Doctor's Note

Also check out these videos on potential nutrient deficiencies associated with plant-based diets:
Safest Source of B12
Vitamin B12 Necessary for Arterial Health

And check out my other videos on zinc and vegetarians

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  • Michael Greger M.D.

    Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. And check out the other videos on zinc and vegetarians. Also, there are 1,449 other subjects covered in the rest of my videos–please feel free to explore them as well!

    • elsie blanche

      Is zinc supplementation safe and maybe advisable for vegans? If so, any forms you suggest? The issue of cadmium in zinc supplements has been raised.

  • squidey

    What do you think about the ratio of zinc/copper in the diet? Iv read the ideal is 8/1 but that seems pretty much impossible on a plant based diet, thoughts?

    • Nickolas

      wheat germ has a better ratio than beef, although oysters are the best by far but oysters also have many other things I would not consider safe for consumption.

    • Nickolas

      Also I found that hemp seeds contain zinc without any copper. 28 grams will provide about 23% of your daily requirement for zinc.

  • Thinkabouddit

    My zinc levels are low. I eat walnuts and flax in my oatmeal, and black beans or potatoes or grains with steamed broccolli, kale, etc., vegetables.

    Is there a quality supplement that will up the zinc level?

  • Stephen Lucker Kelly

    I heard you need to keep a 10 to 1 ratio of zinc to copper. Is this true?

  • Keivan

    My wife was recently diagnosed with having very high levels of copper. What are the chances that her mostly vegan diet has contributed to this problem. There is a lot of hype about copper-zink imbalance in a vegetarian and vegan diets. Although high in zinc, nuts and beans are also generally high in copper. Is this fact or fiction?

    • Since no one has answered you yet, I will. Yes, nuts, seeds and beans are generally high in copper–and while the phytic acid in those foods binds their zinc, calcium, iron and other minerals, their copper is still available to us for absorption. As you probably know, high copper can make you tired and fuels the spread of cancer. I also read recently that it may be linked to Alzheimer’s.

      Here’s the long version of the copper-zinc connection and some suggestions on how to increase zinc and lower copper: http://eatandbeatcancer.wordpress.com/2014/03/01/anti-cancer-diets-and-the-pitfalls-of-plants-part-1-copper-and-zinc/

      • John Axsom

        Since I started a whole plant food diet 6 months ago, I noticed that I am a little more tired, and dizzy at times. I wonder if it is because I am not getting enough zinc. Maybe, I should take a zinc supplement, or go back to eating meat.

        • Thea

          John Axsom: It would be impossible for anyone to know what is going on with you with so little information. But I thought I would share an idea that *might* help. Several other people have reported similar problems in the past and when I got some details about their situation, it seemed clear to me that they were not getting enough calories. That was causing them to feel week and sometimes dizzy. They fixed the problem by adding some more calorie dense foods into their diet, foods such as nuts, seeds, dried fruit, etc.
          .
          I’m not an expert and that may not be your problem at all. I’m just sharing so you can think about it in case it will be of help.

          • John Axsom

            Thank you for your thoughts. When I get outdoors and work in the yard, the dizziness goes away. It seems like I have it when I am in the house and not being physically active. I eat a few nuts, but I am following Esselstyn’s advice of no oils, no nuts or seeds because I am trying to reverse plaque build up in the arteries.

          • Thea

            John Axsom: I must be off base then. If you were going to have dizziness in only one place, I would expect it to be when you are working around outdoors–IF the cause were low calories. So, I’m thinking something else is going on with you.
            .
            Here’s a bizarre idea I just had: I know that people can develop allergies over time. Could there be something in your house (some mold or kind of dust) that you have developed a reaction to? Do you have this problem when you are indoors an inactive in other locations? Just another shot in the dark. I wonder if a doctor would be able to help you figure this out. (FYI: Dr. Klaper does phone consultations if you don’t have a doctor you can trust. Dr. Klaper knows all about nutrition. So, he should be able to help you figure out if you have a nutrition problem or some other problem.)
            .
            It’s just interesting to me that being inactive in the house causes symptoms. Best of luck to you. I hope you are able to figure it out.

          • John Axsom

            I think it might be related to the plaque blockage in my carotid arteries. I have 90 percent blockage in the left artery. Maybe I am not getting enough blood and oxygen to the brain. I don’t know. But, when I go to the gym and work out with the weights I get a lot of vasodillatation, ( blood vessels dialate ), and then I no longer feel dizzy. But, if I am in the house sitting around, I am not getting the vasodillatation from exercise, and maybe then the blood flow is not as great to the brain. However, at home, my thinking processes are OK, I play chess on the computer and usually win, I do mathematics, and I practice foreign language skills…
            Anyhow, I started the strict vegan diet set forth by Esselstyn ( who talked to me on the phone ) in order to dissolve the plaque in my arteries. I have been doing this since Janury of 2016. I think it is working because my blood pressure has come down to normal, I have lost 30 pounds, and my total cholesterol has come down to 153. Because these are all good signs, I am hoping that this also reflects that the plaque in my arteries is going away. I don’t know. Let’s just hope Esselstyn is right.

