Can a Vegan Diet Be Healthy? A Literature Review
erichgrunewald.com
erichgrunewald.com
> [V]egans exhibited a higher estimated prevalence of inadequacies for some nutrients, in particular vitamin B12 (69.9% in men and 83.4% in women <55 years of age), compared to meat-eaters. […] Our study highlighted that, overall, self-reported vegetarians and vegans may meet nutritional recommendations.
Those numbers are crazy high. I am not an expert in any of this, so take this with a healthy dose of skepticism, but I wonder if a vegan diet can be considered healthy without supplements given the current range of available non-animal B12 sources. I think there are some algae sources but I'm not sure you can get enough B12 without getting too much of something else. There's also the question of how efficiently you absorb the nutrients in the food; I heard it's harder to absorb B12 from algae than from cheese for example. Happy to be shown evidence for or against...
http://gorillaprotein.com/2010/01/07/where-do-gorillas-get-t...
It also reminds me of bears, they're often portrayed as honey-hunters, but in the end they are likely most interested by eating bees and larvae as well
The cow certainly won't think about eating insects. It just eats gras. (and I doubt it has a concept of "gras")
Instinctal pattern matching.
But that probably includes the insects in the grass.
So I meant no concept of grass in the meaning of: Photosynthesis based plants of that family.
Concept of smell and taste of a certain patch of grass (including the insects) - certainly.
Oh, certainly not. But, then, neither did humans until the last few centuries.
A cow won't divide between vegan and meat. It just eats what it likes. Apparently grass with insects. Because normal grass has insects with it.
B12 is added as a supplement to soy milk and some other vegetarian stuff (here in Australia, at least, and I assume elsewhere), so I've never needed to worry about that.
Is it true? I don't know. What are the sources for the claim?
I looked up one paper linked to from this article, How prevalent is vitamin B12 deficiency among vegetarians?[0] That paper was made, it says, by searching the literature for other papers that mention B12 deficiency. It says in the abstract "The deficiency rates reported for specific populations were as follows: 62% among pregnant women...". I looked into that figure, as I read somewhere else that pregnant women were one of the groups with lowest B12, or at least greatest risk of deficiency.
When you lookup where that figure came from: "Only one of the studies included pregnant women. This study was conducted in Ethiopia and included participants whose diet was based on either maize or enset."
So I looked up that study, Zinc, Gravida, Infection, and Iron, but Not Vitamin B-12 or Folate Status, Predict Hemoglobin during Pregnancy in Southern Ethiopia[1] The abstract begins:
"The etiology of anemia during pregnancy in rural Southern Ethiopia is uncertain. Intakes of animal-source foods are low and infections and bacterial overgrowth probably coexist. We therefore measured the dietary intakes of a convenience sample of Sidama women in late pregnancy who consumed either maize (n = 68) or fermented enset (Enset ventricosum) (n = 31) as their major energy source. Blood samples were analyzed for a complete blood count, vitamin B-12 and folate status, plasma ferritin, retinol, zinc, albumin, and C-reactive protein (CRP). The role of infection and gravida was also examined. Dietary intakes were calculated from 1-d weighed records. No cellular animal products were consumed. Of the women, 29% had anemia, 13% had iron deficiency anemia, 33% had depleted iron stores, and 74 and 27% had low plasma zinc and retinol, respectively."
I can't actually find the 62% figure in that paper.. well, it says
"Unlike ferritin, neither plasma vitamin B-12 nor MMA was a significant predictor of hemoglobin, despite the high prevalence of elevated concentrations of MMA (i.e. 62%). This discrepancy is attributed to nonfunctional vitamin B-12 analogs present in the plasma of women consuming fermented enset, as discussed earlier, as well as the absence of any hematopoietic defects associated with vitamin B-12-deficiency anemia."
– so I guess it comes from there. But the findings of that paper seem quite a way from finding that pregnant women in general have 62% B12 deficiency, to say the least! Yet these things trickle up to popular articles that announce such findings as Facts. And people feel called to give ominous warnings about disregarding them...
[0] https://academic.oup.com/nutritionreviews/article-pdf/71/2/1...
