Vegetarian Diets: Other Nutritional Shortcomings
You don’t have to look any further than the ADA’s Position Statement28 or the USDA’s recommendations on vegetarian diets142 to discover additional nutrient shortcomings caused by plant based diets. The ADA matter of factly mentions that “…key nutrients for vegetarians include protein, n-3 fatty acids, iron, zinc, iodine, calcium, and vitamins D and B12..“28 The USDA notes that “…vegetarians may need to focus on…iron, calcium, zinc, and vitamin B12.”142 These subtle admissions of potential nutrient deficiency problems associated with vegetarian diets represent the tip of a nutritional nightmare. Just as was the case with vegetarian diets and vitamin B12 deficiency, there is little credible scientific evidence to show that people eating a lifelong plant based diet (without taking supplements or eating fortified foods) can achieve adequate dietary intakes of omega 3 fatty acids (EPA and DHA), iron, zinc, iodine, calcium, and vitamin D. To this list you can also add vitamin B6 and taurine, an amino acid.
Mineral Deficiencies and Vegetarian Diets
One of the major complications with the assessment of dietary nutrient adequacy in vegetarian diets, or for that matter, any diet has to do with whether or not the vitamins and minerals measured in certain foods actually get absorbed into our bodies. The bioavailability of vitamins and minerals in foods is just as important in how they impact our health as is the simple content of these nutrients in a food. By now you know that phytate is not a good thing because it prevents absorption of essential minerals. Whole grains and legumes are rich sources of phytate. Accordingly, our bodies have great difficulty extracting certain minerals from these foods because they are tightly bound to phytate. Phytate in whole grains impairs calcium absorption and may adversely affect bone health. Further, phytate also binds zinc, thereby interfering with its assimilation and incorporation into our cells. To this list you can add iron and magnesium. Because vegetarian diets are virtually impossible to follow without including lots of whole grains, beans, soy and legumes, they are inherently high in phytate. This is why it is difficult or impossible for vegetarians and vegans to maintain adequate body stores of calcium, zinc and iron.
Zinc Deficiencies in Vegetarian Diets
From the discussion above, you know that zinc is crucial for normal male reproductive function, but it is also required for good health and disease resistance in virtually every cell in our bodies, whether you are a man, woman or child.20, 41 Marginal zinc status impairs our immune system, slows wound healing, adversely affects glucose and insulin metabolism, and damages our body’s built in antioxidant system.16, 55 Without adequate dietary zinc we experience more upper respiratory illnesses that last longer. Zinc lozenges can slow or prevent common cold symptoms, and zinc oxide creams applied topically can speed healing. If you have ever experienced painful cracked heels or nose bleeds that just wouldn’t stop, try rubbing zinc oxide ointments on these wounds – you will be amazed at how rapidly zinc can heal these stubborn sores. How we got into this problem (marginal zinc status or deficiencies) in the first place originates directly from our diets. Anybody eating excessive whole grains and/or legumes and not eating meat, fish or animal products on a regular basis45, 59, 62 puts themselves at risk for all illnesses and health problems associated with borderline or deficient zinc intakes.
Iron Deficiencies in Vegetarian Diets
Your body stores of iron run hand in hand with zinc. The same types of diets that produce zinc deficiencies also create iron deficiencies. High phytate vegetarian diets based upon whole grains, beans, soy and other legumes invariably cause iron deficiencies5, 135 which are the most common nutrient deficit worldwide. In the U.S. 9% of all women between 12 and 49 years are iron deficient, while 4% of 3 to 5 year old children have insufficient stores of this crucial mineral.25 If you are pregnant, low iron status increases your risk of dying during childbirth, and frequently causes low birth weights and preterm deliveries. Even more disturbing is the potential for iron deficiencies to prevent normal mental development in our children and young adults.39, 90, 96 As a parent, I would never wish upon my child or for that matter anyone else’s, a diet causing nutritional deficiencies known to impair brain development and normal mental function. But this is just the case if you eat a vegetarian diet and impose it upon your children. Plant based diets not only increase the risk of impaired cognitive function in your children, but will hamper your own mental functioning. Numerous experimental studies show that inadequate iron stores in adults can slow or impair tasks requiring concentration and mental clarity.73
One of the most important outcomes of diets that cause iron deficiencies is that they make us fatigued and tired. If you are an athlete or have a demanding job requiring physical exertion, low iron stores will invariably reduce your performance. A recent (2009) experiment involving 219 female soldiers during military training showed that iron supplements improved blood iron stores, increased performance for a 2 mile run and enhanced mood.92 Similarly a study by Dr. Hinton and colleagues demonstrated that iron supplements in iron deficient male and female athletes improved endurance performance and efficiency.56 Whether you are an athlete, a laborer or even an office worker, your best nutritional strategy to improve iron stores, add vigor to your life and improve performance is to eliminate whole grains and legumes from your diet by adopting The Paleo Diet.
The burden of proof that vegetarian diets will not produce multiple vitamin and mineral deficiencies lies upon the governmental (USDA) and dietary organizations (ADA) that recommend these diets to us all and tell us that they are safe.28, 142 You might expect that the experimental evidence surrounding vegetarian diet recommendations would be convincing and overpowering. Nothing could be further from the truth, particularly when it comes to iron deficiencies and vegetarian diets.
As always the devil is in the details when it comes to getting correct answers to nutritional questions. Scientists who believe that vegetarian diets don’t adversely affect our iron stores often cite scientific papers showing no difference between blood iron concentrations in vegetarians and meat eaters. What they don’t tell us is how iron measurements were performed in the experiments they quote to support their viewpoint. This information is absolutely essential in knowing if iron deficiencies exist or not. Any study examining blood levels of iron in vegetarians using either measurements of hemoglobin (an iron carrying substance in red blood cells) or hematocrit (the concentration of red blood cells) are unreliable indicators of long term iron status. A much better marker is an iron carrying molecule called ferritin.75 Virtually all epidemiological (population) studies of vegans or ovo/lacto vegetarians show them to be either deficient or borderline iron deficient when blood ferritin levels are measured. Given this nearly unanimous finding from epidemiological studies, you might think that either the USDA or the ADA would become concerned and re-examine their endorsement of vegetarian diets. Unfortunately, we still live with governmental and institutional dietary recommendations that may do considerable harm to our health.
The most convincing type of experiments to reveal whether or not vegetarian diets may cause our iron stores to nosedive are called dietary interventions. Why not put a large group of non-vegetarians on a plant based diet for an extended period and see what happens to their blood iron levels? Wow what a great idea – unfortunately no such study has ever been conducted. The closest we have come to this experiment is a short term study (8 weeks) by Dr. Janet Hunt and co-workers at the Grand Forks Human Nutrition Research Center in North Dakota.63 The results of this experiment were anything but conclusive as the researchers made a fundamental blunder in the design of their experiment – they forgot to include a control group. Without a control group, it is impossible to interpret the outcome of this or any experiment.
