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Clean Vegan: Whole-Food Plant-Based (WFPB)

A fully plant-based way of eating built on whole foods only, no mock meats, no refined oils, no processed vegan junk. Drawn from the whole-food plant-based clinical research tradition.

🌱 Zero Animal Products πŸ₯¦ Whole Foods Only 🫘 Soaked & Sprouted πŸ’Š B12 Mandatory 🌊 Algae Omega-⁠3

Last updated:

By the Numbers, United States

How Many Americans Follow This Lifestyle?

~1%
of US adults say they are vegan (Gallup survey, 2023)1
~4%
of US adults say they are vegetarian, for comparison (Gallup survey, 2023)1

Source: Gallup, 2023. Self-reported adherence varies widely across surveys; figures are approximate.

Definition

What Is Clean Vegan / WFPB?

Vegan eating excludes all animal products. "Whole-food plant-based" (WFPB) goes further: it also excludes refined oils, refined sugars, refined grains and ultra-processed plant foods. The defining boundary is processing, not the source.

The word vegan was coined by Donald Watson in 1944 to distinguish strict plant-only eating from vegetarianism2. The modern whole-food plant-based clinical movement grew out of observational studies and small intervention trials from the late twentieth century onward, mainly in coronary artery disease and diabetes.

The clinical case for WFPB rests on observational and interventional data showing reversal markers in coronary artery disease, improvement in type 2 diabetes and reduced risk of several chronic diseases345. The Lifestyle Heart Trial, which randomized 48 people, 28 of them to an intensive program combining a very low-fat vegetarian diet with exercise, stress management and smoking cessation, showed modest regression of coronary narrowing46. It is the most cited evidence here, and it is one small trial of a bundled program rather than of diet alone.

A bowl of farro and brown rice, black beans, red lentils, roasted squash and cauliflower, kale, red cabbage, radishes, avocado and sauerkraut, with seeds, walnuts, seaweed, parsley, a lemon wedge and a glass of water

Clean Vegan vs. Junk Vegan: Same Label, Different Diets

Whole-Food Plant-Based

Soaked legumes, intact whole grains, all vegetables, fruits, nuts, seeds, sea vegetables, ferments, herbs. No added oils or refined flours.

Standard Vegan

Plant-based but uses oils, white pasta, white bread and occasional packaged foods. Often healthier than the Standard American Diet, though its refined grains and oils move it away from the whole-food version.

Junk Vegan

Sandwich cookies, vegan ice cream, mock meats, vegan donuts, French fries. Technically vegan, but plant-based eating built on refined grains, sweets and fried foods has been linked to higher heart disease risk, not lower7.

The Framework

Six Core Principles

🌾

1. Whole Foods Only

If it looks like its original plant form (or close to it), eat it. Whole grains in the husk, dried beans you soak yourself, fresh produce. Skip flours, oils and protein isolates wherever possible.

πŸ’Š

2. B12 Is Essential

There is no reliable plant source of B12 38. Without supplementation, B12 levels start to fall within the first few years, and signs of deficiency can appear as early as two years after intake stops, often silently89. A B12 supplement of 1,000 to 2,500 mcg, 2 to 3 times per week, is the simplest insurance89.

🫘

3. Beans Are the Center

Legumes are the WFPB protein base. Soaked overnight, cooked with kombu, paired with whole grains and eaten alongside a variety of plant foods through the day, they help supply all the essential amino acids, plus fiber and minerals.

🌈

4. Variety = Nutrient Adequacy

No single plant covers every need. A simple daily checklist, beans, berries, cruciferous, greens, other vegetables, whole grains, nuts/seeds, flax, herbs/​spices, water, exercise, B12 (2 to 3 times a week), captures the rotation.

🚫

5. Skip the Mock Meats

Branded plant-based burgers, vegan "chicken nuggets," ultra-processed isolate-based foods. Use whole soy (edamame, tempeh, miso) and whole-bean preparations instead.

πŸ§ͺ

6. Test Periodically

Ask your clinician about periodic blood tests, most usefully B12 (with a methylmalonic acid, or MMA, test if the result is borderline) and ferritin810. Iodine and vitamin K cannot be judged from a single routine test, so cover them through food or a supplement instead1112.

