"Vegans do need supplements or fortified foods, and admitting that a vegan diet is not automatically pure perfection is way better than getting sick."
-Ginny Messina, the Vegan RD, registered dietitian, public health nutritionist, and co-author of the American Dietetic Association’s Position Paper on Vegetarian Diets. She is the co-author of an upcoming book, "Vegan for Life: Everything You Need to Know to Be Healthy and Fit on a Plant-Based Diet," coming out July 12, 2011.
"The most important thing to be aware of regarding protein in vegan diets is that you need to get enough of the amino acid lysine.
Protein is important for maintaining muscle and bone mass, for keeping the immune system strong, and to prevent fatigue.
[L]et's just cut to the chase - the RDA for lysine is more important than for protein. If you meet lysine requirements on a vegan diet, you will most likely meet protein requirements.
There is evidence that people over 60 should be eating well above the RDA for protein to prevent muscle and bone loss.
Legumes are the foods highest in the amino acid lysine. Tofu, tempeh, and soy meats are the highest, followed by other legume foods.
Other than legumes, quinoa and pistachios are decent sources of lysine."
-Jack Norris is a registered dietitian, who provides research-based nutrition advice on his blog, JackNorrisRD.com, as well as authoring a web-based nutrition resource VeganHealth.org. He is the co-author of an upcoming book, "Vegan for Life: Everything You Need to Know to Be Healthy and Fit on a Plant-Based Diet," coming out July 12, 2011.
Perfecting the Plant-Based Diet
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Thanks to crazy Southwest flight delays and getting re-routed into Nashville on Monday, I had seven hours on my way home from St. Louis to go through a pile of articles on vegan nutrition--and to reread a wealth of information from two respected plant-based registered dietitians--Jack Norris and Ginny Messina.
Full Disclosure: Jack & Ginny came to plant-based diets for ethical reasons--not simply for the health benefits. Their perspective is a little different than mine--and I don't necessarily agree with everything they have to say--but be assured that they base their nutritional advice on research--not philosophy.
Here's what we do agree on:
- Get adequate protein through beans, legumes, and quinoa (but kale & oatmeal will give you some, too)--and head straight over to Jack Norris' most excellent page on protein--with his chart on the lysine content of common foods.
- Take a vitamin B-12 supplement--and start from the first day that you begin a plant-based diet
- Take a vitamin D supplement--many vegans are too low!
- Make sure you get adequate calcium--many vegans are too low--half of them are getting less than the 526 mg/day barest minimum!
- Getting enough iron (for one's age)
- Getting enough iodine
- Take a DHA supplement (available also from algal sources) & adequate omega-3s through flax, chia, or walnuts
There's no doubt about it. Eating a nutrient-dense plant-based no-added oil diet will get your weight down, lower your cholesterol, stop type-2 diabetes, prevent heart attacks, strokes, some cancers, and a whole host of other diseases.
But, if you think you don't have to be careful about what you include in your diet--you better think again.
If you think you don't need any supplements--think again.
What About Supplements for Plant-Based Perfection? Let's Ask Ginny Messina!
Messina knows nutrition--that's her profession. She's the go-to-gal for the American Dietetic Association when it comes to vegan & vegetarian nutrition. Click here for her articles that are indexed in PubMed.
She has seen all the nutritional mistakes made by misinformed vegans--so she's taken the time to carefully & objectively look at the medical research to get the latest guidance on eating a healthy plant-based diet.
"I’ve been thinking about protein a lot lately for a number of reasons. The main one is that I’ve been working on a book on vegan nutrition with dietitian Jack Norris. It’s called Vegan for Life, and will be published this summer by Da Capo Press.
We worked on our book for more than a year and spent a lot of time researching and debating every single aspect of vegan nutrition.
Plant-based has a lot of benefits--but frankly--if you aren't careful, you can short-change yourself on important nutrients, mineral, and vitamins.I’ve wanted to focus on what can go wrong with veganism, and how we can do everything possible to make sure that all vegans and aspiring vegans have access to the safest nutrition information possible. And when people experience deficiencies on a vegan diet, we need to be able to help them increase nutrient intake from plant sources."
