Here is an email exchange I recently had:

November 06, 2009

Hi Jack,

I’ve been vegan for almost two years and am wondering about a skin condition I recently developed. I have a red flaky patch of skin right below the corner of my lip and above both eyelids. The patch is not itchy or yellowish, so I suspect it is not eczema. I am wondering if the patches are the result of a vitamin deficiency. I used to take a multivitamin, but I quit taking it because my skin took on a yellowish hue, especially in the winter when I eat more squash (and my doctor thought I might be getting too much beta-carotene). I now only take a B-complex vitamin. Is it possible that the skin patches are a sign that I’m not getting enough of a particular vitamin?

My response:

A lack of vitamin D can cause psoriasis in some cases, but other than D and B-vitamins, which it sounds like you are good on, I don’t know what it might be or if it is likely to be nutrition-related. It’s definitely not a common complaint I hear from people who are vegan.

November 14, 2009

Dear Jack,

I saw my primary care doctor this week and she speculated that I might have a vitamin D deficiency. I began taking supplements and going outside for 30 minutes a day around noon. The patches have all but disappeared in a matter of days. Just wanted to let you know in case you ever come across any other individuals with the same condition. I have since read more about the health problems associated with vitamin D deficiency, and I am thankful my deficiency manifested itself in a way that I was able to take notice and do something about it.

Addendum Nov 15, sent from a different reader:

I had ‘eczema’ for years every winter and when I started taking Vitamin D2, 2000 IU, it went away for good. I also had my 25-hydroxy-Vitamin D level tested and it was at the very lowest end of normal…. Any skin condition that’s worse in the winter (where UV is low in the winter) I would suspect Vitamin D deficiency.

A study was just published showing that Chinese women living in Singapore who ate more soy had a reduced risk of hip fractures. Compared with women in the lowest one-fourth of intakes for tofu, soy protein, and isoflavones, those in all three of the higher intake categories had a 21%–36% reduction in risk. Soy did not show any benefit for men.

Koh WP, Wu AH, Wang R, Ang LW, Heng D, Yuan JM, Yu MC. Gender-specific associations between soy and risk of hip fracture in the Singapore Chinese Health Study. Am J Epidemiol. 2009 Oct 1;170(7):901-9. Epub 2009 Aug 31.

I was corresponding with JoAnn Farb who told me something interesting she has noticed about carrot juice protecting against sunburn:

“I discovered on several occasions that drinking large amounts of carrot juice and/or to a lesser extent — simply eating huge amounts of raw greens, reduces any observable changes in skin color (burning or tanning) when exposed to sun.

“I first noticed this on a canoe trip — years ago — I should have burned — was not using sunscreen and everyone else who didn’t use it did burn badly. But I had been drinking lots of carrot juice every day before hand. Then again in Australia, in January, in Sydney on the beach, Sarina [her daughter] was one year old at the time and pretty much nursing for all her calories. Each day over the noon hour I took her to the beach and let her crawl around naked — and I was in a swim suit. At first I just did ten minutes and then we put full clothing on. Each day I saw no burn and no tan. I increased the time more — until we were fully exposed for well over an hour and saw absolutely no reactions on our skin. There were juice bars everywhere; I was drinking two to three large glasses of fresh carrot juice every day.

“I have certainly had my share of sunburns at other times, from much less exposure, but have tested this repeatedly. Not only will carrot juice protect me and my family from sunburns, but if we have not been drinking carrot juice and do happen to burn, we will drink large amounts right away and the burn fades quickly.”

I have long known about the orange tint that people who drink a lot of carrot juice can get, but I was not aware of any sunburn protection. I checked it out and found research showing that beta-carotene does protect against sunburn:

Köpcke W, Krutmann J. Protection from sunburn with beta-Carotene — a meta-analysis. Photochem Photobiol. 2008 Mar-Apr;84(2):284-8. Epub 2007 Dec 15.

The study found that taking beta-carotene for 10 weeks, in amounts of about 57 mg per day, protected against sunburn. One cup of carrot juice has about 22 mg of beta-carotene.

The researchers said the SPF of beta-carotene was about 4. They thought the benefit from beta-carotene could be due to its antioxidant potential or interference in other parts of the biochemical pathways leading to sunburn.

JoAnn went on to ask:

“I have always wondered, since Michael Hollick mentions the pinking of the skin as a way to get an indication of how much vitamin D one is potentially making, does consuming all this carrot juice in some way inhibit vitamin D production? Or is the pinking of the skin merely a general way to gauge melanin amounts but otherwise not really related to biosynthesis of D?”

