Donald Glover is opening up about a recent health scare that forced him to cancel his tour last year. At the time, he described it as an “ailment,” but Glover said Saturday night at a performance that a doctor told him he’d had a stroke.
Glover, who performs under the moniker Childish Gambino, shared the information on stage at Tyler, the Creator’s Camp Flog Gnaw festival in Los Angeles. His remarks were shared widely on social media.
“You guys voted for a ‘where have I been monologue,’” Glover, 42, said. “I had a really bad pain in my head in Louisiana and I did the show anyway. I couldn’t really see well, so when we went to Houston, I went to the hospital and the doctor was like, ‘You had a stroke.’”
Glover said he felt like he was letting everyone down, lamenting that he still hasn’t been to Ireland. He also revealed that “they found a hole” in his heart and he had to have two surgeries.
“They say everybody has two lives and the second life starts when you realize you have one,” Glover said. “You got one life, guys, and I gotta be honest, the life I’ve lived with you guys has been such a blessing.”
His representatives did not immediately respond to request for comment.
Donald Glover is opening up about a recent health scare that forced him to cancel his tour last year. At the time, he described it as an “ailment,” but Glover said Saturday night at a performance that a doctor told him he’d had a stroke.
Glover, who performs under the moniker Childish Gambino, shared the information on stage at Tyler, the Creator’s Camp Flog Gnaw festival in Los Angeles. His remarks were shared widely on social media.
“You guys voted for a ‘where have I been monologue,’” Glover, 42, said. “I had a really bad pain in my head in Louisiana and I did the show anyway. I couldn’t really see well, so when we went to Houston, I went to the hospital and the doctor was like, ‘You had a stroke.’”
Glover said he felt like he was letting everyone down, lamenting that he still hasn’t been to Ireland. He also revealed that “they found a hole” in his heart and he had to have two surgeries.
“They say everybody has two lives and the second life starts when you realize you have one,” Glover said. “You got one life, guys, and I gotta be honest, the life I’ve lived with you guys has been such a blessing.”
CBS News has reached out to Glover’s representatives for additional comment.
Donald “Frue” McAvoy and his fiancée, Rachel Leaptrott, were taking it easy on a Sunday in early December 2023, making a cheese board and turning on a football game.
After one bite, McAvoy began to choke. He couldn’t swallow or breathe.
Leaptrott leapt into action. She cleared his throat, but realized that McAvoy’s pupils were locked in place. He was talking, but couldn’t see anything. Leaptrott’s daughter called 911.
“It’s like trying to remember a dream. That’s the best way I can describe it,” McAvoy said. “I remember bits and pieces. I get chills, because I couldn’t see and that was extremely scary. But the scariest thing I ever felt, I didn’t know if I’d ever see again.”
McAvoy, 36, had recently been plagued by headaches, a sore neck and exhaustion. The active gym owner thought he had a strained neck and might be getting the flu.
Paramedics said McAvoy was having a neurological issue. Doctors at the Mayo Clinic in Jacksonville, Florida, made a terrifying diagnosis: He was having a severe stroke.
Frue McAvoy, Rachel Leaptrott and her daughter before his stroke.
Frue McAvoy
A “life-changing” stroke
Time is of the essence when treating a stroke. McAvoy was given a clot-busting medication and rushed into surgery.
Dr. Rabih Tawk, a Mayo Clinic neurosurgeon, performed a thrombectomy to remove the clot and found McAvoy had a vertebral artery dissection that caused the stroke and stopped blood flow to his brain and spine. His airway had collapsed, causing the choking. Strokes in someone as young as McAvoy are unusual, but not impossible, Tawk said.
McAvoy came through surgery, but doctors wouldn’t know the extent of the stroke’s effects until he woke up. Tawk said an assessment indicated it would be “life-changing.”
“They did scans of his brain, and they described the MRI as ‘fireworks,’” Leaptrott said. “When you do a scan like that, it shows up as a big white spot and a big hit in one area, whereas for Frue, it was like spurts and different areas were hit. It looked like a fire burst through the scan. I only saw that scan once, and it was enough.”
Frue McAvoy in the hospital.
Frue McAvoy
For seven days, McAvoy was on a ventilator. It was replaced with breathing and feeding tubes that let him begin therapy. Assessments found that all of his motor skills had been impacted. He would need to relearn how to stand, walk, write and speak. He couldn’t see clearly.
Through it all, Leaptrott had just one wish: A hug on Christmas Day.
“I’ve got to do this”
Leaptrott’s request gave McAvoy a goal to focus on. He kept it in mind amid therapy, “prodding and pulling” and complications, including two pulmonary embolisms. At first, it took the support of two people just to help him balance in bed, but he pushed himself to relearn how to stand, walk and raise his arms.
“I just remember whatever they asked of me, I knew I had to do it to move on to the next thing,” McAvoy said. “I was hooked up to every wire you can think of, but you just trust that all those wires and everything they’re doing is going to lead you to better health.”
On Christmas Eve, more than three weeks after the stroke, Leaptrott got her wish.
Frue McAvoy and Rachel Leaptrott holding hands in the early days after his stroke.
Frue McAvoy
“I just said, ‘OK, I’ve got to do this. If this is the last thing I ever do, I’m going to give it to her,’” McAvoy remembered.
After 24 days at the Mayo Clinic, McAvoy was transferred to Brooks Rehabilitation Hospital. When he arrived, he couldn’t stand for more than 10 seconds.
He was enrolled in “Brooks Boot Camp,” which meant working with therapists, nurses and doctors for at least three hours a day in an individualized program, said physical therapist Stephanie Cabret. He started with goals like increasing his stamina and dressing himself, and eventually progressed to more difficult tasks like preparing food, said occupational therapist Shantal Wright. He also underwent vocal therapy and saw an eye specialist.
McAvoy said he focused on staying positive. He asked for extra therapy time whenever possible. He also shared his story online: An Instagram account previously dedicated to fitness became a progress log. Hundreds followed his journey, and McAvoy was able to connect with stroke survivors from around the country.
“It’s a family I never knew I had or expected to have at this age,” McAvoy said. “It’s just amazing to see how far we’ve all come and are still going.”
Frue McAvoy completes a walk at Brooks Rehabilitation.
Frue McAvoy
“Incredibly, incredibly grateful”
McAvoy was discharged from Brooks Rehabilitation in late January. He could walk down a 200-foot hallway alone. He then had three months of outpatient care.
Nearly two years later, McAvoy still struggles with the stroke’s impact. He uses a walker with a seat so he can rest if he gets tired, and he wears glasses now. He struggles with depth perception and can’t drive. But he is back to the activities he loved, including athletics: Four months after the stroke, he took part in a one-mile challenge run. Hours before speaking with CBS News, he and Leaptrott walked the Swinging Mile at Grandfather Mountain, the highest suspension footbridge in the country.
Rachel Leaptrott, Frue McAvoy and Leaptrott’s daughter.
Frue McAvoy
McAvoy regularly visits Brooks Rehabilitation’s Neuro Recovery Center, where therapists developed a program he can do on his own. The program adjusts as he does, so he constantly has new milestones to strive for. He is also still in touch with his care team and maintains his social media presence.
“With everything going on, I never thought I would hear myself speak again. When you’re in that quiet for so long, you really start thinking about life and what matters and what doesn’t,” McAvoy said. “If I get upset about something or frustrated or angry, I remind myself there was a point in time I couldn’t even express that. I’m just incredibly, incredibly grateful for how my journey has gone.”
HARRISBURG, Pa. (AP) — U.S. Sen. John Fetterman had what his office says was a “ventricular fibrillation flare-up” that caused him to feel light-headed and fall during an early morning walk Thursday.
Fetterman was doing well and hospitalized in Pittsburgh, his office said. He sustained minor injuries to his face and was under “routine observation” at the hospital while doctors fine-tune his medication regimen, his office said.
Cardiomyopathy can impede blood flow and potentially cause heartbeats so irregular they can be fatal. Atrial fibrillation can cause blood to pool inside a pocket of the heart, allowing clots to form. Clots then can break off, get stuck and cut off blood, causing a stroke.
Fetterman has said the stroke was atrial fibrillation. Fetterman, 55, underwent surgery after the stroke to implant a pacemaker with a defibrillator to manage the condition.
The lingering effects of his stroke include diminished auditory processing speed, called auditory processing disorder, which makes it harder to speak fluidly and quickly process spoken conversation into meaning.
Weeks after joining the Senate in 2023, Fetterman checked himself into the hospital for clinical depression. He was released six weeks later and has since urged people who are depressed to get professional help.
Post-stroke depression is common and treatable through medication and talk therapy, doctors say.
Copyright 2025 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Treat the underlying cause of chronic lifestyle diseases.
It’s been said that more than 2,000 years ago, Hippocrates declared, “Let food be thy medicine and medicine be thy food.” In actuality, it appears that he never actually said those words, but there’s “no doubt about the relevance of food…and its role in health and disease states” in his writings. Regardless, 2,000 years ago, disease was thought to arise from a bad sense of “humors,” as you can see here and at 0:32 in my video Lifestyle and Disease Prevention: Your DNA Is Not Your Destiny.
