Prothrombin Complex Concentrates for Perioperative Vitamin K Antagonist and Non–vitamin K Anticoagulant Reversal


Vitamin K antagonist therapy is associated with an increased bleeding risk, and clinicians often reverse anticoagulation in patients who require emergency surgical procedures. Current guidelines for rapid anticoagulation reversal for emergency surgery recommend four-factor prothrombin complex concentrate and vitamin K coadministration. The authors reviewed the current evidence on prothrombin complex concentrate treatment for vitamin K antagonist reversal in the perioperative setting, focusing on comparative studies and in the context of intracranial hemorrhage and cardiac surgery. The authors searched Cochrane Library and PubMed between January 2008 and December 2017 and retrieved 423 English-language papers, which they then screened for relevance to the perioperative setting; they identified 36 papers to include in this review. Prothrombin complex concentrate therapy was consistently shown to reduce international normalized ratio rapidly and control bleeding effectively. In comparative studies with plasma, prothrombin complex concentrate use was associated with a greater proportion of patients achieving target international normalized ratios rapidly, with improved hemostasis. No differences in thromboembolic event rates were seen between prothrombin complex concentrate and plasma, with prothrombin complex concentrate also demonstrating a lower risk of fluid overload events. Overall, the studies the authors reviewed support current recommendations favoring prothrombin complex concentrate therapy in patients requiring vitamin K antagonist reversal before emergency surgery.

Timing of anticoagulation after recent ischaemic stroke in patients with atrial fibrillation

About 13–26% of all acute ischaemic strokes are related to non-valvular atrial fibrillation, the most common cardiac arrhythmia globally. Deciding when to initiate oral anticoagulation in patients with non-valvular atrial fibrillation is a longstanding, common, and unresolved clinical challenge. Although the risk of early recurrent ischaemic stroke is high in this population, early oral anticoagulation is suspected to increase the risk of potentially harmful intracranial haemorrhage, including haemorrhagic transformation of the infarct. This assumption, and current treatment guidelines, are based on historical, mostly observational data from patients with ischaemic stroke and atrial fibrillation treated with heparins, heparinoids, or vitamin K antagonists (VKAs) to prevent recurrent ischaemic stroke. Randomised controlled trials have subsequently shown that direct oral anticoagulants (DOACs; ie, apixaban, dabigatran, edoxaban, and rivaroxaban) are at least as effective as VKAs in primary and secondary prevention of atrial fibrillation-related ischaemic stroke, with around half the risk of intracranial haemorrhage. However, none of these DOAC trials included patients who had experienced ischaemic stroke recently (within the first few weeks). Clinicians therefore remain uncertain regarding when to commence DOAC administration after acute ischaemic stroke in patients with atrial fibrillation.

Recent developments

Prospective observational studies and two small randomised trials have investigated the risks and benefits of early DOAC-administration initiation (most with a median delay of 3–5 days) in mild-to-moderate atrial fibrillation-associated ischaemic stroke. These studies reported that early DOAC treatment was associated with a low frequency of clinically symptomatic intracranial haemorrhage or surrogate haemorrhagic lesions on MRI scans, whereas later DOAC-administration initiation (ie, >7 days or >14 days after index stroke) was associated with an increased frequency of recurrent ischaemic stroke.

Where next?

Adequately powered randomised controlled trials comparing early to later oral anticoagulation with DOACs in ischaemic stroke associated with atrial fibrillation are justified to confirm the acceptable safety and efficacy of this strategy. Four such randomised controlled trials (collectively planned to include around 9000 participants) are underway, either using single cutoff timepoints for early versus late DOAC-administration initiation, or selecting DOAC-administration timing according to the severity and imaging features of the ischaemic stroke. The results of these trials should help to establish the optimal timing to initiate DOAC administration after recent ischaemic stroke and whether the timing should differ according to stroke severity. Results of these trials are expected from 2021.

We should never have told people to start taking vitamins.

It seems like simple, obvious advice: Eat your vegetables, get some exercise, and, of course, take your vitamins.

Or not.

Decades of research has failed to find substantial evidence that vitamins and supplements do any significant good.

Nevertheless, several shiny new pills and powders have materialized in recent years that promise to deliver health and wellness in ways no other vitamin has before.


One of them, called Ritual , arrives at your doorstep in a bright white and highlighter-yellow box. Inside, you’ll find a 1-month supply of pills. These aren’t your grandma’s vitamins. Each pill is a clear, glass-like capsule filled with a handful of tiny white beads that float suspended in oil.

Despite the fact that each pill is practically a work of art, Ritual’s pills don’t differ much from your standard vitamin. They contain less of some traditional vitamin ingredients that decades of research have shown we don’t need, but have similar amounts of magnesium, Vitamin K, folate, Vitamin B12, iron, boron, Vitamin E, and Vitamin D as a standard Alive-brand vitamin.

Another one of these newly-designed vitamins is Care/of , whose personalized daily vitamin packets come in a box that looks like a tea-bag dispenser with the words “Hi [your name],” printed on the top right corner. Again, the ingredients don’t differ drastically from those in conventional vitamins.

No matter how colorful their packaging or personal their messaging, all of these vitamin formulations fall prey to the exact same problem: We simply do not need vitamins to be healthy. Instead, we should be getting the nutrients that vitamin-makers peddle from the foods we eat.

