Vitamin K – K1, K2, K3 Forms & Benefits

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What Is Vitamin K?

Vitamin K is a group of fat-soluble vitamins that share similar chemical structures.

Vitamin K was discovered in 1929 as an essential nutrient for blood coagulation (blood clotting),  after restricted diets in animals led to excessive bleeding.  The initial discovery was reported in a German scientific journal, where it was called “Koagulationsvitamin” — which is where the “K” comes from.

Vitamin K was also discovered by the dentist Weston Price, who travelled the world in the early 20th century studying the relationship between diet and disease in different populations. He found that the non-industrial diets were high in some unidentified nutrient, which seemed to provide protection against tooth decay and chronic disease. He referred to this mystery nutrient as “activator X,” which is now believed to have been vitamin K2.

Although there are several different types of vitamin K, the two most often found in the human diet are vitamin K1 and vitamin K2:

  •  Vitamin K1 (phylloquinone),  is mostly found in plant foods like leafy green vegetables. It makes up about 75–90% of all vitamin K consumed by humans.
  • Vitamin K2 (menaquinone), is found in fermented foods and animal products, and is also produced by gut bacteria. It has several subtypes called menaquinones (MKs) that are named by the length of their side chain. They range from MK-4 to MK-13.
  • Vitamin K3, or menadione, is a synthetic form, not recommended; it’s important to note that toxicity has occurred in infants injected with this synthetic vitamin K3.

All members of the vitamin K group share a methylated naphthoquinone ring structure and vary in the aliphatic side chain attached at the 3-position. Although these vitamins share a major physiological role, each has other distinct physiological properties. Interestingly, the body is able to convert vitamin K1 to the more active K2.

Unlike other fat-soluble vitamins (A, D, and E), the body does not store vitamin K. It is recycled by the body but not in significant amounts, and therefore deficiencies are common. This is probably due to inadequate dietary intake, lack of cofactors, prescription drugs, and environmental stressors that place high demands on the body’s vitamin K reserves. Some scientists have suggested that the roles of vitamins K1 and K2 are quite different, and many feel that they should be classified as separate nutrients altogether.

This idea is supported by an animal study showing that vitamin K2 (MK-4) reduced blood vessel calcification whereas vitamin K1 did not. However, more human studies are needed before the functional differences between vitamins K1 and K2 can be fully understood.

Source: J Vasc Res. 2003 Nov-Dec;40(6):531-7. Epub 2003 Dec 3. Tissue-specific utilization of menaquinone-4 results in the prevention of arterial calcification in warfarin-treated rats.

According to a 2018 Medscape article by George D. Lundgren, MD… 

“Deficiencies of vitamin K2 are now being reported in serious journals to be associated with—all-cause mortality, cardiovascular disease, osteoporosis, diabetes, many forms of cancer, dementia, and chronic inflammation.”

According to an 2017 review article published the Journal of Nutrition and Metabolism… 

“Objective. To review the evidence for the use of vitamin K supplementation in clinical conditions such as osteoporosis, vascular calcification, arthritis, cancer, renal calculi, diabetes, and warfarin therapy. Quality of Evidence. PubMed was searched for articles on vitamin K (K1 and K2) along with books and conference proceedings and health conditions listed above. Level I and II evidence supports the use of vitamins K1 and K2 in osteoporosis and Level II evidence supports vitamin K2 in prevention of coronary calcification and cardiovascular disease. Evidence is insufficient for use in diabetes, arthritis, renal calculi, and cancer. Main Message. Vitamin K2 may be a useful adjunct for the treatment of osteoporosis, along with vitamin D and calcium, rivaling bisphosphonate therapy without toxicity. It may also significantly reduce morbidity and mortality in cardiovascular health by reducing vascular calcification. Vitamin K2 appears promising in the areas of diabetes, cancer, and osteoarthritis. Vitamin K use in warfarin therapy is safe and may improve INR control, although a dosage adjustment is required. Conclusion. Vitamin K supplementation may be useful for a number of chronic conditions that are afflicting North Americans as the population ages. Supplementation may be required for bone and cardiovascular health.”

