Vegan nutrition#Nutrition

The American Academy of Nutrition and Dietetics and Dietitians of Canada state that properly planned vegan diets are appropriate for all life stages, including pregnancy, lactation, infancy, childhood, and adolescence.{{Cite journal|last1=Melina|first1=Vesanto|last2=Craig|first2=Winston|last3=Levin|first3=Susan|date=December 2016|title=Position of the Academy of Nutrition and Dietetics: Vegetarian Diets|journal=Journal of the Academy of Nutrition and Dietetics|volume=116|issue=12|pages=1970–1980|doi=10.1016/j.jand.2016.09.025|issn=2212-2672|pmid=27886704|s2cid=4984228 }}{{cite journal|author1=American Dietetic Association|year=2003|title=Position of the American Dietetic Association and Dietitians of Canada: Vegetarian diets|url=http://www.andjrnl.org/article/S0002-8223%2803%2900294-3/fulltext|journal=Journal of the American Dietetic Association|volume=103|issue=6|pages=748–765|citeseerx=10.1.1.739.2592|doi=10.1053/jada.2003.50142|pmid=12778049}} The Australian National Health and Medical Research Council similarly recognizes a well-planned vegan diet as viable for any age,{{cite press release|url=http://www.international.to/index.php?option=com_content&id=8942%3Agovernment-recognises-vegan-diet-as-viable-option-for-all-australians&Itemid=307|archive-url=https://web.archive.org/web/20130922033910/http://www.international.to/index.php?option=com_content&id=8942%3Agovernment-recognises-vegan-diet-as-viable-option-for-all-australians&Itemid=307|archive-date=22 September 2013|title=Government recognises vegan diet as viable option for all Australians|publisher=Vegan Australia|via=News International|date=12 July 2013}}{{cite web|title=Dietary Guidelines for Australia|url=http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n31.pdf|archive-url=https://web.archive.org/web/20160112045909/http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n31.pdf|archive-date=12 January 2016|access-date=21 September 2013|publisher=Australian National Health and Medical Research Council}} as does the Victoria Department of Health,[https://www.betterhealth.vic.gov.au/health/healthyliving/vegetarian-and-vegan-eating "Vegetarian and vegan eating"]. betterhealth.vic.gov.au. Retrieved 26 June 2023. British Dietetic Association,[https://www.bda.uk.com/resource/british-dietetic-association-confirms-well-planned-vegan-diets-can-support-healthy-living-in-people-of-all-ages.html "British Dietetic Association confirms well-planned vegan diets can support healthy living in people of all ages"]. bda.uk.com. Retrieved 22 November 2021. British National Health Service,[https://ruh.nhs.uk/zz_content_include/services/clinical_depts/dietetics/documents/Vegetarian_and_Vegan_Diets.pdf "Plant based, Vegetarian and vegan diets: How to get the best nutrition"]. ruh.nhs.uk. Retrieved 27 June 2023. British Nutrition Foundation,[https://web.archive.org/web/20230627203526/https://www.nutrition.org.uk/putting-it-into-practice/plant-based-diets/healthy-eating-for-vegetarians-and-vegans/ "Healthy eating for vegetarians and vegans"]. nutrition.org.uk. Retrieved 26 June 2023. Mayo Clinic,{{cite web|title=Vegetarian diet: How to get the best nutrition|url=https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/art-20046446|archive-url=https://web.archive.org/web/20190519233803/https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/art-20046446|archive-date=19 May 2019|publisher=The Mayo Clinic}} Finnish Food Safety Authority,[https://www.ruokavirasto.fi/en/foodstuffs/healthy-diet/nutrition-and-food-recommendations/vegan-diet/ "Vegan diet"]. ruokavirasto.fi. Retrieved 11 December 2022. Heart and Stroke Foundation of Canada,{{cite web|title=Vegetarian diets|url=https://www.heartandstroke.ca/healthy-living/healthy-eating/specific-diets/vegetarians|publisher=The Heart and Stroke Foundation of Canada}} Italian Society of Human Nutrition,{{cite journal |vauthors=Agnoli C, Baroni L, Bertini I, Ciappellano S, Fabbri A, Papa M, Pellegrini N, Sbarbati R, Scarino ML, Siani V, Sieri S |year=2017|title=Position paper on vegetarian diets from the working group of the Italian Society of Human Nutrition|journal=Nutr Metab Cardiovasc Dis|url=https://www.nmcd-journal.com/article/S0939-4753(17)30260-0/pdf|volume=27|issue=12|pages=1037–1052|doi=10.1016/j.numecd.2017.10.020|pmid=29174030|doi-access=free|hdl=2434/532991|hdl-access=free}} Norwegian Directorate for Health,[https://www.helsedirektoratet.no/rapporter/vegetar-og-vegankost-ekspertuttalelse-fra-nasjonalt-rad-for-ernaering "Vegetarian and vegan diet - expert opinion from the National Council for Nutrition"]. helsedirektoratet.no. Retrieved 5 December 2022. and the Portuguese Directorate-General of Health.Silva, Sandra Cristina Gomes; Pinho, João Pedro; Borges, Cátia; Santos, Cristina Teixeira; Santos, Alejandro; Graça, Pedro. (2015). [https://nutrimento.pt/activeapp/wp-content/uploads/2015/12/Guidelines-for-a-healthy-vegetarian-diet.pdf "Guidelines for a Healthy Vegetarian Diet"]. National Programme for the Promotion of Healthy Eating. Retrieved 5 December 2022. "When appropriately planned, vegetarian diets, including lacto-ovo vegetarian or vegan, are healthy and nutritionally adequate for all cycles of life, and they can be useful in prevention and treatment of some chronic diseases. However, as in any food pattern, vegetarian diets may be inadequate."

The British National Health Service's Eatwell Plate allows for an entirely plant-based diet,[https://www.nhs.uk/Live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide/ "The Eatwell Guide"], National Health Service; [https://www.nhs.uk/live-well/eat-well/how-to-eat-a-balanced-diet/the-vegan-diet/ "The vegan diet"], National Health Service. as does the United States Department of Agriculture's (USDA) MyPlate.{{cite web|date=23 February 2015|title=What Foods Are in the Protein Foods Group?|url=http://www.choosemyplate.gov/food-groups/protein-foods.html|archive-url=https://web.archive.org/web/20130116120159/http://www.choosemyplate.gov/food-groups/protein-foods.html|archive-date=16 January 2013|access-date=17 January 2013|publisher=United States Department of Agriculture}}{{cite web|title=Vegetarian Choices in the Protein Foods Group|url=http://www.choosemyplate.gov/food-groups/vegetarian.html|archive-url=https://web.archive.org/web/20141018014657/http://www.choosemyplate.gov/food-groups/vegetarian.html|archive-date=18 October 2014|access-date=13 October 2014|publisher=United States Department of Agriculture}} The USDA allows tofu to replace meat in the National School Lunch Program. The American Academy of Nutrition and Dietetics adds that well-planned vegan diets are also appropriate for older adults and athletes.

In 2016, the German Society for Nutrition cautioned against a vegan diet for babies, children, and adolescents, and during pregnancy and breastfeeding, due to insufficient data.{{cite journal|vauthors=Richter M, Boeing H, Grünewald-Funk D, Heseker H, Kroke A, Leschik-Bonnet E, Oberritter H, Strohm D, Watzl B |date=12 April 2016|title=Vegan diet: Position of the German Nutrition Society (DGE) |journal=Ernährungs Umschau |volume=63 |issue=4 |pages=92–102 |doi=10.4455/eu.2016.021|doi-access=free}} Erratum in: 63(5): M262 In 2020, the German Society for Nutrition issued an update stating that they do not recommend a vegan diet for babies, children and adolescents, or for pregnancy or breastfeeding, citing insufficient data for these subpopulations.{{Cite web|last1=Richter|first1=Margrit|last2=Kroke|first2=Anja|last3=Grünewald-Funk|first3=Dorle|last4=Heseker|first4=Helmut|last5=Virmani|first5=Kiran|last6=Watzl|first6=Bernhard|date=September 2020|title=Update to the position of the German Nutrition Society on vegan diets in population groups with special nutritional requirements|url=https://www.ernaehrungs-umschau.de/fachzeitschrift/sonderdruckespecial-editions/|access-date=2021-04-04|website=Ernährungs Umschau|publisher=Deutsche Gesellschaft für Ernährung e. V. (DGE)|doi=10.4455/eu.2020.044|doi-broken-date=1 November 2024|quote=Because the available data remain insufficient, no satisfactory assessment can be made with regard to micronutrient intake and supply status or prevalence of nutrient deficiencies or other adverse health effects regarding a vegan diet in these special population groups.}}

