Medscape Report: Calcium & Vitamin D Decreases Fractures & Cancer

April 28th, 2014 by Jack Norris RD

On April 2, 2014, Medscape sent out a Special Report that included a link to a video and article, Calcium + Vitamin D: Surprises From Long-term Follow-up. You probably need to sign up for a free account to view the article.

Here are some excerpts from the article which was about the Women’s Health Initiative study:

“In this large trial, more than 36,000 postmenopausal women aged 50-79 years were randomly assigned to treatment with a combination of calcium carbonate at a dose of 1000 mg elemental calcium plus vitamin D3 400 IU daily, or placebo.

“We now have 3 lines of evidence of benefit for calcium plus vitamin D supplementation: the reduction in hip fracture seen among adherent women, the reduction in vertebral fracture in the intention-to-treat analyses, and the improvement or better results for bone mineral density…

“In terms of all cancers, among the women who had low baseline intake of vitamin D, there was a statistically significant 9% reduction in total cancer with supplementation, and also a marginally significant 9% reduction in all-cause mortality.”

The report also said that there was no increase in cardiovascular disease for women taking supplements.

Tips for New Vegans

April 26th, 2014 by Jack Norris RD

I have changed the title of the article I was Vegan for a While, But… to Tips for New Vegans.

While most of the facts are the same, I have substantially changed the wording to a more friendly tone and included a link to The Plant Plate, Ginny Messina’s vegan food guide pyramid.

I hope people find it useful for informing new vegans about the nutrition issues they should be aware of when going vegan. (Link)


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Clinical Trial of DHA Supplementation in Vegans

April 25th, 2014 by Jack Norris RD

A 172 mg DHA / 82 mg EPA supplement for 2 months increased levels in vegans to those typical of fish-eaters.

A recently released study measured the omega-3 status of vegans and then placed those with low omega-3 status on an EPA/DHA supplement for two months (1).

The cross-sectional part of the study found that 166 vegans had an average EPA level of .63% (of total fatty acids in red blood cells) and an average DHA level of 2.4%. In comparison to other studies that have measured the percentage of EPA/DHA in meat-eaters in similar ways, those numbers are on the low side, especially for EPA.

The researchers compared a group of the male vegans to a group of male soldiers deployed to Iraq who had very low fish intakes and the vegans had significantly higher levels of EPA and slightly lower levels of DHA.

The researchers then took a group of vegans with low omega-3 levels and gave them a supplement of 172 mg DHA and 82 mg EPA for 2 months. EPA went from about .6% to .8% and DHA increased from about 2.3% to 3.25%.

In other words, this supplementation schedule was adequate for raising EPA/DHA levels to those typical of fish-eaters.

I have updated Omega-3 Fatty Acid Recommendations for Vegetarians with this information.


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1. Sarter B, Kelsey KS, Schwartz TA, Harris WS. Blood docosahexaenoic acid and eicosapentaenoic acid in vegans: Associations with age and gender and effects of an algal-derived omega-3 fatty acid supplement. Clin Nutr. 2014 Mar 14. pii: S0261-5614(14)00076-4. doi: 10.1016/j.clnu.2014.03.003. [Epub ahead of print] | link

Ginny: Paleo Advocates Get Vegan Diets (and Saturated Fat) Wrong

April 22nd, 2014 by Jack Norris RD

Ginny Messina has written a response to Kris Gunnars of Authority Nutrition, Paleo Advocates Get Vegan Diets (and Saturated Fat) Wrong.

Walnuts Improve Cholesterol but Fail to Increase DHA in Vegetarians

April 18th, 2014 by Jack Norris RD

3.0 g of ALA per day via one daily ounce of walnuts for 8 weeks did not increase DHA levels in lacto-ovo vegetarians, but did improve cholesterol ratios.

Previous research has shown that it takes at least 3.7 g of the short-chain omega-3 fatty acid, ALA, to increase DHA levels in vegetarians in the short term, with the longest trial lasting 6 weeks.

