Dr Greger
Should Vegetarians Take Creatine to Normalize Homocysteine?
"Should Vegetarians Take Creatine
to Normalize Homocysteine?" Almost universally, research findings
show a poor vitamin B12 status among vegetarians because they're
not taking vitamin B12 supplements like they should. And this results in
an elevation of homocysteine levels that may explain why vegetarians
were recently found to have higher rates of stroke. Of course, plant-based eating is just
one of many ways to get B12 deficient. I mean, even laughing gas can
do it, in as short as two days, thanks to the recreational use
of whipped cream canister gas. That's something new I learned today.
Anyways, if you do eat plant-based, giving vegetarians and vegans
even as little as 50 micrograms once a day of cyanocobalamin, the
recommended, most stable form of vitamin B12 supplement,
and their homocysteine levels start up in the elevated
zone, and within 1 to 2 months their homocysteines normalize right
down into the safe zone under 10.
Or just 2000 micrograms of
cyanocobalamin once a week, and you get the same beautiful
result, but not always. In this study even 500 micrograms
a day, either as a sublingual chewable or swallowable regular B12 supplement, didn't normalize homocysteine
within a month. Now, presumably if they had kept it up, their levels
would have continued to fall like in the other study. But if you're
plant-based and have been taking your B12 and your homocysteine levels
are still too high, meaning above 10, is there anything else you can do? Now, inadequate folate intake
can also increase homocysteine, but folate comes from
the same root as foliage. It's found in leaves, concentrated
in greens, as well as beans. But if you're eating beans and
greens, taking your B12, and your homocysteine level is still
too high, then I'd suggest trying, as an experiment, taking
one gram of creatine a day and getting your homocysteine levels
retested in a month to see if it helped.
Creatine is a compound formed
naturally in the human body that is primarily involved in energy
production in our muscles and brain. It's also naturally formed in the
bodies of many animals we eat. And so when we eat their
muscles, we also can take in some creatine through our diet. We need about two grams a day,
so those who eat meat may get like one gram from their diet, and
their body makes the rest from scratch. There are rare birth defects where
you're born without the ability to make it, in which case you have to get it
from your diet, but otherwise our bodies make as
much as we need to maintain normal
concentrations in our muscles. When you cut out meat, the
amount of creatine floating around in your bloodstream goes down, but the
amount in your brain remains the same, showing dietary creatine doesn't
influence the levels of brain creatine, because your brain just makes
all the creatine you need. The level in vegetarian muscles is
lower, but that doesn't seem to affect performance, as both vegetarians
and meat-eaters respond to creatine supplementation with similar
increases in muscle power output.
And if vegetarian muscle
creatine was insufficient, then presumably they would
have seen an even bigger boost. So basically, all that happens
when you eat meat is that your body just doesn't
have to make as much. What does this all have
to do with homocysteine? Okay, in the process of making creatine,
your body produces homocysteine as a waste product. Now
normally this isn't a problem because your body
has two ways to detoxify it using vitamin B6 or using a
combination of vitamins B12 and folate. Now B6 is found in both plant and
animal foods; it's rare to be deficient. But B12 is mainly in animal
foods, and so can be too low in those eating plant-based who don't
supplement or eat B12 fortified foods. And folate is concentrated in plant
foods, so can be low in those who don't regularly eat greens or
beans or folic-acid fortified grains, and without that escape valve
homocysteine levels can get too high.
If, however, you're eating a healthy
plant-based diet and taking your B12 supplement, your homocysteine levels
should be fine, but what if they're not? One might predict that if you started
taking creatine supplements, the level of homocysteine might go
down since you're not going to have to be making so much of it from scratch,
producing homocysteine as a by-product. But you don't know until you put it
to the test, which we'll cover next.
Video Transcript – As found on YouTube
The Gladiator Diet How Vegetarian Athletes Stack Up
"The Gladiator Diet –
How Vegetarian Athletes Stack Up" Recently, the remains of
dozens of Roman gladiators were discovered in a mass grave. The clue to their identities
were the rather distinct types of mortal injuries they found, like being speared in
the head with a trident. Using just their skeletons
they were able to reconstruct the death blows, show just
how buff they really were, and even try to reconstruct
their diet of barley and beans. You can look at carbon isotopes and
see what kinds of plants they ate; nitrogen isotopes reflect any
intake of animal protein. You can also look at the
Sulphur in their bones and the amount of strontium,
leading commentators to submit that the best athletes
in ancient Rome ate largely plant-based diets. Then there were the legionnaires,
the Roman army troopers, famed for their abilities, also
eating a similar kind of diet, suggesting “the best fighters
in the ancient world were essentially vegetarian.” So, if the so-called
perfect fighting machines, the great sports heroes of the day,
were eating mostly grains and beans, should that tell us anything
about sports nutrition and the preferred diets
of elite athletes? Well, most of the Greeks and
Romans were basically vegetarian, centering their diets around
grains, fruit, vegetables and beans, so maybe the gladiators’ diets
weren’t that remarkable.
