How to Prevent Prediabetes in Children

How to Prevent Prediabetes in Children
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Prediabetes is a disease in and of itself, associated with early damage to the eyes, kidneys, and heart. The explosion of diabetes in children is a result of our epidemic of childhood obesity. A plant-based diet may help, given that vegetarian kids grow up not only taller, but thinner.

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Prediabetes is not just a high risk state for the development of diabetes–prediabetes can be a disease itself. People with prediabetes may already have damage to their eyes, kidneys, blood vessels, and heart.

Evidence from numerous studies suggests that the chronic complications of type 2 diabetes start to develop during the prediabetic state. So by the time we have prediabetes, it may already too late to prevent organ damage, so best to prevent prediabetes in the first place, and the earlier the better.

Thirty years ago, virtually all diabetes in young individuals was thought to be autoimmune type 1 diabetes. But since the mid-90s we started to see an increase in type 2 diabetes among our youth, particularly in the United States. Indeed, the term adult-onset diabetes has now been scrapped and replaced with “Type 2” because children as young as eight are now developing the disease. And the effects can be devastating. A fifteen-year follow-up of children diagnosed with Type 2 diabetes found an alarming rate in young adults of blindness, amputation, kidney failure, and death in young adulthood.

Why the dramatic rise in childhood diabetes? Because of the dramatic rise in childhood obesity. During the past 30 years, the number of children diagnosed as being overweight has increased by more than 100%. Once an obese child reaches age 6, it’s likely they’ll stay that way. And even if they don’t, being overweight in our youth predicts adult disease and death regardless of adult body weight, even if we lose it.

Being an overweight teen may predict disease risk 55 years later. Twice the risk of dying from heart attack, more cancer, gout, arthritis. In fact being overweight as a teen was a more powerful predictor of these risks then being overweight in adulthood. This underscores the importance of focusing on preventing childhood obesity.

How do we do it? From the official American Academy of Pediatrics clinical practice guidelines. The problem appears to be kids eating too much fat, and added sugars, and not eating enough fruits and vegetables.

Doctors, at every occasion beginning soon after a child’s birth, should endeavor to give sound advice regarding nutrition and growth so that obesity and its complications may be curtailed. What might sound advice sound like?

The chair of the nutrition department at Loma Linda University published a paper suggesting not eating meat at all might be an effective strategy. Population studies have consistently shown that vegetarians are thinner than comparable non-vegetarians. This is from the largest such study to date.

A body mass index over 30 is considered obese, 25 to 30 overweight, and under 25 ideal weight. The non-vegetarians were up at 28.8, the average meateater in the U.S. is significantly overweight. As one gets more and more plant based the average BMI drops. But even the average vegetarian in the U.S. is overweight. The only dietary group that was, on average, ideal weight, were those eating strictly plant-based. So that’s about a 33-pound difference between the vegans and the meateaters.

Vegetarian children grow up not only thinner, but taller. Vegetarian kids grow to be about an inch taller than other kids. Apparently meat intake is somehow negatively associated with height.

I can just hear the dairy council saying it’s because all the milk the veggie kids must be drinking, but no. The veg kids consumed significantly less dairy, and much lower animal protein intake overall.

Meat intake is apparently associated with growing wider, though. In school-aged children, the consumption of animal foods (meats, dairy, or eggs) is associated with an increased risk of overweight, whereas plant-based equivalents like veggie burgers, veggie dogs, veggie cold cuts were not, and the whole plant foods like grains, beans, and nuts were found to be protective.

This may be because plant-based diets are low in energy density and high in starch, fiber, and water, which may increase feelings of fullness and resting energy expenditure, meaning resting metabolic rate. Eating plant-based appears to boost metabolism, such that you just burn more calories at rest, even when you’re sleeping. However, we’re not sure how much of the benefits are due to increased consumption of plant foods versus decreased consumption of meat.

Either way, plant-based diets should be encouraged and promoted for optimal health. Local, national, and international food policies are warranted to support social marketing messages and to reduce the social, cultural, economic, and political forces that make it difficult to promote such diets.

For example, although the advice to consume a plant-based diet is sound, questions arise concerning the relatively high price of produce. Yes we could reduce the burden of childhood obesity, prevent the further spread of the disease, but we need to ensure that plant foods are affordable and accessible to children of all income levels.

