How to Test for Functional Vitamin B12 Deficiency

How to Test for Functional Vitamin B12 Deficiency
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Many doctors mistakenly rely on serum B12 levels in the blood to test for vitamin B12 deficiency.

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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.

Two cases of young strictly vegetarian individuals with no known vascular risk factors—yet suffering a stroke, or multiple strokes. Why? Most probably because they weren’t taking vitamin B12 supplements, which leads to high homocysteine levels, which can attack your arteries.

So those eating plant-based failing to supplement may increase one’s risk of both heart disease and stroke. Now vegetarians have so much heart disease risk factor benefit that they are still at lower risk overall, but this may help explain why vegetarians were found to have more stroke. Presumably this disparity would disappear with adequate B12 supplementation and this benefit, would grow even larger.

Compared with non-vegetarians, vegetarians enjoy all these other advantages: better cholesterol, blood pressures, blood sugars, and obesity rates. But, like what about that stroke study? And even among studies that show benefits, they’re not as pronounced as one might expect, which may be a result of poor vitamin B12 status. Vitamin B12 deficiency may negate some of the cardiovascular disease prevention benefits of vegetarian diets; so, in order to further reduce the risk of cardiovascular disease, vegetarians should be advised to use vitamin B12 supplements.

How can you determine your B12 status? By the time you’re symptomatic with B12 deficiency it’s too late, and initially the symptoms can be so subtle you might even miss them. And well before you develop clinical deficiency, you develop metabolic vitamin B12 deficiency: a missed opportunity to prevent strokes, where you have enough B12 to avoid deficiency symptoms, but not enough to keep your homocysteine in check. Underdiagnosis of the condition results largely from failure to understand that a normal B12 blood level may not reflect an adequate functional B12 status. The levels of B12 in your blood does not always represent the levels of B12 in your cells. You can have a severe functional deficiency of B12 even though your blood levels are normal or even high.

Most physicians tend to assume that if the B12 level in your blood is “normal”, there is no problem. But, within the lower range of normal, 30% of patients could have metabolic B12 deficiency, with high homocysteine levels.

Measuring methylmalonic acid levels or homocysteine directly are a more accurate reflection of vitamin B12 functional status. Methylmalonic acid can be a simple urine test; you’re looking for less than a value of 4 (micrograms per milligram of creatinine). “Elevated MMA is a specific marker of vitamin B12 deficiency while homocysteine rises in [the context of] both vitamin B12 and folate deficiencies”; and so, metabolic B12 deficiency is defined by an elevation in MMA levels or by elevation of homocysteine in people getting enough folate. Even without eating beans and greens, which are packed with folate, folic acid is added to the flour supply by law; and so, high homocysteine levels these days may be mostly a B12 problem. Ideally, you’re looking for a homocysteine level in your blood down in the single digits.

Measured this way, “the prevalence of functional vitamin B12 deficiency is dramatically higher than previously assumed,” like 10%-40% of the general population, and more than 40% in vegetarians, and the majority of vegans who aren’t scrupulous about getting their B12. Some suggest that those on plant-based diets check their vitamin B12 status every year, but you shouldn’t need to if you’re adequately supplementing, and evidently there are rare cases of vitamin B12 deficiency that can’t be picked up on any test; so, better to just make sure you’re getting enough. If you do get your homocysteine tested and it’s still up in the double digits even despite B12 supplementation, I do have a suggestion in the final videos of this series, which we’ll turn to, next.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

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.

Two cases of young strictly vegetarian individuals with no known vascular risk factors—yet suffering a stroke, or multiple strokes. Why? Most probably because they weren’t taking vitamin B12 supplements, which leads to high homocysteine levels, which can attack your arteries.

So those eating plant-based failing to supplement may increase one’s risk of both heart disease and stroke. Now vegetarians have so much heart disease risk factor benefit that they are still at lower risk overall, but this may help explain why vegetarians were found to have more stroke. Presumably this disparity would disappear with adequate B12 supplementation and this benefit, would grow even larger.

Compared with non-vegetarians, vegetarians enjoy all these other advantages: better cholesterol, blood pressures, blood sugars, and obesity rates. But, like what about that stroke study? And even among studies that show benefits, they’re not as pronounced as one might expect, which may be a result of poor vitamin B12 status. Vitamin B12 deficiency may negate some of the cardiovascular disease prevention benefits of vegetarian diets; so, in order to further reduce the risk of cardiovascular disease, vegetarians should be advised to use vitamin B12 supplements.

How can you determine your B12 status? By the time you’re symptomatic with B12 deficiency it’s too late, and initially the symptoms can be so subtle you might even miss them. And well before you develop clinical deficiency, you develop metabolic vitamin B12 deficiency: a missed opportunity to prevent strokes, where you have enough B12 to avoid deficiency symptoms, but not enough to keep your homocysteine in check. Underdiagnosis of the condition results largely from failure to understand that a normal B12 blood level may not reflect an adequate functional B12 status. The levels of B12 in your blood does not always represent the levels of B12 in your cells. You can have a severe functional deficiency of B12 even though your blood levels are normal or even high.

Most physicians tend to assume that if the B12 level in your blood is “normal”, there is no problem. But, within the lower range of normal, 30% of patients could have metabolic B12 deficiency, with high homocysteine levels.

Measuring methylmalonic acid levels or homocysteine directly are a more accurate reflection of vitamin B12 functional status. Methylmalonic acid can be a simple urine test; you’re looking for less than a value of 4 (micrograms per milligram of creatinine). “Elevated MMA is a specific marker of vitamin B12 deficiency while homocysteine rises in [the context of] both vitamin B12 and folate deficiencies”; and so, metabolic B12 deficiency is defined by an elevation in MMA levels or by elevation of homocysteine in people getting enough folate. Even without eating beans and greens, which are packed with folate, folic acid is added to the flour supply by law; and so, high homocysteine levels these days may be mostly a B12 problem. Ideally, you’re looking for a homocysteine level in your blood down in the single digits.

Measured this way, “the prevalence of functional vitamin B12 deficiency is dramatically higher than previously assumed,” like 10%-40% of the general population, and more than 40% in vegetarians, and the majority of vegans who aren’t scrupulous about getting their B12. Some suggest that those on plant-based diets check their vitamin B12 status every year, but you shouldn’t need to if you’re adequately supplementing, and evidently there are rare cases of vitamin B12 deficiency that can’t be picked up on any test; so, better to just make sure you’re getting enough. If you do get your homocysteine tested and it’s still up in the double digits even despite B12 supplementation, I do have a suggestion in the final videos of this series, which we’ll turn to, next.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avocado Video

187 responses to “How to Test for Functional Vitamin B12 Deficiency

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    1. I used to see an allergist in the 80s who said that those dark circles come from allergies, and cause liver stress. If I eat any processed food, even condiments or something from a can or a jar, this happens to me. If I stay with whole, simply prepared foods, they go away. WFPB works for me.

  1. I find the chart at t =0:46 troubling. We’ve seen this chart a few times recently, where it would seem vegetarians have only a meager advantage in CHD over meat eaters of about 37 cases of CHD per 1000 population, as opposed to maybe 48 cases per thousand for meat eaters. The advantage for vegetarians in this chart doesn’t impress me much, given all the “power of plants” encouragements I’ve heard over the years – given all the information we’ve learned on NF.org about whole food plants as a way “Not to Die from Heart Disease,” and as a way to “Reverse our Number-One Killer.”

    Is that meager advantage for vegetarians due exclusively to a deficiency in B12? Is it because so many “vegetarians” are sitting on the couch all day eating taco chips and watching vacu-vision?

    By way of contrast, check out https://nutritionfacts.org/2014/11/11/we-can-end-the-heart-disease-epidemic/ and note the repeated emphasis on the rarity of heart disease, high blood pressure, and heart attacks among rural Africans… This is the understanding I’ve had about WFPB eating up until this video series.

    It would seem that the chart at 0:46 surely did not source its data from populations in rural Africa. So what are non rural African “vegetarians” doing wrong, besides the B12 deficiency?

    Anybody have a different interpretation that might ease my mind a little?

      1. That’s exactly what I was thinking. How are the populations like this getting their B12 naturally? Are they eating small quantities of meat ? Is B12 deficiency perhaps a much bigger cause of vascular disease than previously thought ?

        1. Hi, Breising! Vitamin B12 is not made by animals or plants, but by bacteria that were once abundant in water and soil. While modern water purification has helped us to stop dying from waterborne illnesses like cholera, it has also largely wiped out those bacteria. Likewise, conventional farming practices have killed them off in soil. As a consequence, many animals raised for food are given B12 supplements, because they do not get it from soil or water anymore either. Yes, vitamin B12 may be a significant contributor to vascular disease risk. You can find everything on this site related to vitamin B12 here: https://nutritionfacts.org/topics/vitamin-b12/ I hope that helps!

        2. Rurel Africans do not drink chlorinated tapwater. That’s the reason why they get enough vitamin B 12.
          And this is also the reason why they get plentiful other diseases we in the west don’t get.

      2. No, rural Africans are not taking B12 supplements, they drink natural waters.

        No one will test to validate the theory, but the theory goes: Natural, untreated ground waters contain B12 from the microbes in the soil.

        Millions of Americans drink water from their wells and springs. I am one. BUT I cannot find a lab to test B12 in my water (not that I can afford it, but I have contacted a few). I cannot find any evidence of any official testing of ground water anywhere with regard to B12 content but the theory persists that mankind “got” their B12 from natural waters, naturally.

        And many of us still do, in theory-and in fact.

        I do supplement my B12, but also drink from a well. But will always have an ear to the ground to hear that first lab result showing B12 yet exists in natural water supplies.

      3. Dr.cobolt: rural africans drink unchlorinated water, which has bacteria that makes B12. They don’t buy their plant foods at supermarkets either. They either grow them or buy from or trade them with fellow villagers. Either way, the plant food they eat are not triple pressure-washed, so veggies and fruits are contaminated with dirt, which contains bacteria making B12.

        1. George,

          You wrote: ” rural africans drink unchlorinated water, which has bacteria that makes B12. They don’t buy their plant foods at supermarkets either. They either grow them or buy from or trade them with fellow villagers. Either way, the plant food they eat are not triple pressure-washed, so veggies and fruits are contaminated with dirt, which contains bacteria making B12.”

          How much B12?

          Do those two sources provide the RDA of 2.4 mcg per day?

          Where is the documentation?

          Thank you,

          Vivamus

          1. I wouldnt be surprised because 2.5 mcg is really not much and i read some analysis that showed significant amount of B12 in wild water.

            1. Julot,

              Could you point us to the study showing a “significant amount of B12 in wild water?”

              It would be helpful to see actual numbers.

              Thank you.

              Vivamus

              1. Not actually i didnt save the paper i read few months ago, i dont remember where i got it… it was stating spring water and even lake water was tested with significant amount of B12.

            2. Wild water. I like that description. Could wild water be a container of water set outside for a few days. Would that be long enough for bacteriia to make B-12? Perhaps it could be helped along with a pinch of organic soil. I will look for a YouTube video or experiment on this.

              1. Natural B-12:
                I will guess that people living in high densities, like inner cities and slums; maybe wilth open sewers, pets and chickens have no shortage of B-12.
                Another muse: Can B-12 come from your pets? What about potted plants? Sprouts?

                1. On the topic of Vitamin B12 from “Wild Water” – unchlorinated water – I am not sure that this theory is working out very well for the populations of less developed countries. Please see below:

                  “In the United Kingdom and United States the prevalence of vitamin B12 deficiency is around 6% in people aged less than 60 years, and closer to 20% in those aged more than 60 years. Across Latin America approximately 40% of children and adults have clinical or subclinical deficiency. The prevalence of deficiency is much higher in African and Asian countries—for example, 70% in Kenyan school-children, 80% in Indian preschool children, and 70% in Indian adults.10 In vegan and vegetarian groups the rates vary—in the United Kingdom, 11% of vegans are deficient in vitamin B12 and in Ethiopia 62% of vegetarian pregnant women are deficient.1

                  The British Medical Journal
                  Founded 1840
                  BMJ 2014;349:g5226doi: 10.1136/bmj.g522
                  https://www.bmj.com/bmj/section-pdf/763683?path=/bmj/349/7973/Clinical_Review.full.pdf

                  Unproven theories are nice. They make for fine conversation.

