Vitamins D and K2

Well, a warm welcome to this talk. Now so many people have asked me to do a video where I include vitamin D and vitamin K and especially vitamin K2. So that's what this is about. Now if you haven't got time to watch it, I'll try and give you a bit of a bottom line. Although it's very difficult on this kind of video because it's a bit complicated really. But if you've been watching this channel, you'll be in no doubt about the potential benefits of vitamin D and the fact that in the cold, overcast northern latitudes we're often deficient of it because the vast majority of it comes from the sunshine. So vitamin D, that's what we're talking about. We'll just look at a couple of guidelines on that as well because there's some interesting things on that. But then the other question is, should we be taking vitamin K2 with it? The answer to this seems to be that vitamin K2 is associated with quite a few beneficial effects, so it should certainly be part of a healthy diet. But taking moderate amounts of vitamin D, as I do, I'm currently taking 4,000 units a day. Actually the evidence is not suggesting that it is necessary for me to take vitamin K2 with my three or four thousand international units of vitamin D that I take a day over the winter, but it may be beneficial for other things. There's a more of a sort of a grey area with higher levels of vitamin D. But of course you wouldn't be taking high levels of vitamin D, you'd only be self medicating on lower doses. You'd only be taking high levels if you're supervised by your own doctor, in which case he would be advising you and supervising you. And of course it goes without saying that you never take medical advice from me, you always go to your own doctor. Now having got that out the way, let's move swiftly on. So Here we see COVID 19 Rapid Guideline to Vitamin D from the National Institute of Health and Care Excellence. Now this obviously is excellent because it's got excellence in the title, so called nice, of course, and basically it's still saying. So I read this with some excitement. I thought, oh, they've got their act together published on 17th December 2020. But basically it's saying same old same old, it's Talking about the 400 units a day and slightly different amounts for different age groups and things. So do peruse that with disappointment as I did so latest on vitamin D, National Institute of Health and Care Excellence. That one. Basically, Basically it's saying, consider 400 international units, 10 micrograms per day, very low dose. So consider taking that and it gives a few provisos, but that's basically, it's still saying take the same amount. But then I looked at. There's various NHS sites. This one happens to be from mid Essex. Check it out for yourself. It's in the. On the web, it's publicly available. And let's look at that. Now, this one, slightly more interesting. It's actually written for prescribers and doctors and people like that primarily, but it's talking about vitamin D deficiency and prescription guidelines. Now it talks there about lifestyle. You can read this for yourself. But here we have these flowcharts. Now, these flowcharts are really popular in modern healthcare and I must say they are remarkably useful because you can kind of follow them through without knowing too much about the subject and get to a good result. So patients with high risk factors that may increase risk of vitamin D deficiency, or a patient at a higher risk of having low vitamin D stages at risk group. Right. So if they're in that group, basically they're saying here, does the patient have symptoms indicative of rickets, osteomalacia, sort of bone thinning or symptomatic low blood calcium levels, or symptoms of rickets, including tetany, leg bowing, knock knees, anterior bowing of the thigh, bone of the femur, painful wrist swelling, softening of the skull, spinal curvature, bones. I mean, I could go on, but basically it's focusing on rickets, which we've known about for about a hundred years now. No mention of reduced immunity or autoimmunity or heart disease or cancer of the colon or cancer of the prostate or depression or unexplained aches or pains or multiple sclerosis or the other correlates that may well be associated with vitamin D? None of that. So just focusing on those things there. And then it does go on to make recommendations. And it says here, if the vitamin D, this is the. This is the serum vitamin D, the vitamin D in the blood, if it's less than 30 nanomoles per liter, it gives a treatment option here of oral capsules, 40,000 units Cholec alciferol weekly for seven weeks. And there's various other flowcharts with what to do. And the other ones work out at giving. If. If the levels are higher, Basically, it works out at giving the. The 400 units, one that we know about. So routine screening of vitamin D levels and prescribing a vitamin D is not advised