For over 25 years, Metagenics has been a faithful advocate of chiropractic, and a trusted health partner to tens of thousands of chiropractors around the world. Through the years, we've asked one single question again and again: "How can we help your patients and practice thrive?" Your answers have guided us in developing new innovations, and creating hundreds of highly acclaimed products, programs, services and tools.

At Metagenics, we've been listening to you.

From well-researched formulas for common musculoskeletal conditions to easy-to-use systems that help you integrate nutrition with chiropractic. From educational programs led by world-class clinicians to turnkey programs for implementing lifestyle medicine in your practice-we're committed to helping you make a difference with your patients, and helping you grow your practice.

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Mark Kaye, DC combines his practitioner experience with over 15 years of expertise on our nutritional formulas and protocols. Depend on Mark for practical answers to your questions.
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Recent Answers

Q. Why do you use fructose as a sweetener in the medical foods?

A. Fructose as used in Metagenics medical foods is not a sweetener as often added to empty-calorie food and drink. While some may suggest fructose is fructose is fructose, which is...
» Read More Fructose as used in Metagenics medical foods is not a sweetener as often added to empty-calorie food and drink. While some may suggest fructose is fructose is fructose, which is correct, since fructose is the same carbohydrate as found in fruits (so-called "fruit sugar"); the function, benefit, or problem with fructose must be taken in context with how it is used. Fructose added to empty calorie foods, just as adding sugar or similar, is problematic since one is consuming empty calories.

Pure fructose which is, of course, the same carbohydrate as found in fruits and vegetables, is used in the medical foods as a low-glycemic index, non-insulinogenic macronutrient. Part of the term medical food that may be important to emphasize here is "food." UltraMeal, for example, as any food must contain proteins, carbohydrates, healthy oils, and various micronutrients.

While sugar or simple carbohydrates are often discussed in a negative light, the context of those discussions are generally related to the types of foods we consume in modern society. Simple sugar, glucose for example, remains an important part of our metabolism. The RDA for carbohydrate is greater than approximately 130 grams specifically related support of brain nutrition. In absence of starvation / fasting, the only energy source for the brain (the organ that uses the greatest percentage of dietary carbohydrate intake) is the simple carbohydrate glucose. Of course, it is known that the primary fuel for muscles is also carbohydrate. Further, while the primary fuel for the heart has been stated to be fatty acids, it is when the ability for the heart to use carbohydrates for energy that heart dysfunction is of greater concern.

Generally, the metabolic end-fate of any carbohydrate, whether fruit, vegetable, or pure fructose, is conversion to the simple sugar glucose. While fructose has a different biochemical metabolism than glucose (non-insulinogenic), fructose still is converted to glucose and/or to pyruvate for production of ATP (Kreb's cycle).

When the issue is closely examined, it may be seen that the issue today is not fructose per se — as man has been consuming fructose for millennia. The issue of obesity, metabolic syndrome, or chronic illness today is imbalanced diet & lifestyle where many receive a majority of their calories from empty foods including soda and sweetened juices, highly processed foods, and sedentary lifestyles. Rational fructose intake is not associated with negative health concern.
On the other hand, UltraMeal or any Metagenics medical food cannot be considered "empty calories," but are nutrient dense, low calorie, balanced meals. The amount of "sugar" as found in one serving of UltraMeal is roughly equivalent to a single pear, yet a pear does not provide a full serving of protein, healthy fats, nor the breadth of micronutrients (vitamins, minerals) nor herbs as found in the medical food and all in less than 200 calories — IE, a meal. On the other hand, 12 oz of soda or many sweetened juices also provide about 150-200 calories and 4 or 7 times the sugar content — all without protein, healthy oils, and micronutrients. IE, empty calories.

Often confusing is fructose as compared to high-fructose corn syrup (HFCS). The former, pure fructose, is again that found in most plant foods (fruits and vegetables), while the latter, HFCS, is an inexpensive table-sugar mimic added as a sweetener to empty-calorie foods. Again, if we could, UltraMeal is not an empty-calorie food nor is the fructose used as a sweetener. Its inclusion was purposeful and based on science and research. For example, a recently published article;

Nutr Metab (Lond). 2008 Nov 4;5:29. Enhancement of a modified Mediterranean-style, low glycemic load diet with specific phytochemicals [and a fructose-containing medical food] improves cardiometabolic risk factors in subjects with metabolic syndrome and hypercholesterolemia in a randomized trial. Lerman RH, Minich DM, Darland G, Lamb JJ, Schiltz B, Babish JG, Bland JS, Tripp ML. Functional Medicine Research Center, MetaProteomics, LLC, 9770 44th Ave, NW, Ste 100, Gig Harbor, WA 98332, USA.
Your local area sales representative for Metagenics should have this article as well as a series of case studies surrounding the various medical foods for you.

