During this Q&A, our Plant-based Telehealth doctors discuss K2 supplements, Blood sugar labs, and Diarrhea.
Questions Answered
- (00:03) – Success Stories
- (08:36) – What is your perspective on vitamin K2 and Natto?
- (13:59) – What are your thoughts on hypoglycemic labs?
- (17:24) – Why do I have diarrhea after four months into the plant-based lifestyle?
- (23:39) – Can you address the problem of flatulence?
- (29:03) – Why are my homocystine levels are becoming a bit high?
- (33:02) – Does muscle soreness from workouts increase due to menopause?
Complete Transcript
Dr. Chris Miller
(00:03)
I just wanted to share. I just got off with a patient this morning, and he is a 45-year-old male who's a firefighter and lives in California. And he was found to have really high cholesterol, actually. I wrote it down here, his total cholesterol was 243, his LDL was 173. So he had really high numbers, was very stressed, has family history. And he came to see us at Plant-Based Telehealth. And I got to be his doctor and so we've been working together.
Dr. Chris Miller
(00:32)
And in two months, he changed his diet to low-fat, whole-food plant-based diet, lots of greens, lots of antioxidants and colorful fruits and vegetables, and fiber and a really clean diet. He exercises, working on stress reduction, and really working on his sleep. He is a firefighter, so he's got that limitation. But we got labs, and I was able to follow-up with him today after two months, and his total cholesterol went from 243 to 143, and his LDL went from 173 to 83. He is just thrilled to the moon. He saw his personal doctor who said, “There's no way you did this with diet alone.” And they said, “What are you really doing?” He said, “No, it was just diet. This is really just diet.”
Dr. Chris Miller
(01:20)
So we're super excited and he just wants to tell his story to everyone, so he wanted me to share that with you guys. To anyone getting on board and just starting out, really go for it, because the results speak for themselves. And it's pretty exciting when we get something like that. I wanted to share that with you guys.
Dr. Laurie Marbas
(01:38)
That's awesome, Chris. These are recurring themes. The amazing results. I just want to also just a little housekeeping, if you are on Plant-Based Telehealth page, I'm looking, that's why I'm looking on the phone, I'm just going to look for questions. And if you're on the webinar, please put it in the Q&A box, and I'll be fielding questions there as well. Dr. K, do you have a really fun story of amazing results you'd like to share? Which one?
Dr. Chris Miller
(02:06)
Yeah, right?
Dr. Michael Klaper
(02:07)
Yeah. Really.
Dr. Chris Miller
(02:07)
Where to start?
Dr. Michael Klaper
(02:12)
The whole parade goes by of all of these formerly heavy folks who are now lean and healthy, and they're off their medications. They're all versions of what you just heard from Chris there. I'm trying to think. I don't know, I saw a man yesterday, he's just in dreadful shape, 300 pounds, diabetic, hypertensive, congestive heart failure. He's got osteomyelitis of his foot. He's on antibiotics. He's just a wreck. Some come running, some come limping, and he's found his way to Plant-Based. He says, “My brother-in-law said I should call you.” So we had a good long consultation. And I could just hear the determination in his voice. He knows he's facing the Grim Reaper there.
Dr. Michael Klaper
(03:14)
Just hearing him, he says, “My family's not on board, but I got to do this, Doc. I know I got to do this.” And I gave him some tips about his foot, etc. I'm going to get him to see Forks Over Knives, go to the website. He's so afraid of not being able to eat delicious food. And I was able to reassure him. And then I got a dietician friend to be willing to do some health coaching with him. And I'm going to be check in on him regularly, but it was just, he's got the makings of the success story in his voice. I could hear the determination, and I'll give you reports from time to time, to let you know how Leo's doing. But that's where it starts.
