Vitamin B12 - A Nutrition Guide for Vegetarians & Vegans: From Nori to Mushrooms, Omnivores Can Benefit, Too!

With 77µg per 100g of the Nori leaves in the wrapping sushi makes an excellent B12 source, even if you stick to the vegan, no tuna version ;-)

If this is not your first visit to the SuppVersity you will be aware that I am not a exactly a proponent of vegetarianism let alone vegan dieting. Just like any other severely restrictive diet people who don't eat animal products are at an increased risk of nutrient deficiencies.

For vegetarians and even more so for vegans, it is not exactly easy to cover their daily requirements of vitamin A, vitamin D3, iron, cholesterol (yes, cholesterol is an essential nutrient!), n-3 polyunsaturated fatty acids and saturated fats. The most urgently needed nutrient for the average vegetarian / vegan dieter, however is vitamin B12, or cobalamin, as scientists say.

Actually dairy happens to be an excellent B12 source. Why not become lacto-vegetarian?

Dairy Has Branched-Chain Fatty Acids!

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Foods, Not Ma- cronutrients Build Healthy Guts

Lactulose For Your Gut & Overall Health

Is There a "Fat Advantage" for Dairy Lovers

Want B12, But Hate Meat? Drink Milk!

Vitamin B12 is a water-soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood. It is one of the eight B vitamins. It is normally involved in the metabolism of every cell of the human body, especially affecting DNA synthesis and regulation, but also fatty acid metabolism and amino acid metabolism. Neither fungi, plants, nor animals - including humans - are capable of producing vitamin B12. Therefore a sufficient intake of vitamin B12 is essential for optimal health.

Even in omnivorous humans, vitamin B12 deficiencies are frequent (Stabler. 2004). Among vegetarians and specifically vegans, it is yet rampant (Pawlak. 2013; Pawlak. 2014).

Figure 1: Reliable data on B12 levels is scarce. Based on surrogate markers and B12 deficiency symptoms scientists are still certain that "B12 deficiency as a worldwide problem." (Stabler. 2004) - one vegetarians are particularly susceptible to.

In the latest review by Pawlak et al. who included only studies that assessed serum vitamin B12 an reported actual percentages of vitamin B12 deficiency (40 studies total)...

• the deficiency prevalence among infants reaches 45%,
• the deficiency among the children and adolescents ranged from 0 to 33.3%, and 
• the deficiency among pregnant women ranges from 17 to 39%, dependent on the trimester

Adults and elderly individuals who follow a vegetarian lifestyle had a deficiency range from 0–86.5%. In general, higher deficiency prevalence was reported in vegans than in other vegetarians.  Accordingly, Pawlak et al. conclude that...

"[...]with few exceptions, the reviewed studies documented relatively high deficiency prevalence among vegetarians. Vegans who do not ingest vitamin B12 supplements were found to be at especially high risk." (Pawlak. 2014)

For vegans, specifically, the scientists recommend the routine use of vitamin B12 supplements to ensure adequate vitamin B12 intake and point out that "[v]egetarians, regardless of the type of vegetarian diet they adhere to, should be screened for vitamin B12 deficiency." (Pawlak. 2014)

Why is it so difficult for vegetarians and vegans to meet their requirements?

The Institute of Medicine’s recommended dietary allowance (RDA) of B12 needed to meet an adult’s requirement as 2.4mg per day. B12 is synthesized only by microorganisms, and this is why natural food sources of B12 are limited to meats and foods of animal origin.

 "Clams and beef liver are the highest sources of B12, containing about 84 and 71mg of B12 in a 3 oz serving (USDA. 2011). The amount of B12 found in a chicken varies from about 3.3mg in the entire chicken liver to 0.03mg in achicken’s neck. Pork contains between 0.3mg of B12 in each sausage patty to about 11.4mg in pork liver. 6 The content of B12 in fish ranges from about 9mg in one half of a fillet of sockeye salmon to about 0.5mg in a 3 oz serving of yellow fin tuna." (Pawlak. 2013)

Needless to say that a vegetarian or vegan person mustn't eat any of the aforementioned "good" B12 sources. The question is thus: Where can a vegan or vegetarian get his B12 from?

Diagnosis of low B12 levels is tricky! The most commonly used cobalamin essay has a sensitivity of "only" 62.6% and produces 22%+ false positives. An often-used alternative, the holotranscobalamin essay is a tad better, but with a sensitivity of 64.7% and 18.4% false positives, not exactly accurate, either (Carmel. 2013). Until now no 100% reliable test is available and studies like Salomon (2005) show that patients with "normal" plasma cobalamin levels, but symptoms vitamin B12 deficiency improve after treatment with the vitamin.

In view of the fact that the name of this website contains the word "supplement", the most obvious and probably safest source are supplements. In that, it's important to point out that not all supplements that promise to solve the vegetarian B12 problems will actually deliver.

Fourteen years ago, Micheal S. Donson tested the efficacy of sublingual cobalamine tablets, nutritional yeast, and probiotic supplements in a group of Hallelujah dieters and other raw-food vegetarians and found that only the former two, i.e. the sublingual cobalamine tablets and the nutritional yeast that contained 5µg of cyanocobalamin per tablespoon brought his subjects' depleted B12 levels back into the normal range. The probiotic supplement, on the other hand, was useless (Donaldson. 2000).

For patients with insufficient intrinsic factor production oral supplements are not suitable, though. For them, only injectable vitamin B12 will reliably bring their levels back up (Katz. 1972). People with low stomach acid, which often occurs with aging, as well, and people with gastric bypass (Smith. 1993) have similar, but less pronounced problems to cover their B12 requirements from oral sources (dietary and supplemental).

Now, supplementation and injections are nice, but isn't is possible to get your B12 from foods without having to eat meat and animal products?

In general, it is possible, but there is one major problem: The total content and bioavailability of vitamin B12 in food sources vegetarians and vegans can eat is comparably low.

Table 1: Content and bioavailability of selected "good" dietary sources of vitamin B12 (Watanabe. 2007)

If you take a look at the data in Table 1 you will see that the only source that can keep up with fish and meat are algae. Chloeralla in particular is an excellent source of dietary B12 for both vegetarians and, if I didn't miss yet another stupid dogma, vegans, as well (Watanabe. 2007).

In a previous study, Watanabe et al. (2002) have found that chlorella tablets, but not spirulina, which contains mostly pseudy vitamin B12 is a suitable source of vitamin B12 for man (and woman ;-).