The Danish Health Authority have advised vegan parents to seek professional dietary advice, noting that "young children who are fed a vegan diet can grow and develop normally if they receive the right supplements to the diet, and the energy content is sufficient. It requires detailed knowledge of diet and nutritional needs. The parents must therefore be encouraged to seek advice from a licensed clinical dietitian to ensure that the child's diet is sufficient."[https://www.sst.dk/da/udgivelser/2018/~/media/2986643F11A44FA18595511799032F85.ashx "Ernæring til spædbørn og småbørn– EN HÅNDBOG FOR SUNDHEDSPERSONALE"]. sst.dk. Retrieved 5 December 2022. The National Institute for Health and Welfare in Finland have stated that a well-balanced vegan diet is safe during pregnancy but mothers require the guidance of a nutritional therapist.[https://www.julkari.fi/bitstream/handle/10024/137770/URN_ISBN_978-952-343-264-2.pdf "Eating together - food recommendations for families with children"]. julkari.fi. Retrieved 11 December 2022.

The State of Israel Ministry of Health advises vegan mothers to consult with a dietitian.[https://www.health.gov.il/English/Topics/Pregnancy/Childbirth/feeding/Pages/veg_babies.aspx "Nutrition for Infants in Vegetarian and Vegan Families"]. health.gov.il. Retrieved 5 December 2022. The Swiss Federal Commission for Nutrition do not recommend vegan diets for pregnant women, infants and children or older adults due to lack of data and risk of certain nutrient deficiencies.[https://www.blv.admin.ch/blv/en/home/das-blv/organisation/kommissionen/eek/vor-und-nachteile-vegane-ernaehrung.html "Vegan diets: review of nutritional and health benefits and risks (2018)"]. blv.admin.ch. Retrieved 5 December 2022. The Royal Academy of Medicine of Belgium do not recommend a vegan diet during pregnancy, breastfeeding and infancy.[https://www.armb.be/fileadmin/sites/armb/uploads/Document-site/pdf/Avis/2019/Mise_au_point__version_anglaise_.pdf "Clarification on the vegetalian diet for children, pregnant and breastfeeding women"]. armb.be. Retrieved 5 December 2022.

The German Society for Allergology and Clinical Immunology (DGAKI) position paper on vegan diets in 2023 noted that "to ensure an adequate supply of vitamin B12, but also of calcium, iron, iodine, zinc, as well as high-quality protein and long-chain omega-3 fatty acids (EPA/DHA), an in-depth study of the subject of nutrition, time investment, and supplementation, with regard to various nutrients, is required."{{cite journal|vauthors=Reese I, Schäfer C, Ballmer-Weber B, Beyer K, Dölle-Bierke S, van Dullemen S, Jappe U, Müller S, Schnadt S, Treudler R, Worm M|year=2023|title=Vegan diets from an allergy point of view - Position paper of the DGAKI working group on food allergy|journal=Allergol Select|volume=7|issue=|pages=57–83|doi=10.5414/ALX02400E|pmid=37056444|pmc=10088878 }}

The American Heart Association (AHA) gave the vegan diet a 78% score of its alignment with the 2021 AHA Dietary Guidance. They noted that benefits of a vegan diet are its emphasis on fruits, legumes, nuts, vegetables and whole grains which are heart healthy but a key challenge is its restrictive nature and risk of Vitamin B₁₂ deficiency.{{cite journal|vauthors=Gardner CD, Vadiveloo MK, Petersen KS, Anderson CA, Springfield S, Van Horn L, Khera A, Lamendola C, Mayo SM, Joseph JJ |year=2023|title=Popular Dietary Patterns: Alignment With American Heart Association 2021 Dietary Guidance: A Scientific Statement From the American Heart Association|journal=Circulation|volume=147|issue=22|pages=1715–1730|doi=10.1161/CIR.0000000000001146|pmid=37128940|doi-access=free}}

The position of the Canadian Paediatric Society is that "well-planned vegetarian and vegan diets with appropriate attention to specific nutrient components can provide a healthy alternative lifestyle at all stages of fetal, infant, child and adolescent growth." It is recommended that attention should be given to nutrient intake, particularly protein, vitamins B₁₂ and D, essential fatty acids, iron, zinc, and calcium.{{cite journal|last1=Amit|first1=M|date=May 2010|title=Vegetarian diets in children and adolescents|journal=Paediatrics & Child Health|volume=15|issue=5|pages=303–14|pmc=2912628|pmid=21532796}}

Although position papers from America and Canada have stated that well-planned vegan diets, are suitable for every stage of life, European statements have been more cautious of vegan diets in pregnancy and infancy.{{cite journal|vauthors=Kiely ME|year=2021|title=Risks and benefits of vegan and vegetarian diets in children|journal=Proc Nutr Soc|url=https://www.cambridge.org/core/services/aop-cambridge-core/content/view/A8539A11838C49A98FAF2DB2C6EE0AF2/S002966512100001Xa.pdf/risks_and_benefits_of_vegan_and_vegetarian_diets_in_children.pdf|volume=80|issue=2|pages=159–164|doi=10.1017/S002966512100001X|pmid=33504371|s2cid=231761415 }} The British Paediatric Association (BPA), European Paediatric Association (EPA), European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN), Croatian Society for Pediatric Gastroenterology, Hepatology and Nutrition (HDPGHP) and the Italian Society of Paediatrics (SIP) have included strong recommendations to parents that vegan diets should not be adopted by pregnant women and infants without medical or dietetic supervision.{{cite journal|vauthors=Fewtrell M, Bronsky J, Campoy C, Domellöf M, Embleton N, Fidler Mis N, Hojsak I, Hulst JM, Indrio F, Lapillonne A, Molgaard C |year=2017|title=Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition|journal=J Pediatr Gastroenterol Nutr|url=https://journals.lww.com/jpgn/Fulltext/2017/01000/Complementary_Feeding__A_Position_Paper_by_the.21.aspx|volume=64|issue=1|pages=119–132|doi=10.1097/MPG.0000000000001454|pmid=28027215|s2cid=9893953 }}{{cite journal|year=1988|title=Vegetarian weaning. Nutrition Standing Committee of the British Paediatric Association|journal=Arch Dis Child|volume=63|issue=10|pages=1286–1292|doi=10.1136/adc.63.10.1286|pmid=3196060|pmc=1779028 }}{{cite journal|vauthors=Ferrara P, Corsello G, Quattrocchi E, Dell'Aquila L, Ehrich J, Giardino I, Pettoello-Mantovani M |year=2017|title=Caring for Infants and Children Following Alternative Dietary Patterns|journal=The Journal of Pediatrics|url=https://relaped.com/wp-content/uploads/2018/06/39.pdf|volume=187|issue=|pages=339–340|doi=10.1016/j.jpeds.2017.04.053|pmid=28528222|s2cid=10827195 }}{{cite web |author=Zaja, Orjena |author2=Hojsak, Iva |year=2018 |title=Vegetarian and vegan diet in children–guidelines of the Croatian Society for Pediatric Gastroenterology, Hepatology and Nutrition of the Croatian Medical Association |website=ResearchGate |url=https://www.researchgate.net/publication/331976413}}{{cite journal|vauthors=Baldassarre ME, Panza R, Cresi F |year=2022|title=Complementary feeding in preterm infants: a position paper by Italian neonatal, paediatric and paediatric gastroenterology joint societies|journal=Ital J Pediatr|volume=48|issue=1|pages=143|doi=10.1186/s13052-022-01275-w|pmid=35932061 |pmc=9354266 |doi-access=free}}

