Long-term Vegan Health Study

Vegan Health Study

By Michael Klaper, MD

Although a vegan diet can theoretically provide all essential nutrients required by Homo sapiens, it is evident that some people have far greater success than others in sustaining themselves on completely plant-based diets. Quantitating the effects of vegan diets upon human health, as well as elucidating mechanisms by which the body adapts to purely plant-based diets is the goal of the Vegan Health Study (VHS) currently being undertaken by the Institute of Nutrition Education and Research, based in Manhattan Beach, California.

The Institute has received seed funding for the Study which is intended to answer some of the following questions:

1. What are the ranges of "normal vegan" serum levels for Vitamin B-12, holotranscobalamin II, ferritin, immune globulins, endocrine hormones, etc.?

2. After many years on a vegan diet, do deficiencies develop of any nutrients, e.g., trace minerals, essential fats, vitamins or co-factors, etc.?

3. What are causes of morbidity and mortality among vegans? (From what do old vegans die? Or young vegans, for that matter...)

4. Does a high-carbohydrate, grain-and-potato-based, vegan diet engender chronically high insulin levels - with resulting adverse effects upon blood vessels, pancreas (pancreatic hypertrophy), fat stores (obesity), prostagland in function, etc.?

5. As people change their diets from animal-based to exclusively plant-based foods, what changes occur in tissue composition and in organ function, e.g., vascular flow, hormone levels, immune status, free radical loads/oxidative stress, prostaglandin balance, etc.?

6. Occasionally, vegan people are encountered who do not look well - underweight, sallow complexion, low energy levels, etc. - despite an apparently healthy diet and lifestyle. What are we observing? A deficiency of dietary nutrients? Dysfunction of digestive secretions? Malabsorption problems? Defective liver detoxification mechanisms? Abnormalities of intestinal mucous viscosity? Other unknown factors? These "failure to thrive" vegan people represent an important subgroup and deserve careful study.

7. People who "used to be vegan," but who report they "feel better when they add some animal protein back into their diet," are also an important subgroup (perhaps the same group as in "6." above?). Are these "unsuccessful vegans" a distinct metabolic category of humans - Homo sapiens who are obligate metabolic carnivores? If so, by which biochemical and physiologic characteristics do they differ from the person who thrives on a purely vegan diet? What is the animal-based nutrient that improves their feelings of well being? (If one accepts the "sympathetic/parasympathetic" model of body types, what does it mean biochemically to be a "sympathetic-dominant omnivore" or a "parasympathetic-dominant vegan" re: metabolic markers, nutritional needs, dietary patterns, etc.?)

8. Most people who follow a low-fat, vegan diet eventually develop a lean body configuration - yet, not everyone does. People can carry excess body fat despite their long-term adherence to an apparent low-fat, exclusively vegan diet. Assuming no violation of the second law of thermodynamics, what explains this phenomenon? What does it tell us about the metabolism of these people and of their food choices? Do these people represent a hyperinsulinemic subset of vegans who need to lower their ratio of dietary carbohydrates to fat and protein?

Obviously, the above list of questions encompasses a broad range of topics and disciplines, yet it is by no means exhaustive. Since no study can investigate the entire range of salient questions regarding vegan metabolism, physiology and health, the Vegan Health Study will focus upon those measurable parameters that will promise to generate the most clinically relevant data, with the minimum of expense and inconvenience.

Study Design

Recruitment of Subjects

At the initiation of the VHS, announcements will be placed in publications with wide circulation in the vegetarian and vegan communities, e.g., "Vegetarian Times," the American Vegan Society's "Ahimsa," the North American Vegetarian Society's "Vegetarian Voice," the Vegetarian Resource Group's "Vegetarian Journal," etc. The notices will invite participation of vegans, ex-vegans, and people in transition toward or away from a vegan diet. Announcements will also be placed in newsletters of many local and international vegan and vegetarian organizations, as well as Jain, Hindu, and other religious groups with significant populations of vegetarians and vegans.

The Study will be publicized in major cities through news releases, notices in natural food stores, environmental publications, vegetarian restaurants, etc., while announcements of the VHS will be posted on appropriate computer "bulletin boards" and "web sites" on the Internet. The medical and nutrition communities will be notified through announcements placed in the professional journals of the American Academy of Family Physicians, the American Dietetic Association, the American Society for Clinical Nutrition, the American Medical Association, and others.

To increase participation, a "premium" will be offered to each volunteer of a free copy of their laboratory results, including levels of Vitamin B-12, cholesterol, hemoglobin, thyroxin, etc., as well as assessments of liver function, colon flora, and other important indices of health. Ideally, the VHS study population will exceed 1,000 vegan people. To generate a pool of subjects for the control group, each volunteer will be asked to recruit an omnivorous or lacto/ovo vegetarian cohort of similar age, sex, body habits and activity level.