Now, we have science, and there is “an overwhelming body of clinical and epidemiological evidence illustrating the dramatic impact of a healthy lifestyle on reducing all-cause mortality”—meaning death from all causes put together—“and preventing chronic diseases such as coronary heart disease, stroke, diabetes, and cancer.” But don’t those diseases just run in our family? What if we just have bad genes?
According to the esteemed former chair of nutrition at Harvard, for most of the diseases that have contributed “importantly” to mortality in Western peoples, we’ve long known that non-genetic factors often account for at least 80% to 90% of risk. We know this because rates of the leading killers, like major cancers and cardiovascular diseases, vary up to 100-fold around the world, and, “when groups migrate from low- to high-risk countries, their disease rates almost always change to those of the new environment.” Modifiable behavioral factors have been identified, “including specific aspects of diet, overweight, inactivity, and smoking that account for over 70% of stroke and colon cancer, over 80% of coronary heart disease, and over 90% of adult-onset [type 2] diabetes”—diseases that can largely be prevented by our own actions.
If most of the power is in our own hands, why do we allocate massively more resources to treatment than prevention? And speaking of prevention, “even preventive strategies are heavily biased towards pharmacology rather than supporting improvements in diet and lifestyle that could be more cost-effective. For example, treatment of [high] serum cholesterol with statins alone could cost approximately 30 billion dollars per year in the United States and would have only a modest impact on coronary heart disease incidence. The inherent problem is that most pharmacologic strategies don’t address the underlying causes of ill health in Western countries, which are not drug deficiencies.”
Ironically, the chronic diseases that are most amenable to lifestyle treatment are the same ones most profitably treated by drugs. Why? If you don’t change your diet, you have to pop the pills every day for the rest of your life. So, the cash-cow drugs are the very drugs we need the least. “Even though the most widely accepted, well-established chronic disease practice guidelines uniformly call for lifestyle change as the first line of therapy, physicians often do not follow these recommendations.” “By ignoring the root causes of disease and neglecting to prioritize lifestyle measures for prevention, the medical community is placing people at harm.”
“Traditional medical care relies primarily on the application of pharmacologic and surgical interventions after the development of illness,” whereas lifestyle medicine relies primarily on “the use of optimal nutrition (a whole foods, plant-based diet) and exercise in the prevention, arrest, and reversal of chronic conditions leading to premature disability and death. It looks in a holistic way at the underlying causes of illness.”
Dr. Adriane Fugh-Berman, director of PharmedOut, a wonderful organization I’m proud to support, wrote a great editorial entitled “Doctors Must Not Be Lapdogs to Drug Firms.” “The illusion that the relationship between medicine and the drug industry is collegial, professional, and personal is carefully maintained by the drug industry, which actually views all transactions with physicians in finely calculated financial terms…The drug industry is happy to play the generous and genial uncle until physicians want to discuss subjects that are off limits, such as the benefits of diet or exercise, or the relationship between medicine and pharmaceutical companies…Let us not be a lapdog to Big Pharma. Rather than sitting contentedly in our master’s lap, let us turn around and bite something tender.”
Doctor’s Note
The organization I mentioned, PharmedOut, is a project of Georgetown University Medical Center.
For more on Lifestyle Medicine, see related videos below.
Having a “normal” cholesterol level in a society where it’s normal to die from a heart attack isn’t necessarily a good thing.
“Consistent evidence” from a variety of sources “unequivocally establishes” that so-called bad LDL cholesterol causes atherosclerotic cardiovascular disease—strokes and heart attacks, our leading cause of death. This evidence base includes hundreds of studies involving millions of people. “Cholesterol is the cause of atherosclerosis,” the hardening of the arteries, and “the message is loud and clear.” “It’s the Cholesterol, Stupid!” noted the editor of the American Journal of Cardiology, William Clifford Roberts, whose CV is more than 100 pages long as he has published about 1,700 articles in peer-reviewed medical literature. Yes, there are at least ten traditional risk factors for atherosclerosis, as seen below and at 1:11 in my videoHow Low Should You Go for Ideal LDL Cholesterol?, but, as Dr. Roberts noted, only one is required for the progression of the disease: elevated cholesterol.
Your doctor may have just told you that your cholesterol is normal, so you’re relieved. Thank goodness! But, having a “normal” cholesterol level in a society where it’s normal to have a fatal heart attack isn’t necessarily good. With heart disease, the number one killer of men and women, we definitely don’t want to have normal cholesterol levels; we want to have optimal levels—and not optimal by current laboratory standards, but optimal for human health.
Normal LDL cholesterol levels are associated with the hidden buildup of atherosclerotic plaques in our arteries, even in those who have so-called “optimal risk factors by current standards”: blood pressure under 120/80, normal blood sugars, and total cholesterol under 200 mg/dL. If you went to your doctor with those kinds of numbers, you’d likely get a gold star and a lollipop. But, if your doctor used ultrasound and CT scans to actually peek inside your body, atherosclerotic plaques would be detected in about 38% of individuals with those kinds of “optimal” numbers.
Maybe we should define an LDL cholesterol level as optimal only when it no longer causes disease. What a concept! When more than a thousand men and women in their 40s were scanned, having an LDL level under 130 mg/dL left them with atherosclerosis throughout their body, and that’s a cholesterol level at which most lab tests would consider normal.
In fact, atherosclerotic plaques were not found with LDL levels down around 50 or 60, which just so happens to be the levels most people had “before the introduction of western lifestyles.” Indeed, before we started eating a typical American diet, “the majority of the adult population of the world had LDLs of around 50 mg per deciliter (mg/dL)”—so that’s the true normal. “Present average values…should not be regarded as ‘normal.’” We don’t want to have a normal cholesterol based on a sick society; we want a cholesterol that is normal for the human species, which may be down around 30 to 70 mg/dL or 0.8 to 1.8 mmol/L.
“Although an LDL level of 50 to 70 mg/dl seems excessively low by modern American standards, it is precisely the normal range for individuals living the lifestyle and eating the diet for which we are genetically adapted.” Over millions of years, “through the evolution of the ancestors of man,” we’ve consumed a diet centered around whole plant foods. No wonder we have a killer epidemic of atherosclerosis, given the LDL level “we were ‘genetically designed for’ is less than half of what is presently considered ‘normal.’”
In medicine, “there is an inappropriate tendency to accept small changes in reversible risk factors,” but “the goal is not to decrease risk but to prevent atherosclerotic plaques!” So, how low should you go? “In light of the latest evidence from trials exploring the benefits and risks of profound LDLc lowering, the answer to the question ‘How low do you go?’ is, arguably, a straightforward ‘As low as you can!’” “‘Lower’ may indeed be better,” but if you’re going to do it with drugs, then you have to balance that with the risk of the drug’s side effects.
Why don’t we just drug everyone with statins, by putting them in the water supply, for instance? Although it would be great if everyone’s cholesterol were lower, there are the countervailing risks of the drugs. So, doctors aim to use statin drugs at the highest dose possible, achieving the largest LDL cholesterol reduction possible without increasing risk of the muscle damage the drugs may cause. But when you’re using lifestyle changes to bring down your cholesterol, all you get are the benefits.
Can we get our LDL low enough with diet alone? Ask some of the country’s top cholesterol experts what they shoot for, “and the odds are good that many will say 70 or so.” So, yes, we should try to avoid the saturated fats and trans fats found in junk foods and meat, and the dietary cholesterol found mostly in eggs, but “it is unlikely anyone can achieve an LDL cholesterol level of 70 mg/dL with a low-fat, low-cholesterol diet alone.” Really? Many doctors have this mistaken impression. An LDL of 70 isn’t only possible on a healthy enough diet, but it may be normal. Those eating strictly plant-based diets can average an LDL that low, as you can see here and at 5:28 in my video.
No wonder plant-based diets are the only dietary patterns ever proven to reverse coronary heart disease in a majority of patients. And their side effects? You get to feel better, too! Several randomized clinical trials have demonstrated that more plant-based dietary patterns significantly improve psychological well-being and quality of life, with improvements in depression, anxiety, emotional well-being, physical well-being, and general health.
For more on cholesterol, see the related posts below.
Keeping your mouth healthy may help keep your heart and brain healthy too, according to new research.
In a study published Wednesday in Neurology Open Access, researchers found adults with gum disease may be more likely to have signs of damage to the brain’s white matter than people without gum disease.
“Gum disease is associated with a higher chance of inflammation, and inflammation has been tied to atherosclerosis as well as hardening of the small blood vessels, as we saw in this study,” study author Dr. Souvik Sen told CBS News. Arteriosclerosis is a disease that causes abnormal thickening of the artery walls.
In another study led by Sen and published in the same journal Wednesday, researchers found having both gum disease and cavities is linked to an 86% increased risk of stroke compared to people with healthy mouths.
“What the study suggested was that if you have cavities on top of gum disease, it is double trouble. It means your risk of stroke or adverse heart event doubles,” Sen said.
But, if someone takes care of their mouth — including brushing, flossing and regular dentist visits for preventative cleaning — risk decreases.
“Their risk of having a stroke dropped by as much as 81%, which is a very big finding,” Sen said of the research.
