This is the fourth post in response to concerns raised in an article on the Weston A. Price Foundation’s site by Christopher Masterjohn titled “Vegetarianism and Nutrient Deficiencies.”  I decided to concentrate on cholesterol.  I find this section of his article the most disturbing.  As an emergency physician, I see people who have heart attacks every day, which can probably prevented through a healthier diet.  Unfortunately, this website is advocating just the opposite.  Masterjohn writes about the Smith-Lemli-Opitz Syndrome in which people are unable to make cholesterol and states it is necessary for these people to consume it.  He states, ” There are, however, millions of people with genetic defects in cholesterol synthesis for whom dietary cholesterol is likely an essential nutrient.”   This is a rare genetic condition.  Smith-Lemli-Opitz syndrome affects an estimated 1 in 20,000 to 60,000 newborns.(1)  For the vast majority of the population, consuming cholesterol is absolutely unnecessary because your body makes its own.  Most people in western countries, consume far too much cholesterol, which is a cause for heart disease, strokes, and many other maladies.(2)

Then, Masterjohn quotes Dr. Price saying  “As yet, I have not found a single group of primitive racial stock which was building and maintaining excellent bodies by living entirely on plant foods.”   Weston Price was making observations but did not do any rigorous studies.  He was probably not aware of the fact that most native people did not live long lives.  Innuit Greenlanders, who have limited access to fruits and vegetables, have the worst longevity in North America.(3)  Research shows that they die on average about 10 years younger and have a higher rate of cancer than the overall Canadian population. The  meat-consuming Masai in Kenya have the worst life expectancy. Life expectancy is 45 years for women and 42 for men.  African researchers report that Maasai rarely lived beyond age 60.(4)

In conclusion, I find the advocacy of saturated fat on the Weston A. Price Foundation website disturbing.  As a physician, I want to see my people improve their health through diet, and this website encourages eating habits that may bring about increased heart disease and stroke.  From a journal article on the stance of the American Dietetic Association’s position on vegetarian diets:

It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes…his article reviews the current data related to key nutrients for vegetarians including protein, n-3 fatty acids, iron, zinc, iodine, calcium, and vitamins D and B-12. A vegetarian diet can meet current recommendations for all of these nutrients. In some cases, supplements or fortified foods can provide useful amounts of important nutrients. An evidence- based review showed that vegetarian diets can be nutritionally adequate in pregnancy and result in positive maternal and infant health outcomes. The results of an evidence-based review showed that a vegetarian diet is associated with a lower risk of death from ischemic heart disease. Vegetarians also appear to have lower low-density lipoprotein cholesterol levels, lower blood pressure, and lower rates of hypertension and type 2 diabetes than nonvegetarians. Furthermore, vegetarians tend to have a lower body mass index and lower overall cancer rates. Features of a vegetarian diet that may reduce risk of chronic disease include lower intakes of saturated fat and cholesterol and higher intakes of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals.(5)

(1) “Smith-Lemli-Optiz Syndrome.”  Genetics Home Reference:  Your Guide for Understanding Genetic Conditions.  07 September 2015.  Web. 09 September 2015. <http://ghr.nlm.nih.gov/condition/smith-lemli-opitz-syndrome>

(2) “About cholesterol.”  American Heart Association.  31 July 2014.  Web.  09 September 2015.  <http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp>

(3)  Iburg KM, Brennum-Hansen H, Bjerregaard P. Health expectancy in Greenland. Scan J Public Health 2001;29(1):5-12.

(4) Joel Fuhrman, MD. “The Truth about the Weston Price Foundation.”  Vegsource.com 24 July 2010.  Web.  09 September 2015.  <http://www.vegsource.com/news/2010/07/the-truth-about-the-weston-price-foundation.html>

(5) Craig WJ, Mangels AR.  Position of the American Dietetic Association:  Vegetarian Diets.   J Am Diet Assoc 2009 Jul;109(7):1266-82.

I went to see this movie screening sponsored by the National Resources Defense Council on my trip to Los Angeles. If you have not seen this movie, you must see it! I did not realize how much the noise in our ocean affects whales and other larger marine mammals.

The movie begins in Bahama where whales have beached themselves, and many died. The whales were found to have subarachnoid hemorrhages (bleeding in the brain) and bleeding inside their auditory canal (ear) on CT scan when they brought the dead whales to Harvard Medical School to investigate.

