Donating Blood to Prevent Cancer?

Donating Blood to Prevent Cancer?
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Prioritizing plant-based sources of iron may be more effective than giving blood at reducing the risk of potentially “ferrotoxic” (iron-related) diseases such as cancer and diabetes.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

If cancer is, indeed, a so-called “ferrotoxic disease,” a consequence, in part, of iron toxicity, that would explain not only the dramatic drop in cancer rates after blood donations, but also why people with higher levels of iron in their blood “had an increased risk of dying from cancer,” why women who bleed into their ovaries are at high risk for ovarian cancer, and why those suffering an iron overload disease, called hemochromatosis, have up to 200 times the risk of cancer. There’s even been a call to go back and look at some of the chemotherapy trials that kept taking blood from the chemo group to check for side effects. Maybe, just the iron removal from the blood draws accounted for some of the apparent chemo benefits.

Iron may be a double-edged sword. “Iron deficiency causes anemia, whereas excessive iron [may increase] cancer risk, presumably by” acting as a pro-oxidant, generating free radicals. Iron-deficiency anemia is a serious problem in the developing world, but “[i]n meat-eating countries,…iron excess may be more of a problem than iron deficiency.” Body iron stores accumulate insidiously with ageing, due to the fact that intake exceeds loss,” and our body has no good way of getting rid of excess iron.

Ferritin is a blood test measure of our backup iron stores. The normal range is 12 to 200, but just because it’s normal doesn’t mean it’s ideal. In the blood donor study, those who developed cancer were up to here. The average for men may be over 100.

This suggests that “normal,” “ambient levels of iron stores may be noxious and constitute a…problem that affects large segments of the population.” So, “[t]here may be a need to redefine the normal range…based on…disease risk,” rather than just following a bell curve. “Thus, iron deficiency may exist when ferritin levels decline to less than about 12 ng/mL; whereas, ferrotoxic disease may [start to] occur with levels greater than about 50 ng/mL.”

Harvard recently looked at blood donations and colorectal cancer, and found no connection. But, the range of ferritin levels they were looking at were like from here, to about here, right? And those were the ones who reported giving blood like 30 or more times.

So, maybe instead of draining our blood to reduce excess iron stores, why not just prevent the iron overload in the first place? If you measure the iron stores of men that stay away from heme iron— that get all their iron from plants—their levels come in right around where the cancer-free donor group came in, which may help explain why those eating plant-based diets tend to have less cancer, and other diseases associated with iron overload, such as pre-diabetes, as well as diabetes.

Please consider volunteering to help out on the site.

Image credit: Steel Wool via flickr. Image has been modified.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

If cancer is, indeed, a so-called “ferrotoxic disease,” a consequence, in part, of iron toxicity, that would explain not only the dramatic drop in cancer rates after blood donations, but also why people with higher levels of iron in their blood “had an increased risk of dying from cancer,” why women who bleed into their ovaries are at high risk for ovarian cancer, and why those suffering an iron overload disease, called hemochromatosis, have up to 200 times the risk of cancer. There’s even been a call to go back and look at some of the chemotherapy trials that kept taking blood from the chemo group to check for side effects. Maybe, just the iron removal from the blood draws accounted for some of the apparent chemo benefits.

Iron may be a double-edged sword. “Iron deficiency causes anemia, whereas excessive iron [may increase] cancer risk, presumably by” acting as a pro-oxidant, generating free radicals. Iron-deficiency anemia is a serious problem in the developing world, but “[i]n meat-eating countries,…iron excess may be more of a problem than iron deficiency.” Body iron stores accumulate insidiously with ageing, due to the fact that intake exceeds loss,” and our body has no good way of getting rid of excess iron.

Ferritin is a blood test measure of our backup iron stores. The normal range is 12 to 200, but just because it’s normal doesn’t mean it’s ideal. In the blood donor study, those who developed cancer were up to here. The average for men may be over 100.

This suggests that “normal,” “ambient levels of iron stores may be noxious and constitute a…problem that affects large segments of the population.” So, “[t]here may be a need to redefine the normal range…based on…disease risk,” rather than just following a bell curve. “Thus, iron deficiency may exist when ferritin levels decline to less than about 12 ng/mL; whereas, ferrotoxic disease may [start to] occur with levels greater than about 50 ng/mL.”

Harvard recently looked at blood donations and colorectal cancer, and found no connection. But, the range of ferritin levels they were looking at were like from here, to about here, right? And those were the ones who reported giving blood like 30 or more times.

So, maybe instead of draining our blood to reduce excess iron stores, why not just prevent the iron overload in the first place? If you measure the iron stores of men that stay away from heme iron— that get all their iron from plants—their levels come in right around where the cancer-free donor group came in, which may help explain why those eating plant-based diets tend to have less cancer, and other diseases associated with iron overload, such as pre-diabetes, as well as diabetes.

Please consider volunteering to help out on the site.

Image credit: Steel Wool via flickr. Image has been modified.

Doctor's Note

What blood donor study? See the “prequel” video, Donating Blood to Prevent Heart Disease?

Other examples of when normal lab values are not necessarily ideal can be found in:

Even though a plant-based diet may be preferable for personal disease risk, that still doesn’t mean we shouldn’t all give blood! Join me in supporting the Red Cross.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

134 responses to “Donating Blood to Prevent Cancer?

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  1. Yikes. So here I am starting to sweat again. I’ve been a conscientious vegan for 3 years now and I donate blood 3-4 times a year and yet my ferritin level is 103. As they say, choose your parents wisely.




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          1. Many of us have genes for MTHFR, and, since I have two of them I was advised to take methylcobalamin, as my body doesn’t convert the cyanocobalamin well. Also, my PA said they like to see B12 levels much higher than recommended.

