The Vegan Controversy: Protein, Vitamin B12, and Essential Fatty Acids in Pregnancy and Early Childhood
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Recently, there have been a slew of high profile politicians, athletes, models, and actors who have adopted a vegan diet for reasons ranging from health, beauty, athletic performance, ethical, and environmental reasons. In spite of the benefits that many report from adopting this diet, there are others that claim that such a diet is not only unhealthy, but dangerous. Even experts in the field of medicine and nutrition seem torn on the subject, with prominent experts on both sides of the argument. Veganism becomes even more controversial when determining the diets healthfulness during pregnancy and early childhood. Advocates of the diet claim that the benefits for both mothers and children outweigh the risks, and that any risks can be avoided by careful dietary planning. Critics of vegan diets are concerned that nutritional deficiencies as a result of abstaining from animal foods can have serious, permanent, and sometimes fatal consequences. The purpose of this paper is to explore three of the nutritional deficiencies that are a concern for those on a vegan diet; protein, vitamin B12, and essential fatty acids, specifically during pregnancy and early childhood.
It is important in the understanding of vegetarianism to note that although many people who identify themselves as vegetarians consume eggs, dairy, fish, and honey, the more true definition of vegetarianism is what has now evolved into the term vegan. The term vegan is a result of a progressive misunderstanding of vegetarianism and is a very specific term that means a wholly plant-based diet “including fruits, vegetables, grains and grain products, nuts, seeds and legumes, and dried beans and peas.” (1) In many of the clinical or scientific texts on vegetarianism, they are referring to pure vegetarianism, or in other words a wholly plant-based diet synonymous with veganism. In some of the quotes used in this article the authors use the term vegetarian when referring to a vegan diet, unless it is contextually obvious that they are referring to simply a meatless diet.
One of the most common questions that people have for vegans or when they consider a vegan diet is, “Where do you get your protein?” The conventional wisdom is that protein is only available from animal products. While protein is most abundantly found in animal products, all plant foods contain varying quantities of amino acids, which when combined properly can contain all essential amino acids to provide a complete protein. Protein requirements are especially high in the third trimester of pregnancy due to synthesis of new tissues for mother and fetus. (2) “To some extent the increased need for protein is met through reduced levels of nitrogen excretion and the conservation of amino acids for protein tissue synthesis.” (2) Most of the protein energy requirements are met through maternal dietary protein intake during pregnancy. (2) As with any diet, education and planning go a long way to achieving a healthful vegan diet. Is it possible for a lay person to properly execute a vegan diet in a healthful way, especially during such a critical time as pregnancy? According to the book Being Vegetarian, “as long as you are getting enough wholesome foods to meet your calories needs and are getting a reasonable mix of vegetables, grains, and legumes over the course of the day, you should not have any problems getting enough protein or the appropriate mix of amino acids.” (1) In the United States, protein deficiency is not as much of a concern as the effects of excess protein. Dr. Benjamin Spock, a famous pediatrician wrote, “A vegetarian-based diet for children is generally more healthful than a diet containing cholesterol, saturated fat, and excessive protein found in meat and dairy products.” (3) This observation is important in understanding and weighing the benefits and risks associated with a vegan diet. Animal protein comes with saturated fat and cholesterol which is almost nonexistent in plant-based foods. In the United States, maternal health risks as well as childhood health risks are most heavily due to obesity and related diseases and complications. “A high-fat diet also promotes higher levels of sex and growth hormones” in children, which is a concern because the onset of puberty is being widely experienced at younger and younger ages by children in the United States. (4) It is important to understand that all vegan diets are not created equal. “The American Academy of Pediatrics maintains that some forms of vegetarian diets should be off limits to children.” (5) Macrobiotic diets are of particular concern with weaning infants. (5) Weaning infants and toddlers need calorie dense foods to ensure adequate energy consumption, “such as nuts, olives, dates, and avocados.” (5) The prevalent opinion held by the average lay American is that animal protein is necessary every day for proper growth and nutrition. However, after reviewing clinical and professional writings on the subject, the necessity of animal protein appears to be more myth than fact and is unsupported by experts. From the perspective of experts in the field of nutrition, this appears to be the controversy that wasn’t there. Animal protein is not essential to a healthy diet, even during the critical times of pregnancy and early childhood.
