Vegetarians and Stroke Risk Factors—Vitamin B12 & Homocysteine?

Vegetarians and Stroke Risk Factors—Vitamin B12 & Homocysteine?
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Not taking B12 supplements or regularly eating B12 fortified foods may explain the higher stroke risk found among vegetarians.

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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.

Leonardo da Vinci had a stroke. Might his vegetarian diet been to blame? “His stroke… may have been related to an increase in homocysteine level because of the long duration of his vegetarian diet.” A suboptimal intake of vitamin B12, which is common in those eating plant-based diets unless they take B12 supplements or regularly eat B12-fortified foods, can lead to an increased level of homocysteine in the blood, which is accepted as an important risk factor for stroke. “Accepted” may be overstating it; there’s still controversy surrounding the connection between homocysteine and stroke risk. But, those with higher homocysteine levels do seem to have more atherosclerosis in the carotid arteries that lead up to the brain compared to those with single digit homocysteine levels, and do seem to be at higher risk for clotting strokes in observational studies, and more recently bleeding strokes, as well as increased risk of dying from cardiovascular disease, as well as all causes put together.

Even more convincing is the genetic data. About 10% of the population has a gene that increases homocysteine levels about 2 points, and they do appear to have significantly higher odds of having a stroke. Most convincing would be randomized double-blind placebo-controlled trials to prove homocysteine lowering with B vitamins can lower strokes, and that indeed appears to be the case for clotting strokes, strokes with homocysteine-lowering interventions more than 5 times as likely to reduce stroke compared with placebo.

Ironically, one of the arguments against the role of homocysteine in strokes is that assuming that vegetarians have lower vitamin B12 levels then the incidence of stroke should be increased among vegetarians, but supposedly this wasn’t the case, but it had never been studied… until, now, and vegetarians do appear to be at higher risk and no wonder, as about a quarter of the vegetarians and nearly three-quarters of the vegans studied were B12 depleted or deficient, resulting in extraordinarily high homocysteine levels.

Why so much B12 deficiency? Because only a small minority were taking a dedicated B12 supplement. And unlike the U.S., B12 fortification of organic foods isn’t allowed; so, while U.S. soymilk and other products may be fortified with B12, UK products may not. We don’t see the same problem among U.S. vegans in the Adventist study, presumed to be because of the B12 fortification of commonly eaten foods. It may be no coincidence that the only study I was able to find that showed a significantly lower stroke mortality risk among vegetarians was an Adventist study.

But start eating strictly plant based without B12 fortified foods or supplements, and B12 deficiency can develop, but that was only for those not eating sufficient foods fortified with B12. Those eating plant-based not being careful about getting a regular reliable source of B12 have lower B12 levels and consequently higher homocysteine levels.

The only way to prove vitamin B12 deficiency is a risk factor for cardiovascular disease in vegetarians is to: put it to the test. When researchers measured the amount of atherosclerosis in the carotid arteries, the main arteries supplying the brain, between vegetarians and nonvegetarians, no significant difference was found. They both look just as bad even though vegetarians tend to have better risk factors such as cholesterol and blood pressure. They suggest B12 deficiency is playing a role, but how do they know? Some measures of artery function weren’t any better either. Again, they surmise vitamin B12 deficiency overwhelming the natural plant-based benefits. Yes, the beneficial effects of vegetarian diets on cholesterol and blood sugars need to be advocated, but the necessity to correct vitamin B12 deficiency in vegetarian diets cannot be overstated.

Sometimes vegetarians did even worse. Worse artery wall thickness. Worse artery wall function, raising concern, more than a decade before the new stroke study, about the vascular health of vegetarians. Yes, their B12 was low, yes, their homocysteine was high suggesting that vitamin B12 deficiency in vegetarians might have adverse effects on their vascular health, but what you’d need is an interventional study, where you give them B12 and see if that fixes it and… Here we go, a double-blind, placebo-controlled, randomized crossover study and the title gives it away: Vitamin B-12 supplementation improves arterial function in vegetarians with subnormal vitamin B-12 status. So, that may explain it. Compromised vitamin B12 status among those eating more plant-based diets due to not taking B12 supplements, or regularly eating vitamin B12 fortified foods may explain the higher stroke risk found among vegetarians.

Unfortunately, many vegetarians resist taking vitamin B12 supplements due to misconceptions, like holding on to the old myth that deficiency of this vitamin is rare among plant-based eaters. A common mistake is to think that the presence of dairy products and eggs in the diet, as in a lacto-ovo vegetarian diet can still ensure a proper intake of B12, despite excluding meat.

Now that we may have nailed the cause, maybe future studies should focus on identifying ways of convincing vegetarians to routinely take vitamin B12 supplements in order to prevent a deficiency.

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.

Leonardo da Vinci had a stroke. Might his vegetarian diet been to blame? “His stroke… may have been related to an increase in homocysteine level because of the long duration of his vegetarian diet.” A suboptimal intake of vitamin B12, which is common in those eating plant-based diets unless they take B12 supplements or regularly eat B12-fortified foods, can lead to an increased level of homocysteine in the blood, which is accepted as an important risk factor for stroke. “Accepted” may be overstating it; there’s still controversy surrounding the connection between homocysteine and stroke risk. But, those with higher homocysteine levels do seem to have more atherosclerosis in the carotid arteries that lead up to the brain compared to those with single digit homocysteine levels, and do seem to be at higher risk for clotting strokes in observational studies, and more recently bleeding strokes, as well as increased risk of dying from cardiovascular disease, as well as all causes put together.

Even more convincing is the genetic data. About 10% of the population has a gene that increases homocysteine levels about 2 points, and they do appear to have significantly higher odds of having a stroke. Most convincing would be randomized double-blind placebo-controlled trials to prove homocysteine lowering with B vitamins can lower strokes, and that indeed appears to be the case for clotting strokes, strokes with homocysteine-lowering interventions more than 5 times as likely to reduce stroke compared with placebo.

Ironically, one of the arguments against the role of homocysteine in strokes is that assuming that vegetarians have lower vitamin B12 levels then the incidence of stroke should be increased among vegetarians, but supposedly this wasn’t the case, but it had never been studied… until, now, and vegetarians do appear to be at higher risk and no wonder, as about a quarter of the vegetarians and nearly three-quarters of the vegans studied were B12 depleted or deficient, resulting in extraordinarily high homocysteine levels.

Why so much B12 deficiency? Because only a small minority were taking a dedicated B12 supplement. And unlike the U.S., B12 fortification of organic foods isn’t allowed; so, while U.S. soymilk and other products may be fortified with B12, UK products may not. We don’t see the same problem among U.S. vegans in the Adventist study, presumed to be because of the B12 fortification of commonly eaten foods. It may be no coincidence that the only study I was able to find that showed a significantly lower stroke mortality risk among vegetarians was an Adventist study.

But start eating strictly plant based without B12 fortified foods or supplements, and B12 deficiency can develop, but that was only for those not eating sufficient foods fortified with B12. Those eating plant-based not being careful about getting a regular reliable source of B12 have lower B12 levels and consequently higher homocysteine levels.

The only way to prove vitamin B12 deficiency is a risk factor for cardiovascular disease in vegetarians is to: put it to the test. When researchers measured the amount of atherosclerosis in the carotid arteries, the main arteries supplying the brain, between vegetarians and nonvegetarians, no significant difference was found. They both look just as bad even though vegetarians tend to have better risk factors such as cholesterol and blood pressure. They suggest B12 deficiency is playing a role, but how do they know? Some measures of artery function weren’t any better either. Again, they surmise vitamin B12 deficiency overwhelming the natural plant-based benefits. Yes, the beneficial effects of vegetarian diets on cholesterol and blood sugars need to be advocated, but the necessity to correct vitamin B12 deficiency in vegetarian diets cannot be overstated.

Sometimes vegetarians did even worse. Worse artery wall thickness. Worse artery wall function, raising concern, more than a decade before the new stroke study, about the vascular health of vegetarians. Yes, their B12 was low, yes, their homocysteine was high suggesting that vitamin B12 deficiency in vegetarians might have adverse effects on their vascular health, but what you’d need is an interventional study, where you give them B12 and see if that fixes it and… Here we go, a double-blind, placebo-controlled, randomized crossover study and the title gives it away: Vitamin B-12 supplementation improves arterial function in vegetarians with subnormal vitamin B-12 status. So, that may explain it. Compromised vitamin B12 status among those eating more plant-based diets due to not taking B12 supplements, or regularly eating vitamin B12 fortified foods may explain the higher stroke risk found among vegetarians.

Unfortunately, many vegetarians resist taking vitamin B12 supplements due to misconceptions, like holding on to the old myth that deficiency of this vitamin is rare among plant-based eaters. A common mistake is to think that the presence of dairy products and eggs in the diet, as in a lacto-ovo vegetarian diet can still ensure a proper intake of B12, despite excluding meat.

Now that we may have nailed the cause, maybe future studies should focus on identifying ways of convincing vegetarians to routinely take vitamin B12 supplements in order to prevent a deficiency.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avocado Video

Doctor's Note

I have updated my recommendation for B12 supplementation. I now suggest at least 2,000 mcg (µg) cyanocobalamin once each week, ideally as a chewable, sublingual, or liquid supplement taken on an empty stomach, or at least 50 mcg daily of supplemental cyanocobalamin (you needn’t worry about taking too much). You can also do servings of B12-fortified foods three times a day (at each meal), each containing at least 190% of the Daily Value listed on the nutrition facts label (based on the new labeling mandated to start January 1, 2020—the target is 4.5 mcg three times a day). Note that those over age 65 only have basically one option, taking 1000 micrograms a day.

We started this stroke series what to eat and not eat for stroke prevention, and whether vegetarians really have a higher stroke risk.

The last few videos have looked at specific factors:

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251 responses to “Vegetarians and Stroke Risk Factors—Vitamin B12 & Homocysteine?

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    1. I doubt that we did but possibly via B12 producing bacteria on plants and insects consumed along with plants.

      It’s also possible that our ancestors produced more B12 than we do today. Modern humans do seem capable of manufacturing their own B12 but the amounts are apparently small. It’s not clear to what extent variations in gut microbiota may affect how much is produced.

      https://www.researchgate.net/publication/230782474_Bacteria_as_vitamin_suppliers_to_their_host_A_gut_microbiota_perspective

      1. RichardW,

        I think I’ve read on this site and elsewhere that the water we drank used to contain B12, from the bacteria in the water. Once we started sanitizing our water, that source of B12 disappeared — along with pathogenic bacteria, too.

        But if this is true, and it is true that we also ate more dirty plant foods (contaminated with bacteria which excrete B12), then I wonder how did Leonardo da Vinci die of a B12 deficiency?

        In any case, I like the explanation offered by Mr. Fumblefingers. I’ve read that most mammals Including humans (and I think other animals as well) have bacteria in their large intestines that do excrete B12, but it’s too far down for them to absorb, so they poop it out. Where they and other animals can pick it up through what they eat, and absorb the B12 through their small intestines.

        1. It can be found in bacteria-laden manure and unsanitized water, though we obviously should not be consuming either of those things.

          1. If we eat the skin of all root vegetables, only removing the obvious soil, would that give us the vitamin B12 that we require?

        2. I bet Leonardo Da Vinci was probably filtering/boiling his water or something, the guy was so ahead of his times that anything is possible… He was a genius that was drawing helicopters in the Middle Ages after all.

          1. He was definitely a Renaissance man.

            You know how they say that you could put someone’s picture next to a word in the dictionary.

            Well, he went one better. He was so inspiring that people needed to invent ways to communicate it.

    2. From the natural waters is the theory, yet no one will test for B12 in the waters drunk by modern folks. But that I know that hundreds if not thousands of residents in my county get their water from springs and wells. If the theory that B12 existed in groundwater “back then” is valid, then I say, there’s yet B12 in natural waters. B12 is in the soil.

    3. RW,
      In Dr. Greger’s words, “bugs, feces and dirt.” Oh, and our lower gut makes plenty of it. Dr. Greger cited a study where a researcher took several people and gave them capsules of their own product and their B-12 levels were just fine.

    4. Ancient humans ate a lot of tubers (root vegetables) which are covered in dirt. A travel nurse from China told me that food should not be washed and scrubbed as is done in the US. In China they used to just brush off the excess dirt. Plus ancient humans (and several species of present day primates) actually consumed dirt, for unknown reasons. Apparently in some regions of the world, people consume clay to this day.

      Forks over Knives:

      In the past, vitamin B12 from bacteria was also naturally and more reliably present in plant foods. Today, however, with modern hygienic practices more effectively cleaning and sanitizing produce, along with soil being exposed to more antibiotics and pesticides, most plant foods are no longer reliable sources of this bacterial product. Interestingly, some plant foods still contain some vitamin B12, including certain mushrooms and seaweed.

      Many animal foods contain high amounts of vitamin B12 because they accumulate this bacterial product during their lives. Moreover, livestock feed is often supplemented with vitamin B12. These animals are also exposed to manure in their living conditions, with some even being fed manure. For example, cows are sometimes fed poultry waste.

      Vitamin B12 is produced by bacteria found in bacteria-laden manure and unsanitized water, though we obviously should not be consuming either of those things. It can also be found in the human intestinal tract, but it’s not clear whether sufficient amounts are made and absorbed there to meet our nutritional needs.

      I see a doctor who specializes in geriatric medicine, and he says that everyone over age 50 (including meat eaters) should be taking a vitamin B-12 supplement and should be tested regularly. If levels are very low, he suggests an injection. Otherwise, take a supplement.

      1. Caroline,
        My dog eats dirt and has a favorite spot to get it. I’ve posted videos here of people traditionally eating dirt. I do not scrub my fruits and vegetables. There is so much bacteria in our environment that we are composed of more bacteria than human DNA. There are microbiomes throughout our bodies all with bacteria in them. Our gut has trillions of bacteria which affect numerous functions like nutrition, messaging and brain activity. There are bacteria produced in one animal that can change the behavior in other animals, like cats do with humans. Some health food stores sell clay for eating and removing toxins, I think. Historically, humans have been very dirty. There were some royalty that refused to bathe.

        1. B-12 tip,
          Leave the green cap on fresh strawberries. Lightly rinse the berry and eat the whole berry. The green cap is full of nutrition and maybe some B-12. Apple stem belly button cavities may have B-12 in them. All figs have had a wasp inside them. If you drop food on the floor, there is usually no need to wash it off.

      2. Caroline B-12 injections have been found not to be any better than a good sublingual form of B-12! Plus it has other ingredients I’d rather not have injected I believe. I am off to work now so can’t pull-up the studies, but they are out there! … and show the sublingual is comparable. Consumer Labs had one on their site.

    5. I recently read that we used to get a lot more soil in our diet…everything is so sanitized for packaging we’ve lost that source. I wonder if gardeners have more availale B12 just from digging in the dirt…

    6. Termites are high in B12 and make up 2%-4% of primate diets. I prefer a supplement.
      https://www.sciencedirect.com/science/article/abs/pii/0020179084900271

      Apparently, if B12 is present in the soil, even plants can contain active B12. “The amount of B12 absorbed by garden cress is dependent on the amount present in the growth medium, and the Kent team was able to confirm B12 uptake by showing that the nutrient ends up in the leaf.”
      https://www.kent.ac.uk/news/science/17966/university-scientists-make-vitamin-b12-breakthrough

      Agriculture removes the dead biomass of plants on fields and little natural fermentation can take place. This is the case for other nutrients too btw. Again, I’m fine with a supplement.

    7. It’s made by soil bacteria that was plentiful in our water, on our food, especially root vegetables, and any bugs, grubs, slugs, snails, or whatever creatures we managed to procure to meet our energy needs. Today with chemical fertilizers that deplete our soils, stringent washing and sanitation of crops, and chlorination of our drinking water, we are protected from many disease causing microbes, but the unwanted side effect is we are no longer getting our B12 from nature. Because our soils are so sterilized even meat is B-12 deficient, and factory farmed animals with no access to graze are even more so…unless their feed is supplemented. No way around it, these days B-12 supplementation is cheap insurance to maintain an adequate supply, no matter how you eat.