            Since MTHFR is quite common – various people estimate up to 70% of the population have one or two genes – it seems like the methyl form would be a safer bet for most. I remember Dr G recommends against this, though I don’t recall why. I guess it’s time for a review.




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            1. Cyanocobalamin is the most studied, cheapest and most readily available, so the safety profile is relatively well known, doses well studied and benefit well analysed.
              There is no study I know of (yet) showing great efficiency of methylcobalamin.
              I think the current conclusion is to take whichever keeps your active B12, MMA and homocysteine within ‘normal’ ranges, with B12 preferably closer to the Japanese values (>600), than the Australian or American lab values, where people were showing signs of deficiency in the Japanese studies.




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              1. Thanks for your information. My numbers are well within a healthy range, so I’ll continue with the methycobalamin. This is supposed to help with my compromised ability to methylate.




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                  1. I don’t pretend to understand methylation, but from what I’ve read, in an attempt to understand how having the two genes affects me, it is a very important process that happens thousands of times every second. It seems to be connected with detoxification and also with using B12 and folate. I was told to take methylated forms of both. Perhaps someone who understands it better can speak up.




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    1. Don’t sweat it. The actual equation – as far as susceptibility goes – looks not only at prooxidants – like Fe and Cu, but at antioxidants, of which the typical vegan diet has an abundance, whereas the SAD seems markedly deficient. I would bet that the same correlation between Fe in the blood and cancer looks very different for vegans compared to SADers.




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    2. Reference ranges do vary between labs and countries, so I’d check that your 103 is the same as the levels in this video. For example in this video ‘normal’ is 12-200, whereas the labs I am familiar with use ferritin of 15-300.

      Have you had a gene analysis for haemochromatosis? Interestingly their target is 50-100… more in line with this video! Maybe time to give monthly instead!




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    3. People absorb iron with different efficiency from food. Worst off are those with haemocromatosis. Someone I know currently has ferritin at 600. I am totally freaking out. Under my skin, of course. Luckily, I have already prescribed him a vegan diet before we take his diagnostics further … And I also reduced his B12 dose as a precaution.




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    4. Richard, I’m one of the moderators on the site and have worked as the medical director at several blood banks. If you can find a place that collects donations via a two unit apheresis machine – takes the equivalent of two red cell units but returns all the liquid components as well as additional fluids so you leave with the same fluid volume you arrived with. The donors we saw really had large decreases in the ferritin levels they subsequently ran. Being able to donate in this manner may be easier if you are an O pos or O neg as the machines are usually reserved for these donors as their blood is in high demand. Just a thought prior to getting tested for hemochromatosis as that would throw a different monkey wrench in to the donation process should you turn out to be positive. Thanks for being a consistent and life saving blood donor!!




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      1. Hi DocBeccy,

        I’ve recently donated blood for the first time and I am O negative… I read on the Red Cross site that you lose “200-250mg of iron with each donation”. But my Ferritin levels are really high about 380 ug/L… but how do I know how much my Ferritin levels are dropping if I am losing 200mg each time I donate? I want to get down to the safe range that Dr. Greger has talked about below 70!

        Anyone got any info on how long it would take to lower it through blood donations?

        Thank you!




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        1. Hi Jared,
          Iron and ferritin are two different things. Ferritin is a protein that in a sense carries your iron to where it needs to be. You have your iron levels measured each time you go in to donate and that level indicates whether you are anemic or not. The iron is the central portion of the heme molecule that makes up the hemoglobin in the red cell. Ferritin is no measured when you go to donate but can be ordered when you go for a doctors visit. It is not routinely measured but if you have had a high level in the past or have a relative with hemochromatosis you should mention it to your doctor so they can order it and get this sorted out for you. Since it is difficult to actually measure the iron stored in your tissues the ferritin is a marker to indicate that your stores may be elevated. It is the elevated stores in the tissues that are dangerous to your health, especially for the heart and the liver.
          An internist should be able to help you sort this out. If not, hematologists specialize in this area and the work up is pretty routine.
          Best Regards,




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  2. I wonder if there have been any studies on the Maasai people. They have a particularly gruesome and grizzly diet based upon raw cattle blood & milk and raw beef. I would seem difficult to devise a diet higher in iron than that. If there was a linkage between high iron levels and cancer risk, then cancer should be statistically prevalent among the members of this population.




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      1. Didn’t Dr G say they don’t have a terribly long life? I don’t recall what they die of. My mental image of them is that they do a lot of leaping, or jumping straight up and down.




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          1. Thank you Dr Renae Thomas,
            That would make sense considering both their diet, and their incredible physical exertion. This seems yet another example of not being able to exercise one’s way past a bad diet…




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        1. I imagine that some of them are injured while they dance with their spears, and the coming of age ritual for boys to be accepted into the tribe as a man is to hunt and kill a lion; so definite danger to be had there; and there must be hazards galore practicing a semi-nomadic pastoralist lifestyle on the plains of Africa; lions and hippopotamus and parasitic diseases, Oh my! But some of them must live long enough to start dying from cancer, but we’ll never knows, “Until, we put it to the test.” ;-)
          I find lemonhead’s assertion that the Maasai may have undergone selective adaptive ability to cope with elevated heme iron levels fascinating, and there are precedents for such adaptive responses to dietary pressures, dairy comes readily to mind.