Below, you'll find a summary, with my own supplement additions & comments.
Everyday Supplements for a Plant-Based Diet
Recommended for All Vegans:
1. Vitamin B-12 Take this advice: if you're starting a plant-based diet start taking a B-12 supplement from Day One! If you aren't eating animal products you aren't getting enough! And forget about getting enough from unwashed organic produce, or mushrooms grown in B-12 enriched soil.
Messina recommends 1000 mcg of B-12 2-3 times a week, or starting out with 2000 mcg daily for several weeks if you haven't had any B-12 for awhile. She favors cyanocobalamin or methylcobalamin, which may require higher doses. Or get a blood test if you have concerns on whether or not you're deficient.
I go into more detail about B-12 here--and a top B vitamin researcher at the major hospital where I work recommends 1000 mcg of B-12 taken sub-lingually daily (either methycobalamin or cobalamin). Best to take B-12 on an empty stomach. Be sure to read more about B-12 from Messina here. Jack Norris provides extensive guidance on B-12 in Vitamin B-12: Are You Getting It?
Recommended for Most Vegans:
2. Vitamin D If you live in a sunny part of the world--and get plenty of sun-exposure, lucky you--just skip to #3. Messina recommends getting vitamin D from either fortified foods or supplements to the tune of 1000 IUs a day. I personally take more. The Institute of Medicine thinks we need less. Don't guess--ask your doc for a 25-vitamin D hydroxy test and discuss your vitamin D blood level goal with him or her. Read more about Vitamin D here, here, and here.
And for maximum absorption, be sure to take your D with your largest (or most fat-containing) meal. Here why! My new technique is to take one vitamin D with a big meal--and one with a couple of walnuts--my "new supplement". Don't waste your time taking it on an empty stomach!
3. Iodine If you eat dairy products, Messina says you get most of our iodine from "the iodine solutions used to clean cows and equipment on dairy farms." You may get enough iodine if you regularly eat sea vegetables--but don't depend on getting enough from miso or sea salt.
Messina says "the only reliable sources of iodine are iodized salt or a supplement containing around 90 mcg/a day." My Centrum Silver multivitamin has 150 mcg & it says that's 100% of the recommended Daily Value.
I've adopted Dr. Michael Roizen's recommendation for my multivitamin: Take 1/2 a multivitamin twice a day--once in the morning, once at night. Why? The vitamin level gets too high if you take it once a day--and you just urinate it out. Use a pill cutter, split it up, and have 1/2 in the AM, and 1/2 in the PM.
4. Calcium More than half of all vegans come up short on calcium--under 525 mg a day. Messina explains her recommendation better than I could, so here's what she says:
"We don’t know if vegans have lower needs, but the old “low protein diets reduce calcium needs” theory has taken some real hits in the past years. Based on current understanding—which is admittedly pretty poor—we vegans should strive for the RDA Our ancestors didn’t drink milk and they got all the calcium they needed from wild greens. And even though modern cultivated greens have less, we could get enough calcium just from these foods, too. But the recommendation to eat 4 to 6 cups of cooked greens per day makes veganism a hard sell. Without fortified foods, most vegans fall short on calcium."
Note: 6 cups of raw kale will give you 543 mg of calcium--just enough on the lower level of calcium needs, as recommended by Dr. Walter Willett. But certainly one would be getting additional calcium beyond just kale in a normal plant-based diet!
Calcium Guidance for Vegans: "The Comparative Fracture Risk in Vegetarians and Nonvegetarians in EPIC-Oxford," European Journal of Clinical Nutrition 2007. 61:1400-1406 (click here) is the most important study published on vegans & bone health. The vegans in this study who had adequate protein, calcium that exceeded 525 mg/a day, and adequate vitamin D reduced their fracture risk.
"Research has shown that bone health is also influenced by nutrients such as vitamin D, vitamin K, potassium, magnesium and by foods such as soy and fruit and vegetables. Vegan diets do well in providing a number of those important substances. The maintenance of acid-base balance is critical for bone health. A drop in extracellular pH stimulates bone resorption, because bone calcium is used to buffer the pH drop." Am J Clin Nutr 2009;89(suppl):1627s-33s.
