Essentials for good health

1. Deficiencies of important nutrients are common in modern life

Jaan Suurküla, M.D


Modern lifestyle and food processing has caused a considerable increase in deficiencies of essential nutrients.

This affects non-vegetarians as well as vegetarians, but it is my clinical experience that especially vegetarianism may cause serious deficiencies unless one is well aware of what important nutrients, including vitamins, essential fatty acids, minerals and trace elements may be missing in vegetarian food. Among the most important nutrients that often are deficient are vitamin B12, Iodine, Vitamin D3 (in wintertime), Magnesium and Omega 3 fatty acids. Because of deficiencies of such vital nutrients, serious complications, including coronary heart disease and stroke may occur according to my experience.

A quite common problem among vegetarians is protein deficiency that may cause important health problems. People who switch to vegetarianism often tend to underestimate their protein need. This is because meat is a much more "compact" source of protein. You need to eat considerably larger volumues of vegetarian protein sources. like legumes, than meat. Also you often need to combine different protein sources to ensure that you get enough of the amino acids that the body cannot synthetize. So ensuring protein sufficiency needs quite good nutritional knowledge.

I have met several patients who have given up vegetarianism because of health problems caused by nutrient deficiencies due to incomplete knowledge about nutrition. By conveying this knowledge, I hope to prevent this decision.

Important information including more nutrients that may be deficient, new articles, new sections and scientific references will be added and improved editing and design of the website is planned.

I felt that it is high time to convey this knowledge so I began with listing the most important points using this simple design, and will do the rest as soon as time allows.

Addition Oct 2018: In recent years I have not had time to update the site and there is much to be done. I hope to find more time from now on.


First of all, I want to emphasize that this website not a case against vegetarianism. Vegetarian food has important health advantages, and it is perfectly possible to be well nutrified with vegetarian food, but it requires awareness of what nutrients may become deficient, especially if one shifts to vegetarian diet in a region where it has not belonged to the cultural tradition.

Very important new effects of essential nutrients (nutrients that the body cannot create) have been discovered in recent years. A number of these nutrienst tend to be deficient in vegetarians. Also the officially recommended dosage (Required Daily Allowance - RDA) for several essential nutrients has been found to be far too low, and have not yet been upgraded sufficiently if at all in spite of weighty scientific evidence. For example the RDA of vitamin D3 was upgraded from 800 to 4000 IU by the European food safety authority (EFSA) of the European Union. However it is a bit strange to warn for higher doses when, in a sunny day, the skin produces over 20.000 IU.

I think it is conceivable that people who switch over to vegetarianism in adult age may have a weaker ability to transform and assimilate some essential nutrients found in vegetarian foods than those grown up as vegetarians (this might perhaps for example be the case for beta-carotene, see vitamin A). Therefore they may need to supplement some of the essential nutrients or take more of them (it is known from genetics that important genes that are not required while growing up, can be irreveribly switched off).

I believe that the modest advantage for vegetarian over meat diet, reported by science, would turn to a greater difference in favour of vegetarianism if the vegetarians became more aware of nutritional requirements and potential deficiencies.

There is a bewildering and huge amount of marketing regarding food supplements. I want to help you find out what you most probably need.

Section 1

Often occurring deficiencies

Iodine + Selenium

Iodine summary

  • Vegetarians are at high risk of Iodine deficiency, but also others may be deficient
  • All thyroid disorders are associated with low Iodine
  • Brain dysfunction and many other disturbances are associated with deficiency
  • A higher dose than the present RDI may be needed

Vegetarians may become deficient in Iodine with the present RDI level of 150 mcg per day, because vegetarian food contains little Iodine. But recent research indicates that also many non-vegetarians are likely to have some degree of deficiency.

If you have been using iodized salt the old RDI might have been covered, but new evidence indicate that the dose of Iodine required for optimal health is higher than the present RDI.

Dr Abraham, former endocrinology professor at UCLA is widely quoted for concluding that the requirement is perhaps 80 times greater than the RDI of 150 mcg. However recent reassessment of his test method indicates that it overestimates the degree of deficiency to a perhaps considerable extent. Still it is possible that the optimal need is considerably higher than the RDI.

All thyroid disturbances are associated with low Iodine and can be improved by high dose treatment, according to the experience of Abraham and his collaborators. Low Iodine also brings about brain dysfunction including a tendency for depression and apathy. Iodine is an important and powerful antioxidant which may explain the longevity of Japanese eating their traditional very Iodine-rich food. Iodine can heal fibrocystic breast disorder. Some evidence indicate that it may prevent breast cancer. Color vision disturbance have improvemed in eye patients according to specific tests. Some scientific data indicate it may reduce blood pressure. A few cases of fibromyalgia have improved dramatically. In addition, clinical experiences indicate:

  • improved senile macula degeneration of the eye.
  • improved blood sugar.
  • improved diabetes.(Pancreas needs iodine, for proper functioning including the secretion of insulin)
  • improved cardiac arrhythmia.
  • enhanced immune function.
  • improved breast cancer.
  • cured systemic Candida Albicans.
  • improved restless legs.
  • improved tremor.