What I'm trying to say is that I believe it be important to calculate your diet and not count on accidental vitamin intake from meats.
Absolutely, I only actually bothered trying to figure that out when I stopped meat myself, as I knew I wouldn't be getting everything I was meant to (even though I knew I probably wasn't healthy in the first place).
That shit is difficult to figure out, trying to cover everything recommended nutritional intake for a day feels near impossible.
One is dependent on dietary choices, the other is not.
But these sources of Vit D PALE in comparison to both the amount you need, and the amount you can produce just by being outdoors for a while.
You’re right, though. Salmon is a one or two orders of magnitude better than the rest.
Absolutely this.
Meat is so highly nutritionally dense - vegans you have no clue.
I was a vegan for 20 years of my life. I thought it was env friendly, ethical, bla-bla-bla and had my mum as a company at home while growing up in this seriously flawed cult.
And then I figured that I was not only b12 border line deficient but also in other b-vitamins. And the list continued to Iron, zinc etc. As a vegan you can still get most vitamins other than the most important b12. Even if you can get other vitamins from vegan, you will have to eat a lot to get the same nutrients as in a simple steak!
Since turning into meat, my life has gotten 10 times better probably. Although I prefer to prepare it at home only and have it just once/twice a month.
It is.[0][1]
> And then I figured that I was not only b12 border line deficient
You "figured" that you were deficient? Were you supplementing B12, or eating fortified foods (e.g. most soy milk brands)?
> Even if you can get other vitamins from vegan, you will have to eat a lot to get the same nutrients as in a simple steak!
No, you just need to eat a normal amount, calorically speaking, and make sure you supplement B12 (and vitamin D if you don't get enough sun).
However, it really depends on what the family gene-stocks looks like for these vitamins and how well one can absorb those vitamins. For example, the iron in meat is mighty absorbable compared to say when you eat anything in vegan.
So I would like to urge Vegans to be highly highly skeptical.
>" Vegans showed a significantly lower mean serum iron level (p < .001) and vitamin B12 (p < .001). Wound diastasis was more frequent in vegans (p = .008). After 6 months, vegan patients had a higher modified SCAR score than omnivores (p < .001), showing the worst scar spread (p < .001), more frequent atrophic scars (p < .001), and worse overall impression (p < .001)."
It's well documented that vegans, on average, live longer than omnivores (even controlling for exercise level, smoking, etc), and I don't think there's any evidence that vegans are more nutritionally deficient than omnivores - in fact, I think there's evidence for the opposite.[0] Though I agree that we preface diets with "healthy if..." I think the standard western diet is more in need of that prefix.
[0] "Mean intakes of fiber, vitamins A, C, and E, thiamin, riboflavin, folate, calcium, magnesium, and iron were higher for all vegetarians than for all nonvegetarians. Although vegetarian intakes of vitamin E, vitamin A, and magnesium exceeded that of nonvegetarians (8.3 ± 0.3 vs 7.0 ± 0.1 mg; 718 ± 28 vs 603 ± 10 μg; 322 ± 5 vs 281 ± 2 mg), both groups had intakes that were less than desired. The Healthy Eating Index score did not differ for all vegetarians compared to all nonvegetarians (50.5 ± 0.88 vs 50.1 ± 0.33, P = 0.6)." https://pubmed.ncbi.nlm.nih.gov/21616194/
What is your criteria and evidence for this?
> Eating vegan is great but just like other non-normal diets it requires bloodwork from a doctor regularly
what is a "normal" diet?
Not sure what you mean by this. Are you asking if human milk is considered vegan?
> So not all stages of development I guess.
Almost all of the most reputable health organisations disagree[1]
I have no idea what you are referring to here.
https://www.mdpi.com/2072-6643/9/9/1023/htm
Page 11.
The B12 delta is the most dramatic but some nutrients fall in the vegans favor (eg Vitamin E and Magnesium). It's kind of a mixed bag.
So the takeaway is quite boring: monitor your consumption regardless of dietary identity
Does anyone say differently?
So if you want to be more open about where all the nutritions come from, we should also disclose everything we feed to animals.