                  But reality is an entirely different matter.

                  Take care –

                  Vivamus

    1. If you eat a standard Western diet but don’t eat meat, what are you going to be eating instead? The odds are it will be more dairy, eggs, vegetarian pizza, TVP, chips/fries, pot noodles etc

      Why would people eating that kind of thing have any better health than meat eaters? Junk food diets are junk food diets, meat or no meat.

      ‘Vegetarian’ doesn’t equal WFPB eating. So called vegetarians eat tons of animal foods, just not meat.

      1. Agree. I have known enough “vegetarians” that eat a terrible diet. Usually loaded with dairy and eggs. Some even call themselves “vegetarian” but eat a “little” chicken or fish. The ambiguity of the term makes the whole series questionable. What does all this have to do with a WFPB diet?

        Agree with Wade too. We drink untreated well water and grow a lot of our own organic food. Don’t normally supplement but drink a little unsweet Silk soy milk every day. Silk label, supplement label and Dr. Greger’s RDA’s are all hugely different.

        1. The term “vegetarian” is not ambiguous. It sounds like you’re confused as it’s being misused, which is not the fault of the series or the Nutrition Facts team.

          I would assume that the fact that a vegetarian diet is a step between an omnivorous diet and a WFPB diet is how it is relevant to a WFPB diet. However, this is Nutrition Facts, not Facts That Are Only Relevant To a WFPB Diet.

          As for why vegetarians, even those on your interpretation of a standard western diet, would have better health than omnivores – this entire site has dozens of videos and blogs that speak to that.

          I’m so confused as to how each of your comments could even add to this discussion in a small way.

          1. You appear confused.

            The term ‘vegetarian’ was originally devised to describe people eating the vegetable diet. At that time, a vegetable was any edible plant, fungus or algae. Over the years, the term became progressively watered down so that now it is commonly used to mean someone who doesn’t eat meat. That of course makes about as much sense as defining a fruitarian as someone who doesn’t eat fish.

            Common meanings aren’t always correct meanings.

            In any case, if you think that ‘vegetarian’ is a step on the road to a WFPB diet, then you clearly don’t understand what a WFPB diet is either.

            1. You are correct. I am confused.

              I’m genuinely trying to understand what the value of criticising this video/series is.
              I’m wondering if you don’t like the inference or the implication from the video and are trying to find fault in it? Or perhaps you just enjoy arguing over selective semantics?

              A quick Google search uncovers the very simple, current, and clear definition of vegetarian. Multiple reputable sources consistently define a vegetarian diet as one that excludes animals, but not necessary animal-produced products (eggs, honey, milk, etc.).
              Feel free to check up on the current definition for yourself.

              To help explain the “step on the road”:

              Omnivorous diet: plants, animal products, animals. (or, eats meat)
              Vegetarian diet: plants, animal products. (or, doesn’t eat meat)
              WFPB diet: plants. (or, doesn’t eat meat or any animal products)

              Ultimately, Dr Greger and the NF team tend to recommend a WFPB diet because it seems to be the healthiest according to the studies, research and data available.
              They are not obligated to only speak to a WFPB diet.
              They are not in the business of hiding or misrepresenting some studies, research, and data to suit an agenda.
              This series simply presents studies, research and data.

              1. I did not criticise the video. Whatever gave you that idea?

                My post simply made the point that data about vegetarians’ in general does not necessarily apply to people eating a WFPB diet. Incidentally, people eating WFPB diets are not necessarily vegetarians. In fact, no traditional WFPB diet in the world is, or ever has been, ‘vegetarian’ in the sense of absolutely excluding meat.

                Also, yes we all know that people and institutions often define vegetarians as people who do not eat meat, My previous post made that crystal clear. However, not everybody agrees with that definition. The name itself ‘vegetarian’ provides a pretty big clue as to what the correct meaning of the term is. Common usage and correct usage aren’t necessarily the same thing.

                Thank you but I also have a fair understanding of what the aims of Dr G and the NF team are.

                1. I hadnt learned this until just now, but if a person has recently been exposed to Covid, apparently experts are saying they do not need the Covid test.. wow!

      2. Especially dairy, cheese in particular is the number one source of saturated fat and eggs is the number one source of dietary cholesterol.

    2. dr cobalt,

      I had the same question.

      I wonder if it makes a difference how LONG someone eats a vegan diet. Perhaps the longer on the diet, the lower the risk. Sort of like stopping smoking: some benefits are observed almost overnight, but others take months or even years to be seen. I think it takes about 15 years till the risks from smoking drop to those of never-smokers. And note, for example, with respect to lung cancer, only about 15% of smokers develop that in their lifetime. Which means that 85% don’t. Now, that is still a very high risk, compared to never-smokers, but it’s not 100% either. And all kinds of other disease risks (eg, cardiovascular disease) decrease after stopping smoking.

      Another point is that the vegans may not have been eating a healthy whole plant food diet. You’d have to look at the original study to see if what the study participants were actually eating on a daily basis was provided. Many vegans eat lots of processed and prepared foods — CRAP, Calorie Rich And Processed — and lots of added oils, sugars, and salt.

      I think what you would like to see, as would I, is what happens to disease risks for those who eat whole plant foods, and how does that risk change over the time from starting to eat whole plant foods. Also, does it make any difference at what age this eating habit was adopted? I doubt that this information is available.

    3. Maybe Dr Greger addresses this elsewhere but my first thought was what were the vegetarians diets like in that study? In the same way you can be a junk food vegan, you can be vegetarian and not eat any whole food plants! All studies need to be comparing with WFPB not vegan or vegetarian which really tells us nothing about the healthfulness of their diets. I’ve eaten crap my whole life but have kidded myself that because I don’t eat meat I’m healthier. I’m transitioning to WFPB now having learnt the error of my ways.

      1. Hi, Kate Jones! Congratulations on transitioning to a healthier, WFPB lifestyle! You are right that there is a lot of variation in “vegetarian” and “vegan” diets, and that can be a weakness in studies that do not clearly define the diets of participants. Junk food can absolutely drive up homocysteine, but so can low vitamin B12 status. It is important for everyone, especially vegetarians and vegans, to have adequate, but not excessive vitamin B12 intake. I hope that helps!

    4. dr cobalt, dr greger said it himself in the previous video in this series. Look to paragraph 7 in the written transcripts for the effects of b12 deficiency on heart disease. https://nutritionfacts.org/video/vegetarians-and-stroke-risk-factors-vitamin-b12-homocysteine/

      As I have posted before, the Adventist pescatarian women did much better than the vegan women regarding heart disease. That study impressed me because of their overall beliefs in eating well and maintaining health. With men the difference was not pronounced.

      1. Can Dr Greger explore or even surmise at the fish paradox: all his videos about how fish is very unhealthy too V’s the Adventist pescatarian health benefits

        1. Bob, Dr Greger has mentioned a few things about it throughout the years.

          Fist though, I want to mention that the Adventist women saw a clear advantage in consuming fish, whereas the men did not. Check out Table 4 on the second link I posted. Post menopausal women face declining estrogen levels, and with that they also lose the heart protective effect of the estrogen. My guess is that fish has an impact on estrogen levels in the body, but I am hoping Dr Greger will talk about gender specific effects in trials like these.

          He does speak about the effects of IGF in paragraph 4 of last week’s video. People eating wfpb but still experience high blood pressure have increased risk of stroke. Dr Greger advises addressing the high blood pressure rather than increasing IGF (some of us have done all the tweaks).

          I won’t repeat all the arguments.. you can find them towards the end of the forum discussion.

          https://nutritionfacts.org/video/vegetarians-and-stroke-risk-factors-animal-protein/
          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4191896/?report=classic

        2. In the Adventist study, male ‘vegans’ had a lower mortality risk than male ‘pescatariansl.

          Observational studies are, however, notoriously subject to confounding by a variety of other factors. It’s unwise to infer causality from observational studies alone..

          To cut to the chase, though, I am not aware that Dr G has ever tried to analyse the Adventist 2 mortality study ub full..

          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4191896/

  2. Most doctors (and any search engine) knows that B12 alone does not control homocysteine and do not incorrectly put all of their eggs into one basket. Nutrients involved in the metabolism of homocysteine include folate, vitamin B12, vitamin B6, riboflavin, and choline. Although supplementation with folate, vitamin B6, and vitamin B12 successfully lowers homocysteine concentration in the blood, no significant effect on cardio vascular disease risk has been demonstrated. There is some evidence that riboflavin (B2) supplementation may lower homocysteine and blood pressure in individuals with a certain genetic predisposition.

    1. Adding other B vitamins, folate etc may obscure or counteract the effects of B12 supplementation alone.

      In this study below, B12 alone reduced average homocysteine levels in vegetarians from 16.7 µmol/l to 11.3 µmol/l ………….. and also improved other markers of cardiovascular health.

      ‘Vitamin B-12 supplementation significantly increased serum vitamin B-12 levels (p<0.0001) and lowered plasma homocysteine (p<0.05). After vitamin B-12 supplementation but not placebo, significant improvement of brachial FMD (6.3±1.8% to 6.9±1.9%; p<0.0001) and in carotid IMT (0.69±0.09 mm to 0.67±0.09 mm, p<0.05) were found, with further improvement in FMD (to 7.4±1.7%; p<0.0001) and IMT (to 0.65±0.09 mm; p<0.001) after 24 weeks open label vitamin B-12.'
      https://www.researchgate.net/publication/225097699_Vitamin_B-12_supplementation_improves_arterial_function_in_vegetarians_with_subnormal_vitamin_B-12_status

      1. Thanks Fumbles… I used to take that homocysteine lowering formula years ago with a combo of folate, b6 and b12.

        This study here talks about b12 supplementation in diabetics with kidney disease. Not a good result, so I guess people with diabestes really should consult their physicians. The trial resulted in worsening of GFR and increase in cardiac events and stroke.

        https://pubmed.ncbi.nlm.nih.gov/20424250/

        1. Barb

          Thanks but that study is not about B12 supplementation. It is about the ‘standard’ combination therapy ie ‘Single tablet of B vitamins containing folic acid (2.5 mg/d), vitamin B(6) (25 mg/d), and vitamin B(12) (1 mg/d)’ Clearly, B12 is very much the junior partner in that formula.

          Excess folic acid brings its own risks. Excess B6 can also cause toxicity.

          The study I linked to my post above was about B12 supplementation alone – no folic acid, no B6. But yes, talking to your doctor is essential Certain diabetes drugs cause B12 deficiency for one thing.

          As for chronic kidney disease, some studies suggest that B12 and folic acid are very beneficial
          https://www.ajkd.org/article/S0272-6386(19)30950-3/fulltext

          Throw diabetes into the mix, and things get even more complicated. In the light of this CKD study above, it is at least arguable that the problem with the trial you cited was that it didn’t deliver enough B12. However, it is better to leave this to the experts. Best of all, of course, is to eat in a way that neither diabetes nor CKD come to visit.

  3. Dr. Greger, I’m worried about you. What is causing the dark circles under your eyes? They are getting more pronounced in each new video. If you compare your under-eye area in your early videos, you look great! But now, you look like there is something terribly wrong. What’s going on?
    I love your website, videos, and books. Please stay healthy and keep up the great work! We love you!

  4. “Most physicians tend to assume that if the B12 level in your blood is “normal”, there is no problem. ”

    This is what Ive been talking about.

    “Experts” are often oblivious to their own lack of knowledge, and simply assume things…because they believe they are experts – its what theyve been told. You are a doctor, so therefore you are an expert. The “educated guess” is at play here, and it is bolstered by a feeling of subject matter expertise.

    The main problem is that one turns a corner in ones self-esteem, and simply stops growing – because, why would they? They already are convinced they know what they need to know, perhaps even published some papers, and perhaps have similar social circles of mirrored “expertise”.

    Why the HELL doesn’t every doctor KNOW that a good B12 blood reading doesn’t mean things are ok?

