Preventing Brain Loss with B Vitamins?

Preventing Brain Loss with B Vitamins?
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One week on a plant-based diet can significantly drop blood levels of homocysteine, a toxin associated with cognitive decline and Alzheimer’s disease. Without vitamin B12 supplementation, though, a long-term plant-based diet could make things worse.

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By our seventies, 1 in 5 of us will suffer from cognitive impairment, and within five years, half will progress to dementia, in a progression from cognitive impairment without dementia, to dementia, and death. The earlier we can slow or stop this process, the better.

Although an effective treatment for Alzheimer’s disease is unavailable, even interventions just to control risk factors could prevent millions of cases. So, an immense effort has been spent on identifying risk factors for Alzheimer’s, and developing treatments to reduce them.

In 1990, a small study of 22 Alzheimer’s patients reported they had high concentrations of something called homocysteine in their blood. The homocysteine story goes back to 1969, when a Harvard pathologist reported two cases of children, one dating back to 1933, whose brains had turned to mush. They both suffered from extremely rare genetic mutations that led to abnormally high levels of homocysteine in their bodies. So, “Is it possible?” he asked, that homocysteine could cause brain damage even in people without genetic defects?

Well, now here we are in the 21st century, and homocysteine is considered a strong, independent risk factor for the development of dementia and Alzheimer’s disease. Having a blood level over 14 may double our risk. In the Framingham Study, they estimated that as many as 1 in 6 Alzheimer’s cases may be attributable to elevated homocysteine in the blood–now thought to play a role in brain damage, and cognitive and memory decline. Our body can detoxify homocysteine, though, using three vitamins–folate, vitamin B12, and vitamin B6. So, why don’t we put them to the test?

No matter how many studies find an association between high homocysteine and cognitive decline, dementia, or Alzheimer’s disease, a causal role–a cause-and-effect role–can be confirmed only by interventional studies.

Initially, the results were disappointing—vitamin supplementation did not seem to work. But the studies were tracking neuropsychological assessments, which are more subjective compared to structural neuroimaging–actually seeing what’s happening to the brain.

And a double-blind randomized controlled trial found that homocysteine-lowering by B vitamins can slow the rate of accelerated brain atrophy in people with mild cognitive impairment. As we age, our brain slowly atrophies, but the shrinking is much accelerated in patients suffering from Alzheimer’s disease. An intermittent rate of shrinkage is found in people with mild cognitive impairment. The thinking is that maybe if we could slow the rate of brain loss, we could slow the conversion to Alzheimer’s disease. So, they tried giving people B vitamins for two years and they found it markedly slowed the rate of brain shrinkage. The rate of atrophy in those with high homocysteine levels was cut in half. A simple, safe treatment can slow the accelerated rate of brain loss.

A follow-up study went further by demonstrating that B vitamin treatment reduces, by as much as sevenfold, the brain atrophy in the regions specifically vulnerable to the Alzheimer’s disease process. Here’s the amount of brain atrophy over two years in the placebo group; here’s the amount of loss in the B vitamin group. Less brain loss.

Now the beneficial effect of B vitamins was confined to those with high homocysteine, indicating a relative deficiency in one of those three vitamins. So, wouldn’t it be better to not get deficient in the first place? Most people get enough B12 and B6, but the reason these folks were stuck up at a homocysteine of 11 is that they probably weren’t getting enough folate, which is found predominantly in beans and greens. 96% of Americans don’t even make the minimum recommended amount of dark green leafy vegetables, the same pitiful number who don’t eat the minimum recommendation for beans.

In fact, if you put people on a healthy diet, a plant-based diet, you can drop their homocysteine levels 20% in just one week–up from around 11 down to 9. The fact that they showed significant homocysteine lowering without any pills, without supplements–even at one week–suggests that multiple mechanisms may have been at work. They suggest it may be because of the fiber. Every gram of daily fiber consumption may increase folate levels in the blood nearly 2%, perhaps by boosting vitamin production in our colon by our friendly gut bacteria. It also could be from the decreased methionine intake; that’s where homocysteine comes from. Homocysteine is a breakdown product of methionine, which comes mostly from animal protein. And so, if you give someone bacon and eggs for breakfast, then a steak for dinner, you can get these spikes of homocysteine levels in the blood. Thus, decreased methionine intake on a plant-based diet may be another factor contributing to lower, safer homocysteine levels.

The irony is that those who eat plant-based diets long-term, not just at a health spa for a week, have terrible homocysteine levels. Meat eaters up at 11, but vegetarians at nearly 14, and vegans at 16. Why? They’re getting more fiber and folate, but they're not getting enough vitamin B12. Most vegans can be classified as being likely to suffer from hyperhomocysteinaemia–too much homocysteine in the blood–because most vegans in this study were not supplementing with vitamin B12, or eating vitamin B12-fortified foods, which is critical for anyone eating a plant-based diet. But if you take vegans and give them B12, their homocysteine can drop down below 5. Why not just down to 11? The reason the meat-eaters were stuck up at 11 is probably because they weren’t getting enough folate. But once vegans got enough B12, they could finally fully exploit the benefits of their plant-based diets and come out with the lowest levels of all.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to WikiImages via Pixabay.

By our seventies, 1 in 5 of us will suffer from cognitive impairment, and within five years, half will progress to dementia, in a progression from cognitive impairment without dementia, to dementia, and death. The earlier we can slow or stop this process, the better.

Although an effective treatment for Alzheimer’s disease is unavailable, even interventions just to control risk factors could prevent millions of cases. So, an immense effort has been spent on identifying risk factors for Alzheimer’s, and developing treatments to reduce them.

In 1990, a small study of 22 Alzheimer’s patients reported they had high concentrations of something called homocysteine in their blood. The homocysteine story goes back to 1969, when a Harvard pathologist reported two cases of children, one dating back to 1933, whose brains had turned to mush. They both suffered from extremely rare genetic mutations that led to abnormally high levels of homocysteine in their bodies. So, “Is it possible?” he asked, that homocysteine could cause brain damage even in people without genetic defects?

Well, now here we are in the 21st century, and homocysteine is considered a strong, independent risk factor for the development of dementia and Alzheimer’s disease. Having a blood level over 14 may double our risk. In the Framingham Study, they estimated that as many as 1 in 6 Alzheimer’s cases may be attributable to elevated homocysteine in the blood–now thought to play a role in brain damage, and cognitive and memory decline. Our body can detoxify homocysteine, though, using three vitamins–folate, vitamin B12, and vitamin B6. So, why don’t we put them to the test?

No matter how many studies find an association between high homocysteine and cognitive decline, dementia, or Alzheimer’s disease, a causal role–a cause-and-effect role–can be confirmed only by interventional studies.

Initially, the results were disappointing—vitamin supplementation did not seem to work. But the studies were tracking neuropsychological assessments, which are more subjective compared to structural neuroimaging–actually seeing what’s happening to the brain.

And a double-blind randomized controlled trial found that homocysteine-lowering by B vitamins can slow the rate of accelerated brain atrophy in people with mild cognitive impairment. As we age, our brain slowly atrophies, but the shrinking is much accelerated in patients suffering from Alzheimer’s disease. An intermittent rate of shrinkage is found in people with mild cognitive impairment. The thinking is that maybe if we could slow the rate of brain loss, we could slow the conversion to Alzheimer’s disease. So, they tried giving people B vitamins for two years and they found it markedly slowed the rate of brain shrinkage. The rate of atrophy in those with high homocysteine levels was cut in half. A simple, safe treatment can slow the accelerated rate of brain loss.

A follow-up study went further by demonstrating that B vitamin treatment reduces, by as much as sevenfold, the brain atrophy in the regions specifically vulnerable to the Alzheimer’s disease process. Here’s the amount of brain atrophy over two years in the placebo group; here’s the amount of loss in the B vitamin group. Less brain loss.

