DOCSLIB.ORG

Scientific Opinion on Dietary Reference Values for Vitamin K

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Scientific Opinion on Dietary Reference Values for Vitamin K SCIENTIFIC OPINION ADOPTED: dd mmmm 2017 doi:10.2903/j.efsa.2017.NNNN 1 Dietary Reference Values for vitamin K 2 EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA), 3 Dominique Turck, Jean-Louis Bresson, Barbara Burlingame, Tara Dean, Susan Fairweather- 4 Tait, Marina Heinonen, Karen-Ildico Hirsch-Ernst, Inge Mangelsdorf, Harry J McArdle, 5 Androniki Naska, Grażyna Nowicka, Kristina Pentieva, Yolanda Sanz, Alfonso Siani, Anders 6 Sjödin, Martin Stern, Daniel Tomé, Henk Van Loveren, Marco Vinceti, Peter Willatts, Christel 7 Lamberg-Allardt, Hildegard Przyrembel, Inge Tetens, Céline Dumas, Lucia Fabiani, Sofia 8 Ioannidou and Monika Neuhäuser-Berthold 9 10 Abstract 11 Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition and 12 Allergies (NDA) derives Dietary Reference Values (DRVs) for vitamin K. In this Opinion, the Panel considers 13 vitamin K to comprise both phylloquinone and menaquinones. The Panel considers that none of the biomarkers 14 of vitamin K intake or status is suitable by itself to derive DRVs for vitamin K. Several health outcomes possibly 15 associated with vitamin K intake were also considered but data could not be used to establish DRVs. The Panel 16 considers that Average Requirements and Population Reference Intakes for vitamin K cannot be derived for 17 adults, infants and children, and therefore sets Adequate Intakes (AIs). The Panel considers that available 18 evidence on occurrence, absorption, function and content in the body or organs of menaquinones is insufficient, 19 and, therefore, sets AIs for phylloquinone only. Having assessed additional evidence available since 1993 in 20 particular related to biomarkers, intake data and the factorial approach, which all are associated with 21 considerable uncertainties, the Panel maintains the reference value proposed by the Scientific Committee for 22 Food (SCF) in 1993. An AI of 1 µg phylloquinone/kg body weight per day is set for all age and sex population 23 groups. Considering the respective reference body weights, AIs for phylloquinone are set at 70 μg/day for all 24 adults including pregnant and lactating women, at 10 μg/day for infants aged 7–11 months, and between 25 12 µg/day for children aged 1-3 years and 65 µg/day for children aged 15–17 years. 26 © 2017 European Food Safety Authority. EFSA Journal published by John Wiley and Sons Ltd on behalf of 27 European Food Safety Authority. 28 DRAFT 29 Keywords: vitamin K, phylloquinone, menaquinones, factorial approach, Adequate Intake, Dietary 30 Reference Value 31 32 Requestor: European Commission 33 Question number: EFSA-Q-2011-01232 34 Correspondence: [email protected] 35 www.efsa.europa.eu/efsajournal EFSA Journal 2017;volume(issue):NNNN Dietary Reference Values for vitamin K 36 37 Panel members: Jean-Louis Bresson, Barbara Burlingame, Tara Dean, Susan Fairweather-Tait, 38 Marina Heinonen, Karen-Ildico Hirsch-Ernst, Inge Mangelsdorf, Harry J McArdle, Androniki Naska, 39 Monika Neuhäuser-Berthold, Grażyna Nowicka, Kristina Pentieva, Yolanda Sanz, Alfonso Siani, Anders 40 Sjödin, Martin Stern, Daniel Tomé, Dominique Turck, Henk Van Loveren, Marco Vinceti and Peter 41 Willatts. 42 Acknowledgements: The Panel wishes to thank EFSA staff: Krizia Ferrini, Joaquim Maia, Christos 43 Stefanidis and Olga Vidal Pariente for the support provided to this scientific opinion. 44 Suggested citation: EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 45 Turck D, Bresson J-L, Burlingame B, Dean T, Fairweather-Tait S, Heinonen M, Hirsch-Ernst K-I, 46 Mangelsdorf I, McArdle HJ, Naska A, Nowicka G, Pentieva K, Sanz Y, Siani A, Sjödin A, Stern M, Tomé 47 D, Van Loveren H, Vinceti M, Willatts P, Lamberg-Allardt C, Przyrembel H, Inge Tetens I, Dumas C, 48 Fabiani L, Ioannidou S and NeuhäuserDRAFT-Berthold M, 2016. Scientific opinion on Dietary Reference 49 Values for vitamin K. EFSA Journal 2017;xx(x):xxxx, 91 pp. doi:10.2903/j.efsa.2017.xxxx 50 ISSN: 1831-4732 51 © 2017 European Food Safety Authority. EFSA Journal published by John Wiley and Sons Ltd on 52 behalf of European Food Safety Authority. 