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Several people have recently asked me (via email) about my supplement regime. So I figured I post it here, both to share it with a wider audience, and to get people's feedback & suggestions, if they are so inclined.

 

Several things to note in general about my supplement strategy:

  • I'm a vegan, so several things I take because they are harder to get in a vegan diet (e.g. B12).
  • I eat a very high fiber, unprocessed and mostly raw diet, meaning absorption of vitamins and minerals is likely to be lower than on a typical diet. I've definitely found this for iron. I've become anemic on two occasions in the past when not supplementing with iron. Now, for the last few years, supplement 300% of the RDA of iron per day, my hemoglobin and ferritin levels stay near the bottom of the reference range, and I'm able to donate blood regularly.
  • Based on my 23andMe genetic testing results, and some observations from my eye doctor, I'm at increased risk (5-7x normal risk) of macular degeneration (AMD), so I take Lutein and Zeaxanthin, per the AREDS study that found these two antioxidants in the doses I take to be protective against progression of AMD. 

 

Sorry if the formatting isn't very good, and the lines wrap on a small screen. I've included a screen capture below in case its easier for people to read.

 

Supplement      Quantity             Notes (Brand)
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Vit B12          1 Tab/6 Days        100mcg/6 days = ~800% RDA/day as cyanocobalamin. Nibble 1/6th tab/day. Missing in vegan diet. Solgar
Vit D3            1200 IU/Day         1000IU/day (+ D in calcium supp. below). Sundown
Calcium         1 Cap/Day             250mg Ca / day, + about 175 IU vit D. Bone health. Source Naturals CCM Calcium
Vit K2            1 Cap/2 Days        2.5mg / day. Bone health. Carlson
Strontium       1 Cap/2 Days        340mg / day. Bone health. Vitacost
Iodine            1 Tab/Day            150mg = 100% RDA / day as kelp tablet. I don't eat iodized salt or processed food. Good 'N Natural
Iron               1 Cap/Day            300% RDA / day as Ferrous Sulfate (65mg). Low absorbable sources in vegan diet. Nature Made
Zinc              1 Tab/Day             50mg / day Low in vegan diet. NOW
Lutein/Zea     1 Cap/Day             25mg Lutein & 5mg Zeaxanthin. AREDS dosages for macular degeneration (AMD) prevention. Trunature
DHA/EPA       1 Cap/3 Days         Each cap has 320/130mg DHA/EPA. ~1 serving fish/wk, Prevent AMD - I'm at high risk. Ovega-3
Selenium       1 Cap/4 Days         75% of RDA / day. To make up for diet shortfall. Replaced 1/2 brazil nut on 10/23/15. Now
Probiotic        1 Tab/2 Days         Gut health. 5 billion CFU. 15 strains, slow release. Hyperbiotic Pro-15
Milk Thistle    1 Cap/2 Days         200mg/day. Liver health. Had liver issue (high ALT/AST) for a while in early 2015. LEF
 
Here is the same table as an screen capture image (click to enlarge):
 
post-7043-0-19970700-1446495672_thumb.jpg
 
--Dean
Edited by Dean Pomerleau
Changed to vegan selenium source

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I'm sure you've seen it, Dean, but for others interested in the subject I'll mention my discussion of supplements for veg(etari)ans.
 
You say you "nibble" 1/6 of a 100 µg B12 supplement. I also split up these tablets, but I use a knife. Do you literally nibble them? I'd be concerned about degrading them due to spit exposure.
 
You list "Strontium       1 Cap/2 Days        340mg / day. Bone health. Vitac0st". Do you mean this? If so, youi've misread the label: 680 mg is "per serving" and the serving size is 2 caps.
 
IAC, I didn't trust VitaC0st's private label supplements (VitaC0st and "En Esss Eye"), due to a history of deceptive labeling and bad results on ConsumerLab testing. One of the latter was Pb in their turmeric product, which you may have already seen, but just in case:
http://margaret.healthblogs.org/2008/02/08/report-of-tainted-curcumin/

(Here is an archived version of the link to the forum post where someone reveals the result:

http://web.archive.org/web/20100326014557/http://beating-myeloma.org/forum/therapies/2008/02/07/consumers-warned-lead-some-turmeric-supplements

Here is another such post:
http://www.inspire.com/groups/talk-psoriasis/discussion/turmeric-curcumin-beware-of-lead-contamination/