Now the beneficial effect of B vitamins was confined to those with high homocysteine, indicating a relative deficiency in one of those three vitamins. So, wouldn’t it be better to not get deficient in the first place? Most people get enough B12 and B6, but the reason these folks were stuck up at a homocysteine of 11 is that they probably weren’t getting enough folate, which is found predominantly in beans and greens. 96% of Americans don’t even make the minimum recommended amount of dark green leafy vegetables, the same pitiful number who don’t eat the minimum recommendation for beans.

In fact, if you put people on a healthy diet, a plant-based diet, you can drop their homocysteine levels 20% in just one week–up from around 11 down to 9. The fact that they showed significant homocysteine lowering without any pills, without supplements–even at one week–suggests that multiple mechanisms may have been at work. They suggest it may be because of the fiber. Every gram of daily fiber consumption may increase folate levels in the blood nearly 2%, perhaps by boosting vitamin production in our colon by our friendly gut bacteria. It also could be from the decreased methionine intake; that’s where homocysteine comes from. Homocysteine is a breakdown product of methionine, which comes mostly from animal protein. And so, if you give someone bacon and eggs for breakfast, then a steak for dinner, you can get these spikes of homocysteine levels in the blood. Thus, decreased methionine intake on a plant-based diet may be another factor contributing to lower, safer homocysteine levels.

The irony is that those who eat plant-based diets long-term, not just at a health spa for a week, have terrible homocysteine levels. Meat eaters up at 11, but vegetarians at nearly 14, and vegans at 16. Why? They’re getting more fiber and folate, but they're not getting enough vitamin B12. Most vegans can be classified as being likely to suffer from hyperhomocysteinaemia–too much homocysteine in the blood–because most vegans in this study were not supplementing with vitamin B12, or eating vitamin B12-fortified foods, which is critical for anyone eating a plant-based diet. But if you take vegans and give them B12, their homocysteine can drop down below 5. Why not just down to 11? The reason the meat-eaters were stuck up at 11 is probably because they weren’t getting enough folate. But once vegans got enough B12, they could finally fully exploit the benefits of their plant-based diets and come out with the lowest levels of all.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to WikiImages via Pixabay.

Doctor's Note

This is very similar to the findings in my video Vitamin B12 Necessary for Arterial Health.

For more details on ensuring a regular reliable source of vitamin B12:

There are more benefits to lowering your methionine intake. Check out Methionine Restriction as a Life Extension Strategy and Starving Cancer with Methionine Restriction.

For more on brain health in general, see videos such as:

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

151 responses to “Preventing Brain Loss with B Vitamins?

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  1. I need to dilute my B12 in order to make dosage a bit easier to control. Is there a better powder to mix it with that confectioners sugar? Something that I don’t have to mail-order?

    As it is 1/32 of a tsp is 80mg.




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      1. Exactly. I’m shooting for 2500-5000mcg once per week, but need to bulk it up in order to get enough to measure. Yeah, I forget that changing my FB profile pic changes my avatar over here. No telling what will be next. That one is a mobile selfie on a bumpy back road, blurred at full res. Because.




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      2. Joseph,

        Are the methylated forms of B6 and folate harmful in vitamin supplements? I am considering trying out a B12 supplement that also contains B6 and folate (in mehtaylated forms), hoping this helps as regular B12 supplements don’t help me, and sometimes cause nerve pain in hands and feet (by the way, my folate blood levels are super high and i have not supplemented folate via food or pills in decades.) Any science of a small dose of B6 being safe? Large dose harmful, I know.




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  2. Hmmm, I wonder how Okinawans stayed so healthy being on a near plant-based, nutrient rich diet if the number of animal products they eat are so low?




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    1. Even the minimal amounts of fish and shellfish they ate contained B12 in a rich pure form. A lifetime of eating creatures from the ocean, even in small amounts, probably added up. My guess. And they also ate pig, yet in small amounts, and this probably added up over time to contributing to B12. These people had bodies that were constantly exposed to cholesterol, their organs had to process animal products. It seems to be there might be a synergy with nature. Any early vegans ate bugs, worms, insects, all that stuff, (full of blood, cholesterol, digestive organs (poo, pee!) complete proteins, B12) even if it wasn’t intentional. It was slathered allover the plants growing in nature and they ate away without removing all these creatures.




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      1. With the B12 issue in mind, I try not to be too fastidious about cleaning the food I pick from the garden. (So maybe some bugs, dirt, but no chemicals!) Am I “torturing” myself unnecessarily or is it a good idea? lol… Anyone?




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        1. Frankly, as Dr. Greger suggest is far safer to just take Vit B12.

          You are gambling getting parasites there. (Nor you know if you are getting enough B12)

          In other times people had no options, but now we have the best of both world, no need to risk getting malaria from bacteria in water, nor parasites from soil, just to get Vit B12… you can cheat and get a safe, reliable source these days. :)




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    2. They probably do quite often what Grandpa and I did in 1952. Out in the garden, pull a carrot, wipe it off on Grandpa’s pantleg, and eat. People don’t do that anymore.




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      1. Yes, I agree JoAnn. B12 doesn’t come from animals. It comes from bacteria in the soil. Cows, pig, and sheep don’t care that much if theres’ a bit of dirt in their food. They can’t clean it. If you grow your own food organically, you don’t have to worry about the soil, and you can just be a little lean hyper-clean. It helps with asthma and gut bacteria too.
        John S
        PDX OR




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    3. Maybe it’s the sweet potatoes? At least that is what Dr. Barnard always mentions when we talks about their longevity. I am sure it is a mix of healthy lifestyle factors and diet. Dr. Greger talks about this more in his longevity blogs and videos. “This may also help explain the longevity of populations like the Okinawa Japanese, who have about half our mortality rate. The traditional Okinawan diet is only about 10% protein, and practically no cholesterol, because they ate almost exclusively plants. Less than one percent of their diet was fish, meat, eggs, and dairy – the equivalent of one serving of meat a month and one egg every two months. Their longevity is surpassed only by vegetarian Adventists in California, who have perhaps the highest life expectancy of any formally studied population in history.”




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      1. Sweet potatoes and possibly the beans. All the Blue Zones with their extraordinary longevity and health have one food in common – beans of one kind or another.




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      2. Thanks for those stats Joseph. I’ve been asked how much animal protein the Okinawans ate and have been unsure exactly. Though they were not “formally studied”, out of some of the longest and healthiest lived populations documented, ( the Abkhasians and Vilcabambans included), there are actual birth certificates for the Okinawans, showing some of them living until 130 years! It’s unfortunate now that many of the grandparents are burying their grandchildren due to the introduction of the SAD eating practices into their culture. John Robbins book, “Healthy at 100” is an excellent read on this!




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        1. VegCoach: You say that Okinawans were not formally studied. I’m not sure what you mean by the term, but below is information that I copied from a post from Rami. The post shows results of a study of the Okinawan diet in 1949 based on well over 2000 people. The numbers in parentheses are % of calories. Thought you might find this helpful.

          ——————————–
          Back in the 1950’s the Japanese rural Okinawan group of people had the most centenarians per capita. How did they live so long? Here is their diet:

          Caloric Restriction, the Traditional Okinawan Diet, and Healthy Aging
          The Diet of the World’s Longest-Lived People and Its Potential Impact on Morbidity and Life Span
          Ann. N.Y. Acad. Sci. 1114: 434–455 (2007).

