Author Archive

Absorption of Various Forms of B12

Thursday, August 13th, 2015

Breaking news from 1971 for vitamin B12 junkies!

A reader alerted me to a 1971 study comparing absorption rates of cyanocobalamin, hydroxocobalamin, methylcobalamin, and adenosylcobalamin (1).

They found that at doses of 1 µg, 5 µg, and 25 µg, all forms were absorbed at about the same rate for practical purposes.

However, the researches suggested, based on other research, that at higher doses, cyanocobalamin is better absorbed. They theorized that this could be because absorption of methylcobalamin by way of intrinsic factor is efficient while cyanocobalamin is better absorbed through passive diffusion.

Based on this study, I’ve cleaned up the VeganHealth.org page Methylcobalamin & Adenosylcobalamin where you can also see a table of the absorption rates from this 1971 study.

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References

1. Adams JF, Ross SK, Mervyn L, Boddy K, King P. Absorption of cyanocobalamin, coenzyme B 12 , methylcobalamin, and hydroxocobalamin at different dose levels. Scand J Gastroenterol. 1971;6(3):249-52. | link

Pre-Type 2 Diabetes and Lean Vegans

Sunday, August 9th, 2015

Just added this article to VeganHealth.org:

Preface

by Jack Norris

Recently, I have been contacted by a small group of lean, pre-diabetic vegans. I had never heard of thin vegans developing pre-diabetes; it turns out that it’s not uncommon for lean people to develop pre-type-2 diabetes.

Here is an article by Susan Papuga, one of the people who contacted me, who has researched the topic thoroughly. If you aren’t familiar with the normal references for the numbers discussed below, please see Diabetes: Tests and Diagnosis from Mayo Clinic.

Pre-Type 2 Diabetes and Lean Vegans

by Susan Papuga

The majority of people with type 2 diabetes are overweight and suffer from hyperglycemia (high blood sugar) due to insulin resistance. However, there is also a condition in which thin people suffer from hyperglycemia. Few studies have been done on lean diabetics and are primarily on Asian populations. Many of these studies have found that lean type-2 diabetics are suffering from a deficiency of the insulin-producing beta cells rather than from insulin resistance. An even smaller subset rarely mentioned are lean vegans with high blood glucose; further research is needed to determine the cause of their pre-diabetes or diabetes.

The International Diabetes Foundation has developed a document, Guideline for Management of Postmeal Glucose (PDF), which states, “Although control of fasting hyperglycaemia is necessary, it is usually insufficient to obtain optimal glycaemic control. A growing body of evidence suggests that reducing postmeal plasma glucose excursions is as important, or perhaps more important for achieving HbA1c goals.” Their recommendation is that two-hour postmeal (also known as postprandial) plasma glucose should not exceed 140 mg/dl (7.8 mmol/l) as long as hypoglycemia is avoided.

In order to meet that goal for a lean vegan who is pre-diabetic or diabetic, careful consideration needs to be paid to diet. One challenge is how to prevent postprandial spikes while reducing carbohydrate and still maintaining adequate body weight. The Eco-Atkins diet can be an effective path to follow with higher fat and protein consumption from nuts, seeds, avocados, soy foods, and seitan–all helping to provide needed calories. Carbohydrate should be chosen wisely, emphasizing high fiber and low glycemic foods.

The Guideline further states, “Self-monitoring of blood glucose should be considered because it is currently the most practical method for monitoring postmeal glycaemia.” For a lean vegan, this is an important step in taming impaired glucose metabolism. For a few in our group of lean vegans, our fasting glucose was only slightly elevated while an HbA1c test and/or postprandial glucose identified pre-diabetes.

My first indication of impaired glucose metabolism was during a routine lab which showed a slightly elevated fasting glucose of 101. I started testing my fasting and postmeal glucose at home and mentioned to my doctor that I was seeing some high numbers for postmeal, up to 185. A person with normal glucose metabolism rarely goes over 140 postprandial. An oral glucose tolerance test confirmed a pre-diabetes diagnosis, and then began my journey to find a way to lower those numbers while eating a healthy vegan diet.

