K2 and what the differences are and what they do?

Leon Schurgers: Yeah. Everybody considers vitamin K as vitamin K. There is only one flavor. We found out, or at least it was already known, but we really dived into the food items that have either vitamin K1 or food items that have vitamin K2. I think we were the first in my PhD thesis to describe food items that were rich in vitamin K2. If you look at that, there is really a difference. The activity as being a co-factor in what they really have to do in the body, that is the same, but the side chain between K1 and K2 vitamins is completely different. There is a difference in side lengths and a difference in lipophilicity. Because of that difference of side chain, there is either a better absorption for vitamin K2, but also a longer half-life in the circulation. It stays around longer than for example vitamin K1. That is really a huge difference. Even if the majority of vitamin K is K1 in food—

James Maskell: Hey, sorry, Doc. Sorry. My internet just went out for a minute then. I think it’s doing that. Let’s start with that question again.

Leon Schurgers: Of course.

James Maskell: Can you share a little bit about the difference between K1 and K2?

Leon Schurgers: Actually, vitamin K was always considered as one vitamin, but my topic was to differentiate between K1 and K2. What we analyzed is food items that were either rich in K1 or food items that were rich in vitamin K2. There was no food table available for vitamin K2. Vitamin K1 is mainly present in green leafy vegetables, so all the healthy food, and K2 was more in fermented foods. It is of bacterial origin, so it’s produced by bacteria. You find it in sauerkraut or fermented cheese, for example. The difference between K1 and K2 is not the naphthoquinone ring structure, which is the same in K1 and K2. That is actually the active group in the vitamin K, but the different lies in the side chain. The side chain determines how good vitamin K is absorbed and how long the half-life in plasma is. Especially for the K2 vitamins, they are way better absorbed than K1.

James Maskell: Interesting. I know one of the focuses of your work has been in cardiovascular risk. This is something that I’m particularly passionate about because it’s hit very close to home for friends and family, and specifically calcification. Can you help us understand what causes calcification, what are the drugs that are recommended, how does that play in, and then what role vitamin K2 plays specifically in that process?

Leon Schurgers: Calcification is actually the precipitation of calcium phosphate salts in soft tissue. That is the pathological calcification. Calcification has to happen in teeth and in bone where it is physiological, but in the soft tissues you want to prevent that. Maybe everybody knows from chemistry lessons, if you have calcium and you have phosphate, if they see each other they’re insoluble. They form a complex, they nucleate and they become a crystal. We have in our body, we have proteins that actively regulate calcification and inhibit calcification. One of the strongest inhibitors is matrix Gla protein, a vitamin K-dependent protein produced by vascular smooth muscle cells in our vasculature, and this MGP inhibits the precipitation of calcium phosphate salts in this soft tissue, but it can only do that when it is activated. The activation of MGP happens in the presence of vitamin K. Vitamin K activates MGP, and thereby MGP protects our soft tissues from calcification.

James Maskell: Interesting. How much research is there into this topic now?

Leon Schurgers: There is more and more. When I started, which was late 1990s, it was not that much, but now there is more and more research into vascular calcification. Actually, there is a nice saying from that. When I started my research, I wanted to investigate vascular calcification and the connection to vitamin K. I went to the Department of Pathology in our academic hospital, and I asked the former director, “Do you have vascular specimens that are calcified?” He started laughing. He said, “All of them are nearly calcified. These are old people that we get tissues from, people that have cardiovascular disease. Calcification is always there. Leon, why do you want to work on something that is a passive end stage process?” I said, “It’s such an intriguing process, this calcification, that is not passive because it’s really actively regulated by cells and by proteins. I want to study that.” I became right because now today, vascular calcification is one of the best predictors of cardiovascular mortality and morbidity. It is really an independent predictor of that.

James Maskell: Really interesting. I know most of the people in the community and the practitioners that are listening to this are very interested in the potential for reversing chronic illness. What is the potential to reverse calcification?

Leon Schurgers: That’s a very good question. I think it’s the one million dollar question, how to reverse calcification. Our research is at this moment aiming at stopping the process of calcium buildup in the tissues. What we believe is, and we have some preclinical animal models in which we have tested that, also in vitro models. If from the beginning your vitamin K status is very good, then calcification can be prevented. However, once you have calcification there is a kind of pressure. What we achieved in these animal models is that with a high dose of vitamin K2, we could prevent the further growth of this calcification in our vasculature. This is something by stopping this pathological aging process, this is really a big gain already because then you extend also elderly diseases by several years, for example. Only by stopping and blocking this process, this would already be fantastic.

James Maskell: Yeah. Okay. That makes a lot of sense. Obviously, if you really want to reverse it, the first thing that you have to stop is it continuing to happen more, right?

Leon Schurgers: Absolutely.

