Updated: Jan 12, 2021
Let's tease out the facts from the misinformation, shall we?
So here you are.
You've heard the overwhelming evidence for the benefits of consuming a plant-based diet for cancer prevention, heart disease and type 2 diabetes reversal, weight loss, reducing inflammation, combating the symptoms of autoimmune conditions, etc. But...you've also heard there's increased risk for certain nutrient deficiencies. And then there was that one time Jaden Smith's skin turned grey while eating vegetarian. So - ideally we'd like to avoid that too.
I'VE GOT YOU.
(On the Jaden front - eating one meal a day and then blaming the effects of plain and simple, unadulterated starvation on vegetarianism - well that's a topic for another blog post entirely.)
The truth is, a plant based diet is a MIRACULOUSLY healthful way of eating...when done intentionally.
By definition, vegans follow a strict plant-based diet, in avoidance of all animal byproducts such as meat, dairy and eggs - just to name a few. That means eliminating or significantly reducing intake of a variety of compounds known to cause disease when consumed in significant amounts - such as cholesterol, saturated fat, trans fatty acids, hormones and antibiotics.
It can also mean, however, that one has to be slightly more intentional about ensuring adequate intake of certain nutrients. You see - a standard American diet can very easily provide quite a bit of nutrition, but with quite a bit of baggage as well. Unfortunately you can't get the iron in red meat without the saturated fat, the protein in eggs without the cholesterol, or the phosphorus in coca-cola without the you know - everything else - in coca-cola. I would argue its much more beneficial to seek out sources of nutrition free from the nasty baggage, and with health benefits instead! Even if it means having to be slightly more intentional along the way.
While these micro-nutrient recommendations can get fairly detailed/nuanced, I'll be sure to tie all the information together in a simple recommended plan of action at the very end!
So hang tight, friends.
Here are some of the nutrients we should be thinking intentionally about on a plant-based diet.
1. Vitamin B-12
Hands down, non-negotiable, this supplement is 100% necessary for those on a plant-based diet. Critical for red blood cell formation, protein metabolism and a healthy nervous system, Vitamin B-12 is a must.
Vitamin B-12 is produced by bacteria. Animals typically get their fair share by eating bugs, dirt, feces, or receiving supplementation of it while on factory farms. And while we may have once gotten all we needed by eating crops with small amounts of soil on them or drinking out of mountain streams and wells, modern society now chlorinates its water supply and has stripped its soil nearly sterile. Hence, the need for supplementation.
THE GOOD NEWS: Fortified foods and supplements are the cheapest, safest, and most effective source of the stuff, for omnivores and vegans alike. In order to absorb the recommended 3-7 mcg needed daily, it is suggested that individuals supplement with at least 50 mcg (cyanocobalamin or methylcobalamin) on a daily basis, or at least 2000 mcg once a week. Best to choose sublingual sprays or dissolvable tablets, as gummy vitamins tend to have lower absorption rates - and often contain gelatin too.
Additionally, those with low stomach acid and adults over 65 years of age should take at least 1000 mcg daily, as they are more prone to B-12 deficiency due to reduced intrinsic factor production - a compound required for B-12's absorption.
NOTE: If deficiency is suspected, the best indicator to test for is MMA, not serum B-12.
Another way to add B-12 to the diet is by frequently consuming vitamin B-12 fortified foods such as nutritional yeast (a common vegan staple that adds a cheesy, nutty flavor to a variety of dishes), as well as vitamin B-12 fortified tofu, soy milk and breakfast cereals.
While it may seem counter-intuitive that a healthy diet would require vitamin supplementation, let's keep perspective here. Millions of people suffering from our nation's top killers (heart disease, diabetes and certain cancers) could have their conditions prevented, halted and in some cases even reversed with a Vitamin B-12 fortified, whole-foods plant-based diet.
That's worth a spray on the tongue once a week in my book.