          • Thea

            John: Thanks for the additional details. So interesting. I agree that it sure sounds like things are going in the right direction. I would very interested to hear how you are doing in another few months. I’m keeping my fingers crossed that your arteries open up.

          • John Axsom

            I’ll keep you posted. I just had an evening meal of black beans and rice, and a huge salad. It’s funny how I have come to love the taste of black beans and rice. I usually throw in some diced jalapeno peppers and some salsa into the mix.

          • Andrew Kosta

            I think I have mold in my apt but I’m unable to do much of anything about it due to being unemployed. Its cold outside, however I do try to keep the window open in the daytime for ventilation.

        • Are you drinking green tea? I sometimes get dizzy when I drink too much green tea.

  • Paul Naylor

    I am concerned about cadmium levels in zinc supplements. I have read that zinc orotate is the most bio-available type, but is it a good source of low cadmium zinc? I have also read that zinc gluconate has the lowest levels of cadmium but also low absorption. Which would you recommend Dr Greger? Thank you!

    • Shaylen Snarski

      I think he recommends getting minerals from whole foods. Plus supplementation from minerals can be complex. Getting too much can be dangerous. Minerals in foods are perfectly balanced and it’s still not fully understood how our body absorbs everything. Eating whole foods is the best way to obtain all nutrients especially minerals because balance is so important when it comes to them. Too much of one thing can deplete you in another for example. Supplementing can upset a natural balance. Eat lentils. Go to conrometer.com to measure amounts, I think you’ll be surprised at how much you can get from whole plant foods on even a low calorie diet.

  • Derrek

    How much beans, nuts and grains should be eaten?

    • Thea

      Derrek: Most of the professionals that I follow recommend up to 1 to 2 ounces of nuts and seeds a day. But beans and grains can easily be half of the volume of food that you eat. Check out the PCRM Power Plate, which I find to be a really helpful visual guide:
      http://www.pcrm.org/health/diets/pplate/power-plate

      • Derrek

        I just follow 80/10/10

      • Derrek

        I also found a recommendation for legumes, grains and veggies and fruits but couldn’t find it anymore

      • Derrek

        It was on their website

  • Derrek

    What’s the rda for vegans for zinc? I heard there’s a problem absorbing it.

  • Derrek

    Do you recommend zinc supplements for vegans? How much should I be getting per day? I heard it’s harder to absorb for vegans. How much should I supplement each day?

  • Lauren Bateman

    I just reviewed the comments and questions here. Zinc is best absorbed from whole food, so a supplement is not a good choice. The best way is to be sure to find delicious ways to eat beans, whole grains and/or a palmful of nuts every day.

  • cyndishisara

    I understand that zinc is vital in bode building process. I have read that the most absorptive form of is zinc acexamate.

    ‘Role of nutritional zinc in the prevention of osteoporosis.’

    http://www.ncbi.nlm.nih.gov/pubmed/20035439

    See also the Zinc Acexamate-Osteoporosis Studies
    http://osteoporosis-studies.com/spplements/zinc/zinc-acexamate/

  • CareForTheSentient

    My zinc tends to be a little lower than the commonly cited recommended daily value; I’ve heard Dr. Greger say elsewhere (specifically, here https://www.youtube.com/watch?v=_5FLp1YqPO4&t=2m38s) that if you’re eating a diet rich
    in whole plant foods, especially beans, greens, nuts, grains, and seeds, zinc is nothing to worry about. I eat plenty of those foods, but my zinc levels nonetheless tend to hover at
    around 8.5mg a day, 77% of the standard recommendation. Is this
    something I should seek to remedy, or should I be content knowing I’m
    eating plenty of of cruciferous and green leafy vegetables (in addition
    to beans, nuts, grains, and seeds)?

    • Joseph Gonzales R.D.

      Thanks again for reposting! I suggest upping your zinc intake a bit. You are almost to 11 mg. Keep in mind these are just “averages” to shoot for, but they are the best averages we have, set by the Institute of Medicine. Adding 2.5 mg of zinc to your diet may be pretty easy, especially if you like pumpkin seeds, as 1 ounce offers 2.2 mg of zinc. If you want more foods sources of zinc let me know! Thanks again for reposting.