Food Framework

What to Eat & What to Skip

βœ… Build Meals Around:

🫘 Soaked Legumes

Lentils, chickpeas, black beans, mung, adzuki, navy, kidney, white beans. Soaked, cooked with kombu, used daily.

🌾 Intact Whole Grains

Brown rice, millet, quinoa, buckwheat, oats, barley, farro. Soaked or sprouted before cooking.

πŸ₯¬ All the Vegetables

Leafy greens, cruciferous, alliums, root vegetables, gourds, peppers, mushrooms, herbs. Aim for vegetables at every meal.

πŸ“ Fruits, Especially Berries

Berries daily for polyphenols, plus citrus, apples, pears, stone fruits, melons in season.

🌰 Nuts, Seeds, Sea Vegetables

Soaked almonds, walnuts (omega-⁠3), pecans, Brazil nuts, pumpkin seeds, sunflower, hemp, ground flax (1 to 2 tbsp daily). Nori, wakame, dulse and arame in small amounts for minerals. Iodine in seaweed varies enormously, and some seaweeds hold more than the adult upper limit of 1,100 mcg in a single gram, so do not eat kelp daily or count on seaweed for iodine11.

πŸ₯’ Fermented Plants

Sauerkraut, kimchi, miso, tempeh, natto, fermented pickles. Microbiome support without dairy.

❌ Limit or Skip:

πŸ” Mock Meats

Plant-based burgers, vegan chicken, hot dogs, sausages. Ultra-processed, oil-heavy, isolate-based.

🌽 All Refined Oils

Strict WFPB programs use zero added oil, including olive oil, although extra-virgin olive oil itself has trial evidence for heart protection13. Use whole-fat sources (avocado, olives, nuts, seeds).

🍬 Refined Sugar

Sugar, HFCS, agave, syrups in vegan baked goods and "natural" sweeteners. Use dates, mashed banana or small amounts of pure maple syrup.

🍞 Refined Flours

White bread, white pasta, refined-flour vegan baked goods, packaged crackers.

πŸ₯₯ Vegan Junk Food

Vegan ice cream, vegan cheese, vegan candy. Usually ultra-processed, and often high in refined oils, sugar and salt.

🍢 Isolated Protein Powders

Soy protein isolate, pea protein concentrate. Whole beans and seeds provide protein along with fiber and minerals that isolates leave behind.

A Day on the Plate

Sample 1-⁠Day Clean Vegan Pattern

7:30 to 8:30 AM Β· Breakfast
πŸ₯£ Morning Plate

Steel-cut oats soaked overnight, simmered in water; topped with 1 cup berries, 2 tbsp ground flax, 2 tbsp soaked walnuts, 1 tsp Ceylon cinnamon14. Side: 2 tbsp peanut butter on a sliced apple. Add B12 sublingual (2 to 3 times a week)89.

Vegan morning plate with soaked oats, berries, ground flax and soaked walnuts

πŸ₯£ Sample Morning Plate

Soaked oats Β· berries Β· ground flax Β· soaked walnuts Β· Ceylon cinnamon. Whole-food carbohydrate, plant omega-⁠3 ALA and polyphenols, plus the B12 supplement (2 to 3 times a week), the one nutrient plants cannot supply89.

12:30 to 1:30 PM Β· Lunch
🌯 Buddha Bowl

1 cup cooked quinoa Β· 1 cup black beans (soaked overnight, cooked with kombu and cumin) Β· 2 cups roasted vegetables (sweet potato, broccoli, red onion) Β· 1 cup massaged kale with lemon Β· 1/4 cup hummus Β· pumpkin seeds, hemp hearts, sauerkraut, nori strips. Whole-food tahini-lemon dressing, no oil needed.

Vegan Buddha bowl with quinoa, black beans, roasted vegetables, massaged kale, hummus and seeds

🌯 Sample Buddha Bowl

Quinoa Β· soaked black beans Β· roasted vegetables Β· massaged kale Β· hummus Β· pumpkin seeds + hemp hearts Β· sauerkraut + nori. A complete WFPB plate: protein, fiber, polyphenols, minerals and live cultures in one bowl.