Perhaps the most common deficiency amongst those who adhere to a vegan diet is that of vitamin B12 deficiency. Vegan and physician Dr. Joel Fuhrman says, “It is entirely irresponsible for a health professional to not recommend B12 supplementation in some form or frequent monitoring of MMA with blood tests… for those who do not consume any animal products in their diets. No controversy exists.” (6) Vitamin B12 is commonly understood to be found only in naturally in animal sourced foods. Although many vegans consume spirulina, nori, and tempeh to obtain vitamin B12 from a plant based source, “newer research, however, shows that [this is]… ‘pseudo-vitamin B12’ analogues that may actually block the uptake of real B12.” (6) In the book The China Study, author Dr. T. Colin Campbell suggests that there is vitamin B12 in plant foods as long as they are grown in soils that are rich in organic material. (7) He also attributes the lack of vitamin B12 in plant foods to over washing of plant foods that remove soil borne vitamin B12 from the food, a problem that was nonexistent a century ago. (7) There is also new evidence that aloe vera contains vitamin B12, so perhaps knowledge on the availability of this vitamin from the plant kingdom is still lacking in the scientific and medical communities. Vitamin B12 deficiency is often misdiagnosed due to the multitude of varied symptoms that patients may exhibit resulting from this deficiency ranging from neurological disorders, dementia, infertility, mental illness, autoimmune disease, and more. (6) In children, vitamin B12 deficiency can cause permanent mental retardation and even death if not diagnosed and treated swiftly. (6) “Babies and toddlers affected by severe B12 deficiency begin to lose their speech and social skills, and they become apathetic and irritable. They often refuse to eat, and they regress to the point where they can no longer sit, crawl, stand, or walk. Their heads and bodies grow too slowly, and they fail to gain weight, becoming thin and weak.” (6) The most commonly cited reason for vitamin B12 deficiency among infants and children is a vegan diet, or as a “second-hand” deficiency inherited “because their mothers had deficient levels of B12 during pregnancy or while breast-feeding.” (6) Breast feeding vegan mothers may show no signs of deficiency and yet have babies that have dangerously low levels of B12. (6) Even mothers with normal levels of B12, and yet do not consume adequate amounts of the nutrient during pregnancy will not pass on any of the nutrient to the fetus as only newly absorbed intake of B12 can pass through the placenta. (6) Another risk identified with B12 deficiency during pregnancy is the development of neural tube defects (NTDs) of the fetus, “severe birth defects occurring when the brain or spinal cord fails to form correctly.” (6) A strong link has already been established between maternal intake of folic acid and NTDs, and folic acid and B12 have a “hand-in-hand relationship”. (6) Vegan mothers also tend to be quite health conscious and as a result tend to breast feed for longer periods of time, increasing the risk to children of mothers who do not supplement their diets sufficiently. (6) This leads to the question, how can an otherwise overall healthy diet have potentially dangerous consequences for the fetus and child? I found it interesting in my research that in the same book following all of the potentially harmful and damaging effects on children from a vegan diet lacking in vitamin B12, to find that “even mothers who eat large amounts of meat and other animal products may be B12 deficient and not know it.” (6) In fact, risk factors for vitamin B12 deficiency include undiagnosed pernicious anemia, gastrointestinal disorders, gastric bypass surgeries, poor diets during pregnancy, autoimmune disorders, celiac disease, iron deficiency, and malabsorption disorders, “but a woman who has none of these risk factors, and appears completely healthy, can still be starving her baby of B12.” (6) Though the problem of B12 deficiency mostly appears in vegans, it seems like this problem is widespread enough and occurs for such a variety of reasons that there seems to be more to this epidemic than lack of dietary vitamin B12 from animal products, but from generally inappropriate diets or problems with nutrient absorption. For example, there are many foods that are vegan but not necessarily healthful, as within an omnivore’s diet. For children, “a reliable vitamin B12 source such as a children’s vitamin or cereal or soy milk fortified with B12 is recommended for vegetarians.” (3) It appears that supplementation of a B12 within a diet of varied plant based foods is widely accepted to be a very healthy diet for mothers-to-be and their children.