Reference: Journal of Nutrition and Metabolism – Volume 2017 |Article ID 6254836 | 6 pages | https://doi.org/10.1155/2017/6254836 Vitamins K1 and K2: The Emerging Group of Vitamins Required for Human Health.

Food Sources of Vitamin K1 

Vitamin K1 is produced by plants. It is the predominant form of vitamin K found in the human diet.

The following list includes several foods that are high in vitamin K1. Each value represents the amount of vitamin K1 in 1 cup of the cooked vegetable.

  • Kale: 1,062 mcg
  • Collard greens: 1,059 mcg
  • Spinach: 889 mcg
  • Turnip greens: 529 mcg
  • Broccoli: 220 mcg
  • Brussels sprouts: 218 mcg

Food Sources of Vitamin K2

Food sources of vitamin K2 vary by subtype.

  • One subtype, MK-4, is found in some animal products and is the only form not produced by bacteria. Chicken, egg yolks and butter are good sources of MK-4.
  • MK-5 through MK-15 are forms of vitamin K2 with longer side chains. They are produced by bacteria and often found in fermented foods. Natto, a popular Japanese dish made from fermented soybeans, is particularly high in MK-7.
  • Certain hard and soft cheeses are also good sources of vitamin K2, in the form of MK-8 and MK-9. Additionally, a recent study discovered several pork products contain vitamin K2 as MK-10 and MK-11.

The vitamin K2 content for 3.5 ounces (100 grams) of several foods is listed below:

  • Natto: 1,062 mcg
  • Pork sausage: 383 mcg
  • Hard cheeses: 76 mcg
  • Pork chop (with bone): 75 mcg
  • Chicken (leg/thigh): 60 mcg
  • Soft cheeses: 57 mcg
  • Egg yolk: 32 mcg

Vitamin K activates proteins that play a role in blood clotting, calcium metabolism and heart health. One of its most important functions is to regulate calcium deposition. In other words, it promotes the calcification of bones and prevents the calcification of blood vessels and kidneys.

Sources: 

Here is a more technical description:

  • Vitamin K1 – participates in blood clotting — that is it’s primary purpose. (also, the preferential route of MK-4 production in the body is conversion of K1) Vitamin K1 is transported to the liver and regulates cofactors that aid in coagulation of the blood. The body can partly convert vitamin K1 to K2. This is useful, as the amount of vitamin K1 in a typical diet is ten times that of vitamin K2. However, current evidence indicates that the conversion process is inefficient.
  • Vitamin K2 – on the other hand, comes from a whole different set of food sources, and its primary biological role is to help move 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. “K2 is really critical for keeping your bones strong and your arteries clear,”.

Vitamin K2: A cofactor for carboxylase activity, it facilitates the gamma- carboxylation of bone-specific proteins such as osteocalcin (OC) and matrix Gla (MGP). OC takes calcium from the blood and binds it to the bone matrix, which in turn helps increase bone formation. MGP inhibits vascular and soft tissue calcification

During vitamin K deficiency or insufficiency, osteocalcin and MGP remain uncarboxylated, which is associated with lower bone mineral density (BMD) and an increased risk of osteoporosis and cardiovascular disease.

References: 

Differences Between K1 and K2 in the Body

The main function of all types of vitamin K is to activate proteins that serve important roles in blood clotting, heart health and bone health. However, because of differences in absorption and transport to tissues throughout the body, vitamin K1 and K2 could have profoundly different effects on your health.

Vitamin K1 Phytonadione: This vitamin is the natural form of vitamin K, which is found in plants and provides the primary source of vitamin K to humans through dietary consumption. Vitamin K1 is a yellow, viscous oil and is soluble in vegetable oils. Vitamin K1 is also called phylloquinone since it is an indirect product of photosynthesis in plant leaves, where it occurs in chloroplasts and participates in the overall photosynthetic process. Interestingly, vitamin K1 is sensitive to sunlight (destroyed after 1 hour). It is unaffected by diluted acids but is destroyed by basic solution and transformed by reducing agents. The absorption of vitamin K1 from servings of green vegetables ranging from 200 to 400 g without added fat is only between 5% and 10%. The oral recommended dietary allowance ranges from 90 to 120 mcg/day. The oral bone preservation dose is 10 mg/day.

