Nutrient Intakes of Vegans

May 14th, 2017 by Jack Norris RD

In 2016, a paper reporting vegetarian nutrient intakes was released from EPIC-Oxford (1). Nothing earth shattering was reported, but in keeping the Nutrient Intakes of Vegetarians and Vegans article complete, I’ve incorporated this latest analysis.

EPIC-Oxford is a cohort study of “generally health-conscious” British residents, and it follows large numbers of vegetarians. The assessment was conducted in 2010.

I track these nutrient intake reports to get an idea of how vegans, on average, typically eat, and if we’re meeting our nutrient requirements. However, they have some drawbacks:

  • The nutrient intakes are based on food frequency questionnaires (FFQ). FFQ are more useful for judging relative nutrient intakes between groups than for measuring absolute amounts of nutrients for comparison to dietary recommendations.
  • FFQ don’t include all the foods vegans typically eat, and in the case of EPIC-Oxford, it’s likely they don’t accurately reflect typical portion sizes either. This could explain why a much higher percentage of vegans reported calorie intakes that were implausibly low (43% and 33% of vegan men and women, respectively, compared to 33% and 19% of meat-eating men and women).
  • Nutrients amounts are estimated from nutrient database tables rather than directly measuring the nutrient content of the food. Direct measurements are very expensive to perform.
  • Nutrients from fortified foods—such as vitamin B12 fortified foods—are rarely accounted for, nor are supplements.

Given all these potential problems, the studies should mainly be used to spot glaring problems or trends.

The table below notes the most interesting findings from this current report.

I was pleasantly surprised by the calcium intakes for vegans which were significantly higher than the previous EPIC-Oxford report from 2003. I’m wondering how it was so high without fortified foods being represented. [May 22, 2017 update: The researches appeared to assume some calcium fortification of nondairy milks which represented almost one-third of vegans’ calcium intake.]

Vitamin A and zinc intakes are a little low (the DRI for vitamin A is 900 RAE for men and 700 RAE for women while the RDA for zinc is 11 mg for men and 8 mg for women). I also prefer to see vegan protein intakes higher than the .9 g/kg of body weight (for men). But given that the overall food intake reported for vegans was low, intakes of these nutrients were probably a bit higher than reported.

Vitamin A and zinc are nutrients I consider to be important for vegans and if you don’t know much about them, please check out the VeganHealth.org articles, Vitamin A and Zinc.

The report includes information on supplement intake, indicating that 50% of vegans were supplementing with vitamin B12.

All in all, British vegans seem to be doing well, though let’s hope that much more than 50% are now getting a source of vitamin B12!

The report is available for free here.

Reference

1. Sobiecki JG, Appleby PN, Bradbury KE, Key TJ. High compliance with dietary recommendations in a cohort of meat eaters, fish eaters, vegetarians, and vegans: results from the European Prospective Investigation into Cancer and Nutrition-Oxford study. Nutr Res. 2016 May;36(5):464-77. • link

New Position Paper on Vegetarian Diets

November 27th, 2016 by Jack Norris RD

Position of the Academy of Nutrition and Dietetics: Vegetarian Diets has been released!

It states:

It is the position of the Academy of Nutrition and Dietetics that appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes. Plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources and are associated with much less environmental damage.

The paper contains a review of all the nutrients of concern for vegetarians and a summary of the research on the health and environmental benefits.

As of this writing, a free PDF was downloadable at the links to the paper above and below.

If you like my posts, please like or share them! Thank you!

Reference

1. Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet. 2016 Dec;116(12):1970-1980. • link

Petition: Vegan Cheese Pizza at California Pizza Kitchen

November 17th, 2016 by Jack Norris RD

One of the most common reasons people give for not being vegan is a lack of vegan options at restaurants. Vegan Outreach has launched a campaigns program to increase the number of vegan entrees in national and regional restaurant chains.

Our first campaign is to get a vegan cheese on the menu at California Pizza Kitchen.

Please help us out by signing the petition.

And please share it: VeganOutreach.org/CPK.

Thank you!

Vegan Diet Improves Type 2 Diabetes in Koreans

July 30th, 2016 by Jack Norris RD

A clinical trial from Korea compared the effect of a vegan diet to a conventional diabetic diet, as prescribed by the Korean Diabetes Association (KDA), on glycemic control among Koreans (1).

The trial lasted three months. The vegan diet group had 46 people while the KDA diet group had 47. After three months, there was a statistically significant, greater reduction in HbA1c in the vegan group compared to the KDA group (0.5% vs. 0.2%, p = 0.017). When including only participants with high diet compliance, the vegan diet fared even better (0.9% vs. 0.3%, p = .01).