advisable according to this. So it's not too, it's not too worried about it as a routine. Let me give you my view on this. I think everyone in the country should have their vitamin D levels measured as a measure of some urgency, actually I think. And their vitamin D level should be titrated according to those levels. That's what I would think, but that's not what this protocol is saying. Both clinical symptoms and risk factors must be present before measuring vitamin D levels. In other words, this appears to be actually discouraging GPS from checking vitamin D levels. So if I was the teacher marking this, I think I'd probably give that across. And I'd probably give that across. Having said that, people reading these guidelines have to do it. They don't have any choice because these are the official guidelines. And if a doctor was in contravention of the guidelines, then potentially that's not a good situation for him or her. So they're the guidelines. As yet, there is no clear evidence to prove the risk from non symptomatic vitamin D deficiency. Okay, proves a big word, but I'm not sure I would agree with that. I think there's evidence that suggests to the contrary. In academic essays we always tell students to be tentative. It could be suggested that from this it could be reasonably inferred. A possible implication of this is because until we have definitive answers, we don't have definitive answers. And I'm afraid we don't have answers that, that definitive. I believe with vitamin D, which is this accumulation of evidence anyway, adults, adults, if their vitamin D is less than 30 nanomoles per liter, which is 12 nanograms per mil, oral capsules are 40,000 units, that's 40,000 units, that's 1,000 micrograms or 1 milligram of cholecalciferol. And that's the way they spell it. That's vitamin D3. They spell it in a strange way. I wouldn't have, I would have spelt it with an H, but there you go. Weekly for seven weeks is what that is what they're saying. Very similar to colleagues in India whose doctors have been prescribing them 60,000 units a week for six weeks to top them up. Difference being in India they've been doing that without measuring the blood levels. But I agree measuring the blood levels is good, so that makes sense if it's very low. But to me these are really remarkably low levels. Less than 30 nanomoles per liter or 12 nanograms per milliliter. Very low levels. I would be very uncomfortable with patients or meet me at that level. So it's talking about giving these doses. In contrast, the nice guidelines are saying 2800 units per week. So the treatment dose there is 40,000 units. The NICE guidelines for maintenance is 2800, which many will think is very low. Now, vitamin D levels of 30 to 50, that's 12 to 20 nanograms mil. Basically it's saying, buy your own, which is quite reasonable. 400 units per day to say buy your own. I mean, we did this on A and E all the time. If a patient needed ibuprofen and paracetamol, so just go to take paracetamol and ibuprofen, you might tell them the best way to take it, but you wouldn't need to give it to them because it's readily available OTC over the counter. So that's reasonable. Albeit the recommended dose could be considered low. Vitamin D levels of greater than 50 or that's. So that's greater than 20 nanograms per milliliter. Buy your own. And again, just consider the 400 units per day, depending. Is this rather crude summary of what that is, of what this flow diagram is saying? But it's there. Click on it, Put a copy on your bedroom wall. It's there. Do whatever you want with it. So that's. That's vitamin D. Now, I think basically what we're saying is here that there's no change in government protocol and policy against for vitamin D and it's only advising people, doctors, to treat vitamin D with fairly high doses, it must be said, but only if their vitamin D levels are really quite low. And actually getting the test requires getting through that flowchart. So it's a bit difficult. So that's vitamin D disappointing, to say the least, from the UK government. No real change there. And yet we know there's correlations and some trial data. Okay, the trials are being argued about now, but there's many correlations and observational studies that meet what we've called the Bradford Hill criteria that we've looked at before that indicate a lot of us are short of vitamin D, and that is important. But the government hasn't moved on that. National Institute for Health and Care Excellence has not moved on that. So we could argue now about whether it's excellent or not, but you get the idea. Right, Right, right. Now, moving on to vitamin K. Now, two sorts of vitamin K, really, K1 and K2. Now, K1 we've known about for a long, long time. Phylloquinone is the chemical name for that phylloquinone discovered in 1929 and of course since then we've known it's important for blood coagulation. In fact the reason it's