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Monday, January 24, 2011

Jack LaLanne Dies at 96 (Jack at 71-years old)

Jack LaLanne died Sunday from complications of pneumonia at the age of 96.  He was fit as a fiddle to the end.  He exercised every day up until his death.  He was the American Guru of Fitness and Nutrition before it was in vogue.  In 1936 he opened up the first modern health club (gym) in America and today is the icon of exercise and good nutrition which he preached over TV and other media until this year.  In his 50's and 60's he would demonstrate incredible feats of strength and endurance.  On his 70th birthday, he celebrated by towing 70 rowboats with seventy people on board for a mile and a half across Long Beach Harbor, all while handcuffed and with his feet shackled. 

"With healthier citizens," he said, "we unburden society from sickness, and reduce the medical bills that are draining people's savings and causing so much grief."  He will be remembered for his contributions to all Americans and his warning that the only bad thing you can do to your body is not use it.

Thursday, January 20, 2011

Amazing Vitamin K

The Amazing Vitamin K Story

by JP Saleeby, MD

In very recent years, the medical and scientific communities have begun to focus their attention on the benefits of Vitamin K.  While not as popular as its big brother, Vitamin D, Vitamin K will no doubt come to the attention of mainstream media as soon as its many benefits are realized by the public.   In the last five years, primary care physicians and specialists are testing Vitamin D levels on almost every patient.  As research has poured in on the many health benefits in multiple arenas, from bone health to immune function, Vitamin D therapy is now considered standard of care.  Likewise, Vitamin K is slowly gaining momentum in the public eye and in doctor’s offices. 

Of historical interest, Vitamin K was first discovered as a compound in the 1930's.  It was reported in a German science journal as koagulationvitamin for its control over coagulation, hence the letter designation “K” for koagulation.  Newsworthy in the mid-20th century, Vitamin K made headlines when the 1943 Nobel Prize in Medicine was shared by American Dr. Edward A. Doisy and German Dr. Henrik Dam for their work with this vitamin.  As early as 1938, the first report of using Vitamin K to treat a life threatening case of hemorrhage due to liver disease was documented.  Its use as a therapeutic saved the patient from certain death.

Vitamin K is a lipophilic vitamin (meaning it is fat soluble) and is required chiefly for blood coagulation and metabolism of bone and other tissues.  There are two natural forms of this vitamin and several synthetic versions.  Vitamin K1, also known as phytomenadione, and Vitamin K2, menaquinone, are the two natural forms.  Vitamin K2 is produced chiefly by bacteria in our large intestines. Vitamin K1 is found in green leafy vegetables such as spinach, turnip greens, Swiss chard, and the brassica vegetables like cabbage, broccoli, Brussels sprouts, and kale.  Fruits like kiwifruit and avocado, as well as soybean oil are other food sources of Vitamin K.

The chief utilization of Vitamin K in medicine as a "therapeutic" is in its role with the coagulation of blood.  It plays a key role in factors II, VII, IX and X as well as in protein-C and protein-S.  All of these blood factors and proteins are linked to the clotting cascade that prevents us from hemorrhaging in the event of a severe traumatic injury.  Additionally, Vitamin K has a significant role in bone metabolism with a relation to osteocalcin.  It acts as a bone building hormone in a way, much like Vitamin D.    Osteocalcin is synthesized by Vitamin K and is the "matrix" in bone that holds the calcium molecules together.  Without Vitamin K, hip bone fracture rates increase despite adequate Vitamin D and calcium intake.  In the 1998 Nurse’s Health Study, oral administrations of 110 micrograms per day of Vitamin K proved to decrease hip fractures when compared to control subjects. 

Vitamin K is important in vascular biology as well, especially in the realm of artery plaque formation (calcification).  There are Vitamin K dependent proteins involved in atherosclerosis or hardening of the arteries.   The process of calcium plaque formation is hindered with adequate Vitamin K levels in circulation.  Warfarin (Coumadin ®) is a drug often used to treat folks with coronary artery disease (CAD) and to prevent blood from clotting in heart chambers and deep veins where severe compilations may arise.  However, while treating certain medical conditions with these blood thinners, which inactivate Vitamin K, we create other problems.  Chief among these problems are an increase in our risk for developing arterial plaques, the possibility of affecting our immune system, and the likely impediment of bone mineralization.