On deceptive labeling:
http://www.longecity.org/forum/topic/14982-vitacost-and-nsi/?do=findComment&comment=159968
http://www.longecity.org/forum/topic/14982-vitacost-and-nsi/page-2?do=findComment&comment=177575

(Note that the cited misleading label on their R-LA is STILL in use, eight years later!
http://www.vitacost.com/vitacost-r-alpha-lipoic-acid-stabilized-rala-100-mg-60-capsules-1

(Your Sr product (if, again, I have the right one) is not a case like this: they don't use the most clear means possible, but there is nothing to directly suggest that each cap contains 680 mg, unlike with the R-ALA).
 
Here is someone complaining about misleading kosher labeling: having not seen the  product, I'm not sure how serious this was (did this person just not read properly, or is the label somehow  designed in a way that could genuinely deceive?):
http://reviews.vitacost.com/4595/27779/vitacost-thyroid-complex-with-l-tyrosine-100-capsules-reviews/reviews.htm
"not a clear label,, only the caps are kosher not the actual substance."
 
50 mg Zn/d: really? That's very high.
 
Lutein/zeaxanthin, DHA/EPA: Actually, the original AREDS study supplement contained only vitamins C and E, beta carotene, and zinc: there was no lut/zea or fish oil. These were included in AREDS2, but EPA6+DHA was found ineffective, and lut/zea was only found effective in people with low dietary intake thereof — a category into which I'm sure you don't fall:
 

Kaplan-Meier probabilities of progression to advanced AMD by 5 years were 31% (493 eyes [406 participants]) for placebo, 29% (468 eyes [399 participants]) for lutein + zeaxanthin, 31% (507 eyes [416 participants]) for DHA + EPA, and 30% (472 eyes [387 participants]) for lutein + zeaxanthin and DHA + EPA. Comparison with placebo in the primary analyses demonstrated no statistically significant reduction in progression to advanced AMD  ...
 
We conducted further exploratory analyses of the main effect of lutein + zeaxanthin by stratifying by quintiles of dietary lutein + zeaxanthin intake to examine whether supplementation may have relatively different treatment effects within subgroup of dietary intake. For persons in the lowest quintile [of dietary intake], comparison of lutein + zeaxanthin vs no lutein + zeaxanthin [supplement] resulted in an HR of 0.74 (95% CI, 0.59-0.94; P = .01) for progression to advanced AMD. For participants in the highest quintile of lutein + zeaxanthin intake the corresponding HR was 0.90 (95% CI, 0.71-1.15; P = .41), with the results for remaining quintiles similar to that of the highest quintile (Figure 5). The interaction term for treatment and quintile groups was P = .47. Additional analyses stratified by tertiles, quartiles, and deciles (eFigure 1) showed similar results, with the lowest stratum demonstrating a protective effect compared with the remaining strata.(1)


As you know, I think there is a compelling case that people on CR should avoid EPA+DHA (highly-unsaturated omega-3s), favoring the parent EFA (alpha-linolenic acid) instead. If there were a strong case for a beneift in your particular case, this would obviously fall by the wayside, but AFAICS it doesn't.
 
Milk thistle: dubious on this ... any evidence for chronic use in people with what I assume are modestly elevated liver enzymes (as are common in CR folk) rather than after concomitant or recent hepattotoxin exposure or fulminant liver inflammation?
 
bReference
1: Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA. 2013 May 15;309(19):2005-15. doi: 10.1001/jama.2013.4997. Erratum in: JAMA. 2013 Jul 10;310(2):208. PubMed PMID: 23644932. 

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You say you "nibble" 1/6 of a 100 µg B12 supplement. I also split up these tablets, but I use a knife. Do you literally nibble them? I'd be concerned about degrading them due to spit exposure.

Yes - I literally bite a small bit off each day. I'll be sure to just use me teeth! I find trying to split them with a knife or pill cutter causes them to disintegrate too much.

You list "Strontium 1 Cap/2 Days 340mg / day. Bone health. Vitac0st". Do you mean this? If so, youi've misread the label: 680 mg is "per serving" and the serving size is 2 caps.

Ah - good eyes! Thanks for correcting me on this. Exactly the reason I posted my regime. I am indeed taking 1 cap every 2 days, so I'm getting 170 mg Strontium / day on average, rather than 340mg as listed. Perhaps I'll bump it up to the 340mg your take and recommend.

