My name is Sanjay Gupta and I'm a cardiologist in York. Today I wanted to talk to you about how our bones and our heart are connected and how understanding this connection could help solve the mystery of why coronary artery diseases so prevalent in the Western world. Now as we age there are a couple of pathologies that start becoming more prevalent, frailty and heart disease. Our bones become thinner and weaker due to a lack of calcium and this leads to osteoporosis making our bones more brittle and making them more susceptible to fractures. Also as we age we see that coronary artery disease becomes significantly more prevalent and is characterized by increased calcification in the walls of our coronary arteries. This is interesting because osteoporosis is characterized by a lack of calcium and coronary artery disease is characterized by too much calcium and both pathologies are often found in the same patients. To prevent osteoporosis many patients are given or take calcium supplements. This is even when total body calcium levels are not reduced. However recent research suggests that calcium supplementation could actually increase the risk of coronary artery disease. In a recent publication researchers conducted a systematic meta-analysis of 13 double blind placebo controlled randomized trials and found that a dietary calcium intake of 700 to 1000 milligrams per day or a supplementary calcium intake of 1000 milligrams per day significantly increase the risk of coronary artery disease. I will put all these references down in the description below so you can check them out for yourself. But really interesting, interesting that when you give people calcium for a condition that is characterized by a lack of calcium, something else, I coronary artery disease gets worse, something which is characterized by too much calcium gets worse and even more interestingly in a recent meta-analysis they found that actually calcium and or vitamin D supplementation which was given to reduce the likelihood of fractures does not seem to reduce fracture incidence in community developing older adults anyway. So very interesting again, interesting because you're giving calcium for a condition that is characterized by a lack of calcium but it makes no difference to that but instead it makes coronary artery disease worse and coronary artery disease is characterized by too much calcium. So all very interesting and could it therefore be that as we get older the calcium which was meant to get deposited in our bones is getting deposited in our coronary arteries instead. Could this therefore be the reason why increasing calcium intake does nothing for our bones but actually increases heart disease. Now since these observations a lot of interest is focused on vitamin K and in particular a subtype of vitamin K called vitamin K2. Vitamin K2 is a fat soluble vitamin and it helps activate osteocalsin and this is a compound which helps take calcium out of the blood and deposit it in the bone. So if there is a shortage of vitamin K2 the calcium does not bind to the bone it does not get taken out of the blood and it doesn't get trapped in the bone and therefore the bones get thinner. Now in the tissues especially in smooth muscle cells and our blood vessels are consists of smooth muscle cells there exist proteins called matrix GLA proteins and they have the function of removing calcium from the tissues and putting it back in the blood but to do so they need to be activated by vitamin K2 and vitamin D. So if there's a shortage of vitamin K2 these matrix GLA proteins do not get activated and therefore become non-functional and calcium does not get removed from the blood vessels in the tissues and therefore accumulates there and contributes to heart-artory narrowings. Now interestingly there was a study in the journal of vascular research in 2008 which showed that the amount of non-functional matrix GLA protein i.e. the GLA protein that was not activated by vitamin K2 was directly correlated with the magnitude of vascular calcification i.e. more non-functional matrix GLA protein because there's not enough vitamin K2 to activated the higher the likelihood of vascular calcification. So is there any evidence that making a concerted effort to increase vitamin K2 could be helpful? Well yes there have been several studies that have confirmed this. There was the Rotterdam study which took 5,000 men and women above the age of 55 followed them up for 8 to 11 years and found that diets rich in vitamin K2 were associated with a 50% reduction in arterial calcification and cardiovascular depth. In fact mortality from all causes was reduced by 25%. There was another study called the Prospect Epic study and this looked at dietary K2 levels and coronary disease in 16,000 women and found that with each additional 10 micrograms a day of K2 supplementation there was a 9% reduction in cardiovascular mortality. This is really very good you know these are good numbers. Now in 2015 there was another really interesting study which was which is now known as the Nathan study because the lead author was called Nathan K and A P E N which showed that increased vitamin K2 levels doses of 180 micrograms per day actually resulted in reversal of coronary artery calcification and restoration of arterial flexibility. As doctors we were taught about vitamin K1 and I always know vitamin K1 to be an essential vitamin for formation of blood clarts when the body needs it but I wasn't really taught about vitamin K2. We know good sources of vitamin K1 come from green leafy vegetables such as spinach and broccoli. On the other hand vitamin K2 is actually found in animal products dairy and fermented foods such as cheese, sour, crowd and a soybean product called natto. In fact natto contains the largest amount of vitamin K2 and unless fermented foods are a large part of your diet you end up having to rely on animal products for your vitamin K2. Animals will eat vitamin K1 rich plants and convert the vitamin K1 to vitamin K2 in their bodies. The problem these days are that the quality of animal products is greatly deteriorated as animals tend to be grain fed rather than grass fed and therefore are not consuming as many vitamin K rich plants and therefore may no longer offer a rich source of vitamin K2. This is why the western diet is generally viewed as a K2 deficient diet and in fact there was a publication which suggested that 10 to 40% of matrix GLA proteins in the normal western population are non-activated, pointing to vitamin K2 deficiency and this good in turn be the cause of the higher incidence of coronary disease that is seen in the west. So whilst this is all very thought provoking the benefits of vitamin K2 have not really been taken up by mainstream medical fraternity. Modern day medicine as I'm sure you all realize is servile to clinical guidelines and clinical guidelines in turn are servile to evidence accrued from large scale clinical trials most of which are conducted and funded by big pharmaceutical companies. As there is no large scale randomized placebo controlled clinical trial testing to the benefits of vitamin K2 it will not be recommended or even be advised against by a doctor who incidentally will be more than enthusiastic about recommending statins. The problem is that it is unlikely that such a large scale study will ever be done because firstly it will need to rehoot a very large number of patients. Secondly it will need to follow these patients up for a very long time and therefore it's going to be a very expensive endeavor and no pharmaceutical company is going to get interested because there won't be much money to be made out of this. You know I come across a lot of patients who now end up having coronary calcium scores they want they're worried about their health they come to me they say oh test me out for heart disease and we send them for you know coronary CTs which look at the blood vessels and the CT will tell you how much calcium is in their blood vessels. The problem is I send patients for this but I don't really know what to do about it when the results come back you know at this point in time all we recommend and because this is what the guidelines suggest is if you've got calcium sure your risk is increased what do you do to reduce it well lead a good lifestyle and maybe take statins you know and that's it that's all we have and so I'm always on the lookout thinking well what else can help what else can help these people you know I've now introduced the sphere in their minds by doing a test and I'm telling them they have coronary archive calcification but what can we do about it you know most patients on particularly keen to take statins and they most of them lead good lifestyles anyway and I have to say I've certainly been impressed with the purported benefits of vitamin K2 since I started doing my research on this subject and I've certainly started supplementing with vitamin K2 myself and making a more conscious effort to increase fermented foods in my diet. I hope you found this useful I would love to hear your comments thank you so much for all your support all the best