Here's Jack Norris' analysis of the calcium needs of vegans based on the EPIC-Oxford Study:
"In [the EPIC-Oxford Study] the vegans who got more than 525 mg of calcium had the same rate of bone fractures as the meat-eaters and lacto-ovo vegetarians, showing that vegans need more than 525 mg of calcium. (In the study, 32% of vegans had calcium intakes between 525 and 699 mg per day, and 24% had greater than 699 mg per day.)
This is the only study looking at the bone fracture rates of vegans.What harm could come from encouraging vegans to get at least the low end of what is a normal amount of calcium (like 700 to 800 mg/day) in Western countries? None. But what harm could come from vegans not getting that much? Only osteoporosis!
In summary, there is no direct evidence that a vegan diet with only 400 to 500 mg of calcium per day prevents osteoporosis. The direct evidence is just the opposite."
Read Norris' complete post here.
Recommended for Some Vegans
4. Iron Both vegan & omnivore women who are still menstruating or those who have heavy periods need to be vigilant about getting enough iron and preventing iron-deficiency anemia--but, that's not just a vegan concern.
Messina suggests including iron-fortified foods or taking a low-dose iron supplement, because it's easier on the stomach than the higher doses--and taking it with orange juice or other citrus fruits for better absorption. Most multivitamins designed for the under 50 set include iron. But, take a look at beans. A cup of lentils has more iron than beef--and other beans, as well as spinach are all good sources of iron--and don't forget that old standby of getting iron by cooking with a cast iron pan.
As demonstrated in a 1986 study from the American Dietetic Association, cooking foods in a cast iron skillet can add significant amounts of iron to your food. Click here for an excellent guide to the top food sources of iron.
A Supplement Recommendation to Consider
5. DHA Consider taking 200-300 mg several times a week. As Messina says, "It may be good idea, but we don't know for sure. I take this amount almost daily and would recommend it in particular for anyone who is prone to depression."
This is one of essential fatty acids that's most lacking in plant-based diets. At this point there's no hard evidence that the plant-based short-chain fatty acids we find in flax, chia & walnuts (ALA alpha-linolenic acid) can sufficiently convert to DHA--an essential-must-have fat for our brains. We know ALA can convert to EPA (Eicosapentaenoic acid), but researchers aren't so certain about DHA. To read more about this issue, click here. To read Messina's more detailed explanation of why she recommends taking DHA click here and click here.
I take Spectrum's vegetarian DHA--1 capsule provides 120 mg of DHA.
Recommendations for the plant-based essential fatty acid ALA (alpha-linolenic acid):
1.6 grams/a day for men
1.1 grams/a day for women
You can get enough ALA with 1 tablespoon of flax meal, or 1 tablespoon of chia seed, or 1/2 an ounce of English walnuts a day.
An excellent resource on the omega-three requirements: Gebauer SK, Psota TL, Harris WS, Kris-Etherton PM. "n-3 fatty acid dietary recommendations and food sources to achieve essentiality and cardiovascular benefits" Am J Clin Nutr. 2006 Jun;83(6 Suppl):1526S-1535S. Click here for the article
Want to read even more about the nutritional benefits & shortfalls of a plant-based diet? Check this out: "Health Effects of Vegan Diets," by Winston J. Craig, American Journal of Clinical Nutrition 2009; 89(suppl):1627S-33s.
The Short Story on Protein Needs on a Plant-Based Diet
With due respect to Rip Esselstyn, Dr. Caldwell Esselstyn, Dr. T. Colin Campbell and others--I do think one has to put some serious "meal-planning" thought into getting enough high quality protein on a plant-based diet--especially if you work-out, and if you are over 60. You can make mistakes. Specifically, that means making certain that beans & legumes are a regular part of your diet!