The research just shows an association, so it does not prove that poor oral health causes strokes — but these findings add to growing evidence that oral health may have a significant impact on cardiovascular health.
With 3.5 billion people worldwide suffering from gum disease or cavities, according to the World Health Organization, researchers say prevention and treatment could be an important part of stroke prevention. According to the American Heart Association, more than 795,000 people have a stroke each year in the U.S.
A Mayo Clinic visualization tool can help you decide if cholesterol-lowering statin drugs are right for you.
“Physicians have a duty to inform their patients about the risks and benefits of the interventions available to them. However, physicians rarely communicate with methods that convey absolute information, such as numbers needed to treat, numbers needed to harm, or prolongation of life, despite patients wanting this information.” That is, for example, how many people are actually helped by a particular drug, how many are actually hurt by it, or how much longer the drug will enable you to live, respectively.
If doctors inform patients only about the relative risk reduction—for example, telling them a pill will cut their risk of heart attacks by 34 percent—nine out of ten agree to take it. However, give them the same information framed as absolute risk reduction—“1.4% fewer patients had heart attacks”—then those agreeing to take the drug drops to only four out of ten. And, if they use the number needed to treat, only three in ten patients would agree to take the pill. So, if you’re a doctor and you really want your patient to take the drug, which statistic are you going to use?
The use of relative risk stats to inflate the benefits and absolute risk stats to downplay any side effects has been referred to as “statistical deception.” To see how one might spin a study to accomplish this, let’s look at an example. As you can see below and at 1:49 in my video, The True Benefits vs. Side Effects of Statins, there is a significantly lower risk of the incidence of heart attack over five years in study participants randomized to a placebo compared to those getting the drug. If you wanted statins to sound good, you’d use the relative risk reduction (24 percent lower risk). If you wanted statins to sound bad, you’d use the absolute risk reduction (3 percent fewer heart attacks).
Then you could flip it for side effects. For example, the researchers found that 0.3 percent (1 out of 290 women in the placebo group) got breast cancer over five years, compared to 4.1 percent (12 out of 286) in the statin group. So, a pro-statin spin might be a 24 percent drop in heart attack risk and only 3.8 percent more breast cancers, whereas an anti-statin spin might be only 3 percent fewer heart attacks compared to a 1,267 percent higher risk of breast cancer. Both portrayals are technically true, but you can see how easily you could manipulate people if you picked and chose how you were presenting the risks and benefits. So, ideally, you’d use both the relative risk reduction stat and the absolute risk reduction stat.
In terms of benefits, when you compile many statin trials, it looks like the relative risk reduction is 25 percent. So, if your ten-year risk of a heart attack or stroke is 5 percent, then taking a statin could lower that from 5 percent to 3.75 percent, for an absolute risk reduction of 1.25 percent, or a number needed to treat of 80, meaning there’s about a 1 in 80 chance that you’d avoid a heart attack or stroke by taking the drug for the next ten years. As you can see, as your baseline risk gets higher and higher, even though you have that same 25 percent risk reduction, your absolute risk reduction gets bigger and bigger. And, with a 20 percent baseline risk, that means you have a 1 in 20 chance of avoiding a heart attack or stroke over the subsequent decade if you take the drug, as seen below and at 3:31 in my video.
So, those are the benefits. In terms of risk, that breast cancer finding appears to be a fluke. Put together all the studies, and “there was no association between use of statins and the risk of cancer.” In terms of muscle problems, estimates of risk range from approximately 1 in 1,000 to closer to 1 in 50.
If all those numbers just blur together, the Mayo Clinic developed a great visualization tool, seen below and at 4:39 in my video.
For those at average risk, 10 people out of 100 who do not take a statin may have a heart attack over the next ten years. If, however, all 100 people took a statin every day for those ten years, 8 would still have a heart attack, but 2 would be spared, so there’s about a 1 in 50 chance that taking the drug would help avert a heart attack over the next decade. What are the downsides? The cost and inconvenience of taking a pill every day, which can cause some gastrointestinal side effects, muscle aching, and stiffness in about 5 percent, reversible liver inflammation in 2 percent, and more serious damage in perhaps 1 in 20,000 patients.
Note that the two happy faces in the bottom left row of the YES STATIN chart represent heart attacks averted, not lives saved. The chance that a few years of statins will actually save your life if you have no known heart disease is about 1 in 250.
If you want a more personalized approach, the Mayo Clinic has an interactive tool that lets you calculate your ten-year risk. You can get there directly by going to bit.ly/statindecision.
A chef from California’s Central Coast who had two strokes while traveling internationally on American Airlines was awarded more than $9 million after a federal jury concluded employees failed to follow their own protocols to help him.
In November 2021, Jesus Plasencia, a chef from Watsonville who was 67 at the time, was traveling with his wife, Ana Maria Marcela Tavantzis, on a flight to Madrid from Miami, according to a complaint they filed in federal civil court.
While the plane was still at the gate, Plasencia suffered a “mini stroke” and temporarily lost the ability to speak or pick up his phone, according to the complaint. His wife alerted a flight attendant and the pilot but instead of alerting medical personnel and following company policy, the lawsuit said the pilot dismissed her concerns, “joked with Plasencia, and cleared him for take-off.”
Plasencia then had a stroke while the plane was in the air; he was hospitalized after the plane landed in Spain and was in critical condition for more than three weeks before he went back to the U.S., according to court documents. He can’t speak or write and now “depends entirely on daily, significant, around-the-clock, in-home care and intensive rehabilitation,” according to the lawsuit.
On Thursday, a federal jury in San Jose said American Airlines was on the hook for $9.6 million for its employees failing to follow company protocol in the incident.
According to the complaint filed in 2023, the flight crew had asked other passengers to monitor Plasencia after he suffered a stroke during the flight, but didn’t tell the pilot about the medical emergency, so the flight wasn’t diverted.
The couple argued that because American Airlines crew hadn’t followed protocols, Plasencia was delayed getting care for nearly eight hours and could’ve potentially had a better outcome, according to the lawsuit.
“The safety and well-being of our passengers is our highest priority,” American Airlines said in a statement. “While we respect the jury’s decision, we disagree with the verdict and are currently evaluating next steps.”
Darren Nicholson of Burns Charest, who represented the couple in the lawsuit, argued that the airline didn’t follow stroke protocol, which calls for immediate medical assistance and diverting the aircraft.
“It is shocking that American Airlines responded so poorly to a medical emergency like this,” he said in a statement.
American Airlines was found liable by the jurors under the Montreal Convention, an international treaty that governs international air travel.
How can you calculate your own personal heart disease risk to help you determine if you should start on a cholesterol-lowering statin drug?
The muscle-related side effects from cholesterol-lowering statins “are often severe enough for patients to stop taking the drug. Of course, these side effects could be coincidental or psychosomatic and have nothing to do with the drug,” given that many clinical trials show such side effects are rare. “It is also possible that previous clinical trials”—funded by the drug companies themselves—“under-recorded the side effects of statins.” The bottom line is that there’s an urgent need to establish the true incidence of statin side effects.
“What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug?” That’s the title of a journal article that reports that, even in trials funded by Big Pharma, “only a small minority of symptoms reported on statins are genuinely due to the statins,” and those taking statins are significantly more likely to develop type 2 diabetes than those randomized to placebo sugar pills. Why? We’re still not exactly sure, but statins may have the double-whammy effect of impairing insulin secretion from the pancreas while also diminishing insulin’s effectiveness by increasing insulin resistance.
Even short-term use of statins may “approximately double the odds of developing diabetes and diabetic complications.” As shown below and at 1:49 in my video Who Should Take Statins?, fewer people develop diabetes and diabetic complications off statins over a period of about five years than those who do develop diabetes while on statins. “Of more concern, this increased risk persisted for at least 5 years after statin use stopped.”
“In view of the overwhelming benefit of statins in the reduction of cardiovascular events,” the number one killer of men and women, any increase in risk of diabetes, our seventh leading cause of death, would be outweighed by any cardiovascular benefits, right? That’s a false dichotomy. We don’t have to choose between heart disease and diabetes. We can treat the cause of both with the same diet and lifestyle changes. The diet that can not only stop heart disease, but also reverse it, is the same one that can reverse type 2 diabetes. But what if, for whatever reason, you refuse to change your diet and lifestyle? In that case, what are the risks and benefits of starting statins? Don’t expect to get the full scoop from your doctor, as most seemed clueless about statins’ causal link with diabetes, so only a small fraction even bring it up with their patients.
“Overall, in patients for whom statin treatment is recommended by current guidelines, the benefits greatly outweigh the risks.” But that’s for you to decide. Before we quantify exactly what the risks and benefits are, what exactly are the recommendations of current guidelines?
How should you decide if a statin is right for you? “If you have a history of heart disease or stroke, taking a statin medication is recommended, without considering your cholesterol levels.” Period. Full stop. No discussion needed. “If you do not yet have any known cardiovascular disease,” then the decision should be based on calculating your own personal risk. If you know your cholesterol and blood pressure numbers, it’s easy to do that online with the American College of Cardiology risk estimator or the Framingham risk profiler.
