We need magnesium, zinc, and vitamin K to make proper use of vitamin D

Vitamin D is important for our immune defense, mood, blood sugar, cardiovascular system, bone health, and health in general. However, the form of vitamin D that we synthesize in our skin and from supplements is passive and must be converted. First, the liver converts it into the form of vitamin D that is measured in blood tests. Afterwards, the vitamin is converted into the active steroid form that most cells and organs need. This conversion is not possible without magnesium, zinc, and vitamin K. Therefore, plenty of sun exposure or vitamin D supplementation is no guarantee of having enough vitamin D in the blood or being able to utilize the nutrient. You need the other nutrients, as well, according to a review article published in Nutrients.

Researchers are becoming increasingly focused on vitamin D because deficiencies are so common and may cause a host of diseases and shorten our lifespan. It is important to know that vitamin D comes in different forms. Our major source of vitamin D is exposure to the UVB rays from the sun. In our skin, we produce a vitamin D precursor called cholecalciferol, which is also found in foods like herring, salmon, dairy cream, and eggs. But our diet only provides a small quantity of vitamin D. In the liver, cholecalciferol is converted into calcidiol, a form of vitamin D that is measured as 25-hydrovitamin D3 in blood tests. Afterwards, calcidiol is converted in the kidneys, the white blood cells, and in other tissues into the active form of vitamin D called calcitriol (1,25-dihydroxyvitamin D3). This form is considered a steroid hormone. It is calcitriol that attaches to the vitamin D receptors in our cells. Calcitriol regulates around 10 percent of our genes and dozens of biochemical processes in the body that are relevant for our immune defense, mood, blood sugar levels, circulatory system, bone health, cancer prevention, and health in general.
The officially accepted lower threshold value for vitamin D in the blood is 75 nmol/L, which is enough to ensure that the vitamin can handle all the essential functions. Some studies of vitamin D supplementation have failed to show the expected effect of the vitamin, but that could be because the doses that were used were too low, the studies did not last long enough, or the participants already had plenty of vitamin D in their blood.
Other factors could have been at play, for instance the body’s ability to metabolize vitamin D. Here, genetic factors, the production of parathyroid hormone (PTH) in the parathyroid glands, and calcium levels in the blood may have a role. Moreover, magnesium, zinc, and vitamin K are important for the body’s ability to utilize vitamin D, but this is not described very well in the scientific literature. Being deficient in these (and other) micronutrients is common in Western countries and is referred to as “hidden hunger”. It may contribute to poor health and well-being and various diseases. The aim of the new review article was to look closer at vitamin D’s interactions with magnesium, zinc, and vitamin K.

Magnesium

We get most of our magnesium from coarse and green foods. It is among the minerals that we need in the largest quantities. Magnesium supports several hundred enzymatic processes that are important for our immune system, nervous system, muscles, blood sugar, and many other functions. Magnesium-containing enzymes are also important because they support the body’s conversion passive cholecalciferol into calcidiol and then into the active form, calcritriol. Magnesium affects the parathyroid gland’s production of parathyroid hormone (PTH), and lack of magnesium can indirectly inhibit the ability of our kidneys to convert calcidiol into calcitriol.
Being magnesium-deficient is a particularly big problem for people who already have a risk of lacking vitamin D – including older people, people with dark skin, overweight individuals, and type 2 diabetics.
On the other hand, calcitriol is in itself able to increase the absorption of magnesium from the small intestine, so there is a close link between vitamin D and magnesium
Lack of magnesium is primarily linked to eating unhealthy and refined diets. Poor utilization of magnesium or increased excretion of the nutrient may be a result of alcohol abuse, inflammatory bowel diseases, and type 2 diabetes. Also, different kinds of medicine (diuretics, laxatives. PPI/antacids, methotrexate, etc.) can increase the excretion of magnesium from the kidneys. Type 2 diabetes, overweight, and other things can also increase the need for magnesium. Dietary changes and magnesium supplementation are good ways to address the problem with deficiency.