    I believe that this scenario plays out in almost every reading of lab tests in any area of medicine, due mostly to assumptions, interests, and half assed assessments – with little further knowledge sought on all subjects, but plenty of time for meeting with Pharma representatives.

    1. Well said JazzB.

      One issue we’ll always have with the medical field is that all doctors are human, and humans are fallible and imperfect such that the management of his/her business of the day or week or month may have strong influences on exactly which cases and scenarios get the most focus by those medical professionals. Plus that the education systems and continuing educations systems are human-based, thus imperfect—and these days commonly polluted (if not corrupted) by the profit motives and influence of the rich pharmaceutical and super rich food industries.

      Would that my education were in the proper fields, I’d love to help out, but can only do such as self-educated layperson with regard to natural nutritional health and healing. As such, no one listens to me. Everyone “knows better” and thinks he/she is “just fine”. Until they aren’t.

      Thankfully Colin and Michael and many others are all too ready to tell and show us what lies and garbage have been “sold” to us over the years of our history, and continue to be factors limiting the progress of our Species. The also offer us better perspectives and outcomes.

      Cheers.

      1. [last sentence should read]

        They also offer us better perspectives and outcomes.

        (I will never understand why they ripped all editing tools from our options here, and will never like that fact.)

        1. jazzBass,

          Students at the primary school level, elementary school level, middle school level, junior high school level, high school level, college level, and Master’s degree level are all directed largely to learning the existing body of knowledge.

          And this is as it should be. There are so many things that are already known – and only so much people can learn.

          I envision a funnel pouring raw knowledge into the top of the student’s head, with a huge volume of books and papers and pictures being poured in through it.

          At these levels, it is important to learn the existing body of knowledge, which is already overwhelming, without the need for a tremendous amount of analysis.

          That is one reason (of many) why international scholastic competition at these levels always beats out Americans. Others spend much more time memorizing much more of the vast amounts of information than we do.

          American education – besides, of course, being lazier and wasting a tremendous amount of time on sports – is less oriented toward memorization – and a little more oriented toward analysis.

          People who have not sought higher education beyond these levels may assume that they are simply more of the same – piled higher and deeper. But they are not.

          At the Science Ph.D level and at the M.D level – things are very, very different. Here – American schools actually excel.

          I have seen it. Particularly in talking with foreign students who flock to U.S universities to pursue graduate studies.

          The first lecture you receive as such a student – if you are lucky – perhaps from the Chairman of your Department, perhaps from the Chairman of the Curriculum Committee – typically goes something like this:

          “If historic trends continue as they have in the past, 30% of what you learn in this program will be wrong.”

          (You kinda sit there, stunned. No one has ever spoken to you this way, before.)

          “Unfortunately, at this time – we do not know which 30%.

          These simply is no way to know.

          That is the nature of science.

          So – learn everything you can with care – and with thoughtfulness – and with humility.

          You will have to keep up your entire career – read the journals, go to meetings, discuss matters with your peers, learn from your own experience.

          You have to keep up – not only to learn new things. But just as importantly, to unlearn all the things that you know to be true – but which are wrong.

          Wisdom does not come from books.

          Only time – and experience – and being right – and being wrong – and correcting those wrongs – bring wisdom.

          And always – always – always – always – avoid dogmatism.”

          That is why you go to an active Ph.D to understand the sciences – not just nose around the Internet and try to puzzle things out for yourself.

          That is why when you go to an M.D. – you are seeking out a medical opinion. Not a medical fact.

          ‘Cause the facts change every day.

          But the M.D.’s opinions are the culmination of fact – and time – and the experience of surfing all those changes.

          That is why I like to get an M.D in his 50s. Younger than that – and he has not accumulated the full flower of clinical judgement. Older – and he well retire in a few years.

          So I get ten excellent years or so out of my Physicians.

          The ladies haven’t lasted nearly as long – only five years or so. They tend to either die – breast cancer seem to be particularly popular – I begin to wonder if breast cancer is a communicable disease amogst the ladies – or they tend to wander off to other venues – always dissatisfied with where they are.

          Fine. I take life as it cones. Not my problem.

          The gentlemen seem to find one spot and root there. Which works out well for me.

          In addition, the ladies seem more intent on maintaining a proper and correct social distance appropriate to physicians and patients in a professional setting. All very correct. But this makes the interaction more rigid – they are less likely to entertain possibilities suggested by the patient. They feel the need to establish and maintain their role as guardian of the gates. I find that this actually affects patient care – negatively.

          The gentlemen actually welcome a much warmer sharing of humanity. And are much more open to other’s ideas.

          YMMV.

          ————————-

          Note: in your continued criticisms of Doctors – you are beginning to sound a bit dogmatic, yourself.

          Dr. Greger is an M.D. As is Dr. Ornish. As is Dr. McDougall. As is Dr. Esselstyn.

          Neither they – nor countless other M.D.s out there – are blithering idiots.

          Ans none of them accept the full Dr. Greger dogma.

          Typically when asked why – they will cite their own clinical experience – which they have in abundance and which I believe that Dr. Greger largely lacks – mostly stemming from his earlier days of Medical training.

          And, I tell you – clinical experience makes all the difference.

          Really.

          I certainly do not accept the full Dr. Greger dogma. Much of it is based on extrapolation stacked upon on assumption, on “may be.”

          Not on clinical experience.

          There is a whole lot more to the story than homocysteine and Vitamin B12.

          You might be wise to be careful with such dogma, yourself.

          —————————————-

          “Why the HELL doesn’t every doctor KNOW that a good B12 blood reading doesn’t mean things are ok?”

          Every doctor in the world knows this.

          You are projecting yourself onto others.

          You would be wise to consider a course correction.

          I have confidence that you have the wisdom to accomplish this.

          Ph.Ds and M.D.s do it all the time.

          ————————————————————

          Back when ~2% of the U.S. population identified as Vegetarian – ~8% of M.D.s surveyed identified as Vegetarian.

          M.D.s are not as clueless about nutrition as you might wish to think.

          ————————————————————

          If your new physician is an M.D. – in addition to being plant-based – you have the potential of the best of both worlds.

          He has taken his formal Medical training – kept up – thought for himself – looked at life experience – and expanded his care and learning – which has further expanded his experience.

          If not an M.D.by training – I cannot say.

          ————————————————————

          Earlier you asked:

          ***Any advice here on best approach to break up with your Doc?

          I want all my records, and no drama….

          Just toss her clothes out on the porch and change the locks – that’s what I always do.

          ————————————————————

          Alternatively – call up your new Doc’s office immediately – well to your appointment – and explain the situation.

          They will likely have you sign a form – HIPAA – and they will take care of the transfer for you.

          If they are in the same system – they may not even need to do that – they can just access your records already in the system.

          It is good for your new physician to have the records available for review on first encounter.

          Your prior physician will retain a copy – useful if he new guy does not work out and you choose to return.

          Prodigal son.

          Your prior physician may not even be aware that the whole thing happened.

          Sounds like he is a busy man.

          His staff may or may not inform him.

          jazzBass.

          Stay loose –

          Vivamus

          1. Viv, I understand, and I did expected you to defend Docs, and PH D’s etc, since I suspect you may be one. Are you?

            It was obvious to Wade that I wasn’t referring to Drs.G, O, M, E, and any other thinkers that aren’t stuck.

            Re: my comment regarding GP’s assuming good levels B12 in blood means good B12 levels in general:

            You wrote:

            “Every doctor in the world knows this. You are projecting yourself onto others.”

            On this point, I refer you to the video, where Dr G explains that most doctors are making life threatening wrong decisions, and giving poor guidance , based on assumptions. (I accept if you believe this to not be true, and that he is trying to profit on ideology, but I disagree.)

            Thing is then, if you both are right, the “assuming” Docs are also criminal (and I’m a bad actor).

            I’d prefer to think they don’t know rather than that they do, but are choosing to guide against human interest, and not towards a self superior, and assumed, albeit wrong, diagnosis.

            Re: nature of my course:
            It is forward. Yours?

            Re: Blithering Idiots, I didn’t say that so I’m not sure what you are referring to.

            Now, I did say that people who fancy themselves as “experts” often get it wrong, precisely because they think they are an expert. (If anyone is projecting? ..[elbow to elbow tap w/smiling wink])

            Re: The educational system, I’m aware of its process for all levels of education, and too I’m also aware that there are different approaches in practice as we speak which you may have omitted, but hey you are the expert here. However we also differ, because education to me is not about memorization.

            You may also not that there are thousands flocking to other parts of the world with better education even at the highest levels, and without corporate donors to sway the curriculum. Everyone in science wants to go into research. Any idea who pays for it?
            My son was sought for jobs and schools by the government, the corporations and the military for his hard study in the science field, and just the slightest pulling back of the curtain unearths where the money comes from.

            After that information is gleaned, the thinker can ascertain if there are other interests at play other than, but potentially slightly including, the health and well being of humanity. Now, an “expert” might take what he’s dutifully memorized, go to his colleagues, all mirroring one another at conventions, and simply blindly defend the institutions that pay them with money from the corporations that employ them.

            Another point: I believe this is the second time you have devalued the works of Doctor Greger, calling him a dogmatic guru, and now even lacking in experience.

            I’m thinking, just thinking now, this is a good place for us both. I know I have already said I understand this fine gentleman is not God, but too I have said I do trust his intent. For you, the reason you are here is obvious.

            I am also sure his vision of a healthy world with thinking thoughtful, humble, helpful, physicians includes many many open minded women doctors. Is it still such a boys club as it must have been when you practiced? (Thats an assumption)

            His staff is evidence of his open vision on gender. And they are all great looking! lol I had to say that… its true though..

            My own motto is trust, but verify, because I am a thinker. So I take whats shared with me, then if its new information, I look into it. And I ask lots of questions.

            That’s why it is rare to catch me BS’ing. (opinions are up for debate of course lol)

            Thanks for the info on the change of docs. If my doc is a busy man, so busy that he is unaware that for 10 years I have waited in his waiting room for about an hour, then I submit to you: He has taken on too many patients. (I leave it to you to understand why that may be, and I am sure you are capable.)

            What I was after though, was how to ensure I get the entire file? I have spoken with them before and they literally told me my last blood test was 2 years before two actual subsequent blood tests, so I would like to try to get them to be thorough, just once, as I leave and was looking for advice on this point. I may not have made that clear so apologies for that, my bad.

            My guess is you have some skin in the game here and so I’m cool with your defending this institution which, in my opinion, has been seized by corporations long ago here in this country. Other countries have doctors getting paid the same as teachers. That makes sense to me.
            The argument that there are so many years of school as if it its not an enjoyable wonderful part of someones life is quizzical to me. But then if you put in the $$$, then it makes sense. ” I spent years…”, should read, “I spent dollars, so that’s why I get what I get.”

            The RUB: None of that goes to helping, and all of it goes to potential -though hopefully unwitting – harm, especially when you add in malpractice insurance financial realities.

            Its not clean my friend, not at all. And that is the problem. (read: its not their fault that they focus on other things…sort of)

            Stay young,
            JB

            1. Vivamus and JazzBass,

              Speaking of Doctors in general, I can foresee that in the near future, the regular “Primary Physician” will be replaced by a “technician” of sorts who merely refers to Artificial Intelligence (A.I.) software running on a computer! That way, the knowledge acquired by a team of very smart and experienced doctors can be shared with many “routine” doctors, especially those in the diagnostic field. The team of very knowledgeable doctors work with software engineers to develop the system so the routine doctor merely enters the lab results and other test data into the computer to make a diagnosis or ask for more tests to be done until a firm diagnosis can be made. This scenario is not much different from a car mechanic these days ;-)

              In fact, I have a sneaking suspicion that my current Primary Physician uses some kind of system like this on his laptop that he refers to when I go in for my annual physical after having my blood work done!

              In my past life as a systems engineer, I used to work with early A.I. systems applied to other fields. But I was familiar with early A.I.systems being researched for the medical field. The name of the one I recall was the MYCIN system written in an old A.I. software language called LISP.