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    1. Perhaps not. Maasai men may have higher iron levels but Maasai women tend to have low iron levels. This might obscure any link.
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3179448/

      Also, the Maasai have some genetic adaptations affecting cholesterol regulation. It is not inconceivable that they may also have genetic adaptations which affect iron regulation (as others here have suggested).
      http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0044751

      However, all that said, the one study of cancer and the Maasai that I am aware of (courtesy of PlantPositive) suggests that they do experience higher rates of cancer.
      http://plantpositive.squarespace.com/blog/2012/3/25/tpns-29-30-the-masai-model.html




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  3. Unrelated to the topic, I noticed something on both todays and wednesdays web pages. I normally use secret tab setting when browsing, and these two pages show a ‘broken’ lock icon ie security setting in the browser address bar. I will disable javascript from now on. I have not had a problem with older pages. Thanks.




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    1. Thank you reporting this, Susan. We will look into this on our end and keep our eye out for other users who may be having the same issue. Can you tell me what browser you were using?




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  4. I will go to my grave saying B12 supplements are NOT needed. In 1998 I had a right hemicolectomy and was told to have monthly b12 shots because I would not be able to ever absorb it again since the part of the colon that is needed to do this is now gone. Well…. I rarely if ever have taken the shots and guess what? My B12 levels are actually well over the “norm” Regarding Iron, I am not surprised at the toxicity associated with this… Iron is a heavy metal. I think people forget this because its associated as a “nutrient” Its one of those things that like protein, unless you have a medical condition such as bleeding, you will not be deficient. In the Emergency Room, as an RN, I see lots of people who are anemic in the 8-10 range for hemoglobin… and I see no ill efffects. Im starting to really question whether we should be calling these values normal.. Maybe we should change that term. Optimal, Average and Disease? Normal imparts certain psychological aspects that says, its Ok… but in reality its not. If you were surrounded by a bunch of idiots for a long enough time ( much like todays society) they too would soon become “normal’




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    1. Peter, do you think it’s possible that your microbiome makes up for that part of your missing colon? Perhaps because you eat more plants the type of bacteria in your gut fills that gap. This is just curious speculation, but something is working for you.




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    2. I agree to a large extent. In one of the B12 videos, Dr. G. said a big majority of British vegans were found to be B12 deficient when tested. But it didn’t say anything about any of them experiencing any adverse effects. (I will repeat that in “The China Study” T. Colin Campbell says that there is an increasing body of evidence that plants grown in healthy soil take up B12.) As another example of normality, the Nurses Health Study among others, associates potato consumption with ill health. It turns out that this is only because nurses “normally” consume potatoes refined and processed with 90% added (typically animal) fat by calorie. Where in reality potatoes alone are one of the healthiest foods on the planet.




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      1. Yeah Blair, and Andrew Taylor (SpudFit) pretty much laid to rest any and all criticism of potatoes last year when plain potatoes is ALL he ate for an entire year… he lost almost 120 lbs and is healthier than ever! Even toward the end of the year all the naysayers were still warning him of the detriments! He was even on that bogus show “The Doctors”, who would have trashed him if McDougall wasn’t backing him up! lol




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    3. Neuroscience is my field .. .and it is known that some parts of the brain will ‘take over’ damaged parts at times. We know that blocked coronary arteries around the heart will grow smaller side branching arteries to facilitate needed blood flow. So I’m not entirely surprised that some part of the colon is ‘doing the job’ of the removed piece. The body has lots of plasticity and variability.
      I like the idea of “optimal, average, and disease”.




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    4. That is great that your body has healed in a way to keep your B12 intact. I agree with the idea of range for our blood chemistry. As we are all individuals and the body is amazing at healing itself when it is given the right nurishment such as WPBF that is recommended by Dr. G. based on all these research that he follows up. Thanks for sharing your story.




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    5. Which reference ranges are you using? Many plant-based doctors recommend the Japanese ranges (>600) as well as a normal MMA and homocysteine. I understand where you are coming from and provided you keep an eye on your levels regularly, you may be able to see a trend before a deficiency occurs, however as most people are not in that situation, it’s usually safer to recommend a reliable source of B12, rather than rely on regular testing and potential irreversible consequences….




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  5. I’ve been on a McDougall type whole-food plant-based eating plan for over 40 years.And all that time I have had Willi-Eckbom disease, the neurological disease commonly known as Restless Leg Syndrome (RLS) which makes it almost impossible to sleep without medication. While certain medicines and beverages such as alcohol and caffeine often make symptoms worse, as far as I know there is no other dietary cause. However, people with RLS often benefit by taking an iron supplement such as ferrous bisglycinate, even if they have normal serum ferritin. In fact treatment guidelines say to take an iron supplement if serum ferritin is under 75 to 100 nL/mg. Mine was at 50 when first tested, then after 6 months of supplementing it was up to 125. After a few years I was tested again and it was back at 50. Question: is ferrous bisglycinate heme iron? Seems like people with RLS are in a catch 22: low iron and their RLS gets worse, high iron and their cancer risk goes up.




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    1. “Question: is ferrous bisglycinate heme iron?”

      No, it is not.
      (I tried to place a figure here showing the two chemical structures but I get a message saying I must be logged in to NF.org to upload an image. I haven’t been able to login to NF.org for months, although my Disqus account works. Oh well.)

      Here is an article about ferrous bisglycinate and includes information about absorption from the gut.
      http://www.inchem.org/documents/jecfa/jecmono/v52je20.htm




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    2. My wife too suffers from RLS. She noticed that the frequency and severity has gone down enough that she was able to discontinue using Requip. But what she has noticed is that if she gets very much fat at all during the day she is likely to be up marching in place that night. As a result she is absolutely militant about no added oil and keeping high fat foods to a minimum. Might be worth an experiment and go as fat free as absolutely possible since the only essential fatty acids is a gram or two of omega-6 and the same of omega-3. Our bodies can make all the other fat we need from carbohydrates. Cronometer can by your friend here in identifying sources of fat. Even foods that you never associate with having much fat like oatmeal, which has 16% of its calories from fat, can push percent of calories up. So even though you have been eating a WFPB diet for 40 years, it might take a specific focus within the general diet to address a specific issue.

