A vitamin B12 toothpaste in Germany, developed in conjunction with the German Vegetarian Society, successfully improved vitamin B12 status (link: B12 toothpaste makes vegans smile).

Since people brush their teeth two times or more per day (one would hope), toothpaste can be a good way to get B12 multiple times a day. And because vitamin B12 is much better absorbed in multiple doses throughout the day, toothpaste could enhance absorption over eating B12 only once per day (or less). I am somewhat surprised that enough B12 is swallowed from toothpaste to make it a reliable source, but assuming their data was accurate, it appears plenty is absorbed.

Maybe it will come to the U.S. soon…

Thanks, Chris!

You have to get up pretty darn early to beat Ginny to the punch!

Over at TheVeganRD.com, she is promoting her latest podcast interview (which I look forward to listening to today).

Well, it just so happens that I also have a newly released podcast interview that I did with Sentients Radio (link).

In it, host Sarah Downs and I discuss some of the pitfalls people might encounter when becoming vegan and we also spend a decent amount of time discussing whether the issue of vitamin B12 makes the vegan diet unnatural. Too much time, some might think. 🙂

I have a question in my inbox from someone asking if there “is anything to the ‘no oil’ diets,” such that Dr. Caldwell Esselstyn promotes. My answer is – certainly there is something to it. Dr. Esselstyn (1) and Dr. Dean Ornish (2) have used a very low-fat, plant-based diet (10% of the calories as fat) as part of a cholesterol-lowering program that has decreased the amount of plaque in patients’ arteries and led to much better outcomes than typical treatment for heart disease. Dr. Neal Barnard and the Physician’s Committee for Responsible Medicine have used a very low-fat, vegan diet to treat type-2 diabetes with impressive outcomes (link).

But is it the only healthy diet that all vegans should eat? Let’s look at some other evidence.

A 2000 cross-sectional report (3) on cholesterol levels in men from EPIC-Oxford found the following:

So the vegan men were eating a diet of 30% of their calories as fat while still maintaining cholesterol levels of 158 mg/dl. Some people would consider this level of cholesterol too high, and while trials of people with heart disease who lower their cholesterol levels to below 150 mg/dl have shown a great benefit in doing so, it is not clear (to me, anyway) that people without a history of high cholesterol and heart disease need to go as low as 150 mg/dl. Low calories (or body weight) and saturated fat may be the most important aspect of lowering cholesterol levels.

A cross-sectional study on cholesterol levels is not the highest form of evidence compared to the clinical trials I mentioned earlier. What about trials of higher fat diets?

The Eco-Atkins diet, a high-protein, higher fat version of a vegan diet found better changes in blood lipids and higher levels of satiety when compared to a lower fat, near-vegan diet (4). But this trial only lasted 4 weeks, not nearly long enough to measure heart disease outcomes. Cholesterol levels of the people on Eco-Atkins went from 257 to 205 mg/dl – nowhere near as low as the very low-fat diets generally achieve, but, again, it was only four weeks long. [2014 Update on Eco-Atkins]

Most of the very low-fat diets do not allow for many nuts. While nuts have consistently been associated with positive health outcomes (lower body weight, better cholesterol levels, etc.), one vegan doctor, who uses low-fat diets to treat heart disease, told me that many of his patients binge on nuts when they are part of their diets and so he suggests they avoid them. I’ve heard from others that if they eat nuts they gain weight. It doesn’t completely surprise me that someone on a very low-fat diet might binge on nuts – they might be craving the fat or protein. But if you are someone who can eat nuts in moderation, then having some is most likely beneficial for preventing heart disease and long-term weight maintenance.

Though it may be rare, or even extremely rare, some people who follow a very low-fat diet find that they lose their libido and regain it upon eating more fat.

Earlier this month, Jeff Nelson of Vegsource.com wrote an article, How the ethical argument fails veganism. In it, he disagrees with my co-founder of Vegan Outreach, Matt Ball, and my co-author of Vegan For Life, Ginny Messina, as to whether the health argument is the way to go when spreading veganism. He also disparages “AR dietitians” in general, of which I can’t help but notice that I am one.

Aside from the fact that Matt nor I care about veganism as anything more than a tool for protecting animals and the environment, the central thesis of Nelson’s article is that people who become vegan for health reasons are more likely to stick with the diet than people who go vegan for ethical reasons. He says that people who go vegan for ethical reasons are usually not as educated about health and nutrition due to being persuaded by organizations that do not give them adequate information; so they eat processed foods and end up concluding that a vegan diet is not healthier. The people who go vegan for health reasons, on the other hand, understand the importance of avoiding processed foods and oils, and their health improves.