              Of course, like anything else, these systems have their pluses and minuses. The upside being getting access to vast amounts of medical knowledge and experience. The major downside would be the rigidity, with the “doctor’ not being able to deviate from the recommended treatment for insurance reasons.

              https://en.wikipedia.org/wiki/Artificial_intelligence_in_healthcare

              https://www.theengineer.co.uk/ai-medical-diagnostics/

              https://www.forbes.com/sites/konstantinebuhler/2020/08/04/3-ways-artificial-intelligence-will-change-healthcare/#5a5164e63e4e

              1. Darwin,

                Hong Kong uses AI.

                Hong Kong’s longevity came up in the comment section recently and they use AI.

                Patients who have a symptom, contact a 24/7 AI diagnostic line and they said that they know that the AI diagnostician is 80% accurate. After that, the doctors step in with more complicated or serious cases. But even that is done remote, rather than by appointment.

                It has taken the caseload off of the doctors and emergency rooms aren’t overflowing with non-emergency cases.

                Neither are doctors’ office waiting rooms.

                It seems like an excellent concept to me.

                1. Darwin Galt,

                  As you may recollect, something like this was predicted a little while ago:

                  The Little Black Bag
                  C. M. Kornbluth
                  Astounding Science Fiction
                  July 1950

                  https://gutenberg.ca/ebooks/kornbluth-littleblack/kornbluth-littleblack-00-h.html

                  “It won the 2001 Retroactive Hugo Award for Best Novelette (of 1951) and was also recognized as the 13th best all-time short science fiction story in a 1971 Analog Science Fact & Fiction poll, tied with “Microcosmic God” by Theodore Sturgeon.[1] It was among the stories selected in 1970 by the Science Fiction Writers of America as one of the best science fiction short stories published before the creation of the Nebula Awards. As such, it was published in The Science Fiction Hall of Fame Volume One, 1929-1964.

                  It was the basis of episodes (using the same title) in three television series: Tales of Tomorrow in 1952, Out of the Unknown in 1969 and Night Gallery in 1970.” Wikipedia entry.

                  All the best –

                  Vivamus

              2. Darwin, we do have these types of “guided” self-serve medicine outlets popping up: https://virtualphysical.com/

                I also found, but did not engage another service which is a doctors office of the future incorporating the scanner and blood tests while you wait in a WeWork/Google office environment, then you get a consultation form a 24 year old named Brittney. (With that voice, comes from back of nose to amplify directness)

                I forgot the name of the outfit, but when I saw how aggressive they were (sales), it tuned me off.

                Likewise many industries are getting the people kicked out in favor of an app, for instance Redfin is an example of how a tech company can get into any business. Its not a real estate firm, its tech company.

                So yes, its coming and its here, and here we go! (I personally not as fond of the idea but willing to see if there are any legs/teeth to it.)

            2. jazzBAss,

              You wrote: “What I was after though, was how to ensure I get the entire file? I have spoken with them before and they literally told me my last blood test was 2 years before two actual subsequent blood tests, so I would like to try to get them to be thorough, just once, as I leave and was looking for advice on this point. I may not have made that clear so apologies for that, my bad.”

              Fully understood.

              Suggestions:

              It depends if your current doctor is part of a large system – or an Independent.

              And if you were using his office lab or the lab down the hall or one outside the building.

              Or some motely combination thereof.

              I cannot cover every possibility, but here’s a stab –

              (1) Try the procedure with the new Doc that I already mentioned.

              (2) If you went to a separate lab outside your Doctor’s office – or one down the hall – add to the above information the name and telephone number of that lab and request that your new Doctor obtain this information independently from the lab, as well. If you explain matters to your new Doctor’s clerical staff, they should get the idea and be able to get right on it. Again, this may require a signed HIPAA form. They may or may not have one already on file for you.

              (3) Assuming that all this may fail – Murphy’s Law – I would independently do the following if I were you and in a typical Monolithic health care system: go to the front desk of the Monolith and ask how to obtain hard copies of your medical files.

              They will likely send you to “Medical Records.” The people there may then need some time – minutes or hours or days – to gather the information. Wander off or dawdle as appropriate.

              I tend to bring a copy of “War and Peace” with me. Wonderful book. Choose your poison.

              I am not out to give legal advice – this is merely informational – connect with a locally licensed attorney before getting your dander up – but I believe that – in most states, anyway – you likely have a legal right to this information. They do generally have a legal right to charge you, so ask ahead of time – no one has ever charged me when I have done this – and I do variations on this all the time – but who knows?

              Check that the material you are handed is complete. If not – note this to them and ask for further guidance.

              Be a very, very polite bulldog.

              When first tier staff runs out of ideas, “May I speak to your Supervisor?” can be a helpful phrase.

              Always polite. Never pushy.

              Explaining the specifics of the situation and requesting a specific solution.

              Not complaining.

              (4) If all this fails, I would go to the lab directly and ask how to gain the information you seek. When they try to run you around in circles – send you off to the Doc or to Medical Records – point our that you have been there, done that – and you now need additional guidance.

              Do not hesitate to request to talk to a Supervisor along the way if needed.

              Always unfailingly polite. Always persistent.

              Never sarcastic or ironic or complaining.

              If you have specific dates or date ranges – that can be helpful.

              One thing that is useful to understand, is that these information systems may be separate and incompatible.

              Medical Record software may be completely different form Laboratory software.

              I know, I know.

              As an added bonus – as new records systems come on line, they may not transfer the old records.

              Just looking at one set of Medical Records, you may not realize that they are incomplete.

              You cannot see what isn’t there.

              When you do realize that some records you have are incomplete – then, well, then the hunt begins.

              See above.

              As to the rest – we’ve both said our piece.

              Lotsa thoughts.

              I’m pleased to let it rest.

              Good hunting –

              Vivamus

              1. Viv, re: previous, understood.

                Thanks for office advice though, the office is small enough that I can ask to speak with the Doc himself, which I suppose is partially why I made the joke about a “breakup”. (FYI Ive told him countless times of the wait times, and I even told him that I would install a separate router in his office, for free, so his patients in prison could in fact have internet.

                Nothing. But loves to talk about France, and cheese, and real estate investment.

                Im just loyal to a fault and its time to move on, but Im not enjoying the prospect of asking for ALL my files, never having done so there, and there has been no referral from him for me to see anyone, LOL, so, “why do you need ALL your decades long files again?” is what Id rather not deal with because restraint will be a tough one.

                Hey 10 years of this and Im basically pretty healthy. i kind of wish he had said: ” Hell no! Keto will kill you!”, but that’s a line I suppose many docs wont cross, though I dont think it unethical or illegal. I may be wrong on that.

          2. Vivamus,

            Interestingly, clinical doctors are in the top 10 leading causes of death.

            https://nutritionfacts.org/video/is-it-worth-getting-annual-health-check-ups/

            I combine that with the vast majority of doctors not knowing the statistics of their own field, etc.

            I am not trying to agree with jazzBass but I am thinking that doctors who are reading the studies every year change with those studies and clinical doctors aren’t always keeping up with their field.

            They don’t even have the time to.

            1. I suspect that there will be clinical things that clinical doctors would cream Dr Greger.

              But he is exceptionally disciplined in turning to studies rather than opinion.

              The shocking vegan study continues to be a favorite of mine because the studies showed the same mortality for vegans and he didn’t run away from it back then, nor now.

              Most of the plant-based doctors explained it away. Dr Greger was the voice I was waiting for and he didn’t explain it away.

              That is a discipline experts generally don’t have.

              Dr Greger knew vegan improved all sorts of risk factors And he was sent by some organization with meat in the title and he didn’t put the study back and tell them the good news.

              He could have easily done that.

              He didn’t get defensive and his heart and mind were open to learning new things.

              Many experts lose mental flexibility.

              Honestly, I would need proof if he is somehow lesser than any of the other doctors.

              And it should be demonstratable in studies.

              1. My father just had surgery by an expert.

                But that expert had either never heard of the non-surgical solutions or he lied about it.

                I would rather he had expertise with his experience.

            2. Deb,

              I just watched the video and read the transcript and I see nothing about “clinical doctors are in the top 10 leading causes of death” in this particular presentation.

              Please clarify.

              I do know that there is other stuff out there along those lines – I would be happy to review such material.

              There are little old ladies who have not seen a doctor in thirty years – and my thought has always been to congratulate them and say no more. Except to ask a few questions.

              Time for me to learn from them – not them to learn from me.

              Dr. Greger’s point in the initial portion of the video is that studies show that healthy individuals need not have an annual checkup – I have no interest in challenging that.

              But I suspect that many of the people on this bulletin board do not have a completely clean bill of health – and may or may not benefit from Medical care.

              All very individualized.

              One place that Dr. Greger and I are certainly in accord is his statement: “I mean, if you went to see a lifestyle medicine doctor who spent the check-up giving you the tools to prevent 80% of chronic disease, that’s one thing.”

              Yup.

              That’s what I do.

              I am rooting for jazzBass to go in that direction, as well.

              I hope it works out well for him.

              I also find my own annual checkup a good time to review my numbers – serum lipids, B12, MCV (known Fe deficiency anemia marker), Zn, Cu, BP – and go over any concepts that I may have been considering throughout the year.

              That way I can home in on dietary and exercise strategies that may need changing.

              Results – I learn at the next year’s examination – slow steady decrease in BP, serum lipids, and weight – and a slow increase in serum Fe and Zn. Hey, I’ll take it.

              I find it good to have another set of eyes.

              Gentle encouragement from my M.D. has led to my letting go of that luxurious relaxing daily glass of red wine – hey, it seemed like a good idea at that time – but that time seems to have passed.

              No longer miss it in daily life. Though afew years ago, it was what I looked forward to in my day.

              Now I look forward mostly to the veggies and the fruit.

              Thank you annual visit to a wise and thoughtful Physician.

              I do not think that my annual visit has done me any harm.

              Quite the contrary.

              YMMV.

              ——————————–

              Consider:

              If “Lifestyle Medicine” can handle 80% of disease.

              And I think the number may be closer to 90% – but not to quibble.

              That still leaves the remaining 10-20%.

              And that is where I find quality Medical care to be very, very helpful.

              Lifesaving.

              Saved my father’s life.

              Saved my brother’s life.

              Saved my life.

              So I am not complaining too, too much.

              Interestingly – Medical care has not made that much of a difference for my Mother or my sisters.

              I think that the ladies may be made of tougher stuff that us guys.

              A difficult concept for us fellas to accept – but there you are.

              ————————————————

              I am concerned about the growth of A1 – specifically, if it is controlled by the corporations – and it will be controlled by the corporations – I can easily envision a day when your medical insurance may depend on your cooperation with taking specific medications and undergoing certain surgical procedures according to flow charts and your numbers. No exceptions.

              That day may come sooner than one thinks.

              One reason that I am looking to keep my numbers all in a row.

              For the long haul.

              Deb.

              You take good care of yourself –

              Vivamus

              1. ‘I just watched the video and read the transcript and I see nothing about “clinical doctors are in the top 10 leading causes of death” in this particular presentation.
                Please clarify.’

                I think Deb is referring to a Johns Hopkins paper which estimated that a large number of deaths are due to medical errors of one kind or another. That estimate is, of course, hotly disputed,

                https://www.bmj.com/content/353/bmj.i2139

                1. Mr Fumblefingers,

                  That may be it. Unfortunately, I do not have full access.

                  I do not dispute the general concept. I do wonder how much is nosocomial and how much is iatrogenic. And how much is known possible complication – bleeding, infection, allergic reaction, etc. – that can happen even in the most careful of circumstances vs. how much is actual error.

                  But, hey – I do not have full access to that particular article.

                  There is also have the problem of – when trying to fix this – you start keeping statistics on the Physicians. Sounds good. Hey – how else would you fix this? But . . . the lesser Physicians then do what they can to game the system by dumping and avoiding and referring out their most difficult patients in order to improve their own statistics. And they get gold stars. And the better Physicians – the ones who take on the most difficult patients – end up with terrible statistics – black marks on their records.

                  And then who are you going to go to for help?

                  If you think you’re smart – you’ll go to the guys with the gold stars.

                  I do recollect a conversation I had with my father one day – I treasure thoes memories – an Internist with – I don’t know – maybe 30-40 years experience.

                  Who counts the decades?

                  I was feeling a little down that day. I stated that – as far as I can see – I was getting ready to give up on Primum non nocere (First do no harm).

