My Un-Vegetarianniversary, Announcements, and Being a MTHFR Mutant

Ten years ago last month, after a decade of meatless-and-fishless youthhood, I took a bite of salmon sashimi and never looked back.

It was a very good day.


Actually, that’s not true. It was a very conflicted day. I was seventeen, stubborn, malnourished, college-brain-overloaded, and really flippin’ hungry. I’d spent a good two hours prepping for an English Lit class potluck—carving a watermelon into the shape of a peacock and adorning it with skewered melon balls, assuring myself that even if the rest of the party was a terrifying apocalypse of pizza and cheese cubes, at least I could eat my fruit bird.

It turned out the pizza was a no-show, but someone had the genius idea—and I say that without a shred of sarcasm—of bringing a huge takeout platter of sushi. I spent some time gnawing on a cantaloupe ball, glancing furtively at the fish display, admiring its arrangement in the way one might admire a Van Gogh: with aesthetic awe, but no desire to shove it into my mouth and chew.

That changed pretty fast. I still don’t really know what happened: the salmon seemed to leap supernaturally from its plate to my hand, and then suddenly I was swallowing the first piece of animal flesh I’d touched in ten years. And oh, was it divine. Love at first bite! Utter foodgasm! A soulmate encounter, of sorts, except ending with one person eating the other person instead of them getting married and having 1.7 children. But otherwise the same! Thank you, salmon sashimi, and thank you forgotten classmate who allowed us to unite.

Ultimately, that moment forced me to grab a Humility Crowbar and pry open my then-dogmatically-vegetarian mind. Had I not experienced the the rabid, primal devouring of Forbidden Fish and the full-body ecstasy that followed, I never would’ve realized how starving I was for something it contained. I never would’ve started arguing with people on the internet who insisted I was just high on the fish’s death juju. I never would’ve gotten banned from forums for trying to help struggling vegans. And I most likely never would’ve started this blog, which emerged as a reaction to all the above.

All from some slabs of raw salmon in 2004!

I think that’s well worth celebrating. So I want to take a moment to thank you for joining me on this journey, for following a blog I never expected to have more than a handful of readers, and for generously lending me your time in this little slice of internet real estate. You guys make this whole thing worthwhile. Please know that every comment, email, and pair of silently perusing eyes is appreciated more than I can describe.


One of the only surviving photos of my raw vegan days. Age 16, circa 2003.

And now for some other things!

1. After approximately three quadrillion emails about this blog’s slow-loadingness/hard-to-readness/unwieldiness/appearance of having been slapped together by a visually inept aardvark*, I’ve finally updated the site design. I hope this works better! Please let me know if it’s glitchy or in any way torturous.

*No one actually said this, but I know it’s what we all were thinking.

2. The holidays are upon us! If you’re gift-hunting for someone who doesn’t have time to read books like people did in the olden days, the Audible version of “Death by Food Pyramid” is now available (narrated by none other than my dear father, who is much better at talking than me):


(Of course, the hardcover and Kindle editions are still there too.)

3. In the vein of health-related purchases, I also want to put in a gigantic plug for 23andMe genetic testing. I ordered a kit over a year ago, spent months watching the unopened box sit dejectedly on the corner of my desk, and then finally took the plunge in October. And by plunge, I mean I spit into a little tube and mailed my saliva off to Scientists Unknown.

I was mostly interested in three things: the ancestry breakdown, my ApoE phenotype, and whether I had any of the breast-cancer-associated BRCA mutations that 23andMe can test for. (Considering all five of my grandma’s sisters died of breast cancer, and BRCA mutations are disproportionately common among Ashkenazi Jews (of which I’m now a confirmed 47.7%), I was particularly anxious about the latter.)

But the most interesting discovery (apart from some mysterious South Asian heritage) ended up being something I’d previously known nothing about: MTHFR mutations. The MTHFR gene codes an enzyme called methylenetetrahydrofolate reductase, which is involved in folate metabolism—and when it’s defective, you’re at increased risk of all manner of gnarly ills: blood clots, migraines, Alzheimer’s, miscarriages, fibromyalgia, certain cancers, autism, stroke, chemical sensitivity, birth defects, heart disease, depression, and IBS, oh my! The impact can be far-reaching for not only diet and supplement routines, but also other lifestyle components: for instance, if you’re a premenopausal lady, having a MTHFR mutation could make oral birth control pretty risky.

After running my 23andMe data through, which is free and awesome and discloses all your MTHFR-related goodies, I was greeted with this colorful display:


Those red suckers indicate two copies of a mutated gene; yellow indicates one copy; and green means you’re in the clear. It turns out I’m homozygous (two identical alleles) for MTHFR C667T, which is one of the crummiest mutations to have (A1298C being the other biggie). It means my methylation efficiency is only about 10 – 20% of what it should be, making supplements a potential necessity. It also means both of my parents carry at least one C667T copy, since they’re the ones who generously passed it on to me. And since a not-insignificant portion of the population is also mutant, you could very well be in the same boat! Fun, eh?

I’m still in preliminary research mode on this one, so I’ll refrain from writing more ’til I’ve got my sea legs on the subject. But if you wanna explore elsewhere, you can dive into sites like or the MTHFR Support Group on Facebook and read to your heart’s content. And if you do have your 23andMe results, I highly recommend following the instructions on to see what your methylation status is. Especially if you have a family history of migraines or miscarriages or Alzheimer’s or autism. This is definitely one of those “missing puzzle piece” things that’ll help tighten the thread between diet, environment, genes, and health!

Of course, once you have your genetic data in your hot little hands, there’s a ton of other diet-relevant stuff you can look up: whether you have hereditary hemochromatosis (iron overload), if you’re an ApoE4 carrier (which may affect how you respond to high-saturated-fat diets and alcohol, among other things), whether you’re a fast or slow caffeine metabolizer (will that morning cup o’ joe give you a heart attack?), and so forth.

Last year, the FDA swooped in and obliterated 23andMe’s health reports, so you can’t read about your disease risk directly on their site anymore. But fortuitously, you can still get all the information they used to offer (and more) by downloading your 23andMe raw data and running it through Promethease for free (or $5, if you’re impatient and want it zippy quick). That will give you more info than you’ll ever have time to read, all about the most fascinating subject in the world: you!

There are also plenty of other sites you can use once you have that raw data—with a decent list compiled here:

And lastly, if you’re worried about handing off your genetic secrets to a company that may or may not one day disclose them to more nefarious entities (NSA? an insurance company that’ll hike your rates once they see you’re predisposed to diabetes? your mother in law?), this article has some tips on how to safeguard your DNAey goods:

Moving on!

4. I added a “support this blog” button to the side of this page. I’m not a big fan of having it there, and I’ll be taking it down once I find a non-obnoxious way to make this blog financially sustainable. In the meantime, I keep going broke when I write long blog posts because I end up putting a few hundred hours into research and writing instead of doing my typical bill-paying freelance gigs. Alas! If you find the information here valuable and are in a financial position to do so, donations are accepted with more gratitude and heart-squeeziness than I could ever convey in pixels. If you’re a health-seeker who couch-cushion dives for grocery money like I do, please consider this blog a free service and keep being your rad self (and find a way to stay fed!). I love you all regardless.

5. The post coming next will be the longest one this blog has ever seen. 15,000 words and counting, and a potentially radical shift in paradigm. Brace yourself, young grasshoppers! I hope to have it up before the new year.

Stay safe and healthy, everyone; you’re precious.



  1. So happy to be a follower of your blog Denise. I have unfollowed all of the other Paleo “peeps” because I was starting to find the hype and unsubstantiated claims too irritating, especially when I decided to cross the aisle and start reading what some of the main vegetarian/vegan believers were saying–only to find that they all seem to be making the same claims (with opposite take-homes) based on the same “science”! After reading your book I told myself–OK, now I can stop reading all of these health/diet books–and I really did stop reading them! My only regret is how much time I wasted before finding your book.

    In terms of grocery money (hear ya there), can I make a suggestion? After your be-all-end-all blog post rolls out, STOP writing blog posts and start writing another book to SELL. Given that your writing ability is AWESOME and your take (on the incredibly huge, and hot, topic of nutrition and health) is so welcome and refreshing, you should not be wanting for groceries!!!!