Bottom line: There may be reasons to supplement with Iodine in doses higher than the present RDI. It will ensure optimal functioning of your brain, thyroid and several other bodily organs and may prevent cancer in some organs.

For more, se Iodine page

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Vitamin B12

Vegetarian food contains virtually no vitamin B12.

Milk products contain a little B12, but it is not a reliable source for sufficient intake, as research studies have found a considerably increased risk for B12 deficiency in lactovegetarians. For example in India, a study on students found that 80% of the lactovegetarians had serum values indicating deficiency while the non-vegetarians had much higher values, considered to be normal.

But the risk of deficiency is significant also among non-vegetarians. One study found that almost 50% have too low vitamin B-12 levels.

Deficiency of B12 causes serious disorders:

Alzheimer's dementia: A considerable majority of Alzheimer's disease cases have B12 deficiency. The lower limit for acceptable blood concentration of B12 has been found to be too low. Therefore, the proportion having B12 deficiency has been underestimated in studies on Alzheimer. In reality, if the new values were applied, almost all might be deficient. A major factor causing the brain damage is the neurotoxic amino acid homeocysteine which increases in B12 deficiency.

Although B12 deficiency seems to be a major factor here, some other deficiencies, toxic influences (heavy metals), low melatonin levels and certain disorders (especially diabetes 1) have been reported to aggravate the condition.

Arteriosclerosis: A major factor is believed to be that B12 deficiency causes an increase in homeocysteine, a brain-damaging toxic amino-acid, which also damages blood vessels, causing arteriosclerosis.

Peripheral nerve damage: The first symptoms are tingling, needle-prick or burning sensations in the toes and later in the fingertips. Later numbness in the hands and feet, like “walking on clouds’ and balance disturbances. The muscles get weak and shaky. The bladder and bowel control gets increasingly impaired.

Other disorders associated with deficiency or improved by B12 are: Megaloblastic Anemia, Aphtous stomatitis (whitish painful spots in the mouth) cured, erythema nodosum (a nodular skin disorder) cured, bursitis cured, sulfite sensitivity including asthma caused by it cured, chronic contact dermatitis cured,  chronic urticaria, Bells palsy (facialis nerve paresis), breast cancer improved or cured, herpes zooster, vitiligo, Macula degeneration of the eyes improved.


Should be taken as methylcobalamin, sublingually, not cyanocobalamin which is the commonly sold variety at drug stores. Methylcobalamin is easily found at on-line stores.


If you have not supplemented before start with 5000 mcg for a month or until symptoms are gone. Thereafter 1000 mcg per day if you have had deficiency symptoms, because this may indicate that your uptake into the nervous system is not so good. Otherwise you can take 3-500 mcg depending on what size is available (for more details, see my article on B12).  Unnecessary to take injections. B12 is absorbed effectively under the tongue.

Cyanocobalamin is a synthetic, unnatural variety and the toxic substance cyanide is produced when it is metabolized in the body. Though the amounts are very small I think it is desirable to avoid unnecessary intake of poisons. So avoid cyanocobalamin if possible, but if no other option is available it is much more important to get the B12 if you have a deficiency than avoiding the micro-amounts of poison produced by it. However, some studies indicate that the brain cannot use cyanocobalamin well, so do your best to get methylcobalamin.

For more on B12, see my article at

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Vegetarian food contains no vitamin D.

Produced at exposure to sun at noon

Your skin manufactures D3 in sunshine (UVB radiation) but it must be supplemented in the 4-6 darker/colder months of the year. A major part of the world's population lives above latitude 35° N where ozone in the upper atmosphere completely blocks UVB radiation in autumn-spring. This is the case in, for example, Paris, France (48° N). Ankara, Turkey (39° N), Tokyo, Japan (35°N) and Washington DC, US (38° N). So any place located to the north of these cities get too little UVB in the winter months. UVB is blocked also in the morning and afternoon, depending on time of the year. This is simply because then the sunrays have to travel through more atmosphere. So take the UVB sunbath around noon (about 11-13). Recent research has found that Vitamin D3 is produced surprisingly rapidly in the sun. A full body sun bath can yield 20.000 IU in less than half an hour. More precisely, for full D3 production it is enough to expose the skin to sun for half the time it takes to cause some redness. So if you get red or some stinging sensation after 10 minutes, it is enough to do 5 min for maximum possible result. Longer exposure causes damage to the skin but no more of D3. So start with D3 production and after that time, you can apply sunscreen.

Sunscreens block UVB. Consequently, even in the summer you may not get enough vitamin D3, especially if you avoid the sun at noon. Paradoxically, skin cancers have increased with the usage of sunscreens. This is because sun-screens block UVB that is needed for D-vitamin which protects against cancer, but they don't protect against UVA that causes skin cancer (except for some of the most recent ones).

