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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

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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

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Update on Vegetarian Stroke Risk

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

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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

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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

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Comparing Vegetarian and Vegan Athletic Performance, Endurance, and Strength

"Comparing Vegetarian and Vegan Athletic
Performance, Endurance, and Strength" Few studies have investigated
the impact of a plant-based diet on athletic performance, but
the majority of the studies that have been done show no differences
in endurance, performance, or strength. So, while plant-based diets
do not seem to provide advantages or disadvantages
on exercise performance, what plant-based diets can do
is reduce the risk of chronic disease. This is a point
I made in my video Why All Athletes Should
Eat Plant-Based Diets, because surprisingly,
endurance athletes may have more advanced atherosclerosis
and more heart muscle damage, compared with sedentary individuals.

So, it’s even more important
they eat healthy. But due to the favorable impact
on health, it could be assumed that performance
would also be influenced by plant-based diets. Let’s take a closer look
at the available evidence. This is the most commonly cited review. Studies connecting vegetarian diets
to improved health are well-established; however, the evidence for this phenomenon
to be transferred to improved physical performance
in athletes is less clear, finding no differences
—at least acutely— between a vegetarian-based diet
and an omnivorous diet in muscular power, muscular strength,
short burst, or endurance performance.

The intervention studies in this review,
however, only lasted days or weeks. So, being a vegetarian for four days
may not tip the balance, or even a few months, but that’s
a considerable limitation. These are people
who have been eating meat their whole lives and subsequently adopt
a vegetarian diet only for the duration of the study,
rather than comparing participants who have adhered to a vegetarian
or meat-containing diet long-term. This study compared exercise capacity
of vegan, vegetarian, and meat-eating recreational
runners and found similar maximum power output
among all three groups, suggesting there’s no significant difference
in maximum exercise capacity. But that’s at the same training frequency,
time, and distance. Perhaps plant-based diets
might enhance recovery and allow such athletes
to train longer and harder? A number of studies have come out
since this review was published in 2016.
What’s the update? Well, this study compared
the cardiorespiratory fitness and peak torque strength differences
between vegetarian and omnivore endurance athletes. Most of the vegetarians
were actually vegans and most or at least two years and… results from this study indicate that vegetarian endurance athletes’
cardiorespiratory ﬁtness was greater than that for their
omnivorous counterparts.

They had a greater VO2 max, meaning a greater maximal oxygen uptake, greater aerobic capacity
as measured on a progressive, graded, maximal treadmill test
to exhaustion, though peak torque, peak strength
based on leg extensions didn’t differ between diet groups. Bottom line: these data suggest
that vegetarian diets do not compromise
performance outcomes and may facilitate
aerobic capacity in athletes. In this 2020 study, all the plant-
based participants were eating vegan for an average of four years.

So, they were essentially comparing
those who ate meat for 21 years versus those who ate
meat for 25 years. But after four years
eating plants, you might expect to see
some sort of difference. Yet, no signiﬁcant differences
were noted for upper and lower body muscle strength,
like in the last new study. Both groups of athletes were comparable
for total body weight and lean body mass, though age
was signiﬁcantly higher in vegans compared with omnivores; so, that put them
at a little disadvantage. Yet still, there it is again. Significantly better aerobic capacity. Then, they had them pedal
until exhaustion, and the vegan group lasted
about 25 percent longer— 12 minutes as opposed to
9 minutes. Is that just because their
aerobic capacity is so high? No, even after controlling
for VO2 max levels, there was still a signiﬁcant endurance advantage
in the vegans. The researchers conclude
that in the very least, a strictly plant-based diet
doesn’t seem to be detrimental to endurance
and muscle strength, and endurance might
actually be better in vegans, contrary to popular belief..

Video Transcript – As found on YouTube

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Are Vegans at Risk for Iodine Deficiency?

"Are Vegans at Risk
for Iodine Deficiency?" Adequate dietary iodine is required
for normal thyroid function. In fact, the two thyroid hormones
are named after how many iodine atoms they
contain: T3 and T4. Now, given that iodine is extensively
stored in the thyroid gland itself, it's not something you
have to get every day, but your overall diet needs
to have some good source. Unfortunately, the common sources
aren't particularly health-promoting: iodized salt, [and] dairy foods because iodine-based cleansers
like betadine are used to sanitize the udders, which results in some
iodine leaching into the milk.

They also add iodine to cattle feed, and some commercial breads have
iodine-containing food additives. So if you put people on a paleo-type
diet and cut out dairy and table salt, they can develop an iodine deficiency,
even though they double their seafood intake, which
can also be a source. What about those switching to diets
centered around whole plant foods? They're also cutting down
on ice cream and Wonder Bread, and if they're not eating anything from
the sea—seaweed, sea vegetables— they can run into the same problem. Her parents reported striving to
feed her only the healthiest foods. The 3-year-old only got plant-based,
unsalted, unprocessed foods with no vitamin supplementation.
Now that could have been deadly.

With no vitamin B12, those on strictly
plant-based diets can develop irreversible nerve damage, but
in this case, a goiter arose first due to inadequate iodine intake. Here's another case of veganism
as a cause of iodine deficient hypothyroidism in a toddler after
weaning. Now before weaning, he was fine because his mother
kept taking her prenatal vitamins, which luckily contained iodine. Most vegetarians and vegans are
apparently unaware of the importance of iodine in pregnancy, just as clueless
as their omnivorous counterparts. The American Thyroid Association and
the American Academy of Pediatrics have recommended that women even
just planning on getting pregnant should ingest a daily supplement that
contains 150 micrograms of iodine, yet only 60% of prenatal vitamins marketed
in the US contain this essential mineral. So, in spite of the recommendations,
about 40% lack it. Therefore, it's extremely important that pregnant and
breastfeeding women read the labels to ensure they're receiving
an adequate amount. Women of reproductive age have
an average iodine level of 110, which is fine for nonpregnant
individuals, but we'd really like to see at least
150 in pregnancy. It's basically a 24-hour urine test,
in which iodine sufficiency is defined as 100 mcg/liter of pee in nonpregnant
adults, which your average vegan fails to reach in the largest study
done to date, out of Boston.