                  “What’s up?” he asked.

                  “Well – as far as I can see – Medicine does more harm than good in about one out of five cases.”

                  “I think you’re being optimistic,” he said.

                  So, no – no, I do not dispute the overall concept.

                  I try to navigate my way with my own personal modification of Primum non nocere:

                  Do less harm than good.

                  I try to focus on the good – and focus on avoiding harm. If I can better the ratio of harm to good to one to ten – or one to twenty – or maybe even better – well, that is the goal.

                  And – by paying strict attention to every little detail – it turns out that I can.

                  All of this brings us full circle to the Vitamin B12 megadose concepts that one sees directed at widespread population groups

                  It looks like an untested, unproven extrapolation grafted onto a set of assumptions built upon a foundation of assertions.

                  A great place to begin a twenty year experimental double blind population study with two groups – one receiving the weekly megadose of Vitamin B12 – the other, not.

                  But that study has not been done.

                  Until it has – advising people to go this route is premature.

                  And could easily lead to harm.

                  One recollects widespread tonsillectomies. Margarine. Widespread estrogen-replacement therapy. Widespread stress tests and angioplasty. Widespread PSA testing and prostate surgery. Of many, many good ideas – great ideas! – all intended to help – that when fully vetted, turned out not to be good ideas at all. But which caused harm.

                  I am concerned that megadose B12 recommendations may fall squarely into that trap.

                  It happens all the time.

                  Mr. Fumblefingers.

                  All the best –

                  Vivamus

                  1. Sure Viv but you are using speculation about possible harm to argue against whereas the argument for is that

                    1. B12 deficiency has known, very grave consequences
                    2. various groups are at high risk for deficiency even with ‘normal’ B12 consumption
                    3. in a number of trials, high doses have proven beneficial whereas small doses have not
                    4 there is no known toxicity from B12 consumption which is why the IOM did not not set a tolerable upper limit.

                2. Fumbles,
                  I remember a Dr. G. Leading Causes of Death video where he reported medical error being the 3rd leading cause of death. But the CDC does not report this. There is no requirement for the medical profession to report this error. Also, medical professionals commonly lie about error. CYA. Call me a conspiracy theorist, but I have personal experience that predjudices me to “stay the hell away from the medical professions,” unless I need care, do my homework and develop some trust. Preventative health care is where the yardage is; like diet, exercise and mindful living.

                  1. Sure.

                    Dr G classes his B12 recommendation as a nutrition recommendation rather than a medical recommendation and that’s definitely about preventive health.

                    Dr G also has a couple of videos on the general topic of check ups that you might find unteresting
                    https://nutritionfacts.org/video/is-it-worth-getting-an-annual-physical-exam/
                    https://nutritionfacts.org/video/is-it-worth-getting-annual-health-check-ups/

                    I just think that Dr G’s recommendations on B12 supplementation are prudent. Vivamus disagrees but even he thinks we should make certain to get the RDA.

            3. @Deb,
              “I am not trying to agree with jazzBass but …..” lol

              LMFAO that was a good chuckle, thanks!

              Who was it that said, “I would never want to be a member of a club that would have me.”? or, “You cant handle the truth!”

              good stuff really.

      2. Wade,

        “Would that my education were in the proper fields, I’d love to help out, but can only do such as self-educated layperson with regard to natural nutritional health and healing. As such, no one listens to me. Everyone “knows better” and thinks he/she is “just fine”

        I fit in that category, too.

        Plus, I just didn’t have the aptitude for much of it.

        My father heard from the hospital that I might be doing solar and he immediately wants me to have my brother hear everything because my brothers are more intelligent than I am.

        Well, they are also ridiculously busy with their own stuff and I haven’t made any mistakes since I took over the house so far, so I just know that God must be looking over me.

    2. I am new to whole plant based food lifestyle. One article I read stated that supplementing with vitamin b12 may cause lung cancer in men and breast cancer in women. Is this a fact? I would appreciate a reply.

      1. Not likely I would suggest.

        One study did find an association between B12 supplement use and lung cancer in smokers. Mind you I have seen studies in the UK/US(?) that found an association between wine drinking and greater wealth socioeconomic status. However, That doesn’t prove that wine drinking will make you rich.

        May I suggest that you read these if you want an in-depth look at B12?

        https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
        https://www.mskcc.org/cancer-care/integrative-medicine/herbs/vitamin-b12
        https://lpi.oregonstate.edu/mic/vitamins/vitamin-B12
        https://veganhealth.org/vitamin-b12/

        Looking at Dr Greger’s other videos on B12 might also be useful

        https://nutritionfacts.org/?s=b12

        One thing to bear in mind is that at least some cancers seem to affect B12 metabolism causing increased blood B12 levels

      2. Hi, Possom! There has been a great deal of press coverage of a recent study in which a combination of vitamin B12 and folic acid supplementation appeared to increase cancer risk. This seems to be related to the folic acid. That said, we used to think that vitamin B12 had no toxicity level, and the Institutes of Medicine of the National Academies of Science, the body that sets the dietary recommendations for the US, did not set a tolerable upper level for vitamin B12 for that reason. There has since been some indication that excessive vitamin B12 intake could have negative consequences. We know that vitamin B12 deficiency can cause permanent neurological damage, among other things, so we don’t want to avoid vitamin B12. Vitamin B12 is not made by plants or animals, but by bacteria that were once abundant in soil and water. Modern farming and water treatment practices have killed off most of those bacteria. While water purification processes have largely eliminated the risk of death by waterborne illnesses, it has also made naturally-occurring B12 less available. Because of that, it is common practice to give vitamin B12 supplements to animals raised for food. The bottom line is that it is important to avoid both deficiency and excess of vitamin B12 by taking enough, but not too much, in supplement form. I hope that helps!

  5. This video brings back to mind a similar video, back in the 2004, whispering video era. The theme was that vegetarian and vegan diets were associated with higher death rates than omnivores. The culprit was B-12 and omega-3 deficiencies, two nutrients for which there are no or few plant-based sources (respectively). The lesson for me was, to be a healthy veg, you need to be an educated veg, and to apply that education.

      1. Tom,

        I believe that was the first EPIC-Oxford results from 2002 that he was talking about.

        I am trying to figure out whether the chart that Dr. Cobalt is speaking about is also EPIC-Oxford.

        1. I ended up going to the link and reading the comments.

          Laughing.

          More than one person said that they loved his voice and one person compared his voice to Jerry Seinfeld.

          Finally, we have someone who we could put as a Dr. Greger replacement for the stand-up routine.

          Laughing.

          Wondering if the people who want to replace Dr. Greger on his own site would approve of Jerry Seinfeld as a stand-in?

          Geniuses are usually a little odd, I think its endearing.

        2. Thanks Deb. That would right I think.

          The chart refers to the latest EPIC Oxford study on stroke risk I think. Why Dr Cobalt is stressing over a study which showed 10 fewer cases of heart disease versus 3 more cases of stroke for a net 7 fewer cases overall, beats me.

  6. Could anyone recommend a good Vegan source for Vitamin B12 supplements?

    The more recommendations, the merrier!

    I had been using Freeda Vitamins as my go-to source – they have been around since 1928 or so, and have had a good reputation in the Vegetarian community – but something seems to be going on at Freeda over the last year – I do not know what.

    Looks like is is time to look for another supplier.

    Thank you,

    Vivamus

    1. Right now, I am using 21st Century Cyano B-12 from Amazon. The thing is, I have to chew it (per the webinar) but it is neutral pill taste rather than the yucky tasting flavored sprays.

      I think it was a little over $5 for 110 pills 1,000 mcg

      I have done CVS brand and that was more expensive, but they have both Methyl and Cyano B12.

      I also use nutritional yeast (because I hate taking pills and don’t take them every single day)

      1. Spring Valley. B-12. 1000 mcg. 60 tablets. Less than 2% cyanocobalamin. Distributed by Walmart. Suggested use: 1 tablet per day with food. I also use Red Star yeast.

  7. I watched the video twice, and came away with:
    –40 % of the general population is B-12 defecient. Vegans more so. Time to supplement and / or fortify.
    –Just because B-12 is normal on a test does not mean that homocysteine is low enough.
    –A good strategy may be to blanket supplement whether testing or not.
    –Keep folate strong by eating beans and greens.

      1. Dan C,

        Numbers are always interesting:

        “In the United Kingdom and United States the prevalence of vitamin B12 deficiency is around 6% in people aged less than 60 years, and closer to 20% in those aged more than 60 years. Across Latin America approximately 40% of children and adults have clinical or subclinical deficiency. The prevalence of deficiency is much higher in African and Asian countries—for example, 70% in Kenyan school-children, 80% in Indian preschool children, and 70% in Indian adults.10 In vegan and vegetarian groups the rates vary—in the United Kingdom, 11% of vegans are deficient in vitamin B12 and in Ethiopia 62% of vegetarian pregnant women are deficient.1”

        The British Medical Journal
        Founded 1840
        BMJ 2014;349:g5226doi: 10.1136/bmj.g522
        https://www.bmj.com/bmj/section-pdf/763683?path=/bmj/349/7973/Clinical_Review.full.pdf

        ——————————

        National Institutes of Health
        Vitamin B12
        Fact Sheet for Health Professionals

        “In addition to oral dietary supplements, vitamin B12 is available in sublingual preparations as tablets or lozenges. These preparations are frequently marketed as having superior bioavailability, although evidence suggests no difference in efficacy between oral and sublingual forms [19,20].”

        “Folic acid and vitamin B12

        Large amounts of folic acid can mask the damaging effects of vitamin B12 deficiency by correcting the megaloblastic anemia caused by vitamin B12 deficiency [3,5] without correcting the neurological damage that also occurs [1,35]. Moreover, preliminary evidence suggests that high serum folate levels might not only mask vitamin B12 deficiency, but could also exacerbate the anemia and worsen the cognitive symptoms associated with vitamin B12 deficiency [6,11]. Permanent nerve damage can occur if vitamin B12 deficiency is not treated. For these reasons, folic acid intake from fortified food and supplements should not exceed 1,000 mcg daily in healthy adults [5].”

        Recommended Dietary Allowance (RDA): Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals; often used to plan nutritionally adequate diets for individuals

        Recommended Dietary Allowances (RDAs) for Vitamin B12:

        Age Male Female Pregnancy Lactation
        0–6 months* 0.4 mcg 0.4 mcg
        7–12 months* 0.5 mcg 0.5 mcg
        1–3 years 0.9 mcg 0.9 mcg
        4–8 years 1.2 mcg 1.2 mcg
        9–13 years 1.8 mcg 1.8 mcg
        14+ years 2.4 mcg 2.4 mcg 2.6 mcg 2.8 mcg

        https://ods.od.nih.gov/factsheets/vitamin%20B12-HealthProfessional/

        ——————————

        National Institutes of Health
        Office of Dietary Supplements
        Vitamin B12 Fact Sheet for Consumers

        “Vitamin B12 deficiency affects between 1.5% and 15% of the public.”

        https://ods.od.nih.gov/pdf/factsheets/VitaminB12-Consumer.pdf

        ——————————

        “Vitamin B12 deficiency is common and occurs worldwide. In the US and UK, around 6 percent of the general population have the deficiency; in those over the age of sixty, around 20 percent are deficient. In under-developed countries, the rates are even higher: across Latin America 40 percent are deficient; in some parts of Africa, 70 percent; and in some parts of India, 70 to 80 percent.[1]” Wikipedia

        Best regards –

        Vivamus

    1. I’ve watched the video a few more times. It seems the B-12 test of blood may have little to do with cellular B-12. Also, that a good level of B-12 does not necessarily mean homocystein is in low range. Also, that health conditions may affect B-12 levels.

  8. I want to consider apple cider vinegar vs. beets. We are advised to do both. Aren’t beets alcheline and apple cider vinegar is acidic? If so, aren’t these chemicals enough to produce gas?