Fruits and vegetables may not fit on the Dollar Menu, but our kids are worth it. Getting diabetes in childhood cuts nearly 20 years of their life. Who among us wouldn’t go to the ends of the Earth to enable our kids to live 20 years longer?

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Joe 13 via Flickr.

Prediabetes is not just a high risk state for the development of diabetes–prediabetes can be a disease itself. People with prediabetes may already have damage to their eyes, kidneys, blood vessels, and heart.

Evidence from numerous studies suggests that the chronic complications of type 2 diabetes start to develop during the prediabetic state. So by the time we have prediabetes, it may already too late to prevent organ damage, so best to prevent prediabetes in the first place, and the earlier the better.

Thirty years ago, virtually all diabetes in young individuals was thought to be autoimmune type 1 diabetes. But since the mid-90s we started to see an increase in type 2 diabetes among our youth, particularly in the United States. Indeed, the term adult-onset diabetes has now been scrapped and replaced with “Type 2” because children as young as eight are now developing the disease. And the effects can be devastating. A fifteen-year follow-up of children diagnosed with Type 2 diabetes found an alarming rate in young adults of blindness, amputation, kidney failure, and death in young adulthood.

Why the dramatic rise in childhood diabetes? Because of the dramatic rise in childhood obesity. During the past 30 years, the number of children diagnosed as being overweight has increased by more than 100%. Once an obese child reaches age 6, it’s likely they’ll stay that way. And even if they don’t, being overweight in our youth predicts adult disease and death regardless of adult body weight, even if we lose it.

Being an overweight teen may predict disease risk 55 years later. Twice the risk of dying from heart attack, more cancer, gout, arthritis. In fact being overweight as a teen was a more powerful predictor of these risks then being overweight in adulthood. This underscores the importance of focusing on preventing childhood obesity.

How do we do it? From the official American Academy of Pediatrics clinical practice guidelines. The problem appears to be kids eating too much fat, and added sugars, and not eating enough fruits and vegetables.

Doctors, at every occasion beginning soon after a child’s birth, should endeavor to give sound advice regarding nutrition and growth so that obesity and its complications may be curtailed. What might sound advice sound like?

The chair of the nutrition department at Loma Linda University published a paper suggesting not eating meat at all might be an effective strategy. Population studies have consistently shown that vegetarians are thinner than comparable non-vegetarians. This is from the largest such study to date.

A body mass index over 30 is considered obese, 25 to 30 overweight, and under 25 ideal weight. The non-vegetarians were up at 28.8, the average meateater in the U.S. is significantly overweight. As one gets more and more plant based the average BMI drops. But even the average vegetarian in the U.S. is overweight. The only dietary group that was, on average, ideal weight, were those eating strictly plant-based. So that’s about a 33-pound difference between the vegans and the meateaters.

Vegetarian children grow up not only thinner, but taller. Vegetarian kids grow to be about an inch taller than other kids. Apparently meat intake is somehow negatively associated with height.

I can just hear the dairy council saying it’s because all the milk the veggie kids must be drinking, but no. The veg kids consumed significantly less dairy, and much lower animal protein intake overall.

Meat intake is apparently associated with growing wider, though. In school-aged children, the consumption of animal foods (meats, dairy, or eggs) is associated with an increased risk of overweight, whereas plant-based equivalents like veggie burgers, veggie dogs, veggie cold cuts were not, and the whole plant foods like grains, beans, and nuts were found to be protective.

This may be because plant-based diets are low in energy density and high in starch, fiber, and water, which may increase feelings of fullness and resting energy expenditure, meaning resting metabolic rate. Eating plant-based appears to boost metabolism, such that you just burn more calories at rest, even when you’re sleeping. However, we’re not sure how much of the benefits are due to increased consumption of plant foods versus decreased consumption of meat.

Either way, plant-based diets should be encouraged and promoted for optimal health. Local, national, and international food policies are warranted to support social marketing messages and to reduce the social, cultural, economic, and political forces that make it difficult to promote such diets.

For example, although the advice to consume a plant-based diet is sound, questions arise concerning the relatively high price of produce. Yes we could reduce the burden of childhood obesity, prevent the further spread of the disease, but we need to ensure that plant foods are affordable and accessible to children of all income levels.

