Reducing consumption of animal products is a choice with both moral and practical consequences. Last summer I found myself in contact with many vegans who cared a lot about the moral consequences, but had put little effort into learning about or managing the practical consideration of removing animal products from their diet. I’ve suffered a lot due to bad nutrition, so this made me very concerned. With a grant from the Survival and Flourishing Fund, I launched small a pilot project to give nutritional tests to 5 vegans and near-vegans from the Lightcone Office, which they could use to choose supplements that would hopefully improve their health.
My long-term goal was for everyone to have accurate information on their personal nutritional costs of veganism and make informed choices about how to handle them, with the first line solution being supplements. My goal for the pilot was to work out practical issues in testing, narrow the confidence interval on potential impact, and improve the nutrition of the handful of people. This report is on phase 1: getting the testing done and supplements started. It is aimed at people who might want to run a similar program at scale; if you are interested in running this for yourself I recommend checking out Tuesday’s post on iron deficiency.
Tl;dr: I found rampant iron deficiencies, validating the overall concern. The procedure I used has a lot of room for improvement.
I gave nutrition tests to 6 people in the Lightcone office.
The ideal subject was completely vegan, had never put any effort or thought into their diet, and was extremely motivated to take a test and implement changes. This person does not volunteer for studies, so I ended up with 4 vegans or near-vegans who had put somewhere between 0 and a lot of thought into their diet, 1 vegetarian, and 1 extremely motivated omnivore I used to test out the process. In addition, one hardcore vegan contributed results from private testing. I did not poll the ~vegans on their exact diets.
Unless otherwise stated the results exclude the omnivore.
I gave each of these six people a Genova Metabolomix+ test, ordered from walkinlabs.com, with the iron add-on. This test was selected for being recommended by doctors I trust (in part because they prefer urine to blood testing), having extremely easy-to-read results, being nearly comprehensive (with the unfortunate absence of vitamin D), and because I hoped urine collection at home would be easier than blood draws at a lab. Foreshadowing: I was wrong about that last part.
I also gave people the option of an add-on to determine what variant of the MTHFR gene they have. MTHFR can affect how one processes certain B vitamins, and certain variants can necessitate a more expensive form of supplements.
Several people (although not everyone) scored with undetectably low iron. I offered them follow-up blood tests, which one person accepted. An additional vegan contributed blood test results without urine results.
As of publication all subjects have received their first round of results and started supplements of their choosing.
The original plan was to retest in 3-6 months after people began supplements, using the same urine tests.
My initial predictions
I expected the big shortages to be B12, iron, and vitamin D, the first of which has very few* natural vegan sources and the latter two of which are scarce, although not absent, in vegan sources. This makes it pretty unfortunate the original test did not include vitamin D.
[*B12 is (maybe?) naturally found in some (but not all) seaweeds and algaes, in at least one kind of mushroom, and in nutritional yeast (but possibly in the wrong format?). It’s also added to many wheat products in the US, so if you eat enough wheat and aren’t going out of your way to get unfortified wheat that’s a strong source]
Relative to the mainstream I wasn’t very concerned about protein consumption. Vegan proteins are a little less abundant, a little harder to digest, and have a less ideal distribution of amino acids, but are basically fine as long as you don’t pile on additional constraints.
One reason I was concerned was that lots of people I polled were piling on additional constraints, like keto or gluten-free, and still not doing anything to manage nutrition. I expected a smattering of deficiencies from these people, and to a lesser extent from everyone, as their restrictions and tastes cut off random nutrients. These could have been in any almost nutrient.
I expected everyone to be fine on vitamin C because it is abundant in both produce and processed food (where it’s used as a preservative).
(including only vegans and near-vegans)
- ¾ vegan testers had severe iron deficiencies in their urine tests.
- The one who didn’t had both a stunning dietary intake of iron, and a parent who 23andMe believes to have a genetic predisposition to excessive absorption of iron.
- An additional vegetarian tester was not deficient.
- One of these retested with a blood test and scored low normal (~30). However this person was already taking iron supplements at the time of the test.
- A bonus blood-only participant tested between 13 and 20, meaning they’d be considered deficient by some standards but not others.
- There were no B12 deficiencies, probably because everyone was already on B12 supplements.
- One tester had a lot of deficiencies, including vitamin C, to the point I suspect it’s a problem with digestion rather than diet.