The German Society for Paediatric and Adolescent Medicine, Polish National Consultant in the Field of Paediatrics and Spanish Paediatric Association do not recommend

vegan diets during infancy or childhood and instead advise a balanced omnivorous or lacto-ovo-vegetarian diet to meet nutritional requirements.{{cite journal|vauthors=Rudloff S, Bührer C, Jochum F, Kauth T, Kersting M, Körner A, Koletzko B, Mihatsch W, Prell C, Reinehr T, Zimmer KP |year=2019|title=Vegetarian diets in childhood and adolescence: Position paper of the nutrition committee, German Society for Paediatric and Adolescent Medicine (DGKJ)|journal=Mol Cell Pediatr|volume=6|issue=1|pages=4|doi=10.1186/s40348-019-0091-z|pmid=31722049|pmc=6854160 |doi-access=free}}{{cite journal|vauthors=Dobrzańska A, Czerwionka-Szafarska M, Siwińska-Gołębiowska H |year=2002|title=Position of the National Consultant in the Field of Paediatrics and the Team of Experts on the use of vegetarian diets in the developmental age|journal=Stand Med Pediatr|volume=4|issue=|pages=436–439}}{{cite journal |vauthors=Redecilla-Ferreiro S, Moráis-López A, Moreno-Villares JM |year=2020|title=Position paper on vegetarian diets in infants and children. Committee on Nutrition and Breastfeeding of the Spanish Paediatric Association|journal=An Pediatr (Engl Ed)|url=https://www.analesdepediatria.org/en-position-paper-on-vegetarian-diets-articulo-S2341287920300211|volume=92|issue=5|pages=306.e1–306.e6| doi=10.1016/j.anpedi.2019.10.013|pmid=31866234|doi-access=free|hdl=10486/692237|hdl-access=free}}

The French Pediatric Hepatology, Gastroenterology and Nutrition Group have stated that a vegan diet is "not recommended for infants, children, and adolescents due to the risk of multiple nutritional deficiencies that are inevitable in the absence of supplements".{{cite journal|vauthors=Lemale J, Mas E, Jung C, Bellaiche M, Tounian P |year=2019|title=French-speaking Pediatric Hepatology, Gastroenterology and Nutrition Group (GFHGNP)|journal=Arch Pediatr|url=https://www.gfhgnp.org/wordpress/wp-content/uploads/kdocuments/Recos-v%C3%A9g%C3%A9talisme-Arch-P%C3%A9diatr-19.pdf|volume=26|issue=7|pages=442–450|doi=10.1016/j.arcped.2019.09.001|pmid=31615715|s2cid=204740938 }} In 2017, the Italian Society of Preventive and Social Pediatrics (SIPPS), together with the Italian Federation of Pediatricians (FIMP) and the Italian Society of Perinatal Medicine (SIMP) issued a joint position paper which concluded that vegan diets cannot be recommended for children because the diet leads to deficiencies in vitamin B₁₂, calcium, DHA, iron and vitamin D. When these nutrients are missing, it negatively affects children's growth and neurocognitive development.[https://www.sipps.it/attivita-editoriale/position-paper-diete-vegetariane-in-gravidanza-ed-in-eta-evolutiva/ "Position Paper SIPPS-FIMP-SIMP: Diete vegetariane in gravidanza ed in età evolutiva"]. sipps.it. Retrieved 5 December 2022.

The Slovenian Paediatric Society have advised against vegan diets for pregnant and lactating women, newborns, infants, children, and adolescents.[https://vestnik.szd.si/index.php/ZdravVest/article/view/2994/3765 "Alternative nutrition: literature review"]. vestnik.szd.si. Retrieved 5 December 2022.

{{further|Nutrition and pregnancy}}

According to a 2015 systematic review, there was little evidence available about vegetarian and vegan diets during pregnancy, and a lack of randomized studies meant that the effects of diet could not be distinguished from confounding factors.{{cite journal|last1=Piccoli|first1=GB|last2=Clari|first2=R|last3=Vigotti|first3=FN|last4=Leone|first4=F|last5=Attini|first5=R|last6=Cabiddu|first6=G|last7=Mauro|first7=G|last8=Castelluccia|first8=N|last9=Colombi|first9=N|last10=Capizzi|first10=I|last11=Pani|first11=A|date=April 2015|title=Vegan-vegetarian diets in pregnancy: danger or panacea? A systematic narrative review|journal=BJOG|volume=122|issue=5|pages=623–633|doi=10.1111/1471-0528.13280|pmid=25600902|hdl-access=free|first12=T|last13=Avagnina|first13=P|last12=Todros|hdl=2318/1523463|s2cid=206906653}} It concluded: "Within these limits, vegan-vegetarian diets may be considered safe in pregnancy, provided that attention is paid to vitamin and trace element requirements." A daily source of vitamin B₁₂ is important for pregnant and lactating vegans, as is vitamin D if there are concerns about low sun exposure. A different review found that pregnant vegetarians consumed less zinc than pregnant non-vegetarians, with both groups' intake below recommended levels; however, the review found no significant difference between groups in actual zinc levels in bodily tissues, nor any effect on gestation period or birth weight.{{cite journal|last1=Foster|first1=Meika|last2=Herulah|first2=Ursula|last3=Prasad|first3=Ashlini|last4=Petocz|first4=Peter|last5=Samman|first5=Samir|date=5 June 2015|title=Zinc Status of Vegetarians during Pregnancy: A Systematic Review of Observational Studies and Meta-Analysis of Zinc Intake|journal=Nutrients|volume=7|issue=6|pages=4512–4525|doi=10.3390/nu7064512|pmc=4488799|pmid=26056918|doi-access=free}}

Researchers have reported cases of vitamin B₁₂ deficiency in lactating vegetarian mothers that were linked to deficiencies and neurological disorders in their children.{{cite journal|last1=Pepper|first1=M. Reese|last2=Black|first2=Maureen M.|date=August 2011|title=B12 in fetal development|journal=Seminars in Cell & Developmental Biology|volume=22|issue=6|pages=619–623|doi=10.1016/j.semcdb.2011.05.005|pmid=21664980}}{{cite journal|last1=Mangels|first1=Ann Reed|last2=Messina|first2=Virginia|date=June 2001|title=Considerations in planning vegan diets|journal=Journal of the American Dietetic Association|volume=101|issue=6|pages=670–677|doi=10.1016/S0002-8223(01)00169-9|pmid=11424546}} The UK National Health Service recommends that a physician or registered dietitian should be consulted about taking supplements during pregnancy.{{cite web|url=http://www.nhs.uk/conditions/pregnancy-and-baby/pages/vitamins-minerals-supplements-pregnant.aspx|date=14 February 2020|title=Vitamins, supplements and nutrition in pregnancy|publisher= National Health Service, UK}}{{cite journal|last1=Schweitzer|first1=Amy|date=2006|title=Dietary Supplements During Pregnancy|journal=The Journal of Perinatal Education|volume=15|issue=4|pages=44–45|doi=10.1624/105812406X107834|pmc=1804304|pmid=17768435}}

A 2022 French expert consensus paper recommended a minimum of 800 IU and a maximum of 1600 IU of vitamin D per day for vegan children aged 2-18 years.{{cite journal|vauthors=Bacchetta J, Edouard T, Laverny G, Bernardor J, Bertholet-Thomas A, Castanet M, Garnier C, Gennero I, Harambat J, Lapillonne A, Molin A, Naud C, Salles JP, Laborie S, Tounian P, Linglart A |year=2022|title=Vitamin D and calcium intakes in general pediatric populations: A French expert consensus paper|journal=Arch Pediatr|volume=29|issue=4|pages=312–325|doi=10.1016/j.arcped.2022.02.008|pmid=35305879|doi-access=free}}

Because of the sensitive nature of pregnancy, vegan diets have attracted significant attention from the media, both positive and negative. Much of the reaction has focused on nutrition.

