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Fwd: The Vegan Health Study--from Michael Klaper, MD--very long email

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FYI"Michael Klaper, M.D." <director wrote:


"Michael Klaper, M.D." *suppressed list*

Thu, 09 Dec 2004 00:21:42 "GMT"The Vegan Health StudyDear Participant in the Vegan Health Study,I want to thank you for contributing your time and energy in filling out the questionnaire at our website at veganhealthstudy.org. Along with you, over 900 others have completed the questionnaire and have shared their experiences with vegan diets. Your participaton is helping to create a more accurate picture as to the what works and what doesn't in vegan nutrition.Understanding the health effects of long-term vegan diets has been a passion of mine for a long time. Having been a vegan physician for over 23 years, I have seen great health improvements in those who adopt completely plant-based diets - but more troubling, I have also been consulted by numerous individuals who have been vegan for many years and who are experiencing a "failure to thrive" syndrome of low energy levels, low muscle mass, pale appearance and sometimes, worsening of

their health status, such as elevated blood pressure, high cholesterol levels, etc. I deeply want to understand these effects so we can help everyone who wants to follow a purely vegan diet to do so with optimum benefit - and minimal risk - to their health. Thus, the Vegan Health Study is trying to identify those people who are thriving on vegan diets and to determine exactly what they are eating and what supplements they may be taking, as well as to characterize the food and supplement patterns of those who are not thriving.In analyzing the questionniare results, as well as through reviewing the medical and nutritional literature and performing extensive laboratory testing on over 40 participants, a number of conclusions have been reached that I feel you should know about - and which may help you adjust your dietary and supplement programs. A summary of the research findings and recommendations are contained in this e-mail. Briefly, it has become clear that, at the risk of

stating the obvious, that nutritioun is important. Many of the participants who show the "failure to thrive" syndrome showed low levels of long-chain fatty acids like DHA and EPA, minerals such as zinc and magnesium, some amino acids (signifiying insufficient protein intake) as well as insufficient vitamin B-12. The specifics are contained in the attached summary of findings, and hopefully will be of value to you.Your thoughts, comments and feedback are always welcome and can be directed to me through replying to this email.Through the Vegan Health Study, we have much more work to do to gain a greater understanding of the long term health effects of vegan diets. In the future, we will be contacting you to invite you to complete a brief version of the questionnaire to determine if there have been any significant changes in your food choices or health status. (Of course, all information gathered remains absolutely anonymous and confidential.) A summary of what we learn

through that questionnaire will, of course, be made available to you.Our 501©3 Institute of Nutrition Education and Research needs support to increase the value of the study by developing a stronger computer analysis tool which will permit us to tease out in greater detail the food and supplement patterns of those who are thriving - and those who are not. Financial support will also let us identify and test those special individuals who may hold important keys to understanding the effects of vegan nutrition, namely, people who have been vegan since birth, as well as vegan atheletes and those consuming exclusively raw food diets. Another area of great interest are the so-called "carni-nutrients", like carnitine, taurine and other nutrients found almost exclusively in animal products. Could they hold the key to the "vegan failure to thrive syndrome?" Our current financial needs for computer programing and laboratory testing for the coming year is approximately $18,000. (Our

staff, including myself, draw no salaries for this work.) If you would like to make a tax-deductible contribution to support our research, please send it to:The Institute of Nutrition Education and Research1601 N. Sepulveda Ave.Suite 342Manhattan Beach, CA 90266You will receive a tax-deductible receipt in return.Again, I want to express my appreciation for your help in our Vegan Health Study. I look forward to your continuing participation and to sharing our findings with you.Sincerely,Michael Klaper, M.D.Director----------Vegan Health Study - Clinical Summary 2004A vegan diet is one that includes all foods of plant origin, but excludes all products of animal origin (meat, poultry, fish, eggs, dairy products and honey). An