      And if you do try a month or two of super low fat diets I would be very curious to see if it has any impact for you since to date neither I nor my wife have heard from any other RLS suffers that fat intake has any impact. But those we know eat a more standard diet where fat varies from very high to dangerously high, and so even when eating a “low” fat diet is well above some threshold level of fat consumption.




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      1. Thanks Jim. At 6 feet tall, very active, and weighing only 134lbs I eat a lot of fatty plant foods such as avocados, nuts, and some soy. I will give your idea a try when I get back home from wintering in Baja. You may be on to something. I will give it a try for a few days when I find out what my wife is planning to cook for a few days. I should be able to give up the above food and the ones at Cronometer for a week.




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      2. Thanks again for the tip on Cronometer. Signed up and put yesterdays foods on it. I sure get enough minerals from vegan foods. More than 170% of required magnesium. However the program needs some tweaking. I was low on omega 3s so I ate 1/4 cup of walnut halves, entered it into Cronometer, and there was no change in omegas 3s. You were right though. I’m getting a lot more calories from plant foods than I thought. More than 20%. So I will try your suggestion soon and see what happens.




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        1. Here is my working theory. From what I have read, RLS tends to be a progressive condition that starts mostly the late 20s to mid 30s with mild symptoms and then gets progressively worse over time. This sounds a lot like the progression of atherosclerotic vascular disease. Also I remember reading somewhere that there was some thought that perhaps RLS was related to insufficient blood supply to the portion of the brain that is involved in regulating the “need” to move, but not the part under conscious control of whether to move or not, which was why the article said that sufferers can resist the need to move for a short period of time, but the need eventually becomes overwhelming and they have to move. I know that suppression of initiation sounds funny, but my understanding is that this isn’t unusual in the brain. There can be a part of the brain that initiates the movement and another portion that inhibits that portion while a third part under more conscious control allows you to resist that need to move.

          We know from tests like the brachial artery test that a high fat meal can cause temporary stiffening of the arteries starting an hour or two after the meal and lasting for 3-5 hours. During this time arteries can not dilate normally. Also we know that 95% of everybody who eats a standard western diet has some degree of athlosclerotic plaques in their arteries.

          My theory is that for RLS sufferers one or more plaques have developed in the artery feeding the portion of the brain responsible for movement initiation. Early on the blockage isn’t so severe that the arteries can’t dilate sufficiently to provide adequate blood flow. But the temporary hardening of the arteries plus the increased viscosity due to all the fat in the blood (lipemia) following a high fat meal diminishes the blood flow, along with other factors such as fatigue, causing this portion of the brain to not function properly. The result is a bout of RLS about 3 hours after dinner when you are getting ready for bed and then for about half of the rest of the night. As you get older and the plaques grow it takes less and less interference in the blood flow to trigger the restless leg and the intensity of it gets worse.

          But if I am right, the same low fat WFPB diet that Esselstyn uses to regress coronary plaques should do the same for plaques in the brain and so improve the blood flow to the affected area and reduce the frequency, duration and severity of the bouts of restless leg. Or maybe I am all wet and RLS has nothing to do with atherosclerosis.




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          1. Sounds reasonable Jim. And worth a trial if neurologists and cardiologists agreed on your basic theory. Some such as from walnuts, as one NF video pointed out, improve epithelial function and blood flow. According to research reported online at John Hopkins Univ., 80% of RLS sufferers improve taking iron supplements to bring serum ferritin up to 100ng/ml as I mentioned previously. Maybe brain metabolism of iron is affected by blood flow supporting your theory. Not sure your theory would explain why RLS symptoms (for most people) worsen from use of caffeine and alcohol. Our whole-food plant-based dinners are often completely free of added fats or foods high in fat. Steamed veggies over rice, baked potatoes smothered in mashed beans with greens and fruit, etc. Have never noticed an improvement. On rare occasions when we eat a few pieces of pizza with a small amount of cheese (maybe once a year) with the rare glass of wine, I end up sleeping all night with no symptoms. And then I will have remissions that last for a month or more for no reason I can determine. Latest theory is that RLS is related to glutamate somehow. Of course, as in many unexplained symptoms, some people swear by placebos such as a soap bar under the sheets, copper bracelets, expensive supplements, smartphone apps, etc.,




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      1. Thanks Dar. Yes, I have friends who found magnesium helped. They don’t eat many veggies. I supplemented with magnesium for a while but found it did not help. I probably get plenty from diet.




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        1. hi bajatom, I sympathize with the rls.. I suffered for years, but finally found relief about 18 mos ago when I started to use about 200 mg magnesium glycinate powder every day.. sometimes twice a day. And I eat vegies and fruit all day too. At this juncture I am not sure if Jim’s point about low fat/no added oils didnt didnt have something to do wit it too. It was about that time I quit dairy foods and went wfpb. If I am swimming more than 90 I might get a foot cramp.. but rarely if ever anything at night. Other kinds of mag tabs did not work, though nightly foot soaks in mag salts doesnt hurt.