In general, the vitamin K1 found in plants is poorly absorbed by the body. One study estimated that less than 10% of the K1 found in plants is actually absorbed. Less is known about the absorption of vitamin K2. Yet experts believe that because K2 is often found in foods that contain fat, it may be better absorbed than K1. This is because vitamin K is a fat-soluble vitamin. Fat-soluble vitamins are much better absorbed when eaten with dietary fat.

Vitamin K2 (Menaquinone): By far the most important form of vitamin K is K2. Vitamin K2 has several isoforms or analogues called MK-4 to MK-10. Mammals can synthesize K2 MK-4 from K1 to some degree, so dietary K1 and other forms of vitamin K may contribute to K2 MK-4 status. K2 MK-4 is the most active isoform. This vitamin provides major protection from osteoporosis and pathologic calcification. Calcification of the arteries and soft tissues is a major known consequence of aging. Vitamin K2 is found in animals and bacteria, including beneficial probiotic bacteria from the gastrointestinal (GI) tract. Antibiotics interfere with normal growth of healthy bacteria and impact vitamin K2 production.

MK-7 seems to have the most potent efficacy in terms of absorption and bioavailability. It is absorbed within 4 h of ingestion and exhibits 10-fold higher postprandial serum concentration than Vitamin K1. MK-7 has a longer half-life (72 h) and lasts up to 144 h in the circulation, while Vitamin K1 is rapidly cleared from plasma. Vitamin K1 absorption from green vegetables is less than 10 percent of the consumed amount, and the half-life is calculated to be 3 h. Studies on the excretion of Vitamin K2 in humans are lacking. At present, only one such study is available, and it reports that Vitamin K2 isoform MK-4 is excreted by bile and is removed from the liver faster than Vitamin K1. However, it is important to note that Vitamin K1 can be converted into Vitamin K2 isoform MK-4.

It is generally believed that humans require preformed K2 in the diet to obtain optimal health. This is also supported by feeding experiments. The absorption of vitamin K2 from natto, a fermented soy food, is nearly complete.

In a Japanese research study, vitamin K2 was found to decrease the risk of the development of liver cancer in female patients with viral cirrhosis, possibly by delaying the onset of the cancer. The researchers believe that a substance called geranyl-geraniol (a byproduct of vitamin K2) induces cell death in tumor cells, suggesting that it may play an important role in cell-growth inhibition. The study indicated that vitamin K2 decreased the risk of liver cancer to about 20% compared to the control group.

Additionally, vitamin K2’s long side chain allows it to circulate in the blood longer than K1. Where vitamin K1 may stay in the blood for several hours, some forms of K2 can remain in the blood for days. Some researchers believe that the longer circulation time of vitamin K2 allows it to be better used in tissues located throughout the body. Vitamin K1 is primarily transported to and used by the liver.

Health Benefits of Vitamin K1 and K2

Studies investigating the health benefits of vitamin K have suggested that it may benefit blood clotting, bone health and heart health.

Vitamin K and Blood Clotting

Several proteins involved in blood clotting depend on vitamin K to get their job done. Blood clotting may sound like a bad thing, and sometimes it is. Yet without it, you could bleed excessively and end up dying from even a minor injury.

Some people have blood clotting disorders and take a medication called warfarin to prevent the blood from clotting too easily. If you take this medication, you should keep your vitamin K intake consistent due to its powerful effects on blood clotting.

Although most of the attention in this area focuses on food sources of vitamin K1, it may also be important to monitor vitamin K2 intake. One study showed that a single serving of natto rich in vitamin K2 altered measures of blood clotting for up to four days. This was a much larger effect than foods high in vitamin K1. Therefore, it is probably a good idea to monitor foods high in vitamin K1 as well as vitamin K2 if you are on the blood-thinning medication warfarin.

Vitamin K and Bone Health

Many experts believe vitamin K activates proteins required for bone growth and development. Several observational studies have correlated low levels of vitamin K1 and K2 with a higher risk of bone fractures, though these studies are not as good at proving cause and effect as controlled studies. Most controlled studies examining the effects of vitamin K1 supplements on bone loss have been inconclusive and shown little benefit.

However, one review of controlled studies concluded that vitamin K2 supplementation as MK-4 significantly reduced the risk of bone fractures. 

