Vegan Blog Going On Holiday & 3 Most Popular Posts

While my posts have been sporadic at best over the past 7 years, my blogging efforts for the months to come will be found elsewhere.

For those of you who just stumbled upon this blog, here are the 3 most popular posts over time:

The #1 Favorite: How Can Vegans Be Overweight?

Eliminating animal foods is one step in a healthy direction, but for many it's not the only step that is needed. This post explores a few reasons why people eating a vegan diet can still struggle with their weight. So what to do if you're still struggling? Find a vegan-friendly dietitian to work with and consider slowly picking up serious weight training or running. If that fails, a lifestyle medicine doc might be a good ally.

Many people write looking for a vegan-friendly PCP or Lifestyle Medicine MD. Some potential leads are here:

http://www.lifestylemedicine.org/search
http://www.pcrm.org/
https://eu-lifestylemedicine.org/member-directory/

The #2 Runner Up: Why SOME People Struggle With A Vegan Diet

Each year, tens of thousands of people are inspired to go vegan out of deep concern for animals, the environment and their health. Sadly, the majority of those return to a regular diet of animal foods. Yes, it can be hard to not eat like everyone else and the effort of going out of your way to find vegan options can become hard to sustain for many. But some don't feel they are thriving on a vegan diet. Why is that? It's a topic that's almost never discussed, but one I encounter in clinic periodically and explore in this post. And no, the answer is not because we need to eat meat or combine proteins!

From my clinical experience, the first issue mentioned in this post - not eating enough calories - is the most common problem and is one that can be easily addressed if recognized. The common pattern is someone who switches to a vegan diet, loses a few pounds, feels fantastic at first but as the weeks and months go by they continue to lose too much weight or feel fatigued. Essentially, they need to learn how to eat more calories and monitor for weight periodically.

Dr. Furhman, one of the few docs with extensive clinical experience in this realm, also cites a need for some of his patients to supplement zinc, DHA/EPA and in rare cases possibly taurine, iodine, vitamin k2. Dr. Greger cites a rare Carnitine deficiency caused by a genetic disorder that might be unmasked by a vegan diet here. These are worth considering if other measures fail.

While cutting out a good 1/3 to 1/2 of your diet and replacing it with plants requires some learning for most people, it's definitely a doable (and highly worthwhile) challenge. But for those who struggle, don't revert back to the standard awful diet that is the norm. In the least, eat as many vegan meals as you can during the week and you'll be making a great difference in all realms. Sometimes, compromise is the answer. Adaptation takes a different time course for us all.

The #3 & Original Post: The Fears Of A Suspecting Vegan. Answered. 

Having been vegan for about 24 years, I have encountered innumerable health concerns borne of fear and propaganda along with every possible iteration of "You're vegan?!? Well, where do you get your protein/nutrients/vitamins/etc?". That inspired me to start a blog for some general responses. In this first post, I tried to spell out from my vantage point which things do actually warrant some attention. There's no reason to have fear on the menu, but there are a few important nutritional items those on a vegan diet should head. The list is much longer for those not on a vegan diet, and those can be found elsewhere.

Want More?

I highly recommend Dr. Greger's site - NutritionFacts.Org

Thanks Thanks Thanks!!!

Thanks to you for taking time to read my blog and share both feedback and your appreciation. Can't say how much that has given me over the years. Eventually, I'll get back to blogging more on these and other related topics.

But for now,
Much love to you all,
And thank you for all you do to make this a better world,

Mark

Iron Status - Vegan Style

Here's a helpful guest post by Evelyn Pearce on achieving optimal iron status.

Some take homes:

• Vegans can have optimal iron status
• Iron from meat (heme-iron) might be a causative factor in the link between meat and many chronic  diseases
• Being conscious about eating healthy whole plant foods usually means including an iron rich food at each meal
• There are a few little food tricks that can boost iron absorption which might be important for some people... read on to learn more... 

Demystifying Iron: Why Vegans Can Have Optimal Iron Status

A vegan diet offers many health benefits. It is lower in calories and saturated fat, yet high in antioxidants, B vitamins, potassium and fiber, all of which reduces your risk of heart disease. There is also growing evidence that those who avoid or limit their intake of animal produce are less likely to develop diabetes and cancer. As all three medical conditions are highly prevalent in the United States and other industrialized countries, this can only be a good thing. While the advantages of a vegan diet for your health are well recognized, worries relating to potential nutritional deficiencies are one of the barriers standing in the way of more people adopting a completely plant-based diet.  It is true that you can develop particular vitamin and mineral deficiencies on a vegan diet, but equally this can occur if you eat meat or other animal produce. The key is ensuring you include the right balance of foods whichever dietary approach you choose to adopt.

The question of iron

However, when people hear you follow a vegan diet, one of the most common things they assume is that you must be anemic. It’s still a widely held belief that avoiding all animal produce will leave you deficient in iron. As any vegan with a good awareness of nutrition knows – which to be honest is a lot of us – there are a variety of plant sources of iron and obtaining adequate iron through our diet is easily achievable. We just need some forward planning, but then everyone should be putting thought into their meals irrespective of whether they eat meat or not.