Jack Norris recommends making sure your diet contains enough lysine--that's the amino acid responsible for building & repairing muscle, collagen, connective tissue, and cartilage. According to Norris, if you're getting enough lysine in your diet--your going to get enough protein. It's not difficult to do--but you have to pay attention. For instance: seitan is very high in protein, put doesn't have a speck of lysine!
The other lysine perks? It helps to promote the absorption of calcium--of benefit to bone health. It also boosts the immune system.
Now don't freak out about this lysine thing--it's really not that complicated--it just means you can't skip the beans and legumes! Just start thinking about getting some daily lentils or dal in the same way as your daily bowl of oatmeal.
Lysine: The Limiting Amino Acid in Vegan Diets, by Jack Norris (read Jack's complete post on protein & lysine, here)
"Before getting into a somewhat technical discussion about the protein needs of vegans, let's just cut to the chase - the RDA for lysine is more important than for protein. If you meet lysine requirements on a vegan diet, you will most likely meet protein requirements.
Legumes are the foods highest in the amino acid lysine. Tofu, tempeh, and soy meats are the highest, followed by other legume foods. Other than legumes, quinoa and pistachios are decent sources of lysine.
It is very hard to design a vegan diet that meets lysine requirements for a person who does not exercise daily without including legumes, quinoa, or pistachios, without having too many calories. It is much easier to do for regular exercisers whose calorie requirements are higher - the low lysine foods will add up to provide enough.
The reason why many raw foodists athletes appear to thrive on the diet while many non-athletes struggle with raw diets may be that the athletes are able to eat many more calories, thus meeting lysine needs with low lysine foods.Legumes, quinoa, and pistachios are the only plants foods high in the amino acid lysine. If you are not eating them every day, you might be falling short of lysine needs.
There is evidence that people over 60 should be eating well above the RDA for protein to prevent muscle and bone loss."
OK--Let's Get Down to Basics. How Much Lysine Do I Need a Day?
I'll let Ginny Messina spell it out.
"To ensure that vegans meet needs for protein and lysine, I recommend a minimum of three servings per day of legumes. A serving is ½ cup of beans or soyfood or 1 cup of soymilk. This is a fairly generous amount—more than some people require—but it leaves room for some low-protein foods in your diet—fruits, fats, and treats.Here is a quick guide to meeting vegan protein needs. I'm including information about lysine, too, just to demonstrate why legumes are so valuable in the diets of vegans.Don't obsess about your lysine (or protein) intake, though. As long as you are including legumes/soyfoods in your daily menus, you'll meet requirements for both.To find your protein requirements, multiply your ideal weight (in pounds) by 0.45.To find your lysine requirements, multiply your ideal weight (in pounds) by 21.5.Protein needs are based on lean body mass, which is why we use ideal weight rather than actual weight to calculate requirements. So a person who should weigh around 140 would need 63 grams of protein and 3010 milligrams of lysine."
- One cup of oatmeal: 316 mg
- One cup of quinoa: 442 mg
- One cup lentils: 1248 mg
- One cup of soy milk: 439 mg
- 1/2 cup of tempeh: 724 mg
- 1 cup of cooked kale: 148 mg
- 1 cup of brown rice: 172 mg
- 2 TBS of walnuts: 62 mg
- One baked potato: 263 mg
- 1/2 cup black beans: 523 mg
Grand Total: 4337 mg of lysine--well over my daily requirements!
I've got renewed respect for lentils & tempeh, that's for certain. And, you can easily see why it's important to pay attention to what kinds of food you are putting on your plate.
Ginny Messina and Jack Norris' Vegan Food Guide Mash-Up
We can all reap the pre-publication benefits of Jack & Ginny's research on their blogs & on Jack's Vegan Website.
- Ginny's Recommended Supplements for a Vegan Diet
- Ginny's Food Guide for Vegans
- Ginny's Protein Cliff Notes--Eating Your Beans & Legumes
- Ginny's Guide to Meeting Protein Needs on a Vegan Diet
- Jack's Vegan Protein Needs Updated This post is a "must read"--but be sure to click on the link at the end of his post!
Messina's food guide has all the "usual suspects"--with guidance on how many daily servings we need for grains, legumes, vegetables, and fruits. I was happy to see that she has no minimum amount for fat--but Messina does recommend 1-2 servings of nuts or seeds a day.