      Sincerely,
      Joseph

      • Thanks for your reply. I was kind of hoping for a diet where I didn’t have to measure any particular mineral on a daily basis. I eat a LOT of greens & beans, and a little nuts. Do you have an approximate guideline for the amount of each of these, minus pumpkin seeds, that we need to eat to get what we need? I keep hearing that we need to eat greens, beans & nuts to get zinc. But how much? I mean, doesn’t seem like just winging it is working very well for many (most?) vegans. So this is frustrating as a relatively new convert over the last year, particularly considering that my husband has had 3 serious itching rashes requiring him to go to the doctor (since becoming vegan over the last year) and had to take steroids twice for what were *serious* skin rashes. Now I’m wondering whether a zinc deficiency was to blame.

        • Joseph Gonzales R.D.

          Dr. Greger always says that diet quality is more important than quantity. It should be rather easy to meet zinc needs and actually forgive me I goofed, as women only need 8mg, not 11mg (that is for men). Fattier foods from whole plants are fine based on the research so you shouldn’t have a problem eating nuts and soy. If you haven’t please check out our videos on nuts and body weight they may surprise you!

        • Shaylen Snarski

          the fats found in nuts and other plant foods are healthy. Don’t fear those fats. Study after study shows that people who consume those “high fat” foods tend to be healthier and have healthier hearts. They’re actually heart protective in the whole food form. I know a lot of vegans and what I usually hear is how much better everyone feels. But make sure you’re eating enough and lots of whole foods. I’m a vegan and eat nothing but whole foods and I don’t worry about fat in them, I embrace healthy plant fats. Cronometer.com helps you measure all that stuff really well and it’s free. I find that lentils are an AMAZING sources of zinc and other minerals as well as every essential amino acid, you’ll be happy that they’re very low in fat, too. Red lentils have the most antioxidants, even higher than black beans.

  • Lamella

    I read that men taking zinc supplements increase the risk of developing prostate cancer. I would like to know what is the take of Dr. Greger on this. BTW, I absolutely love this page. It is absolutely amazing.

  • Joy Schwabach

    Once you advise B12 supplements for vegans, it begs the question: “Why can’t other supplements also be useful?” I can’t believe Dr. Joel Furhman would sell his multi-vitamin without making sure it’s 100% safe. It doesn’t have the dangerous vitamin A or folic acid, and it does make it easy to meet my zinc requirement. Still, having read a lot on this site, I may cut down to one tablet a day instead of the recommended two.

    • ScottTrimble

      Hi Joy, I am wondering some of the same things. Even among those advocating a plant-based diet, there are some apparently important discrepancies in their advice, so it’s hard for a layperson to weed through it all. I’m especially curious about Fuhrman’s advice to supplement with Vitamin K2, as I can’t find anyone else advocating that specific variant, and apparently K1 is already abundant in a lot of plant foods. Hopefully, my replying to your question without providing any answers will alert one of the knowledgeable moderators to the need to answer.

      • Joy Schwabach

        Thanks Scott. I temporarily cancelled my recurring order of Dr. Furhman’s multi-vitamin, and explained Dr. Greger’s philosophy. So I got this interesting note from their customer service. (See below.) It’s mentioned that Dr. Furhman has more clinical experience but Dr. Greger’s perusal of thousands of journal articles every day is equally impressive, perhaps more! The show 60 Minutes recently had a segment on artificial intelligence and IBM’s Watson, which now reads something like a million journal articles a minute and came up with the same recommendations a team of super doctors did but added something they didn’t know about. In the end, I decided to stay with the multivitamin for now, as extra insurance, but I hope I’m right!

        Here’s the response I got:

        “I had a chance to discuss this with Dr Fuhrman. I hope you will reconsider cancelling the Women’s formula:

        There is nothing in that book (Dr. Greger’s “How Not to Die”) that addresses the need for K2, iodine or zinc. He does say you need higher dosages of B12 and now he is finally recommending DHA.

        Dr. Fuhrman not only stays on top of the latest research affecting these decisions but also pays particular attention to the symptoms of his patients, who have incurred problems over the last 30 years from not supplementing.

        He has followed the blood work of nutrients in patients on plant-based diets for his entire career solving the issues of the non-thriving vegan, and noting the common and recurring issues.

        Where the research studies are not clear, Dr. Fuhrman errs on the side of caution. So here we are talking about sufficient DHA-EPA, D3, K2 (not in vegan foods), iodine (low in plant foods) and zinc, (poorly absorbed from plants).

        Dr Gregor has no such clinical experience and therefore does not/cannot address these issues.”