    1. When I finished you book I went looking for another one and there was none. So I second the stop writing blog posts and start writing a book, ASAP. I need more common sense diet advice.

  2. Yay!! Finally a new post! Why do you keep us waiting so long?? Can’t wait to read it!!

    Sent from my iPhone


  3. I didn’t have a problem with the old format, but this one is just fine, too. I love your writing. It makes me laugh while educating me. Right now things are pretty grim, financially, but I’ll see what I can to in the (hopefully) not to distant future. Thanks, Ms. Minger.

  4. Denise, I follow your blog, read your book, watched your videos and generally love all that you do. I was ‘this close’ to ordering 23andme, but then I read the negatives on Amazon. I would assume you were aware of these. Thanks and keep up the good work.

    1. Negative reviews of 23andme on Amazon? I only see four reviews there, and only one is negative. And the negative one is pretty silly. Are you looking at something different?

      I ordered 23andme before they stopped giving health information, and have found it very interesting. But as Denise said, you can still take the data to Promethease for health risk analysis.

      23andme also connected me with some cousins I never would have met otherwise. They predicted what exactly our relationships would be to each other, and they were spot on. I’m very happy I did it.


        47 1 star reviews such as

        ByBruce Klitzmanon August 12, 2014.

        I have been a medical scientist for over 35 years. This is a scam. Everything they reported to me was simply a summary of what I had to enter for them on their forms. About 6 hours of filling out a detailed genealogy, family health history, etc. and they re-formatted that information and gave it back to me as a “genetic” report. Absolutely no new information was generated by them. When they were questioned about this on the phone, they provided no rebuttal and basically agreed.

          1. Same here. I just spit in a tube as did my known relatives who actually showed up as being related to me. Are they hiring private investigators to find out all there is to know about us? I seriously doubt it. If they aren’t actually examining our DNA, I wouldn’t be able to see that, in every snp I’ve looked at, I have one allele form my mother and one from my father.

  5. Hello, I tried to order this test kit and there is a $99 fee. Thought there was not cost to test?
    Where can I find this information?

    1. The test kit is $99, and the interpretation through Genetic Genie and Promethease are free, or a nominal charge/donation.

  6. Happy anniversary, Denise. I fell in love with your writing on the first page I read, and it never disappoints. And this post got me to (finally) order the 23andme kit. In fact, I decided that a kit for everyone in the family will be what I do for Christmas this year. Keep up the good work!!

  7. You rock Denise. I fell in love after reading your China Study debunking, got your book as soon as it went on sale, & read any post you put up. I try top convey your insight to my patients every day. Can’t wait for the gigantic post you have on the way. Keep up the great work.

  8. Hi Denise,
    I was a fan of yours before I read this latest post, but now you are approaching goddess status. I had already done the 23andme trip, but with your additional guidance I have now discovered that I have the homozygous mutation at MTHFR A1298! I am generally healthy (especially since I went primal) but this additional information sheds some light on a few things. Thanks!


  9. I’m a reformed-vegetarian too! Being a vegetarian was a very difficult 6 years of my life. So happy to be back to the land of the living. A lot more stable too. Phew! Loved the post!

  10. Hey Denise, I’m also homozygous for C677T.. It can explain a lot, huh? Anyways, I’m writing you to recommend looking into supplementing with L-5-MTHF which will allow you to speed up methylation to a normal rate. I recommend taking this HIPAA-Compliant Free Health Assessment and entering “MTHFR” when you get to the second to last page, “Conditions”. It will compute a supplement recommendation plan just for you. To see how much you should be taking, click “Nutritional Info” and you can print out the list of nutrients, their forms, and the amounts to take daily.

    Go to

  11. Two other ways to monetize your site without being obnoxious about it are to use Patreon, or, even better, the coinbase tip button,, which allows very small individual donations, as little as $0.10 without the hassle and fees of paypal. For a very popular blog, this can be an excellent source of income that allows people who are especially pleased with your posts to provide a small, painless payment, a tip.

    1. +1 to the coinbase tip jar. I was coming to recommend you accept butcoin donations in general (can do this without an account anywhere if you want, just some software and an address/QRCode). I’d love to be the first one to send you some coin!

  12. Hi Denise,
    Thank you for sharing your thoughts on the 23andMe genetic testing! Totally not what I thought I was going to run into in this post! My family keeps asking what I would want for the holidays and I have been on the fence about whether or not this would actually be interesting/satisfying enough to ask for or not. I figure if I’m going to be indulgent I want it to be something good, so thank you for helping me decide! I have been following your blog for about a year and a half, and have read your book, all of which I LOVE – as an anthropologist and nutritionist and daughter of a devoted, 40 + year vegetarian I very much appreciate the work that you have done and continue to do, and further, tend to always strongly agree with your takes on things, fyi. Alright, now I should get back to homework! ‘Tis also the season for finals! Thanks for the respite. And happy anniversary!

  13. Denise, you are a breath of fresh air in an overwrought and somewhat confusing nutritional landscape, the reasons being that you do your “homework” and write about the results with such lucidity and humor. Most of us don’t crunch the numbers like you do or go into the depths for real information like you do, and we love you for it. Please know that your blog is not only well received, but that it adds vital nutritional insight for those of us trying to stay ahead of the ageing curve! Where did you get such research and writing skills???

  14. Denise, happy anniversary! You are absolutely my favorite blogger and easily one of my favorite writers in general! It’s always great to see a new post from you. Keep up all the great research and writing.

    I’m sure you must get inundated with suggestions from readers, “You should look into this…” but I can’t help but add one more. Recently (like for the past 2 1/2 years of my life) I’ve been researching the connection between life trauma and chronic conditions including many types of pain and myriad digestive problems. It’s given me a new, deeper understanding of how my body functions and dysfunctions. The top writers in this field are neurologist Robert Scaer author of 8 Keys to Brain Body Balance; The Body Bears the Burden; The Trauma Spectrum and psychologist/medical biophysicist Peter Levine author of Waking the Tiger; In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Emerging out of my research is a whole new life path for me working with traumatized people to balance their autonomic nervous system through bodywork, mindfulness, and other tools that increase parasympathetic (“rest and digest”) functioning. For me, this was the missing piece in my quest to feel better, after about 8 years of working with my health through diet and supplements.

    1. Pamela – have read Levine and I’m very excited about the prospects somatic experiencing offers as a healing modality. Too often medicine tries to “fix” the body without addressing the mind and spirit. Big mistake, and without a holistic approach healing will never be complete. It is often said, particularly in the realms of food and nutritional blogging, that “all disease begins in the gut”, but I would counter that by saying “all disease begins in the psyche.” Sick mind=sick body, as stress truly does kill. I have also healed IBS, anxiety, depression, and auto-immune symptoms by addressing old spiritual wounds through meditation, mindfulness, and surrender. “That which we resist, persists.”

      Another great source for spiritual healing and consciousness training is Dr. David R. Hawkins, MD PhD.

      1. Thanks, Ann. I’ll look into that! I’ve read some life-changing books based on recommendations of people from blog comments or FB groups! I’m beginning SE training next year in St Paul and can’t wait.

        1. Good luck! It will take healers such as yourself to counter all of the bad medicine being practiced in this country. Good heavens, if doctors would just get a clue…

          Are you a healer now? If so, what modalities? I so envy the person able to launch into an energy medicine practice that will truly bring healing. What a gift to the world you will be!

          1. Actually, I used to be an architect! This is a total change of direction for me. I am currently in massage therapy school so I can practice a bodywork modality for trauma called Associative Awareness Techniques ( I think the SE training will be a great addition to that. I may also get Feldenkrais certification and some sort of certification as a mindfulness teacher. There are so many fascinating modalities out there!