          TABLE 1. Traditional dietary intake of Okinawans and other Japanese circa 1950
          Total calories 1785
          Total weight (grams) 1262
          Caloric density (calories/gram) 1.4

          Total protein in grams (% total calories) 39 (9)
          Total carbohydrate in grams (% total calories) 382 (85)
          Total fat in grams (% total calories) 12 (6)
          Saturated fatty acid 3.7
          Monounsaturated fatty acid 3.6
          Polyunsaturated fatty acid 4.8
          Total fiber (grams) 23

          Food group Weight in grams (% total calories)
          Grains
          Rice 154 (12)
          Wheat, barley, and other grains 38 (7)

          Nuts, seeds Less than 1 (less than 1)
          Sugars 3 (less than 1)
          Oils 3 (2)

          Legumes (e.g., soy and other beans) 71 (6)

          Fish 15 (1)
          Meat (including poultry) 3 (less than 1)
          Eggs 1 (less than 1)
          Dairy less than 1 (less than 1)

          Vegetables
          Sweet potatoes 849 (69)
          Other potatoes 2 (less than1)
          Other vegetables 114 (3)

          Fruit less than 1 (less than 1)
          Seaweed 1 (less than 1)
          Pickled vegetables 0 (0)
          Foods: flavors & alcohol 7 (less than 1)

          Data derived from analysis of U.S. National Archives, archived food records, 1949 and based on survey of 2279 persons.

          More from Rami: “Some points: Their diet was 85% carb, and 6% fat. Sweet potatoes (a Japanese sweet potato) made up almost 70% of their calories. Nuts were less than 1% of calories (the equivalent of 1/10 of an ounce a day) Oil was less than 2% of calories (which is about 1 tsp a day) and sugars were less than 1% of calories (less than a tsp a day)
          The total animal products including fish was less than 4% of calories which is less then 70 calories a day. That is the equivalent of around 2 oz of animal products or less a day.”




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          1. Hi Thea, Thanks so much for that info. I was simply responding to Joseph, who said that the Adventists were the longest-lived of any “formally studied” population. Perhaps we should ask him what constitutes an official “formal study”. I’m pretty sure the Okinawans lived longer than the Adventists, so deduced they must not been in a “formal” study. Perhaps he means that the Okinawans were studied in an epidemiological sense, but not in a controlled systematic lab double-blind, (etc.) sense.




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  3. Can a Homocysteine test thus serve as a great test for B12 levels in plant diet eaters? But what if you and a blood test for B12 already and the level appeared very good? Is there any reason to be concerned regardless?




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    1. Yeah, your blood level of B12 might be high but it might not mean the body is using it and absorbing it into the cells.

      Homeocysteine and MMA levels determine this, in my experience. And “fake” B12’s (spirulina, etc.) will show a high B12 when you test the blood, but this doesn’t mean the body is receiving true bioavailable B12. I suppose the same goes for some B12 supplements.




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      1. I recently had a “hemagram and differential” and “comprehensive metabolic panel” so do either of those usually contain a homocysteine test or maybe another test that serves as a good indicator for homocysteine? I additionally had folate and b12 tests in that group of tests. The looked good too. (Is higher always better for those?)




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          1. Thanks for exact references. I probably don’t need those tests however as my B12 nearly hits the high end of the range and folate apparently off the chart at >24.0 with good levels starting at 5.4 ng/mL.




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          1. I watched this video again. Thanks. I don’t use any of those supplements so looks like I’m good there. I might seem very knowledgeable but really I’m just good at spotting the fakers. :)




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    2. Not necessarily, One can also depress homocysteine by consuming a lot of betaine (mostly from beets and spinach), which may make homocysteine unreliable. Dr. Greger comments on the methylmalonic acid and holotranscobalamin B-12 tests in this video.




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      1. But the person should not assume this with work and therefore not get the blood level tested. I tried this and it did not work. I had to add in some fish and crustaceans, as for me it was a B12 issue and the pills did not lower Homocysteine, nor high consumption of beets or greens. But I think all vegans should get tested, and sooner rather than later, for homecysteine and MMA in order to truly judge the merits of their B12 status as well as any possible detrimental effects occurring in body due to unknown high homecysteine levels (unless one gets checked). I think some folks are high in homocysteine due to lack of the folate, and for others it is the B12 issue, but just assuming all is fine without these blood tests seems like long-term russian roulette for vegans.




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        1. Wouldn’t homocystine levels be higher on a diet high in methionine (which would be egg whites, also eggs, beef, chicken, salmon? I’m vegan and my level is 6.4 which I believe is good?




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      2. Let’s me say that I was discouraged about inquiring into more tests by reading Andrew Weil’s webpage on the topic. He says the test often isn’t covered by insurance, doctors rarely agree to it, and it costs $100. Now, let’s see if Dr Greger’s vid enlightens…




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        1. The tests still doesn’t seem necessary. If low levels are found by those tests (mma, the newer test, etc) the solution is to take supplements. I already take supplements.




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          1. I would still make sure MMA is tested if your doctor feels you may be low in B12. Better safe than sorry in my opinion, as it is such an important vitamin!




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            1. My doctor isn’t really concerned about this at all. She only ordered the B12 at my suggestion. Anyway. That test put me on high edge of the range, so she has more reason to not be concerned. Folate was off the chart high. But if I could confirm that it’s easy to get private tests and it’s not costly, I’d do it in a second.




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              1. Tobias: I once had a similar question. Here is the response that I got back from “suepy”:

                “Dr Mark Hyman, author of The Blood Sugar Solution, recommends going to this website for self testing: http://www.saveonlabs.com/ which uses Quest Diagnostics, or you could go to http://www.walkinlab.com/ which uses Labcorp.”

                I haven’t actually tried it yet myself. But being able to get whatever info I want about my own body when I want it is really appealing. I don’t think I should have to get permission to find out a key measurement of my body composition. Especially if I’m willing to pay for it. I’m sure I’ll be using something like the above companies at some point in the future.




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                1. This Hyman dude is the one who took over as Bill Clinton’s dietary adviser after he’d been in the care of Dean Ornish. Converted him from a plant diet. E V I L. :)




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                  1. I’m no fan of Hyman. But no one’s wrong about everything. He suggestions for self-serve labs may be good. At the moment, it is the only suggestions I have to go on.

                    Are you saying that Bill Clinton isn’t doing the vegan diet any more? If so, that’s news to me. How sad.




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                    1. Yes, Bill is OFF vegan. And Hyman too over. He plays it in the exact middle, I believe. (Like the moderation argument, not quite paleo.) Hillary never started and it shows. I’m pretty sure that Chelsea is mostly whole plant, but maybe less of late.




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                    2. How disappointing. But thank you for letting me know. That way I won’t get caught off guard if the subject comes up in future conversations.

                      Cynical Speculation: I wonder if the change had anything to do with Hilary running for president? Is it possible that being on a vegan diet is so controversial (and animal product lobbies so powerful) that they felt they had to eliminate that issue as a potential problem? Because the only other theory I have is that Bill is so wishy-washy and unable to do his own critical thinking that he is swayed by whichever expert he happens to be talking to. Because why else would Bill go from a diet that cured him of his medical problems back to one that got him in trouble in the first place? It makes absolutely no sense to me. I doubt Bill is really like that. It seems more likely to me that the political angle had more to do with it.

                      Just my thoughts on the matter. Obviously, I have no clue on what is really going on.

                      Thanks again for the info.




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                    3. I face a related situation in my home state of Vermont where Sen. Bernie Sanders is running for US President. I strongly support him. But… He serves free ice cream at events. He’s very friendly with Ben & Jerry, the ice cream guys who’ve supported Bernie for a long time. One of Bernie’s biggest issue is climate change. However, he’s likely politically blinded by this, not able or not willing to make the connection between the ice cream he serves and the climate issues he cares so much about, when actually the two issues are so very closely related, as far as I can tell. (Methane gas from animal food production industries apparently rivals CO2 gas as a warming agent.) Vermont prides itself in its dairy industry. The Cabot Co-op (famous cheese makers) represents much needed employment opportunities.

                      I don’t know how we deal with the vast complexities of our present world.




