Let's talk about the use of the {Vitamin K + Vitamin C} Protocol to Treat Morning Sickness and Hyperemesis Gravidarum

 

This spring, I was super-excited about something that I hoped to publish next year - namely, that I had found something that helped my morning sickness.

If that's not earth-shattering, nothing is.

However, when we miscarried our baby in mid-May (at 11w4d), there were signs - no definites, but certainly strong indications - that our baby may have died long before the actual miscarriage, possibly at the very beginning of the pregnancy. This often results in a pregnancy with reduced pregnancy symptoms. Thus, I can no longer state with any authority that I have definite results for this method working for me.

However, I can say this:

(1) I did still have strong pregnancy nausea, starting at the usual time (3w4d), and

(2) I noticed definite improvement when I used this method - both when I started it, and again when I increased the dose.

That being the case, I wanted to present the data to my readers so that they can do the research themselves, and discuss it with their midwives/physicians. Let's get started.

Before we start, let's quickly differentiate between a remedy and a coping mechanism.

These are my terms, not taken from any source. 

In my personal terminology for pregnancy nausea, a remedy and a coping mechanism are different entities. A remedy is something that actually reduces my pregnancy nausea. A coping mechanism, on the other hand, is something that, while not reducing my absolute level of pregnancy nausea, helps me to cope at the nausea level where I am. Does that make sense?

Coping mechanisms are legion. Some that I use include a protein shake before bed, eating immediately upon getting up, getting more sleep, dropping outside activities, etc. We all have these.

Remedies, on the other hand - something that actually works to reduce my base level of nausea - are incredibly rare. That is, they are a dime a dozen - just check the internet! - but the ones that have actually worked for me are virtually zero. Here are some of the ones that I've tried:

• Bentonite clay
• Ginger
• Preggie pops
• Eating hardboiled eggs before bed
• Herbal morning sickness remedies
• Weekly B6/magnesium shots
• Probiotic therapy
• Basic dietary changes (Paleo, gluten-free, dairy-free, etc.)
• Dramamine

The only remedies that have worked so far for me would include the following:

• Very-low-carb diet, done for 6+ months pre-conception 
• Medications (Unisom, Zofran)

As I never want to do the very-low-carb diet again (and didn't have time anyway, as this pregnancy surprised us), and I hoped to avoid medication, finding another remedy that worked was super-exciting.

What "it finally worked" method are we talking about?

I refer to the Vitamin K + Vitamin C remedy.

If you've spent more than 30 seconds online researching morning sickness remedies, you have run across the Vitamin K + Vitamin C remedy for morning sickness. Trouble is, there's almost no information, details, or advice on how to make it work. It will inevitably be cited thusly:

"Vitamin K and vitamin C , taken together, may provide relief of symptoms for some women. In one study, 91% of women who took 5 mg of vitamin K and 25 mg of vitamin C per day reported the complete disappearance of morning sickness within three days."

I see that I actually posted that information on my blog when I discovered the reference - specifically in 2008 (over fifteen years ago!) - in the article Research: Vitamin K and Vitamin C.

But although I have known about this for many, many years, I have always feared to try it due to the high dose of vitamin K involved. (Daily dietary needs for vitamin K are usually listed in micrograms.)

However, this time around, I really wanted to stay off of medication. (Don't we always.) So I started researching to see if I could find out more - both about safety and efficacy. Firstly, I found this article giving some details about the protocol:

Morning Sickness: Vitamins C & K

Looking up the doctor mentioned in that article, I found a presentation of the detailed results of the study mentioned above - go to slide 35 in this presentation by Dr. Jeremiah Wright.

The basic results of the 1952 study were to have been as follows (quoted from the above presentation): 

"In the study, 70 women with mild to severe nausea and vomiting of pregnancy took simultaneously each day vitamin K3 (5 milligrams) and Vitamin C (25 milligrams).

                ▪ 64 reported complete remission in 72 hours.

                ▪ 3 were relieved of vomiting, but not nausea.

                ▪ 3 obtained no relief."