Metagenics has much experience with the medical foods and it spans well over a decade now in thousands of patients. Please be aware that the healthy content of carbohydrate in our "food" based medical food has not been found to be an issue in any patient. Fructose, as it is found in fruits, vegetable, and yes in simple table sugar, cannot be avoided. Likely what is most appropriately suggested to be avoided today are empty-calorie foods and adoption of healthier lifestyles. The medical foods can play a very positive role in promotion of healthy lifestyles, providing healthy low-calorie snacks (avoidance of poor snack choices), and providing positive health benefit.
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Q. How does MCHC compare to other forms of calcium?

A. Microcrystalline hydroxyapatite concentrate (MCHC) is a compound derived from a whole animal bone, which is comprised of calcium, magnesium, zinc, silica, manganese, and other trace minerals. MCHC has been shown...
» Read More Microcrystalline hydroxyapatite concentrate (MCHC) is a compound derived from a whole animal bone, which is comprised of calcium, magnesium, zinc, silica, manganese, and other trace minerals. MCHC has been shown to support bone health by acting as "bone food." Whereas other forms of calcium should be considered simply as "good sources of calcium," and calcium is important for many health reasons other than bone, MCHC provides more nutrients than just elemental calcium for effective bone support.

While MCHC is an effective source of calcium, its primary benefit comes in bone support formulas. Certainly calcium has many non-bone uses and other types of calcium remain important in overall health.

Of course, "...bones are "more than just calcium," and MCHC is considered an "bone food." Because bone is much more complex than just calcium alone, it also requires more than just calcium for total bone nutrition. Thus, a compound such as calcium citrate or any other form of calcium alone is unlikely to be superior to MCHC as a "complete bone food."

On the other hand, calcium alone is important in many body processes and the use of calcium as citrate, lactate, or other chelated forms also provide excellent sources of calcium. For example, in Metagenics Multigenics Intensive Care, the forms of calcium include MCHC calcium citrate, and calcium glycinate, providing a full breadth of calcium need in a multivitamin. Certainly, adding a bone-specific calcium formula to any multivitamin remains a proper choice.
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Q. I've heard that to "test" the quality of vitamins, one should stick them in a glass of vinegar. I stuck my vitamin pill into vinegar and nothing happened. What happened?

A. This is a difficult question because it is such a common perception. The suggestion of this test is in literature and from generally reputable sources. However, it is not correct....
» Read More This is a difficult question because it is such a common perception. The suggestion of this test is in literature and from generally reputable sources. However, it is not correct.

The "vinegar test" is accurate only with calcium as carbonate or dietary supplements that use alkaline tableting agents such as carbonates.

The origins of the "test"
The vinegar test originated when calcium carbonate tablets were first produced. At that time—as you may recall—vitamin pills were typically covered in shellac (derived from insect exoskeletons) and the concern was that the pill would pass undigested into the toilet. So, this test was developed to assure that digestive enzymes could penetrate the shellac coating and get to the calcium carbonate.

The chemistry is an acid-base reaction. The weak acid (vinegar) reacts with the base of carbonate, pure and simple. That is the whole basis for antacids consisting of calcium carbonate. One can do the same thing with baking soda and vinegar (school chemistry). There are numerous links on the Web where teachers use this test solely to identify calcium in the carbonate form.

Why is this test invalid?
1. No company concerned about quality uses this type of shellac as a tablet coating any longer.
2. There are numerous other ingredients to use in supplements. MOST are not alkaline and therefore do not react with acids. There is nothing to allow an acid-base reaction to occur.
3. There are proper and acceptable testing methods for determining tablet disintegration recognized by the FDA. It's called, of course, USP (United States Pharmacopoeia) disintegration and dissolution testing, which Metagenics performs on every batch of ingredients—actually several times during each batch run. This is the only accepted method for determining tablet disintegration/dissolution according to the USP 27 2004. The test protocol is for disintegration to occur in less than 30 minutes.

In summary, the test might only be considered only valid for calcium carbonate or for pills that contain calcium carbonate as a tableting agent. Metagenics does not use calcium carbonate as a tableting agent. We use plant fiber.

Finally, what about vinegar and food?
Can vinegar in a glass break down food? Of course, it cannot. However, even though vinegar does not break down food we are not concerned that once swallowed that our body does not absorb the food. As a final thought, taking normal blackboard chalk and placing it in vinegar one can see that it will dissolve. Yet, most will not suggest that chalk is an effective form of calcium supplementation. Overall it can be seen that vinegar is a POOR choice to test for the quality of dietary supplements. Perhaps the best suggestion is to leave the vinegar with oil as an tasty dressing for a salad.
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Q. I've read a lot on the benefits of vitamin K2 over K1 for bone and cardiovascular health?

A. There has been some recent interest in vitamin K2 over K1, however, the preponderance of the evidence for all human benefit and the safety remains tied to vitamin K1. The...
» Read More There has been some recent interest in vitamin K2 over K1, however, the preponderance of the evidence for all human benefit and the safety remains tied to vitamin K1. The K2 studies are limited, are not oral dosing studies, but extrapolated from food intake (primarily fermented soy foods) studies from Japan. Other vitamin K2 studies, also from Japan, are drug-dose studies. In Japan K2 as MK-4 is a drug and the dosing is many thousands of micrograms per day, far beyond any dietary intake.