  15. Hello Denise, I have been following your blog ever since I watched “Forks Over Knives,” and then went to the internet to gain some perspective through other’s thought processes. Yours was the first blog to pop up and going further was pointless. Your common-sense driven logic (as opposed to authority dependent) and engaging, clear writing style induced an experience somewhat similar to your first bite of sushi. Thank you.
    You mentioned (a bit ago) that you have some food allergies: dairy and wheat, the two most common of all food allergies. I have struggled with an ever increasing list of food allergies (called the “allergic march”) probably initiated by celiac. There has been no help, caught between the obsessive-compulsive institution of medicine that believes nothing and the hysterical anarchy of naturopathy that believes everything, I was on my own. You are too. My diet is limited, but I am healthy; I have learned a few things about this.
    One is that any generalized inflammatory response will compromise the blood-brain barrier. The resulting influx of blood glucose is addicting. Sugar induces inflammation via glycination of proteins, commercially prepared foods contain synthetic free radicals; these are addicting. For the same reason folks tend to become addicted to whatever food to which they are allergic.
    Once the blood-brain door is open, all sorts of nefarious characters enter at will (including antibodies and inflammatory cytokines), potentially causing a variety of neuropsychiatric symptoms. Judging from the incidence of “allergic shiners” among psychiatric patients, this is a common contributing cause of psychic misery. Because of the addictive component, few people have the will power necessary to change their diet. Most of those who have been able to avoid their allergens have had a dramatic decrease in symptoms.
    As always, there is much more. Let me know if you have any interest in exchanging thoughts and information. Your book is fresh air. Thank you again, John.

  16. Thanks, Denise. I’ve been putting off doing a 23andMe, but now that I’ve looked at MTHFR, I should quit dithering and just do it! Chronic migraine, chronic fatigue, fibromyalgia, depression, IBS…family of origin is hotching with these, and I have the lot too.

  17. Fellow MTHFR (Double C) carrier here. I anxiously await your research on this as I have been trying to pull the various threads together for a number of years. I find that the blogs that focus on SNP’s like Phoenix Rising, don’t talk about the biome much. And the blogs that focus on gut, diet, and exercise, like Mark’s Daily Apple and Free the Animal, don’t address snp’s .

  18. THANK you for the update on 23andMe – I bought one for my 20-year-old son, right before the FDA pulled that particular plug on the company. His father is adopted and knows nothing about his birth parents or their medical history. It’s good to know I can still get what I want and have someone interpret it for me. And he’s been curious lately as to the paternal side of his heritage.

  19. Denise, I’m so happy you’re back!
    I’m a recent reader and very appreciative of all your hard work. I have a PhD in Biochemistry and Molecular Biology (and a clinical medicine and surgery degree) but I lack your ability to see the big picture and distill information into such digestible (no pun intended) packages.
    I believe the mark of,a true intellect is the ability to change one’s opinion in the face of the evidence and that is you. I am so frustrated and disappointed by “gurus” who are evangelical and immovable.
    Thank you. Thank you. Thank you! No really.

  20. Two things: 1) Cute picture! 2) I can’t even look at the words “MTHFR gene” without thinking “Motherf***er gene” as if Jules Winfield from Pulp Fiction became a geneticist. Do they make wallets that say “Bad MTHFR” on them? They totally should…

    I love your blog and your book. Best of luck!

  21. Denise, I’ve enjoyed your work for years and was very happy to donate.

    (Come on, fellow readers — it’s the holidays. Pry loose a few bucks.)

  22. Denise, did you catch Tim Gerstmar’s presentation on methylation at AHS? Also, Sean Croxton did a podcast on it a few weeks back (Underground Wellness is his site, if you haven’t checked it out). Shoreline Community College–not too far from me! 🙂

  23. @Alex, Re: RSS, there may be no visible link but it’s in the source: and while Google Reader was dropped, there are other services like Newsblur.

    Oh, and Hi Denise! I’m looking forward to reading about your potentially radical shift in paradigm. Or not. I mean 15,000+ words? Make it a book, and profit!

  24. Thank you so much for the info on 23andme and extra uses/privacy protection. I had cooled on the idea when they were throttled back on their health information, now that I know there are still ways to get the more extensive info, it’s back on my want list. I might even be able to get my hubs on board once I wade through the privacy link.

    I’ve really enjoyed learning from your blog and book, keep up the amazing work. Lastly, thanks for the sideways promotion of community colleges.

  25. SO loved reading your Death By…I consider you a true white Knight! One who is willing to joust any mis-information (or Mr. mis-information)and put her fragile body on the line for nutritional/food truth.

  26. I love genetics. Thanks so much for your work Denise–you are my heroine and I hope more people follow in your footsteps of learning to think for themselves. A hefty donation has just been made.

  27. Nice! Like the new look here.

    Have you checked your FUT-2 status? This will tell if you secrete fucose in your gut villi, an endogenous source of food for gut bugs. If a non-secretor, you may need some diet tweaks.

    Look at SNP rs601338 on the FUT-2 gene. AA means non-secretor, AG or GG means you are one of the 80% of normal fucose secretors.

    15,000? Can’t wait!


  28. Does 23andMe have an affiliate (referral commission) program? You can see just from the Comments here that people have clicked that link based on your recommendation. That is one way you can earn money from your blog posts – by making your referral links commission links.

    You could also brainstorm ways to turn your existing content into online (digital) courses: You re-format a topic or chunk of content into a different format that either (a) appeals to people with different learning styles (eg. book –> audio course or video course), or (b) makes it EASIER for people to learn and then implement change by giving them added support – or figuring out the missing piece between knowledge and ACTION and providing that.

    Another common way for people who have an audience to provide value to their followers (and get paid for providing it) is to host a “Summit” or specialized Interview Series. Typically, you make the calls (audio replays – not the MP3 files) or videos available for free for 48 hours. Then you charge for the package if people want to have their own set (of the audios and videos). You typically add some bonus content for the paid package.

    A fourth way to leverage your platform into some money is by recommending other people’s programs, courses, or products that you feel are awesome – and taking a commission on any purchases of these programs/products. This can be done in a blog post, an email to your list, or in tasteful ads on the side of your blog.

    NOTE: If you are feeling like any of these methods are “icky” or lack integrity, then first you need to realize that HOW you do it, present it and position it is what determines whether your offering is sincere and helpful, or icky and smarmy. And secondly, may I suggest you look to see if you have any abundance blocks or saboteurs at work.

    Okay, lastly, I can’t tell for sure, but I don’t *think* you have published your own book (unless you own Primal Nutrition Inc?). Unfortunately, this will seriously limit your income from the book. Whatever your reasons for taking this route, I encourage you to do a deeper analysis of self-publishing and run your numbers for both scenarios. Typical beginning author royalty is 12% – not of the cover price – but of whatever the publisher sells the book for. Discount sales, bulk/volume sales, give-aways etc. all result in a lower net for the author.

    When I launched my first book (I have 17 now) if I had given it to a mainstream publisher and received 12% royalties, I would have received about $400/month in royalties after a few months. By publishing it myself, I was netting $2790/month in profit. So that’s the fifth thing: I do encourage you to consider self-publishing for your subsequent books.

    Hope that helped!

  29. Happy Un-Vegetarianniversary, Denise!! From a former vegetarian to another! As always, a fabulous post. I’m going to ask for a 23andMe test for Christmas!

  30. Thanks for this great post, Denise, your sashimi experience sounds magical. I broke my vegetarianism while living in Guatemala, but it wasn’t a sudden break. I definitely looked back to the past for a while. Over a few months, I realized that I feel great when I eat a little beef or fish now and then.

    Based on your rec I think I’m going to get 23andMe for Christmas, too, for myself, my husband, and my bro. What a crazy tool, a little scary though! (I get why the FDA pulled the interpretation for now) I’m so curious to know, though!

  31. I’m really interested in this 23andme stuff!

    Pokin’ around on Amazon, I found there are a lot of negative reviews (47) for the (now-discontinued) health and ancestry kit: . I’m assuming they have a new product page for the kit that provides ancestry alone.

    Also thought you might enjoy this post on issues with 23andme accuracy; (the latter is more technical, written by a computational biologist!)

  32. Denise, I started following your blog posts after reading your excellent analysis of the China Study but I think you should have waited to comment on MTHFR C677T until you had done your typically exhaustive analysis. Nine to 17% of white North Americans are homozygotes for this. In the world of cardiology, a brief infatuation with high homocysteine levels as the cause of vascular disease ended with this study in 2006. Random genetic testing , just like random cardiovascular screening can cause more harm than good (

  33. This is the internet age. Clickthru’s earn money. It appears that 23nme gives 20% discount for repeat customers. What if they gave you $20 for each referral that purchases with a click-thru from your blog? A hundred people would be nice.. a thousand would be nicey nice!

  34. Hi Denise,

    Thank you for all your work!