53 This is an open access article under the terms of the Creative Commons Attribution-NoDerivs License, 54 which permits use and distribution in any medium, provided the original work is properly cited and no 55 modifications or adaptations are made. 56 The EFSA Journal is a publication of the European Food Safety Authority, an agency of the European Union. 57 www.efsa.europa.eu/efsajournal 2 EFSA Journal 2017;volume(issue):NNNN Dietary Reference Values for vitamin K 58 Summary 59 Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition 60 and Allergies (NDA) was asked to deliver a Scientific Opinion on Dietary Reference Values for the 61 European population, including vitamin K. 62 Vitamin K represents a family of fat-soluble compounds with the common chemical structure of 63 3-substituted 2-methyl-1,4-napthoquinone. It naturally occurs in food as phylloquinone (vitamin K1) 64 and menaquinones (vitamin K2). Phylloquinone has a phytyl side chain and is the primary dietary 65 form of vitamin K in Europe: it is mainly found in dark green leafy vegetables (e.g. spinach, lettuce 66 and other salad plants) and Brassica. Menaquinones are a group of compounds with an unsaturated 67 side chain from 4 to 13 isoprenyl units (vitamin K2 or MK-n) and are found mainly in animal products 68 such as meat, cheese and eggs. Apart from MK-4 that is formed via metabolic conversion of 69 phylloquinone during its absorption in the intestinal mucosa and in other organs, menaquinones are 70 produced by bacteria capable of food fermentation and specific anaerobic bacteria of the colon 71 microbiota. In this Opinion, the Panel considers vitamin K to comprise both phylloquinone and 72 menaquinones. 73 Vitamin K acts as a cofactor of the -glutamyl carboxylase (GGCX) that catalyses the carboxylation of 74 glutamic acid (Glu) residues into -carboxyglutamic acid (Gla) residues in vitamin K-dependent 75 proteins (Gla-proteins), which convert them into their active forms. These Gla-proteins are involved in 76 different physiological processes, including blood coagulation or bone mineralisation. MK-7 may have 77 a greater bioactivity compared to phylloquinone in stimulating -carboxylation, but the available data 78 are insufficient to set different activity coefficients for phylloquinone and menaquinones. 79 In adults, vitamin K deficiency is clinically characterised by a bleeding tendency in relation to a low 80 activity of blood coagulation factors, resulting in an increase in prothrombin time (PT) or partial 81 thromboplastin time (or activated partial thromboplastin time). Symptomatic vitamin K deficiency and 82 impairment of normal haemostatic control in healthy adults may take more than two to three weeks to 83 develop at a ‘low’ phylloquinone intake (i.e. < 10 µg/day). Exclusively breastfed infants are 84 susceptible to bleeding, due to the low vitamin K content of human milk and their small body pool of 85 vitamin K. Administration of phylloquinone at a pharmacological dose, either orally or by 86 intramuscular injection, is usual practice for prevention of haemorrhagic disease in newborn infants. 87 Phylloquinone is absorbed in the intestine in the presence of dietary fat. Studies on absorption of 88 phylloquinone in healthy adults show widely variable results. The data for absorption of some dietary 89 menaquinones (MK-4, MK-7 or MK-9) in comparison with phylloquinone are also limited. 90 Absorption of menaquinones produced by gut bacteria in the distal intestine remains uncertain, and 91 therefore their contribution to vitamin K status is unclear. The Panel considers that it is not possible to 92 estimate precisely an average DRAFTabsorption of phylloquinone, menaquinones, and thus vitamin K from 93 the diet. 94 After intestinal absorption, phylloquinone and individual menaquinones are transported into the blood 95 by lipoproteins. The clearance of MK-7 and MK-9 from serum/plasma is slower than for 96 phylloquinone. Vitamin K accumulates primarily in the liver, but is also present in bones and other 97 tissues. The liver contains widely variable concentrations of phylloquinone and menaquinones. 