    1. Hi, Ron Harris! Both apple cider vinegar and beets are suggested here on NutritionFacts because both have health benefits. Don’t worry about the acid and alkaline issue with regard to these two foods. That has nothing to do with gas. You can find everything on this site related to beets here: https://nutritionfacts.org/topics/beets/ Everything related to apple cider vinegar is here: https://nutritionfacts.org/topics/apple-cider-vinegar/ With regard to gas, you might be interested in this video: https://nutritionfacts.org/video/fennel-seeds-to-improve-athletic-performance/ I hope that helps!

  9. https://en.wikipedia.org/wiki/Homocysteine
    Wikipedia description of homocysteine

    This a-amino acid you don’t want to be without unless you welcome heart disease, stroke, mental illness and birth defects.
    At the bottom of this article can be read, “supplementation with B vitamins does not seem to affect CVD outcomes.” Does this mean one doesn’t want to be defeciant in the first place?

    1. Dan C,

      “supplementation with B vitamins does not seem to affect CVD outcomes.”

      Some studies about B vitamins and homocysteine can get complicated by whether they are done on vegans or meat-eaters.

      Meat eaters do not have a lessening risk by taking B Vitamins. They generally need folate (Dr. McDougall points out that the word foliage is a hint of where you get folate) Yes, they need to eat more plants to lower their homocysteine.

      Vegans do get a benefit from raising their B12 and lowering their homocysteine.

      1. Deb,
        Sometimes Wiki has some bizarre statements, although I might go along with, “Once CVD sets in, B vitamin supplementation is closing the barn doors after the horses get out.” I think I do maybe understand what Dr. Greger says about the damage being done with high homocystein levels. Your answer to Bob below reflects this.

      2. “supplementation with B vitamins does not seem to affect CVD outcomes.”

        As far as I know, all those studies were about supplementing with folic acid/folate, B6 and B12 combined (with B12 being the smallest element). They did not trial B12 supplementation alone

        People eating WFPB will get plenty of folate and B6 from their diet. Only B12 is likely to be lacking.

        In Hong Kong vegetarians B12 supplementation alone was associated with lowered homocysteine levels and improved arterial function
        https://link.springer.com/article/10.1007%2Fs12603-012-0036-x

  10. What b12 do WFPB take I follow you Dr Ger, I have your books, also Dr Collins, Dr McDougall, Dr Esselstyn Etc all you good Dr. Please recommend I am confused I am 61 and changed about 5years to this new way of eating WFPB and love it.

    1. Raquel,

      Dr. Greger has a B-12 webinar coming out.

      He recommends Cyano B-12 because that is what actually worked in vegans in studies.

      Some Nutritional Yeasts, like Bragg, have surprisingly high amounts (and some nutritional yeast brands have none)

      1. Deb yes thats the thing, I took to buying NYeast in bulk to save bucks, but it dawned on me that what Im getting might not have one bit of B12…

        I have asked my market now:

        They gave me the number of teh distributer of their bulk NYeast.
        The distributer answered the phone at 6pm (awesome)
        They didnt know, but gave me the UPC

        and….

        Tada! Red Star Nutritional Yeast

        Now, how much B12 does it have in it?

        I looked that up too:
        133% of DV @ 2 tablespoons. (Bragg is way better for that) still its more than 100% f what we need…

        Or is it?

        2 tablespoons is the most Im going to get in a day of the stuff, so its back to how much I will be absorbing?

        Next up: Where do they get it from? (I’m on it)

        Stay tuned….

        or not…

        1. jazzBass,

          Let us know what you find.

          I appreciate your efforts.

          Your conversation with Viv, made me wonder if Lonie will ever show up again. I am still hoping.

          My cousin ended up in the hospital today needing surgery.

          I found that interesting because they are trying to get him to do hospice and he chose surgery.

          It caused me to look up the story behind Dylan Thomas’

          Do not go gentle into that good night

          https://www.brainpickings.org/2017/01/24/dylan-thomas-do-not-go-gentle-into-that-good-night/

          One of my favorite sentences from the article is where they said that he suffered a burst of air pollution that exacerbated his chronic chest illness and that they throw on the words as an afterthought that he succumbed to a round of particularly heavy drinking.

          Nobody gave him any broccoli sprouts.

          Do not go gentle into that good night,
          Old age should burn and rave at close of day;
          Rage, rage against the dying of the light.

          My cousin does that.

          My grandmother’s generation laughed.

          My cousin threatens to throw his mashed potatoes at the nurses.

  11. Why would he say it’s “too late” and “missed opportunity” once you have low B12? As if it’s irreversible so now you have a permanently high stroke risk? He must have meant something else but it’s unclear communication.

    1. Bob,

      Read the transcript. You will see that the defining factor is “By the time you’re symptomatic with B12 deficiency it’s too late, and initially, the symptoms can be so subtle you might even miss them.”

      The concept is that well before you develop symptoms of clinical deficiency, you can have a metabolic vitamin B12 deficiency.

      So you have a stroke before you figure out that you are deficient.

      1. The too late statement sounds like don’t bother taking B12 if ever you got deficient. (I do supplement B12 now).

        My issue with his statement is that based on subtle symptoms when I was very young, I had a possible B12 deficiency identified by my Dr. Then being young and not much information, I probably took some B12 then went a long time without supplementing. I might have taken a multi or a B-complex rarely. I ate infrequent eggs, dairy or seafood so perhaps I got bare minimum B12 (you used to hear the body was efficient with B12). My health is fine but it’s possible my B12 got deficient in the past.

        I read the transcript twice and heard the video. The “too late” is ambiguous. He says “by the time you’re symptomatic with B12 deficiency it’s too late, and initially the symptoms can be so subtle”. So, subtle symptoms can make it too late to supplement is what he just said. He doesnt say if you’re deficient and already had a stroke or CVD, then it’s too late. (Is it though, can B12 still help someone like that even if doesn’t reverse the damage they already have?)

        He also says on the page about B12 don’t worry about taking too much B12. Seems that it can be a problem according to information shared here. Does Dr Greger have any research to say higher B12 supplementation is not a problem? I recently used to take a very high dose of too much B12 as the bottle dose recommendation was much higher than his and allegedly it would just flush out your body. Then I went without for some (months?) more recently. How quickly does it go down? I thought it reduced slowly. I’m reluctant to get a test in this pandemic. Thanks

        1. Bob,

          RDA of B12 is 2.4 mcg daily.

          https://ods.od.nih.gov/factsheets/vitamin%20B12-HealthProfessional/

          Larger doses are appropriate in deficiency states. Generally then reduced over time as the deficiency typically subsides.

          If you believe that you may be in a deficiency state or at risk for one, evaluation and possible subsequent treatment and monitoring by your locally licensed Physician may prove helpful.

          Megadoses of B12 for routine usage are subject to debate – as are megadoses of Vitamin C and other nutrients.

          Megadoses of Vitamin B12 are are not recommended by widely accepted health or nutrition authorities – CDC, NIH, Academy of Dietetics and Nutrition, etc.

          I would be most cautious about ingesting megadoses of anything.

          Take care –

          Vivamus

        2. Bob, I take the statement to mean, “its too late” to diagnose the pre-deficiency, such that one is now already in full blown deficiency, against prevailing prior “assumptions”.

  12. Are you saying that if my Vitamin B12 level is 1123 pg/mL and my homocysteine level is 10 mcmol/L that I’m at risk for a stroke as a vegan?

    1. Gwen,

      Your B12 is high and your homocysteine is low.

      Unless you eat a lot of sodium, I would say that low homocysteine isn’t a risk factor for vegans.

  13. What are the thoughts on duckweed (aka water lentils) as a plant source of B-12? Everything I’ve seen indicates in the positive.

    1. Michael,

      Dr Greger answered that question in an interview and said that it hasn’t been put to the test yet.

      The example is that even Methyl B12 failed to improve B12 status of vegans in a study, so it matters whether duckweed actually works.

          1. jazzBass,

            There are a lot of brands that have sublingual Cyano versions.

            Nature’s Made
            Nature’s Bounty
            Solgar

            Finding them local is another matter entirely.

            At least where I live.

            Google it

  14. Oh, I should add that you have to always use the smile part or it won’t donate.

    It is easy to accidentally use Prime or just Amazon.

    1. I called Amazon, they said, go to amazon smile website. I want it on my android, its not there, (the app is there, but not smile)

      SO…. thats why I posted about…. amazon smile.

    1. Ian

      This is Dr greger’s advice

      ‘A regular, reliable source of vitamin B12 is critical for anyone eating a plant-based diet. Though deficiency for those starting out with adequate stores may take years to develop, the results of B12 deficiency can be devastating, with cases reported of paralysis, psychosis, blindness, and even death. Newborn infants of mothers who eat a plant-based diet and who fail to supplement may develop deficiency much more rapidly with disastrous results. Getting enough vitamin B12 is absolutely nonnegotiable for those centering their diets around plant-based foods.

      For adults under age 65, the easiest way to get B12 is to take at least one 2,000 mcg supplement each week or a daily dose of 50 mcg. Note that these doses are specific to cyanocobalamin, the preferred supplemental form of vitamin B12, as there is insufficient evidence to support the efficacy of the other forms, like methylcobalamin.

      As we age, our ability to absorb vitamin B12 may decline. For those over 65 who eat plant-based diets, the supplementation should probably be increased up to 1,000 mcg of cyanocobalamin each day.

      Instead of taking B12 supplements, it is possible to get sufficient amounts from B12-fortified foods, but we would have to eat three servings a day of foods each providing at least 190 percent of the Daily Value (on the Nutrition Facts label), with each serving eaten at least four to six hours after the last (based on the new labeling mandated to start January 1, 2020—the target is 4.5 mcg three times a day). For B12-fortified nutritional yeast, for example, two teaspoons three times a day may suffice. For most of us, though, it would probably be cheaper and more convenient to just take a supplement. ‘
      https://nutritionfacts.org/topics/vitamin-b12/

      The risks of inadequate B12 intake are well-established, On the other hand, there are no known levels of B12 intake that have been demonstrated to be toxic. Since some people have problems absorbing B12, a number of doctors including Dr Greger advise people to take more than the RDA of B12 to ensure that everyone’s needs are met.

    2. Hi, ian albert sangeles! Recommended Daily Allowances for vitamin B12 range from 0.9 mcg/d for toddlers to 2.8 mcg/d for lactating females. You can see the table of vitamin B12 RDA by age and gender here: https://www.nap.edu/read/11537/chapter/19 Those amounts probably need to be updated, however. More on that here: https://nutritionfacts.org/video/vitamin-b12-recommendation-change/ I hope that helps!

    1. jazzBass,

      You wrote: “Im thinking he asked how much to take, not how much we need?”

      I recommend that you reread the definition of RDA: “Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals”

      That refers specifically to how much to take: “daily level of intake.”

      Not absorption. Intake.

      That is how all the RDAs are set.

      Pretty clear.

      The absorption bugaboo has been used since the 1970s by the megadose vitamin people.

      Vitamin megadose recommendations have been disproven time and time again.

      Looks like nothing changes.

      jazzBass – do you remember who wrote Ecclesiastes?

      I hear he was a pretty smart guy.

      All the best –

      Vivamus

      ——————————

      The thing that hath been, it is that which shall be;
      and that which is done, is that which shall be done;
      and there is no new thing under the sun.

      Ecclesiastes 1:9

      1. Vivamus,

        If there is nothing new under the sun, then why are people trying, or paying attention to all these new diets that were invented in the last 100 years such as Keto, Atkins, Vegan, South Beach, Carnivore, Zone, Dash etc?
        2500 years ago Confucius had around 12 good food rules.
        Was there anything wrong with those 12 rules that people these days need to outsmart?

        1. Yerky,

          You wrote: “If there is nothing new under the sun, then why are people trying, or paying attention to all these new diets that were invented in the last 100 years such as Keto, Atkins, Vegan, South Beach, Carnivore, Zone, Dash etc?”

          Yup.

          ———————————————————–

          Rumor has it that Confucius was no dummy . . .

          I am not aware of Confucius’ 12 good food rules – but I would be delighted to learn.

          If you would be so kind as to enlighten us, I would be most grateful.

          Thank you,

          Vivamus

          1. Viva,

            You gotta go to your local library and enlighten yourself the hard way with sincere effort.
            But if you want quick enlightenment with no effort, then Confucius also said,
            Man who pounce on bedspring this Spring, have offspring next Spring.

