Seeking advice: WFPB and supplements on a vegan diet

[Amarillyde]

I started trying to follow a fully vegan diet following the advice of Dr. Campbell almost a year ago, that goes more or less like 'if you eat a whole foods, plant-based diet you'll be able to get all the nutrients you need and prosper happily ever after'. A few months down the road, I realised that reality is not quite like that. I eat lots of fruits and vegetables, beans, whole grains, nuts and seeds, I definitely get enough calories, and I spend way too much time trying to inform myself and planning how to get the most micronutrients in my diet every day, but overall I definitely feel worse than I did a year ago. Specifically, I have been feeling fatigued for months, experiencing a deep tiredness, with various low points throughout the day almost every day where I almost have to fight the need to fall asleep, despite getting an adequate amount of sleep every night. I feel really spaced out most of the time, too, as if I had suddenly lost 20 IQ points, which leaves me with so little, it's really disconcerting!

I've had blood tests done in March, after telling this to my GP, and the test did signal that I was quite severely deficient in vitamin D (17 nmol/L). Unfortunately I do not seem to be able to tolerate vitamin D3 supplements (which I tried taking at high doses – first 40,000 IU as prescribed by my GP, then 2,500 IU experiencing the same probable allergic reaction), but I have been getting reasonable sun exposure since then, in the last two months, so I wonder how much that could still be the reason for my fatigue. I live in the UK, so we do not have sun daily, and I realise it might take more than a couple of months to restore optimal vitamin D levels. But tbh I have reasons to think that, especially if my vitamin D was so low, this was not probably the first year I have been vitamin D deficient during the winter months, thus I'm hesitant to attribute my extraordinary fatigue solely to that.

I am more concerned about my iron levels because, tracking my micronutrients on cronometer, I've noticed that I struggle to meet my iron RDA (among other things) – though not by far, and I do try to pair iron and vitamin C rich foods most of the time. Blood test serum ferritin was 40 microg/L, so within the normal range (but still on the low side? I'm not sure, though my doctor clearly wasn't concerned about that). I lean towards this explanation as the most probable cause of my issues, and thus this leaves me with the dreaded conundrum: to supplement or not to supplement? I have tracked my nutrition for long enough to know that even if I'm not iron deficient now, I will be at some point. This brings about concerns about other nutrients, too, like DHA - even though I try to eat chia seeds and walnuts a lot, I am not always diligent –, vitamin E, calcium.

In conclusion, to compare my experience against Campbell's ideal WFPB, I believe you can only follow a vegan diet without supplements (aside from B12, which btw it seems to me Campbell is quite reluctant to talk about) if you have the time and patience to eat tons of kale several times a week
I know I could never invest more time and energy in planning my diet than I already do, and despite my awareness and effort to eat healthfully, I fail to fully meet my RDA for certain nutrients. This is really disappointing and disheartening, and makes me think that I won't be able to keep going without at least a small amount of animal products, which at this point I am uncomfortable with the idea of eating.
At the same time, I am equally uncomfortable taking supplements – but possibly even a bit more, and (for time's sake) I won't go into my personal psychological reasons why. But generally, what doesn't convince me is the fact that we know that certain supplements are harmful in high doses, and I don't think we have enough evidence to conclude that they are perfectly safe if taken in small doses – mostly because as a population we have not been taking them for a long enough time and there are no decades long studies. My research on the topic is not solid, so if anyone can chip in some word or some research to look at, that'd be great, although I will probably still feel uncomfortable with the idea of having to pop down a series of pills or similar for the rest of my life if I want to be vegan.
I don't really see a way out, but I'll shut up now before I write another four paragraphs – I welcome your thoughts

[brimstoneSalad]

Sorry for the slow reply, busy weekend.

I've had blood tests done in March, after telling this to my GP, and the test did signal that I was quite severely deficient in vitamin D (17 nmol/L). Unfortunately I do not seem to be able to tolerate vitamin D3 supplements (which I tried taking at high doses – first 40,000 IU as prescribed by my GP, then 2,500 IU experiencing the same probable allergic reaction), but I have been getting reasonable sun exposure since then, in the last two months, so I wonder how much that could still be the reason for my fatigue.

Sun exposure alone, particularly in the UK, is not likely to be able to correct your deficiency. Not in months, and maybe not even in years.

Follow your doctor's advice and take vitamin D.
If they're making you feel ill, try a lower dosage multiple times a day (even a little less during the day is better than none).
There might be *something else* in the vitamins that you're allergic or intolerant to. You can try a different brand.

Here's a liquid, very few ingredients, and it's not derived from sheep wool (in case you're allergic to that?)
https://www.nordicnaturals.com/consumer ... n-d3-vegan

Trying to get D3 from the sun is a very bad idea, and recommended against by professionals. The sun causes cancer, period. It's accumulated DNA damage. Having a dark tan can protect you a little, but it's a risk that there's no reason to take unless you have a skin disease that is treated by sunlight.
Vitamin D supplementation is well researched and not just adequate for vitamin D needs, but recommended. In health this is pretty much the level of consensus that the Earth goes around the Sun is in astronomy. Hands down, it's the most supported and recommended vitamin in the developed world.

