What are the main nutrient deficiency concerns for vegans?

Question

What are the main nutrient deficiencies strict vegans are at risk of and how to avoid them?

Answer 1

Nutrients of concern for Vegans

There are a few nutrients that may be more difficult to obtain on a vegan diet as compared to an unrestricted (omnivorous) diet.

b12 Vitamin B12 is easy, cheap, and safe to supplement. It is not reliably available from any plant-based foods. All vegans should take a vitamin B12 supplement.

fats EPA and DHA are long-chain omega-3 fatty acids that are synthesized from simpler fats like ALA. Non-vegans would get these nutrients by eating fish and other seafood. Human bodies have the ability to create these nutrients when the diet is replete with ALA and low in omega-6 fats. However, synthesis rates vary between individuals and among different populations. Vegans who do not supplement EPA and DHA will have lower levels of these fats, but it's not clear whether this matters for the regular health of adults. Women who are planning to become pregnant, or are currently pregnant or breastfeeding should probably take a vegan DHA supplement with advice of a doctor in order to avoid problems with brain development in the child. EPA and DHA can be safely added to a diet because they are fats that can be metabolized for energy and do not accumulate in the body.

iodine Iodine may be less available on a vegan diet than one that includes milk. Although iodine is present in plant-based foods, the use of iodine for cleaning cow teats provides extra iodine in dairy products. Surprisingly, iodine deficiency affects nearly 2 billion people around the world and is the leading cause of intellectual disability. This is why many countries add iodine to table salt to make iodized salt. Vegans, especially those in Europe where soils contain less iodine, should ensure a reliable source of iodine either by taking a multivitamin or regularly using iodized table salt.

zinc Zinc is an important mineral that may be less available on a vegan diet. Although there are many vegan foods that provide zinc, the removal of meat (especially beef) may not be fully balanced unless the diet is well planned. Males tend to have slightly higher zinc requirements because some zinc is lost through ejaculation. Zinc supplements should be taken carefully because an excess of zinc may inhibit copper absorption.

protein Protein may be a concern on a diet high in refined fats, sugars, or other junk foods. The Standard American Diet compensates low-protein foods (like oils and sugars) with high-protein foods (like meat), so if one follows the Standard American Diet but just avoids meat they may not get enough protein. However, a diet that provides sufficient food energy and incorporates a variety of foods (especially legumes, beans, and pulses) can easily meet requirements for proteins and specific amino acids.

Nutrients of General Concern

These nutrient concerns are not specific to vegans, but are good to be aware of in general.

iron Iron may be a mineral of concern for pre-menopausal women because of the amount of iron that is lost in menstruation. Even though vegan women tend to have lower iron levels, it looks like they experience iron deficiency anemia at about the same rate. Dark chocolate is a surprisingly high source of iron. Iron supplements should be taken carefully and on advice of a doctor because consuming too much iron can be harmful.

vitamin-d Vitamin D can be obtained either from sun exposure or in diet. Vitamin D deficiency is very prevalent in northern countries among all people regardless of diet. Small amounts of Vitamin D (1000 IU) can be safely added to diet, but larger amounts should only be taken on advice of a doctor because vitamin D may accumulate in the body.

Answer 2

When in doubt, consult your doctor, and do bloodwork!

Iron. I have never had anemia problems and iron is replete in dark leafy greens.

Vitamin A. Primarily found in meats, but also in cooked vegetables. If you are a raw vegan you are at risk for Vitamin A.

Vitamin D. You are likely at risk anyway if you live in a northern climate. Vitamin D affects both immune system and mood.

Vitamin B12. This is probably the most important. You need a supplement, probably a high-sounding dose like 1000mg / day, and B12 affects a variety of body functions.

Protein? In my experience people worry about protein too much but understandably vegans tend to be concerned about this. I have been fine just sticking to eating lots of beans and nuts often. Research deficiency symptoms and if you suspect you are deficient, work with your doctor.

If you look further to know more about the topic check these questions about macronutrients and micronutrients requirements.

Answer 3

Whilst the Vegan Society contains a more comprehensive list of the common deficiencies, I'm going to mention vitamin D.

Vitamin D supports your immune system and is thought to contribute to a positive mental state, though personally I think going out in the sun could just as easily have that effect regardless of its nutritional worth.

The reason it's probably not mentioned on some vegan resource sites is because it's not strictly a vegan issue, however, supplementing for it can be tricky because there are non-vegan sources of vitamin D.

Most people know that sunlight contains vitamin D, and might assume that you simply need to go outside every day to get enough, but if you live in a climate like we have here in England you can't rely on getting your vitamin D from sunlight.

In this case, with the exception of fortified foods, it's sensible to supplement to ensure you get enough, vitamin D3 is more readily absorbed by the body, just make sure it isn't made from an animal source, products such as VEG1 and those by Deva are worth a try.

Answer 4

Iron is available in dark leafy greens but still is a concern being less bioavailable than from meat. Iron absorbs better when eaten along with vitamin C so a balanced diet ought to prevent anemia but supplements may be considered, particularly for women as their Iron requirements are higher. Note that it is inadvisable to take Iron supplements if you don't need to, conditions like Haemochromatosis can go be asymptomatic and undiagnosed in young adults.

