Ep 110 What extra vitamins do vegetarians need?

What vitamins should be supplemented if I am vegan?   Val and Cord from The General Conversation Podcast are part of our online community and they have a unique format for their podcast. They sent in a question about having a vegetarian diet and the importance of certain vitamins and minerals.   Their website is https://anchor.fm/vandc   Let's listen their question.   First, let me thank Val and Cord for sending a great question.   When we talk about a vegetarian diet, there are actually several details that overlap and important differences. There's a spectrum of people who consider themselves to be vegetarian. There may be people who eat small amounts of meat regularly, but are trying to move away from that. Some people call them semi vegetarians or flexitarians.   There are some vegetarians who will avoid eggs because they come from animals. However they are allowed to consume milk, cheese, or yogurt.   There are some people who exclude all meat and chicken products, but they allow fish. Those people are called pescatarians.   Then there are people who are very strict in their interpretation and they don't eat any meat, poultry, fish, eggs, or dairy products. They don't even allow the consumption of any substances that contain those ingredients. These people are called vegan.   As a doctor, I always like to explain the information in different categories to make it clearer. If we look at categories of people, we can have a better informed decision about what a particular diet will mean.   For example, if you have a healthy adult male, his calorie requirements, protein requirements, and vitamin requirements are going to be fairly straightforward. It's based on his age, weight, and goals for the next few months with probably minimal variation.   However if you have a diabetic adult male, we know that even if they follow a vegetarian diet there's the chance that they eat too many carbohydrates or simple sugars which in turn could raise your blood glucose. So those people have to be more selective with what they eat, even if it's only fruits, vegetable, and grains.   If you have a healthy adult female, we also have certain ideas of what they need.   But if that female is pregnant or breast-feeding, we know that the calorie requirements, nutritional requirements, and vitamin deficiencies are even more important to identify and correct as soon as possible. Otherwise it harms not just the mother, but also the child.   So what I do is ask you break down some of the specific vitamin deficiencies that I encounter on a routine basis in my patients. Even I'm an ER doctor, some deficiencies can be so bad that people end up in the hospital. Even though they're eating well and following proper vegetarian diets, the human body can still go through phases where a deficiency results in unexpected bad outcomes.   The first thing Val mentioned is protein. The good thing is that protein is likely not going to be deficiency for most adult men and women. Any fruits, vegetables, and grains would be appropriate. It's unlikely you're going to have a protein deficiency simply by giving up meat.   However a vitamin B12 deficiency is very common. Vitamin B12 actually comes from animal products. Specifically these include dairy, meat, and eggs. Most plant-based diets are actually supplemented or fortified with B12. If people have a very strict vegan interpretation, they will exclude all of the B12 that comes from animal sources.   Vitamin B12 deficiency causes a unique type of anemia. Anemia means a lack of healthy red blood cells. When a B12 deficiency occurs, the red blood cells decrease in number, but increase in size. This causes the blood flow in the circulation to become inefficient. Those people are very fatigued and may develop symptoms like palpitations. B12 deficiencies must be corrected with either injections of vitamin B12 or oral supplementation. Once people have adequate B12, they may be good for many months. The anemia will correct itself and they quickly start to feel better. If the B12 deficiency is not corrected, it leads to neurologic problems which affect the nerves in our fingers and toes. Some of those people have permanent damage if it goes on for too long.   Next, we can talk about iron. Iron is necessary for red blood cells. In medical terms, we measure the hemoglobin. Heme means iron. Globin is a type of protein. People who are deficient in iron will have a low hemoglobin which is ,anemia. Whereas the B12 deficiency will make very large blood cells, iron deficiency anemia makes very small blood cells. When these people come to the ER they look very pale, very weak, and looks like they haven't rested well in weeks. They can't go up a  flight of stairs or participate in sports. They  just feel very ill.   For women, we have to remember that with menstrual cycles, iron is lost every month. We do know that even with women who follow an iron rich vegetarian diet by eating spinach, green leafy vegetables, and kale still end up needing extra iron. Women naturally lose iron when they're pregnant because the baby takes some of the iron stores. They lose blood at the time of delivery which further depletes their iron. Then if they are breast-feeding the higher levels drop off even further. For these women iron supplementation either with tablets, capsules, or liquid drops is critical. Untreated iron deficiency anemia can result in very low hemoglobin values which may require transfusion or hospitalization.   When we talk about omega-3 fatty acids we are really talking about the heart, cholesterol, and blood circulation. Normally fatty acids are found in fish and eggs. These actually help the blood circulation and it improves the arteries and veins to reduce cholesterol plaque and buildup. Although plants have omega-3 fatty acids, the way that humans absorb and metabolize it is very inefficient. In these cases, it is recommended to make sure whatever vegetarian foods you're eating are fortified with fatty acids. In the long term, having a lack of fatty acids is linked with issues like heart attacks, strokes, and blood clots.   The last one  is iodine. Iodine is necessary for the thyroid hormone to function properly. The thyroid lives in the front part of the throat. The thyroid has over 200 different functions including food  metabolism, regulating the sleep cycle, controlling the heart rate, and even temperature control for the body. The thyroid requires Iodine to create the active form of the thyroid hormone called T3 or T4. Strict vegans don't get enough iodine and they run the risk of developing a goiter which is a swelling of the thyroid as it tries to compensate. It is interesting that there are certain foods such as soybeans and sweet potatoes that actually increase the development of goiters. An easy way to avoid iodine deficiency is simply to use salt that has iodine. Fortunately in the United States this is easily available. But if you live in more remote areas or in the mountains, iodine is more difficult to locate.   So just to summarize when people talk about being vegetarian, it helps to know where they are on the spectrum. Do they eat any meat do they exclude all forms of dairy and eggs, and are they supplementing any of their foods with other nutrients.   The ones that you should talk to physician about include vitamin B12, iron, omega-3 fatty acids, and iodine. A vitamin B12 deficiency causes anemia with very large blood cells. Iron deficiency anemia causes small blood cells. Omega-3 fatty acids help with the blood circulation and controlling your cholesterol. Iodine is necessary for your thyroid to function properly.   As long as you can manage your dietary restrictions with simple supplements, I'm quite sure that you can maintain a healthy body for many years. So again I want to thank Val and Cord from The General Conversation Podcast for sending in this excellent question about nutrients and vegetarian diets. You can listen to their podcast on www.anchor.fm/vandc   I hope that you consider sharing this episode with other friends and family.   If you have questions that you been thinking about, record them and send them to me via social media. I'll be happy to include them on one of our future episodes.   References:   https://www.healthline.com/nutrition/7-nutrients-you-cant-get-from-plants#section1   https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/vegetarian-diet/art-20046446   https://www.naturespath.com/en-us/blog/the-top-5-deficiencies-on-a-plant-based-diet/   Follow Simple Health Radio on: Twitter Instagram Facebook Pinterest Spotify Itunes Spreaker If you think you may have a medical emergency, call 911 immediately. Dr. Emran and Simple Health Radio do not recommend or endorse any specific tests, physicians, products, procedures, opinions, consults, or any other information that may be mentioned on this website or radio podcast. 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