Negative attention stems from cases of nutritional deficiencies that have come to the attention of the courts, including the death of a baby in New Zealand in 2002 due to hypocobalaminemia, i.e. vitamin B₁₂ deficiency.{{cite journal|last1=Di Genova|first1=Tanya|last2=Guyda|first2=Harvey|date=March 2007|title=Infants and children consuming atypical diets: Vegetarianism and macrobiotics|journal=Paediatrics & Child Health|volume=12|issue=3|pages=185–188|doi=10.1093/pch/12.3.185|pmc=2528709|pmid=19030357}}{{Cite web|title=Religious couple jailed for 5 years for son's manslaughter|url=https://www.nzherald.co.nz/nz/religious-couple-jailed-for-5-years-for-sons-manslaughter/ZNBY72AP26BYJSM66O4P4OFZNI/|access-date=6 January 2021|website=The New Zealand Herald |date=13 June 2002 |language=en-NZ|quote=Caleb died in March last year from broncho-pneumonia associated with anaemia and brain damage caused by vitamin B12 deficiency.}} Positive attention includes in 2018 when journalist Rebecca Seal of The Guardian reported on the growing number of vegan children in the United Kingdom and cited guidance issued by the British Dietetic Association in 2017 that well-planned vegan diets are safe for all ages.{{Cite web |last=Seal |first=Rebecca |date=2018-11-24 |title='If they're not eating any vegetables, you panic': the families raising vegan children |url=http://www.theguardian.com/lifeandstyle/2018/nov/24/not-eating-vegetables-families-raising-vegan-children |access-date=2022-06-22 |website=The Guardian |language=en}} In 2017, BBC Good Food published a guide to vegan feeding for children and infants.{{Cite web |title=Is a vegan diet healthy for kids? |url=https://www.bbcgoodfood.com/howto/guide/vegan-diet-healthy-kids |access-date=2022-06-22 |website=BBC Good Food |language=en}} In 2016, journalist Avery Yale Kamila of the Portland Press Herald wrote about raising a giant baby on a vegan diet who was wearing 24 months clothing at six months.{{Cite web |last=Kamila |first=Avery Yale |date=2016-07-06 |title=Raising a giant baby on a vegan diet |url=https://www.pressherald.com/2016/07/06/vegetarian-kitchen-raising-a-giant-vegan-baby/ |access-date=2022-06-22 |website=Portland Press Herald}}

The American Academy of Nutrition and Dietetics states that special attention may be necessary to ensure that a vegan diet will provide adequate amounts of vitamin B₁₂, omega-3 fatty acids, vitamin D, calcium, iodine, iron, and zinc. These nutrients are available in plant foods, with the exception of vitamin B₁₂, which can be obtained only from B₁₂-fortified vegan foods or supplements.{{Cite web|last=|title=Vegetarian, vegan and plant-based diet|url=https://www.bda.uk.com/resource/vegetarian-vegan-plant-based-diet.html|access-date=2021-05-09|website=British Dietetic Association|publisher=}} Iodine may also require supplementation, such as using iodized salt.

{{further|Vitamin B12 deficiency}}

File:Vegan food pyramid.svg]]

Vitamin B₁₂ is not made by plants or animals, but by bacteria that grow in soil, feces, dirty water, the intestines of animals or laboratories,{{cite journal | vauthors = Fang H, Kang J, Zhang D | title =Microbial production of vitamin 12: a review and future perspectives | journal = Microbial Cell Factories | volume = 16 | issue = 1 | pages = 15 | date = January 2017 | pmid = 28137297 | pmc = 5282855 | doi = 10.1186/s12934-017-0631-y | doi-access =free }}{{cite journal | vauthors = Moore SJ, Warren MJ | title = The anaerobic biosynthesis of vitamin B₁₂12 | journal = Biochemical Society Transactions | volume = 40 | issue = 3 | pages = 581–6 | date = June 2012 | pmid = 22616870 | doi = 10.1042/BST20120066 | s2cid = 26057998 }}{{cite book|last1=Graham|first1=Ross M.|last2=Deery|first2=Evelyne|last3=Warren|first3=Martin J.|chapter=Vitamin B12: Biosynthesis of the Corrin Ring |editor1-last=Warren|editor1-first=Martin J.|editor2-last=Smith|editor2-first=Alison G.|editor2-link=Alison Gail Smith | name-list-style = vanc |title=Tetrapyrroles Birth, Life and Death|date=2009|publisher=Springer-Verlag|location=New York, NY|isbn=978-0-387-78518-9|page=286|doi=10.1007/978-0-387-78518-9_18}}{{cite news|last1=Rooke|first1=Jennifer| name-list-style = vanc |title=Do carnivores need Vitamin B₁₂ supplements?|url=http://baltimorepostexaminer.com/carnivores-need-vitamin-b12-supplements/2013/10/30|work=Baltimore Post Examiner|date=October 30, 2013}}{{cite web|title=Vitamin B₁₂|url=https://www.dsm.com/markets/anh/en_US/Compendium/companion_animals/vitamin_B12.html|publisher=DSM|access-date=January 17, 2017}} so plant foods are not reliable sources of B₁₂.{{cite web|url=http://ods.od.nih.gov/factsheets/vitaminb12.asp |title=Dietary Supplement Fact Sheet: Vitamin B₁₂ |access-date=2018-02-02 |quote= Strict vegetarians and vegans are at greater risk than lacto-ovo vegetarians and nonvegetarians of developing vitamin B₁₂ deficiency because natural food sources of vitamin B₁₂ are limited to animal foods. |publisher=National Institutes of Health: Office of Dietary Supplements }} It is synthesized by some gut bacteria in humans and other animals, but humans cannot absorb the B₁₂ made in their guts, as it is made in the colon which is too far from the small intestine, where absorption of B₁₂ occurs.{{cite journal|last1=Gille|first1=D|last2=Schmid|first2=A|date=February 2015|title=Vitamin B₁₂ in meat and dairy products|journal=Nutrition Reviews|type=Review|volume=73|issue=2|pages=106–15|doi=10.1093/nutrit/nuu011|pmid=26024497|doi-access=free}} Ruminants, such as cows and sheep, absorb B₁₂ produced by bacteria in their guts.

Animals store vitamin B₁₂ in liver and muscle and some pass the vitamin into their eggs and milk; meat, liver, eggs and milk are therefore sources of B₁₂.{{cite web|date=2014|title=Foods highest in Vitamin B₁₂ (based on levels per 100-gram serving)|url=http://nutritiondata.self.com/foods-000116000000000000000-w.html|access-date=16 February 2017|publisher=Nutrition Data, Conde Nast, USDA National Nutrient Database, release SR-21}}{{cite web|title=Dietary Supplement Fact Sheet: Vitamin B12|url=http://ods.od.nih.gov/factsheets/vitaminb12|access-date=28 September 2011|publisher=Office of Dietary Supplements, National Institutes of Health}}

The UK Vegan Society, the Vegetarian Resource Group, and the Physicians Committee for Responsible Medicine, among others, recommend that every vegan consume adequate B₁₂ either from fortified foods or by taking a supplement.{{cite journal|year=2007|title=Vitamin B₁₂ sources and bioavailability|journal=Experimental Biology and Medicine |volume=232|issue=10|pages=1266–1274|doi=10.3181/0703-MR-67|pmid=17959839|last=Watanabe|first=F.|s2cid=14732788}}{{cite web|title=Vegan Society B₁₂ factsheet|url=http://www.vegansociety.com/food/nutrition/b12/|last=Walsh|first=Stephen|publisher=Vegan Society|access-date=January 17, 2008|archive-url=https://web.archive.org/web/20080526073658/http://www.vegansociety.com/food/nutrition/b12/|archive-date=May 26, 2008|df=mdy-all}}{{cite web|url=https://www.vrg.org/nutrition/b12.htm |title=Vitamin B₁₂ in the Vegan Diet |access-date=January 17, 2008|author-link=Reed Mangels|last=Mangels|first=Reed|publisher=Vegetarian Resource Group}}{{cite web|url=https://www.pcrm.org/health/diets/vegdiets/dont-vegetarians-have-trouble-getting-enough |title=Don't Vegetarians Have Trouble Getting Enough Vitamin B₁₂? |access-date=January 17, 2008 |publisher=Physicians Committee for Responsible Medicine}}

Vitamin B₁₂ deficiency is potentially extremely serious, leading to megaloblastic anemia (an undersupply of oxygen due to malformed red blood cells),{{Cite web|title=Anemia, Megaloblastic|url=https://rarediseases.org/rare-diseases/anemia-megaloblastic/|access-date=2021-05-09|website=NORD (National Organization for Rare Disorders)|language=en-US}} nerve degeneration and irreversible neurological damage.{{cite journal |last1=C. |first1=Robert | last2=Brown |first2=David |url=https://www.aafp.org/afp/2003/0301/p979.html |title=Vitamin B₁₂ Deficiency |journal=American Family Physician |volume=67 |issue=5 |pages=979–986 |date=2003-03-01|pmid=12643357 }} Cases of severe vitamin B₁₂ deficiency have been reported in vegan adults, children{{Cite web|title=Individual Cases of B12 Deficiency in Vegans|url=https://veganhealth.org/vitamin-b12/individual-cases-of-b12-deficiency-in-vegans/|access-date=2021-11-30|website=VeganHealth.org|language=en-US}} infants and toddlers.{{Cite web|title=B12 Deficiency Cases in Vegan Infants and Toddlers|url=https://veganhealth.org/vitamin-b12/b12-deficiency-cases-in-vegan-infants-and-toddlers/|access-date=2021-11-30|website=VeganHealth.org|language=en-US}}

Because B₁₂ is stored in large amounts in the liver, deficiency in adults may begin only years after adoption of a diet lacking B₁₂. For infants and young children who have not built up these stores, onset of B₁₂ deficiency can be faster and supplementation for vegan children is thus crucial.