Personally, I’ve had success at keeping my fasting glucose under 100 mg/dl and postprandial glucose under 140 mg/dl with a diet similar to Eco-Atkins. I found that the processed grains in breads and pasta and many mid- to high-glycemic index foods, even in modest amounts, will cause a high postprandial spike. To keep glucose low and slow, the high fiber carbohydrate are best. I’ve stopped eating dried fruit and eat low glycemic index fresh fruit only in small servings; instead, I fill up with hull-less barley (1), soybeans, legumes, chia seeds, wheat bran, non-starchy vegetables, nuts, seeds, avocado, and seitan.

Tracking daily nutrients on Cronometer.com has been invaluable for meeting the RDA targets. Consequently, my lab results are coming back with great numbers: low cholesterol (high HDL), low inflammation, low blood pressure, normal glucose, and HbA1c at 5.0. This diet works well for me and the other vegans in our group. We’ll continue to monitor our glucose and labs, adjusting when needed, but overall we are quite pleased, as are our doctors, with the outcomes.

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Footnotes

1. Barley can be hulled or hull less. Hull less barley has a lower glycemic index and higher nutrient profile.

Latest in Clinical Nutrition: Volume 25 Now Available

Wednesday, June 24th, 2015

Dr. Michael Greger of NutritionFacts.org has released Volume 25 of his Latest in Clinical Nutrition DVD series. This one has a strong focus on digestive ailments. Dr. Greger scours the earth for important studies in peer-reviewed journals…so you don’t have to!

You can order Volume 25 by clicking here.

Gluten Sensitivity: Hard to Self-Diagnose

Wednesday, June 24th, 2015

A 2015 study from Italy found that among people attending a gastroenterology clinic complaining of gluten-related symptoms, few actually improved after six months on a gluten-free diet (1).

A total of 392 patients reported gluten-related symptoms upon an appointment at the clinic. Among them, celiac disease was confirmed in 26 and a wheat allergy was confirmed in 2. The remaining 364 were advised to follow–and apparently complied–with a gluten-free diet. After six months, only 27 were symptom-free. The researchers concluded that 86% of people who think they suffer from gluten-related symptoms actually do not.

Thank you, Joseph Gonzales, RD.

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References

1. Capannolo A, Viscido A, Barkad MA, Valerii G, Ciccone F, Melideo D, Frieri G, Latella G. Non-Celiac Gluten Sensitivity among Patients Perceiving Gluten-Related Symptoms. Digestion. 2015 May 30;92(1):8-13. | link

Vitamin D3 Performs Slightly Better Than D2 in Clinical Trial

Tuesday, June 23rd, 2015

I have updated the VeganHealth.org article, Calcium and Vitamin D, with a synopsis of the following clinical trial:

“A 2013 study from Germany found that with supplementing daily for 8 weeks at about 2,000 IU, D3 was more effective at raising vitamin D levels (1). The average 25(OH)D levels increased 46 nmol/l in the D3 group (for an average of 89 nmol/l) but only 30 nmol/l in the D2 group (for an average of 68 nmol/l). Vitamin D2 supplementation appeared to decrease the amount of circulating vitamin D3. PTH levels were not different between groups. Because D2 raised levels into the recommended range (50 – 125 nmol/l), it seems preliminary to assume that D3 is more healthy based on these results, though evidence is mounting that D3, even at smaller doses, can raise vitamin D levels higher or more quickly than D2.”

I don’t think this has any health implications for most vegans. If you have experienced a stubborn vitamin D deficiency, it adds some credence to the idea that you should try vitamin D3. Vegan vitamin D3 is available.