estimated 1.9% of the American population follows a vegan diet. Common reasons for choosing a vegan diet include concerns about health, the environment, the treatment of animals, and world hunger. Today it is widely recognized that appropriately planned vegan diets are safe and adequate, and can offer health benefits where chronic disease is concerned. However, the research looking at the long-term health consequences of vegan diets is limited.The Vegan Health Study examines vegan health through analyzing questionnaires submitted by over 900 participants who enrolled at the www.veganhealthstudy.org website and includes results of testing of blood and urine samples of some vegan participants. It incorporates findings of numerous surveys of the medical literature, and clinical interviews with many vegans in the past 7 years. This clinical summary presents observations derived from the Vegan Health Study and explores the practical implications of these

findings.Specifically, it addresses three primary issues:1. The major health advantages associated with vegan diets2. The major risks for nutritional deficiencies and disease states associated with vegan diets3. Recommendations for dietary patterns that minimize risks and optimize health and function for long-term vegans.Advantages and BenefitsIn recent years, vegan diets have been shown to exert protective effects against a number of chronic diseases and medical conditions, including cardiovascular disease, type 2 diabetes, and certain cancers,- as well some kidney disorders, immune-inflammatory diseases, toxin exposure, as well as some gastrointestinal diseases and eye disorders.Cardiovascular DiseaseEating a vegan diet and incorporating prudent lifestyle practices (abstinence from tobacco, moderate exercise, etc.) is associated with:·

Regression of coronary atherosclerosis and improved coronary perfusion with reduced frequency, duration and severity of angina.· Reduced oxidation of LDL cholesterol, and lower blood viscosity resulting in advantages to artery health.· Lower total and LDL cholesterol, and triglycerides.· Reduced rates of hypertension – if salt and refined carbohydrates are minimized (Note: Vegans can and do develop high blood pressure as they age and if they consume excessive salt and refined sugar-containing foods.)Type 2 Diabetes:Vegan diets that are high in whole, unrefined foods and low in refined carbohydrates, saturated fat, cholesterol, and trans fatty acids can offer significant benefits in both the prevention and treatment of type 2 diabetes. “Whole food-based” vegan diets improve insulin sensitivity, blood sugar control, reduce insulin requirements, and aid in weight loss in people who have type 2 diabetes. These

advantages are thought to be largely due to the increased intakes of fiber, plant sterols and soy protein, and the reduced intakes of total fats and refined carbohydratesCancer:There is significant evidence that vegans are at a reduced risk of prostate cancer and cancers of the colon and rectum.Prostate cancer – Vegan men appear have a reduced risk of prostate cancer. This is thought to be due to the reduced intake of meat and dairy products, and the increased intake of protective phytochemicalsCancers of the colon and rectum – both male and female vegans appear to enjoy a reduced risk of cancers of the colon and rectum. This is thought to be due largely to the reduced intake of meat and animal fats, and the increased intake of fiber and protective phytochemicals.Genito-urinary Disorders:Low fat, moderate protein-containing vegan diets appear to offer some protection against

genito-urinary disorders; namely, such diets may:· Reduce painful menstrual cramps.· Preserve kidney function – high protein diets cause hyperfiltration of kidney filters.Toxin Exposure:People consuming whole food-based, “organically-grown” vegan diets have reduced exposure to environmental toxins, especially mercury (associated with nervous system and kidney toxicity) and dioxins, associated with elevated risks for numerous types of cancers and birth defects.The reduced toxin levels have favorable consequences for the breast milk of vegan mothers. While levels of hydrocarbon contaminants have been found to be elevated in the breast milk of omnivorous women, levels in vegans tend to be far lower.Immune/Inflammatory Diseases:Vegan diets appear to offer some protection against immune/inflammatory disorders, and there is some evidence that they may provide useful treatment

for some of these conditions. Evidence suggests that vegan diets:· Can effectively reduce symptoms of autoimmune diseases – rheumatoid arthritis and ankylosing spondylitis, although findings are inconsistent for fibromyalgia.· Can improve some skin conditions, such as atopic dermatitis.· Can improve asthma symptoms.· Can possibly reduce severity and frequency of sinus infections.Gastrointestinal Diseases:Evidence suggests that vegans have lower rates of gastrointestinal disorders. This is thought to be due to the increased intakes of fiber-containing plant foods. Vegan diets have been found to:· Minimize risk of constipation, and provide effective treatment of constipation.· Reduce incidence of colonic diverticula.· Reduce incidence of gallstonesEye Diseases:Vegan diets may reduce risk of age-related macular