“We use vitamins as insurance policies against whatever else we might (or might not) be eating, as if by atoning for our other nutritional sins, vitamins can save us from ourselves,” writes science reporter Catherine Price in the book ” Vitamania.

Here’s the thing: They can’t.

Virtually any registered dietitian, doctor, public health expert , or physician will likely reiterate some version of the advice health professionals have been giving for decades. Eat real food. Eat fruits and veggies. Eat in moderation. Stay away from processed foods and sugary beverages when you can. Or, in the words of the well-known journalist and food writer Michael Pollan , “Eat food. Not too much. Mostly plants.”

There’s another reason to stay away from most pills and powders: Some can be harmful. Several supplements have been linked with an increase in certain cancers , for example, while others have been associated with arisk of kidney stones .

In her book, Price suggests that this knowledge about vitamins might help us “rediscover something both surprising and empowering: that, while nutrition itself is amazingly complex, the healthiest, most scientific, and most pleasurable way to eat is not that complicated at all.”

The Gut Microbiome: New Treatments for Diabetes?

The trillions of bacteria and other microbes inside our gastrointestinal (GI) tract, collectively known as the human gut microbiome, play significant roles in our general health.

The scientific community previously believed that the three pounds of bacteria that live in our gut did not affect our health; however, researchers now know that bacteria are essential to good health. Many perform critical tasks such as helping digest certain foods and producing vitamins, including vitamin K.

gut microbiome and diabetes

However, research has shown that a disturbance to our gut bacteria caused by diet, genetics or other lifestyle choices might also contribute to or even cause metabolic disorders like type 2 diabetes. In addition, how well a glycemic-index based diet works varies between people with different types of gut bacteria.

Gut Bacteria & Insulin Resistance

In a recent study, increased abundances of specific bacterial communities in the GI tract were linked to a higher risk of developing insulin resistance, a precursor to prediabetes or type 2 diabetes.

This research, published in Nature by scientists at the University of Copenhagen, might lead to potential treatments for the diabetes epidemic.

Understanding how insulin affects the human required researchers to observe samples from the gut microbiome of 75 type 2 diabetes patients and 277 non-diabetic patients utilizing state-of-the-art sequencing technologies.

Gut Bacteria & BCAAs

In addition to insulin resistance, the research revealed the type 2 diabetes group also had elevated blood concentrations of branched-chain amino acids (BCAAs), a subgroup of amino acids. The increase in BCAAs was correlated to specific shifts in the specific bacterial communities.

The two bacterial species identified, Prevotella copri and Bacteroides vulgatus, were responsible for the majority of the gut BCAAs produced. Once identified, researchers fed mice with P. coprifor three weeks.

The results were fascinating: specific microbial imbalances play significant roles in insulin resistance. The P. copri-fed group developed increased levels of BCAAs, intolerance to glucose, and insulin resistance compared to the germ-free mice.

Validation is required by a larger study with more diverse populations to observe bacterial communities in high risk patients. Future studies that help scientists understand how the microbiome works may lead to more effective therapies or even a cure for diabetes.

Monitoring and Managing Your Gut Microbiome

Adobe Stock photo - Male Patient Having Consultation With Doctor In OfficeExtensive future research is required, especially to translate results into practical and widely applicable treatments. One major potential treatment can be found in personalized probiotics that contain strains targeted to treat specific diseases. We have already discovered clues as to what medicine might look like in the future to keep your microbiome healthy and prevent and cure disease.

  1. Sequence your microbiome. Monitoring changes in your gut microbiome, whether during a diet, exercise or other lifestyle change, is a great way to help figure out what works the best for you at a microscopic level.
  2. Talk with your doctor about including probiotic supplements in your daily diet to rebalance your gut.
  3. Prebiotics (fiber) like fructooligosaccharides (FOS) encourage the growth of beneficial bacteria. Asparagus, tomatoes, garlic, and kale are just a few of the food sources containing prebiotics, which feed beneficial bacteria already living in your gut.

Future studies on the human microbiome and the relation between gut health and diabetes are necessary to establish a definite link and applicable treatments for diabetes. It is great to know this research is happening and trial studies like the one cited in this article are yielding great potential and basis for future studies.

New Study Shows Evidence That Vitamin K2 Positively Impacts Inflammation.

Story at-a-glance

  • A specific type of vitamin K2 (MK-7) may help prevent inflammation, according to new research
  • Vitamin K2, particularly menaquinone-7 (MK-7), has been the subject of extensive research because it stays active in your body longer enabling your body to benefit from much lower levels
  • Vitamin K2 works synergistically with a number of other nutrients, including calcium and vitamin D; one of its biological roles is to help move calcium into the proper areas in your body, such as your bones and teeth
  • MK-7 is found in high levels in the fermented soybean-based food called natto, certain cheeses such as Edam and Brie, and can also be taken in supplement form.

Chronic Pain


Chronic inflammation is low-grade and systemic, often silently damaging your tissues over an extended period of time. This process can go on for decadeswithout you noticing, until disease symptoms suddenly occur long after irreversible damage is done.

Chronic inflammation is the source of many diseases, including cancer, obesity, and heart disease, which essentially makes it the leading cause of death in the U.S.

