Flashback Friday: How to Reduce Your TMAO Levels

Flashback Friday: How to Reduce Your TMAO Levels
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Should we be concerned about high-choline plant foods, such as broccoli, producing the same toxic TMAO that results from eating high-choline animal foods, such as eggs?

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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.

Choline and carnitine-rich foods—meat, eggs, and dairy—can be converted by gut flora into trimethylamine, which can then be turned into TMAO in our liver—a toxic compound which may increase our risk of heart failure, kidney failure, and atherosclerosis (heart attacks and strokes). The good news is, though, that this “opens up exciting new nutritional and interventional prospects” for prevention.

Okay, so how are we going to do it? If our gut bacteria can take meat, dairy, and eggs and turn them into TMAO, all we have to do is destroy our gut flora. We could give people “antibiotics to eliminate the production of” TMAO. However, that could also kill our good bacteria, and “facilitate the emergence of antibiotic-resistant…strains.”

Hmm. How about probiotic supplements? Maybe if we add good bacteria, it will crowd out the ones that take the meat, egg, and dairy compounds, and turn them into TMA, which our liver turns into TMAO. But, it doesn’t work. Adding good bacteria doesn’t seem to get rid of the bad.

What if we added a new bacteria that could somehow siphon off the TMA made by the bad bacteria? Well, there’s a bacteria inside the guts of cows and sheep that turns trimethylamine into methane. So, maybe we could use the bacteria to get rid of some of it from our gut, like a cow fecal transplant. The problem is, if it didn’t take, you’d have to keep giving it to people. So, maybe the fact that Consumer Reports found “fecal contamination” in every sample of beef they tested may be a good thing! No. Methane-producing bacteria may be able to eat up our TMAO, but unfortunately, these bacteria may be associated with a variety of diseases, from gum disease down to colorectal cancer.

So, if antibiotics and probiotics aren’t going to work to prevent gut bacteria from taking meat, dairy, and eggs, and turning them into the trimethylamine which our liver makes TMAO out of, I guess we have no choice but to cut down on—our liver function!

That was the billion-dollar answer to cholesterol. These same foods raise our cholesterol, but dietary change isn’t very profitable. So, the drug industry came up with statin drugs that cripple the liver enzyme that makes cholesterol. So, hey, “pharmacologic inhibition of” the enzymes in our liver that make TMAO could “potentially serve as a therapy for [cardiovascular disease] risk reduction.” But, there’s a genetic condition in which this enzyme is naturally impaired, called trimethylaminuria, in which there is a buildup of trimethylamine in the bloodstream. The problem with that is that trimethylamine is so stinky, it makes you smell “like dead fish.” So, “given the known adverse effects…from sufferers of [this] fish odor syndrome, the untoward odorous side effects…make it a less attractive [drug] target.” So, do we have to choose between smelling like dead fish, or suffering from heart and kidney disease?

If only there was some other way we could somehow stop this process from happening. Well, what do those with trimethylaminuria often do to cut down trimethylamine levels? They stop eating animal products.

About a third of those who complain of really bad BO, despite good personal hygiene, test positive for the condition, but reducing or eliminating meat, egg, and dairy intake can be a real lifesaver. But, given what we now know about how toxic the end product TMAO can be for normal people, cutting down on animal products may not just save the social lives of people with a rare genetic disorder, but help save everyone else’s actual lives.

“The simplest point of intervention is to [just] limit [the] consumption of” foods rich in choline and L-carnitine, which can be an effective strategy to limit circulating TMAO. But, wait, we could always try to genetically engineer a bacteria that eats up trimethylamine, but the simplest, safest recommendation may just be to eat healthier. You can completely eliminate carnitine from the diet, since our body makes all we need. But choline is an essential nutrient. So, we need some, and we can get all we need in fruits, vegetables, beans, and nuts. “However, excess choline, such as that found in eggs, may be worth avoiding.”

Need we worry about high-choline plant foods, like broccoli? Cruciferous vegetable consumption is associated with a significantly longer life: less cardiovascular disease mortality. To see what was going on, researchers took the vegetable highest in choline, Brussels sprouts, and had people eat two cups a day for three weeks, and their TMAO levels actually went down. It turns out that Brussels sprouts appear to downregulate that TMAO liver enzyme naturally—not enough to make you stinky, but just enough to drop TMAO.

And, people who eat completely plant-based may not make any TMAO at all—even if you try. You can give a vegan a steak, which contains choline and carnitine, and not even a bump in TMAO, since vegetarians and vegans have different gut microbial communities. If we don’t eat steak, then we don’t foster the growth of steak-eating bacteria in our gut. So, hey, forget the cow—how about getting a fecal transplant from a vegan? From a TMAO standpoint, maybe we don’t have to eat like a vegan, as long as we poop like one.

Please consider volunteering to help out on the site.

Image credit: Sally Plank via Flickr. Image has been modified.

Motion graphics by Avocado Video

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.

Choline and carnitine-rich foods—meat, eggs, and dairy—can be converted by gut flora into trimethylamine, which can then be turned into TMAO in our liver—a toxic compound which may increase our risk of heart failure, kidney failure, and atherosclerosis (heart attacks and strokes). The good news is, though, that this “opens up exciting new nutritional and interventional prospects” for prevention.

