Any diet that is poorly planned will be missing nutrients, vegan or otherwise. In vegan diets, the nutrient of greatest concern is vitamin B12. The more restrictive the diet, the more of an issue this becomes. Plant foods are not reliable B12 sources, not even fermented foods, sprouts, mushrooms, seaweeds, spirulina, sprouts, or raw plant foods. We obtain little or no true vitamin B12 from these, and we may obtain inactive analog forms of B12 that are worse than useless because they fail to meet human requirements and can interfere with the action of true B12. The only reliable sources for vegans are supplements and fortified foods.  Vegans eating unprocessed, whole food or raw diets need to take a B12 supplement. Although B12 is efficiently recycled, eventually it runs out, and this can happen in 6 months for some individuals and 6 years for others. Although people make B12 in their intestines, most is produced in the large intestine, but absorbed in the small intestine, so insufficient amounts make their way to the bloodstream. If people are using 3 or more servings of fortified foods such as soymilk, meat analogs, B12 rich nutritional yeast and fortified cereals, they are likely getting enough, but it is still a good idea to take a weekly 1000 mcg supplement – just to be on the safe side. If fortified food use is limited, take 1000-2500 mcg 2-3 times a week – seniors are often advised to take 500-1000 mcg daily. I would suggest using cyanocobalmin or both methylcobalamin and adenosylcobalamin.  If using methylcobalamin and adenosylcobalamin, it is best to take it daily. Those who are B12-deficient need to take at least 1000 mcg/day – better still would be 1000 mcg twice a day or 500 mcg 4 x day. The IOM recommends that everyone over 50 NOT rely on animal products as B12 sources. This is because our ability to cleave B12 off the protein it is bound to in animal products diminished as we age. So everyone over 50 – vegan, vegetarian or omnivore should rely only on fortified foods and supplements for vitamin B12.

Certainly, other micronutrients such as iron, zinc, calcium, vitamin D and iodine can also be issues in poorly designed plant-based diets. The nutrition challenges commonly faced by vegans are relatively easy to overcome – my new books, Becoming Vegan: Express Edition and Becoming Vegan: Comprehensive Edition were written specifically to help individuals avoid any potential pitfalls.

Absolutely. All of the essential amino acids are made by plants, so it makes sense that we can get them from these foods. Most vegans meet the recommended intakes for protein. For those who get sufficient calories (not a worry for most of us), and consume a reasonable mix of plant foods, including some of the more protein-rich choices such as legumes, soy foods, whole grains, seeds, and nuts, protein is not typically a worry. However, protein is a legitimate concern for some groups of individuals:

• Those with poorly designed or overly restrictive plant-based diets (e.g., people who eat insufficient calories, people who eat a lot of sugar and fat (e.g. fries and soda), or fruitarians.)
• Those with increased protein needs (we look at this as the amount of protein needed per pound of body weight) – children (at greatest risk are especially picky eaters), pregnant and lactating women, athletes (those with lower calorie intakes are at increased risk), and seniors (especially those with low energy intakes).

The best plant-protein source is legumes. Most of us did not grow up eating beans, lentils and tofu, so it is common for Western vegans to drop meat from the diet and not to replace it with protein-rich plant alternatives. Some people end up living on pasta and bagels, or worse yet, fries and soda. While protein can be an issue for some individuals, it is relatively easy to ensure sufficient intake. Simply including legumes in the daily diet, and other protein-rich foods such as seeds, nuts, whole grains and non-starchy vegetables, will do the trick, especially if fat and sugar intakes are kept very moderate.

To boost protein, think about a source of protein for each meal. For breakfast, if you are using almond milk or other non-dairy beverages with low protein content (1-2 grams per cup), boost the protein content by blending every quart with about a 1/2 cup (125 ml) of hempseeds. This makes the milk much creamier, but also much higher in protein and trace minerals. Add hempseeds, sunflower seeds, soft tofu to your smoothies. Try scrambled tofu or even beans and greens for breakfast. At lunch and dinner, always include a protein rich legume choice – lentil soup, black beans on your salad, tofu or tempeh in your stir-fry, etc. Snack on protein-rich foods such as pumpkin seeds.