While many people do well on a whole-foods only, very low-fat vegan diet, my experience has been that such diets can sometimes result in failure to thrive, while many people do thrive on a vegan diet that includes more fat and processed foods.

The vegans I know are mostly animal advocates, and, therefore, are dedicated to being vegan. Very few of them had been diagnosed with heart disease or type-2 diabetes before becoming vegan, so they are not necessarily in the same boat as people who become vegan to treat their disease. The vast majority of the vegan, animal advocates I have know have stayed vegan, and most eat processed foods. From soy foods to french fries to desserts made with white flour and sugar, the vegans I know eat ’em. Of course, most of them also eat more fruit, vegetables, whole grains, legumes and nuts than the average American.

My cholesterol tends to be around 150 mg/dl. If I were eating a very low-fat diet, it might be even lower, possibly decreasing my risk for heart disease. But I crave protein and feel better when eating a good amount, possibly due to my fairly intensive weight lifting. I do much better eating soyfoods and other processed foods such as pasta, than when eating only whole plant foods.

There are health issues that might prevent people from eating only whole foods, such as digestive problems, and those have to be dealt with on a case by case basis.

I generally tell people who have metabolic syndrome that they should tend towards a whole-foods diet, greatly limiting added oils but including nuts, while those who are not as much at risk can afford to eat more processed foods, especially those high in protein and/or pastas (which generally do not raise blood sugar as high as other processed grains). Monitoring your weight, cholesterol, and blood sugar levels is a good idea to see if the diet you are eating is working for you.

At some point there might be clinical trials examining cardiac outcomes in people on vegan diets that are not so low in fat or in vegans who have not been diagnosed with heart disease. We do have some data on heart disease in vegans from the 1999 meta-analysis, but it isn’t much.

References

1. Esselstyn CB Jr. Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). Am J Cardiol. 1999 Aug 1;84(3):339-41, A8. | link

2. Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec 16;280(23):2001-7. Erratum in: JAMA 1999 Apr 21;281(15):1380. | link

3. Allen NE, Appleby PN, Davey GK, Key TJ. Hormones and diet: low insulin-like growth factor-I but normal bioavailable androgens in vegan men. Br J Cancer. 2000 Jul;83(1):95-7. | Link

4. Jenkins DJ, Wong JM, Kendall CW, Esfahani A, Ng VW, Leong TC, Faulkner DA, Vidgen E, Greaves KA, Paul G, Singer W. The effect of a plant-based low-carbohydrate (“Eco-Atkins”) diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Arch Intern Med. 2009 Jun 8;169(11):1046-54. Erratum in: Arch Intern Med. 2009 Sep 14;169(16):1490. | link

A cross-sectional study was released today describing habits of men age 45-69 in California. Highlights from the abstract:

“Vegetarians accounted for 1.4% (736/51,901) of [white, non-hispanic men] and 20.4% (124/602) of Asian-Indians. Age was not associated with diet among Asian-Indians, but among [white, non-hispanic men], vegetarian diet was associated with younger age (< 55) (45.1% vs. 31.6%, p < 0.001). "Compared to non-vegetarians, vegetarians more often reported healthier behaviors including a lower fat diet, higher fruit and vegetable intake, more physical and less sedentary activity." Reference

1. Ghai N, Van Den Eeden S, Jacobsen S, Ahmed A, Quinn V. PS1-02: Health Behaviors in Asian-Indian and White, Non-Hispanic Vegetarian Males in the California Men’s Health Study (CMHS). Clin Med Res. 2012 Aug;10(3):144. | link

I haven’t posted much in awhile for a few reasons: no studies on vegetarians have been released in some time, I have been spending most of my nights and weekends upgrading Vegan Outreach’s Adopt a College website, and my wife and I have been planning a move from Oakland to Davis, CA. A very busy summer.

