Archive for the ‘Supplements’ Category

DHA Supplements: A Good Idea, Especially for Older Vegan Men

Monday, November 8th, 2010

My October 22 post about Doug Graham’s B12 claims garnered a lot of comments. Among them was one suggesting that I am alarmist at times. So, it is with hesitation that I report the following.

Background: If you are not familiar with omega-3 fatty acids, some of the conversation below might not make much sense. See Omega-3 Fatty Acid Recommendations for Vegetarians for background.

DHA in Elderly Vegan Men

I have been in dialogue with Dr. William Harris about DHA. Dr. Harris has been vegan for many decades and will be 80 years old this December. He has been concerned about making sure he has enough DHA, but in the past when he took DHA, he started bruising very easily. A more recent report from him is that he has been trying DHA again and the bruising has not reappeared.

Dr. Harris cc’d me on a discussion he was having with Dr. Joel Fuhrman and this led me to find out from Dr. Fuhrman that he has been seeing numerous elderly vegans with severe DHA deficiency, and he believes it may have exacerbated Parkinson’s disease and tremors in some of his patients. Upon more questioning, Dr. Furhman had the following to say:

“I have seen thousands of vegan patients, raw foodists, natural hygienists, McDougall and Ornish participants, as well as my own ‘nutritarian clients’ over the last 20 years. I test B12 on everyone, of course we are not talking about B12 [deficiency in regards to the patients with Parkinson’s and tremors], these individuals were well-educated about B12. I have seen some paralysis and other major B12 problems in hygienists and vegan raw foodists. Some that even died from hyperhomocysteine resulting from severe B12 deficiency. I have also seen vegans with balance and ambulation issues with B12 deficiency, unable to walk. One raw foodist who came to see me with this problem, who could not walk, made almost a complete recovery after B12 supplements and then he announced on his radio show that he recovered from M.S. with a raw food diet. ”

“Many of the visits were initiated by complaints. Many people who started or adopted vegan diets went back to eating meat after suffering from fatty acid deficiency symptoms from not eating sufficient seeds and nuts. I have performed fatty acid tests, B12, MMA, amino acid profiles and others on many people. I have seen significant DHA and EPA deficiencies even in middle aged women, but the most predictable pattern is the dramatically low levels in elderly vegan men. I do feel to err on the side of caution, either a blood test to confirm adequacy or a low dose of DHA is indicated, and, as was discussed, you do not need very much [200 – 300 mg DHA per day for one month] to fix the blood test findings.”

Because of the above conversation, I have tweaked my DHA recommendations for vegans, emphasizing that elderly vegans need to take more:

    Under 60 years old: 200 – 300 mg every 2-3 days
    60+ years old, pregnancy, or breastfeeding: 200 – 300 mg per day

This amount may be somewhat more than necessary, but until we know what level can sustain DHA levels long term, it seems like the most prudent amount. This is based both on what Dr. Fuhrman says above, as well as a 2003 study that showed blood levels of DHA to increase 48% in vegans taking 200 mg per day for 3 months (1).

Vegans Convert DHA Better than Fish Eaters

In other DHA news, a study from EPIC-Norfolk recently came out showing that while vegans have lower levels of DHA in their blood, they are more efficient at converting ALA to DHA than people who eat fish (2). This is not surprising, as an abstract by the same lead author was published in 2008 finding the same thing. You can see the EPA and DHA levels in Table 4 of Omega-3 Fatty Acid Recommendations for Vegetarians.

There were only 5 vegan men and 5 vegan women in this study. Despite the higher conversion rate, the vegan men still had significantly lower DHA levels than the fish-eaters. However, the vegan women actually had the highest DHA levels of any diet group (although the standard deviations was quite large indicating that some of the women had very high levels and some had very low). The authors did not address this unusual finding.

Omega-3 Lab Tests

If you are interested in getting your DHA levels tested, Dr. Harris has compiled a list of three labs he was able to find that test them. Dr. Harris was only completely confident in the results from Mayo Clinic.

1. Mayo Labs – $394.60 for 29 different fatty acids including LA, AA, ALA, EPA, and DHA

2. MetaMetrix – $206 for 7 fatty acids

3. Genova – $188.65 for 4 Omega-3 and 6 Omega-6 fatty acids

I am not suggesting that all vegans need to get their DHA levels tested and I do not know anything further about these tests. I am just providing them for people who might be interested.

References

1. Lloyd-Wright Z, Preston R, Gray R, Key TJA, Sanders TAB. Randomized placebo controlled trial of a daily intake of 200 mg docosahexaenoic acid in vegans. Abstracts of Original Communications. Proceedings of the Nutrition Society 2003:42a. (No link available.)

2. Welch AA, Shakya-Shrestha S, Lentjes MA, Wareham NJ, Khaw KT. Dietary intake and status of n-3 polyunsaturated fatty acids in a population of fish-eating and non-fish-eating meat-eaters, vegetarians, and vegans and the precursor-product ratio of alpha-linolenic acid to long-chain n-3 polyunsaturated fatty acids: results from the EPIC-Norfolk cohort. Am J Clin Nutr. 2010 Nov;92(5):1040-51. Link

Can My Recommendations Prevent Failure to Thrive?

Wednesday, June 9th, 2010

A couple weeks ago, I was made aware of the website and blog, Let Them Eat Meat, written by Rhys Southan. He had mentioned me in a post and someone forwarded it to me. I spent a few minutes looking around the site and found it very interesting. Rhys is an ex-vegan and the site is basically a criticism of many aspects of the vegan movement, some of which I can’t say I disagree with. He was vegan for many years, didn’t feel healthy, mentally or physically, and went back to eating meat and felt a lot better.