6:30 to 7:30 PM Β· Dinner
πŸ› Indian-Style Plate

Red lentil dal (soaked, simmered with turmeric, ginger, garlic) Β· 3/4 cup soaked brown basmati rice Β· steamed greens with miso-tahini Β· cucumber-tomato salad with lime Β· roasted cauliflower & chickpeas with garam masala Β· raw fermented pickle.

Vegan Indian-style dinner plate with red lentil dal, soaked brown basmati rice, steamed greens and roasted cauliflower

πŸ› Sample Indian-Style Plate

Red lentil dal Β· soaked brown basmati rice Β· steamed greens with miso-tahini Β· cucumber-tomato salad Β· roasted cauliflower & chickpeas Β· fermented pickle. Warm, well-spiced and easy to digest.

9:00 PM Β· Optional Snack
πŸŒ™ Pre-Sleep

Chamomile tea, optional: 2 dates with 1 tbsp tahini and a sprinkle of sea salt. Many people sleep better if they finish eating a few hours before bed.

Practical Guardrails

The Six Most Common Pitfalls

πŸ’Š Skipping B12

The most dangerous mistake. B12 deficiency can cause nerve damage that may become permanent if it is not caught early89. Supplement B12, 1,000 to 2,500 mcg, 2 to 3x/week89.

πŸ” Relying on Mock Meats

Easy and tasty, but ultra-processed. Use as occasional treats, not daily protein sources.

🌊 No Omega-⁠3 Strategy

Flax and chia provide ALA, which converts poorly15. Use an algae-based EPA/DHA supplement (250 to 500 mg combined daily)15.

🌾 Refined-Grain Vegan

White pasta, white bread, vegan crackers. Replace with intact whole grains.

🩸 Iron, Zinc, Iodine Gaps

Ask your clinician about periodic blood tests, most usefully ferritin10. Pair plant iron with vitamin C. Use pumpkin seeds and sprouted grains for zinc. Use an iodine supplement rather than relying on seaweed11.

🦴 Calcium & Vitamin D

Without dairy, both can fall short. Calcium-rich greens (bok choy, kale), tahini and a D3 supplement (vegan lichen-derived) cover the gap.

Foundational Supplements

Supplements Often Helpful on Clean Vegan

SupplementWhyTypical DoseNotes
Vitamin B12 (REQUIRED)No reliable plant source8. Deficiency can cause nerve damage that may become permanent if not caught early89.1,000 to 2,500 mcg oral or sublingual, 2 to 3x/week89Test serum B12, MMA, homocysteine periodically.
Vitamin D3 (vegan, lichen-derived)Without fatty fish or eggs, food supplies little, so a supplement fills the gap16.Set the dose with your clinician; most adults need no blood test firstOptional: K2 MK-⁠7 100 to 200 mcg. If you take warfarin, clear any vitamin K supplement with the clinician managing your anticoagulation before starting or stopping it: vitamin K antagonizes warfarin, and changing your intake destabilizes the INR12. Consistency matters more than avoidance12. This does not apply in the same way to direct oral anticoagulants such as apixaban or rivaroxaban, but tell your prescriber about any supplement you take17.
Algae EPA/DHAPlant ALA converts poorly15. Direct EPA/DHA from algae is the cleanest fix.250 to 500 mg combined daily15Third-party-tested. In pregnancy, an extra 100 to 200 mg of DHA a day is commonly advised; agree on the amount with your clinician15. In heart trials, omega-⁠3 supplements (fish oil) raised the risk of atrial fibrillation, an irregular heartbeat, more so above 1 g a day18, so check this dose with your clinician first.
IodineNo fish or dairy, and sea salt or a low-salt diet supplies little iodine.150 mcg supplement (the adult RDA); seaweed iodine varies too widely to rely on11Hashimoto's: consult a clinician before any iodine11.
Iron (if ferritin low)Plant (non-heme) iron is absorbed less well, so people on vegetarian diets, including vegan diets, need about 1.8 times as much iron10.25 to 50 mg elemental bisglycinate + vitamin C on empty stomachOnly supplement if ferritin is low. The top of this range sits above the 45 mg/day tolerable upper intake level for adults10. That is appropriate only when correcting a confirmed deficiency under clinical supervision, not as general supplementation. Test ferritin first, and retest rather than staying on it indefinitely. At 25 mg or more, iron can lower zinc absorption, so take it at a different time from zinc10. If an empty stomach upsets you, take it with a small meal10. Keep iron out of children's reach; accidental overdose can kill a small child10.
ZincPlant zinc binds to phytates; absorption can be low19.15 to 25 mg zinc picolinate/​bisglycinateTake with food. Watch copper balance long term20.
Selenium1 to 2 Brazil nuts daily covers most adults21.1 to 2 Brazil nuts/dayOne or two nuts is plenty; selenium varies widely between nuts21. Do not add a selenium supplement on top, and give children less (the upper limit is 150 mcg a day at ages 4 to 8)21.
CholineMost choline comes from animal foods such as eggs and meat, and most people already eat less than recommended, so vegans should plan for it22.Sunflower lecithin 1 tbsp a day, or alpha-GPC 300 mg only on clinical advice, as it has been linked to higher stroke risk23Especially important during pregnancy22. Lecithin is the gentler choice; the alpha-GPC stroke link comes from one large observational study23.
Calcium (only if intake is low)Best from whole foods (kale, bok choy, broccoli, tahini).500 mg from a supplement if food gives you well under the 1,000 to 1,200 mg adults need24Don't take with iron; they compete for absorption10.
Magnesium GlycinatePlant diets supply magnesium, though phytates in grains and legumes may reduce absorption; glycinate is less often linked to loose stools than some other forms300 to 500 mg elemental, at bedtime (or split AM/PM)Soaking and sprouting grains and legumes may also improve mineral absorption. The top of this range is above the 350 mg/day upper intake level for supplemental magnesium; above that, diarrhea is common. With kidney disease, take it only on your clinician's advice.
Zinc CarnosinePlant zinc binds to phytates and absorbs less efficiently than animal-derived zinc; this is an optional alternative to the plain zinc above, not an addition to it75 to 150 mg/day (delivers about 17 to 34 mg elemental zinc)Take with food. Keep total zinc from food and supplements under the adult upper limit of 40 mg a day, and do not combine this with the plain zinc above19. After 8 to 12 weeks, drop to the lower dose to avoid copper depletion. Pair with 2 mg copper if used long term.
Suitability