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References

1. Lehmann U, Hirche F, Stangl GI, Hinz K, Westphal S, Dierkes J. Bioavailability of vitamin D(2) and D(3) in healthy volunteers, a randomized placebo-controlled trial. J Clin Endocrinol Metab. 2013 Nov;98(11):4339-45. doi: 10.1210/jc.2012-4287. Epub 2013 Sep 3. | link

A Tale of Two Books

Monday, June 1st, 2015

In the past year or so, two comprehensive books on plant-based eating have been published by colleagues of mine–Becoming Vegan: Comprehensive Edition by Brenda Davis and Vesanto Melina and The Vegiterranean Diet by Julieanna Hever. Both books deserved a more timely review, but I figure it’s better late than never.

Becoming Vegan: Comprehensive Edition is an encyclopedia of vegan nutrition and if you are a nutrition junkie, I highly recommend it. Davis and Melina are honest and thorough in their evaluation of the literature. For those who want less, they have a shorter version of the book, Becoming Vegan: Express Edition.

As the title suggests, The Vegiterranean Diet examines the Mediterranean diet–for which there is much compelling evidence–and how it might apply to vegetarian eating. As it turns out, it applies quite well. This would be a great book to give to a family member who is suffering from type 2 diabetes, cardiovascular disease, or obesity due to poor eating habits. In addition to the nutrition information, there are over 60 recipes and many tips on weight loss which I found sensible.

Vitamin D is Absorbed Better with Fat

Sunday, May 24th, 2015

I have updated the article, Calcium and Vitamin D, to reflect recent research showing that vitamin D supplements are better absorbed when taken with meals that contain fat.

The study was a randomized controlled trial conducted at Tufts University (1). It compared taking a 50,000 IU dose of vitamin D3 with three different meals: 1) a fat-free meal, 2) a 30% fat meal with high polyunsaturated fats, 3) a 30% fat meal with high monounsaturated fats. To make a short story even shorter, the meals with fat increased vitamin D absorption 32% over the meals without. There was no difference between meals high in polyunsaturated and monounsaturated fats.

Upcoming P-POD Conference

Registered Dietitians and Medical Doctors can earn continuing education credits at the upcoming Plant-based Prevention of Disease Conference.

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References

1. Dawson-Hughes B, Harris SS, Lichtenstein AH, Dolnikowski G, Palermo NJ, Rasmussen H. Dietary fat increases vitamin D-3 absorption. J Acad Nutr Diet. 2015 Feb;115(2):225-30. | link

Spring and Summer Talks by Jack Norris, RD

Monday, April 20th, 2015

Spring and Summer Talks by Jack Norris, RD

Thursday May 21–Elk Grove, CA
Vegan Nutrition: What Does the Science Say?
Elk Grove Vegetarian Society’s monthly meeting
Carlton Plaza | 6915 Elk Grove Blvd
Potluck at 6 pm | Talk at 6:45-7:45

Saturday June 6–Grass Valley, CA
You Are What You Eat: Education Through Nutrition
Responses to the common nutrition questions that vegans receive.
Farmed Animal Conference at Animal Place

Saturday, June 27–Madison, WI
Vegan Nutrition: What Does the Science Say?
Mad City Vegan Fest

Saturday, August 15–Santa Rosa, CA
Vegan Nutrition: What Does the Science Say?
Sonoma County VegFest

Amaranth is a Good Source of Plant-Based Protein

Thursday, April 2nd, 2015

A reader informed me that amaranth was a good source of protein–better than quinoa even. So I checked it out and found that she was correct.

Amaranth has 9 g of protein per cup (cooked) which is slightly higher than quinoa. One cup of cooked amaranth has 250 calories while one cup of cooked quinoa has 222 calories. This gives them about the same amount of protein per calorie.

Amaranth also has a decent amount of lysine, comparable to a serving of soy or other legumes.

I have added amaranth’s amino acid profile to Table 3: Protein & Amino Acids in Common Foods.

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Links: G and Dr. G

Monday, March 30th, 2015

Ginny Messina has two recent posts that I thought were worth sharing:

Pinto Beans or Tofurky? How Food Choices and Motivations Affect Vegan Health

White Rice, Resistant Starch and Vegan Diets

And Dr. Michael Greger has released Latest in Clinical Nutrition – Volume 24. In Volume 24, he includes a number of videos examining the differences between organic and non-organic foods.