In a more recent overview of vegetarian and vegan B12 sources, the researchers from the United Graduate School of Agricultural Sciences at the Tottori University in Japan (Watanabe. 2014) compiled a comprehensive overview of suitable B12 sources which includes...

• 

  Are "organic" vegetables worth it? Find out in a previous article.

  Vitamin B12-Enriched Beans and Vegetables Produced Using Organic Fertilizers or Hydroponics -- Previous research has shown that you can significantly increase the B12 content of spinach by adding an organic fertilizer such as cow manure. Practically speaking this is an increase to to approximately 0.14 μg/100 g fresh weight - that's huge considering the fact that "regular" spinach contains < 0.01µg/100g vitamin B12.
  
  In view of the fact that the RDA for B12 is 2.4 μg/day that's still too little to be able to cover your B12 needs from spinach alone. Still, in the future we may be seeing other "high B12" vegetables on the market even non-vegetarian dieters may benefit from.
• Fermented Beans and Vegetables -- The Vitamin B12 content of soybeans is low or undetectable. In the course of the fermentation process soybean products are yet loaded with B12, so that fermented soybeans (Tempe, a traditional Indonesian food that's made of fermented soybeans) can contain up to 8.0 μg B12 per 100g (Nout. 1990)
  
  Comparable increases in B12 content have been observed in vegetables that have been fermented with certain lactic acid or propionic bacteria (up to 10µg/100g; Gupta. 1998).
  
  

  

  "Pesticide pollution: Chinese tea may not be safe to drink," this is what you could read on the website of Greenpeace in 2012, already and obviously this has not changed over the last 2 years | read more

  Tea, of which most people forget that it is fermented (not green tea, though), as well can also contain significant amounts of vitamin B12. For black tea (Batabata-cha), scientists have shown that drinking 50 mL/day, equivalent to a daily dose of 1 ng Vitamin B12, for 6 weeks, compensated the B12 deficiency of B12 deficient rodents (Kittaka-Katsura. 2004). As Watanabe et al. point out, results like these "indicate that Vitamin B12 found in fermented black tea is bioavailable in rats." Unfortunately, the same cannot be said for human beings, where the consumption of 1–2 L of the fermented tea drink, which is equivalent to 20–40 ng of Vitamin B12, is not sufficient to meet the RDA of 2.4 μg/day for adult humans.
• Edible Mushrooms --  Zero or trace levels (approximately 0.09 μg/100 g dry weight) of Vitamin B12 were measured in the dried fruiting bodies of porcini mushrooms (Boletussp.), parasol mushrooms (Macrolepiota procera), oyster mushrooms (Pleurotus ostreatus), and black morels (Morchella conica).
  
  

  

  Figure 2: The micronutrients in nori and dried shiitake mushrooms complement each other perfectly (see bottom line for explanation)

  In contrast, the fruiting bodies of black trumpet (Craterellus cornucopioides) and golden chanterelle (Cantharellus cibarius) contained higher levels of Vitamin B12 (1.09–2.65 μg/100 g dry weight) than the above mentioned mushrooms (Watanabe. 2012).
  
  In addition, high levels of Vitamin B12 were detected in the commercially available dried shiitake mushroom fruiting bodies (Lentinula edodes), which are used in various vegetarian dishes. The Vitamin B12 contents of dried shiitake mushroom fruiting bodies (100 g dry weight) significantly varied and the average Vitamin B12 value is approximately 5.61 μg (Bito. 2014). 

In conjunction with algae and algae supplements the aforementioned vegetarian sources of B12 may in fact be sufficient to cover the daily requirements of 2.4µg of vitamin B12.

Milk has a built-in B12 absorption enhancer (learn more). Now you tell me: Who would ever doubt that nature knows best?

Bottom line: Of all vegetarian B12 sources, nori is the one marine source of vitamin B12, Watanabe et al. highlight in particular. The consumption of only 4g of dried purple laver (Vitamin B12 content: 77.6 μg /100 g dry weight) supplies the RDA of 2.4 μg/day. Moreover, nori can be easily consumed as a wrapping for rice and fillings and retains most of its precious B12 content upon heating (Miyamoto. 2009).

In conjunction with dried shiitake mushroom fruiting bodies that contain 18.9 mg of Vitamin D2 (ergocalciferol) and 2.0 mg of iron, both likewise micronturients vegetarians usually don't get enough of in their diets, the dried purple lavers that are rich sources of n-3 polysaturated fatty acids and can be easily integrated in Italian, French, and other forms of Western cuisine, are thus probably the best non-supplemental source of B12 vegetarians can get | Comment on Facebook!

References:

• Bito, Tomohiro, et al. "Characterization of vitamin B< sub> 12</sub> compounds in the fruiting bodies of shiitake mushroom (< i> Lentinula edodes</i>) and bed logs after fruiting of the mushroom." Mycoscience (2014). 
• Carmel, Ralph. "Diagnosis and management of clinical and subclinical cobalamin deficiencies: Why controversies persist in the age of sensitive metabolic testing." Biochimie 95.5 (2013): 1047-1055.
• Gupta, Uma, E. R. Rati, and R. Joseph. "Nutritional quality of lactic fermented bitter gourd and fenugreek leaves." International journal of food sciences and nutrition 49.2 (1998): 101-108. 
• Katz, Max, Sook K. Lee, and Bernard A. Cooper. "Vitamin B12 malabsorption due to a biologically inert intrinsic factor." New England Journal of Medicine 287.9 (1972): 425-429.
• Kittaka-Katsura, Hiromi, et al. "Characterization of corrinoid compounds from a Japanese black tea (Batabata-cha) fermented by bacteria." Journal of agricultural and food chemistry 52.4 (2004): 909-911.
• Miyamoto, Emi, et al. "Characterization of vitamin B12 compounds from Korean purple laver (Porphyra sp.) products." Journal of agricultural and food chemistry 57.7 (2009): 2793-2796.
• Nout, M. J. R., and F. M. Rombouts. "Recent developments in tempe research." Journal of Applied Bacteriology 69.5 (1990): 609-633.
• Pawlak, Roman, et al. "How prevalent is vitamin B12 deficiency among vegetarians?." Nutrition reviews 71.2 (2013): 110-117.
• Pawlak, R., S. E. Lester, and T. Babatunde. "The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature." European journal of clinical nutrition 68.5 (2014): 541-548. 
• Smith, C. Daniel, et al. "Gastric acid secretion and vitamin B12 absorption after vertical Roux-en-Y gastric bypass for morbid obesity." Annals of surgery 218.1 (1993): 91.
• Solomon, Lawrence R. "Cobalamin-responsive disorders in the ambulatory care setting: unreliability of cobalamin, methylmalonic acid, and homocysteine testing." Blood 105.3 (2005): 978-985.
• Stabler, Sally P., and Robert H. Allen. "Vitamin B12 deficiency as a worldwide problem." Annu. Rev. Nutr. 24 (2004): 299-326.
• USDA National Nutrient Database for Standard Reference, Release 18.Vitamin B12 (mg) Content of Selected Foods Per Common Vitamin B-12 Measure, Sorted by Nutrient Content. 2005; Available at: http://www.nal.usda.gov/fnic/foodcomp/Data/SR18/nutrlist/sr18w418.pdf. Accessed 27 November 2011. 
• Watanabe, Fumio, et al. "Characterization and bioavailability of vitamin B12-compounds from edible algae." Journal of nutritional science and vitaminology 48.5 (2002): 325-331.
• Watanabe, Fumio. "Vitamin B12 sources and bioavailability." Experimental Biology and Medicine 232.10 (2007): 1266-1274.
• Watanabe, Fumio, et al. "Characterization of vitamin B 12 compounds in the wild edible mushrooms black trumpet (Craterellus cornucopioides) and golden chanterelle (Cantharellus cibarius)." Journal of nutritional science and vitaminology 58.6 (2012): 438-441.
• Watanabe, Fumio, et al. "Vitamin B12-Containing Plant Food Sources for Vegetarians." Nutrients 6.5 (2014): 1861-1873.