Who Benefits Most, and Who Should Be Careful

πŸ’ͺ Often Benefits

Coronary heart disease

Small trials of intensive lifestyle programs: angiographic stabilization or partial reversal in motivated patients46.

Type 2 diabetes

Modest HbA1c reductions in trials, and in one 22-⁠week trial more people on a low-fat vegan diet cut back their diabetes medication than on a standard diabetes diet525.

Hypertension & high cholesterol

LDL cholesterol falls consistently in trials26. Blood pressure results are mixed: vegetarian diets lowered it in one review, while vegan diets lowered it mainly in people whose blood pressure was already high272829.

Reducing animal-product environmental load

Lowest land, water and emissions footprint of common eating patterns30.

Gut bacteria

Fiber feeds gut bacteria that produce short-chain fatty acids31.

⚠️ Use Caution or Avoid

Without B12 supplementation

Not optional. If you will not take B12 reliably, do not go vegan38.

Children

Possible but requires expert pediatric nutrition input: protein, calorie density, omega-⁠3, B12, iron, zinc, iodine, vitamin D and calcium all must be deliberately covered32.

Pregnancy / breastfeeding

High-stakes for choline, B12, omega-⁠3, iron, vitamin D, iodine33. Work closely with a knowledgeable practitioner. If you breastfeed, keep taking B12: babies of vegan mothers can become deficient within months8. Iodine supplements of 150 mcg a day are advised before and during pregnancy and while breastfeeding11.

Active SIBO or severe IBS/IBD

High-FODMAP legumes and cruciferous can aggravate symptoms. Get symptoms under control with your clinician first.

Eating disorder history

Vegan rules can rationalize restrictive eating34. Work with a clinician.

Very high training volume

Possible, and some elite athletes eat this way, but protein, calorie density and recovery require careful planning3.

Next Steps

Plant-Based Done Properly

WFPB has encouraging cardiovascular evidence, mostly from observational studies and small trials, and it works only when done with care. Cover the B12 and omega-⁠3 bases, build meals around whole beans and grains, and let the variety of plants do the work.