Knowing how to keep chronic inflammation at bay is also invaluable in protecting your health, which brings us to a new study on vitamin K2 presented at the 13th International Nutrition and Diagnostics Conference (INDC 2013) in the Czech Republic.1

The study revealed that a specific type of vitamin K2 (MK-7) may help prevent inflammation. But before I get into the details, it’s important to understand the different forms that vitamin K comes in.

The Two Basic Types of Vitamin K – K1 and K2

Vitamin K can be classified as either K1 or K2:

    1. Vitamin K1: Found in green vegetables, K1 goes directly to your liver and helps you maintain a healthy blood clotting system. (This is the kind of K that infants need to help prevent a serious bleeding disorder.)

It is also vitamin K1 that keeps your own blood vessels from calcifying, and helps your bones retain calcium and develop the right crystalline structure.

    1. Vitamin K2: Bacteria produce this type of vitamin K. It is present in high quantities in your gut, but unfortunately most is passed out in your stool. K2 goes straight to vessel walls, bones and tissues other than your liver.

It is present in fermented foods, particularly cheese and the Japanese food natto, which is by far the richest source of K2.

Vitamin K1 can convert to K2 in your body, but there are some problems with this; the amount of K2 produced by this process alone is typically insufficient. Making matters even more complex, there are several different forms of vitamin K2. MK-8 and MK-9 come primarily from dairy products. MK-4 and MK-7 are the two most significant forms of K2 and act very differently in your body:

    • MK-4 is a synthetic product, very similar to vitamin K1, and your body is capable of converting K1 into MK-4. However, MK-4 has a very short biological half-life of about one hour, making it a poor candidate as a dietary supplement.

After reaching your intestines, it remains mostly in your liver, where it is useful in synthesizing blood-clotting factors.

    • MK-7 is a newer agent with more practical applications because it stays in your body longer; its half-life is three days, meaning you have a much better chance of building up a consistent blood level, compared to MK-4 or K1. MK-7 is extracted from the Japanese fermented soy product called natto.

You could actually get loads of MK-7 from consuming natto, as it is relatively inexpensive and is available in most Asian food markets. Few Americans, however, tolerate its smell and slimy texture.

Vitamin K2 as MK-7 Helps Prevent Inflammation in Your Body

Vitamin K2, particularly menaquinone-7 (MK-7), has been the subject of much research because it stays active in your body longer so you are able to benefit from much lower levels. The study from the Czech Republic evaluated the role of MK-7 in inflammation and found that it prevents inflammation by inhibiting pro-inflammatory markers produced by white blood cells called monocytes.

NattoPharma reported:2

The novel finding in our study supplements our three-year clinical study showing MK-7’s ability to slow down cardiovascular aging and osteoporosis, and it should further serve as the catalyst to create the urgency of daily consumption of MK-7… We know that in Western populations, most people do not obtain enough due to modern diet.

Our food is increasingly deficient in vitamin K2 in particular, and up to 98% of the general healthy population may be vitamin K2 insufficient with long-term detrimental impact on bone and cardiovascular health.”

It’s important to realize that dietary components can either trigger or preventinflammation from taking root in your body. For example, whereas synthetic trans fats and sugar, particularly fructose, will increase inflammation, eating healthy fats such as animal-based omega-3 fats found in krill oil or the essential fatty acid gamma linolenic acid (GLA) will help to reduce them.

MK-7 appears to be one more healthful natural substance that can be added to the anti-inflammatory list, and I’ll discuss the best food sources of this shortly.

As for inflammation in general, if you have not already addressed your diet, this would be the best place to start, regardless of whether you’re experiencing symptoms of chronic inflammation or not. To help you get started, I suggest following my free Optimized Nutrition Plan, which starts at the beginner phase and systematically guides you step-by-step to the advanced level.

What Else Is Vitamin K2 Good For?

The health benefits of vitamin K2 go far beyond blood clotting, which is done by vitamin K1, and vitamin K2 also works synergistically with a number of other nutrients, including calcium and vitamin D. Its biological role is to helpmove calcium into the proper areas in your body, such as your bones and teeth. It also plays a role in removing calcium from areas where it shouldn’t be, such as in your arteries and soft tissues.

Dr. Kate Rheaume-Bleue, a naturopathic physician, estimates that about 80 percent of Americans do not get enough vitamin K2 in their diet to activate their K2 proteins to shuttle the calcium where it needs to be and remove it from the places where it shouldn’t be. Vitamin K2 deficiency leaves you vulnerable to a number of chronic diseases, including:

Osteoporosis Heart disease Heart attack and stroke
Inappropriate calcification, from heel spurs to kidney stones Brain disease Cancer


“I talked about vitamin K2 moving calcium around the body. Its other main role is to activate proteins that control cell growth. That means K2 has a very important role to play in cancer protection,” Rheaume-Bleue says. “When we’re lacking K2, we’re at much greater risk for osteoporosis, heart disease, and cancer. And these are three concerns that used to be relatively rare. Over the last 100 years, as we’ve changed the way we produced our food and the way we eat, they have become very common.”