So don't avoid the sun, but avoid sunburn. Use only sunscreens that also protect against UVA. By the way, recent research shows that Melanoma, the most malignant skin tumor, is not caused by sun exposure.

Daily requirement

The recommended dose has formerly been too low - maximum 800 IU per day. Recent research indicates that if you totally avoid the sun, or live above 35°N you need about 5,000 IU vitamin D a day in the winter period.

Formerly it was believed that the vitamin was toxic in that range, but this is wrong. One has to take 50.000 IU for one month or even more before signs of toxicity appears. Vitamin A has a close relation with vitamin D, and some observations indicate that vitamin D can only cause toxic effects when there is a deficiency of vitamin A. 5000 IU per day has been found to prevent calcification of arteries (along with vitamin K2) and has other positive health effects.

5000 IU vitamin D3 per day   in Oct-April in latitudes above 35°N is needed for optimal blood levels (50–99 ng/ml). This may sound much considering the old RDI values, but it is actually what you get in less than an hour in the sun at noontime at the beach.

In the summer, if you are using sunscreens and avoid the sun, you may also need to supplement with vitamin D3. UVB at noontime in the summer makes at least about 1000 IU/10 min, but the synthesis is inhibited above a certain dose (I am checking for the latest data).

Important: D3 requires magnesium that not seldom is deficient

Vitamin D3 and Magnesium are mutually dependent in many respects. Magnesium deficiency may nullify the effects of D3 and vice versa. So you need to ensure that you are not magnesium deficient, which is not uncommon among vegetarians according to my experience. This may seem surprising because many vegetables as well as seeds and nuts contain good amounts of magnesium. I think this has two major reasons:

  • Vegetarians often have a craze for fibre rich hulled grains, as found in Muesli and full-fibre bread. However, the hulls of all grains, including rice, contains a substance that effectively binds important minerals including magnesium, zink and iron. The same goes for the hulls of beans, especially soy beans. The content of phytic acid decreases with soaking, fermentation and cooking. Muesli is especially rich in phytic acid, because it has not been processed and it often contains bran that is very rich in this "mineraleliminator".

  • Another cause is heavy exercise like work-outs that make you sweat. This is because much magnesium is lost in the sweat. A study found for example that 50% of german sportsmen were magnesium deficient probably for this reason.

The most common "Vitamin D" variety is not very effective

Don't take vitamin D2 (ergocalciferol) which is the common version sold at drugstores (sadly enough also in drops for babies). Vitamin D2 is only 10–30% as effective in raising 25–hydroxyvitamin D blood levels compared to vitamin D3, leading the authors of a recent study conclude,

"Vitamin D2 should not be regarded as a nutrient suitable for Supplementation or fortification"

Am J Clin Nutr 2006;84:694–697.

D-vitamin deficiency is associated with:

  • Osteoporosis (along with vitamin K2, see below). Great improvements can be achieved with D3, but must be taken along with K2 and Magnesium to be effective.
  • Depressions. Seasonal Affective Disorder (SAD) has been treated successully with D3.
  • Obesity. Lack of calcium, from D or calcium deficiency, increases fatty acid synthase. This enzyme converts calories into fat. Diet low in D3 and calcium increases fatty acid synthase by as much as five-fold. D3 has been found to stimulate a shift from calorie storage to calorie burning (thermogenesis).
  • Increased risk for cancer. D-vitamin protects against cancers in a/o colon, breast, lung, pancreatic, ovarian, prostate.
  • Buildup of calcium in blood vessels – if not taken together with vitamin K2 which promotes the uptake of the circulating calcium into the bones.
  • Hypertension. Deficiency increases renin, that causes hypertension (see footnote)
  • Metabolic syndrome / Syndrome X. One factor might be that deficiency increased the insulin resistance associated with this syndrome. Deficiency also increases the risk of arertial calfication associated with this disorder. Administration of dietary vitamin D or UV-B treatment has been shown to lower blood pressure, restore insulin sensitivity and lower cholesterol, the hallmarks of Metabolic syndrome. Some researchers therefore think it may basically be a D3-deficiency disorder. Perhaps it could be so, along with some genetic mechanisms that have been found to enhance the insulin intolerance tendency.
  • Congestive heart failure, D-vitamin reducing associated inflammation.
  • Inflammatory – autoimmune disorders, especially Multiple Sclerosis.
  • Muscular pain and weakness.
  • Infertility
  • Premenstrual Syndrome (along with deficiency in Magnesium)
  • Polycystic Ovary Syndrome - can be corrected with D3 treatment
  • Glucose intolerance, increasing the risk for Diabetes II
  • Parkinson and Alzheimer cases have low vitamin D3. Not believed to be the cause but one factor might be that D3 is a powerful antioxidant and it seems that free radicals play an important role in these disorders.
  • Modern diet increases deficiency

    Polyunsaturated and monounsaturated fatty acids decrease the binding of vitamin D to proteins that carry the vitamin in the blood (D-binders). Saturated fats - fat milk, cream, butter, lard, coconut oil, do not have this negative effect. In addition they have naturally contained D-vitamin.