I’m afraid I do not know the answer to this and I could not find any research on it. I did, however, find one study in which higher intakes of beta-carotene were associated with less bone mineral loss in the elderly:

Sahni S, Hannan MT, Blumberg J, Cupples LA, Kiel DP, Tucker KL. Inverse association of carotenoid intakes with 4-y change in bone mineral density in elderly men and women: the Framingham osteoporosis Study. Am J Clin Nutr. 2009 Jan;89(1):416-24. Epub 2008 Dec 3.

It appears that in this case, beta-carotene was not noticeably interfering with any vitamin D formation in these people, though this is a very indirect way to try to answer that question.

Leaky gut syndrome is a phenomenon that may, or may not, actually exist. The theory is that things (such as antibiotics, infections, and inflammation) can damage the cells that line the intestines and weaken the “tight junctions” between the cells. This causes there to be small gaps between the cells and, thus, particles that the cells would normally prevent from entering the bloodstream get through. This, in turn, causes the body to mount an immune reaction against these particles which are viewed as foreign invaders.

A leaky gut has been implicated by various nutritionists as one of the causes of chronic fatigue syndrome — another syndrome about which little is known with certainty.

Wikipedia.org has a concise explanation of leaky gut syndrome. Most interest has been about its relation to autism, but that is not my focus here.

It is my own personal theory that allergy tests that measure immunoglobulin G (IgG), and find that someone is “allergic” to a host of different foods, are sometimes merely uncovering a leaky gut in someone who is not actually allergic to all or most of those foods.

So what does the research say? Not much. There has been very little published on leaky gut syndrome. I could find only one clinical trial (1).

The purpose of this trial was to see if they could get immunoglobulin A (IgA) and M (IgM) levels to go down in people with chronic fatigue syndrome. To do this, they used a dietary regimen, but their purpose was not to actually test this regimen, and they, therefore, give very few details about it; they merely say:

“All patients followed the leaky gut diet and took glutamine, zinc and [N-acetyl-L-cysteine], in combination with other [natural anti-inflammatory and antioxidative substances], which were given according to the immune and biochemical status of the patients, i.e. L-carnitine, coenzyme Q10, taurine and lipoic acid (in case of carnitine and/or coenzyme Q10 shortage); or curcumine and quercitine (in case of systemic or intracellular inflammation).”

They described their “leaky gut diet” as a dairy and gluten-free, low-carbohydrate diet.

Their study found that some people’s IgA and IgM levels were reduced on this regimen. They also found that a younger age at onset of chronic fatigue, a shorter duration of illness, and a younger age of the patient led to a better outcome.

It’s important to note that there was no control group and so it could be that patients were merely responding to the care and attention they were receiving or from a placebo effect.

This blog post is just to get something started on the subject. As more research comes out, I will post updates.

Reference

1. Maes M, Leunis JC. Normalization of leaky gut in chronic fatigue syndrome (CFS) is accompanied by a clinical improvement: effects of age, duration of illness and the translocation of LPS from gram-negative bacteria. Neuro Endocrinol Lett. 2008 Dec;29(6):902-10.

I just updated the High ALA Sources of VeganHealth.org with the following info from a study in the September issue of the European Journal of Clinical Nutrition:

“There is some evidence that people 45 and older do not absorb the oil from ground flaxseeds as well as from flaxseed oil.² The one study indicating this was only for four weeks and using 6 g of ALA per day. With smaller amounts and for longer periods, the difference might be negligible, but that hasn’t been tested.”

What does this mean? If you are age 45 or older, you might want to get your ALA from flaxseed oil, rather than ground flaxseed. Or you might want to wait until more research determines whether this study is applicable to a more typical situation of eating less ALA but on a more consistent basis.

2. Patenaude A, Rodriguez-Leyva D, Edel AL, Dibrov E, Dupasquier CM, Austria JA, Richard MN, Chahine MN, Malcolmson LJ, Pierce GN. Bioavailability of alpha-linolenic acid from flaxseed diets as a function of the age of the subject. Eur J Clin Nutr. 2009 Sep;63(9):1123-9.

I just came across the following email I received last November (before I had this blog) from an old friend which I thought could be helpful:

“I ended up drifting from the vegan diet while in Taiwan because my nails were constantly breaking and my vegetarian girlfriend insisted I try eating meat again. I thought, ‘Well if a vegetarian is insisting I eat meat, maybe I should?’ Actually many other people were constantly urging me to eat meat there too, telling me I’m too thin etc. The carnivorous diet didn’t effect my health at all really, besides effecting my nails.