- Everyone had at least one amino acid deficiency, including the person eating over 100g of protein/day. I don’t know how big a deal this actually is.
- The urine test did not include vitamin D. Of the 2 blood tests, both had low-normal vitamin D.
- Excluding the person with across-the-board deficiencies, there were scattered other deficiencies but nothing else to consistently worry about. People were mostly in their tests’ green zone, with occasional yellow and red.
What does this mean?
Only one near-vegan out of 5 had solidly good ferritin levels. As I discuss here, that’s a very big deal, potentially costing them half a standard deviation on multiple cognitive metrics.
There’s no control group, so I can’t prove that this is a veganism problem. But I’m quite suspicious.
There were no other consistent problems, so broad-spectrum testing is probably overkill for people with no known problems.
Retrospective on the project
I consider the core loop of the study as vindicated as can it be at this stage.
- Deficiencies were identified, and the primary one was one of the three I predicted.
- And another of the three, B12, was probably absent because people treated it preemptively. Note that people were inconsistent in what they took so I can’t say definitively what they were on during testing.
- In the counterfactual timeline the shortages were probably identified much later if at all. No one who participated had any plans for testing, including people with obvious symptoms and people whose doctors had previously recommended testing.
This will be less impressive if supplementation doesn’t turn out to fix anything, but it’s an extremely solid start.
Other things that went well:
- Having the room in my budget for unplanned additional testing, so I could add in serum iron tests when it became obvious they were necessary.
- Creating a shopping list with links. I was worried this was somehow taking advantage of people (since I used affiliate links), but removing a decision and several steps from the ordering process seems to have been pretty crucial.
- Bypassing the need for doctors’ visits to get a test. Given how long it took people to order tests I think doctors’ appointments would have killed the project entirely.
- The Lightcone ops team was extremely cooperative and got all of the vitamins I suggested into the office.
Difficulties + possible changes
Potential changes are framed as recommendations because I am deeply hoping to hand off this project to animal advocates, who caused the veganism in the first place.
- The test ordering workaround was not as good as I had hoped
- I’d originally hoped to just hand participants a box, but they had to order the tests themselves.
- In order to get iron + genetics tests people had to call rather than order online. This is non-standard for the provider and two people had to call twice to insist on what they wanted.
- Tests took a long time to ship, and a long time to return results after shipping. The lab alleges this is a supply chain issue and there’s nothing to be done about it.
- Those two together turned into a pretty big deal because they made it very hard to plan and people lost momentum.
- In combination with the results showing few problems beyond iron I recommend deemphasizing full spectrum urine tests and focusing on blood tests for iron (and vitamin D), and making those convenient, perhaps by bringing a phlebotomist to the office.
- Another option would be to bring in a medical practitioner, who can order tests for other people, to manage tests so the office can be stocked with them. This of course fails to solve the problem for anyone not in the office.
- There are home tests for vitamin D and iron specifically, but I have no idea if they’re any good.
- Ideal test subjects (completely vegan, never done nutritional testing or interventions, promptly puts in the effort to do these tests and act on them once I suggest it) were even thinner on the ground than anticipated.
- I knew there wouldn’t be many, but I didn’t think it would be so hard to get five people pretty close to that profile.
- I loosened restrictions and still consistently found problems, so recommend lowering the eligibility bar for testing in future rounds, especially since that was always the plan. The strict requirements in this round were an attempt to make the signal as loud as possible.
- Getting everyone tested was like herding cats. Beyond the problems with the test distributor, some participants needed repeated reminders to order, one lost a test, results went missing… it was kind of a nightmare.
- One advantage of focusing on blood tests would be to cut down on this, especially if you bring the phlebotomist to the office.
- At points I was uncomfortable with the deference some participants showed me. I was as clear as I possibly could be that this was a best-effort from a knowledgeable amateur kind of thing; they were responsible for their own health and I was a nonexpert trying to provide some logistics help. I nonetheless got more than one person bringing me problems not even related to the nutrition project, and insisting I tell them what to do.
- Recommendation: bring in a skilled nutritionist. They can both give better advice than me and devote more time to helping people.