Okay, so how are we going to do it? If our gut bacteria can take meat, dairy, and eggs and turn them into TMAO, all we have to do is destroy our gut flora. We could give people “antibiotics to eliminate the production of” TMAO. However, that could also kill our good bacteria, and “facilitate the emergence of antibiotic-resistant…strains.”

Hmm. How about probiotic supplements? Maybe if we add good bacteria, it will crowd out the ones that take the meat, egg, and dairy compounds, and turn them into TMA, which our liver turns into TMAO. But, it doesn’t work. Adding good bacteria doesn’t seem to get rid of the bad.

What if we added a new bacteria that could somehow siphon off the TMA made by the bad bacteria? Well, there’s a bacteria inside the guts of cows and sheep that turns trimethylamine into methane. So, maybe we could use the bacteria to get rid of some of it from our gut, like a cow fecal transplant. The problem is, if it didn’t take, you’d have to keep giving it to people. So, maybe the fact that Consumer Reports found “fecal contamination” in every sample of beef they tested may be a good thing! No. Methane-producing bacteria may be able to eat up our TMAO, but unfortunately, these bacteria may be associated with a variety of diseases, from gum disease down to colorectal cancer.

So, if antibiotics and probiotics aren’t going to work to prevent gut bacteria from taking meat, dairy, and eggs, and turning them into the trimethylamine which our liver makes TMAO out of, I guess we have no choice but to cut down on—our liver function!

That was the billion-dollar answer to cholesterol. These same foods raise our cholesterol, but dietary change isn’t very profitable. So, the drug industry came up with statin drugs that cripple the liver enzyme that makes cholesterol. So, hey, “pharmacologic inhibition of” the enzymes in our liver that make TMAO could “potentially serve as a therapy for [cardiovascular disease] risk reduction.” But, there’s a genetic condition in which this enzyme is naturally impaired, called trimethylaminuria, in which there is a buildup of trimethylamine in the bloodstream. The problem with that is that trimethylamine is so stinky, it makes you smell “like dead fish.” So, “given the known adverse effects…from sufferers of [this] fish odor syndrome, the untoward odorous side effects…make it a less attractive [drug] target.” So, do we have to choose between smelling like dead fish, or suffering from heart and kidney disease?

If only there was some other way we could somehow stop this process from happening. Well, what do those with trimethylaminuria often do to cut down trimethylamine levels? They stop eating animal products.

About a third of those who complain of really bad BO, despite good personal hygiene, test positive for the condition, but reducing or eliminating meat, egg, and dairy intake can be a real lifesaver. But, given what we now know about how toxic the end product TMAO can be for normal people, cutting down on animal products may not just save the social lives of people with a rare genetic disorder, but help save everyone else’s actual lives.

“The simplest point of intervention is to [just] limit [the] consumption of” foods rich in choline and L-carnitine, which can be an effective strategy to limit circulating TMAO. But, wait, we could always try to genetically engineer a bacteria that eats up trimethylamine, but the simplest, safest recommendation may just be to eat healthier. You can completely eliminate carnitine from the diet, since our body makes all we need. But choline is an essential nutrient. So, we need some, and we can get all we need in fruits, vegetables, beans, and nuts. “However, excess choline, such as that found in eggs, may be worth avoiding.”

Need we worry about high-choline plant foods, like broccoli? Cruciferous vegetable consumption is associated with a significantly longer life: less cardiovascular disease mortality. To see what was going on, researchers took the vegetable highest in choline, Brussels sprouts, and had people eat two cups a day for three weeks, and their TMAO levels actually went down. It turns out that Brussels sprouts appear to downregulate that TMAO liver enzyme naturally—not enough to make you stinky, but just enough to drop TMAO.

And, people who eat completely plant-based may not make any TMAO at all—even if you try. You can give a vegan a steak, which contains choline and carnitine, and not even a bump in TMAO, since vegetarians and vegans have different gut microbial communities. If we don’t eat steak, then we don’t foster the growth of steak-eating bacteria in our gut. So, hey, forget the cow—how about getting a fecal transplant from a vegan? From a TMAO standpoint, maybe we don’t have to eat like a vegan, as long as we poop like one.

Please consider volunteering to help out on the site.

Image credit: Sally Plank via Flickr. Image has been modified.

Motion graphics by Avocado Video

Doctor's Note

Can you hear the frustration in my voice as I read paper after paper proposing those ridiculous (but profitable!) answers when the safe, simple, side-effect-free solution was staring them in the face the whole time? Makes me think of so many parallels, not the least of which are:

For more on TMAO, the “smoking gun” of diet-microbiome-disease interactions, see:

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

72 responses to “Flashback Friday: How to Reduce Your TMAO Levels

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  1. I liked the slower speech on this video, and the prominence of the papers, quotes, and illustrations. Much easier for me to follow.

    1. Yes, and the humor makes it fun too, like the sound effects (screeching tires).

      These videos contain extraordinarily valuable information… if only the global population would just take it to heart.
      NF.org is an amazing public health service.

