Vitamin K: Wallflower Sister of the

Famous Fat Solubles

Vitamin K is the least glamorous of the fat soluble vitamins, waiting in the wings while
her sisters take repeated bows on stage for their disease-fighting performances. However,
the name gives some indication of its importance; "K" for the Danish word, koagulation,
or for Americans, coagulation, its primary function in blood. And if you're unfortunate
enough to be bleeding, this is one vitamin you don't want to be missing because it helps
your blood to clot to stop the bleeding. So while there doesn't seem to be any intriguing
studies linking the vitamin to disease prevention as there are for its fat soluble
relatives, our need for it is critical.

Vitamin K was discovered in 1935 by the Danish scientist Dam who recognized it as a
compound present in green leaves which prevented hemorrhaging in animals fed a low-
fat diet. He later isolated the vitamin from alfalfa in 1939. Vitamin K occurs in nature in
two groups of compounds: phylloquinone and menaquinone. A third group is related to
the synthetic compound menadione, which is twice as biologically active as the two
natural forms. The two natural groups are produced by many bacteria, and fortunately for
us humans, the bacteria living in our intestinal tract possess this talent.

Vitamin K's blood-clotting ability is related to its role in the formation of prothrombin
and five other proteins that play key roles in the complex process of coagulation. The
vitamin is also needed to make proteins present in plasma, bone, and the kidney.
Interestingly, when a person becomes deficient in vitamin K, other compounds fill in for
these functions. It is the blood-clotting ability that suffers from a deficiency of this
vitamin.

The process of blood coagulation involves over forty different substances, some of which
promote clotting while others inhibit it. It's the balance of these opposing forces that
determines whether blood will clot, and in the normal state, the anticoagulant compounds
run the show-a good thing, too, since you'll recall from the discussion on heart attacks,
clot formation in the blood is a triggering event. Clotting appears to occur in three stages,
which include the formation of prothrombin activator, conversion of prothrombin into
thrombin, and conversion of fibrinogen to fibrin threads. Scientists call the process a
cascade, much like a large snowball rolling down a hill picking up speed and more snow
as it goes along unchecked.

The first step starts with some kind of injury, like the blowout of a blood vessel, which
triggers the formation of prothrombin activator. Prothrombin is a protein made by the
liver and is normally present in blood. The prothrombin activator, in the presence of
calcium, converts prothrombin into thrombin, which acts as an enzyme. The next step
involves thrombin acting on another blood protein made by the liver, fibrinogen, to
convert it into fibrin. The fibrin compounds form long fibrin threads that form the
framework of the clot, like a spider's web, which continues to develop by trapping
platelets, blood cells, and plasma.

The threads also stick to the damaged area and the resulting clot prevents blood from
flowing past it. Clot formation, or thrombosis, is critical in the case of injury to
prevent blood loss. However, this protective mechanism is also responsible for heart
attack and stroke when the clot formed after injury to a blood vessel prevents blood from
flowing to the heart or brain.

Several compounds, called antagonists, are known to interfere with vitamin K activity
because their structure is similar to that of the vitamin. The antagonists compete directly
with vitamin K at the site where the vitamin exerts its important effects. Because they
don't have the same biological activity, these compounds prevent coagulation, and
doctors use several of these for this very purpose, as effective anticoagulants. The first
antagonist researchers identified was a substance found in spoiled sweet clover,
dicumaral, which is one of many compounds that work against vitamin K. Relatives of
dicumaral include warfarin and tromexan, which doctors use to treat blood clots or to thin
the blood of people who are at risk for blood clots.

Our Need for Vitamin K

The RDA for vitamin K is 80 and 65 micrograms for adult males and females,
respectively. The levels were established based on studies that assessed the amount
required to maintain plasma concentrations of prothrombin in the normal range. Food
composition tables don't include vitamin K content because scientists haven't yet come up
with precise techniques of analyzing foods for the vitamin. The best dietary sources are
leafy greens, providing anywhere from 50 to 800 micrograms per 100 grams. Many other
foods contain the vitamin, such as dairy products, meats, grains, fruits, and vegetables,
but the amount is small at 1 to 50 micrograms for every 100 grams of food.

One of the most important sources of vitamin K comes from our intestinal bacteria, those
friendly little organisms that live in the intestine. By itself, this source can't meet the
body's total need for the vitamin; experts aren't sure how much is contributed, but some
estimate that up to 30 percent of our vitamin K is from this source. Studies which have
restricted dietary vitamin K produced alterations in clotting factors. Likewise, people
who are on antibiotic therapy for extended periods may become deficient, because in
addition to destroying disease-causing bacteria, the drugs also kill the "good" bacteria
which produce vitamin K. Studies have shown that even a regimen as brief as five weeks
resulted in a significant drop in plasma prothrombin levels, to about 70 percent of normal.

Elderly people in the hospital may be at risk for vitamin K deficiency. Studies have
shown that in one such group, 75 percent of patients had low plasma prothrombin levels,
which improved after vitamin K treatment. Scientists think that chronic diseases, drug
therapy, and poor diet may make the problem worse in people who are ill and weak. In
contrast to other vitamins, a recent study proves that the problem isn't related to the
effects of aging on vitamin status. In trying to find the best biochemical marker for
evaluating vitamin K status, researchers reported that aging didn't much affect it.

Other high-risk groups include people who have suffered trauma, kidney disease, any
disease that causes fat to not be absorbed, and those who are physically debilitated. Other
compounds besides antibiotics can interfere with vitamin K. One class of drugs which
destroys vitamin K are the sulfas, and chronic use of these drugs is common in people
with ulcerative colitis. Even other vitamins can pose problems, with studies dating back
to the 1940s showing that megadoses of vitamins A and E could antagonize vitamin K.

Newborn infants get an injection of vitamin K, because they're at risk for vitamin K
deficiency for a few interesting reasons. Babies are born with sterile intestinal tracts, free
of vitamin K-producing bacteria. It would take up to several weeks for the bacteria to
start eking out a living in the intestine. In addition, newborns have low prothrombin
levels, which protect them against fatal blood clotting during the stress of birth. But these
two facts could conspire against the little tykes in the event of an injury, if they didn't
receive that gut-priming dose of the vitamin. There has been some concern that the
vitamin K injection newborns receive might be linked to the later devel!Jpment of
leukemia. A recent study evaluated hospital records and was unable to clear the vitamin
or implicate it, so the jury is still out.

Vitamin K is a fat soluble vitamin, which means that excesses are not excreted too easily,
but even large doses given over a long period of time aren't toxic for most people. Two
exceptions are infants and pregnant women, who appear to be more sensitive. High doses
of the vitamin can cause problems for people who take anticoagulant drugs to prevent
clots. In that situation, vitamin K antagonizes the drug and makes it less effective at clot
prevention. If you take anticoagulants, you should avoid eating too much of the foods that
are high in the vitamin, most notably the nutrient-packed green leafies.

The symptoms of vitamin K overdose include jaundice, or yellowing of the skin and
whites of the eyes, destruction of red blood cells, and even brain damage. Some studies
have shown that high amounts of the synthetic form, menadione, can destroy red blood
cells, causing a disease called hemolytic anemia. However, the form which occurs
naturally in foods, phylloquinone, doesn't appear to be toxic.

Compared to what they've done for the reputations of other fat soluble vitamins,
researchers haven't uncovered any exciting connections between this humble vitamin and
the chronic diseases which plague mankind. But if you "spring a leak." vitamin K will be
the most important thing to you aside from a good doctor. As with many of the other
vitamins, scientists have yet to figure out every aspect of vitamin K's role in the body, so
anything is possible.