Admittedly iron deficiency anemia is a relatively common in America, with figures showing that it affects around 9% of women under 50 years of age. It’s not a pleasant condition; you’re left extremely tired, as your blood is unable to carry sufficient oxygen, which makes even day to day activities difficult. However, research suggests that vegetarians are at no greater risk than non-vegetarians of developing this form of anemia. While less well studied in vegans, the National Institutes of Health doesn’t identify us as an at risk group for iron deficiency anemia. However, it does suggest we may need twice as much iron as meat eaters to prevent deficiency, though more on this point shortly.

Vegan source of iron
When relying solely on plant produce for iron, there are a number of key foods that provide this; though as a matter of following a vegan diet, they are probably included already. Pulses (peas, beans and lentils), wholegrain cereals and those which have been fortified with iron (which many are, so check the label), tofu, green leafy vegetables like kale, spinach and cabbage, dried fruit and seeds are the main providers. We should ideally be including at least one of these foods at each meal and consider the likes of cereal, dried fruit and seeds for snacks.

A matter of absorption
As hinted previously, the iron in plant-based foods is not as well absorbed as that from meat and fish, which is why we need to consume more iron to ensure our bodies receive sufficient. This relates to the fact that the iron present in the two sources is slightly different, with that found in animal produce more readily available to the body. However, we can take steps to increase our uptake of iron from plants.

• It’s well-known that vitamin C increases absorption of iron by converting the iron in plant foods to the more favourable form, so a source of the vitamin should be included with meals. Good sources of vitamin C besides citrus fruits include berries, kiwis, peppers, tomatoes and green vegetables. 
• Meanwhile the tannins and polyphenols found in tea and coffee make it more difficult for the body to take up iron if these are consumed near meal times; try to avoid them for an hour either side of meals to give your body a better chance of iron absorption. 
• Phytates, which are found mainly in pulses and wholegrains, also reduce iron absorption. However, as these foods are also a source of iron, you should not avoid these in your diet, but instead concentrate more on increasing your vitamin C intake and avoiding tea and coffee near meals.

Health benefits of non-heme iron
Obtaining your iron from plant sources (known as non-heme iron) in contrast to that derived from animal flesh (heme iron) could be a healthier option according to research. There is increasing evidence that heme iron encourages production of free radicals - damaging substances that cause injury to cells and are implicated in the development of heart disease and cancer. This may explain why meat eaters have been shown by studies to have a higher risk of heart disease and bowel cancer than those who avoid it. Research also suggests that consuming heme iron increases the risk of developing diabetes; this condition of impaired glucose metabolism is certainly less common amongst vegetarians and vegans. As non-heme iron is less readily absorbed, it is unlikely that iron stores will accumulate; it is these high iron stores which have been linked to increased susceptibility to chronic diseases.

About the author:

Evelyn Pearce is a freelance writer and mother of two, who when not at her keyboard or minding the children, likes to take her German shepherd for a walk in the hills around her home in Red Oak, Iowa.

Why SOME people struggle with a vegan diet

Is a vegan diet for everyone?

If consciously crafted, a vegan diet has profound health advantages and allows us to best care for our environment and live in alignment with our innate compassion. So yes, a type of vegan dietary pattern could be ideal for the vast vast majority of humans. And yet, we can't deny that some people (read: the minority) struggle to make a vegan dietary pattern work for them.

Why do SOME people not thrive on a vegan diet? And what can you do about it.

Frankly, this question hasn't been well researched and is poorly understood. But here are a few hypotheses that are worth considering if you or someone you know is not doing well on a vegan diet.

1. Not Enough Calories

One great advantage of a vegan diet is lower calorie density.  People often lose weight when they go vegan. This is super awesome for the majority of people, but not necessarily for relatively-thin, highly-active young people who are also very health conscious. Chances are these people have less appetite-drive and don't absorb calories as well as others. They probably avoid food when they are anxious/stressed and avoid binging on calorie-rich foods. They tend to choose the least calorically dense foods possible because these are healthier - like raw veggies and brown rice.

For some of these folks, they simply will not always be meeting their caloric/energy needs and they might feel more fatigued then usual overtime. Perhaps this is the brain's way of saying "slow down, there just isn't that much food around to support all this extra activity". They might feel better when they return to eating animal products, simply because they begin eating more calories and have a less restricted diet.

Rather than adding back the animal products, a better solution is do some creative meal planning and figure out ways to add back the missing 500 or so calories. There are lots of ways to do this, from emphasizing fat rich foods (e.g avocado, nuts, seeds, coconut) to making food more dense (e.g. smoothies, dehydrated foods/food bars, nut butters, dried fruit) to even sometimes choosing more processed foods (e.g. white rice) and including more protein-concentrated foods (e.g. seiten).

2. Junk-Food Vegan

On the opposite side of the coin is the junk food vegan that lives off vegan pizza, tofutti, french fries, soda, vegan cupcakes, etc. This we know: just because it's vegan, doesn't mean it's healthy. Believe me, I <3 my vegan junk food on occasion. But the problem here is no different from the standard american diet: you are crowding out the nutritious life-sustaining food and stuffing yourself silly with crap.

