Nutrients of Concern in progress

[brimstoneSalad]

The nutrients of concern page on the wiki is in progress and about 1/3rd done.

http://philosophicalvegan.com/wiki/index.php/Nutrients_of_Concern

Also addressed, does B-12 supplementation cause cancer? (This issue has come up recently in response to a study)
http://philosophicalvegan.com/wiki/index.php/Nutrients_of_Concern#B-12_.26_cancer

Any thoughts, concerns, or things in particular to add?

[Jamie in Chile]

"Everybody, vegan and non-vegan, should supplement for vitamin B-12."
My understanding is that regular meat eaters under a certain age (such as 60 maybe) will get sufficient B12 from animal products. I would therefore dispute the above sentence. I don't think health organizations reccomend this, and I don't think there are scientific studies on meat eaters under 60 that would justify this statement. And there certainly isn't an epidemic of B12 deficiency going around even though most people don't supplement.

I like your point about the vegan consensus on B12.

"The body can convert Omega 3 ALA into needed EPA/DHA."
I agree with this statement, and studies seem to support it, but I think there have been limited studies, small sizes etc. Perhaps the jury is still out a little. Do we need a caveat of some sort here, a "probably."

I am not convinced by Zinc, Iron and Choline in the top rank of concern, and I am conflicted on Vitamin A. You have iodine as only marginal concern, but I would have it in the top rank above zinc, iron and choline. When I read about zinc, iron and choline on vegan diets I just thought "OK, then I'll be fine as long as eat a balanced diet" whereas when I read about iodine I realized I immediately needed to plan to avoid a deficiency. Most of the main reliable sources seem to be animal products.

Vegan Health website (Jack Norris) has iodine near the top, and zinc, iron and choline all way down the list.

The Becoming Vegan book I have says that "in most studies to date, vegans met or exceeded the recommended intake for zinc, but in two studies, vegans' average innstake was about 10% short of the reccomended amount". Choline does not even merit a mention in the book (unless I missed it).

Compare that to what they say on iodine "it is absolutely critical to life and health...iodine deficiency during pregnancy has tragic consequences.....vegans may not get enough iodine unless they use iodized salt, eat sea vegetables, or take a supplement..otherwise a vegan diet is likely to provide only about 10% of recommended levels."

This is actually from a flick through of what you wrote, I didn't have time to properly read every word (at least, not yet).

[Jamie in Chile]

You might be interested to know that when I started a vegan diet at the start of 2016 I ranked the nutrients in order of vegan concern. This was my own decision to help me personally plan a diet and I've not shared it with others before. About 70-80% of my reasoning for the list positions was based on the opinions and evidence presented in the Becoming Vegan nutrition book and the info on Jack Norris's vegan website: http://www.veganhealth.org/ The other 20%-30% was based on a huge variety of sources including articles, scientific studies, forum discussion, other books which I won't remember.

The precise order in the list is somewhere between subjective and abritrary, and I wouldn't be interested in arguing with someone who said something should be 1 place above or below on the list, since the goal is only to get things in the approx. right order in the list and I figured better to have a rough list than none at all. So, this is my list, from most concern to least concern for vegans.

1. Vitamin B12
2. Omega 3
3. Iodine
4. Calcium
5. Vitamin D
6. Vitamin A
7. Protein
8. Zinc
9. Iron
10. Selenium
11. Vitamin B6
12. Vitamin B2
13. Choline
14. Vitamin E

Roughly speaking I think 1-5 should be researched by all vegans who should make sure they have adequate sources, and perhaps check specific amounts. I think 6-7 should be briefly checked and read about, but just for 5 minutes to make sure you have at least a basic understanding, and no need to measure specific amounts. And I think 8-14 are there if you want to be really obsessive and super cautious and careful, or already have bad health, or are already ill and want to check every angle, but for most people are not really necessary provided you have a balanced diet including legumes, grains, fruit and veg including green veg, nuts, seeds and the usual.

And then anything not mentioned is something that a vegan never needs to worry about unless they have a specific reason.

