A wealth of  data clearly shows that the single most important lifestyle  change anyone can make is to adopt a whole food plant-exclusive dietary plan. (1) (2)  The consumption of an abundant array of whole fruits and vegetables significantly prevents/reduces risk factors including dangerous increases of chronic inflammation, free radical damage, blood pressure, blood sugar, oxidized LDL-Cholesterol, and body fat (visceral adipose tissue). 

With very few exceptions, the body’s nutritional needs are best achieved with whole, natural, plant-based foods, not supplementation. While the standard American diet is woefully deficient in plant-based nutrients, it is the harmful excesses of animal and processed foods that significantly promote the most devastating diseases that demand the most healthcare dollars ( cancer, heart/coronary artery disease, stroke, diabetes, and obesity). You can’t solve a problem of excess with supplementation. There’s only one way to solve this  problem of excess, and that is to reduce it by shifting to a whole plant food diet.  

The early examination of fruits and vegetables led to the discovery of an array of nutrients that are now well-known, e.g., vitamins, minerals, and other phytonutrients (polyphenols, antioxidants etc.). As these foods have been more closely examined over time, an even greater variety of previously unknown nutrients and cofactors have also been discovered. This suggests that whole foods also potentially contain an array of important, as- yet-undiscovered factors that will continue to be revealed over time in addition to the myriad of nutrients of which we are currently aware.  As discussed by Dr. T. Colin Campbell in his book, Whole: Rethinking the Science of Nutrition, whole foods contain thousands of nutrients that impact thousands of reactions in the body, and calculating the specific influence of individual chemicals and nutrients is not sufficient to explain the effect of any food as a whole. (3)  

When you eat the bounty that nature provides, you are eating both the known and unknown micronutrients they provide in combinations and synergies that support their optimal absorption and utilization and are most essential for life and health. Supplements, however, cannot contain the crucial unknown elements contained in whole foods because we don’t know what they are yet. Therefore, supplements by their very nature are deficient. 

Be very clear: even at its best, supplementation can never be a substitute for a compromised diet. Too many people are spending too much of their food dollar on supplements and not enough on the whole foods that can truly improve the quality of their nutrition and health. As a result, fragmented nutrition has often replaced the natural, unparalleled integrity of whole-food nutrition. Supplements can create a dangerous false sense of security. 

Nutrition is a symphony, an orchestration of known and unknown nutrients directed by the intelligence and wisdom of a body that absorbs, integrates, and transforms these nutrients into the substance and expression of creative life. Eating isolated, fragmented nutrients, as many people do, is like trying to appreciate the full brilliance of a Mozart symphony by listening to the string section alone. You would get the basic idea, but you would never fully appreciate the splendor of the complete composition. I want you to experience the amazing magnificence of whole-food nutrition. 

An argument is often made that because of the compromise of commercial soils, and even the debilitating hybridization and genetic modification of a variety of plant foods, deficiencies of key nutrients may be compromised, and some form of supplementation may be necessary. To a certain extent, some of these concerns are warranted, but by eating a diversity of plant foods in an organic form, grown in a variety of different organically nurtured soils, you can potentially eliminate these concerns. 

However, general information from the large Adventist 2-Health study, involving close to 100,000 Seven-Day Adventists in  North America, suggests that the intake of several nutritional factors, including Vitamin B12, Vitamin D, iodine, calcium and iron may be deficient in certain vegan populations. (2) While whole plant foods contain calcium and iron, this study suggested that supplemenation may be necessary to prevent bone loss in menopausal vegan women and iron deficiency  in heavily menstruating vegan women.  Elevated, rapidly absorbed iron in animal products (heme iron) is dangerous, and can increase the risk of heart disease, and colon cancer. Plants ( including green vegetables, legumes) contain more than adequate amounts of iron that is more slowly absorbed, and also more available, when you consume lots of fruits and vegetables high in Vitamin C, and/or put lemon juice on your cooked greens.  

However, more work needs to be done to better evaluate variations of these nutrients in people eating a whole vegan diet loaded with a diversity of whole plants vs. more processed vegan dietary plans. Yet, since Vitamin B 12, and Vitamin D are the only two nutrients that are not made in plants, and iodine is a significant deficiency world wide, these nutrients are of special concern even in a diverse, vegan, whole plant-exclusive diet, and may warrant some supplementation under certain conditions.

Vitamin B12 

Vitamin B12 is essential for the normal maturation of red blood cells, and the development and function of the part of the spinal cord that processes sensory information. When B12 is deficient, blood cells are incapable of effectively carrying oxygen, potentially leading to a form of anemia called pernicious anemia. Vitamin B12 is not made by plants . It is made by microbes and is a by- product of bacterial metabolism.  It is found in greatest concentrations in animal products. The animals that are grown for slaughter and human consumption ingest bacteria from soil and water they are exposed to, and build up this bacterial waste product in their muscles, tissues, and milk. 

