COMMENTS -- NEJM 2000; 343: 585-586

[Guest guest]

I personally am thankful that the French have done so much laboratory work

on these vegans. However, I don't see how pertinent their lab results -

small-bowel x-ray studies, endoscopy and multiple gastric biopsies,

and mitochondrial-DNA analysis - are to our own experiences and health,

nor for any other randomly selected fellow human being opting to

feed oneself on an unsupplemented vegan diet

 

Meanwhile, carefully visit the following website and check out the article

in the New England Journal of Medicine (NEJM), and allow yourselves

to participate intellectually with the discussion of these two cases in France.

The original article was published in a peer-reviewed journal, the NEJM

(and I was working for the Harvard Medical School at the time -

so it was promptly delivered to my desk when I arrived in the morning).

 

 

 

<A HREF= " http://www.NEJM.org/content/2000/0343/0008/0585.asp " >

Correspondence -- NEJM 2000; 343: 585-586</A>

 

The New England Journal of Medicine -- August 24, 2000 -- Vol. 343, No. 8

 

Blindness in a Vegan

To the Editor:

Enthusiasm is laudable, but simplicity is even better.

The reports by Li and McKay and by Milea et al. (March 23 issue) (1,2)

surprised me because of the excessive diagnostic testing used in patients

who were anemic and nutritionally deficient as a result of strict,

unsupplemented vegan diets. The dietary histories of the two patients

should have been sufficient for understanding the etiology and pathogenesis

of their conditions and for determining their treatment. I am puzzled by

the need for small-bowel x-ray studies, endoscopy and multiple gastric

biopsies, and mitochondrial-DNA analysis at the start.

Harvey E. Finkel, M.D.

92 Dean Rd.

Brookline, MA 02445-4244

References

1. Li K, McKay G. Ischemic retinopathy caused by severe megaloblastic

anemia. N Engl J Med 2000;342:860.

Return to Text

2. Milea D, Cassoux N, LeHoang P. Blindness in a strict vegan. N Engl J Med

2000;342:897-8.

Return to Text

 

To the Editor:

The two reports of nutritional deficiency in vegans include a case of

anemia-associated retinopathy, in which the fundus photographs were rotated

90 degrees from their proper orientation, and a case of optic neuropathy

and peripheral neuropathy. The authors of the latter report make the

undocumented assertion that vegetarians are at risk for nutritional

deficiency if they do not receive vitamin supplementation. Although I agree

that vegans should include a source of vitamin B12 in their diet, there is

no evidence that supplementation of other nutrients is necessary or even

desirable in those following a balanced diet.

Remarkably, both of the patients described in these reports were deficient

in folate, despite the fact that numerous studies have found that both

vegan and nonvegan vegetarians tend to have higher intakes of folate and

higher plasma levels of folate than do omnivores. (1,2,3) These findings

are not surprising, considering that leafy green vegetables, legumes, and

several fruits are among the richest sources of folate. The patient

described by Milea et al. was also said to be deficient in vitamins C and

E, both of which are derived primarily from plant sources.

Clearly, then, these patients were not usual vegans but rather persons who

were following anomalous vegan practices. To impute the tendency toward

nutritional deficiency in such persons to the majority of vegans, who

follow normative dietary practices, is inappropriate and, unfortunately,

all too common in the medical literature. Vegetarian diets rich in a

variety of fruits and vegetables represent the ideal from a

disease-prevention standpoint, undoubtedly because they provide the

phytochemicals that are so lacking in the average Western diet.

Jay B. Lavine, M.D.

P.O. Box 43126

Tucson, AZ 85733-3126

References

1. Haddah EH, Berk LS, Kettering JD, Hubbard RW, Peters WR. Dietary intake

and biochemical, hematologic, and immune status of vegans compared with

nonvegetarians. Am J Clin Nutr 1999;70:Suppl:586S-593S.

Return to Text

2. Harman SK, Parnell WR. The nutritional health of New Zealand vegetarian

and non-vegetarian Seventh-day Adventists: selected vitamin, mineral and

lipid levels. N Z Med J 1998;111:91-4.

Return to Text

3. Fenech M, Rinaldi J. A comparison of lymphocyte micronuclei and plasma

micronutrients in vegetarians and non-vegetarians. Carcinogenesis

1995;16:223-30.

Return to Text

 

The authors reply:

To the Editor:

We agree with Finkel that the dietary history helped us to determine the

right diagnosis in our patient, but diagnostic testing was necessary to

rule out other possible causes of his condition, such as compression or

mitochondrial disease. It is important to exclude other causes of optic

neuropathy before accepting a nutritional origin. (1)

Our patient, being an " unusual " vegan, as Lavine suggests, had not only an

unsupplemented but also an inappropriately strict vegan diet. He had no

nutritional counseling and retrospectively admitted excessive restriction

of his diet, although he did not seem to be anorexic or mentally ill.

Several nutritional deficiencies have been reported in vegans, (2,3) but

the unexpected low levels of folate and vitamins C and E in our patient may

have been caused by inadequate nutrition, probably due to a diet that was

not in accordance with recommended vegan practices. Therefore, appropriate

guidance and nutritional supplementation could have been useful in this

particular case.

Dan Milea, M.D.

Nathalie Cassoux, M.D.