98 Vitamin K has a fast turnover in the body. In the liver, phylloquinone and menaquinones are 99 catabolised to the same metabolites, excreted in bile and urine. Phylloquinone crosses the placenta in 100 small quantities, whilst for menaquinones, this is unclear. 101 PT is the only vitamin K biomarker for which a change (increase) has been associated with vitamin K 102 deficiency. Possible changes in the other biomarkers (concentration/activity of blood coagulation 103 factors, blood concentration of the undercarboxylated forms of vitamin-K dependent proteins, blood 104 concentration of vitamin K, urinary concentration of Gla residues or of the 5C and 7C metabolites) 105 according to phylloquinone intake are difficult to interpret, as no cut-off value to define adequate www.efsa.europa.eu/efsajournal 3 EFSA Journal 2017;volume(issue):NNNN Dietary Reference Values for vitamin K 106 vitamin K status is available. There is no biomarker for which a dose-response relationship with 107 phylloquinone intake has been established. Studies investigating the relationship between biomarkers 108 and menaquinone intake often used doses much higher than the limited observed intake data available 109 in Europe. Thus, the Panel concludes that none of these biomarkers is suitable by itself to assess 110 vitamin K adequacy. The Panel also concludes that data are insufficient for deriving the requirement 111 for vitamin K according to sex or for ‘younger’ and ‘older’ adults. 112 The Panel notes the uncertainties in the food composition data and available consumption data related 113 to phylloquinone, individual menaquinones or vitamin K. 114 After having reviewed the available evidence, the Panel also concludes that available data on intake of 115 phylloquinone or menaquinones and health outcomes cannot be used to derive DRVs for vitamin K.
Load more

Recommended publications
  • Vitamin K: Double Bonds Beyond Coagulation Insights Into Differences Between Vitamin K1 and K2 in Health and Disease
    International Journal of Molecular Sciences Review Vitamin K: Double Bonds beyond Coagulation Insights into Differences between Vitamin K1 and K2 in Health and Disease Maurice Halder 1,†, Ploingarm Petsophonsakul 2,†, Asim Cengiz Akbulut 2,†, Angelina Pavlic 2,† , Frode Bohan 3, Eric Anderson 3, Katarzyna Maresz 4, Rafael Kramann 1 and Leon Schurgers 1,2,* 1 Division of Nephrology, RWTH Aachen University, 52074 Aachen, Germany; [email protected] (M.H.); [email protected] (R.K.) 2 Department of Biochemistry, Cardiovascular Research Institute Maastricht, 6200MD Maastricht, The Netherlands; [email protected] (P.P.); [email protected] (A.C.A.); [email protected] (A.P.) 3 NattoPharma ASA, 0283 Oslo, Norway; [email protected] (F.B.); [email protected] (E.A.) 4 International Science & Health Foundation, 30-134 Krakow, Poland; [email protected] * Correspondence: [email protected]; Tel.: +31-43-3881680; Fax: +31-43-3884159 † These authors contributed equally to this work. Received: 24 January 2019; Accepted: 16 February 2019; Published: 19 February 2019 Abstract: Vitamin K is an essential bioactive compound required for optimal body function. Vitamin K can be present in various isoforms, distinguishable by two main structures, namely, phylloquinone (K1) and menaquinones (K2). The difference in structure between K1 and K2 is seen in different absorption rates, tissue distribution, and bioavailability. Although differing in structure, both act as cofactor for the enzyme gamma-glutamylcarboxylase, encompassing both hepatic and extrahepatic activity. Only carboxylated proteins are active and promote a health profile like hemostasis. Furthermore, 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.
