Links on the Saturated Fat Controversy

March 1st, 2015 by Jack Norris RD

In February, the 2015 Dietary Guidelines Advisory Committee submitted the Scientific Report of the 2015 Dietary Guidelines Advisory Committee which gives recommendations to the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA) for the upcoming Dietary Guidelines. The Advisory Report is not the final Dietary Guidelines.

Of note, the Advisory Committee removed the advice to reduce dietary cholesterol and the advice to include lean meat. Ginny Messina, RD wrote a good summary of what this means for animal advocacy in her article, The 2015 Dietary Guidelines: What Will They Mean for Vegans?

On February 20, the New York Times ran an opinion piece, The Government’s Bad Diet Advice, by Nina Teicholz. It’s the typical Weston Price-type, pro-animal-product piece, in the same vein as writings by Nina Planck (no, they are not the same person).

David L. Katz, MD, MPH wrote a fun response to Teicholz’s piece, We’re Fat and Sick and The Broccoli Did It!

And speaking of Dr. Katz, he recently wrote a well thought-out piece on the Paleo diet, Paleo for a Shrinking Planet?.

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TVA’s Veg Recidivism Survey

February 19th, 2015 by Jack Norris RD

In December, I blogged about the Humane Research Council’s report on vegetarian recidivism (Vegetarian Recidivism Survey, Dec 15 2014).

Another report has been released on vegetarian recidivism, this time from the Toronto Vegetarian Association. You can download the 10-page report from their post, TVA Conducts First Study of Lapsed Vegetarians in Canada.

Their study surveyed 1,112 people of which 113 were lapsed vegetarians.

Getting enough nutrients was listed at the most common challenge for lapsed vegetarians with 83% listing it as a challenge (as compared to 44% of current vegetarians). Eating out was listed as the second most common challenge, with 75% of lapsed and 65% of current vegetarians considering it a challenge.

It would be interesting to know in what way they believed getting enough nutrients was a challenge–was this theoretical or did they feel bad and suspect they weren’t obtaining enough nutrients?

The report quotes a couple of the lapsed vegetarians regarding nutrition. One person said:

“I grew tired of spending so much time on meal planning to make sure I was getting the proper amount of essential amino acids, etc.”

That makes me wonder what sort of information vegetarians are getting. While vegetarians should include high-lysine foods each day, there are so many–all legumes as well as quinoa and seitan–that it really takes little planning. Hopefully they weren’t carrying around a 1971 copy of Diet for a Small Planet, adding up all the essential amino acids from every meal.

Another respondent said:

“My iron levels were dangerously low and I needed to reintroduce meat sources of iron into my diet; I began having extreme meat cravings near the end of my vegetarianism and I believe that was my body telling me I needed the iron (which I found out later due to blood tests).”

This is disconcerting, but it also reinforces a view that I’ve been cultivating for some time–that cravings for meat might be due to iron deficiency. I would like to see research done on whether this is the case and, more importantly, how easily iron deficiency anemia can be cured while vegan by using the methods I suggest of adding vitamin C to meals and avoiding coffee and tea at meal times (more info).

I have been discussing the possibilities of this sort of research with a medical doctor at a large university and perhaps something will come of it.

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B12 Status of Whole Foods Vegans Consuming Nori and Mushrooms

February 11th, 2015 by Jack Norris RD
Summary A German study suggests that whole foods vegans who do not supplement with vitamin B12 have subpar vitamin B12 status and that nori and dried mushrooms do not improve B12 status.

In a 2014 study from Germany (1), a group of 10 whole foods vegans, who did not take supplements, were found to have methylmalonic acid (MMA) levels of almost 400 nmol/l. MMA is the most specific way to measure vitamin B12 status, with healthy levels being 270 nmol/l or less.

A second group of vegans who supplemented – it’s not clear with how much but it seems to have been at least 2 doses of 1,000 µg/week of B12 on average – had MMA levels of just above 200 nmol/l.

The whole foods-only vegans were given a minimum of 12 g/week of nori and 15 g/week of sun dried mushrooms, which the researchers calculated to contain an average of 3.1 µg/day of vitamin B12; the RDA is 2.4 µg. Their MMA levels were measured every 2 months for 8 months and they did not dip much below 350 nmol/l.

The vegans who took supplements were given more B12 than normal (though it’s not clear how much), and their MMA levels steadily decreased to about 150 nmol/l at 6 months, but then back up to 200 nmol/l at 8 months.

This research indicates that at the amounts given, nori and sun dried mushrooms do not improve vitamin B12 status.