    8. No we didn’t, we are omnivore which means we are plants and meat. The meat can come in any form as animals, insects, worms and grubs. Hardly any of the great apes are purely vegetarian. Get your facts straight.

      1. Not sure who you are responding to.

        But you are clearly right when it comes to our closest relatives. Chimpanzees are sometimes wrongly cited as vegetarians in an attempt to support vegan diets. I’m a vegan but facts are facts. Cf.

        https://janegoodall.ca/our-stories/10-things-chimpanzees-eat/

        “4. Meat and Eggs
        One of the earliest and most significant discoveries made by Jane Goodall was that chimpanzees hunt for and eat meat. Prior to this, chimpanzees were believed to be vegetarians. However, meat and other animal products can account for 6% of a chimpanzee’s diet. Interestingly, successful hunters typically share some portion of their kill with other group members in response to a variety of begging behaviours.

        6. Insects
        Insects (ants, termites) account for approximately 4% of a wild chimpanzee’s diet. In fact, one of Dr. Goodall’s most important discoveries was made while observing chimpanzees foraging for termites. In 1960, at Gombe National Park, Jane observed two chimpanzees using small twigs as tools to fish for termites in the ground, which they then swept into their mouths as a snack — Yum!”

        At the time of the debate I asked the folks at the link above to verify their statements, which they kindly did by referring my inquiry to an expert who stood by their statements and provided references.

        1. Hi gengo,

          i’ve made the same point as you above. most animal on earth are primary consumers and east mostly plants. but rarely is it 100% like the cultural definition that is veganism. Gorillas are classified as herbivores but we know that they eat some termites. Deer have been observed to eat bird chicks. Etc.

          At the same time, it cannot be stressed often enough that only primates and fruit bats require vitamin C through their diet as an evolutionary result of heavy fruit consumption. they are also the only two mammalian family groups that can see in color in order to spot fruits easily.

          in the decent of men, Darwin speculated that humans evolved from primates in hot climates. Darwin further speculated that our natural diet was based on frutarianism.

      1. Richard,

        You wrote: “If we humans evolved eating only plants, how did we get our B12 back then?”

        What makes you think humans evolved eating only plants?

        Humans are opportunistic eaters – they evolved to eat anything you put in front of them.

        That is how we spread all over the planet.

        Some traditional diets turns out to be healthier than others. Those people have lower morbidity and mortality.

        If you are health-oriented, those traditional diets are the diets to emulate.

        Those diets are not exclusively Vegan.

        As people turn to ideology to guide their diets – they run into convolutions in explanations.

        And their health suffers.

        Kinda like when you apply ideology to societal health – instead of simply doing what is healthy for the society.

        Richard.

        All the best –

        Vivamus

        1. Actually evidence shows that our earliest ancestors evolved on a plant based diet. They would have had to, we do not have the anatomy of a carnivore or even omnivore. We wouldn’t have been able to eat animals (or catch or kill) before inventing tools and learning to use fire. Except insects, maybe they ate a few bugs on purpose or incidentally.

          Not against ideology directing diet when it’s simple and sound. That is to say, the data shows us we thrive on a WFPB diet; the data shows us animal products harm human health. The data shows us we can survive on a completely plant based diet; the data shows us we can thrive and both prevent and cure disease on a completely plant based diet. Animals need to suffer and be harmed in order for humans to eat their flesh or secretions and since there is clearly no need to eat animals it is immoral to do so. The fact that it is immoral to do so, and making a decision based on moral grounds would cause a diet of preventative and curative medicine (unless you go for the refined stuff). Sometimes the answers lie in ideology, but then that’s not really ideology, it’s just the truth that’s right in front of us, found in logic, found in consequence, found in science, found in that place where we just know right and wrong, found in everything. Not to mention the environment suffers from animal agriculture (far beyond methane). The easiest way to find the truth, might be to look at how much it aligns or doesn’t align with all things.

    9. My understanding is that bacteria in the stream water and in the soil around our veggies made B12, and so just pulling up a carrot and eating it, or drinking stream water, we ingested adequate B12. Of course, Dr. Greger likes to point out that we could also get cholera by drinking unclean water.
      We have B12-producing bacteria in our own colons, too, but we absorb B12 higher up in our terminal ileum (with help from transport proteins in our saliva and Intrinsic Factor made in our stomach). You could theoretically get your B12 by eating your own poop, but I think it’s easier to take the supplement ;) Also, since our soil generally has been over treated with pesticides and herbicides, the usual microbes that our farm animals would be ingesting (by eating grass/dirt) to make B12 are now gone, and farmers have to supplement the diets of farm animals with vitamin B12, as well.

    10. RichardW,

      (only in caps to emphasize the simple and obvious answer, not to express yelling)

      THE SAME WAY EVERY SINGLE OTHER HERBIVOROUS ANIMAL DID.

      No animal–that we know of–produces B12. Every single animal must ingest it. The carnivorous animals get it from eating the herbivorous animals who get it through…. wait for it…. waiiiit for it…. microorganism. These microorganisms are found in untreated water and soil and would be found in the surface of unwashed fruits and veggies, you get the point. Not exactly safe things for us to consume, so it’s best to just take a weekly or daily supplement. However, there are some plants that contain B12, but how we utilize it and how consistent it is, isn’t clear yet. Such as purple laver or nori, there is actually reportedly 100%DV of B12 in 4 sheets, but there is controversy over whether we can use it or not (check out conflicting data on pubmed and elsewhere). There is also some incredible stuff about water lentils, but not enough research into them. The company Chickpea who makes really great legume pasta, has B12 in their chickpea/yellow lentil/red lentil pasta because when testing for nutrients, their lentils have B12 found in them, they’re not fortified. I was amazed by this and am simply reporting back what I was told by the company when asking how, if not fortified, is there B12 in their pasta.

      Lastly, farmed animals don’t even get to graze naturally, so they’re not consuming microorganisms like they would and should be and therefore would be B12 deficient, so they’re actually supplemented. Thus, when you consume animal products which are usually from farmed animals, you’re not only getting a B12 supplement, you’re getting a SECOND HAND B12 supplement. There is DEFINITELY no need to torture an animal over that.

  1. According to the Doctor’s notes above: “I have updated my recommendation for B12 supplementation. I now suggest at least 2,000 mcg (µg) cyanocobalamin once each week, ideally as a chewable, sublingual, or liquid supplement taken on an empty stomach, …”

    I’m wondering what is the rationale for taking Vit B12 on an empty stomach?

    1. Especially if taken from sublingual which is the safest and easiest way because it doesnt even go through a digestive process to be absorbed into the blood.

  2. In the more recent Taiwanese study, though, vegetarians had lower B12 levels and higher homocysteine levels on average than non-vegetarians ….. but they still had only half the stroke risk of non-vegetarians.

    However, adequate B12 intake did appear to be protective. Avoiding B12 deficiency does indeed seem to be important.
    https://n.neurology.org/content/94/11/e1112

    1. Apologies. While the vegetarians were more likely to supplement with B12 than non-vegetarians, it appears that it was the vegetarians who consumed less than the RDA of B12 that had the lowest stroke risk (TABLE 5).

      Unfortunately, the text describing the table is somewhat confusing. It says

      ‘Inverse association between vegetarian diet and lower overall stroke was found in the subgroup with inadequate vitamin B12 intake (<2.4 μg) but not in those with adequate vitamin B12 intake (≥2.4 μg),'

      It probably ought to be instead either

      The association between vegetarian diet and lower overall stroke was found in the subgroup with inadequate vitamin B12 intake (<2.4 μg) but not in those with adequate vitamin B12 intake (≥2.4 μg),'

      or

      'Inverse association between vegetarian diet and overall stroke was found in the subgroup with inadequate vitamin B12 intake (<2.4 μg) but not in those with adequate vitamin B12 intake (≥2.4 μg),'

      I've had to read the study several times to try to get my head around this point.

      1. Fumblefingers, The study language is correct. It is saying that vegetarians with low B12 have more strokes, but vegetarians with adequate B12 do not have more strokes. I believe you may be confused by what is similar to a double negative in the statement where it uses “inverse association” and “lower” in the same sentence. Your morphed sentences are incorrect expressions of the data.

  3. Folate can also lower homocysteine risk. Foods rich in folate like lentils, beans, and spinach are stroke fighters. Better than just their folate. The whole plant is better. B6 is a homocysteine fighter. Foods like sweet potatoes, potatoes and sunflower seeds are known stoke fighters, and they have B6 in them. They are stroke fighters more so than the B6 in them, the whole food is better because of other compounds in it. I am sure Dr. Greger is right and his case is compelling here that B12 can prevent stroke and vegans and vegetarians need to supplement to reduce homocysteine and prevent stroke.

    1. @Matthew, all good and agreed, but spinach is an avoid plant if possible due to the enormous levels of oxylates…

      @Fmbles , rice is not currently in my android app for daily dozen – it may have recently been removed?, you are referring to a written daily dozen or video perhaps?

      @Deb, I hope your dad is getting better

      @Viv, negro tenant farmer with a fantastic view on your grandfathers cotton farm? not sure what to do with that but glad you think about it sometimes.

      @ Sabrina, fascinating story and i hope your BP can get to where you want it and you find how to lower it.

      @Christine volunteer, please reply to my question if you would be so kind.

      1. jazzBass,

        Thank you for the well wishes.

        He is in the hospital. He definitely has things going on and it is going to take probably another 24 hours before they do all of the tests to figure things out.

        I slept over his house to take care of his wife and I laugh because my poor person house has all comfortable furniture and his wealthy person house has the most uncomfortable furniture in the universe. I was quite a bit like Goldilocks and all the beds and chairs were PaPa bears ridiculously hard and some of them were hard and undersized.

        Laughing.

        I never “got” the attraction of a lot of the things the wealthy relatives and friends do and I also know that sleeping in the van out of being homeless might be just as uncomfortable. Maybe. I will have to try that next because I am thinking the van wins.

        1. At 3 in the morning, I was going from room to room looking for MaMa bear’s chair. I saw a baby bear miniature wooden rocker and I honestly could never live in a showroom house.

          1. Laughing….

            This is going to be a long, long week.

            And we are waiting to find out if it is an end-stage situation or maybe something easy.

            So far, it has gone back and forth.

          2. Deb,
            Best wishes in your Alice in Wonderland experience. I’ve made the decision not to go with the Netflix DVD subscription for now. Those discs are being handled by many. I would be interested in how you figured out your emergency power situation.

            1. Dan,

              Thanks. Tonight they got an overnight caregiver but I am back on duty after a night of sleep and I will be bringing some extra pillows to help me be able to sleep on the loveseat and have my feet go over the arm.

              I am still really considering the Titan Solar generator versus solar panels. The thing is, if I can find an installer who charges by the hour rather than trying to charge $20,000, I can get wholesale solar panels and cut the price down considerably. That is on my list. If I can get my carpenter to start the process and then just switch to my electrician for the electrical part, I would be so happy. I am going to have one of the big companies harassing me but luckily, because of COVID, they only harass by phone, but I found horror stories of people who put it in, didn’t get it repaired when it didn’t work and then the electric company doubled its rates and undid any benefit. I suspect that the installer didn’t set it up properly for the electricity to rewind the meter but still, it took them a year to get their panels fixed and in the mean time they were being charged both their electric bill, plus the solar panel bill, and they spent all of their free time trying to get it fixed. Several people ended up having their electric bills go up.

              The thing about the Titan. I could get 2 Titan generators, plus an extra battery and have one charging while the other is running my house for less than the price of Big solar.

              Or just 1 Titan with 4 batteries and it would only be the oven and the dryer that would take more than 2 batteries.

              I am not a math whiz but people can run a cabin on 1 Titan. Two Titans would just be safety and the ability to charge more efficiently.

              I don’t know how long they would last is the factor that I can’t figure out but I wouldn’t have to worry about installation or fires and I could even run my whole house through my generator plug if I got 3 batteries.

              It would be an expensive experiment.

              So far, I LOVE all of the decisions that I have made. Solar is the gamble. My neighbor loves her solar power but her company already got in trouble and were bought by Tesla and their panels caused 7 fires at Walmart and 1 at Amazon from a faulty part. An article that I read said that Vivant also went through that type of process and they expected SunRun to go through that eventually because most people lease the panels but almost nobody wants to re-lease the same panels a second time. Technology has already changed a few times so the panels become obsolete.

              Some people who lease have had serious benefit from it but some people stop having benefits and still have to pay the lease.

              Buying is better if you could DIY and I am not going up on my roof and I don’t know if I can convince my carpenter who does still go up on my roof to install a few things while he is up there. Can he DIY for me? Probably not.

              1. Here is the Titan.

                https://www.youtube.com/watch?v=1C4xt95z6Qg&t=415s

                This is my fantasy solar generator. With 2 batteries, it can power my cooling and heating. With 3 batteries, I could also use my dryer and oven.

                I think I feel like it is the only way I can handle going solar.

                It wouldn’t generate electricity for the electric company. But I could plug it into my generator plug and it would silently power my house.

                I haven’t figured out if I shut off the breaker switch and really have a zero usage whether I would still be charged for delivery fees and carrier fees or would I get to have a zero dollar electric bill and maybe just turn the switch on if something happened where the generator wasn’t able to keep up?

                Yes, I still don’t understand my electric bill and I do not trust any of the solar companies. Walmart called Tesla cold and uncaring about their fire situation.

                1. They say that solar panels cost way less than solar batteries but that doesn’t include installation and maintenance and repair and insurance.

                  I might be naive, but I feel like I could buy 2 Titan solar generators and one or two extra batteries and I can have one plugged in to run my house and one plugged into the wall charging batteries and I could shut off my power so they can’t charge me any more fees.

                  Zero installation. It takes 3 hours to charge 2 batteries ac, so as long as I had 2 inverters, I could go off grid without a single solar panel.

                  1. If I has two inverters with two batteries each, I should be able to swap them every day and have them constantly charged even during ac and heating season.

                    1. I might even be able to get a cheaper solar generator and carry it outside to charge the Titan and then carry it back inside to charge it again. I might be wrong but I think it is possible. Charging things solar takes all day and in the Winter I will not want to do that.

                      But I really want to cut my electric bill and closing the account would make me happy.

                      I could always restart it again if something goes wrong but I feel like it would be cheaper than solar and it would not require a lease or a loan. Just 3 years of zero interest financing.

                    2. I think I could try it just turning the breaker off for a few weeks and maybe switch the power on to use the dryer or oven and see what the electric company charges me.

                    3. Nope, you can’t turn circuit breakers on and off.

                      Solar is for wealthy people.

                      I am still going to get a Titan and run my air conditioning and heating off of that and charge it with my gas generator since that has to run now and then.

                      Well, solar isn’t going to be an easy thing.

                      It isn’t easy to go green.

        2. @DEB, re: rich people dads furniture I say: “It is better to look good, than to feel good.”

          (spoken in the voice of Billy Crystal on SNL – https://www.youtube.com/watch?v=J0RTD7250II)

          But seriously Ive got a friend, 83, whom I call my musical jazz father, just got through valve replacement, and not on his Toyata, today, so I guess we both have some close elderly in hospital were worrying about. A little laughter can help for sure.

          All the best to your dad.

          1. Thanks, jazzBass!

            Best to your musical jazz father.

            Yes, I grew up in a family where we laugh during funerals and laugh in the hospital and I am so glad. It is a spoonful of sugar to help the medicine go down.

            When my cousin was told to go on hospice, he called me and a few other relatives and laughed with us and I laughed because, “No, you are supposed to die and then we laugh about you at the funeral.”