I am not comfortable with anyone using my comments to advise on babies or pregnancy. I have not read as much on it and I think more care is needed.

I summarized my thoughts on vegan nutrition in this blog: https://whytryveg.wordpress.com/2017/03/25/vegan-nutrition/

The idea of the blog is to teach someone about vegan nutrition if they only want to spend 15 minutes on it and are never going to wade through Norris' website or buy a book.

[Jamie in Chile]

Finally, some more broader questions about the page.

Why do we need this page on the internet when we already have this page: http://www.veganhealth.org/ Isn't there going to be too much crossover? How would you differentiate from that page? Why do we need both? I wonder if you might do better to make a backup of that page incase it ever goes down and perhaps write an article drawing attention to it and adding some some supplementary commentary.

Are you the main author or only author of the page? There is a lot of good knowledge on the page.

Also, ideally do you want to provide sources. However, I appreciate it can be time consuming.

[Jebus]

Just writing anecdotally, but zinc, calcium, and iron was never nearly a problem for me, even before I started paying attention to nutrition. As a newbie vegan, I was probably deficient in vitamin E, omega 3, and iodine. I think about 95% of those going vegan know about B12 but surprisingly few know about iodine.

Good article!

[brimstoneSalad]

Thanks Jebus!
And thanks Jaime!

I'll move iodine up the list. It's not an issue for vegans who use iodized salt, which is why I placed it lower... and most vegans who cook at home (most vegans) rather than just eat packaged food will. BUT there is a recent trend of using sea salt, and that is potentially dangerous for vegans.

I'm hesitant to move Choline down due to its importance in pregnancy, but I'll go ahead and do that since it's not relevant to everybody.

Iron and Zinc commonly top lists from dietitians and dietetic organizations for nutrients of concern for vegans, so I think they should stay near the top despite it being pretty easy to get enough of them in practice (and most vegans having pretty good status).

I'll add a vitamin E section to nutrients of marginal concern since there is a tendency to do low fat vegan, and not all vegans eat sunflower seeds or enough vegetable oil.

My understanding is that regular meat eaters under a certain age (such as 60 maybe) will get sufficient B12 from animal products.

Sufficient to avoid severe and life threatening symptoms, but the levels in omnivores who do not consume a lot of beef or organ meats regularly (and they shouldn't do that, eating more meat to get higher B-12 levels is not a good health strategy) are often marginal, and symptoms of deficiency can show up at these levels.

Most good sources are precisely the things people should reduce most (thus the correlation of high B-12 levels and heart disease).
Reducetarians should probably be supplementing, and everybody should be reducetarian.

"Marginal depletion (serum vitamin B-12: 148–221 pmol/L) was more common and occurred in ≈14–16% of those aged 20–59 y and >20% of those >60 y."
http://ajcn.nutrition.org/content/89/2/693S.full

Outright deficiency is only common in the elderly, but marginal levels aren't that much less common in younger people. Maybe because of alcohol? Maybe junk food? Or maybe healthier diets that are lower in red meats?
Sub-clinical symptoms of low levels could be even more common, and optimal levels are probably over 300 pmol/L.

I changed the wording a little. and added in that reference.

Given how cheap and harmless B-12 is, and how it can improve overall health and wellness to have good status, it's a smart supplement (one of few). It's not as good advice to eat more red meat to get more B-12. And the cost of supplementing for a couple years is likely going to be lower than getting tested anyway when you otherwise have no way of knowing how much you're absorbing due to variability in digestion.
B-12 supplementation for "energy" has become more common today, and while it won't help people with high levels, it makes sense given the effects of lower levels. It might only be placebo for 80-90% of people, maybe more, but something that costs pennies a day and has no ill effects and even just a 10-20% chance of actually making you feel a little better after a few days is a good bet.

More wide-spread use of B-12 supplementation also lowers barriers to entry for going vegetarian or vegan, or lets people let off the red meat without concern for having to replace vitamins.

My point was only that it's not just going vegan that makes it a good idea to supplement. You're not the only weird one who benefits from it -- vegans just have to, where for other people (particularly those following healthier diets) it's just probably optimal.

