Recreational and Pharmaceutical Drugs and BAV/Stenosis

[Paleowoman]

As for vitamin K2 helping put calcium in the bones rather than the arteries how does being on warfarin and it's relation to vitamin K affect that process if at all? I know there are people on warfarin who take a regular vitamin K supplement and I assume that would mean they may have to take a higher dose of warfarin to offset the higher K levels but do they still get the benefit of "vitamin K putting the calcium where it belongs , in the bones not the arteries"?

I don't know how vitamin K affects warfarin but the most important thing to remember here is that there are essentially two K vitamins which have diffferent effects. It's vitamin K2 which puts calcium in the bones rather than the arteries. Vitamin K1 is the coagulant vitamin. K2 is nothing to do with coagulation. K1 and K2 come from different food sources too. They are very different vitamins from each other so when you are doing your research that's important to bear in mind.

 

[cldlhd]

I don't know how vitamin K affects warfarin but the most important thing to remember here is that there are essentially two K vitamins which have diffferent effects. It's vitamin K2 which puts calcium in the bones rather than the arteries. Vitamin K1 is the coagulant vitamin. K2 is nothing to do with coagulation. K1 and K2 come from different food sources too. They are very different vitamins from each other so when you are doing your research that's important to bear in mind.

Thanks for the info. I was aware that there were 2 different types of vitamin K but I had no idea one ( K1) had to do with coagulation and the other (K2) affected getting calcium in the bones and not the arteries. I guess if you're on warfarin you'd try to get enough K2 without getting too much K1. From what I've read it seems vitamin D and magnesium play a role in getting calcium where it belongs also.

 

[newmitral]

... K2 is nothing to do with coagulation. .

This is not correct, and it is dangerous to let people on warfarin think that K2 will not affect their INR. Please read my posts in this older thread from about a year ago:
http://www.valvereplacement.org/foru...amin-k-tablets

I give links to some medical journal papers, including several which show that K2 indeed has significant impact on coagulation/INR, and in fact some forms of K2 (MK-7) last much longer in the system so the effect can build up over several days and have a greater impact on INR than equivalent daily amounts of K1.

 

[shanwow1]

Continuing with the anecdotal experience of using "substances" by BAV patients:
1. Caffeine: I stopped drinking caffeinated drinks several years ago because I didn't find they made me more alert, and I found I would just get kind of light-headed and shaky, maybe due to a faster heartbeat and my heart not being able to compensate? Hard to say. Decaf drinks are fine (I still like the taste of coffee). I also do take Tylenol Migraine for my migraines, which has caffeine in it, which is supposed to help migraines, I'm not sure what the science is behind that. My migraines make me weak and shaky anyway so I figure a little caffeine can't hurt.
2. Alcohol: I would say I "drink to excess" (ie. get drunk) every couple of months, socially (I'm still pre-op, likely will not be doing this once I get my mechanical valve). Definitely feel my heart rate increase, and a pounding sensation on hangover day.
3. Marijuana: Use very occasionally, socially. My problem is that my friends tend to bring it out when we have already been drinking, and I don't like to combine the two. I tried it a few months ago and the result was my heart racing, nausea, inability to focus on anything and paranoia. So, probably won't be doing that again.
4. Cigarettes/Nicotine: Never been a smoker/chewer/whatever else you can do with tobacco.
No experience with other recreational drugs.

 

[Paleowoman]

This is not correct, and it is dangerous to let people on warfarin think that K2 will not affect their INR.

I didn't say it didn't affect INR, I said I didn't know how it affects warfarin, but that K2 is what affects calcium, whereas K1 is the coagulation vitamin ! I wouldn't give medical advice to anyone on warfarin ! Sorry if my post came across as though it's okay to take K2 if you are on warfarin, I tried to make it clear that I didn't know.

 

[Paleowoman]

From what I've read it seems vitamin D and magnesium play a role in getting calcium where it belongs also.

Yes indeed. And vitamin A. Vitamins D3, A and K2 are synergistic. This book by Dr Kate Rheaum-Bleue: "Vitamin K2 and the Calcium Paradox" is good at explaining all this: http://www.amazon.com/Vitamin-K2-Ca...1419362204&sr=1-1&keywords=kate+rheaume-bleue

 

[pellicle]

Hi

I didn't say it didn't affect INR, I said I didn't know how it affects warfarin,

I think people need to be careful in their choices of words. Stuff like "I think that .." and "as far as I know...." is much better than saying stuff like:

Vitamin K1 is the coagulant vitamin. K2 is nothing to do with coagulation

when actually (as discussed below) it is something to do with coagulation and anticoagulation.

Given how we all are frustrated by mis-information on anticoagulation (especially from the medical professionals who "care" for us), I think it behooves us to try to not add to that steaming pile of mis-information.

So if you have doubt in your mind instead express to suggest that:
"As far as I know, Vitamin K1 is the coagulant vitamin. I don't think K2 has anything to do with coagulation."


Many people read these forums and take away what we say. So if you speak with absolutes then people may not read the small print disclaimers.