Nevertheless, when women were placed on lacto/ovo vegetarian diets, their intestinal iron absorption was reduced by 70%; however, inexplicably, blood ferritin levels (a marker of their long-term iron status) did not decline for the group as a whole. It should be noted that nearly half of the subjects did experience drops in blood ferritin concentrations. Because the authors of this study failed to include a control group, then extraneous variables likely swayed the experiment’s outcome. You recall from earlier in this essay that vegetarian diets caused 7 out of 9 women to stop ovulating. With the cessation of menstrual periods, monthly blood loses also cease which in turn prevents monthly iron losses because blood is a rich source of iron. Hence, in any study evaluating blood iron stores in women, it is absolutely essential to know if their normal menstrual cycles were altered. Unfortunately, Dr. Hunt did not provide us with this information, thereby making the correct interpretation of her experiment difficult or impossible.
In order to once and for all know whether or not vegetarian diets cause iron deficiencies, we would need to perform Dr. Hunt’s experiment again, for at least a year with more subjects, a control group and monitor changes in menstrual periods. You would think that this kind of very basic experimental evidence would have already been in place before any governmental or institutional organization told us that vegetarian diets were safe and didn’t cause nutritional deficiencies. Unfortunately, these precautionary steps have never been taken, and millions of Americans who adhere to vegetarian diets with the mistaken belief that they will benefit health-wise will actually suffer.
Iodine Deficiencies in Vegetarian Diets
A number of studies have reported that vegetarian and vegan diets increase the risk for iodine deficiency.40, 77, 102, 153 One study from Europe demonstrated that 80% of vegans and 25% of ovo/lacto vegetarians suffered from iodine deficiency.77 Additionally, a dietary intervention by Dr. Remer and colleagues in 1999 confirmed this epidemiological evidence.102 After only five days on ovo/lacto vegetarian diets, iodine status and function became impaired in healthy adults.102 The primary reason why vegetarian diets cause iodine deficiencies is that plant foods (except for seaweed) are generally poor sources of iodine compared to meat, eggs, poultry and fish. Gross deficiencies of iodine cause our thyroid glands to swell producing a condition known as goiter, and in pregnant women result in severe birth defects called cretinism.141 Because salt is fortified with iodine, most people in the U.S. and Europe rarely develop gross iodine deficiencies.40, 140, 141 However moderate to mild iodine deficiencies appear in westernized countries, particularly among vegetarians and vegans.77, 102 Moderate iodine deficiency impairs normal growth in children and adversely affects mental development.140, 141, 152 A large meta analysis revealed that moderate childhood iodine deficiency lowered I.Q. by 12-13.5 points.153 Paleo Diets are not just good medicine for adults, but they also ensure normal physical and mental development in our children because of their high iodine content.
One of the problems with plant based diets is that they may put into play a vicious cycle that makes iodine deficiencies worse. When the thyroid glands iodine stores become depleted, as often happens with vegetarian diets, then certain antinutrients found in plant foods can gain a foot hold and further aggravate iodine shortages. Soy beans and soy products are frequently a mainstay in vegetarian diets and may promote inflammation.66 Unfortunately soy contains certain antinutrients (isoflavones) that impair iodine metabolism in the thyroid gland,43, 95 but only when our body stores of iodine are already depleted. Other plant foods (millet, cassava root, lima beans, sweet potatoes, and cruciferous vegetables [broccoli, cauliflower, turnips, kale, cabbage]) also contain a variety of antinutrients which hinder normal iodine metabolism. So, plant based diets put us at risk for developing iodine deficiencies in the first place, and when this happens our bodies become vulnerable to plant antinutrients that worsen the pre-existing deficiency. The important point here is that antinutritional compounds have virtually zero effect upon our thyroid gland when our body stores of iodine are normal and fully replete. Because meats, fish, eggs and poultry are rich sources of iodine, you will never have to worry about this nutrient when you eat Paleo style.
Vitamin D and Vitamin B6 Deficiencies in Vegetarian Diets
In my paper, Cereal Grains: Humanity’s Double Edged Sword, I have pointed out how excessive consumption of whole grains adversely affects vitamin D status in our bodies.148 Hence it goes without saying that vitamin D deficiencies run rampant in vegetarians worldwide because it is nearly impossible to become a full-fledged vegetarian without eating lots of grains. In the largest study of vegetarians ever undertaken (The Epic-Oxford Study), Dr. Crowe and fellow researchers reported that blood concentrations of vitamin D were highest in meat eaters and lowest in vegans and vegetarians.29 Nearly 8% of the vegans maintained clinical deficiencies of vitamin D. Vitamin D is not really a vitamin at all, but rather a crucial hormone that impacts virtually every cell in our bodies.
By now, you are starting to get a pretty good picture of what a nutritional nightmare vegetarian diets really are. When we let the data speak for itself, the number of nutrient deficiencies and adverse health effects associated with plant based diets are appalling and far outweigh any supposed health effects of this unnatural way of eating. One of the biggest kept secrets about vegan or vegetarian diets is that they frequently cause vitamin B6 deficiencies. If you recall, neither the ADA,28 nor the USDA142 has given us any warning that meatless diets increase our risk for vitamin B6 deficiencies.
On paper, it would appear that vegetarian diets generally meet daily recommended intakes for vitamin B6. This assumption comes primarily from population surveys examining the foods that vegans and vegetarians normally eat. In contrast, when blood samples are analyzed from people relying upon plant based diets, they unexpectedly reveal that long term vegetarians and vegans frequently are deficient vitamin B6. A recent study of 93 German vegans by Dr. Waldman and colleagues showed that 58% of these men and women suffered from vitamin B6 deficiencies despite seemingly adequate intakes of this essential nutrient.131 It turns out that the type of vitamin B-6 (pyridoxine glucoside) found in plant foods is poorly absorbed.47, 103 The presence of pyridoxine glucoside in plant foods along with fiber has been reported to reduce the bioavailability of vitamin B6 so that only 20 to 25% is absorbed and completely utilized.47 In contrast, vitamin B6 found in animal foods is easily assimilated, and an estimated 75 to 100% fully makes its way into our bloodstreams.47
Compelling evidence that vegetarian diets relying upon the plant form of vitamin B6 adversely affect our body’s overall vitamin B6 stores comes from Dr. Leklem’s laboratory at Oregon State University.47 Nine women were put on diets either high or low in the plant form of vitamin B6 (pyridoxine glucoside). After only 18 days, the high pyridoxine glucoside diets consistently lowered blood concentrations and other indices of vitamin B6 status. Deficiencies in this vitamin elevate blood homocysteine concentrations and increase our risk for cardiovascular disease similar to shortages of folate and vitamin B12. Further, vitamin B6 is an important factor in normal immune system functioning149 and shortfalls of this crucial nutrient have been identified in depression150 and colorectal cancer.151
Omega 3 Fatty Acid Deficiencies in Vegetarian Diets
A few years ago I was involved in a series of experiments here at Colorado State University in which we were interested in determining how high and low salt diets affected exercise-induced asthma. Our working hypothesis was that high salt diets would make measures of lung function worse, and low salt diets would improve things. One of our concerns with this experiment was to somehow make sure our subjects had fully complied with either the high or low salt diets. Completely removing salt from your diet is not an easy thing to do, and if some of our subjects had decided to sneak in a piece of pizza or some Doritos, it would mess up the experiment’s outcome. Fortunately, there was an easy way to figure out if our subjects had been compliant with the prescribed diets. All we had to do was to spot check their urine, because measurement of urinary salt levels is an accurate gauge of dietary salt consumption. High urinary salt levels universally reflect high salt consumption, whereas low urinary salt concentrations indicate low salt consumption. Short of major disease, there is virtually no other way high amounts of salt in the urine don’t indicate high amounts of salt in the diet.