Evidence shows that vegans who are not taking vitamin B₁₂ supplements do not consume sufficient B₁₂ and often have abnormally low blood concentrations of vitamin B₁₂.{{cite journal |doi=10.1159/000012827 |title=Homocysteine Levels in Vegetarians versus Omnivores |year=2000 |last1=Krajčovičová-Kudláčková |first1=M. |last2=Blažíček |first2=P. |last3=Kopčová |first3=J. |last4=Béderová|first4=A. |last5=Babinská |first5=K. |journal=Annals of Nutrition and Metabolism |volume=44 |issue=3 |pages=135–8 |pmid=11053901|s2cid=25418416 }} This is because, unless fortified, plant foods do not contain reliable amounts of active vitamin B₁₂. Vegans are advised to adopt one of the following dietary options:{{cite web|title = What Every Vegan Should Know About Vitamin B12|url = https://www.vegansociety.com/resources/nutrition-health/vitamins-minerals-and-more/vitamin-b12-your-key-facts/what-every-vegan-should-know-about-vitamin-b12|access-date = 2015-08-05}}

• consume fortified foods 2-3 times per day to get at least 3 micrograms of vitamin B₁₂,
• or take at least 10 micrograms of B₁₂ as a supplement once per day,
• or take at least 2000 micrograms of B₁₂ as a supplement once per week.

B₁₂ is more efficiently absorbed in small regular doses, which explains why the quantity required rises so quickly as frequency goes down.

The US National Institutes of Health recommends B₁₂ intake in a range from 0.4 micrograms a day for infants, to 2.4 micrograms for adults, and up to 2.8 micrograms for nursing mothers.

[https://ods.od.nih.gov/factsheets/VitaminB12-Consumer/#h2 "Vitamin B₁₂: Fact Sheet for Consumers"] National Institutes of Health Office of Dietary Supplements (retrieved Dec 9, 2016)

The European Food Safety Authority set the Adequate Intake at 1.5 micrograms for infants, 4 micrograms for children and adults, and 4.5 and 5 micrograms during pregnancy and nursing.[https://www.efsa.europa.eu/en/efsajournal/pub/4150 "Scientific Opinion on Dietary Reference Values for cobalamin (vitamin B₁₂)"] European Food Safety Authority Panel on Dietetic Products, Nutrition and Allergies. EFSA Journal 2015;13(7):4150 [64 pp.]. These amounts can be obtained by eating B₁₂ fortified foods, which include some common breakfast cereals, plant milks, and meat analogues, as well as from common multivitamins such as One-A-Day. Some of the fortified foods require only a single serving to provide the recommended B₁₂ amounts.

[https://www.pcrm.org/health/diets/vegdiets/dont-vegetarians-have-trouble-getting-enough "Don't Vegetarians Have Trouble Getting Enough Vitamin B₁₂?"] Physicians Committee for Responsible Medicine (retrieved Dec 9, 2016)

It has been suggested that nori (an edible seaweed), tempeh (a fermented soybean food), and nutritional yeast may be sources of vitamin B₁₂.{{cite journal|last1=Watanabe|first1=Fumio|last2=Yabuta|first2=Yukinori|last3=Bito|first3=Tomohiro|last4=Teng|first4=Fei|date=5 May 2014|title=Vitamin B12-Containing Plant Food Sources for Vegetarians|journal=Nutrients|volume=6|issue=5|pages=1861–1873|doi=10.3390/nu6051861|pmc=4042564|pmid=24803097|doi-access=free}}{{pb}}{{cite journal|last1=Watanabe|first1=Fumio|last2=Yabuta|first2=Yukinori|last3=Tanioka|first3=Yuri|last4=Bito|first4=Tomohiro|date=2 July 2013|title=Biologically Active Vitamin B₁₂ Compounds in Foods for Preventing Deficiency among Vegetarians and Elderly Subjects|journal=Journal of Agricultural and Food Chemistry|volume=61|issue=28|pages=6769–6775|doi=10.1021/jf401545z|pmid=23782218}}{{pb}}{{cite journal|last1=Croft|first1=Martin T.|last2=Lawrence|first2=Andrew D.|last3=Raux-Deery|first3=Evelyne|last4=Warren|first4=Martin J.|last5=Smith|first5=Alison G.|date=November 2005|title=Algae acquire vitamin B12 through a symbiotic relationship with bacteria|journal=Nature|volume=438|issue=7064|pages=90–93|bibcode=2005Natur.438...90C|doi=10.1038/nature04056|pmid=16267554|s2cid=4328049}}Mangels, Messina and Messina 2011, 190, 297; Debra Wasserman, Reed Mangels, Simply Vegan, The Vegetarian Resource Group, 2006, [https://books.google.com/books?id=VSEy_HJ_w7QC&pg=PA171 171]; [https://www.vrg.org/nutrition/b12.htm Mangels 2006]. In 2016, the Academy of Nutrition and Dietetics stated that nori, fermented foods (such as tempeh), spirulina, chlorella algae, and unfortified nutritional yeast are not adequate sources of vitamin B₁₂ and that vegans need to consume regularly fortified foods or supplements containing B₁₂. Otherwise, vitamin B₁₂ deficiency may develop, as has been demonstrated in case studies of vegan infants, children, and adults.{{cite journal|last1=Melina|first1=Vesanto|last2=Craig|first2=Winston|last3=Levin|first3=Susan|date=December 2016|title=Position of the Academy of Nutrition and Dietetics: Vegetarian Diets|url=https://www.eatrightpro.org/~/media/eatrightpro%20files/practice/position%20and%20practice%20papers/position%20papers/vegetarian-diet.ashx|journal=Journal of the Academy of Nutrition and Dietetics|volume=116|issue=12|pages=1970–1980|doi=10.1016/j.jand.2016.09.025|pmid=27886704|s2cid=4984228 |url-access=subscription}}

Vitamin B₁₂ is mostly manufactured by industrial fermentation of various kinds of bacteria, which make forms of cyanocobalamin, which are further processed to generate the ingredient included in supplements and fortified foods.{{cite journal|vauthors=Fang H, Kang J, Zhang D|year=2017|title=Microbial production of vitamin B12: a review and future perspectives|journal=Microb Cell Fact|type=Review|volume=16|issue=1|pages=15|doi=10.1186/s12934-017-0631-y|pmc=5282855|pmid=28137297 |doi-access=free }}{{cite journal|last1=Riaz|first1=Muhammad|last2=Iqbal|first2=Fouzia|last3=Akram|first3=Muhammad|year=2007|title=Microbial production of vitamin B12 by methanol utilizing strain of Pseudomonas specie|url=https://pu-pk.academia.edu/MuhammadAkram/Papers/83315/Microbial_production_of_vitamin_B12_by_methanol_utilizing_strain_of|journal=Pakistan Journal of Biochemistry & Molecular Biology|volume=40|pages=5–10|archive-url=https://web.archive.org/web/20120425162917/http://pu-pk.academia.edu/MuhammadAkram/Papers/83315/Microbial_production_of_vitamin_B12_by_methanol_utilizing_strain_of|archive-date=25 April 2012|access-date=15 December 2017}} A Pseudomonas denitrificans strain was most commonly used {{as of|2017|lc=y}}.{{cite book|last1=Lusas|first1=Edmund W.|title=Kent and Riegel's Handbook of Industrial Chemistry and Biotechnology|year=2007|isbn=978-0-387-27842-1|pages=1549–1656|chapter=Animal and Vegetable Fats, Oils, and Waxes|doi=10.1007/978-0-387-27843-8_34}}{{cite journal|last1=Xia|first1=Wei|last2=Chen|first2=Wei|last3=Peng|first3=Wei-fu|last4=Li|first4=Kun-tai|date=June 2015|title=Industrial vitamin B12 production by Pseudomonas denitrificans using maltose syrup and corn steep liquor as the cost-effective fermentation substrates|journal=Bioprocess and Biosystems Engineering|volume=38|issue=6|pages=1065–1073|doi=10.1007/s00449-014-1348-5|pmid=25561346|s2cid=42246117}} It is grown in a medium containing sucrose, yeast extract, and several metallic salts. To increase vitamin production, it is supplemented with sugar beet molasses, or, less frequently, with choline. Certain brands of B₁₂ supplements are certified vegan.Reed Mangels, Virginia Messina, and Mark Messina, "Vitamin B₁₂ (Cobalamin)", The Dietitian's Guide to Vegetarian Diets, Jones & Bartlett Learning, 2011, [https://books.google.com/books?id=eJ10HoYQ2woC&pg=PA181 181–192].