Overall, the available studies have been somewhat inconsistent, but the current evidence was convincing enough for the European Food Safety Authority to conclude that vitamin K is directly involved in the maintenance of normal bone health.

Vitamin K and Heart Health

In addition to blood clotting and bone health, vitamin K also seems to play an important role in preventing heart disease.

Vitamin K activates a protein that helps prevent calcium from depositing in your arteries. These calcium deposits contribute to the development of plaque, so it’s not surprising that they are a strong predictor of heart disease.

Several observational studies have suggested that vitamin K2 is better than K1 at reducing these calcium deposits and lowering your risk of heart disease. However, higher quality controlled studies have shown that both vitamin K1 and vitamin K2 (specifically MK-7) supplements improve various measures of heart health.

Nevertheless, further studies are needed to prove that supplementing with vitamin K actually causes these improvements in heart health. Additionally, more research is needed to determine if K2 is truly better for heart health than K1.

References: 

  • Nutrients. 2020 Jun; 12(6): 1852. Published online 2020 Jun 21. doi: 10.3390/nu12061852 – Vitamin K2 Needs an RDI Separate from Vitamin K1. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353270/>
  • Schwalfenberg GK. Vitamins K1 and K2: The emerging group of vitamins required for human health. J Nutr Metab. 2017:6254836.
  • <https://www.healthline.com/nutrition/vitamin-k1-vs-k2#section1>
  • <https://link.springer.com/chapter/10.1007/978-1-4899-1789-8_19>
  • Maresz K. Proper calcium use: Vitamin K2 as a promoter of bone and cardiovascular health. Integr Med. 2015;14(1):34-39.
  • Lanham-New SA. Importance of calcium, vitamin D and vitamin K for osteoporosis prevention and treatment. Proc Nutr Soc. 2008;67(2):163-176.
  • Vitamin K Status and Vascular Calcification: Evidence from Observational and Clinical Studies – Adv Nutr. 2012 Mar; 3(2): 158–165. – Published online 2012 Mar 2. doi:  [10.3945/an.111.001644]
  • <https://www.healthline.com/nutrition/vitamin-k2#sources>
  • Int J Mol Sci. 2019 Feb; 20(4): 896. – Published online 2019 Feb 19. doi: 10.3390/ijms20040896 – PMCID: PMC6413124 – PMID: 30791399 – Vitamin K: Double Bonds beyond Coagulation Insights into Differences between Vitamin K1 and K2 in Health and Disease
  • Bugel S. Vitamin K and bone health in adult humans. Vitam Horm. 2008;78:393-416.
  • Shearer MJ, Newman P. Metabolism and cell biology of vitamin K. Thromb Haemost. 2008;100(4):530-547.
  • Beulens JW, Bots ML, Atsma F, et al. High dietary menaquinone intake is associated with reduced coronary calcification. Atherosclerosis. 2009;203:489-493.
  • Kakizaki S, Sohara N, Sato K, et al. Preventive effects of vitamin K on recurrent disease in patients with hepatocellular carcinoma arising from hepatitis C viral infection. J Gastroenterol Hepatol. 2007;22(4):518-522.
  • Okano T, Shimomura Y, Yamane M, et al. Conversion of phylloquinone into menaquinone-4 in mice, J Biol Chem. 2008;283:11270-11279.
  • Schurgers LJ, Vermeer C. Differential lipoprotein transport pathways of K-vitamin in healthy subjects. Biochem Biophys Acta. 2002;1570(1):27-32.
  • Verrax J, Taper H, Buc Calderon P.  Targeting cancer cells by an oxidant-based therapy. Curr Mol Pharmacol. 2008;1(1):80-92.
  • Booth SL, Suttie JW. Dietary intake and adequacy of vitamin K. J Nutr. 1998;128(5):785-788.

Proposed Synergy Between Vitamins D and K: Bone and Cardiovascular Health

  • Animal and human studies have demonstrated that vitamin D helps stimulate the production of vitamin K-dependent proteins, osteocalcin (OC) and matrix Gla (MGP), which support bone mineralization and decrease vascular calcification.
  • Long-term supplementation of vitamin D can lead to increased production of vitamin K-dependent proteins. If the increased demand is not adequately supported through diet or supplementation, the proteins can remain uncarboxylated, which can lead to increased vascular calcification and lower BMD.
  • Excess supplemental calcium intake without the support of vitamins D and K2 can lead to increased calcium deposits in the vascular tissue instead of the bones.