Researchers are also looking into other health benefits, as well. For example, one study published in the journal Modern Rheumatology found that vitamin K2 has the potential to improve disease activity besides osteoporosis in those with rheumatoid arthritis (RA).3 Another, published in the journal Science found that vitamin K2 serves as a mitochondrial electron carrier, thereby helping maintain normal adenosine triphosphate (ATP) production in mitochondrial dysfunction, such as that found in Parkinson’s disease.4 Further, according to a 2009 Dutch study, subtypes MK-7, MK-8 and MK-9 in particular are associated with reduced vascular calcification even at small dietary intakes (as low as 1 to 2 mcg per day).5

What Are the Best Food Sources of Vitamin K2, Including MK-7?

You can obtain all the K2 you’ll need (about 200 micrograms) by eating 15 grams of natto daily, which is half an ounce. However, natto is generally not appealing to a Westerner’s palate, so you can also find vitamin K2, including MK-7, in other fermented foods. Fermented vegetables, which are one of my new passions, primarily for supplying beneficial bacteria back into your gut, can be a great source of vitamin K if you ferment your own using the proper starter culture.

We had samples of high-quality fermented organic vegetables made with our specific starter culture tested, and were shocked to discover that not only does a typical serving of about two to three ounces contain about 10 trillion beneficial bacteria, but it also contained 500 mcg of vitamin K2.

Note that not every strain of bacteria makes K2. For example, most yogurts have almost no vitamin K2. Certain types of cheeses are very high in K2, and others are not. It really depends on the specific bacteria. You can’t assume that any fermented food will be high in K2, but some fermented foods are very high in K2, such as natto. Others, such as miso and tempeh, are not high in K2. In my interview with Dr. Rheamue-Bleue, she identified the cheeses highest in K2 are Gouda and Brie, which contain about 75 mcg per ounce. Additionally, scientists have found high levels of MK-7 in a type ofcheese called Edam.

How Much Vitamin K2 Do You Need?

Although the exact dosing is yet to be determined, Dr. Cees Vermeer, one of the world’s top researchers in the field of vitamin K, recommends between 45 mcg and 185 mcg daily for adults. You must use caution on the higher doses if you take anticoagulants, but if you are generally healthy and not on these types of medications, I suggest 150 mcg daily. Fortunately, you don’t need to worry about overdosing on K2—people have been given a thousand-fold “overdose” over the course of three years, showing no adverse reactions (i.e., no increased clotting tendencies). If you have any of the following health conditions, you’re likely deficient in vitamin K2 as they are all connected to K2:

  • Do you have osteoporosis?
  • Do you have heart disease?
  • Do you have diabetes?

Please note also that if you opt for oral vitamin D, you also need to consume vitamin K2 in your food or take supplemental vitamin K2, as they work synergistically together and an imbalance may actually be harmful. If you do not have any of those health conditions, but do NOT regularly eat high amounts of the following foods, then your likelihood of being vitamin K2 deficient is still very high:

  • Grass-fed organic animal products (i.e. eggs, butter, dairy)
  • Certain fermented foods such as natto, or vegetables fermented using a starter culture of vitamin K2-producing bacteria
  • Certain cheeses such as Brie and Gouda (as mentioned, these two are particularly high in K2, containing about 75 mcg per ounce)

If You’re Considering a Vitamin K2 Supplement …

There’s no way to test for vitamin K2 deficiency. But by assessing your diet and lifestyle as mentioned above you can get an idea of whether or not you may be lacking in this critical nutrient.  The next best thing to dietary vitamin K2 is a vitamin K2 supplement. MK-7 is the form you’ll want to look for in supplements, because in a supplement form the MK-4 products are actually synthetic. They are not derived from natural food products containing MK-4. The MK-7– long-chain, natural bacterial-derived vitamin K2– is from a fermentation process, which offers a number of health advantages:

  • It stays in your body longer
  • It has a longer half-life, which means you can just take it once a day in very convenient dosing

Finally, remember to always take your vitamin K supplement with fat since it is fat-soluble and won’t be absorbed without it.

Vitamin D and breast cancer: Emerging concepts.

Vitamin D and a few of the analogs have been studied for cancer chemoprevention and therapy. ► Vitamin D protects against stress induced cell death whereas suppresses cell proliferation of cancer cells. ► VDR Fok1 polymorphism can be used as a risk factor or for predicting response to vitamin D. ► Vitamin D regulates constitutive splicing of its target gene CYP24A1. ► Regulation of expression of certain microRNA by vitamin D can be used as useful markers for vitamin D responsiveness.


The benefit of vitamin D in cancer prevention and to certain extent therapy has been well recognized. The active form of vitamin D, 1,25-dihydroxycholecalciferol (1,25(OH)2 D3) is a natural ligand for vitamin D receptor (VDR). Since 1,25(OH)2D3 exerts toxic effects at a concentration that is beneficial, nearly 1500 analogs of vitamin D have been synthesized and evaluated for their efficacy in a variety of carcinogenesis and human cancer models both in vitro and in vivo. Among these only a handful of them have been approved for evaluation in clinical trials for leukemia, breast, prostate and colon cancers. The mechanism of vitamin D action is mediated by the nuclear VDR and the signaling cascade for its action is extensively reported. In this review we focus on the newer concepts for vitamin D action. These include (1) differential effects of vitamin D in maintaining cell proliferation when the cells are under stress but suppressing cell growth when the cells are transformed; (2) functional significance of VDR polymorphism in potential vitamin D responsiveness; (3) regulation of constitutive splicing of vitamin D target gene, CYP24a, by the hormone and its significance; and (4) regulation of microRNA by vitamin D in breast cancer. It is anticipated that the new work in these selective areas would expand the understanding of vitamin D in breast cancer prevention and therapy.

