Plant-Based Cooking spoke with sports nutritionist Susan Levin, director of nutrition education for the Physicians Committee for Responsible Medicine. Founded by plant-based pioneer Dr. Neal Barnard, PCRM is a nonprofit research and advocacy organization focused on preventive medicine and promotion of a plant-based diet. Levin is a regular contributor to U.S. News & World Report.
INTERVIEW WITH SUSAN LEVIN
What supplements, if any, should vegans be taking?
There aren’t really any supplements that anyone needs as a blanket recommendation in terms of being vegan except B12. That’s the vitamin all vegans should be consuming regardless. There’s a little bit of controversy there, but I usually recommend 500 mcg at least three times a week.
However, people who follow a vegan diet aren’t the only ones who need B12. People on certain medications, specifically diabetes medication, people who have a history of taking prescription or over-the-counter drugs for stomach issues such as antacids, people over the age of 50 regardless of diet all need b12. That’s not my opinion, that’s what the Dietary Reference Intakes manual says, what the government says.
Why do people over age 50 automatically need B12 supplements?
They estimate that by the time we get to the age of 50 our guts are taxed enough that we are not able to absorb that particular B vitamin through our diets enough. So, they say, “Y’know what, everyone, when you hit 50, just take B12.”
It’s a fairly small amount that you need, 2.4 mcg per day. However, if your gut isn’t very good at absorbing that nutrient through your diet then you usually need more in the supplement, which is why I recommend 500 mcg of B12.
If you’re really low in B12 and the supplement doesn’t seem to work either, your gut may be so compromised that you need a sublingual which bypasses the gut altogether. You put it under your tongue, it absorbs straight to your bloodstream. And that’s a fine way to do it regardless, anyone can do a sublingual.
I think the most egregious thing is that no one knows that they’re supposed to be taking B12 after the age of 50. I’ve told every single one of my loved ones over the age of 50 and none of them have heard that. Like really, your doctor never mentioned that? Because B12 is so closely tied to brain health and neurological health.
Manifestations of deficiencies of B12 are far more common in the elderly than say in somebody who follows a vegan diet. But regardless, this is not a nutrient you want to find your threshold for when you are deficient because you may have incurred some permanent damage. So, you always want to make sure if you’re in one of those categories that you’re taking a B12 supplement.
And frankly, even for young people, it doesn’t hurt to take B12. So, oftentimes if someone’s 40 and sort of vegan, I’ll say “Why don’t you go ahead and take B12?”
What is it about vitamin B12 that is so sensitive to gut health?
B12 is a complex process that becomes less efficient with age. It involves the stomach, pancreas, and small intestines. Even when you’re healthy only about half of B12 is absorbed from food. Loss of function in any of these organs impairs absorption which could lead to a deficiency. (Levin paraphrased this excerpt from “Vitamin B12 and Older Adults.”)
Something about the stomach acid and the stomach enzymes just become less powerful apparently. For some people, like I said, they could have altered stomach acids from the medications they’re taking. That’s why those people need to take the supplement as well because they’re on certain medications. And the one that always comes to mind because I see a lot of patients with diabetes is metformin. If you take metformin, which is pretty common among people with diabetes, you need to take a B12 supplement.
What are the symptoms of vitamin B12 deficiency?
Well, it could be fatigue – but who isn’t fatigued? So, that’s very vague. It could also just be numbness in your fingers. So those are the neurological aspects of it. But regardless, the smart thing to do if you think you’re in a risk group is to make B12 testing a part of your regular blood lab.
When you have your B12 tested your physician or clinician can tell you if it’s normal, it’s low, it’s high, and you’ll know if you’re on the right track. A lot of people report if they’re very low in B12 that they can get a B12 injection and their energy just goes through the roof immediately, that’s how depleted they were. So, some people know just by starting the supplement – being like “I feel completely different.” But for other people, just look at your labs.
You can store B12 for a long time and I think unfortunately a lot of people can rely on that. “Well, I don’t take a B12 supplement, but I’m not having any problems,” they’ll say. But you can store B12 for years, even decades, and then suddenly you’re depleted and you’re in trouble. It’s just not something I would want to mess around with.
You weren’t monitoring it, you were just assuming, “I feel fine, everything is fine.” It is important to get that B12 part of your blood profile every once in awhile when you do a lab workup. Which is kind of standard, I think they typically do that anyway.
What’s the link between vitamin B12 and animal products?
B12 is not actually produced by animals or plants, it’s produced by bacteria. So, wherever there’s bacteria there’s likely a manifestation of this nutrient B12. And while for that reason it could be on anything, like in the soil or in the dirt, so could be on plants, but we’re pretty hygienic these days so we probably wash all that off of our plants before we eat it. However, we make B12 in our own guts, but we make it so far down in our intestinal tract that we don’t absorb it.
You can imagine in your large intestines where you have a lot of fecal matter, there’s a lot of bacteria, you’re producing B12, that’s great. Except that we just end up just pooping it out, just like any animal. That’s why it’s in the soil, there’s bacteria everywhere.