    2. @Dr. J — in case you were not aware of it when watching any youtube content like all the nf.org videos you can click the little gear icon in bottom right hand corner to access settings like playback speed and in case of fast talkers change it from Normal to 0.75, 0.50, 0.25 to make it easier to follow a firehose of information by speaker.

  2. Hello,

    Thank you for this presentation. However, I skipped way ahead to the last couple of minutes. Why? I grew weary of the disparaging recitation of past research even with its many biases. To cut to the chase: Brussels sprouts are better than steak. Vegan gut flora is way better than gut environments of diary and meat-eaters.

    1. H. K. Swearingen,

      The past research provides context, and alternative hypotheses and approaches that were considered but apparently don’t work or prove practical. They strengthen the conclusion that eating whole plants is more effective and simpler and easier. It also answers questions that viewers might otherwise have, such as: “Why can’t I just kill those bacteria that make TMAO?” Or “Why can’t I just take a pill with the bacteria I want?” And still eat my meat, eggs, and dairy.

  3. Smelling like dead fish. There’s an interesting smell. I live by myself, so I do not have to worry about what I smell like to others. I have had a few occasions sitting by women who told me I stink. I wonder if their sense of acute smell is due to a woman’s ability to smell better or if there is something else implied. But, hey, I’m a guy and I don’t lose sleep over it.

    1. Dan C, I’ve had just the opposite reaction. Since going WPF 5 years ago, and dropping all meat, eggs, fish, and dairy products, people tell me I smell better! My skin is also less oily after dropping all foods with added salt, oil, and sugar.

      1. Darwin Galt,
        I did not mean to imply that I think I smell bad. In fact, I’m willing to sell my vegan poop transfers to anyone with a TMAO problem, for $5 each. I would not get rich but I would be doing the world some good. (music) I would like to give the world a poop transfer so everyone could live in perfect harmony. Dr. Greger has done a video on the subject, I think related to bowel diseases. Some treatments work. Dr. Greger has also done a video on eating your own poop to get B-12. It works!

  4. I’m a whole plant vegan, but I also take a statin drug, because of cardio isues. My doctor knows very little about the cardiovascular benefits of veganism, so I’m going with it on my own research. I am also on a blood thinner and a couple more meds for blood pressure. I figure veganism is smart, but so is my doctor, should I do both approaches at the same time? Mostly, I’m concerned I am hurting my liver with the statin drug.

    1. John Daskalakis, I eat a whole food plant based diet and find that it adds greatly to the benefits I get by taking the recommended medications. This plant based doc has written a book which you may find interesting. https://www.forksoverknives.com/success-stories/heather-shenkman-vegan-cardiologist/#gs.4xtxvj

      So have doctors Esselstyn and Ornish. Their patients take prescription medication when required and follow the wfpb eating plans. Medications are not meant to be taken in lieu of good nutrition.

      I follow Dr Greger’s Daily Dozen, exercise a lot, keep my weight down, don’t drink or smoke, and take my medications. Regular lab testing of liver enzymes is something my doctor does to keep track of any possible changes. It’s working. It isn’t an either or situation …medications, nutrition, exercise, meditation, relaxation all add up to substantial benefits.

      1. * Just to clarify, I am talking about wfpb eating, not veganism. Whole foods. A vegan diet can technically include processed junk foods too so just wanted to stress that it’s whole unprocessed foods we are talking about.

        Also, be sure to consult with your doctor to keep him informed about your dietary changes. Some medications may be affected by diet – blood thinners are just one example. Your doctor might suggest testing more frequently, or altering dosages of some meds.

      2. John, just for background, I do nutrition, exercise, counseling for patients with chronic disease.
        You don’t say how old you are, or if you are having muscle pain, energy dysfunction, or cognitive issues with the statins.
        Studies find that for patients with side effects, CoQ10 supplementation helps as statin drugs block, or lower the body’s production.
        Note that adding CoQ10 to diets of healthy young athletes did not improve function, but it significantly helped those older adults with symptoms.
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096178/

        This study used only 50 mg, not the usual dose which is 100mg. taken with a meal twice a day.
        In spite of this, even only 50mg. improved outcomes.
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226312/

        I find the the gel form type works best. I do check with Consumer Labs fo testing on brands.

    2. John J Daskakalakis,

      Congratulations on your eating habits!!

      I am not a medical doctor, but I would say: continue with how you’re eating, making it as healthy as possible (this website is an excellent resource, as are others, such as https://www.forksoverknives.com/ and https://www.pcrm.org/ ) and continue to work with your doctor.

      As I’ve posted here before, my brother had a heart attack at age 66 — even though he was a vegetarian. (He told me that he probably liked cheese too much.) He was on several meds, including for high BP, high cholesterol, and T2 diabetes. That was his wake-up call, I guess; he saw a billboard advertising a lifestyle medicine course (https://chiphealth.com/) which he took; it included learning what to eat (whole plant foods, low to no added oil, salt, and sugar) and how to shop for and cook his meals. He eventually lost about 70 lbs, and went off all his meds except one (high BP, for which he is now on the lowest dose, and hoping to get off). He also increased his exercise levels (the course also included very low rate introductory physical fitness center membership rates).

      Oh, and he did say that he switched to a cardiologist and/or PCP who was supportive of whole plant food eating. But that’s probably not necessary; my husband and I both now eat whole plant foods (we switched several years ago from eating vegetarian), and our doctors tell us to continue doing whatever we’re doing.