Fruits and vegetables may not fit on the Dollar Menu, but our kids are worth it. Getting diabetes in childhood cuts nearly 20 years of their life. Who among us wouldn’t go to the ends of the Earth to enable our kids to live 20 years longer?

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Joe 13 via Flickr.

Doctor's Note

We make life and death decisions at the grocery store buying food for our family. It’s never too early to start our kids off on the right foot. See my video Heart Disease Starts in Childhood.

And healthy doesn’t have to mean more expensive. Check out Eating Healthy on a Budget.

For some tips on getting our kids to eat their vegetables, see my videos Tricks to Get Kids to Eat Healthier at School and Tricks to Get Kids to Eat Healthier at Home.

Once one has prediabetes, there’s a way to prevent it from progressing further. See my previous video How to Prevent Prediabetes from Turning into Diabetes.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

86 responses to “How to Prevent Prediabetes in Children

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  1. Hi dr. Greger, it’s a bit off topic but I have been using a b12 supplement and noticed there’s lactose in there. Could this be a problem?

    1. If you’re lactose intolerant, probably. In terms of health, I don’t think it can be risky. That being said, lactose don’t have to be in a B12 supplement. I’m sure you could easily find lots of cheap vitamin B12 without lactose.

          1. Browse Topics does not show B12 and I can’t find the search box on this new web site. This web site gives some information but many times just leaves more ?’s and there is no where that I can find to get any answers.

            1. Hi there, I’m sorry to hear that the new format isn’t working for you! If you look at the top bar of the website, you should see a magnifying glass–that is the new search icon. If you click that, the search bar will appear. You can find lots of videos on B12 there: http://nutritionfacts.org/?s=b12. I hope that helps!

              Thank you for sharing your feedback. I’m passing it along so hopefully it will improve the site for everyone.☺

              1. Thanks Tommasina. There isn’t a magnifying glass but there is the word menu with 3 bars on the right and in clicking that I find the search box and other items.

                1. Our web developer just changed the format of the search bar based on your feedback, so you should now see a more visible search bar that says “Search NutritionFacts.org” next to a green “Search” button–do you see that at the top of your browser window? If you can’t see it, would you mind emailing me at Tommasina[at]nutritionfacts.org and we can trouble-shoot it together? Thanks for your help with this!

        1. The culture on the Internet and in society in general, last time I checked, is to NOT change the subject when someone initiates a topic. In any context, that is RUDE. I know people do this all the time here.

          1. Chillax Tobias. There is no B-12 “discussion area” at NutritionFacts.org because this is not a forum or bulletin board. Dr. Greger does not micromanage respectful questions, on or off-topic.

          2. So if I understand your logic correctly if I had a patient come to my office for high blood pressure and I walked in and said, “how is your high blood pressure today?” And then they break down and start crying about how they just lost their mother, then I should say, “well you know you made your appointment for high blood pressure we will discuss that today, but you have to make another appointment for your acute depression.”because in any context apparently that is rude.” As far as I’m concerned it would be considered rude not to listen to the patient about their acute stress and depression. So my point is sometimes it’s easier for patients to bring up their problems in the most current area rather than waiting to find the appropriate place because sometimes people can’t find the appropriate place to make their discussion. We, as human beings, should be open to that. So I would look at this website not only as an information site with current discussions but also as a discussion site for other needs of patients that do not get those needs met by their current providers.

            1. This is a discussion board not an emergency room or doctor’s office. If you want to discuss B12, go to a related thread and discuss it there.

              1. @ Tobias…..I manage large groups and forums so I get the frustration. But the real problem is that moderators and admin need to get tough, make general statements about policy on the board and just delete anything that is off topic. It whips everybody into shape quickly.

            2. Dr. HemoDynamic, I think you’re taking liberties with Dr. Greger’s message…stretching your interpretation a bit. You missed the point. (Or ignored it.) Whether your patient has emotional problems or not, the cheapest, most effective treatment for high blood pressure is to take your patient off meat and dairy. It’s that simple. Indeed, this board is most excellent for patients who’s health needs aren’t being met by their current medical providers. I’m guessing that’s most everyone. Unfortunately you won’t refer them here.