Anyway, to clear up a few things: as you said:

I don't know how vitamin K affects warfarin

essentally vitamin K does not effect warfarin ... warfarin effects how our body process vitamin K (and does not act on vitamin K directly).

First, what is Vitamin K
http://en.wikipedia.org/wiki/Vitamin_K

Vitamin K1, also known as phylloquinone, phytomenadione, or phytonadione, is synthesized by plants, and is found in highest amounts in green leafy vegetables because it is directly involved in photosynthesis. It may be thought of as the "plant" form of vitamin K. It is active as a vitamin in animals and performs the classic functions of vitamin K, including its activity in the production of blood-clotting proteins. Animals may also convert it to vitamin K2.

K1

K2

note that they are chemically very similar because they are just variants of each other ... importantly animals can convert K1 to K2 ... (which would make K2 not actually a vitamin but I digress)

http://en.wikipedia.org/wiki/Vitamin...g_interactions

Anticoagulant drug interactions
Phylloquinone (K1) or menaquinone (K2) are capable of reversing the anticoagulant activity (incorrectly but colloquially referred to as "blood-thinning action") of the powerful anticoagulant warfarin (tradename Coumadin). Warfarin works by blocking recycling of vitamin K, so that the body and tissues have lower levels of active vitamin K, and thus a deficiency of the active vitamin.

so both play a role and we see the method of action of warfarin ...


http://en.wikipedia.org/wiki/Vitamin_K_antagonist

These drugs deplete the active form of the vitamin by inhibiting the enzyme vitamin K epoxide reductase and thus the recycling of the inactive vitamin K epoxide back to the active reduced form of vitamin K. The drugs are structurally similar to vitamin K and act as competitive inhibitors of the enzyme. The term "vitamin K antagonist" is a misnomer, as the drugs don't directly antagonise the action of vitamin K in the pharmacological sense, but rather the recycling of vitamin K.

http://en.wikipedia.org/wiki/Vitamin...xide_reductase

Vitamin K epoxide reductase (VKOR) is an enzyme that reduces vitamin K after it has been oxidised ... in blood coagulation enzymes
Its C1 subunit (VKORC1) is the target of anticoagulant warfarin.

So to be clear, both K1 and K2 effect coagulation. Warfarin does not act on Vitamin K (the body uses it thus disabling it, then warfarin prevents the recycling of the "digested" version back to a digestable version"

now onto the issues of calcium ... there is some research on this and as it stands at the moment there is nothing conclusive.
http://en.wikipedia.org/wiki/Vitamin...nd_bone_health

Menaquinone-7 (MK-7), which is abundant in fermented soybeans , has been demonstrated to stimulate osteoblastic bone formation and to inhibit osteoclastic bone resorption.[104] In another study, use of MK-7 caused significant elevations of serum Y-carboxylated osteocalcin concentration, a biomarker of bone formation. MK-7 also completely inhibited a decrease in the calcium content of bone tissue by inhibiting the bone-resorbing factors parathyroid hormone and prostaglandin E2.[105] On 19 February 2011, HSA (Singapore) approved a health supplement that contains vitamin K2 (MK-7) and vitamin D3 for increasing bone mineral density

but:
http://advances.nutrition.org/content/3/2/149.full

Vitamin K-Dependent Carboxylation of Osteocalcin: Friend or Foe?

Abstract

Osteocalcin originates from osteoblastic synthesis and is deposited into bone or released into circulation, where it correlates with histological measures of bone formation. The presence of 3 vitamin K-dependent ? carboxyglutamic acid residues is critical for osteocalcin’s structure, which appears to regulate the maturation of bone mineral. In humans, the percentage of the circulating osteocalcin that is not ?-carboxylated (percent ucOC) is used as a biomarker of vitamin K status. In contrast, when ucOC is not corrected for total osteocalcin, the interpretation of this measure is confounded by osteoblastic activity, independent of vitamin K. Observational studies using percent ucOC have led to the conclusion that vitamin K insufficiency leads to age-related bone loss. However, clinical trials do not provide overall support for the suggestion that vitamin K supplementation of the general population will reduce bone loss or fracture risk. More recently, results from in vitro and in vivo studies using animal models indicate that ucOC is an active hormone with a positive role in glucose metabolism. By inference, vitamin K, which decreases ucOC, would have a detrimental effect. However, in humans this hypothesis is not supported by the limited data available, nor is it supported by what has been established regarding osteocalcin chemistry. In summary, the specific function of osteocalcin in bone and glucose metabolism has yet to be elucidated.

so basically as I understand the situation, we just don't know about bone calcium and vitamin K yet ... anyway


Merry Christmas to everyone

 

[Paleowoman]

Hi Pell,

You are absolutely right about the wording on forums regarding absolutes, I thought I'd worded it correctly, obviously not. I know nothing about warfarin or the effect of any supplement or medication on it.

