Introduction

Reducing consumption of animal products is a choice with both moral and practical consequences. Last summer I found myself in contact with many vegans who cared a lot about the moral consequences, but had put little effort into learning about or managing the practical consideration of removing animal products from their diet. I’ve suffered a lot due to bad nutrition, so this made me very concerned. With a grant from the Survival and Flourishing Fund, I launched small a pilot project to give nutritional tests to 5 vegans and near-vegans from the Lightcone Office, which they could use to choose supplements that would hopefully improve their health.

My long-term goal was for everyone to have accurate information on their personal nutritional costs of veganism and make informed choices about how to handle them, with the first line solution being supplements. My goal for the pilot was to work out practical issues in testing, narrow the confidence interval on potential impact, and improve the nutrition of the handful of people. This report is on phase 1: getting the testing done and supplements started. It is aimed at people who might want to run a similar program at scale; if you are interested in running this for yourself I recommend checking out Tuesday’s post on iron deficiency.

Tl;dr: I found rampant iron deficiencies, validating the overall concern. The procedure I used has a lot of room for improvement. 

The Experiment

I gave nutrition tests to 6 people in the Lightcone office. 

The ideal subject was completely vegan, had never put any effort or thought into their diet, and was extremely motivated to take a test and implement changes. This person does not volunteer for studies, so I ended up with 4 vegans or near-vegans who had put somewhere between 0 and a lot of thought into their diet, 1 vegetarian, and 1 extremely motivated omnivore I used to test out the process.  In addition, one hardcore vegan contributed results from private testing. I did not poll the ~vegans on their exact diets.

Unless otherwise stated the results exclude the omnivore.

I gave each of these six people a Genova Metabolomix+ test, ordered from walkinlabs.com, with the iron add-on. This test was selected for being recommended by doctors I trust (in part because they prefer urine to blood testing), having extremely easy-to-read results, being nearly comprehensive (with the unfortunate absence of vitamin D), and because I hoped urine collection at home would be easier than blood draws at a lab. Foreshadowing: I was wrong about that last part.

I also gave people the option of an add-on to determine what variant of the MTHFR gene they have. MTHFR can affect how one processes certain B vitamins, and certain variants can necessitate a more expensive form of supplements.

Several people (although not everyone) scored with undetectably low iron. I offered them follow-up blood tests, which one person accepted. An additional vegan contributed blood test results without urine results.

As of publication all subjects have received their first round of results and started supplements of their choosing. 

The original plan was to retest in 3-6 months after people began supplements, using the same urine tests.

My initial predictions

I expected the big shortages to be B12, iron, and vitamin D, the first of which has very few* natural vegan sources and the latter two of which are scarce, although not absent, in vegan sources. This makes it pretty unfortunate the original test did not include vitamin D. 

[*B12 is (maybe?) naturally found in some (but not all) seaweeds and algaes, in at least one kind of mushroom, and in nutritional yeast (but possibly in the wrong format?). It’s also added to many wheat products in the US, so if you eat enough wheat and aren’t going out of your way to get unfortified wheat that’s a strong source]

Relative to the mainstream I wasn’t very concerned about protein consumption. Vegan proteins are a little less abundant, a little harder to digest, and have a less ideal distribution of amino acids, but are basically fine as long as you don’t pile on additional constraints.

One reason I was concerned was that lots of people I polled were piling on additional constraints, like keto or gluten-free, and still not doing anything to manage nutrition. I expected a smattering of deficiencies from these people, and to a lesser extent from everyone, as their restrictions and tastes cut off random nutrients. These could have been in any almost nutrient.

I expected everyone to be fine on vitamin C because it is abundant in both produce and processed food (where it’s used as a preservative).

Results

(including only vegans and near-vegans)

1. ¾  vegan testers had severe iron deficiencies in their urine tests.
   1. The one who didn’t had both a stunning dietary intake of iron, and a parent who 23andMe believes to have a genetic predisposition to excessive absorption of iron.
   2. An additional vegetarian tester was not deficient.
   3. One of these retested with a blood test and scored low normal (~30). However this person was already taking iron supplements at the time of the test. 
   4. A bonus blood-only participant tested between 13 and 20, meaning they’d be considered deficient by some standards but not others.
2. There were no B12 deficiencies, probably because everyone was already on B12 supplements. 
3. One tester had a lot of deficiencies, including vitamin C, to the point I suspect it’s a problem with digestion rather than diet. 
4. Everyone had at least one amino acid deficiency, including the person eating over 100g of protein/day. I don’t know how big a deal this actually is.
5. The urine test did not include vitamin D.  Of the 2 blood tests, both had low-normal vitamin D.
6. Excluding the person with across-the-board deficiencies, there were scattered other deficiencies but nothing else to consistently worry about. People were mostly in their tests’ green zone, with occasional yellow and red.

What does this mean?

Only one near-vegan out of 5 had solidly good ferritin levels. As I discuss here, that’s a very big deal, potentially costing them half a standard deviation on multiple cognitive metrics. 

There’s no control group, so I can’t prove that this is a veganism problem. But I’m quite suspicious.

There were no other consistent problems, so broad-spectrum testing is probably overkill for people with no known problems. 

Retrospective on the project

What worked

I consider the core loop of the study as vindicated as can it be at this stage. 