- I initially misread the protein results (which are delivered in terms of “how deficient are you?” rather than “what’s your current level?”, making 0 the best possible score). Luckily I knew I was confused from the beginning and no one had taken any actions based on my misinterpretation. More broadly, I’m just a woman who’s had some problems and read some stuff, I expect my suggestions to be better than nothing but far from the maximum good it would be possible to do.
- Recommendation: bring in a skilled nutritionist
- I underestimated the amount of time and especially emotional labor this project would need. I was hoping to bluff my way through that until people got on supplements, at which point the improvements in health would be their own motivation. I think I always overestimated how well that would work, but it was especially wrong because all the problems with the tests drained people’s momentum.
- Recommendation: I still think you should bring in a skilled nutritionist
- Many of the participants were moving frequently and not in the office by the time their results came in (because they took so long…), so they had to buy supplements themselves. Given the option I would have selected people consistently in the office, but as mentioned I was already managing trade-offs around participants.
- Recommendation: ask for more money to give everyone their first month of supplements and a convenient pill planner.
I previously planned to give people the same urine test 3-6 months after they started supplements. That no longer seems worth it, relative to the cheaper and more convenient blood tests.
It’s not actually clear a formal follow-up is that useful at all. I initially planned that because I expected a wide range of shortages such that literature reviews wouldn’t be helpful. But there was only one real problem, and it has a richer literature than almost any micronutrient. So I don’t think another 5 people’s worth of scattered data is going to add much information.
So the next step for this as a project would be mass blood testing for B12, iron, and vitamin D.
If this has inspired you to test your own nutrition, I haven’t done anything you can’t do yourself. Both the urine and blood tests are available at walkinlabs.com, and if you have a doctor they’re quite likely to agree to testing, especially if you’re restricting meat products or fatigued. I have a draft guide of wisdom on supplementation I’ve picked up over the years here, although again, I’m not a doctor and only learned how to digest food last May, so use at your own risk.
Thank you to the Survival and Flourishing Fund for funding this project, Lightcone for hosting, and all the participants for their precious bodily fluids.
iron levels are mentioned (by Preston Estep's Mindspan) as being particularly bad for the brain (iron increases dementia rates!). Iron increases ROS in the cell by catalyzing the Fenton reaction. As long as one is not feeling too fatigued from it, I don't think that having low-moderate iron levels is a bad thing
I have been near-vegan for many years (though I occasionally eat eggs) and my iron/ferritin levels are both well within the normal range. I've posted my bloodwork here - https://www.crsociety.org/topic/17558-all-my-lab-results-here/#comment-38821. My main health issue is low bone density, though this will not affect quality of life for several decades (and zoledronate is a pro-longevity intervention for this). I am now taking Vitamin K2 and may consider medications for this in the future, if needed, and we will almost certainly have lab-grown salmon by then.
Bryan Johnson (vegan except for collagen peptides) also just posted a tweet about his recent results, which seem near-optimal (ofc, he is also much more disciplined about this than most people).
https://www.crsociety.org/topic/11136-nutrition-and-supplementation-for-vegetarians/ has a good guide on the deficiencies that I'm more concerned about (taurine and carnosine being among them). Much of crsociety.org is vegan.
Estep recommends ferritin of 10 to 40 ng/ml (mine is 89)...
Firstly, just wanted to caution that vegans should be very careful about claims of unfortified plant-based foods containing adequate B12. Although some seaweed/algae/mushroom types contain molecules that are structurally similar to B12, they may not have the same nutritional benefits. e.g. see https://veganhealth.org/vitamin-b12/vitamin-b12-plant-foods/. Some people engage in motivated reasoning around this topic, so I think it is good to be cautious when evaluating such claims.
I strongly support B12 testing for vegans. This is only my anecdotal experience, but I had grown up eating little meat and dairy for various reasons, and at one point decided to cut it out entirely as I felt that it would be more moral. It did not occur to me at all that veganism could have negative side-effects, given how widely it is publicized, so I didn't bother looking into it. I'm certain that there are many others who have done the same.
Later, much to my chagrin, I was diagnosed with severe Vitamin B12 deficiency, which has robbed me of 2+ of my most productive years due to loss of physical strength, nerve pain, extreme fatigue, and possibly loss of cognitive ability.
