Ensuring adequate iron status in vegetarians and vegans

Abstract

Many people, including some physicians, are concerned about iron deficiency anemia in patients consuming a plant-based diet. However, studies show that the risk of anemia in vegetarian and vegan patients is no greater than in omnivorous patients.

Plant foods contain only non-heme iron, whereas meat contains both the heme and non-heme iron. There used to be a concern that non-heme iron would be poorly absorbed resulting in iron deficiency anemia. However, non-heme is well absorbed in most vegetarian patients and vegan because other plant foods, containing substances such as vitamin C and citric acid, can greatly enhance its absorption. Furthermore, non-heme iron absorption increases whenever iron stores are low.

Adequate iron levels can easily be maintained in the vegan patient with a little planning. Consuming foods high in iron along with foods that enhance non-heme iron absorption, will prevent iron deficiency anemia in vegan and vegetarian patients. Because both groups of foods are widely available, this should not be difficult to accomplish.

Patients that are already anemic can be treated by increasing their consumption of iron rich and iron enhancing foods. Supplements are sometimes required. In these cases, iron supplements can be prescribed in the same manner as with omnivorous patients. Continue reading

Ensuring adequate vitamin B12 status for patients on a plant-based diet

Vitamin B12 is a water-soluble vitamin that is naturally present in animal-derived foods. It is added to others and is available as a dietary supplement and a prescription medication. Vitamin B12 exists in several forms and contains the mineral cobalt, (1, 2, 3, 4) so compounds with vitamin B12 activity are collectively called “cobalamins”. Methylcobalamin and 5-deoxyadenosylcobalamin are the forms of vitamin B12 that are active in human metabolism. (5) Continue reading

Protein Combining – Is it necessary?

The myth that plant proteins must be combined at every meal to be of any use to the body was popularized in the early 70’s by the book Diet for a Small Planet by Frances Moore Lappé. The author has since been retracting the statement frequently. “In combating the myth that meat is the only way to get high-quality protein, I reinforced another myth,” she said. Unfortunately, the protein combining myth has taken root in the public and even among a few doctors.

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Academy of Nutrition and Dietetics – Vegetarian Position Statement

Academy of Nutrition and Dietetics“It is the position of the Academy of Nutrition and Dietetics [formerly the American Dietetic Association] that vegetarian diets can provide health benefits in the prevention and treatment of certain health conditions, including atherosclerosis, type 2 diabetes, hypertension, and obesity. Well-designed vegetarian diets, that may include fortified foods or supplements, meet current nutrient recommendations and are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence. Vegetarians must use special care to ensure adequate intake of vitamin B-12.

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The Superiority of Vegan Diets

A recent European study confirmed the superiority of plant-based or vegan diets. This study used several different indexing systems to rate the healthfulness of a wide spectrum of diets, from vegan to vegetarian, semivegetarian, pesco-vegetarian and omnivorous and concluded that, “the use of indexing systems, estimating the overall diet quality based on different aspects of healthful dietary models  indicated consistently the vegan diet as the most healthy one.”  The study goes on to say that, “the vegan diet received the highest index values and the omnivorous the lowest. Typical aspects of a vegan diet (high fruit and vegetable intake, low sodium intake, and low intake of saturated fat) contributed substantially to the total score, independent of the indexing system used.[i]

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Nutrition in Medical Education – the missing ingredient

With diet being the leading health risk factor in the United States[i], one would think that it would occupy a central position in medical education, continuing education and practice. But unfortunately that’s not currently the case. It turns out that, as a group, our nation’s physicians are not adequately trained in nutrition to provide the care their patients need.

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Top Health Risk Factor faced by patients – An Unhealthy Diet!

A recent study published in the JAMA demonstrates that the top health risk factor faced by American patients is an unhealthy diet[i]. The leading risk factors related to DALYs (Disease Adjusted Life years), YLLs (years of life lost due to premature mortality) and YLDs (years lived with disability) were dietary risks.

This study puts unhealthy diet front and center as the greatest health risk faced by most patients in the US. While still important, infectious diseases are no longer the cause of most morbidity and mortality. Now instead lifestyle has come to the fore. Lifestyle choices, especially dietary choices, are either the main etiologic, or a significant exacerbating, factor behind common chronic diseases such as coronary artery disease, hypercholesterolemia, essential hypertension, metabolic syndrome, type II diabetes and some cancers such as prostate and colon cancer.

[i] Christopher J. L. Murray and the US Burden of Disease Collaborators. “The State of US Health, 1990-2010 Burden of Diseases, Injuries, and Risk Factors.” JAMA. 2013;310(6):591-606