“I experienced immediate re-strengthening of my nails within 2 weeks of adding meat back into my diet. Tried going off meat again a few times, but nails would start breaking again.

“During this period I was against supplements for some reason, until reading Paul Pitchford’s Healing with Whole Foods and decided to try taking a B-complex and no meat. It worked! So I went veg again and have been for over a year. Guide to Cruelty Free Eating confirmed what I experientially discovered. Great that you’ll save countless more from needing to do the research and self experimentation on their own. I haven’t tried the mega doses of sublingual B yet – I’m going to try that too as I must have been quite deficient in B’s. I remember seeing somewhere that B’s are related to hair and finger nail nutrition, though I haven’t seen it recently. But taking B complex solved my nail problem.

“It’s great to have found my way back to VO. Thanks for still being here and all of the work you’ve done and are doing!”

Someone asked me about carnosine a few months ago. I didn’t know much about it at the time, so I looked into it and here are the results:

http://www.veganhealth.org/articles/carnosine

Quick summary: No need to worry about it unless you are a serious athlete interested in experimenting with supplements that haven’t been tested long-term.

Well, I’ve had pretty good news for awhile, so now it’s time for some that is not so great — but important to be aware of.

A case report of a lacto-vegetarian boy from Italy with rhabdomyolysis was published in the American Journal of Physical Medicine & Rehabilitation (1).

Rhabdomyolysis is a potentially life-threatening disease of severe muscle damage.

Let me quote the authors:

“The patient is a 16-yr-old boy who was a nationally ranked swimmer at that time. In the 2 wks preceding this episode, he was undergoing training 5 days per week, 2–3 hrs per day, in addition to the 4 hrs per week of school-based physical activity.”

“During the week before the visit [to the doctor’s], the boy experienced progressive weakness and intermittent muscle ache particularly in the legs and reported those symptoms to his coach. At the time of the medical encounter, he also reported malaise, episodic tachycardia, and nausea.”

“A dietary history revealed that, since the age of 14 yrs, his diet had contained adequate energy but very little protein. In particular, he reported to have avoided eating meat, fish, eggs, cheese and dairy products, and legumes. The only source of protein was 100 ml of milk in the morning and soy-derived products once or twice a week. For unexplained reasons, his diet mainly and monotonously comprised pasta, bread, tomatoes, salad, carrots, fruits, white pizza, and potatoes.”

Laboratory results of interest were:

CK is creatine kinase, which is a marker for muscular breakdown.

The authors believed that a low protein intake was the main problem with this boy. Upon adding meat four times a week as well as dairy to his diet, and a B12 supplement, he made a complete recovery.

I am not convinced that it was only, or even mainly, a low protein intake that caused this boy’s problems. It could have been another nutrient deficiency or a combination of deficiencies, including some that were not tested for (such as calcium and magnesium).

Of course, he could have gotten all the necessary nutrients and stayed with his vegetarian diet. Although the authors note that vegetarian diets can be healthy for athletes, they apparently did not find out why the boy was vegetarian or instruct him on how he could maintain a healthy vegetarian diet.

1. Borrione P, Spaccamiglio A, Salvo RA, Mastrone A, Fagnani F, Pigozzi F. Rhabdomyolysis in a Young Vegetarian Athlete. Am J Phys Med Rehabil. 2009 Aug 5. [Epub ahead of print] PubMed PMID: 19661778.

I recently watched a DVD from Physician’s Committee for Responsible Medicine (PCRM): A New Approach to Nutrition for Diabetes. I would suggest recommending it to anyone you know who has type II diabetes and is eating a mainstream diabetes diet.

The DVD is based on a clinical study PCRM did in which they had good success in treating people with type II diabetes. The thrust of the DVD is that people with type II diabetes can stop counting carbohydrates and calories while at the same time becoming healthier by eating a primarily whole foods vegan diet.

I was happy to see that they strongly emphasized the need to take vitamin B12 if you are on a vegan diet.

I have two suggestions for the DVD.

First, I think they should recommend eating some nuts, at least an ounce a day. Nuts have been shown to have positive effects for type II diabetes, as well as for heart disease and weight loss which are two big concerns for most people with type II.

Second, they recommend avoiding foods with a high glycemic index, but I wish they had made a distinction between glycemic index (how fast a food causes your blood sugar to rise) and glycemic load (how much sugar is absorbed into your blood). In some cases, such as with a carrot, a healthy food without much sugar can have a high glycemic index but a low glycemic load (more info on that here).

But these are minor points in what is overall a very good DVD that could be of great benefit to people with type II diabetes.