Humans require iodine for the production of thyroid hormones that enable normal thyroid function.{{Cite journal |date=2021-04-29 |title=Thyroid Hormone Toxicity: Background, Pathophysiology, Epidemiology |website=Medscape |url=https://emedicine.medscape.com/article/819692-overview#showall}} Iodine supplementation may be necessary for vegans in countries where salt is not typically iodized, where it is iodized at low levels, or where, as in Britain and Ireland, dairy products are relied upon for iodine delivery because of low levels in the soil.{{cite journal|last1=Appleby|first1=Paul N|last2=Thorogood|first2=Margaret|last3=Mann|first3=Jim I|last4=Key|first4=Timothy JA|date=1 September 1999|title=The Oxford Vegetarian Study: an overview|journal=The American Journal of Clinical Nutrition|volume=70|issue=3|pages=525s–531s|doi=10.1093/ajcn/70.3.525s|pmid=10479226|doi-access=free}} Iodine can be obtained from most vegan multivitamins or regular consumption of seaweeds, such as kelp.[http://ods.od.nih.gov/factsheets/Iodine-HealthProfessional/ "Iodine"], Office of Dietary Supplements, National Institutes of Health. The RDA is 110 mcg (0–six months), 130 mcg (7–12 months), 90 mcg (1–8 years), 120 mcg (9–13 years), 150 mcg (14+). The RDA for pregnancy and lactation is 220 and 290 mcg respectively.

Vegan diets typically require special attention for iodine, for which the only substantial and reliable vegan sources are sea vegetables, iodized salt and supplements. The iodine content of sea vegetables varies widely and may provide more than the recommended upper limit of iodine intake.

A 2023 review found that vegans have lower iodine compared with people consuming omnivorous diets.{{cite journal|last1=Eveleigh |first1=Elizabeth Rose |last2=Coneyworth |first2=Lisa |last3=Welham |first3=Simon J. M.|year=2023|title=Systematic review and meta-analysis of iodine nutrition in modern vegan and vegetarian diets|journal=The British Journal of Nutrition|volume=130|issue=9|pages=1580–1594|doi=10.1017/S000711452300051X|pmid=36912094|pmc=10551477 }}

{{See also|Protein deficiency|Protein quality}}

Proteins are composed of amino acids. Vegans obtain all their protein from plants, omnivores usually a third, and ovo-lacto vegetarians half.Mangels, Messina and Messina 2011, [https://books.google.com/books?id=eJ10HoYQ2woC&pg=PA71 71]; for their chapter on protein, [https://books.google.com/books?id=eJ10HoYQ2woC&pg=PA65 65–79]. Sources of plant protein include legumes such as soy beans (consumed as tofu, tempeh, textured vegetable protein, soy milk, and edamame), peas, peanuts, black beans, and chickpeas (the latter often eaten as hummus); grains such as quinoa, brown rice, corn, barley, bulgur, and wheat (the latter eaten as bread and seitan); and nuts and seeds. Combinations that contain high amounts of all the essential amino acids include rice and beans, corn and beans, and hummus and whole-wheat pita.Mangels, Messina and Messina 2011, [https://books.google.com/books?id=eJ10HoYQ2woC&pg=PA72 72], [https://books.google.com/books?id=eJ10HoYQ2woC&pg=PA78 78]. In 2012, the United States Department of Agriculture stated that soy protein (tofu) may replace meat protein in the National School Lunch Program.{{Cite web|url=https://www.fns.usda.gov/sites/default/files/SP16-2012os.pdf|title=Crediting Tofu and Soy Yogurt Products|last=Long|first=Cynthia|date=22 February 2012|department=Food and Nutrition Service|publisher=United States Department of Agriculture|location=Alexandria, VA|type=Memorandum|archive-url=https://web.archive.org/web/20170712101903/https://www.fns.usda.gov/sites/default/files/SP16-2012os.pdf|archive-date=12 July 2017|access-date=13 March 2018|quote=The Nutrition Standards in the National School Lunch and School Breakfast Programs final rule was published on January 26, 2012. The final rule gives schools the option to offer commercially prepared tofu as a meat alternate in the National School Lunch Program (NSLP) and School Breakfast Program (SBP).}}

The Academy of Nutrition and Dietetics said in 2009 that a variety of plant foods consumed over the course of a day can provide all the essential amino acids for healthy adults, which means that protein combining in the same meal is generally not necessary.Mangels, Messina and Messina 2011, [https://books.google.com/books?id=eJ10HoYQ2woC&pg=PA75 75ff]. The Dietitian's Guide to Vegetarian Diets writes that there is little reason to advise vegans to increase their protein intake; but erring on the side of caution, the authors recommend a 25 percent increase over the RDA for adults, to 1 g/kg (.45 g/lb) of body weight.Mangels, Messina and Messina 2011, [https://books.google.com/books?id=eJ10HoYQ2woC&pg=PA77 77].

File:Flax seeds.jpgs are a rich source of ALA, the precursor to DHA and EPA, the omega-3 fatty acids]]

File:English Walnuts.jpg are another rich source of ALA, the precursor to DHA and EPA, the omega-3 oils]]

Experts have not established recommended amounts for omega-3 fatty acids, except for ALA (α-Linolenic acid).{{Cite web|url=https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/|title=Office of Dietary Supplements - Omega-3 Fatty Acids}} The human body can use ALA to synthesize DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid). However, this only works efficiently if the ratio between omega 3 (mainly in flaxseed, chia seeds) to omega 6 (mainly in sunflower oil) does not exceed 1:5.{{Cite journal|pmid = 9637947|year = 1998|last1 = Gerster|first1 = H.|title = Can adults adequately convert alpha-linolenic acid (18:3n-3) to eicosapentaenoic acid (20:5n-3) and docosahexaenoic acid (22:6n-3)?|journal = International Journal for Vitamin and Nutrition Research |volume = 68|issue = 3|pages = 159–173}}

Major vegan sources of the essential omega-3 fatty acid ALA include walnuts, flaxseeds and flaxseed oil, canola (rapeseed) oil, algae oil, hempseeds and hempseed oil, olive oil, and avocado.

While there is little evidence of adverse health or cognitive effects due to DHA deficiency in adult vegetarians or vegans, fetal and breast milk levels remain a concern.{{cite journal |doi=10.1016/j.plefa.2009.05.013 |title=DHA status of vegetarians |year=2009 |last1=Sanders |first1=Thomas A.B. |journal=Prostaglandins, Leukotrienes and Essential Fatty Acids |volume=81 |issue=2–3 |pmid=19500961 |pages=137–41}}

DHA supplements derived from DHA-rich microalgae are available, and the human body can also convert DHA to EPA.{{cite web |first1=Colette |last1=Bouchez |title=Good Fat, Bad Fat: The Facts About Omega-3 |url=http://women.webmd.com/features/omega-3-fatty-acids |website=WebMD}}

It is recommended that vegans eat three servings per day of a high-calcium food, such as fortified plant milks, green leafy vegetables, seeds, tofu, or other calcium-rich foods, and take a calcium supplement as necessary.{{Cite journal|last=Craig|first=Winston J|date=2009-03-11|title=Health effects of vegan diets|journal=The American Journal of Clinical Nutrition|language=en|volume=89|issue=5|pages=1627S–1633S|doi=10.3945/ajcn.2009.26736N|pmid=19279075|issn=0002-9165|doi-access=free}}

Vegans consume less calcium than omnivores or vegetarians.{{Cite journal |last1=Bickelmann |first1=Franziska V. |last2=Leitzmann |first2=Michael F. |last3=Keller |first3=Markus |last4=Baurecht |first4=Hansjörg |last5=Jochem |first5=Carmen |date=2022-06-06 |title=Calcium intake in vegan and vegetarian diets: A systematic review and Meta-analysis |journal=Critical Reviews in Food Science and Nutrition |volume=63 |issue=31 |pages=10659–10677 |doi=10.1080/10408398.2022.2084027 |pmid=38054787 |s2cid=249441078 |issn=1040-8398}}