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                    4. What I just wrote to Bernie:

                      Talk of crises in America. What about the health crisis? I’m from Vermont. I was born there. smile emoticon I live there. I support Bernie. I have a question or maybe an observation. Bernie serves free cow’s milk ice cream at events. He’s very friendly with Ben & Jerry, the ice cream guys who’ve supported Bernie for a long time. One of Bernie’s biggest issues is climate change. However, does he see the direct connection between the milk-based ice cream that he serves and the climate issues he cares so much about? The two issues are very closely related, as far as I can tell. Methane gas from animal food production industries apparently rivals CO2 gas as a warming agent. Vermont prides itself on its dairy industry. I know. My own father ran a dairy in Jericho in the 40s. The Cabot Co-op (famous cheese makers) represents much needed employment opportunities. I know. I use to eat that cheese. But, yes, I went strict vegetarian 3 years ago. So, what gives? Anyway. Beyond this, there is a lot of evidence that shows that shifting to diets based almost entirely on plant foods could dramatically improve the health of people in the US (and everywhere in the world) and cut national health care costs dramatically by reducing rates of degenerative diseases (heart disease, cancer, etc). A total conversion could represent, by estimates of credible researchers, of 70 to 80% of medical costs. Anyway. Dairy is a Vermont industry of the past. Jericho had 40-50 farms in the 40s. There are two now. So, maybe focus on shifting Vermont’s economy to a plant diet friendly state, a leader, an outdoorsy, health promoting state. Find new ways to produce our own crops on those old farms. Find ways to get the costs of quality produce down. Find ways to make it work. The money we spend on health care… imagine if it went into developing food independence instead. Millions and millions invested in our people to find better ways to feed us.




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                    5. Right on, Tobias! Berries not Dairies! I, too, like Sen. Sanders and his messages. At the very least, he will shame Hillary into at least sounding more left-leaning than she actually is. I would really like to see a Sanders/Warren ticket. Elizabeth Warren is a real scrapper and would amplify Sen. Sanders’ populist message. The idea of yet another Bush/Clinton election is too horrifying for words.

                      One thing you could add to your message is to appeal to Bernie’s sense of racial justice by reminding him that most Americans of African descent are lactose intolerant, and the idea of foisting cow’s milk on them is unjust. As for Ben & Jerry, I would give Sanders a pass until he can progress in his campaign. That said, why doesn’t Ben & Jerry make a vegan-friendly frozen treat? Maybe they do, but I rarely go down the frozen food aisles anymore so I really would not know.




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                    6. This is an excellent point about ice cream being even more unhealthy for black Americans. Secondly, I seem to recall that Ben & Jerry’s, which was sold to Unilever though maybe Ben & Jerry has some influence on new flavors still.. .yes, they are coming out with their first non-milk product. They are deciding between almond and coconut milk I believe as the milk base. Yes. Confirmed. They’re working on it quite diligently. Though new flavors will appear, I will assume they will remain mostly quite unhealthy for humans except on a limited basis, more standard American diet vegan food. Still unhealthy in general. Poor Ben & Jerry. They both look reasonably healthy but I bet their arteries are filled to the gills with mud.




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                    7. Nice letter Tobias. Have you seen Cowspiracy? I live in California and as I am sure you know we have some water issues. After watching that documentary my husband went vegan. He hates to be messed with.




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                    8. No. I’ve allowed the Internet to destroy my taste for watching longer video productions. Seems like I’ve gotten the basic idea w/o watching any of those, I imagine, excellent films. Beyond this, I don’t like to expose myself to horrifying images. I get it really well in a few paragraphs of text. Congrats on your husband going for it.




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                    9. Veganrunner: I found Cowspiracy to be very powerful. But I was thinking that the message might be too much for many people to take in. Good for your husband for being able to take it that information and then act on it. I bet you are happy because you will be getting a healthy husband out of it!




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                    10. Tobias: I appreciated both of your posts on this topic. I think the key is this part: “…deal with the vast complexities…” On one hand, it would be way better if Sen. Bernie Sanders was consistent between what his campaign does and what he claims to support. However, I find that there is no such thing as a perfect candidate. So, I just try to find the best fit. (I’m not saying Sen. Sanders is or is not a best fit for me personally or anyone else. I’m just making a point.)

                      When it comes to situations like the one you describe, I try to take solace in what happened with Al Gore: For several years, he just couldn’t bring himself to make the connection between food and climate change. But now (at least last I heard), he has finally gone vegan. And when asked about why The Inconvenient Truth didn’t talk about the animal industry, I have heard that he said/says something like, ‘It was just too inconvenient…” The point being: perhaps Sen. Sanders will wake up some day too just like Al Gore did. And in the mean time, maybe Sanders will start serving the non-dairy Ben and Jerry’s at his functions when those options become available. I think that would be awesome and maybe your letter will help make that happen.




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                    11. I’ve been developing my understanding of all these related matters a whole over the past few weeks. The longer I remain on the good path of plant diet health the more clearly I see the extreme depth of the problem yet also the hope that some people will get the message.




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                    12. re: “The longer I remain on the good path of plant diet health the more clearly I see the extreme depth of the problem yet also the hope that some people will get the message.”

                      Perfect. Beautifully said.




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                    13. Thanks for the references to the two labs. I’m slowly trying to process this information. I’m quite concerned because I’ve been trying to resolve a “tiredness” problem with my doctor the past few months. Panels all were fine. Anyway. There’s a concerning discussion going on about this issue at John McDougall’s site now,

                      https://www.drmcdougall.com/forums/viewtopic.php?f=1&t=48860

                      I really wish we had a one-stop information center on this issue. I guess the basic advice is to get those two or three special tests whatever it takes. Meanwhile, if you have any reasons to be concerned, don’t wait to start with a pharmaceutical grade B12 supplement. (Not sure what that is exactly.) This can help but ultimately if those extra tests raise alarms, shots might be required, daily, then week, etc etc for the rest of your life. And all this concerns meat eaters as well. They too can have issues w/B12 absorption.




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                    14. Tobias: Thanks for sharing that link. Wow. I feel bad for that person and grateful that he took the time to share his story. It is indeed a cautionary tale. And I think you are right to be looking into this.

                      Of course, there are other reasons someone may be feeling tired (and of course cases where multiple reasons are involved, making it really hard to figure out). I’m not an expert, but in addition to looking at B12, I suggest considering checking out: iron levels and making sure you are getting enough calories.

                      I sure hope you are able to figure it out soon. As the person discovered in your link above, it is possible you will have to figure it out on your own. Either way, I’m keeping my fingers and toes crossed for you.




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              2. A serum B12 test IS a reliable and inexpensive test. If it’s low, you’re pretty sure you’re deficient in B12. Now if you are vegan since a few years and the test is high without you supplementing with B12, it may be because of B12 analogue (B12-like molecule) probably coming from sea weed (include spirulina and so on) which are not biologically active form of the vitamin. The answer to both of this issue are still the same: pharmaceutical grade B12 supplement. Make sure you follow Dr. Greger recommendations 5000 mcg weekly or 500 mcg daily and everything will be ok, don’t bother with 5 mcg or 10 mcg supplement, because it might not be well absorbed with age (over 50 years, according to the Institute of Medicine). MMA and Homocysteine are good test for the proper diagnosis of pernicious anemia, both can be elevated even when a serum B12 is moderate to high, mostly in elderly though. B12 shot are only necessary in case of overt deficiency or pernicious anemia (absorption problem also known as Biermer’s anemia).
                Hope this is helpfull.
                In Health, Adrien.




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                1. In addition to taking a couple of 1000 mcg B12, I use nutritional yeast liberally on a daily basis. It seems that the Bragg’s brand has lots of b12 however I use a bulk brand now and I have never asked the store owner to see the ingredients list. Maybe B12 is simply a standard additive in most nutritional yeasts.




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              3. You are dropping the ball. Get your M.M.A and Homoccyst. tested regardless of what your good doctor
                thinks. Your high B12 level might not be reflecting if your body is utilizing B12.




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                1. Yes. I really need some prompting on this one. I didn’t see a doctor for 15 years in my recent past. I have a doctor now… Anyway. My b12 signs are good. I’m supplementing with b12. Remind me of why I need to get more testing. :)




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        2. Tobias: you can get most blood tests done now without the involvement of a doctor and it’s not very expensive either. Last year I got B12, folate, and lipid levels tested and I think i paid less than $50.