    D3-deficiency may be an important reason why the use of polyunsaturated fats has been found to shorten life, increase cancers and decrease immunity compared to the use of saturated fats.

    D-vitamin effects

  • Powerful antioxidant. More effective than vitamin E.
  • Powerful immunity enhancer. D-vitamin stimulates numerous natural antimicrobial and antiviral mechanisms. It expressed genes instruct macrophages, front-line immune system cells, to destroy influenza virus.
  • Protects against coronary and other arteriosclerotic disease, including reduction of vessel calcification (plaques)

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Omega 3 fatty acids

These may not be sufficient in vegetarian foods. Omega 3 deficiency may be quite common in non-vegetarians as well, especially if they don't eat fatty fish regularly.



Fish oil and Algae oils (Ameu Algae in Germany, several brands in the US available on the internet) are good supplements.

Hemp seed oil is a fairly good vegetarian source of omega but expensive. In Europe, only Rapunzel in Germany produces it in the proper way to my knowledge – no light, no air, no heat. Shelled hemp seeds are preferable, but expensive.

Rape–seed oil contains omega 3 but the industrially produced forms, commonly available at food stores are harmful because they have been processed in a way that damages the oil. Linseed oil is also a good source but in most cases it has not been processed properly and should then not be used.

Omega 3 is of vital importance for the normal functioning of the brain and other organs including the skin.

Deficiency causes  memory disturbances, emotional instability, irritability, concentration difficulties, depressions, anxiety, dry skin and dandruff, cracking skin on heels and fingers, soft, cracking nails, ear wax accumulation.

The risk for Omega 6 fatty acid deficiency seems to be small.

NOTE 1: Omega oils, and especially so, Omega 3 oils are very sensitive to oxidation. Therefore exposure to air, heat and light causes rancidity unless the oils are in capsules combined with good antioxidants. The bottles must be darkwalled to prevent entry of light. Don't use drops or bottled Omega 3 oils for supplementation - inevitably rancidity develops as soon as the bottle is opened, if not before.

NOTE 2: Taking high doses of Omega 3 may be unhealthy if you are not well provided with antioxidants and if you are exposed to oxidative stress (smoking, air pollution includiong car exhausts and stress are some factors increasing it). So take antioxidants very generously when you supplement with Omega 3, including the "vitamin E(8)", that is all the eight E-vitamin varieties (4 tocopherols and 4 tocotrienols), red palm oil being the best source, but only if organic and ethically sourced. (I hope to find time to write about antioxidants but there are many good sources on the internet already).

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Trace elements

Because of modern agriculture the food has become very deficient in rare trace elements. Scientific knowledge in this field is very incomplete. I believe we need perhaps all trace elements that exist. Organic food, is more rich in trace elements than conventional food. But you may need additional supplementation< to restore the required amounts.

Trace elements are very important for good health. They are required for the proper functioning of many enzymes and proteins in every cell of the body. Recent research indicate that some, perhaps several influence the functioning of the genes. It seems to me that they play vital role for preventing negative aging, including the production of important endogenous antioxidants (eg Q10), for healing processes and for ensuring optimal functioning of the nervous system.

Trace elements include Orbitally Rearranged Mono–atomic Elements (ORME) that seem to be of great value for promoting healing, perfect health and higher states of consciousness.

More about this is to come.

Warning for phytic acid in grain hulls including wholemeal bread

The hulls of grains and legumes contain phytic acid which effectively binds minerals and trace elements and makes them inaccessible to the body. This is a reason for the old wisdom of fermenting grains and of soaking legumes because these procedures reduce or eliminate phytic acid content.

It is not necessary to eat wholemeal bread to ensure a good supply of fibres, but if you still want it, separate the wholemeal-containing meal and the meal that contains minerals and trace elements. For example you could have your Muesli in the morning, but don't take any mineral supplements along with it. At lunch avoid any source of phytic acid including wholemeal breads, etc and take your mineralrich foods and any mineral supplement you use.

I will provide a list of phytic acid sources later. Briefly, Muesli, wheat bran, wohlemeal breads, brown rice, soybeans and other legumes are common sources (unless fermented or soaked).

Considering the great importance of Trace elements for the health it is really worthwhile to take great care to avoid phytic acid along with these vital nutrients. I believe the craze among many vegetarians for wholemeal items in every meal can backfire and cause many health problems due to deficiency of important minerals and trace elements.

Conclusion about nutrient deficiencies

It is my experience important nutrient deficiencies are surprisingly common today, and I have even seen cases of serious disorders because of it, especially among vegetarians, including severe neurological damage and memory disturbances due to B12 deficiency.

Everyone needs to be well educated about the deficiency risks and have to be well supplemented so as to ensure good health. Switching to vegetarian diet requires good knowledge of nutrition especially in cultures where vegetarianism is not traditional.