In a post of June 7, Rhys says that some vegans are claiming that if you follow my nutrition recommendations, you will not fail as a vegan. He goes on to say:

There was a point when I was lazy about B12 pills and relied on supplemented nutritional yeast and soy milk (the vegan health argument at that time downplayed the need for B12, which convinced me this was adequate), but I got into taking B12 more regularly after enduring Restless Legs Syndrome for a few months.

Still, I didn’t follow Norris’ exact recommendations. For one thing, I didn’t know who the hell he was. And even if I had, Norris is constantly revising his recommendations in response to new research, and the B12 dosage Norris now stands behind was posted in March of this year, so that wouldn’t have helped anyway.

I would like to clarify some of this:

1. Though my recommendations have helped many people (who were not coming even close to following them), I do not think that following them insures that someone will have no trouble being vegan.

2. My recommendations do not need to be followed exactly to get most of the benefit. If you followed my pre-March vitamin B12 recommendations, you should not feel any different in the short term than following the new recommendations. Tweaking my B12 recommendations is for preventing long-term, chronic disease, not for daily feelings of well-being.

3. For the main nutrients I focus on (B12, omega-3s, vitamin D, calcium, iodine, vitamin A), I probably change my recommendations for any given nutrient no more than once every 5 years, and I rarely change them by much. My vitamin B12 recommendations change in March was the first I’ve made since about 2003.

4. If new evidence shows me that my recommendations need to be changed, I change them.

5. Restless leg syndrome could very well be from a vitamin B12 deficiency and my recommendations now or at the time might have helped this aspect of Rhys’ health; and it’s possible they could have even improved his mental issues as well. But, that said, see #1 above.

I am interested in reading more of Rhys’ site and possibly responding to things I find of interest, such as the below. Perhaps this is a good place for me to state for any new readers that I am a vegan to prevent animal suffering. There are some worthwhile health benefits, but those are side-benefits for me.

Rhys states in his post linked above:

In my case, when I grocery shop, I buy mostly organ meats. And when I go to a restaurant, I look for the organ option the way a vegan looks for the vegan option. I do this because I think fewer animals will need to be raised and killed if more of the animal parts are used. In that sense, I am accomplishing exactly what vegans are — fewer animals are being born. (But I recognize that my consumer choices are almost totally insignificant in this regard; like veganism, this is a symbolic gesture).

That’s probably true – just like in voting, your vote is unlikely to make a difference. But if enough vegans create a critical mass such that less animals are raised, it is probably in proportion to how many vegans there are and, at that point, one vegan could make a real difference to some animals.

 
Please note that I don’t allow comments through that are impolite or disrespectful.

What Supplements Do I Take?

Tuesday, October 27th, 2009

Updated September 2013

Every month or so, someone reads my recommendations for vegans, checks out some vegan multivitamins, and then writes me asking about the high levels (many times the RDA) of some individual vitamins in many of the vegan multivitamins.

B vitamins (including folic acid) and vitamin C can be very high in multivitamins. There are concerns that taking folic acid could be linked to cancer, but this connection is far from proven. In the meantime, limiting folic acid is prudent. [A meta-analysis from 2013 found no link between folic acid and cancer in the many clinical trials that have been performed using large amounts of folic acid. (1)] I’m not aware of any risks in taking B vitamins and vitamin C in the amounts found in typical vegan multivitamins.

There is also evidence that taking vitamin A (as retinol, retinyl palmitate, or retinyl acetate) can cause osteoporosis at typical amounts of 1,500 mcg (5,000 IU) found in vitamins. Vitamin A as carotenoids does not cause osteoporosis and is what is typically found in vegan vitamins. See Vitamin A at the Linus Pauling Institute for more info.

I thought it might interest readers to hear what supplements I take:

Calcium: I drink a glass of calicum-fortified orange juice with my morning oatmeal.

Zinc: I take 10-13 mg of zinc per day depending on the supplement I currently have in stock.

Vitamin B12: I take half of a Trader Joe’s High Potency B “50” tablet every morning and evening. This provides 25 µg of vitamin B12 twice a day—that’s more than needed. I also suspect I can use a bit extra riboflavin which this provides.

Iodine: I take a 225 µg kelp tablet about once every 3 days. I hardly ever eat seaweed.

Vitamin D: During the warmer months (when sunburn is possible) I get out in the sun a lot, probably too much. During the colder months, I take a vitamin D supplement of 1,000 IU each day. Vitamin D2 supplements should be fine. I had my vitamin D levels tested in September of 2011 and they were at 34 ng/ml (84 nmol/l).

Vitamin A: I am pretty good about eating yellow vegetables or drinking carrot juice every day.

Omega-3s: I am a bit of an anomaly and do not adhere to my own recommendations. Around 2002, I had my blood clotting time tested. Being a vegan, I wanted to make sure I was getting enough omega-3s and that my blood wasn’t clotting too fast. Well, it turned out that it was actually clotting a bit too slowly. I had been taking one teaspoon of flaxseed oil per day for a couple years and decided to stop supplementing. I have had my clotting time tested a number of times since then and it is always a bit slower than normal. So for omega-3s, I will take a DHA tablet once in awhile, but by no means as often as I recommend for other vegans.

Creatine: I am a recreational weightlifter, lifting three times per week with short but intense workouts. For a long time, I supplemented with creatine off and on, but I think I’m finally done with that. It might benefit elite vegetarian athletes, but I did not find any consistent enough results to justify the cost or bother.

Reference

1. Martí-Carvajal AJ, Solà I, Lathyris D, Karakitsiou DE, Simancas-Racines D. Homocysteine-lowering interventions for preventing cardiovascular events. Cochrane Database Syst Rev. 2013 Jan 31;1:CD006612. | link