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            1. hi WFPBRunner, oh no, I just meant that the only thing that I ever get bothering me now are rare foot cramps from spending too much time swimming. I was plagued for years with this horrid nerve type of sensation that almost ‘tickled’ , that was tortuously non-stop . It would start in my feet and spread to my lower leg.
              One thing my physiotherapist recommended was foot exercises which I continue to do out of fear that the restless thing would return. Its the alternate foot pumping exercise, and then also turning the feet inwards to ‘face ‘ each other, then turning the feet outwards. 5 times each way, every day. Has helped a lot with all the hiking ans swimming I do. More stability and strength, very few cramps, zero restless leg.




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          1. Just used Cronometer.com to check my magnesium input. More than 150% of target, some 750mg. BTW, cramping is not one of the symptoms of RLS though people with RLS might also experience cramping for other reasons. The main symptom is creepy crawly tingling aching feeling in the legs and sometimes other body areas mostly in the evening upon sitting or sleeping with an urgent need to get up and move when this happens.




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            1. hi bajatom, yep, thats what I had.. that crawly feeling every night as I tried to go to sleep.. getting up and walking around helped while I was up , but it would just start again when I relaxed. The cramps were a separate issue.
              I have not tried cronometer, but it looks useful to me. I was tested for mag, cal, potassium etc at the doctor’s and all great, but I love the mag glycinate.
              I cant help wondering if Jim Felder’s thoughts on this arent right on the mark – certainly could be in my case. I hope it works for you bajatom, all the best in health




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        2. I am one of the less than 1% of American men who eats the recommended amount of veggies. I still got cramps from rigorous exercise. Overall electrolytes helped tremendously: magnesium, calcium, sodium, calcium, potassium. From whole plant foods.
          John S




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  6. Interesting for sure. Iron happens to be one of those items like Protein that people seem to worry about incessantly. Mostly because the elderly can have issues with these nutrients which causes their kids to worry about it for themselves and then the media picks up on it. Little do they realize the elderly have problems with all sorts of nutrients since their caloric intake tends to be dramatically low for their body mass.




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  7. In my LCHF/ paleo days, my ferritin levels were typically around 195. When I started donating blood, it came down to the 115-120 level. Now, as a vegan that donates twice a year, I am running in the 43-45 level. There is no doubt that the diet got my ferritin level down to an ideal level and it is not too low so I can still donate blood.




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    1. ghoff’s comment hits the nail on the head of the take home message for this video. The human body is designed to regulate iron levels in response to a plant-based whole food diet. Heme consumption (meat) was not a significant part of the primate 65M yr experience and therefore dietary heme iron is not well regulated. [By the way, we synthesize all the heme we need.]

      Regulation of Iron Uptake

      Dietary non-heme iron (inorganic iron from plants) enters the enterocytes that line the duodenal lumen via the divalent metal transporter 1 (DMT1). Dietary heme enters the enterocytes via what was first called heme carrier protein 1 (HCP1).
      Antioxid Redox Signal. 2008 Jun; 10(6): 997–1030.
      Why does an animal evolved to eat plants have a heme specific transport protein in cells lining the gut? Well, we don’t. Shortly after the discovery of HCP1 is was determined that this transport protein has a much higher affinity for folate and a better description of the protein was given to it, proton coupled folate transporter (PCFT).
      http://jpet.aspetjournals.org/content/322/2/469.long

      In response to iron deficiency DMT1 expression is markedly increased resulting in greater uptake of inorganic iron. However, iron deficiency does not affect PCFT or heme transport, and pathophysiological manifestations from mutations that inactivate PCFT are rectified by administration of folate and don’t require heme. This all makes sense to me based on our history of eating plants.

      The liver-derived peptide hepcidin also regulates iron uptake by suppressing iron release from intestinal enterocytes and other cells. In iron deficiency hepcidin levels are reduced and more iron enters the plasma.

      Iron Excretion

      Iron excretion is not actively regulated, but beyond bleeding it does occur as epithelial cells are lost from the skin and the lining of the gastrointestinal tract, which is rich in ferritin, the universal iron storage protein complex. Epithelial cells lining the human GI tract have a turnover of 3.5 day on average. So over time, iron levels can change because they are a balance between uptake and excretion.

      To summarize, eat plants and let your body regulate iron.




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  8. What about those of us who are female, vegan 15 plus years and an athlete? I need my ferritin to be above 67 for training and racing. I am in fact having trouble keeping my iron levels up. If they dip too low, then I’m tired all the time and I have horrible cramping during my menstral cycle. I’d love to have a more in depth conversation about this Dr Gregor.




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    1. Lindsey Hintz, yeah, both my wife and daughter have had the same issue. The combination of monthly blood loss and athletic training often causes more iron loss than a vegan diet can replace. Not only do athletes need more iron to maintain an increased blood volume, the pounding of feet with running tends to destroy red blood cells. Supplementing with 10 mg of iron per day prevents the light-headedness and tiredness my wife and daughter experience with low iron levels.




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      1. I have to take a 65 mg supplement and also get Iron IV a couple times per year. I just hope that for the long term it isn’t going to increase my risk for cancer every if I am Whole Foods plant based.




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    2. Dang ferritin of 60? I have never been able to get it that high or have I ever felt the need. I have always been happy with anything above 40. And I have never read any research suggesting above 60 necessary.




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      1. Above 60 is very helpful for reducing symptoms for many people with Restless Leg Syndrome. Sounds like it could be for very active athletes. At 80 years I am an active mountain climber and hiker everyday where I live in Baja Sur,Mexico. My neurologist wants me to keep serum ferritin above 75. It has helped reduce RLS symptoms markedly for me.




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      2. I think research by it’s nature tends to be reductionist, and the focus is too narrow to incorporate the big picture. Since there are so many variables, I wonder if it is even possible to come up with an average figure that covers everyone, besides the fact there are often unknowns that can dramatically affect the outcome. In my simple world I try to live a healthly lifestyle and play it by ear…if I have no symptoms, I don’t worry about it. I know that can get me into trouble, but worrying about it is way more stressful for me! lol




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        1. You mean reductionist if you take one research article. But if you take all nutrition studies together they give you the picture on how you should eat etc. right?