      Some meds you may need, and some you may not. And some you may need less of. Good health to you!

    3. Hi John, how long have you been on a whole-plant diet?

      It sounds as if your treating your symtoms (drugs) and making sure you prevent the root causes of cardio issues (diet). A whole-plant diet lowers LDL over time and can only help. For example, a whole-plant diet protects the liver from additional damage, a recent study in the the ADA journal explains. “Saturated Fat Is More Metabolically Harmful for the Human Liver Than Unsaturated Fat or Simple Sugars”
      https://care.diabetesjournals.org/content/41/8/1732

      If your cholesterol (LDL) goes down to healthy levels, I’d discuss an off-the-drugs test run with your doctor where you monitor blood levels over time. Even if your doc doesn’t know much about nutrition, a quick PupMed search will assure him of the preventative properties of your diet.

      Incidentally, raw garlic is the healthiest and most effective blood thinner there is. The smell is tricky but I ask you to compare this to the side effects of your current drug.

      Afterthought: When somebody is suffocating or drowning, we don’t call it a disease and distinguish between treatment and prevention, they are one and the same. Too much water or too little oxygen. A broken bone we fix so that it can heal, we don’t just apply antibiotics to the wound. When symptoms and pains are less severe and immediate, we are more tempted to treat the symtoms rather than the cause. Cardio issues and diabetes are such “diseases”. But they too come down to too much saturated fats and complex proteins and too little fruits and veggies.

    4. I’m glad you found a doctor you have confidence in (even if he hasn’t yet adopted a WFPB approach!) and I’m also glad you are eating the healthiest diet you can. For many they may still need a small amount of statin and if that’s true in your case, don’t stress about it. Monitor any side effects (but don’t look for them, either!) and communicate with your doctor about symptoms, while reviewing your cholesterol results regularly in case the combination of good diet and medication brings your you level down to where your doctor might feel comfortable lowering dose. Sometimes a gradual reduction works but with your doctor’s acknowledgement. Best of health to you.

  5. Dr. Greger says that vegans get enough choline in their diet. But if the adequate intake level is 550 mg for men and 450 for woman, I don’t see how vegans can get enough choline. Look at table 2 in the NIH fact sheet. https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/ . It is hard to see how a vegan could construct a diet yielding 550 mg or even 450 mg of choline based on this list. Here is a link where a health care professional tried to create a one-day menu focused on maximizing choline. The menu yielded 255 mg choline with consumption of 2452 calories. https://sharonpalmer.com/getting-choline-on-a-vegetarian-or-vegan-diet/ . So is the NIH wrong? Or do vegans need a choline supplement?

    1. MarcGary, yes, you have to work at it. Chickpeas, lentils, soy milk, and cruciferous veggies broccoli, brussel sprouts contain fairly high amounts.

    2. MarcGary,

      From a linked reference in the article that spring03 linked to:

      “Instead of animal products, choose fruits, vegetables, grains, and beans, which are plentiful in choline. The National Institutes of Health states that certain vegetables and beans are a “rich source” of choline, with grains, nuts, and seeds being reliable sources in general. In fact, soybeans have more choline than beef and chicken, and potatoes and most beans have more than dairy products or even tuna.”. https://www.pcrm.org/news/blog/clearing-choline-confusion

      This link contains a chart of plant food sources and the amounts of choline they contain. And, it’s short!!

      1. Dr J, here are a couple of other links you might find interesting. At the database, the quantity of food is set at 100mg. Click on a particular food to check on amount of choline in different servings of food. The veganhealth article is good info. I don’t eat soy products, potatoes, peanuts, etc. and I try to eat broccoli or a bit of cruciferous daily but dont always succeed.

        https://veganhealth.org/choline/

        https://nutritiondata.self.com/foods-016144000000000000000-w.html?maxCount=36

        1. Hi Barb,

          Thanks for the links; I’ve bookmarked them.

          I liked this paragraph from the first article:

          “The recommendation for choline is specified as an Adequate Intake (AI) which means that there is too little information to establish an RDA. The AI for choline is 550 mg/day for men and 425 mg/day for women but these numbers are based on very limited data. They are derived from a 1991 study at the University of North Carolina at Chapel Hill (5). When subjects consumed 50 mg or less of choline per day, they experienced markers of deficiency such as increased liver enzymes, a fatty liver, or elevated creatine phosphokinase (CPK) which indicates muscle deterioration. The deficiency symptoms resolved when the subjects were given supplements providing 500 mg of choline per day. The study didn’t look at the effects of choline intakes between 50 and 500 mg.” [there are other studies discussed briefly; the conclusion in the first sentence is still true.]

          I don’t worry too much about any particular nutrient, but try to eat a broad and varied diet, using Dr. Greger’ Daily Dozen as guidelines. I rarely hit all 24, but usually manage about 20-22 each day — and of course, I have more of some types of food, and less of others, which vary from day to day. I figure that it might balance out over a few days.

          1. Yep Dr J I think you picked up on the very point that caught Fumbles eye some time ago. Maybe we have no actual need for 450 or 500 mg. I haven’t read the studies he mentions later in the article but it would seem there are no issues found in 300mg . I try to vary things throughout the week too.