    Regarding the MTHFR, here is a link to an interview with Janet Perry (about 5 minutes in part 1…) where she touches on MTHFR. Because there are many MTHFR genes that can compensate for a snp in one MTHFR gene, she suggests a better way to measure methylation is with a histamine test. I have done the 23andme test but have not run the data for snp’s because it may not be telling the whole story.

    I am really excited for you to dig into the science and learn what is good science on this topic and what is not. I have been studying it and am not sure we know enough yet although an easy thing to do is take some folate and see how you feel!

    We sold a bunch of your books in the health food store I manage and the customers love it! We also have a copy in our library.

    Can’t wait to read what you find!

  35. “having a MTHFR mutation could make oral birth control pretty risky.”

    Denise. Because this is Richard….

    Don’t do the birth control. Have a bunch of Denise and Dennis -es. And, if I’m not mistaken, there’s a line out front offering help. 🙂

    You go girl!

    Best always.

  36. Please do put up an affiliate link for 23&Me. I’ve been meaning to get that test, and I would prefer to do it through a link that threw a few bucks your way.

  37. Geez I love reading your blog posts! Informative and hilarious. What a gift you have! Love the new design and I’ll defs be leaving a donation. We (I) need to read more of your writing. Keep up the great work and hopefully you’ll bless us with your presence in Australia one day at a conference or two 😀

  38. I think the accuracy discussions are good to keep in mind. I remember reading the figure 98% accurate on something published by 23andme. I find the health information potentially useful, but for any given finding, you have to remember there’s a small chance of it being inaccurate. If an intervention is unlikely to cause harm or great expense of time or money, then maybe you don’t need to bother retesting. I personally discovered I was heterozygous for a mutation that results in reduced vitamin K recycling. The possible solution is to eat more greens and egg yolks or supplement some vitamin K. Easy. Yummy. So, if the results were in error, and I don’t actually have that mutation, no big deal. If however, I tested positive for a serious genetic mutation that suggested surgery or expensive supplements, I would probably get a more accurate test specific to that gene.

  39. The page title, the menus, and the stuff on the right-hand-side are all easy to read. The title of the articles are not so easy for me to read. The white background is a little too bright. Just my $0.02. Maybe I just don’t like change, maybe I didn’t like the old way either. To be honest I can’t remember. 🙂

    Click here with a grain of salt: (not sure if I used that phrase right)

  40. Denise, the new site looks ace. So nice to read an update from you. I’m sure you’ve already considered this, but you know people would pay good money to have video consultations with you, yes? You can work in pajamas! If this sounds like not so much fun however, then there’s something even better out there and it will find you soon enough.
    Also hope you see some fundage either from Death and/or your next book. You’ve written one of the most important health books of our time and it’s criminal/hilarious that you’re not yet properly compensated for it. However it all works out, I have no doubt you will be buying all the sashimi, oysters, and whatever it is your heart desires one day; hang in there girl… xx

  41. OK, this is a little bit high-schoolish, but every time I see MTHFR I think “Mother f’er”. Am I the only one??? I guess it fits if you are homozygous for the nastier genes!

    I wasn’t sure it was still possible to do 23 and me, so I’m glad to hear it. I’m on the fence if I want to know about my APOE status or not, with my mom and grandma both having Alzheimer’s. OTOH, maybe that’s the one copy of a gene I didn’t get–that would be nice news.

  42. I need to go back and check but I *believe* I am heterozygous for C667T. Definitely one of the MTHFR genes, anyway. I found out with my raw AncestryDNA data, run through Promethease. I had already switched over to supplementing with methyl folate and methyl B12 (when I remember to take them), and now I’m glad, because even if it isn’t the worst mutation, having one copy of it reduces my ability to metabolize things. Like I’m at sixty-something-percent capacity rather than 100 percent. That’s enough to start a little trouble, I think.

  43. Hey Denise,

    Love your blog! I have studied nutrition and yours is one of the best blogs out there for separating the wheat from the shaft. (Oh the irony, since I am gluten-free) I too did 23andme testing and had mthfr defects as well. Compound heterozygous. With my combination of defects, supplementing with 5-mthf, Methyl B12, and Methionine added to my regular supplement routine made a HUGE difference in my health. HUGE! I also found out I had other enzyme defects that made it so that much dietary and supplemental folate was never even getting to the mthfr enzyme, plus defects in the folate receptors and homozygous on the B12 receptor sites as well. Lots of stuff going on.

    My methyl cycle was hardly working at all. No wonder I was so ill all the time even with the purest whole foods diet I could manage with all the food sensitivities

    The mthfr defect and other defects in the methyl cycle sadly are all to common and becoming more common due to the introduction of synthetic folic acid into our food supply and supplements

    A basic understanding of biochemistry really helps here because this stuff can be complicated, but finding out you are homozygous for mthfr can answer a lot of questions for you.

  44. PS I see you are heterozygous for the genes that code for MTR, MTRR as well. I am no physician, but these are two genes that you should definitely look into as well. MTR uses the methyl group off of 5-mthf, to tack onto homocysteine to turn it back into methionine, In the process 5-methyl folate is converted back to THF. MTRR generates the methyl-B12 needed by MTR, The MTR is an upregulation and the MTRR is a down regulation. This combination is a double whammy In the B12 department.

  45. Lol, you’ve got the warrior gene:

    Check for the COMT SNP as well:

    Here are my results, which I am updating when I have time:

    And btw, I always thought you were partially Ashkenazi. The name Minger threw me off, but I guess your mom is the Ashkenazic one.

  46. Hi Denise,

    You are an amazing researcher and writer, with a perspective that this country really needs! So, to keep you healthy (smile)….I have a suggestion for helping with the low level of methylation you mentioned.

    I have studied the differences between the amino acid make-up of plant and animal proteins, which is basically the difference between high arginine and high lysine proteins, respectively. Excess dietary arginine from plant proteins is apparently a major problem regarding methylation. From my website:

    “Creatine, which helps supply energy to cells, is made from arginine. This process uses 70% of the body’s methyl groups, and excess arginine was found to impair methylation.33 …For example, methyl groups are needed to recycle homocysteine to methionine (for methylation), and arginine supplementation was found to raise homocysteine in heart patients.33”

    If you’re interested, I explain what a high lysine diet is on my website. You may be already following it, because you obviously eat meat! However, there’s a lot more involved, so it’s worth a look. And thanks for the great articles!

  47. Very much looking forward to our new blog post Denise. I consider you one of the true free-thinkers of the Ancestral Health Movement who will follow the data wherever it may go.

  48. Hi, Denise,

    Just wanted to share that my awesome OBGYN checked me for MTHFR after I miscarried and found that I do in fact have that mutation. I would tell anyone who is struggling with this to find a doctor who practices NaPro Technology because you can track SOOO many fertility issues without putting anything synthetic into your body! It’s awesome! I now have two beautiful kiddos because of NaPro.

  49. Hi Denise,

    I recently came across the following critique of your book, Death By Pyramid, in the Feb. 2014 McDougal Newsletter. Some of the points seemed significant and hard to refute. I wonder if you’d care to comment.


    Do Vegetarians Live Longer Than Health Conscious Omnivores?

    In the February, May and August 2013 McDougall newsletters, I presented readers with articles addressing the dangers of low-carb and Paleo diets. Please take this opportunity to read these articles.

    Although the question as to whether a plant-based diet extends life expectancy is likely determined by the quality of foods used to replace animal foods, numerous proponents of low-carb and Paleo diets have claimed that diets that exclude flesh do not favor longevity, and are even likely to promote premature death. Whenever health benefits are observed in vegetarians, these proponents have often simply attributed this to other healthy aspects of a vegetarian lifestyle, unrelated to abstention from meat.

    In this article, I examine a number of these concerning claims, and review the literature addressing the life expectancy of vegetarians and health conscious omnivores. In addition, I address a number of important limitations of studies carried out on vegetarians, and in particular, how paradoxical findings can result as the consequence of participants adopting a vegetarian diet in response to deteriorating health.

    It is not news that Denise Minger has a tendency to downplay the health benefits of plant foods and plant-based diets. In her critique of the China Study, Minger claimed that “as a plant-nosher”, she was hoping to find evidence to support Dr. T. Colin Campbell’s findings from the China Study linking dietary fiber to lower rates of colorectal cancer.1 Somehow, however, despite her vegan bias apparently creeping into her critique, Minger suggested that she was unable to find sufficient evidence outside of the China Study supporting the hypothesis that dietary fiber protects against colorectal cancer. And yet, several months later the omnivorous panel of experts of the World Cancer Research Fund concluded based on a review of over 1,000 publications that there was convincing evidence that dietary fiber protects against colorectal cancer.2 In Death By Food Pyramid, Minger continues this trend of downplaying the health benefits of plant-based diets.
    Failing to Equal the Seventh-day Adventists

    In the chapter of her book, Herbivore’s Dilemma, Denise Minger provides a brief overview of the history and the growth of the popularity of vegetarian diets, bringing into picture the earliest of the studies on the Californian Seventh-day Adventists. Loma Linda, California which is highly concentrated by Adventists is considered to be a Blue Zone because of the greater life expectancy compared to other parts of North America. Loma Linda shares the title of Blue Zone with four other populations which are all characterized by traditionally consuming plant-based diets, typically rich in legumes and grains.3 These other Blue Zones include, Ikaria, Greece; Nicoya, Costa Rica; Okinawa, Japan; and Sardinia, Italy. It seems that Minger was not even able to get these simple details right in her book, claiming that the Greek island of Crete is considered a Blue Zone, while citing an article that clearly refers to Ikaria.

    Minger hypothesizes that the longevity of the Adventists maybe unrelated to their low meat diet, and may rather reflect the discouraged use of tobacco and alcohol. To illustrate this, Minger points out that the Mormons who are also discouraged from the use of tobacco and alcohol, “but whose founder never endured any meat-abstinence visions”[p.194] have a greater life expectancy than the average population. Although Joseph Smith, Jr., the founder of Mormonism may not have demanded followers to completely abstain from meat, the Word of Wisdom (section 89 in The Doctrine and Covenants) which he delivered, apparently received as a revelation from god, states that:4

    Yea, flesh also of beasts and of the fowls of the air, I, the Lord, have ordained for the use of man with thanksgiving; nevertheless they are to be used sparingly;

    In regards to longevity, Minger then goes onto state that:

    But what’s even more telling is the fact that meat-eating Mormons and vegetarian Adventists tend to live equally as long. When compared to ethnically matched folks outside their religious groups, both Adventist and Mormon men—once their birthday-cake candles start numbering in the thirties—can expect to live about seven years longer than the rest of the population.[p.194]

    Unlike what Minger appears to have the reader believe, the 7 years greater life expectancy referred to in the study she cites is for the average Adventist male, and not specifically for vegetarian Adventist men. Less than one third of the men in the cited study were considered vegetarians, with more than half considered regular meat eaters.5 What these studies specifically found was that the life expectancy for active Mormon men who reached the age of 35 was about 7.5 years greater than the average U.S. white male, whereas the life expectancy of the average Californian Seventh-day Adventist male who reached the age of 30 was about 7.3 years greater than the average Californian white male.5 6 When specifically looking at the average vegetarian Californian Adventist male, their life expectancy was found to be about 9.5 years greater than the average Californian white male. It is important to note that the Californian whites that the Adventists were compared to have one of the highest life expectancies of any American state, and are expected to live up to a year longer than the average U.S. white that the Mormons were compared to.7

    The more recent 25 year follow-up of the Mormons may allow for a more informative comparison, as like the Adventist study, it included both men and women from California, and examined the effects of other lifestyle factors on mortality. Mormon men and women over the age of 25 with four favorable lifestyle factors associated with significantly reduced mortality were expected to live about 9.8 and 5.6 years longer, respectively, compared to U.S. whites.8 In comparison, vegetarian Adventist men and women over the age of 30 with three favorable lifestyle factors were expected to live about 13.2 and 8.9 years longer, respectively, compared to non-Adventist Californians whites.5 9 Compared to the average U.S. white however, this difference in life expectancy would be expected to be closer to about 14 and 10 years.7 However, and more importantly, a later paper on the Californian Adventists found that those who adhered to a vegetarian diet for at least 17 years were expected to live 3.6 years longer than those who adhered for fewer years.10 This suggests that when restricting the analysis to long-term vegetarian Adventists, the difference in life expectancy compared to the Mormons would be even greater.

    There are also other lines of evidence lending support to the observed greater life expectancy of the vegetarian Seventh-day Adventists compared to health conscious Mormons. For example, one study in which vegetarian Adventists and Mormons were matched for strength of religious affiliation, and consumption of tobacco, alcohol, tea and coffee, the vegetarian Adventists were found to have significantly lower levels of serum cholesterol, blood pressure and rates of obesity (Fig. 1).11 12 The difference in blood pressure remained significant even after controlling for BMI, and could not be explained by differences in sodium intake. Another study also found that vegetarian Adventists had lower blood pressure than Mormons, and that the difference increased with age, suggesting a greater favorable effect of long-term adherence to a flesh-free diet.12
    Figure 1. All percentiles of distribution of blood pressure were found to be lower in the vegetarian Adventists compared to health conscious omnivorous Mormons.

    Although some of the many factual errors in Minger’s book may be passed off as sloppy research rather than as being intentional (one example perhaps being when she confuses Crete for Ikaria), given the number of occasions she has discussed the Adventist studies previously, it is difficult to believe that she was truly being honest and simply was not even aware of the data in the very studies she cites. Furthermore, Minger acknowledges in this book that she had others with knowledge in this field review her manuscript and assist her with the completion of this book (almost exclusively individuals who have demonstrated an anti-vegetarian stance), allowing for little excuse for these misleading statements.
    Mortality in Vegetarians and Health Conscious Omnivores

    As there are no published meta-analyses examining all of the current available prospective cohort studies comparing mortality in vegetarians and health conscious non-vegetarians, I performed a simple meta-analysis using the results for the fully adjusted model from the most recent follow-up of each cohort. For mortality from all-causes, based on 7 cohorts, the vegetarian group had a statistically significant 7%, and a borderline significant 6% reduced risk, using the fixed effects and random effects models, respectively (Fig. 2).10 13 14 15 16 The 6 cohorts that stratified data by sex suggested an even stronger protective effect of a vegetarian diet for men.16 17

    Figure 2. All-cause mortality for vegetarians compared to health conscious non-vegetarians in a meta-analysis using the fixed effects model.
    *Indicates that participants classified as semi-vegetarians were included in the vegetarian group

    It should be stressed that the meat intake in the non-vegetarian group in most of these studies was significantly lower than that of the general population. As described in a different review, the selection criteria for the non-vegetarians in these studies generally included being affiliated with vegetarians in some way or another, likely explaining their relatively low meat intakes. Furthermore, evidence suggests that many of the self-proclaimed vegetarians in these studies actually consumed meat on a regular basis, resulting in minimal differences in meat intake between the groups.10

    Considering the lack of difference in meat intake between the vegetarian and non-vegetarian groups, it would only be expected that these studies would not have the statistical power to demonstrate a significant benefit of a vegetarian diet. Two studies which may be considered as especially having limited statistical power due to such limitations were the Heidelberg Study and Health Food Shoppers Study. In the Heidelberg Study, the non-vegetarian group were predominantly semi-vegetarians, while in the Health Food Shoppers Study, a validity assessment of the survey used to classify the participants vegetarian status suggested that 34% of the participants classified as vegetarians actually consumed meat. In fact, a slightly greater percentage of participants classified as vegetarians in the Health Food Shoppers Study were found to consume meat 3 or more times a week than the non-vegetarians in the Heidelberg Study (7.6% and 6.9%, respectively).14 18 Taking this into consideration, I performed a sensitivity analysis excluding either the Heidelberg Study or Health Food Shoppers Study from the meta-analysis. Excluding the Health Food Shopper Study alone reduced heterogeneity and strengthened the association between vegetarian status and a reduced risk of mortality from all-causes (RR 0.91 [95% CI, 0.87-0.94], and 0.92 [95% CI, 0.86-0.98] using the fixed effects and random effects model, respectively).

    Most of these studies did not provide separate data for length of adherence to a vegetarian diet. As already described earlier in this review, evidence from several of these studies suggest a stronger effect on mortality would have been observed if the analysis was restricted to long-term vegetarians.10 Another important limitation was that most studies also did not verify changes to vegetarian status of the participants throughout the follow-up, which may in part explain why the association between a vegetarian diet and a reduced risk of mortality weakened over time in several of the studies.9 10

    Another important potential limitation of these studies described in detail in the next section, is that some of the participants likely adopted a vegetarian diet in order to improve poor health, such as symptoms of an undiagnosed or developing illness that would ultimately became fatal. Each of these limitations described are expected to have either biased these findings towards null, or even in favor of the non-vegetarian group, suggesting that the findings of this meta-analysis may have significantly underestimated the benefits of an appropriately planned vegetarian diet.

    In order to determine which factors may have contributed to the observed reduced risk of death in vegetarians, I also performed separate meta-analyses for the major causes of death. This included mortality from coronary heart disease and cardiovascular disease, and the incidence of all cancers combined. For mortality from coronary heart disease, based on 7 cohorts, the vegetarian group had a statistically significant 25% and 24% reduced risk, using the fixed effects and random effects models, respectively (Fig. 3).13 14 15 16 17 For mortality from cardiovascular disease, based on 7 cohorts, the vegetarian group had a statistically significant 17% and 14% reduced risk, using the fixed effects and random effects models, respectively (Fig. 4).13 14 15 16 17 For the Adventist Mortality Study and Adventist Health Study, mortality from cardiovascular disease was derived from pooling the relative risk for mortality from coronary heart disease and stroke.17 Excluding the Adventist Mortality Study and the Adventist Health Study, the vegetarian group had a statistically significant 8% reduced risk of mortality from cardiovascular disease, using both the fixed effects or random effects model (0.92 [95% CI, 0.85-0.99]).

    Figure 3. Coronary heart disease mortality for vegetarians compared to health conscious non-vegetarians in a meta-analysis using the fixed effects model.
    *Indicates that participants classified as semi-vegetarians were included in the vegetarian group

    Figure 4. Cardiovascular disease mortality for vegetarians compared to health conscious non-vegetarians in a meta-analysis using the fixed effects model.
    *Indicates that participants classified as semi-vegetarians were included in the vegetation group

    As described in a previous review, the degree of reduction in risk of mortality from coronary heart disease observed in vegetarians in these cohort studies was generally in proportion to the expected reduced risk based on the differences in levels of total and non-HDL cholesterol, and blood pressure. There is a plethora of evidence, not only from epidemiological studies, but also clinical trials that plant-based diets and nutrients have favorable effects on total and LDL cholesterol, blood pressure, among several other factors which are established risk factors for cardiovascular and all-cause mortality.19 20 21 22

    In the Oxford Vegetarian Study, high compared to low intake of saturated animal fat was associated with a nearly 3-fold increased risk of coronary heart disease mortality.23 Similarly, in a meta-analysis of 11 cohort studies, high compared to low intake of saturated fat was associated with a 32% increased risk of coronary heart disease mortality, despite the inclusion of over-adjustments for dietary and serum lipids.24 It was also found in the Oxford Vegetarian Study that high compared to low intake of total animal fat and dietary cholesterol was associated with a greater than 3-fold increased risk of coronary heart disease mortality.23 Furthermore, evidence from thousands of experiments carried out over the last century have shown that the feeding of dietary cholesterol and saturated fat has accelerated the development of atherosclerosis in virtually every animal species in which researchers were able to find a method to sufficiently elevate cholesterol concentrations. This includes herbivores, omnivores and carnivores from mammalian, avian and fish species, and over one dozen different species of nonhuman primates.

    In both the Oxford Vegetarian Study and the Adventist Mortality Study, high compared to low intake of eggs was associated with an increased risk of coronary heart disease mortality.23 25 However, for ill-defined reasons, these studies were excluded from several recent meta-analyses. In the Adventist Mortality Study and Heidelberg Study, high compared to no intake of meat was associated with a 50% and almost 5-fold increased risk of coronary heart disease mortality, respectively.14 25 Similarly, in the Adventist Health Study, high compared to no intake of beef was associated with a greater than 2-fold increased risk for men.26 In addition, recent meta-analyses of prospective cohorts found that an increment of 1 mg/day of heme iron, found only in animal tissue, is associated with a 16% and 27% increased risk increased risk of type II diabetes and coronary heart disease, respectively.27 28 Therefore, the totality of evidence strongly suggests that the observed greater longevity of vegetarians can be explained, at least in part, by the reduced risk of cardiovascular disease as the result of the replacement of animal foods with minimally processed plant foods.

    For incidence of all cancers combined, based on 5 cohorts, the vegetarian group had a statistically significant 8%, and borderline significant 6% reduced risk, using the fixed effects and random effects model, respectively (Fig. 5).13 14 29 30 Excluding the Health Food Shoppers Study removed evidence of heterogeneity and strengthened these findings (RR 0.90 [95% CI, 0.85-0.99] using both the fixed effects and random effects models).

    Figure 5. Cancer incidence for vegetarians compared to health conscious non-vegetarians in a meta-analysis using the fixed effects model.
    *Indicates that participants classified as semi-vegetarians were included in the vegetation group

    The finding of a decreased risk of cancer in vegetarians may also be explained, in part, by a diet devoid in heme iron. Controlled feeding trials have established that NOCs (N-nitroso compounds) arising from heme iron in meat forms potentially cancerous DNA adducts in the human digestive tract, likely in part, explaining the significant association between heme iron and an increased risk of colorectal cancer in recent meta-analyses of prospective cohort studies.31 32 33 Heme iron has also been associated with numerous other cancers. These lines of evidence also provide confidence in the validity of the findings of greater longevity in vegetarians.
    Why Some People Choose to Become Health Conscious

    In health research, the reasons why some people chose to become health conscious is critically important when interpreting data from observational studies. This is because it is possible that it may not have been the health conscious lifestyle that caused the examined outcome, but rather the outcome that caused the health conscious lifestyle, ie. reverse causality. As previously described in a different review, reverse causality occurs when the studied effect precedes the cause. An example in health research is the frequent paradoxical observation that former smokers have worse health outcomes than current smokers. These unfavorable outcomes are not explained as being caused by smoking cessation, but rather that those who quit smoking tend to have done so because they were showing symptoms of illness, illnesses that ultimately resulted in the observed unfavorable health outcomes. A similar phenomenon has been observed in nutritional research where sick people tend to adopt a more plant-based diet, suggesting that this would bias observational studies towards showing an unfavorable effect of plant-based diets and nutrients, and therefore a favorable effect of animal based diets and nutrients.34

    Although Denise Minger suggests that the favorable health outcomes for vegetarians observed in many studies maybe unrelated to dietary factors, but rather explained by other healthy habits associated with vegetarianism, she fails to consider the possibility that these vegetarians may have become health conscious, including adopting a vegetarian diet, in order to improve poor health. The results of a recent study from the Netherlands illustrates the critical importance of considering reverse causality in research on plant-based diets. The researchers found that 75% of the vegetarian participants with cancer adopted a vegetarian diet after diagnosis, consistent with previous research which found that cancer survivors are highly motivated to adopt a more plant-based diet with the intention of improving poor health.35 36

    Although health researchers often attempt to partially control for reverse causality by excluding participants who were diagnosed with cancer, cardiovascular disease and other life threatening conditions prior to baseline of a study, it is nearly impossible to fully control for reverse causality, as participants may make dietary changes due to symptoms or unfavorable risk factors that act as markers of an undiagnosed or developing disease. For example, it is known that in studies carried out as far back as the late 1950s, participants with unfavorable blood cholesterol levels tended to reduce the intake of dietary cholesterol and saturated fat (ie. in part, by abstaining from animal foods). This resulted in paradoxical findings where participants who consumed more dietary cholesterol and saturated fat actually had lower serum cholesterol levels. These paradoxical findings were produced, in part, because those participants who continued to consume a diet rich in these lipids were choosing to do so because they were able to maintain lower cholesterol levels despite consuming such a diet (ie. due to favorable genetics).37 Many individuals who attempt to downplay the harmful effects of these lipids, such as Minger has done in her book have chosen to ignore this critical factor when reviewing research on the diet-heart hypothesis.24

    In the chapter Herbivore’s Dilemma, Minger reviews several prospective cohort studies that compared the mortality rates of vegetarians to health conscious non-vegetarians, carefully selecting only those studies in which vegetarians were not found to live longer. These studies were the Oxford Vegetarian Study, the Health Food Shoppers Study and the Heidelberg Study, all included in my meta-analysis. Minger emphasizes the lack of reduced risk of mortality in the vegetarian groups, while neglecting to mention that the difference in intake of meat between the groups was relatively small. Minger especially focuses on the Heidelberg Study, happening to be the smallest study, which found a non-significant increased risk of all-cause mortality in the vegetarian group. Minger points out that in this particular cohort, the vegetarians had greater levels of physical activity, consumed less alcohol and smoked less. Minger then states “Mortality and disease rates, in this case, might be expected to turn up in favor of the vegetarian crowd, even though the opposite ended up happening”[p.270]. This statement is outright misleading as all these factors were controlled for in the analysis. One could also correctly point out that the vegetarians tended to be older than the meat eaters, but suggesting that this would be expected to turn up in favor of the meat eaters would also be misleading, as age was also controlled for. Either way, the differences in mortality between the groups did not even come close to being statistically significant.

    There are several important findings that Minger neglected to mention that cast doubt on the suggestion that a vegetarian diet had a harmful effect on the participants in the Heidelberg Study. For example, it was shown in an earlier follow-up of this study that, similar to the Adventist studies, the participants who adhered to a very low meat diet for at least 20 years had a 29% lower risk of all-cause mortality compared to those who adhered to such a diet for fewer years.10 Excluding the first 5 years of follow-up significantly strengthened this association, resulting in a 45% lower risk of all-cause mortality, suggesting that reverse causation may have attenuated the results for the entire follow-up.38 This difference in mortality was considerably stronger than the mortality difference between vegetarians and non-vegetarians. Unfortunately the researchers appear to not have provided any data comparing mortality in long-term vegetarians and non-vegetarians. Indeed, in other cohorts it has been observed that compared to non-vegetarians, short-term vegetarians had a higher rate, whereas long-term vegetarians had a lower rate of all-cause mortality.34 These findings suggest that those who adopted a vegetarian diet more recently had done so due to deteriorating health, biasing the results in favor of the non-vegetarians.

    Also as already briefly mentioned, in this study it was also found that intake of meat 3 or more time per week was associated with an almost 5-fold increased risk of mortality from ischemic heart disease, whereas there was a greater than 2-fold risk increase for those who consumed fish more than once per month. One of the reasons that this did not translate into an increased risk of all-cause mortality in the non-vegetarian group may have been due to the very low intake of meat, with less than 7% of the non-vegetarians consuming meat 3 or more times a week.14 Another important finding was that there was a trend towards a favorable effect of a vegetarian diet on mortality in the early years of follow-up, which declined over time (Fig. 6).14 This suggests the likelihood of undocumented changes in vegetarian status in a portion of the participants throughout the follow-up, which would be expected to have attenuated a possible favorable effect of a vegetarian diet. A similar phenomenon was also observed in several other studies included in my meta-analysis.9

    Figure 6. Standard Mortality Rates (SMRs) and their 95% CIs for all-cause mortality, dietary group, and 5-year follow-up period, separately for males and females. (○, female vegetarians; •, female nonvegetarians; □, male vegetarians; ▪, male nonvegetarians).

    Minger also points out that there was a trend towards a higher rate of mortality among the vegans in the Heidelberg Study, which included only 60 vegans, while neglecting to mention that in the Adventist Health Study 2, which included almost 100 times many vegans found that compared to the non-vegetarians, the vegans, especially male vegans experienced a lower rate of mortality.16 In the Heidelberg Study, while current smokers had the same mortality rate from cancer as never smokers, past smokers suffered from a 70% greater risk of cancer mortality than current smokers. This strongly suggests that many of the past smokers in this cohort quit smoking because they had deteriorating health.14 This raises the question as to whether the participants in this cohort also had a tendency to adopt a vegetarian diet after becoming ill, possibly explaining the unfavorable mortality rates in the vegetarian group. Perhaps the reason why the vegetarians in this group tended to be older, was not because they were becoming more ethical with old age, but because they were becoming more health conscious, which included adopting a vegetarian diet due to deteriorating health with old age. As these lines of evidence described suggest, the trends towards elevated mortality in the vegetarian groups in the Heidelberg Study may be explained by reverse causation. It is more than possible that it was not the vegetarian diet that caused these unfavorable outcomes, but deteriorating health, which would ultimately resulted in these unfavorable outcomes that caused a portion of the participants to adopt a vegetarian diet.
    Ignoring the difficult

    There is strong evidence that plant-based diets, including those rich in whole-grains and legumes reduces the risk of premature death from chronic and degenerative diseases, which in-turn helps explain the longevity of a number of plant-based populations. Contrary to the findings for plant-based diets, there is a plethora of evidence demonstrating the harms of popular carbohydrate restricted diets. For example, meta-analyses of clinical trials have found that low-carbohydrate diets elevate LDL cholesterol and impair endothelial function.39 Furthermore, a recent meta-analysis of prospective cohort studies with more than 272,000 participants found that low-carbohydrate diets, particularly those rich in animal foods are associated with an increased risk of all-cause mortality.40 Evidence also shows that the hazardous effects of diets rich in animal foods are also applicable to that of organic, grass-fed animal foods. These, and other lines of evidence described throughout this review appear to have been almost entirely ignored by proponents of these diets, perhaps because they find it too difficult to explain.

    Although there is strong evidence that plant-based diets promote longevity, it is important to replace animal foods with minimally refined plant foods in order to achieve the maximum benefits. This may in part explain why the benefits of a vegetarian diet were more evident in the Adventists than other populations.9 In conclusion, the totality of evidence supports the hypothesis that appropriately planned whole foods, plant-based diets promote longevity.

    1. Hi Carl,

      If you have any specific parts of that you’d like me to address, I’d be happy to — though I’m not planning on doing a full rebuttal as most of these issues are either extremely tangential to the book, taken out of context, or not correct representations of my arguments. I do think he’s right about a few points that I’ll double-check and revise for any future editions!

  50. Denise,

    I just ran my 23andme data through, and after feverishly researching biochemistry I have some concerns with Dr. Yasko’s conclusions cited on that site and others. These websites appear to make a number of biochemistry mistakes, and I’m not seeing a lot of citations to original research (a lot of unpublished “physician observations”)….which is a major red flag.

    Some of their statements about, for example, BH4, appear to be incorrect. They state that impaired BH4 production or increased BH4 utilization can impact ammonia detoxification in the urea cycle, but BH4 is not directly involved as a cofactor in ammonia to urea conversion. Instead, BH4 is involved in one of at least two pathways for generating citrulline. (Citrulline is regenerated in the urea cycle to turn ammonia into urea.)

    Not to say they’re not doing good work, but you have to interpret biochemistry in context. For example, I am homozygous for a mutation in CBS, which they say would upregulate CBS activity and lead to increased cystathione, cysteine, and eventually to increased taurine and sulfite. But I also have a heterozygous mutation in CTH, which would limit the amount of cystathione converted into cysteine, effectively stopping that cascade at the starting line.

    I hope we’re just a short ways off from a website or interface that can actually map all of our unique (SNP-dependent) metabolic pathways, but I think we’re still in the dark ages when it comes to interpretting SNP genome results.

    (That promethease website is great, but is focused on observational studies with tiny effect sizes. Trying to infer causation from those correlational studies is basically the textbook example of how not to do statistics.)

    Faced with the complexity of ~20,000 SNPs and less-than-user-friendly websites like ENSEMBL, I don’t think it is possible for individuals to understand how SNPs influence protein function to the extent necessary to make informed decisions about our biochemsitry.

  51. Hey Denise, I’m a new follower of your work but, so far, I’m hooked! I love your balance of scientific nerdiness and informal slang (particularly the phrase “visually inept aardvark”). Interesting info on genetic testing, I feel as though that’s where personal health strategies are headed — merging ancestral wisdom with individual genetics and biomarkers. I’ll be diving into that realm shortly. Anyways…thanks for your work and I can’t wait for your next post. 15,000 words? That’s practically a book! 🙂

  52. I have to agree with Conor. Just because we can map our genome doesn’t mean we can do anything meaningful with the information. It’s exciting, but I think we are at the very dawn of this revolution. Even with more meaningfully interpreted data, there are countless confounding elements that may or may not influence a mutation or gene positively or negatively. I think at this stage it presents a bit of a danger for some who may take this information and begin wildly supplementing with vitamins or adding certain foods and limiting or abstaining from others. These actions of course could have unintended consequences that could lead to problems or diseases that might otherwise not have developed. I have the same MTHFR C677T mutation you mention. If I went by some of the recommendations I see online, I’d be taking copious amounts of vitamins. Not smart. For now and until we can extract more meaning from these types of tests on an individual level, I’ll let food be my medicine and my medicine be my food. 🙂 Thanks for all you do, Denise! I loved Death by Food Pyramid and wanted to thank you for your countless hours of research and dedication. Keep on keeping on!

  53. Hey Denise,
    I just wanted to flag up a couple of books I read on the topic of food cravings. ‘The Diet Cure’ and ‘The Mood Cure’ both by Julia Ross discuss the role of amino acids and fatty acids in physical and mental health. The idea being, when our stores of these essential building blocks get depleted we experience cravings in an attempt to top them up (except that the things we reach for to treat the symptoms don’t always address the deficiency).

    For instance, Ross suggests*
    1. Cravings for sugar, starches and alcohol – You may need more L-glutamine
    2. Lack of energy, focus or cravings for caffeine and chocolate – Try L-tyrosine
    3. Inability to relax or stress eating – You may be low in GABA
    4. Craving comfort foods or emotional eating – You might need D-phenylalanine (or DLPA)
    5. If you’re low in serotonin – Try supplements of 5-HTP (but not if you’re already taking anti-depressants, obviously)
    *Taken from the chart on pgs 122-123 in ‘The Diet Cure’

    And this is just to name a few of the insights to take away from these books. She also covers vitamins A through Zinc, the importance of omega 3 (especially if you have Scandinavian heritage), how to balance hormones and adrenals, hidden food allergies, recovering from malnutrition or anorexia/bulimia and so much more. Definitely worth reading.

    Just finished reading ‘Death by Food Pyramid’ – fantastic work! I’ll be sending a copy to my dad who seems to be under the delusion that cutting his calories to 1,200/day (he’s a 170 lb, middle-aged man) and cycling 2 hrs per day won’t do him any harm. I hope those Framingham boys scare some sense into him.

  54. A few things…

    A significant chunk of the population is actually homozygous for the MTHFR population, but many of these individuals do not need to supplement with methylfolate to remain healthy. Yet, others are not so lucky.

    The fact of the matter is that your microbiome is responsible for manufacturing many B vitamins (methyfolate included), so your gut biome is a significant factor in determining whether or not you can maintain your methylation with the MTHFR mutation. Eating foods rich in natural folates is also helpful (spinach, legumes, liver, eggs, etc.). Folic acid is certainly to be avoided by pretty much everyone (rinse your rice and avoid processed foods that are fortified with it).

    The other problem with these genetic mutations is that many are poorly researched. Dr. Yasko became famous for highlighting many of these mutations, but there really isn’t a lot of evidence to support some of the findings.

    For instance, I discovered I had a homozygous CBS mutation, and it really freaked me out to read all of the stories and recommendations people were throwing around to deal with it on the Internet. I couldn’t deal with the crazy protocols people were suggesting for CBS (giving up meat and eating like a rabbit for instance). But, I was relieved to learn that the science isn’t settled.

    Yasko’s work was certainly revolutionary, but she also focussed on children. Now her work is being extrapolated to adults in ways that don’t always make sense. For instance, for adults with CBS mutations, I encourage you to read this counter-opinion, which makes it seem far more benign in most adults:

    CBS Upregulation, Myth or Reality?

    And Yasko’s interpretation of CBS may have been in error. As one commenter explained:

    “She misinterpreted a research paper where they intentionally and artificially created a SAM-e independent upregulated CBS enzyme by introducing a stop codon that chopped off the entire 3′ tail of the enzyme (some several hundred residues). That “artificial” enzyme is 10 x upregulated relative to normal WHEN there is no SAM-e present. In the presence of SAM-e the wild type and the artificial were essentially similar activity.

    Yasko et al made a gross error when they assumed any SNP in the regulatory “tail” would cause the same level of effect. It does not work like that, not even close! In fact the C677T homozygous mutation leads to a 10-15% increase in trans-sulfuration flux post methionine loading. While 10-15% may have biological impact, it does not equate at all to the bogus 10x upregulation that falsely terrorizes people on these boards. Just bad science pure and simple.

    The 10x claim always bothered the heck out of me because if true there is NOTHING you can do to correct a defect that severe, and in fact … it does not exist. So paradox resolved ….”

    I Hope that helps anyone who gets freaked out by their CBS mutation. As you can see, these genetic tests can sometimes cause more confusion and unnecessary treatments in some people, particularly if they already feel fine.

    Unless one has lots of mysterious health issues, I’m not convinced that one needs to rush to the nearest pharmacy and start chugging on methylation supplements just because they have MTHFR. Many of these defects, MTHFR in particular, are just too prevalent in our population for them to be as problematic as some practitioners might suggest.

    Do some people with these mutations need methylation support? Yes. Does everyone? I doubt it.

    The microbiome and its ability to manufacture the compounds we need to support methylation is not represented in these genetic tests. When you buy B vitamins from a pharmacy, they are often just synthesized by bacteria by a corporation. It’s probably easier for most (healthy) people to just feed their gut biome with plant fibers and turn their guts into a methylfolate factory, rather than to spend the money on supplements that are synthesized by the same bacteria.

  55. Hi Denise, How do you find stuff like – Copies of AMY1, Apo E2, FUT2 secretor status, and non-MTHFR genes may regulate who CAN versus who CANNOT tolerate the abundance from the fertile crescent and heavy agrarian societies – ??? please.

  56. MTHFR is lovingly referred to as the Mother F’er gene in some circles 🙂

    When the RDA was set for folate it was intentionally set high to account for people with MTHFR, although they didn’t really know the needs at the time. More recently they have looked more closely and found that MTHFR variant is covered by the recommendation (; which luckily means you might not need supplementation.

  57. I’m a fellow mutant MoTHer FR, welcome to the club. 23andMe is very cool, I love the ancestry data and I plugged my data into NutraHacker which gives you supplement recommendations based on your genes, not sure if that’s what Promethease does. It appears everyone in your comments like to write essays. Looking forward to your next post, you’re precious.

    1. I found NutraHacker helpful as well. Specific suggestions for supplementation based on my self-reported food preferences AND my 23andme genetic profile. Quite informative.

      I’m intrigued by the folks who allege that we laypeople will only be confused by having more data at our fingertips. Certainly there is that possibility, but I still review all my blood-work numbers (and ask questions of a guru if I have them). Don’t you?

      Alas, the same guru has no clue about genetics, epigenetics, etc. And he is still in his 50s and a Dartmouth Medical School graduate. I suppose I could search for a 30 year old guru, but I like his “bedside” manner. And my brain works pretty well for an old guy. I’ll keep looking at my own data and doing my own food/diet experiments.

  58. Denise, thanks so much for the information on 23andme. It’s a little hard to understand the findings, but if I read mine correctly, I need to focus more on organically grown foods and I should avoid soy. So two more ways that you’ve improved my eating habits!

  59. Can’t wait for you to post more about MTHFR mutations. Recently got my 23andme results back to find that I’m heterozygous on all 3 MTHFR genes, and like you, I’m homozygous for MAO. After a few days of confused/flustered internet searching I decided to try supplementing with Thorne’s B Complex, Thorne’s 5MTHF, and mucuna puriens. I also found out that my genes do better with a low-fat diet? So good to know!

    It’s been a couple weeks since starting to implement this stuff and I feel incredible. I can’t believe how much energy I have – I feel like an infomercial / like I have super secret life hacks.

    Anyways. Thank you for this post as well as all of your others. Your blog and your book have been monumental in my transition away from veganism a couple years ago, healing my teeth, and now dealing with my MTHFR mutations.

    Seriously. You rock.

  60. As a fellow former vegetarian with MTHFR genetics, I recommend that you be VERY, VERY, VERY careful with eating ANYTHING out of the ocean. Between the methyl mercury, plastics and radiation, it is extremely dangerous and MTHFR has reduced ability to detox (just about everything). I had methyl mercury poisoning from Alaskan caught salmon and I almost died. It truly was the scariest thing i have ever seen.

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