3. Social Isolation Syndrome

It amazes me how poorly we appreciate the effects of social isolation. Watch this video to see how physiologically powerful physical and social isolation can be. Being vegan doesn't mean you have to be socially isolated, but for a few it can make them feel more isolated. This is not a recipe for optimum health.

Early adopters have to cope with a little isolation, but one idea how is to cultivate a greater sense of compassion for human-animals who eat other animals. They are just as flawed as you are and there's no reason they can't be your friend, share meals with you, be your lover, etc. In fact, if you really want to influence the world, the more you hang out with these creatures the better. (unless of course you're a miserable conspiracy-lover who refuses to shower and thus has the effect of decreasing the odds that other people will move to a vegan diet. Apologies for the rant.) 

4. It's Not The Food

Food makes a huge impact in health. Ok. But just because you're vegan doesn't mean that really bad stuff can't happen to you. And it doesn't mean that every health problem you have has something to do with your diet.

Genetics, horrific bad luck, mood/psychology, drugs, infections, and many other factors can trump diet. It's always wise to considering whether your diet caused the problem or can contribute to healing it, but you've got to be open to the idea that it might have nothing to do with what you eat.

Also remember that many people became vegan because their health was not optimal to begin with. Those same underlying issues might not go away on a vegan diet, and some might get worse over time.

5. Unmasking Effects & Rare Genetic Disorders

Changing your lifestyle can, in rare cases, unmask hidden problems. For example, fructose malabsorbtion - a not too uncommon issue whereby eating concentrated fruit sugar causes irritable-bowel like symptoms and is associated with depression. If you suddenly start eating fruit-juice sweetened desserts and more fruit and fruit juice, then these symptoms will get worse. The solution is a plant-based diet that favors vegetables over fruit and avoids concentrated fruit sugar and juice and minimizes refined sugars.

Another example is diabetes in a long-time Atkins-style eater. If you eat no carbohydrates but are very overweight and have insulin resistance, switching to a more carb rich plant-based diet may initially make blood sugar control worse.  The answer is weight loss, avoiding processed carb-rich foods, eating only healthy fats, exercise, minimizing/moderating fruit, along with a high-fiber vegan diet.

Finally, there is also at least one type of rare genetic disorder involving carnitine transport which can be mitigated by carnitine-rich foods (i.e. meat). However, this is better treated with high dose carnitine supplements then with meat. Dr. Greger has a great post on this. 

6. Under Supplemented

Yes, it would be ideal if we got all our nutrients from our diet. Frankly, there are just some cases where this is not possible (vitamin D, vitamin B12). And there are some individuals who need higher levels of some nutrients (iron, zinc, omega-3s) because they don't absorb them well for whatever reason. This is true for meat-eaters too.

Sometimes, you've just got to add some supplements to your diet. Some vegans have a ridiculous hang-up about taking an "unnatural" supplement. While I applaud their idealism, they are doing themselves and our movement a huge disservice.

People ask me what I take: Vitamin D 1000 IU to 2000IU with food (most days, but especially in the winter); B12 (I buy a bottle a few times a year to boost my body stores); occasionally I get paranoid and buy a bottle of algae-based DHA/EPA. And I regularly eat some nutritional supplements: flax oil, fortified soy milk, chia seeds, flax meal, hemp seeds, nutritional yeast, marmite (because I was born in South Africa and it's delicious ok!).

At the same time, I'm super skeptical of the functional/orthomolecular medicine folks who advocate massive supplement regiments to cure everything.

7. High-Fiber Exercise-Deficiency

We did not evolve to blog. Or read blogs or work at a desk. Sitting is one of the worst things for your health, and we do it all day. My sense is that our guts function way better when we are regularly active and that exercise becomes even more important when you increase your fiber intake.

A very high-fiber diet with a sedentary high-stress lifestyle can set you up for a lot of bloating and gas pain. The solution is daily movement/exercise and plenty of water.

8. Beat By Cravings

Our understanding of cravings is amateur. Just because your brain craves something doesn't mean you have a deficiency. Craving chocolate does not mean you are magnesium deficient. Craving meat does not mean you are iron deficient and need to go back to killing animals for sustenance.

It's not to say that cravings can't have true information embedded in them, it's just that it's complex. For example, we make psychological associations with food. When we are stressed, we seek comfort, and food is one way to get comfort. Thus when stressed I might crave my comfort food, not because I need the nutrients in the food but because I need to be comforted. Your comfort food is probably different from mine - not because we have different blood types (or other such nonsense) but because of the different exposure to comforting food we had as kids.

Another random psychological nuance: the more one tries to avoid thinking about something, the more likely one is to think about it. If you are obsessed with avoiding meat, you are more likely to think about it and to crave it. We are funny creatures that way.

One last example, dissection lab -- the formaldehyde has been known to illicit cravings for meat. You can imagine how disturbing that is to an unaware vegan med student, on many levels.

Point being -- cravings are complex and often misinterpreted. Take them with a grain of salt. Roll with them and focus your attention elsewhere when the craving defies common sense.

