How to Eat Vegan and Avoid Heart-Damaging Nutrient Deficiencies

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

If you’re among the growing number of people adopting a vegan diet, or know someone who is, listen up – I have some important information to share with you about how to avoid nutritional deficiencies that can affect your heart health.

Vegan Diets: Both Good and Bad for Heart Health

First, the good.

I like vegan diets because they emphasize many of the high-vibrational foods found in my Pan Asian Modified Mediterranean (PAMM) diet—fresh fruits and vegetables, legumes, whole grains, olive oil, and nuts and seeds. These foods are rich in inflammation-fighting antioxidants, fiber, and healthy fats, all of which which help balance the body and and promote cardiovascular health.

In fact, a study published in Complementary Therapies in Medicine found that a vegan diet can help protect against heart disease by lowering the inflammatory marker C-reactive protein (CRP). Who wouldn’t want that?!?

Now, the bad.

Strictly adhering to a plant-only diet—no eggs or dairy—puts you at risk for not getting enough protein, and it opens the door to developing nutrient deficiencies in coenzyme Q10 (CoQ10), L-carnitine, alpha lipoic acid, and vitamin B12. All four of these nutrients have a direct impact on heart health.

  • CoQ10 and L-carnitine play vital roles in the production of cellular energy (ATP), which supports the heart’s pumping ability. CoQ10 is also a powerful antioxidant that helps fight free-radical damage in the arteries.
  • Alpha lipoic acid is a specific antioxidant necessary for maintaining healthy levels of glutathione in the body. Glutathione plays a key role in detoxifying the body and removing waste. It also help protect against cancer.
  • Vitamin B12 helps maintain the health of arteries and is specifically needed to help neutralize homocysteine, a cause of inflammation.

How to Eat Heart-Smart on a Vegan Diet

If you’re committed to going vegan, I have no problem with that—but it’s imperative that you work hard to find additional sources of CoQ10, L-carnitine, alpha lipoic acid, and vitamin B12. Where you come up short, consider nutritional supplements to make up differences.

  • To get CoQ10: Eat a lot of spinach, broccoli, and cauliflower (raw is best). Avocado and peanuts are good, too. Tofu is often held up as a good alternative, but I would be careful with that because it’s made from soy—and that has a light and dark side of its own. To supplement, take up to 100 mg of CoQ10 daily.
  • To get L-carnitine: This is a tough one because the word carnitine comes from the Latin carnis, which means flesh or meat. Mushrooms and avocado have some carnitine, but you’ll probably be best off taking a supplement. Any kind of carnitine supplement will help, but I prefer broad-spectrum products that combine multiple forms of the nutrient. Take up to 2 grams daily.
  • To get alpha lipoic acid: Vegetables will be your primary go-to for this, including spinach and broccoli, but the amounts in them are limited. I’d go with supplements here, as well. Use as directed on the label.
  • To get vitamin B12: You’ll probably have to look for fortified nut or coconut milks, or cereals to get any vitamin B12 through food. Again, though tofu may be fortified, it comes with issues and I wouldn’t recommend it on a daily basis. Supplement with 250 mcg daily.

Don’t Forget About Omega-3 Fatty Acids

Another issue that should concern you is getting enough omega-3 fatty acids.

Vegans and vegetarians are actually no more deficient in omega-3s than meat eaters, but sticking to a plant-based diet does make it trickier to get maximum omega-3 benefits.

Fish and fish (or squid) oils are typically recommended as the best source for omega-3s, but obviously this will be off the table—literally—for you. There are plant sources of omega-3s, including flaxseed and walnuts; however, when you consume omega-3s in plants, they enter the body in the form of alpha-linoleic acid, or ALA. Your body then has to convert ALA to the more useable omega-3s, DHA and EPA. That’s fine so long as your body is 100 percent efficient at the conversion, but few of us are that lucky.

That leaves one last option: omega-3 supplements derived from algae.

If you ever wondered why fish are so high in omega-3s, well, it’s because they eat algae. More and more of these products are hitting the market, so finding one you like shouldn’t be too difficult.

For Best Results, Go 80/20

Here’s one more thought, for those of you who appreciate what a vegan diet has to offer, but are okay not committing to it 100 percent: Consider adopting an 80/20 approach to your meal planning. That is, eat 80 percent plant foods and 20 percent animal products.

This is how I try to eat, and I think it’s the best of both worlds. With an eating plan like my PAMM diet, you get the high nutritional value of a plant-based diet, but the relatively small amount of meat it includes still provides you with the vital nutrients only found in animal products. Just be sure to always buy organic to ensure the most natural and humane treatment of animals raised for these purposes.

One last note: When you’re eating lots of vegetables, be sure to eat some healthy fat with them to help your body absorb nutrients. Steaming vegetables to al dente, then tossing them with extra virgin olive oil and my signature olive oil spice blend is my favorite way to do this!


© Stephen Sinatra, MD. All rights reserved.

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