2. Omega-3 fatty acids
Omega-3 fatty acids are critical for reducing inflammation - the root cause of a myriad of chronic diseases within our society. Additionally, they aid in the neurological development of infants and children, as well as reduce the risk of conditions such as heart disease, Alzheimer's and dementia. They even slow the natural shrinking of the brain as we age.
The three main omega-3 fatty acids are alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ALA is found in many plant foods such as flax seeds, chia seeds, hemp seeds and canola oil. While ALA is beneficial, EPA and DHA are the biologically active forms of omega-3 fatty acids - and therefore are much more important to consume. ALA can be converted to EPA and DHA, but the conversion rates are so poor that it is critical to consume sources of EPA and DHA directly in order to ensure adequate omega-3 status. And while some preliminary evidence suggests the conversion rate increases significantly in those eating plant-based diets, we probably shouldn't bank on a spoonful of chia seeds every now and then getting the job done. Especially when pregnant.
Given that plant-based eaters have lower rates of the very conditions that omega-3 supplements are intended to help prevent (heart disease, Alzheimer's, etc.), it does not appear that blanket supplementation is recommended at this time. However for those with heart disease risk factors, cognitive impairments, or who are pregnant or breastfeeding while eating primarily plant-based, research does support EPA/DHA supplementation.
While fish oil is the most common source of EPA and DHA, there's one problem with it. Pollution. Unfortunately the manner in which human civilization has treated its waterways (like sewers, landfills and drill-sites) has left our once-pristine oceans in polluted disarray - along with their inhabitants. But luckily, pollutant-free sources of EPA and DHA can be attained from plant-based sources such as yeasts and algae grown in controlled, toxin-free environments. In fact, the reason fish posses these beneficial fatty acids at all is because they feed off of the algae itself! So let's cut out the middle man (and the bio-accumulated heavy metals and toxins within said middle-man), shall we?
250 mg of long-chain omega-3 fatty acids (EPA/DHA) per day will get the job done just fine. My favorite Omega-3 supplement is Nordic Naturals Algae Omega, as this brand is third party tested to ensure its product is free from environmental toxins and pollutants.
You can find it discounted at my online dispensary, linked here.
3. Vitamin D
Vitamin D is critical for bone health, immune function and mood regulation. It also aids in the absorption of other nutrients, such as calcium and phosphorus.
The body can actually synthesize vitamin D when it gets enough sun exposure (sans the SPF). However, evidence is showing more and more people are struggling to synthesize adequate amounts due to the pollution levels in our atmosphere. Vitamin D synthesis also varies greatly with melanin content of the skin, geographical latitude, and season.
Very few foods contain vitamin D naturally. Fatty fish, egg yolks, and some types of mushrooms pretty much sums up the list. It is for this reason that many foods are vitamin-D fortified. Breakfast cereals, dairy products (cow's milk, cheese & yogurt), some orange juices and certain plant-milks are some of the most common.
However the average intake of vitamin D from food sources alone tends to be inadequate for omnivores and vegans alike, so unless you're life-guarding on the equator 12 months out of the year, a simple supplementation regimen of 2000 IUs per day would be ideal.
4. Iron, Calcium, Zinc & Iodine
I've lumped these four together because unlike the first three nutrients discussed, these four by no means require supplementation if the diet is well-planned. In fact, there are whole food sources of each of these that can be deliciously incorporated into your meals on a daily basis!
Iron is crucial for the development of healthy blood cells and helping them carry oxygen throughout the body. It has two different forms: heme and non-heme. Heme iron comes from animals/meat, while non-heme iron comes from plants such as beans, legumes, whole grains, nuts, dark chocolate, dried fruit, dark leafy greens and some fortified foods & cereals. While heme iron is easier for the body to absorb and use, its has also been shown to increase the risk of cardiovascular disease. Non-heme iron, however, (that is - iron from plants) does not increase the risk of CVD. And while this form of iron is more difficult to absorb, the absorption rates can improve significantly by pairing it with foods rich in vitamin C.
I SEE ACCIDENTAL A+'s LEFT, RIGHT AND CENTER here folks. Hummus and bell peppers, beans and greens, spaghetti with a red lentil 'bolognese', salad with a citrus dressing, oatmeal topped with strawberries - these are all common vegetarian foods we eat that pair iron with vitamin C!