Reference: van Ballegooijen AJ et al. The synergistic interplay between vitamins D and K for bone and cardiovascular health: A narrative review. Int J Endocrinol. 2017;2017:7454376.

ADDITIONAL NOTE: To date, vitamin K2 is the only known nutrient that can not only protect from, but also reverse plaque buildup in the arteries. 

“Conclusions: A 270-day course of vitamin K2 administration in patients with chronic kidney disease stages 3-5 may reduce the progression of atherosclerosis, but does not significantly affect the progression of calcification. Vitamin K2 significantly changes the levels of calcification promoters and inhibitors: dp-ucMGP, OC, and OPG.”

“Conclusions: Dietary calcium is linked to many benefits, particularly bone health. Those benefits are why adequate daily intakes for calcium have been established. Because diets often fall short of the guidelines, in particular in individuals with higher needs, such as children, older adults, and postmenopausal women, dietary supplementation can help address the body’s demands. Although the outcomes in studies evaluating high calcium consumption are controversial, some studies do suggest caution when considering supplementation, particularly excessive supplementation, because some evidence points to health problems at elevated levels.3–8That issue could be remedied, however, if the right amount of vitamin K2 were to be added to a high-calcium regimen. Vitamin K2 promotes arterial flexibility by preventing accumulation of arterial calcium,10,47,62 and supplementation with it could correct calcium amounts in the body that are out of balance. Thus, calcium in tandem with vitamin K2 may well be the solution for bringing necessary bone benefits while circumventing an increased risk for heart disease.

“Taking a daily vitamin K2 MK-7 supplement is an action people can take to prevent arterial calcification. K2 has even been shown to reverse existing calcification and restore flexibility and elasticity to vessels. K2 regulates calcium in the body. Vitamin K2 is the necessary cofactor for the activation of osteocalcin proteins, which are produced by osteoblast cells located in the bones. Activated osteocalcin binds free-floating calcium in the blood and transports and integrates it into the bone matrix. Fully activated blood osteocalcin levels ensure that the maximum amount of available calcium is utilized for bone building.”

References: 

Vitamin K Toxicity…

“Toxicity of Vitamin K:  Although allergic reaction is possible, there is no known toxicity associated with high doses (dietary or supplemental) of the phylloquinone (vitamin K1) or menaquinone (vitamin K2) forms of vitamin K.”

“…vitamin K2 in the form of MK-7 has been shown to be a bioactive compound in regulating osteoporosis, atherosclerosis, cancer and inflammatory diseases without risk of negative side effects or overdosing.“

The same is not true for synthetic menadione (vitamin K3) and its derivatives. Menadione can interfere with the function of glutathione, one of the body’s natural antioxidants, resulting in oxidative damage to cell membranes. Menadione given by injection has induced liver toxicity, jaundice, and hemolytic anemia (due to the rupture of red blood cells) in infants; therefore, menadione is no longer used for treatment of vitamin K deficiency No tolerable upper intake level (UL) has been established for vitamin K.

Nutrient interactions of Vitamin K

Large doses of vitamin A and vitamin E have been found to antagonize vitamin K. Excess vitamin A appears to interfere with vitamin K absorption, whereas vitamin E may inhibit vitamin K-dependent carboxylase activity and interfere with the coagulation cascade. One study in adults with normal coagulation status found that supplementation with 1,000 IU/day of vitamin E for 12 weeks decreased γ-carboxylation of prothrombin, a vitamin K-dependent protein. Individuals taking anticoagulatory drugs like warfarin and those who are vitamin K deficient should not take vitamin E supplements without close medical supervision because of the increased risk of hemorrhage (excessive bleeding).

Drug interactions of Vitamin K

The anticoagulant effect of vitamin K antagonists (e.g., warfarin) may be compromised by very high dietary or supplemental vitamin K intake. Moreover, daily phylloquinone supplements of up to 100 μg are considered safe for patients taking warfarin, but therapeutic anticoagulant stability may be undermined by daily doses of MK-7 as low as 10 to 20 μg. 