Vitamin K's effect on coronary arteries goes like this.  With low levels of circulating Vitamin K in the serum, there is an impact on the function of a protein within the endothelial lining of the arteries called the Matrix Gla protein (MGP).  The effect of low Vitamin K on this protein is that it allows for an increase deposition of calcium in arteries.  Drugs that lower Vitamin K's effect in a sense raise the risk for coronary artery disease.  Vitamin K facilitates our immune system with positive links to phagocytosis and chemotaxis (the process by which “microorganism attacking cells" in our body find and eliminate infectious organisms).  Furthermore, Vitamin K appears to have a role in apoptosis, the process of natural and desirable cell death.  Apoptosis is the process by which our bodies can eliminate damaged, old or mutated cells thus reducing many forms of cancers.

Because Vitamin K2 is produced by bacteria in the human alimentary tract, the overuse of broad-spectrum antibiotics can wipe out this good type of bacteria in our intestines and may cause a relative deficiency.  Poor nutrition with inadequate consumption of greens and fruit is another way to attain deficiency.  Both means of deficiency can lead to clotting dysfunction, immune disruption, bone loss, and coronary disease.  With a look at the latest research, it appears that Vitamin K2 is longer acting, has better bioavailability, and provides better bone strength when compared to Vitamin K1 supplementation.  A subset of Vitamin K2 known as menaquinone–7, or MK–7 shows promise in current research as even a more potent form of Vitamin K.  In the future, we may learn the better Vitamin K supplement to take is in fact MK-7.

There is no known upper limit or toxic level of the natural Vitamin K1 & K2, however, scientists show toxicity with the synthetic forms and that they should be avoided as a source of supplementation.  This fact was demonstrated in a recent ban on synthetic Vitamin K3 due to the occurrence of hemolytic anemia and cytotoxicity.  This is yet another example of how natural compounds often trump synthetics in nutritional medicine.  It appears Mother Nature can rarely be outperformed in the lab.

How to get the most Vitamin K out of your veggies?  Well, cooking them in water will yield less concentration due to the hydrophobic properties of this vitamin.  You will probably throw out much of the Vitamin K in your vegetables when you pour off the cooking water.  Cooking them in oil (sautéing in olive oil, for example) will retain the bioavailability of this vitamin three-fold.  Eating meat, eggs, and dairy is another source of providing Vitamin K2 in addition to that produced by E. coli in our gut.  But it is with a healthy gut microflora that we acquire most of our Vitamin K2.

Deficiencies can occur with Inflammatory Bowel Syndrome (IBS), cystic fibrosis, alcoholism, liver disease, in bulimics, and those taking chronic anticoagulants, antibiotic therapy, and salicylates.  Bleeding and bruising disorders are signs of deficiency; osteoporosis and coronary artery disease (CAD) are also associated, but realized over the course of many years.  Unlike many other vitamins, Vitamin K is recycled in our bodies, thus reducing the threat of deficiency, provided both enzymes responsible for this process in our bodies are working well.  Warfarin (Coumadin ®) blocks Vitamin K epoxide reductase (VKOR), one of the two enzymes responsible for Vitamin K recycling and maintaining healthy levels.  Interesting to note, long term use of aspirin (ASA) and
cephalosporins (an antibiotic class) can lead to K1 deficiencies by interference with enzyme function.  Furthermore, the drugs cholestyramine, cholestipol, orlistat, and the fat substitute, olestra, have been noted to decrease Vitamin K absorption, in all probability leading to a drop in serum Vitamin K levels that can affect health. 
Because newborns are susceptible to clotting abnormalities, due to immature livers and sterile guts (inability to have E. coli produce Vitamin K2), they are usually born deficient in varying degrees.  There is a 1.5% incidence of unexpected bleeding in newborns due to low levels of Vitamin K.  Mothers on anticonvulsants, rifampin and isoniazid (both antibiotics) while pregnant tend to have offspring with sterile guts and an even higher incidence of Vitamin K deficiency.  Therefore, the American Academy of Pediatrics recommends about 1.0 milligram of Vitamin K1 be administered to each newborn. 

