1. As they almost always do, doctors see no deficiencies because they are looking in the wrong place. The bloodstream, into which all of the body’s nutrients are dumped. Who would look for deficiencies in a storage depot or the supply lines? Only doctors. Cannot tanks in the field be short on shells even though the storage depot is filled to the rafters with tank shells? Look for deficiencies where the shells are being used. Look for deficiencies in the tissues that are using the nutrients, not in the supply lines to those tissues.
2. Doctors notice only level 3 deficiencies – those deficiencies serious enough to produce severe and readily apparent medical symptoms. But there are many levels of deficiency and adverse outcomes (invisible symptoms means they are insidious, and indicate the need for more sensitive assays) – levels 1, 2, and 3, and local deficiencies, which tend to show up in areas that get last dibs on nutrients (my best guess: hair, nails, skin, and saliva).
3. Doctors rely too much on unreliable nutritional surveys. People do not recall everything they are eating, and they will tell you what you want to hear.
4. Doctors tell us to limit fat in the diet, and they never even mention the importance of emulsifiers to proper vitamin K absorption. Anyone limiting eggs, mayonnaise, salad dressing, lecithin, and choline supplements, and fats generally is not absorbing vitamin K efficiently, even if they are eating green leafy vegetables.
5. It is well-known that those who consume too little vitamin C bruise easily and heal slowly. What is less well-known is that vitamin K deficiency does the same. I have noticed that even people who consume vitamin C supplements bruise easily and heal slowly. Classic vitamin K deficiency symptoms in the skin, where doctors rarely look.
6. On any given day, I believe that >90% of Americans do not consume even a single serving of dark green leafy vegetables (ex spinach, kale, collard greens, Swiss chard), the best source of vitamin K. Is this belief true? All we have is a single, unreliable survey done a long time ago by the government. On the day of that survey, 11/12 or more than 90% of Americans, did not have a single serving of dark green leafy vegetables.
Using the insensitive prothrombin clotting time assay, doctors can detect vitamin K deficiency in less than a month on a severely vitamin K restricted diet. This probably means that the adipose pool of the fat-soluble vitamin K is small at best. In the rest of the body, save the liver, vitamin K pools are not large, and they turnover (K1 much faster than K2), but for the most part, the body maintains status quo by recycling vitamin K (the vitamin K cycle). Turnover can occur to molecules involved in this cycle and occurs in vitamin K when it binds the SXR receptor in cells and alters gene expression.
Vitamin K deficiency is most often local – in bones and in blood vessels walls, and in the skin (again, even in people who supplement vitamin C, they still bruise easily and bruises heal slowly). If people are deficient in vitamin K in the brain, which after the bloodstream, gets first dibs on nutrients, then they may even have systemic and liver deficiencies of vitamin K. Conversely, vitamin K deficiency in liver may point to a deficiency in brain.
Since the menaquinone (K2, largely MK-7 to MK-13) pool in liver is a slow turnover pool, vitamin K deficiency is not so common in liver, where the blood clotting factors, at least four of which are vitamin K dependent, and anticlotting factors, at least three of which are vitamin K dependent, are made. Prothrombin time is an important medical marker, but it is useless as a measure of anything but the grossest vitamin K deficiency because coagulation is a cascade: any “bleed through” at any step and the next one amplifies it, and thus easily makes up for the deficiency in the previous step.
As noted above, even those who consume large quantities of vitamin K do not co-consume large quantities of fat and some emulsifier. I know a woman who eats plain green leaves and plain carrots like a rabbit. Later in the day she consumes an avocado by itself. We need to consume them in the same meal to have the intended effect. And don’t forget the emulsifier! Don’t rely on unreliable bile!
In a diet rich in K1, but poor in fat and/or emulsifiers, some of that K1 will be converted into K2 forms by intestinal bacteria. The enterohepatic circulation supplies the liver with some of this K2, but that uptake does not adequately supply the peripheral tissues. They need a constant supply of K1, which they convert locally to K2, as needed, for their own use.
Some people who consume vitamin K1 and fat, but not emulsifier, suffer from poor bile secretion. And who takes digestive bitters anymore? Their absorption of vitamin K would be poor as well. It is likely that proper absorption of vitamin K requires other nutrients, both essential and not-so-essential, and doctors do not know what they are. It is also likely that vitamin K absorption is inhibited by other nutrients, both essential and not-so-essential, and guess what, doctors do not know what they are either. How can doctors’ ignorance be helping this situation?