Dr. Michael Klaper
(04:01)
Without being blasphemous here, but I've talked to former heroin addicts, I say, “When did you know that you had to stop that?” He says, “One morning after getting off the floor on a Sunday morning, after another Saturday night debauch, and I saw this wreck of a person in front of me. And I can't do this and anymore, I got to change something.” And we all kind of reach those points a little bit with our lives on various things. I had to come to it with sugar eating etc. And so here's this man at that sacred point, and it's a wonderful time. And he's one of those that six months, and 12 months, and 18 months. Now, if he stays on the healthy diet we're going to give him, you can see, I can see the leaner guy inside there, and it'll be a real miraculous turnaround. So that gave me a lot of hope. So I'll keep you posted on how Leo's doing there.
Dr. Chris Miller
(04:57)
That's great. And if he's listening out there, go for it, whoever that is.
Dr. Michael Klaper
(05:01)
Really.
Dr. Chris Miller
(05:01)
Got your back.
Dr. Laurie Marbas
(05:04)
That's really important. So again, across the spectrum of chronic disease, you have diabetes, hypertension, heart disease, obesity, which is connected to 85% of these things. All those things, autoimmune disease. Chris has got her own lupus story and joint discomfort, sleeping. You name it, but the quality of life gets better. And the beautiful thing about a plant-based diet versus some of these other “diets” that are promoted, there's no side effects other than feeling better. Some individuals may have some GI as their guts getting used to all that nice fiber and some other things, but there really is no downsides to this. It's good for the person, it's good for the planet, it's good for the animals. So it's what we call that triple win. And I would say keep going for it. But I have a few questions here, Kelly Ann asked, “Have you or do you work with family units or kids?” I do. How about Dr. K, Dr. Miller, any thoughts on working with families?
Dr. Chris Miller
(06:02)
Love it. So it's great when the whole family gets on board. It's those people who have a family unit that are willing to work together that they're so lucky, because you have the support. So I love when I get to talk to a whole family, and everyone understands, and people bring in questions, and bring in different perspectives, and can help each other and support each other through it. So if you can get the kids on board, if you can get your husband, your wife, your partner, your mother-in-law, whoever you can get on board, the more, the better. And the better support, the better it is for all of us. We're all looking for support to do this. And so if you have that, I recommend it. And I love when people bring other people to the appointments if they want to come or if they want to share it.
Dr. Michael Klaper
(06:45)
Yeah, of course, it all starts with the example you set. The kids are watching what you eat and the food that's being prepared, and how you talk about it, and you know why you're doing it. And the goodness on so many levels to the plant-based diet is the kids who tune into the animal thing and they don't want to be killing and eating the animals. Right away, you've got an open door to them then that way, if you start talking about why plant-based diet are so good. But I get all the classic holds or strategies, take the kids shopping, let them point of the colorful produce that they want to bring home and try. And as soon as they can safely hold a knife, let them start cutting up the veggies or peeling the fruits or something, and get them involved in the food preparation.
Dr. Michael Klaper
(07:32)
If you can, get a box of soil on the back porch and grow some peas or grow some kale. And complete the cycle for the kids so they can see where food comes from. And they have a hand in growing their own food and actually eating the tomatoes. And so lots of ways to make this normal and fun and not this strange, weird thing. And if you've got someone who's into science, then let them know, we are plant eating hominids, there's lots of science why we should be a plant-based diet. So lots of ways to incorporate kids.
Dr. Michael Klaper
(08:05)
And the rest of the family members, you got to do what you got to do. And the mother-in-laws, she'll do what she's going to do. But again, the example you set, especially if the food tastes great. Make some dynamite curries, and chilies, and lasagnas, and get the people just enjoying this wonderful food. And pretty soon, it becomes, it's just what we eat. It's not an issue anymore that we're not having steak tonight. It's not an issue. We're having tofu lasagna and it's going to be great.