Processed Meat is Bad for You, But Only if You Are Already a Type II Diabetic - Reduced Satiety Hormones, Vitamin C and Glucose Control After Veggie vs. Meat Burger

Is your love for meat going to kill you? Not if you're not already a walking candy stick with sugar coated ateries and a beer belly.

I am pretty sure that the mainstream interpretation of the study at hand will be missing the important "but only if you ARE ALREADY a type II diabetic" in the headline of today's SuppVersity article. Meat bashing and vegetarian protein worshiping is simply too "en vogue" these days for the average "science journalist" to stick to the actual data and tell you that the ingestion of isoenergetic processed meat vs. vegan high carbohydrate meals leaves only one conclusion:

For healthy individuals, processed fatty meals produce a much more favorable postprandial peptide response compared to the "allegedly super healthy" (and morally superior ;-) acetic vegetarian plant-based burger meal (a couscous burger: boiled couscous, baked with onion, garlic, plant oil, spices, oat-flakes in a wheat bun with sesame seedsmeal).

Learn more about meat at the SuppVersity

Meat-Love: You May Eat Pork, too!

You Eat What You Feed!

Meat & Prostate Cancer?

Meat - Is cooking the problem?

Meat Packaging = Problem?

Grass-Fed Pork? Is it Worth it?

Apropos burger! Now that you know the constituents of the the vegetarian test meal the 50 type II diabetics and 50 healthy controls were forced to eat contains, it's about time to reveal that the processed meat meal was a standard fast food menu: cooked-pork seasoned meat in a wheat bun with sesame seeds, tomato, cheddar-type cheese, lettuce, spicy sauce, onion.

Table 1: Composition of the processed meat and vegetarian test meals (Belinova. 2014)

As you can see in Table 1 the veggie burger had a significantly lower caloric density, but delivered the same 455kcal per serving as its meaty counterpart.

In view of what you've read about the importance of energy density as a determinant of food intake and subsequent obesity risk in previous SuppVersity intakes, you'd be forced to believe that 56% lower nutrient density alone should be an unfair advantage for the vegetarian meal.

Figure 1: Differential reaction of markers of glucose management (plasma glucose and immonreactive insulin) and satiety (Ghrelin and GLP-1) in response to processed meat or veggie burger (Belinova. 2014)

As the data in Figure 1 clearly indicates, the low nutrient density alone couldn't make up for the low nutrient quality and protein content. At least in the healthy subjects (dashed lines),

"[t]he plasma concentrations of glucose-dependent insulinotropic peptide (GIP), peptide tyrosine-tyrosine (PYY) and pancreatic polypeptide (PP) were higher and the ghrelin concentration was lower after the [processed meat] M-meal." (Belinova. 2014)

Similarly, the postprandial increase in triglycerides (rectangles, solid lines; Figure 2), we see in the diabetic subjects is not present in the healthy individuals, either.

Figure 2: Changes in markers of inflammation (Belinova. 2014).

And the TBARS and vitamin C levels (see Figure 2), as well as the levels of glutathione and superoxide dismutase (all markers of the inflammatory response to the meal; not shown in figure 2) didn't differ between the allegedly bad meat and the allegedly healthy vegetarian meal, anyway.

My previous article "CHO Shortage in Paleo Land" deals w/ another instance of over-generalized data from studies on obese / sick subjects and the confu- sing consequences | learn more.

Bottom line: Don't fall for the tricks of vegetarian bloggers and mainstream science journalists who abuse hand-picked data from the study at hand to "prove" their personal (or the public) conviction that meat is bad and vegetarian meat "alternatives" are good for all of us - that's bullshit.

If there is anything the study at hand "proves", it is the already well-known, but commonly ignored  fact that overweight individuals with a BMI of 33kg/m² or more and significantly elevated HbA1c levels (indicative of full-blown type II diabetes) react totally different to foods than the ever-shrinking majority of people with normal insulin sensitivity | Comment on Facebook!

What? No, that's not a reason to lose your focus on unprocessed meats and whole foods, it just adds to the existing evidence that simple-minded over-generalizations from studies in obese subjects to the whole population will do more harm than good... what? No I didn't say anything about ketogenic diets and low carbing, did I?

References:

• Belinova, Lenka, et al. "Differential Acute Postprandial Effects of Processed Meat and Isocaloric Vegan Meals on the Gastrointestinal Hormone Response in Subjects Suffering from Type 2 Diabetes and Healthy Controls: A Randomized Crossover Study." PloS one 9.9 (2014): e107561.

Obese Vegan Salmon!? Vegetable Oils and Proteins Reduce DHA and EPA Content by -28% and Increase Overall Adiposity and Triglyceride Levels in Atlantic Salmon.