Plato, for example, pushed
plants, preferring plant foods for their health and efficiency. So yes, the Roman gladiators
were known as the ‘‘barley men,’’ but is that because barley
gives you strength and stamina, or was that just the basic food
that people ate at the time, not necessarily for performance,
but because it was just so cheap? Well, if you look at the modern
Spartans, the Tarahumara Indians, the ones that run races where
they kick a ball for oh, 75 miles just for the fun of it,
running all day, all night, and all day, maybe 150 miles
if they’re feeling in the mood. What do you get if you win? A special popularity with the ladies
(although how much of a reward that would actually prove to be
for a man who had been running for two days straight is questionable; though, maybe their endurance
extends to other dimensions). “Probably not since the
days of the ancient Spartans has a people achieved such a high
state of extreme physical conditioning.” And what did they eat? The same kind of 75 to
80 percent starch diet based on beans, corn, and squash. And, they had the cholesterol
levels to prove it, total cholesterol levels down at an
essentially heart attack proof 136.
And it’s not just some
special genetics they have— you feed them enough egg yolks and
their cholesterol creeps right up. Modern day Olympian runners
eat the same stuff. What are they eating over there in Kenya? A 99 percent vegetarian diet centered
mostly around various starches. But as in all these cases, is
their remarkable physical prowess because of their diets, or
in spite of their diets? Or have nothing to do with their diets? You don’t know…until
you put it to the test.
In spite of well-documented health
benefits of more plant-based diets, less is known regarding the effects
of these diets on athletic performance. So, they compared elite vegetarian
and omnivore endurance athletes for aerobic fitness and strength. So, comparing oxygen
utilization on the treadmill, and quad strength with leg extensions. And the vegetarians beat out
their omnivore counterparts for cardiorespiratory fitness,
but their strength didn’t differ. Suggesting, in the very least,
that vegetarian diets don’t compromise athletic performance. But this was a cross-sectional study. Maybe the veg athletes were just
fitter because they trained harder? Like in the National Runners' Health Study looking at thousands of runners:
vegetarian runners were recorded running significantly
more on a weekly basis; so, maybe that explains
their superior fitness.
Though, maybe their superior fitness
explains their greater distances. Other cross-sectional studies
have found no differences in physical fitness between
vegetarian and non-vegetarian athletes, or even worse performance, as in this
study of vegetarian athletes in India. Of course, there could be socioeconomic
or other confounding factors. That’s why we need interventional
studies to put different diets to the test and then compare
physical performance, which we’ll explore next..
Video Transcript – As found on YouTube
Plant-Based Diet for Treating and Reversing Stage 3 Kidney Disease
"Plant-Based Diet for Treating and
Reversing Stage 3 Kidney Disease" Is it possible to ameliorate
chronic kidney disease using a whole food,
plant-based diet? In my last video
on kidney disease, I talked about how randomizing
people to cut just around 10 grams of protein from their
daily diet could cut their risk of dialysis and death
by a whopping 77%. That was cutting protein
across the board. But while animal-based
protein ingestion — meat, dairy, and egg white
protein ingestion — promotes an acidic environment
in the kidneys, inflammation, and stresses the kidneys to what's
called hyperfiltration mode, plant-based protein can be
alkaline-producing and anti-inflammatory and contain
kidney-protective properties.
So, what if you have kidney patients
eat a plant-dominant low-protein diet, abbreviated adorably as PLADO,
I guess for plant-dominant. If you fashion up a plant-based diet
index score where you get points for healthy plant foods and get points deducted
for eating animal foods, those with serious kidney disease
with higher scores were found to have lower systemic inflammation. But does that actually translate
into living a longer life? Apparently so.
Even a 10% increase in the
proportion of plant-based protein was associated with a significant
reduction in all-cause mortality. Even just eating more servings of
fruits and vegetables, like two a day compared to two a week,
is linked to living longer. Without fully functioning kidneys, there are concerns about
phosphorus and potassium overload, though, on a plant-based diet. But the phosphorus in plant-based
foods is not as much of a problem as the phosphorus additives
in processed and animal foods. And the risk of potassium overload
from plant-based diets appears overstated and not supported
by the evidence. But you don't know about
ameliorating chronic kidney disease using a whole food, plant-based
diet until you put it to the test. Here's a case report of a 69-year-old
man with type 2 diabetes, high blood pressure, and
stage 3 chronic kidney disease, resulting in elevated phosphorus
and potassium in the blood, Interested in changing his diet
to improve his medical condition. That's my kind of patient! He was on 12 different medications,
eating a diet that may actually be slightly better than
the average American: some whole grains and beans, but then his doctor advised to try
eating whole food, plant-based.
So, oatmeal with fruit and flax,
beans and greens, whole wheat spaghetti and
veggies, fruit as snacks. Counselled to eat as much as he
wanted from whole healthy foods; no carb counting, no calorie counting,
no portion size restriction — improving the quality of food rather
than restricting the quantity of food. He adopted the whole food,
plant-based diet, packed with carbs, yet rapidly reduced his insulin
requirements by more than 50%, and subsequently saw
improvements in weight, blood pressure,
and cholesterol.
Because eating healthy
can have such a rapid effect on improving your body's
insulin sensitivity, immediate adjustments
in insulin dosing were made. Within four days, his insulin dose
was able to be reduced from roughly 210 units of insulin
a day down to 70 units daily, and an oral blood-sugar lowering
medication had to be stopped due to rapidly improving blood sugar. He also was able to stop his
carvedilol, the hydrochlorothiazide, amlodipine, sitagliptin
within the first two months due to improving blood pressure
and blood sugars.