    2. The lactose is just a filler and a few hundred mgs won’t cause a problem. But there are B12 preps out there with less adulteration…ask the clerk. Good luck

  2. Every new parent needs to see this video. Pediatricians should be giving this information to their patients. It amazes me that some parents will watch what they eat for health or weight control reasons, but feed their kids unlimited saturated fat and sugar. The perception is that the kids will burn it off or even that they need it to grow. Heartbreaking!

  3. Nice. Vegetarian kids grow taller! That is a nice little snippet.

    Exercise works well for diabetic adults, I wonder if the same holds true for kids.

  4. Great video! I wanted to say that the new website is fantastic using Google Chrome, but when using Internet Explorer I’m not able to your page. This is a big problem because I use this website every single day in my patient rooms demonstra to my patients the benefits of eating healthiealso the editor in my iPad doesn’t allow me to press enter to make another line and it is much more difficult to edit a message
    I even have my IT department working on the problem but they haven’t been able to resolve it. Any suggestions?

      1. I use Firefox. The new webpage works well on my new, wide-screen Vaio notebook, however, there is a problem on my older Vaio, which has a smaller screen. The smaller screen notebook only shows the video portion of the webpage –like an extreme closeup–no room for the rest of the page! It is a bit off-putting to open the page and find this huge picture staring me in the face!

        1. On my Firefox, the home page used to show the lastest video when I signed on, now it shows on old video not the latest video as it did in the past. Now I have to search for the latest video

      2. I do not think many people will have this problem with Internet explorer, unless they are running it under a Microsoft server. This is what we run at her office and the terminals we have in the rooms are not actually full blown computers they are what are called thin”clients”. It is not allowing me to view the pages, search engine, sources cited, transcripts, search engine etc. I will keep you updated and give you info as to the fix when we discover it.

      3. Update to the Video display problem with the patient room Terminals Screens: Apparently it is caused by outdated Java. It will be updated this weekend and I will keep you informed of the result.
        Enjoy the weekend!

        1. Unless you really *really* need Java in those computers (which very rarely would be necessary)
          deinstall the java plugin — For example, this site works perfectly for me, and I don’t have Java installed.

          The reason there is nothing more vulnerable to attacks. Avoid Java, you don’t need it to browse this site. Of course given that those are thin terminals you would need to say something regarding this to the IT department.

          In your personal computer tho, make sure you don’t have the plugin for Java in your browser. That is valid for everyone.

          1. Java should be a lot safer than activeX and most likely flash also. The reason is the Java applet security model tightly controls network connections and only allows connection back to the original server that served the page.

            That said, Java would be less safe than no java, all else equal. The real question is, do you care about losing the web pages that require it?

  5. Thank you for the video. A bit off topic, I was wondering if there was any constructive thoughts regarding the latest article from the Times article, ”

    A Call for a Low-Carb Diet That Embraces Fat – NYTimes.com”

      1. I feel that is a great response from Dr. Katz. I don’t agree with Dr. Katz a lot but I have to give credit when credit is due.

        The research that they quote is junk, just like the food they ate!

  6. Hi,
    Great video there!
    I’m interested to know that vegetarians are growing taller than meat-eaters. Any idea, though, as to how I can maximise my kids’ height?
    Thanks for everything,
    Paul

  7. Surely children on high dairy diets grow faster and taller? with the attendant problems of eating dairy products meant for an animal that grows much faster than humans. I have been a vegan for decades on a mostly raw diet at 71 works for me :-)

    1. This surprised me as well.

      This result was among Adventists, and only about 15% of Adventist “vegetarians” are vegan. The majority are ovo-lacto vegetarian, and childhood growth and plasma IGF-1 have repeatedly correlated with dairy intake, rather than other animal protein sources.

      1. When eggs,or milk or even meat consumed are referred to in research findings without specific information about how the animals were fed and treated important differences may be missed,as with supplements, surely food state will have different outcomes from the synthetic cheap type made down to a price often produced by big farm companies?

        1. Many of the constituents of animal foods of most concern are also present in organic, grass-fed, free-range, lovingly stroked animals too. Organic dairy milk will have high levels of leucine and microRNA-21, for example. Its intrinsic to milk’s biological purpose.