I have updated the VeganHealth.org article B12 in Plant Foods with this information.

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References

1. Schwarz J, Dschietzig T, Schwarz J, Dura A, Nelle E, Watanabe F, Wintgens KF, Reich M, Armbruster FP. The influence of a whole food vegan diet with Nori algae and wild mushrooms on selected blood parameters. Clin Lab. 2014;60(12):2039-50. | link

Can Supplements be Trusted?

February 8th, 2015 by Jack Norris RD

On February 3rd, the New York Times released an article, New York Attorney General Targets Supplements at Major Retailers, in which they found that four of five herbal supplements did not contain the herb they purported to. The supplements came from four national retailers: GNC’s Herbal Plus, Target’s Up & Up, Walgreens’ Finest Nutrition, and Walmart’s Spring Valley. Even most of the garlic supplements didn’t contain garlic – a component that would seem rather unchallenging to obtain.

A reader asked me to weigh in on whether this has any ramifications for the supplements vegans are recommended.

In my recent Interview with Talk to a Doc, I talked about how vegans do not necessarily need to take supplement pills since there are other ways to obtain recommended nutrients. That said, it’s often easier and more convenient, and some might argue even more American to just take a pill!

So what does this NY Attorney General report mean for those of us taking supplements? In most cases, the controversy over what’s in supplements is about herbal supplements that are supposed to have medicinal effects rather than for vitamins and minerals. Even so, I’d be hesitant to rely on the exposed companies even for vitamins and minerals.

You can trust that supplements with the U.S. Pharmacopeia’s USP Verified symbol have what the label indicates. But getting the USP Verified symbol is expensive and so most smaller companies don’t go through the process.

While I can’t know for sure, I have no reason to doubt the supplement brands I generally take (Whole Foods, Trader Joe’s) or the supplements popular in the vegan community such as VegLife, Deva, Vitashine, or Opti3.

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Dr. Greger: New DVD and More on Paleo

February 6th, 2015 by Jack Norris RD

Michael Greger, MD has released the Latest in Clinical Nutrition Volume 23 which has a strong focus on the Mediterranean Diet. From his website:

The Mediterranean Diet is an “in” topic nowadays, in both the medical literature and the lay media. More than 450 papers were published in the medical literature during just the last year alone, more than one a day. As a recent commentary noted “Uncritical laudatory coverage is the common parlance. Specifics are hard to come by: what is it? what is its history? why is it good? Merits are rarely detailed; possible downsides are never mentioned.” I answer these questions and more in a 6-part video series.

You can order the full DVD from his website (click here), or you can watch them in short videos as they are released starting with another interesting one about the Paleo diet, The Problem With the Paleo Diet Argument.

Interview with Talk to a Doc

January 23rd, 2015 by Jack Norris RD

I recently did a 30-minute interview with Katya Trent of Wellness with Katya: Talk To A Doc.

We mainly discussed whether vegans need to take supplements.

Towards the end of the interview, I said that vegans can get all the nutrients they need without taking supplements. I should have clarified that this is based on three assumptions:

1. You’re getting vitamin B12 through fortified foods.

2. You’re getting enough sunlight to make adequate vitamin D or that you’re eating UV-treated mushrooms with large amounts of vitamin D.

3. You’re getting enough short chain omega-3 fatty acids from plant foods and that your body is converting enough to the long chain DHA. The jury is still out on whether vegans, especially older vegans, need a direct source of DHA (more info).

If you listen, I hope you enjoy it!

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Dr. Greger on Paleo

December 22nd, 2014 by Jack Norris RD

Dr. Greger has a video to share with your paleo friends, Paleo Diets May Negate Benefits of Exercise. He tackles the myth that plant foods raise insulin levels more than meat.

The video above is part of Latest in Clinical Nutrition: Volume 22 available for download or DVD (all proceeds go to charity). In Volume 22, Dr. G also takes on the idea that has been making the rounds for a while, that saturated fat does not contribute to heart disease.

Vegetarian Recidivism Survey

December 15th, 2014 by Jack Norris RD

The underlying motivation for my nutrition work is to prevent vegetarian/vegan recidivism. I have focused on nutrition and put myself out there as someone who will help people who are having health issues with becoming vegetarian/vegan. Because of this, I regularly hear from people who are struggling and it can sometimes seem like a lot of people, but I know my view is likely skewed and I have always wanted to know just how many people quit due to health difficulties.

On December 2, the Humane Research Council (HRC) released a report, How Many Former Vegetarians Are There? which sheds some light on this question. I helped out a bit in designing some of the nutrition-related questions and have been anxiously anticipating the results. I would like to thank HRC and all the people who funded this important research.