My favorite is the American College of Cardiology’s estimator because it gives you your current ten-year risk and also your lifetime risk. So, for a person with a 5.8 percent risk of having a heart attack or stroke within the next decade, if they don’t clean up their act, that lifetime risk jumps to 46 percent, nearly a flip of the coin. If they improved their cholesterol and blood pressure, though, they could reduce that risk by more than tenfold, down to 3.9 percent, as shown below and at 4:11 in my video.
Since the statin decision is based on your ten-year risk, what do you do with that number? As you can see here and at 4:48 in my video, under the current guidelines, if your ten-year risk is under 5 percent, then, unless there are extenuating circumstances, you should just stick to diet, exercise, and smoking cessation to bring down your numbers. In contrast, if your ten-year risk hits 20 percent, then the recommendation is to add a statin drug on top of making lifestyle modifications. Unless there are risk-enhancing factors, the tendency is to stick with lifestyle changes if risk is less than 7.5 percent and to move towards adding drugs if above 7.5 percent.
Risk-enhancing factors that your doctor should take into account when helping you make the decision include a bad family history, really high LDL cholesterol, metabolic syndrome, chronic kidney or inflammatory conditions, or persistently high triglycerides, C-reactive protein, or LP(a). You can see the whole list here and at 4:54 in my video.
If you’re still uncertain, guidelines suggest you consider getting a coronary artery calcium (CAC) score, but even though the radiation exposure from that test is relatively low these days, the U.S. Preventive Services Task Force has explicitly concluded that the current evidence is insufficient to conclude that the benefits outweigh the harms.
Country star Ronnie McDowell suffered a stroke mid-performance at the Summer Solstice Music Festival in Pennsylvania earlier this summer.
McDowell slurred his words onstage June 21 in Oley, before his son and tour manager stepped in and paused to show to make sure his dad was OK.
In a new interview with Town & Country, McDowell revealed what he told his son at that moment.
Ronnie McDowell reveals he had to have surgery after suffering from a stroke onstage.(Erika Goldring/FilmMagic)
“And I said, ‘No, I think I’m having a stroke,’” he told the outlet. Ronnie was taken to a nearby hospital in Pennsylvania where the stroke was later confirmed.
At the hospital, McDowell was informed that surgery was needed to clear the blockage that caused the stroke. He was told by the doctors onsite that he could travel home for the procedure and emergency surgery was not needed.
“[The doctor] said, ‘I’m gonna let you go home, and let me tell you why. I’ve been doing this 30-something years. I listened to your heart, and you’ve got the strongest heart I have ever heard,’” McDowell recalled the conversation with his doctor.
“[The doctor] said, ‘I’m gonna let you go home, and let me tell you why. I’ve been doing this 30-something years. I listened to your heart, and you’ve got the strongest heart I have ever heard.’”
— Ronnie McDowell
He continued, “He said, ‘That’s what saved you. Because you were 70-, almost 80 percent blocked.’ He said, ‘Your heart was pumping through that really hard, and it scraped the plaque off.’”
McDowell had surgery a few weeks after his onstage stroke. He told the outlet that it was a successful procedure, but did not come without complications.
“They woke me up the first time, and the doctor said, ‘Ronnie, I hate to tell you this, but we gotta put you back to sleep, because a…hematoma formed and we’ve got to wash it out,’” McDowell recalled.
His son, Tyler, told the outlet that the hematoma that formed was due to blood thinners his father was on.
Ronnie McDowell gained fame in the 1970s.(ABC Photo Archives/Disney General Entertainment Content via Getty Images)
Following the surgery, McDowell had some issues recovering from the anesthesia.
“It was quite unbearable. The swelling and how I felt was just terrible, but I’m improving every day,” McDowell said.
The singer thanked fans for the overwhelming support she’s received since the stroke.
“Most times I go to my mailbox there’s so much mail in there, I can’t hardly get it out. I’m sure the post office is wondering why Ronnie McDowell is getting so much mail all of the sudden. But it just shows you how people care,” he said.
Dick Clark and Ronnie McDowell hosting “Coverage” in 1977.(ABC Photo Archives/Disney General Entertainment Content via Getty Images)
McDowell, 75, has a new appreciation for life after his health scare.
“It makes you realize, every morning when we get up — you, me, every human — that we take for granted that all this stuff is just gonna work perfectly.
“You know, we’ll all so fearfully but wonderfully made. I mean, just, in a second, you can be dead. When the ticker stops ticking, you’re gonna leave here anyway,” he told the outlet.
“It made me realize even more that we are all so fearfully but wonderfully made,” McDowell concluded.
Ronnie McDowell in 1970.(Michael Ochs Archives/Getty Images)
McDowell gained fame in the 1970s after releasing the song “The King Is Gone,” which paid tribute to Elvis Presley. He quickly released another hit, “I Love You, I Love You, I Love You.”
He went on to release a string of hit albums and singles between 1979 and 1986. During this time, he was best known for his songs “Older Women” and “You’re Gonna Ruin My Bad Reputation.”
Other hits released by McDowell include “Watchin’ Girls Go By,” “Personally,” “You Made A Wanted Man Of Me,” “All Tied Up” and “In A New York Minute.”
Janelle Ash is an entertainment writer for Fox News Digital. Story tips can be sent to janelle.ash@fox.com.
Restaurateur Tommy Fello was driving from his Ohio establishment to his house on Christmas Eve when he started veering off the road. Fello, then 71, had been awake since 4 a.m. local time preparing a holiday buffet for his family. He chalked the disturbance up to a flat tire. Driving slowly and relying on the vehicle’s autocorrect feature, he was able to complete his journey home safely.
But when Fello stepped out of the truck, he couldn’t get his balance.
“I finally realized it wasn’t the truck that was veering. It was me that was veering,” Fello said. He went indoors and talked to his wife and daughter, who said he looked unwell. About five minutes later, they called 911. Paramedics took him to an area hospital, where he lost all movement in his left arm and leg.
“They were literally just like appendages on me. I could not feel them and could not do anything,” Fello said.
A clot-busting drug reversed the stroke, but the numbness on the left side of his body, including his face, remained. He struggled to swallow, eat or drink. Physical and occupational therapy produced only minor improvements.
Tommy Fello walks during a rehabilitative therapy session before his surgery.
Thomas Fello
Dr. Sharon Covey, Fello’s occupational therapist and the founder of the Center for Stroke and Hand Recovery, Inc., told CBS News that his arm was essentially stuck in a bent position with his fingers curled when he met her in January 2024. The position and tension in the limb caused Fello constant pain. Working in his restaurant was out of the question.
“It was very scary. You take for granted so many of the things you do, and even the common, simplest things become like a chore,” Fello said. “We mark all these small victories … Being able to lift up your arm or pick up a cup is a gigantic accomplishment. Those little accomplishments are gigantic to a stroke victim. They encouraged me to keep going on. But there was always a thought in the back of my mind: ‘Is this as good as it’s going to get?’”
A “first-of-its-kind technology”
One day, another recovering stroke patient suggested Fello look into an implant called the Vivistim System. The FDA-approved implant, developed by the medical device company MicroTransponder Inc., uses vagus nerve stimulation during rehabilitation to improve hand and arm function for stroke victims. The vagus nerves are the body’s longest cranial nerve, with one on each side of the body, according to the Cleveland Clinic. They regulate the body’s involuntary functions.
The Vivistim Therapy system involves a physical or occupational therapist sending wireless signals to the device. That signal delivers a brief, gentle pulse to the vagus nerve while the stroke patient performs rehabilitative tasks. The stroke patient also does at-home exercises.
Dr. Erez Nossek, a neurosurgeon and director of the cranial bypass program at NYU Langone, told CBS News that the vagus nerve stimulation can enhance the brain’s ability to rewire itself, known as neuroplasticity. That increased neuroplasticity can result in “greater and faster improvements in motor function for stroke survivors,” Nossek said in emailed remarks.
An illustration from MicroTransponder, Inc. shows the positioning of the Vivistim System device.
MicroTransponder, Inc.
“There is no other FDA-approved technology proven to boost neuroplasticity for stroke survivors, creating new connections in the brain, which is theirs to keep, even after the device is no longer in use,” Nossek said. “This is (a) first-of-its-kind technology that is redefining what is possible for this patient population.”
A 108-person trial published in The Lancet in 2021 found that the device generated two to three times greater improvement in hand and arm function for stroke survivors when compared with just rehab. Stroke patients who have limited hand and arm function six months or more after their stroke and are considered to have “moderate to severe deficits” qualify for the device, the company said in a fact sheet.
Implant aids in recovery
Fello turned to the Cleveland Clinic, where he met cerebrovascular neurosurgeon Dr. Mark Bain. He studies stroke recovery, especially in the cases of patients like Fello, whose rehab progress has plateaued months after the stroke. Bain determined that Fello was a candidate for the Vivistim System. Fello became the first Cleveland Clinic patient to receive the implant on April 29, 2025.
“It didn’t really scare me to try and do it. I was anxious to see how it worked,” Fello said.