        2. The differences between animal meat and dairy caused by differences in diet are insignificant when you learn ANY animal meat overloads humans with too much protein and taxes our kidneys tying to digest it. Meat protein triggers cancer growth. “Lean” “healthy” meat clogs arteries. Meat has zero fiber causing colon cancer. The list goes on. Sounds like you WANT to believe you can eat meat and not be at risk. Look at the facts objectively and you will want to change your dietary ways. I’d get nauseous if forced to eat meat.

    2. Milk grows animals faster when that dairy is of that species. Cow milk overloads human babies with protein and fat and deprives us of what mother’s milk contains. A baby rat won’t do as well on cow milk either.

  8. It will be nice when plant-based/vegan diets are more common so that we can get more of all of this information specifically for vegans. Maybe the vegetarian kids aren’t getting more animal protein, and it’s the plant consumption/lack of meat consumption making them taller. Or maybe it’s the steroids found in dairy, that they’re most likely getting more of than their meat-eating counterparts if total animal protein is constant. On the other hand maybe dairy is constant between them, and meat is instead being replaced by more eggs. Further complicating is the huge range within the label “vegetarian”. In so many studies you see vegans studied by themselves but labelled as vegetarians, you see them all lumped in together with lacto-ovo vegetarians, and in others, who knows how of a range there is in plant/animal consumption within a population of true lacto-/ovo-veg/pesca-tarians. Can we please start conducting research with meaning and clarity and for cripes sake, can someone go measure some vegan kids??

  9. Americans have been eating fast food for so long that they do not know how to feed themselves let alone their kids. People believe giving up fast food and meat means they are going to starve to death which I guess is why every time I tell some one I’m a vegan they ALWAYS ask, “Well, what do you eat?” People might be feeling they are taking their kids’ childhoods away by denying them junk food or that their kids would never eat a wfpb diet. There are so many dairy and meat alternatives so kids could still take a sandwich to school for lunch and so many delicious recipes that kids would not miss the animal products. Parents just need to educate themselves and plan meals out in advance which I understand is a hard job but worth it.

  10. Plant based diet seems to me to be less expensive than when i was buying meats and fish, so i was a bit confused by Dr. Greger discussing the high cost of plant based, since processed pre made foods and snack foods are what many people seem to purchase on food subsidies from studies i have read and personal observations at the store.

    1. I also found the phrasing in that bit surprising. If one looks at cost in terms of servings rather than calories, then most of the produce section would be considered the “dollar menu” or less. And grains and beans would be on the “three to six servings for a dollar” menu. The concept of a plant based diet being more costly is absolutely a myth, and I do hate to see it repeated.

      That said, access to healthy food and education on what to eat and how to prepare it are important challenges for many. I would like to see the plant based movement as a whole become more aware of social justice issues and make a pointed effort to reach out to the disenfranchised in our society who are disproportionately affected in our current health crisis.

      1. Don’t want to put words in his mouth but sometimes it seems Dr. Greger is reading what the article says and we presume it’s his view. It might become irritating if at the end of each video he provided a disclaimer saying he just reads em. Once you get his rhythm and views it’s easy to discern between what he reads and when he is making his point…often with emphasis.

        1. It’s true, he’s often just the messenger for whatever research other people are doing. But he does provide critiques and counterarguments at times, particularly when a study’s findings are in disagreement with the promotion of a plant based diet. I guess I’m surprised he didn’t choose to present a contrary opinion to what the researchers state in this case. Especially given his previous videos about this very subject where he argues that healthy food is in fact cheaper.

  11. It doesn’t seem that new posts are coming along by 7 AM as they had been. I miss the dates/times/et.al. Today’s Blog post. I have checked every day at 7 AM and look forward to news posts daily. THANKS!!!! Please advise.

    1. Hi David! We’re posting at 7 AM as usual, but I think there’s some sort of bug we need to work out that might be preventing your browser from loading the new video-of-the-day. I’ve heard that clearing out one’s web history may solve the problem, but our web developer is working on it. Thanks for your feedback!

  12. Pulmonary Fibrosis Awareness.
    Any thoughts or nutritional suggestions for treating this condition.
    Would like to pass it along to a good friend who is suffering and working hard for a resolution.
    Thank you!