In it, he also gives the citation for the original study - here it is, for anyone who wants to look it up: 

Merkel RL. The use of menadione bisulfite and ascorbic acid in the treatment of nausea and vomiting of pregnancy: a preliminary report. Am J Obstet Gynecol 1952;64:416-418

I also found a podcast/radio show in which Dr. Wright discussed his efforts to publicize this method of pregnancy nausea control:

Nausea Caused By Pregnancy and Preventative Vitamins 

I also found another doctor discussing his use of K2 (in the form of intramuscular injections) for pregnancy nausea. He discusses a case in which K2 injections did not work - or did not work on their own - but his background experience was that this method almost always did work:

Hyperemesis Gravidarum: Reversing Autotoxic Hormone Reactivity/Antihormone Therapeutics

He writes:

"Until this year I have had nearly 100% success with intramuscular administration of vitamin K2 (menatetrenone) 2 cc at 10 mg/cc for nausea and vomiting (N/V) of pregnancy in scores of patients. Thanks to Jonathan Wright, MD, for teaching this many years ago... With N/V of pregnancy, I usually administer vitamin K2­ 2 cc daily for the first couple of days until the N/ V stops and then weekly or as needed. Sometimes one shot stops it for the whole pregnancy."

I also found, when I looked up my own post from back in 2008, the following quote from another physician:

 "For morning sickness, I recommend 100 to 200 milligrams of B-6 and 10 milligrams of vitamin K a day. Occasionally, more than 200 milligrams is necessary, but this amount should be taken under a physician's supervision. I also give patients an initial injection of vitamin K, which works in a day or two. Taken orally, the Vitamin K takes somewhat longer to produce results - about ten days." - Superimmunity for Kids by Leo Gallard & Dian Dincin Buchman, p. 47

Safe and effective? This was super-exciting stuff. But...

Are high doses of vitamin K safe for pregnancy?

There are two questions: (1) Are high doses of vitamin K safe in general, and (2) Are high doses of vitamin K safe for pregnancy.

The research that I found was surprisingly reassuring. Besides the doctors quoted above (all of whom used very high doses of vitamin K with pregnant women, with great success and good outcomes), I found a number of physicians quoting the use of very high dosage vitamin K as safe for both pregnancy women and the general population. Here are some of them:

For the general population:

From LiveStrong:

"The recommended daily intake for vitamin K set by the Food and Nutrition Board of the National Academies of Medicine (FNB) is 120 micrograms for men and 90 micrograms for all women, including those who are pregnant and breastfeeding. These RDAs aren't hard to achieve through a balanced diet, and the National Institutes of Health reports that vitamin K deficiency is very rare.

"The FNB sets upper, tolerable intake levels (ULs) for vitamins that pose health risks when taken in excess. However, there is not a UL for vitamin K, because there have been no reported adverse effects from vitamin K excess in any amount from food or supplements in the general population." (emphasis added)

From National Biochemistry (NBI):

"The amount of MK4 (a type of vitamin K) used in studies is 45-135 mg, which is 500 to 1,500 times greater than the IOM adequate intake. Thus, an important question is whether or not it’s safe to consume vitamin K at this high dose. The short answer is unambiguously, Yes. MK4 is safe even at doses much higher than the top amount used in clinical trials.

"US Institute of Medicine (IOM) conclusion:

"The Tolerable Upper Limit (TUL) is the highest daily dose that is safe for almost all individuals in the general population to take on an ongoing basis. The IOM concluded that for natural forms of vitamin K, of which MK4 is one, there is no known TUL. This means that the IOM considers vitamin K to be extremely safe, even at very high doses." (emphasis added)

From WebMD:

"When taken by mouth: The two forms of vitamin K (vitamin K1 and vitamin K2) are likely safe when taken appropriately. Vitamin K1 10 mg daily and vitamin K2 45 mg daily have been safely used for up to 2 years. It's usually well-tolerated, but some people may have an upset stomach or diarrhea." (emphasis added)

 

 For pregnant women: 