What Else? & What if My Problem isn't on this list?

This is not an exhaustive list, and admittedly it is a list of hypotheses, but chances are the reasons people don't thrive on a vegan diet are fairly small in number and have a feasible solution if there is a will, an understanding and a few good measures of creativity.

Sometimes it can be hard to figure out (or you lack a doctor who can help you figure it out), and sometimes adding back some animal-products seems to make the difference and provide a sense of well-being that was missing. In that case, think of the animal-products as supplements - not to be eaten at every meal, but in the smallest dose possible. You'll still be eating a predominantly plant-based diet and doing a lot for your health and the world.

Obesity and The First Law of the Jungle

Check out my first blog on onegreenplanet.org

Obesity has to be viewed through many lenses.

The first is "the population lens". We have to understand that weight gain is happening to almost everyone around the world. It's happening because we are biologically programmed to consume food when it is available to us and the food that is now available is more plentiful and energy-dense then ever before in history.

Read more here. 

Vegetron in the works: Software Engineer Wanted!

Wanted: a capable and passionate, software-engineer co-founder  

There is an urgent need to change the way people eat 

Global meat consumption is skyrocketing and so too are the epidemics of obesity and other chronic diseases caused by a meat-centric diet.

To what extent can the internet and the emerging tools of social-gaming help? That's the question I'm exploring in my latest project: vegetron.com.

Vegetron helps people master vegan meals and healthy living

Vegetron is for the vegan-curious and vegan-savvy folks who want to improve their health and do something good for the world at the same time. Vegetron will help people master the basic food and lifestyle skills needed to thrive in the modern meat-centric world.

Fun and easy

Our goal is to make the process of learning (and sharing your own knowledge) about food and lifestyle more fun, more social and more effective. Designing game and social layers into the experience can help us do just that.

The ideal dev partner

Vegetron has enormous potential, in part because it is tackling an extremely challenging problem. So I'm looking for a partner who's skilled at transforming an idea into it a tangible product, realizing there will be many hurdles to jump over along the way.

I seek a talented software engineer who shares a passion for improving health and making the world a better place, who understands the world of game mechanics and dynamics and appreciates human-centered design. Ideally, you live near enough to or in San Francisco and are available to start working part-time now and full-time in January.

If you know of anyone who might be interested in joining our team, please contact me at: mbermanmd@gmail.com 

My NAVS 2011 Talk

I promised I'd share slides from my talks at this year's NAVS Summerfest. Here's the first talk - a background primer on the internet, the importance of social networks, how ideas spread, and why online social games are the next hottest trend... And why the vegan movements needs to jump all over online social gaming.  

Vegan Social Gaming Talk

Soy Concerns?

I get asked about Soy a lot. Is it safe?  

The short answer is yes.

• Assuming you don't have a soy allergy, moderate consumption of soy is likely to improve your health rather than diminish it. 
• As with most foods, highly processed varieties of soy are probably less healthful than less processed varieties. 
• And just as common sense would dictate, basing your diet exclusively on soy is not the best idea, mostly because it will crowd out a large variety of health promoting fresh fruits, veggies, nuts, seeds, whole grains and other legumes.

If you're interested in this topic, I strongly suggest this great post by vegan dietitian Jack Norris,RD who does a wonderful job summing up studies addressing the potential harm from eating soy.

Avoiding isolation... Influencing social norms

In this post we talk about the need to avoid social isolation and help change social norms.


Let's start with some basic questions:

In North America, why are so few people vegan?
And why are there many people who claim to be vegetarian, but actually eat meat?

The answer to both questions has a lot to do with social norms.
The dietary social norm in America is to eat and enjoy meat, milk and other animal-based products. The vast majority of people in wealthy nations follow this same social norm. And even those who identify with another dietary ideal (e.g. being vegetarian), often still follow this same social norm. Why?

Social norms are incredibly powerful.

Science is gradually waking up to this realization. Sure, we've known for ages that children learn by mimicking others. And we're quick to point out that most people follow trends and behaviors blindly "like sheep", victims of fashion and gadget fads. Strangely, we forgot to notice that even "free thinking and independent" adults cave-in to powerful social pressures, which have a measurable impact on our health and well-being.

Nicholas Christakis, a physician-scientist at Harvard Medical School, along with his colleagues has demonstrated this nicely with several recent studies. One study examined the evolution of a large social network over 30 years in the famous Framingham Heart Study - which revealed that obesity actually spreads through a social network the same way that an infectious disease might spread - i.e. through close contacts and friends. The take home here was that the health behaviors that lead to weight gain are in effect contagious. Ultimately, people do what their friends do because they want to be "normal."

((More recently Christakis and colleagues demonstrated that your happiness is actually influenced by the happiness of your friend's friends. (This by the way is one reason I left Boston and moved to San Francisco!) In other words, emotions are contagious.

More on Christakis's work: an Edge interview; NYT article on happiness study; NYT on spread of obesity))

If you really stop to think about it, you will be forced to agree that the way we think is profoundly influenced by others. The vast majority of what we "know" is knowledge told to us by others. Our language is a product of how those around us speak. And so to our actions. More often than not we do what other people do.