The device was placed during an hour-long procedure. The vagus nerve sits just below the carotid artery, so Bain and his surgical team made a small incision to place the leads of the implant and hid the scar in a fold of Fello’s neck. The key-fob sized implant was placed under Fello’s clavicle. Bain said the procedure itself is low-risk, with “less than 1% chance of any complications.” Two weeks after the surgery, the device was turned on and Fello returned to his rehabilitative work with Covey.
Tommy Fello and Dr. Sharon Covey during a therapy session.
Cleveland Clinic
Covey said Fello has made huge progress since the device was implanted four months ago. She said he has no pain or tension in the limb, and is beginning to practice using his left arm to carry items. The task is difficult, she said, but isn’t “something he could have done before.” Fello, now 72, said he’s been thrilled by the progress he’s made in a short time.
“I’m very, very happy to do it, very proud to do it, and I’m glad I did it,” he said.
“The sky’s the limit”
About 800,000 people in the United States experience an ischemic stroke each year, Bain said. Vivistim and other new technologies may offer hope to the patients like Fello who struggle to recover with just rehabilitation, Bain said.
“I think over the next probably five to 10 years, what you’re going to see is an explosion of procedures, devices and things in rehab that will help people, once they’ve had strokes, to get their lives back,” Bain said. “In the future, I think the sky’s the limit for what we can expect for stroke recovery.”
At the time of his conversation with CBS News, Bain had given seven other stroke patients a Vivistim implant. Covey said at her practice, there are eight patients with the implant receiving the paired therapy course. MicroTransponder Inc. declined to say how many patients have received the implant, but shared a map that shows dozens of surgeons and rehabilitation therapists that provide the therapy.
“I think this is the newest, most effective strategy for people getting their affected limbs back,” Covey said. “This is the first real technique that has been available, at least in the last 20 years, for stroke rehab. The theories that we use as practitioners to increase somebody’s use of their affected arm are 50 to 75 years old. So this is a new technology that’s really going to turn the stroke recovery world upside down.”
Kerry Breen is a news editor at CBSNews.com. A graduate of New York University’s Arthur L. Carter School of Journalism, she previously worked at NBC News’ TODAY Digital. She covers current events, breaking news and issues including substance use.
Switching to a plant-based diet has been shown to achieve far better outcomes than those reported on conventional treatments for both active and quiescent stages of Crohn’s disease (CD) and ulcerative colitis.
Important to our understanding and the prevention of the global increase of inflammatory bowel disease (IBD), we know that “dietary fiber reduces risk, whereas dietary fat, animal protein, and sugar increase it.” “Despite the recognition of westernization of lifestyle as a major driver of the growing incidence of IBD, no countermeasures against such lifestyle changes have been recommended, except that patients with Crohn’s disease should not smoke.”
We know that “consuming whole, plant-based foods is synonymous with an anti-inflammatory diet.” Lists of foods with inflammatory effects and anti-inflammatory effects are shown here and at 0:50 in my video, The Best Diet for Crohn’s Disease.
How about putting a plant-based diet to the test?
Cutting down on red and processed meats didn’t work, but what about cutting down on all meat? A 25-year-old man “with newly diagnosed CD…failed to enter clinical remission despite standard medical therapy. After switching to a diet based exclusively on grains, legumes [beans, split peas, chickpeas, and lentils], vegetables, and fruits, he entered clinical remission without need for medication and showed no signs of CD on follow-up colonoscopy.”
It’s worth delving into some of the details. The conventional treatment he was started on is infliximab, sold as REMICADE®, which can cause a stroke and may increase our chances of getting lymphoma or other cancers. (It also costs $35,000 a year.) It may not even work in 35 to 40 percent of patients, and that seemed to be the case with the 25-year-old man. So, his dose was increased after 37 weeks, but he was still suffering after two years on the drug. Then he completely eliminated animal products and processed foods from his diet and finally experienced a complete resolution of his symptoms.
“Prior to this, his diet had been the typical American diet, consisting of meat, dairy products, refined grains, processed foods, and modest amounts of vegetables and fruits. Having experienced complete clinical remission for the first time since his Crohn’s disease diagnosis, the patient decided to switch to a whole food, plant-based diet permanently, severely reducing his intake of processed foods and limiting animal products to one serving, or less, per week.” Whenever his diet slipped, his symptoms started coming back, but he could always eliminate them by eating healthier again. After six months adhering to these diet and lifestyle changes, including stress relief and exercise, a follow-up “demonstrated complete mucosal healing [of the gut lining] with no visible evidence of Crohn’s disease.”
We know that “a diet consisting of whole grains, legumes, fruits, and vegetables has been shown to be helpful in the prevention and treatment of heart disease, obesity, diabetes, hypertension, gallbladder disease, rheumatoid arthritis, and many cancers. Although further research is required, this case report suggests that Crohn’s disease might be added to this list of conditions.” That further research has already been done! About 20 patients with Crohn’s disease were placed on a semi-vegetarian diet—no more than half a serving of fish once a week and half a serving of meat once every two weeks—and they achieved a 100 percent remission rate at one year and 90 percent at two years.
Some strayed from the diet, though. What happened to them? As you can see below and at 3:32 in my video, after one year, half had relapsed, and, at year two, only 20 percent had remained in remission. But those who stuck with the semi-veg diet had remarkable success. It was a small study with no formal control group, but it represents the best-reported result in Crohn’s relapse prevention published in the medical literature to date.
Nowadays, Crohn’s patients are often treated with so-called biologic drugs, expensive injected antibodies that suppress the immune system. They have effectively induced and maintained remission in Crohn’s disease, but not in everybody. The current remission rate in Crohn’s with early use of REMICADE® is 64 percent. So, 30 to 40 percent of patients “are likely to experience a disabling disease course even after their first treatment.” What about adding a plant-based diet? Remission rates jumped up to 100 percent for those who didn’t have to drop out due to drug side effects. Even after excluding milder cases, researchers found that 100 percent of those with serious, even “severe/fulminant disease, achieved remission.”
If we look at gold standard systematic reviews, they conclude that the effects of dietary interventions on inflammatory bowel diseases—Crohn’s disease and ulcerative colitis—are uncertain. However, this is because only randomized controlled trials were considered. That’s totally understandable, as that is the most rigorous study design. “Nevertheless, people with IBD deserve advice based on the ‘best available evidence’ rather than no advice at all…” And switching to a plant-based diet has been shown to achieve “far better outcomes” than those reported on conventional treatments in both active and quiescent stages in Crohn’s disease and ulcerative colitis. For example, below and at 5:37 in my video, you can see one-year remission rates in Crohn’s disease (100 percent) compared to budesonide, an immunosuppressant corticosteroid drug (30 to 40 percent), a half elemental diet, such as at-home tube feedings (64 percent), the $35,000-a-year drug REMICADE® (46 percent), or the $75,000-a-year drug Humira (57 percent).
Safer, cheaper, and more effective. That’s why some researchers have made the “recommendation of plant-based diets for inflammatory bowel disease.”
It would seem clear that treatment based on addressing the cause of the disease is optimal. Spreading the word about healthier diets could help halt the scourge of inflammatory bowel disease, but how will people hear about this amazing research without some kind of public education campaign? That’s what NutritionFacts.org is all about.
Plant-based diets can be 98 percent effective in keeping ulcerative colitis patients in remission, far exceeding the efficacy of other treatments.
“One of the most common questions physicians treating patients with IBD [inflammatory bowel disease] are asked is whether changing diet could positively affect the course of their disease.” Traditionally, we had to respond that we didn’t know. That may now be changing, given the “evidence in the literature that hydrogen sulfide may play a role in UC,” ulcerative colitis. And, since the sulfur-containing amino acids concentrated in meat cause an increase in colonic levels of this rotten egg gas, perhaps we should “take off the meat.” Indeed, animal protein isn’t associated only with an increased risk of getting inflammatory bowel disease in the first place, but also IBD relapses once you have the disease.
This is a recent development. “Because the concept of IBD as a lifestyle disease mediated mainly by a westernized diet is not widely appreciated, an analysis of diet in the follow-up period [after diagnosis] in relation to a relapse of IBD has been ignored”—but no longer. Ulcerative colitis patients in remission and their diets were followed for a year to see which foods were linked to the return of their bloody diarrhea. Researchers found that the “strongest relationship between a dietary factor and an increased risk of relapse observed in this study was for a high intake of meat,” as I discuss in my video The Best Diet for Ulcerative Colitis Treatment.
What if people lower their intake of sulfur-containing amino acids by decreasing their consumption of animal products? Researchers tried this on four ulcerative colitis patients, and without any change in their medications, the patients experienced about a fourfold improvement in their loose stools. In fact, they felt so much better that the researchers didn’t think it was ethical to try switching the patients back to their typical diets. “Sulfur-containing amino acids are the primary source of dietary sulfur,” so a “low-sulfur” diet essentially means “a shift from a more traditional western diet (high in animal protein and fat, and low in fiber) to more of a plant-based diet (high in fiber, lower in animal protein and fat).” “Altogether, westernized diets are pro-inflammatory, and PBD [plant-based diets] are anti-inflammatory.”
