QuasiVegan, written by Christina Arasmo, is a new blog discussing failure to thrive in vegans. Christina is not a health professional, but I have been very impressed with what she has written.

In particular, I am intrigued by what she has been saying about low cholesterol possibly being the cause of many of the health problems ex-vegans have experienced. I have considered this in the past, but given that cholesterol levels of around 100 mg/dl are supposedly commonplace in Asian countries, I have figured it probably was not such a problem for most people to have a low cholesterol level.

Early studies on blood cholesterol and mortality showed a U shaped-curve, indicating that very low blood cholesterol was associated with increased mortality. But this was thought to be due to undiagnosed disease causing low cholesterol levels and not that low cholesterol levels were causing the disease.

Meta-analyses such as this indicate that the lower the blood cholesterol, the better.

That said, I have often wondered that perhaps a cholesterol of 150 to 170 mg/dl might be ideal (for people without heart disease) and have told otherwise healthy people who have written me worried because their cholesterol was not under 150 mg/dl that they should not worry about getting it that low.

I would love to find out if the problems are caused by low cholesterol because in most cases there is a very easy and fun solution to that problem – eat more fat.

Looks like another topic to add to the queue of research reviews I need to do.

Speaking of which, remember that you can support JackNorrisRd.com by purchasing things through the Amazon, Vegan Essentials, or Pangea links on the website (if you can’t see the Amazon links, you will need to turn off your ad blocking software), as well as a direct donation.

And if you do not subscribe to the comments for my posts, you are missing out on some interesting conversations. If you go to the website, the comments are linked from the bottom of each post.

The reason I have not yet commented on the vitamin D news of yesterday is because I have been working for a couple weeks on updating the VeganHealth protein page. In the midst of doing that, Voracious Vegan became a voracious omnivore, which distracted me. But, it made the subject of protein even more relevant because I have a sneaking suspicion some vegans are not eating an ideal amount.

In particular:

• Legumes, quinoa, and pistachios are the only plants foods high in the amino acid lysine. If you are not eating them every day, you might be falling short of lysine needs.
• There is evidence that people over 60 should be eating well above the RDA for protein to prevent muscle and bone loss.

I encourage everyone to give it a read, at least through Lysine: The Limiting Amino Acid in Vegan Diets, and the next section, Protein Needs for People Over 60, if you happen to be over 60. The rest of the text is technical details that are not necessary for everyone to read, although if you are skeptical that vegans need as much protein as I’m suggesting, you might want to read the entire page.

Link

Laboratory Tests for Vegans is an updated version of this article.

I am regularly asked by vegans what they should be tested for. Here is a run down:

Vitamin B12

As I say in Should I Get My B12 Status Tested? –

Vegans do not need to get their homocysteine or B12 levels checked merely because they are vegan. Rather, being vegan means that you should get a regular, reliable source of vitamin B12 from fortified foods and/or supplements. (Though if you’ve gone a month or so without a reliable source of B12, you should replenish your stores as described in Step 1 of the Recommendations.)

About 2% of people do not absorb B12 well. While this has nothing to do with being vegan, it is nice to know if you are such a person. You will not be able to tell unless you first have a reliable source of B12 for at least a few weeks before your B12 level is checked. Additionally, there are specific tests that directly measure B12 absorption.

If you get your B12 level checked, please note that eating seaweeds can falsely inflate B12 levels. Methods for determining B12 levels do not distinguish between B12 and some inactive B12 analogues. Many seaweeds contain a variety of inactive B12 analogues. Someone who is eating large amounts of seaweed may have serum B12 levels well above normal, but much of it could be inactive B12 analogues.

Vitamin D

This is probably the one nutrient that vegans really can benefit from getting tested even if they do not have any symptoms of poor health.

Calcium

The body keeps blood calcium levels relatively constant regardless of your diet, so getting calcium levels tested doesn’t tell you much of anything (other than that you are not seriously ill). Getting your bone mineral density tested is the best way to find out what shape your bones are in. I don’t necessarily recommend this, unless you have reason to believe you might have osteoporosis. I’ve said it many times before, but I’ll say it again – most vegans should drink calcium-fortified non-dairy milks (or other foods) or take a calcium supplement.

Omega-3s

If you’re taking a DHA supplement, then you don’t need to be tested unless you suspect you’re having a cognition or other possible omega-3-related problem. Here are some testing companies.

There is a more common test that could shed some light on your EPA status—blood clotting time. Most doctors test for this routinely. If your blood is clotting too fast, you might be lacking EPA. I rarely hear from a vegan whose blood is clotting too fast.

