I often hear vegans state that if one follows a vegan diet, supplementation is unnecessary. While I used to believe that for the *most* part (I was educated on B12 pretty early on), I consider it irresponsible and potentially dangerous to tell vegans not to supplement. There are some key areas that need to be addressed in a vegan diet (just as there are in non-vegan diets). If they are not, the results can be devastating. Does this mean that I don't think a vegan diet is healthy or that I don't recommend it to others? Not at all. I want EVERYONE to be vegan, but just like I would not recommend an unhealthy donut-based vegan diet devoid of vegetables I'm not going to recommend that someone follow a vegan diet that is missing key nutrients, even if some of those nutrients have to come from a pill.
As previously mentioned, I decided to follow a vegan lifestyle nearly 21 years ago (my Veganniversary is coming up!) to avoid exploiting and harming animals. This remains my primary motivation as a vegan. I wasn't sure if avoiding animal foods was the healthiest thing to do, but I had no doubt that it was more ethical than consuming non-vegan foods. It didn't take long for me to become acquainted with some of the health arguments of a vegan diet, and I soon came to believe that veganism was the perfect diet and that supplements were largely a waste of time and money and were "unnatural." I was a Natural Hygienist for a long time. While I still believe in many of the tenets of Natural Hygiene, I have learned a few lessons since then, some the hard way. I'm not nearly as rigid about living in accordance with NH now, and I recognize that NH philosophy was missing some key components.
But, getting back to veganism, particularly to the health aspects of vegan diets, it's important to note a few things.
First, there is no single vegan diet, so statements about "the" vegan diet being healthiest are not accurate. A vegan could subsist wholly on potato chips and beer while another vegan could live on organic fruits, vegetables, legumes, nut/seeds, etc. The chip-eating, beer-guzzling vegan is almost certain to be more unhealthy than the average omnivore whereas the whole foods vegan is likely to gain some benefits over the average omnivore. Few would disagree with that, but it's worth noting because there are too many generalizations made about how a vegan diet prevents ABC or XYZ diseases. Which vegan diet? The first one or the second one or some other one? It may seem obvious that it is not the first, but we can't assume that everyone knows this when we state it as a generality about vegan diets.
Second, from a health perspective, even the best diet can have certain pitfalls. A healthy whole foods vegan diet can prevent/reverse heart disease, reduce chances of cancer, and help prevent or reverse Type 2 diabetes, but if not supplemented in key areas it can lead to a host of issues. Even "whole foods" such as fruit, grains, or nuts can be over-consumed, leading to obesity.
Third, animal foods are not the only foods that lead to heart disease, diabetes, and obesity. Vegan junk food can do the same. Most vegans that I know are *NOT* eating healthy whole foods vegan diets and still have a considerable amount of junk food in their diet, though they may or may not be including some very healthy foods.
Getting back to supplementation, there are three key areas to which vegans should pay attention: Vitamin B12, Vitamin D, and Omega 3 fats. It is possible to be deficient in other areas, but a healthy diet and good multi will generally cover you. Of course, it's always wise to get checked out regularly just in case you are falling short somewhere.
Vitamin B12 deficiency is nothing to toy with, particularly considering that you could end up paralyzed or with irreversible nerve damage. (See some videos from vegan physician Dr. Michael Greger on the topic of B12 here: http://nutritionfacts.org/topics/vitamin-b12/.)
Vitamin D is an area of concern for everyone vegan and non-vegan, but vegan sources in the diet are even more limited (certain mushrooms and fortified foods). I'd recommend an annual blood test to everyone (vegan or not) to ensure that they have adequate levels. It is imperative to supplement even if you go outside regularly if your levels are insufficient or sub-optimal. Vitamin D deficiency can also lead to a lot of problems, not just rickets but also cancer, issues with glucose metabolism, multiple sclerosis, and cognitive impairment among other things. See http://www.drfuhrman.com/library/vitaminD_update.aspx.
Another area of concern has to do with Omega-3 fats. Dr. Fuhrman has clinical experience with many thousands of vegans over a ~25 year medical career and has stated that in long-term vegans he has seen a lot of issues with Omega-3 fatty acid levels. Some of this has to do with overconsumption of Omega-6 fats and underconsumption of Omega-3 fats, but even in people consuming adequate Omega-3 fats in the form of flax and walnuts and other seeds/nuts there can be issues because the short-chain Omega-3 fatty acids need to be converted to long-chain Omega-3 fatty acids. Long-chain Omega-3 fatty acids like DHA and EPA are now available in completely vegan forms, so vegans can take them to avoid issues. Vegan DHA has been around a long time now, but vegan EPA is relatively new.
There are other areas that can also get low in vegans or others who rely on non-animal foods for the bulk of their calories, so if you don't get annual blood tests, it's a good idea to take a multi to avoid issues with trace minerals.
I was a non-supplementer for much of my early vegan career. I didn't have any significant issues, but was experiencing some fatigue and fogginess at one point after 10 years. I went to a physician and had my blood tested. We found that my B12 was on the low side of normal, even with some fortified foods. (Dr. Greger doesn't recommend relying on one fortified source like nutritional yeast because it is too inconsistent and instead says to also include a regular supplement.) A low normal on a B12 test can actually still indicate a deficiency, so I should have taken an MMA test to rule one out. Unfortunately I didn't know that. Still, I was concerned enough that it was in the low end of the normal range, and so I changed my attitude towards supplementation. The last decade I have been an on-and-off supplementer, getting more serious and regular in the last year or so. Unfortunately I did not get regular blood tests, so it's hard to assess if I was supplementing properly or not. I also struggled with my weight and binge eating, so it's tough to determine whether I had symptoms from unhealthy eating and excess weight or from improper supplementation. The two may even be interwoven.