A few health advocates have suggested that the body doesn’t adequately convert vitamin K1 to K2 and that people require dietary sources of vitamin K2. While vitamin K1 serves blood-clotting processes and activities such as bone building, vitamin K2 is needed for protection against heart disease, arthritis, and cancer.

Although vitamin K2 has a wider range of biological activity, individuals with a healthy, normal supply of gut bacteria are well-equipped to convert K1 to K2. Scientific evidence supporting a requirement for a direct source of vitamin K2 is lacking, and the IOM doesn’t suggest that any direct intake of vitamin K2 is necessary. However, people who’ve had significant antibiotic therapy and are concerned about a temporary loss of ability to convert K1 to K2 can obtain a vegan source of vitamin K2 by taking a supplement or consuming natto. Natto (fermented soybeans) contains 23 mcg of vitamin K1 plus 941 to 998 mcg vitamin K2 per 100 g (a little more than ½ cup).

In a word, no. There is no question that we need calcium and that it is important for bone health, and consuming the milk of other mammals will boost calcium intakes substantially. Cow’s milk provides about 300 mg calcium per cup. Moose and deer milk provide about twice as much calcium per cup as cow’s milk. That doesn’t make them essential foods for humans. To me, the important question is what is the optimal way for humans to acquire the calcium they need. While cow’s milk products are certainly one way, their production comes at such a cost to animals, to their offspring, and to the environment that it seems to me, quite unjustifiable. It makes more sense for people to rely on calcium-rich plant foods such as low-oxalate greens, tofu, legumes, figs and almonds for calcium. It also makes sense to further boost intakes to meet the RDA by including some fortified non-dairy alternatives such as soy milk or almond milk. It is important not to ignore calcium. An important study found vegans who consume less than 525 mg calcium per day had a 30% increase in fracture risk compared to nonvegetarians. However, those consuming more than 525 mg had about the same fracture risk as other dietary groups.

So, what foods would you need to eat to get 1000 mg calcium (the RDA for adults 19-50 years)?

1 cup (250 ml) fortified almond milk – 300 mg

4 oz tofu (120 g) – 200 mg

4 servings fruit – 120 mg

5 servings vegetables including 2 low-oxalate, high calcium greens – 300 mg

2 servings beans – 150 mg

2 oz (60 g) nuts and seeds – 50 mg

Vegan foods are less energy-dense and more bulky, so you simply need to eat more. You can do this by increasing portion sizes, and eating more often. It is important that you do not skip meals and that you allow for a few snacks throughout the day. If you are not used to eating breakfast, consider having a full meal smoothie to start your day. (This means a smoothie with a protein and fat source such as hempseeds, soy milk, etc.) Choose plenty of higher calorie vegan options, such as nut and seed butters, tofu and avocados. Bring convenient snacks with you to eat throughout the day, especially pre- and post-workout. Trail mix, power bars, sandwiches and tofu jerky are good options. Drink caloric beverages such as fruit juice and shakes.

There are several websites dedicated to vegan athletes, with extraordinary examples of buff vegans. Consider hiring a dietitian to do a nutritional analysis so you know your actual nutrient and protein intakes.

Check out these excellent websites for more information

http://www.greatveganathletes.com/

http://www.nomeatathlete.com/

http://www.organicathlete.org/

http://www.veganathlete.com/

http://www.veganbodybuilding.com/

The American Dietetic Association’s 2009 position paper on vegetarian diets states:

It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes.… An evidence-based review showed that vegetarian diets can be nutritionally adequate in pregnancy and result in positive maternal and infant health outcomes. The results of an evidence-based review showed that a vegetarian diet is associated with a lower risk of death from ischemic heart disease. Vegetarians also appear to have lower low-density lipoprotein cholesterol levels, lower blood pressure, and lower rates of hypertension and type 2 diabetes than nonvegetarians. Furthermore, vegetarians tend to have a lower body mass index and lower overall cancer rates.