    [Show full text]
  • Multicenter Randomized Controlled Trial of Vitamin K Antagonist
    CLINICAL RESEARCH www.jasn.org Multicenter Randomized Controlled Trial of Vitamin K Antagonist Replacement by Rivaroxaban with or without Vitamin K2 in Hemodialysis Patients with Atrial Fibrillation: the Valkyrie Study An S. De Vriese ,1,2 Rogier Caluwé ,3 Lotte Pyfferoen,4 Dirk De Bacquer,5 Koen De Boeck,6 Joost Delanote,4 Didier De Surgeloose,7 Piet Van Hoenacker,8 Bruno Van Vlem,3 and Francis Verbeke 9 1Division of Nephrology and Infectious Diseases and 4Department of Medical Imaging, AZ Sint-Jan Brugge, Brugge, Belgium; Departments of 2Internal Medicine and 5Public Health, Ghent University, Ghent, Belgium; 3Division of Nephrology and 8Department of Medical Imaging, Onze Lieve Vrouw Hospital, Aalst, Belgium; 6Division of Nephrology and 7Department of Medical Imaging, ZNA Middelheim, Antwerp, Belgium; and 9Division of Nephrology, University Hospital, Ghent, Belgium ABSTRACT Background Vitamin K antagonists (VKAs), although commonly used to reduce thromboembolic risk in atrial fibrillation, have been incriminated as probable cause of accelerated vascular calcification (VC) in patients on hemodialysis. Functional vitamin K deficiency may further contribute to their susceptibility for VC. We investigated the effect of vitamin K status on VC progression in 132 patients on hemodialysis with atrial fibrillation treated with VKAs or qualifying for anticoagulation. Methods Patients were randomized to VKAs with target INR 2–3, rivaroxaban 10 mg daily, or rivaroxaban 10 mg daily plus vitamin K2 2000 mg thrice weekly during 18 months. Systemic dp-ucMGP levels were quantified to assess vascular vitamin K status. Cardiac and thoracic aorta calcium scores and pulse wave velocity were measured to evaluate VC progression. Results Baseline dp-ucMGP was severely elevated in all groups.
    [Show full text]
  • Randomised Controlled Trial of Nutritional Supplement on Bone Turnover Markers in Indian Premenopausal Women
    nutrients Article Randomised Controlled Trial of Nutritional Supplement on Bone Turnover Markers in Indian Premenopausal Women Pramod B. Umarji 1, Pankaj Verma 2, Vivek Garg 2, Marian Schini 3,* and Richard Eastell 3 1 Umarji Healthcare, Pune, Maharashtra 411045, India; [email protected] 2 Hindustan Unilever Limited R&D, Gurugram, Haryana 122002, India; [email protected] (P.V.); [email protected] (V.G.) 3 Academic Unit of Bone Metabolism, University of Sheffield, Sheffield S10 2NR, UK; r.eastell@sheffield.ac.uk * Correspondence: m.schini@sheffield.ac.uk; Tel.: +44-0114-215-9667 Abstract: Young Indian women may be at risk of poor bone health due to malnutrition. The aim of this study was to examine the effects on bone metabolism of a nutritional supplement in women aged 25 to 44. The nutritional supplement was a protein-rich beverage powder fortified with multi- micronutrients including calcium (600 mg), vitamin D (400 IU), and vitamin K (55 mcg) per daily serving, while a placebo supplement was low-protein non-fortified isocaloric beverage powder. This 6-month randomised, controlled trial showed favorable changes in bone turnover markers (decreased) and calcium homeostasis; such changes in older adults have been associated with slowing of bone loss and reduced fracture risk. For example, serum CTX decreased by about 30% and PINP by about 20% as a result of the increase in calcium intake. There were also changes in the ratio of carboxylated to undercarboxylated osteocalcin and such changes have been linked to a slowing of bone loss in older subjects. For example, the ratio increased by about 60% after 3 months as a result in the improvement in vitamin K status.