Or alternatively, we can simply start enriching some basic foods like plant based milk with b12 and d3.
That said, omnivores often lack nutrients too, including B12. It's seems veganism actually forces you to be conscious about it.
Everybody should be eating a broad diet with a lot of nutrients, including a lot of plants. Vegans have to be more careful about it since they're not getting the broadest array of sources, but I keep seeing this weird trope of "Well, I could eat vegetables, therefore I'm protected against scurvy and constipation even though I never actually eat them."
Both vegan and omnivorous diets are healthy if you eat them well. Both are unhealthy if you practice them badly. But seeking out studies for the sole purpose of proving "veganism is bad" seems like a recipe for eating unhealthily.
In that case, advertisements for meat should also show the bottle of "supplements" that livestocks get (including B12, btw). In that sense, vegans just cut out the middlemen (or better: middleanimal).
Even in pharmacies, I have to tell that the supplement may be my only source of B12 and that I know about the dosing. I reduce the frequency when I have other sources like toothpaste. I think it is worth to RTFM for something that is relevant for the rest of my life.
Moreover it's the same form of B12 as found in beef, liver, fish, etc, so you have no worries of bioavailability.
I am not a vegan nor vegetarian, though in the summer I mostly love plant based.
From personal interest some time ago I was looking for plant based alternative sources and stumbled (next to others) onto [1].
I find it annoying that the rise in veganism means there are far more bad choices I can make: big chain burgers, ready meals, cakes, cheesy pizzas are all now available to me.
But people still consume deep-fried unhealthy foods, and with the dawn of global food chains offering veg options, the problem amplifies.
Being veg alone does not guarantee health, consuming healthy food in moderation should be priority.
On the other hand, situation for meat eaters is worse. zero standards for meat quality, rat meat served in place of chicken. its a nightmare.
The sugary tea many consume, often multiple times a day, is also a problem — to be clear the sugar is the problem, not the tea. And then there’s Indian sweets and a national love of biscuits (en-GB not en-US) and fried snacks.
Wait, what?!
to increase profits, hotel owners, mix rat meat with chicken because its cheaper and impossible to detect.
All of them are probably fine in that they, at first, forced you to avoid all the processed crap. But eventually it became too profitable a segment to ignore for the food industry and suddenly it is easy to eat 5,000 calories a day of keto desserts.
Fats/protein take longer to process and are more satiating. That's not to say you couldn't consume 5,000 calories of them in one sitting, but you wouldn't be hungry again any time soon.
Whole carbs with the fiber intact can be quite satiating. Most of the problems people attribute to carbs really only pertain to refined carbs.
Edit since I can't reply to the reply:
>the idea that carbs = fat
That is the most stupid thing I have ever heard. No-one eating keto have ever said that or they would only eat candy.
And yes you can look it up but insulin level index is only like 1/10 of the story. The fact is still that if a vegan eat an apple the blood spike is higher than if someone in ketosis does. Higher spike = hungry faster, which is the whole point of keto. 1 calorie from non-fat != 1 calorie from fat.
https://en.wikipedia.org/wiki/Insulin_index
Beef is above even white pasta. Your blood glucose and insulin levels are two different things.
The healthiest populations in the world eat a lot of (untefined) carbs so the idea that carbs = fat is simple and appealing but also wrong.
If you eat a bowl of rice this likely will happen: Your blood sugar spikes, insulin is released. If after a while your blood sugar is still elevated, another dose of insulin is released which can push your blood sugar below baseline and to the point where "hunger" is triggered.
If you eat the caloric equivalent of that in the form of a steak, your blood sugar stays more or less constant.
How exactly this plays out depends on your insulin sensitivity. It may be different for highly insulin sensitive people, but empirically it is true for me and probably for most people, otherwise "sugar crash" wouldn't be a word.
Of course, you probably won't eat just a bowl of rice except for experiment, adding some fat and protein can greatly mitigate the effect.
> The healthiest populations in the world eat a lot of (untefined) carbs so the idea that carbs = fat is simple and appealing but also wrong.