Iron

If a doctor is going to draw blood, getting an iron panel to see if you have enough (or too much) iron is a good idea, especially for menstruating women.

Iodine

There is no direct test for iodine. Like B12, it’s best to just make sure you’re getting enough (but not too much). Iodine deficiency (and excess) can lead to thyroid problems, so getting your thyroid tested would be an indirect indicator. Click here for more on iodine.

And that covers it for any routine nutrients to test for regarding the vegan diet.

If you haven’t heard yet, Tasha the The Voracious Vegan has gone back to eating meat (I had never even heard of Tasha before she went back to eating meat).

Ginny Messina responds to the ex-Voracious Vegan’s blog post about her journey: Do Ex-Vegans’ Stories Make the Case Against Vegan Diets?

One comment from me. Tasha writes:

My first bite of meat after 3.5 years of veganism was both the hardest and easiest thing I’ve ever done. Tears ran down my face as saliva pooled in my mouth. The world receded to a blank nothingness and I just ate, and ate, and ate. I cried in grief and anger, while moaning with pleasure and joy.

This is the exact same reaction I have every time I eat a Jokerz candy bar!

PCRM sent out a press release on November 15 titled Women on Vegan Diets Have More Long-Chain Omega-3s, Compared with Fish-Eaters.

I already blogged about the study they are referring to in my November 8th post, DHA Supplements: A Good Idea, Especially for Older Vegan Men. Three people have written me about this press release and so I am going to share my comments about why this finding is most likely an anomaly.

The women categorized as vegan in the study did have the highest DHA levels – 286 µmol/l compared to 271 for the fish-eaters. But “vegan” was simply defined as someone who did not list eating animal products in their 7-day diet diaries. These vegans might have only been vegan for one week. Second, there were only 5 vegan women in the study making the finding unlikely to be statistically significant. Third, the standard deviation for the DHA levels of the vegan women was very high at 211 µmol/l. That means that one or two of the vegan women had very high levels of DHA but some have very low levels.

Unfortunately, this finding should not give us any confidence that vegan women do not need to be concerned about their DHA levels.

An October 21, 2010 article in New Scientist, Low levels of vitamin B12 linked to Alzheimer’s, describes research that adds more evidence to the idea that high homocysteine and low B12 levels are associated with Alzheimer’s Disease.

More info at VeganHealth.org.

On November 10, NPR featured an article on vegetarian children, Raising Vegetarian Kids? Here Are Some Pointers.

As with most nutrition articles on vegetarian children, they make it seem much harder than it actually is. I will only address the scariest statements in the article. It says:

“Iron is the most common nutrient deficient in vegetarians, and especially in vegans, who don’t eat any animal products, the American Academy of Pediatrics’ Pediatric Nutrition Handbook says.”

Reed Mangels, PhD, RD (quoted in the NPR article and an expert on nutrition for vegetarian children) was kind enough to forward me the excerpt from the 6th Edition (2009) of the Pediatric Nutrition Handbook. Reed’s comments are in brackets:

“The iron nutritional status of vegetarian infants and children varies. Iron deficiency is by far the most common of the micronutrient deficiencies exhibited by vegetarian children (62). It is particularly common in children consuming vegan diets [no reference] because plant foods contain nonheme iron as opposed to heme iron in animal sources [it would be more accurate to say a mix of heme and nonheme iron in animal sources]…Recommended iron intakes for vegetarians are 1.8 times those of nonvegetarians because of the lower bioavailability of iron in a vegetarian diet (64), and although vegetarians have lower iron stores their serum ferritin concentration is usually within the normal range (65, 66). Incidence of iron deficiency anemia among vegetarians is similar to nonvegetarians (55). Although many studies have been short-term, there is evidence that adaptation to low intakes takes place over a longer term and involves increased absorption and decreased losses (67, 68).”

Reed commented further:

“Reference 62, the Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride, is an odd reference to cite for this; it does not provide evidence for iron deficiency incidence in vegetarian children.

“As you can see, they say iron deficiency (not anemia) is the most common deficiency in vegetarian children. This is likely true since iron deficiency is the most common nutritional deficiency in all children and why should vegetarian children be the exception? I don’t think there is evidence that it is particularly common in vegan children. The two studies I know of (Swedish and UK) that look at iron intakes of vegan children and teens actually found higher or similar intakes in vegans compared to non-vegetarians (3, 4).

“Anemia does not appear to be more common in vegetarians and while serum ferritin levels are lower, they are within the normal range. Note that these findings are mainly, if not exclusively, in adults – there just aren’t that many studies of vegetarian children. So, when the article said that iron is the most common nutrient deficient in vegetarians, this should have been qualified to say ‘and in children in general’ or something like that.”