I don't claim this list to be complete. It lists the deficiencies I have found to be among the most common and important in vegetarians. More will be added.

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Section 2

Important potentially deficient nutrients


They are very important and exist in many vegetables so it is commonly believed that vegetarians have no problem with it.

But B–vitamins are heat sensitive and get spoiled if they are cooked long. Studies indicate that much of them get destroyed in micro–ovens. They are water soluble, so with cooking they are leached out into the broth. Recent research indicates that B–deficiency is becoming increasingly common among people who eat at lunch restaurants or eat micro–heated prepared food at home.

With broccoli, a good B–source, for example, the Italians traditionally know it should not be cooked until it turns soft – it should be "al dente" and all the juice/broth should be taken as most of the B–vitamins go out of the Broccoli into the water.

Everybody eating food from large kitchens should supplement with B-vitamins. A fairly good natural source is Brewers yeast (Bierhefe).

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Vitamin K2

The risk of K2 deficiency is not insignificant today. I want to mention it because of its great importance and can be insufficient in as vegetarian as well as non-vegetarian diet mostly contains much K1 but may be sparse in K2.

The best source of K2 is the Japanese Natto, from which now supplements are made. The "sauerkraut" is also a source, but I have found no info about contents yet. Also a good gastrointestinal flora may provide K2, but it is not known to what extent. K–vitamin withstands cooking but does not tolerate light well.

K2 has different varieties, MK7 which is produced through fermentation being the best (found in natto, sauerkraut and other fermented foods including cheese). It may prevent:

  • Osteoporosis
  • calcification of arteries
  • weakness of veins
  • Certain forms of Cancer
  • Alzheimer's dementia has been associated with K2 deficiency. Perhaps it might be the variety caused by brain ischemia due to narrow calcified brain arteries. I will find out more about it.
  • Insulin release and blood sugar regulation is dependent on vitamin K.

Vitamin K1 is found in green leafy vegetables (broccoli and all other cabbage varieties, spinach, Swiss chard), kiwi fruit, avocado, parsley. But K1 seems to have more limited health benefits and is 6 times less potent than K2. So you need to go for fermented foods to ensure sufficient uptake of K2. The K1 versus K2 issue is not yet quite clear. I will update .

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Vitamin A (Retinol, not beta-carotone which is not vitamin A)

Recent research has discovered that the transformation of betacaroten (in carrots and other especially red or yellow vegetables) does not occur as effectively as believed formerly. Initial studies indicated that at best 25% of Beta-Caroten is transformed into Vitamin A, but more recent studies have established that no more than 8% (1:12) are transformed, and this is used today for calculating the "retinol activity equivalent" (RAE) of a certain amount of betacarotene. It is conceivable that the ability to transform beta-carotene is greater in those who have been vegetarians since childhood or have eaten much beta-carotene-rich food throughout that period (this is a hypothesis that needs to be checked). This is because genes not needed during the growth period may be switched off more or less completely.

This means that you need to eat impratically great amounts of carrots (a whole cup) or other carotene sources to get enough A-vitamin to cover the recommended daily requirement (3000 IU for men). The ability to transform betacaroterne is decreased by some factors, including stress and infections (measles can cause blindness because it depletes A-vitamn). Moreover, recent research indicates that the real daily requirement is higher than formerly believed. Also it has been discovered that Vitamin A has several other very important functions than being involved in the visual system.

New roles of vitamin A

  • Vitamin A plays a vital regulating role in the immune system.
  • Vitamin A deficiency leads to a loss of ciliated cells in the lung, an important first line defense against pathogens.
  • Vitamin A promotes mucin secretion and microvilli formation by mucosa, including the gastrointestinal tract mucosa.
  • Vitamin A regulates T-cell production (important immune system cells) and apoptosis (programmed cell death) (Nutrition Reviews 1998;56:S38-S48).
  • It has been used with remarkable success in bringing terminal cancers to complete regress.
  • Treatment with megadoses of vitamin A (100,000 IU per day) resulted in a 92 percent cure rate of menorrhagia (excessive menstrual bleeding) at Johannesburg General Hospital in South Africa (S Afr Med J 1977).

Recent studies have found that vitamin-A supplements help prevent infant mortality in Third World countries, protect measles victims from severe complications and prevent mother-to-child transmission of HIV virus. African and Asian children receiving vitamin-A supplements grow faster, have better hemoglobin values and die 30-60 percent less frequently than nonsupplemented peers.

It has been known since many years that Vitamin A is important for eye health, including curing night blindness. New knowledge is that it helps against a severe eye disease, retinitis pigmentosa, that leads to blindness. Recently a randomized controlled trial with more than 600 patients having this eye disease indicated that supplementation with 4,500 mcg (15,000 IU)/day of preformed vitamin A (retinol) significantly slowed the loss of retinal function over a period of 4-6 years.

Source: Weston-Price foundation.