← Back to Lifestyle Library Compare to Clean Macrobiotic β†’

References & Evidence Notes

Each numbered entry below is either a source you can follow or a note setting out what the evidence does and does not support. Both are numbered together so the markers in the text line up.

Last reviewed October 20, 2026. This page is nutrition education, not medical advice, and it does not replace your doctor. B12 is not optional on a vegan diet, and seaweed is not a safe way to get your iodine. If you take warfarin, or are pregnant or breastfeeding, plan your supplements with your clinician, and plan a vegan diet for a baby or child with their doctor or a dietitian.

  1. Jones JM. In U.S., 4% Identify as Vegetarian, 1% as Vegan. Gallup. 2023. news.gallup.com. A poll of 1,015 US adults in July 2023. It measured how people describe themselves, not how strictly they eat, and it gives no count of people. ↩
  2. The Vegan Society. History. vegansociety.com. The society's own account: Donald Watson coined the word at a November 1944 meeting with five other non-dairy vegetarians, who wanted a shorter name for their way of eating. ↩
  3. Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet. 2016. PubMed 27886704. The Academy's position paper, read here from its abstract. It supports the page's statements that vegetarian and vegan diets are linked to lower risk of heart disease, type 2 diabetes and other chronic diseases, that vegans need a reliable B12 source such as fortified foods or supplements, and that well-planned vegan diets can suit athletes. It covers vegetarian and vegan diets in general, not whole-food plant-based eating in particular. ↩
  4. Ornish D, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990. PubMed 1973470. Forty-eight people with coronary heart disease: 28 were assigned to a low-fat vegetarian diet with exercise, stress management and stopping smoking, and 20 to usual care. Average narrowing of the arteries went from 40.0% to 37.8% in the program group. The diet was vegetarian, not vegan, and the program was a bundle, so diet alone was not tested. ↩
  5. Yokoyama Y, Barnard ND, Levin SM, Watanabe M. Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis. Cardiovasc Diagn Ther. 2014. PubMed 25414824. Six trials in 255 people with diabetes: vegetarian diets lowered HbA1c by 0.39 points on average, a modest effect. ↩
  6. Ornish D, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998. PubMed 9863851. The five-year follow-up of the same trial, in which 35 of the 48 had a repeat angiogram: narrowing fell by 3.1 points in the program group and rose by 11.8 points with usual care. It describes the diet as a whole-food vegetarian diet that was 10% fat. ↩
  7. Satija A, et al. Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults. J Am Coll Cardiol. 2017. PubMed 28728684. US health professionals followed over time. A plant-based diet score weighted toward juices, refined grains, fries and sweets was linked to higher coronary heart disease risk (hazard ratio 1.32), and a healthful plant-based score to lower risk (0.75). It is observational, and it scores diets rather than studying vegans as such. ↩
  8. Office of Dietary Supplements, National Institutes of Health. Vitamin B12: Fact Sheet for Health Professionals. Updated July 2, 2025. ods.od.nih.gov. The source for B12 not being naturally present in plant foods, though some foods are fortified with it; for B12 having no upper limit and oral and sublingual forms working alike; for nerve damage from deficiency becoming permanent if it is not treated early; for methylmalonic acid (MMA) being the most sensitive marker of B12 status; and for breastfed babies of mothers who eat no animal products becoming deficient, sometimes very early in life. ↩
  9. Rizzo G, et al. Vitamin B12 among Vegetarians: Status, Assessment and Supplementation. Nutrients. 2016. PubMed 27916823. A review of B12 in vegetarians and vegans. Blood B12 falls within the first five years after intake stops, first signs can appear as early as two years and nerve signs are often irreversible. It reports that 2,000 mcg a week, split into two oral doses, could meet adult needs, which is the low end of this page's dose. ↩
  10. Office of Dietary Supplements, National Institutes of Health. Iron: Fact Sheet for Health Professionals. ods.od.nih.gov. The source for ferritin as the most efficient test for iron deficiency; for people on vegetarian diets needing 1.8 times as much iron; for the adult upper limit of 45 mg a day; for supplements of 25 mg or more lowering zinc absorption; for taking iron with food to reduce side effects; and for the advice to take calcium and iron supplements at different times, although calcium's effect on iron absorption has not been definitively established. ↩
