Dr. Mellanby's Tooth Decay Reversal Diet

I have a lot of admiration for Drs. Edward and May Mellanby. A husband-and-wife team, they discovered vitamin D, and determined that rickets is caused by poor calcium (or phosphorus) status, typically due to vitamin D deficiency. They believed that an ideal diet is omnivorous, based on whole foods, and offers an adequate supply of fat-soluble vitamins and easily absorbed minerals. They also felt that grain intake should be modest, as their research showed that unsoaked whole grains antagonize the effect of vitamins D and A.

Not only did the Mellanbys discover vitamin D and end the rickets epidemic that was devastating Western cities at the time, they also discovered a cure for early-stage tooth decay that has been gathering dust in medical libraries throughout the world since 1924.

It was in that year that Dr. May Mellanby published a summary of the results of the Mellanby tooth decay reversal studies in the British Medical Journal, titled "Remarks on the Influence of a Cereal-free Diet Rich in Vitamin D and Calcium on Dental Caries in Children". Last year, I had to specially request this article from the basement of the University of Washington medical library (1). Thanks to the magic of the internet, the full version of the paper is now freely available online (2).

You don't need my help to read the study, but in this post I offer a little background, a summary and my interpretation.

In previous studies, the Mellanbys used dogs to define the dietary factors that influence tooth development and repair. They identified three, which together made the difference between excellent and poor dental health (from Nutrition and Disease):

1. The diet's mineral content, particularly calcium and phosphorus
2. The diet's fat-soluble vitamin content, chiefly vitamin D
3. The diet's content of inhibitors of mineral absorption, primarily phytic acid

Once they had defined these factors, they set about testing their hypotheses in humans. They performed eight trials, each one in children in an institutionalized setting where diet could be completely controlled. The number of cavities in each child's mouth was noted at the beginning and end of the period. I'll only discuss the three most informative, and only the most successful in detail. First, the results:

I'll start with diet 1. Children on this diet ate the typical fare, plus extra oatmeal. Oatmeal is typically eaten as an unsoaked whole grain (and soaking it isn't very effective in any case), and so it is high in phytic acid, which effectively inhibits the absorption of a number of minerals including calcium. These children formed 5.8 cavities each and healed virtually none-- not good!

Diet number 2 was similar to diet 1, except there was no extra oatmeal and the children received a large supplemental dose of vitamin D. Over 28 weeks, only 1 cavity per child developed or worsened, while 3.9 healed. Thus, simply adding vitamin D to a reasonable diet allowed most of their cavities to heal.

Diet number 3 was the most effective. This was a grain-free diet plus supplemental vitamin D. Over 26 weeks, children in this group saw an average of only 0.4 cavities form or worsen, while 4.7 healed. The Mellanbys considered that they had essentially found a cure for this disorder in its early stages.

What exactly was this diet? Here's how it was described in the paper (note: cereals = grains):

...instead of cereals- for example, bread, oatmeal, rice, and tapioca- an increased allowance of potatoes and other vegetables, milk, fat, meat, and eggs was given. The total sugar, jam, and syrup intake was the same as before. Vitamin D was present in abundance in either cod-liver oil or irradiated ergosterol, and in egg yolk, butter, milk, etc. The diet of these children was thus rich in those factors, especially vitamin D and calcium, which experimental evidence has shown to assist calcification, and was devoid of those factors- namely, cereals- which interfere with the process.

Carbohydrate intake was reduced by almost half. Bread and oatmeal were replaced by potatoes, milk, meat, fish, eggs, butter and vegetables. The diet is reminiscent of what Dr. Weston Price used to reverse tooth decay in his dental clinic in Cleveland, although Price's diet did include rolls made from freshly ground whole wheat. Price also identified the fat-soluble vitamin K2 MK-4 as another important factor in tooth decay reversal, which would have been abundant in Mellanby's studies due to the dairy. The Mellanbys and Price were contemporaries and had parallel and complementary findings. The Mellanbys did not understand the role of vitamin K2 in mineral metabolism, and Price did not seem to appreciate the role of phytic acid from unsoaked whole grains in preventing mineral absorption.

Here are two sample meals provided in Dr. Mellanby's paper. I believe the word "dinner" refers to the noon meal, and "supper" refers to the evening meal:

Breakfast- Omelette, cocoa, with milk.
Lunch- Milk.
Dinner- Potatoes, steamed minced meat, carrots, stewed fruit, milk.
Tea- Fresh fruit salad, cocoa made with milk.
Supper- Fish and potatoes fried in dripping, milk.

Breakfast- Scrambled egg, milk, fresh salad.
Dinner- Irish stew, potatoes, cabbage, stewed fruit, milk.
Tea- Minced meat warmed with bovril, green salad, milk.
Supper- Thick potato soup made with milk.

In addition, children received vitamin D daily. Here's Dr. Mellanby's summary of their findings:

The tests do not indicate that in order to prevent dental caries children must live on a cereal-free diet, but in association with the results of the other investigations on animals and children they do indicate that the amount of cereal eaten should be reduced, particularly during infancy and in the earlier years of life, and should be replaced by an increased consumption of milk, eggs, butter, potatoes, and other vegetables. They also indicate that a sufficiency of vitamin D and calcium should be given from birth, and before birth, by supplying a suitable diet to the pregnant mother. The teeth of the children would be well formed and more resistant to dental caries instead of being hypoplastic and badly calcified, as were those in this investigation.

