Hi all! Glad that folks took interest in yesterday’s post on DHA in vegan diets (and in the product review!).

That post, like most posts in which I touch upon the role of supplementation in a vegan diet, prompted concern from one of my readers. She commented:

I haven’t supplemented before, and I’m wary to start doing it. If I have to supplement to stay healthy, how can I tell others inquiring about my lifestyle that it’s a healthy choice? I think I’ll keep trying to get enough naturally. Can people eat algae?

A lot of vegans echo this sentiment. How can we try to advocate the diet to others, they reason, if there are essential nutrient gaps that demand supplementation? Vegan critics are also quick to latch onto this issue, claiming that no diet in which supplementation is vital could be “natural”. And if it’s not “natural”—if it’s not nature’s perfect diet—then why are we doing it?

This is a complex issue, both among vegans and between vegans and our critics. It’s important for vegans to address it logically, because it continues to exert a powerful influence on skeptics of plant-based diets. So today, let’s chat about supplementation for vegans: why we do it, how it fits into the broader scheme of modern nutrition science, and whether supplementation is indeed a knock against veganism. I’ll use Vitamin B-12 as my primary talking point.

As all vegans know, B-12 is the one nutrient that vegans must supplement without question. Yes, there are fortified foods that provide good amounts of B-12 (nutritional yeast, fortified non-dairy milk), and some B-12 may also be available in spirulina (though the studies on algae as a B-12 source are not conclusive), but regardless, health practitioners agree that a B-12 supplement is still necessary for vegans. Everyone likes the idea of getting everything we need and want from whole foods, but good quality B-12 supplements give us protection and insurance at essentially no cost to our health. By contrast, if fortified foods and algae fail to meet our B-12 needs—which they often do—vegans can get genuinely sick, which is harmful both to us and to vegan messaging on the whole. I agree with many that the natural supplement industry has become as large, powerful, and problematic as the big pharma industry, but that doesn’t mean that certain supplements don’t have a vital and important role in diets of all kinds.

In spite of how easy it is to obtain in supplement form, B-12 remains a topic of endless debate, in part because critics of veganism have used it as evidence that veganism is “unnatural.” Some time ago, I had my friend, Dr. Stuart Seale of the Renovo clinic in AZ, speak to the great B-12 debate on my blog. For the entire discussion, I really recommend you check out his guest post, which also contains his recommendation for supplementation dosage. But to clear up some of the details, I’ll share a portion of the post:

Vitamin B12 is an essential micronutrient for humans. “Essential” means that it must come from external sources – we can’t manufacture it in our bodies using other nutrients as building blocks. The vitamin, in its full form, must therefore be supplied dietarily. This fact is what creates a potential rub for vegetarians, because no plant foods serve as a reliable source for B12. It’s only found predictably in animal foods – meat, eggs, and dairy.

Does this mean that we weren’t designed to be vegetarians, and that plant-based diets are inferior? In order to answer these questions, we need to look at the ultimate source for all vitamin B12, which is bacteria. The vitamin is made in nature only by bacteria that reside in soil, the upper intestinal tracts of ruminant animals (cows, sheep, deer, etc.), and also the lower intestines of animals. In the case of ruminants, the B12 that is made by the bacteria residing in their stomachs can then be absorbed into their tissues. In addition, the food they eat is contaminated with soil, which contains vitamin B12. Livestock are also fed B12 fortified foods to boost tissue levels. For wild, non-ruminant vegetarian animals there likely is enough ingestion of bacteria from foods contaminated with soil to provide adequate B12. In the case of wild, carnivorous animals, B12 is supplied from the liver (the animal storage organ for excess B12) and the intestinal bacterial of their prey.

The daily requirements of B12 for humans is very low, and in the past when we didn’t live in such a sterile and germophobic society it is likely that soil and other bacterial contamination of plant foods provided all the B12 needed. But our environments are different in the modern age. We are not only living much more sanitarily and bacteria-free, but our agricultural soils have also become sterilized. Of course, there is still the bacterial production of B12 in the lower intestinal tracts of animals, including humans, but we can’t absorb the vitamin from that location. However, undoubtedly much of the B12 found in animal foods is derived from intestinal bacterial contamination during the slaughter process.

There is an abundance of nutritional research demonstrating the benefits of eating whole plant foods, even if no animal foods are included. Humans are perfectly capable of eating a totally plant-based diet and maintain superior health while doing so. In our former agrarian society when bacteria-rich soils were worked by hand, there simply wasn’t an issue with humans getting enough B12, because it was supplied by soil contamination of our foods and skin. The issue of vegans requiring vitamin B12 supplementation is therefore not an indicator of a plant-based diet being inferior or unhealthy. The two really have nothing to do with each other. The fact that modern vegans require B12 supplementation is related to the sterility of our environment, not to the overall nutritional quality of the foods we eat. Humans haven’t changed, but our environment has.