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          1. My doctor had all of those tests done for me. It’s part of my insurance plan.
            They all look fine so I’m loath to be concerned, yet maybe I should be.




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      3. I eat plenty of greens and beans, so I suppose I get enough folate. Whien I started supplementing with B-12 lowered my homocystine a little, but it wasn’t until I took betaine supplements (also called trimethyl glycine) that my homocystine dramatically reduced.




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        1. Chris, I eat plenty of greens and beans, too, and have total cholesterol of 135 (down from an adult lifetime average of 180, after giving up fish two years ago…my last vestige of animal protein). But my homocysteine level has risen from 8 to 9.7 over past 5 years. I’m 52, don’t drink coffee, walk, weight-train, do yoga…healthiest lifestyle possible. Tested negative for MTHFR mutation. My “wellness doc” would like my level to be in the 6 range and has me on 500mcg methylcobalamin daily as well as something called Homocystrol + TMG (a Douglas Labs product), of which 3 capsules provide 1000mg trimethyl glycine. How long did it take to see your homocysteine levels decrease, and what did they go from/to, if you don’t mind sharing that info? Thanks!




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    1. Lots of people have trouble utilizing the synthetic folic acid used to fortify foods. Real foods, like leafy greens and beans, contain the usable form of folate.




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    2. “Fortification” doesn’t always equate to “useful nutrition”. I try to avoid “fortified” foods because it’s generally sign of heavy processing and trying to replace some of the good stuff that was removed. Whole Food Rulz.




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  4. Another power-packed video with lots of new information! I wasn’t aware that homocysteine was associated with dementia or methionine intake, nor that fiber increases folate levels in the blood. Question: IIs a daily multivitamin with 12 mcg B12 enough or should vegans take larger doses?




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      1. In this video and on NutritionFacts.org , Dr. Greger recommends cyanocobalamin. His justification for the choice is economy and stability. My concern with cyanocobalamin is that it is not a naturally occurring compound.




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    1. Hmm…in my nutrition class, I learned that high homocysteine levels is also associated with CVD. After watching this video, I really have to be strict with B12 supplementation




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      1. The view on homocysteine and CVD has changed recently. Homocysteine lowering vitamin trials have no effect on CVD events/mortality (1), and genetic predispositions to higher homocysteine aren’t predictive of cardiovascular risk (2, 3), casting doubt on the assumption that homocysteine plays a causal role. Some researchers have looked to high methionine intake (4, 5) and low folate intake (6, 7, 8, 9), which increase both atherosclerosis and homocysteine, as the real reasons for the association.

        With respect to dementia, the jury is still a big maybe for a causal role for homocysteine. For Alzheimer’s, a common genetic predisposition to higher homocysteine wasn’t associated with risk in Caucasians, but was in East Asians (10). For vascular dementia and this same gene, there was again no association in Caucasians and Indians, but a robust one in East Asians (11).

        BTW, these genetic disposition or Mendelian randomization studies are utterly fascinating, if you’re curious about how modern medical science is distinguishing causal risk factors from coincident ones (12.




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        1. The neuroprotective effects of homocysteine-lowering B vitamins seems only to be observed in poeople with above-avarage plasma levels of EPA/DHA (significant interaction in post-hoc analysis), raising the hypothesis that they excert their effects by facilitating the metabolism/tissue distribution of HUFAs:

          http://www.nutri-facts.org/eng/news/detail/backPid/1/article/benefits-of-b-vitamin-supplementation-in-reducing-the-effects-of-mild-cognitive-impairment-in-elderl/

          (I hope I’ll be forgiven for linking to NutritionsFacts evil DSM-twin, but as a matter of fact they often provide fine mini reviews)




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    2. You should take more. I’ve heard ~1500 mcg once a week is enough, I take 2 a week (one Saturday and one Wednesday) just to be sure.




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  5. If vegans have to take supplements to get b12, does it mean eating animal products is the natural diet for humans?
    Is it possible humans got enough b12 from other sources in the past? Is their any science on this?




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    1. Before they started chlorinating the water supply, water had B12. When people grew their own vegetables and ate them without “triple washing” them, they got B12 from vegetables due to soil residues. Vegans’ being unable to get B12 from food is a result of modern living.




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      1. So for all of us rural folks (lots and lots of us) who yet get our water from wells and springs and grow our own vegetable and harvest from the wild, we are likely getting all the B12 we need. BUT THAT no one has any information on that subject because it might cut into the sales of B12 supps. And really it shall be moot for me soon enough as I’ll be using rainwater only when I move off this stinkin’ grid. If I had money to burn, I’d get my blood tested and my water tested and all of that.




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    2. Hi Jongreen. I think it’s hard to say. There is some discussion about the matter here. Please follow this link to read the many comments within the thread.




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    1. Are your D3 levels normal with only modest supplementation? I found my body had good use for extra D3. The minimums recommended may be low for many healthy individuals.




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      1. I had it tested last year and my vitamin D was 35, (normal range is 30-80) so I went from 1000 IU every day to 2000 IU. I am going in again this year and will have it tested again.




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  6. hi, I have been following dr. greger’s recommendation for b12 supplements of about 250 mcg/day. however, my neurologist told me last week that as a vegan with multiple sclerosis I needed 2,500 mcg/day. that’s 10 times more! I don’t know what to think about this. will I just manufacture some expensive pee with this high dose?
    Olga in DC




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    1. Hi olga. I am not a health-care professional. That said, I am guessing you have already seen this video in which Dr. Greger goes through the math of taking 2500 mcg/week of vitamin B12
      http://nutritionfacts.org/video/cheapest-source-of-vitamin-b12/
      You can scale that up to 2500 mcg/day and see what’s what.

      Also, I did a quick google search on vitamin B12 and MS and this paper popped up:
      http://www.ncbi.nlm.nih.gov/pubmed/1430153
      If you rummage around Pubmed I’m sure there are others.

      Bottom line, if I were in your shoes I would follow your neurologist’s advice. There doesn’t seem to be a downside and the upside for you may be considerable. All the best and good luck!




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      1. Hi Lawrence. Thanks a lot for your answer and links. That NIH paper is interesting. I actually see a specialized MS researcher there once a year and she hasn’t mentioned B12. At least she isn’t against vegan lifestyle and doesn’t push medication on me. I’m grateful for that and also for the excellent service at NIH.
        So I guess I will go with my non-NIH neurologist for the B12 dose.
        Thanks again and good luck to you too!
        Olga




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    2. Hi Olga. We have not seen any research that says more B12 is better for MS. I agree with you, since there is no upper limit, taking more should be just fine. As Lawrence said I would listen to your doctor, as there may be an underlying reason we’re not aware why she or he is prescribing more B12. Here is a suggestion for the cheapest source of B12.

      Best to you,
      Joseph




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  7. Do I still need methylated B’s ESP folates (due to genetic polymorphism) if I also eat whole food veg? Also have ms. Ie will I get enough folates from diet without methylated supplements? (I know the science is not yet established in this area)
    Thanks !




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    1. Folate deficiency is not a problem in vegetarian diet. The problem is vit B12 deficiency due to lack of plant sources. Although B12 and folate deficiency can both manifest the same in the beginning (megaloblastic anemia), and folate can correct this problem, the long term effect of B12 deficiency (neural degeneration) can not be corrected with only folates. Therefore vit B12 supplementation is necessary in vegetarian diet. This video is also another proof for it. I am not sure if you need more than usual folate if you are affected by MS. I hope previous comments would help you.




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  8. My information regarding impaired cognition is limited to medical school. I know there is no cure but progression can be slowed down with lifestyle changes. Very interesting that B12 can help with that. I was also surprised by the fact that vegetarians & vegans have high homocysteine levels. That in fact is not a bad side of vegetarian diet, but can emphasize the role of B12 supplements in revealing true benefits of vegetarian diet.




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  9. Arent all B vitamines in seeds ,nuts end other nut-likes fruits and what we need is just to eat them, we need not any tbls and pulvis and any animal products. Is that correct ?