I didn't trust VitaC0st's private label supplements

Thanks for the reminder about your suspicions on Vitacost. I'm certainly not wedded to them for my Strontium. Do you have an alternative you recommend? I've marked my bottle to try switch to a different brand when I run out on this one.

 

 

50 mg Zn/d: really? That's very high.

The original AREDS macular degeneration trial used 80mg/d and got good results. But AREDS II used 25mg/d and got similar results, so you're probably right - it would prudent to drop my Zinc. My only other reservation is competition with copper, which is high in my diet. I'll probably cut it in half to 25mg/day.

 

 

Lutein/zeaxanthin, DHA/EPA: Actually, the original AREDS study supplement contained only vitamins C and E, beta carotene, and zinc: there was no lut/zea or fish oil. These were included in AREDS2, but EPA6+DHA was found ineffective, and lut/zea was only found effective in people with low dietary intake thereof — a category into which I'm sure you don't fall...

Yes - you are right. The Lutein/zeaxanthin was effective for people with low dietary intake of those antioxidants. I admit it may be overkill, but I'm nervous enough about my eye health that I'm taking the lut/zea anyway, based on the recommendation of my opthamologist...

 

As you know, I think there is a compelling case that people on CR should avoid EPA+DHA (highly-unsaturated omega-3s), favoring the parent EFA (alpha-linolenic acid) instead. If there were a strong case for a beneift in your particular case, this would obviously fall by the wayside, but AFAICS it doesn't.

Yes I'm well aware of and appreciate your perspective on preformed DHA/EPA. I consider it a small dose (about equivalent of one fatty-fish meal per week, although from a vegan source) and as a deliberate way to 'hedge my bets', both for possible (although uncertain) benefits for eye and cognitive health.

 

Milk thistle: dubious on this ... any evidence for chronic use in people with what I assume are modestly elevated liver enzymes (as are common in CR folk) rather than after concomitant or recent hepattotoxin exposure or fulminant liver inflammation?

I started taking milk thistle because I think I was exposed to some form of hepatotoxin (quite possibly via too much cinnamon). I may discontinue the milk thistle after this bottle runs out, but on the other hand, I eat a number of unusual things in unusual amounts, so a little insurance on my liver health I consider a good thing...

 

Thanks so much for your quick and thorough response Michael!

 

--Dean

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All,

 

I've adjusted the brand & dosages based on all the feedback I've received on this thread and others. Thanks everyone! Nothing has changed too much in the list below, mostly different sources to ensure they are all vegan, and avoid unreputable sources. I've also included Amazon links for each of the supplements, in case anyone wants to purchase items for themselves.

 

--Dean

 

Supplement            Quantity                   Notes (Brand)
----------------------------------------------------------------------------------------------------------------------------------------------------------------
Vit B12           1 Tab/6 Days        100mcg/6 days = ~800% RDA/day as cyanocobalamin. Nibble 1/6th tab/day. Missing in vegan diet. Solgar
Vit D3            1 Tab/Day            1000IU/day (+ 175 IU D in calcium supp. below). KAL
Calcium          1 Cap/Day            300mg Ca / day, + about 175 IU vit D. Bone health. Source Naturals CCM Calcium
Vit K2            1 Cap/Day            100mcg MK-7 / day. Bone health. NOW Foods
Strontium       1 Cap/Day            250mg / day. Bone health. LEF
Iodine           1 Tab/Day             150mg = 100% RDA / day as kelp tablet. I don't eat iodized salt or processed food. Good 'N Natural
Iron              1 Cap/Day             300% RDA / day as Ferrous Sulfate (65mg). Low absorbable sources in vegan diet. Nature Made
Zinc              1 Tab/2 Days         25mg / day. Low in vegan diet. Offset high copper in diet. Close to ARED-II dosage. NOW Foods
Lutein/Zea       1 Cap/Day                20mg/2mg Lutein/Zeaxanthin. Close to AREDS dose for macular degeneration (AMD) prevention. Doctor's Best
DHA/EPA       1 Cap/3 Days         Each cap has 320/130mg DHA/EPA. ~1 serving fish/wk, Prevent AMD - I'm at high risk. Ovega-3
Selenium        1 Cap/4 Days        75% of RDA / day. To make up for diet shortfall. Replaced 1/2 brazil nut on 10/23/15. NOW Foods
Probiotic        1 Tab/2 Days         Gut health. 5 billion CFU. 15 strains, slow release. Hyperbiotic Pro-15
Milk Thistle     1 Cap/2 Days         150mg/day. Liver health. Had liver issue (high ALT/AST) for a while in early 2015. NOW Foods
Edited by Dean Pomerleau
Edited Leutin/Zea to fix link