His insulin dose was
steadily titrated downward. His pravastatin dose was cut in half,
and he lost about 50 pounds. Okay, so what happened
to his stage 3 kidney failure? He was no longer in
stage 3 kidney failure! Doctors watching this will understand
what all these numbers mean. Here's a graph of his GFR, which
is a measure of kidney function, declining for years before shooting
up after he started eating healthy. He experienced an increase
in estimated GFR of 73%, suggesting that the improvement
in estimated kidney function was greater than what would be
expected from weight loss alone. For example, lose about 60 pounds
from bariatric surgery, and you only get
about a 12 to 15% boost. Bottom line: for individuals
with chronic kidney disease, especially those with obesity,
hypertension, or diabetes, a strict, all-you-care-to-eat
whole food, plant-based diet may confer significant benefit. I mean, apart from the
kidney-specific outcomes, overall mortality is significantly
lower among kidney patients who eat more plants. And that's critical because most
kidney patients don't even make it to dialysis because they die first, most often from
cardiovascular disease.
Let's hear from the patient. "At the outset, it seemed like
this was going to be a difficult and restrictive way to eat, but I began feeling different
almost immediately and we had to decrease
my insulin after ONE day. It seemed like almost overnight I had
more energy than I'd had in years. Weight I'd been trying to lose for
a decade began dropping off. As the weight came off, I felt lighter,
and more able to move my body again.
This lifestyle change has been
the greatest gift I've ever received. I am off most of my medications,
I've lost over 70 pounds, and I've regained control
over my health. I feel empowered
by this lifestyle change, and I finally feel like I'm
in charge of my health, not just an unlucky victim shuffling
from one specialist to the next. My only regret was that
I didn't know about this sooner."
Video Transcript – As found on YouTube
Treating Advanced Prostate Cancer with Diet: Part 1
"Treating Advanced Prostate
Cancer with Diet: Part 1" Dr. Dean Ornish showed that a plant-
based diet and lifestyle program could apparently reverse the
progression of prostate cancer by making men’s bloodstream nearly 8 times
better at suppressing cancer cell growth, but this was for early stage, localized,
watch-and-wait prostate cancer. What about for more advanced
stage life-threatening disease? There had been sporadic case reports
in the literature suggestive of benefit. A man, for example, with
extensive metastatic disease, given maybe three years to live,
goes on a strict plant-based diet. Four years later, it appears
the cancer has disappeared.
Six years in, he gets a little cocky
and backslides a little bit on the diet. Cancer comes raging
back and he dies. But, that could have been
a total coincidence. That’s the problem with case reports,
which are just kind of glorified anecdotes— you have no idea how representative the
outcome is unless it’s formally studied. But throughout the 20th century, all we had
were these kinds of case reports… until 2001. So, we had this preliminary evidence
based on all the case reports that prostate cancer may be sensitive
to diet even after it metastasizes, may prolong survival
and even cause remission of bone metastases in men
with advanced disease. So, researchers decided to put it to
the test, 4-month intervention. They figured too much saturated fat,
too little fiber, and too much meat may be the biggest players in
tumor promotion and progression. So, they put people on a
whole food plant-based diet of whole grains, beans,
seeds, and fruit. Figuring this would be quite the
departure from their regular diet, they included a stress reduction component
in hopes of improving dietary compliance.
Okay so, who were
these ten men? They all didn’t just
have prostate cancer; they all had underwent a radical
prostatectomy to remove their primary tumor, and then subsequently
had increasing PSA levels, indicative of probable
metastatic disease. PSA stands for prostate-specific antigen;
it’s only made by prostate cells, and they just had their
entire prostates removed. So the level
should be zero. The fact that they not
only still had some PSA, but that it was rising suggests
that the surgery failed, and the cancer had spread
and was making a comeback. Here’s where they started
out before the study began. This is a graph of the speed at
which each of their PSAs was going up. So, if after 4 months of eating healthy,
the graph looked like this, it would mean the
diet had no effect. The cancer would presumably still be powering
away and spreading just as fast as before. Instead, this happened. In two men, it looks like the cancer
accelerated, grew even faster, but in the other 8 men, the
intervention appeared to work, apparently slowing
down cancer growth, and in three it didn’t
just slow or stop, but appeared to
reverse and shrink.
Why the different
responses? Well, in the Ornish study,
the more people complied with the diet and lifestyle
recommendations, the better they did. Dietary changes only work
if you actually do them. Just because you tell people to start
eating a whole food plant-based diet, doesn’t mean patients
actually do it. One can use fiber intake as a
proxy for dietary compliance, since all whole plant
foods have fiber, and Ornish’s patients about doubled
their fiber intake from 31 to 59. How did this group do? They started out even worse,
averaging 14 grams a day, and only made it up
to 19 grams a day. That’s not a whole
food plant-based diet— that doesn’t even make it up to
the recommended minimum daily intake. If you look closely, only 4 men
increased their fiber intake at all. So maybe that may explain
the different responses. Like, how did
patient 2 do? The man whose fiber improved the
most had the best PSA result, and the man whose fiber intake dropped
the most had the worst PSA result. Here’s the graph. And indeed, it appears the
more change they made to their diet, the
better their results.