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      3. Well I’m training to hopefully make the Olympic Marathon Trials qualifying time so training is a part time job for me. I feel crappy when Ferritin is any lower than 67. I know it’s different for everyone. Some people feel great at 30, some 50.




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        1. I used this drink to get my wife’s iron levels up. Take two tablespoons of blackstrap molasses and heat it up in some water so it melts. Now add one teaspoon of amla powder (Dr. Gregor recommends one teaspoon of amla per day, high vitamin C content of amla helps you absorb more of the iron from the molasses. You can also squeeze some lemon in it. Shaking it up or stir it in 20 ounces or so of water. This can be used like a sports drink. You can add unsulphored dried apricots (trader joes has them) and have that soaking in the liquid overnight in a blender. Then in the morning, just blend it up. Talk about high iron, you got the molasses, the apricots, the vitamin C helping it all absorb.




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            1. Lindsey I had to laugh because at times I have taken 2-65 mg 3 times per day and was never able to get above 50. We all absorb different amounts. I would love to be able to take just 65 mg! And something interesting I have always been low. Even as a meat eater or running 50 miles per week. How you talked someone into an IV is interesting conversation.




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      1. Thanks so much for the kind thought. I’ll check it out for sure. I do WFPB Nutritional Counseling and have my Masters Degree in Holistic Nutrition, but I’m always looking for new and different recipes. I really appreciate all the positive and helpful comments by everyone. Be well!!




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    1. Yes there are some components of plants such as grains, beans, legumes and nuts and seeds that have compounds such as Lectin, phatic acid, and saponins to name a few. These compounds bind to vitamins and minerals to make them unavailable , is a form of defense mechanism so that pests, bugs don’t get them and allow the plant to grow and reproduce. But good news is that once cooked or sprouted the vitamin and minerals become available to us. Some individuals have difficulty digesting them and are sensetive and whatever that is not digesteted properly can become an issue for the immune system and the inflammatory response can be turned on. That is how I can interperate it. I shall look further to see if I can find a paper to send to you.




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      1. Hi Foroogh,

        Lectins are on a different playing field altogether to the other anti-nutrients in food (Phytates, Oxalates et. c).
        Saponins are also somewhat elevated, compared to the others, however the amounts consumed are generally low relative to Lectins (Unless of course your stable food is potatoes).

        All of the Lectins in food have not been identified or studied however the available science suggests that the Lectins in beans have the highest levels of toxicity to animals and that most, if not all, bean Lectins are significantly reduced after pre-soaking followed by pressure cooking. In some studies they breakdown entirely using this method.
        However this is not the case for sprouts.
        Soaking and four day sprouting increases the Lectin content of some beans in their raw state.

        http://europepmc.org/abstract/MED/26355953




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        1. Thanks for clarification of
          sprouting Lectin in bean rises.
          Hiwever, I was also mentioning that it get destroyed by cooking.
          The article you referenced is talking about phytohemagglutinin is that classified as Lectin?




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    2. Hi Todd,

      This is a massive and complex subject.

      All living things have Lectins and so they are in all ‘natural’ food sources e.g. dairy, fish, eggs, beans, legumes, grains, nuts, seeds, fruit and veges.
      A single food can have more than one Lectin type and they tend to function as aggregates of similar compounds i.e. isolectins.
      All of the types, found in food, have not been identified let alone studied in detail.
      Some might be beneficial, especially when isolated from food and used as medicines to target specific conditions.

      The main interest, nutritionally, is centred around the foods that contain high levels of toxic Lectins e.g. beans and dairy.
      The foods that are high in toxic Lectins are also the foods considered to be strong allergens to susceptible people.
      The toxicity of some Lectins, to animals, has been known for decades with a significant body of research starting to come in from around the 80’s.
      The research shows that toxicity, defined as ‘depressing the growth rate of laboratory mice’, is highly correlated to the Lectin content of the food.
      There is some reasonable science that looks at the inflammatory effects of Lectins but it isn’t limited to that.
      The science also tends to suggest it is a genetic susceptibility but more research is needed in all areas as there are no unequivocal answers at this stage.

      The Paleos (Loren Cordain) are the main prosecutors of the case against plant foods in general and Lectins in particular (of the compounds in plants that are claimed to be anti-nutrients Lectins are the most significant.

      At the non-scientific end of the spectrum we have people like Joseph Cohen (self-hacked dot com) who is an unqualified person who claims he is highly sensitive to Lectins and promotes a Lectin avoidance ‘elimination diet’.
      He gets around 100K visitors a month to his website.

      I do recommend elimination diets for complex nutritional/autoimmune issues.
      They range from the Paleo (AIP) at one end of the spectrum, to the McDougall (vegetarian, 100% cooked food) ‘diet for the desperate’ at the other.
      All elimination diets require tweaking to suit the individual and possibly supervision by a health professional for those with chronic health issues or who are on medication.

      I have posted a couple of references elsewhere in this forum (refer to NF/Gut Microbiome: Strike It Rich On Grains?)

      Do you have any specific questions?

      I can post the science if requested to do so.




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  9. I’m a little confused. I dragged out my last blood work for one year ago. Here is how it is listed in my lab result:
    IRON, TOTAL 126 45-160 mcg/dL
    When I converted mcg/dL to ng/mL using a converter:
    https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=convert+mcg/dl+to+ng/ml

    I got a result of 1260 ng/mL. Yet my lab results showed my result as “normal range”.