Dr. Laurie Marbas
(08:36)
Exactly. So everyone benefits, but just to reiterate, all of the family docs, most of the docs on plant-based health are family physicians or have experience with kids. So you absolutely can see. I have probably at least four families, I have three generations from the small… I started with the four year old type one diabetic, started seeing a sister, then the mom, then the dad, and then the grandpa. And that's happened multiple times. So at least four families, three generations, so that can occur. So please feel free to schedule at any point with any of our doctors. And yeah. So we'll be happy to work with kids. Joseph asked, “Would love to hear about your perspective about vitamin K2. I'm considering eating Natto.” Any of you would to take on? I know Chris and I have had some conversations about K2, but what are your thoughts on K2?
Dr. Chris Miller
(09:26)
So I'll share my thoughts on that. Thank you for that question. It's a great question. And there's been more and more about it. We didn't used to talk about K2 a lot. We talked about K1, and we know leafy greens and all of our vegetables are really high in K1, which is important for blood clotting. And so we didn't talk a lot about K2, but now, we're finding out that K2 is a subset of another one of the K vitamins and that it actually plays a role in helping calcium deposit in your bones instead of your blood vessels. And that it's actually protective of both your bones for bone health as you age and of your blood vessels to prevent against cardiovascular disease. And now we're finding out that actually, a plant-based diet is not that rich in vitamin K2 like it is in K1.
Dr. Chris Miller
(10:10)
And so I am starting to recommend a supplement now or have been for a little bit, and that's new from what I was doing several years ago. But that there is data. This is what Laurie and I were talking about. We were looking at the data together, and there is more and more data coming in supporting that. That People long term who take vitamin K2 or eat a source of it, that they are doing better, both cardiovascularly and osteoporosis in separate studies. And so I now feel comfortable recommending it, and I am recommending it to my patients along with vitamin D3 and making sure they have optimal sources of calcium in their diet for bone health.
Dr. Chris Miller
(10:46)
But so the question about the Natto is, Natto is a fermented vegetable. I'm not sure exactly what vegetable it is, that's supposed to… I've never tasted it myself. It's supposed to have kind of an interesting flavor that people get used to, but they eat it a lot in Japan and it's extremely good for you. And so if you get a good source of it and you eat it, I'd say that would be a good thing. It's a way to use whole foods instead of a supplement. So if you could get back to us how that goes for you, how it tastes and how you eat it, I would be curious to hear more about it. But yeah, my feelings are that I would recommend and support that.
Dr. Laurie Marbas
(11:24)
Any other thoughts?
Dr. Michael Klaper
(11:28)
The latest theory I read is that the same bacteria that make K1 also make K2, there is some. If you eat enough greens, you're going to get you K2 production in your gut there. And there's a question whether you gain much by taking supplemental K2, but I'm open to reviewing the literature. And Chris, if you could send me any of those studies, I'd appreciate that.
Dr. Chris Miller
(11:50)
Yeah. I'll send you some.
Dr. Michael Klaper
(11:51)
Great.
Dr. Chris Miller
(11:51)
…and I'm not sure the right answer yet either. Are we making enough or is it helping people with weaker bones as people are aging and they have osteoporosis? Is it helpful to analytics? I'm not sure either. So I'm watching the data and I find it interesting so far. It looks like extra K2 is not harmful, but it is interesting as it's playing out. So fermented soybeans. Oh, Natto is actually fermentative soybeans. Thank you for sharing.
Dr. Laurie Marbas
(12:16)
Kip always comes-
Dr. Chris Miller
(12:17)
I know!
Dr. Laurie Marbas
(12:18)
… to rescue answering questions.
Dr. Chris Miller
(12:18)
Kip, thank you.
Dr. Laurie Marbas
(12:19)
So thanks Kip.
Dr. Chris Miller
(12:19)
He gave us all a link, so if you want to read more about it.
Dr. Laurie Marbas
(12:23)
I just also want to just mention that it's really difficult to measure K2. There's not a direct test of measurement. So that's the other thing. You have to do this ratio of osteocalcin. It's a weird… I'm trying to figure out how to do that because I've had some patients ask. I haven't quite figured out the best way to do that yet, at least from Quest and LabCorp. And there's some research in how they do it. So I'm trying to figure out how I can do the same thing for the patients, because there is that question. But yeah, osteoporosis, heart health, we go back to, what were our lifelong habits? So is this one element going to be the magic bullet? I think it's everything. It's not just one thing, but so there's just so many things we got to look at totally.