    [Show full text]
  • Vitamin K the “Forgotten” Vitamin
    Vitamin K The “Forgotten” Vitamin Ask anybody what vitamins they know about, and you’re likely to hear Vitamin C, Vitamin D, Vitamin E, and many people will even know that there are multiple vitamins called B. But if you ask about Vitamin K, a lot of people will say “is that really a thing?” Well, we’re here to tell you that not only is it a thing, but it’s as essential as any of the other vitamins you may have heard of. That’s why it’s one of the so-called “13 Essential Vitamins,” which are actually REQUIRED by our bodies in order to Function. Complicating matters even more is the fact that Vitamin K is actually a COMPLEX of vitamins, each with its own distinct properties. In order to understand Vitamin K, its importance in our diet, how to make sure we’re getting all the benefits of it, and how it interacts with other vitamins, we need to know what it is, what it does, what foods it can be found in, and what the different types are. Not Just One Vitamin Just as Vitamin B is actually a whole group of vitamins (B6, B12, Niacin, Riboflavin, etc.), Vitamin K is also a group of compounds, and not just one vitamin. The two most important of these are K1 and K2. There is also a synthetic form of Vitamin K known a K3, but as it can be toxic, it is not generally used in supplementation. Clean, Quiet, & Dark To make things even more complicated, there are two different forms of Vitamin K2 – MK4 and MK7.
    [Show full text]
  • Vitamin K2 Needs an RDI Separate from Vitamin K1
    nutrients Review Vitamin K2 Needs an RDI Separate from Vitamin K1 1, 1, 1, Asim Cengiz Akbulut y, Angelina Pavlic y , Ploingarm Petsophonsakul y , 2, 3 2 1,2, Maurice Halder y , Katarzyna Maresz , Rafael Kramann and Leon Schurgers * 1 Department of Biochemistry, Cardiovascular Research Institute Maastricht, 6200MD Maastricht, The Netherlands; [email protected] (A.C.A.); [email protected] (A.P.); [email protected] (P.P.) 2 Division of Nephrology, RWTH Aachen University, 52074 Aachen, Germany; [email protected] (M.H.); [email protected] (R.K.) 3 International Science & Health Foundation, 30-134 Krakow, Poland; [email protected] * Correspondence: [email protected]; Tel.: +31-43-3881680; Fax: +31-43-3884159 These authors contributed equally to this work. y Received: 25 May 2020; Accepted: 17 June 2020; Published: 21 June 2020 Abstract: Vitamin K and its essential role in coagulation (vitamin K [Koagulation]) have been well established and accepted the world over. Many countries have a Recommended Daily Intake (RDI) for vitamin K based on early research, and its necessary role in the activation of vitamin K-dependent coagulation proteins is known. In the past few decades, the role of vitamin K-dependent proteins in processes beyond coagulation has been discovered. Various isoforms of vitamin K have been identified, and vitamin K2 specifically has been highlighted for its long half-life and extrahepatic activity, whereas the dietary form vitamin K1 has a shorter half-life. In this review, we highlight the specific activity of vitamin K2 based upon proposed frameworks necessary for a bioactive substance to be recommended for an RDI.