  13. Organic produce is more expensive but organic meat is absurdly expensive so its good to think of eating meat once a week or less, actually. I have gone weeks with no meat purchased because of the cost, and we won’t eat conventionally raised meat for humane reasons and GMO contamination.

  14. Hello, what is the opinion on this site of whole bread? This thing seems to be very hard to digest and very irritating on GI tract and is also very salty most of the time~~

    1. “Whole bread” might not be the same food as “whole grain bread”. Read the label and discover what’s actually in it. What is added to preserve or flavor your choice of breads? If you can’t find a whole grain product, try making your own whole grain bread before you give up. If you cannot bake or buy a healthy bread that you find palatable then eating white bread is still a very poor choice. Don’t give up yet, it may simply be a matter of your palate needing a couple weeks to adjust to the new flavor and texture.

  15. Using Firefox the top banner on the webpage cuts off part of the video. I can’t see the journal references without making the video full screen.

  16. Hi Dr, Greger,
    First let me say that I really appreciate your work.
    Your site has made a huge difference in the way I see nutrition.
    Practising a method described in one of your videos regarding crohn’s disease has really changed my life.
    And now to my question :)
    I couldn’t find any video in your site regarding Diabetes type I – I think it will be very interesting to know more about it from your perspective.
    Thanks again,
    Ron.

  17. overweight is bad, but how about too low BMI?
    In vegan group we see low summary BMI, but some of them has to be more heavy and some less, and the most skinny vegan may have too low BMI and to be starving – that’s not really good too.
    It’s not so easy to made vegan diet full of all nutrients, so it has to be vegans with problems that obviously differ from common obesity population problems, but still are problems.
    How about little discover that? Because the less we know, the scarier the vegan diet looks like.
    It’s like white rice – it takes 30 years and thousands of death and illnesses to figure out why white rice is deadly, it could be the same situation with vegan.
    Not so many of them and nobody watching for their specific problems.
    I don’t gave excessive life or 30 years of my life so I agree that vegan treat some obese problems, but I can’t be 100% vegan until it’s 100% safe.

  18. Do cancer cells start to grow in Childhood and later in life when we are in 20’s, 30’s start killing people as well?
    Any supporting evidence or explanation please?

    Thanks

  19. The Adventist study cited here suggests that vegetarian kids are taller even though the veg kids consumed *less* dairy. But should we extrapolate and assume that totally vegan is best? When I search for “vegan children growth”, I see mostly negative studies like the following:
    https://www.ncbi.nlm.nih.gov/m/pubmed/29471576/
    https://www.ncbi.nlm.nih.gov/m/pubmed/28299420/
    https://www.ncbi.nlm.nih.gov/m/pubmed/21092700/
    https://www.ncbi.nlm.nih.gov/m/pubmed/9286766/
    https://www.ncbi.nlm.nih.gov/m/pubmed/9001364/

    I realize the AND position: appropriately planned vegan diets are appropriate for all states of the life cycle. But if most vegan families fail to achieve this, is it really a good idea? Perhaps it’s best to raise our kids *almost* vegan, but not totally vegan?

    1. Hello,

      I believe one of the big reasons that the adventist research showed such a positive in those children who grew up plant based is that they have overall healthy diets. They’re focusing on whole plant foods and eating a wide variety of foods. The research pretty clearly shows that if vegans consume adequate amounts of calcium, there are no differences in skeletal development. It is likely that the diets of those in studies showing negative outcomes were not overall balanced or adequate. Beyond that, a plant based diet can help reduce risk of asthma, eczema, and many other conditions that often effect children.

      I hope this helps,

      Matt, Health Support

      1. Can you cite that research on vegan childhood skeletal development? The only research I’ve read on this was done on adults. No question, well-planned vegan diet is beneficial for adults. The big question is childhood. If the Adventist vegetarians were taller, and vegan brings you back down to average or slightly below average, this suggests that something is not working as well.

        1. Hello again,

          After looking at the research I was referencing, I believe it would more accurate to state that “consuming inadequate calcium leads to decreases in BMD in children/adolescents.” A very similar message regardless. I have linked several studies that examined children consuming vegan or macrobiotic diets and they find consistently that those not consuming adequate amounts of calcium are the ones with lower BMD. Does that mean we have definitive answers about vegans who consume adequate calcium vs. their omnioerous counterparts? No. But I believe it’s pretty clear that skeletal development is tightly linked to overall calcium intake.

