We just added a new child to the Real Vegan Children page. This page lists kids who have been “vegan since conception.” The new child is Zander Earl and his mother provides an interesting and extensive write-up.

Dr. Greger recently highlighted an exciting study at NutritionFacts.org in his video, Preventing Prediabetes By Eating More. In this study, adding 5 cups of pulses (beans and peas) per week to the diets of people at risk for type 2 diabetes resulted in improvements similar to counseling patients to reduce food intake by 500 calories per day.

Dr. Greger also recently came out with a new DVD, Dr. Greger’s 2014 Year-in-Review Presentation.

Ginny Messina posted an interesting article, Vegans Drink Almond Milk Because It’s Cruelty-Free–Not Because It’s Hip. Excerpt:

“I like almond milk, but I rarely drink it. I actually don’t drink plant milk much at all, but when I do, it’s always soymilk. I want the protein it provides, and it’s also easy on the environment.”

This past week, a study was released from Poland in which the diet and iron status of vegetarian children were investigated (1). To the researchers knowledge, it was the first study to examine the diet and iron status of Caucasian children, and I know of only one other study on any vegetarian children, a study from India that I mention below.

Some quick background: Meat contains about 40% of its iron as heme-iron, which is more easily absorbed than non-heme iron. Non-heme iron is the only iron found in plants. Because iron deficiency anemia is the most common nutrient deficiency in Western countries, especially among menstruating women who lose blood (and, therefore, iron) every month, there is a concern about vegetarians getting enough iron.

The study from Poland compared 22 vegetarian children (5 ate fish, none were vegan) to 18 omnivores, aged 2 to 18 years old. Of the vegetarian girls of menstruating age, 2 of the 5 had iron deficiency anemia, whereas none of the 4 omnivore menstruating girls had iron deficiency anemia. The researchers noted that their anemia was not due to menstrual period disorders, and that they had been trying to lose weight for “quite a long time.” Of the vegetarians, 36% (8) had iron deficiency compared to only 11% (2) of the omnivores.

Median iron intake in vegetarians was only 65% of the RDA, but the omnivores was even lower at 60%. 82% of vegetarian children did not meet the iron RDA while none of the omnivore children met it. As for vitamin C, which increases plant iron absorption, the vegetarians had higher intakes (171% vs. 95% of the RDA). The average vitamin C intake for the vegetarians was 69 mg per day.

As the vegetarian children got older, their iron intake decreased (as a percentage of the RDA). The researchers suggested that as the kids got into their teens, parents had less input on their food choices and the quality of their diets suffered.

There was no association found between vitamin C intake and iron status. A significant amount of other research has shown that vitamin C can greatly increase iron absorption from plants when eaten at the same meal. It’s possible that you need more vitamin C at meals than these children were getting. The research showing that vitamin C increases iron absorption uses doses from 50 mg up 500 mg per meal. In the study from India mentioned above, vegetarian children with iron deficiency anemia (and low vitamin C intakes) were given 100 mg of vitamin C at both lunch and dinner for 60 days. They saw a drastic improvement in their anemia, with most making a full recovery (2).

It might be a good idea for vegetarian kids, and especially teenage girls, to make sure they eat a food that has a large amount of vitamin C with at least two meals each day, especially meals with legumes. Some foods that are high in vitamin C per typical serving are orange juice and grapefruit juice (80 mg per cup), oranges (50 mg per small orange), broccoli (50 mg per 1/2 cup cooked, chopped), strawberries (85 mg per 1 cup of whole berries), grapefruit (40-50 mg per 1/2 fruit), yellow peppers (70 mg per 1/4 cup chopped), and red peppers (50 mg per 1/4 cup chopped).

I just added a large table of iron amounts in plant foods to the the article, Iron, at VeganHealth.org.

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As an aside, the note I had in my post about supporting JackNorrisRD.com by purchasing music through Amazon links might have seemed strange given that if you get my blog as an email via Feedburner, it did not include the links. So, I have reproduced them below. Thank you!

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Music I’m listening to:

Daft Punk: Contact

Daft Punk: Doin’ it Right

Dusty Springfield: I Found My Way (Previously unissued Version)

Justin Timberlake: Pusher Love Girl

Justin Timberlake: That Girl

Neko Case: Nothing To Remember

Lana del Rey: Paradise (album)

Lana del Rey: Burning Desire

The Guards: Ready To Go

Consider a gift basket from Pangea through the link below for Father’s Day or some other holiday!