But tbh I have reasons to think that, especially if my vitamin D was so low, this was not probably the first year I have been vitamin D deficient during the winter months, thus I'm hesitant to attribute my extraordinary fatigue solely to that

You were probably eating more processed foods that were fortified with vitamin D in the past, so may not have has such severe deficiency. These things come in degrees.

I am more concerned about my iron levels because, tracking my micronutrients on cronometer, I've noticed that I struggle to meet my iron RDA (among other things) – though not by far, and I do try to pair iron and vitamin C rich foods most of the time. Blood test serum ferritin was 40 microg/L, so within the normal range (but still on the low side? I'm not sure, though my doctor clearly wasn't concerned about that).

Your iron is probably fine. A lower level (low end of normal) can be protective against infection as long as your body has enough. If you don't bleed heavily then you may never develop deficiency. You're doing a good job to eat vitamin C sources with your iron.

You could take a supplement if you want (and a multivitamin IS a good idea for everybody), but Vitamin D deficiency explains your symptoms just fine.
If you hear hooves you think horse, not zebra. The known issue is likely the cause of your fatigue. No need to speculate until that has been resolved for a while.

I lean towards this explanation as the most probable cause of my issues

Why? Your doctor did not. What do you know that your doctor doesn't?

and thus this leaves me with the dreaded conundrum: to supplement or not to supplement?

It shouldn't be a dreaded conundrum. There's nothing wrong with supplementing as a safety net. It's cheap, and you pretty much pee out everything you don't need.

I don't understand this prevalent anti-scientific fear of supplements. It seems to be based on a fundamental misunderstanding of biology.

This brings about concerns about other nutrients, too, like DHA - even though I try to eat chia seeds and walnuts a lot, I am not always diligent –, vitamin E, calcium.

In conclusion, to compare my experience against Campbell's ideal WFPB, I believe you can only follow a vegan diet without supplements (aside from B12, which btw it seems to me Campbell is quite reluctant to talk about) if you have the time and patience to eat tons of kale several times a week

If you look at our closest relatives, they all eat HUGE amounts of greens. Yeah, that's pretty much the only way to be totally foolproof without having to put in a lot of planning.

But why not just take a multi and a couple other easy supplements?
Do you have trouble swallowing pills?

This is really disappointing and disheartening, and makes me think that I won't be able to keep going without at least a small amount of animal products, which at this point I am uncomfortable with the idea of eating.
At the same time, I am equally uncomfortable taking supplements

Supplements aren't harmful to animals or the environment, and if you go with reputable companies, not harmful to your health either. They won't give you super powers, but they're a good safety net.

– but possibly even a bit more, and (for time's sake) I won't go into my personal psychological reasons why.

I think you should, because that's the root of the issue. If I really explain the science and send you links to professionals saying supplements are fine and recommending them will it change your mind without addressing the psychology?

But generally, what doesn't convince me is the fact that we know that certain supplements are harmful in high doses,

Yeah, so is water, salt, anything.
You need to understand the difference between acute toxicity, which everything has (you can kill yourself on certain whole foods too if you eat only them in large amounts), and cumulative harm.

Things like carcinogens and heavy metals like mercury build up harm over time by cumulative DNA damage, or building up in your tissues.
Supplements do not: your body clears out what you do not need. These are biological compounds that your body is used to working with, not poisons.
It's only harmful if you get a HUGE dose all at once.

Don't confuse the fact that something can be harmful in overdose with the idea that it must be harmful in smaller doses too.

and I don't think we have enough evidence to conclude that they are perfectly safe if taken in small doses – mostly because as a population we have not been taking them for a long enough time and there are no decades long studies.

We have been taking supplements for decades, and there's no good evidence of harm from them. Likewise we've been using fortified foods for a very long time, and there's so much evidence in favor for public health that it's even been legislated in many areas.
Beyond that there's also TPN: https://en.wikipedia.org/wiki/Parenteral_nutrition, Infant formula (VERY well studied), and the fact that we've been using supplementation with pets and farmed animals for many generations. These are well studied across species.

Supplements work, and there's no credible evidence that they're harmful UNLESS they're egregiously misused.

But any amount of evidence I can give you probably won't mean anything if there are psychological hangups against it. Please let me know what your trouble is and I'll do my best to help.

[Amarillyde]

Thank you for your answer, @brimstoneSalad

if you hear hooves you think horse, not zebra.