    [Show full text]
  • Further Food Facts and Bones – Looking Beyond Calcium and Vitamin D
    Further Food Facts and Bones – looking beyond calcium and vitamin D Most people know that calcium and vitamin D are essential What is osteoporosis? for our bones, but these alone cannot keep them healthy and strong. Other nutrients are also needed. A healthy, mixed Osteoporosis occurs when the struts which make up the and well-balanced diet contains the variety of minerals and mesh-like structure within bones become thin causing vitamins, proteins and other nutrients that our bones need. them to become fragile and break easily, often following The ‘Eatwell Guide’ below shows the proportions of different a minor bump or fall. These broken bones are often food groups that make up well-balanced healthy eating. The referred to as ‘fragility fractures’. The terms ‘fracture’ and range of nutrients typically obtained from these groups is ‘broken bone’ mean the same thing. Although fractures also shown. can occur in different parts of the body, the wrists, hips and spine are most commonly affected. It is these broken A more detailed picture and explanation of the Eatwell Guide bones or fractures which can lead to the pain associated is in our booklet ‘All about osteoporosis and bone health’. with osteoporosis. Spinal fractures can also cause loss of This, and the central message on healthy eating for strong height and curvature of the spine. bones, is in Section 2 of the booklet and is also on our website. This fact sheet answers common questions about the role of specific nutrients in bone health and explains how to get these through healthy eating.
    [Show full text]
  • Vitamin K, an Example of Triage Theory: Is Micronutrient Inadequacy Linked to Diseases of Aging?1–3
    Perspective Vitamin K, an example of triage theory: is micronutrient inadequacy linked to diseases of aging?1–3 Joyce C McCann and Bruce N Ames ABSTRACT selection, metabolic resources are preferentially allocated to The triage theory posits that some functions of micronutrients (the functions necessary for reproductive survival at the expense of ’40 essential vitamins, minerals, fatty acids, and amino acids) are those required for survival beyond reproductive age. The triage restricted during shortage and that functions required for short-term theory is unique in that it proposes a mechanistic trigger for the survival take precedence over those that are less essential. Insidious reallocation of micronutrient-dependent metabolic resources and Downloaded from changes accumulate as a consequence of restriction, which increases suggests that age-related disease is easily preventable by en- the risk of diseases of aging. For 16 known vitamin K–dependent suring an adequate supply of micronutrients. (VKD) proteins, we evaluated the relative lethality of 11 known If the theory is correct, the implications for public health are mouse knockout mutants to categorize essentiality. Results indicate enormous. Virtually every metabolic pathway includes one or that 5 VKD proteins that are required for coagulation had critical more enzymes that require essential micronutrients for activity. functions (knockouts were embryonic lethal), whereas the knockouts Micronutrient intake below recommended concentrations, but not www.ajcn.org of 5 less critical VKD proteins [osteocalcin, matrix Gla protein severe enough to cause overt clinical symptoms, is widespread (Mgp), growth arrest specific protein 6, transforming growth factor not only in poor countries but also in the United States (especially b–inducible protein (Tgfbi or big-h3), and periostin] survived at in the poor, children, adolescents, the obese, and the elderly), least through weaning.
    [Show full text]
  • VITAMINS D3 and K2 – Another Dynamic Duo!
    VITAMINS D3 AND K2 – Another Dynamic Duo! By Dr Nyjon K. Eccles BSc MBBS MRCP PhD Introduction In my last article “Vitamin D: An Underestimated Ally”, I summarised the science behind the many beneFits oF Vitamin D and how in the light oF this accumulating scientiFic support that no-one can aFFord to be deFicient in this important hormone. And yet evidence would indicate that as many as 70% oF us may be deFicient or have too low levels oF this God-given molecule. People are becoming aware oF this and although they may not have checked their blood levels, have taken it upon themselves to large doses oF vitamin D3. Whilst undoubtedly there are benefits to correcting your vitamin D deficiency, there lies a hidden danger in taking large doses oF Vitamin D3 without its sister vitamin, Vitamin K2. This article aims to clariFy the synergy between these two important molecules and explain why we need them both together For optimum bone and cardiovascular health. To reiterate, Vitamin D has been shown to inFluence dozens of conditions, including: Cancer, Hypertension, Heart Disease, Obesity, Rheumatoid Arthritis, Autism, Type 1 and Type 2 Diabetes, Osteoporosis, Multiple Sclerosis, Crohn’s and other InFlammatory Bowel disease, Flu, Tuberculosis, Dementia and Alzheimers, Eczema and Psoriasis, Muscle pain, Peridontal disease, Macular degeneration, Pre-eclampsia, InFertility, Asthma, Cystic Fibrosis, Migraines, Depression, Schizophrenia and Seizures. Some of these have been discussed in more detail in my previous article referenced above. The RDA for vitamin D remains at a measly 600 IUs. This is despite the overwhelming evidence showing that vitamin D is extremely important for a wide variety of health conditions besides bone health, and that most people may need about ten times this amount or more.