The researchers concluded that
a plant-based diet delivered in the context of stress management
may slow the rate of tumor progression, and unlike other treatments, may give
patients some control over their disease. And, as Ornish
pointed out, “the only side effects
are beneficial ones.”.
Video Transcript – As found on YouTube
Do Vegetarians Really Have Higher Stroke Risk?
"Do Vegetarians Really
Have Higher Stroke Risk?" When ranked in order of importance,
among the interventions available to prevent stroke, the three
most important are probably diet, smoking cessation, and
blood pressure control. Most of us are doing pretty
good on smoking these days, less than half of us are exercising
enough, but according to the American Heart Association only 1
in a thousand Americans are eating a healthy diet, and fewer than 1 in 10
are even eating a moderately healthy diet. Why does it matter? Because diet is an important
part of stroke prevention. Reducing sodium intake, avoiding egg
yolks, limiting the intake of meat, and increasing the intake of whole grains,
fruits, vegetables and lentils. Like the sugar industry, the meat
and egg industries spend hundreds of millions of dollars on propaganda,
unfortunately with great success. I was excited to check out Box number 1,
and was then honored, when I did. The strongest evidence for stroke
protection is for increasing fruit and vegetable intake, with
more uncertainty regarding the role of whole grains, animal products, and
dietary patterns such as vegetarian diets. I mean one would expect they’d do great.
Meta-analyses have found that
vegetarian diets lower cholesterol and blood pressure, and enhance
weight loss, and blood sugar control, and vegan diets may work even better.
So, all the key biomarkers are going in the right direction, but
you may be surprised to learn that there hadn’t ever been any
studies on the incidence of stroke in vegetarians and vegans… until, now. And if you think that's surprising,
wait until you hear the results.
The risks of heart disease
and stroke in meat eaters, fish eaters, and vegetarians
over 18 years of follow-up. Yes, less heart disease
among vegetarians (by which they mean vegetarians and vegans combined) no surprise—been there, done
that, but more stroke. An understandable knee-jerk
reaction might be “Wait a second, who did this study?” But this is EPIC-Oxford, world-class
researchers whose conflicts of interest may be more likely to read “I was
a member of the Vegan Society.” What about overadjustment? If you crunch the numbers
over a ten-year-period they found 15 strokes for every thousand
meat-eaters compared to only 9 strokes for every thousand
vegetarians and vegans. Wait, so how can they say there
were more strokes in the vegetarians? This was after adjusting
for a variety of factors. For example, the vegetarians
were less likely to smoke; so, you want to cancel that
out by adjusting for smoking, so that you can effectively
compare the stroke risk of nonsmoking vegetarians
to nonsmoking meat-eaters.
If you want to know how a vegetarian
diet itself affects stroke rates, you want to cancel out these
non-diet-related factors. Sometimes, though, you can overadjust. The sugar industry does it all the time. This is how it works. Imagine you just got a grant
from the soda industry to study the effect of soda on
the childhood obesity epidemic. What could you possibly do after
putting all the studies together to arrive at the conclusion that
there was near zero effect of sugary beverage consumption
on body weight? Well, since you know that
drinking liquid candy can lead to excess calories that can lead
to obesity, if you control for calories, if you control for a factor
that’s in the causal chain, effectively only comparing soda
drinkers who take in the same number of calories as non-soda-drinkers
then you could undermine the soda-to-obesity effect, and
that’s exactly what they did.
That introduces overadjustment bias. Instead of just controlling
for some unrelated factor, you control for an intermediate
variable on the cause-and-effect pathway
between exposure and outcome. Overadjustment is how meat-and-
dairy industry funded researchers have been accused of obscuring
the true association between saturated fat and cardiovascular disease. We know that saturated
fat increases cholesterol which increases heart disease risk. Therefore, if you control for
cholesterol, effectively only comparing saturated fat eaters with the
same cholesterol levels as non-saturated-fat eaters,
you see how you could undermine the saturated fat-to-heart disease effect. Now let’s get back to this. Since vegetarian eating
lowers blood pressure, and a lowered blood pressure
leads to less stroke, controlling for blood pressure would be an
overadjustment, effectively only comparing vegetarians to meat-eaters
with the same low blood pressure. That’s not fair, since that’s one
of the benefits of vegetarian eating, not some unrelated factor like smoking; and so, it would undermine
the afforded protection. So, did they do that? No. They only adjusted for unrelated factors, like education, and socioeconomic class,
and smoking, and exercise, and alcohol. That’s what you want. You want to tease out the effects of a vegetarian diet on stroke risk…
you want to try to equalize everything else to tease out the
effects of just the dietary choice.
And since, for example, meat eaters
in the study were on average 10 years older than the vegetarians,
you can totally see how when you adjust for that
vegetarians could come out worse. Since stroke risk can increase
exponentially with age, you can see how having 9 strokes among
a thousand vegetarians in their 40s could be worse than 15 strokes among
a thousand meat-eaters in their 50s. The fact that vegetarians had
greater stroke risk despite their lower blood pressure suggests
there’s something about meat-free diets that so increases stroke risk it’s enough
to cancel out the blood pressure benefits, but even if that’s true you
still would want to eat that way. Stroke is our 5th leading cause of
death, whereas heart disease is #1. So, yes, in this study there
were this many more cases of stroke in vegetarians, but there were this many
fewer cases of heart disease, but if there is something increasing
stroke risk in vegetarians it would be nice to know what
it is in hopes of figuring out how to get the best of both worlds.