If I could add something to this program, I would recommend daily tooth brushing and flossing, avoiding sugar, and rinsing the mouth with water after each meal.

This diet is capable of reversing early stage tooth decay. It will not reverse advanced decay, which requires professional dental treatment as soon as possible. It is not a substitute for dental care in general, and if you try using diet to reverse your own tooth decay, please do it under the supervision of a dentist. And while you're there, tell her about Edward and May Mellanby!

Preventing Tooth Decay
Reversing Tooth Decay
Images of Tooth Decay Healing due to an Improved Diet
Dental Anecdotes

Beef Tallow: a Good Source of Fat-Soluble Vitamins?

Suet is a traditional cooking fat in the US, which is a country that loves its cows. It's the fat inside a cow's intestinal cavity, and it can be rendered into tallow. Tallow is an extremely stable fat, due to its high degree of saturation (56%) and low level of polyunsaturated fatty acids (3%). This makes it ideal for deep frying. Until it was pressured to abandon suet in favor of hydrogenated vegetable oil around 1990, in part by the Center for Science in the Public Interest, McDonald's used tallow in its deep fryers. Now, tallow is mostly fed to birds and feedlot cows.

I decided to make pemmican recently, which is a mixture of pulverized jerky and tallow that was traditionally eaten by native Americans of many tribes. I bought pasture-raised suet at my farmer's market. It was remarkably cheap at $2/lb. No one wants it because it's so saturated. The first thing I noticed was a yellowish tinge, which I didn't expect.

I rendered it the same way I make lard. It turned into a clear, golden liquid with a beefy aroma. This got me thinking. The difference between deep yellow butter from grass-fed cows and lily-white butter from industrial grain-fed cows has to do with the carotene content. Carotene is also a marker of other nutrients in butter, such as vitamin K2 MK-4, which can vary 50-fold depending on what the cows are eating. So I thought I'd see if suet contains any K2.

And indeed it does. The NutritionData entry for suet says it contains 3.6 micrograms (4% DV) per 100g. 100g is about a quarter pound of suet, more than you would reasonably eat. Unless you were really hungry. But anyway, that's a small amount of K2 per serving. However, the anonymous cow in question is probably a grain-finished animal. You might expect a grass-fed cow to have much more K2 in its suet, as it does in its milkfat. According to Weston Price, butter fat varies 50-fold in its K2 content. If that were true for suet as well, grass-fed suet could conceivably contain up to 180 micrograms per 100g, making it a good source of K2.

Tallow from pasture-raised cows also contains a small amount of vitamin D, similar to lard. Combined with its low omega-6 content and its balanced n-6/n-3 ratio, that puts it near the top of my list of cooking fats.

Vitamin D: It's Not Just Another Vitamin

If I described a substance with the following properties, what would you guess it was?

-It's synthesized by the body from cholesterol
-It crosses cell membranes freely
-It has its own nuclear receptor
-It causes broad changes in gene transcription
-It acts in nearly every tissue
-It's essential for health

There's no way for you to know, because those statements all apply to activated vitamin D, estrogen, testosterone and a number of other hormones. Vitamin D, as opposed to all other vitamins, is a steroid hormone precursor (technically it's a secosteroid but it's close enough for our purposes). The main difference between vitamin D and other steroid hormones is that it requires a photon of UVB light for its synthesis in the skin. If it didn't require UVB, it would be called a hormone rather than a vitamin. Just like estrogen and testosterone, it's involved in many processes, and it's important to have the right amount.

The type of vitamin D that comes from sunlight and the diet is actually not a hormone itself, but a hormone precursor. Vitamin D is converted to 25(OH)D3 in the liver. This is the major storage form of vitamin D, and thus it best reflects vitamin D status. The kidney converts 25(OH)D3 to 1,25(OH)D3 as needed. This is the major hormone form of vitamin D. 1,25(OH)D3 has profound effects on a number of tissues.

Vitamin D was originally identified as necessary for proper mineral absorption and metabolism. Deficiency causes rickets, which results in the demineralization and weakening of bones and teeth. A modest intake of vitamin D is enough to prevent rickets. However, there is a mountain of data accumulating that shows that even a mild form of deficiency is problematic. Low vitamin D levels associate with nearly every common non-communicable disorder, including obesity, diabetes, cardiovascular disease, autoimmune disease, osteoporosis and cancer. Clinical trials using vitamin D supplements have shown beneficial and sometimes striking effects on cancer, hypertension, type 1 diabetes, bone fracture and athletic performance. Vitamin D is a fundamental building block of health.

It all makes sense if you think about how humans evolved: in a tropical environment with bright sun year-round. Even in many Northern climates, a loss of skin pigmentation and plenty of time outdoors allowed year-round vitamin D synthesis for most groups. Vitamin D synthesis becomes impossible during the winter above latitude 40 or so, due to a lack of UVB. Traditional cultures beyond this latitude, such as the Inuit, consumed large amounts of vitamin D from nutrient-rich animal foods like fatty fish.