What can treatment with a plant-based diet do after the onset of ulcerative colitis during a low-carbohydrate weight-loss diet? A 36-year-old man lost 13 pounds on a low-carb diet, but he also lost his health; he was diagnosed with ulcerative colitis. When he was put on a diet centered around whole plant foods, his symptoms resolved without medication. He achieved remission. That was just one case, though. Case reports are akin to glorified anecdotes. The value of case reports lies in their ability to inspire researchers to put them to the test, and that’s exactly what they did.
Until then, there had never been a study published that focused on using plant-based diets for treating ulcerative colitis. Wrote the researchers, a group of Japanese gastroenterologists, “We consider that the lack of a suitable diet is the biggest issue faced in the current treatment of IBD. We regard IBD as a lifestyle disease caused mainly by our omnivorous (Western) diet. We have been providing a plant-based diet (PBD) to all patients with IBD” for more than a decade and have published extraordinary results, far better than have been reported elsewhere in the medical literature to date. (I profiled some of their early work in one of the first videos that went up on NutritionFacts.org.) The researchers found a plant-based diet to be “effective in the maintenance of remission” in Crohn’s disease by 100 percent at one year and 90 percent at two years. What about a plant-based diet for relapse prevention in ulcerative colitis?
“Educational hospitalization” involved bringing patients into the hospital to control their diet and educate them about the benefits of plant-based eating (so they’d be more motivated to continue it at home). “Most patients (77%) experienced some improvement, such as disappearance or decrease of bloody stool during hospitalization.” Fantastic!
Here’s the really exciting part. The researchers then followed the patients for five years, and 81 percent of them remained in remission for the entire five years, and 98 percent kept the disease at bay for at least one year. That blows away other treatments. Those relapse rates are far lower than those reported with medication. Under conventional treatment, other studies found that about half of the individuals relapse, compared to only 2 percent of those taught to eat healthier.
“A PBD was previously shown to be effective in both the active and quiescent stages of Crohn’s disease. The current study showed that a PBD is effective in both the active and quiescent stages of UC as well.” So, the researchers did another study on even more severely affected cases with active disease and found the same results, with plant-based eating beating conventional drug therapy by far. People felt so much better that they were still eating more plant-based food even six years later. The researchers conclude that a plant-based diet is effective for treating ulcerative colitis to prevent a relapse.
Why? Well, plant-based diets are rich in fiber, which feeds our good gut bugs. “This observation might partly explain why a PBD prevents a variety of chronic diseases. Indeed, the same explanation applies to IBD, indicating that replacing an omnivorous diet with a PBD in IBD is the right approach.”
It’s like using plant-based diets to treat the cause of heart disease, our number one killer. Plant-based eating isn’t only safer and cheaper, but it also works better with no noted adverse side effects. Let’s compare that to the laundry list of side effects of immunosuppressants used for ulcerative colitis, like cyclosporine, which you can see below and at 5:40 in my video.
We now have even fancier drugs costing about $60,000 a year, about $5,000 a month, and they don’t even work very well; clinical remission at one year is only about 17 to 34 percent. And, instead of no adverse side effects, the drugs can give us a stroke, give us heart failure, and can even give us cancer, including a rare type of cancer that often results in death. Also, a serious brain disease known as progressive multifocal leukoencephalopathy, which can kill us, and for which there is no known treatment or cure. One drug lists an “increased risk of death” but touts that it’s just “a small pill” in an “easy-to-open bottle.” I’d skip the pills (and their potential side effects) and stick with plant-based eating.
The diving reflex shows that it’s possible to have selective adrenal hormone effects.
Thermogenic drugs like DNP can cause people to overheat to death; they can increase resting metabolic rates by 300 percent or more. A more physiological spread would range about ten times less, from a 30 percent slower metabolism in people with an underactive thyroid to a 30 percent higher metabolism when the part of our nervous system that controls our fight-or-flight response is activated. In response to a fright or acute stress, special nerves release a chemical called noradrenaline to ready us for confrontation. We experience this by our skin getting paler, cold, and clammy, as blood is diverted to our more vital organs. Our mouth can get dry as our digestive system is put on hold, and our heart starts to beat faster. What we don’t feel is the extra fat being burned to liberate energy for the fight.
That’s why people started taking ephedra for weight loss—“to stimulate the release of noradrenaline from nerve endings.”
Ephedra is an evergreen shrub. It’s been used in China for thousands of years to treat asthma because it causes that same release of noradrenaline that offers relief to people with asthma by dilating their airways. In the United States, it was appropriated for use as a metabolic stimulant, shown to result in about 2 pounds (0.9 kg) of weight loss a month in 19 placebo-controlled trials. By the late 1990s, millions of Americans were taking it. The problem is that it also had all the other noradrenaline effects, like increasing heart rate and blood pressure. So, chronic use resulted in “stroke, cardiac arrhythmia, and death.” The U.S. Food and Drug Administration warned of its risks in 1994, but ephedra wasn’t banned until a decade later after a 23-year-old Major League Baseball pitcher dropped dead. His “autopsy report revealed evidence of ephedra, which the medical examiner said contributed to his death.”
In the current Wild West of dietary supplement regulation, not only can a supplement be “marketed without any safety data” at all, but the manufacturer is under no obligation to disclose adverse effects that may arise. No surprise, then, that online vendors assured absolute safety: “No negative side effects to date.” “No adverse side-effects, no nervous jitters or underlying anxiety, no moodiness…” “100% safe for long-term use.” “It will not interact with medications and has no harmful side effects.” The president of Metabolife International, a leading seller of ephedra, assured the FDA that the company had never received a single “notice from a consumer that any serious adverse health event has occurred…” In reality, it had received about 13,000 health complaints, including reports of serious injuries, hospitalizations, and even deaths.
If only there were a way to get the good without the bad. As I discuss in my video How to Get the Weight Loss Benefits of Ephedra Without the Risks, there is. But to understand it, you first have to grasp a remarkable biological phenomenon known as the diving reflex.
Imagine walking across a frozen lake and suddenly falling through the ice, plunging into the freezing depths. It’s hard to think of a greater, instantaneous fight-or-flight shock than that. Indeed, noradrenaline would be released, causing the blood vessels in your arms and legs to constrict to bring blood back to your core. You can imagine how fast your heart might start racing, but that would be counterproductive because you’d use up your oxygen faster. Remarkably, what happens instead is your heart rate slows down. That’s the diving reflex, first described in the 1700s. Air-breathing animals are born with this automatic safety feature to help keep us from drowning.
In medicine, we can exploit this physiological quirk with what’s called a “cold face test.” To determine if a comatose patient has intact neural pathways, you can apply cold compresses to their face to see if their heart immediately starts slowing down. Or, more dramatically, it can be used to treat people who flip into an abnormally rapid heartbeat. Remember that episode of ER where Carter dunked a patient’s face into a tray of ice water? (That show aired on TV when I was in medical school, and a group of us would gather around and count how many times they violated “universal precautions.”)
What does this have to do with weight loss? The problem with noradrenaline-releasing drugs like ephedra is the accompanying rise in heart rate and blood pressure. What the diving reflex shows is that it’s possible to experience selective noradrenaline effects, raising the possibility that there may be a way to get the metabolic boost without the risk of stroking out. Unbelievably, this intricate physiological feat may be accomplished by the simplest of acts: Instead of drowning in water, simply drink it. Really? Yes, you can boost your metabolism by drinking water. Buckle your safety belts because you are in for a wild ride—one that continues next.
This is the first in a four-part video series. Stay tuned for:
Those on a healthy plant-based diet who have elevated homocysteine levels despite taking sufficient vitamin B12 may want to consider taking a gram a day of contaminant-free creatine.
The average blood levels of homocysteine in men are about 1.5 points higher than in women, which may be one of the reasons men tend to be at higher risk for cardiovascular disease. Women don’t need to make as much creatine as men since they tend to have less muscle mass. That may help explain “the ‘gender gap’ in homocysteine levels.” If you remember from my previous video and as seen below and at 0:36 in The Efficacy and Safety of Creatine for High Homocysteine, in the process of making creatine, our body produces homocysteine as a by-product. So, for people with stubbornly high homocysteine levels that don’t respond sufficiently to B vitamins, “creatine supplementation may represent a practical strategy for decreasing plasma homocysteine levels”—that is, lowering the level of homocysteine into the normal range.
It seemed to work in rats. What about humans? Well, it worked in one study, but it didn’t seem to work in another. It didn’t work in yet another either. And, in another study, homocysteine levels were even driven up. So, this suggestion that taking creatine supplements would lower homocysteine was called into question.
However, all those studies were done with non-vegetarians, so they were already effectively supplementing with creatine every day in the form of muscle meat. In that way, researchers were testing higher versus lower supplementation. Those eating strictly plant-based make all their creatine from scratch, so they may be more sensitive to an added creatine source. There weren’t any studies on creatine supplementation in vegans to lower homocysteine until now.
Researchers took vegans who were not supplementing their diets with vitamin B12, so some of their homocysteine levels were through the roof. A few were as high as 50 when the ideal is more like under 10, for example. After taking some creatine for a few weeks, all of their homocysteine levels normalized. You can see the before and after in the graph below and at 2:04 in my video.