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    1. The conclusion said that there was a difference as long as there was sufficient omega 3 and B vitamins. You need both apparently. “The beneficial effect of B vitamin treatment on brain atrophy was observed only in subjects with high plasma ω-3 fatty acids.” “, B vitamin treatment slowed the mean atrophy rate by 40.0% compared with placebo”




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  10. Hello, I recently got a concussion from a car rear ending us. This is my fourth head injury, what nutrition is good for healing the brain and surrounding tissue? I am taking one handful of walnuts a day, normally don’t take that many cause I need to keep the cholesterol down, any suggestions? Thank You.




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    1. I am so sorry to hear about your injury. I am sure that this site would recommend less animal protein to reduce inflammation.

      Here’s a link you may find of benefit:

      http://www.brainline.org/content/2010/12/feed-your-body-feed-your-brain-nutritional-tips-to-speed-recovery.html

      This website has a video on fighting inflammation with nuts as you have been doing:

      http://nutritionfacts.org/video/fighting-inflammation-in-a-nut-shell/

      Here’s an abstract from pubmed about how this is an area of research challenge:

      http://www.ncbi.nlm.nih.gov/pubmed/19033220




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    2. Hi Maria. Here is everything we have on brain health. Please let me know if any of these resources help? I am unfamiliar of any research on diet for concussions, but at any rate keeping our brains healthy and active are important regardless.




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    3. It has been suggested elsewhere to avoid caffeine in all forms, anything stimulatory. Even tea and chocolate.
      It has also been suggested elsewhere to avoid
      any cooked fats, heated in any form. No white sugar, corn syrup, artificial anything.




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  11. Thanks again Dr Greger for yet another informative, clear video on an important topic. Greatly appreciate your thoughtful, insightful clips – shared with a dose of humour. Does wonders for one’s health!




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  12. Dr Greger’s sense of humor definitely helps !
    I have been taking the B12 tablet (Cyanocobalamin) up until now, but will be trying the B12 drops (methylcobalamin) just to see if there is any noticeable difference. I was just wondering what constitutes “a drop” in medical terms? I sound fastidious but would like to get the dosage right.




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  13. thx for the video post, I am wondering what kind of pills or [url=http://www.best-dietary-supplements.com/]supplement[/url] can increase my B12?




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  14. I could not find anywhere a recommendation on what type of blood tests should be done periodically. Especially for those who just started the vegan journey or are on it for a while. You did mention that some tests, for example, are better indicators of insufficient B12 than traditional ones. Even if blood tests are not recommended you as a rule, some people who start this journey more casually and with insufficient guidance may want to insure they are not getting off the charts. Anyway, doctors are ordering periodical blood tests, so it is better to come informed.




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  15. I was looking at the Wikipedia entry for B12, and they talk about 3 forms of B12 –

    1. Hydroxocobalamin (also hydroxycobalamin, OHCbl, or B12a) is a natural form, or vitamer, of vitamin B12.

    2. Methylcobalamin (mecobalamin, MeCbl, or MeB12) is a cobalamin, a form of vitamin B12. It differs from cyanocobalamin in that the cyanide is replaced by a methyl group.[1]

    3. Cyanocobalamin is the most common and widely produced form of the chemical compounds that have vitamin B12 activity. Vitamin B12 is the “generic descriptor” name for any of such vitamers of vitamin B12. Because the body can[citation needed] convert cyanocobalamin to any one of the active vitamin B12 compounds, by definition this makes cyanocobalamin itself a form (or vitamer) of B12, albeit a largely artificial one. Cyanocobalamin contains cyanide?

    Acording to Wikipedia:
    * Cyanocobalamin is commercially prepared by bacterial fermentation.
    * Methylcobalamin is produced by some bacteria.

    ( I am not sure about hydroxycobalamin, still I think the ultimate source is a bacteria )

    NATURAL SOURCE OF B12:
    There is a Japanese fermented black tea known as Batabata-cha has been found to contain biologically active B12.[36] Unlike kombucha, which is made by fermenting already prepared tea, Batabata-cha is fermented while still in the tea leaf state.

    My questions is this. Knowing these big pharmaceutical companies and how they like to increase production on everything, I think back to the L-Tryptophan contamination from the 80’s. This contamination was written about in the book about GMO’s “Altered Genes, Twisted Truth” where there was extremely compelling evidence that this contamination was caused by a genetically engineered bacteria that was modified to produce like 5 times the amount of L-Tryptophan as the normal bacteria.

    The problem was that these products contained an extremely small contaminant that caused a horrible disease in thousands of people, many of whom died, and many of whom got very sick with permanent damage.

    How can we know that the B12 supplementation that we buy in the store is not derived from GMO bacteria, and if it is, how can we know there is no such contamination in these products as there was in the GMO L-Tryptophan.

    Having read this book, “Altered Genes, Twisted Truth”, and this L-Tryptophan story in the beginning of the book, I have serious doubts about the purity and safety of any GMO produced B12, and I wonder if the Dr. or anyone here can speak to this issue, or recommend a variety of B12 that is absolutely positively certain is non-GMO? The methods used to produce the GMO varieties of bacteria have been very haphazard and clumsy, and have also caused the upset of the cell metabolism and production of other unintended proteins and toxins that have never been tested for because the FDA and USDA changed the testing requirements for GMO foods in order to force them on us as guinea pigs … and that is a quote from from one of the scientists in the GMO industry.




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  16. Just a note on B12 supplements…..many people seem quite concerned that the cheap form of B12 – cyanocobalamin – contains cyanide.

    Comparing the amount of cyanide from 25µg of
    cyanocobalamin to 2tbspoons of flax seeds based on data taken from this paper:

    http://www.sciencedirect.com/science/article/pii/S0308814601003132

    140ppm (µg/g) x 20g Flaxseed = 2800µg in 2Tbsp Flax
    Seed

    In 25µg Cyanocobalamin 25µg x 27g/mol/1355g/mol = 0.5µg

    So the amount in 2tablespoons of flax seed is over
    5600x the amount in 25µg of cyanocobalamin. Funny, the same people who fear
    cyanocobalamin (raw foodists in particular) are the same people who make an
    effort to eat lots of flax seeds.

    Even at 1000µg dose, the cyanide in cyanocobalamin
    is 140x less than 2 tablespoons of flax seeds.




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    1. If it is not necessary I see no reason to consume any cyanide myself, but that’s just me.

      My greatest concern is that the bacteria used to produce the B12 these days is coming from bacteria that have been genetically engineered to overproduce B12 compared to their natural state. In the book “Altered Genes, Twisted Truth”, a national bestseller, a similar production process for L-Tryptophan turned out to have very minute, but very toxic impurities in it that were never tested for and seriously injured thousands of people and killed many others.

      I would just like to find a really safe, pure version of B12 that is not produced by GMO bacterial fermentation.




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  17. This is an interesting video, although it has raised more questions for me. I have recently been trying to do some research on possible non-pharmaceutical treatments for dysthymia (long-term, low-level drpression). One line of thought is that dysthymia is caused by low levels of S-Adenosyl-methionine (SAMe) in the brain and spinal fluid, which could be remedied by SAMe supplementation. As shown in the video, SAMe is formed in the body from methionine. Whilst I understand the benefits to aging and reduced cancer growth from restricting methionine, is there perhaps a corresponding deterioration in mental health as a result? What am I missing from my understanding of this? Thanks for any input you can provide.




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  18. Have a question not related to B-12, but not sure where to post it. I have been looking at recommended dietary intake in general, and it seems to very difficult to obtain the recommended amount of vitamin B3 (niacin) through a fully plant-based diet, whereas some oily fish (i.e. mackarel) contain a large amount. Not sure how to interpret this, and it seems to be a non-issue since it is not mentioned anywhere about the dangers of deficiency. Would be very grateful for an input on this. Thank you for an amazing source of information and inspiration!