Dr. Laurie Marbas
(13:07)
But yeah, I don't think the answer's going to be known for a while. Probably not even in our lifetime or practice. They'll learn some other things and do other things. So again, just eating this wide variety of foods, if you like the special taste of Natto, go for it. I don't know if I would, but there's a lot of healthy plant-based [inaudible 00:13:30] been plant-based for many, many decades. Looking at Dr. K is one of them. And then you thought the special supplementation other than B12, of course, but keep that open. Because if it's one more thing we can do, yeah. Maybe they'll figure out a different taste for Natto, or Natto, or however you say it. Natto I think natto, I think it's right. Anyway. So that's that. We did have another question. Oh, Joseph said he'll keep us posted with our feedback.
Dr. Chris Miller
(13:58)
Yeah. Thank you, Joseph.
Dr. Laurie Marbas
(13:59)
Thank you. Tody asked a question. She had labs for pre-op and noted blood sugar was low at 51 and this was after she had eaten about two hours earlier. So what are your thoughts on hypoglycemic labs? And I have my thoughts, but what do you guys think?
Dr. Michael Klaper
(14:23)
This is a great physiology demonstration. This woman has a pancreas that should be able to enrolled in the Olympics for the 50 yard insulin. Gosh, and because she's a lean rabbit. She's got a BMI of 18.5. So this is a lean muscular woman seriously, but she has a lot of fat reserve. So her insulin receptors are wide open. And when she eats a high carbohydrate meal, which she did, her pancreas was boom, right off the starting line. There put out quite a little spurt of insulin there and dropped that blood sugar down. She wasn't any real danger. She didn't report any hypoglycemic episodes and I'm sure hypoglycemic symptoms. And I'm sure she put out some glucagon shortly after from her liver brought the blood sugar up and it's just, she's got this very responsive carbohydrate, insulin storage mechanism going on and nothing to worry about, but she, but noticeable very interesting.
Dr. Michael Klaper
(15:25)
And she might want to experiment with slower absorbing starches to see what a piece of sweet potato and breakfast would do or other low glycemic grains, if she wants to eat something in the morning and not eat the granola, which probably had good dough or sugar in it and really spike that blood sugar up. So, I'll just advise her to go have some starches in the morning that are a bit slower absorbed. If this bothers her at all, there's just kind of a demonstration of how vigorous, how healthy she is and how vigorously her pancreas response and with a low fat body configuration, how sensitive that makes you to your insulin mechanism. She's okay.
Dr. Laurie Marbas
(16:13)
I'd say if you're not hypoglycemic or having evidence of symptoms fatigue, dizziness wanting to pass out that you're probably okay. Or they'll always look at lab. There's always that the measurement was incorrect. And as long as you're not concerned about the symptoms, I wouldn't worry about it at all. Because when I wore the CGM, my blood sugars readily got under 50 or not under 50, but right in the low fifties, granted that was overnight. But I wouldn't be too worried about it at all, Chris [inaudible 00:16:46]
Dr. Chris Miller
(16:46)
And you can be a little lower everything you guys said. I agree completely. So it's a physiology thing and as long as you're not feeling bad, so that would be the big question I would want to know from you. Laurie just said, but if you exercise too, after eating that meal and you're so revved up, Dr. K just pointed out, then that can definitely lower it, exercising after a meal like that, if you're so physiologically ramped up. So those would be my thoughts, but mostly I just want to make sure that you were feeling okay, you don't have any problem. And then I'm not too worried about it either. As long as your doctor's not too worried, hopefully they're going to let you do the surgery you need and they're not, you're not going to fill your pre-op because of that.
