Vegan Nutrition with Martey Davey

Marty Davey is a Registered Dietitian and has a Masters degree in Food and Nutrition from Marywood University. Currently, Marty is working on a book for elderly vegetarians/vegans discussing daily nutrition needs and including issues with acute and long term facility care when following a plant-based diet. A website is being built for Marty to further educate people about plant-based diets. She also has a private practice specializing in assisting clients transitioning from the conventional Western foods to a plant-based regime.

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My wife, my 9 yr. old daughter and I have been vegan for 9 years or so. We have tried to eat a fairly healthy diet- fruit, veggies, grains, legumes, fortified soy milk, daily multi-vitamin, etc. I had blood work done and had my vitamin B₁₂ level checked a year ago. It was in the low-normal range, 300 or so, and my wife's was much higher, 600 or so. My homocysteine was a little high, but still in the normal range of 11 or so. Everything else was great, cholesterol 136, everything else was perfect. Blood pressure perfect- 110/65

My physical health has been okay. I get sick once or twice a year with colds or flu. My wife has been sicker though&$+#8212;frequent upper respiratory infections, etc. Our daughter was the picture of health until the last year or so, when she has been sick a time or two. However, I have noticed a gradual decline over the years in our mental health. My wife is irritable, doesn't sleep well, angry, has anxiety, depression, etc. I have been slightly depressed and lacking in energy for a number of years and I often feel stressed, more than I should feel given the situation. I often feel overwhelmed at work.

Our daughter was great until the past year or two. Then, she started poor behavior, grinding her teeth at night and was more afraid than is normal for a child her age. She reverted to acting like a baby or small child at times, using baby language. She became more oppositional, refused to do what we told her, and lost her zest for life that she used to have.

I did lots of internet research on diet. We occasionally eat vegan junk food, but mostly we eat a varied, healthy vegan diet and use Dr. Fuhrman's multi-vitamin supplement. We have even been using his DHA supplement.

After doing some internet research, I decided that the vegan diet wasn't working for us and decided to eat some eggs and some yogurt. For the past week, I have added some free-range, DHA eggs and some Stonyfield Farms yogurt to my diet and I feel much better. I am much more motivated at work, I sleep better, I am less depressed, and my energy levels have gone up. I put some yogurt in my daughter's smoothie and she didn't grind her teeth that night, although she had been grinding her teeth at night regularly.

My question to you is what nutrient, vitamin or mineral do you think was lacking in our vegan diet? I have pretty much decided that the vegan diet didn't work for me and have decided to include a few animal products in my otherwise vegan diet so that I can maintain some sanity.

We tried to cover B-12, vitamin D, iodine, DHA, calcium, etc. as advised and to eat a healthy mix of fruits, veggies, grains, soy products and legumes. We thought it was the healthiest diet possible, but it turned out to ruin our mental health. I know that you don't have a complete nutritional analysis, but what is your best guess as to what the problem was?

This is a very interesting dilemma. I think you are a pretty smart cookie for all of the research you did. What I write below may be a little proletariat for you, but many folks have not done your research and need concepts spelled out. I dug out some textbooks to check my facts, but I used a Stanford University website for type of the verbiage written. I also need to thank my colleague, Kathy Voige, RD for her most helpful input. As soon as she gets a website, I'll mention it.

Adoning my Sherlock RD hat, the first thing I noticed was that the entire family had problems occurring around the same time. So, what changed? If it was a drain on a stored nutrient, the daughter probably would have had problems way before the parents since she has been on this diet since birth. She would have no stored nutrients. If it was just one parent and the daughter, I would throw in a supposition of metabolic differences. We all have different biochemistry. I need more meals than my husband. He processes fat better than I do. One of the parents may have needed more protein or a higher level of B₁₂ supplementation than the other. But, they all had issues as an ensemble routine. Dr. Watson, the game's afoot.

So, as I make my food detective deductions I look at what the clinical tests showed. I'm not sure which B₁₂ test was given. The gold standard is the MMA or Methlymalonic Acid test. It will indicate a B₁₂ deficiency, but not the severity. However, it was stated that B₁₂ was low, but not abnormal and homocysteine level was fine, albeit a little high. Note that the writer says nothing of folic acid intake, except for the multi-vitamin. A study of B₁₂, folic acid and homocysteine affects on depression stated that there may be a relationship with folic acid and homocysteine, but not B₁₂. The multi-vitamin may have covered the folic acid issue or not. A normal B₁₂ can mask a folic acid deficiency (You can skip the next to paragraph if you understand the B₁₂ ? homocysteine relationship.) .

When your B₁₂ is low, your homocysteine level will rise. Homocysteine is used by the body in small amounts. It is a neural toxin causing much nerve and cardiac damage when elevated. B₁₂ is what the body uses to convert the homocystiene into another protein. For your neural health, you want to maintain good B₁₂ levels. For vegans, I would ensure meeting this level by taking a B₁₂ sublingual supplement of 100mcg/day or 2000mcg/week. Sublingual means you let it melt under your tongue. Don't buy just any B₁₂ supplement, especially for children. Make sure it is a sublingual. Previous studies I have read stated to use sublingual. A search this week for updates led to two studies concerning sublingual. One pro, one stating it doesn't matter. I err on the side of caution.

The experiment for our questioning family to regain their health is to ingest dairy and eggs. Voila! The neural symptoms subside. The National Institute of Health reports that adults need 2.4mcg/day of B₁₂. An egg has 0.6mcg and yogurt has 1.4mcg/serving. This would increase your B₁₂ pretty quickly if you were deficient. Eating cereal or other products enriched or fortified with B₁₂ would add to the intake amount. This leaves me to think, B₁₂ may be part of the nutrition issue.