A quick overview of the report is that it was a cross-sectional survey of 11,000 people in the USA aged 17 and older. They found that 2% are currently vegetarian/vegan, 10% are ex-vegetarian/vegan, and 84% of people who go vegetarian/vegan quit.

The researchers used a high bar for determining who was vegetarian/vegan and ex-vegetarian/vegan – the participants had to answer a food list questionnaire indicating that they were vegetarian/vegan and then also say that they considered themselves “vegetarian” or “vegan”. I have not seen such a high bar used in any previous research.

Their report covers many of the difficulties former vegetarians/vegans had on the diet, but I’m only going to focus on the health aspects in this post. I have more to say about the rest in my post Humane Research Council Survey on Vegetarian Recidivism on Vegan Outreach’s blog.

The HRC blog post linked above does not include much information about health issues, but their complete report (which you can access by signing up for a free account on their site) has more. Below are excerpts followed by my comments.

“Former vegetarians/vegans were asked if they began to experience any of the following when they were eating a vegetarian/vegan diet: depression/anxiety, digestive problems, food allergies, low cholesterol, an eating disorder, thyroid problems, protein deficiency, B12 deficiency, calcium deficiency, iron deficiency, iodine deficiency, vitamin A deficiency, vitamin D deficiency, zinc deficiency. The findings show that 71% of former vegetarians/vegans experienced none of the above. It is quite noteworthy that such a small proportion of individuals experienced ill health.”

HRC sounds pleased that only 29% experienced ill health – but that’s almost one-third of people who tried the diet. I was actually hoping to find out that, say, only 1% of former vegetarians experienced poor health because it would allow me to retire from my nutrition work that, while being a labor of love, is indeed a labor, and takes away from my other efforts. At almost 1 out of 3 people, I’m not so sure it’s time to cross the finish line and declare victory.

“All of the conditions [listed above] were experienced by some participants, though only rarely. In each case, less than 10% of lapsed vegetarians/vegans experienced one of these issues, except iron deficiency (experienced by 11%).”

Fatigue is the most common complaint I hear. I have not found any one explanation for most cases of fatigue though vitamin D deficiency and iron deficiency in female endurance runners are common.

The fact that B12 deficiency was not a big complaint is not surprising given that overt vitamin B12 deficiency symptoms normally take years to develop whereas most of the former vegetarians/vegans were only on the diet for a few months, and any lacto-ovo-vegetarians would be getting B12 from dairy and eggs.

“Respondents who indicated they began to experience at least one of the conditions were asked if it improved after they started eating meat. 82% of these respondents indicated that some or all of the conditions improved when they reintroduced meat. The most typical timeframes for improvement were: within 2–6 days (20%), within 1–3 weeks (33%), and within 1–3 months (22%).”

Interesting. For some people who come to me with severe problems that we cannot seem to solve, I have often wondered if I should suggest they try going back to eating animal products, reset their health (if it does in fact reset), and then try becoming vegetarian/vegan again more slowly.

HRC emphasized the rates at which vegetarians/vegans had gotten their vitamin B12 levels checked. I would find this somewhat irrelevant other than as a marker for knowing that vitamin B12 is important for vegans. I generally discourage vegans from getting their B12 levels checked as a way to prevent B12 deficiency in most cases because of the unreliability for people who regularly eat seaweed (including sushi) and the fact that no matter what your B12 levels turn out to be, all vegans should be getting a regular, reliable source of B12 (see Should I Get My B12 Status Tested?).

In their section on Taste, they found that about one-third of former vegetarians/vegans craved meat compared to about 8% of current. It’s a mistake to consider “cravings” and “taste” to be equivalent. You can’t simply add the taste of meat to a low-fat, low-protein vegetable and expect that to take away someone’s meat cravings. Meat cravings are about the nutrients, most notably fat and protein. Craving the “taste” of meat is a Pavlovian response for craving those nutrients. (Note: I don’t know if this has been scientifically tested in a rigorous way.)

There were two positive findings from the HRC report:

More than one-third of former vegetarians/vegans said they are interested in resuming the diet, and vegans were less likely to abandon the diet (at rate of 70% compared to 86% for vegetarians).

The rest of my comments on this survey are regarding what it means for advocacy. If interested, please see Humane Research Council Survey on Vegetarian Recidivism.

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Dietitian Perspectives on Protein, Calcium and Vegan Bone Health

November 6th, 2014 by Jack Norris RD

Note: this article is co-authored by Jack Norris, RD and Ginny Messina, MPH, RD and appears on Ginny’s blog as well as this one.