            1. I think that there is some indication from animal studies that choline activation efficiency may be higher in those on low choline diets, which may affect outcomes.
              https://www.researchgate.net/publication/285575811_Progressive_Changes_in_the_Plasma_Metabolome_during_Malnutrition_in_Juvenile_Pigs

              The levels of folate, betaine and iron in the background diet may also affect the need for dietary choline. Possibly, the liver’s production of choline may also increase when dietary intake is low but again there appear to be no human studies on this.

              It’s also worth noting some of the very low levels of certain vitamins and minerals (including B12) in the traditional Okinawan and traditional Japanese diets, which clearly didn’t prevent them from having the longest life expectancies in the world at the time.. There was no apparent excess of cardiovascular or neurological diseases.either. While choline and taurine intake wasn’t measured, it was presumably quite low given the foods reportedly consumed.
              https://www.researchgate.net/publication/5859391_Caloric_Restriction_the_Traditional_Okinawan_Diet_and_Healthy_Aging_The_Diet_of_the_World's_Longest-Lived_People_and_Its_Potential_Impact_on_Morbidity_and_Life_Span

              It may be that requirements for certain nutrients differ depending on the background diet. Most studies on this appear to conducted on people eating high fat, high protein, high sugar, low fibre Western diets. People on traditional WFPB diets may possibly have lower requirements. They certainly don’t seem to have higher mortality, CVD or dementia rates than average.

              1. Mr Fumblefingers,

                Thanks for pointing out that diet matters. I usually ask, when I read nutrition studies: But what were the study subjects eating?

                That’s one reason I take most nutrition research studies with a grain of salt — figuratively speaking. As just one example, blueberries may have pronounced effects on study subjects eating SAD — Standard American Diet. But how much of an effect would they have above and beyond what is observed in study subjects eating a variety of healthy whole plant foods?

                As another, Dr. Greger has pointed out that the effect of zinc supplements on the duration of colds (and maybe getting one in the first place?) may make a difference if a diet is deficient in zinc, but not if no zinc deficiency exists.

                It’s complicated. That’s why I like the general conclusion: Eat whole plant foods. Using the Daily Dozen as guidelines. It’s so much easier to remember. And to implement.

  6. Sorry, I didn’t know where else/how to post a general comment. I’ve purchased and read “How Not to Die” and the related cookbook, terrific materials which are helping my wife and I in moving to whole-food, plant-based eating with all the benefits. My question is, is there anywhere on this site where updates to the book can readily be identified (as the book was copyrighted/released in 2015 and thus no longer fully current)? I realize the general concepts are surely still accurate/relevant, but there are likely certain specifics that are no longer fully valid with new data/research. For example, if new research suggests that a particular recommended food has been deemed to have adverse health issues, not previously recognized or discussed in the book, rather than trying to learn of the change by watching the many new videos regularly released on this site, is there a place where such updates to information in How Not to Die can be seen? If you prefer to email me directly on this please feel free, or perhaps you want to add this to an FAQ for all to see. Thank you very much, and hope everyone is staying safe/healthy! Steve

    1. I think this is an excellent question. Too bad I do not have an answer because I am curious myself. I hope someone let’s us know or perhaps this will set up an initiative to begin such a capability on the website.

      I often wonder similar things with You Tube videos. When a person claims that something worked well for them at the time of producing the video, how is it working a few months or years later.

  7. John,
    Serious liver problems from statin drugs are actually quite rare. If you have had a cardiac event such as a heart attack or required a stent, you should be on a statin. However, lifestyle is an important part of the treatment for heart disease. Diet and exercise are extremely important, as is control of life stress and maintenance of a good social support system. I would point you to Dr. Dean Ornish’s most recent book for more information about a comprehensive approach to heart disease prevention and treatment. Rick Roll has an excellent interview with Dean and his wife Anne on YouTube, if you want to check that out first.

  8. For all of those who provided links on obtaining sufficient choline on a vegan, diet, thank you. I will start eating roasted soy beans and wheat germ. I will try to consume more soy milk. But after reading the links, I don’t believe 1 in 1,000 vegans are satisfying NIH’s adequate intake level of choline. If I ate everything on the NIH list every day, I would barely meet the 550 mg/day adequate intake level. Of course consuming the entire list every day is unrealistic. At https://veganhealth.org/choline/ –thank you Barb–the authors make an heroic effort to design a one-day, 2000-calorie menu that meets the target, but they fall short. And, the menu is fruit-deficient. There does not seem to be much research on the adequate intake level, so I am hoping the NIH is wrong.

    In looking into this more I came across a BBC article that said vegans are short of several nutrients that our brains need: choline, creatine, carnosine and taurine. One medical professional said all vegans should all be taking taurine supplements, for instance. https://www.bbc.com/future/article/20200127-how-a-vegan-diet-could-affect-your-intelligence . To be fair, I also came across a rebuttal article . https://www.plantbasednews.org/opinion/bbc-article-bashing-veganism-inaccurate-biased-sensationalist .