For a description of what the condition can do to even the greatest of minds, see Eugene Wigner's description of the great mathematician David Hilbert's condition after contracting pernicious anemia (the condition was named before scientists realized the anemia + symptoms were caused by lack of B12) in his autobiography:
thank you. I had only glanced at non-animal B12 and was trying to be fair to vegans, if my sources were bad that's extremely useful to know. And if VeganHealth.org is being rigorous about this that increases my respect for them.
A relevant experience of mine: after being vegan for ~1 year, I got my blood tested to see if there was anything I should watch out for. It turned out that my iron reserves were low, so I was told to take iron supplements. One year later I got another blood test where my iron levels came back as too high. My doctor was confused until I told him I still sporadically took iron supplements; he told me to stop immediately, and that as a male I didn't need to supplement iron much.
Now I feel like I'm in a damned-if-I-do-damned-if-I-don't limbo; it would be great to have some sort of framework of when/if to take iron supplements.
Is there not an option to take a lower dose of iron supplements?
Sure, but my point was I don't know what dose per unit time to take.
One what later? Year, month?
Whoops, I meant year. Edited.
Did you notice supplementing iron making you feel better? If so, perhaps it would be worth getting several tests and adjusting your dose until the tests come back consistently normal?
I didn’t feel a difference; I guess because it was my iron reserves that were low, not my actual iron levels.
But yeah, if it does continue to be a problem I will do something like that.
How does urine testing for iron deficiency work? I was under the impression that one needs to measure blood ferritin levels to get a meaningful result... but I might be wrong?
They're looking for byproducts, but it indeed didn't work very well and that's why I've refocused on blood testing.
Thanks for this post! I'm guessing the main drive for this project is just compellingly exemplifying that nutrient deficiency is also present in the rationalist community, so as for more people to treat their dietary health seriously? Even though there's no a priori reason to expect nutrient deficiency not to happen amongst non-dietary-conscious rationalists.
I say that because (and sorry for maybe being blunt) the sample size is so small compared to the rich existing literature on this topic, that this feels more like an emotionally compelling "take care of yourself" advice than any scientifically relevant discovery.
On a related note:
I don't understand why the target subject here should be people who have never put any effort or thought into their diet. That way you don't get relevant evidence about the prevalence of iron deficiency among veg*ns, but only the almost trivial conclusion that people who don't take any care of their dietary health have some deficiencies.
It makes plenty of sense to me; I think the vast majority of people don't put any thought into what vitamins they might be deficient in. I was vegan in college for ethical reasons, and I was in the school's vegan / animal welfare club, and the entire year I was in that club I didn't hear a single mention of taking supplements to offset what we weren't getting through our diet. I had never heard about B12 or creatine supplementation until I came to the rationalist community.
And in any case if Elizabeth is trying to study the impact that ~veganism has on micronutrient levels, then comparing [~vegans who don't take supplements] to [omnivores who don't take supplements] will give the clearest data.
I don't doubt your anecdotal experience is as you're telling it, but mine has been completely different, so much so that it sounds crazy to me to spend a whole year being vegan, and participating in animal advocacy, without hearing mention of B12 supplementation. Literally all vegans I've met have very prominently stressed the importance of dietary health and B12 supplementation. Heck, even all the vegan shitposts are about B12!
Even if that might be literally true for scientific purposes (and stressing again that the above project clearly doesn't have robust scientific evidence as its goal), I do think this won't be an accurate representation of the picture when presented to the community, since most vegans do supplement [citation needed, but it's been my extensive personal and online experience, and all famous vegan resources I've seen stress this], and thus you're comparing the non-average vegan to the average omnivore, giving a false sense of imbalance against veganism. As rational as we might try to be, framing of this kind matters, and we all are especially emotional and visceral with regards to something as intimate and personal as our diet. On average, people raised omnivores have strong repulsion towards veganism (so much so as to override ethical concerns), and I think we should take that into account.
It sounds like you're really passionate about vegan nutrition. Can I suggest channeling that into sharing resources that help naive vegans? Even if you don't think they're representative they clearly exist, and if the problem can be solved by linking to existing resources that seems incredibly high return.
Tbh I'm not that passionate, I feel like I'm just doing the necessary minimum to stay completely healthy?
Anyway, of course! But most are just really basic reviews/explainers that are one google search away, to get the big picture of what you need. Some of these are:
And regardless of these resources you should of course visit a nutritionist (even if very sporadically, or even just once when you start being vegan) so that they can confirm the important bullet points, whether what you're doing broadly works, and when you should worry about anything. (And again, anecdotically this has been strongly stressed and acknowledged as necessary by all vegans I've met, which are not few).