            Except for one relative. One cousin got up with a funny talk about his funny mother and just bawled his eyes out and his wife got up to try to help him and looked at him for one second too long and bawled her eyes out, too. But that is okay. It was real and honest and it was the first funeral that we had that nobody shared funny stories and laughed.

  4. I still say that my well water may contain more than enough B12, but have been unable to find a way to test such. Even contacted some water-testing professionals. I’m satisfied that there are yet millions of rural Americans (and surely other lands) drinking from natural water-sources replete with B12.

    This is always ignored by our good doctor. But because B12 is fairly safe to take, I do supplement with a weekly dose.

    1. You may be right. However, I suspect that Dr G (and everybody else) ignores the possibility simply because there is no good evidence either way.

      This Indian study below suggests (but does not prove) that water-borne B12 may be a thing. There’s probably variability between regions though and who knows if it is sufficient on its own to prevent deficiency.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4948445/

  5. [I now suggest… at least 50 mcg daily of supplemental cyanocobalamin… Note that those over age 65 only have basically one option, taking 1000 micrograms a day.]

    I speak as one without knowledge, but here goes anyway:

    I’ve never been comfortable with this abrupt gap up for those over age 65. I can’t understand why you would need only 50µg per day when you’re 65 and then [bang!] 1000µg once you turn 66, a 2000% increase. Why so suddenly? Why wouldn’t there be a gradual schedule that ramps up a bit more slowly from 50 to 1k, say between 55 and 65 years, for example?

    Just thinking out loud.

    1. dr.cobalt(yadda yadda yadda),

      When tested, about 1 in 3 elderly adults are vitamin B12 deficient. Apparently, they lose the ability to actively transport B12 from their food, and so have to absorb it passively, and to absorb it passively they need large amounts, as only a small amount of what is available can actually be absorbed passively.

      I’ve also read that some of the medications that many older folks take interfere with B12 uptake (such as metformin for T2 diabetes, as well as strong acid suppressing drugs, such as esomeprazole, lansoprazole, or omeprazole, all of which seem fairly commonly prescribed), so I wonder if that partially explains the B12 deficiency observed in older people. It would in younger ones, too.

      And yet, doctors don’t routinely test for B12!! Which seems highly negligent, given that upwards of 1/3 of their elderly patients may be deficient in it. They also don’t appear to know that vegans and even vegetarians should be tested for it, as well as their patients on meds which interfere with the uptake of B12. Are they simply ignorant? Because the consequences of a B12 deficiency can be severe: from pernicious anemia to peripheral neuropathy to dementia!!

      Oh, and about 1 in 6 meat eaters also appear to be deficient in B12. So, that is a huge number of people potentially deficient in B12, and everybody should be routinely tested for it.

      Finally, excess B12 is just excreted in urine, so there seems no downside to taking too much of it.

      1. Medicare does not reimburse blood tests for vitamin B-12. So, that could be one reason that B-12 levels are not checked in the elderly. Medicare will reimburse for homocysteine and methylmalonic acid, which I understand can determine if there are adequate B-12 levels.

      2. I can’t cite anything but from memory high B12 levels have been associated with certain cancers. I took a daily high B12 dose and when I had bloods tested my levels were too high. So it may be excreted but I believe the body can accumulate quite a large stockpile before it does excrete. Also it takes a long time to get levels down. I’m currently not supplementing but am regularly testing to check my levels. I agree with others that B12 testing is prudent.
        On the topic of supplements I tried adding low concentration Iodine supplements to my diet but they made me feel ill. I assume I’m getting enough from WFPB. I keep wondering whether I should do DHA omega 3 supplements but the experts are divided so I’m on the fence till more research has been done

        1. My endocrinologist says not to take iodine supplements. Seaweed is fine. I use Maine Coast kelp granules, to sprinkle on food as you would pepper.

        2. My eye doctor said that omega 3 supplements are something to try for dry eye if you have had no success with drinking more water or hygiene measures (Lid Scrub eyelid cleanser).

        3. There are are studies showing an association between high B12 levels and cancer but the current understanding is that cancer affects B12 metabolism rather than that B12 drives cancer. That is, high B12 is a possible marker for cancer rather than a possible risk factor

          ‘It is not entirely understood how the underlying cancer can cause high plasma B12 levels. Circulating B12 is exclusively bound to either haptocorrin or transcobalamin. The cancer may affect B12 metabolism by affecting the levels of these B12-binding proteins that in turn give rise to elevated plasma B12 levels (1). These protein alterations may involve inflammation cells that can produce either haptocorrin (30) or transcobalamin (31), and the potential underlying inflammation may also explain why high plasma B12 is associated with higher mortality risk and risk of venous thromboembolism among cancer patients (32, 33). These results are in concurrence with our previous finding that haptocorrin is elevated in cancer patients with high plasma B12 (2), and earlier reports showing that malignant proliferating leukocytes in patients with chronic myeloid leukemia’
          https://cebp.aacrjournals.org/content/28/4/814

    2. dr cobalt, I barely take 50 micrograms daily anymore. I tested too high last january and was told to stop taking it for some time. I retested fine in the high normal with taking a small amount daily.

      With studies showing an association with cancer and high serum levels of b12, I don’t want excess… of anything really! We have been wrong so many times with vit and min.

      1. According to Dr. McDougall, an interventional study was done on smokers to prevent lung cancer through beta carotene supplementation. The study was stopped early because the treatment group was getting more cancer.

        Why? There are over 50 carotenoid compounds in plants. All bind to the same cell receptor sites. The receptor sites were being saturated with beta carotene and unable to absorb any of the other carotenoid compounds.

        Could something similar happen with B12?

        1. No doubt. Our bodies have spent millennia evolving with our natural environment to optimize how we obtain and utilize nutrients, then man comes along thinking he is wiser, making sweeping decisions about the intake of fractional elements of nutrients/foods. I love me some good science, but c’mon, look at the mistakes we make in our arrogance!

          1. @vegetater, I hear you, and you are likely right on concerning the human paradigm in previous millennia.

            But too, along with fancy directives and science, man came along and destroyed our natural environment such that is is barely recognizable in how we get, transport, store, and eat food.

            And that’s where we were intended to get these fractional elements, as you know.

            Right about now, Monsanto (and ilk), Tyson, etc.. are calling our shots through corporate global legislative “influence”, creating our general isolation from a true farm to table consumption model, (never mind the hunter gatherer paradigm long gone from previous millennia) by way of introduction of or substitution with: additives, chemicals, and processing.

            So, with that all said, I’d suggest that this particular millennia is different from all the previous ones. A lot.

            Like a lot, a lot.

    3. It is not necessarily the case that you do. At about age 70, on 1000µg per day my B12 blood levels were too high (off the scale at one point). Cutting it to 500µg /d brought it down but it was still quite high, around 900.

      Why is there only one option?

      Pays to know your own body, which means getting tested.

      1. I should add that I get no B12 from any fortified foods. I am 100% WFP and check everything I eat, e.g. soy milk (use Westsoy plain, no additives)?

        1. Also, I noticed Dr.Fuhrman dropped the B12 in his multi’s significantly. The Women’s and the Men’s Daily multi are down to 75 mcg of methycobalamin from (as I recall) 300 mcg. That’s what I take these days but have not been retested because of the pandemic.

      2. Dr Greger recommends urine test not blood test for B12? Why?

        Also, any real evidence you can or can’t supplement with too much B12? WFPB diets are already low risk for cancer, seems the bigger risk is stroke

        1. Bob, this topic came up for discussion some time ago, and not long afterwards, Dr G changed his recommendations. Because I am having trouble posting multiple links on NF these days, I will post this one, with all the study links in the video description. https://m.youtube.com/watch?v=U7-xswH7IQA
          My experience was similar… b12 too high, stopped supplements for some months, and now I’m back to ok.

          1. Blair wrote:

            “According to Dr. McDougall, an interventional study was done on smokers to prevent lung cancer through beta carotene supplementation. The study was stopped early because the treatment group was getting more cancer.

            Why? There are over 50 carotenoid compounds in plants. All bind to the same cell receptor sites. The receptor sites were being saturated with beta carotene and unable to absorb any of the other carotenoid compounds.

            Could something similar happen with B12?”

            Yes.

            Obviously.

            Of course.

            It goes without saying.

            We used to think that Vitamin A supplementation is great – until we found out that it is isn’t.

            We now see problems with Vitamin E supplementation. Iron supplementation. Zinc supplementation. Copper supplementation.

            For a while, there – everyone was being advised to intake 1200-1500 mg of calcium a day – Consumer Reports was very, very big on it. Until calcium supplementation became associated with atherosclerotic arterial calcification. And all that bad nutrition advice just kinda quietly slithered out the door, never to be seen or heard from again.

            Did you fall for that one?

            Remember Linus Pauling and his megadose Vitamin C? “Orthomolecular Medicine.”

            Did you fall for that one?

            We used to think that excess dietary protein is just urinated and is harmless – now we know it is renal toxic.

            Will we similarly find detrimental effects of high dose B12 supplementation one day?

            By what we have seen in the past – I suspect a 50-50 chance or so.

            But whatever the odds may be – they do not appear to be appropriate for advising the population at large to engage in megadose weekly B12 supplementation at this time.

            The RDA for B12 is 2.4 mcg. Pregnancy – 2.6 mcg. Lactation – 2.8 mcg.

            Not 2000 mcg.

            2000 mcg is 833 times the RDA.

            That is just wild.

            A basic principle in Pharmacology – just because a little is good, more is not better.

            If one or two aspirin is good – 500 aspirin is not better.

            500 is overdose.

            Sola dosis facit venenum.

            The dose makes the poison.

            Paracelsus – the Father of Toxicology

            ————————————————–

            I suggest the Precautionary Principle.

            Murphy’s Law.

            Scientific humility.

            A recommendation of 2000 mcg as a weekly dosage is way out of the scientific mainstream.

            It appears reckless to me.

            A much lower daily dose seems appropriate.

            Lowest I can find is 50 mcg tablets – which are scored for cutting in half.

            Seems the best bet I can come up with.

            Taken in the midst of a meal of very healthy food to further gentle the hit. While diluting the cyanide molecule to a level of minomal concern .

            Analogous to how the presence of food gentles the effect of a glass of wine – compared to the harshness of drinking on an empty stomach.

            With monitoring of B12 levels by your wise and thoughtful locally licensed physician.

            Do as you think best –

            Vivamus

            1. You forgot or dont know the human body is only able to absorb around 2% of high dose B12 supplement, so if you take 1000-2000mcg per week, you only absorb around 20-40mcg of vitamin B12 hence the recommendation for this dosage since the body need between 2 and 5mcg daily long term.
              Sublingual B12 supplement dont pass through a digestive process to get absorbed into the bloo, it seems to be the safest way.

              1. Julot,

                You wrote: “You forgot or dont know the human body is only able to absorb around 2% of high dose B12 supplement”

                I did not forget and I do know.

                I fully understand the logic of your argument.

                Such logic has been used to justify pill supplementation of megadoses of vitamins and minerals in the past, time and time again.

                And failed the test of time – time and time again.

                All the best –

                Vivamus

            2. Vivamus

              Arguing from basic principles is fine but what does the actual evidence show?

              ‘Later studies reported blunted metabolic responses in many elderly persons with subclinical deficiency until doses reached 500 g or more [40][41][42] ‘
              https://www.researchgate.net/publication/7241609_Diagnosis_and_management_of_clinical_and_subclinical_cobalamin_deficiency_advances_and_controversies

              There is no known toxicity from consuming high levels of B12 and there is experimental evidence that at least some people benefit from larger doses (but not from smaller doses), Prudence might therefore suggest sticking with Dr G’s recommendation on B!2 supplementation.

              1. Mr Fumblefingers,

                (1) Studies on Vitamin B12 are all over the place.

                (2) Recent history is replete with nutritional and medical interventions that had no known toxicity at the time – but were found to be toxic later. The Precautionary Principle applies. Murphy’s Law applies.

                (3) “Prudence might therefore suggest sticking with” something a lot closer to the RDAs for most people – a whole lot closer than 833 times the daily RDA in one dose, anyway – that is extreme! – with serum or urinary monitoring of B12 to titrate as appropriate.

                (4) Are there any long term experimental double blind placebo controlled large scale population studies of populations that are taking 2 grams of vitamin B12 as cyanocobalamin once a week? If not – we do not know what we are doing for the long term as a nutritional intervention, and we should not be recommending it – recommending it is just a series of suppositions stacked upon a series of assumptions, any of which may go awry.

                I know that I haven’t found any such studies.

                Mr Fumblefingers.

                All the best –

                Vivamus

      3. A very common reason for high B12 levels is because the blood test has been carried out too soon after the administration of a B12 injection. This should be avoided and tests should be delayed by 7-10 days post-injection. Results can otherwise be very misleading, as B12 that has not yet been metabolised elevates the blood level. Nonetheless, high B12 levels are absolutely harmless in these cases.

        Taking high-dose oral B12 supplements can also greatly increase blood levels – here, the same period of 7-10 days should be observed before testing.
        https://www.b12-vitamin.com/high-blood-levels/

  6. So, since water is a part of this discussion, pH. Was there ever any study or reputable scientific evidence put forth that shows what ph water is best for us to consume. I just learned that my water is acidic, that alkaline waters are a big market (doesn’t mean they’re necessary of course-despite marketing drivel).

    There’s only one water/pH video here and it’s old with comments spanning many years and experts arguing in the comments about how smart each one is. Perhaps someone knowledgeable on the subject could address this for us “laypersons” and maintain civility with his fellow “experts”. Thank you.

    I understand that if our good doctor took interest in this question it would be six months to a year before we’d see any video response. This is why I inquire generally.

    1. Wade TN,

      Don’t fall for marketing hype. Alkaline water is all about marketing. Your body keeps your blood pH within fairly narrow limits; this is one example of homeostasis, or “the tendency toward a relatively stable equilibrium between interdependent elements, especially as maintained by physiological processes.”

      If you want more information about the effect of diet on alkalinity, type “alkaline” in the search bar on this site. One video that came up is: https://nutritionfacts.org/video/alkaline-water-a-scam/. (Or is this the video you already saw?)

      I just read the transcript, and learned this: “Now, baking soda is sodium bicarbonate, so this would add about a gram of sodium to our daily diet. But sodium bicarb doesn’t seem to have the same effect as sodium chloride, or table salt.” So now I feel much better about the baking soda I add to waffle batters and other baked goods. Whew!!

      1. Dr. J, yes that is the single alkaline water video for the site. And everything elsewhere on the web is selling Alki water or says there’s no standard that anything goes apparently because our bodies will correct it.

        But, as you and I know the body has to utilize resources to affect this balancing of pH. Could it be that too much acidic water intake or conversely, alkali water intake would be a bad thing because it is not how water is normally found in nature. OR is it an area where we can use a little knowledge to enhance our health by drinking water on the “preferred” side of the pH scale.

        I drink a lot of water and these days a bunch of it is carbonated (at home). If perchance acidic water, or alkali waters are better or worse for a person I could be enhancing or detracting from my general health by adjusting, or not adjusting the water I drink.

        My pH tests with cabbage and urine look good, but perhaps they could be better?

        My next quest is to see if it’s safe to adjust my water with hydrated lime, as I do for the garden plants (to give them best access to the nutrients they require) rather than bicarbonate of soda.

  7. I switched to a whole food plant based diet last November and started taking a vitamin B12 supplement almost immediately that stated 100% RDA. It all seemed fine until a couple months ago when I started getting really cold feet and legs that were a little painful as well. After some research I thought B12 deficiency was the most likely candidate. I switched to a high strength vitamin B complex and after about 10 days all the symptoms disappeared.

    In general I think I’ve really benefited from the switch to a whole food plant based diet, but B12 deficiency is no joke.