While there is some controversy on this subject, at this time the majority of the research as to efficacy and safety related to bone health is with oral vitamin K1. Overall, vitamin K research remains in an early stage. What is known is that oral vitamin K1 intake is directly related to bone health (carboxylation of osteocalcin and improvement in osteoprotegrin) and the majority of vitamin K intake in humans is K1 — up to 90% of total dietary intake of vitamin K is in the form of K1. Pharmacologic studies of K2 where extremely high doses were utilized cannot be extrapolated to dietary supplement use.

Research also suggests that cell accumulation of bone-specific vitamin K metabolites important in bone health is via synthesis from K1 rather than direct uptake of K2. Studies show that the preferential route of MK-4 production in the body is conversion of K1 and not conversion of K2.

"...The human intervention studies have demonstrated that vitamin K can not only increase bone mineral density in osteoporotic people but also actually reduce fracture rates. Further, there is evidence in human intervention studies that vitamins K and D, a classic in bone metabolism, works synergistically on bone density. Most of these studies employed vitamin K(2) at rather high doses [up to 45,000 mcg per day], a fact that has been criticized as a shortcoming of these studies. However, there is emerging evidence in human intervention studies that vitamin K(1) at a much lower dose may also benefit bone health, in particular when coadministered with vitamin D. Several mechanisms are suggested by which vitamin K can modulate bone metabolism. Besides the gamma-carboxylation of osteocalcin, a protein believed to be involved in bone mineralization, there is increasing evidence that vitamin K also positively affects calcium balance, a key mineral in bone metabolism..." Nutrition. 2001 Oct;17(10):880-7. Vitamin K and bone health. Weber P.

"...MK-4 accumulation in non-hepatic organs was shown to result from a synthesis rather than an uptake from the gut..." J Nutr. 2004 Jan;134(1):167-72. Menaquinone-4 concentration is correlated with sphingolipid concentrations in rat brain. Carrie et al.

Finally, related to cardiovascular health and vitamin K. Again, the same issue applies. Can studies of vitamin K intake solely from food be extrapolated as oral intake of supplemental vitamin K? Not easily. In any study of dietary intake there are many variables. Where studies have been done, while not consistent, have shown oral K1 is of potential benefit related to cardiovascular support. For example, Shea et al. reported reversal of pre-existing coronary artery calcification at only 500 micrograms of K1 (phylloquinone) per day. In contrast to direct oral intake of vitamin K1 as a supplement, what is also reported is that high phylloquinone intake from vegetables is an effective marker and determinant of reduced risk for cardiovascular disease, including myocardial infarction, stroke, fatal, and non-fatal coronary heart disease. Going along with that information is that overall vitamin K intake has gone down due to changes in healthy dietary habits.


Of interest related to bone health, healthful diets such as the Mediterranean style, along with oral K1 is a recent paper authored by Michael Holick MD and co-authored by Metagenics FMRC. If you don't have the paper, please contact your local area representative for Metagenics for a copy.

"...Osteoporosis is a major health issue facing postmenopausal women. Increased production of pro-inflammatory cytokines resulting from declining estrogen leads to increased bone resorption. Nutrition can have a positive impact on osteoporosis prevention and amelioration. The objective of this study was to investigate the impact of targeted phytochemicals and nutrients essential for bone health on bone turnover markers in healthy postmenopausal women. In this 14-week, single-blinded, 2-arm placebo-controlled pilot study, all women were instructed to consume a modified Mediterranean-style low-glycemic-load diet and to engage in limited aerobic exercise; 17 randomized to the placebo and 16 to the treatment arm (receiving 200 mg hop rho iso-alpha acids, 100 mg berberine sulfate trihydrate, 500 IU vitamin D(3) and 500 mug vitamin K(1), twice daily). Thirty-two women completed the study. Baseline nutrient intake did not differ between arms. At 14 weeks, the treatment arm exhibited an estimated 31% mean reduction (P = 0.02) in serum osteocalcin (a marker of bone turnover), whereas the placebo arm exhibited a 19% increase (P = 0.03) compared to baseline. Serum 25-hydroxyvitamin D (25(OH)D) increased by 13% (P = 0.24) in the treatment arm and decreased by 25% (P < 0.01) in the placebo arm. The between-arm differences for OC and 25(OH)D were statistically significant. Serum IGF-I was increased in both arms, but the increase was more significant in the treatment arm at 14 weeks (P < 0.01). Treatment with hop rho iso-alpha acids, berberine sulfate trihydrate, vitamin D(3) and vitamin K(1) produced a more favorable bone biomarker profile that supports a healthy bone metabolism..." J Bone Miner Metab. 2009 Dec 19. Hop rho iso-alpha acids, berberine, vitamin D(3) and vitamin K (1) favorably impact biomarkers of bone turnover in postmenopausal women in a 14-week trial.
Holick MF, Lamb JJ, Lerman RH, Konda VR, Darland G, Minich DM, Desai A, Chen TC, Austin M, Kornberg J, Chang JL, Hsi A, Bland JS, Tripp ML.
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