Questionnaire

A detailed questionnaire will be prepared, covering health history, nutritional intake, and health experiences (positive and negative) before and since adopting a vegan diet.
Designed with the assistance of registered dietitians, physicians, nutritional biochemists, and lay personnel experienced in vegan nutrition, the questionnaire will enable detection of subtle but significant differences in food choices and lifestyle practices. Information will be elicited on types, quantities, and forms of grains ingested, intake of refined sugars, hydrogenated oils, and nightshade vegetables, proportion of raw foods to cooked foods, intake of fruit and/or vegetable juices, etc. History of parasitic infections, assessment of stress levels and exercise patterns, use of food supplements and/or digestive enzymes will be elicited, as well as ideas about food combining, food sensitivities, and belief systems motivating the volunteer to adopt and maintain their current dietary practices.

All respondents to announcements of the VHS will be mailed a kit containing the questionnaire, laboratory containers, and instructions for collecting urine, stool, and saliva specimens. "Vacu-tainer" tubes for blood specimens will be included, along with a slip for the local laboratory requesting venipuncture services, and a mailer to return the tubes to the VHS processing lab. (Arrangements will be made to reimburse the local laboratory for the phlebotomy.)

"Phase I" Testing

Consultations are currently being conducted to determine which laboratory tests will yield the most accurate characterization of vegan biochemistry and physiology for the minimum of expense and inconvenience. Readers of this article are invited to contribute their suggestions as to which tests or methodologies they feel should be included in the VHS in order to help explain why certain subgroups experience greater or lesser success adapting to vegan diets.

The laboratory investigations proposed for inclusion in the VHS can be grouped as follows: "Biochemical," "Immunologic," and "Physiologic." Details of the above proposed investigations are as follows:

Biochemical

Standard blood chemistry determinations will be performed to detect differences in lipid profiles, electrolyte balances, renal function, etc. In addition, the following studies may help predict characteristics of successful vs. unsuccessful adaption to vegan diets:

a. Fatty Acid Composition/Metabolism - especially omega-3 and omega-6 fats. Perhaps "successful" vegans are more efficient synthesizers of longer-chain fatty acids, especially EPA DHA? Source materials - RBC and/or platelet membranes? Fat biopsy?

b. Carnitine and Taurine Metabolism - while vegan people must synthesize essentially all their own carnitine, omnivores ingest it in animal-based foods. Perhaps "successful" vegans are more efficient synthesizers of carnitine?

c. Vitamin Status - Vitamin B-12 (holotranscobalamin II) MMA and homocysteine.

d. Trace Mineral Balance - especially chromium, zinc, copper, selenium, iron, iodine, calcium and magnesium. Perhaps people who maintain a vegan diet and later feel they "have to have some animal protein" develop subclinical deficiency of a trace mineral or other nutrient? Source material for analyses - RBC membrane? Hair? Fingernail/toenail clippings? Others? - (Readers' suggestions are invited.)

e. Xenobiotics - Do pesticides, heavy metals, trans fatty acids, food preservatives, etc., interfere in susceptible individuals, preventing their successful adaption to a plant-based dietary?

Immunologic

Immunologic mechanisms may, at least in part, determine long-term successful adaption to vegan-style diets. Investigations being considered for inclusion in VHS:

a. Blood Groups - Are certain blood groups better suited to be vegetarian/vegan than others? Are particular ABO types more sensitive to the adverse effects of food-borne lectins interacting with the intestinal mucosa? Are there other mechanisms by which blood group determines ease of adaption to plant-based diets?

b. Antigen/Antibodies - Immunoelectrophoresis to detect antibodies generated in response to food-borne antigens. Perhaps "unsuccessful" vegans suffer the effects of low-grade allergic/immune reactions to wheat gluten, corn or soy protein, or other food constituents?

c. HLA Typing - to detect groupings and patterns among "successful" vs."unsuccessful" vegans. The VHS will correlate HLA types with histories of autoimmune diseases, and their clinical course following adoption of a vegan diet.
Physiologic

a. Insulin Levels - Do the high carbohydrate diets so commonly consumed by people following grain-based, vegan diets (based upon breads, pastas, cereals, etc. + potatoes) produce chronic hyperinsulinemia, and are there resulting detrimental effects?

b. Functional Liver Profile - Phase I (oxidative) and Phase II (conjugative) excretion mechanisms may differ in "successful" and "unsuccessful" vegans. [Hepatic detoxification function is determined through analysis of urine and saliva following ingestion of test doses of caffeine (Phase I) and acetaminophen (Phase II).] Significant differences in liver function among the various dietary groups may be detected, as well as within the same individuals as they progress from omnivore diets to exclusively vegan food choices.

c. Oxidative Stress Markers - Antioxidant reserve, possibly low in "failure-to-thrive" vegan subjects, can be determined by measuring levels of glutathione and lipid peroxides, urinary creatinine/sulfate ratios, etc.