Image 1: Could this be made of obes vegan
salmon? (img from littlesteps.eu)

If you listened to yesterday's episode of Carl Lenore's Super Human Radio, you may remember that I repeatedly pointed out that "not all milk is created equal" and that milk quality is determined by food quality (if you want to read more about milk in general and colostrum in particular, I suggest you read last week's Ask Dr. Andro, as well). Today I am going to tell you about another of the industry's economic (in the monetary sense) ways of reducing the quality of animal foods in our foodchain - and we are talking about a food with a much better reputation than milk or beef: Salmon, the "heart-healthy cold-water fish" that is literally in on (or rather between) everyone's lips, lately.

Note: Salmon is explicitly mentioned in the "sample one-day menu" scientists at Colorado State developed according to the USDA dietary guidelines (Dietary Guidelines for Americans), so don't tell me you are not supposed to eat Norwegian fish, anyway, because you, my American friends, are supposed to have Grilled salmon, steamed broccoli, barley pilaf, low-fat milk and cake with fresh berries for dinner ;-)

Bente E. Torstensen and his (her?) collegues from the National Institute of Nutrition and Seafood Research and the Skretting Aquaculture Research Centre in Norway conducted an interesting experiment (Torstensen. 2011). For about a year, the researchers fed 6,000 smolt of Atlantic salmon (mean weight 355g) which had previously been randomly assigned to one out of three experimental + one control groups with diets containing...

• maximal amounts of fish meal and fish oil (Control)
• the "safe maximum replacement" of both fish meal and fish oil with plant meal (80% plant protein) and vegetable oil (70% vegetable oil) (80PP70VO)
• half the maximum replacement with plant meal (40%) and maximal replacement with vegetable oil (70%) (40PP70VO)
• maximum replacement with plant protein (80%) and half of the maximal replacement with vegetable oil (35%) (80PP35VO)

While the control diet obviously resembles what salmon, which primarily feeds on other fish, would naturally eat, the diet composition of group 2 remotely reminds me of what the food-industry has been feeding the less health-conscious masses in the US and Europe over the last decades. What... as a animal-loving vegan you are more interested in the fate of the poor salmon than in that of your sick and obese fellow human beings? Ok, here is what happened:

Maximum dietary VO [vegetable oil] and PP [plant protein replacements] increased visceral lipid stores, liver TAG, and plasma VLDL and TAG concentrations. Increased plasma TAG correlated with an increased expression of apoB100, indicating increased VLDL assembly in the liver of fish fed the high-plant protein- and VO-based diet.

Veganism, it turns out, ain't the preferable diet for salmon. Depending on which end of the dietary spectrum you belong to - the carnivorous hunter or the vegan gatherer -  you will probably now be asking yourselves one of the following questions:

1. Hunter: "What does that have to do with me? I always knew plant proteins and oils are bad for you!"
2. Gatherer: "What does that have to do with me? I don't eat salmon and the results from a 'fish-model' certainly won't apply to human beings!"

In isolation both the carnivorous hunter as well as the vegan gatherer appear right, when they ignore a prick like me citing the results of an insignificant fish study, the amalgam of both of these trains of thought does yet bring up a more unsettling question: What happens to the average health-conscious customer on a budget who thinks he is doing him/herself good by frying his economically raised, i.e. vegetable oil and protein fed, salmon in "healthy" vegetable oils and finishes dinner with a tofu dish? To be honest, I don't think we really need a study to answer that question. You just have to look at your peers to see the health consequences of eating sick animals and other vegetables that were either never intended for human consumption or have been (over-)processed beyond all recognition.

Figure 1: Relative changes in the fatty acid profile compared to "real", i.e. fish-fed, salmon after 1 year on vegetable oil and protein (data calculated based on Torstensen. 2011)

A pros pos "beyond recognition" if you have a closer look at the combined effects of vegetable oils and proteins on the fatty acid (figure 1) of the fish you will notice that industrially produced salmon fed with the "safe maximum replacement" dose of vegetable oils and proteins has little resemblance with the healthy food most consumers believe they were eating, when they buy "salmon" at the grocery store. Most obviously, the beneficial n3:n6 ratio of 7.6 in "real" salmon changed for the worse and ended up at roughly 3.0 after one year on a 80% plant protein 70% vegetable oil diet. Moreover, the individual composition of the fatty acids changed, as well. These changes include -28% reductions in EPA and DHA levels. After all, customers are left with something that looks like salmon, because it has been artificially colored, and tastes like "salmon", simply because 99% of the customers do not even know how "real" salmon would taste, because since the 1980s the ratio of wild-caught (real) salmon to farmed (fake ;-) Atlantic salmon has declined from 10:13 to 1:480 and fewer and fewer people have even had the chance to taste non-industrially produced salmon.

Want B12, But Hate Meat? Drink Milk! SNAC-Fortified Cyanocobalamin 136% More Bioavailable Than Standard B12 - Still Less Effective Than B12 From Cow's Milk

Figure 1: Milk still rules the
world (of B12 supplements ;-)

Vitamin B12 deficiency is probably more prevalent, than many people would have it. The water-soluble vitamin is most abundant in foods of animal origin and vegetarians (let alone vegans) are as much at risk of having inadequate B12 levels, as people with achlorhydria and, consequently, low intrinsic factor (an enzyme that requires an acidic environment to function and facilitate the utilization of B12 from foodstuff), or more generalized disturbances of the gastrointestinal structure due to aging (food-cobalamin malabsorption becomes increasingly prevalent after the age of 50), gastric resection, ileal resection, Crohn's disease, and bacterial overgrowth of the intestine. With vitamin B12 deficiency affecting cell division and precipitating to megaloblastic anaemia and neuropathy, close monitoring not only of vitamin B12 intake, but also of its proper utilization is of utmost importance for people belonging to one of the aforementioned groups.

Scientists from Emisphere Technologies in Cedar Knolls, New Jersey, have now come up with a new cyanocobalamin/SNAC coformulation, in which the sodium caprylic acid salt, N-[8-(2-hydroxybenzoyl)amino]caprylate (SNAC), a proven drug delivery agent, shall facilitate a more pronounced and more reliable absorption of orally supplemented vitamin B12 (Castelli. 2011). The formula, which contained 5-mg cyanocobalamin and 100-mg SNAC was administered to 6 human subjects in the fasted state in the form of 1 tablet, which had to be taken with 50 mL of water. Blood samples were taken at staggered intervals with the last blood draw taking place 24h after the ingestion of the B12/SNAC coformulation.

Figure 1: Time to and maximal serum concentration of B12 after oral administration or infusion of cyanocobalamine with and without SNAC; note: in order to compensate for the major differences between oral cyonocobalamine with and without SNAC a logarithmic scale was used (data adapted from Castelli. 2011).