called K, it's for the German, it's a German discovery. So coagula in German it's something like coagula vitamin or something in German but it's spelled with a K. So therefore we have the vitamin K. A quite reasonable K for coagulation in German. So quite sensible name found in plants like leafy greens. So vitamin K deficiency can be a problem in newborn babies. In adults not usually. So that's vitamin K1 fairly well known about lack of it causes problems with blood clotting. Not common at all in children and adults past the. Past the baby stage. But let's go on to vitamin K2 now which really is quite a bit different. Now vitamin K2 the. The information I'm going to get from the National Institutes of Health so this institutes from there and this is an excellent article I thought on Healthline. So click on that, read it for yourself, see if your interpretation is the same as mine. Now the vitamin K2 is the menoquinone. So it's a different chemical and there are subdivisions within that. That's why I've called it S menoquinones. There's not just one of them. Now these are mostly from bacterial origin animal based and fermented food. So a fermented food is a food on which. Which there's been bacterial action. I'd say I'm a bit peckish. Just a minute, I'm going to. Just going to stop and have a quick snack. I'll be back with you in a minute. I've just got this recently sauerkraut. Tell you the truth, Quite got used to it yet it's better with things because sauerkraut is a. Is a fermented food. This is cabbage and there's been some bacterial action on that cabbage which is generated sauerkraut. It's actually quite nice in the. Right. I ate this in Germany and loved it actually. But of course I don't know what's like in the US but in the UK we don't eat many fermented foods. So the vitamin K2 mostly bacterial origin. So it's the action of the bacteria on the cabbage that produce the vitamin K2 animal based and fermented foods. So we'll look at some other foods that it's in in a minute. Adult Vitamin K. Now the adequate intakes, this, this concept of adequate intakes, this I'm pretty sure this is from the National Institutes of Health site. I got that. Now this is for vitamin K. That's sort of the adult female, that's the adult male range. But this is vitamin K. It's not subdivided into vitamin K1 and K2. So basically we don't have published guidelines on the appropriate dose. Now a lot of people are saying, you know, this supplement here for example is 600 micrograms, which seems quite a high, which seems quite a high dose. You know, a lot of supplements are recommending about 100 micrograms a day. So that seems quite high. So that might be more a weekly dose. Not that I'm prescribing. Ask your doctor if you want to know how much to take. So 100 micrograms a day seems to be roughly the range that people are talking about. But you can't really find. Well I haven't yet found any specific evidence for that. That's why I was a bit reluctant to do this because there's a bit of a lack of firm evidence. So how much vitamin K2 should we be taking a day? That's the amount of vitamin that. Did I say D? Then the amount of vitamin K2 should we be taking a day? Well, that's the amount of vitamin K we should be taking. How much K2? I don't really know. I don't really find published figures on that. Although around about 100 micrograms a day seems to be what people are talking about. But what that is based on, I don't know. You see there's things people say and you've always got to go back to the evidence. This is why it's frustrating, this is what I'm trying to do here, trying to relate to the evidence because I don't know, I don't know what, I don't want to know what he said, she said. They said, you know, we want to know what the evidence is based on empiricism. So anyway, it's in fermented food. Sauerkraut, Natto I think is a fermented soya bean thing. High fat, high fat dairy, high fat cheese. Milk from grass fed cows needs to be grass fed cows. Presumably the reason for that is the grass will be acted on in the, I don't know what you call them, the ruminants. Is it the stomachs of the cow and the vitamin K2 will be produced there. Egg yolks especially animal origin, animal organs Rather so hearts, livers, what we call the offal of the animal gut bacteria in you and me, which of course might be decreased with antibiotics because the antibiotics will kill off our gut bacteria. Now, the reason that this does kind of make sense is that in so. So we see that the vitamin K2 mostly comes from fermented products like sauerkraut, fermented soybeans, and animal organs like liver and hearts and kidneys of animals. But of course, in Western countries, very often we tend to eat the animal skeletal muscle and feed the rest to dogs and things. So why we eat one particular part of the animal and not the other is a bit strange. But if you can imagine in the evolution