Most of the debate about whether or not people ought to be vegetarian is much ado about nothing.

Or rather, it’s much ado about nothing when it comes to your health provided that you live conscientiously.  It’s much ado about something when it comes to crafting your identity, making moral judgments about the treatment of animals, and perhaps indulging in a little bit of group identity.   Divulging what you eat is a digital novelty that keeps us coming back to the digital cocaine pellet dispenser.

But when it comes to what you actually ought to eat it doesn’t really matter if you completely eliminate meat or not.  It’s true that vegetarians live longer, have lower BMI’s and generally seem like healthier people.  But contrary to what they think, that has little to do with the soy dog they eat for lunch and mostly to do with the fact that vegetarians are just better people in general.

They exercise more, drink less, have more peaceful social activities, go hiking, call their grandma more often, attend meetups together, throw potlucks, wear cute PETA t-shirts, are civically engaged, care more about social justice, stand up for minority rights, graduate college, read Jane Austen novels, leave comments on each other’s blogs, and just generally do a better job of being the person you wish you could be if only you could muster that annoying esprit de corps that keeps them chugging along.

But when meat eating people take the time to act like vegetarians but still eat meat most of the observed health differences begin to melt away.  And occasionally having a nice cut of beef bestows some unique health benefits your herbivorous friends would have to jump through a kid-sized hoolihoop to replicate.

Of course this doesn’t mean being a vegetarian is a bad idea.  Or that going vegetarian wouldn’t be a good choice for lots of people.   Albert Einstein was vegetarian.  So was Nicola Tesla.  And Gandhi.  Bill Clinton’s busy looking like he does it except for when he eats Salmon and eggs on Saturdays (does that count?).  One of my best exes was a vegetarian, and I’m sure Kate Upton was at one point or another.

And hey, if Fauja Singh can run A MARATHON AT THE AGE OF 102 while being a vegetarian then certainly we should accept the precedent that people can healthily subsist on starch and tofu even if it chagrins you to give up your burger.

But contrary to some rhetoric, most vegetarian diets can default to nutritional states that’ll likely be lacking in one way or another even if close rules are followed.

No, not in a way that’ll leave you anemic and malnourished or obese. And probably not in a way that’ll leave you in worse shape than if you hadn’t gone vegetarian at all (you Dorito loving heathen you).

But it can be easy to subtly veer off the track, even if that same diet left you feeling like a bottlerocket when you woke up in the morning when you first started doing it.

The Deficiencies That Aren’t

But before we go into what a vegetarian diet might lack let’s make sure we cover our bases about the most common accusations that were never really true in the first place. (At least not for anyone living on this continent for the last 117 years).

Protein Deficiency.  

This is probably the most common complaint about vegetarian diets and the one with the least validity.  People seriously underestimate how little protein you need in order to maintain yourself.  And contrary to popular perception most vegetables DO have a high protein content on a per-calorie basis.  It’s just that their caloric content is so low that you’d have to eat the equivalent of a small dump truck of lettuce to get what’s available in a strip steak.  But it’s an uncontroversial fact that practically every natural food will contain protein (protein is by definition the molecule that’s used to build cells) and so long as you’re eating a sufficient amount of calories to keep yourself full then even a daily feast of potatoes, rice, beans, salad and kale chips will provide you with at least the 50 grams you need to survive.  Protein deficiency has been non-existent in the western world for at least the past 50 years.

(Another way to see how silly the notion of protein deficiency is:  Ask yourself:  “Who do I know or know of in my entire adult life that suffered serious medical complications because of a lack of protein?”

Now ask yourself:  “Who do I know that’s suffering from heart disease, stroke, or type II diabetes?”)

It’s not the protein that’s the problem.

Iron Deficiency (Sort of).  

This one’s a little more of a grey area.  The most elegant way to put it is that vegetarian diets do provide fair amounts of iron but it’s not as well as absorbed as the iron in meat so vegetarians have to get more of it to satisfy their daily needs.  The iron from meat is heme iron, the iron from vegetables is non-heme iron.  Heme iron makes its way into your body more efficiently than non-heme, and the best kind of heme oozes out of the foods vegetarians loathe the most: succulent, bloody, red meat.

But the “good” form of iron is a double edged sword because some people have a genetic tendency to hoard it, and too much iron is just as big of a problem as too little, and if your cells are packin’ away the heme for a day of scarcity that never arrives you could end up singing a sorry tune because excess heme deposits interfere with healthy cell growth and mitochondrial functioning.