Source: cancer letters





“FORGOTTEN for Over 80 Years – Could this Be the New Vitamin D?”

Considered unimportant and forgotten for decades, scientists worldwide are now recognizing its extraordinary benefits to your bones and heart health.* This is one vital nutrient you do NOT want to be deficient in…

It’s been over 10 years, since I began educating and helping people understand the importance of vitamin D… specifically, vitamin D3.

Of course, I wasn’t alone in this effort. Many others contributed to helping overcome some of the myths about sunlight and how critical vitamin D3 is to your overall health.

And now I believe another nutrient, appropriately labeled the ’forgotten vitamin,’ is about to explode in popularity as researchers are uncovering more of its spectacular health benefits every day.

Why has it been forgotten and somewhat ignored for over 80 years?

I’m not sure anyone can really answer why this vitamin’s health-enhancing benefits have been so overlooked. But certainly there’s a clue to its importance here because in some areas of the world (like India), government health agencies regulate this vitamin.

If this nutrient did not have any beneficial health advantages, why would it be regulated by government health agencies?

Plus, your potential benefits from this extraordinary nutrient are pretty much off the chart.

For example, this vitamin…

  • Helps you build strong bones and keep them healthy*
  • Helps boost your vascular (arteries and veins) system*
  • Promotes your healthy heart*
  • Helps you fight against premature aging*
  • Enhances your memory function*

And this is just a start…

Before I get into more details on this vital nutrient, I must warn you up front… there are synthetic forms of this nutrient that may put your health at risk.

So, it’s very important to make sure you fully understand what to look for.

After all, the whole purpose here is to give more exposure to the ‘forgotten vitamin’ so you can reap the benefits… not to spike any health risk.

And that’s exactly what I’m planning to do. Just please pay close attention to the details on the different types of this nutrient to avoid potentially risky synthetics.

Next, let’s discover…

Why You Could be Deficient in this Vital Nutrient

It’s hard to understand why this vitamin has been so overlooked over the years. And estimates range as high as 99% of the population could be deficient in this nutrient.

There are many conditions where you could be putting yourself at risk for a higher likelihood of deficiency.

First of all, this vitamin is fat-soluble.

What does that mean? Well, fat-soluble simply means that dietary fat is necessary for efficient absorption.  So, if your diet does not contain adequate amounts of dietary fat, your absorption of this nutrient could be impacted.

There are additional conditions that could increase your risk of deficiency in this essential vitamin…

  • Eating a poor or restricted diet
  • Having certain conditions like Crohn’s, ulcerative colitis, celiac, and others that interfere with nutrient absorption
  • Dealing with a liver condition that interferes with vitamin storage
  • Taking certain medications such as broad-spectrum antibiotics, cholesterol drugs, and potentially aspirin that may impact or block vitamin absorption
  • Eating foods containing the wrong type of this vitamin with poor bioavailability

I’m ready to dive into your best natural source of this ‘forgotten vitamin’… but first, right up front, I want to further raise your awareness of…

Synthetic Pretenders – What to Look For and Avoid

If you haven’t figured out what the ‘forgotten vitamin’ is by now let me tell you that this new wonder kid on the block is vitamin K.  You can rest assured that in the next few years you will hear the media rave about its benefits.

But fortunately, since you are reading you can learn about this long before the rest of population discovers its benefits.

Danish scientist, Dr. Henrik Dam, discovered vitamin K in 1929. The ‘K’ is for ‘koagulation’ – essential for blood clotting.* But it only starts there.

Vitamin K is unique because it has multiple effects in your body, but doesn’t demonstrate any known toxicity. With research focused on potential effects on your skeletal system, brain, liver, and pancreas, vitamin K is one of the most promising nutrients of our time.*

But you should know about the different types. And in particular, know which synthetic type to be on the look out for.

There are three main forms of vitamin K…

  • K1-phylloquinone, aka phytonadione
  • K2-menaquinone
  • K3-menadione synthetic variant

Vitamin K3 is a synthetic variant of the vitamin which I don’t recommended for human consumption… this is the one you and your family need to avoid at all costs.

Green leafy vegetables – including lettuce, broccoli, and spinach contain vitamin K1. And it makes up about 90 percent of the vitamin K in the Western-style diet.

The vitamin K which I recommend is vitamin K2 natural, non-toxic, and made in your body as well.

Vitamin K2 includes several menaquinones (MK-n, with the ‘n’ determined by the number of prenyl side chains), such as MK-4 found in meats, MK-7, MK-8, and MK-9 found in fermented food products like cheese and natto.

What is Your Best Source of the ‘Forgotten Vitamin’?

One of the best natural sources of vitamin K2 comes from an ancient Japanese food called natto.

So, what is natto?


  • Is a fermented soybean food
  • Comes loaded with a healthy bacteria called bacillus subtilus that may also serve as a probiotic*

Fermented foods, like natto, typically have the highest concentration of vitamin K in the human diet. Levels of vitamin K found in natto (K2) have been shown to far exceed those amounts found in dark green vegetables (K1).