As a result, vegans often have vitamin B12 levels that are lower than those of meat- and dairy-eaters, and most plant-based physicians feel that Vitamin B12 supplementation is mandatory for everyone on a plant exclusive diet.  However, keep in mind that the typical, normal values and ranges of blood tests have been established on large statistical samples of  more unhealthy populations eating excesses of processed food and animal products. This includes B12 levels on typical blood tests that have been  established in a more typical, meat-eating population. So the “normal ” values may be typical but not necessarily normal for a more healthy vegan population. There are some scientists and physicians who feel that the ranges of normal for many standard blood tests may need to be modified to reflect more accurate values found in healthy people. Therefore, the lower levels seen in vegans may not be unusual for them and may be normal. 

To more  accurately assess vitamin B12 levels to determine if there is a problem,  vegans should check the levels of both B12 and methylmalonic acid (MMA).  MMA is a chemical in the body that reacts with vitamin B12 to produce a coenzyme (CoA), which is essential for normal cellular function and energy production. MMA is elevated in the urine or blood of more than 90% of people with true B12 deficiency. If your B12 level is lower than normal on a typical blood test and your MMA level is normal or low, it is not likely that you have a true B12 deficiency. However, if your B12 level is low and your MMA level is high, it is likely that you have a true B12 deficiency and it needs to be supplemented as soon as possible. 

Many physicians and /or nutritional counselors will just recommend supplementation without lab testing, although, the lab testing will allow you to accurately monitor the efficacy of your supplementation regimen. While the daily need for Vitamin B12 is 2.4 micrograms per day, oral intake is poorly absorbed, and larger amounts are typically recommended knowing that any excess of this water soluble vitamin will be eliminated by the body in your urine. Commonly, 500-1000 micrograms of the methylcobalamin form of B12 is recommended  taken as sublingual tablets or liquid sprays, daily or every other depending on need.  This form is more active and expensive than the cyanocobalamin form, but it is more directly available to the body and does not require any conversion steps. 

Vitamin D 

With the exception of wild or U V-light exposed mushrooms ( maitake and shitake) which are fungi, no plants produce Vitamin D. It is  linked with bone health, hormonal regulation, and the health of a wide variety of body systems. When sunlight reacts with cholesterol in your skin, it produces vitamin D3 that is transported to your liver and converted into 25-hydroxy vitamin D before it is processed into its final form in the kidney. 

Typically, 10-15 minutes of soft sun exposure (early morning or late afternoon) three to four times per week, on as much of the body surface as you can expose, should be adequate to meet your vitamin D needs. 

The blood test that is done is for 25-hydroxycholecalciferol, which is the form of vitamin D that is processed in the liver. Typically, 30-100 nanograms (ng)/milliliter (ml) is considered normal. I like to see the blood levels closer to mid-range (40-50 ng/ml). There are some who feel that 20 ng/ml or greater may still be normal, but many doctors typically supplement people with levels less than 30. For me, sun exposure is the first and perhaps the only necessary approach However, if you live in environments with limited sun exposure, or if  your sun-exposure approach is not working to maintain normal levels, I recommend supplementing 1,000-2,000 IU of vitamin D3 per day with follow up blood tests at 3 or 6 month intervals to evaluate the efficacy of your supplementation regimen. 

Iodine

Unfortunately, insufficient iodine intake is a global problem  affecting two billion people worldwide, particularly people in South Asia and parts of Africa, with mild iodine deficiency affecting 50% of Europe and declining levels becoming more apparent in the U.S. in recent years. (4) Iodine deficiency interferes with the healthy growth and development of children, promotes an increase in infant mortality, and fosters a decline in thyroid function in people of all ages that can significantly increase metabolic dysfunction, weight gain and obesity. 

The RDA recommended by the Food and Nutrition Board of the U.S. is 150 micrograms per day for children and adults. Typically, plant foods are too low in iodine to meet the RDAs, with the exception of sea vegetation (seaweed), which extracts iodine from sea water. Iodine can be obtained from small amounts of iodized salt, but since I am advocating a whole plant diet without added salt, this is not an option. Keep in mind that unless the salt container states that it is iodized, commercial salt, sea salt, and Himalayan salt do not contain iodine. 

While eating some seaweed can satisfy your daily need for iodine, the iodine content in certain seaweed, especially kelp and wakame, is too high and can promote health problems associated with excessive iodine consumption. The seaweed hijiki should also be avoided because of its high arsenic content. Instead, the best seaweed options to satisfy your daily need for iodine are 1/2  teaspoon of dried dulse flakes or powder or one teaspoon or a couple of dried sheets of vegan, fish-free nori. These options will provide the 150 micrograms of iodine you need and can be sprinkled on salads, used in cooked dishes, or consumed as a snack in the case of nori sheets, or veggie sushi. A multivitamin or a liquid mineral supplement containing 150 micrograms of iodine can also be used to provide the daily iodine requirement. 

References

     1. Key TJ, et al. Plant-based diets and long-term health: findings from the EPIC-     Oxford study. Proc. Nutr. Soc. 2022 May;81(2):190-198. 

     2. Orlich MJ, et al. Vegetarian dietary patterns and mortality in Adventist Health Study 2. JAMA Int Med. 2013 July 8;173(13):1230-1238.

     3. Campbell TC, Jacobson H. Whole. Dallas, TX: BenBella Books; 2013.

4. Zimmermann MB. Iodine deficiency. Endocr Rev. 2009;30(4):376- 408. doi:10.1210/er.2009-0011