So, it's really not surprising that most Japanese eat Japanese food, that Americans eat very similarly to each other, and that Europeans typically gain weight when they move to America. Social norms exert influence on all humans to some degree.

On vegans and social norms:

Vegans are different. It takes a certain kind of person to be able to say "I don't care what most people think or do, I'm going to do what I think is right and best, even if that makes me different and weird in the eyes of society."

Many vegans, at least those who were not raised as such, share this characteristic. I'm not trying to say that all vegans are the same. Far from it. But by nature of the current dietary social norms, to be vegan is to choose to be different.

My concern is that for some (if not many) vegans, being different from the rest of society lends itself to a certain amount of social isolation. This social isolation may have some costs that we should understand and mitigate. Costs that are probably less than the benefits but which may need to be managed.

Even more importantly: learning to minimize social isolation may be the best tool for helping us change the current societal dietary norms.

On eating and social isolation:

Food is central to almost everything we do. Sharing food is incredibly important for social bonding and maintaining relationships (be they business, intimate or plutonic). This is why saying "no" to eating someone's food (say because it's steak and you're vegan) is often interpreted as a personal rejection even when it's rationalized.

Does this mean vegans can't have close non-vegan friends or are destined to be lonely? Of course not. Many of my closest and dearest friends eat meat, and they readily support my vegan-ness in any way they can.

Still, one can't help but feel a little isolated when you're eating with friends at a restaurant and everybody else is merrily sharing chunks of animal flesh, talking about this great steak they ate last week and you are in the corner eating something scrumptious but different, sharing only with yourself.

My point: as a vegan, a certain amount of social isolation is unavoidable if you are living among and with omnivores. We can pretend this isolation is minimal or doesn't exist, or we can explore it and learn how to mitigate it.

The cost of social isolation

Is it possible that the cost of social isolation, even if it's subtle, includes decreased health?

Perhaps. It has always seemed curious to me that studies among vegetarians and vegans who are not shunning the social norm - for instance, among large populations of Seventh Day Adventists (SDA) - demonstrate consistent and marked health benefits compared with SDA's who eat meat and other animal products. Whereas there is more variability in the results of studies that assess vegans or vegetarians who are living mostly among non-vegetarians (generally the results are positive, but not often as robust as we'd expect).

Of course, there are many other reasons why epidemiological studies may not show as large an effect (or even no effect) of a vegan diet compared to non-vegan diets. These reasons include methodological factors (e.g. poor sample size, study design, etc.) but they could also be from unknown confounders. (see definition at end*)

Some of these confounders include poor mental health, shunning of other normal health practices (like going to the doctor, or taking vitamins or medication when prescribed), the inability to self-deceive (this is a fascinating concept, perhaps a topic of a future post, but in short people who can pet their dog with one hand, eat a chicken with the other are good self-deceivers. good self-deceivers do better in business and probably in health as well; i.e. in part it's the ignorance is bliss phenomenon), or other genetic or behavioral factors that may be linked with the personality-type that allows people to shun social norms.

Furthermore, social isolation may have a significant impact on whether someone can maintain a vegan/vegetarian diet. I've met hundreds of people who "used to be" vegetarian/vegan. Why did they return to a meat centered diet? "It was too hard." "I felt better when I started eating meat again." "I missed cheese." etc. Some of these folks were experiencing the side-effects of social isolation and how difficult it is do shun the social norm. (As well as some of the addictive properties of animal-foods, but that's for another post!)

Please keep in mind that this is simply an emerging thesis I am describing; one that I think deserves attention and study, but to my knowledge lacks investigation.

Minimizing isolation, changing the social norms:

Think about the small but meaningful changes we have seen in the last 2 decades. Soymilk - once an obscure drink to North Americans - is now mainstream. When a good restaurant served salad it used to be iceburg lettuce, now it's mixed field greens. Tofu and veggie burgers used to be something to make fun of, now it's a question of preference. In a small crowd, foods like quinoa or tempeh will not be new to everyone. Even the word vegan is relatively mainstream and usually no longer denotes someone from an alien planet.

If you've been paying attention, you'll notice that knowledge of these words has spread throughout society and that enjoyment and preference of "new" vegan foods has spread alongside.

How did this happen? It happened because people like you and me decided that it's normal to eat these foods. We purchased them and essentially financed their existence. Other people did the same. Still other people paid attention (consciously or not) to what we were eating, and decided to take a chance on something new. Knowledge and behaviors spread.

The same phenomenon happens in reverse. Red meat, and especially veal, consumption has slowly but steadily declined over the past few decades in North America. Why? Again, because the idea that red meat is unhealthy, inhumane and environmentally disastrous has slowly spread. In short, because it is becoming less normal to consider red meat good or desirable.

The point is this: everything you do influences people around you, whether you like it or not. If you decide to lock yourself in your home, not patronize restaurants that serve meat and avoid delusional meat-eaters then you lose the opportunity to influence them. You also risk maximizing the downsides of social isolation.