Amazon.com Gift Cards – E-mail Delivery

Vegan for Life: Everything You Need to Know to Be Healthy and Fit on a Plant-Based Diet from Amazon.com

1. Gorczyca D, Prescha A, Szeremeta K, Jankowski A. Iron Status and Dietary Iron Intake of Vegetarian Children from Poland. Ann Nutr Metab. 2013 May 25;62(4):291-297. [Epub ahead of print] | link

2. 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. (Abstract only) | link

A report from the National Birth Defects Prevention Study (1) was recently released. Counter to two previous studies, it found no association between vegetarian diets in pregnant women and having a boy with hypospadias. This makes six studies examining the association to date with four finding no association.

This is great news, but we are not completely out of the woods yet. There is still reason to make sure that pregnant vegans cover all of their bases.

I have revamped the article Hypospadias and Vegetarian Diets on VeganHealth.org where you can read the fine print.

Reference

1. Carmichael SL, Ma C, Feldkamp ML, Munger RG, Olney RS, Botto LD, Shaw GM, Correa A. Nutritional factors and hypospadias risks. Paediatr Perinat Epidemiol. 2012 Jul;26(4):353-60. (link)

With all the columnists telling parents not to feed their kids vegan, this was quite an enjoyable read:

Don’t Feed the Baby: In a live chat, Dear Prudence offers advice on a vegan infant,…

Nina Planck is up to her old shenanigans of spreading joy to the world. Ginny’s response:

The New York Times, Nina Planck, and Safety of Vegan Diets

And Ginny and VeganHealth.org are mentioned in a seemingly related LA Times piece:

In vegan debate, one thing parents must agree on

I thought this story was interesting enough to share, Obese kids have hard time sticking to low-carb diet:

“For the new study, researchers randomly assigned 100 obese 7- to 12-year-olds to one of three eating plans: one that followed the conventional wisdom of portion control; a low-carb diet; or a reduced glycemic load plan that cut down on certain carbs that typically cause surges in blood sugar…

“Over one year, all three plans worked equally well in controlling kids’ weight gain. The difference, researchers found, was that the low-carb plan was tough to stick with.

“…kids in all three diet groups ended up with healthier cholesterol levels.”

Thanks, Chris!

According to the article Guidelines for Introducing Foods to Infants Being Developed, the American Academy of Pediatrics (AAP) discussed the idea of promoting red meat as the best first food to introduce to infants on October 17 at their AAP ConvergeNCE conference.

The write-up says that Frank R. Greer, MD, FAAP would talk about guidelines for feeding infants that are under development, and was going to address the idea that “Red meat is the nutrient-rich food that biologically may be best as the first complementary feeding for infants.”

I don’t know that this is a huge emergency as vegetarian and vegan parents can opt to ignore the guidelines (if they even find out about them). However, it does seem to be a step in the wrong direction in terms of the evolution of human nutrition and I thought it would be good to write the AAP a letter about it:

Dear American Academy of Pediatrics:

Jack Norris, RD
President, Vegan Outreach

It might be good for others, especially health professionals, to write polite letters to the AAP expressing concerns about such guidelines and to ask them to consider a plant-based point of view.

You can contact them here.

I just added a page on VeganHeatlh.org for vegan teens. It’s nothing new, just puts all the information in as concise as possible terms.

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)

I just updated VeganHealth.org with information from an April 2009 review on soy infant formulas (link). Here is an excerpt from the paper:

“Even though soy isoflavones can bind and activate [estrogen receptors (ER)], they do not behave like typical estrogen agonists but rather as selective ER modulators and, in addition, have many other actions that are ER independent, eg, tyrosine kinase inhibition. It is unfortunate that soy isoflavones have been called “phytoestrogens,” because they are not estrogens and are not truly estrogenic at nutritionally relevant concentrations. The weak isoflavone potency for activating the ERs combined with competition with endogenous estrogens for the ERs make isoflavone-related ER activity minimal when fed in amounts similar to those found in [soy formula], even when fed during early development. Moreover, although some studies have shown similar gene expression profiles for genistein (the major soy isoflavone) and [estrogen] in some tissues in vitro and in vivo, ingestion of soy foods results in a complex mixture containing hundreds of phytochemicals and peptides being introduced to the gastrointestinal tract, many of which are absorbed and have biological actions. This situation is not unlike the mixture of phytochemicals found in a typical meal containing a mixed salad and vegetables.”