  11. Office of Dietary Supplements, National Institutes of Health. Iodine: Fact Sheet for Health Professionals. ods.od.nih.gov. The source for seaweed iodine ranging from 16 to 2,984 mcg per gram, the adult upper limit of 1,100 mcg and the adult recommended amount of 150 mcg a day; for vegans possibly not getting enough; for single urine samples not showing one person's iodine status; for people with autoimmune thyroid disease reacting to intakes that are safe for others; and for the American Thyroid Association's advice of a 150 mcg daily supplement when planning pregnancy, in pregnancy and while breastfeeding. ↩
  12. Office of Dietary Supplements, National Institutes of Health. Vitamin K: Fact Sheet for Health Professionals. Updated March 29, 2021. ods.od.nih.gov. The source for vitamin K status not being routinely tested except in people on anticoagulants or with bleeding disorders, and for people on warfarin and similar anticoagulants needing to keep their vitamin K intake consistent. ↩
  13. Estruch R, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018. PubMed 29897866. In 7,447 Spanish adults aged 55 to 80 at high cardiovascular risk, a Mediterranean diet with extra-virgin olive oil lowered major cardiovascular events compared with a low-fat control diet (hazard ratio 0.69). The olive oil was part of a whole diet. This is the corrected republication of the trial. ↩
  14. German Federal Institute for Risk Assessment (BfR). FAQ on coumarin in cinnamon and other foods. bfr.bund.de. Cassia cinnamon, the common kind, is high in coumarin, which can harm the liver in sensitive people: an adult of 60 kg reaches the tolerable daily amount with about 2 g of cassia cinnamon a day, and a small child with about 0.5 g, so people who use cinnamon often should choose Ceylon cinnamon, which holds little coumarin. USDA FoodData Central lists a teaspoon of ground cinnamon as 2.6 g. ↩
  15. Office of Dietary Supplements, National Institutes of Health. Omega-⁠3 Fatty Acids: Fact Sheet for Health Professionals. ods.od.nih.gov. The source for the body's conversion of plant ALA to EPA and DHA being very limited, and for the European Food Safety Authority's advice of 250 mg a day of EPA plus DHA for adults, with an extra 100 to 200 mg of DHA in pregnancy. There is no US recommended amount for EPA plus DHA. ↩
  16. Office of Dietary Supplements, National Institutes of Health. Vitamin D: Fact Sheet for Health Professionals. Updated June 27, 2025. ods.od.nih.gov. The source for few foods naturally containing vitamin D, and for an animal-free vitamin D3 made from lichen. ↩
  17. Kampouraki E, Kamali F. Dietary implications for patients receiving long-term oral anticoagulation therapy for treatment and prevention of thromboembolic disease. Expert Rev Clin Pharmacol. 2017. PubMed 28635328. A review of diet and long-term blood thinners. Whether vitamin K in the diet affects the response to direct oral anticoagulants in people remained to be investigated. ↩
  18. Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of long-term marine omega-⁠3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: a systematic review and meta-analysis. Circulation. 2021;144(25):1981-⁠1990. PubMed 34612056. Seven trials with 81,210 people followed for about 5 years: omega-⁠3 supplements were linked to a higher risk of atrial fibrillation (hazard ratio 1.25), more so in trials of more than 1 g a day (1.49), and the risk rose with each additional gram. ↩
  19. Office of Dietary Supplements, National Institutes of Health. Zinc: Fact Sheet for Health Professionals. ods.od.nih.gov. The source for phytates in plant foods binding zinc and reducing its absorption, and for the adult upper limit of 40 mg a day from all sources. ↩
  20. Office of Dietary Supplements, National Institutes of Health. Copper: Fact Sheet for Health Professionals. ods.od.nih.gov. The source for heavy use of zinc supplements leading to copper deficiency. ↩
  21. Office of Dietary Supplements, National Institutes of Health. Selenium: Fact Sheet for Health Professionals. ods.od.nih.gov. The source for Brazil nuts holding very high and variable amounts of selenium, 68 to 91 mcg per nut, enough to cause toxicity if eaten regularly; for the adult recommended amount of 55 mcg a day; and for upper limits of 400 mcg a day for adults and 150 mcg at ages 4 to 8. ↩