The body has several mechanisms for regulating the amount of vitamin D produced from sunlight exposure, so overdose from this source is impossible. Sunlight is also the most effective natural way to obtain vitamin D. To determine the optimal blood level of vitamin D, it's instructive to look at the serum 25(OH)D3 levels of people who spend a lot of time outdoors. The body seems to stabilize between 55 and 65 ng/mL 25(OH)D3 under these conditions. This is probably near the optimum. 30 ng/mL is required to normalize parathyroid hormone levels, and 35 ng/mL is required to optimize calcium absorption.

Here's how to become vitamin D deficient: stay inside all day, wear sunscreen anytime you go out, and eat a low-fat diet. Make sure to avoid animal fats in particular. Rickets, once thought of as an antique disease, is making a comeback in developed countries despite fortification of milk (note- it doesn't need to be fortified with fat-soluble vitamins if you don't skim the fat off in the first place!). The resurgence of rickets is not surprising considering our current lifestyle and diet trends. In a recent study, 40% of infants and toddlers in Boston were vitamin D deficient using 30 ng/mL as the cutoff point. 7.5% of the total had rickets and 32.5% showed demineralization of bone tissue! Part of the problem is that mothers' milk is a poor source of vitamin D when the mother herself is deficient. Bring the mothers' vitamin D level up, and breast milk becomes an excellent source.

Here's how to optimize your vitamin D status: get plenty of sunlight without using sunscreen, and eat nutrient-rich animal foods, particularly in the winter. The richest food source of vitamin D is high-vitamin cod liver oil. Blood from pasture-raised pigs or cows slaughtered in summer or fall, and fatty fish such as herring and sardines are also good sources. Vitamin D is one of the few nutrients I can recommend in supplement form. Make sure it's D3 rather than D2; 3,000- 5,000 IU per day should be sufficient to maintain blood levels in wintertime unless you are obese (in which case you may need more and should be tested). I feel it's preferable to stay on the low end of this range. Vitamin D3 supplements are typically naturally sourced, coming from sheep lanolin or fish livers. A good regimen would be to supplement every day you get less than 10 minutes of sunlight.

People with dark skin and the elderly make less vitamin D upon sun exposure, so they should plan on getting more sunlight or consuming more vitamin D. Sunscreen essentially eliminates vitamin D synthesis, and glass blocks UVB so indoor sunlight is useless. Vitamin D toxicity from supplements is possible, but exceptionally rare. It only occurs in cases where people have accidentally taken grotesque doses of the vitamin. As Chris Masterjohn has pointed out, vitamin D toxicity is extremely similar to vitamin A deficiency. This is because vitamin A and D work together, and each protects against toxicity from the other. Excess vitamin D depletes vitamin A, thus vitamin D toxicity is probably a relative deficiency of vitamin A.

I know this won't be a problem for you because like all healthy traditional people, you are getting plenty of vitamin A from nutrient-dense animal foods like liver and butter. Vitamin K2 is the third, and most overlooked, leg of the stool. D, A and K2 form a trio that act together to optimize mineral absorption and use, aid in the development of a number of body structures, beneficially alter gene expression, and affect many aspects of health on a fundamental level.

Thanks to horizontal.integration for the CC photo.

Acid-Base Balance

Numerous health authorities have proposed that the acid-base balance of a diet contributes to its effects on health, including Dr. Loren Cordain. Here's how it works. Depending largely on its mineral content, food yields net acid or base as it's metabolized. This is not the same as the acidity of a food as you eat it; for example, lemons are base-yielding. The pH of the body's tissues and blood is tightly regulated, so it must find ways to resist pH changes. One way it deals with excess acid and base is by excreting it. Acidifying food causes the urine and saliva to become more acidic, while alkalinizing food has the opposite effect.

Another mechanism some believe the body uses to neutralize acidity is by drawing calcium from the bones. The modern diet tends to be acid-yielding. Vegetables and fruit are base-yielding while meat, refined carbohydrate, dairy and most other foods are acid-yielding. Some authorities believe this leads to osteoporosis, cancer and a number of other health problems. This is one of the reasons we're told to eat immoderate quantities of vegetables.

I've always been skeptical of the acid-base balance theory of health. This mostly stems from the fact that many hunter-gatherer societies were essentially carnivorous, yet they didn't suffer from osteoporosis, tooth decay or any other signs of calcium deficiency. Also, if acid-yielding diets strip calcium from the bones, how did calcium get into the bones to begin with? The body clearly has mechanisms for creating and preserving bone density in the face of an acid-yielding diet, it's just a question of whether those mechanisms are working properly.

I came across a gem of an article today on acid-base balance by none other than Dr. Weston Price. As usual, he hits it out of the ballpark. There are two tables in the article that sum it up beautifully. In the first, he compares the occurrence of cavities in healthy non-industrial groups to genetically identical groups living on modern foods (wheat flour, sugar). As you know by now if you've been reading this blog, the modern groups have 5-100 times more cavities than their non-industrial counterparts, along with crooked teeth, feeble frames and a number of other problems.

