SA Vegan Society responds to furore over malnourished Italian children
In recent years, there has been a rise in headlines and articles in the mainstream press that demonise the vegan diet. The latest spate, arising out of Milan, Italy, claim that children have had to be hospitalised due to medical problems associated with their vegan diets.
Before dissecting this issue, we need a clear definition of a ‘vegan diet’. Vegan diets do not contain any meat, chicken, fish, eggs, milk or cheese. There are many ways to eat as a vegan. Healthy vegan diets are centred around a variety of plant foods, like whole grains, starches, fruits and vegetables whereas unhealthy vegan diets are centred around foods which contain refined sugars, saturated fats and trans fats, and which are devoid of any real nutritional value. Like all diets,vegan diets can vary substantially, depending on how healthy and responsible individuals choose to be in relation to what they eat. But the media seems to have actively sensationalised these reports by categorically incriminating ‘vegan diets’ without specificity.
A position paper was published by the American Dietetic Association and Dieticians of Canada after a full review of all the available high-quality evidence regarding vegan/ vegetarian diets. The position of this group of top experts in the field of nutrition reads as follows: ‘Well-planned vegan and other types of vegetarian diets are appropriate for all stages of the life cycle, including during pregnancy, lactation, infancy, childhood, and adolescence. Vegetarian diets offer a number of nutritional benefits, including lower levels of saturated fat, cholesterol, and animal protein as well as higher levels of carbohydrates, fibre, magnesium, potassium, folate, and antioxidants, such as vitamins C and E and phytochemicals.
‘Vegetarians have been reported to have lower body mass indices than non-vegetarians, as well as lower rates of death from ischemic heart disease; vegetarians also show lower blood cholesterol levels; lower blood pressure; and lower rates of hypertension, type 2 diabetes, and prostate and colon cancer’.
It is unmistakable that a well-planned vegan diet is actually a healthier alternative, so what can explain these reports? Were these merely cases of bad parenting?
The aforementioned position paper also states that ‘when vegetarian infants receive adequate amounts of breast milk or commercial infant formula and their diets contain good sources of energy and nutrients such as iron, vitamin B-12, and vitamin D, growth throughout infancy is normal. Extremely restrictive diets such as fruitarian and raw food diets have been associated with impaired growth and therefore cannot be recommended for infants and children’.
There are many ways to feed a child and vegan parents should be well educated in the best practices to ensure that vegan children eat enough calories for their energy requirements, especially while they are developing. The issue at stake here is clearly not ‘veganism’; this is a parenting issue.
In a recent case in Genoa, Italy, many reports turned out to be completely false as the child at the centre of the controversy was not actually a vegan.
Senator Lello Ciampolillo, an Italian politician, exposed the media manipulation surrounding this case. Here is a translated excerpt from his address to parliament:
‘Two-year-old child put into intensive care because of vegan diet. Well, the news was not only reported on by Repubblica but also many national headlines and also by RAI2 (TV) at lunch time. Well, today I phoned Genoa’s Gaslini Hospital directly and this news reporting the case of a child who ended up in intensive care because of a vegan diet is false because as the chief medical officer of Gaslini Hospital let me know roughly one hour ago, the doctor’s report shows that the child was also consuming parmesan cheese. Obviously as you can guess, those who follow a vegan diet do not eat meat or fish but also by-products such as milk, eggs and cheese. So this news is absolutely false.’
He went on to say:
‘Well, I said this is the umpteenth manipulation, which is obviously carried out by the usual people that manipulate these personal tragedies to attack those who have chosen this type of diet, completely plant based. Vegans are people who deserve respect and attention.’
It is interesting that all media reports labelled the child as ‘vegan’ and not ‘vegetarian’, and also and they do not report on all of the sick omnivorous children. Vegans only account for 2–3% of the population in Italy which would make for a minuscule portion of childhood cases.
Here are some translated excerpts from an article published on the website of Italian newspaper Il Fatto Quotidiano titled ‘Vegan children “undernourished”, how many cases of misinformation?’:‘In Italy, 25% of children aged 3-6 years are overweight or obese, a problem which UNICEF calls a “silent epidemic” and creates significant health problems. And it is spreading diabetes among young people, due to their poor diet and it just doesn’t make the news – as well as the thousands of vegan children who grew up healthy and strong.’
