I don’t believe you have talked about glucosamine. I am a 53-year old female, vegan for 6 years, in excellent health. However, I have had various joint problems and just been told to take glucosamine by my doctor (750 mg twice daily). Whole Food Market carries several vegan brands. In your opinion do these really strengthen joints/cartilage and which would be the best one to take?

I performed a full literature review on glucosamine and chondroitin a number of years ago for a print newsletter I had at the time. I have checked in on the literature occasionally since then and thought now would be a good time to do so again.

Background: Cartilage is a substance that exists in many joints, such as the knee, that provides cushion between bones. When cartilage starts to wear away, bones start to grind against each other and osteoarthritis results. Glucosamine and chondroitin are components of cartilage and have been promoted as being able to rebuild or at least prevent the deterioration of cartilage. Glucosamine is generally vegan while chondroitin is not. There are vegan forms of glucosamine, especially glucosamine HCl. Glucosamine sulfate often comes from shellfish, but there are vegetarian forms. To my knowledge, there are no vegan forms of chondroitin. Methylsulfonyl methane (MSM) has also been touted to have similar beneficial effects on joints.

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Nutrient Composition of Foods | Diet Analysis | Dietary Reference Intakes

When I wrote my first review, the conclusion at the time, based on a lot of research, was that 1500 mg per day of glucosamine might help prevent the progression of osteoarthritis if it was in its early stages.

I did a little searching today and found that things had not changed much.

I came across an abstract of a 2005 meta-analysis of studies on glucosamine and the progression of new osteoarthritis. It found that glucosamine reduced the amount of pain and progression of the disease (1).

An abstract from a 2010 meta-analysis of studies on glucosamine and chondroitin found no effect of treatment for the first year, but did find a “small to moderate protective effect” over the course of two to three years (2).

The most recent information I found was a 2011 meta-analysis from the British Medical Journal on glucosamine and chondroitin’s effects on osteoarthritis of the hip or knee. If found no benefit. The authors state:

“Results from randomised trials about the effectiveness of chondroitin and glucosamine are conflicting. Trials that have reported large effects on joint pain were often hampered by poor study quality and small sample sizes, whereas large methodologically sound trials often found only small or no effects.”

They conclude:

“Our findings indicate that glucosamine, chondroitin, and their combination do not result in a relevant reduction of joint pain nor affect joint space narrowing compared with placebo. Some patients, however, are convinced that these preparations are beneficial, which might be because of the natural course of osteoarthritis, regression to the mean, or the placebo effect. We are confident that neither of the preparations is dangerous. Therefore, we see no harm in having patients continue these preparations as long as they perceive a benefit and cover the costs of treatment themselves.”

I personally take glucosamine occasionally. It might not be effective if taken only occasionally, but I only have so much money I want to spend on a therapy that is questionable.

I do not have an opinion on which brand is best. There is some debate about whether glucosamine sulfate or glucosamine hydrochloride is better. I do not know the answer to that.

References

1. Poolsup N, Suthisisang C, Channark P, Kittikulsuth W. Glucosamine long-term treatment and the progression of knee osteoarthritis: systematic review of randomized controlled trials. Ann Pharmacother. 2005 Jun;39(6):1080-7. Epub 2005 Apr 26. Abstract

2. Lee YH, Woo JH, Choi SJ, Ji JD, Song GG. Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis. Rheumatol Int. 2010 Jan;30(3):357-63. Abstract

3. Wandel S, Jüni P, Tendal B, Nüesch E, Villiger PM, Welton NJ, Reichenbach S, Trelle S. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ. 2010 Sep 16;341:c4675. Full Text

According to the article Guidelines for Introducing Foods to Infants Being Developed, the American Academy of Pediatrics (AAP) discussed the idea of promoting red meat as the best first food to introduce to infants on October 17 at their AAP ConvergeNCE conference.

The write-up says that Frank R. Greer, MD, FAAP would talk about guidelines for feeding infants that are under development, and was going to address the idea that “Red meat is the nutrient-rich food that biologically may be best as the first complementary feeding for infants.”