In the second table, he lists the acid-base balance of the same non-industrial and modern groups. There is no real pattern. Some of the non-industrial groups ate a diet that was heavily acid-yielding (Inuit, he calls them Eskimo), while others were fairly balanced or even base-yielding (South sea islanders). The unhealthy modern versions, ironically, were fairly balanced between acid and base-yielding foods. This is not consistent with the idea that acid-base balance contributes to the diseases of civilization.

There was one consistent trend, however. The non-industrial diets tended to be higher in both acid and base-yielding foods than their modern counterparts. That means they were richer in minerals. Just as importantly if not more so, their diets were rich in fat-soluble "activators" of mineral absorption and metabolism that ensure the proper use of those minerals. These are the fat-soluble vitamins A, D and K2. Here's what Weston Price says:

It is not my belief that [tooth decay, dental/skeletal deformity, general poor health] is related to potential acidity or potential alkalinity of the food but to the mineral and activator content of the nutrition during the developmental periods, namely, prenatal, postnatal and childhood growth. It is important that the very foods that are potentially acid have as an important part of the source of that acidity the phosphoric acid content, and an effort to eliminate acidity often means seriously reducing the available phosphorus, an indispensable soft and hard tissue component.

In other words, the acid-base balance isn't what matters, it's getting enough minerals and the vitamins you need to make good use of them.

Why were the diets of healthy non-industrial people so rich in minerals? It's simple: they ate whole foods. "Empty calorie" foods such as sugar, vegetable oil and refined grains constitute more than half of the calories in the modern diet. Eliminating those "foods" and replacing them with whole foods instantly doubles your mineral intake. Properly preparing grains and legumes by soaking, sprouting or fermenting further increases their mineral availability. Add some grass-fed dairy, organ meats, shellfish and eggs for the vitamins and you're in business!

How to Cause a Cancer Epidemic

A report came out recently showing that melanoma incidence has increased dramatically in the US since 1973, particularly among women. The authors suggested the rise could be due to increasing sun exposure, which I am highly skeptical of. The data he cites to support that idea are quite weak. I think the prevalence of vitamin D deficiency in this country suggests otherwise.

Melanoma is the most deadly form of skin cancer, and the only type that is commonly life-threatening. Its link to sun exposure is tenuous at best. For example, it often occurs on the least sun-exposed parts of the body, and its incidence is lower in outdoor workers.

What is the solution to rising melanoma incidence? Sunblock! Slather it on, ladies and gentlemen! No matter that we evolved outdoors! No matter that it may do nothing for melanoma incidence or mortality! No matter that you'll be vitamin D deficient! No matter that it contains known carcinogens! 30+ SPF, the more the better. Don't let one single deadly UV photon through.

The irony of all this is that if you believe the data on vitamin D, avoiding the sun would cause many more cancers than it would prevent, even if all melanoma were due to sun exposure.

Cancer and the Immune System

My understanding of cancer has changed radically over the past few months. I used to think of it as an inevitable consequence of aging, a stochastic certainty. The human body is made of about 50 trillion cells, many of which replicate their DNA and divide regularly. It's only a matter of time until one of those cells randomly accumulates the wrong set of mutations, and loses the molecular brakes that restrict uncontrolled growth.

Strictly speaking, the idea is correct. That is how cancer begins. However, there's another check in place that operates outside the cancer cell itself: the immune system. A properly functioning immune system can recognize and destroy cancerous cells before they become dangerous to the organism. In fact, your immune system has probably already controlled or destroyed a number of them in your lifetime.

I recently read a fascinating account of some preliminary findings from the lab of Dr. Zheng Cui at Wake Forest university. His group took blood samples from 100 people and purified a type of immune cell called the granulocyte. They then evaluated the granulocytes' ability to kill cervical cancer cells in a cell culture dish. They found that it varied dramatically from one individual to another. One person's granulocytes killed 97% of the cancer cells in 24 hours, while another person's killed 2%.

They found some important trends. Granulocytes from people over 50 years old had a reduced ability to kill cancer cells, as did granulocytes from people with cancer. This raises the possibility that cancer is not simply the result of getting too old, but a very specific weakening of the immune system.

The most important finding, however, was that the granulocytes' kung-fu grip declined dramatically during the winter months. Here's Dr. Cui:

Nobody seems to have any cancer-killing ability during the
winter months from November to April.

Hmm, I wonder why that could be?? Vitamin D anyone??

In the next post, I'll talk about cancer in non-industrialized cultures.

Celiac and Fat-Soluble Vitamins

One of the things I've been thinking about lately is the possibility that intestinal damage due to gluten grains (primarily wheat) contributes to the diseases of civilization by inhibiting the absorption of fat-soluble vitamins. If it were a contributing factor, we would expect to see a higher incidence of the common chronic diseases in newly-diagnosed celiac patients, who are often deficient in fat-soluble vitamins. We might also see a resolution of chronic disease in celiac patients who have been adhering faithfully to a long-term, gluten-free diet.