There is a connection in theory with Alzheimer’s disease.  The APOE4 gene that has been implicated in Alzheimer's disease seems to be responsible for low Vitamin K levels in this subset of patients.  It is surmised that supplementation with Vitamin K may reduce the occurrence of Alzheimer's disease, but more research is needed.  There also appears to be a connection with some types of cancers.  Interestingly, there are two Japanese studies showing females with liver disease with a high risk for liver cancer, having a 90% reduction in development of liver malignancy if they were supplemented with Vitamin K.  In a 2008 published German study of male subjects, there was a drop in prostate cancer risk with Vitamin K supplementation.

Vitamin K must be rather important to our body as there are at least three ways in which it is maintained; by diet (eating greens), by production in our gut (bacterial), and by enzymatic recycling.  Sometimes the importance of a particular substance can be found in the redundancies our body creates to conserve it, such is the case with Vitamin K.

Pearls from Dr. Saleeby:
  • Vitamin D dependent osteoblasts effect production of osteocalcin, a Vitamin K dependent protein, leading to good bone health, as long as both vitamins are in adequate and balanced supply.
  • Growth arrest specific gene 6 protein (Gas6) a Vitamin K dependent protein is responsible for cellular growth regulation factor found in nerve tissue, heart, lung, kidney and cartilage.
  • Good idea to supplement with between 10 - 120 mcg/d of Vitamin K2 (providing Coumadin users are monitored closely under physician supervision).
  • Large Vitamin A doses have been noted to affect absorption of Vitamin K, while large doses of Vitamin E can affect and antagonize Vitamin K enzymatic activity.  We see a rise in bleeding risk with large doses of Vitamin E intake.  There is a balance between the fat soluble vitamins that needs to be adhered to.  It is unwise to guess and gamble with what you take and supplement.

JP Saleeby, MD is an integrative and nutritional medicine practitioner.  He has been the chief formulator for a number of independent nutraceutical companies.  He is a medical writer / blogger and offers telemedicine consultations to his patients.

(c) 2011


Berkner, K. L. and Runge, K. W. (2004), “The physiology of vitamin K nutriture and vitamin K-dependent protein function in atherosclerosis”. Journal of Thrombosis and Haemostasis, 2: 2118–2132.

Neil C Binkley, Diane C Krueger, Tisha N Kawahara, Jean A Engelke, Richard J Chappell and John W Suttie. (2002) "A high phylloquinone intake is required to achieve maximal osteocalcin {gamma}-carboxylation". American Journal of Clinical Nutrition 76 (5).

Higdon (2008).
"Vitamin K". Linus Pauling Institute, Oregon State University. Retrieved 01-10-2011.

Warner, E.D.; Brinkhous, K. M.; Smith, H. P. (1938). Proceedings of the Society of Experimental Biology and Medicine 37: 628.

Stafford, D.W. (2005), “The vitamin K cycle.”. Journal of Thrombosis and Haemostasis, 3: 1873–1878.

Saxena S.P.; Israels, E.D.; Israels L.G. (2001). "Novel vitamin K-dependent pathways regulating cell survival.". Apoptosis 6 (1-2): 57–68.

Nimptsch K, Rohrmann S, Linseisen J (2008). "Dietary intake of vitamin K and risk of prostate cancer in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition. (EPIC-Heidelberg)". Am. J. Clin. Nutr. 87 (4): 985–92.

Brown, S.E.,
"Key vitamins for bone health — vitamins K1 and K2". Retrieved Jan., 10 2011.