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    1. Elin: I waited a couple of days to see if a more knowledgeable person would reply to you. In the absence of an expert, here’s my 2 cents: I think you keyed into the pertinent point when you pointed out that there doesn’t seem to be a wide spread B3 deficiency problem in people who eat whole plant foods. Dr. Greger isn’t shy about pointing out problems with whole plant food diets. He has many videos on B12 deficiency, but nothing that I remember seeing on B3 (or niacin – thank you for the translation). So, I’m not personally worried about it. But if you find out some specific information that causes alarm, I’d be interested. Thanks for your post.




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  19. Dear Mister Greger and great job team,

    would you do an another great think to rescue a poor German who is getting
    crazy by not detecting a right answer?

    I can’t find a answer to my issue concerned the vitamin B12 metabolism.

    Vitamin B12 is dpread to our cells by the bloodstream.

    To messur how sadisfied the cells are you and ohters recommend to
    messure the methylmalonic acid (mma) at the urine – not the serum level
    of vitamin B12 because there is much mor vitamin B12 free running trough
    the blood then arriving and impliying into the cells. Ok this sound
    logical to me.
    It sounds alos logical to me that some humans have problems to get
    enough vitamin B12 by absorbing at the gut – because the intrinsic
    factor isn’t enoigh avilable. So for this people it is better to take
    the B12 sublingual or due to injection i.m.

    Until here I understand all.

    But, if the mma test positiv (not enough vitamin b12 in the cells) all
    physicans and all the ohter medical educaded person recommend to take
    the vitamin i.m. or sublingual even if the vitamin in the serum is enough?

    This sound not logical to me.

    In my understanding has a person whose vitamin b12 level at the serum is
    high a problem be implying the vitamin into the cells – not a supply
    problem.

    To make my thinking more clear I like to picture a parable. There is a
    house with some holes (the house is the body of a human and the holes
    are cells they need vitamin B12 urgendly), to fix the holes comes a
    bricklayer (he is the bloodstream) and started to fill up the holes with
    bricks (that’s the vitamin B12). He has already enough bricks and work
    very well, every day, every hour. But by the time he becomes a flue and
    can not longer working well, so insted to fill 500 brick at a hour he
    only makes 200 bricks. The house is starting to get mor holes the he can
    fill up. That’s not a good think, so we decide to give the bricklayer
    faster and much more directly the bricks (injektion of vitamin B12
    i.m.), to fix this imbalance between arising holes and fixing holes .

    But instead to give the bricklayer more and faster stones would it be
    not better to treat the bricklayer in the first place???

    Do you understand what my issue is?

    I ask me since weeks now, what I haven’t understand at the vitamin B12
    metabolism…

    Can you give me a little extra lessons at this theme?

    Thank you so much in advance.

    Beside: I know the link between starting kidney malefunction and false
    positiv mma test…




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    1. Hi Steffen, let me see if I can take a stab at this question. If I understand your question you are asking why would someone need B12 injections as opposed to oral/sublingual supplements if their B12is low.
      There is one key thing, in my opinion, that the studies that Dr Gregor sites in this video don’t address. That is the role that genetics plays in elevated homocysteine and low B12 and folate. Homocysteine is an intermediate amino acid formed in the production of cysteine from methionine. If one has a single nucleotide polymorphism (SNP) on the MTHFR gene (which by the way is quite common) it can significantly decrease their ability to methylate and form cysteine from homocysteine. This increases their requirement for B12 and folate and also requires that they take a methylated (active) form. These people will usually be fine with an oral supplement as long as they take the methylated form, their gut is functioning normally and they have intrinsic factor. In these cases the homocysteine will be lowered by taking the supplement. See this study. They will however need to take higher amounts than someone without a genetic SNP because they use more due to the inefficiency caused by the SNP. Outside of that scenario, sometimes as we age our absorption becomes less efficient due to decreased gut function resulting in B12 injections giving better results than oral administration. Other than those cases, lack of intrinsic factor is the only other reason why someone should need to supplement with B12 injections versus oral.
      As you see this is not black and white, there are several factors that come into play. I hope this explanation helps and I didn’t confuse you more. :-)




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    2. Good morning payoung,
      thank you for the reply, unfortunaly you did’nt hit the gold only the blue (think on the arrow sports ;-) )
      This was not exactly my question – I try to ask more clear, again.
      For example: A patient went to his physican and he is messuring his B12 level at serum. All is fine. But because the patinet is compaining about some vague symptomes the doctor arrange a mma test and voila this test says the saturation level of B12 is not good. So he decide to make a treatment by giving some injection to the patient.
      My question is, when the level of B12 im serum still is adequate but the fullness of the cells not (how the mma test is showimg). So, how can a injection (which fill up in the first line the blood b12 level) make sure that the the filling level of cells increase? Or to ask in a other way, why was the blood level still ok but not the level in the cells?
      Is there such kind of B12 metabolic disorder by going into the cells?
      I also think in the direction of the role of satured fad by the galactose metabolic, Dr. Greger wrote that animal satured fad can stopp or make more difficult the work of insulin to bring the galactose into the cells.

      I hope I didn’t killed your beautiful day, because I’m so persistent…

      I no my english isnt the best its more a German pik English but I hope my theme is now more clear.

      PS.: I’m a vegan for more then 3 years now, in the first 3 months I avoided to take some B12 and then my brain startet to lose sometimes a word, the concetration was not so good and also my mood. So I put all vitamins to the test and…. shit happens, the B12 was already in the celler. So I immediately took B12 but not sublingual (at this time I didn’t know that a side like nutritionfacts.org exist). I was thinking by taking a Vitamin B12 daily I have to take no concern about the B12 anymore. But now, since christmas last december, I feel more uncomfortible, not all days but some days I have the felling to going crasy, forget was I did the day before – not important thinks but…. I also had some difficults by the conduction system of my heart.
      My blood sreum level of B12 is still ok, a mma test I didn’t make it yet. BUT, last week I started with injections an fellt good for 3 days, yesterday some symtomes cam back, but disappeared immediately after a new injection…
      this is the backround, why I’m so interested in this theme. Sorry.




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  20. Hi there,

    In this video, Dr. Greger touches on folate being important along with B-12 and fiber. I just found out from a diagnostic report that I have the MTHFR mutation where I don’t metabolize folate very efficiently. Since I’m vegan, eat a decent amount of fiber, and supplement with B-12, could you please advise the best way to deal with the MTHFR mutation? I’m sure I’m not the only one who suffers from this and would love to see (and be grateful for) a video addressing this issue, if not a comment response.

    Thanks so much for your time.




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  21. I want to supplement with B12, there are countless brands selling the vitamin, I have no idea which one to choose, some are multivitamins containing all the B group, others just B12 but still, which one should I choose? Please help




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  22. am a vegan who tested going from 20% protein to under 10% and saw homocysteine increase from 11.5 to 12.3. blood b12 level came in high by US standards on both tests, so that wasn’t a factor. did increase fat intake from 20% to 35%, but that shouldn’t matter for homocysteine, should it?




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  23. Hey people , excuse me , what do you think about HoloTranscobalamin Test (HOLO TC) ? Im vegan for 4 years now and i have difficulty to memorize , be totally present , i have tinnitus , many pain near my ears (inside my head i mean). My serum B12 is normal , my AMM is good , Holo TC can be an accuracy thing to be sure ? yea im little paranoiac , but i want to know truly if i need other complementation B12 (Injection or other forms etc…) or if it’s a defiency of others Viramins. Thank you all :)




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  24. Do i need to take B Complex in order to have the B12 work efficiently? I am taking a natural B Complex supplement after receiving advice from a vitamin store. I was using a natural vitamin b12 supplement in a spray and switched to the B complex pill. Should I switch back to the B12 spray? I am completely plant based and have concerns about supplements.




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    1. Dr. John McDougall says we only need B12. Eating a whole food plant based minimally processed diet should more than supply all the other B vitamins. Folic acid is connected to cancer and heart disease in many studies – better to just eat the vegetables to get folate.