One thing that definitely associates with celiac disease is bone and tooth problems. Celiac patients often present with osteoporosis, osteopenia (thin bones), cavities or tooth enamel abnormalities (thanks Peter).

An Italian study showed that among 642 heart transplant candidates, 1.9% had anti-endomyosal antibodies (a feature of celiac), compared with 0.35% of controls. That's more than a 5-fold enrichment! The majority of those patients were presumably unaware of their celiac disease, so they were not eating a gluten-free diet.

Interestingly, celiac doesn't seem to cause obesity; to the contrary. That's one facet of modern health problems that it definitely does not cause.

The relationship between cancer and celiac disease is very interesting. The largest study I came across was conducted in Sweden using retrospective data from 12,000 celiac patients. They found that adult celiac patients have a higher overall risk of cancer, but that the extra risk disappears with age. The drop in cancer incidence may reflect dropping gluten following a celiac diagnosis. Here's another study showing that the elevated cancer risk occurs mostly in the first year after diagnosis, suggesting that eliminating gluten solves the problem. Interestingly, celiac patients have a greatly elevated risk of lymphoma, but a lower risk of breast cancer.

There's a very strong link between celiac and type I diabetes. In a large study, 1 in 8 type I diabetic children had celiac disease. This doesn't necessarily tell us much since celiac and type I diabetes are both autoimmune disorders.

One last study to add a nail to the coffin. Up to this point, all the studies I've mentioned have been purely observational, not able to establish a causal relationship. I came across a small study recently which examined the effect of a high-fiber diet on vitamin D metabolism in healthy (presumably non-celiac) adults. They broke the cohort up into two groups, and fed one group 20g of bran in addition to their normal diet. The other group got nothing extra. The bran-fed group had a vitamin D elimination half-life of 19.5 days, compared to 27.5 for the control group. In other words, for whatever reason, the group eating extra bran was burning through their vitamin D reserves 30% faster than the control group.

Unfortunately, the paper doesn't say what kind of bran it was, but it was probably wheat or oat (**Update- it's wheat bran**). This is important because it would determine if gluten was involved. Either way, it shows that something in grains can interfere with fat-soluble vitamin status, which is consistent with the staggering negative effect of wheat products on healthy non-industrialized cultures.

Add to this the possibility that most people may have some degree of gluten sensitivity, and you start to see a big problem. All together, the data are consistent with gluten grains interfering with fat-soluble vitamin status. As I discussed earlier, this could strongly contribute to the diseases of civilization. These data don't prove anything conclusively, but I do find them thought-provoking.

Thanks to Dudua for the CC photo

Real Food VIII: Ghee

All this talk about butter is making me hungry. Richard mentioned in the comments that he bought some ghee recently and has been enjoying it, so I thought I'd post a recipe. Ghee is the Hindi word for clarified butter. It's butter that has had everything removed but the fat. Rich in fat-soluble vitamins and lacking the sometimes problematic lactose and casein, ghee has rightfully been considered a health food in India since ancient times.

Another advantage of ghee is its high smoke point, which is higher than butter because it doesn't contain any protein or sugars. Consequently, food sauteed in ghee has a clean, rich taste.

The recipe is simple but touchy. I recommend using the best butter you can get your hands on. 100% grass-fed, unsalted cultured butter is the best.

Ingredient and materials

• Butter (1 lb minimum)
• Wide-mouth glass jars
• Cheesecloth
• Rubber bands
  

Recipe

1. Place the butter in a saucepan and turn the heat to medium until it's melted.
   
2. Once it begins to boil, turn the heat down to low. It's very important to calibrate the heat correctly. Typically, you will want the burner on its lowest setting. The idea is to evaporate the water without burning the oil. It should boil, but slowly.
3. The melted butter starts out cloudy but gradually clears up as the water evaporates. At the same time, a crust will form on the surface of the ghee and the bottom of the pan. Keep the heat very low.
   
4. Push a portion of the top crust to the side with a spoon to see inside of the saucepan. When the butter looks clear and bubbles only rise from the bottom every few seconds, it's done. You have to be very careful because once the water has evaporated, the fat heats up quickly and burns the crust. This gives the ghee an acrid flavor and color. Make sure to handle the pot cautiously, because hot oil can give severe burns.
   
5. Allow the ghee to cool until it's warm but not hot. Place a piece of cheesecloth over the lid of your jar. Secure it with a rubber band. Pour the ghee through the cheesecloth, into the jar.
   
6. Store ghee in the refrigerator or at room temperature. It keeps much longer than butter.

The picture above is of my last batch of ghee.

More Fat-Soluble Vitamin Musing

If vitamin A, D and K2 deficiency are important contributors to the characteristic pattern of chronic disease in modern societies (the 'disease of civilization'), we should see certain associations. We would expect to find a lower fat-soluble vitamin status along with the most prevalent chronic diseases: cancer, cardiovascular disease, diabetes, osteoporosis, tooth decay, etc. We would also expect that improving vitamin status could reduce the incidence or recurrence of these diseases, which would be more convincing than a simple association.