  8. I just love Dr Gregor, and have been a fan and supporter of his site and have shared his videos and blog posts widely for years. But I have to say that I can’t watch his latest videos, the ones with him performing in them. His very animated gesturing and appearance are very distracting and I’m unable to focus on the information he’s putting forth. I end up closing the screen and reading the transcript. Others I know have expressed similar sadness about this new trend. Some have moved on to other sites.

    This is meant as a supportive critique, because I have to admit, my attention to his emails and new uploads has gone WAY DOWN since this trend started. Sorry Dr. G. You’re great, and maybe it’s just me and my friends that find the whole new format less attractive. But I’m hoping at least some upcoming releases will be closer to the older, more watchable format.

    1. @ellen,

      Sorry, I’m really trying, but your syntax is difficult to read through and I must simply turn off my screen. The message is probably fine, but your delivery is just something I can no longer tolerate. And that font! How do you get up in the morning?

      I will turn to reading posts on facebook again.

      Goodbye, and let me know when you plan to write your posts in a way that I like.

      1. JazzB, I must say that is a unique comeback!

        It reminds me of how the Hollywood actors and actresses keep voicing their opinion on politicians. They don’t seem to realize that none of us in the real working world gives a hoot what they think! Large numbers of people nowadays seem to think the world revolves them ;-)

        1. You’re merely expressing opinions too JB & DG but worse, you’re passing opinions on opinions, lol, with nothing constructive to contribute, so get off your high horses. I agree with Ellen as do others who’ve made similar complaints.

          Constructive criticism: There’s a problem with striving to educate the public if your delivery is turning many away. I’ve seen it actually has turned off newcomers, (eg sometimes very fast talking, endlesss cliffhangers producing too many videos to wade through, ambiguous recommendatiins) isn’t following best adult learning educational principles. Otherwise, a big fan, thanks for the information sharing

          1. You are doing exactly the same thing that you accuse JB and Dg of doing.

            Also, quite a few people enjoy Dr G;s style and want him to continue. Aren’t they allowed to respond to critics like you?

    2. “Some have moved on to other sites.” So what? There’s plenty of Atkins, paleo, low carb, etc sites. If they don’t like this site then they can find another. I love Dr. Greger’s presentation and hope he remains in the videos.

      1. Ellen,

        I agree with your concern.

        As to others moving on to other sites – witness the quality of the people who are left – such as those who are childishly critical of your carefully voiced concern.

        I suggest that childish criticisms of your post are hardly worth ignoring.

        Ellen.

        All the best –

        Vivamus

  9. IT IS A HUGE DISSERVICE TO IMPLY THAT B12 IS THE ONLY VITAMIN THAT AFFECTS HOMOCYSTEINE. B6, B12, and FOLIC ACID are equally important.

    See any search engine.

    There are many supplements out with the three specifically made for this purpose.

    1. That’s all very well but it’s a matter of which of these is actually measured and discussed in the studies being reported,

    2. True, in addition to vitamin B12, sufficient vitamin B6 and folic acid are needed for healthy homocysteine levels. While B12 is more likely to be deficient in a vegan diet, we need to eat plenty of healthy whole plant foods to get enough B6 and folate; it’s not just a given. After reviewing the amounts of folic acid in foods, I think it would be quite difficult to get enough without the 3 servings of beans Dr. Greger recommends in his Daily Dozen. Vitamin B6 is also high in beans, as well as in bananas, peas and bell pepper. However, I do think if one is not careful, a vegan or vegetarian can be low in folate &/or vitamin B6. Check out the levels of these homocysteine lowering vitamins on cronometer. https://cronometer.com/

    3. Hey @Reality, did DR. G actually say (or suggest): “Vitamin B12 is the ONLY vitamin that affects homocysteine levels”?

      I looked in the transcript but couldn’t find it.

      My understanding is we want folates from food, not folic acid (a supplement), and that we should be getting plenty of folates and B6 if we are awesome at WFPB.

      Am I off on that?

    4. RB

      You wrote

      ‘IT IS A HUGE DISSERVICE TO IMPLY THAT B12 IS THE ONLY VITAMIN THAT AFFECTS HOMOCYSTEINE. B6, B12, and FOLIC ACID are equally important.’

      Perhaps but it is a huge disservice to ignore the fact that

      ‘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].’
      https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/#en42

    5. ‘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].’
      https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/

  10. Am I missing something, or did this whole stroke series just say that my being vegetarian is a waste of time? The last part of this video referenced an older study that showed carotid arteries of vegetarians had the same atherosclerosis as non-vegetarians. What is true for the carotid is true for the whole body. Why was his study not mentioned before? I find the info provided in this stroke series devastating to the plant based diet idea.

    1. Then you seem to have missed a number of key points. You need to revisit the videos and refer to the sources cited to get the full picture..

      In any case, there’s a whole world of difference between ‘vegetarians’ and people eating whole food plant based diets.

      1. Thank you. I have read all of Dr. Greger’s books, and Campbell, Esselstyn, Ornish, EPIC Oxford. Gone to see Greger speak. I parsed this string regarding stroke. I think I have some idea of the picture. I admire Dr. Greger. But remember, this whole string is an attempt to refute the EPIC Oxford study and in the first 3 videos he admitted there was no refutation except “perhaps” the Brit vegetarians did not eat a healthy vegetarian diet–but that was supposition, not fact. This final video cites a different study “more than a decade before the new stroke study” that shows “vegetarians” (Dr. Greger’s word”) have equal atherosclerosis as others. What study is that? Why not mentioned before? Then Dr. Greger raises B-12 as the issue. But that is also just supposition. As he puts it “that may explain it”. I admire Dr. Greger and thank him for all the work and effort he has put in, but this inability to refute the EPIC Oxford takes the air out of the bubble for me. Thank you.

        1. Eating a WFPB diet won’t make you immortal. It’s good for loads of reasons, and it’s great that the diet is pulled apart and understood better so we can all optimise our eating. I’m sure there will be cons but the pros outweigh them

        2. Peter, we (myself and a couple of others ) tossed around similar concerns yesterday towards the end of Monday’s video comments. The problem for me is in dealing with bp issues and learning I could be hardening arteries because of the link with low IGF1. I won’t repeat it all here, but check out the discussion if you are interested.

        3. Peter thanks for that smart response. This is a problem with many of the videos. Where’s there’s uncertainty or ambiguity, it could be usefully elaborated further. Instead it’s glossed over or it’s expressed in 1 word eg “may” and that 1 word can be doing a lot of heavy lifting to carry a few videos.

          Also, for clarification, if recommending B12 but not the methylated B12, also mention that (and summarise why).

          The result of watching these stroke videos is to feel more stressed: powerless to take any actions to reduce the risk. Already take high B12, is there evidence the recommended high dose really is safe?

          1. Bob, I replied to your post, above in earlier post, with a link to a short video on the topic of too high serum b12. It also has links to the studies mentioned in the video in the video description.

          2. ‘ Already take high B12, is there evidence the recommended high dose really is safe?’

            The US National Institutes of Health note

            ‘The IOM did not establish a UL for vitamin B12 because of its low potential for toxicity. In Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline, the IOM states that “no adverse effects have been associated with excess vitamin B12 intake from food and supplements in healthy individuals” [5].’
            https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/

            (IOM = Institute of Medicine)

        4. @Peter, did Dr.G not suggest that Brits arent allowed the B12 fortification by law, which goes to Brits data informing global results?

          I saw the vids myself in this series, and I dont recall his stated mission was to refute the Oxford study.

          Can you share that part of the transcript?

        5. @ peter, no worries, you mentioned which studies he may have gotten his info from so we got you covered:

          Öztürk Ş, Altieri M, Troisi P. Leonardo Da Vinci and stroke – vegetarian diet as a possible cause. Front Neurol Neurosci. 2010;27:1-10.
          Ozturk S. Leonardo Da Vinci (1452-1519) as a stroke victim: hemiparesis: a result of a vegetarian diet?. J Med Biogr. 2009;17(1):7.
          Chrysant SG, Chrysant GS. The current status of homocysteine as a risk factor for cardiovascular disease: a mini review. Expert Rev Cardiovasc Ther. 2018;16(8):559-565.
          Spence JD. Carotid plaque burden is associated with higher levels of total homocysteine. Stroke Vasc Neurol. 2017;2(1):40.
          He Y, Li Y, Chen Y, Feng L, Nie Z. Homocysteine level and risk of different stroke types: a meta-analysis of prospective observational studies. Nutr Metab Cardiovasc Dis. 2014;24(11):1158-65.
          Zhou Z, Liang Y, Qu H, et al. Plasma homocysteine concentrations and risk of intracerebral hemorrhage: a systematic review and meta-analysis. Sci Rep. 2018;8(1):2568.
          Peng HY, Man CF, Xu J, Fan Y. Elevated homocysteine levels and risk of cardiovascular and all-cause mortality: a meta-analysis of prospective studies. J Zhejiang Univ Sci B. 2015;16(1):78-86.
          Hankey GJ, Eikelboom JW. Homocysteine and stroke. Lancet. 2005;365(9455):194-6.
          Martí-carvajal AJ, Solà I, Lathyris D, Dayer M. Homocysteine-lowering interventions for preventing cardiovascular events. Cochrane Database Syst Rev. 2017;8:CD006612.
          Finsterer J. Low risk of ischaemic stroke in hyperhomocysteinaemia. Lancet Neurol. 2017;16(9):682-683.
          Tong TYN, Appleby PN, Bradbury KE, et al. Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study. BMJ. 2019;366:l4897.
          A M J Gilsing, F L Crowe, Z Lloyd-Wright, T A B Sanders, P N Appleby, N E Allen, T J Key Serum Concentrations of Vitamin B12 and Folate in British Male Omnivores, Vegetarians and Vegans: Results From a Cross-Sectional Analysis of the EPIC-Oxford Cohort Study. Eur J Clin Nutr . 2010 Sep;64(9):933-9
          Sobiecki JG, Appleby PN, Bradbury KE, Key TJ. High compliance with dietary recommendations in a cohort of meat eaters, fish eaters, vegetarians, and vegans: results from the European Prospective Investigation into Cancer and Nutrition-Oxford study. Nutr Res. 2016;36(5):464-77.
          Bonner G, Warwick H, Bmardo M, Lobstein T. Fortification examined: how added nutrients can undermine good nutrition. The Food Commission (UK) Ltd: London, 1999.
          Mariotti F., editor. Vegetarian and Plant-Based Diets in Health and Disease Prevention. Elsevier; New York, NY, USA: 2017.
          Key TJ, Fraser GE, Thorogood M, et al. Mortality in vegetarians and non-vegetarians: a collaborative analysis of 8300 deaths among 76,000 men and women in five prospective studies. Public Health Nutr. 1998;1(1):33-41.
          Mądry E, Lisowska A, Grebowiec P, Walkowiak J. The impact of vegan diet on B-12 status in healthy omnivores: five-year prospective study. Acta Sci Pol Technol Aliment. 2012;11(2):209-12.
          Obersby D, Chappell DC, Dunnett A, Tsiami AA. Plasma total homocysteine status of vegetarians compared with omnivores: a systematic review and meta-analysis. Br J Nutr. 2013;109(5):785-94.
          Pawlak R. Is vitamin B12 deficiency a risk factor for cardiovascular disease in vegetarians?. Am J Prev Med. 2015;48(6):e11-26.
          Su TC, Jeng JS, Wang JD, et al. Homocysteine, circulating vascular cell adhesion molecule and carotid atherosclerosis in postmenopausal vegetarian women and omnivores. Atherosclerosis. 2006;184(2):356-62.
          Su TC, Torng PL, Jeng JS, Chen MF, Liau CS. Arterial function of carotid and brachial arteries in postmenopausal vegetarians. Vasc Health Risk Manag. 2011;7:517-23.
          Kwok T, Chook P, Tam L, et al. Vascular dysfunction in Chinese vegetarians: an apparent paradox?. J Am Coll Cardiol. 2005;46(10):1957-8.
          Kwok T, Chook P, Qiao M, et al. Vitamin B-12 supplementation improves arterial function in vegetarians with subnormal vitamin B-12 status. J Nutr Health Aging. 2012;16(6):569-73.
          Rizzo G, Laganà AS, Rapisarda AM, et al. Vitamin B12 among Vegetarians: Status, Assessment and Supplementation. Nutrients. 2016;8(12)

        6. Peter,

          The vegans were heavier than the meat-eaters and ate more sodium and only 1 serving of vegetables different and didn’t eat much fruit either and used vegetable oil and drank alcohol and smoked and still had significantly fewer ischemic strokes.

          Not exactly Whole Food Plant-Based at all.

        7. Thanks Peter.

          One of the problems with EPIC Oxford is that they seem likely to be junk food vegetarians/vegans. Even so, they had 10 fewer heart disease events than meat eaters versus 3 more stroke events. In other words, 7 fewer adverse events overall. I don’t see why this would cause anyone to despair of vegetarianism

          ‘This difference was equivalent to 10 fewer cases of ischaemic heart disease (95% confidence interval 6.7 to 13.1 fewer) in vegetarians than in meat eaters per 1000 population over 10 years…………………………………By contrast, vegetarians had ………………. equivalent to three more cases of total stroke (95% confidence interval 0.8 to 5.4 more) per 1000 population over 10 years, mostly due to a higher rate of haemorrhagic stroke’
          https://www.bmj.com/content/366/bmj.l4897

    2. Peter, this series is in NO WAY discrediting a vegetarian diet, especially one filled with whole plant foods. What this series IS saying loud and clear: TAKE A B12 SUPPLEMENT!! A vegetarian whole food plant based diet PLUS a vitamin B12 supplement significantly cuts stroke risk.

    3. @Peter, you were definitely missing something. If you will go back over it with the idea that:

      A. Dr G is smart.
      B. He will likely take down this site if he finds eating meat is the way to go and thee is no benefit derived from eating plants.
      C. The reference of veggies to meat eaters having similar cardio issues was shown to be directly related to being B-12 deficient.
      D. Dr. G will likely never throw a meat grenade into our community with the purpose of devastating it.

      If, after watching with these things in mind and rereading the studies referenced, you still feel that this has caused a Hiroshimic event in the plant based community, where Dr G will have trojan-horsed his own livelihood and life’s message, then please share the info you find here.

  11. My homocysteine level was 12.9 so my functional medicine doc told me to take 400 mcg of Folate and 1,000 mcg of B12 three times a week. She stressed that the Folate was important. The tablets made me nauseous for 24 hours after taking them, so I had to stop. Did Dr. Greger mention Folate and I missed it? Also, the B12 I’m taking is sublingual Methylcobalamin and I see in the Notes he says Cyanocobalamin. Does that matter?

    1. Judy, folate comes in a methyl version as well. You might try that. Due to my gene variants, I thought that methyl versions of both were better for me, although Dr. Greger prefers the other versions, folic acid and cyanocobalamin. I agree with Reality bites above and your physician, you should consider B-6 and folate as well as B12. You can check your levels of folate and B12. https://requestatest.com/vitamin-b12-and-folates-testing

        1. Judy, no but I have a gene variant for poor conversion of folic acid to folate, so I avoid folic acid. I use the Jarrow brand ( hydroxypropylmethylcellulose; other ingredients cellulose and magnesium stearate). Instructions are to take either with or without food. I take it after a meal.

          1. Thanks, again, Caroline. I couldn’t find hydroxypropylmethylcellulose on the Jarrow website. Would you please tell me what Jarrow calls the product? Now that I know that a high homocysteine level could lead to stroke, I guess I’m freaking out. I no longer go to the functional medicine doc because I was not able to tolerate any of the many supplements and prescriptions she recommended. She gave up on me and now I’m on my own. I only recently found Dr. Greger but who knows anymore who you can trust?

                1. In my case I guess it is — at least if I can trust that the labs were correct and my homocysteine level was high. Reading the posts here, though, I wonder if we can rely on labs. Since I’m an old lady, the buzz word for me was “stroke.”

