Is It Necessary to Take Vitamin K2 with Vitamin D3?

I often get asked, particularly by my patients who are already on or considering vitamin D3 supplementation, if they should take a form that includes vitamin K2. 

While it is widely known that the two fat-soluble vitamins, D3 and K2, are central to bone metabolism and cardiovascular health, newer research indicates that D3 and K2 possess a synergy. (1)

Let’s dive into what these vitamins can do for you and how they work together to invigorate your body’s natural responses and enhance your health.

Vitamin D

D3 is the active form of vitamin D and is produced in the kidneys. Oil-rich fish, such as salmon and herring, also contain vitamin D3. (2)

Upon exposure to sunlight, vitamin D is produced in the skin, then converted in the liver and kidney, respectively, to form D3.

D3 not only enhances intestinal calcium absorption, but it is also well established that Vitamin D3 is essential to immune function modulation. (3)

Vitamin K

Vitamin K1 is found in dark leafy greens and an important factor in blood coagulation. K2, however, is mostly found in fermented foods and animal products, and also produced by our intestinal microflora. (4)

There are vitamin K2-dependent proteins that require vitamin D3 in order to be promoted in the body. (5)

Vitamin D as Key to the Management of Osteoporosis and Overall Bone Health

Because Vitamin D helps with calcium absorption and metabolism, it is essential to the management of osteoporosis, particularly with postmenopausal women. (6)

But patients who are at greater risk of fracture can also benefit from calcium absorption, and both vitamin K2 and magnesium appear to play central roles in bone metabolism.

Interestingly, a 2018 randomized controlled trial showed that adequate magnesium levels may be required to optimize Vitamin D status. (7)

It appears that the efficacy of calcium and vitamin D can be enhanced by vitamin K2 supplementation.

Also, magnesium deficiency can negatively impact bone and muscle health. And a 2015 study shows that fat-soluble vitamin deficiency is also strongly associated with cardiovascular disease. (8)

Not only this, but decreased insulin sensitivity leads to chronic hyperglycemia and subsequent bone demineralization. Some preliminary research indicated that changes in serum osteocalcin and insulin are tied to vitamins D3 and K2 deficiencies and that these vitamins significantly decrease glucose levels in T2DM. (9)

Vitamin D in Cardiovascular Health

There are several pathways by which vitamin D affects the cardiovascular system, such as by way of the renin-angiotensin-aldosterone system and vascular endothelial growth.

In cross-sectional and longitudinal studies, there is an association between serum vitamin D levels and hypertension, heart attack, heart failure, and death from cardiovascular disease. (10)

Vitamin K in Cardiovascular Health

According to cross-sectional and cohort studies, a high vitamin K status is associated with lower cardiovascular risk as well as reduced coronary artery calcification. The mechanism by which it is thought that vitamin K may prevent coronary artery calcification is via activation of matrix-gla protein (MGP). (11)

In other words, vitamin D and K appear to confer a protective role epidemiologically in cardiovascular disease, but randomized controlled trials have not been yet performed.

Evidence appears to indicate that taking vitamin K2 with vitamin D3 is a good thing for cardiovascular health.

Image credit via Study: Vitamin D3 and K2 and their potential contribution to reducing the COVID-19 mortality rate.

Consult Your Naturopathic Physician Today

But the question remains: How much should we take and how do we customize supplementation to the individual?

The answer is that it will depend on your health condition and your Vitamin D serum levels, and it will depend on who you talk to.

If you are wondering how much to take, or if you even need to take any, then consult your naturopathic physician or integrative medicine practitioner today.

Resources:

1. van Ballegooijen AJ, Pilz S, Tomaschitz A, Grübler MR, Verheyen N. The Synergistic Interplay between Vitamins D and K for Bone and Cardiovascular Health: A Narrative Review. Int J Endocrinol. 2017;2017:7454376. doi: 10.1155/2017/7454376. Epub 2017 Sep 12. PMID: 29138634; PMCID: PMC5613455.
2. Nair R, Maseeh A. Vitamin D: The “sunshine” vitamin. J Pharmacol Pharmacother. 2012 Apr;3(2):118-26. doi: 10.4103/0976-500X.95506. PMID: 22629085; PMCID: PMC3356951.
3. Goddek S. Vitamin D3 and K2 and their potential contribution to reducing the COVID-19 mortality rate. Int J Infect Dis. 2020 Oct;99:286-290. doi: 10.1016/j.ijid.2020.07.080. Epub 2020 Aug 6. PMID: 32768697; PMCID: PMC7406600.
4. Vitamin K. (2021, January 01). Retrieved January 18, 2021, from https://lpi.oregonstate.edu/mic/vitamins/vitamin-K
5. van Ballegooijen AJ, Pilz S, Tomaschitz A, Grübler MR, Verheyen N. The Synergistic Interplay between Vitamins D and K for Bone and Cardiovascular Health: A Narrative Review. Int J Endocrinol. 2017;2017:7454376. doi: 10.1155/2017/7454376. Epub 2017 Sep 12. PMID: 29138634; PMCID: PMC5613455.
6. Capozzi A, Scambia G, Lello S. Calcium, vitamin D, vitamin K2, and magnesium supplementation and skeletal health. Maturitas. 2020 Oct;140:55-63. doi: 10.1016/j.maturitas.2020.05.020. Epub 2020 May 30. PMID: 32972636.
7. Dai Q, Zhu X, Manson JE, Song Y, Li X, Franke AA, Costello RB, Rosanoff A, Nian H, Fan L, Murff H, Ness RM, Seidner DL, Yu C, Shrubsole MJ. Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial. Am J Clin Nutr. 2018 Dec 1;108(6):1249-1258. doi: 10.1093/ajcn/nqy274. PMID: 30541089; PMCID: PMC6693398.
8. Tsugawa N. Cardiovascular Diseases and Fat Soluble Vitamins: Vitamin D and Vitamin K. J Nutr Sci Vitaminol (Tokyo). 2015;61 Suppl:S170-2. doi: 10.3177/jnsv.61.S170. PMID: 26598844.
9. Aguayo-Ruiz JI, García-Cobián TA, Pascoe-González S, Sánchez-Enríquez S, Llamas-Covarrubias IM, García-Iglesias T, López-Quintero A, Llamas-Covarrubias MA, Trujillo-Quiroz J, Rivera-Leon EA. Effect of supplementation with vitamins D3 and K2 on undercarboxylated osteocalcin and insulin serum levels in patients with type 2 diabetes mellitus: a randomized, double-blind, clinical trial. Diabetol Metab Syndr. 2020 Aug 18;12:73. doi: 10.1186/s13098-020-00580-w. PMID: 32831908; PMCID: PMC7436967.
10. Zittermann A, Pilz S. Vitamin D and Cardiovascular Disease: An Update. Anticancer Res. 2019 Sep;39(9):4627-4635. doi: 10.21873/anticanres.13643. PMID: 31519560.
11. Tsugawa N. Cardiovascular Diseases and Fat Soluble Vitamins: Vitamin D and Vitamin K. J Nutr Sci Vitaminol (Tokyo). 2015;61 Suppl:S170-2. doi: 10.3177/jnsv.61.S170. PMID: 26598844.