Menstruating women (plant-based or omnivorous) should consume iron-rich foods + vitamin C sources regularly as well as get checked for iron deficiency anemia every few years. Alas, the perfect excuse to eat dark chocolate-covered strawberries on your period. You're welcome, ladies.
Calcium plays an important role in bone and teeth formation, muscle function, and heart health. You probably already know milk, cheese, and yogurt are good sources of calcium. But so are TONS of plant-foods! Dark leafy greens, legumes (such as chickpeas and white beans), and plenty of fortified plant-milks, juices, and breakfast cereals - just to name a few. I try to incorporate dark leafy greens and legumes into almost every meal, and have had zero issues maintaining adequate calcium levels without supplementation while eating plant-based for my entire adult life. 600 mg of calcium daily from whole plant foods is ideal here.
NOTE: Best to choose low-oxalate greens, as oxalates can bind minerals such as calcium and decrease their absorption. Spinach, chard and beet greens are all high in oxalates, but all other dark leafy greens are excellent sources of highly bio-available calcium.
Zinc is a critically important compound for both metabolism and immunity. Zinc is found in a variety of plant and animal foods. However certain plant-foods contain phytates, which impair the absorption of zinc. It is for this reason that plant-lovers like vegans are advised to increase their intake of zinc by 50%.
An excuse to go back for seconds? Twist my arm.
But in the case you're not a volume eater like myself - just add some garlic or onion to your meals! These mineral-absorption enhancers increase the bio-accessibility of zinc AND iron by up to 50% by just consuming 1-2 cloves or 1-2 thin onion slices per meal.
Lastly, iodine is necessary for a healthy thyroid gland and therefore a healthy metabolism. It can be found in small amounts in plants depending on the soil in which they grew, but is primarily found in sea vegetables. Vegans who eat edible seaweed a few times a week can meet their necessary iodine requirements no problem. Dulse is a delicious source of iodine! It's a sea vegetable that can be purchased (in dried form) at Whole-Foods and other health grocers and tastes great sprinkled on Asian-style salads or bowls.
Additionally, iodized salt is common in many regions (including the U.S.). So if you include iodized salt regularly in your diet, there is potential you could be meeting the required 150 mcg without any issues. Just be sure in an effort to get sufficient iodine, you don't make a habit of eating excessive amounts of sodium, which can contribute to heart disease, high blood pressure & other chronic conditions over time.
NOTE: The sea vegetable hijiki should be avoided due to high arsenic levels. Additionally kelp should be avoided as it tends to have too much iodine.
OKAY WHAT A MOUTHFUL.
Let me hit you with the spark-notes version.
I highly recommend consuming a multi-vitamin, an Omega -3 soft-gel, and an abundance of fresh, whole-foods, plant-based goodness on a daily basis.
Most multi-vites provide more than enough B-12, meet the needs for vitamin D and zinc almost perfectly, and provide somewhere between 25-100% of the needs for iodine and calcium (the rest can easily come from your diet) - so that's why a generic multi is such a great safety net for vegans and omnivores alike.
I recommend that all women of child-bearing age take specifically a pre-natal multivitamin (in place of, not in addition to, a regular multi-vite) with iron in it, to ensure adequate iron intake (as menstruation depletes our iron levels) while also covering the aforementioned nutrients as well.
For Omega-3 fatty acids, as mentioned, I recommend the brand Nordic Naturals Algae Omega (available on my online dispensary for a practitioner's discount, linked here).
I hope you have found this helpful and encouraging my plant-curious people!
Rest assured that a well-planned plant-based diet is suitable for all ages and life stages. There is no nutrient found in animal foods that we can't find with more benefits and less baggage in plants. It just requires a little intention and a hearty appetite along the way.
This post was written & medically reviewed by a Registered Dietitian Nutritionist.
Grace Pascale, MS, RDN. Grace Pascale Nutrition.