Last year, I decided to have some of my levels checked. I was concerned about Vitamin D after reading about the connection of deficiency to disease and I was experiencing fatigue and back pain. The doctor tried to talk me out of getting tested, saying that most of what was being said about Vitamin D was hyperbolic. He looked at me and said, "You look pretty tan, so you must get enough from being in the sun." I pushed the issue until he agreed, and I found that my Vitamin D was in fact a deficient 15. Everything else was normal. My B12 was in the adequate range (no additional tests).
I recently had a lot of labwork done, because I changed (improved) my diet, started exercising more vigorously, and wanted to make certain that I didn't have any underlying issues not only from my new stricter diet but also from years of not always eating a balanced diet or supplementing right. I've gotten most of my results back now, and it's kind of interesting. I will post more about my blood tests separately. I am going to start testing annually to avoid future issues but also to see what effect physical fitness, an improved diet, and smart supplementation have on my blood levels.
Most of my numbers were awesome (protein, calcium, iron, cholesterol, glucose) after 21 years as a vegan and three months on a strict Eat to Live regimen, but there is definitely room for improvement in some areas. My B12 was normal, but I went ahead and did a separate MMA test and will post the results when I receive them. My Vitamin D was a 26, which is considered sub-optimal by the new standards. This was actually up from last year when I was a deficient 15. I have been supplementing regularly with a lot of Vitamin D2 (4,000 to 8,000 IUs) but still was lower than where I should be, particularly after more than a year of supplementing and several hours of sunshine a week.
Vitamin D2, aka ergocalciferol, is the non-animal version of Vitamin D. Vitamin D3, or cholecalciferol, is generally derived from animal sources so is not usually vegan. There is a lot of debate about whether D2 is as effective as D3, but it is generally agreed that D2 is not as well absorbed and requires higher dosages to match D3's effectiveness. This has always been kind of bummer for vegans. Just recently, though, an exciting product came out! It's called Vitashine Vegan Vitamin D3 Spray, and it is derived from lichen. Because I've had such a tough time getting my Vitamin D to an appropriate level, I'm excited to be trying this new product. I started taking 15 sprays a day (3,000 IUs ) on September 1st. I plan on retesting my level in December to see if it has been effective. I have to say that the spray tastes kind of odd, like movie theater popcorn "butter," so hopefully they will encapsulate it in vegan gel-caps at some point. (Edit: My new vegan grocery store is now carrying the vegan D-3 in vegan capsules: http://www.rabbitfoodgrocery.com/shop/index.php?main_page=product_info&cPath=9&products_id=73.)
I have never had my Omega 3 fatty acid levels checked. I didn't check mine because I rely on a supplement already, so my levels would reflect that rather than show whether I am an efficient short-chain to long-chain converter. If you want to determine whether or not you actually need a supplement and you are not taking any currently, you can have a test done that determines if your levels are sufficient. I'm okay with taking the supplement and since conversion can get more inefficient as one ages, I just take it without worrying if I might be okay not taking it. At present, I am taking the vegan EPA by Futurebiotics. I have taken V-Pure in the past, which contains both DHA and EPA, but it was sometimes unavailable for months. I may add DHA back into the mix at some point, since it's possible that there are some benefits found in DHA and not in EPA. I'll have to evaluate that and decide.
In summary, for vegans, I suggest the following:
1) Eat as healthy as you can. I am a big fan of Eat to Live. While Dr. Fuhrman doesn't only promote vegan diets, E2L is very compatible with veganism and easier to do if you are vegan. It is groundbreaking stuff. In a nutshell, base your diet on dark leafy greens, a variety of vegetables, beans, some fruit, nut/seeds, limited grains, and avoid or minimize oils, sugars, and other unhealthy items. Read the book to get complete details.
2) Take a good quality vegan multivitamin that includes B12. I take Gentle Care Formula because it's the only one I found without some harmful and possibly cancer-causing toxins. Dr. F is good about keeping it up to date based on the latest research. If you are female and of child-bearing age, you may want to consider his Gentle Prenatal formula. Generally he recommends non-pregnant females who still are of menstruating age take one capsule of the Gentle Prenatal and one of the Gentle Care. Pregnant females should take two of the Gentle Prenatal. Of course, individual needs may vary, which is why blood tests can be helpful.
3) Get your Vitamin D levels checked annually to see if they are in a good range or more frequently if sub-optimal or deficient. Take a regular Vitamin D supplement unless your levels are too high. You may have to experiment with the dosages some, but 2000 IUs is safe for most. If you are deficient, you may want to try Vitashine Vegan Vitamin D3 Spray (As mentioned earlier, I just started taking 3,000 IUs. Check back in December, 2011 to see if it raises my levels as desired.)
4) Check your B12 annually, as some people may need more than what is in the multivitamin, particularly if they have been deficient for a long time. Get an MMA test if you are under 500 pg/ml.
5) Take some long-chain vegan Omega 3 fatty acids. There are several good ones out there. The best bet is probably to take something that contains both DHA and EPA. Read my blog regularly for updates on new products.
6) Don't forget to engage in some form of healthy exercise!
9/7: Running class + drills