The Nutritarian diet is designed to fuel our bodies with high-nutrient plant foods and super-charge our immune defenses. This helps us reach our ideal weight, reverse and protect against chronic diseases, and age slowly. This eating style emphasizes colorful plant foods that provide us with thousands of beneficial phytochemicals while avoiding foods that may harm us. It is a diet designed to give us the happiest life possible. Scientific studies suggest that those who eat more whole plant foods live longer.1-5
As we increase the proportion of these life-protective plant foods and reduce animal products we slow aging and get further healthy life expectancy; however, the reduction and elimination of most animal-sourced foods reduce our exposure to certain beneficial nutrients such as zinc, B12, DHA, iodine and a few others. With the high plastic contamination of seafood and carcinogenic effects of meats, it is a more logical, earth sustainable and healthier option to optimize levels of these nutrients with supplements. With smart supplementation, we do not need to add animal products to our diets for these valuable nutrients.
This means that the ideal diet for longevity is so plant-rich that it requires only conservative and judicious supplementation to make it 100% effective and protective. Supplementation is a more sensible choice compared to trying to add enough seafood or meat to source these nutrients.
Deficiencies, even mild insufficiencies, of B12, zinc, iodine and DHA, can undermine our health. However, with the right supplementation, we can ensure we are using the advances in nutrition science and the ability of testing to optimize nutrient levels in the body to assure we not only protect against nutritional deficiencies, but achieve the optimal levels for maximizing our health, performance and longevity.
Vitamin deficiencies and insufficiencies increase the risk of chronic diseases. Inadequate vitamin and mineral intake is also common in the general population, even in those eating more animal products.6
In contrast, consuming an nutrient rich, plant-based diet with the appropriate amounts of vitamins and selected minerals has the potential to extend lifespan dramatically. Recent research concluded multivitamin use is associated with longer telomere length, which is an indicator of a slower rate of biological aging.7
Of course, do not forget that conventional multivitamins use cheap synthetic ingredients and contain vitamins that can increase cancer risk, such as folic acid and synthetic Vitamin A derivatives, so which multi you take can be a matter of life or death.
Ten years of life: Is it a matter of choice?
Does Nut Consumption Reduce Mortality and/or Risk of Cardiometabolic Disease? An Updated Review Based on Meta-Analyses
Plant-Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults
Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies
Legumes: the most important dietary predictor of survival in older people of different ethnicities
Foods, fortificants, and supplements: Where do Americans get their nutrients?
Multivitamin use and telomere length in women
We cannot be sure that we are getting the precise and optimal amounts of vitamins and minerals every day from our diet, since absorption efficiency and utilization of nutrients varies from person to person. A high-quality multivitamin can fill these gaps, ensuring that we get adequate amounts of essential micronutrients.
The following vitamins should be found in your multivitamins in optimal amounts:
Vitamin B12 is required for important biological functions like red blood cell production, nervous system function, and DNA synthesis. Deficiency in B12 can cause a variety of health problems, including anemia, depression, confusion, fatigue, digestive issues, and nerve damage.8 Insufficient B12 levels increase homocysteine – a risk factor for cardiovascular disease, also associated with cognitive decline and dementia,9 and are also associated with increased risk of Alzheimer’s disease.10
Vitamin B12 is made only by microorganisms. Because our produce is washed and often transported much before we eat it (soil contains B12-producing microorganisms), most of us are unable to get B12 from plant foods. B12 deficiency is common, especially in vegans who don’t supplement and in the elderly, since absorption efficiency decreases with age. Our ability to absorb B12 decreases with age, and about 20 percent of adults over the age of 60 are either insufficient or deficient in vitamin B12.11 Supplementation with vitamin B12 is likely important for most people, since research suggests we absorb only a small proportion of B12 ingested, and absolutely required for most vegans.12,13 I recommend approximately 75 mcg B12 daily for most healthy people.
The metabolism and significance of homocysteine in nutrition and health
Cognitive impairment and vitamin B12: a review
How common is vitamin B-12 deficiency?