            1. Yerky,

              Thank you for your kind guidance.

              Effort we have.

              Sincerity – I am content to let you be the judge.

              Recommended books?

              For now – the Internet will do.

              As I do not speak Chinese – I will start with what I can find in English. I concede – I do not know if these web sites give faithful renditions of true Confucian thought, or some sort of hybrid American Chinese restaurant version.

              Not that there is anything wrong with Chinese American restaurants. There was a time . . .

              But we live in a new era.

              There are warnings on Wikipedia that quotations said to be from Confucius are often misattributed. Prudence councils caution.

              It’s a beginning.

              I do not see anything that has not stood the test of time.

              2500 years, huh?

              Not too shabby . . .

              https://you.stonybrook.edu/babyface/confucius-on-dining-etiquette/

              https://helloworldciv.squarespace.com/blog/confucius-says-food

              https://sites.google.com/site/geoghuatzaiyah/4i-pure-geographers-page/confucius-discourses-on-eating-food

              Again – I do not see anything that has not stood the test of time.

              And I never knew that “. . . the eastward seat of the table is regarded as the most honourable . . .”

              Ya know – ya learn sumpin’ new every day.

              Yerky.

              All the best –

              Vivamus

            2. Hey Viv, I looked it up, it says 50 grams.
              I only ask because you wrote:

              “That refers specifically to how much to take: “daily level of intake.”

              Not absorption. Intake.

              That is how all the RDAs are set.

              Pretty clear.”

              Going by what you said then, I feel its important to let everyone know, that we should be finding ways to consume refined added sugar to that level.

          2. Vivamus,

            If you want to be enlightened, read the book, Cholesterol is not the Culprit, by Dr. Fred Kummerow.
            At age 102 he still had a full head of hair, smooth skin, smooth voice and sharp mind.
            He had over 460 published scientific food research reports and helped find a cure for the Pellagra disease and tried for over 50 years to get the FDA to get artificial trans fats out of the diet and finally was able to do so in 2015.

  15. Question: (and please no links, just think and summarize please)

    What about these total body scanning solons with medical consultation?

    Are they a direct cancer infusion waiting to happen?…and/Or complete quackery?

    1. Groucho.

      Nicholson.

      —————————-

      “Question: (and please no links, just think and summarize please)

      What about these total body scanning solons with medical consultation?”

      ——————————–

      Not medical advice. Merely informational. For medical advice, see your locally licensed M.D.

      jazzBass,

      Don’t have to think.

      Know.

      If you are talking about going to one of these without your own M.D.’s independent non-investor non-owner recommendation – I always suggest against.

      Always.

      Particularly if it is presented as a bargain.

      That’s the come-on. Like the free trip to Florida by the timeshare facility.

      ‘Cause there will likely be repeat scans at full price . . .

      That is the business model.

      If your Physician is recommending one – unless he has a specific reason to do so or is trying to root out a mystery ailment that has defied all efforts at rooting – you might wish to check on his credentials and follow his monetary interests – and you might wish to seek out the opinion of a second Physician.

      Obtained independently.

      I know about this. Trust me.

      This is a repeat telephone call situation with old friends and family.

      Calls to me.

      So far I have headed them all off at the pass. So far.

      I would guess that something about this smells funny, even to the layman.

      Haven’t had one of these pop up in years – I thought that they had all gone out of business.

      Along with the snake oil salesmen – faith healing – and talking in tongues.

      But I would put this in the same sort of category as the genetic analysis people and MTHFR.

      Or Vitamin megadosing.

      There are lots of reason not to do this.

      Alternatively:

      If you feel that you are in excellent Medical hands, and you find your locally licensed M.D.’s guidance compelling – I am content to stand down.

      There can only be one Captain of that ship. And that is the Man on the spot.

      jazzBass.

      Navigate carefully.

      The shore is on one side – the reef on the other – and the wind is gusting unpredictably –

      Vivamus

      1. Vivamus, Re: “The shore is on one side – the reef on the other – and the wind is gusting unpredictably –”

        Drop anchor and wait for a steady wind on the beam ;-)

      2. Ok if thats the summary, then…. I believe I did mention medical consultation in the original post. But I’m with you on this one, but the questions do arise.

        So, it appears you are saying that if a medical doctor has you get a scan then consults with you, it makes perfect sense to you, but if you get your own scan, and a medical doctor consults with you, then it is to be avoided.

        Re vitamin bugaboo:
        Hey Viv, why do medical doctors prescribe 50,000 vitamin D when the number is too low a comfort zone for them, and why do they advertise B12 shots in their waiting rooms?

        1. jazzBass,

          You wrote: “Hey Viv, why do medical doctors prescribe 50,000 vitamin D when the number is too low a comfort zone for them, and why do they advertise B12 shots in their waiting rooms?”

          I wouldn’t.

          I am content to sit back and let you take that up with them.

          All the best –

          Vivamus

    2. Jazzbass,

      Some people have solved their health concerns in a natural way as was explained by Ray Charles in the 1966 recording of
      “I don’t need no doctor.”
      And yes, that is a female named Carol Kaye playing the Fender Precision bass guitar with flat wound strings and a pick.

      1. Yerky I am hip to the magnificence of Carol, and…. you said it brother re: the Charles reference, no more arrogant and self absorbed a soul exists in these parts. I cant wait for every new installment of war and peace. Literally put in writing that he rewrote his own hipocratic oath to suit his emotional shortcomings of approval.

        I wonder if he knows this practice doesn’t have an opening?

        1. I am listening to Now’s the Time, and Confirmation by Charlie Parker. They called him Bird, because he loved to eat all kinds of chicken.
          Do you think that had anything to do with his musical genius and being considered as the greatest saxophone player of all time? Some people are focused on food only being related to health, not talent.
          But then again Art Tatum could play the piano better than almost anyone, yet had almost no vision.

          1. I heard 2 stories while studying, one was the chicken story but that one was also suggested of Jaco Pastorious with the concept of greasing up the strings to access his early prowess in hot clubs for 6 sets – and beyond. The other was because Parker had newly created a style which is still emulated today with flurrying passages (not to mention advanced unique harmonic concept) and so his solos were recognizable because if you think a bird playing and singing in a fountain or chasing a mate, and singing urgently, rapidly as some do, that was his sound too. An untrained ear though, erstwhile jazz aficionado, listening to a radio broadcast at the time could say: “Hey that must be bird!”

            Yes man Art was fast like that too!

            Hey check out Chris Potter to have your mind blown on where the saxophone has come because of Bird. A good one to A/B from both titans is Star Eyes .

            1. Potter is a great player and there are many incredible players but something mysterious has happened since the mid 1970’s.

              The recording technique went from analog to digital and all the soul, breath, life and excitement has seemed to vanish regardless of the musicians ability. The cruddy old analog tube technology from the past sounded better.

  16. I have a question about b12 supplements. Could the excipients be responsible for causing lung cancer? The excipient I’m thinking about is the colloidal anhydrous silica. Silica, silicosis, would this excipient cause problems? Microcrystalline cellulose i don’t know maybe that one too.

    1. Nobody knows. Silica appears not to have been studied in any depth

      Also, the links with lung cancer were primarily in male smokers. These sorts of things make great headlines but associations are just associations.

      It may just be that the male smokers who felt poorly or lacking in energy were the ones who took B12 supplements
      https://www.doctoroz.com/article/end-your-energy-crisis-vitamin-b12

      They would also have been the ones more likely to have undiagnosed lung cancer.

      1. I found this about it on a Google search. Citation:

        Solà, Rosa et al. “Silica in oral drugs as a possible sarcoidosis-inducing antigen.” The Lancet 373 (2009): 1943-1944.

  17. Don’t know if I missed this, only watched it once at the moment. If I get my homocysteine levels checked and they are low (I think you said below 10 is good?) does that mean that my B12 levels are automatically good as a result or do I need to test b12 levels as well to be sure?
    Thanks

  18. I hope my experience will help some others concerning the subject of B12

    I have been vegetarian for almost 35 years (female, age 67). Started out vegan but over the years some dairy crept into my diet–butter, cheese, yogurt–otherwise I ate lots of vegetables, whole grains, beans, all home cooked and almost no junk food. No supplements, even though at each (infrequent) doctor visit I mentioned that I was vegetarian and no doctor asked about B12 supplements, even a few who were themselves vegetarian.

    Over the years I noticed some symptoms such as more fatigue, shortness of breath on exertion such as hiking, etc, lots of respiratory infections and bronchitis, prickly sensations on my skin, increasing incidence of broken blood vessels in my eyes, and thinning eyebrows and facial hair. I attributed all of these to aging. But when all of my eyebrow hair fell out in one week’s time, I headed to the dermatologist.

    She ordered a thyroid test which came back normal. I followed up with two other doctors who shrugged their shoulders at all of this. Finally at a new dermatologist the young physician’s assistant ordered a full blood panel including B12 and MMA. The B12 was borderline low and MMA was high. Homocystine was not checked at that time.

    From these test results my primary care doctor (who originally questioned the need for the B12 test and was actually surprised at the results!) diagnosed pernicious anemia and I now take 1000 mcg of B12. My levels are now at the high end of normal and MMA and homocystine are low. All other tested levels are normal. I learned that people most at risk for pernicious anemia are women over age 60 with light skin and hair and Northern European ancestry. This description fits me exactly. People with pernicious anemia have trouble absorbing B12 so large doses are prescribed.

    Two years ago a friend loaned me “How Not To Die” and I dropped the dairy and oil from my diet. Most of the symptoms have at least partially resolved–even a few stray eyebrow hairs are growing back. When I stopped consuming dairy and oil my skin appearance improved and my digestion improved. Of course I don’t know for sure which symptoms are B12 related.

    I am of course relieved to have corrected the B12 situation before something worse happened. My mother, who was not vegetarian and who had many of these same symptoms, plus hypertension, died of congestive heart failure. She never had a B12 test and I think it is likely that she was deficient as well.

    One can’t change the past, but I am confident with the B12 and my improved diet (loaded with home grown greens) that my body will respond and begin to heal as much of the damage as possible. I feel it is worth the small expense to know your B12 levels no matter what type of food you eat.

      1. chickadee,

        Also – any change in deep tendon reflexes? Hyporeflexia? Hyperreflexia?

        Ever had a spinal MRI – say, for back pain? Anything said about B12 deficiency?

        If you ever do get an MRI, you may wish to mention – repeatedly, so that you know that the information definitely reaches the Radiologist supervising and reading the scan – the history of “pernicious anemia” and the history of “B12 deficiency.” You may wish to make sure that the Radiologist has been alerted prior to the scan – he may or may not wish to make adjustments in the
        scanning technique which cannot be made post scan.

        All the best –

        Vivamus

  19. I am interested to learn that Leonardo da Vinci was vegan. This is revealed in his diary Codex. I am not certain how some may think he had high homocysteine. Did he have health problems? I will easily agree upon his genius. Buuuuut, I cannot go along with the consensus that the Mona Lisa is a supreme work of art. There are many other masterpieces.

  20. Beans are rich in Molybdenum. Molybdenum is a mental health mineral. There was a study in China that people who lived in an area with high levels of Molybdenum in the soils had a greater chance of living to 90 than those that didn’t. Molybdenum is good for the mental illnesses and poorly treated mental illnesses. So beans should be good for mental illnesses because of the other nutrients in them. Better than just their Molybdenum. There is a lot of Nickel in green tea. Nickel was another element that helped people live to 90, like Selenium and Boron. Brazil nuts are rich in Selenium and Raisins are rich in Boron. Did you know that Boron can fight arthritis, and raisins in some form are thought to fight arthritis maybe more than the Boron in them? So beans, green tea, raisins, and Brazil nuts should help you live to 90, more than just the minerals in them. They are longevity foods because of Selenium, Boron, Nickel, and Molybdenum and the other more superior plant compounds in them. https://pubmed.ncbi.nlm.nih.gov/21153714/ Beans are thought to be good for brain health. Maybe even illnesses like schziophrenia and ADHD. It might be because of the Molybdenum in them and other more superior compounds in them. Molybdenum is very electronegitive and can scavenge the body mopping up bad compounds and oxidizing molecular debris.

  21. Vivamus,

    Thank you for the comments. I have not had an MRI for my spine but if I ever do I will remember your suggestions. I don’t normally have memory problems, but once in a while I might wonder what did I come into this room to do. I always attributed that to trying to do too many things at once. I do have low reflexes in my legs but not my arms. I didn’t know that might be related. I had to look up the definition of fasciculations! Very rarely when sleeping my body will jerk but that might be once every several years.

    1. Not medical advice. Merely informational. For medical advice, consult with your locally licensed M.D.

      chickadee,

      Sounds good.

      And thank you – most helpful.

      Full recovery timeline – things may continue to improve over a one year period since the initiation of Rx. Or so.

      That is just ballpark. Everyone is different.

      Your timeline? Does this fit with what you are seeing?

      B12 deficiency neuropathy case reports are all over the place on reflexes – anywhere from brisk to absent – hence the question.

      Why the wide span of reflexes – one can speculate, of course – but I cannot say for certain.

      I am happy to leave that to the Neurologists. They tend to be very good at what they do.

      Lower extremities tend to be more affected than upper extremities – so that fits.

      Other neurological signs may be present, as well. Your description of “prickly sensations on my skin” fits nicely. I hope that is resolving / has resolved.

      The eyebrow loss sounds more thyroid to me than anything – but you have been checked out. Could be lotsa things – we can leave that to others. You indicate that it is recovering, so – by Occam’s razor – B12 it likely is. The suddenness fits in with the way that B12 deficiency sx.s tend to be variably mild and gradual – but also to jump suddenly to center stage attention.

      Different sx.s with different people.

      Recovery may be total – or no. Stats are all over the place. What is important is you.

      It looks like you have avoided the worst. Good.

      I wouldn’t sweat the memory. What you are describing sounds typical of humans – particularly as we “mature.”

      I wouldn’t sweat the fasciculations.

      MRI – likely not indicated at this time.

      With luck – ‘most everything will be fine.

      It is certainly good of you to help by warning others via your example.

      Last question(s): some Rx. regimens for Pernicious Anemia focus exclusively on intramuscular B12. Others rely on intramuscular shifting to oral. Others a continuing mix. May I ask your Physicians’ approach?

      How often the follow-up?

      1000 mcg per day? Cyanocobalamin, methylcobalamin, hydroxycobalamin? Empty stomach? Sublingual or oral?

      Are you being monitored via serology or – ahem – other? Random or 24-hour?

      May I ask your country?

      ————————

      You wrote : “Two years ago a friend loaned me “How Not To Die” and I dropped the dairy and oil from my diet.”

      How does that fit into the timing of your illness?

      Much of “How Not To Die” is sound. The question of timing causes one to be thoughtful.

      Consider that B12 deficiency is a demyelinating disorder. Recovery involves remyelination. The myelin sheath, of course, is the fatty sheath surrounding the nerve cells.

      The following is not hard science – it is merely my own impression gained over a number of years.

      Over time – I have learned to trust such impressions. But I cannot prove this to you.

      It is my impression that significant exclusion of fatty foods is an excellent strategy when dealing with cardiovascular disease – but may exacerbate neurologic disorders.

      And there are times when neurological concerns outweigh cardiovascular concerns.

      My own gut says to go with moderate fat in your situation – say 20-30% by calories – with a spirit of variety and moderation.

      Unless contraindicated.

      If your ideology allows it – I would consider some animal content (say, 3 oz) twice a week or so.

      Again – this can be dismissed as unscientific – but Vivamus sometimes knows best.

      You do as you – and, of course, your locally licensed Physician – feel appropriate.

      From what I have seen, it is not uncommon for long term Vegetarians and Vegans to eventually hit a wall – bam! – and continue their explorations of diet and heath with other forms of Whole Food Plant Based diets – to good effect.

      The difficulties that you have experienced may not be entirely due to B12 deficiency – there remain many things about nutrition that we simply do not know.

      This may be a good time for reflection on such matters with a broadly open mind.

      —————————————-

      Your experience does illustrate one aspect of the Patient Physician relationship which I think is important to every person who pursues a plant based diet.

      Whenever I encounter a new Physician – first thing out of the gate – I note that I have been on a plant-based diet for many years, and request attention to B12 and iron.

      So far – the direct initial approach has served me well.

      If ever I found myself with a Physician who was dismissive of such concerns – I would persist – or seek out a different Physician.

      chickadee.

      All the best –

      Vivamus

  22. I had to look up fasciculations, too.

    I used to get them back decades ago when I was up all night editing films. Severe enough that I wasn’t sure if it was a seizure but when I looked at the epileptics around me, nope. Probably not a seizure.

    I got more of them when I was younger.

    I wonder why they have stopped. I also wonder if it is possible that I am getting more sleep now than I did back then.

    Is that possible?

  23. Deb,

    If they they have stopped – I would not be concerned.

    Speculation would be a bit of a game at this point.

    Time for sleep.

    Good night –

    Vivamus

  24. Vivamus,

    Again, thank you for the comments–very much to think about. I live in the United States in a remote area with limited medical resources. It was five years ago that the eyebrow incident occurred and I began my search for answers. It took about two years to find the doctor to help me pursue something other than thyroid tests. About one year later I read “How Not to Die”. So the exclusion of dairy and oil was about one year after beginning the B12 supplementation.

    I have been using blood tests to measure the B12 levels, usually yearly, though this year I have not yet followed up due to the virus concerns.

    I take 1000 mcg of cyanocobalamin daily, sublingual after breakfast. The doctor that prescribed this also prescribed 65 mg of ferrous sulfate per day. I thought this was rather high but I took it and after about a month I began to experience very disturbing heart palpitations. This doctor was retiring and I was not inclined to pursue it with him because of his dismissive attitude. An online search revealed that too much iron can cause heart palpitations, so I stopped the iron and they went away in a short time. I am also extremely sensitive to caffeine and cinnamon which cause palpitations, also.

    Pernicious anemia is now often referred to as megaloblastic anemia and my tests indicated a borderline high level of enlarged red blood cells. This causes some problems with oxygen delivery to the cells. From more online search I discovered that red blood cells are formed in the bone marrow but mature in the spleen. Forty five years ago I had my spleen removed due to an auto accident, so this might complicate matters.

    I will not say “never”, but at this point I doubt if I could even swallow meat, eggs or fish. I’ve tried–even the smell makes me queasy. I have been repulsed by animal foods since I was a child, though growing up in the “meat & potatoes” Midwest I begrudgingly ate small amounts of meat and never questioned not doing so. It was quite a revelation to me to discover that there were people who did not eat animal foods at all! I do eat nuts and seeds every day, almost every meal, as well as tahini and peanut butter and avocados when I can get good ones.

    I am looking forward to Dr. Greger’s series on B12 and I hope some of these topics are covered.

  25. chicadee,

    All understood.

    Timeline has helped

    There are additional issues.

    Let’s segue over to Wednesday’s bulletin board and put this board to rest so there is no need to monitor two boards.

    More to come –

    Vivamus

  26. SpectraCell Laboratories has a micronutrient test that they claim measures micronutrient status at a cellular level, as opposed to serum levels. Do you know anything about the SpectraCell micronutrient testing? Is this a reliable way to test for B12 and other micronutrient deficiencies?

    I tested high for homocysteine (12-13) and started supplementing with a B complex that included methyl-B12, methy-Folate, and more. My serum B12 rose from low to the higher end of normal. I then took the SpectraCell test. The report showed my cellular B12 levels to be low. My homocysteine was still high (no change). How long does it take for cellular levels of B12 to rise and homocysteine to lower? Should I be patient, or increase the dose?

    The SpectraCell report also showed low Serine. Their methylation chart seemed to show that high homocysteine could be linked to my borderline low levels of Serine. Should I supplement with Serine to lower my homocysteine?

    Final question, does B12 or homocysteine status have an impact on blood pressure?

    1. Hugh,

      Your elevated homocysteine levels could be from a combination of issues including, B6- B12- folate and/or betaine also known as trimethylglycine (TMG).

      You should also consider your thyroid and kidney function along with any medications your taking. As to the serine you’ll find this article of interest: https://pubmed.ncbi.nlm.nih.gov/11434358/

      And yes the elevated homocysteine levels may indeed have a distinct impact on your blood pressure over time. Remember for a really functional approach you wanting a homocysteine level of less than 8……

      Another consideration is that your needs, dependent on many factors, may be much higher than the standard RDA/DRI’s. Working with a physician to monitor and adjust your levels should result in a notable change in levels within weeks.

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

  27. For the serum tests, apparently I’m over 300 units above the maximum normal levels for B12. I’d definitely be interested in a functional B12 test.

  28. I understand the need to take Vitamin B-12 supplements. But, given that Dr. Greger has stated that the supplement industry is unregulated, and that (if I recall correctly) about 4 in 5 tested samples of off-the-shelf supplements do not contain what they’re supposed to and we basically cannot be sure that what we’re taking is actually the correct dose or even the right ingredients, how can we be sure to get the right amount?

    Is there any one brand that has consistently tested better than others? Or, failing that, should we pop pills from a dozen different brands and hope for the best?

  29. I supplement with what I think is plenty of B12 but it seems like getting the MMA test would be prudent. I called my doctor’s office to see if I could come in for the test without seeing my doctor since she knows I eat a WFPB diet and that I’m generally healthy. They refused to provide the test without me seeing the doctor first. I’m so frustrated with our medical care system since this just seems like an obvious money grab since every visit costs me $100 plus the cost of the test. I decided to pass. My health insurance is $7,000/year and this is what I get.

  30. Not sure if this point has been made raised elsewhere but the comments seem almost endless at times….

    Dr G, Is cyanocobalamin the best form of B12 to take? I know you say it’s the most stable. However Dr Chandry, an NHS GP in North East England who has been studying b12 deficiency for 40 years seems to think that it is not the best supplemental form. He states that methylcobalamin, adenosylcobalamin or hydroxocobalamin are all more likely to be more effective in the treatment of vitamin b12 deficiency than cyanocobalamin.

    http://www.b12d.org/blog/view?id=48

    Look forward to hearing from yourself and others with more information/knowledge than me on the subject of which form of B12 supplement is best for treating deficiency.

    Best Regards and many thanks for all the material and research.

    Al

  31. Dr. G always bases his decisions on high quality clinical research. Other’s don’t’ necessarily do that, often taking into consideration studies based on low quality lab data or even non-evidence such as anecdotal reports or even just personal opinions which often end up being wrong.

  32. Thanks for your reply Ben.
    With respect you haven’t answered my question though.
    Dr Chandy is a renowned health care professional who’s opinion is at odds with the establishment here in the UK. This is something that followers of Nutritionfacts can relate to I’m sure.
    I look forward to finding out more about b12 through this website and others. It’s so important for us on a vegan diet that I think we should devote more time to it.
    Here is a link to a film that some may find interesting and hopefully useful. I must admit that I found it mildly terrifying as well.

    https://youtu.be/BvEizypoyO0

    Best Regards

    Al

  33. I am unable to find B12 supplements that carry the certification thatDr Greger recommends. What brand should I look for? Also Dr Greger recommends cyanocobalamin over methylcobalamin. The stores carry mostly methylcobalamin. I wonder why.

  34. Hi, Rhonda K! I am not sure what certification you are talking about, and we do not endorse any brands or specific products here on NutritionFacts. The stores mostly carry methylcobalamin because there are a lot of internet ‘heatlh gurus’ claiming that it is superior, and so there is more demand for it. More on that here: https://nutritionfacts.org/questions/which-type-of-b12-is-best/ You should be able to find an appropriate supplement online, if it is not available in your local stores. I hope that helps!

  35. Hi Doctor Greger,

    I have been following your videos for quite a while now. What a superb job, thank you so much.
    In the masses of your many videos I haven’t been able to find answers to following questions though:

    – how much B12 (there are options between 2.5µg – 1000µg)
    – which types of B12 is better (Methyl-, Adenosylcobalamin and Hydroxocobalamin)
    – tablet vs. liquid vs. ?

    Thanks again and keep up your amazing work.

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