This is the question we'll turn to, next..
Video Transcript – As found on YouTube
Update on Vegetarian Stroke Risk
"Update on Vegetarian Stroke Risk" Healthy plant-based diets
have been associated with lower all-cause mortality,
up to a 34 percent lower risk of death from any cause over an average
of an eight-year period, just being in the top
versus bottom quarter of healthy plant-based consumption. If sustained, that could translate
into more than four extra years of life. A meta-analysis of a dozen studies
prospectively following more than a half a million people
for up to 25 years similarly found significantly lower
heart disease and overall death rates among those eating more plant-based. No surprise,
a systematic review concluded since plant-based diets
may arrest or even reverse our number one killer—
cardiovascular disease. Those eating wholly plant-based
tend to be significantly slimmer with lower LDL cholesterol, triglycerides,
blood sugars, blood pressures, significantly less inflammation,
and less carotid artery wall thickening (a sign of atherosclerosis measured
via ultrasound in the neck), as good as what you see
in endurance athletes who’ve run an average of 50,000 miles,
which is like twice around the globe.
And changes in risk factors
can happen fast, as evidenced by results
from one to three-week ad libitum (eat-all-you-want)
plant-based “kickstart” programs. For example, the results from the first
few hundred participants of the at-home
15-day Jumpstart program created by the nonprofit Rochester
Lifestyle Medicine Institute were recently published. On a whole food plant-based diet,
obese patients lost an average of 7 pounds without controlling portions
or counting calories or carbs. Diabetics saw their fasting blood sugars
drop 28 points. Those with LDL cholesterol
over 100 experienced a 33-point drop (comparable to some statin drugs), and hypertensive individuals
experienced a 17-point drop in systolic blood pressure,
which is better than drugs, and all within just two weeks! Studies dating back nearly 40 years
show those eating meat-free diets also have improved blood “rheology,”
meaning fluidity or flowability, which may play a role
in cardiovascular protection. Subsequent interventional studies putting
the cross-sectional findings to the test, show that switching people
to a plant-based diet can improve rheology measurements
within three to six weeks.
But might the blood of vegetarians flow
a bit too well, though? In 2019, a study of thousands
of British vegetarians called EPIC-Oxford found that they were at higher risk
of hemorrhagic (bleeding) stroke. They had such a lower risk
of heart disease that they still had less
cardiovascular disease overall (and a half dozen studies show no overall
increased risk of stroke mortality), but why the greater stroke incidence? I suggested it might be vitamin B12
deficiency, which can lead to excessive levels
of a stroke- associated metabolite called homocysteine
which is normally detoxified by B12. This is thought to be the reason
why vitamin B12 supplementation can improve artery function
of vegetarians. Vitamin B12 supplements
or fortified foods are critical for anyone eating plant-based,
but my 12-part video series on vegetarians and stroke risk
triggered by the 2019 publication was all in vain.
It turns out vegetarians don’t appear
to have higher stroke risk after all. In response to the EPIC-Oxford results,
researchers around the world scrambled to see if the findings
were merely a fluke. In 2020, UK Biobank, a massive study
following more than 400,000 volunteers, confirmed that vegetarians
had lower cardiovascular disease rates and importantly,
no increased incidence of stroke. And two studies from Taiwan
found vegetarians had significantly
lower risk of stroke. Following tens of thousands
of vegetarians for up to ten years, they only had about half the stroke risk
compared to nonvegetarians (including a 64 percent lower risk
specifically of hemorrhagic stroke). By 2021, Harvard researchers
had finished and published their analyses of the 200,000+ participants
of the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals
Follow-Up Study. They too found no increased stroke risk
for vegetarians and indeed a decreased risk of stroke among those eating
healthy plant-based diets.
A meta-analysis putting all the studies
together found that indeed the EPIC-Oxford data appeared
to be a fluke after all, finding, if anything, a lower risk
of stroke in a subgroup analysis. A 2022 systematic review
concluded that vegetarian and low-animal product diets are associated with a significantly
lower risk of bleeding strokes, a significantly lower risk
of clotting strokes, and a significantly lower risk
of total strokes across the board..
Video Transcript – As found on YouTube
Is Vegan Food Always Healthy?
"Is Vegan Food Always Healthy?" In my video on flexitarians,
I talk about how the benefits of eating a plant-based diet
are not all-or-nothing. Simple advice to increase
the consumption of plant-derived foods with
parallel reductions in the consumption of foods from
animal sources was found to confer a survival advantage,”
a live-longer advantage. They call it a pro-vegetarian eating
pattern, just moving in that direction, as a more gradual, gentle
doable approach. If you’re dealing with a serious
disease, though, like diabetes, avoiding some problem foods
completely may be easier than attempting to moderate their intake. It’s like clinicians would never tell
alcoholics to simply cut down on alcohol. Avoiding alcohol entirely
is a more effective and, ironically, easier for a problem drinker. Paradoxically, asking patients
to make a large change may be more effective than
making a slow transition. Diet studies show that recommending
more significant changes increases the changes that
patients actually accomplish. It may help to replace the common
advice, ‘all things in moderation’ with ‘big changes beget big results.’ Success breeds success. After a few days or weeks of
major dietary changes, patients are more likely
to see improvements in weight and blood sugar levels— improvements that
reinforce the dietary changes.