    So I’m clearly missing something here. Does one have to have a ferritin-only test? and how does that compare to an “Iron, Total” test which is what my lab results show. I’m guessing I’m not the only one confused by this. Anyone have some information that might help tease this out?
    Thanks!!




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      1. Well, I just had my blood work done and as I suspected, my intake of molasses has my iron level at 276 !! I’ve been a vegan for 17 years so I really think it must be the molasses that’s spiking my iron. No more molasses for me. This (molasses consumption) might be a good topic for Dr. G to expound on.




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  10. speaking of b-12 deficiency, spend the money and GET TESTED . I got tested and my b-12 was really low. It does bad things to you and it took the better part of a year for my mind to come back to normal.




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    1. David,

      Glad to hear of your return. Please note that you do not want to use the B-12 serum test but rather the MMA test to accurately know the level of B-12 in the tissues…… Dr. Alan Kadish moderator for Dr. Greger




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  11. So if donating blood reduces the risk of cancer does donating plasma increase it because it would temporarily increase iron concentration in the blood?




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      1. Dr. Alan, Thanks for the link to this abstract. I used to direct several blood banks and have often seen people have very low ferritins after double red cell donations as well as very low total proteins in our frequent plasma donors. This abstract is very surprising to me in light of that experience and I could not find any reference to a full study published beyond the abstract to be able to get more information regarding the paired samples. Do you have other references you know about? I’m not in this field anymore but after spending nearly 20 years working in blood banks it certainly piqued my curiosity! Thanks again, Ann Secord, MD NF Moderator




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    1. Dominik,

      If indeed you have the genetic expression of over absorption of iron, the short answer is not at this time.

      Please make certain that indeed this is the case vs. having an abnormally high intake or other factors, such as a medication/supplement influencing your iron levels.

      Dr. Alan Kadish moderator for Dr. Greger




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  12. Hi Dominik, I am one of the volunteer moderator at the site. The article below explains about the topic of your question and also the treatment. “Hemochromatosis is now a well-defined syndrome characterized by normal iron-driven erythropoiesis and the toxic accumulation of iron in parenchymal cells of liver, heart, and endocrine glands. It can be caused by mutations that affect any of the proteins that limit the entry of iron into the blood. Research in the 1930s showed that iron enters the human body exclusively through the small intestine (Table 1);4 once it enters, it has to be used or stored because there are no active physiological means for its removal apart from menstrual blood loss. Bloodletting (phlebotomy) is the standard treatment for all forms of hemochromatosis. It was first used in 1950 to eliminate excess iron in patients with hemochromatosis11 (Table 1). There are no evidence-based guidelines on the use of therapeutic phlebotomy. Systematic studies have never been conducted to determine when it should be started, how frequently it should be performed, or therapeutic end points. The goal of bloodletting during the iron-depletion stage is generally the induction of a mildly iron-deficient state. Weekly removal of 1 unit (400–500 mL) of blood (which contains approximately 200–250 mg of iron) can generally restore safe iron levels to blood (reflected by serum ferritin levels less than 20–50 μg/L and a TS of less than 30%) within 1 to 2 years. Maintenance therapy, which typically involves the removal of 2 to 4 units a year, is then started to keep serum ferritin levels between 50 and 100 μg/L, whereas iron deficiency with lower serum ferritin levels should be avoided because this may be associated with unnecessary symptoms or, paradoxically, lead to further hepcidin depression and increased iron absorption. Despite the nonspecificity of the test, serum ferritin levels should always be monitored during phlebotomy.The goal of bloodletting during the iron-depletion stage is generally the induction of a mildly iron-deficient state. Weekly removal of 1 unit (400–500 mL) of blood (which contains approximately 200–250 mg of iron) can generally restore safe iron levels to blood (reflected by serum ferritin levels less than 20–50 μg/L and a TS of less than 30%) within 1 to 2 years. Maintenance therapy, which typically involves the removal of 2 to 4 units a year, is then started to keep serum ferritin levels between 50 and 100 μg/L, whereas iron deficiency with lower serum ferritin levels should be avoided because this may be associated with unnecessary symptoms or, paradoxically, lead to further hepcidin depression and increased iron absorption. Despite the conspecificity of the test, serum ferritin levels should always be monitored during phlebotomy.”

    Hereditary Hemochromatosis: Pathogenesis, Diagnosis, and Treatment




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  13. What’s the difference between ferritin and serum iron? And because my crit’s is half low, 39%, hemoglobin also lower level, but ferritin more than 200?




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  14. Hi Sver, Thanks for your question. I am one of the volunteer moderators on the website. Ferritin isn’t the same thing as iron in your body. Instead, ferritin is a protein that stores iron, releasing it when your body needs it. Ferritin is stored in body cells, with very little actually circulating in your blood. According to the Mayo Medical Laboratories, ferritin contains 20 percent iron.
    I also found this artical that gives more information and explaination of different form of iron. I hope these are useful to you.
    Antioxidants Mediate Both Iron Homeostasis and Oxidative Stress




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  15. Hope this okay to ask here!

    Hi there! I asked a question in the Q&A video with Dr. G yesterday and he lost his internet connection mid answer and then lost his train of thought. :) I was very intrigued at his response as it was first time I have ever heard that kind of response. Question was: I am an endurance athlete. I have normal iron. Actually ALL of my blood work is normal except for my ferritin. My ferritin levels are decreasing and is below “normal” levels. My RBC is good though. Dr. G said something about we WANT low ferritin, something about it be pro-oxidavtive in the body and then he lost connection! Is there anyway to get the full answer please? I am very interested to hear this because like I said, it’s the first I have heard of it and it would easy my worries! Thanks and love you guys!