During this time, Dr. Michael Greger, the hardest working man in vegan nutrition, has released 3 DVDs. I finally watched them this past week. The first is a 1-hour talk he recently gave, Uprooting the Leading Causes of Death, in which he presents evidence that a plant-based diet can reduce the risk of most of the top 15 causes of death in the USA. The other two DVDs, Volume 9 and 10 of his Latest in Clinical Nutrition series covered some interesting topics. Here were the highlights for me:

– Meat causes a general state of inflammation in the body, which is linked to heart disease, and this is primarily due to the endotoxin load from the bacteria in these foods.
– Green tea and kiwi = awesome.
– Magnesium is important for preventing sudden cardiac death and the best sources are whole grains and leafy greens.
– Plant foods boost serotonin levels better than does meat.
– Plant proteins are incomplete, but this is good because their incompleteness prevents the production of the protein IGF-1 which is lower in vegans. But plant protein is not so incomplete that it prevents the production of IGF-1 Binding Protein, which is higher in vegans. The combination of low IGF-1 and high IGF-1 Binding Protein should significantly decreases the risk of cancer.

And, as always, the DVDs were loaded with all the ways in which meat gets contaminated and causes foodborne illnesses.

Whenever I get done watching one of Dr. Greger’s DVD’s I find it amazing that people who eat meat can live more than a few weeks. Dr. Greger points out that while the lifespan has increased in the USA, the sickspan (length of time at the end of people’s lives that is spent sick) has increased even more.

As always, for anyone interested in nutrition, I highly recommend these DVDs or subscribing to the daily videos at Dr. Greger’s website NutritionFacts.org.

Now I need to get this posted, as I imagine the next one is on its way!

Question:

I am 19 years old and I get chronic kidney stones. I have had over 30 or so (I lost count). I have been vegetarian for over a year and vegan for four or so months. I cannot eat high oxalate foods which is confusing because they are the healthy foods I am supposed to eat while being vegan! I drink three liters of water a day and barely eat any foods high in sodium. Once I became vegan I got more stones (having to pass them). It went from every two months to once a month to every two weeks. I really want to stay vegan because I know how much healthier it is but I cannot deal with all of this pain. Any information you can give me would be greatly appreciated. I have gone to a urologist but she hasn’t given me any helpful information and right now I am just so frustrated I want to give up. So please help!

Answer:

Assuming your stones are oxalate stones, I would say that doing two things could help:

1. As it sounds like you’re doing, avoid the high-oxalate vegetables ‒ spinach, swiss chard, and beet greens. Kale, broccoli, collard greens, mustard greens, turnip greens, and bok choy should all be safe. According to the Mayo Clinic, you should also limit or avoid rhubarb, beets, okra, sweet potatoes, nuts, tea, chocolate and soy products. Yikes – that’s no fun. But maybe if you cut them all out, you could then slowly add back in small amounts of nuts and soy products and see if they are safe for you.

2. Consider a calcium supplement with meals. Calcium can bind oxalates and cause them to be excreted in your feces, but you should ask your doctor about this before doing it. Here is some more info on this:

mayoclinic.com/health/kidney-stones/ds00282/dsection=prevention

Follow-up:

I am mainly concerned that with all these restrictions I will not be able to receive all the essential nutrients I will need. I eat mostly nuts and beans to receive protein and those are some things I can’t eat.

Answer:

Have you seen ohf.org/docs/Oxalate2008.pdf

It lists beans as being moderately high in oxalates. I would think that you could eat small amounts of beans without it being a problem.

Unfortunately, it looks like quinoa (a non-legume, non-nut source of vegan protein) is high in oxalates:

whfoods.com/genpage.php?dbid=142&tname=foodspice

Adam Merberg of the site, Say what, Michael Pollan?, has a very interesting review of Pollan’s book, In Defense of Food. Click here.

Excerpt:

…Pollan’s prose is so lively that most readers won’t want to stop and give things a closer look. However, the reader who does bother to check the details sees that In Defense of Food is not a credible work of nonfiction. Pollan twists facts and misrepresents the way science works in the course of assembling exaggerated, false, and contradictory narratives.

I just updated Mild B12 Deficiency – Cardiovascular Disease & Homocysteine with the following from a study that just came out:

A 2012 randomized, placebo-controlled, crossover clinical trial tested B12 supplementation’s effects on flow-mediated dilation (FMD) of the brachial artery and intima-media thickness (IMT) of the carotid artery, both of which are markers of cardiovascular disease (1). The study was done in Hong Kong and there were 50 vegetarians, two of whom were vegan. Twelve subjects (24%) had serum vitamin B-12 between 203-406 pg/ml and 35 subjects (70%) < 203 pg/ml. After 12-week periods of 500 µg of B12 per day, average homocysteine levels went from 16.7 to 11.3 µmol/l. Brachial artery FMD significantly increased and carotid IMT significantly decreased, both of which improves cardiovascular function, after vitamin B12 but not after placebo treatment. These positive effects appeared to be better correlated with the correction of vitamin B12 deficiency than with the lowering of homocysteine. The authors noted that the effects “on carotid intima-media thickness was quite subtle and of uncertain biological significance.”