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All,

 

I've adjusted the brand & dosages based on all the feedback I've received on this thread and others. Thanks everyone! Nothing has changed too much in the list below, mostly different sources to ensure they are all vegan, and avoid unreputable sources. I've also included Amazon links for each of the supplements, in case anyone wants to purchase items for themselves.

Dean,

 

This table is a useful enhancement of the original. Thank you.

 

Please feel free to delete this post if you think it just adds noise to your thread. I won't mind.

 

I had completed my search for vegan substitutes yesterday, and noticed one oddity: The Doctor's Best 20 Mg Lutein I came up with is available on Amazon Prime, while the one you list is on Amazon Prime Pantry, which might not be convenient for small quantities (I'm not experienced with Amazon Pantry).

 

Amazon Prime Pantry

Lutein/Zea       1 Cap/Day                20mg/2mg Lutein/Zeaxanthin. Doctor's Best

 

Amazon Prime

Lutein/Zea       1 Cap/Day                20mg/1.5mg Lutein/Zeaxanthin. Doctor's Best

 

I know we can't always trust Amazon product information, but there is a difference in the ingredients:

  • Prime only 1.5mg of Zeaxanthin whereas the Pantry choice has 2.0mg.
  • The Prime product lists 0.15mg of Cryptoxanthin, whereas the Pantry choice doesn't list Cryptoxanthin.
I don't know if it's better or worse to have the Cryptoxanthin, again assuming the labeling is reliable. Edited by Greg Scott

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 The Doctor's Best 20 Mg Lutein I came up with is available on Amazon Prime, while the one you list is on Amazon Prime Pantry, which might not be convenient for small quantities (I'm not experienced with Amazon Pantry).

 

Thanks Greg. Good catch. I haven't ordered the new, vegan Doctor's Best Lutein / Zea yet, since I've got a lot left from my previous source. I would have noticed the "Prime Pantry" status of the one I linked to, and have corrected it. I've found Prime Pantry is really of not much use, unless you order a lot of large stuff in bulk at once.

 

Regarding the apparent ingredient difference between the two Doctor's Best Lutein / Zea supplements, it looks like one or the other is a new, slightly modified formulation. I'm not too particular between the two, and will go with whichever is available via Amazon Prime (not Prime Pantry) next time I order. I've corrected the link above.

 

--Dean

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All,

 

As listed above, one of the supplements I've been taking for a long time is calcium for bone health. I'm now wondering if its wise, and what other CR practitioners think and do with respect to calcium supplementation.

 

Background: I take only 300mg / day in calcium citrate / malate form (per a recommendation for that form many years ago from Michael). I take it out of concern that, while I theoretically get enough calcium from my diet, mineral absorption (like iron) seems like it may be an issue for me, and out of the particular concern over long-term bone health that we CR practitioners face, and in my specific case, past DEXA-scans that show osteopenia. But on the other hand, in the past Michael has pointed out that DEXA bone scans are of limited value due to miscalibration for skinny people like us, and it's not clear that we're at higher risk of fracture despite the reduced BMD that accompanies CR, since the quality of our bones appears to be maintained by long-term CR in humans [1]. 

 

With that as background, everyone's favorite, Michael Greger :)xyz had a two-part video series this week on the benefits and risks associated with calcium supplementation. Here is Part1 and Part2. In Part1, he addresses the issue of the safety of calcium supplements, and concludes that a number of large trials have shown that "users of calcium supplements tended to have increased rates of heart disease, stroke, and death." He talks about the possible cause of this association being the unnaturally high levels of calcium in the blood that persists for several hours after supplementing, which can result in a hypercoagulative state, and thereby an increased risk of blood clots leading to artery blockages or strokes. This doesn't seem like it is likely to be a problem for me (or CR practitioners in general), given our low risk of heart disease, and given the modest level at which I'm supplementing. 