situation, when we were hunter gatherers, then we would kill an animal and we would eat every bit of it, because you might not get them, the young men might not make another kill for another month. You would eat the whole animal. If we were on the Savannah 30, 40,000 years ago, or whatever it was, and also when we were storing foods, it's not surprising that they could become fermented as we stored them with bacterial action. So if you imagine the hunter gatherer situation, probably eating stored fermented foods and certainly eating animal organs much the more than we do now, so we might end up with much less of it in the modern Western diet. Having said that, in Korea, they eat a lot of kimchi. I worked with Koreans when I was teaching in Cambodia. They have kimchi with every meal. It's like a crunchy vegetable stuff, even breakfast. I remember asking what it was and they said, you don't eat kimchi with every meal. You know, they eat kimchi with every meal, which presumably provides them with lots of vitamin K2. So it does kind of make sense. And it's this, you know, at the same time, when we're out there on the savannah, we wouldn't be as wearing as many clothes and we would be producing lots of vitamin D. So it does make sense that the vitamin D from the sun and the vitamin K2 from animal organs and from fermented food aren't that present in the Western diet. So it would make sense that we could be short of them. Right, let's go on to look at some of the evidence now. And I've put in the links. You peruse the evidence, see what you think. Vitamin K might play a role in preventing osteoporosis and coronary heart disease. So osteoporosis very common, especially in women. Basically, it's thinning of the bone, loss of bone Mass which leads to pathological fractures. So very, very common in older people. They come in with a broken neck of femur. We call it a knof neck off femur fracture. Very, very common as the neck of femur demineralizes. And that's often where the bone breaks first or wrist fractures, forearm fractures, especially in older people. Very, very common related to osteoporosis causes a lot of pain and suffering. A lot of pain and suffering. So lack of vitamin K2 especially, this is K2 we're talking about, can be associated with osteoporosis and coronary heart disease. I think you probably know this, but if you think about a heart, I won't draw a whole moon. It's kind of a heart like this, isn't. It's got a, it's got a. These are the bottom pumping chambers like that. They would be the valves, they would be the valves there going off to the arteries. Then there's valves going down the way like that. And then there's the, the top chambers where the veins, the veins going in like this. Top chambers of the heart, the atria. And again the valves pointing down the way there like that. So that's the left side. So that would be the aorta and that's the pulmonary arteries going off to the lungs and that's the pulmonary veins and that's the vena cava. Anyway, never mind that. But all this is the heart muscle, the myocardium. So in order for these chambers to pump, in order for the heart chambers to pump the blood out, they must have contractile myocardium. And the myocardium depends on, because it's, it's always active, very active muscle. Of course it's contracting 60, 70, 80 times a minute. So its blood supply depends on these coronary arteries. And these break down into smaller branches. They're called coronary arteries because they look a bit like a crown surrounding the heart. But the trouble is these get furred up and so the blood doesn't get through to an area of tissue. So suppose, suppose that's an area of tissue supplied by the arterial branch. If that's getting furred up, then there's less blood getting through to that. That's called ischemia. And then if there's a blood clot there, all that bit dies there. That's called an infarction. And because it's the myocardium, it's a myocardial infarction. So this coronary heart disease, really, really very, very common. Still the most common Cause of this death in the uk, I think so very, very common. So it's associated with these two diseases, the lack of vitamin K2. But what's the level of evidence? Well, it does kind of make sense because there's vitamin K dependent proteins. Now, what vitamins do is vitamins are coenzymes that they work with. Vitamins work with enzymes, so the enzyme won't work on its own, it needs the vitamin to make the enzyme work. So if there's, if there's like calcium in the blood, then vitamin K2 is needed for enzymes that put calcium from the blood into the bones, which is where you want it to prevent the osteoporosis. And there's also other proteins which require vitamin K2 that prevent the. Prevent the calcium going into the tissues, because you don't want tissue and arterial calcification. And what we find is when these arteries start clogging up, at the same