I see your point. However, the reasons why I was inclined to believe the problem might be with iron rather than vitamin D levels is that I've had things like a cut in the corner of the mouth for entire months (also very dry skin between fingers, which the doctor mentioned as an iron deficiency symptom ) and I've not seen that listed as a vitamin D deficiency symptom anywhere. It has finally gone away, but it's been quickly replaced by other problems. That's another thing that has been going on for months and, even if it's silly, it's really annoying and makes me feel like I'm doing something wrong. The vitamin D3 supplements I tried (I tried two different brands, the high-dose one the doctor prescribed was probably sheep-wool-based, whereas the lower dose one I tried was vegan) both gave me an allergic reaction, again, on my lips, with severe swelling, scaling, bubbles, and itchiness. GP said she's never heard of it and to try again with a much lower dose, but tbh my lips problems are still ongoing (now they switched to cold sores) and I really don't think it's a good idea to try again until my lips are completely healed (if ever). This is just one more thing that makes me feel like just eating healthy doesn't cut it.

The other reason why I thought vitamin D is not the whole problem is that I believed it was easier to restore close-to-normal levels with sun exposure –- I've been getting reasonable sun exposure for 10 to 30 minutes at a time, depending on the intensity of the sun, every time we've had sun, which has been not everyday but often in the last couple of months. I am fair skinned, and if it's true that 10 min of limbs exposure to the sun can produce around 1000-2000 iu of vitamin D, is it really reasonable to think that I am still so severely deficient to explain my fatigue? I know it's not an exact science, nor sun exposure is a long-term solution, but I would think there would be some improvement Overall, anyways, I agree that I should focus on solving the vitamin D problem and that perhaps I've overestimated the possibility to do it naturally – so thanks for the useful external perspective!

Here's a liquid, very few ingredients, and it's not derived from sheep wool (in case you're allergic to that?)
https://www.nordicnaturals.com/consumer ... n-d3-vegan

thank you for this, I will try it if my lips ever recover.

If you look at our closest relatives, they all eat HUGE amounts of greens. Yeah, that's pretty much the only way to be totally foolproof without having to put in a lot of planning.

My problem is that I *do* put in a lot of planning, so much so that it's very stressful. I cook all my meals, I try to keep up with cronometer. But I seldom achieve the sweet spot in which I manage to both accomplish having a *variety* of fruit and vegetables *and* a lot of leafy greens, on top of getting enough vitamin E, proteins, calcium... I find it really hard to keep up with everything, and even if I try at the end of the week my cronometer is far from perfect, and I've come to believe for a while now that the only way to eat a vegan diet without supplements is to be able to intake a large amount of daily calories, no less than 2500 and ideally more. Whereas I have to fit all my nutrients in something like 1800/day on average, which has been frustrating.

I don't understand this prevalent anti-scientific fear of supplements. It seems to be based on a fundamental misunderstanding of biology

Well, some part of the scientific community doesn't fully agree with this though, does it? Colin Campbell, for instance, doesn't recommend supplements. His argument, which I find very compelling, underlines the fact that our body is meant to get nutrients in a complex way, from food which by itself contains a variety of nutrients in certain combinations, and that we do not know (and probably will never know exactly, because the human body is way too complex) what happens when a nutrient is taken in its isolated form. It seems to me like the problem is not so much in the fact that 'nutrients might accumulate in the body', which is not the case, but rather in the fact that we feed our body something in a form which it's not designed to process.

But why not just take a multi and a couple other easy supplements?
Do you have trouble swallowing pills?

My problem with the idea of taking supplements is first of all social/psychological in nature: I grew up in a family where drugs were taken only in serious cases – not with an attitude of skepticism towards medicine per se, only nobody would ever take a drug for a headache in my household, or take antibiotics lightly, or anything like that. Now, I do not live with my parents anymore, but I have sort of inherited that mindset and I see how it's reasonable. Supplements are not drugs but, especially in the light of the above mentioned divide in the scientific (and vegan) community, I think the same logic applies. Not to make an appeal to nature, but it's very difficult for me to imagine taking a synthetic form of a nutrient because I can't get enough in the way that my body is supposed to get it. But also from a purely logical point of view, how does it make sense for me to take a pill to make up for something that I am not capable of getting from my diet? Even if supplements were perfectly safe, over which experts can't agree, I can only consider the impossibility of meeting my nutritional needs from foods as a failure of my attempt at a vegan diet.

We have been taking supplements for decades, and there's no good evidence of harm from them. Likewise we've been using fortified foods for a very long time, and there's so much evidence in favor for public health that it's even been legislated in many areas.

I understand, but honestly we've been having official public recommendations for many things before which then have turned out not to be healthy (like meat). The fact that some part of the scientific community is not convinced by supplements makes it very hard for me to believe that this might not be one of those cases.

So to recap, the idea of taking supplements makes me uncomfortable because 1) I couldn't justify it to my family, which is already a social obstacle to my vegan diet as things currently stand. I can feel their judgement just thinking of taking supplements, and ultimately if I did take them I would feel like they're right to suggest that my diet is not healthy, which I really don't want to believe.