    [Show full text]
  • High-Dose Vitamins
    BREASTFEEDING MEDICINE c Volume 14, Number 5, 2019 LactMed Update ª Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2019.0077 High-Dose Vitamins Jason B. Sauberan1,2 oncentrations of most vitamins in breast milk are creases milk concentrations by 30–70 mcg/L in both under- Cdependent on maternal diet.1 Daily vitamin supple- and well-nourished lactating mothers. mentation to achieve adequate dietary intake is thus a re- The highest supplemental dose studied has been 10 mg/day; commended intervention for lactating mothers who are milk concentrations increased from 200 mcg/L at baseline to undernourished, or for those with dietary restrictions. Even in 750 mcg/L after several months of supplementation.8 There mothers with no known dietary deficiency risks, the use of have been no reports of milk concentrations or breastfed in- prenatal vitamins during lactation is commonplace and is fant safety during maternal high-dose riboflavin therapy. considered safe for the breastfed infant (Table 1).2,3 Some Intravenous high-dose riboflavin has been safely used in lactating mothers may elect to consume high-dose or hyperbilirubinemic newborns as an adjunct to phototherapy. ‘‘megadose’’ vitamin therapy, beyond that required for ade- Riboflavin is considered to have a wide safety margin in quate daily intake. Commonly used vitamins taken in humans and there is no established upper limit of tolerability. megadoses are listed in Table 2. Depending on the vitamin, A common benign side effect of larger doses is bright yellow dosage, and the mother’s underlying vitamin status, this urine discoloration.6,9 Owing to a lack of data, other drugs for practice could potentially lead to vitamin concentrations in migraine prophylaxis with good safety records during milk that are harmful to the infant.
    [Show full text]
  • Brands and Types of Supplements We Recommend
    Brands and Types of Supplements We Recommend Magnesium glycinate http://amzn.to/2mdZC4W Bifido bacteria http://amzn.to/2mTG1UG l-carnitine http://amzn.to/2mdWw0O l-tyrosine http://amzn.to/2mTGeHs Estrovera http://amzn.to/2nCrxZs Kaprex http://amzn.to/2nCqjgG Ultraflora Spectrum http://amzn.to/2mG7sk6 D-HIST http://amzn.to/2mTJvH1 Lipotain http://amzn.to/2mD1sYz SAMe (Do not take with antidepressant) http://amzn.to/2oqcgxC Vitamin B-6 http://amzn.to/2o07Yd7 Magnesium L-Threonate http://amzn.to/2nZRSk4 Siberian Ginseng http://amzn.to/2mD80Gq GLYCINE http://amzn.to/2wRbYVR l-glutamine http://amzn.to/2ojMBop GELATIN http://amzn.to/2nxHzHK The Green can doesn’t gel up (Red can does, like jello) if you prefer that. http://amzn.to/2nxSocC Emu Oil http://amzn.to/2w9VGpn Kelp (for iodine) http://amzn.to/2n8CzYJ Estrofactors http://amzn.to/2mefc0x potassium http://amzn.to/2mGqd6K Heath Tip: There are a couple of prescription medicines that you’ve got to be aware of if you significantly increase your potassium intake, so if you’re on blood pressure medicines, talk to your doctor before you to take potassium. Vitamin D Make sure to take WITH FOOD and in the AM. Take 1000iu per 25 pounds you weigh. http://amzn.to/2mTQwYb Vitamin K2 http://amzn.to/2mTT34F Selenium http://amzn.to/2nk8YM6 7-KETO http://amzn.to/2nCKjjs Resveratrol: http://amzn.to/2nknDqD CURCUMIN: http://amzn.to/2mTJItt B-Complex http://amzn.to/2nxKDDO chromium (with cinnamon) http://amzn.to/2nCDzBT Choline http://amzn.to/2n8Io8t Zinc: http://amzn.to/2mTGyWP OsteoVantiv http://amzn.to/2mG5wIp Berberine http://amzn.to/2mG6XGC Ultra Potent Vitamin C http://amzn.to/2nCLwau HCL with Pepsin http://amzn.to/2oYA5dC Ashwagahnda http://amzn.to/2ogIRWP GUGGAL http://amzn.to/2mTRGTE CoQ10.