Let's start with cancer. This one is like shooting fish in a barrel. There are consistent associations between low vitamin D status and numerous cancers, most notably breast and colon. And it doesn't just stop at associations. Here's a double-blind, placebo-controlled trial showing a 60% reduction of internal cancers in 1,179 American women taking 1,100 IU of D3 (and calcium) per day for 4 years. I won't go through the rest of the mountain of data linking low vitamin D to cancer, but if you want to see more science go here.

Vitamin K2 has been less well studied in this respect, but preliminary evidence is promising. Cancer patients are often vitamin K deficient. Supplementation with menatetrenone (K2 isoform MK-4) may reduce the recurrence of liver cancer. There's a strong inverse association between K2 intake and advanced prostate cancer, with the effect coming mostly from dairy.

In my post on K2 last week, I mentioned a study in which investigators found a strong inverse association between K2 consumption and cardiovascular as well as all-cause mortality. Patients with severe arterial calcifications tend to be K2 deficient, and K2 deficiency can induce arterial calcification in rodents. Marcoumar, a drug that interferes with K2 status, also causes calcification in humans. There's a mechanism behind K2's effect on CVD. There are several K2-dependent proteins that may protect the arteries from calcification, lipid accumulation and damage: matrix Gla protein, gas6, and protein S.

There is also a compelling association between vitamin D status and cardiovascular disease. Here's a quote from one study that struck me:

The adjusted prevalence of hypertension (odds ratio [OR], 1.30), diabetes mellitus (OR, 1.98), obesity (OR, 2.29), and high serum triglyceride levels (OR, 1.47) was significantly higher in the first than in the fourth quartile of serum 25(OH)D levels (P<.001 for all).

In other words, the 25% of people with the lowest D status are more likely to have hypertension and high triglycerides, and much more likely to be obese and/or have diabetes than the 25% with the highest D status. Keep in mind it's just an association, but that is nevertheless an impressive list of problems that are linked to low D status. Here's a large study that looked specifically at the association of vitamin D status and heart attack risk, and found a strong association even for people who are only mildly deficient. Supplementing elderly women with a modest amount of D3 improves hypertension.

The link between fat-soluble vitamins and bone/dental health is very strong. Vitamins D and K2 are required for proper formation and mineralization of the bones and teeth, and proper development of the cranium and face (this is exactly what Weston Price saw). K2 supplementation has a major protective effect on osteoporosis and fractures, according to several controlled trials. The salivary glands have the highest concentration of K2 MK-4 of any organ, and they secrete it into saliva along with K2-dependent proteins. Weston Price documented the dramatic protective effect of cod liver oil (A and D) and butter oil (A and K2) against tooth decay.

I couldn't find any consistent associations between vitamin A status and chronic disease. This may be because, as opposed to D and K2, few people in the US or Europe are deficient. It's interesting to note that grain-fed dairy is still a good source of vitamin A, while it loses most of the vitamin D and K2 that's found in grass-fed dairy.

Osteoporosis and arterial calcification are not due to a lack or an excess of calcium. In fact, the two problems often come hand-in-hand. Calcium supplements are unnecessary at best. The Japanese, who eat far less calcium than the average American, have a lower risk of osteoporosis and fracture. The problem with both osteoporosis and arterial calcification is that the body is not using its calcium effectively. The studies mentioned above show that the fat-soluble vitamins are critical for proper calcium use by the body, among other things.

I hope you can see that a deficiency of fat-soluble vitamins could well be a major contributor to the characteristic pattern of diseases that afflict industrialized nations. There are two more facts that we need to complete the picture. First of all, most Americans are vitamin D deficient and nearly all of us are K2 deficient. A, D and K are synergistic. A and D have their own nuclear receptors that alter the transcription of hundreds of genes, while K activates many of these genes once they are translated into proteins. Thus, you'd expect that giving them together would have a much larger effect that giving them alone. This suggests that the studies using single vitamins may be falling far short of the protection afforded by optimal status of all three.

Vitamin Deficiency

I'm going to do some speculating today. More than usual. What are some of the deficiency symptoms of A, D and K2? Another way of putting the question is, what problems can you prevent or cure by giving people the right fat-soluble vitamins? If you read my last post, you know that cardiovascular disease, osteoporosis (and resulting fractures) and tooth decay are all strongly linked to fat-soluble vitamin status, probably in a causal way. There's also a strong suggestion that they could be involved in diabetes, kidney stones, resistance to infection and cancer. Well, we've just about covered all the major modern health problems, haven't we?

What if the 'disease of civilization' is simply a deficiency of fat-soluble vitamins? What if the only reason we haven't realized it yet is because we haven't understood the critical importance of K2 MK-4, and its synergy with A and D? I'm not totally convinced it's true, but it does make sense. I'm interested to hear other peoples' opinions on this.

There are two mechanisms that could cause deficiency. The first is the obvious: reduced intake. In general, we have a lower intake of A, D (from sunlight) and especially K2 than non-industrial populations past and present that did not suffer from the disease of civilization. Most Westerners fall short of optimal serum vitamin D, and K2 deficiency is nearly ubiquitous.