As expected the concomitant administration of sodium N-[8-(2-hydroxybenzoyl)amino]caprylate (SNAC) increased the meager biovalability of cyanocobalamine (which is absorbed really poorly, anyway) significantly:

Absolute bioavailability of B12 with the SNAC formulation was calculated from non–baseline-adjusted data to be 5.09% and was significantly greater (P < 0.05) than the commercial formulation (2.16%).

In view of the recently elucidated bioavailability of natural B12 from plain cow's milk (Matte. 2011), or should I say "liquid white gold", the 136% increase in bioavailability Christina Castelli and her coworkers achieved with their artificial combination of B12+SNAC appear quite ludicrous. 8%-10% that is the bioavailability et al. report in Jacques Matte and his colleagues from Canada report in their study on the bioavailability of vitamin B12 from cow's milk. Granted, this is a pig model, but other than rodents, which are usually used when it comes to studies, in which surgical interventions are necessary to elucidate the exact pharmacodynamics of a specific drug, pigs provide a very adequate model for the human gastrointestinal system, or as Miller and Ullrey already stated it in a 1987 paper on the "The Pig as an Animal Model For Human Nutrition" (Miller. 1987)

[...]with the possible exception of nonhuman primates, it is apparent that the omnivorous pig is one of the best models for study of nutrition issues in the omnivorous human.

This long established adequacy of the pig model of the human gastrointestinal tract has only recently been confirmed by Goulloteau et al. (Guilloteau. 2010). Matte et al.'s result that vitamin B12, which is naturally and abundantly present in cows’ milk, is more available at the intestinal level than the synthetic form - even if the latter is supplemented with SNAC - are thus very likely to apply to humans, as well.

Figure 2: Pharmacokinetics of vitamin B12 from different sources measured in pigs with an ultrasonic flow probe around the portal vein and a catheter inside the portal vein; values expressed as differences vs. unsupplemented animals; both values for cyanocobalamine alone are effectively 0, i.e not different from unsupplemented pigs (data adapted from Matte. 2011).

These results are also in accordance with retrospective studies in human subjects showing that vitamin B12 status is highly correlated with dairy product intake and studies on the absorption (absorption = entering the cells vs. bioavailability = becoming available in the blood stream) of vitamin B12 from dairy products in older men and women (>60y) by Robert M. Russel et al. (Russel. 2001), who report absorption of up to 65% for milk, which would be almost identical to the generally accepted absorption coefficient for meat products.

Note: Using a pig model Matte et al. were able to actually measure the portal-drained viscera (PDV) flux of vitamin B12, which provides more reliable results than radio-labelling studies, as they were used in Russel et al. It is thus all the more intriguing that the PDV for the unsupplemented diet or cyanocobalamin supplements [...] were not different from 0", or in other words - providing pigs with cyanocobalamine, which is the form of vitamin B12 that is used in most common dietary supplements, had no effect  on serum B12 concentrations, at all.

So, what does this tell you, after all? Well, let me phase it like that: If you have a Ferrari Enzo (milk and meat) waiting for you at the front door (in the fridge), wouldn't it be plain-out stupid to try to chip-tune (add SNAC) the family car (cyanocobalamine)? An the moral of the Story? Eat, don't supplement your vitamins!

Fishing for Muscle: Cod Protein Promotes Muscle Repair After Injury More than Casein or Peanut Protein

Image 1: There are obviously more nutritionally valuable parts to cod than just its liver.

On Wednesday, you have learned that diet-deoptimization with rice instead of casein protein is a possible way to gain less weight. Today, we are going to tackle what appears to be a way more promising alternative to the dairy-based top-dogs among the protein supplements: Cod protein! Within the health and fitness community, the cold(er) water fish is hitherto, above all, known for its vitamin-laden liver and the oil humans have been producing from it and consuming for centuries, now. That the arginine-, glycine- and taurine-rich protein of its tasty white flesh could soon replace - or at least complement - dairy proteins (casein, whey) as the physical culturists' go-to protein for muscle building and regeneration will yet probably be news to most of you, right?

COD - Canned or dried? Probably doesn't matter as long as you eat it.

In a recently published paper on yet another rodent protein feeding trial (Dort. 2012), Junio Dort and his colleagues from the Laval University and the Research Center of CHUQ, CHUL in Quebec, Canada, report that the artificially injured tibialis muscle of rodents that were kept on cod-protein based diets for 21-days healed significantly faster than the skeletal muscle of the peanut or casein protein control groups.

Figure 1: Amino acid profile of casein, peanut and cod protein source on which the otherwise identical rodent diets were based (based on Dort. 2012)

For the smart SuppVersity student you are, it should not take more than just a brief glance at the amino acid profiles of the three protein sources to identify cod protein and casein as superior and peanut (as it was to be expected) inferior protein source. With -24% and -30% less branched-chain (BCAA) and total essential amino acids (EAA), peanut protein would certainly not be the first choice of any non-vegan physical culturist, let alone bodybuilder, who is interested in opti- and not deoptimizing his his/her diet (on an unrelated not: Don't you Americans never refer to the ladies, first? I always read "his/her" - that would not exactly be gentleman-like here, in Germany!).

118 neutrophils and still counting: Cod protein (not oil, in this case) tames the inflammation

In order to assess how peanut, casein and cod-based diets would modulate the rodents' response to muscular injury the animals were treated with bupivacaine, a substance that is myotoxic ("kills" muscle cells, but - and this is a specialty of bupicacaine - not satellite cells) at higher doses (here 100µL). The drug was injected into one of the animals' tibialis muscles, while the contra-lateral side was sham-injected (saline injection) to serve as a control. At days 3, 14, and 24 post-injury, both the injured and sham-injected tibialis muscles were "collected" (8 animals per dietary group) and the neutrophil count, and macrophage infiltration - both measures of ongoing inflammation and thusly incomplete healing subsequent to prior muscle damage - were assessed.

Figure 2: Neutrophil count and EDI+ macrophage count in bupivacaine injected tibialis muscle 3 and 14 days and 14 and 24 days after the injection; data expressed relative to sham control (data calculated based on Dort. 2012)

As the data in figure 2 goes to show, the cod protein group showed a markedly faster reduction in neutrophil and EDI+ macrophage count than the casein group, which - in a separate experiment - had already been found to sustain the healing process better than the nutritionally inferior peanut proteins, which also exhibited a -19% lower feeding efficacy (meaning that similar to the rice protein in Wednesday's newspost, it lead reduced weight gain; again, not necessarily desirable, specifically in injured rats) and, "in results previously published, [...] lower skeletal muscle mass than those fed casein [even] before injury" (Dort. 2012).