                  1. Wow, ok so youve made sure to get enough of the beans and lentils etc.? Was just hoping you could avoid the supp pill form and somehow get adequate amounts of folate so you don’t have the backlash of the aftereffects of the pills, etc…

                    Best of luck!

                    1. Oh yes, almost forgot, I think its possible that some dont quite get enough of these tasty legumes because of its own after effects. Rhymes with party.
                      It can make some think twice about how much they eat. (no pun intended)

                    2. Thanks, jazzBass! Sorta lost my mind there for a few minutes. After reading Amazon reviews about that supplement, I came to my senses. Guess I’ll try harder with beans and lentils. I’ve been a vegetarian for 50 years, but as Dr. Greger has pointed out, that does not mean I’ve had a good diet.

                    3. [Corrected post] Thanks, jazzBass! Sorta lost my mind there for a few minutes. After reading Amazon reviews about the Thorne supplement I found (not the one that Caroline mentioned), I came to my senses. Guess I’ll try harder with beans and lentils. I’ve been a vegetarian for 50 years, but as Dr. Greger has pointed out, that does not mean I’ve had a good diet.

            1. Judy, this is from Life Extension, explaining why some people (I am included) might need to take the methyl version and avoid the synthetic version, folic acid.

              Choosing L-methylfolate over Folic Acid

              Supplements are usually made with the shelf-stable synthetic version of folate, folic acid, which in most people is readily converted to the form used in the body, 5-methyltetrahydrofolate (5-MTHF). However, a substantial percentage of the population has one or more genetic variations that interfere with the efficient transformation of folic acid to 5-MTHF.67

              L-methylfolate is a form of folate available in some supplements that is already in the 5-MTHF form. This means that the L-methylfolate form does not require the MTHFR enzyme to create functional folate to be used in homocysteine metabolism.68 People with these inefficient MTHFR genetics benefit more from L-methylfolate than from synthetic folic acid supplements.69 Even people with normal MTHFR genetic status have been shown to respond better to the L-methylfolate form compared with conventional synthetic folic acid.70-74

              Importantly, it has been demonstrated that high-dose synthetic folic acid can prevent proper folate metabolism in both normal individuals and people with 5-MTHFR genetic variants.75,76 Fortunately, supplementation with L-methylfolate avoids this problem altogether.

              1. Thanks, Caroline. I found a Thorne supplement that has half the methyl form of folate as the one I tried before — L-5-MTHF 200 mcg instead of 400 — so I’m hoping it won’t make me nauseous. Unfortunately, it does have other forms of B as well, but they look pretty low dose. I remember a million years ago when low-dose B-complex wasn’t hard to find. https://www.thorne.com/products/dp/cdn-stress-b-complex

              2. Hi Caroline,

                I have the T,T MTHFR polymorphism, so I, too, am particularly interested in homocysteine-related issues. I take an L-methylfolate supplement and a methyl-B12.

                I still have two nagging questions, despite hours of research on this subject. I am looking for definitive, science-based recommendations regarding the following:

                1. Are MTHFR-deficient individuals covered if they get a lot of natural dietary folate (from lots of daily dark green leafy vegetables)? Are they able get their folate requirements from a sufficient quantity of green leafies, or should they still be taking L-methylfolate supplements?

                2. Should MTHFR-deficient individuals be taking the methyl form of B12 (methylcobalamin instead of the more common cyanocobalamin)?

                It is hard to get hard recommendations from sources that are not motivated by financial gain.

                1. Vegetarians – on a WFPB diet, not junk-food Vegetarians – typically get much more folate in their diet than omnivores, and usually have no need to supplement – unless advised to do so by an M.D. (Prenatal Vitamins, etc.).

                  Nutrients are usually best obtained from food rather than from supplements.

                  Folate, B6 and B12 from food. Scroll down the pages to get to the larger orange charts:

                  Folate: http://www.whfoods.com/genpage.php?tname=nutrient&dbid=63

                  B6: http://www.whfoods.com/genpage.php?tname=nutrient&dbid=108

                  B12: http://www.whfoods.com/genpage.php?tname=nutrient&dbid=107

                  Best regards –

                  Vivamus

                  1. Vivamus,

                    Thank you for taking the trouble to reply. However, perhaps you are not aware that a certain percentage of the population has a genetic polymorphism that strongly compromises the homocysteine/MTHFR-r/B12 metabolic pathway. The charts and text in your links cite DRI/DV percentages that apply to the general population, not the special MTHFR population to which which my question refers.

                    Of course I agree with you that, “nutrients are usually best obtained from food rather than from supplements”. However, one of Dr. Greger’s main points in this video is that there is at least one nutrient (B12) that we cannot obtain adequate levels of from food. It may also be the case that certain special genetic populations need to make special adaptations.

                    Methylfolate is actually more like a medication than a supplement, since it doesn’t duplicate something that occurs naturally in food but supplies something that the bodies of MTHFR people are not making. Because they lack the ability to make the MTHFR-r enzyme, the metabolic pathway that utilizes this enzyme does not function properly, and homocysteine tends to build up in their bodies. Dr. Greger is very clear about how harmful too much homocysteine can be, and this explains why MTHFR people want to get this right.

                    1. Plant_this_thought,

                      You wrote: “perhaps you are not aware that a certain percentage of the population has a genetic polymorphism that strongly compromises the homocysteine/MTHFR-r/B12 metabolic pathway.”

                      ———————————————–

                      From Wikipedia:

                      “Alternative medicine

                      With the growth of direct-to-consumer genetic testing, the alternative medicine industry has aggressively targeted a range of dubious tests[38] and highly profitable quack treatments for claimed MTHFR polymorphisms, despite the lack of any demonstrated health effects of these mutations.[39] The promotion of supplements and other treatments for MTHFR polymorphisms, especially centered on autistic spectrum disorder,[40] have been characterised as snake oil. Tests for MTHFR, while gaining popularity, are generally unnecessary because the association of MTHFR gene mutations with various diseases have not been established as clear-cut cause-and-effect relationship.[41]”

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

                      ———————————————–

                      From the CDC:

                      “People with MTHFR C677T variants can process all types of folate, including folic acid.

                      Folate is a general term for many different types of vitamin B9. Folate includes naturally occurring folates in foods, such as leafy green vegetables, citrus fruits, and beans, and several types of folate in dietary supplements, such as folic acid and 5-methyltetrahydrofolate (5-MTHF). The MTHFR C677T variant affects how your body processes folate. You might have read or heard that folic acid is not safe if you have one or two copies of the MTHFR C677T variant. This is not true. Even if you have one or two copies of the MTHFR C677T variant, your body can safely and effectively process the different types of folate, including folic acid.

                      You may have heard or read that if you have an MTHFR C677T variant, you should take other types of folate (such as 5-MTHF), but this is not true. Folic acid is the only type of folate shown to help prevent neural tube defects (severe birth defects of the brain or spine).1-4,6

                      No scientific studies exist that show that supplements containing other types of folate (such as 5-MTHF) can help prevent neural tube defects.

                      Gene variants are common and normal. In fact, there are more people in the United States who have one or two copies of the MTHFR C677T variant than people who do not have it.7 Variants in genes are what make us unique. They cause differences, such as eye color, hair color, and blood type.

                      You may have seen the MTHFR C677T variant referred to as a “gene mutation;” however, the word, “mutation,” usually refers to a change in the gene that is much less common. It is more accurate to refer to MTHFR C677T as a ‘gene variant.’

                      The MTHFR C677T variant is more common in some races and ethnicities than in others. Hispanic individuals are more likely than non-Hispanic whites and non-Hispanic blacks to have the MTHFR C677T variant.7”

                      https://www.cdc.gov/ncbddd/folicacid/mthfr-gene-and-folic-acid.html

                      ———————————————–

                      From The Academy of Nutrition and Dietetics

                      “There is insufficient evidence regarding C677T polymorphism in the MTHFR gene to modify current folate recommendations from those provided in the Dietary Reference Intakes.”

                      https://jandonline.org/article/S2212-2672(13)01783-8/fulltext

                      ———————————————–

                      Plant_this_thought.

                      All the best –

                      Vivamus

                2. plant_this_thought, it looks like you and I (as well as a large percentage of the population!) need to test frequently for homocysteine levels and perhaps consider supplementing with vitamin B2 (riboflavin) if we develop high blood pressure. I did not realize how many people are affected! “It is estimated that between 5 and 10% of the population has a gene variant that reduces MTHFR activity by 70%,32 while nearly 50% of people of European descent have a genetic variation that decreases MTHFR activity by as much as 35%.” “Vitamin B12, B6, and folic acid levels should be measured in patients with hyperhomocysteinemia,” but 23andme feels that we need not worry too much about health consequences, unless homocysteine levels are very high. https://blog.23andme.com/health-traits/our-take-on-the-mthfr-gene/

                  In addition to getting enough B12, B6 and folate from diet or supplements, Linus Pauling Institute suggests a riboflavin supplement when homocysteine and blood pressure are high. https://lpi.oregonstate.edu/mic/health-disease/high-homocysteine:

                  By assisting the enzyme MTHFR, riboflavin (vitamin B2) helps convert folate to a form required for the transformation of homocysteine to methionine. We know that individuals with a certain genetic variation (polymorphism) in MTHFR may have an increased risk of developing high blood pressure and cardiovascular disease (CVD).In hypertensive individuals with the MTHFR c.677C>T polymorphism (homozygotes), low-dose riboflavin supplementation lowers both homocysteine concentration and blood pressure.

                  A low status of riboflavin status may interfere with the metabolism of folate, particularly in individuals homozygous for the MTHFR C677T gene variant; these individuals exhibit a higher risk of cardiovascular disease (CVD). Emerging evidence from intervention trials supports a protective role for riboflavin against hypertension in individuals with the MTHFR 677TT genotype. 

                  It may be particularly important, however, for us to supplement with B12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294092/: In conclusion, our results showed a significant association between MTHFR-c.677C>T genotypes and vitamin B12 deficiency in a subset of the Jordanian population. On the other hand, the c.1298A>C variants did not show an association with the deficiency of B12. Further studies are required to elucidate the role of MTHFR variants in the metabolism of vitamin B12 and other associated metabolites like folate and homocysteine….Our results could further help explain higher rates of vitamin B12 deficiency in Jordan.

                  There is a long list of articles at https://www.snpedia.com/index.php/Rs1801133 that might answer to your question regarding whether a high dietary intake is preferable to supplements; that is usually the case since the body cannot regulate supplements and too much is often consumed. I have a gene variant for low conversion of folic acid to folate, so I switched from folic acid to methyl folate as an occasional supplement. There does seem to be concern over taking this over the long term in supplement form if it is not needed though (it feeds existing cancers https://cebp.aacrjournals.org/content/15/2/189#:~:text=The%20safety%20of%20chronic%20very,1%20and%208%20(21)).

                  Online articles suggest that for MTHFR the preferable form of B12 to take is methylcobalamin, so I switched to that. “‘I may recommend an over-the-counter B12 pill of 1,000 micrograms daily if B12 is borderline low or MMA is borderline high. After the level is back to the normal range, I will often decrease the dosage,’ says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center. If you take a B12 pill, Dr. Stampfer recommends taking the natural form (methylcobalamin), not the synthetic form (cyanocobalamin). ‘Studies suggest cyanocobalamin may impair kidney function in people with borderline kidney problems, so it’s better to stay on the safe side.'” https://www.health.harvard.edu/staying-healthy/should-you-take-a-vitamin-b12-supplement

                  A one cup serving of plant milk like Silk Soy has more than the RDA of vitamin B12, so perhaps many vegans do not actually need an additional supplement. It also contains 10% of RDA for folate from the soybeans, and 30% of RDA for riboflavin (vitamin B2). The current U.S. recommended dietary allowance of vitamin B12 for adults is 2.4 micrograms per day. Absorption of B12 varies from about 50%, if about 1 microgram or less is consumed, to about 0.5% for doses of 1000 micrograms (1 milligram) or above. https://www.vegansociety.com/resources/nutrition-and-health/nutrients/vitamin-b12/what-every-vegan-should-know-about-vitamin-b12

                  1. Thank you for telling me B2 can lower homocysteine levels. Foods rich in B2 include Soybeans, beets greens, and spinach. These foods are known stroke fighters and probably work better than just their B2.

                  2. Thanks, Caroline, for the links and further thoughts.
                    I do need to get my homocysteine level checked, as this is ultimately the criterion for whether I have “a problem.”
                    I have been through the Snpedia citations exhaustively, and I would recommend this to anyone who wants a good overview of the research.
                    Thanks also for bringing up the riboflavin angle.

                3. Hi, plant_this_thought! MTHFR “mutations” (more aptly called polymorphisms or variations) are a hot thing right now in some circles, and are used to sell all kinds of special, expensive genetic tests and supplements. Dr. Greger has not covered this topic yet. I have asked him to address it, but it takes time to research and produce videos for all of the requests he receives daily, and he has not yet gotten to it. Vivamus is correct in stating that quality research does not adequately support the claims made with regard to MTHFR variants and folate at this time. That said, if you feel more comfortable taking these supplements, I am not aware of any particular harm in it. I hope that helps!

    2. Hi, Judy! No, you didn’t miss it. Dr. Greger did not mention folate, because it is generally abundant in plant-based diets. You can find everything on this site related to folate here: https://nutritionfacts.org/topics/folate/ Dr. Greger’s rationale behind suggesting cyanocobalamin is that it is less expensive than methylcobalamin and more stable. More on that here: https://nutritionfacts.org/questions/which-type-of-b12-is-best/ I personally don’t think it matters that much what form of B12 you take, as long as you take it! I hope that helps!

    1. Yes, a fascinating study. I am not sure that I fully understand its implications though. That study found:

      ‘Our subgroup analysis by vitamin B12 intake is shown in table 5. Inverse association between vegetarian diet and lower overall stroke was found in the subgroup with inadequate vitamin B12 intake (<2.4 μg) but not in those with adequate vitamin B12 intake (≥2.4 μg), p interaction = 0.046.'

      In other words, B12 consumption under recommended levels appears to be associated with strongly reduced stroke risk whereas B12 consumption at or above recommended levels seemed to be associated with stroke levels at almost the same rate as non-eaters.

      Since Taiwanese vegetarians eat eggs and dairy, the authors speculated that 'Vitamin B12 may be a surrogate marker for animal product consumption'

      They also add

      'the generalizability of study findings may be limited to populations that abstain from cigarettes and alcohol. The overall finding contrasts with that of the EPICOxford study but is consistent with previous studies on plant-based diets and stroke.11–14'

      https://n.neurology.org/content/neurology/early/2020/02/26/WNL.0000000000009093.full.pdf

      1. Oo[s

        ‘In other words, B12 consumption under recommended levels appears to be associated with strongly reduced stroke risk whereas B12 consumption at or above recommended levels seemed to be associated with stroke levels at almost the same rate as non-eaters.’

        ‘non-eaters’ should be ‘non-vegetarians’

        Clearly I couldn’t decide whether to write ‘non-vegetarians’ or ‘meat eaters’

    2. Hi M85, thanks for the link and the study you refer to. It does not indicates why with low level of B12 and high folate and homocysteine their subgroup showed lower incidence of stroke! It could be that some other dietary and life style factor is at play in Tiawanise lifestyle. One has to read the whole study to know more detail about the study.

  12. I understand from a friend who worked in medical labs, that the homocyteine test, to be accurate, has to be done correctly: that is, drawn with the correct tube, spun down and chilled within the hour and transported frozen to the location where it is analyzed. Some labs do not follow the necessary steps in a timely fashion (understaffed, not well trained), especially for a test that is not routine. IF it sits around unrefrigerated and as whole blood, the homocysteine levels rise.
    So check that your lab is doing it correctly before you sit down for a blood draw. When this first came on my radar, the tech at the labcorp site was not familiar with homocysteine draws, but the lab at the hospital was totally on top of it.