Nimptsch K, Rohrmann S, Linseisen J (2008).
"Dietary intake of vitamin K and risk of prostate cancer in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition. (EPIC-Heidelberg)". Am. J. Clin. Nutr. 87 (4): 985–92.

Allison (2001). "The possible role of vitamin K deficiency in the pathogenesis of Alzheimer's disease and in augmenting brain damage associated with cardiovascular disease.". Medical hypotheses  57 (2): 151–5.

Habu, D., (2004) "Role of Vitamin K2 in the Development of Hepatocellular Carcinoma in Women With Viral Cirrhosis of the Liver.". JAMA, 292 (3): 358-361.

Bellido-Martin, L. (2008) "Vitamin K-dependent actions of Gas6.". Vitam. Horm. 78:185-209.

Hendler S.S., Rorvik D.R., eds. (2001) “PDR for Nutritional Supplements.”. Montvale: Medical Economics Company.

Saturday, January 15, 2011

Shakeology Lecture by Dr. Saleeby

Click on this for a PowerPoint Lecture on Shakeology (given 3/2009)

Friday, January 14, 2011

New Online Laboratory launch

AtroGene is soon to launch an online Direct Access Testing (DAT) web site for lab testing.  Keep your eye out for as it will be up and running in a month.

Thursday, January 6, 2011

Osteoporosis Lecture by Dr. Saleeby

Tuesday, January 4, 2011

Happy New Year - Important new info from Dr. Saleeby


My main practice web site has changed... have a look at the new pages of  The practice name and location has changed.  New space is shared in a finer, more upscale property downtown Conway.  The name AtroGene will represent the practice as it moves more into the 21st Century reliance on the Internet & Tele-medicine.  Will also be offering best-in-the-industry Online Labs at great cost savings to the consumer.  Access to my active patients to the full line of Xymogen nutraceuticals will be offered to my patients, via the web ( email me for more information.

Today I want to feature a very well written article by Dr. Klein on the relationship between Diabetes and select supplements to deminish the coronary artery disease properties.

JP Saleeby, MD

Diabetes and Atherosclerotic Vascular Disease- Nutraceutical Intervention Update

David S. Klein, MD, FACA, FACPM

Alpha Lipoic Acid: The incidence of type 2 diabetes mellitus (DM) in the U.S.
is already high, and the rate is climbing rapidly. Medical complications seen in
DM patients include coronary heart disease, peripheral vascular disease,
nephropathy, neuropathy and retinopathy. While control of blood sugar levels is
of paramount importance, attention to the sequelae may reduce morbidity and help
reduce healthcare costs.

Pivotal in the development of diabetic complications is dysfunction of vascular
endothelia. Inflammation of the inner lining of the blood vessels results in
platelet aggregation and deposition of cholesterol resulting in atherosclerotic
plaque development. The formation of atherosclerotic plaque is results directly
from endothelial inflammation, often monitored by serum CRP levels.

Recently, it was observed that intravenous alpha lipoic acid (ALA), was found to
be beneficial in patients with DM who suffer from endothelial dysfunction.(1)
Forearm blood flow was measured before and after 21 days of either IV treatment
of 600mg ALA or placebo. Intravenous ALA treatment improves endothelium-dependent
vasodilatation. The investigators also observed that LDL-cholesterol was
reduced in the ALA treatment group.

It was postulated that ALA might improve endothelial function through inhibition
of NF-kappa B and metalloproteinase-9 and upregulation of intracellular adhesion
molecule-1 (ICAM-1).

Alpha Lipoic Acid may also be useful in the treatment of obesity, which is
itself a risk factor for the development of DM. At this time, 34 percent of
adults aged 20 and older are obese; 34 percent are ‘overweight.’
In a recent study, ALA was studied for weight loss in ‘pre-obese’ and obese
adults. Findings of a recent study observing 1,127 men and women between the
ages of 18 and 60 years, observations after measuring the BMI of all
participants, 53 percent were found to be obese and 43 percent were pre-obese.
Study participants were given ALA for 4 months at a dosage of 800mg per day.