The "healthiest" populations also are outliers in many other respects. I'm not making an argument that a high-fat diet is healthy or unhealthy. I'm saying that fat, protein and carbohydrates are quite different in how they are experienced from a dietary perspective, regardless of caloric equivalence.
Really what you need to do in order to avoid this effect is to add fat and protein into your meal.
As for what "most humans ate for most of history", it's not really clear-cut.
https://pubmed.ncbi.nlm.nih.gov/3001740/
Add some veggies to your meal.
https://i0.wp.com/www.gestationaldiabetes.co.uk/wp-content/u...
https://en.wikipedia.org/wiki/Insulin_index
Note that insulin level and blood sugar level are two independent things.
That Wikipedia article doesn't seem to cite very many studies. At least from my own perspective I can tell you that even after two hours of eating many kinds of meals your blood sugar can rise and you will need insulin to counteract that, either produced by the body itself or injected.
As an aside I would really like to know where the two hour postbrandial measuring for blood glucose levels etc. comes from as it feels completely arbitrary.
Maybe on paper, but it's not the same effect. If I eat a steak, my blood sugar doesn't go up and then way down, it stays constant. I'm not going to be hungry soon afterwards.
> Most of the problems people attribute to carbs really only pertain to refined carbs.
I did explicitly refer to "simple carbs" and "excess consumption".
Fat is 9 calories per gram. Fat is incredibly easy to over-consume by the very nature of it being more calorically dense and having very little fibre.
As for fibre, I disagree that it is satiating. It may make you feel "full", but that is not the same as being satiated. Your body doesn't tell you to "stop eating" just because your stomach is full of matter that it doesn't actually process. Blood sugar plays a role, as do many other things.
If it were any different, diets based around eating lots of high-volume/low-calorie food should "just work", but they just don't.
This is a great site full of Indian recipes: https://www.vegrecipesofindia.com/
Thank you, good idea, maybe I should find some recipes boxes for Indian dishes :D
https://www.priyakrishna.me/indianish
It's her mother's recipes, living in the US. It breaks down Indian cooking into a literal flowchart, giving you a lot of options for creativity. It's not a "vegan cookbook"; it's just that the don't happen to use animal products. (There's even a couple of meat recipes, in fact. Oddly, no paneer, either, though adding pressed tofu to a lot of the recipes is a good way to stretch them and complement the flavors.)
It's also pretty heavy on the lentils, but you might find the Indian way of looking at lentils to be a lot more tasty (and a lot more variety) than "just a pot full of cooked beans". The keys are (a) pickles and chutneys, mixed and matched, and (b) the "chhonk", basically cooking spices in oil and adding it at the last minute. Between the two there's a ton of room for improvisation and different flavor profiles.
But actually it was unexpectedly non partisan. It read like a good and readable literary review. My SO studied nutritional science (actually Ecotrophology) and I gained quite some insights by reading lots of the studies directly. A lot of them I recognized in this article.
It has been very amusing having long discussions with my cardiologist trying to explain to him the changes I did as he could not believe the data he was getting.
Perhaps our common benefits are as much from the foods that we no longer eat as from those we do eat.
I was raw vegan for six months a decade ago. I bounced off of that with health problems including brain fog at that point. At the moment carnivory feels more sustainable to me. Possibly the "raw" part is a difference between our experiences.
Yes I would bet just being deliberate and having a philosophy will have an impact.
Doing labwork regularly is a good tool. There are so many things that can be monitored that gives you data to supplement your self-reported feelings.
(being raw vegan can not have been fun)
I wonder why you say that. I enjoyed the food a lot, as well as the shopping and prep. I was surrounded by a large supportive raw vegan community, and it may have been one of the most social times of my life. It was literally fun and I would have continued if not for the health issues. And yes, some cravings. It was culturally easy for me in a way that carnivory isn't, yet here I am.
That brain fog issue sounds like you were missing something, did you test yourself? I am sure if you miss your old diet you can still do it with some additions. As mentioned in the article B12 is important.
However 1) correlation does not mean causation, less so with one data point 2) people who radically change their diet often do some other lifestyle change out of the same concerns.