    I also know you can have elevated methylmalonic acid (a functional test that indicates B12 deficiency) and yet have plenty of B12 in your serum..in fact too high.
    This is likely reflective of a genetic mutation in the genes that make B12 transporter proteins to shuttle blood B12 across the cell membrane into the interior. https://pubmed.ncbi.nlm.nih.gov/14585166/. So in essence…your blood shows elevated B12 because it cannot get into the cell to do its job. Maybe this is one explanation for some why elevated B12 seems to increase cancer risk…your cells literally cannot get enough of it…it is floating in the bloodstream and cannot cross the threshold.

    Or, you can get B12 into the cell….but you are not efficient in getting it into the mitochondrial (which requires another different transporter). Efficient B12 metabolism relies on many middle men to get the job done start to finish. I remember reading somewhere that they are working on “chaperone” molecules that can do this for people who are genetically at risk. But I could be confusing tis with another disorder involving transport proteins.

  13. Michael,

    BRAVO to you for you lifelong dedication to bringing awareness of plant diet to to world. You receive endless praise and I’m all in also a supporter.

    HOWEVER – As a former military officer and business person always working on large consequence situations I MUST tell you your THEATRICS and DRAMATIZED vocal style is MUST DISTRACTING AMD ANNOYING.

    NOT GOOD. TAKES AWAY FROM SIMPLE DELIVERY OF THE DATA.

    THIS IS SERIOUS STUFF.

    If you want to be on a late night comedy / talk show, go do it. If you want to do voice work for children’s cartoons, DO IT.

    BUT PLEASE – folks watching videos intent on understanding the science and improving health are not here for awful attempts at entertainment.

    I struggle to get through any video you make because of the awful vocal tone games you play.

    PLEASE STOP!!! How about speak clearly as if talking to serious adults and stop trying to entertain a room full of 5 year olds.

    This subject is far too serious.

    SPEAK SLOWLY, STEADILY, EVENLY, LOUDLY, CLEARLY…YOU BLAST AND BABBLE through content that it becomes a waste of my time to watch and infuriatingly annoying.

    You DESPERATELY NEED THIS NEGATIVE FEEDBACK REF DELIVERY STYLE.

    Dr. Klaper, great vocal style, Esselstyn, Kim Richards, all great. Dr.Colin Campbell, all great – no need for a carnival Barker persona – just the facts, hold the theater/THEATRICS. “put it to the test” does NOT need to be animated thirty times in a short video.

    Not a hater, just being honest. Talk to us like intelligent adults, not 3-5 yr olds.

    1. @rick, THE CAPS AND YOUR OPINION.

      I’M GLAD THIS DOESN’T COME OFF LIKE I’M YELLING AND TALKING TO 3-5 YEAR OLDS.

      BY THE WAY THE MILITARY IS A GREAT WAY TO LEARN TO DELIVER A MESSAGE. HIROSHIMA COMES TO MIND, AND THE MESSAGE THERE WAS AWESOMELY DELIVERED. (We effectively neutered their entire population into supplication after being the only place in the world to have been the recipient of such a powerful gift. Military and business is the absolute best place to learn restraint of personal gains and interests, so that’s a job well done for sure.)

      But seriously have you ever thought about how this type of thing can get in the way of you simply moving on to another more cookie-cutter situation?
      A ha! I bet you haven’t. Well, you never know….

      “Until you put it to the test!”

      ….Here we go, a double-blind, placebo-controlled, randomized crossover study showed that ex military officers had become so agitated by the historical requirement to take orders from some, while giving orders to others, that they became completely deficient in vitamin T (tolerance), and so they became unwilling to accept the way other people were doing things – until they got tested.

      AND WHOA!

      The funsie wunsie study showed that nothing helped? ..except perhaps, juice and cookies at nap time. Tune in next week when we explore this more…

      Not a hater, just being honest.

      1. JB please wind back the histrionics and policing other people’s feedback like you’re NF Police. I feel you may enjoy some soothing meditation instead.

        1. @BOB good point. But again, I’m not here to read that people dont like being here. isnt that pointless?

          Meanwhile I accept your policing of my policing.

          Btw, Which raga is your favorite for morning meditation?

    2. Agree with Rick M and I’m a big fan of Dr Greger’ s work. I also think he needs to be more thorough in explaining his recommendations. Eg safety of high dose B12? Increased B12 cellular absorption issues, cancer rates? How to best test for B12. If not methylated B12, say so and why. Also mention related factors such as how else to lower homocysteine. You shouldn’t have to be a 24×7 NF zealot to be aware of the bigger picture. Half the story can be leaving people at risk.

      1. Rick Morgan,

        Agreed.

        I haven’t been able to refer anyone to this site since Dr. Greger went into “Celebrtiy” mode.

        Too embarrassing.

        Which is a pity. Dr. Greger can do excellent work when he doesn’t get in over his head.

        Rick.

        All the best –

        Vivamus

        1. Jeeez you too viv?

          Ok. You guys both are saying, along with a few others that you don’t like Gregers “new” style, but I gotta say there doesn’t seem to be much difference from this to the old video of him in a college classroom. Or when he was a bit overweight.

          Throughout, it seems a simple common thread of usage and delivery, then and now. (to me of course, and musical ears hear this sort of thing fairly well apparently) Yes a few things like some graphics have changed, but maybe thats just it. Change.

          I don’t see the issue really, but that’s ok I don’t have to of course.

          But, the main puzzlement then is this:

          Why are you and other people that dislike (and have done for a while now) here, in spite of the fact that you guys want to turn off the screen, or can’t refer anyone here out of …what?…embarrassment? Or is it because there isn’t any useful info to be gleaned.

          I’m starting to think that most people here are over 60 and as such have turned a social corner where its just easier to go with what you know, and it frustrates them when things change.

          Its all part of losing your edge really and that’s ok and comes with aging and I can feel its onset when I hang around whipper snappers. It kinda sucks, but too its just part of life i guess.

          But still, at any age, given the opportunities available, I am wondering how anyone can be on a website, with a fair amount of regularity, and then post that they don’t like and wont refer the same website?

          The reason I ask is that there are nearly 2 billion websites to choose from.

          I’m thinking this new Greger trashing is like the typical day of an older guy who goes into the diner, again, sits down, waitress asks: “The soup?”,
          He replies with a nod, and as he takes his first sip, he thinks: “This is awful!”.
          Later, the waitress comes over: “Nice and tasty hon?”
          “Yep, same as usual.”
          “See you tomorrow hon?”
          “You bet.”

          1. jazzBass,

            You can call me “Brutus.” ;-)

            I understand where you are coming from. Everything you are saying.

            Crystal clear.

            But you have slid off the road on this one.

            The prior format worked very, very well for serious study. For those of us who prefer not to be spoon fed our information – nor to be entertained by a dancing bear.

            But to be informed of the science.

            The current format is terrible for serious study.

            Distracting.

            Embarrassing.

            Pretty simple.

            Not old-fogeyism.

            Listen to the criticism instead of responding with guru worship – and you may be able to learn.

            If you are not too rigid in your thinking – hey, it happens with age – I understand, Pops!

            Question – is there any music that was better once than today?

            No – of course not. We should entirely erase the past.

            There – that’s better.

            Justin Bieber is the GREATEST, man!

            Agreed?

            jazzBass.

            See ya in the funny papers –

            Vivamus

            1. Ha ok Viv, well, man I can say that I did listen to the criticism, and the criticism appears to be that you and others do not like the current “style” of delivery.

              I hope that sounds reasonably accurate.

              My rails are solid, and on track. Stay tuned:

              When you say “old format” its hard to tell what you mean because I have seen various substyles within the Greger “genre”.

              Again please recall I did write that I personally do not see such a grave difference between this latest effort, his middle efforts and the early efforts.

              As a guy delivering a message he is there, in all three “eras”. Its unmistakable, and I doubt he is or should be embarrassed.

              In fact, Guru worship is a thing we can aspire to. If we are talking about a true Guru. If a person goes through life in honesty and giving, and finds their way to you in that spirit, without opportunism as a focus, then I’m on board if it is also backed by scientific data. Thats rare.

              That said I am thrilled that person may also earn a living doing what they love. Too, this relationship remains as it is, another viewpoint which is still subject to scrutiny.

              Your use of the term Guru Worship though, implies the blind following of a cult of personality. I believe that is for the stupid. I am certain, you don’t think I am stupid, since if you do after these dialogues, you would have to accept your own absence of critical thinking. I doubt that very much, and your intelligence comes through to me.

              My guess is, and its just a guess, that Dr. Greger does not consider this site a source of serious study. Its a website where he delivers a message of health through the ever validated prism of plants based eating, in his words and with his chosen delivery method. Its light, fun, and deep all at the same time. Kinda like you.

              He makes his own choices how to do this, while providing links for …serious study.

              But he does this: “So, you don’t have to.” (While realizing some will, of course)

              If I have asked here in the past for information as to Dr Greger recommendations, its not out of blind worship, but rather to cull the field of opinion we all seem to be immersed in here, you included. Some experts, most (99.999%) not.

              This is why I ask about knowledge of his recommendations, which I then will weigh and do my own research since Id rather get the info from him than you, or anyone else on the site. With no disrespect intended.

              At least we know his real name etc…If you guys don’t like whats here now, and feel it was somehow better before, that’s fine.

              Again though, I wish it wasn’t necessary to state on this free website that you don’t like the website, and cant refer it to your social circle, from the stench of it.

              News item: Doing that is not useful, which ironically is your main complaint of the site – that it lost is usefulness. Its what you guys seem to be after.

              They do have a contact us button I believe and you can let them know you wish to change their format to something more suitable for your tastes or high end medical serious study.

              RE: Justin Beiber, good point. He’s no Lawrence Welk, and few could aspire to such artistic heights.

              Pop has always been shlop. “How much is that doggie in the window……”, ….”Tip toe through the tulips”…”…flying purple people eaters….”

              One cannot erase that which is in the past, since it actually doesn’t exist now and change isn’t a threat, its a fact.

              I realize change for change’s sake is never always the best thing, and one should never say always unless the two words are in the same sentence.

              1. jazzBass,

                Well said.

                Your position is clear.

                There is much to reply to – points that are now missing which might further inform you. But then you might likely feel it appropriate to reply. And then I . . .

                And this could go on for quite a while. Quite a bit of time and effort involved, yet resulting in barely a ripple in the cosmic ether.

                LIGO would barely detect that anything had changed, at all.

                Conversely, this sort of discussion would probably work pretty well over dinner – rapid adjusting of positions as understanding increases – vocal and facial and body language communication cues which are lost in the ether – with some bawdy thoughts and laughter thrown in along the way, inappropriate to the presence here of women and children. But it is my best judgement that this discussion cannot be satisfactorily resolved in the current Internet posting format.

                So – with a nod – I will will withdraw from further discussion of this matter at this time.

                It is probably best to choose one’s battles – terrain, time and place – and opponent – carefully.

                Or whether battle is appropriate at all.

                And I am not feeling particularly opposed to anyone or anything on this fine sunny afternoon.

                It’s a beautiful day to be alive.

                jazzBass.

                All the best –

                Vivamus

                1. @viv, tip o’ the hat, and Im glad we have met on this site, however one feels about it. Ive not had a din din socially in ages really, its a bit forced in restaurants, and most are not entertaining, including here. Trying desperately to get back to France for such fun too, but dang Macron not a willing partner in my affairs.

                  Last reply, for now.

                  In health,
                  JB.

      2. People already complain that the videos are too long. Covering everything that could possibly be relevant to very conceivable minority would take hours if not days.

        The video is about ‘vegetarians’ and stroke risk. It has to focus on the topic at hand.

        I’m a fan of long, in-depth videos myself but the site seems to have policy of examining narrowly focused topics via relatively short videos ….. presumably on the grounds that most people these days have limited attention spans.

  14. Hi,
    Thanks for the video and comments.

    I am on a plant-based diet and in very early stages of pregnancy and would like to checkon the advice I got in regards to the amount of vitB12. I was told that I needed to boost my B12 urgently as my B12 was on the low limit (280 pg/mL) and high on Homocysteine (12,2 umol/L). I started taking the source of life spray which supplies 500ug, but then doctor said that I should just stay with the amount of the multivitamin prenatal, which is just 4ug. I am boosting with about one tablespoon of nutritional yeast some days a week but not all. I would appreciate any advice you have.

    best wishes,
    marta

    1. medina guez,

      The 4 ug in your prenatal is probably not enough, especially since your B12 levels were low and Dr. Greger recommends taking 50 mcg per day.Take the B12 at least 4 hours apart from your prenatal, for maximum absorption. In “Becoming Vegan”, Brenda Davis, RD recommends pregnant women take 25 to 100 mcg per day of vitamin B12.

      1. Julie,

        Are you an Obstetrician or an R.D. knowledgeable in nutrition in pregnancy?

        If not – be very careful in making nutritional recommendations to a pregnant woman.

        That is not a place you ever want to be wrong.

        I would never contradict an Obstetrician in this matter, myself.

        If there is a patient concern – a second opinion with another Obstetrician or with an R.D. knowledgeable about nutrition in pregnancy may be appropriate.

        Respectfully –

        Vivamus

        1. Vivamus,

          Julie is quoting Brenda Davis’ advice to pregnant vegan women.

          Medina needs to make sure that her OB-GYN has worked with vegans before because the risk of miscarriage and other problems are higher when the pregnant woman is lower in B-12.

          I am going to tell you that my father is going to go through a surgery this week and I found 2 ways to avoid surgery performed by physical therapists and he and I didn’t fight but he said, “Deb, I am in a hospital and I have to do something. I can’t just leave and try to find a physical therapist and see if they can figure something out.”

          He wouldn’t even look at the cat scans that were on the site.

          I am opposite of him. I was already upset that his PC didn’t do tests. He might have more than one thing going on but for one, he is going to go through a surgery that could make his condition worse and he knows that risk but wouldn’t even look at the PT page.

          I would have walked out of the hospital as fast as possible.

          The PT page said that their success rate is that 90% of the people don’t need surgery at the end. The people still have issues but they don’t have to have surgery and that doesn’t even tempt him.

          1. It isn’t even going to be a laparoscopic surgery. He is going to be going through a big surgery and it is not even going to help and I was so happy I found 2 non-surgical ways with pictures.

            I am going to be sleeping on a love seat for weeks.

      1. medina,

        Maybe at least ask WHY is it okay for you to stay low versus using Nutritional Yeast every day or drinking fortified milk with your supplement?

        I ask because it might be that the doctor is afraid of cancer or something where there is a “cancer rumor” that has floated around the internet and Dr. Greger’s webinar had a video that you don’t have to worry about it. If there is a secondary reason like that, then challenge it.

        If your doctor has never walked a vegan through pregnancy, maybe it would be good to know.

    2. Hi Marta, Dr. Greger recommends taking a separate B12 supplement, rather than relying on it through a multivitamin to ensure proper absorption.

  15. In the last study, “Vitamin B12 Supplementation Improves arterial function in Vegetarians with sub-normal B12 status”, what form of B12 were the subjects given? The link to the article only shows the abstract, which does not include form of B12 used. Thanks!

    1. I was able to go further into the study beyond the abstract but when the authors describe their methods here is all they said” Fifty healthy vegetarians (vegetarian diet for at least 6 years) were recruited. Intervention: Vitamin B-12 (500µg/day) or identical placebo were given for 12 weeks with 10 weeks of placebo-washout before crossover (n=43), and then open label vitamin B-12 for additional 24 weeks (n=41).” They unfortunately did not disclose what form of B12 they used, although they did divulge dose.

  16. I was registered to participate in Dr. Greger’s live webinar today, 8/26, and was supposed to receive an email from Zoom an hour before the event with the link to join. I have NOT received an email from Zoom and so am unable to attend. I have tried contacting Zoom directly and get only robotic help with links to troubleshooting articles. No real help. I have checked my spam folder and there is nothing there, either. I am very disappointed!