In fact, vitamin K2 concentration after the consumption of natto has been shown to be about 10 times higher than that of vitamin K1 after eating spinach.

Unfortunately, most people do not eat or enjoy many fermented foods.

And the absorption of vitamin K1 through eating green leafy vegetable is not very efficient… some research shows only about 10-15% gets absorbed even when consumed with dietary fat.

The problem with natto is that most people do not enjoy eating it because they find it very distasteful. It has a slippery texture with a strong flavor and pungent aroma.

Some people do acquire a taste for natto over time.  But many never do.

Any wonder why most people may be deficient in vitamin K?… They simply may not be eating the right food to provide what’s needed.

So, what can be done to solve this issue? That’s where I can offer some recommendations to help out.

Before we dive into that, I first want to address the natto issue and the fact that it comes from soy. If you’ve been a visitor to my site, you’re probably already aware that I’m not a big fan of soy. But if you look closely, there is one exception and that’s…

Why This Type of Soy Could be Healthful for You

Like I said, I’m not an advocate of eating unfermented soy.


Many people still believe unfermented and processed soy products like soy milk, soy cheese, soy burgers, and soy ice cream are actually healthful when nothing could be further from the truth.

Today’s high-tech processing methods leave toxic and carcinogenic residues created by high temperatures, high pressure, alkali and acid baths, and petroleum solvents in unfermented soy.

Natto does not come from unfermented soy… it’s derived from healthful fermented soy and provides an extraordinary rich source of vitamin K2.

Fermented Dairy – Another Excellent Source of Vitamin K2


While natto is the most potent natural source of vitamin K2, the nutrient is also readily available in fermented dairy products, especially cheeses.

Most cheeses are rich in vitamin K2… particularly, curd cheese. And even though it’s not as high in vitamin K2 as natto, curd cheese may be more palatable on a day-to-day basis for many people. Raw curd cheese made from grass fed cows would be best.

Like I mentioned earlier, most people have a difficult time acquiring a taste for natto… especially on the regular basis needed for healthy K2 absorption.

Curd cheese is also a good vitamin K2 source because it’s lower in fat (animal fat) than regular cheese.

When compared to natto in equal portions… Japanese food natto contains over 27 times more vitamin K2 than curd cheese.

No Good Vitamin K2 Test

One of the reasons vitamin D became so popular is that a relatively inexpensive test became commercially available in the 1990s.  That allowed researchers and clinicians to gain a better understanding of vitamin D.  Unfortunately there really isn’t a great commercial assay for vitamin K2 yet.

Sure there is a blood test.

But, this classic measure of vitamin K deficiency uses clotting time and what’s called ‘prothrombin’… which provides almost no value for determining vitamin K deficiency in your bones or arteries.

In fact in some cases, blood levels of vitamin K may appear normal while a real deficiency exists in your bones.

So, more work needs to be done in the area of vitamin K deficiency testing.

As this ‘forgotten vitamin’ gets more and more of the attention it deserves, I’m confident modern medical science will determine a more accurate test… just like the comprehensive test eventually created for vitamin D.

With potential health advantages (in addition to the ones already mentioned above) in which vitamin K has been shown to…

  • Promote your heart health*
  • Protect and support your skin*
  • Provide the calcium path ‘key’ from your bloodstream to your bones*
  • Boost your overall immune system*
  • Help regulate calcification of your tissues*
  • Provide you powerful antioxidant benefits*
  • Protect your cells against oxidative damage*
  • Aid in supporting your already normal blood sugar levels*

…it’s only a matter of time before a more comprehensive test evolves.

In the meantime, it’s important you take vitamin K deficiency seriously and take action to provide yourself and your loved ones with enough vitamin K.

And if you do not like the taste of natto, or prefer not to eat curd cheese, I have a phenomenal solution for you coming up.

But next, let’s take a closer look at…

How This Vitamin Goes to Work for YOU

While other nutrients are important for maintaining and promoting your bone health (like vitamin D3, calcium, and magnesium), evidence continues to grow indicating a vital role vitamin K plays in bone metabolism and healthy bone growth.*

In fact it may be the modern day “missing link” to increasing your bone density.

Vitamin K has been linked to osteoblasts, the cells that generate or ‘lay down’ bone and produce a specific protein known as osteocalcin.*

You can think of osteocalcin like the studs in the wall of your house. Basically, osteocalcin acts as the structural framework holding calcium in place in your bones.*

And vitamin K is critical for producing osteocalcin protein.*

Why is this so important? Because osteocalcin cannot perform its job until vitamin K converts it to an active bone-building form.

The bottom line – vitamin K is the ‘key’ that unlocks the door from your bloodstream to let calcium flow into your bones and bone marrow.*

Without this vitamin K key action, you simply wouldn’t have the strong bones you do.* Plus, there’s another area vitamin K plays an important role, particularly vitamin K2.

I mentioned earlier how osteoblasts are important cells responsible for bone formation.

Well, while these osteoblast cells are busy building bone, other cells called osteoclasts are trying to break down bone and remove bone tissue.