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  25. Recent labs showed my Homocysteine at 12. Why? Fully vegan for over 2 years and vegetarian for years prior. I’ve taken double the amount of Cynacobalamin -two tablets/week of 2500 mcg- that Dr. G recommends for the last 2 years, due to MTHFR mutations that had me suspect I could need a higher dose. I eat beans and greens 2 – 3 times a day. I get above the RDI for folate and B-6 daily through food, as tracked by Cronometer data entry. Since these labs I’ve added a spray of vegan Methylcobalamin daily, to see if it will help. –Open to any ideas or suggestions. My HMO Dr. said a homocysteine of 12 was “normal” (and therefore fine)… As Dr. G says “Being normal, in a society where it’s normal to die of heart disease; not so good.”.




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    1. I have a similar situation. Fully WFPB for several years. My blood test showed good levels for B12 (797) and folate (15.1) but my homocysteine was 15.3! Choline is another pathway for handling homocysteine and using Cronometer I believe I may only get 40-50% of recommended amount. But everything from Dr. Greger on choline seems like it is something to avoid/minimize. Not really sure what to do at this point. My LDL is 91 and my LDL particle number is 963 so hopefully my overall cardio risk is low.




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      1. dcraze: I can’t speak to your specific problem, but I have some information about choline that may help. Dr. Greger has recommended the book, Becoming Vegan, for when people have questions about specific nutrients. The Express Edition of the book has this to say on page 118:
        .
        “Choline has hopped back and forth across the line between vitamin–and therefore essential–and nonvitamin. That’s because the body can produce sufficient choline unless a persn’ diet is short on folate, vitamin B12, and the amino acidmethoionine. … Women should bet 425 mg choline per day, and men should bet 500 mg. … There are plenty of good sources of choline. A few that are particularly rich are beans, broccoli, peas, quinoa, and soy foods.”
        .
        Maybe you could focus on those foods?




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        1. Thanks! I do have that book. Problem is I already eat over 3 servings of beans a day, usually a serving of quinoa, at least 3 oz of broccoli everyday as well as around a cup of soy milk. I eat well over a pound of vegetables a day. Still leaves me a bit short of 50% on the Cronometer site. I think I will try the methylated B supplements for now and maybe get a genetic test for MTHFR.




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          1. dcraze: Sounds like you have an *awesome* diet. I got nothing else. :-( Happily, it sounds like you are totally on top of things. I hope you figure it all out.




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  26. I’m still confused. I love vegetables, and I love eating completely plant based. But if there is such a vital nutrient that we must have to function, why do we suggest receiving this through synthetic forms? Doesn’t that mean a plant based diet is not providing all the essential needs that we have? It doesn’t feel balanced to me if I need to take a pill to ”balance it”

    Can I have some insight (from the official/credible doctors please)




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  27. A couple years ago on a 20%-fat 20%-protein vegan diet, got a homocysteine level of 11.5. Last year i anticipated driving the homocysteine level under 10 by returning to a 10% protein vegan diet, since less protein means less methionine which homocysteine is made from, but the homocysteine level actually rose to 12.3. Both years blood B12 levels were recorded as too high. This year i tested dissolving some folic acid tablets in a solution i’d drink a few ounces of every couple hours during the day. This time on a 10% protein vegan diet, my B12 level registered in the normal range, blood folate registered too high, and homocysteine came in at a more desireable 9.4.




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  28. Hi Alfredo,

    I am a volunteer for Dr. Greger. Thanks for your question.

    Unfortunately, I do not believe there are any dietary treatments for cerebral palsy.

    That being said, a whole food, plant-based diet will still be effective at reducing health complications down the line, such as heart disease, cancer, diabetes, etc.




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  29. I’m looking for help.
    My grandma has some memory problem, but I think it’s not dementia or Alzheimer. She just repeat questions, and she doesn’t even know that :( Or she forgets that she made a phone call, and she called again in a few minutes. I would love to know if I could help her with plants or some safe supplements. I am vegan but she is not unfortunately, so I’m looking into some vegan ways to help her. Maybe I could improve or cure that memory loss by natural plant-based diet, if she could agree to that.
    Please I need some professional help of doctors who know and promote veganism ;)
    Thank you in advance




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  30. Hey Marta, there are so many things that could be going on with your Grandma. It sounds like what Neurologists call ‘cognitive decline’, and it can lead to dementia/Alzheimer’s. But in folks her age, infections and drug-drug/drug-diet interactions can cause similar problems. If infection and drug interactions have been ruled out as causes, then Yes – a plant-based diet can help, by reducing the inflammation in the brain that causes memory loss. In early stages of cognitive decline, omega-3 supplements have been found helpful (see this study: https://www.ncbi.nlm.nih.gov/pubmed/26268080 or this one: https://www.ncbi.nlm.nih.gov/pubmed/26718417) However, it seems unlikely that omega 3 fats will help if her diet isn’t a plant-based one.




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  31. Hello everyone ! I am from belgium and i have looked at almost everything (if not all) content from dr Greger online, has teached me so much about nutritiion ! I have his book as well and have seen a lot from dr Neil Barnard also. Now i am wondering, i always here Dr Greger say “It will only cost you 5 dollars a year” to get your Vitamin B12. Thing is the ones i buy are from Mannavital Platinium B12, 60 tablets cost arround 12-13$. We are 2 persons taking them so this means if we take them on a daily base (which we do) it comes arround at 140-50$ a year which we are OK with i mean if its healthwise we don’t look at the cost of it but i wonder is there a place/shop online where they are reliable and maybe cheaper to buy them ? Thank you in advance for the possible answers wish you all the best !




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  32. Hi Eatliveyoga,

    I am a volunteer for Dr. Greger. Thanks so much for your question. You never mentioned the vitamin B12 content of the supplement you are taking. Dr. Greger recommends a 2,500 microgram (ug) supplement ONCE per WEEK. Therefore, a supplement will last you a lot longer. I’m not sure how costs of things compare in Belgium versus the U.S., but many grocery stores here carry 60-100 tablets of 2,500 micrograms of B12 for $8-12, which can come in around $5/year. Here is one example: https://www.target.com/p/nature-made-vitamin-b-12-2500-mcg-tablets-60ct/-/A-14362033?ref=tgt_adv_XS000000&AFID=google_pla_df&CPNG=PLA_Health+Beauty+Shopping_Brand_Competitor&adgroup=SC_Health+Beauty&LID=700000001170770pgs&network=g&device=c&location=9031447&gclid=EAIaIQobChMIsYH108bU1QIVApJ-Ch0X1A5DEAQYAiABEgIUz_D_BwE&gclsrc=aw.ds

    I hope this helps! There are many other sources of it online as well. Just be sure to get “cyanocobalamin” and not “methylcobalamin”.

    Best of luck!




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  33. Hello whollyplantfoods and thank you for the fast and detailed answer ! I hope you are doing well !

    What the box of B12 says: 1000mcg B12 methylcobalamin (sigh) and 200mcg folic acid for 1 tablet and they recommend 1tablet a day. What is the difference between “cyanocobalamin” and “methylcobalamin”, is methylcobalamin bad or just not efficient as cyanocobalamin ?

    Thank you so much for the link ! Have a great day !




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    1. I have searched a little while waiting :) and found this, can you elaborate more on the fact that they recommend methylcobalamin above methylcobalamin cyanocobalamin ? A snippet from what they state at http://www.dadamo.com/B2blogs/blogs/index.php/2004/02/07/cyanocobalamin-versus-methylcobalamin?blog=27

      “Compared with cyanocobalamin, it appears that methylcobalamin is better absorbed and retained in higher amounts within your tissues. In simple terms, they are used much more effectively. In general, methylcobalamin is used primarily in your liver, brain and nervous system.

      Methylcobalamin is the specific form of B12 needed for nervous system health. Because of this it should be the first form of this vitamin thought of when interested in attempting to optimize the health of the nervous system with vitamin supplementation.”

      Thank you for you time !
      Wish you the best.




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