A new study from Loma Linda University (1) put a group of lacto-ovo vegetarians, average age of 38, on three different daily regimens for 8 weeks each:

– 1 oz of walnuts (3.0 g of ALA)
– 1 regular egg (110 mg DHA)
– 1 fortified egg (~500 mg DHA, 40 mg EPA, 1 g ALA)

The ratio of omega-6 to omega-3 was 6 to 1 in the walnut phase, which is relatively low for a vegetarian diet, but DHA levels did not increase. The ratio of total cholesterol to HDL was lower in the walnut treatment compared to both egg treatments and there were no significant differences for any inflammatory markers.

In conclusion, 8 weeks of 1 oz walnuts daily improved cholesterol markers but did not increase DHA levels.

I have updated Omega-3 Fatty Acid Recommendations for Vegetarians with this information.


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1. Burns-Whitmore B, Haddad E, Sabaté J, Rajaram S. Effects of supplementing n-3 fatty acid enriched eggs and walnuts on cardiovascular disease risk markers in healthy free-living lacto-ovo-vegetarians: a randomized, crossover, free-living intervention study. Nutr J. 2014 Mar 27;13(1):29. | link

VeganHealth Update: Hexane in Soy

April 11th, 2014 by Jack Norris RD

Just added two links to both Soy What’s the Harm: Hexane and Response to Not Soy Fast:

Hexane in Soy Food – Berkeley Wellness | May 01, 2012
Do Veggie Burgers Contain Hexane? – Shereen Jegtvig, MS | Updated Feb 07, 2014

Thanks, Brenda!

VeganHealth Update: Irritable Bowel Syndrome

April 11th, 2014 by Jack Norris RD

Just added the article, Irritable Bowel Syndrome – from the Academy of Nutrition and Dietetics to Digestion at

Dr. Greger on Blood Type Diet, New DVD

April 9th, 2014 by Jack Norris RD

Dr. Michael Greger is up to his foils again!

He had some very interesting videos on phytates and cancer recently (start here).

But even more exciting, Dr. Greger just posted the first episode from his Latest in Clinical Nutrition: Volume 18 DVDBlood Type Diet Debunked. In it, he discusses a paper from the Journal of the Norwegian Medical Association which I had not previously been aware of when writing my posts on the blood type diet.

And even if Dr. G didn’t have anything new, let’s face it, it’s just fun to debunk that diet!

Jack Norris, RD Speaking in Corvallis on May 7 – CPE Available

April 8th, 2014 by Jack Norris RD

Vegetarian Nutrition: What Does the Science Say?
    – a presentation by Jack Norris, RD
Wed May 7, 2014
7:30 – 9:30 pm
First United Methodist Church
Community Center room
Corner of 12th and Jackson near OSU
Corvallis, OR

Talk is free.
2.0 hours of CPE are available for RDs/DTRs for $25.

Brought to you by:
Corvallis Veg Education Group & Vegans & Vegetarians at OSU

From a reader:

“[A]fter explaining [vitamin B12 and vegans] to my doctor, she read up on this, and in the past few months, has helped multiple vegan patients with vague neurological symptoms but normal serum B12! She now recommends MMA testing to her vegan patients, and would never have found their problems without it.”

Austrian Vegetarian Study Making Waves

April 3rd, 2014 by Jack Norris RD

A CBS Atlanta story is promoting a poorly designed cross-sectional study from Austria as though it is the best evidence we have regarding vegetarian diets.

As I hope most of my readers know, I do not quickly dismiss a study just because I don’t like the results.

In 2007, when EPIC-Oxford found a higher risk of fractures among vegans who didn’t get over 525 mg of calcium day, rather than finding some limitation of the study which is always possible to do, I started emphasizing that vegans need to get more than 525 mg of calcium per day. There are many other examples.

So when I say a study whose results I don’t like is pretty much useless, it’s because the study is pretty much useless and not because I don’t like the results.