Dr. Laurie Marbas
(17:24)
I had a few other questions over here. Patricia asked, been doing whole plant-based app for four months, lost weight. Then a few weeks ago I started having diarrhea only in the morning, getting better drinking, more water, more fiber. I just don't understand why my bowels changed after four months into the lifestyle. I didn't change anything except adding more tofu and beans and I'm drinking enough water. So what about these bowel changes that occur with patients who have switched over to the plant-based diet after a few months? Any thoughts there?
Dr. Michael Klaper
(17:54)
Well, it's truism that the food we eat determines the microbes that live in our gut. If you eat a bunch of sugar, you sum up sugar eating microbes, you eat a bunch of meat, you sum up Carine eating microbes. And now she's been on this whole food plant-based diet for four months. So for four months of a relatively high fiber diet has been coming down regularly through intestinal tract. And that's going to sum up a particular set of microbes that colonize the internal, the lining of the mucus layer of the gut. And there's a lag tree. The microbes that diet X that she was on before the beans and the Tofu were added, produced microbiome A, and they're metabolizing producing vitamins and digesting fiber doing all the things they should, but maybe they've never seen the lectins and beans or the proteins and beans that are going to be coming down.
Dr. Michael Klaper
(19:04)
And then down comes the Tofu in the beans and these microbes I've seen them before and some strange digestion of carbohydrates will happen or they just hurry it along. They don't want to make the bowel underneath more active just to move it along there. And so you get some loose stools, but so now there's Tofu and beans coming in regular lead. The diet of the Lu stool should settle down, but now you've got microbiome B. Now, if you suddenly start eating some mangoes or fruit or something, you might create the same phenomenon. There's the food, there's the lag period as the microbiome changes, and then a new food is introduced. And that may take another week or two or five for the gut and the microbes gut wall to all adjust to that.
Dr. Michael Klaper
(19:59)
So these things will happen. It's shifting metabolic years, it's a major shift to go from the standard diet, with meat and eggs and dairy in it to a whole food plant-based diet. It takes a lot of mini adjustments, but give it a good year or more before you have those regular easy stool, it should be happening more commonly anyway, but before you're feeling really good, and again, the guts are working, it's okay to have this lag period. And don't worry about the little fits and starts of slightly disordered function there.
Dr. Laurie Marbas
(20:37)
Chris, any other thought?
Dr. Chris Miller
(20:38)
That was the great review. Thank you, Dr. Klaper, how lucky are we to have you go over that for us? I love that every time you add something new, you're changing your microbiome. So that was excellent. And I agree completely. And so we see this in a lot of people that as you change your diet. And so I always say, just start real slowly. Anything you add in, don't add like we're oh, eat a cup of beans a day. So you add a cup of beans, and that is way too much for your poor microbiome who's not used to it yet. So start with a tablespoon at a time, and then a two tablespoons and gradually build the microbiome muscles so that it can now handle it, or if you're adding mangoes or whatever, new food you're adding.
Dr. Chris Miller
(21:14)
And I always recommend a food symptom journal. So you can kind of look at what you're eating and what you've added it on. And I also, with that, look at lifestyle. So are you more stressed out now? Did you not sleep as well? So those factors also play a role along with what you're eating. And so you may say I didn't change anything, but maybe you're more stressed out and suddenly you have looser stools. So they all kind of play a role. So, that was such a good explanation. I don't have much more to add than that.
Dr. Laurie Marbas
(21:40)
The only other thing I've seen with patients switching to the plant-based diet with the diarrhea concerns is pancreatic insufficiency, the extra clean function. So there's a test for it. You can do a fecal elastase test. And some, I have caught probably eight or nine on plant-based cell health and people who are having bloating after eating high fat stools, some diarrhea, and we give them a pancreatic enzymes and it goes away completely, just had a follow up with a gentleman two days ago. So that was really cool. So just another thing, if it persists after you've given a good length of time, six months, seven months, whatever, and you're still not seeing improvement, you're still having some bloating that's something to consider what causes that. Well, sometimes if there's a problem, if you're a type one diabetic that can happen alcoholism history of chronic pancreatitis.