But if you eat another animal, you’re going to get their bacteria and whatever those bacteria are producing. So, you’ll get the B12 from that animal. So, neither option is that appealing but that’s how you get it from another animal and how you probably why you don’t want to get it from plants, because then that means you’re eating dirty plants.
Can vegans get vitamin B12 from plant foods?
I’ve heard the argument, “Oh, well, we make B12 in our gut.” Some vegans think they do absorb enough B12 through their large intestine, but other people say, “No, you can’t rely on that.” There are a lot of different schools of thought concerning B12 in a vegan diet. Some people say, “Oh, you can get B12 from mushrooms because it’s a fungus, it’ll have B12 in it.”
No. None of this is a reliable source of B12. Just take the supplement. You can get B12 from fortified plant milk, for example. That’s fine if you drink that regularly. But if not, just take the B12 supplement, it’s just such an easy way to prevent issues.
What about vegans with specific health conditions?
As a blanket recommendation supplements other than B12 are not necessary for vegans. But that isn’t to say someone might have a specific condition where a supplement might be very useful. An example might be someone with osteoporosis – they might benefit greatly from a calcium and vitamin D supplement, depending.
But that’s a disease diagnosis that requires some follow-up recommendation. If a woman is anemic, she may benefit from temporary iron supplements until she can rework her diet to work better for her. If you’re low in vitamin D, and again you can get a lab to show that, then you may benefit from a vitamin D supplement because you don’t get out in the sun, you wear sunscreen, you wear clothes, you sit in an office all day, you’re scared of skin cancer.
Whatever the reason is you might be like “I’m not getting in the sun,” so therefore I need a supplement and my labs show that that’s the case. But those are supplements I would want a diagnosis for before I would say, “Take that.”
But those supplements are not really vegan specific, are they?
No, not at all. Because even in the world of whatever-you-eat so much of our food supply is supplemented because of deficiencies. Someone long ago, bless them, said we need to iodize our salt because we’re not eating seaweed, we’re not getting any iodine so iodize the salt. Or, too many women are having babies with neural tube defects, guess what – folic acid in refined grains.
Refined grains are actually supplemented with a few different B vitamins in order to compensate for a lack of B vitamins in our diet. So that’s just America, we supplement our diet a lot. Vitamin A in cow’s milk, vitamin D in cow’s milk, those don’t actually exist there. Milk is supplemented with those because they’re seen as nutrients that we don’t get enough of in our normal food processes.
So, with all that in mind, it’s not like vegans are running around with special needs. In fact, I would say vegans arguably get a lot more of those nutrients that are supplemented in our food supply whether we want them there or not, because they do eat a variety of colorful plants, vegetables, and beans, so they do get a lot of folate. The word “folate” comes from the word “foliage.”
I’m not condemning the fact that we do that in our food supply. I do think that it’s better to be safe than sorry. Especially in terms of pregnancy, that’s just not a time when you want to test things. But, to the point that if anyone ever shakes their finger, “Like look, you need to take a B12 supplement because you eat a vegan diet, there’s something wrong with that.”
Well, wait a minute, our whole food supply is supplemented because we don’t do anything right. The fact that we need a B12 supplement, to me, it just resonates with the fact that we have a very hygienic diet and it’s just not that big of a deal.
How can vegans get omega-3 fats and why do we need them?
Omega-3 is one of the two essential fats we need to eat because our bodies can’t produce it, the other one being omega-6. Omega-3 is an unsaturated fat and the only fat that’s anti-inflammatory, whereas all other fats are inflammatory, including omega-6. Omega-3 is anti-inflammatory because it converts into DHA/EPA, which is critical, and that conversion is critical.
And when omega-3 and omega-6, or omega-3 and the other fats in your diet are kind of out of whack, that conversion just doesn’t happen. So that’s why the ratio is oftentimes what’s emphasized.
Almost any plant is going to have the perfect ratio of omega-3 to omega-6, which is what is the most critical aspect for taking omega-3s is the ratio to other fats.
Good plant sources include flax seeds, chia seeds, hemp seeds, walnuts – those are very intense sources of omega-3.
Should vegans take omega-3 supplements?
I recommend a DHA/EPA supplement for nursing moms. If you gave your baby formula, DHA would be in the formula. If you’re nursing, which is obviously far superior, and you’re not necessarily eating a large source of omega-3s – which you could do, for sure – but again this is not a time you want to test how well you’re doing and I will often times just suggest an EPA/DHA supplement for nursing moms.
The vegan versions are algae sourced. When I was breastfeeding, I took one. For that I took 300 mg of DHA and EPA combined. They’re maybe $20 a bottle for a 90-day supply. There are also food sources.
What are EPA and DHA?
They’re good for our brains. They’re anti-inflammatory and inflammation is the root of all of our chronic disease problems – heart disease, diabetes, cancer – all chronic illness. The omega-3 molecule elongates into these other molecules called EPA and DHA, DHA being the end result of all of it. So, if your ratios are out of whack, then it can’t elongate into that ever-so-important DHA/EPA.
Now DHA and EPA are not the essential fats themselves, you don’t necessarily need to consume those. It’s the omega-3s that convert to that. Omega-3s elongate first into EPA and then into DHA.