Vegans typically have lower calcium intakes than other vegetarians and meat-eaters. But just how much does this matter?

The popular thinking has long been that it doesn’t matter much at all. According to the acid-ash hypothesis of osteoporosis, vegans experience smaller calcium losses since we don’t eat animal protein. The theory is that calcium is “leached” from bones to counter acidic conditions caused by animal protein.

It’s supported by studies that find higher levels of both calcium and acidic compounds in the urine when people are fed big doses of animal protein (1). This is also supposedly why hip fracture rates are higher in countries with high animal protein intakes (2).

But while the theory had great support several decades ago, it hasn’t held up to the scientific evidence. An article by vegan dietitian Dr. Reed Mangels, based on a presentation she gave at the Sixth International Congress on Vegetarian Nutrition sums up the more recent research very well (3). It should be required reading for all vegan and vegetarian nutrition professionals.

Unfortunately, a quick Google search of “vegan-calcium-bone-health” shows that many vegan educators, including some who are health professionals, are still promoting the idea that protein causes calcium loss from bones.

We thought it would be interesting to see where vegetarian dietitians fit into all of this. So, we created a true/false questionnaire about bone health, protein and vegan diets. We asked dietitians who subscribe to the email list for the Vegetarian Nutrition Dietetic Practice Group (VNDPG) to answer the questions.

Although this was a small, unscientific survey, the results were interesting. They showed that VNDPG members were more aware of the issues than the general vegan community and are sharing better information than what is often available on the internet and elsewhere. But in some cases, even RDs weren’t aware of the newer research on protein and bone health.

Here is the survey with our answers.

1. Protein contributes to bone structure. TRUE

Most RDs got this one right. Bone contains collagen and other proteins and you can’t build and maintain bones without protein (4).

2. Protein from animal foods causes calcium loss from bones. Probably FALSE

According to a 2009 meta-analysis of epidemiological studies, protein is not harmful to bone health and may be beneficial (5). Particularly relevant to vegetarians, in the Adventist Health Study-2, vegetarians who ate the most protein-rich foods like legumes and veggie meats, had the fewest fractures (6). It’s true that studies link higher protein intake with higher urinary calcium losses. But this is in response to eating isolated proteins, not protein-rich foods (7). The phosphorus in those higher-protein foods seems to cancel out the effect on bone loss. Protein also improves calcium absorption when calcium intakes are low (8), so it’s possible that the higher amounts of calcium in the urine simply reflect that greater amounts being absorbed from the diet.

In fact, another 2009 meta-analysis—this one looked at clinical studies—found that the amount of calcium lost in the urine didn’t correlate with calcium balance in the body or with markers of bone health (9). That is, acidic conditions didn’t produce a net loss of calcium from the bones.

The studies comparing hip fracture rates among countries have also been called into question. Since they’re ecological studies, they don’t control for anything and are only marginally useful.

Better information comes from The Hong Kong Osteoporosis Study. This research found that hip fracture rates were lower in Hong Kong than Sweden but that spinal fracture rates were higher (10). And while that seems conflicting, it’s really not. Hip fracture rates are affected less by bone health and more by the likelihood of falling. Spinal fractures, on the other hand, actually reflect bone health. In fact, the researchers said that despite lower hip fracture rates, the Hong Kong women had more osteoporosis.

3. Drinking cow’s milk promotes osteoporosis. Probably FALSE but maybe TRUE

Given the discussion above, it doesn’t seem that the protein in milk would raise risk for osteoporosis. But, research published just last week did raise questions about the effects of milk-drinking on bone health.

The Swedish researchers found that women who drank more than 3 glasses of milk per day had a much higher rate of fracture than those who drank less than a serving (11). In contrast, though, they found that cheese and yogurt were associated with lower rates of fracture. Earlier research in Adventists also found a protective effect of cheese on bone health (12).

One possible explanation, according to the Swedish researchers, is that the sugar galactose—high in milk, but low in cheese and yogurt—is the factor affecting fractures. The research supporting this is in animals, though.

Although it would be premature to say that milk raises fracture risk, there isn’t much evidence that milk-drinkers have any particular health advantage, either. Since we oppose dairy consumption on ethical grounds, it seems like it’s enough to know that nobody actually needs dairy foods in their diet.

4. Research shows that vegans have fewer bone fractures than meat-eaters. FALSE

What evidence we have for this — and admittedly, it’s very little — isn’t especially favorable for vegans. In the EPIC-Oxford study, vegans had a 30% higher risk for fracture after adjusting for numerous variables like age, smoking, alcohol consumption, and physical activity. After adjusting for calcium intake, however, there was no difference in fracture rates. Vegans who got enough calcium were no more likely to break a bone than milk-drinkers (13).