Vitamin K2 is so important because, not only has it been shown to stimulate and enhance osteocalcin production, it has also been shown to inhibit osteoclasts and help maintain your bones.*

Some Compelling Research

There are many research studies supporting how vitamin K2 works to help maintain healthy bone mass and growth through its effects on osteocalcin, osteoblasts, and osteoclasts.*

Here are few examples for reference purposes…

  • Journal of Bone and Mineral Research, 1997, Y. Koshihara and K Hoshi
    Journal reference: “The results proved that vitamin K2 increased Gla-containing osteocalcin, which accumulated osteocalcin in the extracellular matrix, and facilitated mineralization in vitro.”
  • Molecular and Cellular Biochemistry, 2001, ZJ Ma and M Yamaguchi
    Journal reference: “These results suggested that MK-7 (K2-7) has a suppressive effect on osteoclasts.”
  • Molecular and Cellular Biochemistry, 2001, M Yamaguchi et al1
    Journal reference: “This study demonstrates that MK-7 (K2-7) has an anabolic effect on bone tissue and osteoblastic (MC3T3-E1) cells in vitro, suggesting that the compound can stimulate osteoblastic bone formation.”

In a human study, Japanese scientists examined the effect of vitamin K2 from fermented soybeans on normal individuals.

The scientists reached the following conclusion – “This illustrates that intake of K2-7 can stimulate carboxylation (gamma-carboxylated osteocalcin), which plays an important role in bone formation in normal individuals.”

So, the evidence is quite compelling when it comes to the vital role vitamin K2 potentially plays in promoting your healthy bones.*

What is the Best Way for You to Get Vitamin K2?

Since I promised you an alternative natto solution for vitamin K2, let’s get right to it.

The bottom line here… your best bet for a natural source of K2 is from natto. And maybe you can find a reliable natural source and come to acquire a taste for it.

But I can tell you… I tried it myself on a regular basis but never really got used to the taste and smell. So, I decided to do the next best thing and look for a high quality inexpensive natural K2 supplement made from natto.

And let me tell you, finding a natural source of vitamin K2 turned out to be a real challenge.

Why? Well, not only did my team and I have to be on the lookout for risky synthetic imposters out there, we had to scrutinize the manufacturing processes very closely as well.

See, as I dug deeper and deeper into this, it became quite apparent how important a role the manufacturer must play in creating a natural high-quality K2 product.

Here are the key issues my team and I looked for when searching for a top manufacturer to deliver the highest quality vitamin K2 formula…

  • Must be non-GMO – Formulas including genetically modified organisms or processes are absolutely unacceptable.
  • Must be allergen-free – Other than fermented soy content from the soybeans, the formula has to be free from known allergens such as peanuts, tree nuts, milk, eggs, fin fish, shellfish, and wheat.
  • Must have a stable fermentation process – Natto fermentation process that involves other derivatives can be very unstable. Need a consistent reliable process that ensures product quality in the formula.
  • Must use vitamin K2-7 in the formula – Just like there are many varieties of vitamin K (K1, K2, K3), there are many varieties of K2. K2-7 produced from natto has proven to be one of the most bioavailable, stable, and beneficial varieties.*
  • Must be pure – Formula must be of the purest fashion with both internal and external lab validations following GMP standards and high-quality best practices.
  • Must be affordable – With all these rigorous requirements for this K2 formula, cost could be a real challenge. But affordability is one of my top priorities and cannot be overlooked.

The good news with all this is I was able to find, what I believe to be,  the highest quality vitamin K2 manufacturer in the world that could deliver the formula you need. 

Plus, this manufacturer not only met all of the stringent selection criteria, they exceeded many of them as well.

I’ll have more on that coming right up. But first I want to take a closer look at another reason why the vitamin K2 type requirement is so important.

Powerful Synergy with Vitamin D3


The surprising thing about what I’m going to review next is that some of the research has been available for over 10 years.

I guess this goes along with the whole ‘forgotten vitamin’ story.

If you’ve been a regular visitor to this site, you undoubtedly know how I feel about the vital role vitamin D3 plays in your optimal health.

Well, the amazing thing is research has shown vitamin K2 and vitamin D3 may provide you another level of benefits when taken together.*

Several studies have shown the following potential synergistic benefits when vitamin K2 and D3 are combined…

  • Increased bone formation*
  • Enhanced osteocalcin accumulation in cells*
  • Amplified bone mineral density*

So, vitamin K2 and D3 worked together in certain situations to help improve your bone health even more.*

Because vitamin D3 encourages calcium uptake to promote your strong and healthy bones, it’s not only a natural complement to vitamin K2, the two nutrients work together to boost your bone health to a higher level.*

What a phenomenal combination. Wouldn’t you agree?

Manufacturer’s Report Card for Producing this Health-Boosting Formula*

I mentioned earlier how I found a unique manufacturer of vitamin K2 that not only met my demanding requirements, but exceeded them.

Here’s a handy chart showing you how this selected K2 producer stacks up… and then next we’ll get into more details on how they exceeded my expectations.