I don’t know that this is a huge emergency as vegetarian and vegan parents can opt to ignore the guidelines (if they even find out about them). However, it does seem to be a step in the wrong direction in terms of the evolution of human nutrition and I thought it would be good to write the AAP a letter about it:

Dear American Academy of Pediatrics:

Jack Norris, RD
President, Vegan Outreach

It might be good for others, especially health professionals, to write polite letters to the AAP expressing concerns about such guidelines and to ask them to consider a plant-based point of view.

You can contact them here.

Just got a note from a reader that her dog developed signs of B12 deficiency:

“I was feeding her a [home-cooked] vegan diet, except for a little fish oil, and giving her 500 micrograms B12 every 4 days. She started yelping when I’d open her mouth to give her a pill. The vet couldn’t find a reason. That went away, but she got chronic diarrhea and decreased appetite, also no reason found. Then on a walk, she started limping, then staggering around. Then she collapsed. The vets found no reason for her problems. But B12 deficiency can cause diarrhea, fatigue, loss of appetite and ataxia, and nothing else I know of causes all those symptoms. I’m now giving her 500 micrograms every day, and she’s almost completely back to normal. I wrote the vet a letter suggesting it was B12 deficiency, but I haven’t heard back.”

“She needs 10 mcg B12 if given every day, according to Nutrient Requirements of Dogs – but probably at least 2,000 micrograms if only every 4 days.”

I thought this was an interesting, short article worth passing on:

LiveScience.com: Did Alternative Medicine Kill Steve Jobs?

(Thanks, Matt.)

A new report on the safety of supplement use in older women has been released from the Iowa Women’s Health Study (1).

The study tracked women 55 to 69 years old, almost entirely white, for an average of 19 years. After adjusting for age, education, place of residence, diabetes, high blood pressure, body mass index, waist to hip ratio, hormone replacement therapy, physical activity, smoking, energy, alcohol, saturated fatty acids, whole grain products, fruits, and vegetables, they found the following:

– Multivitamins were associated with a 6% increase in mortality (1.06, 1.02-1.10).

– Iron (1.10, 1.03-1.17) and copper (1.45, 1.20-1.75) were associated with an increased risk for mortality.

– Vitamin B6 (1.10, 1.01-1.21), folic acid (1.15, 1.00-1.32), magnesium (1.08 1.01-1.15), and zinc (1.08, 1.01-1.15), were all associated with a borderline statistically significant increased risk of mortality.

– Vitamin A, beta-carotene, vitamin B complex, vitamin C, vitamin D, vitamin E, and selenium supplements were not associated with an increase in mortality.

– Calcium supplements were associated with a decreased risk of mortality (0.91, 0.88-0.94).

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There was not a lot of data on amounts, except for iron and calcium. The groups with an increased risk of mortality from iron were taking fairly hefty amounts of iron, with the biggest risks associated with 50 to > 400 mg/day! That is a lot of iron ‒ the RDA for women 51 to 70 years old is 8 mg.

The levels of calcium associated with the reduced risk of mortality were basically anything less than 1,300 mg per day.

The authors summed up their findings with, “In conclusion, in this large prospective cohort of older women, we found that most dietary supplements were unrelated to total mortality rate. However, several commonly used dietary vitamin and mineral supplements were associated with increased total mortality rate, most strongly supplemental iron; calcium showed some evidence of lower risk.”

This study is just one piece to a very large puzzle, and I would not take it to mean anything conclusive. If you look at the entire body of research, results regarding supplements have been quite mixed and this tends to make me think they do not have a strong effect on mortality one way or the other, although there is still more to be learned.

One thing I would take away from this study is that it is further evidence that people should not take iron supplements, especially more than the RDA, unless under the guidance of a physician.

As for vegans, studying supplements in terms of their ability to decrease or increase mortality in a population that does not have acute deficiencies is not the same as for people whose diets are significantly lower than the DRIs for particular nutrients. This study would not give me any reason to change my recommendations.