 

But in Part2, he reviews the recent evidence (see references below) that calcium supplements don't really work to reduce risk of bone fractures anyway. Some of this evidence we discussed recently in this thread. He points to evidence that the body is pretty good at maintaining calcium levels required for bones by modulating the amount it excretes vs. retains depending on the amount of calcium in one's diet (assuming one's diet isn't badly deficient in calcium).

 

So, I'm conflicted. On the one hand, there is some credible evidence that bone health may be an especially important issue for CR practitioners, although this evidence is by no means a slam dunk. On the other hand, it is not clear supplemental calcium will do any good at helping prevent fractures, at least among the general population.

 

So I'm wondering what others think about calcium supplements. Michael - you didn't mention calcium one way or the other in your original response to my supplement regime. Does that signal tacit approval? Do you supplement with any calcium? If this (rather dated, from 2012) description of your supplement regime is correct, it doesn't look like you do. So I'm wondering if you would come down on the side of not supplementing, even for CR practitioners, in agreement with Dr. Greger  :)xyz .

 

--Dean

 

-----------

References on Calcium supplements and Heart disease from Part1 Video:

 

 

M J Bolland, A Grey, I R Reid. Calcium supplements and cardiovascular risk. J Bone Miner Res. 2011 Apr;26(4):899; author reply 900-1.

R P Heaney, S Kopecky, K C Maki, J Hathcock, D Mackay, T C Wallace. A review of calcium supplements and cardiovascular disease risk. Adv Nutr. 2012 Nov 1;3(6):763-71.

C M Weaver. Calcium supplementation: is protecting against osteoporosis counter to protecting against cardiovascular disease? Curr Osteoporos Rep. 2014 Jun;12(2):211-8.

M J Bolland, A Grey, A Avenell, G D Gamble, I R Reid. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis. BMJ. 2011 Apr 19;342:d2040.

I R Reid, M J Bolland. Calcium supplements: bad for the heart? Heart. 2012 Jun;98(12):895-6.

I R Reid. Should we prescribe calcium supplements for osteoporosis prevention? J Bone Metab. 2014 Feb;21(1):21-8.

I R Reid, S M Bristow, M J Bolland. Cardiovascular complications of calcium supplements. J Cell Biochem. 2015 Apr;116(4):494-501.

I R Reid, S M Bristow, M J Bolland. Calcium supplements: benefits and risks. J Intern Med. 2015 Oct;278(4):354-68.

M J Bolland, A Grey, I R Reid. Calcium supplements and cardiovascular risk: 5 years on. Ther Adv Drug Saf. 2013 Oct;4(5):199-210.

I R Reid, M J Bolland. Calcium risk-benefit updated--new WHI analyses. Maturitas. 2014 Jan;77(1):1-3.

M J Bolland, P A Barber, R N Doughty, B Mason, A Horne, R Ames, G D Gamble, A Grey, I R Reid. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ. 2008 Feb 2;336(7638):262-6.

J R Lewis, K Zhu, R L Prince. Adverse events from calcium supplementation: relationship to errors in myocardial infarction self-reporting in randomized controlled trials of calcium supplementation. J Bone Miner Res. 2012 Mar;27(3):719-22.

I R Reid, M J Bolland. Does widespread calcium supplementation pose cardiovascular risk? Yes: the potential risk is a concern. Am Fam Physician. 2013 Feb 1;87(3):Online.

M U Kärkkäinen, J W Wiersma, C J Lamberg-Allardt. Postprandial parathyroid hormone response to four calcium-rich foodstuffs. Am J Clin Nutr. 1997 Jun;65(6):1726-30.

M A Denke, M M Fox, M C Schulte. Short-term dietary calcium fortification increases fecal saturated fat content and reduces serum lipids in men. J Nutr. 1993 Jun;123(6):1047-53.

I R Reid, A Horne, B Mason, R Ames, U Bava, G D Gamble. Effects of calcium supplementation on body weight and blood pressure in normal older women: a randomized controlled trial. J Clin Endocrinol Metab. 2005 Jul;90(7):3824-9.

L E Griffith, G H Guyatt, R J Cook, H C Bucher, D J Cook. The influence of dietary and nondietary calcium supplementation on blood pressure: an updated metaanalysis of randomized controlled trials. Am J Hypertens. 1999 Jan;12(1 Pt 1):84-92.