Furthermore, they may enjoy other health
benefits of plant-based eating. that may give them further motivation. Those who choose to eat plant-based
for their health say it’s mostly for general wellness and disease
prevention, or to improve their energy levels or immune function. They felt it gave them a sense
of control over their health, helps you feel better emotionally,
improves your overall health, and makes you feel better. Most felt it was very important for
maintaining their health and well-being. For the minority that used it
for a specific health problem, it was mostly for high cholesterol
or weight loss, followed by high blood pressure
and diabetes, with most reporting they felt it helped a great deal. But others choose plant-based diets
for other reasons like animal welfare or global warming, and it looks
like they’re more likely to be eating things like vegan doughnuts,
sugary and fatty foods, compared to those eating
plant-based because of religious or health reasons. I mean the veganist vegan could bake
a cake using soda instead of eggs, with frosting, covered in marshmallow
fluff and chocolate syrup, topped with Oreos, with a side of Doritos
dipped in, vegan bacon grease.
But fruit for dessert… in the form of
Pop Tarts and Krispy Kreme pies. This, is a vegan meal. Yes, plant-based diets have
been recommended to reduce the risk of type 2 diabetes. However, not all plant foods
are necessarily beneficial. Like in that pro-vegetarian scoring
system you got points for eating potato chips and French fries,
just because they were technically plant-based, but Harvard researchers
wanted to examine the association of not only an overall plant-based diet,
but both healthy and unhealthy versions. So, they created the same kind
of pro-vegetarian scoring system weighted towards any sort
of plant-based foods, and against animal foods and then also
created a healthful plant-based diet index, where at least some whole
plant foods took precedence and Coca-Cola was no longer
considered a plant.
Then lastly, they created an
unhealthful plant-based diet index by assigning positive scores
to processed plant-based junk, and negative scoring healthier
foods and animal foods. And then they found that a more
plant-based diet in general was good for reducing diabetes risk, but eating
especially healthy plant-based foods did better, nearly cutting risk in half, while those eating more
unhealthy plant foods did worse. Now, but is that because they
were also eating more animal foods? People often eat burgers with their fries; so, they separated out the
effects of healthy plant foods, less healthy plant foods,
and animal foods.
And healthy plant foods were
protectively associated, animal foods were
detrimentally associated, and less healthy plant foods were more
neutral when it came to diabetes risk. Here’s what the graph looks like:
higher diabetes risk with more and more animal foods, no protection
whatsoever with junky plant foods, and lower and lower diabetes risk
associated with more and more healthy whole plant foods in the diet. So, they conclude that yes, plant-
based diets are associated with substantially lower risk of
developing type 2 diabetes, but it may not be enough to just
lower the intake of animal foods, but also less healthy plant foods as well..
Video Transcript – As found on YouTube
Update on Vegetarian Stroke Risk
"Update on Vegetarian Stroke Risk" Healthy plant-based diets
have been associated with lower all-cause mortality,
up to a 34 percent lower risk of death from any cause over an average
of an eight-year period, just being in the top
versus bottom quarter of healthy plant-based consumption. If sustained, that could translate
into more than four extra years of life. A meta-analysis of a dozen studies
prospectively following more than a half a million people
for up to 25 years similarly found significantly lower
heart disease and overall death rates among those eating more plant-based. No surprise,
a systematic review concluded since plant-based diets
may arrest or even reverse our number one killer—
cardiovascular disease. Those eating wholly plant-based
tend to be significantly slimmer with lower LDL cholesterol, triglycerides,
blood sugars, blood pressures, significantly less inflammation,
and less carotid artery wall thickening (a sign of atherosclerosis measured
via ultrasound in the neck), as good as what you see
in endurance athletes who’ve run an average of 50,000 miles,
which is like twice around the globe. And changes in risk factors
can happen fast, as evidenced by results
from one to three-week ad libitum (eat-all-you-want)
plant-based “kickstart” programs.
For example, the results from the first
few hundred participants of the at-home
15-day Jumpstart program created by the nonprofit Rochester
Lifestyle Medicine Institute were recently published. On a whole food plant-based diet,
obese patients lost an average of 7 pounds without controlling portions
or counting calories or carbs. Diabetics saw their fasting blood sugars
drop 28 points. Those with LDL cholesterol
over 100 experienced a 33-point drop (comparable to some statin drugs), and hypertensive individuals
experienced a 17-point drop in systolic blood pressure,
which is better than drugs, and all within just two weeks! Studies dating back nearly 40 years
show those eating meat-free diets also have improved blood “rheology,”
meaning fluidity or flowability, which may play a role
in cardiovascular protection. Subsequent interventional studies putting
the cross-sectional findings to the test, show that switching people
to a plant-based diet can improve rheology measurements
within three to six weeks. But might the blood of vegetarians flow
a bit too well, though? In 2019, a study of thousands
of British vegetarians called EPIC-Oxford found that they were at higher risk
of hemorrhagic (bleeding) stroke.
They had such a lower risk
of heart disease that they still had less
cardiovascular disease overall (and a half dozen studies show no overall
increased risk of stroke mortality), but why the greater stroke incidence? I suggested it might be vitamin B12
deficiency, which can lead to excessive levels
of a stroke- associated metabolite called homocysteine
which is normally detoxified by B12. This is thought to be the reason
why vitamin B12 supplementation can improve artery function
of vegetarians.
