Tell me again Vegans don't need supplements…

Published 9.30.2016
Veganism is only possible in our modern world of supplements and fortified foods. Vegans MUST supplement to be healthy—and the doctor (Dr Greger) prescribing this is a vegan himself.

I have written previously about vegans needing supplements, but only in that a vitamin B12 supplement is essential. B12 isn't found in any plant foods, and a B12 deficit can have devastating effects on heart and brain health. Well, it turns out that B12 isn't the only essential supplement for vegans— particularly aging vegans. Docosahexaenoic acid (DHA) is a long chain omega three fatty acid that is important for brain health, as the human brain is roughly 50% fat.

DHA is not found in plants, but it is found in dairy, eggs and especially fish. Fish oil supplements are an attempt to increase omega three fatty acids— though obviously vegans would have no interest in fish oil, and recent news on fish oil supplements has not been good. If you want omega three fatty acids from fish, then you should eat fish.

Shorter chain omega three fatty acids such as linoleic acid are found in plants, and a healthy body will manufacture the longer chain fatty acids from the shorter chain fatty acids. However, the rate of transformation varies by individual and with age.

As we age, our ability to make the long chain omega-3s, like DHA, from the short chain omega-3s in plant foods, such as flaxseeds, chia seeds, walnuts, and greens, may decline. And so, researchers compared DHA levels to brain volumes in the Framingham study, and lower DHA levels were associated with smaller brain volumes.

A new randomized control trial showed that DHA supplements derived from algae rather than fish were successful in raising blood DHA levels in vegans. So Greger recommends that vegans take a 250 mg supplement each day to avoid developing a deficit. Based on the comments under the video, the pills are very expensive. So now there are two essential supplements for vegans to be healthy, and Greger I think also recommends a daily vitamin because he knows that most vegans don't eat the diet that lays out in his book and videos.

This is why vegetarianism is a way of eating that has historical precedence while veganism does not. Vegetarians who eat either eggs or dairy or both will consume DHA, because those foods contain it. Vegetarianism has a long history (for instance consider India), but the word vegan was only coined in 1944.

Necessary to be vegan?

I've praised Dr Greger previously for his frank acknowledgement that to be healthy vegans must supplement, but there is something about Greger's diet stance that doesn't make sense to me, and as I've highlighted his video above, I'm going to take the opportunity to discuss it. I've seen enough of his videos at this point to know that he credits his career choice to the remarkable recovery from CVD* his grandmother experienced under the treatment designed by Nathan Pritikin (who was an engineer, not a doctor).

All well and good, it's a great story. However, Pritikin's protocol was not and is not vegan. Pritikin's plan is plant based and ruthlessly low fat, but it allows for the consumption of lean animal products such as white fish and chicken. In short, Nathan Pritiken designed a plan to reverse CVD that required no supplementation. Why then, does Greger think that a vegan diet is better than Pritikin's?

Greger (to my knowledge) has never addressed the reason that a plant based diet must be vegan. Pritikin's diet is plant based, as is Joel Fuhrman's Eat to Live (EtL) diet, but neither is vegan. Fuhrman's nutritarian (a word he coined) definition is based on his nutrients per calorie, which is how plant foods wind up being primary. Fuhrman also emphasizes maximizing longevity now, which means avoiding as much disease as possible. Fuhrman's teachings incorporate the CRON** belief that leaner is better (his weight guidelines offered in EtL were would have me back to weight I exceeded in middle school), and to be leaner you need to eat fewer calories and to eat fewer calories and get the nutrients you need you must eat nutrient dense food over calorie dense food. And still, EtL is not a vegan diet.

This bring me to Dr. Caldwell Esselstyn, a vegan cardiologist I have mentioned a time or two, and will be mentioning again in my series on CVD. Esselstyn's claim to fame is that by prescribing a very low fat, vegan diet he has been able to reverse CVD— more precisely he's shown that blocked arteries will become unblocked on this diet. Esselstyn's work is derided in some quarters because most of the people he has studied have also been taking statin drugs. But not all were on statins, and his big applause line is showing the newly unblocked arteries of the subject who did not use statins.

The link provided above is from a presentation Esselstyn gave in 2013, but there are plenty of other examples on the web. Essentially, he gives the same presentation every time. Esselstyn's diet prescription is extremely low fat:

• No oil
• Nothing with a face
• No eggs or dairy
• No nuts
• Whole grains
• Beans
• Vegetables- especially green leafy vegetable
• Fruit

Esselstyn is not a fan of smoothies, preferring that people chew their food to begin the digestive process in the mouth. He doesn't like oil for the fat and calorie content. Nuts he eliminates due to the calorie content and the fact that nuts are too easy to overeat. Red meat, at least in the later presentations is railed against due to the effects of Trimethylamine N-oxide (TMAO), which has been linked to cancer. But beyond that, no real reason is given for demanding that the diet be vegan.

Again, the Pritikin diet works to reverse heart disease, though seemingly his diet hasn't been tested in the same way Esselstyn's diet has. But as Dr Greger testifies in his stock presentation, Pritikin healed his grandmother when doctors could not. Actually, the effects of Pritikin's diet have been studied, but the change in artery blockage was never measured— perhaps because the techniques to do so didn't exist.

Here's my point: I have long been impressed by Esselstyn's results, and would if I was diagnosed with CVD, give his protocol a go. However, more recently, I'm wondering if that's really the best option. Perhaps something along the lines of EtL, Pritikin or even Dean Ornish's Spetrum (which offers a non-vegan option) would be a better bet.

I remain convinced that a diet that leaves you dependent on supplementation for health is not a healthy diet. The strike against veganism used to be vitamin B12. Now however, there is a second strike.

I think if I was to be diagnosed with CVD, I'd become vegetarian again. Actually, given my aversion to dairy, I'd be an ovo-vegetarian— for those who care about such labels.

*CVD = cardiovascular disease.
**Calorie Restriction Optimal Nutrition
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• Evidence of Ancestral Veganism Found!
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