The vegan group ate less calories and saturated fat than the KDA group. Fiber intake for the vegan group and KDA group was 33.7 g and 24.9 g.

The vegan group lost weight while the KDA group didn’t. However, neither group’s blood pressure or LDL-cholesterol went down. The vegan group’s triglycerides went up while the KDA group’s went down; this might indicate the vegan group was eating more simple sugars.

I have posted these results in the VeganHealth.org article Type 2 Diabetes and the Vegan Diet.

Reference

1. Lee YM, Kim SA, Lee IK, Kim JG, Park KG, Jeong JY, Jeon JH, Shin JY, Lee DH. Effect of a Brown Rice Based Vegan Diet and Conventional Diabetic Diet on Glycemic Control of Patients with Type 2 Diabetes: A 12-Week Randomized Clinical Trial. PLoS One. 2016 Jun 2;11(6):e0155918. | link

Story from a Once-Failing, Now-Thriving Vegan

March 21st, 2016 by Jack Norris RD

From an anonymous, female animal advocate:

I went vegan in 1992 at age 15. At that time, most of us in the vegan community believed and promoted that eating only plants was the most natural and complete diet for humans. We pointed to our flat molars and long intestines as proof that humans are natural herbivores. We rejected supplements because we thought our diet was naturally perfect. We thought we’d get our B12 from mushrooms, sea vegetables, or microscopic bits of soil clinging to our farmer’s market produce. We thought we’d get enough vitamin D naturally from the sun. We had never heard of DHA and EPA.

After seven years of being an unsupplemented vegan, I had a health crisis when I was 22 and in graduate school. I wasn’t a junk food vegan–I cooked my own meals and ate my share of fresh produce. I’d always been an ace student, but I was finding it harder and harder to read my textbooks. I couldn’t concentrate. My short-term memory was shot. I felt tired and weak all the time and I was diagnosed with depression. I learned that these are all symptoms of B12 deficiency and I started to take vegan supplements: B12 and a multi-vitamin for extra insurance.

I have now proudly celebrated my 25th year as a vegan, and I take supplements regularly. In addition to the B12 and multi-vitamin, I now take vegan vitamin D3 supplements (I was diagnosed as vitamin D deficient a couple of years ago), algae-based DHA/EPA, and the occasional calcium pill.

I am healthier than any of my family members who are all omnivores. They suffer from a variety of illnesses (including diabetes and heart disease). In contrast, I can walk into a doctor’s office at 40 years old and check exactly zero disease boxes. I’m an active rock climber and hiker and still weigh what I did in high school, which is uncommon in my genetic family.

One other very powerful experience I had with my diet was using a nutrition-tracking food diary website for about a year. I logged every single food I ate, including home-cooked recipes, and the website broke down my daily, weekly, and monthly nutrition stats. It taught me a few important things:

  • I am not going to eat enough variety of food every single day to get all the nutrients I need, so a multi-vitamin really is a good idea for me.
  • I feel better when I eat a balance of good fats, protein, and healthy carbs at every meal.
  • I need a significant amount of vegan protein to feel my best.

I think many of us vegans get so fed up with being questioned about, “Where do you get your protein?” and we spend so much time debunking the protein combining myth, that we overcorrected in the other direction and began to believe that we’ll get enough protein no matter what plants we eat. It just isn’t true for me, at least based on how I feel after eating a low-protein meal. This is one of the reasons why I love and embrace the vegan meats (seitan, veggie burgers, veggie dogs and sausages, Field Roast, Beyond Beef, etc.) and soy products (tofu, tempeh, soyrizo). They may not be “natural”, but they help keep me healthy and feeling good as an active vegan, and that’s my most important dietary value.

Thank you for sharing your story!

Dr. Greger Strikes Again!

March 21st, 2016 by Jack Norris RD

Dr. Michael Greger of NutritionFacts.org has another DVD out, Latest in Clinical Nutrition: Volume 29. It covers Splenda, lupus, CoQ10, and reversing diabetes. As always, it’s packed with interesting and often surprising info!

All proceeds are donated to charity.

Breast Cancer in Vegetarians & Vegans

March 21st, 2016 by Jack Norris RD

There’s a new report from Adventist Health Study-2 (AHS-2) comparing breast cancer incidence in vegetarians and vegans to non-vegetarians (1).

The study included 24,211 non-vegetarians, 3,748 vegans, 14,336 lacto-ovo vegetarians, 5,179 pesco-vegetarians, and 2,930 semi-vegetarians. Meat intake among non-vegetarians was quite low at less than a serving per day (54 g/day). Participants were followed for an average of 7.8 years (which isn’t very long for a cancer study).