[No authors listed] Osteoporosis prevention, diagnosis, and therapy. NIH Consens Statement. 2000 Mar 27-29;17(1):1-45.

M Nestle, M C Nesheim. To supplement or not to supplement: the U.S. Preventive Services Task Force recommendations on calcium and vitamin D. Ann Intern Med. 2013 May 7;158(9):701-2.

-----------

References on Calcium supplements and Fracture Risk from Part2 Video:

 

H A Bischoff-Ferrari, B Dawson-Hughes, J A Baron, P Burckhardt, R Li, D Spiegelman, B Specker, J E Orav, J B Wong, H B Staehelin, E O'Reilly, D P Kiel, W C Willett. Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr. 2007 Dec;86(6):1780-90.

 

C D Hunt, L K Johnson. Calcium requirements: new estimations for men and women by cross-sectional statistical analyses of calcium balance data from metabolic studies. Am J Clin Nutr. 2007 Oct;86(4):1054-63.

H A Bischoff-Ferrari, B Dawson-Hughes, J A Baron, J A Kanis, E J Orav, H B Staehelin, D P Kiel, P Burckhardt, J Henschkowski, D Spiegelman, R Li, J B Wong, D Feskanich, W C Willett. Milk intake and risk of hip fracture in men and women: a meta-analysis of prospective cohort studies. J Bone Miner Res. 2011 Apr;26(4):833-9.

S Mundi, B Pindiprolu, N Simunovic, M Bhandari. Similar mortality rates in hip fracture patients over the past 31 years. Acta Orthop. 2014 Feb;85(1):54-9.

P Haentjens, J Magaziner, C S Colón-Emeric, D Vanderschueren, K Milisen, B Velkeniers, S Boonen. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010 Mar 16;152(6):380-90.

S A Frost, ND Nguyen, J R Center, J A Eisman, T V Nguyen. Excess mortality attributable to hip-fracture: a relative survival analysis. Bone. 2013 Sep;56(1):23-9.

K Michaëlsson, A Wolk, S Langenskiöld, S Basu, E Warensjö Lemming, H Melhus, L Byberg. Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ. 2014 Oct 28;349:g6015.

M C Chapuy, M E Arlot, F Duboeuf, J Brun, B Crouzet, S Arnaud, P D Delmas, P J Meunier. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. 1992 Dec 3;327(23):1637-42.

M Nestle, M C Nesheim. To supplement or not to supplement: the U.S. Preventive Services Task Force recommendations on calcium and vitamin D. Ann Intern Med. 2013 May 7;158(9):701-2.

P N Sambrook, I D Cameron, J S Chen, R G Cumming, S Durvasula, M Herrmann, C Kok, S R Lord, M Macara, L M March, R S Mason, M J Seibel, N Wilson, J M Simpson. Does increased sunlight exposure work as a strategy to improve vitamin D status in the elderly: a cluster randomised controlled trial. Osteoporos Int. 2012 Feb;23(2):615-24.

V A Moyer; U.S. Preventive Services Task Force*. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013 May 7;158(9):691-6.

B M Tang, G D Eslick, C Nowson, C Smith, A Bensoussan. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007 Aug 25;370(9588):657-66.

H E Theobald. Dietary calcium and health. Nutrition Bulletin Volume 30, Issue 3, pages 237-277, September 2005.

B Dawson-Hughes, P Jacques, C Shipp. Dietary calcium intake and bone loss from the spine in healthy postmenopausal women. Am J Clin Nutr. 1987 Oct;46(4):685-7.

 

----------------------

[1] Aging Cell. 2011 Feb;10(1):96-102. doi: 10.1111/j.1474-9726.2010.00643.x. Epub

2010 Nov 15.

Reduced bone mineral density is not associated with significantly reduced bone
quality in men and women practicing long-term calorie restriction with adequate
nutrition.

Villareal DT(1), Kotyk JJ, Armamento-Villareal RC, Kenguva V, Seaman P, Shahar A,
Wald MJ, Kleerekoper M, Fontana L.

Author information:
(1)Division of Geriatrics and Nutritional Science, Washington University School
of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.