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  16. Hi Pam, Thanks for your question. I am one of the volunteer dietitians on the website. I think what Dr Greger was explaining as he points out in the below video about iron is that,
    “Iron may be a double-edged sword. “Iron deficiency causes anemia, whereas excessive iron [may increase] cancer risk, presumably by” acting as a pro-oxidant, generating free radicals. Iron-deficiency anemia is a serious problem in the developing world, but “[i]n meat-eating countries,…iron excess may be more of a problem than iron deficiency.” Body iron stores accumulate insidiously with aging, due to the fact that intake exceeds loss,” and our body has no good way of getting rid of excess iron. I hope that makes it clear for you.
    Donating Blood to Prevent Cancer?




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    1. Thanks. It actually muddles things more but I appreciate the fast reply!
      You say our body has no good way of getting rid of excess iron … but as an endurance athlete, I find that we tend of have varying levels of iron especially in the heat of heavy training loads and most athletes have low iron.
      And if “iron body stores accumulate insidiously with aging,” isn’t ferritin just iron stores within the body? As I am getting older, mine are decreasing. I’ve eaten a wfpbno diet for the last 23 years (I am 40, with two kids) … I guess I am just confused. I did hear Dr. Greger say we ‘want’ low ferritin before he was cut off. I just wish I could have heard the rest of his answer. :)




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  17. Pam,

    When it comes to ferritin levels we don’t want to be too low as it will have an impact on both your mental and physical state. Dr. Greger was discussing the accepted numbers… please read on.

    In the functional medical field the lower end of the spectrum, ~ 50-100 ng/ml is considered a safe and desirable level. Below 30 is clearly of concern and typically has some level of clinical manifestation, for the average individual.

    As a note the “accepted” normal range is 11 to 307 nanograms per milliliter in women, however you might find the piece by irondisorders.org of interest. They suggest a change to 50-150 ng/ml for adults…..much more in line with my clinical experiences.

    There are different findings in runners….especially endurance athletes. You might read the following: Clinical Journal of Sports Medicine back in the 90’s….still very applicable…

    Your situation should be evaluated based on your situation in toto, not just one isolated finding. If you’re continuing to drop the ferritin levels you should be seen and have a comprehensive evaluation. Have you changed your training levels or other factors such as having a change in GI function or……again with a continuing drop I would check into the underlying issues. Keep in mind you might see these changes secondary to your running schedule so don’t rely on a single reading and chart all factors.

    Dr. Alan Kadish moderator for Dr. Greger http://www.Centerofhealth.com




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  18. Phil

    Good question…. and it would depend on which cytokines were increased by the procedure.

    I was not able to find a definitive answer, however we might be able to extrapolate based on the study: https://www.ncbi.nlm.nih.gov/pubmed/8974712 . When they tested blood donors they found some changes in lowering some cytokines, and then there is the work of immunomodulation, post donation at: http://cvi.asm.org/content/6/5/652.full.

    The overriding effect of blood donation is transient and not long lasting in all the publications I reviewed.

    You might find this article of interest…https://joshmitteldorf.scienceblog.com/2017/01/23/first-fruits-of-research-with-young-blood-plasma/

    Dr. Alan Kadish moderator for Dr. Greger http://www.Centerofhealth.com




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  19. I’m not sure what to do about low ferritin levels. My ferritin was measured at 24, which my doctor had explained indicates probable iron deficiency, even though the rest of my blood work (e.g. hemoglobin and hematocrit) was fine. I took 150 mg of iron supplement per day for three months on her recommendation. After three months, my blood was tested and ferritin dropped to 22. No improvement from the iron pills! As a fairly new vegan woman (6months), should I continue to supplement? I should mention that I feel more or less fine. My hair may be thinning a bit and I’m a little tired from time to time, but thought this was part of normal aging/living. Any thoughts appreciated!




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  20. Hi there! I have a question about leukemia. A friend of mine has been diagnosed with leukemia at the age of 22. He’s been eating processed foods, cheap meat, cheese, dairy products, etc. his whole life and i can’t convince him to change his habbits… I was wondering if anybody knows a study which shows whether switching to a plant-based diet can reverse leukemia?




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  21. Hi I’m a RN and health support volunteer with nutritionfacts.org. I’m sorry to hear about what your friend is going through. It is hard to make people believe that cancer can be a diet related illness. It’s really hard to watch someone put unhealthy foods into their body when you know what it can do. Please wish your friend all the best from us here at nutritionfacts.org.
    Many cancers including leukemia have been linked to poor diet. I thought you might like this article from Dr. McDougall (mentor and colleague of Dr. Greger’s) about the viruses in meat being linked to leukemia which states “Nationwide and worldwide, leukemia is more common in higher dairy- and beef consuming populations.” https://www.drmcdougall.com/misc/2004nl/040200pubovine.htm

    Here are a few things Dr. Greger has done on leukemia:
    https://nutritionfacts.org/topics/leukemia/
    https://nutritionfacts.org/video/hot-dogs-leukemia/

    Most of these are more about prevention of leukemia. I’m not sure if any randomized studies have been done to see if diet alone can reverse leukemia. But if a healthy diet can prevent leukemia, it stands to reason that it would give you a much better chance at surviving it in conjunction with medical treatment. I did find one study on pubmed.gov about diet and leukemia.
    https://www.ncbi.nlm.nih.gov/pubmed/26071869

    Dr. Greger has a lot of videos on cancer in general you might like:
    https://nutritionfacts.org/video/how-not-to-die-from-cancer/

    All the best to you and your friend
    NurseKelly




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