Reading Nutrition and Physical Degeneration, as well as other accounts of non-industrial groups transitioning from their traditional diets to a more Westernized one, it struck me how badly these people were being affected. Even when they were still eating some nutrient-dense traditional foods, their development and health suffered tremendously. I asked myself this question: could the Western food they were eating have actively interfered with their vitamin status, and could it be doing the same to us?

The most common foods that replaced traditional diets in Weston Price's studies were white wheat flour and sugar. Wheat contains a lot of gluten, which in some people causes celiac disease. Celiac is an immune response to gluten that causes the degeneration of the intestinal lining, which is responsible for absorbing nutrients, among other things. Celiac patients are often deficient in many nutrients, including fat-soluble vitamins. So there's clearly a link between gluten damage and fat-soluble vitamin status.

The interesting thing about celiac is it may actually be a spectrum, with nearly everyone showing some degree of gluten damage, but only severe cases being diagnosed. The diagnosis involves looking for antibodies against gluten, but there is evidence that some people may mount an immune response without producing antibodies (through the innate immune system). Peter pointed this out a while back.

So the hypothesis goes: the disease of civilization is caused by a deficiency of fat-soluble vitamins, due to both a lower intake and inefficient absorption through a damaged intestinal lining. Comments?

Vitamin K2, menatetrenone (MK-4)

Weston Price established the importance of the MK-4 isoform of vitamin K2 (hereafter, K2) with a series of interesting experiments. He showed in chickens that blood levels of calcium and phosphorus depended both on vitamin A and K2, and that the two had synergistic effects on mineral absorption. He also showed that chickens preferred eating butter that was rich in K2 over butter low in K2, even when the investigators couldn't distinguish between them. Young turkeys fed K2-containing butter oil along with cod liver oil (A and D) also grew at a much faster rate than turkeys fed cod liver oil alone.

He hypothesized that vitamin A, vitamin D and vitamin K2 were synergistic and essential for proper growth and subsequent health. He particularly felt that the combination was important for proper mineral absorption and metabolism. He used a combination of high-vitamin cod liver oil and high-vitamin butter oil to heal cavities, reduce oral bacteria counts, and cure numerous other afflictions in his patients. He also showed that the healthy non-industrial groups he studied had a much higher intake of these fat-soluble, animal-derived vitamins than more modern cultures.

Price found an inverse correlation between the levels of K2 in butter and mortality from cardiovascular disease and pneumonia in a number of different regions. A recent study examined the relationship between K2 (MK-4 through 10) consumption and heart attack risk in 4,600 Dutch men. They found a strong inverse association between K2 consumption and heart attack mortality risk. Men with the highest K2 consumption had a whopping 51% lower risk of heart attack mortality and a 26% lower risk of death from all causes compared to men eating the least K2! Their sources of K2 MK-4 were eggs, meats and dairy. They obtained MK-5 through MK-10 from fermented foods and fish. The investigators found no association with K1, the form found in plants.

Perigord, France is the world's capital of foie gras, or fatty goose liver. Good news for the bon vivants: foie gras turns out to be the richest known source of K2. Perigord also has the lowest rate of cardiovascular mortality in France, a country already noted for its low CVD mortality.

Rats fed warfarin, a drug that inhibits K2 recycling, develop arterial calcification. Feeding the rats K2 completely inhibits this effect. Mice lacking matrix Gla protein (MGP), a vitamin K-dependent protein that guards against arterial calcification, develop heavily calcified aortas and die prematurely. So the link between K2 and cardiovascular disease is a very strong one.

Mammals can synthesize K2 MK-4 from K1, but humans seem to be bad at it since most of us are K2 deficient despite eating ample K1. This suggests that through evolution, we lost the ability to synthesize K2 in sufficient amounts because we always obtained it abundantly in our diets from nutrient-dense animal tissues.

The synergism Weston Price observed between vitamins A, D and K2 now has a solid mechanism. In a nutshell, vitamins A and D signal the production of some very important proteins, and K2 is required to activate them once they are made. Many of these proteins are involved in mineral metabolism, thus the effects Price saw in his experiments and observations in non-industrialized cultures. For example, osteocalcin is a protein that organizes calcium and phosphorus deposition in the bones and teeth. It's produced by cells in response to vitamins A and D, but requires K2 to perform its function. This suggests that the effects of vitamin D on bone health could be amplified greatly if it were administered along with K2. By itself, K2 is already highly protective against fractures in the elderly. It works out perfectly, since K2 also protects against vitamin D toxicity.

I'm not going to go through all the other data on K2 in detail, but suffice it to say it's very very important. I believe that K2 is a 'missing link' that explains many of our modern ills, just as Weston Price wrote. Here are a few more tidbits to whet your appetite: K2 may affect glucose control and insulin release (1, 2). It's concentrated in the brain, serving an as yet unknown function.

Hunter-gatherers didn't have multivitamins, they had nutrient-dense food. As long as you eat a natural diet containing some vegetables and some animal products, and lay off the processed grains, sugar and vegetable oil, the micronutrients will take care of themselves.