Although I don't know this for sure, my guess is that the more normal, happy, successful and healthy you appear to others, the more they will look to mimic your behaviors, be they lifestyle, political or social behaviors. Yes "radical" people do influence others, but perhaps their main function is to stretch the boundaries of known behavior. If you have 100 body piercings, then suddenly someone with 2-4 piercings seems pretty normal.

As we grow older and evolve, we need to decide what role is the most meaningful and enjoyable for each of us to play. No one can tell you how radical or different from the norm you should be. My only hope is that you consciously weigh the pros and cons, and that the concept of social isolation is something you consider.

To be clear: I don't believe social isolation is a reason not to be vegan. I just think it's something to manage.

Along the way, remember that your actions can help "nudge" people to one day do the same thing. And this can happen without "preaching" or revealing your judgment on their behaviors. The more you understand other people, the more they will understand you.

Granted, there's always a time and place when you have to be vocal about your beliefs and convictions. But it's nice to know they are influencing other people even when you are not trying.
-------------

* A confounder is something that could appear to be causing an effect/result/outcome, but is really only linked with the outcome for some other reason. For example, people who buy large size clothes tend to gain weight more than people who buy small size clothes; therefore, a misguided person could say "don't buy large clothes because it will cause you to gain weight". It's easy to see how in this case the shopping habit (buying large clothes) is not the cause of weight gain, but actually the result of it. Buying large clothes is a confounder in this analysis.

How can vegans be overweight?

Recently I visited Portland OR, a wonderful city that is especially vegan friendly. I found myself returning again and again to same vegan restaurant/yoga studio a few blocks from my hotel. And every time I went, I was reminded of a question I ponder often:

Why are many progressive, health-conscious, yoga-doing vegans overweight?

Before I offer my answer, let me point out two basic facts. First, on average vegans weigh less than lacto-ovo vegetarians who weigh less (on average) than omnivorous humans. A vegan dietary pattern can protect people from some excess weight gain but it's obvious that many vegans (including raw-foodists) are still overweight. On the other hand, it's fair to presume that these folks are probably a few pounds (if not many) lighter than they would be if they were not vegan.

Second, almost everyone in the US is gaining excess weight. Over two-thirds of US adults are overweight and the entire population weight distribution has shifted drastically over the past 4 decades. This means that even "normal weight" people probably weight 5-10 pounds more than they would had they been born 40 years earlier. Vegans aren't exempt from this phenomenon. We live in a world that makes it easy to eat a lot and hard to expend much energy.

So the main reason why vegans struggle with their weight is the same reason why most people in developed countries are struggling with their weight. (Actually it's a set of reasons which deserve a separate blog or perhaps a book to address)

Let's touch on a few factors that are particularly relevant for vegans:

Vegan Restaurant Portions. If you eat too much healthy food you will gain weight. Vegan restaurants consistently offer mammoth portions. I've eaten at Vegan restaurants in a few dozen cities. One meal typically provides me with enough leftovers for another 1-3 meals. Granted, I am one of those rare cursed folks who has a real hard time eating an enormous volume of food in one sitting. Most people (vegans included) don't have this problem. Think about some of the vegan animals you know (gorillas, elephants, hippos, cows, pigs) and you'll conclude that given ample food any vegan animal can grow enormously large.

Why do vegan restaurants serve so much?! Well, the same reason most restaurants do - economics. Large quantities for little money is considered "good value" by consumers and the cost of the extra portion of food is usually much less than the small additional price increase of the meal. Cheap food means a higher volume of consumers which means more profit. Vegan restaurants often cater to students who are particular sensitive to the value proposition of restaurant meals. And larger portions may broaden the amount of people willing to eat at an all vegan restaurant. Hey Joe Omnivore, want to check out this new vegan restaurant with me? They give you tonnes of food and it doesn't cost much.

Optimistic bias and health halos. Two fun psychological concepts worth understanding. In the context of eating, optimistic bias means you don't think anything bad will happen to you because of your food choices. Other people might gain weight from vegan food, but not me. (This is the same phenomenon that leads most people to think they are not going to die from a heart attack, even when they know that most people do die from heart attacks). We have an intense innate need to feel in control and routinely fool ourselves into believing that is the case. It's hard for us to imagine that a healthy whole foods vegan meal could contribute to weight gain, even in ample quantity.

What's a "health halo"? Here's an example to explain - you see the word "organic" on the front of a cereal box and then throw it in the shopping basket without scrutinizing the nutritional facts or ingredients. The label "vegan" acts as a health halo, magically transforming anything vegan into a healthy food. Vegan smoothie. Healthy! Vegan pizza. Healthy! Vegan donut. Can't be too bad!

In no way am I trying to say you shouldn't be choosing the vegan option. What I'm saying is that all of us are prone to overestimating how good it is for us because it fits a small (albeit valid) list of requirements (no animals killed, organic, etc.). This is particularly true when it comes to calorie content and weight management. We are likely less stringent about portion sizes and calorie monitoring for vegan food then we would be for non-vegan food. And this applies to health conscious vegans too. I do yoga everyday for 2 hours and eat only vegan food. I shouldn't be overweight.