All vegetarians combined had similar rates of breast cancer to non-vegetarians (0.97, 0.84-1.11), while vegans had a 22% lower risk that didn’t reach statistical significance (0.78, 0.58-1.05). After adjusting for body mass index, the reduced risk was 15% for vegans (0·86, 0·62-1·21), indicating that lower body weight could explain some of the lower risk for vegans.

The authors write, “In conclusion, participants in this cohort who follow a vegetarian dietary pattern overall did not experience a lower risk of [breast cancer] as compared with non-vegetarians. However, those adhering to a vegan dietary pattern showed consistently lower point estimates in various subgroups but these were not statistically significant. Numbers of cancers in vegans were relatively small, and these analyses should be repeated in the AHS-2 cohort after a longer follow-up to determine whether the same trends continue when power is greater.”

I have posted these results in the VeganHealth.org article Cancer, Vegetarianism, and Diet.

References

1. Penniecook-Sawyers JA, Jaceldo-Siegl K, Fan J, Beeson L, Knutsen S, Herring P, Fraser GE. Vegetarian dietary patterns and the risk of breast cancer in a low-risk population. Br J Nutr. 2016 Mar 18:1-8. • link

Ginny Messina on Irritable Bowel Syndrome

March 21st, 2016 by Jack Norris RD

Never afraid of providing too much information, Ginny Messina has done a great service by putting together an informative post on Vegan Diets and Irritable Bowel Syndrome.

If you suffer from IBS, I highly recommend checking it out!

Best Study on Vegan Protein Intakes to Date

January 31st, 2016 by Jack Norris RD

I just updated the Protein page at VeganHealth.org with a new section, Intakes and Plasma Amino Acid Levels in Vegans, based on a recent study from EPIC-Oxford.

The new research cannot substitute for a nitrogen balance or protein synthesis study on vegans, which I have been hoping to see, but for now it’s what we have.

The takeaway message is that vegans, and particularly vegan women, should continue to make sure they eat plenty of lysine-rich foods, and that if you do, you should be covering all your protein needs.

I have reproduced the new section below.

Intakes and Plasma Amino Acid Levels in Vegans

A 2015 report from EPIC-Oxford analyzed the dietary intakes and blood levels of amino acids in various diet groups in adult men (15). The study included 98 men for each diet group (vegan, lacto-ovo, pesco, and meat-eater). The authors say, “[T]his is the largest study to date of amino acids in the circulation or in the diet by habitual diet group, and on average participants had followed their diet for several years.”

RDA

The study didn’t compare the intakes of the various diet groups to the US RDA for amino acids, but I have done so in Table 4 below.

AminoRDA

Vegan men met the RDA for all essential amino acids.

This study bolstered the idea that lysine is the limiting amino acid in vegan diets, with vegan men surpassing the RDA by the lowest amount–9%. Methionine, the amino acid of second most concern, surpassed the RDA at the next lowest level of 33%.

The 95% confidence interval for lysine was 2.69-2.95 g/day; with the lower margin coming in at 104% of the RDA. The people on the lower end might have been the people who weighed less (and thus had a lower RDA than the average vegan).

The RDA for protein and amino acids is the same for women as it is for men (based on a percentage of their body weight). Male vegans in EPIC-Oxford were found to eat 10.7% more protein than female vegans (62 vs. 56 g per day; link). If you assume female vegans eat the same percentage of high-lysine foods as men, their average lysine intakes would be only 98.7% of the RDA.

Given that women have a lower percentage of lean body mass on average, it might seem curious that they have the same RDA for protein (and amino acids). In determining the RDAs, the Institute of Medicine says (Ref 2, p. 644):

Although the data indicate that women have a lower nitrogen requirement than men per kilogram of body weight, this was only statistically significant when all studies were included, but not when the analysis was restricted to the primary data sets. This difference may be due to differences in body composition between men and women, with women and men having on average 28 and 15 percent fat mass, respectively. When controlled for lean body mass, no gender differences in the protein requirements were found. However, in view of the uncertain significance of the difference between the genders, the same protein EAR [i.e., Estimated Average Requirement, a foundation for the RDA] on a body weight basis for both men and women is chosen.

Another consideration is that the vegans in the UK may eat lower amounts of protein than those in the U.S. Adventist Health Study-2 found an average protein intake of 71 g/day for men and women combined, considerably more than in EPIC-OXford (link). It seems safe to assume that Seventh Day Adventist woman are likely getting plenty of lysine and other amino acids.

Finally, according to the authors, “[T]he validation of the [food frequency questionnaire] showed that protein intake was particularly difficult to estimate.”

Blood Levels

In comparing blood levels of amino acids between diet groups, vegans had lower levels of lysine, methionine, tryptophan, and tyrosine, and higher levels of alanine and glycine.