 From Sanford Health, showing that high doses of vitamin K are used therapeutically during pregnancy already, for purposes other than pregnancy nausea:

"Vitamin K is important in helping blood clot. Though extra vitamin K is not needed during pregnancy, women who are pregnant and using anti-seizure medications are at increased risk of vitamin K deficiency in their baby. These women should take oral vitamin K, at a rate of 10 mg daily, from 36 weeks until delivery." (emphasis added)

From Oxford Academic (Volume 78, Issue 10, October 2020), regarding high doses of vitamin K for use in osteoporosis in pregnant women:

"Vitamin K2 at 45 mg/d has been used as a safe treatment option in a case series of pregnancy-associated osteoporosis... There is no known toxicity for vitamin K2, and no tolerable upper level has been set for either K1 or K2 in pregnancy as there have been no studies on reproductive or teratogenic risk." (emphasis added)

When you start looking at links, opinions do vary. Some do not recommend vitamin K supplementation during pregnancy. Some say it's okay up to a point. Some say that it's perfectly safe and that there is no upper limit on safety. For myself, I was confident from my reading that therapeutic doses of vitamin K were safe during pregnancy. 

Additionally, it has to be taken in perspective. If I do supplement with high doses of vitamin K, and it works, then I am exposed to a very-mostly-likely safe vitamin. If I don't supplement with vitamin K, then I will most certainly be taking Unisom (doxylamine succinate), which is an artificial drug and has been several times implicated in risks for the unborn child. I think I'd probably take my chance with an all-natural, already-present-in-the-human diet supplement if I have that choice. 

Who should not supplement with vitamin K:

The only firm contraindication seems to be for people who are taking the drug Warfarin. From the NBI article:

"People who take the drug warfarin (Coumadin) should not take MK4. Warfarin is a blood thinner that works specifically by blocking vitamin K’s actions in the blood clotting cascade. Providing vitamin K as a dietary supplement counteracts warfarin. People taking warfarin should absolutely not take MK4 and they shouldn’t take any vitamin K-containing products without first consulting their healthcare provider." 

What about the different forms of vitamin K?

Vitamin K is actually a family of closely-related vitamins, rather than a single compound. There are three forms of vitamin K:

Vitamin K1 and K2 (and there are two forms of K2) are found in nature and are naturally present in the human diet.

Vitamin K3 is an artificial form.

There are some concerns with toxicity from high doses of vitamin K3 - although the doctor mentioned above still used it very successfully for morning sickness treatment. 

Vitamin K3 is not available over the counter in this country at the present time (that I know of). Vitamin K1 and K2 are widely available and can be purchased over the counter (OTC).

How I put this protocol into practice, and how it worked for me:

This spring's pregnancy was a complete surprise - it was much sooner than expected, and at my age, I wasn't sure if another baby would be on the horizon at all for us. So I was not doing any preparations at all - no dietary changes, no supplements, no nothing. 

I got a positive test - quite randomly! - at about 3w4d. My pregnancy nausea started, much to my annoyance, later that same afternoon. While it may or may not have been as strong as with a healthy pregnancy, it was definitely present, strong, and followed my usual pattern. (Week 3 = nausea starts. Week 4 = I'm still okay. Week 5 = I need help.)

I immediately started researching the Vitamin K + Vitamin C method (for some reason, it came to mind strongly in a way that it hasn't in previous pregnancies). I believe that I started using it at 4w2d. And here's the thing: I felt an immediate and powerful improvement in my nausea levels. (Translation: I took the remedy at night, and felt much better the next day.) And while I continued to feel worse as the pregnancy progressed (which is normal), I was functional. I could get up on time, and eat most foods. I did not have to obsessively eat the same thing over and over until my cravings changed. I did not need to take medication. I could keep things down. While I had a lot more on-the-couch time, I was much more "okay" than usual. I didn't descend into the depths of despair. And I only threw up about five times, total. It wasn't a miraculous nausea-cleared-up-completely! sort of thing, but it was profoundly effective and positive. If I'd increased the dosage more - which, again, I wanted to do but was afraid to try - it is very possible that I would have seen even more awesome results. 