Cows’ milk contains ideal amounts of fat and protein for young calves, but far too much for humans. And eggs are higher in cholesterol than any other food, making them a leading contributor to cardiovascular disease.

Vegan foods, such as whole grains, vegetables, fruits, and beans, are low in fat, contain no cholesterol, and are rich in fiber and nutrients. Vegans can get all the protein they need from legumes (e.g., beans, tofu, peanuts) and grains (e.g., rice, corn, whole wheat breads and pastas); calcium from broccoli, kale, collard greens, tofu, fortified juices and soymilks; iron from chickpeas, spinach, pinto beans, and soy products; and B12 from fortified foods or supplements. With planning, a vegan diet can provide all the nutrients we were taught as schoolchildren came only from animal products.

Please see VeganHealth.org for more information.

Yes. According to the position of the Academy of Nutrition and Dietetics (formerly ADA), well-planned vegetarian diets (including vegan diets) are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes. Of course, it is important that the diet is well-planned and that is why we can taken great care to provide appropriate guidelines for people at all stages of the lifecycle in Becoming Vegan: Express Edition and Becoming Vegan: Comprehensive Edition.

Soy has a long history of use in Asia, and within vegetarian populations throughout the world. Two of the healthiest, long-lived populations in the world – the Okinawan Japanese and the Seventh-day Adventists in Loma Linda California – are frequent soy consumers. The traditional Okinawan diet derives about 5-6% of calories from soy or about 2 servings a day. If soy foods were dangerous, its effects would be reflected in the health and longevity of these populations. Soy has been extensively researched – about 2,000 new studies on soy are released yearly. The value of soybeans for human health depends on the form and quantity eaten.

There is considerable negative press about soy on the internet. It can usually be traced back to groups that promote animal-based diets. These groups are strongly invested in encouraging the consumption of meat, eggs and dairy, and they do an exceptional job of convincing consumers to steer clear of soy. When plant-based enthusiasts jump on the anti-soy bandwagon, they remove a whole category of food that has the potential to make their diets more nutritious, more healthful and more enjoyable. While it is not necessary to eat soy, it is not necessary to avoid it either. Some individuals need to avoid or limit soy due to allergy or severe thyroid problems, however, for most people, soy foods safe and nutritious.

Traditional soy foods are generally the most healthful choices. They fall into two categories: fermented (e.g. tempeh, miso and natto) and unfermented (e. g. tofu, soymilk, edamame soybeans and soy nuts). Both are healthful. The soaking and cooking that occur when soybeans are prepared for use in unfermented products such as soy milk and tofu reduces antinutrients and improves digestibility and mineral availability. The same can be said for fermented soy products such as tempeh. The fermentation process also helps to support beneficial gut bacteria and, in some cases, can add vitamin B12 (e.g. in tempeh fermented in some Asian countries such as Indonesia) and/or vitamin K2 (e.g. in natto). More heavily processed soy products such veggie meats and protein powders are rich sources of high quality protein, however, the burgers and other meatless products are higher in sodium and added fats. Read labels, and use these products less often than traditional soy foods. Some soy products such as soy cheeses contain partially-hydrogenated oils (trans fats) and should be completely avoided. Read labels.