Dr. Laurie Marbas
(22:33)
So there's some definite elements, but then there's a lot of cases we just don't know. But that is something to consider for those going to plebes diet, and they're struggling with the bloating and discomfort, and they've given it a good try for several months. Just another test to be looked at. I've also had some patients improve with doing a really high quality probiotic for three months and then stopping it. And that seems to help move things along a little faster too. So there's just a few interventions that might be helpful for you in the long term is to keep in the back of your mind, if you don't see this changes.
Dr. Chris Miller
(23:07)
Things IBS or irritable bowel syndrome. But usually I see that early on. So if it's coming back even on this four months, then I think it's more likely just your microbiome out of balance, but early on, there are a lot of reasons that some people initially really can't take it and get gas bloated and loose stools. So if it happens right at the beginning, then yes, I would recommend doing some testing and really making sure that there's not something else going on before you struggle with it. I don't know, four months in seems maybe something switched. I don't know.
Dr. Laurie Marbas
(23:39)
But adding the more fiber, the more resistant starts and stuff that definitely could be it. And you just got to give your body a chance to adjust. So we do have another question that just kind of comes up often is, since he says Joseph fast, since we're in the discussion bowel situations, can you address the changes to flatulence? My wife is not happy with the extreme smell. It's actually been really bad and I've been whole food plant-based for one and a half years. Any thoughts on stinky gas?
Dr. Michael Klaper
(24:09)
Yeah. I'll let you go after you [crosstalk 00:24:12]
Dr. Laurie Marbas
(24:11)
This conversation yet again, let's talk about toots.
Dr. Michael Klaper
(24:19)
I'm going to have to go through to get my crown replaced here. The… At the dinners, of all the complaints we get over by far they got me bloated, I got gassy. I got farting a lot and we are carbohydrate digesting organ and all mammals fart. They all do cows, and I've been around them a lot and elephants and giraffes and all animals do now because as carbohydrates are digested, they're going to release carbon dioxide, nothing in various gases there's. And plus we swallow airs. We eat this food there's air in the floreta broccoli. And we eat and chew and quickly and swallow it. And so we swallow a lot of air. Some air, some gases are made by the digestion of the starches and cynical GI professor of mine said, no one ever died of gas.
Dr. Michael Klaper
(25:20)
It's not a fatal disease, but there are social issues there. Now as long as we're in the muck of it, most people notice the opposite of this, that the guy who's been eating a lot of meat, which really is the microbes and the colon, digestive meat, they release these dreadful smelling are captain compounds Cute scene and Corpus scene. And they smell horrible. And usually when people go to the whole food plant base, those molecules disappear. Hey, my far don't smell so bad anymore. She doesn't smell bad anymore. What's going on? And the horses they're dropping almost sweet, the flavors, the aroma is so different. So it's usually the plant-based that gets you more gas, but better smelling. If this is, if there's really mer odorous, there's probably a lot of sulfides being produced there.
Dr. Michael Klaper
(26:26)
And you might want to look at the planned foods that have the most sulfides perhaps legumes you want about onions, garlic, etc you just Google high sulfide containing foods. You'll get the list there and you might want to take a break from them. But Dr. Marbas suggestion about getting on a good probiotic for a month or two, and see if you can shift the microbes to less gas producing ones that might also really help as well. And so take out any of the suspect food, pull it out for a few days and see if things don't… If the air doesn't clear a bit there, see if the wife isn't a bit happier. OK guys.
Dr. Laurie Marbas
(27:08)
Have fun at the dentist.
Speaker 4
(27:08)
Thank you.
Dr. Michael Klaper
(27:14)
You're welcome guys. All the best bye.