time, there's deposition of calcium in the walls of the arteries. The two processes go hand in hand, they go side by side. So as the arteries clog up, they also calcify, or as they calcify, they also clog up. They're concomitant processes, they go on together. They've associated. But of course, which is cause and effect is interesting. So with this, with this K2 idea, it could be that the furring up, that the atheroma is more caused by the calcification, in which case you want the K2 to take the calcium from the tissues back into the blood, where the K2 can put it from the blood into the bones to give you strong bones where it's supposed to be. Now, having said that, of course, I've known for 30 or more years that atherosclerosis, the furrowing up of the arteries, is associated with calcification. But I always assumed it was the calcification that came after the atheroma formation. So this is kind of hinting that it might be the other way around. I'm going to need quite a lot of evidence to prove that. But that's. It's interesting, it's an interesting idea. Which is the chicken and which is the egg sort of thing, which is the cause and which is the effect. Anyway, vitamin K2 supplement may improve bone health and heart health, while vitamin K1 has no significant benefit. So that is suggested by this evidence here. So check that one out. So, in other words, this is clearly differentiating between the effects of vitamin K1 and the effects of vitamin K2. Vitamin K1 for the, the blood clotting vitamin K2 to promote calcification of bones and reduce calcification of tissues is the, is the hypothesis there? Now this study here gives evidence that it promotes bone calcification. 3 year low dose menoquinone 7 that's the type of vitamin K2 involved supplement helps decrease bone loss in healthy post menopausal women. Sounds good to me. Of course you need to evaluate the validity of this because some people would disagree. But these, these are the studies that are providing the evidence for this sort of hypothesis that is being, that is being developed around the world. The ultimate answer, yes, of course we don't know may prevent tissue calcification. So preventing the calcification of the arteries especially you get this quite a lot in, in the peripheral arteries as well. I remember the first time, I haven't got a copy but I looked at an X ray and you could see the bones and then there was like these other two bones going up and down through the top of the legs, the hip joints and of course they weren't bones at all, they were calcified femoral arteries. So it can be quite pronounced calcification of arteries which of course we don't want. So this article is saying may prevent tissue calcification. Tissue specific utilization of Methaquin 4, that's another type of vitamin K2 results in the prevention of arterial calcification in warfarin treated rats. So that's an animal study. But there you go, that's. This is the way the evidence develops. Another study, K2 reduces blood vessel calcification whereas again vitamin K1 did not. So again differentiating between the K1 and the K2 dietary intakes of vitamin K2 is associated with the reduced risk of coronary heart disease from the Rotterdam study. So quite a few studies accumulating that do seem to be strengthening this link between adequate amounts of vitamin K2 increased bone mineralization, giving stronger bones, which is what we want but at the same time preventing calcification of the soft tissues which we don't want. We don't want calcified soft tissues. I mean an artery know if you feel your pulse in your wrist, you know, just, just feel, feel your pulse in the wrong way around. Can I do it on that one? So feel the knobbly bone there. Feel your pulse just in there, just on that. You'll feel the elasticity. It's going like this as the pulse goes through it. Well there's one in your neck, the pulse is all over the place carotid artery in the neck. And the whole point is that once it's moved out with a pulse pressure wave, the arterial wall contracts again. And that maintains the pressure during what we call dicystole, the time when the heart is not contracting. So systole, when the heart is contracting, and then the arterial elastic wall pushes down on that, and that maintains blood perfusion of the tissue during diacystole. But of course, if the artery is calcified and hardened, it can't do that. So it messes things up. So it's exactly what we don't want. As well as being associated with atherosclerosis, the clogging up of the arteries, which, of course is associated with thrombosis, the pathological clotting of the blood, which blocks off the blood supply to the tissues and causes infarction, such as a myocardial infarction, or if it occurs in the arteries that go to the brain, a cerebral infarction. That would be a stroke. This is the basis of a lot of pathology. Vitamin K2 may help with dental