Safety of Vitamin A

It is not yet clear what doses are really optimal in view of present knowledge. Formerly cod-liver oil was used at a large scale for children at a dosage of 15.000 IU per day with good results and without causing any problems. This is five times more than the recommended daily allowance for men according to FDA. The safe upper limit has been set to be 10.000 IU in spite of extensive experience of good results from a considerably higher dose. Actually people have taken 100.000 IU for months before any toxicity symptoms appeared.

The fallacy of the research behind the low dose considered safe is discussed excellently in the following article: "Vitamin A Saga" published by Weston A. Price Foundation.

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Protein deficiency is a significant risk

It is my clinical experience that western people switching to vegetarianism tend to become protein deficient. This I think is because there is no cultural tradition of handling full vegetarian diet. Elderly are under increased risk because their uptake is commonly reduced.

Signs of pronounced protein deficiency

  • Reduced energy levels, fatigue,
  • mental imbalance, depression
  • dry and flaky skin,
  • brittle nails with ridges or deep lines,
  • splitting of hair and hair loss,
  • slow wound healing,
  • constipation
  • decreased immunity, frequent infections
  • Physical weakness and low muscle tone,
  • Loss of muscle tissue,
  • generalized loss of body fat even in the buttocks (pain when sitting for some time on a hard surface is often an indicator) and face

You need not have all of these symptoms. Because of genetic differences, some of these signs may be absent or come at a more advanced stage. My own clinical experience is also that there may be memory impairment and other mental disturbances including sleep disturbances. These signs are not very specific one by one and may occur for other reasons (dry skin and brittle nails may for example be due to A-vitamin deficiency), but the pattern as a whole may indicate protein deficiency and it is the most likely alternative if your protein intake has been low.

Most important: you don't need to have any of these symptoms, but may still need more protein:

More protein than so far believed is required for optimal health

Recent reseach indicates that a generous protein intake, well above the level required to alleviate deficiency symptoms is important for good health. So the RDA for proteins is not sufficient for ensuring optimal health (about 0,8-1 gram/kg bw./day). Therefore, I believe that it is possible that in the future the RDA will be ajdusted upwards for ensuring optimal health.. See footnote.

For effective build-up of muscles and bones the amino acid leucine found abundantly in legumes is required. In the food of adults, and especially elderly persons, high quality protein contianing all essential amino acids including leucine should be present in every meal to ensure preservation of muscles and bones.

The crux about vegetarian food - lack of essential amino acids

One common reason for protein malnutrition in vegetarians is that very few protein sources contain all the amino acids required for building protein in the body. There are a number of so called "essential amino acids" that the body cannot manufacture itself. These must be present in the food every day.

Especially vegans run the risk of becoming protein deficient for this reason. A safer strategy is lacto-vegetarianim, that uses a combination of plant and milk products or lacto-ovo-vegetarianism that also allows for eggs because eggs and milk contain all the essential amino acids.

Another simple reason for deficiency is that the proteins are not as compactly "packaged" as in meat, so you need to take a substantially larger portion of for example beans to get the corresponding amount of protein.

To avoid protein deficiency it is necessary to know what plant food items are rich in protein and which ones contain most or all the essential amino acids. For a beginner a simple rule is to always include a good amount of some milk or egg product in order to ensure that you are provided with all the essential amino acids every day.

I recommend you to read the footnote "Proteins"). It can help you to ensure full protein nutrition.

My experience is that vegetarians from western cultures tend to take significantly less protein than required for good health.

I believe that protein deficiency is a reason why quite some initially devoted vegetarians give up.

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More nutrients will be added under this section including

  • Magnesium, Zinc, Selenium, Copper and some other minerals
  • And more

Planned additional articles at the website or in the Newsletter:

  • Beta-carotene is not A-vitamin. It is a provitamin out of which at best 25% is transformed into A-vitamin (retinol) but much less may not seldom be the case. Also it seems that we may need more A-vitamin than formerly believed. Especially vegetarians are then at risk of getting less than optimal amounts as beta-caroten is the main source of this vitamin.
  • The harmful effects of chemistry–based agriculture
  • Safe detoxification - strong chelators not necessary
  • A simple and effective approach to curing Candida
  • Why saturated fat is good for health and the "lean food" (low fat, veg. oils) habits shorten life and increase illness rate
  • The story about Omega 3, 6 and 9 oils.
  • Beware of transfats (found in hydrogenated fats)
  • Curing cardiovascular disease including arteriosclerosis and hypertension without drugs
  • Important measures for Cancer prevention – vegetarian food a superior alternative
  • Why raw food vegetarianism will inevitably create major deficiencies
  • The most important nutrients for promoting optimal functioning of the nervous system
  • The new understanding about vitamin E - alfa-tocopherol alone may be harmful
  • C-vitamin - too low RDI. Greatly increased need in stress and infections. Antiviral effects documented.
  • Magnesium very important. More often deficient than formerly believed
  • Showering with common chlorinated tap water not healthy. Why you should use a chlorine filter
  • Ayurvedic principles of nutrition
  • The miracle supplement/medicine hoaxes. Be suspicious about uncorroborated stories by people claiming fabulous improvements.
  • Stress - what can you do about it?
  • And more
Jaan Suurküla M.D.