Consuming a vegan diet is associated with lower bone mineral density (BMD).{{Cite journal |last1=Herrou |first1=Julia |last2=Lecerf |first2=Jean-Michel |last3=Paccou |first3=Julien |date=2022-01-31 |title=Do vegans have a higher fracture risk? |journal=Joint Bone Spine |volume=89 |issue=4 |pages=105349 |doi=10.1016/j.jbspin.2022.105349 |issn=1778-7254 |pmid=35093612|s2cid=246428141 }}{{Cite journal |last1=Iguacel |first1=Isabel |last2=Miguel-Berges |first2=María L. |last3=Gómez-Bruton |first3=Alejandro |last4=Moreno |first4=Luis A. |last5=Julián |first5=Cristina |date=2019-01-01 |title=Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis |journal=Nutrition Reviews |volume=77 |issue=1 |pages=1–18 |doi=10.1093/nutrit/nuy045 |issn=1753-4887 |pmid=30376075|doi-access=free }} It is unclear if the magnitude is clinically relevant,{{Cite journal |last1=Ho-Pham |first1=Lan T. |last2=Nguyen |first2=Nguyen D. |last3=Nguyen |first3=Tuan V. |date=October 2009 |title=Effect of vegetarian diets on bone mineral density: a Bayesian meta-analysis |journal=The American Journal of Clinical Nutrition |volume=90 |issue=4 |pages=943–950 |doi=10.3945/ajcn.2009.27521 |issn=1938-3207 |pmid=19571226|doi-access=free }} but it seems that vegans tend to have higher fracture rates.

However, diet quality is not always considered in studies. High quality vegan or vegetarian diets may therefore afford the same bone health as that of omnivores.{{Cite journal |last1=Li |first1=Tao |last2=Li |first2=Yanhong |last3=Wu |first3=Shanshan |date=2021-06-18 |title=Comparison of human bone mineral densities in subjects on plant-based and omnivorous diets: a systematic review and meta-analysis |journal=Archives of Osteoporosis |volume=16 |issue=1 |pages=95 |doi=10.1007/s11657-021-00955-0 |issn=1862-3514 |pmid=34145511|s2cid=235475271 }} Especially when sufficient vitamin D and calcium are consumed there seems to be no difference in bone health.{{Cite journal |last=Hsu |first=Emory |date=August 2020 |title=Plant-based diets and bone health: sorting through the evidence |journal=Current Opinion in Endocrinology, Diabetes, and Obesity |volume=27 |issue=4 |pages=248–252 |doi=10.1097/MED.0000000000000552 |issn=1752-2978 |pmid=32618637|s2cid=220325305 }}

It is recommended for vegans to daily eat iron-rich foods in combination with vitamin C, because vitamin C enhances iron absorption.{{cite web|title=Iron deficiency—adults|url=http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/iron_deficiency_adults?open|quote=High-risk groups such as vegetarians, adolescent girls and women athletes need to eat iron-rich foods each day (combined with foods that are high in vitamin C). ... Vegetarians who exclude all animal products from their diet may need almost twice as much dietary iron each day as non-vegetarians. Sources include dark green leafy vegetables—such as spinach—and raisins, nuts, seeds, beans, peas, and iron-fortified cereals, breads and pastas}}{{cite journal|vauthors=Sanders TA|year=1999|title=The nutritional adequacy of plant-based diets|journal=The Proceedings of the Nutrition Society|volume=58|issue=2|pages=265–9|doi=10.1017/S0029665199000361|pmid=10466165|doi-access=free}}

Due to the low absorption rate on non-heme iron, it is recommended to eat dark leafy greens (and other sources of iron) together with sources of vitamin C.{{Cite journal|quote=The key role of ascorbic acid for the absorption of dietary nonheme iron is generally accepted. The reasons for its action are twofold: (1) the prevention of the formation of insoluble and unabsorbable iron compounds and (2) the reduction of ferric to ferrous iron, which seems to be a requirement for the uptake of iron into the mucosal cells.|title=The role of vitamin C in iron absorption|journal=International Journal for Vitamin and Nutrition Research. Supplement|volume=30|pages=103–8|pmid=2507689|year=1989|last1=Hallberg|first1=L|last2=Brune|first2=M|last3=Rossander|first3=L}}

Iron levels of vegans may be of concern because of the limited bioavailability. There are concerns about the bioavailability of iron from plant foods, assumed by some researchers to be 5–15 percent compared to 18 percent from a non-vegetarian diet.Mangels, Messina and Messina 2011, [https://books.google.com/books?id=eJ10HoYQ2woC&pg=PA138 138ff], 143–144. For a detailed discussion, [http://www.nap.edu/openbook.php?record_id=10026&page=290 "Iron"], Food and Nutrition Board, Institute of Medicine, National Academy Press, 2001, 290–393. Iron-deficiency anemia is found as often in non-vegetarians as in vegetarians. Vegetarians' iron stores are lower. Lower iron stores may increase the risk for iron deficiency. However, as high iron stores are associated with health risks, lower iron stores may be beneficial.{{Cite journal |last1=Haider |first1=Lisa M. |last2=Schwingshackl |first2=Lukas |last3=Hoffmann |first3=Georg |last4=Ekmekcioglu |first4=Cem |date=2018-05-24 |title=The effect of vegetarian diets on iron status in adults: A systematic review and meta-analysis |journal=Critical Reviews in Food Science and Nutrition |volume=58 |issue=8 |pages=1359–1374 |doi=10.1080/10408398.2016.1259210 |issn=1549-7852 |pmid=27880062|s2cid=25792199 }}

High-iron vegan foods include whole grains, legume (soybeans, black beans, lentils, chickpeas), nuts, spinach, tempeh, tofu.Davida Gypsy Breier, Reed Mangels, Vegan & Vegetarian FAQ, The Vegetarian Resource Group, 2001, [https://books.google.com/books?id=MdrSAAra88IC&pg=PA27 27].Mangels, Messina and Messina 2011, [https://books.google.com/books?id=eJ10HoYQ2woC&pg=PA142 142]; Reed Mangels, [https://www.vrg.org/nutrition/iron.htm "Iron in the Vegan Diet"], The Vegetarian Resources Group.{{Cite book |title=Advanced Nutrition and Human Metabolism |publisher=Cengage Learning |year=2018 |isbn=978-1-305-62785-7 |editor-last=Gropper |editor-first=Sareen S. |edition=Seventh |location=Boston |pages=480}}

Zinc levels of vegans may be of concern because of the limited bioavailability.

In general zinc intake and serum zinc is lower in vegans.{{Cite journal |last1=Bakaloudi |first1=Dimitra Rafailia |last2=Halloran |first2=Afton |last3=Rippin |first3=Holly L. |last4=Oikonomidou |first4=Artemis Christina |last5=Dardavesis |first5=Theodoros I. |last6=Williams |first6=Julianne |last7=Wickramasinghe |first7=Kremlin |last8=Breda |first8=Joao |last9=Chourdakis |first9=Michail |date=2021-05-01 |title=Intake and adequacy of the vegan diet. A systematic review of the evidence |journal=Clinical Nutrition |language=en |volume=40 |issue=5 |pages=3503–3521 |doi=10.1016/j.clnu.2020.11.035 |pmid=33341313 |s2cid=229341062 |issn=0261-5614|doi-access=free }}