James Maskell: I’m really interested about sources of vitamin K2 because when I looked at the foods that have it, the natto and the cheese, I was just like, “Where is this coming from in our diet?” I don’t eat natto regularly. I know some biohackers do, but it’s not in the conventional diet. Obviously, I think there’s some way in which the microbiome is involved in the production. What’s happening in the microbiome to produce K2 and how far along is the research and the understanding of what microbes make that transformation?

Leon Schurgers: Yeah. Starting with the food, we get vitamin K…“Vitamin” stands for a vital amine. Actually, the name says it all. It’s a bioactive. We cannot produce it, so we have to take it from the food. We get it either via green leafy vegetable in the source of K1 or by fermented foods. That is for example cheese or sauerkraut. Of course, you have this natto, but natto is only appreciated very much in Japan, and outside Japan nobody really eats and loves this rotten soybean as it is. I think 100 years ago before we had refrigerators, I think way more food was fermented because it was lying out there and bacteria grow on it. I think it’s really important that fermented foods, that this is really considered to be healthy.

Leon Schurgers: Now, in our body we have also bacteria that are working together with us. They are actually healthy, they are good, and most bacteria in our body are found in the colon, which is in the end part of our intestines. Now, the absorption of fat-soluble compounds is in the jejunum, which is the upper part of the small intestines. It is today still questionable how much the microbiome really contributes to human nutrition or let’s say dietary intake. There is not that much research at this moment going on, but it is a very interesting topic. I think that we will learn from the microbiome in the near future way more.

James Maskell: What are the building blocks that have to go in for it to produce? What are the foods that have to come in to end up with vitamin K through the microbiome?

Leon Schurgers: Certain bacteria like the Lactobacillus, for example, they make vitamin K. I’m not sure what kind of fruits, but I think all the healthy fruits are always good of course. These bacteria produce the vitamin K for their own health, for their own energy metabolism. They produce it just to support their own energy metabolism.

James Maskell: Interesting. Okay. I guess one of the things that happened this year I think with COVID is people realizing that your levels of vitamins can really affect the chances of you getting an illness. I think with vitamin D3, for instance with COVID, it was really clear that that was a pretty big factor. How do you even test your vitamin K levels? Is that something that people are doing? What’s the best way to understand where you are today and how much you’re getting in your diet?

Leon Schurgers: It’s a very good question. A clinical vitamin K deficiency would directly be seen because then you would have bleedings. Vitamin K is a very important co-factor to support normal blood clotting. We need vitamin K for normal coagulation. If you have a very severe vitamin K deficiency, you would end up with bleedings. We see that, for example, in the hemorrhagic disease of the newborn. If babies are born, they have vitamin K deficiency, you see that in bleedings. That is why we give them a shot of vitamin K. Now, in the elderly we see a chronic vitamin K deficiency, which is leading to osteoporosis, so no bone mass. We see it in calcification of the vessel walls.

Leon Schurgers: Now, how to test for this vitamin K deficiency? There are a few ways that you can do that. One is to measure vitamin K directly in the circulation. We do that with a very advanced technique. It’s very timely and it’s costly and it’s not very easy to do. It’s also not that accurate because actually it predicts or tells you what you have eaten the day before. If you eat a meal of spinach in the evening, the next day your vitamin K1 levels are very high. If you eat a lot of natto in the evening, the next day you have a lot of MK-7 in your bloodstream. Now, you can also measure the result of vitamin K, which is the activation of the vitamin K-dependent proteins. We have several that we can measure. For example, osteocalcin, but also Matrix Gla protein. This was part of my post-doctoral period where I created antibodies against the active form of MGP or the inactive form of MGP. We are able to measure the inactive form of MGP, which is a result of vitamin K deficiency. Actually, that is the most accurate way of determining a vitamin K deficiency.

James Maskell: Interesting. Okay. Now, you’ve identified where they are, where patients are. I know a lot of practitioners in our community now are recommending vitamin K for their patients. Obviously sauerkraut is a great, easy way to do it on a consistent basis. I’ve even enjoyed making sauerkraut with my daughter. It’s pretty easy. I guess I was wondering what’s the best form of vitamin K for it to be taken by humans? What’s the best way to supplement?

Leon Schurgers: Yeah. You have several forms. You have vitamin K1 and K2, and then K2 we can subdivide into menaquinone, MK-4, MK-7, MK-9. These are the most popular ones. Actually, we tested all of them in terms of absorption, but also in term of half-life in the body. What we found is that MK-7, which is actually produced by these bacteria that are on these natto fermented soybeans, MK-7 has the best absorption. It is extremely well absorbed, and it has a very long half-life. It stays available in the circulation, available for all the tissues, not only for the liver, but also for the bone and also for the vasculature. If we consider dietary intake of K vitamins, we found that MK-7 has the best qualities.

James Maskell: That’s interesting. In that regard, I’m sure you have your eye on the bull of what’s going on in vitamin K research generally across. What are the kinds of conditions outside of cardiovascular health where it seems like vitamin K deficiency may be playing a role and vitamin K supplementation might be useful in helping with specific conditions?