In a similar manner, there are equivalent telltale indicators of omega 3 fatty acids in our bloodstreams that tell us beyond a shadow of a doubt whether or not we have regularly consumed fish, seafood or other good sources these healthful fats. The three main types of omega 3 fatty acids we need to concern ourselves with are EPA, DHA and ALA. EPA and DHA are called long chain omega 3 fatty acids and are only found in high amounts in fish, seafood, certain meats, and other foods of animal origin. Plant foods contain no EPA or DHA. On the other hand, ALA is called a short chain fatty acid and is found in both plant and animal foods. Both EPA and DHA in our red blood cells are markers of these important fatty acids in our diet. Without good dietary sources of EPA and DHA such as are found in fish, seafood and certain meats, our blood levels of EPA and DHA will decline. Just like salt in our urine was an indicator for dietary salt, EPA and DHA concentrations in our red blood cells are markers for our dietary intake of these long chain omega 3 fatty acids. It is virtually impossible to achieve high blood levels of EPA and DHA without regularly consuming fish, seafood and certain meats and organ meats (particularly grass produced meats and organ meats).
One of the major nutritional shortcomings in vegans is that they obtain absolutely no EPA or DHA from their diets.108, 110, 111 Consequently, they are totally dependent upon plant based ALA, supplements or fortified foods to obtain these healthful long chain omega 3 fatty acids. Without supplements or fortified foods, all vegans will become deficient in EPA and DHA because plant based ALA is inefficiently converted into these long chain fatty acids in our bodies. The liver converts less than 5% of ALA into EPA and less than 1% of ALA into DHA.15, 97 Virtually every epidemiological study that has ever been published shows that vegans, who do not supplement or consume long chain omega 3 fortified foods, to be deficient in both EPA and DHA76, 88, 108, 110, 111 Lacto/ovo vegetarians don’t fare much better because milk and egg based vegetarian diets simply do not supply sufficient DHA or EPA to maintain normal blood concentrations.88, 111
There is little doubt that vegan or vegetarian diets cause reductions in blood concentrations of DHA and EPA, which in turn represent a potent risk factor for many chronic diseases. Perhaps the single most important dietary recommendation to improve your health and prevent illness is to increase your dietary intake of EPA and DHA. Thousands of scientific papers covering an assortment of diseases clearly show the health benefits of these fatty acids. In randomized clinical trials in patients with pre-existing heart disease, omega-3 fatty acid supplements significantly reduced cardiovascular events (deaths, non-fatal heart attacks, and non-fatal strokes).19, 48, 138 Omega-3 fatty acids lessen the risk for heart disease through a number of means including a reduction in heart beat irregularities called arrhythmias, a decrease in blood clots, and reduced inflammation which is now known to be an chief factor causing atherosclerosis or artery clogging.
In addition to lowering the risk for heart disease, regular consumption of fish or supplemental omega-3 fatty acids may be useful in averting, treating, or improving a wide range of diseases and disorders, including virtually all inflammatory diseases (any disease ending with “itis”): rheumatoid arthritis,99 inflammatory bowel disorders (Crohn’s disease, ulcerative colitis), periodontal disease (gingivitis). Also mental disorders (autism, depression),3, 84 postpartum depression, bi-polar disorder, borderline personality disorder, impaired cognitive development in infants and children) may respond favorably to these beneficial fatty acids. Further, acne, asthma, exercise induced asthma, many types of cancers,120 macular degeneration, pre-term birth, psoriasis, insulin resistance, type 2 diabetes, cancer cachexia, intermittent claudication, skin damage from sunlight, IgA nephropathy, lupus erythematosus, type 1 diabetes, multiple sclerosis, and migraine headaches also improve with omega 3 fatty acids.
Taurine deficiencies in Vegetarian Diets
Although the number of nutrients which are frequently lacking in vegetarian and vegan diets may seem endless to you, we are now at the end of the list. Taurine is an amino acid (actually a sulfonic acid because it lacks a carboxyl group) in our bloodstreams that has multiple functions in every cell of our body. Unfortunately, this nutrient is not present in any plant food and is found in low concentrations in milk (6 mg per cup).80 In contrast, all flesh foods are excellent sources of taurine.80 For example, ¼ pound of dark meat from chicken provides 200mg of taurine. Shellfish are even richer still with over 800mg per quarter pound. The daily taurine intake in non-vegetarians is about 150mg, whereas lacto/ovo vegetarians take in about 17mg per day, and vegans get none. Although our livers can manufacture taurine from precursor molecules, our capacity to do so is limited – so much so that this amino acid is regularly fortified in infant formulas. As you might expect, studies of vegans show that their blood taurine levels are lower than meat eaters.81, 100 How depleted blood concentrations of taurine affect our overall health, is not entirely understood. Nevertheless, shortages of this amino acid and omega 3 fatty acids (EPA and DHA) may cause certain elements (platelets) in our blood to clot more rapidly which in turn increase our risk for cardiovascular disease.85, 91 Despite their meat free diets, vegetarians almost always exhibit abnormal platelets that excessively adhere to one another. In one dietary intervention, Dr. Mezzano and colleagues demonstrated that after eight weeks of EPA and DHA supplementation normal platelet function was restored in a group of 18 lacto/ovo vegetarians.85 Obviously, compromised taurine status will never become a problem in Paleo Diets, because meat, fish, poultry and animal products are consumed at nearly every meal.
In summary, if you have adopted, or are considering adopting a plant based diet for reasons of improving your health, make sure you reread this chapter and look up all of the references I have provided you. The evidence that vegetarian and vegan diets almost always cause a multitude of nutritional deficiencies is overwhelming and conclusive. Over the course of a lifetime, vegetarian diets will not reduce your risk of chronic disease and will not allow you to live longer. Rather, this abnormal way of eating will predispose you to a host of health problems and illnesses. Vegetarianism is an unnatural way of eating that has no evolutionary precedence in our species. No hunter-gatherer society ever consumed a meatless diet, nor should you. The ADA has labeled The Paleo Diet a fad diet because it eliminates “two entire food groups” (grains and dairy). Yet hypocritically, they exempt vegan diets from this characterization despite also eliminating two food groups (dairy, meats and fish). If The Paleo Diet is a fad diet, then it is the world’s oldest.