Vitamin K2, MK-4 is only found in animal products. The best sources known are grass-fed butter from cows eating rapidly growing grass, and foie gras. K2 tends to associate with beta-carotene in butter, so the darker the color, the more K2 it contains (also, the better it tastes). Fish eggs, other grass-fed dairy, shellfish, insects and other organ meats are also good sources. Chris Masterjohn compiled a list of food sources in his excellent article on the Weston Price foundation website. I highly recommend reading it if you want more detail. K2 MK-7 is found abundantly in natto, a type of fermented soybean, and seems to have some of the same effects as MK-4 on bone health in clinical trials. However, it is not the from of K2 that mammals synthesize for themselves so I'm not convinced it's the real thing.

Finally, you can also buy K2 supplements. The best one is butter oil, the very same stuff Price used to treat his patients. I have used this one personally, and I noticed positive effects on my skin overnight. Thorne research makes a synthetic liquid K2 MK-4 supplement that is easy to dose drop-wise to get natural amounts of it. Other K2 MK-4 supplements are much more concentrated than what you could get from food so I recommend avoiding them. I am generally against supplements, but I've ordered the Thorne product for a little self-experimentation. I want to see if it has the same effect on my skin as the butter oil (update- it does).

Activator X

Activator X, the almost-mythical vitamin discovered and characterized by Weston Price, has been identified! For those of you who are familiar with Weston Price's book 'Nutrition and Physical Degeneration', you know what I'm talking about. For the rest of you, allow me to explain.

Weston Price was a dentist and scientist in the early part of the 20th century. Practicing dentistry in Cleveland, he was amazed at the poor state of his patients' teeth and the suffering it inflicted. At the time, dental health was even worse than it is today, with some children in their teens already being fitted for dentures. Being a religious man, he could not bring himself to believe that 'physical degeneration' was what God intended for mankind. He traveled throughout the world looking for cultures that did not have crooked teeth or dental decay, and that also exhibited general health and well-being. And he found them. A lot of them.

These cultures were all considered 'primitive' at the time, and were not subject to the lifestyles or food choices of the Western world. He documented, numerically and with photographs, the near-absence of dental cavities and crooked teeth in a number of different cultures throughout the world. He showed that like all animals, humans are healthy and robust when occupying the right ecological niche. Price had a deep respect for the nutritional knowledge these cultures curated.

He also documented the result when these same cultures were exposed to Western diets of white flour, sugar and other industrially processed foods: they developed rampant cavities, their children grew with crooked teeth due to narrow dental arches, as well as a number of other strikingly familiar health problems. I think it's worth mentioning that Price's findings were universally corroborated by doctors in contact with the same cultures at the time. They are also corroborated by the archaeological record. Many of his findings were published in respected peer-reviewed journals. 'Nutrition and Physical Degeneration' is required reading for anyone interested in the relationship between nutrition and health.

Naturally, Price wanted to understand what healthy diets had in common besides the absence of white flour and sugar. Having studied cultures as diverse as the carnivorous Inuit, the dairy-eating Masai and agricultural groups in the Andes, he realized that humans are capable of thriving on very diverse foods. However, he did find one thing in common: they all had a high intake of fat-soluble, animal-derived vitamins. Even the near-vegetarian groups ate insects or small animals that were rich in these vitamins. He looked for, but did not find, a single group that was entirely vegetarian and had the teeth and health of the groups he described in 'Nutrition and Physical Degeneration'.

There were three vitamins he found abundantly in the diets of healthy non-industrialized people: A, D, and an unknown substance he called 'activator X'. He considered them all to be synergistic and critical for proper mineral metabolism (tooth and bone formation and maintenance) and general health. He had a chemical test for activator X, but he didn't know its chemical structure and so it remained unidentified. He found activator X most abundantly in grass-fed butter (but not grain fed!), organ meats, shellfish, insects, and fish eggs. Many of these foods were fed preferentially to pregnant or reproductive-age women in the groups he studied.

Price used extracts from grass-fed butter (activator X), in combination with high-vitamin cod liver oil (A and D), to prevent and reverse dental cavities in many of his patients. 'Nutrition and Physical Degeneration' contains X-rays of case studies showing re-calcification of severe cavities using this combination.

After reading his book, I wasn't sure what to make of activator X. If it's so important, why hasn't it been identified in the 60+ years since he described it? I'm happy to say, it finally has. In the summer of 2007, Chris Masterjohn wrote an article for the Weston Price foundation website, in which he identified Weston Price's mystery vitamin: it's vitamin K2, specifically the MK-4 isoform (menatetrenone).

It occurs exactly where Weston Price described it, and research is beginning to find that it's also critical for mineral metabolism, bone and tooth formation and maintenance. Its function is synergistic with vitamins A and D. To illustrate the point, where do A, D and K2 MK-4 all occur together in nature? Eggs and milk, the very foods that are designed to feed a growing animal. This is true from sea urchins to humans, confirming the ubiquitous and critical role of these nutrients. K2 has not yet been recognized as such by the mainstream, but it is every bit as important to health as A and D. The scientific cutting edge is beginning to catch on, however, due to some very tantalizing studies.

In the next post, I'll go into more detail about K2, what the science is telling us and where to get it.