health, which makes sense. Strong bones and teeth do tend to go together, don't they? Especially with vitamin D. So the vitamin D and the K2 have been particularly associated with good dental health and strong bones. Links between low levels of vitamin K2 and liver cancer. Well, who knows? Maybe this indicates it's true. The liver cancer here is called a hepatocellular carcinoma. It's the primary form of liver cancer. It's when the cancer actually starts in the liver. So you probably know with cancers, you get a primary site, which is where the cancer starts, and then it can metastasise, it can spread to another site. There's a whole problem with cancer, of course. It metastasises, spreads around the body. The patient can end up with carcinomatosis with cancer everywhere. So the hepatocellular carcinoma is the form of cancer that starts in the liver. Very often we do see cancer that spread from the colon, for example, to the liver, the liver as a secondary site. But this is talking about the primary form of liver cancer. More data needed, of course, as with all of these studies, but interesting links with preventing advanced prostate cancer. So that paper, there's. Check it out if you're interested in prostate cancer. And I have been looking at. Not surprising, really, for my stage of life, Prostate cancer is the most common cancer in men. So I've been looking at it lately. Gets more common with age, of course, and the links between increased levels of prostate cancer and low levels of vitamin D seem to be accumulating. So the evidence that good levels of vitamin D are helping to prevent prostate cancer and the prevention of prostate cancer are accumulating. Are accumulating. But here the link is with vitamin K2. So that is that link there. So from this, it would indicate that maybe good levels of vitamin D and levels of vitamin K2 combined might help reduce the incidence of prostate cancer. You see, dietetics, it's so frustrating. What we know is so limited. It's so hard to do proper clinical trials on this. You know, for about 30 years I taught this idea that eating fatty food increases your cholesterol. Now we're much more worried about sugar, you know, and yet I always followed the guidelines, but the guidelines, it turns out, weren't as accurate as would have liked them to be. So. So dietetics is very frustratingly uncertain in many respects. But anyway, we're doing the video now, so let's get on with it. We've committed ourselves. Synergistic effects with vitamin D. So this is saying synergistic effects with vitamin K2 especially, and vitamin D. So synergistic synergy. 2. 2 plus 2 equals 7 sort of thing. That. It's not an additive effect, it's a. It's a. It's an enhanced effect. They can enhance each other. Vitamin D and vitamin K as a pleiotrophic. Now that, that, that actually means more than one. So. And, and that means action, really, or movement. So basically it's saying that the two together. Pelial actually is Greek for more, I think. So there's more. So it's not just the vitamin K on its own. It's not just the vitamin D on its own, it's the two together making more than one. And that has an additional effect. It's a bit like saying a synergistic effect. The palaeotrophic nutrients, they work well together, is what it's saying. Clinical importance to the skeletal and cardiovascular systems and preliminary evidence for synergy. So this paper claims. Interesting. Now, going on a bit long today, but I'm just, I'm just going to quickly go through one of the things that people are very worried about, the vitamin D supplement and is increased blood calcium levels. And it looks like you have to have very high vitamin D levels for that to be a problem. Let's just have a look at the evidence for that, that prevalence of hypercalcemia related to hypervitaminosis D in clinical practice. This paper here, check it out. Don't take my Word for anything. The papers are all there. Determine the con. So it wanted to determine the concentrations of vitamin D at which the risk of hyper high calcium emia in the blood. High purse high. The reason I'm hesitating is that in the UK we spell it emia A E M I A. In the States you don't bother with the A, which of course is much more sensible, but too old to change really. So hyper high cal calcium emia in the blood. Right number in the study, Good number in the study, 25,000. Hypervitaminosis D was defined at vitamin D levels of greater than 160 nanomoles per liter. Not that high actually about 64 nanograms per milliliter. Now on my vitamin D thing that I got from the NHS when I did my test, it actually says there that total vitamin d levels above 220 nanomoles per liter are considered high. So this was, this study was setting a much lower threshold than this particular NHS lab does. But this is the result we have. So results. 