Vitamin B12 in health and disease
When exposed to the sun, our skin makes vitamin D. Once thought to be important only for bone health, scientists have now found that vitamin D has important actions throughout the body, and low vitamin D levels are associated with diminished immune function, several cancers, diabetes, cardiovascular disease, and autoimmune diseases.14,15
Insufficient vitamin D levels are also very common.14 Since many of us live in cool climates and work indoors, and because of the potential risks of skin damage and skin cancer from too much sun exposure, supplementing is the best choice for achieving adequate vitamin D levels. In my experience, 2000 IU (50 mcg) has been an appropriate dose to bring most people into the favorable blood 25(OH)D range of 30-45 ng/ml (I also recommend getting a blood test to confirm adequate levels). For extra assurance, I also utilize (vegan) vitamin D3 in my multivitamins because of its high biological value. It is the most effective form for raising 25(OH)D levels.16
Vitamin D: Update 2013: From rickets prophylaxis to general preventive healthcare
Vitamin D for skeletal and non-skeletal health: What we should know
Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis
There are two forms of vitamin K: K1 and K2. Vitamin K1 is abundant in leafy green vegetables, so those who follow a healthful diet do not need to supplement with K1. Vitamin K2 – which is produced by microorganisms and is low in plant foods – is more important to supplement on a Nutritarian diet. Vitamin K is important for blood coagulation, cardiovascular health, and bone health.17 Vitamin K2 supplementation may also offer additional health benefits beyond those of K1 alone.18,19
Vitamin K2 supplementation reduced the risk of fractures in several studies.20-23
In the cardiovascular system, vitamin K helps prevent coronary artery calcification.24 In several studies, vitamin K2 intake was associated with reduced risk of heart disease. Some evidence suggests K2 is more protective than K1, but this issue remains unclear.18,25,26 The human body can synthesize some K2 from K1, and intestinal bacteria can produce some usable K2, but these are very small amounts.27 Therefore, it is likely important to supplement with K2. There is no recommended daily allowance for vitamin K2 specifically; a reasonable daily dose is likely 30-40 mcg, which would represent about one-third of the recommended daily vitamin K intake.
The role of menaquinones (vitamin K(2)) in human health
Vitamin K2 Needs an RDI Separate from Vitamin K1
Vitamin K intake and the risk of fractures: A meta-analysis
Does vitamin K2 play a role in the prevention and treatment of osteoporosis for postmenopausal women: a meta-analysis of randomized controlled trials
Quantifying dietary vitamin K and its link to cardiovascular health: a narrative review
Iodine is required by the body to make thyroid hormones. A vegan or near-vegan diet, especially one that avoids table salt, may be low in iodine.28,29
Most plant foods are low in iodine. An exception is kelp, a sea vegetable that is a good source of iodine, but kelp is not commonly eaten on a regular basis and may actually provide excessive amounts of iodine. The chief source of iodine in the typical American diet is iodized salt. Since added salt should be avoided to prevent elevated blood pressure, arterial stiffness, and other negative effects, it is important to supplement with iodine for the optimal amounts, approximately 150 mcg/day.
Office of Dietary Supplements, National Institutes of Health. Dietary Supplement Fact Sheet: Iodine
Vegans, Vegetarians, and Omnivores: How Does Dietary Choice Influence Iodine Intake? A Systematic Review
Zinc is essential for immune function, growth, and reproduction, and supports hundreds of chemical reactions. Zinc is abundant in whole plant foods, but is not readily absorbed. Beans, whole grains, nuts, and seeds contain zinc, but also contain substances that inhibit zinc absorption. Zinc intake and circulating zinc levels are lower in vegetarians and vegans,30,31 and zinc requirements for those on a completely plant-based diet are estimated to be about 50 percent higher than the standard recommendations.32-34
Zinc adequacy is especially important for men, because it is concentrated in the prostate where it has protective effects against prostate enlargement and prostate cancer.35 A reasonable supplemental dose to complement a Nutritarian diet is 7.5-10 mg zinc daily.
Effect of vegetarian diets on zinc status: a systematic review and meta-analysis of studies in humans
The role of zinc in life: a review
Zinc Deficiency in Men Over 50 and Its Implications in Prostate Disorders
In this article, I am highlighting important information regarding multivitamins, but I wanted to take a moment to speak about the importance of DHA and EPA.
The long-chain omega-3 fatty acids DHA and EPA are associated with many aspects of brain health. I recommend supplementing with these beneficial fats, since most modern diets are low in DHA and EPA unless fish is consumed regularly. Research confirms that vegans tend to have a low omega-3 index.36
No matter what your age, maintaining adequate omega-3 stores is crucial for the current and future functionality of your brain and life health. A Nutritarian diet provides many nutrients that benefit brain health, but is low in pre-formed DHA and EPA since frequent fish consumption is discouraged. Algae-based supplements are preferable to fish, to avoid excess animal protein and pollutants, such as dioxin and mercury, present in fish.