Dr. Laurie Marbas
(27:17)
Oh my goodness. I would agree. I think a probiotic for a bit might be helpful. And then also looking, just paying attention into any dried fruit, because I do notice that some people say some of the stuff that's broken down a little bit faster, the more higher glycemic foods that might be a problem as well. So you just, I notice that whenever I eat things, let's say I put a little maple syrup on some waffles that I don't normally do or eat some dried fruit. I don't need a lot of dates or anything. I was Hmm, things are changing. So anyway, that just might be another thought or suggestion. And Chris, any thoughts there?
Dr. Chris Miller
(27:51)
I was going to say, we're all getting so intimate here. I like these conversations. I feel we're all one who big happy family talking about whatever. So this is awesome. So I would say again, the food symptom journal, so you can see what time of day or after what you eat. There are combinations of things that seem to do it more like certain people maybe don't break down oats quite as well. And we'll notice it days when they have big bowls of oatmeal, that they notice it more blending foods smoothies or soups where it's cooked that tends to cause less gas. So you can kind of play with that a little bit and see if there're certain foods. And then there are things where probiotics can be helpful for sure. And certain herbs can be helpful.
Dr. Chris Miller
(28:29)
If you have an overgrowth of certain bacteria that are fermenting the carbohydrates readily and causing this foul smell and gas, because ideally on a plant-based site, you should have a lot of gas because eating fiber rich foods, but it shouldn't really be foul smelling. So when your microbiome is humming, it shouldn't be so foul smelling. So I feel like you're eating a lot of something that your body is reacting to. So either the Sulfites or look at combinations or what time of day you get it or after what type of meals and see if we can help it to not be quite so foul smelling.
Dr. Laurie Marbas
(29:00)
Food journals are really, really, really, really helpful.
Dr. Chris Miller
(29:02)
Very helpful.
Dr. Laurie Marbas
(29:03)
So many ways. There's I got some other good questions here. I really want to throw on Richards here. It says I'm in the process of figuring out my homocystine levels are becoming in a bit high at 12. My doctor's doing a test to see if Carella will bring it down. Note that my full NB 12 levels are normal. I have a thought I think Chris and I have talked about this as well. So B12, a lot of the supplements that people are taking are the Methylcobalamin, whereas you might want to switch to cyanocobalamin and there's some shunt of the pathways and some different things. Anyway, there's really interesting trends we're seeing. And I have some patients that were consistently kind of in that range, 11, 12, 13 homocystine and there B 12 levels were in the normal range, we switched them to cyanocobalamin and it went back, the home assisting dropped.
Dr. Laurie Marbas
(30:01)
The other thing is some individuals will have an elevated home assisting if your B12 is a less than 500. So you might want to try and push it up a little bit higher if you're in that quote unquote normal range, but still in the lower end of it. And that might be enough as well. But those are the two things that I definitely think shift the homocysteine in the right way. But Chris, any other suggestions?
Dr. Chris Miller
(30:26)
I agree with you on both of those Laura, you and I have talked about it, that has been helpful in our patients. And the last thing is if you're still having a hard time, some people are also aren't having other B vitamins. So it's more than just B12 that helps break down homocysteine B six. And I think B-
Dr. Laurie Marbas
(30:41)
B nine.
Dr. Chris Miller
(30:42)
Thank you. There's another B are also important in breaking it down. And so some people will put on a multi, B complex type thing. If for some reason we get tons of B vitamins, but for some reason, people aren't absorbing it or they're not putting it in the active form. And so we'll see that, but I also start with the B12 like what Laurie said, and then because that will help a lot of people. And then if that isn't helping it then look into other B vitamins.
Dr. Laurie Marbas
(31:08)
And he asked the same question. Similarly, he says mini vegans tend have lower platelet counts from around 110 to 155. I've seen that less. I've definitely seen lower white blood cell counts. I have not seen a majority of cases of low platelets. You might get a spurious one or two, and I've seen thousands and thousands of plant-based years at this point. And even in the last years with plant-based cell health. And so this just might be you or, but you want to be mind if you're seeing you were always hanging around, let's say 275 and then suddenly you're dropping. That might be an issue or you're just having lower inflammation as a plant-based Cedar and you'll see lower plates because the platelets are on acute phase reactant, meaning they respond to inflammation. So Chris, I don't know if you have any other thoughts on low platelets.