Loren Cordain, Ph.D., Professor Emeritus
1. Alexander D, Ball MJ, Mann J. Nutrient intake and haematological status of vegetarians and age-sex matched omnivores. Eur J Clin Nutr. 1994 Aug;48(8):538-46.
2. Appleby P, Roddam A, Allen N, Key T. Comparative fracture risk in vegetarians and nonvegetarians in EPIC-Oxford. Eur J Clin Nutr. 2007 Dec;61(12):1400-6.
3. Appleton KM, Rogers PJ, Ness AR. Updated systematic review and meta-analysis of the effects of n-3 long-chain polyunsaturated fatty acids on depressed mood. Am J Clin Nutr. 2010 Mar;91(3):757-70
4. Baines M, Kredan MB, Davison A, Higgins G, West C, Fraser WD, Ranganath LR. The association between cysteine, bone turnover, and low bone mass. Calcif Tissue Int. 2007 Dec;81(6):450-4
5. Baines S, Powers J, Brown WJ. How does the health and well-being of young Australian vegetarian and semi-vegetarian women compare with non-vegetarians? Public Health Nutr. 2007 May;10(5):436-42.
6. Bhushan S, Pandey RC, Singh SP, Pandey DN, Seth P. Some observations on human semen analysis. Indian J Physiol Pharmacol. 1978 Oct-Dec;22(4):393-6.
7. Bennett M. Vitamin B12 deficiency, infertility and recurrent fetal loss. J Reprod Med. 2001 Mar;46(3):209-12.
8. Berker B, Kaya C, Aytac R, Satiroglu H. Homocysteine concentrations in follicular fluid are associated with poor oocyte and embryo qualities in polycystic ovary syndrome patients undergoing assisted reproduction. Hum Reprod. 2009 Sep;24(9):2293-302
9. Bissoli L, Di Francesco V, Ballarin A, Mandragona R, Trespidi R, Brocco G, Caruso B, Bosello O, Zamboni M. Effect of vegetarian diet on homocysteine levels. Ann Nutr Metab. 2002;46(2):73-9.
10. Bocherens H, Drucker DG, Billiou D, Patou-Mathis M, Vandermeersch B. Isotopic evidence for diet and subsistence pattern of the Saint-Cesaire I Neanderthal: review and use of a multi-source mixing model. J Hum Evol. 2005 Jul;49(1):71-87
11. Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod. 2007 Jun;22(6):1506-12.
12. Boxmeer JC, Smit M, Weber RF, Lindemans J, Romijn JC, Eijkemans MJ, Macklon NS, Steegers-Theunissen RP. Seminal plasma cobalamin significantly correlates with sperm concentration in men undergoing IVF or ICSI procedures. J Androl. 2007 Jul-Aug;28(4):521-7
13. Boxmeer JC, Brouns RM, Lindemans J, Steegers EA, Martini E, Macklon NS, Steegers-Theunissen RP. Preconception folic acid treatment affects the microenvironment of the maturing oocyte in humans. Fertil Steril. 2008 Jun;89(6):1766-70.
14. Boxmeer JC, Smit M, Utomo E, Romijn JC, Eijkemans MJ, Lindemans J, Laven JS, Macklon NS, Steegers EA, Steegers-Theunissen RP. Low folate in seminal plasma is associated with increased sperm DNA damage. Fertil Steril. 2009 Aug;92(2):548-56.
15. Brenna JT, Salem N Jr, Sinclair AJ, Cunnane SC. alpha-Linolenic acid supplementation and conversion to n-3 long-chain polyunsaturated fatty acids in humans. Prostaglandins Leukot Essent Fatty Acids. 2009 Feb-Mar;80(2-3):85-91.
16. Brown KH, Peerson JM, Baker SK, Hess SY. Preventive zinc supplementation among infants, preschoolers, and older prepubertal children. Food Nutr Bull. 2009 Mar;30(1 Suppl):S12-40.
17. Bucciarelli P, Martini G, Martinelli I, Ceccarelli E, Gennari L, Bader R, Valenti R, Franci B, Nuti R, Mannucci PM. The relationship between plasma homocysteine levels and bone mineral density in post-menopausal women. Eur J Intern Med. 2010 Aug;21(4):301-5
18. Bunn, HT, Kroll EM. Systematic butchery by Plio-Pleistocene hominids at Olduvai Gorge, Tanzania. Curr Anthropol 1986;20:365–398.
19. Calder PC, Yaqoob P. Omega-3 (n-3) fatty acids, cardiovascular disease and stability of atherosclerotic plaques. Cell Mol Biol (Noisy-le-grand). 2010 Feb 25;56(1):28-37.
20. Campbell-Brown M, Ward RJ, Haines AP, North WR, Abraham R, McFadyen IR, Turnlund JR, King JC. Zinc and copper in Asian pregnancies–is there evidence for a nutritional deficiency? Br J Obstet Gynaecol. 1985 Sep;92(9):875-85
21. Cappuccio FP, Bell R, Perry IJ, Gilg J, Ueland PM, Refsum H, Sagnella GA, Jeffery S, Cook DG. Homocysteine levels in men and women of different ethnic and cultural background living in England. Atherosclerosis. 2002 Sep;164(1):95-102.
22. Clarke R, Sherliker P, Hin H, Nexo E, Hvas AM, Schneede J, Birks J, Ueland PM, Emmens K, Scott JM, Molloy AM, Evans JG. Detection of vitamin B12 deficiency in older people by measuring vitamin B12 or the active fraction of vitamin B12, holotranscobalamin. Clin Chem. 2007 May;53(5):963-70
23. Clarke R. B-vitamins and prevention of dementia. Proc Nutr Soc. 2008 Feb;67(1):75-81.
24. Clarke R, Birks J, Nexo E, Ueland PM, Schneede J, Scott J, Molloy A, Evans JG. Low vitamin B-12 status and risk of cognitive decline in older adults. Am J Clin Nutr. 2007 Nov;86(5):1384-91.
25. Cogswell ME, Looker AC, Pfeiffer CM, Cook JD, Lacher DA, Beard JL, Lynch SR, Grummer-Strawn LM. Assessment of iron deficiency in US preschool children and nonpregnant females of childbearing age: National Health and Nutrition Examination Survey 2003-2006. Am J Clin Nutr. 2009 May;89(5):1334-42
26. Cordain L, Miller JB, Eaton SB, Mann N, Holt SH, Speth JD. Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets.Am J Clin Nutr. 2000 Mar;71(3):682-92.
27. Cordain L, Campbell TC. The protein debate. Catalyst Athletics, March 19, 2008. http://www.cathletics.com/articles/article.php?articleID=50
28. Craig WJ, Mangels AR; American Dietetic Association. Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc. 2009 Jul;109(7):1266-82.
29. Crowe FL, Steur M, Allen NE, Appleby PN, Travis RC, Key TJ. Plasma concentrations of 25-hydroxyvitamin D in meat eaters, fish eaters, vegetarians and vegans: results from the EPIC-Oxford study. Public Health Nutr. 2011 Feb;14(2):340-6.