  • Abraham, G.E., Iodine Supplementation Markedly Increases Urinary Excretion of Fluoride and Bromide. Townsend Letter, 238:108-109, 2003.
  • Abraham GE,2004a. "The Safe and Effective Implementation of Orthoiodosupplementation In Medical Practice" The Original Internist, March 2004
  • Abraham GE, 2004b. "The concept of orthoiodosupplementation and its clinical implications." The Original Internist, 11(2):29-38, 2004
  • Abraham GE, 2005. "The Wolff-Chaikoff Effect". The Original Internist, 12(3):112-118,2005
  • Abraham GE, 2006 "The History of Iodine in Medicine Part III: Thyroid Fixation and Medical Iodophobia." The Original Internist, 13: 71-78, June 2006
  • Abraham GE, Flechas, JD. 2007. "Evidence of Defective Cellular Oxidation and Organification of Iodide in a Female with Fibromyalgia and Chronic Fatigue". The Original Internist, Vol. 14, 77-82, 2007
  • Abraham GE, Flechas, JD. 2008. "The Effect of Daily Ingestion of 100 mg Iodine Combined with High Doses of Vitamins B2 and B3 (ATP Cofactors) in Five Subjects with Fibromyalgia The Original Internist, Vol. 15, No. 1, pg. 8-15, March 2008
  • Abraham GE, 2008. "Facts about Iodine and Autoimmune Thyroiditis." The Original Internist, Vol. 15, No. 2, pg. 75-76, June 2008
  • Brownstein D, 2005, "Clinical experience with inorganic, non-radioactive Iodine/iodide." The Original Internist, 2005; 12(3):105-108.
  • Fleming JE, Shibuya1 RB, Benschand KG (1987) "Lifespan, oxygen consumption and hydroxyl radical scavenging capacity of two strains of Drosophila melanogaster". AGE 10, 86-89, 1987
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  • Stadel B., Dietary Iodine and Risk of Breast, Endometrial, and Ovarian Cancer, The Lancet, 1:890-891, 1976.
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    The authors concluded: "This study showed that there are dysregulation of free radical metabolism and poor activities of the antioxidant defense systems in schizophrenic patients. Excess free radicals formation may play a critical role in the etiology of schizophrenia. Using antioxidants might be an effective therapeutic approach to partially alleviate or prevent the symptoms of schizophrenia."
  • Miller, D. "Extrathyroidal Benefits of Iodine" Journal of American Physicians and Surgeons Volume 11 Number 4 Winter 2006.
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1. For example, the Okinawans have the highest percentage of centenarians in the world and the lowest death rates from cancer, heart diseases and stroke. They are notably vital at high age and have a much shorter period of decrepitude before death than commonly. See The Okinawa centenarian study

2. D-vitamin deficiency has been found to increase the harmful bloodpressure-increasing substance renin, which also increases insulin resistanse leading to metabolic syndrome.

3. Proteins are mainly present in beans, legumes, grains, seeds and nuts and to a lesser degree in grains including rice. Milkproudcts including milk, yoghurt, cottage cheese and cheese contain high quality milk protein. The best source is Whey. It is easier to digest and has a high quality protein cotent. For this reason it has recently become popular among body builders. I recommend Ricotta cheese and other chees products based on whey.

Among vegetarian sources, legumes have the by far highest content of proteins, around 20 gram per 100 gram. Most of them either contain all the nine necessary essential amino acids that the body needs or have a little less than optimal of methionine-choline.

Because Mung beans have become popular, I will mention a few facts. They have as high a protein content as meat and fish. But they are a little low in Methionine-Coline, so you need to compensate with some cereal, out of which Rice is among the richest in protein. Kelp and seaweed are an especially good source of Methionine and contain other good nutrients as well including Iodine and valuable trace minterals so I recommend using that. Chestnuts are a good complement. Brazil nuts are also recommended by some as they are high in Methionine but there are considerable fungal toxin problems with them so I recommend to avoid them. Mungbeans have the advantage of generating less gas than other beans.

In grains, including rice one of the essential amino acids, lysine is a little low (maize is also deficient in tryptophan). By combining for example rice and legumes you can get all the amino acids, but do remember that the protein content of rice and other cereals is low, about 2-4 grams per 100 gram so they are not a realistic protein source on their own, other than for supplying what is missing in beans.

It is good to use nutrition tables and weigh up the food or follow guidelines from a nutritionist to ensure enough protein when you switch to vegetarianism, otherwise you are likely to become protein deficient. A good information source is "SelfNutritionData". I recommend to enter your favorit foods into their search box and have a look, especially at the Protein Quality diagram, that shows the balance of essential amino acids. See the diagram below taken from that website which shows the score for lentils:

The diagram shows that there is sufficient of all essential 9 amino acids except for "M+C" which stands for Methionine &Choline. If you go to the webpage for lentils you will find a link under this diagram: "Find foods with complementary profile" to a list of nutrients that contain the missing amino acid in lentils in this case.