Calorie restriction (CR) reduces bone quantity but not bone quality in rodents.
Nothing is known regarding the long-term effects of CR with adequate intake of
vitamin and minerals on bone quantity and quality in middle-aged lean
individuals. In this study, we evaluated body composition, bone mineral density
(BMD), and serum markers of bone turnover and inflammation in 32 volunteers who
had been eating a CR diet (approximately 35% less calories than controls) for an
average of 6.8 ± 5.2 years (mean age 52.7 ± 10.3 years) and 32 age- and
sex-matched sedentary controls eating Western diets (WD). In a subgroup of 10 CR
and 10 WD volunteers, we also measured trabecular bone (TB) microarchitecture of
the distal radius using high-resolution magnetic resonance imaging. We found that
the CR volunteers had significantly lower body mass index than the WD volunteers
(18.9 ± 1.2 vs. 26.5 ± 2.2 kg m(-2) ; P = 0.0001). BMD of the lumbar spine (0.870
± 0.11 vs. 1.138 ± 0.12 g cm(-2) , P = 0.0001) and hip (0.806 ± 0.12 vs. 1.047 ±
0.12 g cm(-2) , P = 0.0001) was also lower in the CR than in the WD group. Serum
C-terminal telopeptide and bone-specific alkaline phosphatase concentration were
similar between groups, while serum C-reactive protein (0.19 ± 0.26 vs. 1.46 ±
1.56 mg L(-1) , P = 0.0001) was lower in the CR group. Trabecular bone
microarchitecture parameters such as the erosion index (0.916 ± 0.087 vs. 0.877 ±
0.088; P = 0.739) and surface-to-curve ratio (10.3 ± 1.4 vs. 12.1 ± 2.1, P =
0.440) were not significantly different between groups. These findings suggest
that markedly reduced BMD is not associated with significantly reduced bone
quality in middle-aged men and women practicing long-term calorie restriction
with adequate nutrition.

PMCID: PMC3607368
PMID: 20969721

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This is regarding vegetarians, not vegans, but since many folks here are vegetarian, this might be of some interest. Several findings are counter-intuitive.  I found it very interesting that supplementing with minerals like iron and zinc does not result in greater absorption of these minerals in vegetarians specifically, because their physiology habituated to the vegetarian diet optimizes absorption of these minerals from vegetarian sources, and when you supplement the body correspondingly deprecates absorption from food, so you don't end up with net more absorption of these minerals. What I als found of especial value were all the references that lead to other interesting papers. 

 

Bioavailability of iron, zinc, and other trace minerals from vegetarian diets

  1. Janet R Hunt
  2.  
  3. Am J Clin Nutr September 2003 
    vol. 78 no. 3 633S-639S
  4.  

Abstract

Iron and zinc are currently the trace minerals of greatest concern when considering the nutritional value of vegetarian diets. With elimination of meat and increased intake of phytate-containing legumes and whole grains, the absorption of both iron and zinc is lower with vegetarian than with nonvegetarian, diets. The health consequences of lower iron and zinc bioavailability are not clear, especially in industrialized countries with abundant, varied food supplies, where nutrition and health research has generally supported recommendations to reduce meat and increase legume and whole-grain consumption. Although it is clear that vegetarians have lower iron stores, adverse health effects from lower iron and zinc absorption have not been demonstrated with varied vegetarian diets in developed countries, and moderately lower iron stores have even been hypothesized to reduce the risk of chronic diseases. Premenopausal women cannot easily achieve recommended iron intakes, as modified for vegetarians, with foods alone; however, the benefit of routine iron supplementation has not been demonstrated. It may be prudent to monitor the hemoglobin of vegetarian children and women of childbearing age. Improved assessment methods are required to determine whether vegetarians are at risk of zinc deficiency. In contrast with iron and zinc, elements such as copper appear to be adequately provided by vegetarian diets. Although the iron and zinc deficiencies commonly associated with plant-based diets in impoverished nations are not associated with vegetarian diets in wealthier countries, these nutrients warrant attention as nutritional assessment methods become more sensitive and plant-based diets receive greater emphasis.

Edited by TomBAvoider

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Dean, I'm wondering if you are still taking 1/6 of a 100mcg B12 pill and where you got that amount as the right amount to take.

 

I've been cutting a 100 mcg pill into fourths (I can't cut it smaller than that without it crumbling to pieces).