Re the vitamin K2, there is currently a human clinical trial going on to assess "The Effects of Vitamin K2 Supplementation on the Progression of Coronary Artery Calcification" at Maastricht University:

"Both Coronary Artery Calcification (CAC)and its annual progression are a strong predictors of cardiovascular events. The development of arterial calcification results from imbalance between calcification promoting and inhibiting factors. An important inhibitor of calcification is Matrix Gla Protein (MGP): a protein present in the vascular wall where it is synthesized by Vascular Smooth Muscle Cells (VSMC). MGP requires Vitamin K-mediated carboxylation to function properly. Deficiency of Vitamin K has been demonstrated to cause arterial calcification and a diet containing large amounts of Vitamin K2 was associated with lower CAC and cardiovascular risk. In animal studies, active supplementation of Vitamin K2 caused regression of existing arterial calcification. Therefore, the aim of this randomized, double-blind, placebo-controlled clinical trial is to investigate whether daily supplementation of Vitamin K2 (Menaquinone-7) to patients with established CAC will lead to a decreased progression-rate of CAC after 24 months of follow-up in comparison to placebo."

https://clinicaltrials.gov/ct2/show/NCT01002157

But, as far as I know, BAV becomes stenosed and calcified because the valve is narrow to begin with due to having two cusps, not the normal three, and that leads to turbulent blood flow which leads to calcification and increased stenosis and so on.

 

[cldlhd]

Hi



I think people need to be careful in their choices of words. Stuff like "I think that .." and "as far as I know...." is much better than saying stuff like:



when actually (as discussed below) it is something to do with coagulation and anticoagulation.

Given how we all are frustrated by mis-information on anticoagulation (especially from the medical professionals who "care" for us), I think it behooves us to try to not add to that steaming pile of mis-information.

So if you have doubt in your mind instead express to suggest that:
"As far as I know, Vitamin K1 is the coagulant vitamin. I don't think K2 has anything to do with coagulation."


Many people read these forums and take away what we say. So if you speak with absolutes then people may not read the small print disclaimers.

Anyway, to clear up a few things: as you said:


essentally vitamin K does not effect warfarin ... warfarin effects how our body process vitamin K (and does not act on vitamin K directly).

First, what is Vitamin K
http://en.wikipedia.org/wiki/Vitamin_K



K1

K2

note that they are chemically very similar because they are just variants of each other ... importantly animals can convert K1 to K2 ... (which would make K2 not actually a vitamin but I digress)

http://en.wikipedia.org/wiki/Vitamin...g_interactions




so both play a role and we see the method of action of warfarin ...


http://en.wikipedia.org/wiki/Vitamin_K_antagonist




http://en.wikipedia.org/wiki/Vitamin...xide_reductase



So to be clear, both K1 and K2 effect coagulation. Warfarin does not act on Vitamin K (the body uses it thus disabling it, then warfarin prevents the recycling of the "digested" version back to a digestable version"

now onto the issues of calcium ... there is some research on this and as it stands at the moment there is nothing conclusive.
http://en.wikipedia.org/wiki/Vitamin...nd_bone_health



but:
http://advances.nutrition.org/content/3/2/149.full



so basically as I understand the situation, we just don't know about bone calcium and vitamin K yet ... anyway


Merry Christmas to everyone

Thanks for the interesting post. I've read a few studies that claim K1 is converted to K2 in the gut so K2 in your diet is unnecessary . Others say the converted K2 is largely unavailable due to being coated in bacteria so it mostly just passes through your system. The latter suggest getting K2 in your diet eating fermented cheeses or natto. Unfortunately fermented foods are known migraine triggers so for those of us that occasionally suffer from that affliction that's probably not something we'd want to eat regularly. Which leads me to wonder if a K2 supplement would also be a migraine trigger, if not that would be preferable to fermented foods.
Merry Christmas

 

[Paleowoman]

Thanks for the interesting post. I've read a few studies that claim K1 is converted to K2 in the gut so K2 in your diet is unnecessary . Others say the converted K2 is largely unavailable due to being coated in bacteria so it mostly just passes through your system.

It's the bacteria in your gut which can convert K1 into K2 BUT the bacteria keep it for themselves. Rabbits eat their droppings and so get K2. I once contacted Dr Vermeer who is doing research into K2 and coronary calcification at Maastricht university and asked how people got K2 before supplements and fermented foods. The answer is that prior to even 100 hundred years ago people did not have refrigeration and so the foods they ate, particularly meat, were ever so slightly putrefying - not dangerously so but just sightly - and in the process K2 was made by the bacteria doing the putrifying and people got it from their foods. It's simple though to get K2 from supplements and has not been shown to be harmful….EXCEPT I cannot say that with impunity for those on warfarin !

PS - I take 300 mcg of K2 as MK-7 per day and have taken it now for over four years. My cardiologist, cardiac surgeon, GP and all the other doctors I'm under know this and are fine with it, I was even taking it in hospital post surgery - the nurse would hand it to me along with my prescribed meds. My endocrinologist is most interested in the ongoing research into K2.

Happy Christmas !

 

[cldlhd]

So my options are eating semi rotten meat, "droppings" , or supplements ? I just ordered Douglas Labs soy free MK-7 k2. My only hesitation is that I never knew what it was about fermented foods that trigger migraines and since they're loaded with K2 I thought that may be it but a little research shows that's supposedly Tyramine is the culprit.