30. Dasarathy J, Gruca LL, Bennett C, Parimi PS, Duenas C, Marczewski S, Fierro JL, Kalhan SC. Methionine metabolism in human pregnancy. Am J Clin Nutr. 2010 Feb;91(2):357-65.
31. Davey GK, Spencer EA, Appleby PN, Allen NE, Knox KH, Key TJ. EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. Public Health Nutr. 2003 May;6(3):259-69.
32. de Bortoli MC, Cozzolino SM. Zinc and selenium nutritional status in vegetarians. Biol Trace Elem Res. 2009 Mar;127(3):228-33.
33. de Heinzelin J, Clark JD, White T, Hart W, Renne P, WoldeGabriel G, Beyene Y, Vrba E. Environment and behavior of 2.5-million-year-old Bouri hominids. Science. 1999 Apr 23;284(5414):625-9
34. Dhonukshe-Rutten RA, van Dusseldorp M, Schneede J, de Groot LC, van Staveren WA. Low bone mineral density and bone mineral content are associated with low cobalamin status in adolescents. Eur J Nutr. 2005 Sep;44(6):341-7.
35. Dror DK, Allen LH. Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms. Nutr Rev. 2008 May;66(5):250-5.
36. Ebisch IM, Peters WH, Thomas CM, Wetzels AM, Peer PG, Steegers-Theunissen RP. Homocysteine, glutathione and related thiols affect fertility parameters in the (sub)fertile couple. Hum Reprod. 2006 Jul;21(7):1725-33.
37. Ebisch IM, Pierik FH, DE Jong FH, Thomas CM, Steegers-Theunissen RP. Does folic acid and zinc sulphate intervention affect endocrine parameters and sperm characteristics in men? Int J Androl. 2006 Apr;29(2):339-45.
38. Elmadfa I, Singer I.Vitamin B-12 and homocysteine status among vegetarians: a global perspective. Am J Clin Nutr. 2009 May;89(5):1693S-1698S.
39. Falkingham M, Abdelhamid A, Curtis P, Fairweather-Tait S, Dye L, Hooper L.The effects of oral iron supplementation on cognition in older children and adults: a systematic review and meta-analysis. Nutr J. 2010 Jan 25;9:4.
40. Lightowler HJ, Davies GJ. Iodine intake and iodine deficiency in vegans as assessed by the duplicate-portion technique and urinary iodine excretion. Br J Nutr. 1998 Dec;80(6):529-35.
41. Fischer Walker CL, Ezzati M, Black RE. Global and regional child mortality and burden of disease attributable to zinc deficiency. Eur J Clin Nutr. 2009 May;63(5):591-7.
42. Food habits of a nation. In: The Hindu, August 14, 2006.
43. Fort P, Moses N, Fasano M, Goldberg T, Lifshitz F. Breast and soy-formula feedings in early infancy and the prevalence of autoimmune thyroid disease in children. J Am Coll Nutr. 1990 Apr;9(2):164-7.
44. Freeland-Graves JH, Ebangit ML, Hendrikson PJ. Alterations in zinc absorption and salivary sediment zinc after a lacto-ovo-vegetarian diet. Am J Clin Nutr. 1980 Aug;33(8):1757-66.
45. Freeland-Graves JH, Bodzy PW, Eppright MA. Zinc status of vegetarians. J Am Diet Assoc. 1980 Dec;77(6):655-61
46. Gilsing AM, Crowe FL, Lloyd-Wright Z, Sanders TA, Appleby PN, Allen NE, Key TJ. Serum concentrations of vitamin B12 and folate in British male omnivores, vegetarians and vegans: results from a cross-sectional analysis of the EPIC-Oxford cohort study. Eur J Clin Nutr. 2010 Sep;64(9):933-9
47. Hansen CM, Leklem JE, Miller LT. Vitamin B-6 status indicators decrease in women consuming a diet high in pyridoxine glucoside. J Nutr. 1996 Oct;126(10):2512-8
48. Harris WS, Kris-Etherton PM, Harris KA. Intakes of long-chain omega-3 fatty acid associated with reduced risk for death from coronary heart disease in healthy adults. Curr Atheroscler Rep. 2008 Dec;10(6):503-9.
49. Herbert V. Staging vitamin B-12 (cobalamin) status in vegetarians. Am J Clin Nutr. 1994 May;59(5 Suppl):1213S-1222S
50. Herrmann W, Obeid R, Schorr H, Geisel J. Functional vitamin B12 deficiency and determination of holotranscobalamin in populations at risk. Clin Chem Lab Med. 2003 Nov;41(11):1478-88.
51. Herrmann M, Widmann T, Colaianni G, Colucci S, Zallone A, Herrmann W. Increased osteoclast activity in the presence of increased homocysteine concentrations. Clin Chem. 2005 Dec;51(12):2348-53
52. Herrmann W, Schorr H, Obeid R, Geisel J. Vitamin B-12 status, particularly holotranscobalamin II and methylmalonic acid concentrations, and hyperhomocysteinemia in vegetarians. Am J Clin Nutr. 2003 Jul;78(1):131-6.
53. Herrmann M, Peter Schmidt J, Umanskaya N, Wagner A, Taban-Shomal O, Widmann T, Colaianni G, Wildemann B, Herrmann W. The role of hyperhomocysteinemia as well as folate, vitamin B(6) and B(12) deficiencies in osteoporosis: a systematic review. Clin Chem Lab Med. 2007;45(12):1621-32
54. Herrmann W, Obeid R, Schorr H, Hübner U, Geisel J, Sand-Hill M, Ali N, Herrmann M. Enhanced bone metabolism in vegetarians–the role of vitamin B12 deficiency. Clin Chem Lab Med. 2009;47(11):1381-7.
55. Heyland DK, Jones N, Cvijanovich NZ, Wong H. Zinc supplementation in critically ill patients: a key pharmaconutrient? JPEN J Parenter Enteral Nutr. 2008 Sep-Oct;32(5):509-19.
56. Hinton PS, Sinclair LM. Iron supplementation maintains ventilatory threshold and improves energetic efficiency in iron-deficient nonanemic athletes. Eur J Clin Nutr. 2007 Jan;61(1):30-9.
57. Hirwe R, Jathar VS, Desai S, Satoskar RS. Vitamin B12 and potential fertility in male lactovegetarians. J Biosoc Sci. 1976 Jul;8(3):221-7
58. Ho-Pham LT, Nguyen ND, Nguyen TV. Effect of vegetarian diets on bone mineral density: a Bayesian meta-analysis. Am J Clin Nutr. 2009 Oct;90(4):943-50.
59. Hotz C. Dietary indicators for assessing the adequacy of population zinc intakes. Food Nutr Bull. 2007 Sep;28(3 Suppl):S430-53.
60. Huang YC, Chang SJ, Chiu YT, Chang HH, Cheng CH. The status of plasma homocysteine and related B-vitamins in healthy young vegetarians and nonvegetarians. Eur J Nutr. 2003 Apr;42(2):84-90.