degeneration and cataracts. Dietary components that appear particularly protective include a variety of carotenoids, particularly zeaxanthin and lutein. These phytochemicals are concentrated in a variety of fruits and vegetables, especially dark greens such as collards and spinach.Risks and Possible DisadvantagesWhile vegan diets offer considerable protection against many chronic diseases, the Vegan Health Study has found that vegans may be at increased risk for certain nutritional deficiencies. For optimal long-term health, it is essential that vegans are aware of the potential pitfalls, and make the necessary dietary adjustments to avoid them.Vitamin Deficiencies:The Vegan Health Study confirms numerous other studies that vegans who do not supplement their diets with vitamin B-12 are at definite risk for deficiency of vitamin B12. The effects of vitamin B-12 deficiencies may appear as soon as 6 months after adopting a

purely plant-based diet, or may not appear following consumption of an exclusively vegan diet for 10 years or more.Vitamin B-12 deficiencies:Vitamin B12 deficiency has numerous negative consequences for health:Artery Damage:When vitamin B12 levels fall, homocysteine levels in the blood begin to rise. Homocysteine is a waste product of the metabolism of the amino acid, methionine. Elevated levels of homocysteine can damage the inner surfaces of arteries and in doing so promote deposition of cholesterol plaques - thus elevating the risk of heart attacks and strokes.Neurological Damage:Peripheral nerves – numbness and tingling and burning sensation in extremities and profound muscular fatigue.Spinal cord injury – a serious form - subacute combined degeneration - may cause paralysis and be irreversible.Other neurological hazards of vitamin B12 deficiency:

dementia and depression in adults.Risks to children:If mother is B-12 deficient while pregnant: birth defects.If mother is B-12 deficient while breastfeeding: nerve and brain damage, poor weight gain and “failure to thrive syndrome.”If child is B-12 deficient during infancy and adolescence: impaired intellectual function impairment.Blood system damage:Vitamin B12 deficiency leads to macrocytic anemia (abnormal shape and function of red blood cells), causing weakness, fatigue, irritability and inability to concentrate.Vitamin D deficiencies:Vegans who have limited exposure to warm sunshine, such as those living in northern climates, as well as those who have dark skin, and older adults, are at increased risk for vitamin D deficiency, leading to weakened bones. The vegetarian form of vitamin D (vitamin D2) is also 60 percent as available as the animal form (vitamin D3), which would

raise requirements for vegans who rely on vitamin D2 in the form of supplements or fortified foods.Mineral deficiencies:High fiber diets can conspire against effective mineral absorption because (a) minerals are bound tightly to phytate molecules in the plant fibers and (b) because the food mass moves through the intestine so quickly that there is less time for mineral absorption. In addition, some minerals, like iodine, magnesium and zinc, simply exist in far lower concentrations in plant-based foods than animal-derived foods.Minerals Commonly Inadequate in Vegan DietsIodineVegans who do not include iodized salt or seaweeds in their diet appear are at increased risk of iodine deficiency, needed for production of vital thyroid hormones.Minerals Sometimes Inadequate in Vegan DietsCalciumVegan women and men are not immune to osteoporosis and actually may be at greater risk for low bone

density and possible fracture. I have seen several frankly osteoporotic men and women in my practice in the past 5 years. The osteoporosis observed in vegan women may be from failure to consume - or to absorb and utilize - sufficient calcium. Other factors may play roles, such as insufficient amounts and/or function of hormones like estrogen and testosterone, excessive intake or production of thyroid hormones, insufficient weight-bearing physical activity, and inadequate intake or absorption of trace minerals, including boron and vitamins, especially vitamin D and K.IronVegan iron intakes are often higher than that of non-vegetarians and lacto-ovo vegetarians. Yet many vegans and vegetarians can show low levels of iron in the tissues (measured as ferritin) indicating low absorption of the iron they consume. Iron from vegetable sources is not as absorbable as iron from animal sources. This chemical difference, combined with insufficient intake of vitamin C, which