          I hope the information below is what you were looking for.

          Macrobiotic children/infants: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528709/
          Growth/development of vegan children (growth was normal across the group): https://www.ncbi.nlm.nih.gov/pubmed/3414589
          Low calcium intake in vegans = low BMD: https://www.researchgate.net/publication/49623957_The_influence_of_vegan_diet_on_bone_mineral_density_and_biochemical_bone_turnover_markers

          1. Thank you for posting these. All three reinforce my concerns. It’s not easy for me to admit. I’ve been vegan now for almost 20 years, originally for health reasons (WFPB), but I also long for the possibility of a kinder world. I’m also a long-time fan and supporter of Dr G’s work. But as a new father, I have to do what’s best for my kids, and the evidence seems to suggest that 100% vegan is not optimal for them. It’s not enough to know how they might be deficient, and try to prevent this. According to the Farm Study, even well-educated parents who knew about all this came out a bit short. Maybe they’re all failing for reasons we don’t yet understand? I only know that for now, with the best information I have, it seems irresponsible to impose a totally vegan diet on my kids. Perhaps we’ll learn how to do it correctly one day. Or perhaps we’ll learn that too much growth during childhood actually causes problems later on. I don’t know. The more you learn, the more you realize there’s so much more we don’t know.

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528709/
            “The Farm Study (14) analyzed 404 children from a vegetarian community in which parents were well educated about the diet and children were supplemented with the appropriate minerals and vitamins. While these vegetarian children were within the 25th and 75th percentiles for United States growth standards, height for age and weight for age were below the median when compared with reference populations for most ages. Values were statistically significant for children younger than five years of age. Thus, with the appropriate supplementation and parent education, children on vegetarian or vegan diets can attain adequate growth, but it may be somewhat less than reference populations.”

            https://www.ncbi.nlm.nih.gov/pubmed/3414589
            “they did tend to be smaller in stature and lighter in weight than standards for the general population.”
            (lighter in weight is probably a good thing, if most kids are over-weight. But smaller in stature means they’re shorter, which is not so good.)

            https://www.researchgate.net/publication/49623957_The_influence_of_vegan_diet_on_bone_mineral_density_and_biochemical_bone_turnover_markers
            “In studied vegans, the dietary intake of phosphate was adequate while calcium and vitamin D were below the recommended range.”

              1. You never responded to my earlier question: is there evidence that the vegan children are junkier than the vegetarians in the Adventist study? If not, all evidence on vegan children (that I’m aware of) seems to agree: there are greater developmental risks in being 100% plant-based during periods of intense growth and development. I’d love to see your counter-evidence, if you have it. I don’t like this conclusion any more than you do. But we need to be scientific about this. We can’t just call studies “fatally flawed” just because we don’t like the conclusions.

  20. Dr. G does not recommend veganism. He recommends Whole Food Plant Based. Big difference. I know plenty of vegans that eat white bread with margarine, cookies, french fries and soda. All vegan, all very unhealthy. We call them junk food vegans. Thus “vegan” is not an appropriate word to describe what the medical literature clearly shows is the optimal human diet, which is WFPB.

    Dr. Ben

    1. Well, he sure does use the term “vegan” a lot in his videos, and says things like “according to probably the most renowned cardiovascular pathologist in the world, that means the cause of our #1 killer is: not eating vegan.” I realize he means the healthy version of it. But if you search for “WFPB children growth” on PubMed, you get nothing.

      Anyway, most of the studies that showing WFPB benefits were done on adults. This Adventist study is great, but the children who were taller still consumed dairy/eggs. Maybe we should do like they do? Is there evidence that the vegan children are junkier than the vegetarians in the Adventist study? If not, the only evidence (that I’m aware of) seems to suggest that there are greater developmental risks in being totally plant-based during periods of intense growth and development.

      1. Hi C4,

        I am a volunteer for Dr. Greger. Thank you so much for your questions.

        The studies you have shared do not seem to provide very strong evidence that exclusively plant diets are not suitable or optimal for children.