Essential fatty acids (EFAs) are an important nutrient throughout life but are more critical during pregnancy and early childhood. EFAs such as “Omega-3 fats are necessary for the complete development of the human brain during pregnancy and the first two years of life” and “play an ongoing role in brain function, healthy immune system function, and general growth throughout childhood and adolescence.” (8) If there is a deficiency in Omega-3 fats and its derivative DHA (docosahexaenoic acid) in either the mother or infant, “the child’s nervous system and immune system may never fully develop, and it can cause a lifetime of unexplained emotional, learning, and immune system disorders.” (8) During pregnancy EFAs, particularly DHA is necessary “for the proper development of the mammary gland, placenta, and uterus during pregnancy, and most importantly for development of the fetus.” (9) DHA deficiency has also been linked to preterm births, low birth weight babies, post-partum depression, and other mood disorders in mothers. (9) During lactation “deficiency of the Omega-3 and Omega-6 fats causes insufficient milk production and breast engorgement.” (8) For vegan mothers, this may pose a potential problem because many nutritional experts recommend fatty fish, fish oil, or eggs as the best and most complete source of EFAs. (10) While there are many plant sources of omega-3 fatty acids, “vegetarian diets are lacking in direct sources of long-chain omega-3 fatty acids (EPA and DHA).” (10) Vegans “blood and tissue levels of EPA and DHA are about one half of nonvegetarians.” (10) Considering all of the health risks associated with EFA deficiency, this is a serious concern for vegans, particularly during pregnancy and early childhood when EFA requirements are much higher and deficiency can have more serious consequences. The problem is in that animal sources of EFAs contain long-chain polyunsaturated fatty acids (LCPUFAs) which are synthesized from parent EFAs such as omega-3 and omega-6, but the ability of the body to synthesize LCPUFAs from the parent EFAs (found in plant foods) is widely debated. (11) However, flaxseed and flaxseed oil known to have particularly high levels of DHA and is recommended as a supplement for formula fed babies and breast fed infants of mothers who are deficient in EFAs. (8) “Low levels of another fatty acid – GLA – have been noted in infants with eczema and seborrheic dermatitis.” (9) In some parts of Europe, infant formula is being supplemented with borage oil (an oil derived from an herb) to compensate for the almost nonexistence of GLA in infant formula. Vegan children who are breast fed still fare much better than formula fed infants in their levels of EFAs. (8) Various long-chain fatty acids are present in breast milk but are virtually non-existent in commercial baby formula. (9) In my research into EFAs and a vegan diet, there appears to be less of a controversy than I first assumed. The reality is that the standard American diet is already severely deficient in EFAs, and it is suspected to be linked to “the enormous increase in emotional, learning, and immune system disorders in our population today.” (8) There does not appear to be any link between vegan diets and EFA deficiency, but rather it appears to do more with our modern diet which on one hand is loaded with unhealthy fats like saturated fat and trans fatty acids, and on the other hand is obsessed with weight loss by cutting out fats which are essential to good health. There is versions of vegan diets that are low fat, high carbohydrate diets and this would be the vegans that would probably be at highest risk of EFA deficiencies, but overall, vegans tend to eat more nuts, seeds, avocados, olives, and healthy oils than the typical American. Vegans tend to be slim due to the absence of cholesterol, saturated fat, and trans fats from their diets, so unless the individual has an eating disorder, vegans are not usually obsessed with weight loss. Everyone should supplement with EFAs or make sure they are getting them from their food, regardless of whether or not they are vegans. This is especially true for the times of pregnancy, lactation, and early childhood.