The anti-inflammatory effects of cod protein reach beyond skeletal muscle

Though muscle is, as my friend Carl Lanore likes to say, "metabolic currency" and it's protection and repair should be on everyone's, man and women top list of health priorities, the benefits of cod protein extend beyond skeletal muscle. A brief review of the literature revealed among others ...

• increases in HDL, decreasse in VLDL with cod over casein and soy (Jacques. 1995)
• restoration of GLUT-4 activity in skeletal muscle of HFD obese rodents (Trembley. 2003)
• lower hepatic triglyceride production vs. beef or casein (Demonti. 2003)
• lowest insulin / glucose ratio (vs. soy or casein), when given as part of complex test meal (Post-Skagegard. 2006)
• improvements in insulin sensitivity and reductions in C-reactive protein vs. diet containing beef, pork, veil, eggs and dairy in insulin resistant men and women (Ouellet. 2007; Ouellet. 2008)

Just as the improved healing of the muscoskeletal injury in the rodent study at hand, most of the aforementioned effects are probably attributable to the modulatory the homemade cod protein (the scientists simply used frozen cod fillets to prepare their protein powder) exerts on the immune system. In this context, it is particularly important to mention that

[...] an impairment of insulin-stimulated glucose uptake and a reduction of protein synthesis, combined with an increase of muscle protein degradation, are the main adverse metabolic changes induced by injuries in skeletal muscle.

In previous studies, the researchers were also able to show that the profound impairment of the AKT /PKB pathway, which is one of the key mechanisms behind the nutrient induced increase of protein synthesis, is protected from the impairments of "high fat diets" (the researcher variety, which is more akin to the standard American than to "low carb" diet), if the latter contains cod, instead of soy- or casein-protein (Tremblay. 2003).

Arginine for repair, EAA for growth: It may be of interest that Dort et al. attribute the muscle building and muscle repairing effects of cod protein to different amino acid in the cod protein. While they believe that its high arginine content suffices as NO precursor to drive and accelerate the repair process, they hold the high essential amino acid (EAA) content responsible for its pro-anabolic effects which are comparable to those of casein (and probably even whey) proteins.

Image 2: Fish is not for you? Maybe you just don't know how to prepare it properly? It's not really difficult to grill a fillet, trust me - even I can do that.

It stands to reason, that both the restoration and / or maintenance of skeletal muscle mass and insulin sensitivity, as well as the general anti-inflammatory properties of cod protein (remember: the protein in the study was derived directly from frozen fillets and contained almost no fat!) come handy for everyone who wants to live a healthy and active live into the old age. In this regard the study result do not only underline the importance and multifaceted benefits of regular fish consumption (fatty or not) as part of a healthy diet, they also support my repeatedly proffered believe that the latter should not be defined by macronutrient ratios, let alone calories, but must be build around concrete meal and food suggestions, as well as general and flexible recommendations regarding the frequency and combinations in which these can be consumed.

Science Round-Up Seconds: "Tomatorade(R)" or Why Tomato Juice is the Better Intra- & Postworkout Beverage. Up to 90% B12 Deficiency in Vegetarians & Vegans. Aluminum in Your Testes? Not With Vitamin E & Zinc.

Can't find "Tomatorade(R)", at your local supplement store, yet (surprising, right ;-)? The guys over @ SimplyRecipes have an easy and tweakable recipe describing how you can make your own "Tomatorade" or however you want to call it (photo by SimplyRecipes).

If you listened live to yesterday's installment of the SuppVersity Science Round-Up on Super Human Radio, you will probably have noticed that due to the technical problems and my teacherly tendency to talk for hours, Carl Lanore and I did not cover all the topics (click here do download the podcast if you haven't already done so)... but hey, that leaves more stuff for today, doesn't it?

I guess I will best package the newsitems into three servings, starting out with the one I like best, namely my Tomatorade(R) aka plain tomato juice news... but before I do so, I must thank Maxim Okhrimenko who corrected the statement I made about vodka in Russian babies' tea or other beverages. Normal Russians don't this. I actually did not intend to make that sound like "common practice" - sorry if it got across like that.

My sincere apologies for promoting prejudices like that. From a science perspective you could even argue that the Brits came up with the idea. In the 1850s William Woodward "invented" a concoction of dill seed oil, sodium bicarbonate and alcohol, called it "gripe water" and sold it as a soothing remedy for gastrointestinal troubles (Agarwal. 2000).

Tomatorade(R) - Tomato Juice turns out to be the ideal periworkout carb drink

What's LDH and CPK? While the former stands for lactate dehydrogenase and the latter is identical to CK, which is creatine kinase, both are considered markers of muscular exertion (LDH) and damage (CK) due to exercise. Very high levels of LDH occur for example in hemolytic situations, i.e. at times your red blood cells disintergrate or after a major trauma to a muscle (incl. a myocardial infarction), the same is true for CK, for which most laboratories will analyses tissue specific isoforms with CK-MB being the one that's indicating muscle damage from the minor DOMS after a leg workout to full rhabdomyolysis.

I know many of you will probably be shuddering, right now. "Carbohydrate drinks? I don't care if it's Tomato- or Gatorade, I don't want any of them." Still, what would you say, if I told you that "Tomatorade(R)", which consists of nothing else but 100% tomato juice could not just replenish your muscle glycogen levels, but would also reduce and even normalize LDH and CPK levels? Allow you to regenerate faster, train more frequently and eventually increase your performance and muscle gains- specifically if you are into weight lifting or other anaerobic activities? I see, now, I got you interested.

According to a paper that is going to be published in the next issue of Food Chemistry and Toxicology, the administration of tomato juice instead of a commercial exercise beverage to 9 out of 15 anaerobically trained athletes (11 men, 4 women) with elevated LDH (>300mg/dl) and CPK(>210mg/dl) baseline levels (as the scientists have it a clearcut sign of "endothelial dysfunction through oxidative stress" (Tsitsimpikou . 2013)) returned the LHD ad CPK levels back into the normal range in the course of the two months study period.