61. Humphrey LL, Fu R, Rogers K, Freeman M, Helfand M. Homocysteine level and coronary heart disease incidence: a systematic review and meta-analysis. Mayo Clin Proc. 2008 Nov;83(11):1203-12.
62. Hunt JR, Matthys LA, Johnson LK. Zinc absorption, mineral balance, and blood lipids in women consuming controlled lactoovovegetarian and omnivorous diets for 8 wk. Am J Clin Nutr. 1998 Mar;67(3):421-30.
63. Hunt JR, Roughead ZK. Nonheme-iron absorption, fecal ferritin excretion, and blood indexes of iron status in women consuming controlled lactoovovegetarian diets for 8 wk. Am J Clin Nutr. 1999 May;69(5):944-52
64. Hvas AM, Morkbak AL, Nexo E. Plasma holotranscobalamin compared with plasma cobalamins for assessment of vitamin B12 absorption; optimisation of a non-radioactive vitamin B12 absorption test (CobaSorb). Clin Chim Acta. 2007 Feb;376(1-2):150-4
65. Jathar VS, Hirwe R, Desai S, Satoskar RS. Dietetic habits and quality of semen in Indian subjects. Andrologia. 1976;8(4):355-8.
66. Jenkins DJ, Kendall CW, Connelly PW, Jackson CJ, Parker T, Faulkner D, Vidgen E. Effects of high- and low-isoflavone (phytoestrogen) soy foods on inflammatory biomarkers and proinflammatory cytokines in middle-aged men and women. Metabolism. 2002 Jul;51(7):919-24
67. Karabudak E, Kiziltan G, Cigerim N. A comparison of some of the cardiovascular risk factors in vegetarian and omnivorous Turkish females. J Hum Nutr Diet. 2008 Feb;21(1):13-22.
68. Katre P, Bhat D, Lubree H, Otiv S, Joshi S, Joglekar C, Rush E, Yajnik C. Vitamin B12 and folic acid supplementation and plasma total homocysteine concentrations in pregnant Indian women with low B12 and high folate status. Asia Pac J Clin Nutr. 2010;19(3):335-43.
69. Key TJ, Fraser GE, Thorogood M, Appleby PN, Beral V, Reeves G, Burr ML, Chang-Claude J, Frentzel-Beyme R, Kuzma JW, Mann J, McPherson K. Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies. Am J Clin Nutr. 1999 Sep;70(3 Suppl):516S-524S.
70. Key TJ, Appleby PN, Rosell MS. Health effects of vegetarian and vegan diets. Proc Nutr Soc. 2006 Feb;65(1):35-41.
71. Key TJ, Appleby PN, Spencer EA, Travis RC, Roddam AW, Allen NE. Mortality in British vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). Am J Clin Nutr. 2009 May;89(5):1613S-1619S
72. Key TJ, Appleby PN, Spencer EA, Travis RC, Roddam AW, Allen NE. Cancer incidence in vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). Am J Clin Nutr. 2009 May;89(5):1620S-1626S
73. Khedr E, Hamed SA, Elbeih E, El-Shereef H, Ahmad Y, Ahmed S. Iron states and cognitive abilities in young adults: neuropsychological and neurophysiological assessment. Eur Arch Psychiatry Clin Neurosci. 2008 Dec;258(8):489-96. Epub 2008 Jun 20.
74. Koebnick C, Hoffmann I, Dagnelie PC, Heins UA, Wickramasinghe SN, Ratnayaka ID, Gruendel S, Lindemans J, Leitzmann C. Long-term ovo-lacto vegetarian diet impairs vitamin B-12 status in pregnant women. J Nutr. 2004 Dec;134(12):3319-26.
75. Knovich MA, Storey JA, Coffman LG, Torti SV, Torti FM. Ferritin for the clinician. Blood Rev. 2009 May;23(3):95-104
76. Kornsteiner M, Singer I, Elmadfa I. Very low n-3 long-chain polyunsaturated fatty acid status in Austrian vegetarians and vegans. Ann Nutr Metab. 2008;52(1):37-47
77. Krajcovicová-Kudlácková M, Bucková K, Klimes I, Seboková E. Iodine deficiency in vegetarians and vegans. Ann Nutr Metab. 2003;47(5):183-5.
78. Krivosíková Z, Krajcovicová-Kudlácková M, Spustová V, Stefíková K, Valachovicová M, Blazícek P, Nĕmcová T. The association between high plasma homocysteine levels and lower bone mineral density in Slovak women: the impact of vegetarian diet. Eur J Nutr. 2010 Apr;49(3):147-53
79. Kumar J, Garg G, Sundaramoorthy E, Prasad PV, Karthikeyan G, Ramakrishnan L, Ghosh S, Sengupta S. Vitamin B12 deficiency is associated with coronary artery disease in an Indian population. Clin Chem Lab Med. 2009;47(3):334-8.
80. Laidlaw SA, Grosvenor M, Kopple JD. The taurine content of common foodstuffs. JPEN J Parenter Enteral Nutr. 1990 Mar-Apr;14(2):183-8.
81. Laidlaw SA, Shultz TD, Cecchino JT, Kopple JD. Plasma and urine taurine levels in vegans. Am J Clin Nutr. 1988 Apr;47(4):660-3
82. Leboff MS, Narweker R, LaCroix A, Wu L, Jackson R, Lee J, Bauer DC, Cauley J, Kooperberg C, Lewis C, Thomas AM, Cummings S. Homocysteine levels and risk of hip fracture in postmenopausal women. J Clin Endocrinol Metab. 2009 Apr;94(4):1207-13
83. Lee-Thorp J, Thackeray JF, van der Merwe N. The hunters and the hunted revisited. J Hum Evol 2000; 39: 565–576.
84. Lin PY, Huang SY, Su KP. A meta-analytic review of polyunsaturated fatty acid compositions in patients with depression. Biol Psychiatry. 2010 Jul 15;68(2):140-7.
85. Mezzano D, Kosiel K, Martínez C, Cuevas A, Panes O, Aranda E, Strobel P, Pérez DD, Pereira J, Rozowski J, Leighton F. Cardiovascular risk factors in vegetarians. Normalization of hyperhomocysteinemia with vitamin B(12) and reduction of platelet aggregation with n-3 fatty acids. Thromb Res. 2000 Nov 1;100(3):153-60.
86. Molloy AM, Kirke PN, Brody LC, Scott JM, Mills JL. Effects of folate and vitamin B12 deficiencies during pregnancy on fetal, infant, and child development. Food Nutr Bull. 2008 Jun;29(2 Suppl):S101-11
87. Molloy AM, Kirke PN, Troendle JF, Burke H, Sutton M, Brody LC, Scott JM, Mills JL. Maternal vitamin B12 status and risk of neural tube defects in a population with high neural tube defect prevalence and no folic Acid fortification. Pediatrics. 2009 Mar;123(3):917-23.
