Whether a patient has mild gut issues or more severe problems like Crohn’s disease, you probably know that gut issues can make it difficult for them to absorb the nutrients they might need. Some gut conditions can cause leaky gut, where absorption is compromised, others might cause rapid evacuation of foods so that those foods are not completely broken down and their nutrients made bioavailable, while still other gut issues may mean fats can’t be processed efficiently. One of the triggers for these and other gut issues may be food allergens or sensitivities, which can limit which foods a patient may be able to safely consume. Gluten, dairy, legumes, and some fats are common culprits. While problems with absorption may mean a patient has had to adjust their diet accordingly, there are some nutrients that can become exceedingly difficult to get enough of through diet alone once malabsorption issues have developed. One of these is Vitamin K, particularly K2, and if a patient has a problem absorbing Vitamin K2, that means they may have a problem getting enough Vitamin D, particularly D3 as well. Let’s focus on K2 and its link to D3.
Naturally occurring vitamin K is found as either K1 or K2. K1 is typically found in food sources such as leafy greens and is the form most often consumed in modern diets. K2 can typically be found in animal foods and fermented foods, and synthesized through the work of highly specialized bacteria found in the gut. Structural differences between vitamin K1 and K2 affect bioavailability and the rate at which your body can absorb this key nutrient. We typically do not consume sufficient quantities of vitamin K2 through diet alone and supplementation becomes an important part of most wellness plans. This is true for many adults, regardless of health status. Once you add gut issues to this equation, the problem becomes even more acute. Patients who develop malabsorption issues because of leaky gut, colitis, or an autoimmune condition are much less likely to be getting enough K2 or D3 in their diets.
Vitamin K2 plays an important role in calcium utilization. Calcium is a critical mineral for building and maintaining bones and teeth. The main function of vitamin K is to modify protein, giving it the ability to bind calcium. This mechanism is crucial for healthy bones. Vitamins K and D have emerged in research as a superhero combo working together to support bone growth and cardiovascular health (Ballegooijen, et al 2017). Indeed, the authors state “Current evidence supports the notion that joint supplementation of vitamins D and K might be more effective than the consumption of either alone for bone and cardiovascular health”. Vitamin K is critical to bone health as it is necessary for bone mineralization. Vitamin D is critical to pair with Vitamin K because of Vitamin D’s function of powerfully enhancing calcium absorption. This pairing is even more important as we age to maintain stronger bones, healthier arteries, and a stronger immune response.
Many patients understand that they may need to supplement with calcium as they get older, particularly women. This is because of an increasing risk of osteoporosis due to the demineralization of the bones, especially in post-menopausal years. Fewer patients know that Vitamin D3 supplementation is also recommended for many as they age as well. This is because raw calcium may not be bioavailable unless there is enough vitamin D to help absorb the calcium. Even fewer patients know that vitamin K2 “supercharges” the ability of vitamin D3 to do its job of calcium absorption. Indeed, “The combination of vitamin K and D can significantly increase the total BMD and significantly decrease undercarboxylated osteocalcin, and a more favorable effect is expected when vitamin K2 is used.” (Kuang, et al, 2020). Bone mineral density (BMD) is essential for bone health, especially as we age and lower BMD is correlated with fractures, osteoporosis, joint problems, and general bone fragility. Osteocalcin is a common protein found in bone and is dependent upon Vitamin K for production. It is essential for building bone structure and assists with other processes in the body like coagulation. Lower levels of vitamin K2 are correlated with a decreased ability to build bone structure (Wagatsuma, et al, 2019).
Unfortunately, many different gut conditions can decrease the absorption of vitamin K2. Any sort of fat absorption disorder, for instance, those related to lower bile levels can mean neither vitamin D nor K can be absorbed in sufficient quantities. Wagatsuma, et al, cited above, conducted a study with Crohn’s patients whose Crohn’s Disease was inactive at the time of the study and still found that those patients had a similar incidence of vitamin K deficiency as those with active Crohn’s. Why? Because Crohn’s and other gut conditions can rapidly and permanently change the microbiome of the gut. This same study found that “The diversity of the gut microbiota was significantly lower, and Ruminococcaceae and Lachnospiraceae were significantly decreased in the vitamin K-deficient group in comparison to the vitamin K-normal group”, and further “Vit K deficiency is rare in healthy individuals, but has been found to be more common in patients with inflammatory bowel disease (IBD)” So, the risk is that IBD, Crohn’s, bile and pancreatic disorders, and most likely those that have other gut disorders as well will have lower levels of vitamin K, particularly K2, that those who have lower levels of K2 have lower levels of bone mineral density because vitamin D3 levels are both potentially lowered and impeded in its ability to bind to calcium to make it bioavailable to the bones and heart resulting in risks of osteoporosis, fractures and cardiac events, and potentially suppresses the immune system. Yikes! Luckily, the authors of these studies recommend supplementation with a D3-K2 combination for those individuals with gut issues to help ward off these problems by raising overall serum levels of these vitamins and minimizing the risk of these effects from vitamin deficiency.
Whether or not you decide to have your gut-compromised patients supplement with K2/D3 is of course entirely up to you, the practitioner. If you do have patients who have gut issues, the first step should be functional testing to determine the nature and degree of the problems. Tests that are offered by Precision Point Diagnostics that could be of great use in the case of suspected gut/bone issues are:
- The P88 Dietary Antigen Test– This is the gold standard of dietary antigen tests. 88 different foods, specially chosen to represent a wide range of foods commonly consumed are tested for four different antigens. IgE (allergens), IgG (sensitivities), C3d (Complement), and IgG4 (mitigates sensitivities and shows the body has compensated for the allergen/sensitivity)
- The Advanced Intestinal Barrier Assessment– assesses intestinal permeability and concurrent inflammation using novel markers.
- The Male and Female Functional Wellness Panels both assess levels of vitamin D along with a range of other essential health markers that would be useful for establishing a baseline and tracking general health for gut-compromised patients.
The gut in many ways is central to so many other systems in the body. Ideally, a practitioner would identify patients who are at risk for developing more severe gut dysbiosis through allergy and sensitivity testing, and for those patients who already have demonstrated gut issues, this same DAT testing can make sure that root causes of that dysbiosis are identified and eliminated from the diet. Other testing to monitor general health and degree of damage would seem to be part of a comprehensive functional approach.