My Favorite feature: she includes the best sources for calcium within each food group--like the top calcium vegetables & legumes.
So, What Food Group Does Rice or Almond Milk Fall Into?
News to me: Messina does a great job of clarifying the relative values of the non-dairy milks--what's the best choice? Rice, almond, hemp, oat, or soy? Decide for yourself?
"A note about milks: Many people prefer almond, rice or hemp milk to soymilk. If these milks are fortified, they are a great source of calcium.The problem is that they aren’t a great source of much else.They don’t really fit into the Legumes group, because they provide minimal protein. That doesn’t mean that you shouldn’t consume them. Just keep in mind that they are likely to displace more protein-rich foods in meals, so you’ll need to make adjustments accordingly."Soy gives you calcium (if it's fortified) & protein + lysine!
So there you have it! Everything in one place--the recommended supplements for a plant-based diet--and guidance on protein needs!
It may seem complicated at first, but once you figure out what you need to include daily for plant-perfect nutrition--it's just like following a simple template everyday! And I'm definitely going to purchase a copy of "Vegan for Life" when it comes out! A bargain at $10.85!
H.L.'s Favorite Finds of the Week
My Must-See Movie Recommendation of the Week: Win-Win with Paul Giamatti
My Favorite New Recipe of the Week: Mama Pea's Spicy African Peanut Sweet Potato & Lentil Stew My changes: Substituted 1 cup of soy milk & 1 tsp of coconut extract for the coconut milk. I use Muir Glen's Fire-Roasted chopped tomatoes with green chilis for extra heat, and my giant sweet potato measured in at 3 cups, not 1 cup--and I used it all! This is an easy-to-put-together slow cooker recipe that's absolutely delicious. Thank you Wendy, and thank you Mama Pea! Looking forward to the left-overs for lunch today!
My Favorite Podcast/Transcript thanks to Ken Leebow: For a fascinating interview with Dr. William Castelli, the former long-time director of the Framingham Study, "Heart Disease Risk, Cholesterol & Lipids: What Do We Really Know in 2011?" Click here. Think about getting your triglycerides way down--under 80--or 60 is even better!
My Favorite NYT article of the week: Estrogen Lowers Breast Cancer and Heart Attack Risk in Some You might find my earlier post on HRT of benefit--or not--as well as the April 4, 2010 NYT article: The Estrogen Dilemma
Here's an excerpt:
"Imagine that, out of the blue, you are arrested, accused of planning a dangerous crime, held in jail for 4 days, and tortured so badly that you lose part of a kidney. You feel like you were hit by a truck. Then, just as suddenly, you are released and told it was all a case of mistaken identity. How would you react?
Would you feel lucky? Grateful to the police for the arrest and beating? We doubt it.
But just change a few words and see what happens.
Imagine your patient undergoes a computed tomographic (CT) scan for low back pain. The spine looks fine, but the scan picks up a totally unexpected kidney mass. It is suggestive of cancer. The patient is hospitalized for 4 days and undergoes a partial nephrectomy. He feels like he was hit by a truck. And the tumor? Not cancer. It was a case of mistaken identity.
Recently, the brilliant New York Times columnist Nicholas Kristof1 wrote about how he experienced this sort of scenario. How did he react? He was not angry. He felt lucky and grateful. He had "far more appreciation for the glory of life."1(p12) So did most of the nearly 300 New York Times readers who posted comments on Kristof's blog.2
It is easy to understand why—Kristof survived a brush with death.
Only he did not. He survived a brush with overdiagnosis.
Because CT scans are so sensitive, it is not unusual for radiologists to stumble onto unexpected abnormalities— incidentalomas —that have nothing to do with why the scan was ordered. Scans performed for back pain or trauma, for example, often detect abnormalities in the kidney or liver. Incidentalomas present a dilemma because they may be a treatable cancer. To find out if they are, patients generally undergo further testing. Far more often than not, the whole episode is a false alarm......" Get a copy of the article to read more!