How much protein is needed?

Several studies indicate concurrently that the minimum protein requirement for avoiding deficiency symtpom is:

  • for adults at least 0,8 g/kg body weight/day .
  • for young people and elderly, about 1 g/kg body weight/day .

Minimum protein intake is not enough for optimal health

Recent research has found that taking more than this minimum amount provieds significant increased health benefits. The benefits are really important, for optimal health as they include, among others, an improved signallig between cells (see Wiki Cell signalling) and optimal regulation of satiety and glucose utilization. Increasing data actually indicate that weaknesses or disturbances in cell signalling play a role in major diseases including cancer, auotoimmune disoders (for example rheumathoid artritis) and diabetes. For a scientific note about this, see fotnote on a new understanding of proteins

The amounts really needed for optimal health have not yet been established, because the benefits of additional intake have only been discovered recently. Myself, I am opting for 1,5 g/kg bodyweight.

Against this background it is most unfortunate that some vegetarians tend to believe that the need for protein is lower than what scientific research indicates. It is fairly easy for science to to find out what is the minimum protein requirement for avoiding deficiency as there are reliable methods that sensitively measure whether the body is breaking down its own protein which indicates too low intake.

An example of required amounts of food items for minimum intake

  • In 100 gram mungbeans for example, there is 23 g protein (mungbeans contain all essential amino acids but are a little low in methionine - compensate with chestnuts, rice or other grains that contain methionine).
  • In 100g cottage cheese or ricotta there is about 10 g protein.

So, if you are a young woman weighing 50 kilos, you need 50 * (1 g/kg/day) of protein per day = 50 grams to cover the minimum daily need. you need for example to take 150 g of the beans = 35 g protein, plus almost 200 g of cottage cheese = 20 g protein plus some chestnuts or a good portion of rice. This is quite a great heap compared to meat because it contains more water. Yet it is too little for optimal health as explained above.

You should ensure that you eat a varied diet containing beans, grains, nuts, and seeds every day. However if you suspect a protein deficiency, it is safer to look up the contents so as to ensure that you get enough.

Here is a good article about how to ensure enough protein: "Protein in vegan diet." (this link does not mean that I support veganim, but some of their websites do have good knowledge how to ensure enough protein intake because this is a major issue in veganism.) However it recommends tofu, which is a soy product that is unhealty. Soy contains antinutritionally and hormonally active substances. Only the soy product Miso has been fermented enough to eliminate these harmful components, while tofu is not sufficiently fermented.

The reason why you need all the essential amino acids is that without them the body cannot make full use of the proteins you eat. Proteins generally contain all the essential amino acids. If anyone is lacking completely, proteins cannot be synthesized in the liver and the amino acids are tranformed to fat or carbohydrtaes in stead. Mostly, however, for example regarding legumes, there is also some deficiency. If for example there is 20% too little of an amino acid in a food, this means that your body will only be able to utilize 80% of the protein in that food.

More about essential amino acids is found in "Wiki doc". I don't agree with the statement in this Wiki article that protein deficiency occurs seldom in vegetarians - I think this is because the criteria for identifying deficiency have been too rough so that only pronounced deficiency is identified. Here is a more balanced view:

"The developing controversy about Dietary Guidelines for protein stems from current perceptions that protein intakes above minimum requirements have no benefit and may pose long-term health risks. These beliefs are largely based on assumptions and extrapolations with little foundation in nutrition science. Diets with increased protein have now been shown to improve adult health with benefits for treatment or prevention of obesity, osteoporosis, type 2 diabetes, Metabolic Syndrome, heart disease, and sarcopenia [1-4]. " Source: Dietary Guidelines should reflect new understandings about adult protein needs

A simple and well written summary is found here Adult protein deficiency"

Back to the section on proteins

A new understanding of proteins

(This is an excerpt from the article "Dietary Guidelines should reflect new understandings about adult protein needs" by Donald K Layman)

Protein and amino acids contribute to multiple metabolic roles beyond simple substrates for protein synthesis. Dietary protein influences cell signaling, satiety, thermogenesis and glycemic regulations and each of these roles is initiated by increases in plasma and intracellular amino acid concentrations. These metabolic outcomes only become important with intakes above the minimum RDA. Using current measures of nitrogen balance and amino acid oxidation as the only criteria for protein requirements, these metabolic outcomes are rejected out-of-hand as inefficient and wasteful. A more logical view is that these new metabolic outcomes provide the basis for the AMDR and provide for individualization of dietary choice. Individuals can design healthy and adequate diets around the minimum RDA to prevent deficiency or design diets around higher levels of protein with additional health benefits.

Back to the section on proteins




1. Important common nutrient deficiencies

2. Important potential nutrient deficiencies