Why do we need this page on the internet when we already have this page: http://www.veganhealth.org/ Isn't there going to be too much crossover? How would you differentiate from that page? Why do we need both? I wonder if you might do better to make a backup of that page incase it ever goes down and perhaps write an article drawing attention to it and adding some some supplementary commentary.

There will be some crossover, but this probably won't be as detailed, and it'll be written from more of a meta-activism perspective.

Are you the main author or only author of the page? There is a lot of good knowledge on the page.

Currently, but please join in!

If you're not signed up on the wiki, sign up and I'll give you editing permissions.

Also, ideally do you want to provide sources. However, I appreciate it can be time consuming.

Yes, that's the plan to add in more sources. I was just going as fast as possible and filling in information mostly from memory and checking a few things.
Ideally everything that we can source will be sourced.

[Jamie in Chile]

If you are reccomending people supplement B12 because B12 has a worse status in general population then other vitamins it makes sense, likewise if that specific reccomendation has gone out by health authorities from at least two major countries fair enough. But if other vitamins have just as borderline status in general population than I don't think it's fair to single out B12, especially if part of the reason it to make the barrier to veganism less. We don't need to use disengenuous arguments to promote veganism, the true arguments should be enough for anyone moral, open minded, smart and/or well read to at least consider it.

To be frank I'm not convinced there is enough of a need for this particular article to warrant me spending a lot of time on it, I am still not convinced about the differentiation vs. vegan health site. Also, I don't really know much about nutrition other than the main points covered. I don't really want to write a formal guide to nutrition. I am just about happy enough writing a casual blog or informal forum advice, perhaps with disclaimers like "I am no expert and could be wrong so check this with someone else, but..." which is not really the style of the wiki.

Zinc and iron constantly crop up in generic articles about vegan deficiencies with no sources, usually puff pieces that look like they have been written in half an hour's work, but when you look at the results of real studies of vegan populations, or which foods have them, I think the issue with zinc and iron are exaggerated. People like to exaggerate the nutritional deficiencies of a vegan diet as part of their strategy to find excuses to ignore the moral arguments for veganism and iron is always getting thrown around just to pad out the list of supposed deficinecies. Still, we have to be very careful what we say because I am sure there are vegans out there with zinc and iron deficiencies - presumably not too many and perhaps because they have special nutrition concerns or eat a not so balanced diet or something.

Will write more shortly...

[Jamie in Chile]

I am thinking about the editing but I'm not convinced I know quite enough yet. I think I could do the critiquing which is actually easier than the writing probably. Also, I'd be concerned we could both spend hours and hours on it and then have only 20 or 30 people ever read all the site. Could you just write a few pages, and then find a way to tracker visitor stats, and then make sure you get 50 or 100 page reads before you go on and do more. I want to advocate in the most effective way.

[Jamie in Chile]

I have to create a separate account for the wiki, by the look at it.

If you like I'll have a go at (any or all of the below, let me know which and I can start next week if I have time, not promising anything)
Arguments for Veganism (suggest about 500-2,000 words)
Speciesism (suggest about 500-2,000 words)
Dining Out (suggest about 400-1,000 words)
All the Arguments Against (presumably meaning arguments against veganism) (suggest about 1,000-3,000 words) If you want a long list of 50 arguments I'm not going to do that, but I can highlight 10-15 of the most common? A lot of the others are just variants of those 10-15 or are just dumb.

As a general rule I'd do better at ones that require logical, rational thought and being fairly well read (ish) on the basics and less well about ones that involve actual life experience, interaction with other vegans etc. And I have essentially no activism experience.

[brimstoneSalad]

If you are reccomending people supplement B12 because B12 has a worse status in general population then other vitamins it makes sense,

There are several vitamins everybody should be supplementing in because they have more potential benefit than risk. D is another even though some people get plenty from sun and/or diet, many people benefit from more, there are a lot of people with low status, and even if you get enough a little extra is harmless.
Multivitamins (which include B-12 and D, among some other things like vitamin K) are commonly recommended as a safety net, although not all health organizations and doctors agree (some are obsessed with getting everything from food, which is an unnecessary and ridiculous goal). It doesn't make sense to wait until people are 65 to recommend B-12 supplementation given borderline status isn't rare in younger people either (it's just not as critical until that point).