• Deficiencies were identified, and the primary one was one of the three I predicted.
  • And another of the three, B12, was probably absent because people treated it preemptively. Note that people were inconsistent in what they took so I can’t say definitively what they were on during testing.
• In the counterfactual timeline the shortages were probably identified much later if at all. No one who participated had any plans for testing, including people with obvious symptoms and people whose doctors had previously recommended testing.

This will be less impressive if supplementation doesn’t turn out to fix anything, but it’s an extremely solid start.

Other things that went well:

• Having the room in my budget for unplanned additional testing, so I could add in serum iron tests when it became obvious they were necessary.
• Creating a shopping list with links. I was worried this was somehow taking advantage of people (since I used affiliate links), but removing a decision and several steps from the ordering process seems to have been pretty crucial. 
• Bypassing the need for doctors’ visits to get a test. Given how long it took people to order tests I think doctors’ appointments would have killed the project entirely. 
• The Lightcone ops team was extremely cooperative and got all of the vitamins I suggested into the office.

Difficulties + possible changes

Potential changes are framed as recommendations because I am deeply hoping to hand off this project to animal advocates, who caused the veganism in the first place. 

1. The test ordering workaround was not as good as I had hoped
   1. I’d originally hoped to just hand participants a box, but they had to order the tests themselves.
   2. In order to get iron + genetics tests people had to call rather than order online. This is non-standard for the provider and two people had to call twice to insist on what they wanted.
   3. Tests took a long time to ship, and a long time to return results after shipping. The lab alleges this is a supply chain issue and there’s nothing to be done about it. 
   4. Those two together turned into a pretty big deal because they made it very hard to plan and people lost momentum.
   5. In combination with the results showing few problems beyond iron I recommend deemphasizing full spectrum urine tests and focusing on blood tests for iron (and vitamin D), and making those convenient, perhaps by bringing a phlebotomist to the office.
   6. Another option would be to bring in a medical practitioner, who can order tests for other people, to manage tests so the office can be stocked with them. This of course fails to solve the problem for anyone not in the office.
   7. There are home tests for vitamin D and iron specifically, but I have no idea if they’re any good.
2. Ideal test subjects (completely vegan, never done nutritional testing or interventions, promptly puts in the effort to do these tests and act on them once I suggest it) were even thinner on the ground than anticipated.
   1. I knew there wouldn’t be many, but I didn’t think it would be so hard to get five people pretty close to that profile. 
   2. I loosened restrictions and still consistently found problems, so recommend lowering the eligibility bar for testing in future rounds, especially since that was always the plan. The strict requirements in this round were an attempt to make the signal as loud as possible.
3. Getting everyone tested was like herding cats. Beyond the problems with the test distributor, some participants needed repeated reminders to order, one lost a test, results went missing… it was kind of a nightmare.
   1. One advantage of focusing on blood tests would be to cut down on this, especially if you bring the phlebotomist to the office.
4. At points I was uncomfortable with the deference some participants showed me. I was as clear as I possibly could be that this was a best-effort from a knowledgeable amateur kind of thing; they were responsible for their own health and I was a nonexpert trying to provide some logistics help. I nonetheless got more than one person bringing me problems not even related to the nutrition project, and insisting I tell them what to do.
   1. Recommendation: bring in a skilled nutritionist. They can both give better advice than me and devote more time to helping people. 
5. I initially misread the protein results (which are delivered in terms of “how deficient are you?” rather than “what’s your current level?”, making 0 the best possible score). Luckily I knew I was confused from the beginning and no one had taken any actions based on my misinterpretation. More broadly, I’m just a woman who’s had some problems and read some stuff, I expect my suggestions to be better than nothing but far from the maximum good it would be possible to do.
   1. Recommendation: bring in a skilled nutritionist
6. I underestimated the amount of time and especially emotional labor this project would need. I was hoping to bluff my way through that until people got on supplements, at which point the improvements in health would be their own motivation. I think I always overestimated how well that would work, but it was especially wrong because all the problems with the tests drained people’s momentum.
   1. Recommendation: I still think you should bring in a skilled nutritionist
7. Many of the participants were moving frequently and not in the office by the time their results came in (because they took so long…), so they had to buy supplements themselves. Given the option I would have selected people consistently in the office, but as mentioned I was already managing trade-offs around participants.
   1. Recommendation: ask for more money to give everyone their first month of supplements and a convenient pill planner.

Next Steps

I previously planned to give people the same urine test 3-6 months after they started supplements. That no longer seems worth it, relative to the cheaper and more convenient blood tests. 

It’s not actually clear a formal follow-up is that useful at all. I initially planned that because I expected a wide range of shortages such that literature reviews wouldn’t be helpful. But there was only one real problem, and it has a richer literature than almost any micronutrient. So I don’t think another 5 people’s worth of scattered data is going to add much information. 

So the next step for this as a project would be mass blood testing for B12, iron, and vitamin D. 

Feeling motivated?

If this has inspired you to test your own nutrition, I haven’t done anything you can’t do yourself. Both the urine and blood tests are available at walkinlabs.com, and if you have a doctor they’re quite likely to agree to testing, especially if you’re restricting meat products or fatigued. I have a draft guide of wisdom on supplementation I’ve picked up over the years here, although again, I’m not a doctor and only learned how to digest food last May, so use at your own risk. 

Thank you to the Survival and Flourishing Fund for funding this project, Lightcone for hosting, and all the participants for their precious bodily fluids.