This rather unique title, borrowed from the hospital emergency room concept of giving aid first to those with the most urgent need, helps clarify many seemingly controversial vitamin research study results. The body has a great innate ability for survival and directs nutrients that are under supplied by the diet to perform the most vital functions while holding off on less important processes until more nutrients arrive. While this doesn't work for all nutrients, let's look at a few examples where it does.
VITAMIN K
Vitamin K was for a long time a forgotten nutrient by scientists. They assumed that since the diet usually supplied adequate levels from green leafy vegetables, fermented cheeses, butterfats, and that the beneficial bacteria in the intestinal tract also produced vitamin K, they did not have to pay much attention to it.
The major function they knew about was to stop bleeding from an injury by activating coagulating proteins in the liver to clot blood.
It is now known that vitamin K has many other vital functions that are represented in bone structure, prostate tissues, and cardiovascular artery health. For bone health, Doctors for many years measured the amount of activated osteocalcin in the blood as a marker for bone building. Since vitamin K is needed to activate osteocalcin, what these tests were really measuring was the level of vitamin K action. But Doctors never communicated that fact to their patients. To this day, the Osteoporosis Foundation does not mention vitamin K in their recommendations for healthy bones.
Vitamin D directs the production of the nonactive form of Osteocalcin. Vitamin K has to activate it before it helps bind calcium to bone crystals. That seems like a vital action for bone building, but only recently have some bone supplements started to include vitamin K.
People with weak and broken bones often test low for vitamin K. But studies have not always shown a benefit by increasing vitamin K intake. It turns out there are many different forms of vitamin K and they each exhibit different action levels. All the forms seem to do the coagulation part, but K2 has greater action on bone, cardiovascular, and prostate health. Even between the different K2 forms there are various different life span times. Vitamin K2 as MK7 lasts for a few days while MK4 only a few hours. This explains why much larger dosages of MK4 are needed. In some studies, the vitamin K1 form did not show an effect on some of these other functions. The body is able to convert some K1 into K2 and the degree that this happens might influence research results. Beneficial probiotic bacteria levels might have some effect on K1 conversion to K2.
Scientists now know that probably only Gorillas who consume their own feces get a significant amount of this bacteria developed vitamin K2 from the intestinal tract. Thus there may be a need to consume the pre-formed K2 from fermented food products, such as natto, a fermented soy product that is often used in supplements, listed as MK-7.
When body production and dietary vitamin K are low, the body allocates the available vitamin K to the building of coagulation proteins first, and then to less vital but still important functions of preventing calcium from entering arteries or binding calcium to bones, and then only the amount it is able to convert from K1.
VITAMIN D
Vitamin D has two forms that circulate in the blood. One is a low activity form that has a longer life and serves as the material for the body to build the 1000x higher activity hormone form produced by the kidneys. The size of the pool of the low activity form is influenced by the amounts from supplements, fortified foods, and sun exposure time.
It is only at very low and deficient levels that this vitamin D form has any influence on the production levels of the hormone form. This hormone form is used to balance the calcium level of the blood, and thus has an influence on calcium absorption, elimination, and bone health. The blood calcium balance is one of the most critical processes in the body. Without the calcium balance, nerves would not fire and muscles would not contract.
But, this is not the only function for the low active vitamin D pool. It is now known that when the pool levels are at an optimal amount, this low active D enters into the cells in the prostate, breast, and colon and at least 9 other tissues where an enzyme converts it into the active hormone form to direct the building of proteins needed to protect these cells. If the low active D pool is too low, this protection process is incomplete. More damaged cells could be formed. The same process probably occurs in breast tissues, but science is still researching. BUT, it is only at very low levels of the vitamin D pool that it's conversion into the hormone form is hindered. The body obviously knows it needs to prioritize protecting blood levels of calcium first.
CoQ10
Coenzyme Q10 is vitally needed by most organs, tissues, and cells to maintain energy production. CoQ10 is made in the Liver in adequate amounts when young, but with ageing, less and less CoQ10 is produced each year. Many organs exhibit a gradual reduction in CoQ10 levels, but the lungs stay up until after age 60 when CoQ10 levels simply drop off the cliff. This explains why the lungs are often the weak link at this stage. The Liver is the last organ to show any redcution of CoQ10 levels due to it's critical funcitons for survival.
MINERALS
The body has very specific needs where minerals are concerned. First, some minerals compete with each other for absorption space. Zinc to Copper, Calcium to Magnesium, Calcium to Phosphorus, Sodium to Potassium. Plus, if not enough of a mineral such as calcium is supplied, the body will take it from storage areas such as in bones to help balance the blood level. If not enough potassium is present, calcium and magnesium will be used instead to buffer acid conditions the body creates. If too much sodium is present, calcium is eliminated by the kidneys. Over time, the body has developed mechanisms to quickly eliminate excess minerals that are typically supplied by the diet in large amounts and different mechanisms to conserve scarce minerals.**
**These mechanisms explain why sodium, a usually rare mineral in the natural diet but plentiful in prepared foods, presents health problems for some people. It could also by a factor in the potassium to sodium ratio. Nature puts 10 to 100 times more potassium in natural foods than sodium, but this ratio is often reversed in recipes for modern day foods. The body is still operating as if sodium was a scarce mineral and conserves it.
The Most Obvious Triage Example
In a pregnant woman who does not consume enough nutrients to nourish both her body and the growing fetus, nature satisfies the growing fetus requirments first by robbing the mother's nutrient reserves, even to the point of taking them out of vital structures.
Thus the triage theory can explain some of the more controversial research results. Often it is really not controversial, but simply how the body functions to survive. The best example may be that the body tries to find positive uses for potentially negative body generated free radicals. One recent study looking into the possible protection of the prostate by taking vitamin E and selenium (SELECT) was stopped when the mid study results showed slightly higher cancer rates in the vitamin E group and a little more diabetes in the selenium group. There are sound body function process mechanisms to explain both of these findings. Of course they were not the ones the Media talked about, or that the vitamin industry challenged, but a few scientists and past study results predicted these findings before they were announced.
Vitamin E is another radical action example. Test tube studies is the Lab reveal that both Flax oil and Evening Primrose oil have cancer cell killing properties. When vitamin E is added to the test tube, this killing action stops. Evidently, the antioxidant activity of vitamin E (alpha tocopherol) works so well that it stops the lipid peroxidation created cancer killing radicals that the flax oil and EPO set in motion. Of course, this is just a test tube study and needs verification that this process could also happen inside the body.
The Vitamin Workshop simply finds this information and incorporates it into the parameters of the vitamin criteria. Not many other websites or nutritionists are even talking about some of these concepts yet. Amazing!