‘In all cases, what you need is the right information, both for vegans and for those omnivorous parents. Weaning a child in the correct way requires attention in both cases. It was stated by Dr Alberto Ferrando, president of the Ligurian paediatricians’ committee earlier today: “The vegan diet is not incompatible with a child’s growth, but it must be accompanied with special attention to include essential substances for the growth of the child. Moreover, attention to diet should be extended to all children, including non-vegans or vegetarians, because every day I witness problems resulting from the wrong diet.” But, as it happens, many of those cases that Dr.Ferrando faces daily will not make the newspapers and there is no criminalization of these parents for their choices or for their mistakes. Perhaps the problem is not only some parents but also some journalists who are only interested in making sensationalist claims to get on the front page?’
The Italian website The Local stated: ‘Calcium deficits are common in vegans, as they do not consume dairy products, one of the most popular ways we get our calcium. Vegans who have low calcium intake are also at greater risk for compromised bone health as they age.’ Vegans are commonly low in three nutrients; calcium, iodine and Vit B12; but omnivores (meat eaters) are inclined to be low in eight nutrients, including calcium, iodine and Vit B12, as well as fibre, folate, magnesium, Vit C and Vit E. Calcium deficiency is not a ‘vegan only’ issue.
But how can both vegans and omnivores be deficient in calcium? Because neither vegans nor omnivores include enough calcium-rich whole plant foods like beans, legumes and leafy greens in their diet. Calcium, it seems, is only effective if eaten in food, not supplements. Researchers have found that taking calcium supplements offers no reduction in hip fracture risk; in fact, an increased risk is possible. Randomized controlled trials showed a 64% greater risk of hip fractures with calcium supplementation compared to just getting a placebo sugar pill. More recent calcium-balance studies suggest that the calcium requirement for men and women is also lower than previously estimated. They found calcium balance was highly resistant to change across a broad range of intakes, meaning our body is clever. If we eat less calcium, our body absorbs more and excretes less, and if we eat more calcium, we absorb less and excrete more to stay in balance.
You, a local South African magazine, quoted a New York Times editorial which said: ‘Babies are built from protein, calcium, cholesterol and fish oil. Children fed only plants won’t get the precious things they need to live and grow.’ Let’s investigate these ‘precious things’ that vegan children are apparently not getting, keeping in mind that omnivores are prone to five more nutrient deficiencies than vegans, as already mentioned.
Protein is a common talking point for the anti-vegan faction, but protein can be found in many plant foods and it appears that animal protein is in fact terrible for human health. Because animal proteins have more sulphur-based amino acids in them, animal proteins metabolise into sulphuric acid in your body, creating a metabolic acidosis. This state of metabolic acidosis is obviously responsible for changing body pH (acidity), but it also increases inflammation in the body, which increases aging and affects enzyme activity. This puts immense strain on your kidneys and can also play a role in diabetes. When insulin attaches to insulin receptors on a cell, it activates enzymes to help transport glucose into cells and out of the bloodstream. This affected enzyme activity involving insulin could contribute to the progression of diabetes. Increased inflammation of your epithelial cells in your blood vessels, caused by this acidity, can lead to heart disease, and it also affects your blood vessels’ ability to dilate and contract.
The argument for animal protein is especially thin when it comes to cancer because of the amino acid ratios in animal products. Methionine is an amino acid mostly found in animal foods; in fact, milk has double the amount of methionine as a high-protein plant food, like beans. Chicken has five times more methionine than beans, and fish is the worst offender with seven times as much. Methionine is directly related to cancer growth as most human cancers have a dependency on methionine and need it to grow, and this may be one of the reasons why only animal protein seems to grow cancer in animal studies.
What about calcium? We have already seen that both vegans and meat eaters are generally deficient in calcium because neither group eats enough calcium-rich plant foods. A recent study even showed that countries with higher amounts of dairy in their diet often encounter many more osteoporosis cases than other countries with significantly less dairy intake. Another factor that contributes to a great loss of calcium is a higher amount of animal protein consumption due to the increase in body acidity. Except, according to studies with radioactive calcium, the calcium seems to come from the muscles, not the bones; still, it leads to muscle wasting.