Vitamin B12 supplements
or fortified foods are critical for anyone eating plant-based,
but my 12-part video series on vegetarians and stroke risk
triggered by the 2019 publication was all in vain. It turns out vegetarians don’t appear
to have higher stroke risk after all. In response to the EPIC-Oxford results,
researchers around the world scrambled to see if the findings
were merely a fluke. In 2020, UK Biobank, a massive study
following more than 400,000 volunteers, confirmed that vegetarians
had lower cardiovascular disease rates and importantly,
no increased incidence of stroke. And two studies from Taiwan
found vegetarians had significantly
lower risk of stroke. Following tens of thousands
of vegetarians for up to ten years, they only had about half the stroke risk
compared to nonvegetarians (including a 64 percent lower risk
specifically of hemorrhagic stroke).
By 2021, Harvard researchers
had finished and published their analyses of the 200,000+ participants
of the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals
Follow-Up Study. They too found no increased stroke risk
for vegetarians and indeed a decreased risk of stroke among those eating
healthy plant-based diets. A meta-analysis putting all the studies
together found that indeed the EPIC-Oxford data appeared
to be a fluke after all, finding, if anything, a lower risk
of stroke in a subgroup analysis. A 2022 systematic review
concluded that vegetarian and low-animal product diets are associated with a significantly
lower risk of bleeding strokes, a significantly lower risk
of clotting strokes, and a significantly lower risk
of total strokes across the board..
Video Transcript – As found on YouTube
Should Vegetarians Take Creatine to Normalize Homocysteine?
"Should Vegetarians Take Creatine
to Normalize Homocysteine?" Almost universally, research findings
show a poor vitamin B12 status among vegetarians because they're
not taking vitamin B12 supplements like they should. And this results in
an elevation of homocysteine levels that may explain why vegetarians
were recently found to have higher rates of stroke. Of course, plant-based eating is just
one of many ways to get B12 deficient. I mean, even laughing gas can
do it, in as short as two days, thanks to the recreational use
of whipped cream canister gas.
That's something new I learned today.
Anyways, if you do eat plant-based, giving vegetarians and vegans
even as little as 50 micrograms once a day of cyanocobalamin, the
recommended, most stable form of vitamin B12 supplement,
and their homocysteine levels start up in the elevated
zone, and within 1 to 2 months their homocysteines normalize right
down into the safe zone under 10. Or just 2000 micrograms of
cyanocobalamin once a week, and you get the same beautiful
result, but not always. In this study even 500 micrograms
a day, either as a sublingual chewable or swallowable regular B12 supplement, didn't normalize homocysteine
within a month. Now, presumably if they had kept it up, their levels
would have continued to fall like in the other study. But if you're
plant-based and have been taking your B12 and your homocysteine levels
are still too high, meaning above 10, is there anything else you can do? Now, inadequate folate intake
can also increase homocysteine, but folate comes from
the same root as foliage.
It's found in leaves, concentrated
in greens, as well as beans. But if you're eating beans and
greens, taking your B12, and your homocysteine level is still
too high, then I'd suggest trying, as an experiment, taking
one gram of creatine a day and getting your homocysteine levels
retested in a month to see if it helped. Creatine is a compound formed
naturally in the human body that is primarily involved in energy
production in our muscles and brain. It's also naturally formed in the
bodies of many animals we eat. And so when we eat their
muscles, we also can take in some creatine through our diet. We need about two grams a day,
so those who eat meat may get like one gram from their diet, and
their body makes the rest from scratch. There are rare birth defects where
you're born without the ability to make it, in which case you have to get it
from your diet, but otherwise our bodies make as
much as we need to maintain normal
concentrations in our muscles. When you cut out meat, the
amount of creatine floating around in your bloodstream goes down, but the
amount in your brain remains the same, showing dietary creatine doesn't
influence the levels of brain creatine, because your brain just makes
all the creatine you need.
The level in vegetarian muscles is
lower, but that doesn't seem to affect performance, as both vegetarians
and meat-eaters respond to creatine supplementation with similar
increases in muscle power output. And if vegetarian muscle
creatine was insufficient, then presumably they would
have seen an even bigger boost. So basically, all that happens
when you eat meat is that your body just doesn't
have to make as much. What does this all have
to do with homocysteine? Okay, in the process of making creatine,
your body produces homocysteine as a waste product. Now
normally this isn't a problem because your body
has two ways to detoxify it using vitamin B6 or using a
combination of vitamins B12 and folate. Now B6 is found in both plant and
animal foods; it's rare to be deficient. But B12 is mainly in animal
foods, and so can be too low in those eating plant-based who don't
supplement or eat B12 fortified foods.
And folate is concentrated in plant
foods, so can be low in those who don't regularly eat greens or
beans or folic-acid fortified grains, and without that escape valve
homocysteine levels can get too high. If, however, you're eating a healthy
plant-based diet and taking your B12 supplement, your homocysteine levels
should be fine, but what if they're not? One might predict that if you started
taking creatine supplements, the level of homocysteine might go
down since you're not going to have to be making so much of it from scratch,
producing homocysteine as a by-product.
But you don't know until you put it
to the test, which we'll cover next..