More Options. There are many reasons why a vegan diet causes less weight gain. One simple reason is that it restricts the sheer volume of convenient, readily available calorie heavy food options. At one point this seemed like a bad thing. What do you actually eat? It must be really hard to eat out. My friends used to say this all the time 10 years ago. That's less and less the case, which makes me happy. But in terms of weight management, the more vegan calorie-dense foods available the more vegans will struggle with their weight. Of course, I rejoice at the launch of a new brand of vegan cupcakes, but there is a down side for some.

Basic energy expenditure. We are living in an age of unprecedented calorie-density (e.g. 1200 calorie smoothies) and technological advancement (I have sat unmoving for the past 3 hours only lifting my fingers, but I can honestly claim to be "working"). For most, it's so easy to eat more calories than you use. Adding one hour of exercise a day will make you healthier and happier but it may not fully protect you from weight gain, even on a vegan diet.

A concluding thought.

It is possible for us to create a vegan-friendly world that makes it easier for us all to have a healthy weight. If you are struggling with your weight, adopting a whole-foods vegan diet can be a great step in the right direction. But our work does not stop there.

Vitamin D Must Knows

As you are reading these sections please keep in mind that the science of measurement and definitions of normal vs. optimal levels for these substances is still evolving. Plus there is incomplete standardization of these tests in the US - meaning the reference normal range may be different from one lab to the other. But these few paragraphs will give you a good background with which to interpret new discoveries and opinions as they emerge!

Vitamin D

The sunshine vitamin. The emerging science of vitamin D is beginning to paint D as a "master vitamin". In short, the effects of vitamin D go way beyond building and maintaining strong bones and normal calcium levels, but may even protect us against certain cancers and help keep our moods bright.

There is little naturally occurring vitamin D in vegan food (although, I have heard that UV exposed mushrooms which then contain vitamin D will soon be on the market), and only a few rare sources of D in animal foods (fatty fish for example). Get this - our skin makes vitamin D (well the precursor to D which is then activated in the liver and kidneys) in response to UV from the sun. Yay for the sun! and skin!
 
You see the problem. Many of us live where the sun don’t shine. And rates of vitamin D deficiency even in healthy young adults (especially those who live north of the 42th parallel, say in Boston for example, where this blog was written) are alarmingly high - 30% in some series. Vegan and non-vegan alike are at risk for vitamin D deficiency if you avoid or get little sun exposure throughout the year. For instance, it's thought that from November through February, the sun north of the 42th parallel is too weak to stimulate D production.

In the US, dairy milk is always fortified with vitamin D - so this remains the main source for non-vegans, but even this effort has not proven effective at boosting D levels for some northerners. (Granted, rickets (aka osteomalacia in adults) - a consequence of severe vitamin D deficiency - is much more rare than a century ago)

So here's what you should do:
 
1/ Make sure you have a regular source of D
Your two main options are fortified soy or rice milk plus a daily multivitamin (which will typically have 200 IU of vitamin D), or a vitamin D supplement (which is often coupled with calcium). Cereals and "cliff"/or equivalent granola bars are often fortified as well. Vitamin D is a "fat-soluble" vitamin so it will be better absorbed if taken with some fat containing food.

The exact amount of vitamin D to aim for is a matter of debate. But with the exception of B12 and perhaps a few others, more is not necessarily better and does have potential for harm. In extreme megadoses for example, vitamin D is toxic. Most experts suggest aiming between 400IU and 800IU total per day. That said, some have recently advocated for higher doses (up to 1200 IU)...so follow the news and your docs advice for updates to these guidelines. The IOM is expected to issue comprehensive revised guidelines mid 2010.

2/ Get your D levels checked once (preferably during the winter), if you live where there is a winter or don't get daily sunshine (you use sunblock or avoid the sun like the plague). The name of the vitamin D we test for in the blood is 25-hydroxyvitamin D.

Just like B12 there is some debate about whether having a low but "normal" level of 25-hydroxyvitamin D is good enough. Typically we say below 20 ng/mL is deficient, below 12 is severely deficient, and 20-30 is low normal. It will take more science for us to know what is "ideal", but based on what is known now I aim to be near 40 or above.

3/ Respect the sun. I detest the word moderation - that meaningless cop out - so I'll say respect. There are probably important benefits of sunshine (vitamin D production being one), but sun burning undoubtedly causes skin cancers, which kill many many people each year. So avoid the summer sun in the mid-day hours when it is strong, but enjoy the early morning and late afternoon rays. Obviously, if you have a high risk for skin cancer this advice does not apply to you - use sunscreen always (and more importantly avoid the strong sun) and get your vitamin D the modern way - through fortified food or vitamins.
 
Please note - light therapy (aka full spectrum) lights which are wonderful for SAD (seasonal affective disorder, aka the "winter blues") do NOT give off UV rays or stimulate vitamin D production.

Vitamin D Summary - find a daily reliable source - sunshine or a fortified item. This is especially important if you live north of the 42nd latitude (think of a line between northern California and Boston) or if you avoid the sun - and in either case: do get your levels checked one time (preferably in the winter).