Zinc

Some of the best sources of zinc are oysters and other types of shellfish, red meat, poultry, nuts, and wholegrains. The body’s absorption of zinc from animal sources is better than from plant sources. We are not able to store zinc and therefore need to get the mineral daily.
Zinc supports well over 600 different enzymes and helps regulate a host of gene activities that are important for growth, the immune system, fertility, sense of taste, skin, mental balance, antioxidant protection, and other things.
Zinc is also needed to help calcitriol bind to the cells’ vitamin D receptors (VDR). Zinc is a component of the VDR structure, also known as zinc fingers.
In one study, it was seen that an increased zinc concentration in cells helps zinc bind to the VDR, thereby indicating that zinc affects VDR interactions and the utilization of vitamin D. On the other hand, vitamin D also affects the intestinal zinc uptake and the body’s utilization of zinc.
Zinc deficiencies are rather common in Western countries and represent an underdiagnosed problem. Zinc deficiency can be a result of poor eating habits, pregnancy, breastfeeding, gastrointestinal diseases, excessive alcohol intake, type 2 diabetes, diuretics, antibiotics, and excessive intake of iron or cadmium that interferes with the absorption.
The official recommendation for zinc varies from country to country and lies in and range between 7-20 mg (adults). The safe upper intake level is 40 mg daily but is safe to use larger therapeutic doses (50-75 mg) for shorter periods. High-dosed zinc supplementation for longer periods can impair the uptake of iron and copper.

Vitamin K

Vitamin K occurs naturally in the form of vitamin K1 (phylloquinone) and vitamin K2 (menaquinone). Vitamin K1 is primarily found in cabbage, spinach, parsley, and other leafy greens. A well-functioning gut flora is able to convert vitamin K1 into vitamin K2, but normally only in limited quantities.
Vitamin K2 is found in foods like butter, cheese, and fermented foods like the Japanese soy product natto and is a result of bacteria. There is also vitamin K2 in egg yolk and in fat-rimmed cuts from free-range animals. In Western countries, we mainly get vitamin K1, and there is not enough focus on K2.
It is commonly known that vitamin K1 helps the blood coagulate, while vitamin K2 supports the calcium metabolism, bones, and the cardiovascular system. K2 is important for the production of matrix Gla protein (MGP), a protein that clears calcium from the bloodstream, and for the production of osteocalcin, a protein that embeds calcium into bone tissue. Being vitamin K2-deficient increases the risk of atherosclerosis and osteoporosis because calcium fails to reach the tissues that need it
Vitamin D works in synergy with vitamin K. Therefore, calcitriol helps upregulate MGP that removes calcium from the blood. Vitamins D and K also collaborate and help each other to control inflammation. Chronic inflammation is seen in connection with many chronic diseases.
In connection with COVID-19 infections, it has been seen that combined supplementation with vitamin D and vitamin K helps counteract hyperinflammation and the damage it causes to lung tissue. Vitamins D and K also work in synergy by counteracting stiff arteries and atherosclerosis. Supplementation with vitamin K (especially K2) is able to counteract the harmful effect of excessive calcium intake.
Lack of vitamin K is normally a result of eating a diet that contains too few food sources of vitamin K1 and vitamin K2. Lack of magnesium and zinc, and various intestinal ailments can also impair the uptake of vitamin K. Different medical drugs (blood thinners, antacids, and antibiotics) can also interfere with the uptake and utilization of vitamin K.

• Lack of vitamin D, magnesium, zinc, and vitamin K is often an underdiagnosed problem
• Vitamin D, magnesium, zinc, and vitamin K work closely together in the metabolism of vitamin D and in other essential ways
• Health authorities need a greater insight into and understand of the many risk factors that being deficient in these nutrients can result in
• Many acute and chronic lifestyle diseases are caused by deficiencies – including “hidden hunger”. This is because cells and organs lack the vital nutrients they need.

References:

Andrius Bleizgys. Zinc, magnesium and Vitamin K Supplementation in Vitamin D Deficiency: Pathophysiological Background and Implications for Clinical Practice. Nutrients 2024

Anne Marie Uwitonze, Mohammed S Razzaque. Role of magnesium in Vitamin D Activation and Function. The Journal of the American Osteopathic Association. 2018

Ashton Amos, Mohammed S. Razzaque. Zinc and its role in vitamin D function. Current Research in Physiology. 2022