Although I recommend a multivitamin to fill some nutritional gaps, it is important to choose the right one. Just as it is important to make sure we are getting important nutrients that are lacking, it is equally important to avoid consuming excessively high levels of certain nutrients. There are even ingredients to steer clear of completely because they may do more harm than good.
Do not take a multivitamin containing folic acid, vitamin A, or beta carotene.
Synthetic folic acid found in many supplements and food products is not the same as natural folate, which is found in high concentrations in green vegetables and other plant foods. Luckily, Nutritarians have their fill of green vegetables and do not need to worry about obtaining folate as it is plentiful in plants. Folate is especially important for women of childbearing age, to prevent against birth defects, and adequate folate intake helps protect against cancers. However, there is evidence that synthetic folic acid, due to its higher bioavailability, may have cancer-promoting effects.38-40
There is no need to supplement with beta-carotene or vitamin A on a Nutritarian diet, since beta-carotene and other provitamin A carotenoids are plentiful in orange, yellow, and green vegetables and fruits. Research suggests vitamin A and beta-carotene in supplement form increase the risk of cancers, possibly by interfering with the absorption of other carotenoids with anti-cancer properties.41 Studies also suggest vitamin A supplementation contributes to osteoporotic fractures,42 may have cancer-promoting effects,43 and especially at higher doses, both vitamin A and beta-carotene are associated with an increase in risk of premature death.43, 44
Beta-carotene, carotenoids, and disease prevention in humans
Vitamin A intake and osteoporosis: a clinical review
Dietary Supplements and Risk of Cause-Specific Death, Cardiovascular Disease, and Cancer: A Systematic Review and Meta-Analysis of Primary Prevention Trials
Vitamin E in its many forms is plentiful in nuts and seeds. However, supplementation with alpha-tocopherol only (the primary supplemental form of vitamin E) in high doses is linked to increased mortality risk.44 We need sufficient but not excessive amounts of selenium (which is present in nuts, beans, and whole grains); selenium levels that are too high are linked to diabetes, elevated cholesterol, prostate cancer, cardiovascular disease, and impaired immune and thyroid function.45-50 Iron and copper are essential for the proper function of many chemical reactions in several of the body’s cells and tissues. However, as we age, excess amounts of these metals may build up and become toxic, contributing to oxidative stress that promotes cardiovascular disease and neurodegenerative diseases.51-53 Iron should only be taken in the case of deficiency or an increased biological requirement, such as in pregnancy.54,55
Meta-regression analyses, meta-analyses, and trial sequential analyses of the effects of supplementation with beta-carotene, vitamin A, and vitamin E singly or in different combinations on all-cause mortality: do we have evidence for lack of harm?
Adverse health effects of selenium in humans
Metal Toxicity Links to Alzheimer's Disease and Neuroinflammation
New insights into the role of iron in inflammation and atherosclerosis
Iron status during pregnancy: setting the stage for mother and infant
These surprising scientific findings mean that most conventional multivitamins act as a double-edged sword, containing both helpful and harmful elements. Use the latest advance in nutritional research to your advantage by understanding the ingredients found in your multivitamin and making sure that they are present in optimal amounts. It is this reason I created my own multivitamins for my patients to ensure that they supplement wisely.
Joel Fuhrman, M.D. is a board-certified family physician, seven-time New York Times bestselling author and internationally recognized expert on nutrition and natural healing, who specializes in preventing and reversing disease through nutritional methods. Dr. Fuhrman coined the term “Nutritarian” to describe his longevity-promoting, nutrient dense, plant-rich eating style.
For over 30 years, Dr. Fuhrman has shown that it is possible to achieve sustainable weight loss and reverse heart disease, diabetes and many other illnesses using smart nutrition. In his medical practice, and through his books and PBS television specials, he continues to bring this life-saving message to hundreds of thousands of people around the world.
*There is no guarantee of specific results. Results can vary. All material provided on the DrFuhrman.com website is provided for informational or educational purposes only. Consult a physician regarding the applicability of any opinions or recommendations with respect to your symptoms or medical condition.