Cholesterol is the number one risk factor for heart disease. Atherosclerosis refers to the build-up of cholesterol deposits in damaged parts of your blood vessel walls. These deposits become bigger as they become more inflamed and filled with cholesterol and pus. Inflammation is your body’s protective response to damage and harmful stimuli, special cells are moved from the blood into the injured tissue to try and eliminate the cause of the injury and clear out the damaged cells. This accumulation of cells causes swelling and pus formation. These deposits also become filled with cholesterol floating around in the blood and form into bigger sores, called plaques. It is these plaques that cause a heart attack. If a plaque ruptures, a clot will form in the blood vessel. A heart attack is when this happens to the small blood vessels around the heart. The clot cuts off the blood supply and the heart muscle dies.
The level of bad cholesterol, called LDL, in your blood is directly related to atherosclerosis. In fact, Dr William Roberts, editor in chief of The American Journal of Cardiology specifically states that cholesterol, especially LDL, is the only critical risk factor for plaque formation. There are three things found in one’s diet that makes cholesterol go up, especially the bad one, LDL. The first two are trans fats(found in processed foods and naturally found in meat/dairy), and saturated fats(found in animal products and junk foods, as well as coconut and palm oil). Eating these fats causes your liver to produce more cholesterol, your liver already makes all the cholesterol you need, but these fats cause it to produce even more – an excess amount that raises your bad cholesterol. The third one is cholesterol itself, which is only found in animal foods, especially eggs. And yes, eating cholesterol raises your cholesterol; it is that simple.
The only people whose blood cholesterol is not raised by their dietary cholesterol are those with very high cholesterol levels: they’re essentially full.
Finally, let’s discuss fish oils and their supposed benefits. The reason we even started eating fish oils for health in the first place was due to a notion that Eskimos were protected from heart disease because of fish oil consumption – but this turned out to be a complete myth. There was also a promising study that sparked the rise of fish oils called the DART trial. Researchers followed about 2000 men and found that consumption of fish and fish oils was associated with a 29% reduction in mortality, which was very impressive. But the same group of researchers did a sequel and found the exact opposite.
The DART 2 trial, following around 3000 men this time, and found that eating fish actually resulted in increased risk and fish oils were the worst. Other researchers have also found that omega-3 fatty acids in fish have none of the heart-health benefits for which they are marketed. They followed nearly 4 000 heart attack patients and no difference was found between those who consumed the fish-based omega-3 supplements and those who took placebo pills.
Sandy Cook, journalist for You magazine, states that ‘veganism requires extra effort on the part of parents and caregivers’. We have already seen that the correct information is crucial for both vegans and omnivorous parents. ‘Weaning a child in the correct way requires attention in both cases,’ as previously stated by Dr Alberto Ferrando. And we now know that omnivores generally have five more nutrient deficiencies than vegans, so where is the extra effort really required?
Prof Linsay Allen was quoted in the You article and several others saying:‘Studies have shown [vegan] kids are at a disadvantage. Everything from muscle mass to cognitive function is better in children who are fed meat. Children who eat meat are also more talkative and playful and show more leadership skills. There’s absolutely no question that it’s unethical for parents to bring up their children as strict vegans.’
What is Prof Allen’s definition of ethics? Especially since the vegan diet, by definition, is the most ethical diet one could adopt. Veganism is a way of living which seeks to exclude, as far as is possible and practicable, all forms of exploitation of, and cruelty to, animals for food, clothing or any other purpose.
Prof Allen has also stated that:‘Animal source foods have some nutrients which are not found anywhere else.’ But how accurate is this statement? Prof Allen is implying that these nutrients ‘only found in animal products’ are essential for health and normal development.
Let’s compare a meat blend versus a plant blend head to head – the plant blend includes equal parts of tomatoes, spinach, lima beans, peas and potatoes, and the meat blend is equal parts beef, pork and turkey. The plant blend contains no cholesterol and virtually no fat – the meat blend may have more protein, but remember that the protein from meat and dairy has more sulphur amino acids (methionine), so this is not a positive thing. The plant blend actually contains Beta-carotine, fibre and Vit. C, where the meat blend has none at all – and the plant blend also contains more folate.