 

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So part of why vegans need to supplement is because we live in a world in which it has become harder and harder to obtain B-12 without relying on animal foods. It may indeed be possible that adequate B-12 was obtainable from plant-foods in our pre-industrial society, but that simply isn’t the case now. Does that mean we need to abandon all of the other good reasons for eating a plant based diet? Hardly. The B-12 issue is a good example of the fact that our dietary needs can shift with our environment; pondering what is “ideal” or “natural” is fallacious without considering specifics of soil, air, lifestyle, and food production.

To use another example, Vitamin D deficiency is so prevalent right now that a physician friend has called it an “epidemic,” and suggested that two thirds of her patients had been deficient at some point or another. The deficiency seems to affect everyone all over the US, not just vegans. So does that mean that omnivorous and vegetarian diets are inherently “unnatural,” too? Probably not. Vitamin D deficiency is rising for a number of reasons, the primary of which is sunlight deprivation. As counterintuitive as it seems, the prevalence of vitamin D deficiency illustrates an important reality, which is that the culprit behind vitamin deficiencies is not always to be found in what we are or aren’t eating.

If we start to make the claim that any diet that demands regular or occasional nutrient supplementation is by definition an inadequate diet, we’ll soon find that we’re condemning nearly all diets, because deficiencies can creep in regardless of how responsibly we eat. One of the advantages of living in the modern world is that we can identify potential gaps in our diets—be they due to environment, socioeconomic status, circumstances, or individual health conditions—and fill those gaps in with supplements and fortified foods. Vitamin deficiencies or nutrient gaps are nothing new: throughout time, most people throughout the world have found it hard to obtain one or a few nutrients with food alone. Nowadays, science gives us tools to help manage those challenges.

It’s also worth pointing out that vegans are not the only people who develop nutrient deficiencies in the U.S.. Indeed, B-12 deficiency is a phenomenon that extends far beyond the vegan community. To quote the National Institute of Health,

Some people—particularly older adults, those with pernicious anemia, and those with reduced levels of stomach acidity (achlorhydria) or intestinal disorders—have difficulty absorbing vitamin B12 from food and, in some cases, oral supplements [22,23]. As a result, vitamin B12 deficiency is common, affecting between 1.5% and 15% of the general population [24,25]. In many of these cases, the cause of the vitamin B12 deficiency is unknown [8]. (Click through for article and footnotes).

15% of the population is a large number, and the article does not state that all, or even a majority of those who are susceptible are vegans. Indeed, the most at risk group seems to be older adults, which is also why the article states that “the IOM recommends that adults older than 50 years obtain most of their vitamin B12 from vitamin supplements or fortified foods [5].” As my friend Ginny Messina pointed out on her wonderful interview on Our Hen House this week, does the fact that most people over the age of 50 are advised to take a B-12 supplement mean that we’re not supposed to live over the age of 50?

In other words, it’s overly simplistic to use deficiencies as fodder in an argument about what’s “natural” or unnatural. The reality is that most diets contain potential weak points in terms of nutrition, and demand a certain amount of planning. Whether you’re vegan or omni, you probably will need to give some amount of thought to getting proper nutrition through food choices, and there’s a good chance you’ll want to take a supplement of some kind at some point in your life. What that supplement needs to be may vary with your diet, your age, your gender, your health history, your environment, and your eating style. The idea that vegan diets need to be more “well planned” than other diets is a little misleading: smart eating habits demand consideration across the board.

And let’s suppose for a moment that vegan diets do demand a little more planning than other diets—so what? Taking a B-12 supplement and considering a DHA or D2 supplement seems like a very small price to pay when we consider veganism’s many advantages—namely, the fact that vegan diets help to spare billions of sentient beings pain, suffering, and early death. For this reason alone, I’m happy to take B-12, but it’s not the only reason: vegan diets are also beneficial to the environment, and they offer us plenty of health advantages that outweigh the small hassle of a B-12 supplement, such as reduced changes of obesity and high cholesterol on average. Fretting endlessly about whether or not veganism is the “ideal” or “natural” diet is counterproductive and futile, since it’s unlikely that science will show us conclusively what the “ideal” diet—if such a thing has ever existed—is anytime soon. What strikes me as a far more urgent question is “what is the most responsible, ethical, and intelligent diet I can eat healthily in this day and age?”

We all have different answers to that question, but veganism is my answer. I believe it’s the diet that makes most sense for me, for animals, and for the planet. Fortunately for me, current science shows us without question that the diet can be healthy. If a B-12 or Vitamin D supplement is the only price of admission, well then, I’m happy to pay.

For more on this hot topic, I seriously recommend you listen to Ginny Messina’s Saturday podcast on Our Hen House! And that you consider subscribing on iTunes! Jasmin and Mariann frequently get into the nitty gritty of vegan health, and their conversations with health practitioners are illuminating and important.

I’d love your thoughts, of course, on this topic. Have a wonderful holiday!

xo

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