2) I can't help but thinking that if I could survive on a vegan diet (or at least one that I can sustain, which is neither a 2500 calories/day nor an overly kale-inclusive one) I should be able to do so by eating real foods. I *have* modified my lifestyle, but I feel like I've reached my limit and plants still can't provide everything I need. It sucks. Of course I care about the animals and the environment but this to me still feels like a choice between ethics and my health, and even if it would be nice to be able to choose the first, in reality that would be a very anguishing choice for me. I know it because that's been my experience taking B12 or fortified milks for the past months.

I hate it, but I really believe only a plant-based diet that includes small but regular amounts of animal products is sustainable without supplements and this now puts me in a horrible position.

[brimstoneSalad]

However, the reasons why I was inclined to believe the problem might be with iron rather than vitamin D levels is that I've had things like a cut in the corner of the mouth for entire months (also very dry skin between fingers, which the doctor mentioned as an iron deficiency symptom ) and I've not seen that listed as a vitamin D deficiency symptom anywhere. It has finally gone away, but it's been quickly replaced by other problems.

I would not assume it's not caused by vitamin D deficiency. Wound healing is complicated, and impaired wound healing is a symptom of many deficiencies.

There's not a lot of study on vitamin D and wound healing, but there's a little:
https://www.ncbi.nlm.nih.gov/pubmed/23174792

Extreme anemia can cause something like that too, but you don't have anemia. That's why your GP doesn't think it's that, and is not worried about your iron.

Again, horse not zebra.
Fixing your vitamin D issue is not optional. It also has nothing to do with being vegan or not (although I'm glad to try to help you with it).

The vitamin D3 supplements I tried (I tried two different brands, the high-dose one the doctor prescribed was probably sheep-wool-based, whereas the lower dose one I tried was vegan) both gave me an allergic reaction, again, on my lips, with severe swelling, scaling, bubbles, and itchiness. GP said she's never heard of it and to try again with a much lower dose, but tbh my lips problems are still ongoing (now they switched to cold sores) and I really don't think it's a good idea to try again until my lips are completely healed (if ever). This is just one more thing that makes me feel like just eating healthy doesn't cut it.

Just eating healthfully won't cure every disease. This dematological problem is likely something else. It may be coincidence, or it could even be one of those cases where correcting a deficiency or getting healthier has side effects.

E.g. people lose weight, and all sorts of nasty stuff dissolved in the fat can get released as well as spike cholesterol.
You improving your vitamin D levels could be improving your immune system, which is attacking a previously latent herpes infection.

This is speculation, but the point is that you don't know what's going on. Don't assume it's a good idea to ignore your doctor's advice.

In the very unlikely case you're allergic to D3, try taking D2.
If that affects you too, try a topical form like a patch... although absorption may not be great that way, maybe you have some kind of intestinal reaction.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508301/
Or talk to your doctor about getting D injections.

If all else fails, you'll need to purchase a UV light which delivers the right wavelength and basically sleep half naked under it every night for months.
Again, talk to your doctor.

The other reason why I thought vitamin D is not the whole problem is that I believed it was easier to restore close-to-normal levels with sun exposure

It is not, unless you live in the tropics and spend literally all day outside without sunscreen.

I've been getting reasonable sun exposure for 10 to 30 minutes at a time, depending on the intensity of the sun, every time we've had sun, which has been not everyday but often in the last couple of months.

If you're obsessive about it, that might be barely enough to *prevent* deficiency. That is far from adequate to correct an existing deficiency.

If you had a fish tank that evaporated a cup of water a day, and you left it for months until the fish were flopping around and dying on wet gravel at the bottom of your empty tank, then you decided it'd be OK to just start adding a cup a day like you were supposed to originally, would that resolve the problem and save your fish?

A dosage that can prevent deficiency is not necessarily going to fix a deficiency you already have.

is it really reasonable to think that I am still so severely deficient to explain my fatigue?

Yes.

thank you for this, I will try it if my lips ever recover.

Please try it immediately, and go to a dermatologist about your lips.

My problem is that I *do* put in a lot of planning, so much so that it's very stressful. I cook all my meals, I try to keep up with cronometer. But I seldom achieve the sweet spot in which I manage to both accomplish having a *variety* of fruit and vegetables *and* a lot of leafy greens, on top of getting enough vitamin E, proteins, calcium... I find it really hard to keep up with everything, and even if I try at the end of the week my cronometer is far from perfect, and I've come to believe for a while now that the only way to eat a vegan diet without supplements is to be able to intake a large amount of daily calories, no less than 2500 and ideally more. Whereas I have to fit all my nutrients in something like 1800/day on average, which has been frustrating.

It should not be that difficult. Can you give me some sample days of what you're eating?

I'm going to guess you're eating too many sweet fruits and rice, which are mostly empty calories.

Well, some part of the scientific community doesn't fully agree with this though, does it? Colin Campbell, for instance, doesn't recommend supplements.

Most of these fad vegan doctors are considered quacks.