  9. This is an off-topic post.

    The BMJ recently published an interesting piece on covid 19 and response measures in the UK. This in particular caught my eye

    ‘ Opportunity costs will also include mortality and morbidity from conditions other than covid-19 because of reduced use of health services and delays in treatment of other illnesses arising from the NHS prioritising resources on covid-19. Some indication of these from the Office for National Statistic’s regular monitoring suggests that for the week ending 3 April for England and Wales, there were 3475 deaths from covid-19 but 6082 more deaths from all causes compared with the five year average for this week.10 It remains to be seen how many of the “excess” non-covid deaths could be the result of covid-19 interventions and changes in the public’s healthcare seeking behaviour.’
    https://www.bmj.com/content/369/bmj.m1496?

    This of course raises the question of whether draconian responses to covid 19 might result in greater total mortality rather than less – at least in societies like the UK with older (and presumably therefore sicker) populations. The author also touches upon the effects of the economic damage caused by responses to the covid 19 threat.

    1. Mr. Fumblefingers,

      I think I’ve read that a decrease in deaths due to decreased air pollution is estimated to be greater than the increase in deaths due to the virus.

      That said, I wonder how much effect simple measures alone have, such as covering coughs and sneezes — but never in your hands!! With a tissue or in your sleeves, washing hands thoroughly and frequently, and not touching your face. And how much more benefit social distancing and wearing masks in public places have.

      A vaccine looks to be very far off. And it’s always a matter of balancing the benefits vs the risks.

      1. Dr. J.,

        Yes, places where people have masks and where they weren’t taking masks away from the doctors did do better.

        But people have been taught simple measures their whole lives and yet NY has almost a quarter of a million cases.

        And NJ has over 100,000 and MA has over 50,000

        Apparently, the heartland has started having an increase in cases. It took longer to get there and they may have few enough deaths at the end that it will be a risk / benefit ratio.

        But we already have had nurses refusing to work and doctors crying and medical people dying.

        The purpose of shutting down was to prevent the medical establishment from being overwhelmed.

        I don’t know if we would have had the ability to not get angry if people were laying on the street in NY city.

        People got outraged at how bodies of people at nursing homes were treated, but if we hadn’t done this process, we would have had probably closer to 2 million deaths is what the models were estimating.

        I am not sure that we had the inner strength to just accept that outcome and understand that would have been our choice.

      2. I did buy some Silvertize gloves today.

        They have same-day shipping.

        The concept that I know that I touch my face all day like other people do, either I had to buy a gadget to help me stop touching my face or I had to buy something better than applying hand sanitizer all day long.

        The gloves kill viruses in as little as 1 minute. The longest the material took to kill something was 8 minutes.

        I guess I am going to be putting them on once every hour for a few minutes and then taking them off and maybe use them for shopping and under my gloves in the Winter.

        They said that wounds heal faster with it so I figure that I can use them whenever I get a cut.

        Or if I ever get nail fungus, which has never happened, but it says it helps.

        Anyway, I bought a pair for my car and a pair for my desk at work and a pair for home because they are going to be with me for the rest of my life.

        1. I watched Fauci say that he washed his hands 50 times a day or something like that.

          Not going to happen.

          I have enough things like UVC lamps and cabinets and steam cleaners, and I have hand sanitizer at work but it dries out my skin.

          I know that I wipe my eyes all day long and that I blot my nose even with tissues all day long because I have allergies. Plus, I eat with my hands because I eat things like fruit.

          So I guess using them before breakfast, lunch, dinner, and driving and shopping maybe would be enough.

    2. Tom,

      That is interesting.

      They had more deaths compared to a 5-year average versus what had been said about China having fewer deaths.

      Postponed medical care versus fewer accidents and less air pollution.

    3. Tom,

      Does the logic follow that if we had not stopped it those ratios would be the same?

      My friend just texted me that COVID-19 was spread to 9 people from 1 person in a restaurant through the air conditioning.

      If we had just let it go, I would think the models were more like millions of people dying.

      Do they do it from that direction, too?

      1. Tom,

        Maybe you are smarter at math than I am?

        So right now, at this level of COVID-19 spread, other deaths went up that amount.

        So I can go back to the R-naught being higher and having COVID-19 deaths rise exponentially for longer.

        Does that number suddenly overwhelm the extra “other cause” deaths?

        The perspective videos that I watched, shutting down lowered the rates by so much that I don’t even think it is close.

        1. Here are a few of the perspective videos again:

          https://www.youtube.com/watch?v=gxAaO2rsdIs&t=53s

          https://www.youtube.com/watch?v=sz1bGzYdRdk

          https://www.youtube.com/watch?v=LnQcbAKWkPE

          I put this one because about 5 minutes in he did the old version of COVID deaths per day versus things like car crashes and cancer and strokes, etc.

          Since COVID causes strokes, you can’t give all of the strokes to a separate category, but some smarty pants probably could figure out how many average strokes there were and how to find out how many there are for COVID-19 patients and subtract the COVID-19 strokes to make sure all is fair.

          https://www.youtube.com/watch?v=6dDD2tHWWnU

          1. Tom,

            The part that I am looking at is that this is a question of who we value and who we trust.

            We do not value animals or the earth.

            We would have valued our own lives and the lives of young people if this had hit the young more – that is why the protests didn’t come right away.