Now, they didn’t normalize, as that would have been a level under 10, but that’s presumably because they weren’t taking any B12. Give vegetarians and vegans vitamin B12 supplements, either dosing daily or once a week, and their levels normalize in a matter of months, as you can see below and at 2:20 in my video. However, the fact that you could bring down homocysteine levels with creatine alone, even without any B12, suggests—to me at least—that if your homocysteine is elevated (above 10) on a plant-based diet despite taking B12 supplements and eating greens and beans to get enough folate, it might be worth experimenting with supplementing with a gram of creatine a day for a few weeks to see if your homocysteine comes down.
Why just a single gram? That’s approximately how much non-vegetarians do not have to make themselves; it’s the amount that erased vegetarian discrepancies in blood and muscle, as you can see in the graph below and at 3:01 in my video, and how much has been shown to be safe in the longer term.
How safe is it? We can take a bit of comfort in the fact that it’s “one of the world’s best-selling dietary supplements,” with literally billions of servings taken, and the only consistently reported side effect has been weight gain, presumed to be from water retention. The only serious side effects appear to be among those with pre-existing kidney diseases taking whopping doses closer to 20 grams a day. A concern was raised that creatine could potentially form a carcinogen known as N-nitrososarcosine when it hit the acid bath of the stomach, but, when it actually put to the test, researchers found this does not appear to be a problem.
Bottom line: Doses of supplemental creatine up to 3 grams a day are “unlikely to pose any risk,” provided “high purity creatine” is used. However, as we all know, dietary supplements in the United States “are not regulated by the US Food and Drug Administration and may contain contaminants or variable quantities of the desired supplement” and may not even contain what’s on the label. We’re talking about “contaminants…that may be generated during the industrial production.” When researchers looked at 33 samples of creatine supplements made in the United States and Europe, they found that they all actually contained creatine, which is nice, but about half exceeded the maximum level recommended by food safety authorities for at least one contaminant. The researchers recommend that “consumers give their preference to products obtained by producers that ensure the highest quality control and certify the maximum amount of contaminants present in their products.” Easier said than done.
Because of the potential risks, I don’t think people should take creatine supplements willy-nilly, but the potential benefits may exceed the potential risks if, again, you’re on a healthy plant-based diet and taking B12, and your homocysteine levels are still not under 10. In that case, I would suggest giving a gram a day of creatine a trying to see if it brings it down.
The reason I did this whole video series goes back to “Risks of Ischaemic Heart Disease and Stroke in Meat Eaters, Fish Eaters, and Vegetarians Over 18 Years of Follow-Up: Results from the Prospective EPIC-Oxford Study,” which found that, although the overall cardiovascular risk is lower in vegetarians and vegans combined, they appeared to be at slightly higher stroke risk, as you can see in the graph below and at 5:06 in my video.
I went through a list of potential causes, as you can see at 5:11 and below, and arrived at elevated homocysteine. What’s the solution? A regular, reliable source of vitamin B12. The cheapest, easiest method that I personally use is one 2,500 mcg chewable tablet of cyanocobalamin, the most stable source of B12, once a week. (In fact, you can just use 2,000 mcg once a week.) And, again, a backup plan for those doing that but still having elevated homocysteine is an empirical trial of a single gram a day of creatine supplementation, which was shown to improve at least capillary blood flow in those who started out with high homocysteine levels.
In sum, plant-based diets appear to “markedly reduce risk” for multiple leading killer diseases—heart disease, type 2 diabetes, and many common types of cancer—but “an increased risk for stroke may represent an ‘Achilles heel.’ Nonetheless, vegans have the potential to achieve a truly exceptional ‘healthspan’ if they face this problem forthrightly by restricting salt intake and taking other practical measures that promote cerebrovascular [brain artery] health…Nonetheless, these considerations do not justify nutritional nihilism. On balance, low-fat vegan diets offer such versatile protection for long-term health that they remain highly recommendable. Most likely, the optimal strategy is to adopt such a [plant-based] diet, along with additional measures—appropriate food choices, exercising training, judicious supplementation [of vitamin B12]—that will mitigate the associated stroke risk.” And try not to huff whipped cream charging canister gas. Leave the “whippets” alone.
This concludes my series on stroke risk. If you missed any of the other videos, see the related posts below.
I’m assuming that nearly everyone taking their B12 will have normal homocysteine levels, so these last two videos are just for the rare person who doesn’t. However, those on a healthy plant-based diet with elevated homocysteine levels despite taking sufficient vitamin B12 should consider taking a gram a day of contaminant-free creatine, which should be about a quarter teaspoon.
Where do you get contaminant-free creatine? Since regulations are so lax, you can’t rely on supplement manufacturers no matter what they say, so I would recommend going directly to the chemical suppliers that sell it to laboratories and guarantee a certain purity. Here are some examples (in alphabetical order) of some of the largest companies where you can get unadulterated creatine: Alfa Aesar, Fisher Scientific, Sigma-Aldrich, and TCI America.
What are the consequences of having to make your creatine rather than relying on dietary sources?
“Almost universally, research findings show a poor vitamin B12 status among vegetarians” because they aren’t taking vitamin B12 supplements like they should, which results in an elevation in homocysteine levels. This may explain why vegetarians were recently found to have higher rates of stroke, as you can see in the graph below and at 0:30 in my video Should Vegetarians Take Creatine to Normalize Homocysteine?.
Of course, plant-based eating is just one of many ways to become deficient in vitamin B12. Even nitrous oxide (laughing gas) can do it in as little as two days, thanks to the recreational use of whipped cream canister gas. (I just learned about “whippits”!)
When researchers gave vegetarians and vegans as little as 50 daily micrograms of cyanocobalamin, which is the recommended and most stable form of vitamin B12 supplement, their homocysteine levels, which had started up in the elevated zone, normalized right down into the safe zone under 10 mmol/L within only one to two months. Just 2,000 micrograms of cyanocobalamin once a week gave the same beautiful result, as you can see in the graph below and at 1:15 in my video.
Not always, though. In another study, even 500 daily micrograms, taken as either a sublingual chewable or swallowable regular B12 supplement, didn’t normalize homocysteine within a month, as shown below and at 1:24. Now, presumably, if the participants had kept it up, their levels would have continued to fall as they did in the 50-daily-microgram study.
If you’re plant-based and have been taking your B12, but your homocysteine level is still too high (above 10 mmol/L), is there anything else you can do? Well, inadequate folate intake can also increase homocysteine, but folate comes from the same root as foliage. It’s found in beans and leaves, concentrated in greens. If you’re eating beans and greens, taking your B12, and your homocysteine level is still too high, I’d suggest taking 1 gram of creatine a day as an experiment, then getting your homocysteine levels retested in a month to see if it helped.
Creatine is a compound formed naturally in the human body that is primarily involved with energy production in our muscles and brain. It’s also formed naturally in the bodies of many other animals. So, when we eat their muscles, we can also take in some of the creatine in their bodies through our diet. We only need about 2 grams of creatine a day, so those who eat meat may get about 1 gram from their diet and their body makes the rest from scratch. There are rare birth defects where you’re born without the ability to make it, in which case, you have to get it from your diet. Otherwise, our bodies can make as much as we need to maintain normal concentrations in our muscles.
As you can see in the graph below and at 2:54 in my video, when you cut out meat, the amount of creatine floating around in your bloodstream goes down.
However, the amount in your brain remains the same, as shown in the graph below and at 2:57. This shows that dietary creatinine doesn’t influence the levels of brain creatine, because our brain makes all the creatine we need. The level in vegetarian muscles is lower, but that doesn’t seem to affect exercise performance, as both vegetarians and meat eaters respond to creatine supplementation with similar increases in muscle power output. If vegetarian muscle creatine were insufficient, then presumably an even bigger boost would be seen. So, all that seems to happen when we eat meat is that our body doesn’t have to make as much. What does all of this have to do with homocysteine?
As you can see below and at 3:36 in my video, in the process of making creatine, our body produces homocysteine as a waste product. Now, normally this isn’t a problem because our body has two ways to detoxify it: by using vitamin B6 or a combination of vitamin B12 and folate. Vitamin B6 is found in both plant and animal foods, and it’s rare to be deficient. But, vitamin B12 is mainly found in animal foods, so its level can be too low in those eating plant-based who don’t also supplement or eat B12-fortified foods. And, as I mentioned, folate is concentrated in plant foods, so it can be low in those who don’t regularly eat greens, beans, or folic-acid-fortified grains. Without that escape valve, homocysteine levels can get too high. However, if you’re eating a healthy plant-based diet and taking your B12 supplement, your homocysteine levels should be fine.
What if they aren’t? We might predict that if we started taking creatine supplements, our level of homocysteine might go down since we won’t have to make so much of it from scratch, producing homocysteine as a by-product, but you don’t know until you put it to the test. I’ll cover that next.
This whole creatine angle was new to me. I had long worried about homocysteine levels being too high among those getting inadequate B12 intake, but I didn’t realize there was another potential mechanism for bringing it down other than with vitamin B. Let’s see if it pans out in my final video of the series: The Efficacy and Safety of Creatine for High Homocysteine.
Many doctors mistakenly rely on serum B12 levels in the blood to test for vitamin B12 deficiency.