Phuc LeHoang, M.D., Ph.D.

Groupe Hospitalier Pitie-Salpetriere

75651 Paris CEDEX 13, France

References

1. Miller NR, Newman NJ. The essentials: Walsh & Hoyt's clinical

neuro-ophthalmology. 5th ed. Baltimore: Williams & Wilkins, 1999:664.

Return to Text

2. Zmora E, Gorodischer R, Bar-Ziv J. Multiple nutritional deficiencies in

infants from a strict vegetarian community. Am J Dis Child 1979;133:141-4.

Return to Text

3. Remer T, Neubert A, Manz F. Increased risk of iodine deficiency with

vegetarian nutrition. Br J Nutr 1999;81:45-9.

Return to Text

 

 

 

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2000 by the Massachusetts Medical Society. All rights reserved.

 

 

 

[Guest guest]

Since Food Not Bombs lovingly feeds nourishing vegan meals

to the general public several times each week in various

localities throughout North America, lots more needy folks

have actually been BETTERED by consuming vegan foods.

 

(Of course, those homeless and other folks are probably not

" intentional vegans " , nor even willing to be " vegan " all the time.

Nonetheless, when I first became vegetarian, I constantly heard

the suggestion that being vegetarian would locate me squarely

in the context of the worst poverty in American society, and

that for those reasons alone I should avoid publicly identifying

myself as a vegetarian.)

 

I think that, if we ARE constantly bei9ng cast into a

self-destructive cultural bubble, we HAVE as a diverse

community - or merely constituency - managed to

effe4ctively fight ourselves out of that paper bag,

and we have, over the past thirty years, been able

to draw together thousands of vegetarian and vegan

medical doctors, thousands of vegan and vegetarian RD's,

and hundreds of medical and nutritional researchers who

are constantly making our case for veganism in the

medical, research, nutritional, and academic communities.

The information faces the long, arduous process of " filtering down "

from the researchers to the general public, and IMO our best

position as " vegetarian advocates " is to live as responsibly

and knowledgeably as we possibly can, to become as

well-informed about vegetarian and vegan diet, and to

be no-nonsense all-business type people regarding our

diets, and to become good examples - even if we are tempted

to sacrifice ourselves for organization purposes, to establish

new resources for the common good.

 

I'm a pretty bad e3xample of that kind of advice,

and Vegetarian Times actually features many of those

vegans and vegetarians who HAVE become admirable

examples of who veggies can become on plant-based diets.

 

Surely we have some decisions to make here on whether

or not we are going to be " selfish " in applying the wealth

of resources and knowledge on ourselves and in developing

ourselves - or to insist that we continue to be " altruistic "

and to sacrifice ourselves in the process.

 

The simple fact is that BEING VEGAN does not,

in itself, require self-sacrifice or even altruism.

However, the social reconstruction of the general public

probably DOES require that, unless everyone is willing

to pitch in an do their fare share of the resource develop0ment.

If that is the case - if every college student is willing to

devote her or his intellectual, vocational, and academic

skills to the promotion of vegetarianism and veganism,

at least for a short period of time, we would merely

see new vegetarian structures emerging for

organizing the free time of these vegetarian volunteers,

and little if any real " self-sacrifice " would be required

to accomplish great objectives - and everyone would

be able to learn much in the process of volunteering

for this noble long-term historical objective.

 

Maynard S. Clark

 

 

 

At 11:38 AM 8/29/00 -0400, Holly wrote:

>This reminds me of an amusing 1968 exchange. It started off when a Dr.

>Haler published an opinion in the Times stating that the vegan diet is a

> " potential killer. " Three doctors wrote a letter to The Lancet telling Dr.

>Hale " To suggest that it is a 'grossly deficient diet' shows ignorance of

>available knowledge about the vegan diet.... " [they say she died of

>bronchopneumonia] " We should like to ask Dr. Haler on what grounds he bases

>his evidence that this case is the third recent death attributable to the

>vegan diet. It is known that there are large numbers of old people who for

>financial and other reasons subsist mainly on 'tea and buns' and such a

>diet can lead to serious deficiencies and malnutrition. It is obvious that

>one could not classify this group as vegans. "

>

>Mind you, this is all under a big heading of " DEATH AFTER VEGAN DIET. "

>

>In the next issue or so, Dr. Haler has a reply:

>

> " ...I was concerned with the cause of death of an elderly lady who had been

>sufficiently misguided to indulge in a grossly abnormal diet. She was not a

>vegan; she had merely deprived herself of essential nutriment out of

>misguided sympathy with a lot of living animals. If she had been a vegan

>she would have had, I have no doubt, a dietetic supplement which turns this

>peculiar diet into one which is not necessarily always lethal. I fully

>accept that such cults must be permitted, or tolerated, but, Sir, it is my

>submission that, when the old misguidedly eat grossly deficient diets

>without supplement, attention should be directed to the risks they run.

>[b-12 blah blah] As for the suggestion...that the old lady did not die from

>her stupid dietetic habits and, in fact, might have been preserved, I can

>only say that this is ludicrous. ...I know that there are large numbers of

>old people who subsist mainly on 'tea and buns': may I point out that this

>diet is not a vegan diet, because buns should be made with milk. "

>

>Ah, well--touché!!