            We do somewhat as a wider culture value medical people emotionally anyway. Not necessarily when it hits our pocketbooks.

            They are on the continuum.

            Today, a black person said that wanting to open society is because we do not value the Black and Latino communities

            And, obviously, we can find all sorts of ways to justify letting the elderly and prisoners and people in institutions die.

            I go back to the movie and the real-life incident where the Greenpeace lady got everybody to care about the whales. She even got the people who hunt whales for a living to care about specific whales. She got rivaling countries and rivaling parties to care about specific whales. She got people to risk their lives and ruin their ships for whales when they let people die all the time and kill animals all of the time.

            Psychologically, it is interesting to me that we convinced people to stay home and not be money-oriented for as long as we have.

            Culturally, in the USA, there have been times in history where people didn’t even care when the Black community was enslaved, beaten and murdered or when they went to prison and lived in poverty at such high levels.

            I am not trying to stir things up, I am just wondering where the line of “care” versus “won’t care” will be.

            My friend’s son has a lot of co-morbidities and he is in an institution where people on his floor, in close proximity to him have tested positive.

            His mother cares and desperately doesn’t want him to die, but I already know that he has mental illness and it would be so hard to get society to do what it did back with the whales if it were just that floor in that mental hospital.

            My other friend has a 92-year old mother in a nursing home and every nursing home has cases. I already know that she is the type of elderly person that people would be so charmed that they would rally to have her live.

            I watched PBS today and I was thinking about how arbitrary “caring enough” really is.

            1. And I didn’t mean that to sound manipulative.

              Way back when I debated with Scott about women’s pay as an issue being a “professional” issue versus something that affects the poorest women and I said the truth, males die earlier and males are homeless more and males are prisoners more often and males drop out of school more and males kill themselves more and males have so many vulnerabilities, but we get “compassioned out” and because we used to have women being prostitutes to feed their children and women not having jobs, we never let the males back in when the women started graduating high school and going on to college more often. The thing is males are dying won’t be something there is ever a movement for. And that is wider society.

              Medicine may never study women’s issues is a way where women are neglected.

              We just don’t have enough room to care about every single thing so we choose what to care about.

              I am interested to see how long the compassion will last with this and I do think some areas are already “compassioned out” because of the economics. We don’t want to sacrifice for every single group. Just the ones we identify with.

        2. Deb

          You’d need to read the article in full.

          The article estimated that there could be up to half a million covid 19 deaths over two years in the UK if nothing were done. So approx 250,000 deaths per year. But now with the measures in place, total excess deaths (covid 19 and non covid 19) in one particular week amounted to 6.082. This is simplistic extrapolation but annualised, that figure would amount to some 312,000 extra deaths per year (although the author himself didn’t annualise the weekly figure because, as I wrote, it is just simplistic extrapolation. I suspect that it would have been regarded as much much too provoctive also). So, up to 250,000 versus up to 312,000 deaths.

          So that paper implies a question about whether the response will actually result in more deaths than just letting the disease run its course would have done.

          However, from what I can make out, the up to half a million extra deaths over 2 years from covid-19 takes no account of any extra non-covid 19 deaths that would occur if the hospital and medical systems were overwhelmed by covid-19 patients (as they would be). Some very sophisticated modelling would have to be done to assess the likely effects.but nonetheless the question remains about whether all these measures (and the resulting huge economic damage) will in the end result in a significant net reduction in expected deaths. Compared to say just treating it as a very, very bad flu season.

    4. It’s important to note that all countries on earth have imposed “draconian” measures like lockdowns and shutdowns. The difference between countries is one of degree and not type. I.e. how early did the lockdown start and how long does it last.

      The German chancellor Merkel is one of the few world leaders with a science background. It’s a pleasure to listen to her talks. She has explained several times, saving the economy and saving lives, is one and the same challenge. Merkel argues that if one is more diciplined earlier on, the economy can open earlier without fears of a 2nd wave.

      The scientific approach to this balancing act is a function of hospital beds per capita. It’s interesting that the media doesn’t discuss this much but refreshing that a world leader like Merkel does. A country with more beds per capita has less pressure to flatten the curve and can test more efficiently as well.

      Countries that have invested in the health care and have reacted early are be better off and should get their economies back the on track first. Countries who have few health care investments, reacted too late and reopen too early, will have the highest economic cost imo. The hope of rich countries with poor health care (aka the US) is that the corona virus will cost the economy less than the health care investments would have. I’m not sure about this.

      The meat industry seems to suffer the most as corona outbreaks at meat processing plants are 20 times more likely than anywhere else. That type of short-term economic loss is actually a long term gain. This economic lesson is important. A fellow from Harvard and one from John Hopkins recently wrote the following: “Oddly, many people who would never challenge the reality of climate change refuse to acknowledge the role meat-eating plays in endangering public health. Eating meat, it seems, is a socially acceptable form of science denial.”
      https://www.theguardian.com/commentisfree/2020/apr/16/coronavirus-covid-19-pandemic-food-animals

    1. Thanks for the link. I’m just a layman and unconnected with the Nutrition Facts website but here are my comments for what they are worth

      It’s a very interesting paper but it doesn’t actually discuss red meat consumption anywhere. Instead it discusses the effects of high choline vs low choline diets on mice. There was also discussed a separate study of other groups of mice fed resistant starch and native starch diets. These latter were described as high carb, low protein diets (10% protein, 20% fat).