Dr. Chris Miller
(32:03)
I don't have anything on other thoughts. I also don't see a lot of low platelets. So I would want to look at your whole CBC counts and make sure everything else was okay. Not that it means anything to worry about if it's just a little bit low, but I would just want to look at everything to make sure it was all okay.
Dr. Laurie Marbas
(32:19)
Absolutely. He said my platelets dropped a bunch. Renee said that. So yeah. Renee, you definitely want to talk to your doctor about that, because that is a bit unusual. Jonathan did say here, he says creatine supplementation may help also home assisting. Yes you do a gram a day and it's not harmful. So it should be if you want to give that a shot to you, but I would try to go to the core cause first and see if those other things improve. So many questions. Let's see here. You're welcome. Kelly Ann. She's leaving us. So let's see here. This is kind a good one. Helen asked whole food plant-based, no oil for six years started menopause one to two years ago. Does muscle soreness from workouts increase due to menopause? Any thoughts on that Chris on I'm not aware of muscle fatigue or soreness increasing with menopause. I'm kind of in the middle of that mess myself. But I haven't, and I'm not that aware of any studies or researches. That's a potential symptom of menopause are you've come across any of that?
Dr. Chris Miller
(33:27)
I don't know anything off hand. That's what I'm trying to think back right now. If I've read anything or come across anything, I don't know. Are you trying to work out harder to keep your muscle mass? Because you're going through menopause because that's what we recommend. So maybe harder workouts or you didn't get enough fluids or stretching and I'm not really sure, but I don't know that's directly linked with menopause.
Dr. Laurie Marbas
(33:47)
And then just being a doctor for two decades, I've never come across that as a pot other than come, Chris says, are you being more mindful of your exercise? So I would vote no on that one if I had to go. But again, I'm not a hundred percent. Let's see here, someone here had an interesting question and it kind of gets back to the protein question that we get often. Chris, do you have time for one more question?
Dr. Chris Miller
(34:13)
I do. Yep.
Dr. Laurie Marbas
(34:15)
She says I'm having trouble getting sufficient protein and I've been doing whole plant-based diet, no sugar, oil or salt added for over a year to struggle to get eating 10 grams of protein a day, which I find unusual. I think you can probably get your protein very simply with a plant-based diet. But she says I'm eating beans, grains, starchy, greens, flax seed, chia, hemp hearts. I just don't seem to have the stomach size, eat the volume of plants to get the 68 to 85 grams of protein that they already told me I need. All the vegan protein drinks have oils and 15 grams of fat per serving. How can I get more protein? Well, I have my answer, but Chris, would you like to say anything?
Dr. Chris Miller
(34:57)
So if you're eating beans, a cup of lentils has close to 20 grams of protein, a serving of toe food has a serving to a tofu. So if green leafy vegetables, nuts cheese, if you're eating all those foods and you're adding up your protein, that's got to be more than 10 grams.
Dr. Laurie Marbas
(35:16)
A hundred. It has to be. And so I think what are you using to track your food. So if you're eating insufficient calories to maintain your weight, you would definitely get over 10 grams. I mean one cup of tofu alone has like 40 grams of protein. So beans in themselves, even half a cup would be 10 grams. A full cup would be almost 20 and some beans. So I would definitely look at, what is the app or what are you using? Chronometers' probably the most accurate app that you would have access to.
Dr. Laurie Marbas
(35:48)
And then if you have some questions, come see one of us have them all resolved and let us re-look at that because there just may be an issue with what your already saying. I'm just struggling to visualize that because it should be very easy. Very, very easy. I easily get, I eat 1500 to 17 of calories a day and I easily get 60 to 90 grams of protein a day. It just depending on what I'm getting in. So there's just some thoughts there for you. But, these are great questions.