Discussed a bit in this thread:
viewtopic.php?t=2282

They're about as bad as the paleo quacks.
You can find good advise from credible dietitians.

https://veganhealth.org/
https://www.theveganrd.com/

His argument, which I find very compelling, underlines the fact that our body is meant to get nutrients in a complex way, from food which by itself contains a variety of nutrients in certain combinations, and that we do not know (and probably will never know exactly, because the human body is way too complex) what happens when a nutrient is taken in its isolated form. It seems to me like the problem is not so much in the fact that 'nutrients might accumulate in the body', which is not the case, but rather in the fact that we feed our body something in a form which it's not designed to process.

That's just completely false. Like I said, a lot of these doctors are quacks.

We can track mineral supplements and follow them very easily by way of isotopes. It's a bit trickier but we can do that with synthetic vitamins too.
Figuring out how something is absorbed and metabolized is a very active field of medicine. We don't even need to do that all the time, though, when we can take somebody with deficiency, give the person a supplement, then observe the deficiency to be corrected.

Colin Campbell is ancient so maybe he never learned about that in school, but its reckless for him to be spreading ignorant misinformation like that. This kind of pseudoscience fear mongering against supplements (which save millions of lives) can really hurt people.

My problem with the idea of taking supplements is first of all social/psychological in nature: I grew up in a family where drugs were taken only in serious cases

Supplements aren't quite in the same class as drugs. They're studied like drugs, but their purpose is nutritive.
You can avoid taking drugs except in serious cases but have a sensible attitude toward supplements as a safety net and a way to be more casual about your diet and not worry too much.

nobody would ever take a drug for a headache in my household

Not taking pain medication for a headache is not going to harm you. If you can tough it out that's perfectly fine. That doesn't apply to nutritional deficiency.

or take antibiotics lightly

And you shouldn't take antibiotics lightly. Because they're prescribed so much (and in a large part because of casual application to animal agriculture) they're losing their efficacy. That's a serious social issue that threatens to drag medicine back into the dark ages if super bugs negate all of our best defenses against them due to our foolish misuse.

Again, does not apply to supplements *at all*.

Supplements are not drugs but, especially in the light of the above mentioned divide in the scientific (and vegan) community, I think the same logic applies.

...But there isn't a real divide. There's an illusion of a divide due to pop-pseudoscience. That's like saying global warming is a scientifically contentious issue. It isn't.
There are a few quacks who deviate from mainstream consensus, and it's relatively easy to show that they're quacks because their deviations don't stop there.

It's like how many people mistakenly believed evolution was controversial.

Not to make an appeal to nature, but it's very difficult for me to imagine taking a synthetic form of a nutrient because I can't get enough in the way that my body is supposed to get it.

Not to make an appeal to nature, but... appeal to nature?

You know there are synthetic forms that are actually better absorbed, right? A diet containing man-made products can be healthier than a "natural" diet.
And if you really want something "natural" for spiritual reasons or whatever, you can get bioidentical or concentrated plant derived supplements.

But also from a purely logical point of view, how does it make sense for me to take a pill to make up for something that I am not capable of getting from my diet?

You can get it from your diet if you make supplements part of you diet. Hey, there are even chewable ones. And literal food with supplementation in it.

Even if supplements were perfectly safe, over which experts can't agree,

Again, even if the Earth weren't flat, over which experts can't agree...

I can only consider the impossibility of meeting my nutritional needs from foods as a failure of my attempt at a vegan diet.

Why?

You could if you really wanted to (you're probably doing something wrong, I'll only know when you give some details of what you're eating), but there's nothing wrong with taking a few supplements for convenience. It's not convenient to eat a lot of greens. It's healthy, sure, but most people don't want to eat that many vegetables.

If you're only in it for health, there's still reason to believe taking B-12 and iron is healthier than eating a bunch of beef, taking calcium is healthier than drinking a bunch of milk, etc.
With plants and supplements you're getting the good without the bad.

Likewise, if you're in it for any sense of ethics your vegan diet has NOT failed because you took a supplement; you still save hundreds of animals immense suffering every year, and you still massively reduce your contribution to climate change and human suffering. You also still reduce antibiotic use and the chance of catastrophic super-bugs.

Health, animal ethics, environment -- NONE of those goals fail from taking supplements.
The only thing that fails is an ego game of trying to eat nothing but 100% natural plants for some bizarre reason.
It's every bit as silly an endeavor as if I decided to only eat rhyming foods on a given day. It may be possible, but why? There's no nutritional or ethical reason to only eat rhyming foods, and no nutritional or ethical reason to avoid supplements.

I understand, but honestly we've been having official public recommendations for many things before which then have turned out not to be healthy (like meat).

Before the discovery of B-12 it was important for people to eat some animal products. Likewise, in the past nutritional science was in its infancy, and we didn't know how to properly plan a very diet: nor was our agricultural ability up for it. You can't plan a good vegan diet from potatoes and carrots if that's all you have to work with.