The typical American probably gets more heme iron than is good for them.

And even though vegetarians might have slightly lower intakes of iron over the long term, there’s good reason to believe that your body adjusts to this shortcoming over time and begins to use it less and get better at extracting it from the food you eat.

Calcium

“Milk Makes Strong Bones” has been a popular catch phrase for the dairy industry for several decades now, but the truth looks like raw amounts of calcium intake isn’t as important for your bone health as calcium balance, which depends just as much on how much calcium is secreted out of your bones as there is calcium coming in through your diet.  Calcium absorption and resorption usually requires a wide variety of nutrients that are usually only present in the right quantities if you’re eating right (regardless of how much milk you’re drinking).  People who have healthy diets typically have adequate levels of calcium.

And it’s a little secret that lots of vegetables are very good sources of calcium.  Milk is far from the only viable source.  Most epidemiological studies suggest that lifelong healthy vegetarians are actually more likely to avoid osteoperosis than omnivores.

Here’s a useful graph that compares lifelong animal protein intake and the rate of bone fractures throughout most of the world:

Remember:  it’s being overweight, not being vegetarian, that puts you at risk for bad bone health.

The Shortcomings That Matter

So we know at least a good deal of the conventional wisdom surrounding vegetarian diet insufficiency is bunk.

But where exactly can the wheels start to come off?

There are five critical nutrients that at least some vegetarians or vegans need to be aware of if they want to sustain the diet over the long run.

Vitamin B12

Vitamin B12 is a substance made by bacteria that your body needs in teensy-weensy quantities in order to keep on going.  What’s tricky is that the substance is only stored in animal cells and not plant cells.  Some sea vegetables and fermented foods can make a crude version of it but at the end of the day it’s just not the same thing.

The truth is that no plant foods are a reliable source of B12.  None!  

That might sound dire, but the situation is less serious than you think.  Your body needs trace amounts of it to survive and if you were to deliberately starve yourself of any and all access to B12 it’d probably be close to 3 years before you started to show signs of deficiency.

Your body uses it very well, and even has an ample working supply of it camping out in your colon that’s just out of reach.  The cruel irony about vitamin B12 is that every time you go to the john we regularly dispose of more than enough to keep us going for months.  But the B12 in your colon is just south of where our bodies can actually use it so we can only ironically waive “buh-bye!” as it leaves us and try and get enough through our diet.

Even McDougall (a staunch advocate of the vegan diet) has come out and said most vegans should take a B12 supplement.

There’s no need to get picky with a particular brand.   Practically any one will do. Vegetarians can likely go years without having to take one, but if you’re a vegetarian for the long haul then it’s a good idea to plan on taking B12 at some point.

DHA

DHA is an “essential” fatty acid which means you have to get it through your diet because your body can’t make it on its own.

It’s very important for infant development, regulating inflammatory pathways and cognitive function. Your brain is about 10% DHA by weight.  People who don’t get enough of it are at-risk for deteriorating mental conditions later on in life and DHA deficiency is fairly common among the elderly with cognitive disorders.   Vegetarians frequently have a hard time getting enough DHA.

To be fair there’s not a lot of hard evidence that shows lower levels of DHA hurt vegetarians.  My guess is that because vegetarians are healthier people in general they maintain good health despite not getting very much DHA and not because of it.

A common chestnut about DHA is that your body can transform other fatty acids into it so getting similar fatty acids like ALA will suffice because they’re omnipresent in the vegetarian diet through a variety of nuts and oils.

Not quite.

It’s technically true that your body is capable of doing this, but the process isn’t very efficient and for most people the conversion rate from ALA to DHA is 4-5% and for some people it can be twice as less.  The conversion process also requires a variety of other vitamins and minerals to take place and if you’re lacking in any of those then your body will get roadblocked.

The best food source to get DHA outside of an animal product is through seaweed and algaes.  If you eat those regularly then great.  But most sea vegetable recipes are right there with kale recipes in the “Dishes I’ll fawn over on Pinterest but never actually eat” category.

Fish oil is the most common supplement form of the product, but you can also get DHA that’s extracted from algae if you wish to avoid animal products in your supplements.

Creatine

Creatine is a poorly understood nutrient.  Your body makes it so it’s not considered essential and usually isn’t included in multi-vitamins.  It’s most popular with bodybuilders so any package you see for it usually has a scary looking, barrel-chested, lubed-up hercules with who’s staring right at you with bulging eyes and claims of getting MAX GAINS from your time at the gym.