382 samples were identified as the first recorded hypovitinosis D. So that's just 382 as the first occurrence. Out of the 25,000 samples taken, 39 of those presented with high levels of calcium in the blood, 10.2%. But these are people with abnormally high levels of vitamin D, with some had vitamin D levels between 161 and 375. But most they were much higher. Most of them there were 375 nanomoles per milliliter, which is 150 nanograms per milliliter, which I think everyone would agree is high. Although they are saying we can't get away from the fact the paper is saying 161 is high, that they define it as above 160, which is high. In 15 subjects hypercalcemia could be attributed to vitamin D. So basically that's 15 out of that many altogether. And although the calcium level, to tell you the truth, I would be uncomfortable with the patient of these calcium levels. But to use their words, it didn't reach critical values. The high calcium levels didn't reach critical values. So this paper seems to be saying that even though the vitamin D levels were high, the calcium levels didn't reach critical values. Abnormally high. Yes, critically high. They are saying not conclusion. Hypercalcemia due to vitamin D represented less than 4% of the total hypervitaminosis D detected. But of course this is people with abnormally high levels of vitamin D. The problem in most northern latitudes is people that are low in vitamin D. These are people with particularly high levels, very low percentage of the tests performed. So to conclude from that paper, can high levels of vitamin D be associated with high levels of calcium? Yes, they can. That's what it's saying. But they're people with very high levels. And just remind ourselves, the NHS level I have here, so my level here was 84.4 nanomoles per liter, whereas they're saying it's only high when it gets to 220 nanomoles per liter. And that was with me taking about 3,000 units per day. But of course I can't tell you what to take because. And this is just not. I mean, I am trying to cover myself, obviously I can't, I can't prescribe for you. But apart from that, two people can take the same amount of vitamin D and end up with very different blood levels. That's just the way it is. So the only correct way to do this is to go to your doctor, get your vitamin D levels checked, because, remember, I tested myself on that and I did another test and they both came out different. And ideally, titrate your vitamin D levels, but there's no likelihood of nice doing that at the moment. That's why I'm still taking my 4,000 units a day over winter. Anyway, let's leave the last word to Healthline. No strong evidence proves that moderate amounts of vitamin D are harmful without an adequate intake of vitamin K. So there we go. If you're taking moderate levels of vitamin D, there's no evidence that you need to take vitamin K with that. According to Healthline, however, research is ongoing and the picture might become clearer in the near future. Well, let's hope so. So what they're saying is moderate levels of vitamin D supplement do not. There's no evidence that moderate amounts of vitamin D are harmful without an adequate intake of vitamin K. So this is saying, basically, people taking moderate amounts of vitamin D just because they're on vitamin D need not take extra vitamin K. They don't need to take extra vitamin K, is what that is saying. Having said that, the evidence we've looked at does indicate that quite a few of us might be short of vitamin K and that this shortage of vitamin K, vitamin K2, that this because we don't get enough organs and we don't eat enough fermented food, this may be associated with osteoporosis and it may be associated with calcification of the tissues. And that is as strongly as I can put it, because that is all the evidence that we have. So that's why I was a bit reluctant to do that, because I know the evidence is not conclusive. But that is my review of the current evidence and they are my conclusions. So personally, I'm going to carry on taking my vitamin D until I get some overall sun exposure. I am considering taking some vitamin K2. So talk it over with your healthcare provider and see what they think. Okay. That is that video. I hope that created more clarity than confusion, but it is confusing because we don't have definitive answers. This human body is just so complicated. It interacts with so many things who can understand it, and yet there are some things that we can do that we know are harmful. And there's some things that we can do that we know are beneficial. Some things are beneficial, some things are harmful. It's not always clear which is which. But that's the ongoing process. And if more evidence comes to light, I will certainly be discussing it. But I'm not holding my breath for anything too definitive at the moment. Yep. That I'm. I'm waffling now. That means. That means I've said everything. So thank you, of course, for watching. I seriously, I hope it's helped.