facilitates iron absorption, can lead to low tissue levels.ZincA significant percentage of vegans have zinc intakes below the RDA, and suboptimal zinc status. Absorption of zinc in vegan diets is reduced relative to those consuming non-vegetarian diets, probably because vegan diets are higher in phytates, which can significantly compromise zinc absorption, and lower in animal protein, which appears to enhance zinc absorption. To ensure sufficient zinc in vegan diets, intakes above the RDA may be required.MagnesiumMagnesium is a metal required by hundreds of essential enzymes needed in energy production and vital tissue functions (blood, muscle, etc.)While vegan diets can be higher in magnesium than non-vegetarian diets, absorption may be lower due to higher fiber intakes.Essential fat deficiencies:Long-term vegans commonly have low tissue levels of highly unsaturated fatty acids (HUFA) of the omega-3

family – namely, EPA (eicosapentaenoic acid – 20 carbon atoms in length) and DHA (docosahexaenoic acid – 22 carbon atoms in length).Deficiencies in these fatty molecules may lead to dry skin and feelings of low energy levels. as well as increased risk for: cardiovascular disease, cancer, diabetes, osteoporosis, obesity, neurological/behavioral disorders such as Alzheimer’s disease, depression, (possibly) ADHD, schizophrenia, immune/inflammatory disorders such as asthma, rheumatoid arthritis, lupus, inflammatory bowel diseases, psoriasis, and atopic dermatitis. Also, deficiencies of EPA and DHA can lead to sub-optimal infant development with compromised brain function and reduced visual acuity.The primary reasons for depressed omega-3 fatty acid status in vegans are several fold:First, vegans consume insufficient amounts of alpha-linolenic acid (the essential omega-3 fatty acid found primarily in flaxseeds, hempseeds, canola oil, walnuts, green

vegetables), relative to their intake of linoleic acid (the omega-6 fatty acid found in margarines, commercial mayonnaise and many salad dressings, crackers, chips cookies and snack foods, as well as cooking and other oils like safflower, grape seed, sunflower, corn oil [60-75% omega -6] soy, cottonseed oil and sesame [45-50% omega -6]).Second, vegans seldom consume the pre-formed omega-3 fatty acids, EPA and DHA, which in non-vegetarian diets, come mainly from fish.Third, vitamins B6 (pyridoxine) and B3 (niacin) and C (ascorbic acid) as well as the element zinc are needed for the conversion of linolenic acid to EPA and DHA. Since these nutrients can be in short supply in a vegan diet that does not contain enough fresh fruits and vegetables or appropriate supplementation, long chain fatty acid deficiencies can result.Protein deficiencies:Although the majority of reports suggest adequate protein intakes in vegans, the Vegan Health Study

has found that sub-optimal amino acid status (the “building blocks” of protein) can be common among vegans, and many of the vegans whose levels of amino acids were determined though blood testing showed low levels of some amino acids, especially the “branched-chain” ones, valine, leucine, and isoleucine.Vegans who do not consume enough sulfur-containing amino acids, particularly cysteine and methionine are at risk for reduced production of carnitine, a protein necessary for metabolizing fats for energy. Low levels of carnitine can lead to fatigue and reduced physical performance. A lack of these sulfur-containing amino acids also reduces the production of glutathione, a powerful antioxidant needed for detoxification of tissue- damaging free radicals, which can accelerate aging of tissues and increase cancer risk.Organ dysfunction:Heart and blood vessels:Elevated blood cholesterol levels:While vegans

generally have lower blood cholesterol levels relative to non-vegetarians, vegan diets do not impart immunity to elevated cholesterol and triglycerides. Those who consume a diet with:(a) large amounts of refined carbohydrates (both sugars and starches found in highly processed breads and cereals, pastas, white rice, pretzels, pastries, candies, soft drinks, etc.),(b) trans fatty acids and deep-fried foods, and© insufficient fiber, and green and yellow vegetables,seem to be at higher risk to develop elevated blood cholesterol.Elevated triglycerides:Vegans generally have lower levels of the blood-fat family of triglycerides than non-vegetarians; however those who consume excessive amounts of refined carbohydrates – both sugars and starches - commonly develop elevated levels of triglycerides, possibly elevating their risk of blood vessel disease.High blood pressure