The nutritionist might recommend yearly (or less frequent) blood testing, which does feel like a good failsafe. I've been taking them for ~6 years and all of them have turned out perfect (I only supplement B12, as nutritionist recommended).
I guess it's not that much that there's some resource that is the be-all end-all on vegan nutrition, but more that all of the vegans I've met have forwarded a really positive health-conscious attitudes, and stressed the importance of this points.
I've also very sporadically engaged with more extensive dietary literature, but mainly in Spanish (for example, Lucía Martínez's Vegetarianos con ciencia).
There was one very high up guy who ran around vegan ea for years yelling at anyone who suggested veganism required the slight bit more effort, thought, or money. He left in 2018 or 2019 for unrelated reasons but I think he may have done serious long term damage to ea vegan culture in particular.
That's a pity to hear, since undoubtedly any dietary change or improvement does require some thought (and we also should think about our dietary health regardless of them). That said, I do generally feel the required effort, thought, and money are way less than mainstream opinion usually pictures.
Regarding effort and thought, my experience (and that of all almost all vegans I've known who didn't suffer of already-present unrelated health issues) was that the change did required some effort and thought the first months (getting used to cooking ~15 nutritious comfort vegan meals, checking the labels, possibly visiting your nutritionist for the first time), but it quickly became a habit, as customary as following an omnivore diet.
And regarding money, the big bulk of a healthy vegan diet aren't meat substitutes, processed burgers etc., but vegetables, legumes, cereals... some of the cheapest products you can buy, especially when compared to meat. So a healthy vegan diet is indeed usually cheaper than an omnivore diet, even including the B12 supplementation, which is really cheap, and maybe even including the sporadic nutritionist visit and blood testing (in case they're not already part of your public health/medical plan), unless doctor visits are absurdly expensive in your country.
I agree 100% that the sample size is too low to compete with existing literature, and the error bars are too wide to make it very useful on prevalence. Luckily...
As a bonus, the results let me make an informed guess on which part of the existing literature to engage with, which I published last week.
I do take issue with calling the existing literature "rich". It's scarce and mostly extremely low quality. The 5 person study doesn't fix that and the upcoming 20 person one won't either, but nutrition literature is bad even by medical standards.
Nice! I guess I was just worrying about framing, since most people who see this will only skim, and they might get the impression that veganism per se induces deficiencies, instead of un-supplemented veganism (especially since I've already seen a comment about fixing this with non-vegan products, instead of the usual and recommended vegan supplementation).
And totally agree. Nonetheless, I do think available reviews can be called rich in comparison to a 5 or 20 person study.
The post is about testing vegans for deficiencies specifically so the author could provide (presumably vegan) supplements to people with deficiencies. It would be very strange to read this as an argument that you can't solve deficiencies in a vegan diet with supplements.
I might have noticed lower iron levels on the nutrition facts of vegetables, as well as all other vitamins and minerals (relative to a few years ago, but I wasn't paying much attention a few years ago). Like, a 1-cup serving of organic peas having 6% iron, 4% vitamin B, and 1-0% on everything else, which was weirdly low for basically half a day's intake of vegetables (this was ~november-december, all vegetables I could find at Whole Foods and Trader Joes in Foggy Bottom DC). It might have had something to do with FDA labelling though. I looked it up and the internet had surprisingly little to say other than that soil/fertilizer quality is degrading. It might plausibly be worth doing an experiment.
(To clarify, that's 6% RDI, not 6% by volume, which would be worrying.)
I'm confused. Are you saying 1 cup of organic peas is "half a day's intake of vegetables" for you?
Hmm, I'm a bit surprised that iron/B12 deficiencies showed up so much. Lots of vegan food like oat and soy milk are enriched/fortified, so if you drink your coffee with oat milk and pour some soy milk in your cereal, it goes a long way toward avoiding being low on iron and B12. Of course, this is highly individual, as is most of nutritional advice. As for Vit D... if you are fair-skinned, just being in the morning/afternoon sunshine frequently enough and with some skin exposed ought to help.
Fortified milks usually don't contain much iron. The soymilk in my fridge (Silk unsweetened) has 120% RDA of B12 but only 6% RDA of iron.