 

But I recently saw these two videos (one and two) by Dr. Greger which seems to suggest we should be taking 2500 mcg's a week or 250 mcg's a day. Unless I'm reading things wrong, that is quite a bit more than you or I are currently taking and I'm trying to understand where all of these recommendations are coming from and if I should increase my dosage. I'd rather be taking a little extra than too little.

 

My own current supplement regime is VERY minimalist. I'm only taking D3 and B12 and trying to get everything else I need from the foods I eat. I'll need to revisit and re-investigate soon since I might need to add a few other small supplements.

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Thomas,

 

Sorry for the brief reply (I'm traveling and using my phone). I am still nibbling ~1/6 of a 100 mcg tablet of b12 per day. My b12 blood level has looked good on that regime for quite a while despite my vegan diet, do I figure it works, at least for me.

 

An alternative you might consider are the Viter b12-fortified caffeinated mints I've reviewed on the "Cool Tools" thread. They are much tastier than the tablet I nibble. :-)

 

--Dean

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Why bother breaking them up and taking daily?  Your body stores it away. Dr. G recommends just taking it once a week:  

 

"In my professional opinion, the easiest and most inexpensive way to get one’s B12 is to take at least 2,500 mcg (µg) of cyanocobalamin once each week, ideally as a chewable, sublingual, or liquid supplement (you can’t take too much–all you get is expensive pee)."

 

I'd think a 1000 mcg should be adequate but the stuff costs next to nothing and excess doesn't hurt...

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I guess that is something that I'm confused by. On the one hand our receptors can't absorb to much of it at a time and pees out the rest, yet on the other hand our bodies stores it away? Those two seem to be at odds with each other.

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I'd be careful not to overdo the B12 supplementation. You might, as Gordo indicates, piss away the excess, but that does not mean that the excess consumption might not be harmful.

 

http://www.webmd.com/cancer/news/20091117/folic-acid-b12-may-increase-cancer-risk#1

 

It seems true of so many vitamin supplements: megadoses are harmful. Not just fat soluble, but also water soluble (like vit. C). I eat small amounts of salmon (Tuesdays) and sardines (Fridays) in part so that I don't have to resort to certain supplements, but I understand it's an issue for vegans... in that case, I'd supplement with just the minimum to avoid deficiency and I'd definitely not take large doses. YMMV.

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I guess that is something that I'm confused by. On the one hand our receptors can't absorb to much of it at a time and pees out the rest, yet on the other hand our bodies stores it away? Those two seem to be at odds with each other.

 

Thomas, a reasonable (and allegedly well-researched) B12 intake scheme is being advised by the vegan society. Either methods can be followed, according to individual preferences (some people choose to just take a pill once a week then forget about it). The small dosages, pill-nibble method appears to be the most efficient (but it is the less convenient).

 

 

Achieving an adequate B12 intake is easy and there are several methods to suit individual preferences. Absorption of B12 varies from about 50%, if about 1 microgram or less is consumed, to about 0.5% for doses of 1000 micrograms (1 milligram) or above. So the less frequently you consume B12, the higher the total amount needs to be to give the desired absorbed amount.

Frequent use of foods fortified with B12 so that about one microgram of B12 is consumed three times a day with a few hours in between will provide an adequate amount. Availability of fortified foods varies from country to country and amounts of B12 vary from brand to brand, so ensuring an adequate B12 supply from fortified foods requires some label reading and thought to work out an adequate pattern to suit individual tastes and local products.

Taking a B12 supplement containing ten micrograms or more daily provides a similar absorbed amount to consuming one microgram on three occasions through the day. This may be the most economical method as a single high potency tablet can be consumed bit by bit. 2000 micrograms of B12 consumed once a week would also provide an adequate intake. Any B12 supplement tablet should be chewed or allowed to dissolve in the mouth to enhance absorption. Tablets should be kept in an opaque container. As with any supplement it is prudent not to take more than is required for maximum benefit, so intakes above 5000 micrograms per week should be avoided despite lack of evidence for toxicity from higher amounts.

 

All three options above should meet the needs of the vast majority of people with normal B12 metabolism. Individuals with impaired B12 absorption may find that the third method, 2000 micrograms once a week, works best as it does not rely on normal intrinsic factor in the gut. There are other, very rare, metabolic defects that require completely different approaches to meeting B12 requirements. If you have any reason to suspect a serious health problem seek medical advice promptly.

Edited by mccoy

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