Based on some articles that were floating around the Internet suggesting that vegan infants might be at risk for vitamin A deficiency, I asked Reed Mangels, PhD, RD what evidence we have that the breast milk of vegan mothers is adequate in vitamin A. She wrote an article about it and posted it in the Vegetarian Resource Group’s blog:
“The bottom line – Vegan women who are breastfeeding should make sure that their diet includes good sources of precursors of vitamin A. These are foods rich in beta-carotene such as winter squash, carrots, pumpkin, sweet potatoes, cantaloupe, and green leafy vegetables. Dietary fat is needed to promote beta-carotene absorption so it is important that lactating women not overly limit dietary fat.”
The Linus Pauling Institute says, “Vitamin A and retinoic acid play a central role in the development and differentiation of white blood cells, such as lymphocytes, which play critical roles in the immune response (1).”
Unlike omnivores, vegans do not have a direct, dietary source of vitamin A, but rather get it indirectly via carotenoids (mainly beta-carotene). Beta-carotene is fat-soluble. It seems theoretically, possible then, that a low intake of carotenoids or fat could contribute to lower vitamin A status and white blood cell count (WBC).
This is purely hypothetical; to my knowledge vitamin A levels have not been measured in vegans and other signs of low vitamin A status have not been a noted problem. Anecdotally, I had been eating plenty of beta-carotene and fat at the last measurement of my WBC which showed them to be below normal.
Paul Appleby, of EPIC, passed on a study to me of a clinical trial using a “Daniel Fast” from the University of Memphis (2). In this trial, mostly healthy and some vegetarian subjects (13 men, 30 women; 20-62 years old) went on a Daniel Fast for 21 days, eating no processed or packaged food and only plant foods (as much as they wanted). Their WBC went from an average of 5.7 to 5.0 (2). 5.0 is within the normal range, but on the lower end (normal being about 3.5 to 12.5 billion per liter).
The authors of the Daniel Fast study say, “It has been suggested that ingestion of food additives and preservatives can increase white blood cell count by triggering an immune response due to a sensing of invading pathogens from the food stuff; however, we are unaware of any scientific reports that confirm this hypothesis.” I should point out that lots of things have been suggested, but it doesn’t seem impossible that vegans generally eat less food additives and preservatives and this could be contributing to low WBC.
The authors did an analysis which showed that the improvements in these parameters did not occur in only the unhealthier subjects, but rather across the board. They say, “It is interesting to note that even those subjects who were vegetarian prior to starting the fast experienced dramatic reductions in total and LDL-[cholesterol], in addition to improvements in other markers. Clearly, the exclusion of meat from the diet (as is the case for vegetarians) is not the only dietary factor involved in raising circulating cholesterol and other risk factors for cardiovascular and metabolic disease.”
It should be noted that this trial had no control group and was not randomized in any way.
I found this interesting because even though the subjects didn’t lose much weight (the weight change wasn’t even statistically significant), their blood pressure and cholesterol levels went down substantially in only 3 weeks. That’s impressive. But does it mean that it is the diet that everyone should be on all the time, indefinitely?
1. Linus Pauling Institute. Micronutrient Information Center. Vitamin A. Accessed 5/20/13 | link
2. Bloomer RJ, Kabir MM, Canale RE, Trepanowski JF, Marshall KE, Farney TM, Hammond KG. Effect of a 21 day Daniel Fast on metabolic and cardiovascular disease risk factors in men and women. Lipids Health Dis. 2010 Sep 3;9:94. | link
Vitamin A is found only in animal products, but the body can create it out of carotenoids, like beta-carotene.
When I first got involved in vegan nutrition, vitamin A was considered a non-issue because we assumed most vegans would easily get enough beta-carotene with any sort of varied diet to cover our needs.
But in 2001, the Food and Nutrition Board (FNB) doubled the amount of beta-carotene they said was enough to meet vitamin A needs. According to the FNB, this change was based on “data demonstrating that the vitamin A activity of dietary β-carotene is one-sixth, rather than one-third, the vitamin activity of purified β-carotene in oil (1).”
They go on to say:
“This change in bioconversion means that a larger amount of provitamin A carotenoids, and therefore darkly colored, carotene-rich fruits and vegetables, is needed to meet the vitamin A requirement. It also means that in the past, vitamin A intake has been overestimated.”
This change mostly flew under the radar, but it made a significant difference in how easy it would be to get enough beta-carotene.
I recently became more concerned about vitamin A, quite literally, by accident. Early last Fall, I twice got up in the middle of the night and walked straight into my bedroom door that was halfway open, face-first!
Over the previous year or so, I had slacked off on vitamin A, relying only on a bit of shredded carrots on salad and mangoes on most days. In mid-November, I decided I needed to make a real effort to add more yellow vegetables to my diet and started eating sweet potatoes every day. A few weeks later, I realized that I had been having no trouble seeing the bedroom door at night. I wondered if there was a connection to what seemed to be my improved night vision.
In checking out whether it was likely that my apparent change in night vision was possibly caused by eating more beta-carotene, I was reminded that vitamin A metabolism is involved with immune function. When vegans get sick easily, I tell them to think about more zinc or protein, neglecting any concern about vitamin A. (Interestingly, vitamin A metabolism appears to rely on zinc.)
Vitamin A deficiency symptoms begin with night blindness, and if it progresses, can lead to the more severe eye problems of corneal ulcers, scarring, and blindness (2). Vitamin A is also important for growth and development in infants and children, and for red blood cell formation (2).
Because I suspect that many vegans might not be giving vitamin A any thought, I decided to make this post and add some information to Vitamin A at VeganHealth.org. That link has a chart showing which foods are high in carotenoids. I would encourage everyone to check the chart to make sure they are getting enough. And you might save yourself a few bumps on the noggin!
1. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: The National Academies Press, 2001. | link
2. Vitamin A. Linus Pauling Institute. Accessed 1/25/2013. | link
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 & Zinc: In the morning, I drink calcium-fortified soy milk and take a 25 mg zinc supplement (I break a 50 mg supplement in half). In the evening, I take one-half of a Trader Joe’s Ca/Mg/Zn supplement which provides 250 mg of calcium, 125 mg of magnesium, and 3.25 mg of zinc. I take it for the calcium and zinc.
Vitamin B12: I take half of a Trader Joe’s High Potency B “50″ tablet every morning and evening. This provides 50 µg of vitamin B12. 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.
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