Then, the movie tracks the trend of the rapidly growing shipping industry. Ships are getting larger and louder unfortunately, since larger ships need larger motors have to propel their motion. I thought about how I am guilty of shipping my car from the mainland and buying some groceries shipped from California to Hawaii at Costco! Sometimes it is unavoidable, but buying local can reduce the demand for shipping and probably somewhat ameliorate the situation. Also, the oil companies have been causing very loud underground explosions which wreak havoc on the wildlife since they cannot escape the noise in the ocean. Looking for alternative sources of energy will definitely take the focus away from finding more fossil fuel by drilling in the ocean. Apparently the Navy has also been using sonar to echolocate submarines from other countries which is also disturbing the whales.

It is explained in the movie that the whales become sick since the noise is so loud, and they cannot communicate with each other. They try to escape by going to the surface but in effect get “the bends” or decompression sickness, and that is how they get the hemorrhages in their brain and damage to other organs similar to the decompression sickness that divers get when ascending too quickly. The movie shows different circumstances in which whales beached themselves. In one instance, the oil company was drilling in the area, and in another case, a large navy ship passing through (using their sonar).

I hope to get the word out about this movie. Please see it if you get a chance. Recommend it to your friends. I had no idea about how much the sound we create as humans can affect these animals.

This is the third in my series of blog posts addressing possible nutrient deficiencies raised by the Weston Price Foundation article “Vegetarianism and Nutrient Deficiencies” by Christopher Masterjohn.

Essential Fatty Acids:

Two essential fatty acids, linolenic and linoleic acid, cannot be synthesized in the body and must be obtained from food. These basic fats, are used to build specialized fats called omega-3 and omega-6 fatty acids. Omega-3 and omega-6 fatty acids are important in the normal functioning of all tissues of the body.

Deficiencies in these fatty acids lead liver and the kidney problems, reduced growth rates, decreased immune function, depression, and dryness of the skin. Numerous health benefits of fatty acids include reduced heart disease, stroke and breast cancer, and improvement of ulcerative colitis, menstrual pain and joint pain.(1)

Omega-6 fats are derived from linoleic acid which are found in leafy vegetables, seeds, nuts, grains, and vegetable oils. Most diets provide adequate amounts of this fatty acid.  Omega-3 fatty acids are derived from linolenic acid. The principal omega-3 is alpha-linolenic acid (ALA), which is then converted into eicosapentaenoic acid (EPA) and docosahexaenonic acid (DHA) by the body. This makes ALA the only essential omega-3 fatty acid. ALA can be found in many vegetables, beans, nuts, seeds, and fruits.  Masterjohn states  that vegetarians have lower levels of EPA and DHA than omnivores, vegans have lower levels than vegetarians and cites a study by Rossell which compares British vegetarians and vegans to omnivores.(2)

Oily fish contain omega-3’s, but it also have high amounts of other fats and cholesterol and lacks fiber. Fish are also often high in mercury and other environmental toxins.  Fish oils are a popular omega-3 supplement option, but the omega-3s found in fish oils (EPA and DHA) are unstable and tend to decompose and unleash harmful free radicals. Research has demonstrated that taking fish oil supplements does not actually produce significant protection on cardiovascular health.(3)

Research has shown that omega-3s from plant sources are more beneficial for one’s health. Omega-3s are found in a more stable form, ALA, in vegetables, fruits, and beans.  Conversion of ALA to the longer chain omega-3s, DHA and EPA, is usually sufficient to maintain tissue function.  According to a European Prospective Investigation into Cancer and Nutrition (EPIC) study, women on vegan diets actually have more long-chain omega-3s in their blood compared with fish-eaters, meat-eaters, and lacto-ovo vegetarians.(4)

It is important to also consume these fatty acids in the proper ratio. Excessive intake of omega-6 fatty acids can inhibit omega-3s.  The ideal ratio of omega-6 to omega-3 fatty acids should be  1:1 to 4:1.8, but most Americans consume these fatty acids at a ratio of 10:1 to 25:1.  This is due to the high American intake of processed foods and oils. A low omega-6:omega-3 ratio is desirable for reducing the risk of many chronic diseases.  Grinding up flax seeds in your morning smoothie like I did in the Green Smoothie Episode 1, is a great way to get your omega 3’s! (1)

Amino Acids

Master john then goes through some non-essential amino acids.  He states that vegetarians may be deficient in carnitine because there is limited availability in plants.  The bioavailability of L-carnitine varies due to dietary composition. In fact, there has been more bioavailability found in vegetarians.(5)  The bioavailability of L-carnitine in  vegetarians who are adapted to low-carnitine diets is higher (66% to 86% of available carnitine) than regular red-meat eaters adapted to high-carnitine diets (54% to 72% of available carnitine).(6)   Carnitine is not an essential amino acid.  Carnitine can be made from two essential amino acids, lysine and methionine.  Carnitine influences carbohydrate metabolism.  Aberrations in carnitine regulation are implicated in complications of diabetes mellitus, hemodialysis, trauma, malnutrition, cardiomyopathy, obesity, fasting, drug interactions and endocrine imbalances.(5)