d. Endocrine Balance - including androgenic and estrogenic steroids, DHEA, and pituitary-thyroid axis hormones.

e. Bone Turnover - Urinary markers of bone catabolism - (Type I collagen cross-linked N-telopeptides). Are (non-dairy-consuming) vegans at higher risk for osteoporosis?

f. Intestinal Permeability - Lactulose/mannitol excretion ratios. Do "unsuccessful vegans" suffer from "leaky gut syndrome?"

g. Comprehensive Digestive Stool Analysis [as per Great Smokies Diagnostic Laboratory(8)] - to detect subclinical digestive dysfunction or malabsorption syndromes.

h. Comprehensive Parasitology - including stool mycology, bacteriology, and fluorescent immunoassays for Giardia, amoebae, and other parasites.

"Contrast Group" Studies

If resources permit, the above studies will be performed upon specimens of blood, urine, saliva, and stool from a "contrast group" - people who have followed traditionally meat-based diets for many years (for generations, actually), such as Inuit (Eskimos), Laplanders, etc. As well, specimens will also be obtained from long-time vegetarians, e.g., observant Jains, second or third generation life-time vegans, etc. Their results would then be compared with the VHS's population of vegans, especially the "successful" and "unsuccessful" recent adaptee groups, to elucidate possible common mechanisms. (That is, do the "unsuccessful" vegans share significantly more characteristics with the "personal/cultural" meat-consuming subjects of the contrast groups, and are "successful" vegans more like the "personal/cultural" lifetime vegan contrast groups?)

"Phase II" Testing

After the initial testing phase, further studies will be done to elucidate specific mechanisms of successful or unsuccessful adaption to vegan diets. Volunteers from the subgroup of "unsuccessful" vegans will resume a vegan diet until they feel the need where they "must" consume animal-based products - preferably for intervals of at least several months. During this time, they will be monitored to detect any objective changes or imbalances that prompt the person to resume an omnivorous diet. As the person elects to add animal-based foods back into their diet, laboratory determinations will be done throughout the process to detect quantity, quality, and direction of change of significant parameters.

Registry and Repeat Testing

The Institute of Nutrition Education and Research intends to (1) maintain a registry of all subjects participating in the Vegan Health Study to determine morbidity and mortality statistics of vegans and the control populations over the course of time, and to (2) administer repeat testing of the Study population, possibly every three to five years.

Conclusion

The Vegan Health Study has the potential to provide important information on human responses to purely plant-based diets. The VHS is still in the formative stages, and suggestions are welcome regarding any and all aspects of Study design, e.g., specific laboratory studies to include observations upon mechanisms or parameters not yet identified, etc. Of special interest are tests reliably reflecting chronic hyperinsulinemia.

A benefactor has provided the Vegan Health Study with a significant initial grant and has agreed to continue with 1-to-1 matching funding for laboratory testing, data collection and analysis, etc. Additional funding is required, and potential contributors interested in making tax-deductible donations to support the Vegan Health Study are invited to contact the Institute at the address below. Assistance is also solicited from individuals and institutions who can make laboratory and/or computer services available at reduced cost.

People who would like to volunteer as subjects for this unique health study are invited to submit their names to the Institute.

Michael A. Klaper, M. D., Director
Institute of Nutrition Education and Research
1601 North Sepulveda Boulevard, Suite #342
Manhattan Beach, CA 90266-5133
Telephone/Fax: (310) 374-3733

References

1. Kjeldsen-Kragh, J. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet, 991; 338: 899-902.

2. (a) Fisher, M., et al. The Effect of Vegetarian Diets of Plasma Lipid and Platelet Levels. Archives of Internal Medicine, 1988; 146:1193-1197.
(b) McDougall, J., et al. Rapid Reduction of Serum Cholesterol and Blood Pressure by a Twelve-Day, Very Low Fat, Strictly Vegetarian Diet. Journal of the American College of Nutrition, Vol. 14, No. 5, 491-496 (1995).
(c) Resnicow, K., et al. Diet and Serum Lipids in Vegan Vegetarians: A Model for Risk Reduction. Journal of the American Dietetic Association, 1991; 91:447-453.

3. (a) Ling, W. Shifting from a Conventional Diet to an Uncooked Vegan Diet Reversibly Alters Fecal Hydrolytic Activities in Humans. Journal of Nutrition, 122: 924-930,1992.
(b) Peltonen, R., et al. Changes of Faecal Flora in Rheumatoid Arthritis During Fasting and One-Year Vegetarian Diet. British Journal of Rheumatology 1994; 33:638-643.

4. Lindahl, O., et al. Vegan Regimen with Reduced Medication in the Treatment of Bronchial Asthma. Journal of Asthma, 22(1) 45-55 (1985).
Michael Klaper is founding director of the non-profit Institute of Nutrition Education and Research and serves on the Nutrition Task Force of the American Medical Student Association.

Dr. Klaper's site