(hypertension):Vegans are generally at an advantage were blood pressure is concerned; however those consuming a high sodium (salt) diets, combined with excessive stress levels and insufficient exercise can and do develop hypertension - leading to increased risk of heart attack and stroke. (Risk for hypertension is especially high if either parent or a sibling had high blood pressure.)Heart attacks:Vegans experience considerable protection against heart attacks, however, this advantage can be virtually negated in those consuming insufficient vitamin B12, with resulting elevated levels of artery-damaging homocysteine.Bones:Vegans are at definite risk for osteoporosis (despite lower protein intakes) if they do not consume and absorb enough calcium, magnesium, trace minerals like boron, zinc and manganese, as well as vitamins K and D – and get enough weight bearing exercise.Tissue

aging:In the body, refined sugars are oxidized, forming “advanced glycosylation end products” (“AGE’s”). These molecules then cross-link with protein strands throughout the body (the Maillard reaction) which causes stiffening and dysfunction of connective tissues in arteries, eye tissues, and other vital organs. Consequently, vegans who consume diets rich in refined sugars (candies, pastries, soft drinks) age their tissues prematurely through these dietary choices.Nutrition and Lifestyle Recommendations1. Make whole plant foods the foundation of your diet.Emphasize (non-genetically modified, organically grown) whole foods (“foods as grown”). Include a variety of fresh, colorful vegetables, including green leafy vegetables on a daily basis, fruits, legumes, nuts, seeds and whole grains. (If there is any question of gluten intolerance - e.g. abdominal cramps, bloating, diarrhea or hives after eating wheat, barley, oats

and rye, consider eliminating products made from those grains and emphasize low-gluten grains like quinoa, millet & buckwheat.)2. Minimize refined carbohydrates – both sugars and starches.Refined sugars such as white sugar, brown sugar, syrups, candy and sodas, as well as refined starches, such as white flour products and white rice products, crowd out foods that nourish and protect us, and contribute to a variety of health problems. These foods cause oxidative damage to tissues and contribute to premature aging of the body. They elevate blood sugar levels, adversely affect blood lipids (particularly triglycerides), and increase risk for type 2 (adult-onset) diabetes, as well as cardiovascular diseases and gastro- intestinal disorders.3. Include a healthful intake and balance of essential fatty acids.Aim for 3 to5 grams of alpha-linolenic acid per day for most adults. This can be achieved by consuming 2 T. freshly

ground flax seeds or 2 tsp. of fresh flaxseed oil daily (add to gravies, cereals, smoothies, salads, etc.), or an equal amount of alpha-linolenic acid from a combination of foods such as hempseed oil, hempseeds and walnuts. If taking omega-3 fats in the above forms is impractical or undesirable, consider taking an algae-derived DHA supplement (300 mg./day, in “vegi-cap”), available at natural food stores. This is particularly important for those who may have increased needs (e.g. pregnant or lactating women), or reduced ability to convert alpha-linolenic acid to EPA and DHA (e.g. people with diabetes or hypertension).4. Assure an adequate protein intake - approximately 60 to 70 grams per day for average vegan adults, and up to 90 grams per day for athletes and those with higher protein needs, like pregnant women and those healing fractures, burns and other wounds.Liberally ingest protein-rich foods – lentils, chickpeas, beans, and other legumes, as