Note: since a vitamin D test can cost up to $200, an alternative strategy to testing once is to take a relatively high-dose daily supplement (e.g. 800-2000 IU).

For those seeking a great and thorough medical review on vitamin D search the New England Journal of Medicine for "Vitamin D Deficiency" by Michael Holick : N Engl J Med 2007; 357:266-81.

As always, this blog does not provide individualized medical advice - for that you should find a good doctor.
 
If any of the above is unclear, please feel free to post related questions.

The fears of a suspecting vegan. Answered.

Maybe you're a touch freaked out about becoming vegan...about abandoning the dietary staples that billions of dollars in marketing have told you are essential to a happy successful productive and fertile life?

You're asking yourself: "But, where will I get my protein?!!!"

Now, I do believe that you're genuinely concerned about your amino acid pool, though I think what you're really asking is: how easy is it for me to screw this vegan business up and end up a crippled wreck? What do I really need to worry about? And what can I chill out about?

Important questions. Here is my answer:

If you're vegan, there are 5 major concerns you should address:

Pssst. don't tell anyone, but you should concern yourself with these things even if you're not vegan. Oh, and I have a much longer list for non-vegans, but I'll spare you that for now.

From easiest to tackle to hardest:
1. Vitamin B12
2. Vitamin D
3. Omega 3 Fatty Acids
4. Befriending refined Carbs
5. Getting cozy with isolation
 

Notice that protein isn't on this list. But it does get an honorable mention in my rant on carbs...so read on! If I had to list a number 6, it would probably be Iron (mostly for women) and 7 might be getting enough calories (though this would only apply to maybe 10-20% of us at most)...

Update: This blog will provide a BRIEF overview of the above worry list and I will wax philo-medical on each topic in more detail in separate blogs. If you're interested in topics 6 or 7 let me know and I'll happily offer a spiel!

1. Vitamin B12 - the vitamin that makes doctors and scientists alike wave their big wobbly index finger at us crazy vegans. And they are right (but they conveniently forgot to wave it at themselves as well) - you need to hunt out little bits of this vital substance and get your B12 level checked periodically. Read why and how by clicking here.

2. Vitamin D - the sunshine vitamin. Understanding this master vitamin will give you a new found respect for that golden globe that warms our spirits. Vitamin D deficiency runs surprisingly rampant in us northerners and it's so easy to prevent. In the least, take a supplement in the fall and winter. Read why and how by clicking here.

3. Omega-3 - the rarest of the "essential fatty acids". It's the fat you need in your diet for your heart, brain and maybe more. But omega-3s are a little tricky to find in good quantities unless you're a regular fish eater (which I'm guessing you're not). Read why and how to get vegan sources by clicking here.

4. Refined carbs - unlike D, B12, and omega-3s the problem here is that these little devils are just too easy to find and they are awfully tasty. We all (vegan or not) need to crack the whip and get these foods off the everyday menu. But they are everywhere. Like mosquitoes ruining a good sunset picnic. Take a hard look at what you eat and you'll be surprised. Read about your options for switching to whole grains, and why that's important, here.

5. Avoiding isolation - say what?! I don't eat isolation. Thank goodness you don't, because being vegan can be a good recipe for adding isolation into your life.

Let me rewind for a second. I've often asked myself: if eating animal foods is so damn harmful and eating plant foods so protective, why doesn't the medical literature abound with data that blows the efforts of our friendly meat and dairy lobby groups to smithereens? (Don't get me wrong - it does support the benefits of a whole food vegan diet).

Well, one answer (of many) may be that people who choose to buck society and become vegan are different. Maybe (and for good reason) they are more often depressed about the world they see around them. Maybe (and for good reason) they feel different and more isolated from the average Joe or Jane. Maybe there is an unspoken psychological toll that befalls those of use who care deeply about what we eat and what we don't. No, I'm not advocating ignorance - just that as a community we need to start thinking and talking about this. I'll muse on this more, tell you why I think it deserves a place on the top 5 list and offer a few suggestions on the topic if you click here 

The unofficial 6th worry: keeping it in context.

I want to be clear - eating a whole-foods vegan diet is a great way to help maximize your health and make the earth a better place. It's a great way to bring purpose and meaning into your life, to minimize cruelty to animals, to lessen your environmental foot-print and hey, it may even help you stay lean in America.

But let's face it, eating vegan doesn't cure malaria or prevent SUVs from running you over. Being Vegan = one important piece of the puzzle, but it rarely stands alone. There are many other important determinants of health and well-being. But we can muse more on that later.

Oh, and worrying IS bad for you. So take action on these concerns, but don't let them cause undue stress!
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Note: take everything you read on The Internet with a grain of salt. My writings do not constitute individual medical advice - for there is no advice that applies to everyone. These are just my informed opinions and I hope they can provide some guidance in your quest for wellness. In short: Please don't sue me. I'm Canadian.

One final disclaimer: my views do not represent the views of my employers or the academic centers I have been fortunate to attend.

Thanks for reading this. Feel free to comment, or offer suggestions on further blogs...