Leon Schurgers: Actually, every tissue that makes vitamin K-dependent proteins. In the teeth and in the bone, we have cells that produce osteocalcin, which is a vitamin K-dependent protein. In our endothelial cells, we produce protein S which is a vitamin K-dependent protein. In our liver, we synthesize the coagulation factors. In fact, two, seven, nine and 10 are vitamin K-dependent proteins. Any tissue where we find vitamin K-dependent proteins, the role of vitamin K is really important. For example, bone. We need vitamin K to support a healthy bone, a good bone quality. In the cartilage, we also produce MGP by chondrocytes. Vitamin K is important for cartilage health. Also, besides the vasculature more tissues in our body really benefit from extra vitamin K.

James Maskell: Interesting. You mentioned osteocalcin a little bit earlier. Can you understand the mechanism, what’s happening in bone health?

Leon Schurgers: Osteocalcin is the protein that is produced by the osteoblast, which is the bone-forming cell, and researchers in the United States found out that this osteocalcin is really important in laying down the calcium in the bone, but in a way that it interacts with the collagen. Remember, if you have bones, which are very calcified, they become brittle because they are very hard, but the bone, although it is very hard needs also to be very flexible because we jump and our muscles pull on these bones. There needs to be strength combined with flexibility. We need collagen. This osteocalcin lays down this calcium matrix in the bone in such way that we have orderly mineralization supporting strong bones.

James Maskell: It’s really interesting, isn’t it, how one nutrient like calcium and bones becomes a big deal. Suddenly everyone should be drinking milk and all people should be taking calcium. Ultimately, there’s this point of no return or this inflection point where the focus on one nutrient and forgetting everything else actually has these detrimental effects, and ultimately it’s more of like a systems or a holistic way of thinking that’s necessary to really chart a progress towards long-term healthy bones.

Leon Schurgers: Yes. I think it has also to do with evolution. Until you’re 40 years old, you need to build strong bones, but actually out of evolution we know that we didn’t become that old, and nowadays people become on average 80 years old. In these last 40 years, actually this whole mechanism of building bone is not necessary anymore. This excess of calcium and this metabolism that actually supports the calcification of other tissues, which is actually detrimental.

James Maskell: Yeah. That’s really interesting. I guess just to go back to the cardiovascular health, ultimately we have cardiologists that watch this, but we also have practitioners that are more focused on nutrition. I guess just to look a little bit at the state of cardiology, how important do you think this research is in the context of creating healthy human hearts? What is the current standard of care doing to the human heart? From your perspective, how do we facilitate healthy human heart throughout lifetimes?

Leon Schurgers: Yeah. Proving that a bioactive is really important for vascular health is really difficult, and convincing medical doctors, cardiologists, internal medicine, hematologists that vitamin K, a nutrient is really important to support vascular health is even more difficult. What we did in the past is we went to a medical drug that is called warfarin. Warfarin is a vitamin K antagonist. What it does, it blocks the recycling of vitamin K, and this is a drug that is prescribed by doctors. Actually, it was looking back a smart move because I could convince medical doctors that there’s vitamin K antagonist. This drug that interacts with the metabolism of vitamin K created more calcification. This is something that is now really established. If you give patients warfarin, they end up with more cardiovascular calcification, and then it becomes very logical also for the medical doctors if vitamin K antagonists are detrimental causing calcification. It is very logic to reason that vitamin K prevents and maybe even inhibits that. I think that nowadays there is more and more awareness that vitamin K can be a treatment to prevent cardiovascular calcification and to support vascular health.

James Maskell: Absolutely. Yeah. That’s interesting. Sometimes, you have to go a little bit in an unexpected order to evolve the way in which healthcare is delivered. Look, I really appreciate you coming on and sharing. I hope that for the doctors and practitioners that are listening this stimulates some thinking about vitamin K, about how to use it. We will have in the show notes, we actually have a white paper from your talk that was at the Integrated Health Symposium. Practitioners who want to go deep into the mechanism, understand how to find it, how to work with it, we’ll share that in the show notes. Doc, thank you so much for being part of the Evolution of Medicine podcast. We’re fiercely committed to looking at what are optimal ways for chronic disease prevention and reversal. I think that a lot of what you shared here is things that our community needs to know to do medicine well. I hope that we could be on the front lines of really creating a system that facilitates healthy heart health throughout a lifetime. Thank you for being part of the conversation.

Leon Schurgers: Couldn’t agree more. It was a pleasure to be on the show.

James Maskell: All right. We have been so grateful to be here with Dr. Leon Schurgers. He is one of the leaders in the world of vitamin K research all the way from the Netherlands Germany border. Thanks so much for being part of the show. I’m your host, James Maskell, and we’ll see you next time. Thanks for listening to the Evolution of Medicine podcast. Please, share this with colleagues who need to hear it. Thanks so much to our sponsors, Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please, visit goevomed.com/lmrc to find out more about the clinical tools like the group visit toolkit. That’s goevomed.com/lmrc. Thanks so much for listening, and we’ll see you next time.

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