Interestingly, arginine, a dietary concern for vegans with herpes virus, was actually lower in the blood of vegans, but not significantly. It was also lower in the diet (3.92 g/day for vegans vs. 4.13 g/day for meat-eaters; lacto-ovo vegetarians had the lowest intake at 3.36 g/day).

The authors didn’t seem alarmed by any of the differences found between diet groups. I decided to take things a bit further and compare the plasma levels found in this study to the reference ranges given by the U.S. National Library of Medicine in Table 5 below.

AminoPlasma

In comparing the vegan’s blood levels to the reference range:

  • Alanine, glutamate, glycine, leucine, ornithine (a non-protein amino acid), phenylalanine, and serine are higher.
  • Aspartate is also higher, but the reference range is curiously low.
  • There is no reference range for tryptophan, with no explanation as to why.
  • There is a reference range for cystine (which is two cysteine molecules combined), but EPIC-Oxford didn’t list plasma levels for cystine or cysteine.

It is not clear what any of this means and the U.S. Library of Science notes that these numbers are dependent on the specific laboratory methods used.

Conclusion

The above research is not a great substitute for a nitrogen or protein synthesis study on vegans, but for now it’s what we have. The takeaway message is that vegans, and particularly vegan women, should continue to make sure they eat plenty of lysine-rich foods. There is no reason to think that the vegans in this study were aware of lysine or trying to increase their lysine intakes, so any vegan who does so should be well covered.

Support JackNorrisRd.com

If you like my posts, please like my posts! Or share them!

I am very grateful for donations of any amount (click here).

Purchase anything through these links and JackNorrisRD.com gets a percentage:

Pangea – The Vegan Store
Amazon.com
Vegan for Life by Jack Norris & Ginny Messina

Thank you!

References

2. Dietary Reference Intakes: Macronutrients. National Academy of Sciences. Institute of Medicine. Food and Nutrition Board. DRI table for carbohydrate, fiber, fat, fatty acids and protein. | PDF

15. Schmidt JA, Rinaldi S, Scalbert A, Ferrari P, Achaintre D, Gunter MJ, Appleby PN, Key TJ, Travis RC. Plasma concentrations and intakes of amino acids in male meat-eaters, fish-eaters, vegetarians and vegans: a cross-sectional analysis in the EPIC-Oxford cohort. Eur J Clin Nutr. 2015 Sep 23. | link

16. Plasma amino acids. Medline Plus. U.S. National Library of Medicine. Accessed January 30, 2016. | link

Mortality Rates of Vegetarians and Vegans

January 10th, 2016 by Jack Norris RD

A paper came out in December reporting mortality rates of different diet groups from the large EPIC-Oxford study containing 60,310 people from the UK  (1).

The mortality rate before age 90 was no different between vegetarians (including vegans) and regular meat-eaters (1.02, 0.94-1.10). Vegetarians had lower rates of mortality from pancreatic cancer (0.48, 0.28-0.82) and lymphatic cancer (0.50, 0.32-0.79). Semi-vegetarians had lower rates of death from pancreatic cancer (0.55, 0.36-.86). Pesco-vegetarians had lower death rates from all cancers (0.82, 0.70-0.97) but higher rates of cardiovascular disease (1.22, 1.02-1.46).

In the main analysis (in the paragraph above), some participants were recategorized based on a change in their diet over the course of the study which included over one million person-years of follow-up. The researchers did a second analysis in which participants who changed their diets were removed, and found an 8% reduced risk of early death in vegetarians that was just statistically significant (0.92, 0.84-0.99). Limiting the results further, to deaths before age 75, strengthened the finding (0.86, 0.77-0.97).

When vegans were separated from other vegetarians, there were no statistically significant differences in mortality rates for the six main categories of death. Eliminating participants who had changed diet categories didn’t significantly change the results for vegans. There were only 166 vegan deaths as distinct from 1,929 deaths in the entire cohort; meaning that reaching statistical significance was going to be unlikely.

Results above were not adjusted for differences in body mass index (BMI); such adjustments were performed but they didn’t change the results substantially.

The fact that vegetarians didn’t have lower rates of death from heart disease in this study is surprising given that a 2013 report from EPIC-Oxford showed a highly statistically significant, 31% reduction in heart disease incidence among vegetarians (0.69, 0.58-0.82). This discrepancy as well as the lower death rates for vegetarians before age 75, but not before age 90, might be explained by cases of nonfatal heart disease leading to effective treatment.

See the link in the reference for a free copy of the paper. For results of other similar studies, please see Disease Rates of Vegetarians and Vegans.

References

1. Appleby PN, Crowe FL, Bradbury KE, Travis RC, Key TJ. Mortality in vegetarians and comparable nonvegetarians in the United Kingdom. Am J Clin Nutr. 2016 Jan;103(1):218-30. | link