Figure 1: Effects of two month on an isocaloric amount tomato juice (here jovially called "Tomatorade(R)" ;-) vs. the regular carbohydrate workout drink the subjects usually consumed during and after their workouts (Tsitsimpikou. 2013)

Moreover, the consumption of vitamin, mineral and polyphenol-laden superdrink, in place of the athletes regular carbohydrate drink (the scientists made sure that the energy content was identical) also reduced the highly health relevant markers of whole body inflammation, homocysteine and C-reactive protein (CRP; see figure 1) - whether the mainly lycopene induced reductions in homocystein is actually protecting against endothelial damage or not, is yet still (or I should say, again) a matter of scientific debate (cf. Xaplanteris. 2012).

Brief update:  Just got a question from Sofeen on facebook about simply eating tomatoes. Now, you would have to eat plenty of them to see the effect, but in essence it should work. Nevertheless, when I contemplated the question I came up with an even better alternative: Tomato paste! When Tomatorade(R) is the carb beverage, then the paste would be one of those fancy carb gels - a gel, by the way, which has a 2.5x higher bioavailability for lycopene than you would get from regular tomatoes (Gärtner. 1997).

Vitamin B12 defieciency is rampant among vegetarians and (even more) vegans

I have previously pointed out that unless you are at least lacto-ovo-vegetarian, which means that you eat dairy products and eggs, you are going to have a very hard time building and maintaining the physique of your dreams. As a recent meta-analysis and review study by Pawlak et al. suggests, not being the leanest and most muscular on stage should yet actually be your least concern.

Suggested Read: "Want B12 But Hate Meat? Drink Milk!" Even some of the more advanced supplements cannot compete.

According to the data the researchers from different US institutions collected, the deficiency rates for "normal" vegetarians are

• 62% among  pregnant  women,
• between  25% and almost 86% among children,
• 21–41% among adolescents, and
• 11–90% among the elderly

Even higher rates, bordering the 90%+ range, when they were measured by holo-transcobalamin II essays were reported for vegans (adults). On top of that the scientists did not find any confounding factors,:

"The main finding of this review is that vegetarians  develop  B12 depletion or deficiency  regardless  of demographic  characteristics,  place of residency,  age, or type of vegetarian  diet. Vegetarians should thus take preventive measures to ensure adequate intake of this vitamin, including regular consumption of supplements containing B12." (Pawlak. 2013)

As preferable dietary sources the researchers suggest, the aforementioned dairy products and eggs:

• milk, which contains between 0.3 and 0.4 mg/100 g of B12, with an absorption rate of about 65%.
  
• the B12 content of cheese or cottage cheese ranges from 20 to 60% that of milk.
• the amount of B12 in a whole egg is between 0.9 and 1.4 mg/100g

Unfortunately, the amount of B12 is profoundly reduced during the heating process. For milk the B12 loss amounts to up to 30-50%, when you boil it and I bet you won't be much better off with hard boiled (yolks = hard) eggs.

If you avoid meat not for ethical reasons, but because you are afraid it's bad for you, read the "Meat-Ology" post

The scientists also point out that the vegan myth that your body a great ability to store B12 and it would take years if not decades for them to be depleted:

"Studies do not support the position that it takes up to 20 or 30 years to develop a deficiency.7 According to Donaldson, 47% of the sample developed a deficiency, and most of these individuals had adhered to a raw vegan diet for between 23 and 49 months or about 2–4 years. In a study conducted by Herrmann et al.66% of German participants who had adhered to a vegetarian diet for at least 2 years were found to be B12 deficient." (Pawlak. 2013)

Since the whole problem is further increased by the lack of hydrochloric acid (low-to-no intrinsic factor production, which is necessary for the absorption of B12), low iron induced damage to the gut mucosa and subsequent nutrient malabsorptions, I'd suggest that all of you who insist on following a vegetarian life-style go, have their levels checked and get some B12 injections if you are where Pawlak et al. believe you are: Rock bottom.

Protect your testes, rescue your sperm and testosterone production

A recently published paper has taken yet another look at ways to prevent testicular damage / toxicity subsequent to heavy metal exposure. Other than usual, the "suspect" is yet not lead, but rather aluminum, which was administered in toxic doses to male albino rodents.

Figure 2: Relative levels of testosterone, FSH, LH and prolactin in aluminum (50mg/kg) treated male albino rats after the administration of zinc, vitamin E or both; data expressed relative to healthy (non-Al intoxicated) control (Rawy. 2013)

As the data in figure 2 goes to show you, the Saudi-Arabian researchers were able to counter much of the detrimental effects on testicular morphology, spermatogenesis and hormone production by administering either zinc sulfate or vitamin E alone or in conjunction at human equivalent doses of 8mg/kg zinc sulfate (I may remind you that these were 8mg/kg of zinc sulfate, not of elemental zinc, so that we are talking about ~1.8mg/kg elemental zinc) and 2.4mg/kg vitamin E (~1,200-1,500IU), respectively.

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Now while that's it as far as today's Seconds are concerned, tomorrow is Saturday and in case you are into those shorter news items, you better make sure to come back for another installment of On Short Notice. And just in case you have not done so already, I would also suggest that you take a peek at the following recent Facebook news:

Older tomato news: The dehydrotomatine, α-tomatineand trigonelline from green tomatoes has fat burning effects (read more).

• Galactooligosaccharides increase bifido bacteria content in obese patients and result in positive effects on the immune response, and insulin, total cholesterol and triglyceride concentrations (read more). 
• Women with brittle bones cannot squat? False! They must squat, recent study says (read more)
• The fries a mother eats during pregnancy predispose her kids to become obese and develop metabolic syndrome syndrome - at least if the oil was (as it almost always is) oxidized during the heating process (read more).
• The Zinc equation: For every doubling in Zn intake, the difference in Zn serum or plasma concentration is 6% - this assumes zinc intakes in the normal range of <30mg/day (read more).

As usually there will be more for you to read in the course of the next 24 hours - so just "like" the SuppVersity Facebook page to make sure you are not missing out on anything important ;-)

References

• Agarwal KN, Gupta A, Pushkarna R, Bhargava SK, Faridi MM, Prabhu MK. The gripe water story.J R Soc Med.2000;93:172-174.
• Gärtner C, Stahl W, Sies H. Lycopene is more bioavailable from tomato paste than from fresh tomatoes. Am J Clin Nutr. 1997 Jul;66(1):116-22.
• Pawlak R, Parrott SJ, Raj S, Cullum-Dugan, D Lucus, D. How prevalent is vitamin B12 deficiency among vegetarians? Nutrition Reviews. 2 JAN 2013 [epub ahead of print]
• Rawy SM, Seif Al Nassr FM. Zinc sulphate and vitamin E alleviate reproductive toxicity caused by aluminium sulphate in male albino rats. Toxicol Ind Health. 2013 Jan 2.
• Tsitsimpikou C, Kioukia-Fougia N, Tsarouhas K, Stamatopoulos P, Rentoukas E, Koudounakos A, Papalexis P, Liesivuori J, Jamurtas A. Administration of tomato juice ameliorates lactate dehydrogenase and creatinine kinase responses to anaerobic training. Food Chem Toxicol. 2013 Jan 3.
• Xaplanteris P, Vlachopoulos C, Pietri P, Terentes-Printzios D, Kardara D, Alexopoulos N, Aznaouridis K, Miliou A, Stefanadis C. Tomato paste supplementation improves endothelial dynamics and reduces plasma total oxidative status in healthy subjects. Nutr Res. 2012 May;32(5):390-4.