In December 2013, a cross-sectional study from Austria aiming to compare the health status of vegetarians to other diet groups was released (1), and I wrote about it in the post Austrian Vegetarians: Good News? It was, with all due respect to the researchers, one of the most oddly designed studies I have seen to describe vegetarians.

In the study, the diet categories were:

– Vegetarian (vegans, lacto-ovo-vegetarians, and pesco-vegetarians)
– Carnivorous diet rich in fruits and vegetables
– Carnivorous diet less rich in meat
– Carnivorous diet rich in meat

The researchers didn’t define these categories for the participants when they were asking them which category they belonged to.

The researchers also created a number of health indicators that I didn’t feel confident in even though they concluded that vegetarians had the best self-rated health and the lowest incidence of chronic conditions.

Then on February 7 2014, another paper from this same study was published (2). I read the abstract and saw that their conclusions were somewhat different in the more recent paper, and less favorable to vegetarians, but given the boondoggle that I considered the study to be, I put it aside with no intention of doing another write-up.

Fast forward to April 1, when an article about the February paper was published on (Atlanta), Study: Vegetarians Less Healthy, Lower Quality Of Life Than Meat-Eaters. This CBSlocal article made the rounds quickly and so I decided it was time to comment on the study.

My criticisms of the February paper are pretty much the same as for the one from December. However, the February paper had more information.

With the diet categories so poorly designed, it’s surprising that they found a number of statistically significant differences in disease incidence between the groups. In comparing the vegetarian group to the carnivorous diet rich in meat group, the vegetarians had a higher rate of allergies, cancer, and mental illness, while the rich meat group had a higher rate of urinary incontinence. Asthma, diabetes, cataracts, hypertension, heart attack, stroke, osteoporosis, among other diseases, were not significantly different across diet groups.

As for the self-reported quality of life scores, some of the information didn’t match between the two papers; for example, the December paper lists the chronic conditions score for vegetarians as 1.45 while the February version lists it as 1.29 (lower is worse), a meaningful difference in their scheme.

Enough said about the specifics of this study, other than that the February paper is available for free at the link from the citation below, so if you want to check it out on your own you can. But quibbling over the details of either of these papers is fairly pointless. As the authors state in their relatively long section on the limitations of their study (2):

“Potential limitations of our results are due to the fact that the survey was based on cross-sectional data. Therefore, no statements can be made whether the poorer health in vegetarians in our study is caused by their dietary habit or if they consume this form of diet due to their poorer health status.”

They also bring up my earlier criticism:

“Further limitations include the measurement of dietary habits as a self-reported variable and the fact that subjects were asked how they would describe their eating behavior, without giving them a clear definition of the various dietary habit groups.”

The study from Austria, with all it’s limitations, is one thing. But the article from CBS Atlanta (link), adds insult to injury.

The CBS Atlanta article suggests that the Austrian study indicates causation (“But the vegetarian diet…carries elevated risks of cancer, allergies and mental health disorders”) and ignores a huge body of much better evidence regarding vegetarian diets, making it seem like this Austrian study is all we have to go on.

In fact, as most of my readers probably already know, much better studies following vegetarians over time have shown them to have equal or better health than regular meat-eaters in a number of diseases. You can read all about those studies in the section, Research on Vegetarians and Vegans.

For those not familiar with this research, I will point you to the fact that vegans have been found to have only a fraction of the risk of developing type 2 diabetes compared to regular meat-eaters (Type 2 Diabetes and the Vegan Diet).


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1. Burkert NT, Freidl W, Großschädel F, Muckenhuber J, Stronegger WJ, Rásky E. Nutrition and health: different forms of diet and their relationship with various health parameters among Austrian adults. Wien Klin Wochenschr. 2014 Feb;126(3-4):113-118. Epub 2013 Dec 17. | link

2. Burkert NT, Muckenhuber J, Großschädl F, Rásky E, Freidl W. Nutrition and Health – The Association between Eating Behavior and Various Health Parameters: A Matched Sample Study. PLoS One. 2014 Feb 7;9(2):e88278. | link