B12 is a major concern for vegans and strict vegetarians, as moderate intake of eggs or dairy is sufficient to prevent deficiency. It is a stored vitamin which vegans are at risk of developing long-term so monitoring B12 blood levels and supplementation may be necessary.

Incomplete proteins are not a problem on a balanced diet (rather than relying on a single staple crop such as corn), any amino acids missing in one plant food source are available in another. Protein should not be a major concern for adult vegans since all plants contain proteins, even if they are often higher in fibre and starch than fats or protein. However, protein intake may be a concern for growing children, teenagers, or active people (such as athletes) in which case nuts, beans, and legumes are good vegan protein sources. If you have nut allergies or FODMAP intolerance it may be advisable to consider an ovo-lacto vegetarian diet to ensure enough protein intake for these people.

Answer 5

The think tank Organisation for the Prevention of Intense Suffering provides the following list:

• Essential: Vitamin B12, 10-50 µg daily (can also be obtained from a multivitamin)
• Essential if not regularly consuming iodised salt or seaweed: Iodine, 150 µg daily (can also be obtained from a multivitamin)
• Strongly recommended if getting little sun exposure: Vitamin D3 (vegan source), 2000-3000 IU daily (this is significantly more that the standard recommendation of 600 IU, to get potential full benefits)
• Strongly recommended if dietary intake is low: Calcium, 400 mg daily
• Recommended: Long-chain Omega-3 (EPA/DHA) (non-fish vegan source), 250-500 mg daily
• Recommended (for long-term benefits): Vitamin K2, 100 µg daily
• Recommended, especially if diet is sub-optimal: Vegan multivitamin, 1 tablet every 1-3 days
• Consider: Creatine, 5 g daily
• Consider, especially with high degree of physical activity: Taurine, 1 mg daily

Most of the other nutrients have already been discussed, so I'll only quote a few of the sections:

Vitamin B12

[...] One of the common recommendations for getting enough B12 is to take a 1 mg tablet 3x/week, or a single dose of 2.5 mg once a week, the higher concentration enabling absorption through a less efficient passive mechanism that transports about 1% of the B12. However, there is some evidence from a recent observational study for an increased lung cancer risk in men who smoke and take high doses over many years. A prudent recommendation is therefore to take a lower daily dose of 10-50 µg. Some plant-based milks, such as soy milk, and other vegan foods may also contain added B12 and provide a sufficient dose if consumed a few times a day. It's a good idea to have your B12 levels checked occasionally, but also MMA (methylmalonic acid) levels to rule out a false negative for B12 deficiency.

Vitamin K2

Vitamin K2 might be the most neglected vitamin worth supplementing, with evidence for numerous benefits, including skeletal and cardiovascular health and prevention of cancer. There are several forms of vitamin K2. One form, MK-4, can be produced in the human body from vitamin K1, which is found in various plants such as leafy greens. Other forms, most notably MK-7, are made by bacteria during fermentation. The conversion of vitamin K1 into vitamin K2 in the body is probably not sufficient to obtain optimal levels, and there are very few plant-based sources of vitamin K2. Fermented sources like sauerkraut have low levels, and the only reliable plant source with high levels is a Japanese food called “natto”, made from fermented soybeans. Unless you have a ready source of natto and enjoy the apparently peculiar taste, it is recommended to take a daily dose of 100 µg of vitamin K2 daily.

Creatine

Creatine supplementation is not strictly necessary for good health, as the body can produce enough of it itself to avoid any serious consequences. However, vegans and vegetarians do have lower levels than omnivores, and there is clear evidence that supplementation can increase muscle mass and endurance, and possibly reduce depression and improve cognition. Given its low cost, consider supplementing with 5 g of creatine monohydrate daily.

Taurine

Taurine is a non-essential amino acid made by the body. However, it is not found in plants, and levels have been found to be lower in vegans. Higher levels might be helpful for various body functions, including endurance as well as mental health. It is not typically found in multivitamins. You could consider supplementing with 1 g/day.

Source: http://www.preventsuffering.org/eating/

Unfortunately the article doesn't provide citations, but here are a few references:

• Vitamin K2: https://examine.com/nutrition/supplementing-vitamin-k/, https://examine.com/supplements/vitamin-k/
• Creatine and muscle creatine and performance: https://journals.humankinetics.com/view/journals/ijsnem/18/4/article-p389.xml, https://europepmc.org/abstract/med/14600563. The latter article claims an increased effect in vegetarians, while the former article finds no difference in effect due to diet. Of course, creatine is a common supplement for muscle performance among omnivores too.
• Creatine and cognition: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1691485/, https://www.ncbi.nlm.nih.gov/pubmed/29704637, https://www.ncbi.nlm.nih.gov/pubmed/21118604 show increased performance boosts from supplementation in vegetarians than omnivores. Note that these studies are fairly small
• Creatine and depression: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1399-5618.2007.00532.x, though this is a small study and is not about vegetarians.
• Taurine and platelets: https://www.sciencedirect.com/science/article/pii/S0306987704002178

Answer 6

There is also a carnitine deficiency, the symptoms of which are less subtle.

Answer 7

According to research B12 is available in Tempeh, a traditional, Indonesian soy product which involves fermentation. B12 is produced by bacteria and archaea. (Good sources of B12 also include insects, which some vegetarians, but not vegans, may eat).