For instance is not uncommon to switch diet and start exercising at the same time, or switching to a more regalar sleep schedule. Did you?
I think any change you make will feed into changing other things about you.
In my case I changed only diet. This in turn changed me so that I could move more. Both of those things changed how I sleep. Which again feeds back into new changes about my mood and goals. I do not think I could have started with one of the other changes and end up here. Especially in my own circumstance.
I'm myself eating vegetarian since 2016 with no issues. But I never check if my food is balanced and wouldn't know if I would be missing some proteins or nutriments.
Do you check your blood regularly, or do you have other approaches to ensure that you have an adequate diet?
- I eat a lot more fruits, salad, and vegetables as a vegan (duh!)
- The diversity of the food I eat _increases_ as a vegan (even though there are less options to eat)
- I do feel the need to supplement protein (which I hate to do and stay away from when non-vegan)
- I also supplement B12 as a vegan
Shiitake mushrooms are an excellent source of B12 (and it's in the same form as the B12 from beef, liver, or fish, so it has a very good bioavailability). It's not widely known even by vegans.
For both vegans and omnivores, the easiest way to keep an adequate level of B12 is with supplements. Omnivores have them fed to their steaks/cheese/milk during intensive farming.
The best of best B12 supplement is hydroxycobalamin, if you can find it in sublingual tablets (it's not readily available in every countries, but you can import it).
Twenty or more years hence problem
For the ultra poor we need to get them the wealth for animal products for the micro-nutrients. It's too difficult to get them on supplements (exactly like vegans and B12)
Then it's about satiation, satiety and palatability.
> In Western studies, vegans had lower body mass index, lesser waist circumference, reduced blood sugar levels, lower low-density lipoprotein (protein that transfer lipids around the body; fats are a kind of lipid) cholesterol (a type of lipid), less body fat & lower blood pressure than omnivores.
My question is, do the studies shown account for body weight? Sure if you are comparing your average USA citizen (40.0% of which are obese) to a group that happens to be fit, you are definitely going to have much better outcome of the later.
First part of the question would be, does veganism help with obesity? Or is it just correlated to it for other reasons? Conjecture: it seems no surprise that people who spend a significant amount of time worrying about their diet have on average much better BMI, but maybe the diet itself also helps.
Second part would be, when adjusting for BMI, does veganism also show these benefits? Or are they benefits related only to BMI? There seem to be no separation of the benefits of being vegan vs the benefits of being fit when the health outcome is being discussed.
I have no trouble believing that vegans have on average fairly lower BMI and bodyfat than omnivores. I eat a fairly well-balanced omnivore diet, I lift heavy, and I hover anywhere between 13-18% BF. My BMI is quite high because of lifting, and sometimes I'll allow my BF to rise to a certain point if I want to meet particular strength goals. But I'm not fat by any stretch of the imagination.
I don't feel any healthier at 13% than at 15% BF, and I am not aware of any science that supports that. So what if a vegan is two points of BF leaner?
An outcome-based perspective is much more useful. Do they live longer, and by how much?
Also, I'm always wary about definitions and confounding factors in these analyses. One could eat very poorly as a vegan (lots of processed vegetable oils, etc.) but on average they probably eat in a much more health-conscious manner. "Omnivores" as a category will tend to lump in people on bologna sandwich and pepsi diets with people who eat mostly unprocessed foods, watch their energy balance and macros, etc.
Are there any studies that compare vegans with health-focused omnivores?
The biggest link between obesity and food is sugar intake. The thing that's making most omnivores fat is the needless sugar flavoring and breading surrounding a bad piece of food (be it vegetable, meat, fish, fruit, whatever) as something delicious. Nutritional sciences contradicts itself at any corner, finding healthy vegans, healthy vegetarians, healthy carnivores and healthy omnivores, except for the part where sugar is undoubtedly spiking insulin. Insulin in turn sets people up to be more easily overeat, as well as storing all those sugars as fat more easily.
Considering health-conscious people will avoid these foods, they will eat less isolated sugar, fructose and foods high on the glycemic index, even if vegans end up getting most of their daily energy from fruit. Fruit offsets this somewhat thanks to the fiber you're eating with it (also why people say not to drink juice, or at least drink the pulp with it), but fiber can only do so much and fiber being a "mostly good" thing is also being put under scrutiny.