Don’t let that fool you.  Creatine is very important, and not just for someone who uses Barry Bonds as a workout role-model.  It’s chief function is to load your cells with phosphorus which can the be used to make ATP.  Fatigue, motor function, and mood regulation are all aided and abetted by creatine.

Its effect on the brain is similar to serotonin, and in some cases it’s been shown to help alleviate depression for people with acute conditions.  It helps brain function in a variety of ways and in severe cases people who can’t create it often suffer from a form of mental retardation.

And while it’s true that your body can make it on its own, it’s also true your body’s ability to make it internally is fairly sensitive and usually only sufficient for about half of your body’s daily needs.  Creatine is exclusively stored in the tissue of animals so if you’re vegetarian you’re not going to get it by what you put on your plate.

Most vegetarians aren’t technically deficient in creatine, but they do typically have permanently lower levels than omnivores, and taking a creatine monohydrate powder usually results in your muscle’s holding more of it.

In fact, creatine supplementation seems to have a much more pronounced effect on vegetarians than omnivores, especially for performing mental tasks.  There have been quite a few double-blind, placebo controlled studies that demonstrate ample cognitive improvements in vegetarians when they take creatine.

Be aware that it does cause your body to hold more water so if you take a lot of it (consistently more than 5g/day) you might end up gaining water weight.

There are a lot of “high end” creatine supplements that purport to have unique benefits but these are either a waste of money or for bodybuilders looking for a competitive advantage.  Most creatine comes in a powder called creatine monohydrate and most likely any powder in this form will do.

You can get it on Amazon for $20 for a 2.2lb tub.

Is there a particular dosage you should look for?  Unless you have specific performance goals  it probably doesn’t mean much, but 2-5g is the standard dose for lightweight creatine users .  Feel free to mix a scoop in with a smoothie or other drink a few times a week and that’ll suffice.

L-Carnitine

L-Carnitine is another molecule that’s associated with improving workout performance and thus overused by athletes and underused by everyone else.

For vegetarians getting L-Carnitine is possible through nuts and seeds but these foods carry the pseudovitamin in much smaller quantities than red meat.  Your body synthesizes creatine by itself and uses the amino acids lysine and methionine and for many people, including most vegetarians, there’s no need to supplement with L-Carnitine at all.

However, vegetarian diets might not always supply the necessary substrate to continually synthesize carnitine at optimal levels and vegetarians typically have lower levels than omnivores, although it’s very rare for people to have a deficiency because your body produces it already.

L-Carnitine is important for mitochondrial function and energy utilization, and not having enough contributes to the feeling of drag you get 5 hours after you’ve had your morning cup of coffee.

Regularly supplementing with carnitine is not necessary for most people.  But occasionally taking carnitine is a good idea for vegetarians, especially among the elderly, who are more likely to be unable to synthesize it in sufficient quantities on their own.

Does This Mean You Can’t Be Vegetarian?

Saying such-and-such eating might require a supplement from time to time isn’t the same thing as saying you shouldn’t eat that way at all.

Taking any of these moderately on an “Oh, hey…..I read somewhere that I ought to take that” basis will be enough for most people.  And there’s no reason to worry about particular brands.  All of these are perfectly suitable to be taken with the cheapest bottles you can find at WalGreens or on Amazon.

But there’s no reason to think categorically shifting the way you eat won’t alter your nutrient consumption in ways that might have to be modified *ever so slightly* from time to time.

The specific forms and dosages of these vitamins are summarized in the following table:

[table id=15 /]

Have a nice day!

References

Chang-Claude, Jenny.  Lifestyle Determinants and Mortality in German Vegetarians and Health-Conscious Persons: Results of a 21-Year Follow-up.

Chang Claude J, Frentzel Beyme R. Dietary and lifestyle determinants of mortality among German vegetarians.

Bastide, Nadia.   Heme Iron from Meat and Risk of Colorectal Cancer: A Meta-analysis and a Review of the Mechanisms Involved.

Feskanich, Diane.  Protein Consumption and Bone Fractures in Women.

Sanders, Thomas.  DHA Status of Vegetarians.

del Favero, S.  Creatine but not betaine supplementation increases muscle phosphorylcreatine content and strength performance.

Nasrallah, F.  Creatine and creatine deficiency syndromes: biochemical and clinical aspects.

Benton, David.  The influence of creatine supplementation on the cognitive functioning of vegetarians and omnivores.