I have been consuming a vegan diet for three years. My first son was two years old when we began the transition from a standard American diet to a vegan diet. I was a vegan during my entire pregnancy with my second son and he has been vegan for his entire two years of life. I am currently entering the third trimester of my most recent pregnancy and I have been on a vegan diet for this pregnancy as well. Knowing what I know now from research and personal experience, there are some things I will do differently from now on, and some things I wish I had known. The primary thing I am changing is my vitamin B12 supplementation. I have found appropriate supplements for myself during this pregnancy that will ensure I am getting vitamin B12 daily, and I am also researching supplements for my children and my husband. Vitamin B12 can have dramatic effects on a person’s cognitive and physical function and it is a problem for a lot of people. One of the main texts I used to study vitamin B12 is called Could it be B12? An Epidemic of Misdiagnoses. There are many health problems that are becoming increasingly prevalent in our society that are seemingly unrelated, but many can be traced back to vitamin B12 deficiency. Actually, after reading that book, I would recommend vitamin B12 supplementation even for meat eaters due to the prevalence of this deficiency in the United States. The typical American consumes about three times the recommended daily value of protein daily. I have read multiple experts who suggest that excess protein consumption could be at the route of the epidemic rise in allergies that has occurred progressively over the recent decades. In observing my family and our physical development over the past 3 years, I have noticed that we are not underweight, but we are all within the low end of the normal Body Mass Index (BMI) and my children are at the low end of normal range growth charts for weight, and in the middle of the normal range for height. My second son has developed in certain ways a little more slowly than my first son, but it is hard to determine if it is just individual differences between the two children or a result of his diet. I can count on one hand in the number of runny noses my second son has last in the last two years. My first son has not been sick since we changed his diet whereas before he suffered constantly from sinus congestion for the first two years of his life. My first born experienced indigestion and spit up frequently as a baby whereas my second son never has. I have made flax a staple of our diet almost from the beginning of our transition to a vegan diet, but my research has led me to conclude that we need more and I plan to begin supplementing with flaxseed oil daily in smoothies or other foods, as well as studying various plant sources to ensure my family receives a variety of EFAs. I plan to continue with a vegan diet because I have noticed tremendous benefits for myself and my family in areas such as sleep, positive body image, ease and enjoyment of pregnancy and childbirth, texture and beauty of skin, calm and attentive children, and less turbulent moods. I recognize that a vegan diet is actually not very specific, and that a person who attempts a vegan diet of packaged processed food without consuming a variety of whole, fresh foods including lots of fresh fruits and vegetables as the basis of their diet will likely be less healthy than an omnivore who eats plenty of fresh foods along with dairy, meat, and eggs. Though vegan seems to be a pretty specific term, vegan diets are as varied as individual people and require balance, planning, and variety to be healthful. Overall, the benefits of a vegan diet outweigh the risks because in the United States, the problems threatening the health of most people are related to obesity, degenerative disease, and their related complications which can be greatly reduced or even eliminated by adhering to a plant based diet.
References:
- Havala, Suzanne. Being Vegetarian. Minneapolis: Chronimed Publishing, 1996.
- Brown, Judith E., and Janet S. Isaacs. Nutrition through the Life Cycle. Belmont, CA: Wadsworth, CENGAGE Learning, 2011. Print.
- Spock, Benjamin, and Steven J. Parker. Dr. Spocks’s Baby and Child Care. 7th ed. New York: Pocket Books, 1998.
- Klaper, Micheal. Vegan Nutrition: Pure and Simple. Paia, Maui, Hawaii: Gentle World, 1997.
- Goldstein, Myrna Chandler, and Mark A. Goldstein. Controversies in Food and Nutrition. Westport, CT: Greenwood, 2002. Print.
- Pacholok, Sally M., and Jeffrey J. Stuart. Could it be B12?: an epidemic of misdiagnoses. Sanger, CA: Quill Driver Books/Word Dancer Press, 2005. Print.
- Campbell, T. Colin. The China Study: The Most Comprehensive Study of Nutrition Ever Conducted & the Startling Implications for Diet, Weight Loss & Long-term Health. Dallas, TX: Benbella, 2006. Print.
- Finnegan, John. The Facts about Fats: A Consumer’s Guide to Good Oils. Malibu, CA: Elysian Arts, 1992. Print.
- McColl, B.S.P., M.Sc., M.H., Janice. “Essential Fatty Acids During Pregnancy, Infancy and Childhood.” Bioriginal. Web. 19 Apr. 2012. <http://www.bioriginal.com/services/files/file_28.pdf>.
- Davis, RD, Brenda. “Vegetarian’s Challenge – Optimizing Essential Fatty Acid Status.” Today’s Dietitian Magazine. Feb. 2010. Web. 19 Apr. 2012.
- Sanders, Thomas AB. “Essential Fatty Acid Requirements of Vegetarians in Pregnancy, Lactation, and Infancy.” The American Journal of Clinical Nutrition 555S-559S 70.3 (1999). The American Journal of Clinical Nutrition. American Society for Nutrition, Sept. 1999. Web. 19 Apr. 2012. <http://www.ajcn.org/content/70/3/555S.full>.