The nutritional benefits of soy are similar to other legumes, although soybeans are higher in protein and fat, and lower in carbohydrates. Soybeans derive about 25-38 percent of their protein from protein, compared with about 20 to 30 percent for other legumes. The quality of protein in soy is similar to that of animal products, and is better than that of other legumes. Soyfoods provide an excellent and often easy way for children and adults to reach recommended intakes of the amino acids lysine and tryptophan. While most legumes are low in fat (about 2-15% of calories), soybeans derive about 40 percent of calories from fat. The fat in soybeans is mainly polyunsaturated, including 7 percent alpha-linolenic acid (an omega-3 fatty acid). Whole soybeans are a rich source of fiber, although processing diminishes fiber content. Soybeans are also high in B-vitamins, especially niacin, pyridoxine and folic acid. They are also good sources of minerals such as calcium, iron, magnesium and copper. Calcium is often added to soymilk, and tofu is commonly set with calcium, so these products are particularly rich calcium sources. For many years experts thought that iron was poorly absorbed from soy, however, more recent evidence suggests absorption is quite high. When consumed with vitamin-C-rich fruits and vegetables, absorption is further enhanced. Nutrient absorption is also improved when soy is soaked, cooked or fermented. Soy products can contribute very significantly to nutritional needs of people during every stage of the lifecycle.

Evidence suggests that regular soy consumption may provide a variety of health benefits, including lower risk of coronary heart disease, reduction in hot flashes, protection against some forms of cancer, and possible protection against osteoporosis. In addition, compared with animal protein, soy protein may protect kidney function.

I would suggest that a safe and reasonable soy intake is 1-2 servings per day for children and 2-4 servings per day for adults.

I am convinced that high-fat plant foods not only deserve a place in our diets, but they deserve a place of honor. A number of highly respected vegan health advocates have taken a hard-line view against fat, including fat found in whole plant foods such as nuts, seeds, coconut and avocados. As a result, many vegans restrict or completely avoid these foods. The question that arises is whether or not their avoidance is necessary or even helpful for the average vegan. While there is impressive evidence for the use of very low-fat plant-based diets for people with severe coronary artery disease, there is little evidence to suggest that such diets should serve as the gold standard for vegans.

Nuts and seeds are valuable sources of healthful fats, including essential fatty acids. They are loaded with trace minerals such as calcium, copper, iron, magnesium, manganese, potassium, selenium and zinc, and are important sources of vitamins, especially vitamin E and folate. They are good sources of plant protein, with a particularly rich content of L-arginine. This amino acid is a precursor of nitric oxide, which is a helps to preserve the elasticity and flexibility of blood vessels, enhancing blood flow. Nuts and seeds are rich in phytochemicals and antioxidants. These protective compounds favorably alter inflammation, oxidized LDL and endothelial function. Due to their low carbohydrate content, nuts and seeds have the lowest glycemic index and glycemic load of any whole plant foods.

Not surprisingly, the research on nuts and seeds and human health overwhelmingly favorable. In fact, their consumption is associated with a reduction in heart disease, stroke, hypertension, type 2 diabetes, metabolic syndrome, overweight, macular degeneration, dementia and gallstones. Their consumption has also been positively associated with longevity. Maximum benefits are associated with moderate intakes of about an ounce or two a day.

A good target intake is about an ounce of nuts and an ounce of seeds per day – slightly more for those with high energy needs and slightly less for those with low energy needs. Eat a variety of nuts and seeds, as each variety offers something unique. Keep some omega-3 rich options such as chia, flax, hempseeds and walnuts in the mix. I recommend buying raw nuts and seeds and soaking and dehydrating them. This reduces antinutrients, boosts nutrients and makes them more digestible. I always store them in the freezer – once they are out of their shell they are more susceptible to oxidative damage.

I think the biggest barriers are fear of giving up favorite foods and having to eat less tasty replacements, and being socially and culturally isolated as a result of dietary choices. One way to overcome the “taste” barriers is to transition slowly, learning to replace favorite foods with even tastier options. For example, banana-mango-pineapple “ice cream” makes an even tastier dessert than regular dairy ice cream. Look for plant-based versions of family favorites – tacos, spaghetti, pizza, shepherd’s pie, tamale pie, burgers, stews, curries, etc. In social situations, bring enough food for everyone to enjoy. When you share delicious, fun food, it opens social doors instead of closing them. When you make something that is really special, share it with colleagues and friends. Get together with like-minded individuals – check out the support that is available in your community and beyond.