    1. Hi Judy, I am sorry to hear you weren’t able to join the webinar. You should be getting an email today with the replay. If you don’t receive it by Friday afternoon, please contact us through the green support button on the bottom right side of the page.

  17. Have any studies detected a possible connection between high levels of Vitamin K in plant-based diets and stroke risk? I’d like to hear Dr. Greger’s take on this.

    1. Mary, I do know from personal experience (DVT and PE) that it is crucial to monitor vitamin K intake while you are on Coumadin. My hematologist was not concerned in general though. He said that my risk of clotting needed several risk factors to coincide before I had a problem. In my case it was hereditary thrombophilia plus hereditary accelerated wound healing plus a foot fracture plus immobility. At that point vitamin K intake might be relevant; in normal times it should not be. Moreover, garlic and many spices that you add if you prepare a WFPB diet from scratch will work to offset the clotting tendency of vitamin K rich foods.

    1. Wade,

      I love your comment.

      I probably would put the How Not to Die series first, but this is the most important now that I am eating vegan.

      I was so happy that he took this topic on.

      My vegan used to have an -ish next to it but I haven’t had even one piece of birthday cake this year.

  18. When I went from meat eating to vegan, I got tested for a baseline B12. It turns out I was already deficient because long term metformin use blocks my B12 absorption. So not only was I at a high stroke risk because of my type 2 diabetes, the remedy was also increasing my stroke risk!!! They should start testing long term metformin users as well.

    1. Dori,

      I totally agree with you. I posted a comment earlier that included the observation that several drugs interfere with B12 absorption, including metformin. This was news to me.

      Because so many people are likely to be deficient in B12 for any number of reasons — elderly, taking meds, vegans, whole plant foods eaters, even younger meat eaters — everybody should be routinely tested for B12 levels.

  19. The diet of the Buddist vegetarians mentioned in a couple of comments above was close to WFPB diet ideals. Note that they do not eat eggs. “Buddhists consume dairy products but exclude eggs, poultry, fish, and meat from their diet.” The diet of the Oxford vegetarians was essentially a standard Western diet, presumably with extra high fat dairy products and eggs added to replace the meat, since in the vegetarian diet saturated fat content and total fat content were so high. 

    The Epic-Oxford study authors noted that their vegetarian cohort had lower circulating levels of  vitamin B12, vitamin D, and long chain n-3 polyunsaturated fatty acids, and speculated that these nutritional factors could contribute to the observed associations. So Dr. Greger focused on these possibilities. However, he failed to mention the most obvious explanation: increased egg consumption in the vegetarian group was the cause of increased incidence of hemorrhagic stroke.  

    Egg consumption is “positively associated” with a higher risk of hemorrhagic stroke. In the EPIC study, participants consumed less than 20 g/day of eggs, on average. Each additional 20 g/day of eggs was associated with a 25% increase in the relative risk of hemorrhagic stroke. PCRM: eggs increase risk for stroke, according to a study published online in the journal Stroke. Researchers followed the diets of 11,601 participants from the Atherosclerosis Risk in Communities (ARIC) Study and monitored protein sources and stroke incidence rates. Those who consumed the most eggs had a 41 percent increased risk for hemorrhagic stroke, compared with those who consumed the least. https://www.pcrm.org/news/health-nutrition/meat-and-eggs-increase-risk-stroke 

    Moreover, the Epic-Oxford study came to the same conclusion. Their study published in July 2020 in the European Heart Journal found that higher egg consumption increased the risk for hemorrhagic stroke.  https://academic.oup.com/eurheartj/article/41/28/2632/5748325 The researchers found that for every extra 20g of eggs consumed a day there was a 25% higher risk of haemorrhagic stroke, equivalent to 0.66 extra cases per 1000 (or around two cases per 3000) of the population over ten years. Science Daily points out that an average large-sized egg weighs approximately 60g. https://www.sciencedaily.com/releases/2020/02/200224102024.htm

    So rather than focusing on this laundry list of possible causes for hemorrhagic stroke, Dr. Greger might have simply pointed out the big difference between the vegetarian diets in the Epic Oxford study and the Taiwanese Buddhist study: eggs. That alone explains the conflicting results in the two studies.

    1. The Buddist vegetarian study, from the link above: “Despite higher homocysteine due to lower vitamin B12 intake, vegetarians did not have higher risk of overall, ischemic, or hemorrhagic strokes….The overall finding contrasts with that of the EPICOxford study, but is consistent with previous studies on plant-based diets and stroke.11–14.

    2. Caroline

      That Taiwanese study reported

      ‘Vegetarian status was defined by avoidance of meat and fish in face to face confirmation by trained interviewers and in the FFQ in cohort 1. As for cohort 2, the diet section includes a question inquiring whether the participant was a vegetarian or a nonvegetarian. Participants who identified themselves as vegetarians in this question and reported consuming no meat and fish in the FFQ were classified as vegetarians; those who self-identified as nonvegetarians or reported any consumption of meat or fish within the previous year (in the FFQ ) were classified as nonvegetarians.’
      https://n.neurology.org/content/94/11/e1112

      ……………… by which I assume that eggs were or could have been in the diets of those ‘vegetarians’.

      1. Fumbles, I have been trying to root around Dr Greger’s source materials for this past Monday’s video. (Regarding people who were vegan but suffered increase in stroke risk ) Many of the links were just not acessible.. not even the abstracts. However, I did find 2 interesting ones that were on point. The second I find particularly useful for the ‘checklist’ contained in the results. https://pubmed.ncbi.nlm.nih.gov/24920855/ 20 g / day imncrement in dietary protein was associated in 26% reduction in stroke risk.
        https://pubmed.ncbi.nlm.nih.gov/12944100/ IGF-1 meta analysis. re: reduction in stroke, and stroke as vegan ‘achilles heel’.

        1. Also, I wonder if focussing on one set of risks (eg for stroke) may not lead us to increasing risk for a whole srt of other things.. For example, that dietary protein and stroke risk study

          ‘After fine controlling for all assessed cardiovascular risk factors that could act as confounding variables, as well as for total energy and saturated and unsaturated fat intake, we found that women had a statistically significant 5% increase in the incidence of cardiovascular events per 2 unit increase in the 20 unit low carbohydrate-high protein score. In practical terms, and taking into account the rough correspondence in the ranking of energy adjusted and crude tenths of intake, a 20 g decrease in daily carbohydrate intake and a 5 g increase in daily protein intake would correspond to a 5% increase in the overall risk of cardiovascular disease…………………………….
          he incidence rate ratio associated with a 2 unit increase in the low carbohydrate-high protein score varied from a statistically significant 1.04 for ischaemic heart disease to a statistically non-significant 1.07 for subarachnoid haemorrhage and a statistically significant 1.07 for ischaemic stroke. ‘
          https://www.bmj.com/content/344/bmj.e4026

      2. It is unlikely that the Taiwanese Buddhist vegetarians were eating eggs.

        Wikipedia: In China, Korea,[32] Vietnam, Taiwan and their respective diaspora communities, monks and nuns are expected to abstain from meat and, traditionally, eggs and dairy, in addition to the fetid vegetables – traditionally garlic, Allium chinense, asafoetida, shallot, and Allium victorialis (victory onion or mountain leek), although in modern times this rule is often interpreted to include other vegetables of the onion genus, as well as coriander – this is called pure vegetarianism or veganism (純素 chún sù). Pure Vegetarianism or Veganism is Indic in origin and is still practiced in India by some adherents of Dharmic religions such as Jainism and in the case of Hinduism, lacto-vegetarianism with the additional abstention of pungent or fetid vegetables.

        Also:
        Explanation – “How could eggs be bad [for Buddhists]”

        Recognition of life in Buddhism is not only walking talking life,it also includes potential life (like an egg). An egg is not a creature, true. But if correct conditions are given it turns to life. So it is potential life.And killing things alive or killing potential life is recognized as bad Karma. We are Buddhists from birth in my country (Sri Lanka) and we are not in a common understanding about Farmed eggs (the white eggs you see in the market) because they supposedly have been modified to not to give birth. But most of us keep away from eggs unwilling to take the risk. Chinese and Vietnamese monks and nuns are strictly vegetarian and the lay community try to follow their example although many do not.

        And more:
        I’m guessing you are asking what the boundaries are for Vietnamese Buddhism (which is generally similar in practice to Chinese & Korean Buddhism, at least with respect to how the dietary precepts are practiced). The vegetarian precepts come from the Brahma Net Sutra and the Upaseka Sutra. These precepts discourage animal husbandry of any sort. So on that ground, it would imply animal products are off the menu. The precepts related to preservation of life make it pretty clear that the problem with meat and animal products is that a sentient being must be killed. In modern agriculture, to make eggs, the male chicks must be killed, they are economically useless. The old hens are killed when they stop laying. The calves from cows are killed and sold as veal. The dairy cows in turn are killed when they can no longer produce milk. I’ve heard of a no-kill dairy in India, but I’ve never heard of a no-kill egg farm.

        1. I stand corrected. Table 2 says that vegetarians and non vegetarians in the Taiwanese Buddhist study both consumed 0.3 eggs daily. So two eggs per week. I have noticed that the local Chinese markets sell eggs, but they are different from and smaller than commercial eggs at the grocery store, perhaps quail eggs. “Because quail eggs have a greater ratio of egg yolk to egg white, they are also higher in protein, fat, and phosphorus. However, it takes about 5 quail eggs to equal 1 chicken egg in volume, so you need to eat a lot of quail eggs before this extra nutrition adds up.”

          In Taiwan they typically consume eggs as either iron eggs or tea eggs, both boiled for a long time in a spiced tea or broth. They may be chicken, pigeon or quail eggs.

          1. Thanks Barb.

            I couldn’t find a full version of the first abstract you linked to. The abstract was not immediately convincing to me because it’s not cl,ear what the inverse of increasing dietary protein in that study was ….. more protein less fat? More protein fewer refined carbs? It may not have been the higher protein that delivered benefits but lower fat and/or fewer refined carbs?

            The second one was interesting but then McCarty’s papers are always interesting. I’d note though, that he concludes

            ‘Although low-fat vegan diets may markedly reduce risk for coronary disease, diabetes, and many common types of cancer, an increased risk for stroke may represent an ‘Achilles heel’. Nonetheless, vegans have the potential to achieve a truly exceptional ‘healthspan’ if they face this problem forthrightly by restricting salt intake and taking other practical measures that promote cerebrovascular health.’

            He also wrote

            ‘Vegans are thus well advised to adopt practical countermeasures to minimize stroke risk–the most definitive of which may be salt restriction.’

            https://pubmed.ncbi.nlm.nih.gov/12944100/

            1. Fumbles, yes, that second paper had a few choice lines in it worth considering. The authors ‘checklist’ ( my wotds) was/ is useful to me, and I was not surprised to see green tea among them. I will definitly have to cultivate a few new habits though I am pleased to see I am on the right track with food choices and exercise.

  20. Community question: RE: Corn

    In our daily dozen (or just getting enough of what we need, but not too much), would you consider a serving of fresh corn as a vegetable, or a grain?

    Daily dozen has corn as vegetable AND pop corn as grain.

    Can I consider an ear of fresh corn as BOTH a veg and grain in a particular meal? or… in that meal, which to check off? veg/grain

    Any takers?

  21. ***Also*** sorry if this was answered, but I am taking vegan sublingual spray B12 methyl, and @ 2 sprays, its super high in dose: 5000mcg (yikes! I don’t want cancer, but too, I don’t mind peeing harmless excess.)

    So two questions:
    1. Is this recommended dose (on the bottle) too much, and definitively, why? (without postulation please)
    2. Is methyl worse than or not as good as cyano? Again definitively, why? ( and again, please just facts if known)

      1. Julot, I have, hence my question for a definitive answer. I suppose you don’t have it?

        You really just pointed me back to this site? Helpful?

        1. Sorry i thought you were new on this site, i’m pretty sure there are some answers to your questions in the old B12 video, cyano is considered better and safer because there are many more studies on cyano than on methyl and in some studies methyl have been failing to reverse B12 deficiency but cyano worked, cyano also keep itself longer~

    1. jazzBass,

      There was a study with vegans and Methyl failed to improve B12 levels. I have personally had it fail a few times. Why? Perhaps because it is not shelf-stable. Heat and light and shelf time make it less effective. There might be other reasons. One researcher felt that it needed to be given with Adenosylcobalamin to be complete. Another researcher tested Methyl PLUS Hydroxy or Methyl PLUS Adenosyl VERSUS Cyano by itself and when you combine 2 or 3 of the others they become as effective as Cyano.

      For the people who are afraid of the cyanide, Hydroxy B12 is the antidote to cyanide poisoning. But there aren’t any cases on the books where anyone has gone to the ER for cyanide poisoning from B-12. Flaxseed has 5000 times more cyanide than Cyano B-12 and nobody has gone to the ER for flaxseed poisoning either that I could find. Bitter apricots is the level of cyanide where people started getting poisoned. There is cyanide in everything including fruits and vegetables and as long as you have enough….. glutamate…. I think… your body just easily flushes it out.

      1. Deb, regarding your shelf stable comment: I had looked into this and called manufacturers in the context of probiotics. The lost potency depends on the trip from the manufacturer to the vendor’s warehouse, storage conditions at the warehouse, conditions on the trip from warehouse to vendor, and then storage conditions at the vendor. Again in the context of probiotics, my grocery store chain (HEB here in TX) stores the probiotics refrigerated at their warehouse, sends them to the store in the refrigerator truck with the produce (as they do with other supplements) and then displays them in a refrigerator case at the store. The manufacturer said there should be minimal loss of potency under those conditions; otherwise the product declines by 1% daily. If you purchase the same item from say Amazon, it may not be treated as carefully.

  22. Lastly, and looking forward in this series, I will share only a personal story which is simply, that while on meatfest Keto, I took creatine when working out as it was purported to be a way to have more endurance, strength, and to recover quickly.

    I felt sick after the first “dose” and just threw it away, not for me. It also tasted like a combination of gatorade with added: sugar, food coloring, and some unrecognizable purple “fruit”, making Koolaid taste like water in comparison.

    Fingers crossed Dr G is not going to suggest we take creatine.

    Wait, does creatine lower blood pressure?

  23. I always wonder why so few people mentioned about b12 from fermentation? I haven’t try to replicate the method in the study from link, but myself make & eat sour porridge everyday.

    What I’m thinking is, when b12 happen to be produced from bacteria in the soil, then we can make use to those specific bacteria cultures, just like how we make beer, sourdough & other fermented legume isn’t it?

    One of the bacteria it mentioned in the study is Propionibacterium freudenreichii, which is the culture common uses in Swiss cheese and some other cheese production. Just I’m not sure to where & how I can purchase those culture to get it started.

    Below are the links to the study
    https://www.foodnavigator.com/Article/2020/08/10/Grain-fermentation-can-produce-a-cost-effective-vegan-alternative-to-B12-fortification
    https://helda.helsinki.fi/bitstream/handle/10138/317682/insitufo.pdf?sequence=1&isAllowed=y

  24. Dr. Esselstyn:  Egg whites, fat free milk and yogurt ALL contain animal protein, and animal protein injures the lining of the arteries. Do not eat this. https://www.dresselstyn.com/site/faq/

    Dr. McDougall::
    The Problem with Eggs
    A whole egg is 32% protein and the white of an egg is essentially 100% protein.  Infants, growing children, and adults need, at most, 5% of their calories from protein.  Therefore, eggs and egg products are 6 to 20 times more concentrated in protein than we need.  Excess protein places burdens on our body, and especially on organs of metabolism, the liver and kidneys.  Animal proteins, and particularly those from egg whites, are high in the troublesome, sulfur-containing amino acids, such as methionine.  