As someone who grow up in rural russia in 90s, meet was a rare usually on holidays/birthday, and i believe i grow up perfectly healthy, ofc it's a fallacy to look at personal experience, but even tho.
I'm not an expert on this, but my guess is that by mass their most important products for us are short chain fatty acids. They might assist in breaking down some proteins that we lack enzymes for or modifying amino acids, but the absorption of amino acids happens mostly in earlier sections of our intestines, whereas the microbial biomass and activity increases towards the later stages of the gut.
Eat a varied diet with enough calories, make sure you are getting enough b12 from either supplementation or in fortified foods and when in doubt use a nutrition tracker like Cronometer. I would give almost the same advice to anyone about their diet (except maybe the opposite with caloric intake).
Anyway, it's a statistical fact that a lot of vegans are deficient.
In this case the Jain are a prime example.
One of the major criticisms of a vegan diet is the a almost complete lack of B12.
If okay = "survive long enough to leave offspring", then yes. However, health and quality of life are a lot more complicated than survival, that's why we look deeper into the science instead of using these rules of thumb.
It can take many years for freshly minted vegans to have their stores of essential nutrients depleted, so they may in fact reproduce successfully for one generation, but in the long run severe malnutrition is inevitable.
Of course there is more to healthiness thsn that and science is important, but as far the rule of thumb goes, the second part is important.
Jains are generally vegetarians, not vegans. There may be some anecdotes that some Jains did live off truly vegan diets, but then again there are anecdotes of people living off sunshine. Neither are plausible.
My point is I don't think there is a single "Western" diet with distinct health outcomes (just like the "Mediterranean" diet is also a myth).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3828681/
> Results. Soft drink consumption increased globally from 9.5 gallons per person per year in 1997 to 11.4 gallons in 2010. A 1% rise in soft drink consumption was associated with an additional 4.8 overweight adults per 100 (adjusted B; 95% confidence interval [CI] = 3.1, 6.5), 2.3 obese adults per 100 (95% CI = 1.1, 3.5), and 0.3 adults with diabetes per 100 (95% CI = 0.1, 0.8). These findings remained robust in low- and middle-income countries.
I was just pointing out how you mentioned “Western” diet, but I don’t think that’s a thing.
Although the nation of India checks out for vegetarianism. One wonders what that collective moment of culture was that a whole group of people decided that meat eating was not going to be a part of their lifestyle.
Giving up Tamas food (meat, garlic, onion etc.,) is the first set of rules to follow on a spiritual journey.
once a family starts on this path, the behavior permeates to next generation automatically.
even though my family allowed me to eat meat, i started & stopped within a year because of ethical reasons (and not spiritual reasons).
Cannibalism, nutritionally speaking, is perfectly healthy, if you stick to muscle meats. Eating the brain of prion-infested sheep can kill you just as thoroughly as the brain of prion-infested humans.
We don't practice cannibalism for other reasons...
[1]: doi:10.3390/pathogens2030472
The diets in the US have gotten worse in recent decades (way more processed foods especially) and the US is objectively facing the ramifications of those diets. That doesn't make them any less powerful but this discussion was actually about health and I think in this regard it paints a clear picture that this is not the way to go.
But this is because they aren't following a healthy approach. Moreover, unfortunately there we found out that there are basically no non-meat sources of B12. Except for the original bacteria. There were some almost-b12 options people were trying but failed. So even if you supplement b12, it's likely to be sourced via a meat source.
Worse yet, B12 isnt the only problem. There are 3 others that vegans often dont get in their diet because to get enough would require ungodly amounts of rather unusual foods like flaxseed or seaweed. Like how much can you really eat of those?
That said, there is a valid path of veganism. You can find the proper nutrition. You have to thoroughly investigate how to do it but you can.
Even rural chinese sustained on rice and salt, need a chicken once a week.
Eating only carbs like rice, isn’t.
i used to follow 2 day per month fasting, and it serves me well.