    [Show full text]
  • Vitamin K and Thrombosis
    Vitamin K and thrombosis Rithik Raina, Ayush Karnik, Prasad Shetye, Atul Laddu, On Behalf of the Georgia Thrombosis Forum The role of the fat soluble vitamin K (VK) in thrombosis is getting more clear every day. VK plays a major role in the coagulation cascade. VK deficiency can occur in any age group, but is encountered most often in infancy. The body needs VK to use calcium to build bone. Low levels of VK may be associated with a higher risk of osteoarthritis. VK improves bone health and reduces the risk of bone fractures, particularly in postmenopausal women who are at risk for osteoporosis. Our research in the physiology, role in thrombosis and uses of VK tell us that VK is one of the very important vitamins in life. Although use of warfarin is gradually going down due to the discovery of NOAC’s, warfarin is there to stay, and therefore we know that vitamin K is going to stay. Introduction Following the discovery of warfarin, a Vitamin K Antagonist (VKA), the importance of Vitamin K has become more apparent. The “K” in Vitamin K originated from the German word, "koagulation". Millions of patients who take warfarin for atrial fibrillation, DVT, PE, and prosthetic cardiac valves. The wide use of warfarin, an agent with a very narrow therapeutic index, has resulted in significant risk for major bleeding. Vitamin K serves as one of the major reversing agents for patients over- anticoagulated with warfarin. We at GTF took a challenge of researching the physiology of vitamin K and its role in thrombosis.
    [Show full text]
  • Association of Dietary Vitamin K and Risk of Coronary Heart Disease in Middle-­ Age Adults: the Hordaland Health Study Cohort
    Open access Original research BMJ Open: first published as 10.1136/bmjopen-2019-035953 on 21 May 2020. Downloaded from Association of dietary vitamin K and risk of coronary heart disease in middle- age adults: the Hordaland Health Study Cohort Teresa R Haugsgjerd ,1 Grace M Egeland,1,2 Ottar K Nygård,3,4 Kathrine J Vinknes,5 Gerhard Sulo,6,7 Vegard Lysne,4 Jannicke Igland,1 Grethe S Tell1,8 To cite: Haugsgjerd TR, ABSTRACT Strengths and limitations of this study Egeland GM, Nygård OK, Objective The role of vitamin K in the regulation of et al. Association of dietary vascular calcification is established. However, the ► The study had a long follow-up time with minimal vitamin K and risk of coronary association of dietary vitamins K1 and K2 with risk of heart disease in middle- age competing risk from other causes of death. coronary heart disease (CHD) is inconclusive. adults: the Hordaland Health ► Linkage to a nationwide database assured complete Design Prospective cohort study. Study Cohort. BMJ Open cohort follow- up. Setting We followed participants in the community- based 2020;10:e035953. doi:10.1136/ ► We had information on history of coronary heart dis- Hordaland Health Study from 1997 - 1999 through 2009 bmjopen-2019-035953 ease (CHD) at baseline which enabled us to evaluate to evaluate associations between intake of vitamin K and incident (new onset) CHD. ► Prepublication history and incident (new onset) CHD. Baseline diet was assessed by additional material for this ► The Food Frequency Questionnaire was not validat- a past- year food frequency questionnaire. Energy- adjusted paper are available online.
    [Show full text]