88. Mann N, Pirotta Y, O’Connell S, Li D, Kelly F, Sinclair A. Fatty acid composition of habitual omnivore and vegetarian diets. Lipids. 2006 Jul;41(7):637-46
89. Mariani A, Chalies S, Jeziorski E, Ludwig C, Lalande M, Rodière M. [Consequences of exclusive breast-feeding in vegan mother newborn–case report]. Arch Pediatr. 2009 Nov;16(11):1461-3.
90. McCann JC, Ames BN. An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function. Am J Clin Nutr. 2007 Apr;85(4):931-45.
91. McCarty MF. Sub-optimal taurine status may promote platelet hyperaggregability in vegetarians.Med Hypotheses. 2004;63(3):426-33.
92. McClung JP, Karl JP, Cable SJ, Williams KW, Nindl BC, Young AJ, Lieberman HR. Randomized, double-blind, placebo-controlled trial of iron supplementation in female soldiers during military training: effects on iron status, physical performance, and mood. Am J Clin Nutr. 2009 Jul;90(1):124-31.
93. Michie CA, Chambers J, Abramsky L, Kooner JS. Folate deficiency, neural tube defects, and cardiac disease in UK Indians and Pakistanis. Lancet. 1998 Apr 11;351(9109):1105.
94. Misra A, Vikram NK, Pandey RM, Dwivedi M, Ahmad FU, Luthra K, Jain K, Khanna N, Devi JR, Sharma R, Guleria R. Hyperhomocysteinemia, and low intakes of folic acid and vitamin B12 in urban North India. Eur J Nutr. 2002 Apr;41(2):68-77.
95. Messina M, Redmond G. Effects of soy protein and soybean isoflavones on thyroid function in healthy adults and hypothyroid patients: a review of the relevant literature. Thyroid. 2006 Mar;16(3):249-58.
96. Osendarp SJ, Murray-Kolb LE, Black MM. Case study on iron in mental development–in memory of John Beard (1947-2009). Nutr Rev. 2010 Nov;68 Suppl 1:S48-52. doi: 10.1111/j.1753-4887.2010.00331.x.
97. Plourde M, Cunnane SC. Extremely limited synthesis of long chain polyunsaturates in adults: implications for their dietary essentiality and use as supplements. Appl Physiol Nutr Metab. 2007 Aug;32(4):619-34.
98. Pront R, Margalioth EJ, Green R, Eldar-Geva T, Maimoni Z, Zimran A, Elstein D. Prevalence of low serum cobalamin in infertile couples. Andrologia. 2009 Feb;41(1):46-50.
99. Proudman SM, Cleland LG, James MJ. Dietary omega-3 fats for treatment of inflammatory joint disease: efficacy and utility. Rheum Dis Clin North Am. 2008 May;34(2):469-79.
100. Rana SK, Sanders TA. Taurine concentrations in the diet, plasma, urine and breast milk of vegans compared with omnivores. Br J Nutr. 1986 Jul;56(1):17-27.
101. Refsum H, Yajnik CS, Gadkari M, Schneede J, Vollset SE, Orning L, Guttormsen AB, Joglekar A, Sayyad MG, Ulvik A, Ueland PM. Hyperhomocysteinemia and elevated methylmalonic acid indicate a high prevalence of cobalamin deficiency in Asian Indians. Am J Clin Nutr. 2001 Aug;74(2):233-41.
102. Remer T, Neubert A, Manz F. Increased risk of iodine deficiency with vegetarian nutrition. Br J Nutr. 1999 Jan;81(1):45-9.
103. Reynolds RD: Bioavailability of vitamin B-6 from plant foods. Am J Clin Nutr 1988;48:863-67.
104. Richards MP, Pettitt PB, Trinkaus E, Smith FH, Paunovic M, Karavanic, I. Neanderthal diet at Vindija and Neanderthal predation: The evidence from stable isotopes. Proc Natl Acad Sci 2000;97: 7663–7666.
105. Richards MP, Hedges REM, Jacobi R, Current, A, Stringer C. Focus: Gough’s Cave and Sun Hole Cave human stable isotope values indicate a high animal protein diet in the British Upper Palaeolithic. J Archaeol Sci 2000;27: 1–3.
106. Roe DA. History of promotion of vegetable cereal diets. J Nutr 1986;116:1355-1363.
107. Roed C, Skovby F, Lund AM. Severe vitamin B12 deficiency in infants breastfed by vegans]. Ugeskr Laeger. 2009 Oct 19;171(43):3099-101
108. Rosell MS, Lloyd-Wright Z, Appleby PN, Sanders TA, Allen NE, Key TJ. Long-chain n-3 polyunsaturated fatty acids in plasma in British meat-eating, vegetarian, and vegan men. Am J Clin Nutr. 2005 Aug;82(2):327-34.
109. Rush EC, Chhichhia P, Hinckson E, Nabiryo C. Dietary patterns and vitamin B(12) status of migrant Indian preadolescent girls. Eur J Clin Nutr. 2009 Apr;63(4):585-7. Epub 2007 Dec 19.
110. Sanders TA, Roshanai F. Platelet phospholipid fatty acid composition and function in vegans compared with age- and sex-matched omnivore controls. Eur J Clin Nutr. 1992 Nov;46(11):823-31.
111. Sanders TA. DHA status of vegetarians. Prostaglandins Leukot Essent Fatty Acids. 2009 Aug-Sep;81(2-3):137-41.
112. Sato Y, Honda Y, Iwamoto J, Kanoko T, Satoh K. Effect of folate and mecobalamin on hip fractures in patients with stroke: a randomized controlled trial. JAMA. 2005 Mar 2;293(9):1082-8.
113. Schneede J, Ueland PM. Novel and established markers of cobalamin deficiency: complementary or exclusive diagnostic strategies. Semin Vasc Med. 2005 May;5(2):140-55
114. Selhub J, Morris MS, Jacques PF. In vitamin B12 deficiency, higher serum folate is associated with increased total homocysteine and methylmalonic acid concentrations. Proc Natl Acad Sci U S A. 2007 Dec 11;104(50):19995-20000.
115. Shapin S. Vegetable love: the history of vegetarianism. New Yorker. 2007 Jan 22:80-4.
116. Singh K, Singh SK, Sah R, Singh I, Raman R. Mutation C677T in the methylenetetrahydrofolate reductase gene is associated with male infertility in an Indian population. Int J Androl. 2005 Apr;28(2):115-9.
117. Srikumar TS, Johansson GK, Ockerman PA, Gustafsson JA, Akesson B. Trace element status in healthy subjects switching from a mixed to a lactovegetarian diet for 12 mo. Am J Clin Nutr. 1992 Apr;55(4):885-90.
118. Stabler SP, Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr. 2004;24:299-326
119. Stephen EH, Chandra A. Declining estimates of infertility in the United States: 1982-2002. Fertil Steril. 2006 Sep;86(3):516-23.
120. Szymanski KM, Wheeler DC, Mucci LA. Fish consumption and prostate cancer risk: a review and meta-analysis. Am J Clin Nutr. 2010 Nov;92(5):1223-33.