There were two cases of young, strictly vegetarian individuals with no known vascular risk factors. One suffered a stroke, and the other had multiple strokes. Why? Most probably because they weren’t taking vitamin B12 supplements, which leads to high homocysteine levels, which can attack our arteries.
So, those eating plant-based who fail to supplement with B12 may increase their risk of both heart disease and stroke. However, as you can see in the graph below and at 0:47 in my videoHow to Test for Functional Vitamin B12 Deficiency, vegetarians have so many heart disease risk factor benefits that they are still at lower risk overall, but this may help explain why vegetarians were found to have more stroke. This disparity would presumably disappear with adequate B12 supplementation, and the benefit of lower heart disease risk would grow even larger.
Compared with non-vegetarians, vegetarians enjoy myriad other advantages, such as better cholesterol, blood pressure, blood sugars, and obesity rates. But, what about that stroke study? Even among studies that have shown benefits, “the effect was not as pronounced as expected, which may be a result of poor vitamin B12 status due to a vegetarian diet. Vitamin B12 deficiency may negate the cardiovascular disease prevention benefits of vegetarian diets. To further reduce the risk of cardiovascular disease, vegetarians should be advised to use vitamin B12 supplements.”
How can you determine your B12 status? By the time you’re symptomatic with B12 deficiency, it’s too late. And, initially, the symptoms can be so subtle that you might even miss them. What’s more, you develop metabolic vitamin B12 deficiency well before you develop a clinical deficiency, so there’s “a missed opportunity to prevent dementia and stroke” when you have enough B12 to avoid deficiency symptoms, but not enough to keep your homocysteine in check. “Underdiagnosis of this condition results largely from a failure to understand that a normal serum [blood level] B12 may not reflect an adequate functional B12 status.” The levels of B12 in our blood do not always represent the levels of B12 in our cells. We can have severe functional deficiency of B12 even though our blood levels are normal or even high.
“Most physicians tend to assume that if the serum B12 is ‘normal,’ there is no problem,” but, within the lower range of normal, 30 percent of patients could have metabolic B12 deficiency, with high homocysteine levels.
Directly measuring levels of methylmalonic acid (MMA) or homocysteine is a “more accurate reflection of vitamin B12 functional statuses.” Methylmalonic acid can be checked with a simple urine test; you’re looking for less than a value of 4 micrograms per milligram of creatinine. “Elevated MMA is a specific marker of vitamin B12 deficiency while Hcy [homocysteine] rises in both vitamin B12 and folate deficiencies.” So, “metabolic B12 deficiency is strictly defined by elevation of MMA levels or by elevation of Hcy in folate-replete individuals,” that is, in those getting enough folate. Even without eating beans and greens, which are packed with folate, folic acid is added to the flour supply by law, so, these days, high homocysteine levels may be mostly a B12 problem. Ideally, you’re looking for a homocysteine level in your blood down in the single digits.
Measured this way, “the prevalence of subclinical functional vitamin B12 deficiency is dramatically higher than previously assumed…” We’re talking about 10 to 40 percent of the general population, more than 40 percent of vegetarians, and the majority of vegans who aren’t scrupulous about getting their B12. Some suggest that those on plant-based diets should check their vitamin B12 status every year, but you shouldn’t need to if you’re adequately supplementing.
There are rare cases of vitamin B12 deficiency that can’t be picked up on any test, so it’s better to just make sure you’re getting enough.
Not taking vitamin B12 supplements or regularly eating B12-fortified foods may explain the higher stroke risk found among vegetarians.
Leonardo da Vinci had a stroke. Might his vegetarian diet have been to blame? “His stroke…may have been related to an increase in homocysteine level because of the long duration of his vegetarian diet.” A suboptimal intake of vitamin B12 is common in those eating plant-based diets (unless they take B12 supplements or regularly eat B12-fortified foods) and can lead to an increased level of homocysteine in the blood, which “is accepted as an important risk factor for stroke.”
“Accepted” may be overstating it as there is still “a great controversy” surrounding the connection between homocysteine and stroke risk. But, as you can see in the graph below and at 0:57 in my video Vegetarians and Stroke Risk Factors: Vitamin B12 and Homocysteine?, those with higher homocysteine levels do seem to have more atherosclerosis in the carotid arteries that lead up to the brain, compared to those with single-digit homocysteine levels, and they also seem to be at higher risk for clotting ischemic strokes in observational studies and, more recently, bleeding hemorrhagic strokes, as well as increased risk of dying from cardiovascular disease and all causes put together.
Even more convincing are the genetic data. About 10 percent of the population has a gene that increases homocysteine levels by about 2 points, and they appear to have significantly higher odds of having a stroke. Most convincing would be randomized, double-blind, placebo-controlled trials to prove that lowering homocysteine with B vitamins can lower strokes, and, indeed, that appears to be the case for clotting strokes: Strokes with homocysteine-lowering interventions were more than five times as likely to reduce stroke compared with placebo.
Ironically, one of the arguments against the role of homocysteine in strokes is that, “assuming that vegetarians have lower vitamin B12 concentrations than meat-eaters and that low vitamin B12 concentrations cause ischaemic stroke, then the incidence of stroke should be increased among vegetarians…but this is not the case.” However, it has never been studied until now.
As you can see in the graph below and at 2:16 in my video, the EPIC-Oxford study researchers found that vegetarians do appear to be at higher risk.
And no wonder, as about a quarter of the vegetarians and nearly three-quarters of the vegans studied were vitamin B12-depleted or B12-deficient, as you can see below and at 2:23, and that resulted in extraordinarily high homocysteine levels.
Why was there so much B12 deficiency? Because only a small minority were taking a dedicated B12 supplement. And, unlike in the United States, B12 fortification of organic foods isn’t allowed in the United Kingdom. So, while U.S. soymilk and other products may be fortified with B12, UK products may not. We don’t see the same problem among U.S. vegans in the Adventist study, presumably because of the B12 fortification of commonly eaten foods in the United States. It may be no coincidence that the only study I was able to find that showed a significantly lower stroke mortality risk among vegetarians was an Adventist study.
Start eating strictly plant-based without B12-fortified foods or supplements, and B12 deficiency can develop. However, that was only for those not eating sufficient foods fortified with B12. Those eating plant-based who weren’t careful about getting a regular reliable source of B12 had lower B12 levels and, consequently, higher homocysteine levels, as you can see below and at 3:27 in my video.
The only way to prove vitamin B12 deficiency is a risk factor for cardiovascular disease in vegetarians is to put it to the test. When researchers measured the amount of atherosclerosis in the carotid arteries, the main arteries supplying the brain, “no significant difference” was found between vegetarians and nonvegetarians. They both looked just as bad even though vegetarians tend to have better risk factors, such as lower cholesterol and blood pressure. The researchers suggest that B12 deficiency plays a role, but how do they know? Some measures of artery function weren’t any better either. Again, they surmised that vitamin B12 deficiency was overwhelming the natural plant-based benefits. “The beneficial effects of vegetarian diets on lipids and blood glucose [cholesterol and blood sugars] need to be advocated, and efforts to correct vitamin B12 deficiency in vegetarian diets can never be overestimated.”
Sometimes vegetarians did even worse. Worse artery wall thickness and worse artery wall function, “raising concern, for the first time, about the vascular health of vegetarians”—more than a decade before the new stroke study. Yes, their B12 was low, and, yes, their homocysteine was high, “suggest[ing] that vitamin B12 deficiency in vegetarians might have adverse effects on their vascular health.” What we need, though, is an interventional study, where participants are given B12 to see if that fixes it, and here we go. The title of this double-blind, placebo-controlled, randomized crossover study gives it away: “Vitamin B-12 Supplementation Improves Arterial Function in Vegetarians with Subnormal Vitamin B-12 Status.” So, compromised vitamin B12 status among those eating more plant-based diets due to not taking B12 supplements or regularly eating vitamin B12-fortified foods may explain the higher stroke risk found among vegetarians.
Unfortunately, many vegetarians resist taking vitamin B12 supplements due to “misconceptions,” like “hold[ing] on to the old myth that deficiency of this vitamin is rare and occurs only in a small proportion of vegans.” “A common mistake is to think that the presence of dairy products and eggs in the diet, as in LOV [a lacto-ovo vegetarian diet], can still ensure a proper intake [of B12]…despite excluding animal flesh.”
Now that we may have nailed the cause, maybe “future studies with vegetarians should focus on identifying ways to convince vegetarians to take vitamin B12 supplements to prevent a deficiency routinely.”
I have updated my recommendation for B12 supplementation. I now suggest at least 2,000 mcg (µg) of cyanocobalamin once weekly, ideally as a chewable, sublingual, or liquid supplement taken on an empty stomach, or at least 50 mcg daily of supplemental cyanocobalamin. (You needn’t worry about taking too much.) You can also have servings of B12-fortified foods three times a day (at each meal), each containing at least 190% of the Daily Value listed on the nutrition facts label. (Based on the new labeling mandate that started on January 1, 2020, the target is 4.5 mcg three times a day.) Please note, though, that those older than the age of 65 have only one option: to take 1,000 micrograms a day.