We've really only had the ability to plan modern vegan diets for a couple generations. And yeah, public health recommendations are a little behind. Doesn't mean they were inherently wrong in their original contexts... except when you mix in a heap of politics (which is particularly bad with the USDA, but even they recognize plant based diets now).

1) I couldn't justify it to my family, which is already a social obstacle to my vegan diet as things currently stand. I can feel their judgement just thinking of taking supplements, and ultimately if I did take them I would feel like they're right to suggest that my diet is not healthy, which I really don't want to believe.

Why would you even tell them? I don't think it's their business, is it?

They're right right now because you're doing something wrong. But they'd no longer be right if you added supplements. They might still be judgmental, but they'd be wrong... like a family who can't accept your sexuality. That's their problem.

2) I can't help but thinking that if I could survive on a vegan diet (or at least one that I can sustain, which is neither a 2500 calories/day nor an overly kale-inclusive one) I should be able to do so by eating real foods.

Maybe you just need to broaden your concept of what foods are. There's nothing wrong with supplements.

Of course I care about the animals and the environment but this to me still feels like a choice between ethics and my health,

It isn't, though. If I'm understanding the situation correctly, it's a choice between ethics and... some weird ego thing of having to win at this and prove your judgmental family wrong.

even if it would be nice to be able to choose the first, in reality that would be a very anguishing choice for me. I know it because that's been my experience taking B12 or fortified milks for the past months.

Have they been onto you about drinking fortified plant milks? That's terrible. Like really really terrible. This kind of behavior is no better than a homophobic family being shitty to a gay child because of their beliefs and traditions.

I hate it, but I really believe only a plant-based diet that includes small but regular amounts of animal products is sustainable without supplements and this now puts me in a horrible position.

You're the one putting yourself in this position by caring FAR too much about what your family thinks due to their irrational appeal-to-nature beliefs. Something that seems very hard for you to shake. You can make that choice. You just have to stop believing that nonsense and recognize that your family is treating you unfairly.

You can do a 100% whole foods plant based diet if you want... you'll probably just need a little help diet planning because you're doing something wrong. Like I said, let me know what you're eating and I'll help you.

But it seems kind of silly and unnecessary. Again, like a rhyming diet. Every single benefit of a plant based diet can be realized by including supplements too, and saving yourself some inconvenience and giving yourself a lot more flexibility on what you want to eat in a given day.

There's no reason you'd need to include animal products in your diet. If you want to give up and give into your family's pressure I doubt there's anything I cay say to dissuade you, but there's no health, environmental, or ethical reason not to be vegan and take a couple modest supplements to make things easier.

I'll help you plan a 100% whole foods plant based diet that will tick all the boxes on chronometer if that's what you really want. But I think you need to do some introspection on how much power you're giving your family's irrational judgement of your life choices.

[Amarillyde]

I would not assume it's not caused by vitamin D deficiency. Wound healing is complicated, and impaired wound healing is a symptom of many deficiencies.

Yes, but I haven't been able to find anything about vitamin D deficiency being the 'cause' of cracks at the corner of the mouth. It's normally iron, zinc or B vitamins, which seem all quite possible to me, since absorption rates are not a certainty anyway.

Just eating healthfully won't cure every disease. This dematological problem is likely something else. It may be coincidence, or it could even be one of those cases where correcting a deficiency or getting healthier has side effects.

It might be a coincidence, that's true... But I've gotten yet another brand of D3 supplement (vegan and in liquid form, this time), I took the first dose yesterday (1000 IU, possibly less since it was the very first spray and that's less precise) and, without fail, today I'm developing again a mouth-corner crack – I really hope it's not going to turn into the week-long hell of blistering and swelling like the last two times, ugh :/. But in other words, taking the supplement seems to be the cause of these problems, rather than a deficiency of vitamin D being the reason of impaired wound healing, here.
But apart from my personal case, it's no mystery that, not only some supplements in high doses are harmful, but also that certain supplements do have very likely side effects (like iron, in high or just excessive doses). While I understand that drugs are useful, despite their side effects, to solve physical problems which might otherwise be left unsolved, in the case of supplements vegans must accept the side effects on purely ethical grounds. It is a perhaps small sacrifice, but it still does mean sacrificing your health a little. That's why I think it's misleading to tell people that a "well-planned vegan diet" is perfectly safe, instead of saying "a well-planned vegan diet that includes some supplements" is perfectly safe. Eating a diet that includes only small but regular amounts of animal products (I think it might be limited to two servings a week of fatty fish and seafood, though I'm not sure whether that would be enough for B12) essentially eliminates both the need for supplements and the negative effects of animal products on health. I see how if you take no issue whatsoever with taking supplements the choice is easy, but what other solution there is for those of us who do take issue with that?

We can track mineral supplements and follow them very easily by way of isotopes. It's a bit trickier but we can do that with synthetic vitamins too. Figuring out how something is absorbed and metabolized is a very active field of medicine. We don't even need to do that all the time, though, when we can take somebody with deficiency, give the person a supplement, then observe the deficiency to be corrected.