I ran into two snags with the protocol:

(1) The original protocol wording that I found said to use the method for a month. That landed me straight into week 8, when I was feeling pretty awful and was in no way ready to give it up cold turkey.

(2) During week 9, I started feeling that I need some extra help. My two options were to increase my dose of vitamin K, or to go back to using the Unisom protocol to some extent.

In an effort to get more information, I reached out via email to two of the doctors referenced in the articles above. To my surprise and dismay, I never heard back from either of them. This was a deep disappointment, as I would have greatly valued their input and advice regarding this method, and was willing to pay consultant fees. If I had felt more confident and energetic, I would have called up their offices to try to deal with the red tape involved in consulting them through their official practices. However, I was feeling (1) awful enough not to be up to the challenge, but (2) not awful enough to be desperate. So that didn't happen.

Another option for me would have been to go to the naturopathic college medical clinic that we have here in the Phoenix valley. However, the same attitude of "I feel too awful to go, and not awful enough to be desperate" kept me from trying it this time. However, I would definitely be up for that in the future. This would be a good way to consult a physician regarding dosage safety, as well as to have the IM injection method of delivery possible, which is often more effective than oral delivery, but which I cannot do at home. 

Some of this information above regarding the safety of super-high dosages of vitamin K I actually didn't see until writing this article, which I regret, because I would have continued to increase the dosage when I felt that I needed it if I had felt comfortable with the safety. As it was, I did increase my vitamin K dose during week 9 to about 7.5 mg, and again felt an immediate improvement. I held that dosage steady until our loss at 11w4d.

Some may wonder if the placebo effect had anything to do with my improved levels of nausea, and to that I will say that I am sure that there was no placebo effect going on. 

Some years ago, I read in "The Case for Miracles" (Lee Strobel) that some conditions are well-known for being vulnerable to improvement due to the placebo effect; other conditions are much less affected by it (in the book, the example given was hearing loss).

In my experience, I have found that pregnancy nausea is not at all affected by the placebo effect - I have tried so, so many nausea remedies, and no matter how much I want a given remedy to work, or how I believe that it is going to work, or how I know that it has worked for other people, pregnancy nausea just doesn't budge. It is implacable. I think other pregnancy nausea mamas will back me up on this one. So when I find something that I sense really works, I have no problem in being confident in my assessment, simply because I have seen how ruthless pregnancy nausea is, and how unaffected it is by my wishes and beliefs. 

A few details:

For vitamin K, I used the Super K supplement - two pills at first, and then three when I increased the dosage at 9 weeks.

For vitamin C, I just used an over-the-counter 1000 mg vitamin C pill. The protocol calls for an absurdly low amount of vitamin C (25 mg), but there is no absolute need (that I know of) to achieve that low dosage. 

My conclusions:

* I believe that the Vitamin K + Vitamin C combination is safe, and I have experienced that it is effective. 

* To say this authoritatively, though, I would have to use it throughout a healthy pregnancy with full symptoms.

* I do not believe that using this protocol caused our miscarriage, as physical evidence showed likelihood of a very early loss - possibly even before I began using the protocol.

* I do not know if this method could help HG sufferers - though several of the doctors above stated quite firmly that it could - but I believe that it would be a good auxiliary treatment even if other treatments were used at the same time. 

* As usual, I think that the best time to research all of this would be pre-conception, when one is not panicking over rising nausea levels. I plan to make some contacts and appointments to discuss this with caregivers, in order to be ready for next time, should there be a next time. (Very likely there won't be, at my age, but one likes to be prepared.)

I would love to hear thoughts, experiences, or input. As always, comments must be rational, conversational, and kind, and offered in the spirit of charity (i.e. no "you are an idiot, woman!" comments). 

I very much hope that this information can be of use to mamas out there. 

As always, this is not medical advice. Take the information and the articles to your midwife, OB, naturopath, or other physician. and get his/her take on it.