If you look at nutrients like iron, calcium and magnesium, the plant blend has way more than the meat blend, and the iron found in meat is actually carcinogenic. So the nutrients that Prof Allen claims are essential are in fact detrimental to human health. The Heme Iron in animal foods has been shown to cause cancer and the cholesterol and saturated and trans fats cause heart disease and diabetes. It is clear that the most important nutrients are actually found in plant foods.
Malnourished children should indeed be getting more media coverage, but for the right reasons. South African Registered Dietician Jessica Kotlowitz, who has had experience working with malnourished children, comments:
‘In South Africa we have a major issue with childhood malnutrition. A good percentage of our population is hungry and thousands of children die each year due to malnutrition. Vegetarianism has never been identified as a risk factor for malnutrition in this country.
‘Our risk factors are poor food availability along with a whole lot of complex social issues. Having worked in the public health setting with hundreds of malnourished children, many of whom have died, I can tell you that none of them were vegan or vegetarian.
‘Having one reported case in Italy of a vegan child dying is nothing compared to the millions of non-vegetarian children worldwide who die of malnutrition yearly. Diverting attention away from the real issue when it comes to childhood malnutrition is socially irresponsible for any health professional or journalist who claims to care about the wellbeing of infants and children.
‘The South African government has great programmes in place at the moment for addressing childhood malnutrition. Interestingly, the recommendations are to increase consumption of plant-based proteins (legumes, peanut butter and soy specifically) as it is an affordable and culturally acceptable form of protein. Furthermore, veganism and vegetarianism present one of the best macro-solutions to tackling world hunger and food shortages. So if any of the people quoted in this article really want to make a difference and prevent childhood deaths from malnutrition, they will promote the adoption of vegan and vegetarian diets.’
To sum it all up, here is a quote from Spectator magazine: ‘It isn’t a vegan diet that kills kids; it’s neglectful parenting.’ All parents should be held to the same standard and governments should be taking on the challenge of providing accurate health information to all citizens, including vegans and especially vegan parents. However, the responsibility must still lie in the hands of individuals, and vegan parents should become more familiar with best practices by consulting a local plant-based nutritionist if unsure about anything. Weaning a child can be a complicated process and consulting a professional is recommended in difficult cases.
The sensationalist claims that we have seen making headlines are designed for shock value and in some cases could even be described as propaganda. The medical science is irrefutable and a properly planned vegan diet is the only diet proven to reverse both heart disease and diabetes type 2 as well as halt the progression of cancer in clinical trials – and these studies have been published in prestigious journals around the globe.
It has also been clearly stated that a vegan diet is appropriate for all stages of life, including infancy, and that there is a multitude of ways to feed your child as a vegan parent. A vegan diet encompasses a broad spectrum of variance, so on reflection, taking into account the appropriate facts, these sensationalist headlines should have gone through the editor’s desk one last time and perhaps have been thrown out – or at least labelled correctly, as a parenting issue.
Dr Paul Palmer heads up the Health and Nutrition Portfolio for South African Vegan Society. He is a qualified chiropractor practicing in Johannesburg and has completed a certificate in Plant Based Nutrition through Cornell University. Dr Paul Palmer adopts an objective and conservative approach to treating patients and strives to educate them about the importance of a healthy lifestyle incorporating chiropractic, evidence-based nutrition and exercise. He acknowledges Jessica Kotlowitz (qualified dietician) and Rohan Millson (author of Why Animals Aren’t Food) for their contribution in reviewing and endorsing this article to ensure medical accuracy.
- Appleby, A. Roddam, N. Allen, and T. Key. Comparative fracture risk in vegetarians and nonvegetarians in epic-oxford. Eur J Clin Nutr, 61(12):1400-1406, 2007.
- Senges J. Omega-3 fatty acids on top of modern therapy after acute myocardial infarction (OMEGA). Report presented at: American College of Cardiology Annual Meeting; March 30, 2009: Orlando, FL.