Questions Answered! Plant-based Eating: Enhancing Health Benefits, Minimizing Nutrition Risks

Cover image: "Resilience Glow", a derivative of "Resilience" by Neil Cummings, used under CC BY SA. "Resilience Glow" is licensed under CC BY SA by Bob Bertsch. by MonkeyBusiness Images

Did you miss this fantastic webinar Plant-based Eating:  Enhancing Health Benefits, Minimizing Nutritional Risks? Over 400 professionals attended and a lively discussion, and questions and answer session occurred in the chat pod.

Dietitians can still earn CPEUs by listening to the recording located on the event page.

Below are questions that were answered later by Dr. Pawlak and Dr. Kolasa.

Q. Are there any studies that look at whether lower ferritin & iron levels in vegans and vegetarians is clinically harmful?  I have heard some people say that these lower levels could actually be healthier b/c they are indicative of lower amounts of heme iron which can have harmful effects on the body.


A. I am well familiar with this explanation. It is true that a lower vs. higher normal ferritin concentration may be beneficial, for example, in terms of CVD risk. However, the documented low ferritin among vegetarians was NOT normal. In fact, according to the WHO, ferritin below 15 is not normal and in some of the studies low ferritin was defined as below 12. I am not aware of a study that assessed the actual health implication in vegetarians. However, one would expect to see similar health outcomes (e.g. iron-deficiency anemia and its symptoms) in vegetarians with inadequate iron status as in non-vegetarians.

Q. Are there any good apps for the DASH diet?

A. DASH for Health

Q. Is the type of B12 supplement of oral vs injection an important consideration with the aging population due to diminishing intrinsic factor?

A. No. Oral supplements are as effective as injections as long as the adequate dose is utilized. In one study with elderly participants, the average adequate dose to treat mild B12 deficiency was over 600 mcg. Thus, in treatment, a dose of 1000 is likely adequate. In order to prevent a deficiency, one should follow the recommendations Dr. Kolasa mentioned during the presentation.

Q. Thoughts on crystalline b12 that is being added to nut/plant milks?

A. My only thought is that I wish the dose was higher. This dose may somewhat help in preventing a deficiency, it might be adequate in children and adolescents with no absorption issues (one Polish study showed a steady decline in serum B12 among young adults who ingested B12 from fortified foods), but is more than likely too low to make any difference in older adults and elderly.

Q. I have read that heme iron is a reactive substance in the gut leading to dysbiosis and inflammation but not well studied at this point.

A. This is true. There are a number of adverse health outcomes associated with heme iron intake. Thus, the concentration should be on adequate intake of non-heme iron sources. In fact, the bulk of dietary iron intake comes from grain products and non-heme iron accounts for the majority of intake. If people follow the MyPlate guidelines to ingest a bulk of foods as plant foods, it will result in heme iron intake being low. Heme iron intake should be decreased, while emphases should be on the non-heme iron intake.

Q. What about exposing mushrooms to light for increasing vitamin D?

A. Mushrooms contain vitamin D2 only when they are exposed to the sunlight. Thus, whether the mushrooms that we purchase from a store contain any (or how much) is questionable. However, one can unwrap them and place them on a patio for a couple of hours and get some vitamin. D that way (not the best/reliable way).

Q. Iso Vege diets lower risk of Alzheimer’s, but EHA< DHA levels are ND based on that one study. What is the connection w lower risk of Alzheimer’s because isn’t EHA/DHA important for brain health?

A. Alzheimer’s disease (AD), like most other health conditions, is a multifactorial disease. Evidence that DHA (and possible EPA) plays a role in AD is accumulating. All three nutrients mentioned above (B12, vit. D, and DHA) play a role in AD. Thus, vegetarians may have a lower risk for AD due to favorable CVD risk factor profile but they can further reduce the risk by ensuring adequate intake of B12 and DHA and maintaining adequate vitamin D level.

Q. Subclinical B12 deficiency seems to be out there especially with the excessive use of acid blockers.

A. Perhaps not “especially” but yes, the anti-acids do play a role. In my book “Vitamin B12. Combating the epidemic of deficiency” I have listed a number of medications that impact B12 status. Perhaps the most important of them is metformin but acid blockers do play a role.

Q. Please comment on cardiovascular risk with calcium supplements

A. They increase the risk. This may surprise you but from my reading of the literature, I find no benefit of Ca, including Ca supplements on bone fracture prevention. Thus, perhaps the only benefits of the extra calcium have to do with reducing the risk of pregnancy-induced hypertension. Again, this is just a personal take, based on my research. Disclaimer: I am not an expert on Ca.

Q. Are there any special considerations for athletes who are interested in becoming vegetarian or vegan?

A. A few. 1. Make sure you have adequate variety and quantity of foods. 2. Use appropriate supplements (the same that non-athlete vegans should). 3 Consult with a trained health professional (e.g. RDN) rather than your coach or fitness trainer (in one study, if I correctly remember, coaches correctly answered just slightly over 50% of questions on a basic nutrition test).

This blog was posted by Robin Allen, a member of OneOp (MFLN) Nutrition and Wellness team that aims to support the development of professionals working with military families.  Find out more about the OneOp Nutrition and Wellness concentration on our website on Facebookon Twitter, and LinkedIn.

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