  22. Office of Dietary Supplements, National Institutes of Health. Choline: Fact Sheet for Health Professionals. ods.od.nih.gov. The source for animal foods such as liver and eggs being the richest sources, for most people in the US eating less than the recommended amount, and for 90% to 95% of pregnant women falling short. ↩
  23. Lee G, et al. Association of L-Ξ± Glycerylphosphorylcholine With Subsequent Stroke Risk After 10 Years. JAMA Netw Open. 2021. PubMed 34817582. About 12 million South Korean adults aged 50 and over: people prescribed alpha-GPC had a higher stroke risk over 10 years (adjusted hazard ratio 1.43), rising with dose. It is observational, and a correction to the paper has been published. ↩
  24. Office of Dietary Supplements, National Institutes of Health. Calcium: Fact Sheet for Health Professionals. ods.od.nih.gov. The source for the adult recommended amount of 1,000 to 1,200 mg a day and for supplements being absorbed best in doses of 500 mg or less. It also lists collard greens among high-oxalate foods whose calcium is poorly absorbed, while calcium from kale, broccoli and cabbage is absorbed about as well as from milk. ↩
  25. Barnard ND, et al. A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care. 2006. PubMed 16873779. At 22 weeks, 43% of the low-fat vegan group and 26% of the group on the American Diabetes Association diet had reduced their diabetes medication. Across all participants, the difference in HbA1c between the groups was not statistically significant. ↩
  26. Koch CA, Kjeldsen EW, Frikke-Schmidt R. Vegetarian or vegan diets and blood lipids: a meta-analysis of randomized trials. Eur Heart J. 2023. PubMed 37226630. Thirty randomized trials: vegetarian and vegan diets consistently lowered LDL cholesterol and apolipoprotein B. ↩
  27. Yokoyama Y, et al. Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern Med. 2014. PubMed 24566947. Seven controlled trials: vegetarian diets lowered systolic blood pressure by 4.8 mmHg. ↩
  28. Lopez PD, Cativo EH, Atlas SA, Rosendorff C. The Effect of Vegan Diets on Blood Pressure in Adults: A Meta-Analysis of Randomized Controlled Trials. Am J Med. 2019. PubMed 30851264. Eleven randomized trials in 983 adults: no significant overall effect of vegan diets on blood pressure, but a fall where starting systolic pressure was 130 mmHg or higher. ↩
  29. Termannsen AD, et al. Effects of vegan diets on cardiometabolic health: A systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2022. PubMed 35672940. Pooled randomized trials of vegan diets found no effect on blood pressure. ↩
  30. Scarborough P, et al. Vegans, vegetarians, fish-eaters and meat-eaters in the UK show discrepant environmental impacts. Nat Food. 2023. PubMed 37474804. The diets of 55,504 UK adults: vegan diets had the lowest greenhouse gas, land use and water use impacts, and every measure rose with the amount of animal food eaten. These are UK diets. ↩
  31. Makki K, Deehan EC, Walter J, BΓ€ckhed F. The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease. Cell Host Microbe. 2018. PubMed 29902436. A review: dietary fiber is broken down by gut bacteria, which produce short-chain fatty acids. It does not measure microbiome diversity on vegan diets. ↩
  32. Verduci E, et al. Vegan diet and nutritional status in infants, children and adolescents: A position paper based on a systematic search by the ESPGHAN Nutrition Committee. J Pediatr Gastroenterol Nutr. 2025. PubMed 40819279. The European pediatric nutrition society's position: the evidence is inconclusive on whether strict vegan diets support normal growth, children on them should be monitored regularly and B12 supplements are essential. The Academy (reference 3) takes a more positive view of well-planned vegan diets at every life stage. ↩
  33. Meulenbroeks D, et al. The Association of a Vegan Diet during Pregnancy with Maternal and Child Outcomes: A Systematic Review. Nutrients. 2024. PubMed 39408296. Babies of mothers on vegan diets had lower birth weights, but the studies were few and small. ↩
  34. Sergentanis TN, et al. Vegetarian Diets and Eating Disorders in Adolescents and Young Adults: A Systematic Review. Children (Basel). 2020. PubMed 33379220. Twenty studies in 14,391 young people: most found vegetarian eating associated with eating disorders. The studies were cross-sectional, so they cannot show which came first. ↩