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Check out Plant-Based on a Budget for inexpensive yet tasty vegan recipes!

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I was surprised that with 500 µg B12 per day, homocysteine levels did not decrease even further, especially since these participants were shown to have good folate status. The study contained no control group of non-vegetarians, so it’s not clear if the same results would be found for non-vegetarians, though rarely do non-vegetarians have an average homocysteine level as high as 16.7 µmol/l.

In any case, this appears to be the first direct evidence on cardiovascular function to show that mild vitamin B12 deficiency could have a negative effect.

None of the participants experienced side effects, including skin reactions, while on the B12 supplementation regimen.

Reference

1. Kwok T, Chook P, Qiao M, Tam L, Poon YK, Ahuja AT, Woo J, Celermajer DS, Woo KS. Vitamin B-12 supplementation improves arterial function in vegetarians with subnormal vitamin B-12 status. J Nutr Health Aging. 2012;16(6):569-73. | link

For background on the discussion below, please see Omega-3s in Vegetarian Diets.

The July 2012 issue of the Academy of Nutrition and Dietetics (AND) contained a meta-analysis of studies examining the intake of the omega-6 polyunsaturated fat, linoleic acid (LA), and whether it increases markers of inflammation (1). The AND recommends that people get 3-10% of calories as omega-6s, most of which will be in the form of LA. There is concern that large amounts of LA will be converted to arachidonic acid (AA) and will also prevent the conversion of alpha-linolenic acid (ALA) into EPA and DHA, both of which could increase inflammation.

The meta-analysis found no evidence that intakes of LA up to 10% of calories increased markers of inflammation. Adding LA to the diet did reduce levels of EPA in the blood, but this did not increase inflammation. Adding LA to the diet did not decrease the amount of DHA in the blood, but this is probably due to the fact that so little ALA is effectively converted all the way to DHA in the first place.

In a study from 1992 (2), vegans ate 9-10% of their calories as LA and, of course, had no natural dietary source of DHA. Whether large amounts of LA harm the DHA status of vegans has yet to be determined, but this meta-analysis indicates that reducing LA, a recommendation vegan health professionals have long suggested as a way to reduce inflammation and increase the conversion of ALA to DHA, might not be effective. It also provides more evidence that a DHA supplement might be the only reliable way for vegans to increase DHA levels, since reducing (or, actually, “not increasing”) LA intake does not appear to matter.

I have not changed my recommendations to limit LA based on this meta-analysis alone, but I’m leaning in that direction. Hopefully, there will be more research to come.

References

1. Johnson GH, Fritsche K. Effect of Dietary Linoleic Acid on Markers of Inflammation in Healthy Persons: A Systematic Review of Randomized Controlled Trials. Journal of the Academy of Nutrition and Dietetics. 2012 Jul;112(7):1029-41. | linklink

I read two studies from the May issue of the Journal of the Academy of Nutrition and Dietetics for continuing education credit. I normally don’t post about such studies, but these two were rather interesting.

Energy density is a way to measure food in calories per weight. Generally, this means that foods high in fiber and water are going to have lower energy density. A meta-analysis of 17 studies in adults and six studies in children found that low energy density foods were associated with lower fat mass and lead to improved weight loss and weight maintenance among both adults and children (1).

But when it comes to fiber intake, Americans barely increased their fiber intake from 1999 to 2008; it changed from 15.6 to 15.9 grams per day. The recommended amount of fiber for adults is 25 to 38 grams per day (or 14 grams per 1,000 calories consumed).

References

1. Pérez-Escamilla R, Obbagy JE, Altman JM, Essery EV, McGrane MM, Wong YP, Spahn JM, Williams CL. Dietary energy density and body weight in adults and children: a systematic review. J Acad Nutr Diet. 2012 May;112(5):671-84. | link

2. King DE, Mainous AG 3rd, Lambourne CA. Trends in dietary fiber intake in the United States, 1999-2008. J Acad Nutr Diet. 2012 May;112(5):642-8. Epub 2012 Apr 25. | link