Back to the NPR article. Dr. Jatinder Bhatia, the chairman of the American Academy of Pediatrics’ committee on nutrition is quoted:

“If the child’s pediatrician isn’t aware that the child is a vegetarian, the doctor may not know to test for iron deficiency, Bhatia says…Iron deficiency may not become apparent until the child is older, Bhatia says, and at that point, the child may actually have irreversible cognitive defects.”

Dr. Mangels responds:

“Dr. Bhatia is correct that iron deficiency does affect brain development but this should be a concern for all parents, not just parents of vegetarians. The AAP handbook suggests either universal screening for iron deficiency at 9-12 months and then at 15-18 months for communities where a significant level of iron deficiency exists or selective screening using the same time points and measures for infants believed to be at risk, including those over 6 months not consuming a diet with adequate iron content. Annual screening should also be done for children with a possibly low iron diet who are 2-5 years old. So, I can’t fault him for saying parents should tell their pediatrician about their child’s diet. I can see why parents might not bring it up if they thought they would be discouraged from raising their child on a vegetarian diet. ”

A 1985 study of vegetarian children in India indicated that iron deficiency anemia was not uncommon, at least at that time (1), but this was not the case in the one study that tested vegan children’s iron levels, none of whom had anemia (2). As someone who corresponds with many parents of vegan children, I am not aware of any prevalence of iron deficiency anemia (or any recent cases at all).

Parents of vegetarian children do need to know a few things, but it is not rocket science. A good summary is Vegan Nutrition in Pregnancy and Childhood by Reed Mangels, PhD, RD and Katie Kavanagh-Prochaska, RD.

1. Seshadri S, Shah A, Bhade S. Haematologic response of anaemic preschool children to ascorbic acid supplementation. Hum Nutr Appl Nutr. 1985 Apr;39(2):151-4. (Link)

2. Kim Y-C. The effect of vegetarian diet on the iron and zinc status of school-age children. [master’s thesis]. Amherst: University of Massachusetts; 1988. Cited in: Messina V, Mangels AR. Considerations in planning vegan diets: children. J Am Diet Assoc. 2001 Jun;101(6):661-9. (Link)

3. Sanders, T. A. B. and Manning, J. The growth and development of vegan children. Journal of Human Nutrition and Dietetics,1992 5(1): 11–21. (Link)

4. Larsson CL, Johansson GK. Dietary intake and nutritional status of young vegans and omnivores in Sweden. Am J Clin Nutr. 2002 Jul;76(1):100-6. (Link)

Just added to Another Internet Soy Article:

A 2010 study found that low (1.64 mg/day) or high (61.7 mg/day) isoflavone consumption for 8 weeks did not significantly affect semen volume or sperm concentration, sperm count, total motile sperm count, or sperm motility in a sample of 32 healthy adult males (15).

62 mg is the amount of isoflavones found in about 2.5 cups of soymilk.

Thanks, Marco!

Reference

15. Beaton LK, McVeigh BL, Dillingham BL, Lampe JW, Duncan AM. Soy protein isolates of varying isoflavone content do not adversely affect semen quality in healthy young men. Fertil Steril. 2010 Oct;94(5):1717-22. Link

Potato Diet

As someone who loves hearing good news about my bad habits, I was excited to read about Chris Voigt, the Executive Director of the Washington State Potato Commission, who is eating nothing but 20 potatoes per day for 60 days (link). Potatoes have been linked to diabetes and the theory is that it’s because of their high glycemic index (see here).

After 30 days Voigt’s health markers changed drastically:

Weight – 197 to 189 lbs
Total cholesterol – 214 to 162 mg/dl
HDL (good) – 45 to 46 mg/dl
Triglycerides – 135 to 100 mg/dl
Blood Glucose – 104 to 92 mg/dl

It only takes 11 potatoes to meet the RDA for all amino acids, and 13 to meet the RDA for protein (calculated using a white, baked potato and with a 10% buffer for vegetable protein).

It appears that he isn’t eating sweet potatoes or yams (especially since his vitamin A intake is very low), but I wasn’t able to verify that.

To be clear, I’m not recommending this diet.

Junk Food Diet

And here is another article, Twinkie diet helps nutrition professor lose 27 pounds, about Professor Mark Haub from Kansas State University. Professor Haub lost 27 lbs in two months of eating nothing but junk food. He says that this shows you can lose weight eating anything, as long as you eat less calories than you use.

Don’t forget that you can support this blog by buying things from Pangea, Vegan Essentials, and Amazon using the links on the website. Thank you!

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