 Hi, this is Dr. Ruscio and let's discuss the ability of vitamin K2 to help increase cardiac output or the ability of your heart to circulate blood. A very exciting study was recently published that essentially showed a 12%, which is very significant, increase in cardiac output after eight weeks on supplemental vitamin K12. And I'll put the abstract of the study up here on the screen. The study was entitled Oral Consumption of Vitamin K2 for eight weeks associated with increased maximal cardiac output during exercise. So in this study, 26 participants, trained athletes essentially, were divided into either a placebo group where they were given a placebo or a control group where they were given either 300 or I believe was 150 milligrams of vitamin K2, 300 milligrams for about four weeks and then 150 milligrams for another four weeks. And they assess cardiac output before the intervention. So at week one essentially or week zero technically, and then again in eight weeks, and they found a 12% increase again in cardiac output, which is very significant. This may increase one's energy level, certainly could increase one's endurance performance or exercise performance, and may also help someone if they have shortness of breath or fatigue with exertion. So this is definitely a very significant finding. Now it's one study, it's a small study, so we can infer too much from it, but certainly very exciting. Now why might it be that vitamin K2 helps? Well vitamin K2 is a part of what's known as the electron transport chain, which is part of the mechanism through which your mitochondria produce energy. Your mitochondria are the energy producing aspects of your cells. So having good mitochondrial function can ensure that you have good energy production in a cellular level via something known as ATP. And of course if your heart muscle has adequate energy, it can output blood and hence the connection to cardiac output. So definitely something to keep in mind if you're trying to increase your heart health, your cardiac output, or potentially your sports or endurance performance. Now the other aspect of this is where can you get vitamin K2 from foods? And unfortunately, and part of the reason why the supplementation with vitamin K2 may have helped is because many people do not eat much in the way of vitamin K2 rich foods. And I'll put a list up here on the screen of foods that are rich in vitamin K2, but you have things like many fermented foods and things like liver. And fermented foods and liver are definitely an important part of a healthy diet and are things that should be incorporated into the diet. But unfortunately many people don't love liver and not everyone eats much in the way of fermented foods. So part of the reason why this group is benefited was because they were a bit deficient in vitamin K2 to begin with. Now what about the question of well I want to use vitamin K2 forever now because it seems to have this benefit should be taken every day. Is there a potential risk of toxicity of overdose? To my knowledge, no. However, I still would not recommend taking a concentrated supplemental dose 300 milligrams, 150 milligrams of vitamin K2 indefinitely, because there may be some unintended negative side effect. Again, I don't know of anything reported in terms of toxicity with vitamin K2. I also have not looked very indefinitely, but as a general rule, I think the most prudent approach is to use a supplement for a few months, try to get yourself up out of the range of being deficient, and then from there trying to rely on food sources. So looking at some of those fermented foods that we outlined a moment ago. Now I sent this study over to my colleague, Dr. Mikey Nelson, who's a brilliant exercise physiologist, because I really wanted to get a way in from someone who is an expert in health, fitness, and exercise physiology. And I'll put his comments in the video here. Hey, what's going on? It's Dr. Mikey Nelson here. I'm actually down in El Padre, Texas. You can kind of see the ocean out there, hence the funniest sunglasses for kiteboarding. But Dr. Ruchio wanted me to comment about the K2 study. And overall, I thought it was like super interesting. So one, that's a pretty big increase in pretty trained individuals. My only quick comment is it would be really nice to see a follow-up study that instead of doing just a pure randomized control trial, which I know is always considered the highest level of evidence, the downside with that is that we don't know what their K2 status was when they enrolled. So it'd be nice if you took a group of people and you said, okay, we're going to look at your K2 status, and then we're going to segment you between a group that's low and a group that maybe is adequate or high, run the performance test on both groups, and see if there's a difference between the two groups. And then what you can do as a follow-up is you could take the group that was low, you could supplement them up to an adequate level, run the performance test again, and see if the supplementation in a group that was low helped, or if you supplement the group that was okay to even a little bit higher level, if that would be beneficial. My guess is that in most studies you need to look at different types of vitamins and minerals that once you get to an adequate level, you usually don't see much of a performance increase at that point. I do some of the research done on zinc, so athletes that were low in zinc, we give them zinc back to an adequate level, they tend to do better. If they were already at a good level, we give them more, they don't tend to get any better. Vitamin D is kind of the same way too. If you're super deficient, we get you back to a good level, you're going to be better. If you're already at a good level and we get you higher with vitamin D, it doesn't seem to confer any other benefits. So again, I'm Dr. Mike Tenelson, and those are my thoughts on the study. And so Dr. Tenelson makes some great points. I think we're definitely on the same page in looking at this study in an exciting manner but also being a bit cautious. And so remember, if you're trying to improve your cardiac output or put in more plain talk, if you're trying to increase your endurance, then supplementation with vitamin K2 and also incorporating K2 foods into your diet may be very helpful. Again, this is only one study, so we can't draw too much from it. Certainly exciting when we see just a basic vitamin cause a pretty significant impact in improving sports or endurance performance. So this is Dr. Ruscio, and I hope this information helps you get healthy and get back to your life. Thanks.