    Sulfur-containing Methionine (mg/100 Calories)
     
    Potato  35
    Rice  52
    Pinto Beans  98
    Beef  250  
    Whole eggs  251
    Chicken  317
    Salmon  318
    Egg whites  700  
     
    This is how excess sulfur-containing amino acids in your diet can adversely affect your health: 
    1)  The sulfur-containing amino acid methionine is metabolized into homocysteine.  This substance is a risk factor associated with strokes, heart attacks, peripheral vascular disease, venous thrombosis, dementia, Alzheimer’s disease, and depression.3
    2)  Amino acids, as the name implies, are acids; the sulfur-containing amino acids are the strongest acids of all, because they break down into powerful sulfuric acid.  Excess dietary acid is the primary cause of bone loss leading to osteoporosis and kidney stone formation.2  
    3)  Sulfur feeds cancerous tumors.  Cancer cell metabolism is dependent upon methionine being present in the diet; whereas normal cells can grow on a methionine-free diet (feeding off other sulfur-containing amino acids).4-8
    4)  Sulfur from sulfur-containing amino acids is known to be toxic to the tissues of the intestine, and to have deleterious effects on the human colon, even at low levels – possibly causing ulcerative colitis.9-11

    Note that restriction of methionine in the diet has been shown to prolong the life of experimental animals.12-13  https://www.drmcdougall.com/misc/2005nl/march/050300pueastereggs.htm

  25. Not Medical Advice. Merely informational. For Medical Advice, please see your wise and knowing Locally Licensed M.D. Thank you.

    Sabrina,

    I have been reviewing your posts of August 25. Plus the associated posts of Barb, Mr Fumblefingers and Caroline.

    A few thoughts to begin with:

    (1) Seems to me that it is time for you to stop reading and doing things on your own and surfing the Internet and to connect with the people you actually need to connect with.

    (2) The search that I have for French plant-based M.D.s (Jérôme Bernard-Pellet, Sebastien Demange) includes also some plant-based R.D.s (Perrine Bellanger, Claire Lamboley). Have you tried both of these M.D.s? If you were to contact the R.D.s, on this site, one or the other may be able to refer you to an appropriate M.D. – or may be able to connect you with the disappeared plant-based Physician(s). A call to the disappeared may then be helpful. He may have disappeared because that sort of thing just doesn’t play well in France – probably true – and he may be able to refer you to someone – or he may have disappeared for other reasons. I would stick with M.Ds and R.D.s over other credentials. And check ’em out. Caveat emptor.

    Technique: I searched “Paris” and then expanded the mileage – first 100, then 200, then 300 miles – and restricted myself to France. If you are open to Belgium, United Kingdom, Netherlands, Germany, Switzerland, etc., your options expand considerably. Costs may vary considerably in different countries: if all are private physicians – I dunno – even if you have nation-based medical insurance it may not cover any of this, anyway. Your call:
    https://www.plantbaseddoctors.org/find

    (2) You are best off with someone nearby! They know the local territory – local labs, local referrals. And as I am sure you are aware: Good Docs refer to Good Docs. Distant Physicians will not have the local lay of the land.

    Failing a local connection, Dr. McDougall seems to be credible, and he is reported to do telephone consultations. He is set up for this sort of thing.
    https://www.drmcdougall.com/connections/
    Phone: 1-800-941-7111
    Monday – Friday:
    9:00a – 5:00p (PST)

    You might check out patient stories on his web site. You may find your doppelgänger:
    https://www.drmcdougall.com/health/education/health-science/stars/

    (3) Failing the above, Drs. Esselstyn and/or Ornish might be your next best bets:

    Dr. Esselstyn has been at this a little while ;-) http://www.dresselstyn.com/site/contact/

    Dr. Ornish’s work is legendary: https://www.ornish.com/

    (4) I have thoughts, as well – but let’s get you headed in the right direction, first. You need someone on site if you can get him. If not – go with the guys who are set up for this.

    (5) Then and only then – in order to offer help, if you are then interested – I would need more information. But this is really best done with someone locally – and my attempting to help you may then just be redundant – and at the cost of your privacy. If you are still interested, transmit only that information which you are comfortable with living on the Internet for the rest of celestial time. No problem if you do not wish to proceed. Questions would revolve around:

    BP. Range. Circumstances. Recent change or no? Prior? Current target? Relevant family hx.? Atherosclerosis? Circulation?

    WNWDWF? NAD? Vitals – possibly including T/P/RR/pO2/BP/Ht/Wt.

    I never – ever – ever – ask a lady her age.

    There is never any need.

    Briefest rundown on diet and lifestyle. Actual numbers are preferred over “low” or “high.”

    Sabrina.

    All for now –

    Vivamus

    1. Sabrina,

      Dr. Greger is focused on what he calls “Lifestyle Medicine.”

      There are apparently affiliates to his organization around the world:

      https://www.lifestylemedicine.org/ACLM/About/GLOBAL_ALLIANCE/ACLM/We_re_Global/We_re_Global.aspx?hkey=956abcef-0b70-4335-b079-21914714ecdd

      —————————–

      There seems to be a European Society of Lifestyle Medicine – which may or may not be affiliated with Dr. Greger’s crew.

      Or it could just be an imitation. I do not know.

      There is at least one French doctor involved with this organization – perhaps there are more:

      https://www.eulm.org/

      https://www.eulm.org/country-representatives#

      —————————–

      The above information is largely just from Internet searches – I have no direct knowledge.

      If you choose to explore any of these resources, please vet them very carefully yourself.

      I do not want to see you kidnapped by Aliens.

      Not again!

      Careful – it’s a forest out there –

      Vivamus

    2. Hey there,
      Dr Démange is the guy who has disappeared. I’ve heard Dr Pellet speak on video, he’s between Paris and Marseille, both cities red zone for COVID at the moment. We live centre.
      Tonight’s BP 102/67.. maybe the beet juice, hibiscus tea, exercise, no salt and meditation are working.
      I’m very familiar with all works of Ornish, Mc Dougall, Esselstyn, Williams, Kahn and more.
      I don’t surf internet concerning health and this is the first time that I’ve participated in these online ‘chats’
      My initial concern was on how IGF1
      may keep arteries supple and thus be beneficial in lowering hypertension. I honestly don’t think that I would learn anything new from a French RD.
      Thanks for the feedback Vivamus,
      Sabrina

  26. Watching this whole “Vegetarians and Stroke Risk Factors” series was a little like having a beautiful woman you’ve recently started seeing suggest, every date for a month, that maybe tonight she will want you to stay over, without it ever actually happening.

    1. It seems B12 could help prevent both types of strokes: In the video you were reviewing see this statement at the end of the first paragraph: “But, those with higher homocysteine levels do seem to have more atherosclerosis in the carotid arteries that lead up to the brain compared to those with single digit homocysteine levels, and do seem to be at higher risk for clotting strokes in observational studies, and more recently bleeding strokes…”
      Hope this helps.

  27. I have to say that I really enjoy this type of format with you speaking on one side and the information on the other side. Also thank you for this series on vegan/vegetarian stroke risk. I enjoyed the delayed gratification of waiting for each installment! I had read this in headlines, but it’s nice to know what we can do. Thankfully I take B12 regularly along with nutritional yeast. Hopefully I’ll benefit from it all.

  28. If you implement all of Dr. Greger’s recommendations and still have high homocysteine then consider the next step supplementing with TMG (trimethylglycine). Here is the research on the topic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3610948/
    We leaned this more than 20 years ago from Dr. Rishard Kunin’s presentation at the “Smart Life Forum” in Silicon Valley (now called the Silicon Valley Health Institute).

    1. @codor thanks for that. Does anyone know if that is available in foods in enough quantity to make a difference, and can we have homocystein too low?

  29. The world of medicine,

    I went to my primary doc yesterday for a 1pm appointment. Id asked for this time because they told me the doc would be finishing lunch then and so I wouldnt have to wait so long as they usually make me wait. I was 7 minutes late. Now, in the past it hasnt mattered if I come early, late, or on time. I always wait. Usually 1 hour before I see him, if….

    So I did tell them I had a flight (wife actually but i had to drive her) and that it was important not to wait too long. The office attendant replied, there are 2 ple before you. (Im thinking how is this possible? Im just a few minutes late.)

    Historically, no matter when I am brought back to the exam room, I will wait there no less than 10 minutes, usually 20.

    No wi-fi.

    I ended up leaving, before they called me. My BP reading would have blown up the instrument Im sure.

    So, folks:
    What is the most allowable time to wait (on a regular basis)?
    How long do you typically wait?
    This is common, or unique?

    1. I was in the waiting room once for a doc about 10 years ago.

      I noticed in the waiting room the plants were dying so I got the hint and I split.

  30. **update: Game Changer connection (accidental)

    Im just sharing here, so if its boring I get it, understand and just continue on with your day, with my acknowledgement of your time.

    I decided to make a change, since I realized my doc is either too busy with so many patients, or just has less urgency than my tastes allows for in my healthcare as I grow a bit older and wish to stay on top of it.

    SO, I found a plants based doctor practice. I had watched Game Changer back in November and it helped me make the move from animal proteins. So, Dr. G is there in the film as we know but apparently so too is my doctor, who I’m seeing next week.

    Very excited to see a doc who truly knows this stuff.

    (BTW they said wait time is never more than 15 mins. imagine that!)

    1. jazzBass,

      How’d ya find him?

      I found a Vegetarian Nutrition-oriented M.D. a decade or two ago via the grapevine. With a Master’s in Nutrition – pretty serious about this stuff. Highly respected in the health care community in general. Unfortunately, his practice was closed to new patients.

      Sometimes there may be ways.

      I found him to be most helpful.

      He loved attending conferences and would come back excited with the latest concepts.

      I learned to schedule appointments as far from his conferences as possible – so he could experiment with his new knowledge on other patients first. Thank you very much.

      If you have any leads to finding Plant-based M.D.s in France – please let us know.

      Your new Physician may have an idea . . .

      Na Zdrowie!

      Vivamus

      1. Viv, i suspect it will be easy in France to find a PB Doc, and here, I had actually done the search previously (ironically related to my docs service delivery), but I believe one can find am PB doc of this sort with a simple search:

        https://duckduckgo.com/?t=ffnt&q=plants+based+doctors&ia=web

        I just happened to luck out and get locally, one of the stars of the show I guess. Seeing him Wednesday so will let youz know, enshallah.

        You in France? Re: Docs in france, I’ve never visited one, but I will say that in my town there, if it pops up, I wont have trouble finding a sexologist. I have never seen even a sign anywhere before, stateside, for a sexologist, but simply walking around in France, I see several.

        It may be pure density, because in my neighborhood there is a concentration of Docs in general because it is the site of one of the medieval gardens (predecessor to Paris Botanical Gardens in scope, design, and intent), Jardin de Plantes 1593.

        It was founded to grow,collect, study, medicinal plants – so…. I suppose early Harmaceuticals.

        My appointment will be by telehealth visit, so im not thrilled about that but is what it is, then Im sure Ill come in and get bloodwork etc…

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

        I want all my records, and no drama….

  31. This is what I read on one site about B12: Research shows that cyanocobalamin may be absorbed better in your body, while methylcobalamin likely has a higher retention rate. Other studies have found that the differences in absorption and retention are minimal.

    Are the differences minimal? Many multi vitamins do not list if their B12 is cyanocobalamin or methylcobalamin.

    1. Paul, avoid multi-vitamins is the best thing. Buy cyanocobalamin and take it according to recommendations to be sure what you’re getting. I also buy D3 and take it. Otherwise all the “main things” that multi-vitamins have in them are fully well covered by a wide-variety of WFPB foods.

      If you eat any other way, then sure-you might benefit from a multi-vitamin. BUT you’ll surely get better nutrients, in their most available forms, replete with other unknown phytonutrients (that are likely necessary) by adopting a WFPB way of life.

    1. The B12 is manufactured by bacteria (in a lab),

      There’s no evidence that I’m aware of. In fact, exogenous B12 appears to be essential for good health

    2. Yerky, Man doesn’t make B12, it’s made by microorganisms and then man packages it up for distribution and sales. There’s no synthetic analog AFIK.

  32. Above where it says “ at least 50 mcg daily of supplemental cyanocobalamin”, shouldn’t it be 250 mcg? That aligns better with the 2500 once a week

  33. Hi Ralph, this is Dr Greger recommendation
    At least 2,000 mcg (µg) cyanocobalamin once each week, ideally as a chewable, sublingual, or liquid supplement taken on an empty stomach
    or at least 50 mcg daily of supplemental cyanocobalamin (you needn’t worry about taking too much)
    or servings of B12-fortified foods three times a day (at each meal), each containing at least 190% of the Daily Value listed on the nutrition facts label (based on the new labeling mandated to start January 1, 2020—the target is 4.5 mcg three times a day).
    Those over 65 years of age should take at least 1,000 mcg (µg) cyanocobalamin every day.
    Tip: If experiencing deficiency symptoms, the best test is a urine MMA (not serum B12 level)

  34. This might be a stupid question, but I can’t find any source of cyanocobolamin but only methylcobolamin in all the apothecaries where I live. They can’t even order it. How bad is taking methylcobolamin compared to cyanocobolamin? (I live in Europe)

    Thanks for the help!

    1. Here is what Dr. Greger had to say about Methylcobolamin v cyanocobolamin:
      Michael Greger M.D. says: FEBRUARY 5TH, 2012 re: cyanocobalamin (the inexpensive form) vs. methylcobalamin. Vitamin B12 supplements are so cheap to produce that supplement manufacturers try to come with all sorts of fancy ways to “add value” to products so they can make more money. The coral calcium scam is the classic example–how else can you charge $20 for a bottle of chalk? Likewise, unless you’re a smoker, have kidney failure, or base your diet around cassava root, cyanocobalamin should be fine. If it’s unavailable, then I would shoot for about 2,000 mcg a day of methylcobalamin.

  35. Both too low and excessively high levels of folate and vitamin B12 seem to be implicated in mental illness.

    With many types of vitamin supplements, the conventional wisdom has been that too much is not harmful, that the body will flush out the excess. That may not be the case with folic acid and vitamin B12. …  Researchers found that if a new mother has a very high level of folate right after giving birth—more than four times what is considered adequate—the risk that her child will develop a condition on the autism spectrum doubles. Very high vitamin B12 levels in new moms are also potentially harmful, tripling the risk that her offspring will develop an autism spectrum disorder. If both [folate and B12] levels are extremely high, the risk that a child develops the condition [an autism spectrum disorder] increases 17.6 times. 
    https://www.sciencedaily.com/releases/2016/05/160511105352.htm#:~:text=Very%20high%20vitamin%20B12%20levels,the%20disorder%20increases%2017.6%20times.

  36. I’m stunned by Dr. Gregor’s recommendation of 1000 mcg of B12 daily for those 65 and above, which translates to over 400 times the RDA of 2.4 mcg for adults.

    What am I missing here?

  37. I bought a bottle of B12 from Sprouts Farmers Market. The only size they had was 1,000 mcg . It recommends one tablet a day. Is it okay to take 1,000 mcg daily ?

  38. I have a question about b12 recommendations for former smokers. My fiancé and I both quit smoking almost 6 months ago. We were both long term smokers (10+years). My fiancé was just diagnosed with a b12 deficiency and I need to purchase a supplement. I have seen some concerning research on the affect of Cyanocobalamin and lung cancer risk in male smokers. I’m curious if the affect is the same in former smokers and if we would be better off taking the methyl form. I’m having trouble finding any information on this. Thank you! We are just trying to do what is best for our health now!

  39. Hi, at the age of 75, I should be taking 1,000 mcg of B 12 per day, but when I do (first thing in the a.m. before food), I have sleep issues. This happens even when I cut back to 500 mcg. (B 12 liquid sold at the True North Store) I’ve read that B 12 reduces melatonin production.
    Has anyone else had this problem? Should I take melatonin and magnesium at night to offset the B 12?
    Also, I weigh 114lbs. why would the same 1,000 mcg amount be recommended for someone weighing 220 lbs.?
    Thanks in advance for any help on this!

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