Vegan Eco Atkins?! Getting Rid of the Blubber W/ Seitan Sausages & Soy Burgers. You CAN Lose Weight & Get Health(ier) on a Gluten-Laden "Vegan Paleo" Diet

YamYol :D - The perfect diet food *rofl* ➲ "delicious" gluten-laden Seitan Sausages are apparently still healthier than pizza, burgers and fries.

Let me ask you a question: Do you believe that there is a such a thing as a vegan Paleo or Eco Atkins diet? No? Well, me neither, at least until, I read about the latter, i.e. Eco-Atkins, in the title of a long-term (6-months) weight loss study by David J A Jenkins and his colleagues from the University of Toronto that was recently published in the peer-reviewed scientific journal BMJ Open (Jenkins. 2014). If you take a look at the actual macros of the alleged "low-carbohydrate vegan diet", it's ~40% carbohydrate content and its relatively high protein content (~23%), as well as the focus on high quality plant food this whole thing does yet rather look like "vegan Paleo" than "Eco Atkin".

The actual diet looked more like "Vegan Paleo" w/ tons of soy & gluten

Vegan paleo with two deadly sins: Soy and (even worse) gluten protein! While only one-third of the 20 overweight participants (n_total = 40) who had originally been randomized to the active arm of the study actually consumed the prescribed amount of soy and gluten protein, the mere fact that they still made up the lions share of the diet will probably have one or the other conservative paleo worshiper shake his heads about the results.

Figure 1: The macronutrient compo-sition of the prescribed "Eco-Atkins" diet looks much different from what the subjects actually ended up eating - despite reporting bias, by the way.

How exactly was Eco-Atkins supposed to look like? The major carbohydrate sources on what was supposed to be a low carbohydrate diet featured viscous fibre-containing foods (such as oats and barley) and low-starch vegetables (emphasizing okra and eggplant) for the relatively limited amount of carbohydrate allowed. The vegetable proteins were prescribed as gluten (54.8% of total protein), soy (23%), fruits and vegetables (8.7%), nuts (7.5%), and cereals (6%). Gluten was contained in the nut bread and wheat gluten (also called ‘seitan’) products. Soy protein was present in the form of burgers, deli slices, breakfast links, veggie bacon, tofu and soy milks. Nuts included almonds, cashews, hazelnuts, macadamia, pecans and pistachios. The fat sources were nuts (43.6% of total fat), vegetable oils (24.4%), soy products (18.5%), avocado (7.1%), cereals (2.7%), fruits and vegetables (2.3%), and seitan products (1.4%).

Results that confirm, once again, that the keys to weight loss success are a significant, but not exorbitant energy deficit (here -24%) and the removal of 90% of the processed junk 99% of the average Joes and Janes call "food" (shocking truth: More ~25% of the male adolescents consume Pizza everyday, see figure in recent Article from The Atlantic)

Figure 2: Rel. changes (% of baseline) in anthropometric and metabolic parameters (Jenkins. 2014)

If the replacement is relatively high in protein and fiber and contains "super foods", such as nuts, this is an extra bonus of which you can see that it had the "Eco Atkins" diet outperform its lacto-ovo vegetarian (higher carb) competition in almost all health- and physique relevant markers the Canadian researchers assessed. And still, the conclusion the wording of the conclusion is, as so often, misleading:

Figure 3: De facto dietary composition in the two groups (Jenkins. 2014)

"We conclude that a weight loss diet which reduced carbohydrate in exchange for increased intakes of vegetable sources of protein, such as gluten, soy and nuts, together with vegetable oils offers an opportunity to improve both LDL-C and body weight, both being risk factors for CHD.

Further trials are warranted to evaluate low-carbohydrate diets, including more plant-based lowcarbohydrate diets, on CHD risk factors and ultimately on CHD." (Jenkins. 2014)

With a reported ~40% vs. 54% carbohydrate intake (see Figure 3)and an adherence to the diet protocol that was <30% even in those 10 out of 20 subjects who were initially randomized to the "Eco Atkins" group, it's of paramount importance to mind the exact wording, here. The "reduced carbohydrate diet", the subjects consumed had after the macronutrient composition of a "Vegan paleo" (another oxymoron, by the way) diet - not that of an "Eco Atkins" (or more appropriately "vegan Atkins") diet the scientists actually wanted to investigate.

Figure 4: Irrespective of tons of gluten and a adherence rates of <33% the "Eco Atkins" brought about significant improvements in all relevant health markers (data expressed rel. to baseline Jenkins. 2014)

The main take home message of the study is thus food quality and quantity rule. If those are in place, the macros will usually come on their heels - just like the desirable weight loss and health effects, by the way. In that, the answer to the question how "high" the quality of the prescribed "Vega paleo" or "Eco Atikins" (call it whatever you want) eventually was, is obviously debatable. The data in Figure 3 on the right hand side of this conclusion, as well as the additional information that the main marker of inflammation, i.e. hsCRP dropped by 13% despite the high amount of gluten in the "Eco Atkins" diet do yet would suggest that the contemporarily highly popular neo-paleolithic gluten scare is more than overblown.

Consequently, the exclusion of all gluten containing foods should by no means be presented as an obligatory first step on an individuals way towards a healthier lifestyle. The dropout and adherence rates of 50% and <33% of the study at hand do after all leave no doubt that the surprisingly successful baby-steps the 10 dieters who made it past the finish line of this 6-months dietary intervention took were already hard enough.

References:

• Jenkins, David JA, et al. "Effect of a 6-month vegan low-carbohydrate (‘Eco-Atkins’) diet on cardiovascular risk factors and body weight in hyperlipidaemic adults: a randomised controlled trial." BMJ Open 4.2 (2014): e003505.