The recommended average daily
intake is 150 mcg/day for most people, which you can get in like a
cup and a half of cow's milk. Sadly, plant-based milks are
typically not fortified with iodine, averaging only about 3 mcg/cup.
In the largest systematic study to date, although many plant-based milks are
fortified with calcium, they only found just 3 of 47 fortified with iodine. Those that were had as much as cow's
milk, but those that weren't fell short. Plant-based milk companies brag about
enriching their milks with calcium, and often vitamin B12, D, and vitamin A,
but only rarely are attempts made to match the iodine content. The only reason cow's milk has as
much as it does is that they enrich the feed, or it comes
dripping off their udders. So why don't plant-milk
companies add iodine, too? I was told by a food scientist at
Silk that my carrageenan video played a role in them
switching to another thickener. Hopefully, they'll see this video
and consider adding iodine, too, or some company will snatch at
the market advantage opportunity.

The researchers conclude that individuals
who consume plant-based milks not fortified with iodine may be
at risk for iodine deficiency, unless they consume alternative
dietary iodine sources, the healthiest of which is sea
vegetables, which we'll cover next..

Video Transcript – As found on YouTube

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Improving VO2 Max: A Look at Vegetarian and Vegan Athletes

This is the first of a three
video series about exercise. Do plant based diets have an
impact on fitness? What are the best times
to workout? Watch the series to find out. "Improving VO2 Max: A Look
at Vegetarian and Vegan Athletes" In my video about comparing vegetarian
and vegan athletic performance, endurance, and strength, I discussed
a 2020 study that found that vegan athletes—even though
they were significantly older— had significantly superior
aerobic capacity and endurance, lasting 25 percent longer on a
time-to-exhaustion cycling test. The question is why? One potential mechanism
that could explain the greater level of endurance performance
in vegans may be a higher amount of carbohydrate intake, which could
lead to better endurance performance through higher
muscle glycogen storage. Other potential mechanisms
that may explain the better endurance performance in vegans could
be due to the anti-oxidant and anti-inflammatory
profiles of their diet. Maybe it’s even their hearts. Yet another study showing superior
VO2 max in vegan athletes, meaning superior
aerobic capacity: this time they also
did echocardiograms, looking at their hearts
in real-time using ultrasound, and the lower relative
wall thickness and better main ventricle
systolic and diastolic function in the vegans are most
likely positive ﬁndings.

Now wait a second. Given
the higher VO2 max reached by the vegan athletes, maybe
they were just better trained than the nonvegan athletes,
and that’s why their hearts looked like they
were working better. However, the weekly training
frequency and running distance were similar in both groups,
suggesting benefits even with the same
amount of training. So, it’s important to educate
healthcare professionals; so they don’t try
to discourage a vegan diet and may even want to consider
telling folks implementing an exercise training
program to give it a try. But you don’t know if it
has the same kinds of effects in nonathletes, until
you…put it to the test. A vegetarian vs. conventional
calorie-restricted diet: the effect on physical fitness
in response to aerobic exercise in patients with
type 2 diabetes.

Diabetics were randomized
to the same caloric restriction, the same exercise, but just
vegetarian versus nonvegetarian. They provided all the meals
so they could ensure compliance and closely monitored
the exercising. VO2 max increased by 12 percent
in the vegetarian group, significantly better than in
the non-vegetarian group who didn’t significantly
improve at all. Maximal performance increased
by 21 percent in the vegetarian group, again, significantly better than in
the non-vegetarian group who didn’t significantly
improve at all. In other words, the results indicated
that more plant-based diets led more effectively to
improvement in physical ﬁtness than less plant-based diets, after the same aerobic
exercise program.

Here’s what the graphs look like: significantly better power
output and aerobic capacity in the group that was randomized
to a vegetarian diet. It seems that those eating vegetarian were able to better burn off carbohydrates compared
to nonvegetarians, and had better insulin sensitivity, both markers of improved
metabolic ﬂexibility, meaning the ability
to switch back and forth between burning sugar and fat. Besides physiological
mechanisms, there may also be
psychological factors. They observed reduced hunger
and reduced feelings of depression in the vegetarian group
which may have given them a more positive attitude
towards exercise. Here’s the psychological data. Those randomized to eat vegetarian
had a greater improvement in quality of life and mood. They felt less constrained,
meaning the calorie restriction didn’t seem as burdensome; they had less disinhibition, meaning less tendency
to binge and overeat, along with maybe
less feelings of hunger. Not to mention the superior effects
of a vegetarian diet on body weight, glycemic control,
blood lipids, insulin sensitivity,
and oxidative stress.

Wait, better body weight? I thought they were given
the same number of calories. Yes, both diets were isocaloric,
the same calories, yet just eating meat-free led
to significantly more weight loss— about six pounds more;
more waist loss, a slimmer waist; lower cholesterol, of course;
and less superficial fat, meaning the external jiggly fat; and most importantly, significantly
more visceral fat loss, the most metabolically
dangerous deep belly fat. Same calories, yet more
loss of body fat. And not surprisingly,
better control of their diabetes. All in addition to leading
more effectively to improvements
in physical ﬁtness..

Video Transcript – As found on YouTube

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