The participants experienced After supplementation, investigators found that
participants experienced an 8-9 percent reduction in body weight, a reduction in
BMI by 2-4 points, and a reduction in waist size by 2.5-4 inches.(3)

Resveratrol: Resveratrol is a naturally occurring polyphenol found in the
skin of red grapes and is found in red wine. Thought to offer a range of
beneficial medical effects, Resveratrol is being studied for anti-cancer effects
and for cardiovascular benefits.

Recently, Resveratrol was studied (2) in patients given Resveratrol 40 mg, or
placebo, for six weeks. In the Resveratrol group, there was a significant
reduction in the generation of reactive oxygen species, binding of NF-κB (a
major regulatory component of pro-inflammatory cytokine production), and
expression of JNK-1 and Iκκβ (pro-inflammatory molecules). Study participants in
the Resveratrol group had decreased levels of CRP, TNF-alpha and IL-6 (two major
pro-inflammatory cytokines that are regulated by NF-κB.

According to the authors: “The extract induced a significant reduction in
reactive oxygen species generation, the expression of p47(phox), intranuclear
nuclear factor-kappaB binding, and the expression of jun-N-terminal kinase-1,
inhibitor of kappaB-kinase-beta, phosphotyrosine phosphatase-1B, and suppressor
of cytokine signaling-3 in mononuclear cells when compared with the baseline and
the placebo. PCE intake also suppressed plasma concentrations of TNF-alpha,
IL-6, and C-reactive protein.”

Whey Protein: In a recent study, (4) the effects of supplemental dietary whey
protein was observed in relation to body composition, lipids, insulin and
glucose in comparison to casein and glucose (control) supplementation. In this
12 week study, subjects were randomized to receive whey protein, casein or
glucose supplementation. Seventy men and women, mean ages of 48.4 (SEM 0.86)
years and a mean BMI of 31.3 (SEM 0.8) kg/m2 completed the study. Subjects
supplemented with whey protein had no significant change in body composition or
serum glucose at 12 weeks compared with the control or casein group. Fasting
glucose levels were significantly lowered in the whey group, as compared with
the control group at 6 weeks, and there was a significant decrease in total
cholesterol and LDL cholesterol at week 12 in the whey group as compared with
the casein receiving cadre. Fasting insulin levels were also significantly
decreased in the whey group compared with the control group. Demonstrating that
supplementation with whey proteins improves fasting lipids and insulin levels in
overweight and obese individuals.

Recommendation: Increasing scientific data support the use of Alpha Lipoic Acid
and Resveratrol in the treatment of patients with type II Diabetes. Available
at reasonable cost, these two nutraceuticals are useful in the treatment of a
variety of other conditions, as well, and afford the practitioner an additional
modality to offer patients.
These two nutraceuticals are widely available, but should be used in conjunction
with appropriate diet modification.

1. Heinisch BB, Francesconi M, Mittermayer F, et al: Alpha-lipoic acid improves
vascular endothelial function in patients with type 2 diabetes: a
placebo-controlled randomized trial. Eur J Clin Invest 2010 Feb:40(2):148-54.
2. Ghanim H, Sia CL, Abuayseh S, et al: An antiinflammatory and reactive oxygen
species suppressive effects of an extract of Polygonum cuspidatum containing
Resveratrol. J Clin Endocrinol Metab 2010 Sept;95(9):E1-8. .
3. Carbonelli MG, Di Renzo L, Bigioni M, et al: Alpha-lipoic acid
supplementation: a tool for obesity therapy? Curr Pharm Des. 2010;16(7):840-4.
Pals S, Ellis V & Dhaliwal S: Effects of whey protein isolate on body
composition, lipids, insulin and glucose in overweight and obese individuals. Br
J Nutr. 2010 Sept; 104(5):716-23.

David S. Klein, MD has practiced pain medicine for the past 27 years and is the author of over 50 published articles and textbook chapters.  His writings have appeared in this blog previously.

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Charleston; Myrtle Beach, SC; Raleigh-Durham, NC; Orlando, FL, GA, NC, SC, VA, FL, United States