I don't think Campbell is denying that we can track a single mineral or nutrient in the body per se, his point is exactly that this is a reductionist approach that does not take into consideration the complexity of human nutrition, and when it comes to it a wholistic approach is needed. While we might be able to track the journey of one single nutrient in the body, we are currently unable to know exactly everything that is happening in our body when we eat an apple, a real food with a complexity of nutrients. The whole is more than the sum of its parts. While we know that supplements can work in solving short-term problems (and Campbell agrees on this), we do not know their long-term use outcomes. (more here, for example: https://nutritionstudies.org/evaluating ... mentation/)

Colin Campbell is ancient so maybe he never learned about that in school, but its reckless for him to be spreading ignorant misinformation like that. This kind of pseudoscience fear mongering against supplements (which save millions of lives) can really hurt people.

I hardly think that's very fair to dismiss someone as a quack just in virtue of his age. If we had definitive studies which show that supplements are completely safe and Campbell ignored them, sure... but it seems to me that the situation is nutritional science is more complex than that right now, hence the divide in the scientific community. In the same way, we can't dismiss a doctor just for being "pop" and trying to popularise a diet which can prevent some of the leading causes of disease in the Western world. He is a Cornell graduate and professor, published in world leading journals, without any ties to any industry... I would hesitate to dismiss him only because he (as many others) is not convinced by the role of supplements in nutrition.

Supplements aren't quite in the same class as drugs. They're studied like drugs, but their purpose is nutritive.
You can avoid taking drugs except in serious cases but have a sensible attitude toward supplements as a safety net and a way to be more casual about your diet and not worry too much.

Yes, only supplements are not 'nutrition', they are effectively drugs in as much as they behave differently from anything that our body has evolved to process. It might be able to deal with them, maybe all the time, maybe in the majority of the time, and maybe only sometimes... but I don't think the current status of research can make any assurances, otherwise it would be simply ridiculous to state the contrary for any doctor who would state otherwise, and it would be equally easy to produce scientific proof that they are wrong.

Not taking pain medication for a headache is not going to harm you. If you can tough it out that's perfectly fine. That doesn't apply to nutritional deficiency.

Sure, but nutritional deficiencies should be avoided by eating the right foods. Taking a supplement means that you're not doing that, in the same way that taking a drug means that there is something that needs to be fixed in your body.

You know there are synthetic forms that are actually better absorbed, right? A diet containing man-made products can be healthier than a "natural" diet.

In circumstances in which your body is malfunctioning, sure. But one thing is taking a supplement to fix a health problem which has come to be and would take very long to fix otherwise (if at all), another is to eternally keep the circumstances that generate that mistake in place, and to keep "fixing" the mistake with something that our body is not designed to use. Again, drugs and supplements work short term, but the idea of substituting in the long run natural sources of nutrition which are available and we know are healthy with man-made ones doesn't seem wise to me. Not because everything natural is good and everything synthetic is bad and should be avoided at all cost, but because we know that our bodies have evolved to eat real food while we don't know for sure whether they will at all be able to evolve to survive on isolated nutrients. And since we are fortunate enough to know what animal products are actually bad for us (not unlike supplements, they are most likely sustainable if taken occasionally, but not so if taken systematically, as the "blue zones" show), we can avoid those.

Again, even if the Earth weren't flat, over which experts can't agree...

This seems to me to be hardly the same. Flat Earth theory started in the 19th century, after the publication of a book written by a random dude who got a lot of following. We have plenty of proofs that the Earth is a sphere, and the only way to deny it would be to imagine a ridiculous, world-wide conspiracy. Scientific studies, their validity and interpretation are quite a different thing, infinitely more complex.

If you're only in it for health, there's still reason to believe taking B-12 and iron is healthier than eating a bunch of beef, taking calcium is healthier than drinking a bunch of milk, etc.
With plants and supplements you're getting the good without the bad.

I don't think beef and milk would be the answer, but salmon and seafood might, as I said above. This would still include some supplement (in calcium-set tofu, and plant milks), but in a much less systematic way.
'If you're only in it for health' is a bit off-putting: as I said, I'm all for the ethics of avoiding animal products, but I'm not convinced that replacing food with supplements is not harmful, and I'm pretty sure nobody would choose ethics over health because at that point you might just kill yourself, that'd be definitely more effective.

You can do a 100% whole foods plant based diet if you want... you'll probably just need a little help diet planning because you're doing something wrong. Like I said, let me know what you're eating and I'll help you.

Thank you for your offer, but I can plan a diet which would meet my nutritional needs in theory, I'm just saying that in practice it would be unrealistic, as my attempts have shown (and no, I rarely eat rice, and I don't eat very much fruit). Even if I'm relatively new to the micronutrients world, I have a long history of checking calories and macronutrients, so it's not for lack of theoretical knowledge that I can't fully meet my nutritional requirements, but because... life. I simply can't always be perfect, nobody can.