Master john states that taurine is particularly important for nursing infants, since the developing brain contains three to four times as high a concentration of taurine as the adult brain.   The serum concentrations of vegans and infants nursing from them are lower than that of their omnivore counterparts.(7)  Taurine is not an essential amino acid.  Adults produce taurine by a combination of cysteine with the help of pyridoxine (vitamin B6), methionine and vitamin C. Cysteine is found in red peppers, garlic, onions, broccoli, Brussel sprouts, oats, granola and wheat germ.  Methionine can be found in a lot of vegan foods including Brazil nuts, sunflower seeds and butter, sesame seeds, oats.(8)  I spoke about vitamin B6 in the last post.  Vegans can eat complete proteins like soy, hemp seed, quinoa, buckwheat, amaranth regularly to ensure they can synthesize taurine from amino acids in these foods.   A paper by Dr. Joel Fuhrman recommends possible supplementation of Taurine for vegan athletes to improve performance of 500 mg twice daily. (9)

Masterjohn then goes on to state that vegetarians have lower levels of creatine than meat-eaters, but vegetarians are not at risk for creatine deficiency anyway.  Creatine is another non-essential amino acid.  Creatine supplementation is common among athletes   Evidence from mostly healthy young adult male subjects shows that exercise performance involving short periods of extremely powerful activity can be enhanced.   Potential acute effects of high dose creatine  supplementation on body fluid balance has not been fully investigated.  An article written by the American College of Sports Medicine article states that  “Creatine supplementation exhibits small but significant physiological and performance changes.  Increases in performance are realized during very specific exercise conditions. This suggests that the apparent high expectations for performance enhancement, evident by the extensive use of Creatine supplementation, are inordinate.”(10)

Master john states that carnosine is exclusively found in animal products and cites one study showing  vegetarians with higher levels of AGEs than omnivores.(11)   Carnosine is found in several tissues most notably in muscle.  Studies have demonstrated that they possess strong and specific antioxidant properties:  preventing peroxidation of model membrane systems and protecting cell membranes from oxidative damage. Other roles  include actions as neurotransmitters, modulation of enzymic activities and chelation of heavy metals.(12)

Carnosine is another non-essential amino-acid.  It is formed from amino acids beta-alanine and histidine. Carnosine is only found in meat, but both of its constituents are found in a wide variety of plant foods. This is why vegetarian animals like cows have so much in their tissues.(13)

To summarize this week’s blog, basically essential fatty acids can be obtained with a plant-based diet, and none of the amino acids he listed in his article are essential.  Therefore, they can be formed from other amino acids that are obtainable on a plant based diet.  Stay tuned for next week’s blog post where I will talk about his last concern, cholesterol.

(1) “Essential Fatty Acids.”  Physicians Committee of Responsible Medicine.  Web.  08 September 2015.  <http://www.pcrm.org/health/health-topics/essential-fatty-acids>

(2) Rosell MS, Lloyd-Wright Z, Appleby PN, Sanders TA, Allen NE, Key TJ. Long-chain n-3 polyunsaturated fatty acids in plasma in British meat-eating, vegetarian, and vegan men. Am J Clin Nutr. 2005;82(2):327-34.

(3)  Kwak SM, Myung SK, Lee YJ. Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials. Arch Intern Med. 2012;172:986-994.

(4) Welch AA, Shakya-Shrestha S, Lentjes MAH, Wareham NJ, Khaw KT. Dietary intake and status of n-3 polyunsaturated fatty acids in a population of fish-eating and non-fish-eating meat-eaters, vegetarians, and vegans and the precursor-product ratio of a-linolenic acid to long-chain n-3 polyunsaturated fatty acids: results from the EPIC-Norfolk cohort. Am J Clin Nutr. 2010;92:1040-1051.

(5) Flanagan J, Simmons PA, Vehige J, Willcox MDP^,,Garrett Qian.  “Role of Carnitine in Disease.”  Nutrition & Metabolism 2010, 7:30.

(6)  Rebouche CJ, Chenard CA.  “Metabolic fate of dietary carnitine in human adults: identification and quantification of urinary and fecal metabolites.” J Nutr 1991,  121:539-546.