        • Thea

          Joy Schwabach: Thank you for sharing this information. I found it a bit offensive that the letter says, “…and now he is finally recommending DHA…” Dr. Greger has been recommending DHA, vitamin D, B12 and other nutrients since 2011 at least. (maybe earlier, I don’t know). It’s not like the recommendation is a new thing.
          .
          While I understand that Dr. Fuhrman is trying to say that his experience is more important or relevant than the clinical evidence, the bottom line is that the clinical evidence does not actually support supplementing with K2 at this time. It *may* not hurt to supplement with K2, but why would anyone do it if they didn’t need to? While the letter may be technically correct that K2 is not addressed in How Not To Die, Dr. Greger does specifically refer people to the book Becoming Vegan to address specific nutrient concerns. If you are interested, I copied below the information I commonly give out when people ask about K2, which includes a quote form the Becoming Vegan book.
          .
          Dr. Fuhrman may be right. I don’t know. But I REALLY don’t like the pressure they are putting on you to purchase an (expensive) product they sell based on zero scientific evidence, trying to scare you with Dr. Fuhrman’s experience. If Dr. Fuhrman feels that he has some good clinical evidence to share with us, I wish he would write it up and get it published.
          .
          Dr. Greger does address iodine and zinc on this site. Here are Dr. Greger’s Optimal Nutrition Recommendations (which were first published in 2011, but which have been reviewed this year). http://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/ Zinc is mentioned here: http://nutritionfacts.org/video/vegetarian-zinc-requirements/
          .
          ********************************

          To directly address the K2 question: Brenda Davis and Vesanto Melina wrote a reference book called Becoming Vegan. They did extensive research into individual nutrients, including vitamin K. On page 119 of the Express Edition, the book says: “If you follow popular health gurus on the Internet, you may wonder if you need supplemental vitamin K2, since little of this form is present in a vegan diet. At this time, there is no scientific evidence to suggest that vegans need to worry about supplementing with Vitamin K2.”
          .
          That’s a trustworthy source. They make note that leafy green veggies are vitamin K superstars. And it is easy to get enough Vitamin K on a whole plant food diet. That seems to be all we need to worry about. There is no (credible) scientific evidence, at least by 2013 that says otherwise.
          .
          On page 119 is the text, “…intestinal bacteria synthesize forms of this vitamin known collectively as vitamin K2…” I interpret that to mean: It looks like our bodies make K2, at least in those people who have healthy guts. Perhaps rather than worrying about consuming K2, people should strive for the goal of consuming gut health promoting foods such as intact grains.
          .
          I found backup for my understanding of K2 from an article written by another well respected expert, Jack Norris RD: “Menaquin one (K2) is produced by a number of different bacteria species that typically live in the digestive tract of humans, and can be absorbed in the distal part of the small intestine. Unless someone has had significant antibiotic therapy, they should have plenty of such bacteria providing them with menaquinone.” Anyone concerned about vitamin K in any form, may want to check out this article: http://www.veganhealth.org/articles/vitamink (Thank you Darchite for bringing this to my attention!)
          .
          For anyone that missed it, Tom Goff replied to George in another post with a page link on some more technical information about K2. (Thank you Tom!). If you want the more technical details, check out this interesting page: http://lpi.oregonstate.edu/mic/vitamins/vitamin-K.

          • Joy Schwabach

            Thank you so much. I have Brenda Davis’ book. It’s excellent. You’ve given me a lot to think about.

          • Thank you both for your quick replies, and for all the info. I need to read those links, but I am already aware of Jack Norris, and generally trust what he has to say; and to be honest, I was a bit suspicious that both Fuhrman and Mercola, who make the case for K2, are selling their own brands of supplements (and both a bit pricey). I know Fuhrman has had some remarkable results in his clinical practice, but it does seem like he should publish more of his scientific findings in some peer-reviewed journals rather than just trying to monetize his knowledge.

          • Joy Schwabach

            Anyone who talks to Dr. Furhman or listens to his videos or reads his many books knows that he is a person of the highest integrity. He’s contributed thousands to this website and comes across as a deeply caring and brilliant individual. I don’t blame him for wanting to be sure that his multivitamin has only the safest and best ingredients and if he offered them for free, it would not be self-sustaining for long. I appreciate all that Dr. Greger offers (that’s an understatement) but also trust Dr. Furhman.

      • Thea

        ScottTrimble: I addressed Joy below, but the post contains a lot of information about K2. I hope the post is helpful to you also.

  • Shaylen Snarski

    Should women take an iron supplement during their period or would their multivitamin containing iron be efficient if they’re worried they didn’t get enough from food everyday? And are zinc supplements a good idea for women? If so, at what percent DV and will that interfere with your copper absorption from foods even if you take the zinc supplement between meals?

  • Kevin

    I love the ending.

  • FAB_Team

    I have extremely low zinc and high copper found in blood test. I was sick constantly with flus, sinus, stomach problems skin problems for over 12 months and was advised that its was due to the imbalance in the zinc/copper. As a vegan how can I increase my zinc levels without taking a supplement or should I take a supplement. I have been told my zinc levels will take 1 to 2 years to balance again which concerns me and I may have pyroles disorder