121. Taneja S, Bhandari N, Strand TA, Sommerfelt H, Refsum H, Ueland PM, Schneede J, Bahl R, Bhan MK. Cobalamin and folate status in infants and young children in a low-to-middle income community in India. Am J Clin Nutr. 2007 Nov;86(5):1302-9.
122. te Velde E, Burdorf A, Nieschlag E, Eijkemans R, Kremer JA, Roeleveld N, Habbema D.
Is human fecundity declining in Western countries? Hum Reprod. 2010 Jun;25(6):1348-53.
123. Tikkiwal M, Ajmera RL, Mathur NK. Effect of zinc administration on seminal zinc and fertility of oligospermic males. Indian J Physiol Pharmacol. 1987 Jan-Mar;31(1):30-4.
124. van der Merwe NJ, Thackeray JF, Lee-Thorp JA, Luyt J. The carbon isotope ecology and diet of Australopithecus africanus at Sterkfontein, South Africa J Hum Evol 2003;44: 581–597.
125. van Meurs JB, Dhonukshe-Rutten RA, Pluijm SM, van der Klift M, de Jonge R, Lindemans J, de Groot LC, Hofman A, Witteman JC, van Leeuwen JP, Breteler MM, Lips P, Pols HA, Uitterlinden AG. Homocysteine levels and the risk of osteoporotic fracture. N Engl J Med. 2004 May 13;350(20):2033-41.
126. van Mil NH, Oosterbaan AM, Steegers-Theunissen RP. Teratogenicity and underlying mechanisms of homocysteine in animal models: a review. Reprod Toxicol. 2010 Dec;30(4):520-31.
127. Vegetarianism in American. Vegetarian Times Magazine, 2008. http://www.vegetariantimes.com/features/archive_of_editorial/667
128. Verkleij-Hagoort AC, Verlinde M, Ursem NT, Lindemans J, Helbing WA, Ottenkamp J, Siebel FM, Gittenberger-de Groot AC, de Jonge R, Bartelings MM, Steegers EA, Steegers-Theunissen RP. Maternal hyperhomocysteinaemia is a risk factor for congenital heart disease. BJOG. 2006 Dec;113(12):1412-8.
129. Vogel T, Dali-Youcef N, Kaltenbach G, Andrès E. Homocysteine, vitamin B12, folate and cognitive functions: a systematic and critical review of the literature. Int J Clin Pract. 2009 Jul;63(7):1061-7
130. Wald DS, Law M, Morris JK. Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis. BMJ. 2002 Nov 23;325(7374):1202.
131. Waldmann A, Dörr B, Koschizke JW, Leitzmann C, Hahn A. Dietary intake of vitamin B6 and concentration of vitamin B6 in blood samples of German vegans. Public Health Nutr. 2006 Sep;9(6):779-84.
132. Wang Q, Yu LG, Campbell BJ, Milton JD, Rhodes JM. Identification of intact peanut lectin in peripheral venous blood. Lancet. 1998;352:1831-2
133. Werder SF. Cobalamin deficiency, hyperhomocysteinemia, and dementia. Neuropsychiatr Dis Treat. 2010 May 6;6:159-95
134. Whorton JC. Historical development of vegetarianism. Am J Clin Nutr 1994;59 (suppl) 1103S-9S.
135. Wilson AK, Ball MJ. Nutrient intake and iron status of Australian male vegetarians. Eur J Clin Nutr. 1999 Mar;53(3):189-94.
136. Wong WY, Merkus HM, Thomas CM, Menkveld R, Zielhuis GA, Steegers-Theunissen RP. Effects of folic acid and zinc sulfate on male factor subfertility: a double-blind, randomized, placebo-controlled trial. Fertil Steril. 2002 Mar;77(3):491-8.
137. Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, Gupta R, Joshi P, Kerkar P, Thanikachalam S, Haridas KK, Jaison TM, Naik S, Maity AK, Yusuf S; CREATE registry investigators. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet. 2008 Apr 26;371(9622):1435-42.
138. Zhao YT, Chen Q, Sun YX, Li XB, Zhang P, Xu Y, Guo JH. Prevention of sudden cardiac death with omega-3 fatty acids in patients with coronary heart disease: a meta-analysis of randomized controlled trials. Ann Med. 2009;41(4):301-10.
139. Zhao JH, Sun SJ, Horiguchi H, Arao Y, Kanamori N, Kikuchi A, Oguma E, Kayama F.
A soy diet accelerates renal damage in autoimmune MRL/Mp-lpr/lpr mice. Int Immunopharmacol. 2005 Oct;5(11):1601-10.
140. Zimmermann MB. Iodine deficiency. Endocr Rev. 2009 Jun;30(4):376-408
141. Zimmermann MB. The adverse effects of mild-to-moderate iodine deficiency during pregnancy and childhood: a review. Thyroid. 2007 Sep;17(9):829-35.
142. United States Department of Agriculture (USDA). Choose My Plate. gov. Tips for Vegetarians, http://www.choosemyplate.gov/healthy-eating-tips/tips-for-vegetarian.html
143. Micha R, Mozaffarian D. Saturated fat and cardiometabolic risk factors, coronary heart disease, stroke, and diabetes: a fresh look at the evidence. Lipids. 2010 Oct;45(10):893-905.
144. Siri-Tarino PW1, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010 Mar;91(3):535-46.
145. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Saturated fatty acids and risk of coronary heart disease: modulation by replacement nutrients. Curr Atheroscler Rep. 2010 Nov;12(6):384-90.
146. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Saturated fat, carbohydrate, and cardiovascular disease. Am J Clin Nutr. 2010 Mar;91(3):502-9
147. Pirke KM, Schweiger U, Laessle R, Dickhaut B, Schweiger M, Waechtler M. Dieting influences the menstrual cycle: vegetarian versus nonvegetarian diet. Fertil Steril. 1986 Dec;46(6):1083-8.
148. Cordain L. Cereal grains: humanity’s double-edged sword. World Rev Nutr Diet. 1999;84:19-73.
149. Rall LC, Meydani SN. Vitamin B6 and immune competence. Nutr Rev. 1993 Aug;51(8):217-25.
150. Folstein M, Liu T, Peter I, Buell J, Arsenault L, Scott T, Qiu WW.The homocysteine hypothesis of depression. Am J Psychiatry. 2007 Jun;164(6):861-7.
151. Zhang XH, Ma J, Smith-Warner SA, Lee JE, Giovannucci E. Vitamin B6 and colorectal cancer: current evidence and future directions. World J Gastroenterol. 2013 Feb 21;19(7):1005-10
152. Bougma K1, Aboud FE, Harding KB, Marquis GS. Iodine and mental development of children 5 years old and under: a systematic review and meta-analysis. Nutrients. 2013 Apr 22;5(4):1384-416.
153. Zimmermann MB. The effects of iodine deficiency in pregnancy and infancy. Paediatr Perinat Epidemiol. 2012 Jul;26 Suppl 1:108-17