well as nuts, seeds, and products made from them, tempeh, hummus, etc.5. Assure an adequate supply of trace minerals.Consume ample helpings of dark green leafy vegetables, legumes, nuts, seeds, root vegetables and fruits. It is not enough to eat the minerals – you must absorb them. So, break up the plant fibers by chewing your foods well and/or using food preparations methods that help to break up plant fibers – cooking (e.g. soups or stews), grinding, juicing, grating or pureeing.6. Insure a reliable source of vitamin B12.Reliable sources include fortified foods and supplements. Fortified foods such as non-dairy beverages (rice-based and soy-based drinks), Red Star nutritional yeast (Vegetarian Support Formula), and some cereals are good choices. Make food choices so consume at least 3 mcg. of B12 in total.If there is any doubt that your intake of B-12 may not be sufficient (as is common with many

long-term vegans), then a vitamin B12 supplement is advised. Take a sublingual “microdot” of approximately 1000 mcg. - 2000 mcg. vitamin B12 at least once a week. When using large amounts of B-12, only 0.5 to 1.0% will be absorbed - thus high intakes are required to insure sufficient absorption.7. Keep sodium intake to not more than 2400 mg (1/2 teaspoon of salt) per day, and preferably around 1800 mg per day.About 75% of the sodium in most diets comes from processed foods, and about 20% is added at the table. This is one more reason to limit processed foods (meat analogs, canned soups, etc.). Use flavored vinegars, lemon juice and other low-sodium taste enhancers, rather than soy sauce and other salty seasoningsNote: Athletes, especially those living in warm climates may require higher amounts of sodium in their diets.8. Eliminate trans fatty acids.Commonly found in processed foods containing

“hydrogenated vegetable oil,” “partially hydrogenated vegetable oil” or shortening (read the labels!), trans fatty acids distort the shape, flexibility and permeability of cell membranes, thus compromising their function and increasing risk for artery disease, type 2 diabetes, and possibly some cancers. Again, minimize processed foods and emphasize fresh, whole foods.9. Consider taking a (vegan) multi-vitamin/mineral supplement.If there is any question of adequate intake of any given vitamin, mineral or essential fat, consider taking a high-potency (vegetarian) multivitamin-mineral preparation (tablet or liquid or powder) daily, or approximately 2-3 times per week. This supplement should contain the following nutrients in approximately these amounts: iodine – 150 mcg., zinc - 15 mg., copper – 1-2 mg., boron - 2 mg., vitamin K - .5 mg., and vitamin D2 – 5 mcg (or approximately 400 International Units.)Other possibly helpful supplements

to consider taking several times per week would be:1. a calcium/magnesium supplement (approximately 1000 mg. of calcium and 800-1000 mg. of magnesium),2. 300 mg of algae-derived DHA3. 3 mcg. vitamin B12 daily in fortified foods or 1000 mcg. - 2000 mcg. vitamin B-12 weekly in a sublingual microdot supplement.4. If low energy levels or deficient muscle mass are concerns, additional nutrients, like taurine and carnitine may be of value. The Vegan Health Study will be researching these substances and will share recommendations about them with you in our next report.10. . Be sure to get a consistent reliable source of vitamin D.The best place to get your vitamin D is sunshine. Aim for about 20-30 minutes on your face and forearms each day, and more if you have dark skin. (Such brief exposure times will not damage your skin or increase cancer risk, and will produce substantial benefits for your

immune system.) If you live in a cooler climate, sunshine may not be intense enough to produce vitamin D during the winter months, and you will need to rely on fortified foods such as fortified non-dairy beverages or vitamin D supplements. Vitamin D3 is generally derived from animal sources, while vitamin D2 is plant-based. The recommended daily intake is approximately 5 mcg. or approximately 400 International Units.11 Try to get 20 to 30 minutes of active, weight-bearing exerciseat least every other day.Include a balance of cardiovascular, flexibility and strength exercises.12. For optimal health, a positive mental and emotional state is essential – and possibly more important - than nutritional intake. Life is about more than avoiding disease and death. Get as much love, laughter and meaningful service into your daily life as possible.(Acknowledgment and appreciation is expressed to Brenda Davis, R.D. and

Vesanto Melina R.D. for their valuable contribution to these recommendations.)

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