      The paper’s final conclusion was

      ‘Our data suggest that there is no direct association of plasma TMAO and the extent of atherosclerosis. However, we did demonstrate an association of TMAO plasma levels with atherosclerotic plaque instability. The latter is in accordance with TMAO being associated with an increased risk of cardiovascular events. ‘
      https://academic.oup.com/cardiovascres/advance-article/doi/10.1093/cvr/cvaa094/5817823?guestAccessKey=99a58313-278f-4a33-8fb8-fcb10d05c24f

      It also observed

      ‘TMAO is but one of many factors that can influence atherosclerosis and its complications. Depending on the magnitude of each factor, TMAO could be more or less dominant. Although plasma TMAO was increased in mice on a high-choline diet, so were other metabolites with known associations to platelet activation and vascular inflammation such as ADMA63, 64 and L-NMMA. 65 Overall, it is highly likely that, rather than a single mediator such as TMAO, high-choline diets exert their effects via a constellation of these pro-inflammatory and platelet-activating mediators.’

      It’s worth noting that these both the high choline and low choline mice groups were all fed what was described as high fat, high cholesterol diets. Consequently, I don’t personally think that this study much affects the overall findings of Dr Greger’s video especially since the paper concluded TMAO is associated with plaque instability and thereby with cardiac events.

      The discussion of red meat diets in the story you linked is a bit of a leap of logic from a study of high choline mice chow diets but it’s newsworthy enough I suppose.

      1. That is interesting, Tom.

        My first thought is that high fat and high cholesterol maybe could both contribute so much that it would be hard to see TMAO’s effects.

      2. Thanks Mr Fumblefingers, Unfortunately the local news didn’t say anything about mice, but made the link between red meat and TMAO.

      1. Deb, on the heartburn meds, have to wonder if the peasants did better because they couldn’t afford all that rich food.
        Maybe got more exercise, less hbp, etc.

    1. Barb,

      I listened but I still wonder because in the part of USA where I live, there have been about 250,000 people who tested positive in NY, over 100,000 who have tested positive in NJ, over 50,000 who have tested positive in MA and something like 25,000 in Connecricut.

      NY tried to do what Sweden is doing.

      But racial diversity and comorbidities and housing all made it so unwise for us.

      The states that shut down before they got it have almost no cases at all.

      1. The farm belt didn’t close and suddenly there are 900 cases in one meat packing plant.

        Other epidemics and this one, the USA has neighboring states where one has a lot of deaths and next door one has almost none at all.

        I am not saying that Sweden made a mistake but I will say that I would be terrified if I were an elderly person or one of the Somalis living there.

        I would probably be upset that they didn’t value us.

      2. Deb, sweden does not do ‘nothing’. They do use social distancing etc They did have a problem with the elderly in care homes and he acknowledged that. Their care homes are huge, so an infection would spread like wildfire through them.

        NY was somewhat defiant as I recall. I think we also have to look at the health of the general population as to how numbers might be affected. Didn’t they hold st patrick day parades or was that someplace else? Anyway, we have been in lockdown since mid march, and have until july 1 when just a few stores/services may open up (maybe). Things like events (including weddings, funerals etc) may be prohibited for another year. (or more, we will see). We have no cases locally, and very few regionally. There are no protests here.

        I am hoping testing is further developed to be accurate, cheap, and available. I don’t hinge my hopes on a vaccine since the flu vaccines seem to have low efficacy rates… certainly in my own case that’s true.

    1. I had heard that so far the virus was remarkably stable (i guess that can change at any time). But my impression was that the health of various populations differ somewhat, as do the availability of quality healthcare. Dr John Campbell has a video on comorbidities this morning where he cites a new study from usa.

  10. Plus, the WHO says that only 2-3% have antibodies and they don’t necessarily believe that people will become immune at all.

    https://amp.theguardian.com/society/2020/apr/20/studies-suggest-very-few-have-had-covid-19-without-symptoms

    And it destroys the heart, lungs, and kidneys so people who live through it may have a shorter life expectancy.

    My friends volunteered in NY city during the clean-up of 9/11 and those people are dying earlier even though intellectually it probably didn’t feel as risky back then.

    People getting it may regret it some day.

  11. If we verify that some countries got milder strains, we would be able to see which places might be able to open and which ones need to be more careful.

  12. Sorry to write this here but it would be great if you did some videos on vegan baby nutrition. For example, how is soya vs dairy formula (cause they say not to give soya formula under 1 year but I’m not sure how true that is). Also some meal planning ideas for vegan babies/infants? Thank you and sorry to post this here!

  13. Any chance this inflammatory disease in children could be precipitated by diet esp animal products such as eggs that cause inflammation of vascular lining????:

    “Doctors around the world have reported more cases of a rare but potentially lethal inflammatory syndrome in children that appears to be linked to coronavirus infections.

    Nearly 100 cases of the unusual illness have emerged in at least six countries, with doctors in Britain, the US, France, Italy, Spain and Switzerland now reported to be investigating the condition…”

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