(7) Bender DA. Nutritional Biochemistry of the Vitamins: Second Edition. Cambridge: Cambridge University Press (2003).

(8)  Butterflies Katz.  “What every vegan needs to know to optimize their diet.”  Veganism: A truth whose time has come.  03 June 2014.  Web.  08 September 2015.  <http://thevegantruth.blogspot.com/2014/06/what-every-vegan-needs-to-know-about.html>

(9) Fuhrman J, Ferreri DM.  “Fueling the Vegan Athlete.”  Curr. Sports Med 2010. 9 (4) 233-241.

(10) Terjung RL, Clarkson P, Eichner ER, Greenhaff PL, Hespel PJ, Israel RG, Kraemer WJ, Meyer RA, Spriet LL, Tarnopolsky MA, Wegenmakers AJ, Williams MH.  Medicine and Science in Sports and Exercise 2000.  32(3):706-717.

(11) Sebeková K, Krajcoviová-Kudlácková M, Schinzel R, Faist V, Klavanová J, Heidland A. Plasma levels of advanced glycation end products in healthy, long-term vegetarians and subjects on a western mixed diet. Eur J Nutr. 2001;40(6):275-81.

(12) Quinn PJ, Boldyrev AA, Formazuyk VE.  Carnosine:  its properties, functions and potential therapeutic applications.  Mol Aspects Med. 1992;13(5):379-444.

(13) Andrea Lewis.  “Carnosine and Raw Veganism.”  Skinny Limits.  02 April 2015.  Web.  09 September 2015.  <http://www.skinnylimits.com/blog/carnosine-and-raw-veganism/>

This is a continuation of the series of posts regarding concerns of vitamin deficiency raised in the article posted on the Weston A. Price Foundation’s web page titled “Vegetarianism and Nutrient Deficiencies” by Christopher Masterjohn.

In the first article I wrote about how vegetarians or vegans who eat a varied plant-based diet are not at risk for deficiencies in fat soluble vitamins A, D, and K.  Today I am going to talk about Vitamin B deficiencies.

Vitamin B12:

Vegans are indeed at risk for B12 deficiency. In the past, most people lived in close contact with their farm animals and consumed B12 left as residues by bacteria living on their un-sanitized vegetable foods.  Because this is no longer the case, those eating a plant-based diet are now at risk for B12 deficiency.  Vitamin B12 is found in animal foods, but it is not synthesized by plants or animals.  Bacteria make biologically active vitamin B12, and animal tissues store it and  pass it to other animals eating those animals tissues.  Ruminants, like cows or goats, have bacteria in their stomachs that synthesize vitamin B12, which is then passed down and absorbed by their small intestines.  Other carnivores get their B12 from eating these grazers.

Most cases of vitamin B12 deficiency seen in patients are due to diseases of the intestine.  Damage to the stomach’s parietal cells,  from disease or surgery, and damage to the intestine prevents absorption or reabsorption, causing the loss of B12. “Pernicious anemia” from B12 deficiency occurs once the body’s stores of vitamin B12 are depleted.   It can take up to 3 to 6 years for it to manifest (when the body’s stores of vitamin B12  become depleted).(1)

Master john states that ” even vegetarians who supplement with standard B12supplements could be at risk for deficiency. ”  This is simply untrue.  Blood levels of B12 can be measured directly in the blood.  I have been taking vitamin B12 supplements since I have been eating a plant-based diet for greater than 20 years and just had my B12 levels checked and they were high due to my supplementation.  As long as vegans take an over the counter supplement of  B12, there should be no problem with deficiency.  Requirements are pretty minimal and easy to get with supplementation.  I have a chart from the National Institutes of Health showing the different recommended amounts of B12 for different ages of people here: (2)

Vitamin B6:

In the article, Masterjohn asserts that  plant foods simply contain much less B6 than most animal foods and that the  plant form of vitamin B6 is inferior to the animal food form because its conversion to the active form depends on B2 status, and vitamin B2 levels tend to be higher in animal foods.  He states that plant foods contain much of their B6 bound up with sugars that make it difficult or impossible to absorb. He claims that plant foods require more cooking than animal products,  decreasing the yield of active B6 in vegetarian diets, since heat destroys B6.  He cites a study comparing lactating Nepalese women to their American omnivore counterparts The Nepalese women consumed more B6 but had lower serum levels of the active form.  They had equivalent levels in their breast milk, but their infants had lower levels of the active form.  It would be more fair to compare American vegans to American omnivores as Nepalese vegetarian women probably have less access to fresh fruits and vegetables containing B12.