Video Transcript – As found on YouTube
How to Reverse Heart Failure with Diet
"How to Reverse Heart Failure with Diet" It is a hopeful sign of the times when
entire issues of cardiology journals are not just dedicated to nutrition,
but to plant-based diets in particular. Dr. Williams, past president of the
American College of Cardiology, starts out with a quote
attributed to Schopenhauer. "All truth passes through three
stages. First, it is ridiculed. Second, it is violently opposed. Third,
it is accepted as…" like, well, duh. And the truth for the benefits
of plant-based diets, plant-based nutrition
continues to mount. The evidence, we got; the problem
is the inertia, culture, habit, and widespread marketing of
unhealthy foods.
"Our goal must be to get the data out to the medical
community and the public where it can actually change lives…" That's like my personal life's mission
in four words: get the data out. Based on what we already know in the
existing medical literature, plant-based nutrition clearly represents the single
most important yet underutilized opportunity to reverse the pending
obesity and diabetes-induced epidemic of morbidity and mortality,
meaning disease and death. The issue included your typical
heart disease reversal cases: a 77-year old woman with heart disease
so bad she couldn't walk more than a half-block or go up a single flight
of stairs, severe blockages in all three of her main arteries, and referred
to open heart surgery for a bypass. She chose, however, instead to
adopt a whole-food plant-based diet, which included all vegetables, fruits,
whole grains, potatoes, beans, legumes, and nuts. Even though she said she
was trying to eat pretty healthy before, within a single month of going plant-
based her symptoms had nearly resolved.
And forget about a block, she
was able to walk on a treadmill for up to 50 minutes without chest
discomfort or becoming out of breath. Her cholesterol dropped about a hundred
points from around 220 down to 120, with an LDL under 60. But then, a few months later she must
have started missing her chicken, fish, and low-fat dairy, and went back
to her prior eating habits. And within a few weeks, with no change
in her meds or anything, her chest pain was back, and she went on to have
her chest sawed in half after all. Then she continued to eat the same diet
that contributed to cause her disease in the first place and went on to
have further disease progression.
This one, though, has a happier ending.
It started out the same: a 60-year-old man, severe chest pain
after as little as a half-block. Decided to take control of his health
destiny and switched to a whole food plant-based diet from his "healthy" diet
of skinless chicken, fish, low-fat dairy that had been choking off his heart. And within a few weeks, the same
amazing transformation. From not being able to exercise
at all, to walking a mile, to then being able to jog more than
four miles, completely asymptomatic, off all drugs, no surgery,
off to live happily ever after. Now, of course, case reports are
just really glorified anecdotes. I mean, what we need is a randomized
controlled trial to prove heart disease can be reversed with lifestyle
changes alone. And guess what? There was one, published literally
30 years ago, proving angiographic reversal of heart disease
in 82% of the patients, opening up arteries without
drugs, without surgery. So these case reports are just to
remind us that hundreds of thousands of Americans continue
to needlessly die every year from what was proven to be a
reversible condition decades ago. The conventional use of case reports,
though, is to present some novel results in hopes of inspiring trials
to put it to the test.
For example, a case report on a plant-
based diet for congestive heart failure. So not just coronary artery disease, but
the heart muscle itself was so weakened it couldn't efficiently pump blood, only
able to eject about 35% of the blood in the main heart chamber with every
beat, whereas normally the heart can pump out at least half; which is
exactly what his heart was able to do just six weeks after switching to
a whole-food plant-based diet, instead of choosing to get
his chest cracked open. The first report of an improvement
in heart failure following adoption of a plant-based diet, but not the last.
A 54-year-old woman, obese, type 2 diabetic, presenting with
swelling ankles due to her heart failure. She switched from her chicken
and fish to whole plant foods. She started out eating healthier and lost
50 pounds, reversed her diabetes— meaning normal blood sugars on
a normal diet without the use of diabetes medications—and
her heart function normalized, from an abysmal ejection fraction
of just 25% up to normal.
Now since it's not a
randomized controlled trial, all we can say is
that her improvements coincided with her adoption of
a whole food plant-based diet. But given the burden of heart failure
as a leading cause of death, how it usually just gets progressively
worse, and the overall evidence to date, a plant-based diet should be
considered as part of heart failure care. And look, we already know it can
reverse her coronary artery disease, and so any heart failure
benefits would just be a bonus. Now, we just need good strategies
for healthcare practitioners to support patients in plant-based eating. Here are some excellent suggestions
to pause and reflect on. For example, doctors can
use the Plantrician Project's prescription pads and
prescribe a good website or two.
While it is certainly true that
many people would be resistant to fundamental dietary changes, look, it is equally true that
millions of intelligent people motivated to preserve their health
are now taking half-way measures that may provide only modest benefit—
choosing leaner cuts of meat, using reduced-fat dairy products.
Most of these people have neither the time nor the training to actually see
what the science shows themselves. Don't they deserve honest, forthright
advice when their lives are at stake? Those who wish to ignore that advice,
or implement it only partially, are certainly at liberty to do so. I mean, you want to go smoke
cigarettes, go bungie jumping? It's your body, your choice.
It's up to each of us to make our own decisions as to
what to eat and how to live.
But we should make these choices
consciously, educating ourselves about the predictable
consequences of our actions..
Video Transcript – As found on YouTube