        1) The population in the first study you shared was not vegan; they were vegetarian, and they still had a height for age that was below the median. So these children were likely getting animal-sourced nutrients from foods like milk, cheese, and egg, yet still had lower height for age than the median. Additionally, in this Farm study, those children approached the 50th percentile in height as age increased. Perhaps plant-based children have a different rate of growth at different times during childhood. To me, it would be irresponsible to come to any conclusion based on this study, that children eating more plant-based diets are at a greater risk for anything negative.

        2) Most studies in children find that they may be shorter, but their physical and cognitive abilities are the same. I don’t believe there is much evidence to suggest that being a bit shorter on average is detrimental to health whatsoever. If anything, taller individuals may have an increased risk of mortality, especially from cancer.

        3) Just because the Adventist Health Study children ate eggs and dairy and were taller than omnivorous children does not mean that eggs and dairy were the cause of this. This study doesn’t do a comparison in vegan children, so how can that comparison be made? Again, even if vegetarian children were taller than vegan children, you’d have to also provide evidence that that is clinically meaningful.

        Overall, the studies and rationales you provided don’t seem to support the hypothesis that eating dairy, eggs, or meat improves a child’s health. If a child has (maybe) a slightly greater chance to be an inch or 2 shorter, but has reduced risk of overweight and obesity, as well as potentially other chronic conditions, to me the odds seem to work in the favor of plant-based diets. Of course, proper care should be taken in ensuring adequate intake of calcium, vitamin B12, and vitamin D in children, as with any age group. Most importantly, the Academy of Nutrition and Dietetics position paper on vegetarian and vegan diets suggests that well-planned vegan diets are appropriate for ALL stages of the life cycle, and may even provide benefits. To the best of my knowledge, there isn’t a single well-respected health/nutritional organization that suggests that vegan diets are nutritionally inadequate for proper growth and/or development of children.

        Of course, more research should be done, but we simply do not have the evidence to suggest that what you have proposed is correct.

        Thanks again for your questions!

        1. Hi Cody,

          Thanks for your thoughtful and detailed response, and for contributing to this discussion. I feel like this is an area where many people are probably confused. I hope it might be addressed in a future video one day.

          1) The first study: https://www.ncbi.nlm.nih.gov/m/pubmed/29471576/
          “Children on pure vegan diet need ongoing elaborate dietary strategies and continuous supplementation at any age, similar to nutritional management in children with metabolic disorders. A vegan diet is disadvised during all periods with intense growth and development.”

          Are we talking about the same study? This is from the abstract. I unfortunately don’t have access to the full text.

          2) Okay, I did a quick google, and this study seems to support your claim that height and cancer risk might be positively correlated: https://royalsocietypublishing.org/doi/10.1098/rspb.2018.1743

          But how do you reconcile that with the Adventist study which shows meat consumption to be negatively associated with height? Seems inconsistent to extol the virtues of WFPB on the grounds that meat makes you shorter (in the Adventist study), but then extol the virtues of being slightly shorter to justify not eating milk/eggs (in all the vegan studies).

          3) I agree we don’t know for sure that dairy/eggs caused this difference. The vegetarian Adventists could have been taller for completely unrelated reasons since it wasn’t a perfect control study. I agree, more research needs to be done. But for now, we have imperfect information, and the score is:
          Adventist vegetarians: taller
          Vegans in every vegan study I’ve seen: shorter
          Do we have evidence to suggest that what I have proposed is *not* correct?

          As for increased risk of obesity, is that the case for children with small amounts of dairy/eggs? The BMI ranges in this video (where it showed only vegans are in the optimal range) was done on adults.

          Thank you

          1. Keep in mind that there is no evidence of health benefits of a vegan diet. All available evidence shows that an unprocessed vegan diet supports optimal heath. BIG difference.

            1. On the contrary, there’s plenty of evidence that avoiding dairy/eggs has benefits that have nothing to do with being unprocessed (not that I disagree that may be better). For example, estrogen in dairy, casein and cancer promotion (read the China Study?). What about TMAO? Vegans of any kind also consume zero dietary cholesterol, which has been shown to be comparable to light smoking: https://nutritionfacts.org/video/what-women-should-eat-to-live-longer/

              But again, all these studies were done on *adults*, and the studies on vegan *children* are pretty scary, if you’re a parent that wants to do what’s optimal for their kids. I only hope we might understand this better one day.

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