Likewise, in the Adventist Health Study-2, there was a trend toward higher fracture rates among the vegans compared to other vegetarians as well as non-vegetarians (6). (This study didn’t test for statistical significance.)

5. People eating plant-based diets have lower calcium needs than meat-eaters. Probably FALSE

If protein doesn’t have a negative effect on bone health, then there is no reason to think that vegans have lower calcium needs. The EPIC-Oxford study mentioned above suggests that the lower calcium intakes that are typical of vegans may be harmful.

6. The US RDAs for calcium are similar to the World Health Recommendations. TRUE

A common belief is that the WHO recommends just 400 to 500 milligrams of calcium per day. But, the WHO recommends 1000 mg of calcium for adults which is the same as the US RDAs.

Two last questions on our survey looked at the more holistic story of diet and bone health.

7. Weight-bearing exercise is important for bone health TRUE

8. A variety of nutrients including vitamin D, potassium, magnesium, and calcium is needed for healthy bones. TRUE

No surprise that 100% of our respondents knew that bone health is about much more than calcium. No single nutrient or food can make or break the strength of your bones. Keeping bones strong takes a whole diet and lifestyle approach. Getting enough calcium is just one part of that, but it is still an important part. Right now, there is no reason to think that vegans have any particular advantage where this is concerned.

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References

1. Schuette SA, Linkswiler HM. Effects on Ca and P metabolism in humans by adding meat, meat plus milk, or purified proteins plus Ca and P to a low protein diet. J Nutr 1982;112:338-49.

2. Frassetto LA, Todd KM, Morris RC, Jr., Sebastian A. Worldwide incidence of hip fracture in elderly women: relation to consumption of animal and vegetable foods. J Gerontol A Biol Sci Med Sci 2000;55:M585-92.

3. Mangels AR. Bone nutrients for vegetarians. Am J Clin Nutr 2014;100:469S-475S.

4. Boskey AL, Coleman R. Aging and bone. J Dent Res 2010;89:1333-48.

5. Darling AL, Millward DJ, Torgerson DJ, Hewitt CE, Lanham-New SA. Dietary protein and bone health: a systematic review and meta-analysis. Am J Clin Nutr 2009.

6. Lousuebsakul-Matthews V, Thorpe DL, Knutsen R, Beeson WL, Fraser GE, Knutsen SF. Legumes and meat analogues consumption are associated with hip fracture risk independently of meat intake among Caucasian men and women: the Adventist Health Study-2. Public Health Nutr 2013:1-11.

7. Spencer H, Kramer L, DeBartolo M, Norris C, Osis D. Further studies of the effect of a high protein diet as meat on calcium metabolism. Am J Clin Nutr 1983;37:924-9.

8. Kerstetter JE, O’Brien KO, Insogna KL. Dietary protein affects intestinal calcium absorption. Am J Clin Nutr 1998;68:859-65.

9. Fenton TR, Lyon AW, Eliasziw M, Tough SC, Hanley DA. Meta-analysis of the effect of the acid-ash hypothesis of osteoporosis on calcium balance. J Bone Miner Res 2009;24:1835-40.

10. Bow CH, Cheung E, Cheung CL, Xiao SM, Loong C, Soong C, Tan KC, Luckey MM, Cauley JA, Fujiwara S, et al. Ethnic difference of clinical vertebral fracture risk. Osteoporos Int 2012;23:879-85.

11. Michaelsson K, Wolk A, Langenskiold S, Basu S, Warensjo Lemming E, Melhus H, Byberg L. Milk intake and risk of mortality and fractures in women and men: cohort studies. Bmj 2014;349:g6015.

12. Matthews VL, Knutsen SF, Beeson WL, Fraser GE. Soy milk and dairy consumption is independently associated with ultrasound attenuation of the heel bone among postmenopausal women: the Adventist Health Study-2. Nutr Res 2011;31:766-75.

13. Appleby P, Roddam A, Allen N, Key T. Comparative fracture risk in vegetarians and nonvegetarians in EPIC-Oxford. Eur J Clin Nutr 2007;61:1400-6.

Dr. Greger: Turmeric for Alzheimer’s

September 28th, 2014 by Jack Norris RD

Dr. Michael Greger has posted a very interesting video, Treating Alzheimer’s with Turmeric.

He has also just released Latest in Clinical Nutrition: Volume 21 which includes four videos on the safety of GMOs.