Selection criteria: Mercola manufacturer? Other manufacturers?
Must be non-GMO
  • Yes – The product is not genetically modified in either the processes or the ingredients.
Some synthetic manufacturers of vitamin K3 and K2 natural formula ‘pretenders’ use GMOs.
Must be allergen-free (other than soybeans)
  • Yes – This manufacturer not only avoids using known allergens, it has effective procedures in place to avoid cross contamination during production processes.
Not all manufacturers of vitamin K2 go through both painstaking processes to avoid cross contamination and avoid allergen ingredients in their formulas.
Must be non-animal sourced
  • Yes – No animal sources are used in the formulation process
Some manufacturers may use animal sourced ingredients to create their vitamin K formula.
Must have a stable fermentation process
  • Yes – Stability and consistent high-quality are this manufacturer’s forte. Shelf life of K2 product is over 2 years. And not only do they have a dedicated facility for producing K2, they also filed a drug master file (DMF) fully characterizing the product to help ensure stability.
Very few if any manufacturers have dedicated facilities for producing vitamin K2 and even fewer ever file a DMF to characterize their formula.
Must use vitamin K2-7 in the formula
  • Yes – Only vitamin K2-7 (from natto fermentation) gets produced by this manufacturer in its dedicated facility in India.
There are many synthetic formulas of vitamin K (K3) produced that could be risky to your health. Plus, other varieties of vitamin K2 produced may not be as beneficial.
Must be pure
  • Yes – This manufacturer ensures purity by using a dedicated facility, adhering to GMP standards, and by voluntarily fully characterizing its K2-7 formula by filing DMFs.
To date, my team could not find any other manufacturer who followed such rigorous purity standards as this. To our knowledge, no other manufacturer has submitted a DMF for their vitamin K2.
Must be affordable
  • Yes – This is a big sticking point with the complex processes involved to produce K2-7. Yet, by using natto and a dedicated facility, economies of scale have kept costs reasonable.
Many forms of vitamin K2, and particularly K2-7, can be very expensive and almost prohibitive from practical use.

So, you can see how this manufacturer met my selection criteria with flying colors.

But what about the ways they exceeded (that I mentioned earlier)?

Well, I feel the biggest area they exceeded my expectations was with the…

Drug Master File – How Our Manufacturer Clearly Stands Above the Crowd

The comparison chart above introduced you to a new concept called drug master file (DMF).

The manufacturer I chose to provide vitamin K2 voluntarily submitted these types of files in India. Since it conforms to strict standards, the DMF can be used in any country.

What is a DMF and why is it so important here?

A Drug Master File (DMF) is a submission that may be used to provide confidential detailed information about facilities, processes, or articles used in the manufacturing, processing, packaging, and storing of one or more human drugs..

The astonishing thing about a DMF…it’s totally voluntary.

So, why would any manufacturer wish to expose their formula, facilities, processes, etc., when they don’t have to?

Well, that’s exactly why I chose this manufacturer to provide the vitamin K2 formula I was looking for… they have nothing to hide and go to the ‘nth degree’ to ensure stability and consistency of their formula.

In fact, to our knowledge, this manufacturer is the only one who has filed DMFs for vitamin K2.

Their Type II and Type III DMF submissions totally expose…

  • Formula substance and…
  • Materials used in the formula preparation and…
  • Packaging materials

Plus, the fact they have a dedicated and certified cGMP facility to only produce K2-7, speaks volumes for their commitment to purity and cross contamination protection.

Now you know why I only recommend Vitamin K2 as your source of vitamin K.

And there’s another area where this manufacturer’s dedicated facility in India comes into play…

How Production Costs are Kept in Check to Make the Formula Affordable

Many sources of vitamin K2 supplements tend to be expensive.

So, why is Vitamin K2 able to be reasonably priced?

It really all boils down to many of the same things we’ve already talked about that this manufacturer does. Things like…

  • Economies of scale By using a dedicated facility for vitamin K2-7, costs are more easily kept in check. Potential costly cross contamination issues from other formula lines are avoided. Manufacturer spent over 4 years building this super-efficient facility dedicated to vitamin K2 production.
  • Efficient fermentation processes By using natto from fermented soybeans to produce the Vitamin K2 formula, this is one of the most cost-efficient processes to yield vitamin K2-7.
  • Leveraging competitive advantages Many competitors are composed of very large companies (one is a Japanese billion-dollar conglomerate) that have very expensive overhead and processes to produce K2. Not so, with the Vitamin K2 manufacturer.

11 Powerful Reasons Why I Strongly Recommend this Formula

Let me quickly summarize the extraordinary potential benefits to your overall health from vitamin K2 – available in the Vitamin K2 formula…


  • Helps you build strong bones and keep them healthy*
  • Helps boost your vascular (arteries and veins) system*
  • Protects your cells against oxidative damage*
  • Promotes your heart health*
  • Protects and supports your skin*
  • Helps you fight against premature aging*
  • Provides calcium path ‘key’ from your bloodstream into your bones*
  • Boosts your memory function*
  • Helps regulate calcification of your tissues*
  • Provides you powerful antioxidant benefits*
  • Aids in supporting your already normal blood sugar levels*

These powerful benefits tell an incredible story about vitamin K2… rather amazing it’s been ‘forgotten’ for so long.

But keep in mind, without the high-quality manufacturer focused on stable and pure production of this nutrient built into the Vitamin K2 formula, your benefits could be significantly reduced.

Don’t just settle for any vitamin K or K2 supplement. Do like I do… demand the absolute best you can find.

And that’s exactly what I believe you have with Vitamin K2.