Multis:
https://www.webmd.com/vitamins-and-supplements/nutrition-vitamins-11/choose-multivitamin

Harvard school of public health has a few articles on multivitamins, as insurance policies that are harmless.
https://www.health.harvard.edu/mens-health/do-multivitamins-make-you-healthier
https://www.hsph.harvard.edu/nutritionsource/multivitamin/
etc.

The important assessment is potential benefit (either in everybody, or in some people who may not know they're borderline deficient) vs. risk.

There are high dose vitamins that are more risky than potentially beneficial, and high doses of iron in multivitamins is a risk.

But if other vitamins have just as borderline status in general population than I don't think it's fair to single out B12,

I didn't mean to imply B-12 was being singled out/for people to only take B-12. It's just one of a small number that are without negative effects. Some other B vitamins may have negative effects due to the larger amounts. B-12 is in micrograms.

especially if part of the reason it to make the barrier to veganism less.

I'm assuming the reason that "everybody is deficient in B-12 in the modern world" (an exaggeration with a grain of truth) is a common argument in vegan circles is to dispel the appeal to nature fallacy.

This isn't really a resource meant for carnists, though.
The point is that we have limited time and resources, and the fact that it may reduce barrier to entry is why it may be useful for vegans to talk about it with friends or family, whereas with other vitamins it may make people a little healthier but not reduce barrier to entry making that a less effective use of resources.

Everybody should also be getting physical activity, but I'm not sure vegans need to spend time recommending that.
A multi is probably even better at reducing barrier to entry, and there are mainstream sources recommending those. I'm a little more hesitant to recommend multivitamins because in some formulations there are potential dangers from high doses of unnecessary and potentially harmful things. I think that'd need more looking into.

We don't need to use disengenuous arguments to promote veganism, the true arguments should be enough for anyone moral, open minded, smart and/or well read to at least consider it.

Well, this is for meta-activism, not to reach carnists.

I mention it because it's a common vegan argument (albeit sometimes exaggerated to everybody being deficient instead of just many or most people having sub-optimal levels), and it's relevant to answering questions about B-12.

To be frank I'm not convinced there is enough of a need for this particular article to warrant me spending a lot of time on it, I am still not convinced about the differentiation vs. vegan health site.

Vegan Health is great, so is Harvard School of Public Health, and even Nutritionfacts has some really good info (although a little more skepticism needs to be taken for that info).

There are minor problems with all of these on their own, sometimes due to incorrect info, sometimes due to a hesitancy to speculate when speculation is reasonably well grounded. There would be too many links and caveats to all sorts of different sources to get a compilation that provides the most relevant info.
Veganhealth is probably the most reliable, but Norris also occasionally makes some small mistakes (I've seen three, and they were fairly significant ones). So does Willett. And Greger definitely does (even big ones). And the wording on vegan-health isn't always great at presenting arguments for activism and answering challenges.

The point is, I'd rather have a streamlined source where information is condensed, with activism related commentary and arguments, and checking for consistency with other sources. Something that's willing to speculate a little more, but not lose touch with reality like Greger sometimes does.

Zinc and iron constantly crop up in generic articles about vegan deficiencies with no sources, usually puff pieces that look like they have been written in half an hour's work,

I see them referenced in mainstream sources often.
For example:
https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/vegetarian-diet/art-20046446?pg=2

Doesn't look like a puff piece, and mayo clinic is usually regarded as fairly credible among web sources.

WebMD is usually pretty credible too:
https://www.webmd.com/diet/tc/vegan-diet-topic-overview#1

Harvard School of Public Health even discusses them:
https://www.health.harvard.edu/staying-healthy/becoming-a-vegetarian

but when you look at the results of real studies of vegan populations, or which foods have them, I think the issue with zinc and iron are exaggerated.

I agree that they're often exaggerated, just skeptical of moving them down because of how often they're cited.