(I know I wrote to take 100mcg of B₁₂ and 100 is a lot more than the National Institute of Health's 2.4, but studies on vegans show this amount keeps us where we need to be. I don't want to write a book here.) But, not only did the egg and yogurt increase B₁₂ intake, it also increased DHA and albumin levels. Albumin is a plasma protein. This acts as a reservoir for amino acids needed quickly by the body. I know Geroge Eisman, RD and author of The Most Noble Diet, states it is almost impossible to have too low protein in your diet, but the egg and dairy, no matter what you think about them, are highly concentrated proteins. Maybe the family really needed a protein boost. Or perhaps a kick in the DHA. The writer knew enough to ponder DHA intake.

After playing my violin to clear my mind, I was led back to question what this family was eating. I didn't notice nuts or seeds in the list of foods. English walnuts, as well as flax seeds, are high in omega 3 fatty acids. Hemp seeds are another great source. You will also get some amount from sea vegetables, green leafy vegetables, wheat germ and canola oil. Why do I care about nuts or seeds? Omega-3 makes DHA (DHA is docohexanoic acid, for you fact-wonks out there). What does that have to do with anxiety and sleeping? Well, here's the scoop on how the oils work:

There are two oils that you must eat. Your body cannot synthesize them from anything. The first is the precursor, or maker, of DHA (that's the supplement mentioned in the original question). The precursor is called alpha-linolenic acid (ALA), the omega-3 we all hear about. You also need to intake linoleic acid (LA). That is the omega-6 family. You find this in sesame seeds, corn oil and nuts.

Let's look at how the conversion of ALA to DHA works. DHA is abundant in human milk, as long as mom's intake is sufficient. It is great at lowering heart disease and also used for the nervous system. According to Stanford University, DHA is the "most abundant fatty acid in nerve cell membranes and is thought to contribute significantly to the fluidity of the cell membrane. DHA is also found in the synapses between nerve cells and is thought to greatly aid the nerve cells in sending signals to each other." Our writer is quite correct in thinking that a low DHA level may be linked to his sleep deprived wife.

The writer also states that sometimes his family ate veggie junk food. Well, don't we all? But that junk food is usually high in omega-6 fats. Why does that matter? There is a ratio that needs to be kept between omega-3's and omega-6's. A 1:1 ratio is fabulous. A 4 omega-6 : 1 omega 3 is also fine. Unfortunately, most Americans have a 20 omega?6:1 omega?3. Ouch! The balance is necessary because these two compete for the same conversion enzymes in the human body.

By competing for conversion enzymes, I mean its like going to one of those places that convert VHS to DVD. You (omega-3) have the top 100 movies ever made recorded on VHS (ALA) and want to convert them to DVDs (DHA). However, as you park your car at the DVD Enzyme Converter Shop, a busload of 20 Girl Scouts (omega-6s) pulls up and they run ahead of you wanting to convert their favorite Hello Kitty! episodes and all six years of soccer practices onto DVD for their parents, who will be obliged to watch them all Christmas Day. The most you can get converted is Citizen Kane and It's a Wonderful Life (recording stops when George says, "You want the moon? Just say the word and I'll throw a lasso around it"). If the family was low in DHA, any high omega-6 knoshing added insult to injury by increasing the imbalance with the omega-6 to omega-3 ratio. Another insult would have been from any trans-fats eaten.

Trans-fats interfer with the conversion of ALA to DHA. Right behind the omega-6 Girl Scouts at the DVD Enzyme Converter Shop was a van of Transfats Little Leaguers with copies of Bad News Bears (thankfully, no sequels.) In this scenario, we never even get to hear Kane say the famous line, "Rosebud."

If the family weren't eating a DHA source, the supplement on which they were relying on could have been insufficient. Jeff Novick, MS, RD, writes that the daily intake of DHA should be 300mg/day. Dr. Fuhrman's supplement, (that's what the family was using) provides 175mg. You need to intake 125mg/day. Here is a website from Tufts University that shows how much omega-3 is contained in various food sources: Notice that many fish do not provide as much as flaxseed. http://www.tufts.edu/med/nutrition-infection/hiv/health_omega3.html. In spite of this, one must note that fish oil is DHA. The omega-3 from flax must be converted to DHA, so you need more flax than fish oil to end up with the same amount.

In re-reading the question, the writer states that he purchased eggs from chickens fed to produce a high DHA content, then symptoms subside.

Aha! I think I have found a path to the Dr. Moriarity of their imbalance. Folic acid, albumin and DHA are possibilities, although, not so elementary, Dr. Watson.

References:

http://www.ncbi.nlm.nih.gov/sites/... Jorm AF. (2005) Relationship of homocysteine, folic acid and vitamin B₁₂ with depression in a middle-aged community sample. Psychological Medicine, Apr;35(4):529-38.

http://www.ncbi.nlm.nih.gov/sites/... Yazaki Y, Chow G, Mattie M., (2006). A single-center, double-blinded, randomized controlled study to evaluate the relative efficacy of sublingual and oral vitamin B-complex administration in reducing total serum homocysteine levels. Journal of Alternative and Complementary Medicine. Nov;12(9):881-5.

http://www.ncbi.nlm.nih.gov/sites/ Sharabi A, Cohen E, Sulkes J, Garty M. (2003) Replacement therapy for vitamin B₁₂ deficiency: comparison between the sublingual and oral route. British Journal of Clinical Pharmacology. Dec;56(6):635-8.

Huntington's Outreach Program for Education. (2007) http://www.stanford.edu/group/hopes/treatmts/fatty/ao5.html

A common myth about the benefits of flaxseed oil

Disclaimer: The advice given here is for eductional purposes only. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider.

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