Phytates can inhibit the absorption of zinc. Depending on the amount of zinc in the diet (low, moderate, high), the German Nutrition Society (DGE) has established three different reference values for intake of zinc.{{Cite journal |last1=Haase |first1=Hajo |last2=Ellinger |first2=Sabine |last3=Linseisen |first3=Jakob |last4=Neuhäuser-Berthold |first4=Monika |last5=Richter |first5=Margrit |last6=German Nutrition Society (DGE) |date=2020-04-23 |title=Revised D-A-CH-reference values for the intake of zinc |journal=Journal of Trace Elements in Medicine and Biology |volume=61 |pages=126536 |doi=10.1016/j.jtemb.2020.126536 |issn=1878-3252 |pmid=32380426|s2cid=218556288 |doi-access=free |bibcode=2020JTEMB..6126536H }}{{Cite web |title=Zink |url=https://www.dge.de/wissenschaft/referenzwerte/zink/?L=0 |access-date=2023-01-12 |website=www.dge.de |language=de}} For diets that include mostly or exclusively plant-based protein sources the DGE recommends 16mg of zinc per day for men and 10mg of zinc per day for women.{{Cite journal |last1=Haase |first1=Hajo |last2=Ellinger |first2=Sabine |last3=Linseisen |first3=Jakob |last4=Neuhäuser-Berthold |first4=Monika |last5=Richter |first5=Margrit |date=2020-09-01 |title=Revised D-A-CH-reference values for the intake of zinc |journal=Journal of Trace Elements in Medicine and Biology |language=en |volume=61 |pages=126536 |doi=10.1016/j.jtemb.2020.126536 |pmid=32380426 |s2cid=218556288 |issn=0946-672X|doi-access=free |bibcode=2020JTEMB..6126536H }}

The main function of vitamin D in the body is to enhance absorption of calcium for normal mineralization of bones and calcium-dependent tissues.{{cite web|url=https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/es |title=Vitamin D|publisher=Office of Dietary Supplements, US National Institutes of Health |date=26 March 2021|access-date=3 April 2021}}

Sunlight, fortified foods, and dietary supplements are the main sources of vitamin D for vegans. Humans produce vitamin D naturally in response to sun exposure and ultraviolet light (UV) acting on skin to stimulate vitamin D synthesis. UV light penetrates the skin at wavelengths between 290 and 320 nanometers, where it is then converted into vitamin D₃. Vitamin D₂ can be obtained from fungi, such as mushrooms exposed to sun or industrial ultraviolet light, offering a vegan choice for dietary or supplemental vitamin D.{{cite web|vauthors=Haytowitz DB|title=Vitamin D in mushrooms|url=https://www.ars.usda.gov/ARSUserFiles/80400525/Articles/AICR09_Mushroom_VitD.pdf|publisher=Nutrient Data Laboratory, US Department of Agriculture|access-date=16 April 2018|date=2009}}{{cite journal | vauthors = Keegan RJ, Lu Z, Bogusz JM, Williams JE, Holick MF | title = Photobiology of vitamin D in mushrooms and its bioavailability in humans | journal = Dermato-Endocrinology | volume = 5 | issue = 1 | pages = 165–76 | date = January 2013 | pmid = 24494050 | pmc = 3897585 | doi = 10.4161/derm.23321 }} Plant milks, such as from oat, soy, or almond, and breakfast cereals are commonly fortified with vitamin D.

The recommended daily intake of vitamin D for adults is 600 IU (15 micrograms), and for adults over 70 years old, 800 IU (20 micrograms).

Vitamin D comes in two forms. Cholecalciferol (vitamin D₃) is synthesized in the skin after exposure to the sun or consumed from food, usually from animal sources. Ergocalciferol (vitamin D₂) is derived from ergosterol from UV-exposed mushrooms or yeast. When produced industrially as supplements, vitamin D₃ is typically derived from lanolin in sheep wool. However, both provitamins and vitamins D₂ and D₃ have been discovered in various species of edible {{lang|la|Cladina}} lichens (especially {{lang|la|Cladina rangiferina}}).{{cite journal|last1=Wang|first1=Ting|last2=Bengtsson|first2=Göran|last3=Kärnefelt|first3=Ingvar|last4=Björn|first4=Lars Olof|date=September 2001|title=Provitamins and vitamins D2 and D3 in Cladina spp. over a latitudinal gradient: possible correlation with UV levels|url=https://lup.lub.lu.se/record/133512|journal=Journal of Photochemistry and Photobiology B: Biology|volume=62|issue=1–2|pages=118–122|doi=10.1016/s1011-1344(01)00160-9|pmid=11693362}} These edible lichen are harvested in the wild for producing vegan vitamin D₃.{{Cite news|last=Watson|first=Elaine|date=13 March 2012|title=Veggie vitamin D3 maker explores novel production process to secure future supplies|work=NutraIngredients-USA|publisher=William Reed Business Media|url=https://www.nutraingredients-usa.com/Article/2012/03/13/Veggie-vitamin-D3-maker-explores-novel-production-process-to-secure-future-supplies|url-status=live|access-date=22 March 2018|archive-url=https://web.archive.org/web/20180322234242/https://www.nutraingredients-usa.com/Article/2012/03/13/Veggie-vitamin-D3-maker-explores-novel-production-process-to-secure-future-supplies|archive-date=22 March 2018}} Conflicting studies have suggested that the two forms of vitamin D may or may not be bioequivalent.Mangels, Messina and Messina 2011, [https://books.google.com/books?id=eJ10HoYQ2woC&pg=PA209 209]. According to 2011 research from the U. S. National Academy of Medicine (then called Institute of Medicine), the differences between vitamins D₂ and D₃ do not affect metabolism, both function as prohormones, and when activated, exhibit identical responses in the body.Ross et al. (Institute of Medicine) 2011, [http://books.nap.edu/openbook.php?record_id=13050&page=75 75]. Although vitamin D₃ is produced in small amounts by lichens or algae exposed to sunlight,{{cite journal | last1=Björn | first1=LO | last2=Wang | first2=T | title=Vitamin D in an ecological context. | journal=International Journal of Circumpolar Health | volume=59 | issue=1 | year=2000 | issn=1239-9736 | pmid=10850004 | pages=26–32}}{{cite journal | last1=Jäpelt | first1=Rie B. | last2=Jakobsen | first2=Jette | title=Vitamin D in plants: a review of occurrence, analysis, and biosynthesis | journal=Frontiers in Plant Science| volume=4 | pages=136 | year=2013 | issn=1664-462X | doi=10.3389/fpls.2013.00136 | pmid=23717318|pmc=3651966| doi-access=free }} industrial production in commercial quantities is limited, and there are few supplement products as of 2019.{{cite web |author=Adi Menayang| title=AIDP: "There is a significant market potential for vegan D3" | publisher=NutraIngredients-USA, William Reed, Inc | date=29 April 2019 | url=https://www.nutraingredients-usa.com/Article/2019/04/29/AIDP-There-is-a-significant-market-potential-for-vegan-D3 | access-date=10 August 2019}}

Some news reports presented vegan diets as deficient in choline following an opinion piece in the BMJ by a nutritionist affiliated with the meat industry.{{Cite web|last=Frost|first=Rosie|date=2019-08-30|title=Could a plant-based diet be making you dumb?|url=https://www.euronews.com/green/2019/08/30/could-a-vegan-diet-be-making-you-dumb|access-date=2022-01-13|website=Euronews|language=en}} Although many animal products, like liver and egg, contain high amounts of choline (355 mg/3 oz and 126 mg/large egg, respectively), wheat germ (172 mg/cup), Brussels sprouts (63 mg/cup), and broccoli (62 mg/cup) are also good sources of choline.{{cite web|date=July 2023|title=Choline|url=https://lpi.oregonstate.edu/infocenter/othernuts/choline/|publisher=Micronutrient Information Center, Linus Pauling Institute, Oregon State University, Corvallis|accessdate=22 March 2024}}

The National Academy of Medicine in the United States recommends a daily intake of 550 mg for men and 425 mg for women, while the European Food Safety Authority (EFSA) set an adequate intake level of 400 mg per day for adults in 2016.

The German Society for Nutrition does not mention choline as a critical nutrient in its latest 2024 evaluation of vegan nutrition.{{Cite web |title=Neubewertung der Position der Deutschen Gesellschaft für Ernährung zu veganer Ernährung |url=https://www.dge.de/wissenschaft/stellungnahmen-und-fachinformationen/positionen/neubewertung-der-position-zu-veganer-ernaehrung/ |access-date=2025-02-16 |website=DGE |language=de-de}}

• Vegetarian nutrition
• Raw veganism
• The China Study, a book about vegan versus non-vegan nutrition from 2005
• Vegan diets, substitutions, and meat analogues, a section about common vegan foods in the article Veganism

{{Reflist}}

• [https://web.archive.org/web/20210714192007/https://www.rdash.nhs.uk/wp-content/uploads/2021/06/DP8695-Vegan-nutritional-services-05.21.pdf Vegan Nutritional Support] published by the NHS Foundation Trust

{{Vegetarianism}}

Category:Nutrition by type

Category:Veganism