It is generally recommended that individuals using warfarin try to consume the AI for vitamin K (90-120 μg/day) and avoid large fluctuations in vitamin K intake that might interfere with the adjustment of their anticoagulant dose. 

The prescription of anti-vitamin K anticoagulants, anticonvulsants (e.g., phenytoin), and anti-tuberculosis drugs (e.g., rifampin and isoniazid) to pregnant or breast-feeding women may place the newborn at increased risk of vitamin K deficiency.

Prolonged use of broad spectrum antibiotics, such as cephalosporins and salicylates, can interfere with vitamin K synthesisby intestinal bacteria and lower vitamin K absorption. The drug amiodarone, used in the management of certain cardiac arrhythmias (irregular heartbeat), including atrial fibrillation, can enhance the anticoagulant effect of warfarin and thus increase the risk of hemorrhage. Further, the use of cholesterol-lowering medications (like cholestyramine and colestipol), as well as orlistat, mineral oil, and the fat substitute, olestra, which interfere with fat absorption, may affect the absorption of fat-soluble vitamins, including vitamin K.

References:

  • Int J Mol Sci. 2019 Feb; 20(4): 896. – Published online 2019 Feb 19. doi: 10.3390/ijms20040896 – PMCID: PMC6413124 – PMID: 30791399 – Vitamin K: Double Bonds beyond Coagulation Insights into Differences between Vitamin K1 and K2 in Health and Disease
  • Ferland G. Vitamin K. In: Erdman Jr. JW, Macdonald IA, Zeisel SH, eds. Present Knowledge in Nutrition. 10th ed. Ames: Wiley-Blackwell; 2012:230-247.
  • Food and Nutrition Board, Institute of Medicine. Vitamin K. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, D.C.: National Academy Press; 2001:162-196. (National Academy Press) 
  • <https://lpi.oregonstate.edu/mic/vitamins/vitamin-K>

Vitamin K and Blood Thinning Medications

“We conclude that short-term variability in intake of K(1) is less important to fluctuations in the international normalized ratio (INR) than has been commonly assumed and that food supplements providing 100 mcg/day of vitamin K(1) do not significantly interfere with oral anticoagulant therapy.“

Source: Blood. 2004 Nov 1;104(9):2682-9. Epub 2004 Jul 1. – Effect of vitamin K intake on the stability of oral anticoagulant treatment: dose-response relationships in healthy subjects.

“CONCLUSIONS: MK-7 supplementation at doses as low as 10 μg (lower than the usual retail dose of 45 μg) significantly influenced anticoagulation sensitivity in some individuals. Hence, the use of MK-7 supplements needs to be avoided in patients receiving VKA therapy.“

Source: J Thromb Haemost. 2013 Jun;11(6):1085-92. doi: 10.1111/jth.12203. – Effect of low-dose supplements of menaquinone-7 (vitamin K2 ) on the stability of oral anticoagulant treatment: dose-response relationship in healthy volunteers.

Editor’s Note: As was pointed out by Stephen Sinatra. MD from the HeartMD Institute™ regarding the use of fish oils / omega-3 fatty acids (which would also apply to the health benefits of vitamin K)… “If you find that fish oil causes your blood to thin too much, use it as an opportunity to ask about reducing the dosage of your prescription blood thinner. But don’t give up your fish oil, unless you absolutely have to. The benefits are simply too great to forego.”

Note: The real concern is the consistency of consumption of vitamin K or any natural substance that has the potential of thinning the blood, so the blood thinning medication dose can be adjusted based in the INR. The goal is to have a consistent level of vitamin K and a therapeutic INR.

Note: Coenzyme Q10 is chemically similar to vitamin K2 (menaquinone) and can have vitamin K-like effects, including antagonism of warfarin. Concomitant use of coenzyme Q10 and vitamin K might cause additive effects and increase the risk of clotting in people taking anticoagulants.

Sources: 

  • Spigset O. Reduced effect of warfarin caused by ubidecarenone. Lancet 1994;334:1372-3. 
  • Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm 2000;57:1221-7.


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