That being said this article certainly does not prove that vegetarians will develop B6 deficiency as there are plenty of vegetarian sources of B6 including:  soy,  bananas, watermelon, peanut butter, almonds, sweet potatoes, green peas, avocados, hemp seeds, spirulina, chia seeds, beans, rice bran, chickpeas, sunflower seeds, pineapple, plantains, hearts of palm, artichokes, water chesnuts, all squash and pumpkin, Brussels sprouts, green beans, pistachios, figs, yeast, garlic, sage, peppers, kale, collards!(3)  In a study comparing Korean Buddhist vegetarians to non-vegetarians, the vegetarians actually had slightly higher B6 levels than the non-vegetarians. (4)

Zinc:

I am also going to address his concerns for zinc deficiency in this post.  Masterjohn states “Although [zinc is] present in grains, legumes, fruits and vegetables, it is found in much lower amounts compared to animal foods and is much less bioavailable…While a well planned vegetarian diet may escape overt zinc deficiency, it would be virtually impossible to maintain a truly robust zinc status without the inclusion of animal foods.”

An article by the American Dietetic Association addresses some of these concerns about zinc.  The article states that the bioavailability of zinc in vegetarians may be lower than non-vegetarians, due to the higher phytic acid content of vegetarian diets, but zinc deficiency is not evident in Western vegetarians. Zinc sources include soy products, legumes, grains, cheese, and nuts. You can reduce the binding of zinc by physic acid by soaking and sprouting beans, grains, and seeds as well as leavening bread, increasing zinc bioavailability. Citric acid can also enhance zinc absorption to some extent. (5)

In conclusion, a person eating a well-balanced plant-based diet in western countries should not have difficulty in obtaining adequate amounts of B6 and Zinc.  B12 will not be a problem with supplementation.  Next week I am going to address the concerns about essential fatty acids, amino acids, and cholesterol raised in this article.  Stay tuned!

(1) John McDougall.  “Vitamin B12 deficiency-The Meat- Eaters’ Last Stand.”  McDougall Newsletter.  November 2007.  Web.  07 September 2015.  <https://www.drmcdougall.com/misc/2007nl/nov/b12.htm>

(2) “Vitamin B12 Factsheet for Consumers.”  National Institutes of Health Office of Dietary Supplements.  Web.  07 September 2015.  <https://ods.od.nih.gov/factsheets/VitaminB12-Consumer/>

(3) Heather McClees.  “B Vitamins: How to get them in a Vegan Diet.”  One Green Planet.  11 July 2014.  Web.  07 September 2015.  <http://www.onegreenplanet.org/natural-health/b-vitamins-how-to-get-them-in-a-vegan-diet/>

(4) Lee, Yujin.  “The nutritional status of vegetarian Buddhist nuns compared to omnivorous women in South Korea.”  Web. 07 September 2015.  <http://geb.uni-giessen.de/geb/volltexte/2011/8061/pdf/LeeYujin_2011_03_14.pdf>

(5) Craig WJ, Mangels AR.  “Position of the American Dietetic Association.”  Journal of the American Dietetic Association 2009, 109(7):1266-1282.  

This is the 3rd episode in my interview series with Dr. Terrence Young, DDS.  Dr. Young talks about devices that bring the lower jaw forward to prevent snoring.  This is not for those people with sleep apnea, who should be using CPAP machines.  He has used the device himself and has found himself better rested.  He screens patients by placing a high resolution pulse oximeter on them while sleeping to see if the device will help them.

You can find Dr. Terrence Young at :1441 Kapiolani Blvd #1207, Honolulu, HI 96814.

This Week we are making lilikoi pie.  It is raw and has no added sugar!  :

Ingredients:

The pie crust is the same as the one for the Ulu pie that I made, for those of you who remember that episode!  For pie crust:

1 cup of dates

1 cup of almonds

1 cup of shredded coconut

For filling:

1 cup of cashews

4 apple bananas

8 lilikoi (passionfruit) -may use purple or yellow variety (purple variety tends to be sweeter), cut lilikoi in half and spoon out pulp

Directions:

Mix all ingredients for crust together in a food processor into they are shredded to fine pieces.  I use the pulse function on my Cuisinart food processor, but you can use any kind of food processor you want.  Then you can pour it into a pie pan and pat it down.  Then mix all ingredients for the filling in the food processor until it is a smoothie type consistency and pour it on top of the crust.  Freeze overnight!  When you are ready to eat it, you can either put it in the refrigerator to defrost for a few hours or bring it outside to thaw which is quicker.  Enjoy!

Lilikoi  nutritional benefits: