B-12, cholesterol, and doctor visits
Seven or eight years ago a neurologist had me tested for B12 blood levels (looking for the cause of what turned out to be migraine aura, unrelated), which proved to be low, and told me I should get injections unless I started a few months of megadoses. So I did the megadoses. Then, the question of how to maintain B12 levels ongoing. I'm not a pill taker, and don't like megadoses of anything generally, and was disappointed to find that all the B12 products out there are at zillion-percent-of-requirement levels, if the labels are true. I went shopping online, and found that a company called Bio-Alternatives makes a B12 solution without any extraneous flavorings or junk, just B12 and water. I've been mixing small amounts into things I use regularly, at about 25x the nominal requirement, with the idea that the more similar to natural B12 sources the product is, the more intuitively I can eat; I've put it into the yogurt I make, into the powdered soy milk I use in recipes, mixed it with honey. And it has worked - my blood level last year tested in the high end of normal range. B12 is a hard one to monitor, since the liver stores so much that there can be a years-long lag between cause and effect, but it's been long enough I can be sure that this is a good product and a workable strategy. Also confounding the issue is the reduced absorption of gut-produced B12 with age, so something that has always worked for you may just not work any more. And the close similarity of compounds in things like yeast, that can assay like B12 in some simpler and older tests, but that aren't active in the body (this one has been around since the '60 as received wisdom, but apparently doesn't really work.)
On that same recent doctor visit, for the first time in my life my cholesterol tested a bit high, with a poor LDL/HDL balance. That would be the result of adding more eggs and butterfat into my diet four or five years ago to combat an abrupt and slightly scary weight loss (down to 130 pound from 140, at 5' 11") Put the weight back on, OK. But no way am I going to take my doctor up on his suggestion to try statins, so we've agreed on a one-year experiment. I'm backing off the eggs sharply, reducing butterfat (particularly grain-fed butterfat), using more sesame seeds and less oatmeal in my breakfast, for the calories and calcium and reduced bulk. He's OK with a small weight loss if it helps the cholesterol. So we'll see. I'm glad I have a sympathetic doctor.
How have you all navigated your diet long-term with regard to health issues?
I have not had any B-12 deficiency issues as of yet, although I have only been vegan about 7 years, and the thought of all the scary neurological symptoms of a B-12 deficiency does worry me enough that I don't just rely on getting it from food or occasional seasoning with nutritional yeast alone - I have been taking a supplement. From the initial research I did, and the expert opinions I've seen, the recommendations were for a sublingual lozenge rather than a pill or capsule, since they absorb into the bloodstream better that way, and to look for the Methylcobalamin B-12 instead of the cheaper and more widely-sold Cyanocobalamin B-12, because the Methyl version is more efficiently absorbed by the body. Amazon has a good find at https://www.amazon.com/Amazon-Elements-Methylcobalamin-Flavored-Lozenges/dp/B075DC51YC/ref=pd_pgh_B0013OQGO6_B075DC51YC?pf_rd_p=86fe6acb-a898-40dc-b63b-ee4afab02c5a&pf_rd_s=lpo-top-stripe-1&pf_rd_t=201&pf_rd_i=B0013OQGO6&pf_rd_m=ATVPDKIKX0DER&pf_rd_r=P53TK2W5QZMTKFN8Q4ME&pf_rd_r=P53TK2W5QZMTKFN8Q4ME&pf_rd_p=86fe6acb-a898-40dc-b63b-ee4afab02c5a
and I take those, letting them dissolve under my tongue instead of chewing them up. So far, I have not had any problems, but not having had decades of vegan diet to track, I don't know if that's a sure thing or not...time will tell.