Reference

1. Mursu J, Robien K, Harnack LJ, Park K, Jacobs DR. Dietary Supplements and Mortality Rate in Older Women: The Iowa Women’s Health Study. Arch Intern Med. 2011;171(18):1625-1633.   |   Link

Vegans have a lower risk of developing diabetes!

Ho, hum. This is something we already knew, right? Well, not really. There have not been any prospective studies on the rates of diabetes for vegans. Until now, that is!

A report was just released from Adventist Health Study 2 that found that after 2 years of follow-up, vegans had a 60% reduced risk of being diagnosed with diabetes (1).

More information can be found in the VeganHealth.org article, Type 2 Diabetes and the Vegan Diet or by clicking on the link to the abstract below.

Reference

1. Tonstad S, Stewart K, Oda K, Batech M, Herring RP, Fraser GE. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr Metab Cardiovasc Dis. 2011 Oct 7. [Epub ahead of print]   |   Link

I have created a nutrient analysis website that I think might be of use to many of my readers:

PeaCounter.com

You can create daily menus to see how much of each nutrient you are getting. It all started when I tried to create an Excel spreadsheet for people to calculate their amino acid intakes on VeganHealth.org’s Protein page many years ago. This was a terribly user-unfriendly and incomplete way to calculate amino acid needs and slowly but surely I created something I hope will be much better.

Two additional features of PeaCounter.com are:

1. All the Dietary Reference Intakes are listed at PeaCounter.com/dris.

2. You can quickly look up the nutrient amounts for a particular food and also create links that can be sent to others by clicking on the navigation bar in the top right.

I hope you will find it useful!

Is a typical daily multivitamin with 100% RDA of B12, taken once a day, sufficient to reliably cover my B12 needs?

Quick answer:

No. The RDA for vitamin B12 is 2.4 µg. I recommend getting at least 25 µg per day if only getting B12 in one dose per day.

Note that nutrition labels on supplements usually show the percentage of the Daily Value, not the RDA. The Daily Value for B12 is 6 µg, which is still not enough.

Longer answer:

The body can absorb B12 two ways:

1. Using transport proteins that ferry B12 from the digestive tract into the blood.

2. Through passive diffusion without any transport proteins.

The transport proteins get saturated at about 1.5 µg while only 1% to 1.5% of B12 is absorbed through passive diffusion. Because of this, I recommend 25 to 100 µg if only getting B12 in one dose per day.

More information:

Vitamin B12 Recommendations

Vitamin B12: Are you Getting It? – How Recommendations Were Formulated

Table of Daily Recommendations – Shows amounts needed for two daily doses, one daily dose, and two weekly doses.

A study was reported earlier this week that found an association between B12 deficiency and brain shrinkage. Time had a write-up: Low Vitamin B12 Linked to Smaller Brains and Cognitive Decline.

It inspired me to create a separate page on VeganHealth.org, Mild B12 Deficiency – Dementia & Depression. Most of that information used to reside at Mild B12 Deficiency – Elevated Homocysteine, but I decided that it is important enough to warrant its own page.

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The paper is a report from the Chicago Health and Aging Project. Rather than trying to describe their methods and statistical analysis in detail, I will simply copy two important paragraphs from the paper that summarize their findings:

“Thus, our findings lend support for the contention that poor vitamin B12 status is a risk factor for brain atrophy and possibly WMHV [white matter hyperintensity volume] which in turn may contribute to cognitive impairment.”

“Marginal vitamin B12 status in older age is frequently missed by measurement of serum vitamin B12 levels alone. Our findings suggest that [methylmalonic acid], the specific marker of B12 deficiency, may affect cognition by reducing [total brain volume] whereas the effect of homocysteine on cognition may be [caused by] increased WMHV and [strokes].”

In other words, long-term moderate vitamin B12 deficiency is not good for the brain.

Reference

1. Tangney CC, Aggarwal NT, Li H, Wilson RS, Decarli C, Evans DA, Morris MC. Vitamin B12, cognition, and brain MRI measures: A cross-sectional examination. Neurology. 2011 Sep 27;77(13):1276-82. Link

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