Finally, wrt my family, I don't care about what my family thinks of me a priori, nor they're the reason why I don't trust supplements or I have a careful attitude towards taking drugs. It's not just because "they said so and they must be right", but because it seems reasonable to me, and I haven't been able to find evidence of the contrary. The comparison with judgements over sexuality or the like don't seem to apply, to me, for the reasons explained above – there is evidently nothing wrong in loving whomever you want, but the safety of supplements... a much more complex story.

[Minos]

While I understand that drugs are useful, despite their side effects, to solve physical problems which might otherwise be left unsolved, in the case of supplements vegans must accept the side effects on purely ethical grounds. It is a perhaps small sacrifice, but it still does mean sacrificing your health a little. That's why I think it's misleading to tell people that a "well-planned vegan diet" is perfectly safe, instead of saying "a well-planned vegan diet that includes some supplements" is perfectly safe. Eating a diet that includes only small but regular amounts of animal products (I think it might be limited to two servings a week of fatty fish and seafood

Leaving aside your reaction to taking vitamin D supplements, I'm convinced that eating fish two times a week is more harmful to health than any side effects from supplements. Fish are predators and can accumulate a lot of toxic pollutants, for example:
Microplastics
Heavy metals
Fish & Diabetes

[brimstoneSalad]

in the case of supplements vegans must accept the side effects on purely ethical grounds. It is a perhaps small sacrifice, but it still does mean sacrificing your health a little. That's why I think it's misleading to tell people that a "well-planned vegan diet" is perfectly safe, instead of saying "a well-planned vegan diet that includes some supplements" is perfectly safe. Eating a diet that includes only small but regular amounts of animal products (I think it might be limited to two servings a week of fatty fish and seafood

Leaving aside your reaction to taking vitamin D supplements, I'm convinced that eating fish two times a week is more harmful to health than any side effects from supplements. Fish are predators and can accumulate a lot of toxic pollutants, for example:

And bioaccumulation of pollutants is only part of it. It's always perplexing when people just know that the modest supplements that support a convenient vegan diet have deleterious effects (something for which there is NO evidence at all), and yet just choose to reject the evidence of harmful effects from animal products.

The minute heavy metal contamination in some supplements is nothing compared to fish.

[Amarillyde]

I don't "just know" anything... I've articulated why I am not comfortable taking supplements. I am no more comfortable eating fish twice a week, otherwise I would have already made that decision, clearly. The status wrt multivitamins is not that they have no negative effects, but rather that their long term consumption effects are unknown (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241405/). My point was that there is no solution, I don't think vegans do a good service to others nor to the cause by encouraging the consumption of supplements or implying that they are perfectly safe, when it's simply not clear. I simply don't see an optimal way out of the woods.

[brimstoneSalad]

On vitamin D: you need to correct your deficiency. You will not feel good otherwise.
Ask your doctor for a shot or a transdermal option. Otherwise, ask your doctor for a light you can sleep under.

If you do not fix this problem, any other endeavors to improve your health are futile, like trying to plug a pinhole in a barrel when it's split in two and the contents are gushing out.

I really hope it's not going to turn into the week-long hell of blistering and swelling like the last two times, ugh :/.

Again, that sounds viral or immune-related. please go see a dermatologist before coming to conclusions.

But in other words, taking the supplement seems to be the cause of these problems, rather than a deficiency of vitamin D being the reason of impaired wound healing, here.

Like I said, it may be triggering a flare up in response to a herpetic infection, since your immune system may be suppressed due to your deficiency.
You don't know. Please go see an expert and stop self-diagnosing.

But apart from my personal case, it's no mystery that, not only some supplements in high doses are harmful, but also that certain supplements do have very likely side effects (like iron, in high or just excessive doses).

The body is pretty flexible in ability to up and down-regulate absorption, including the ability to deal with very different ratios of things.

Heme iron may be harmful. But non-heme iron is adapted to by your body in any reasonable amount. Only a very sudden or high dosage is harmful. Your body otherwise down-regulates absorption.

Some people have conditions where they absorb and retain too much iron, but you don't have that condition (it would have been evident to your doctor from your blood test). Those people basically have to eat a low-iron diet. Nothing prescribes animal products.

in the case of supplements vegans must accept the side effects on purely ethical grounds. It is a perhaps small sacrifice, but it still does mean sacrificing your health a little.

As Minos suggested, in order to claim it's a health sacrifice you'd have to show evidence that supplementation does more harm than, say, eating fish.
Actually oysters would be the more obvious choice being higher in B-12, Zinc, and Iron. But the point is you can't say something is sacrificing your health unless there's evidence that the alternative is better, and there isn't. To the contrary, there's good reason to believe that supplements are better than animal products.

That's why I think it's misleading to tell people that a "well-planned vegan diet" is perfectly safe, instead of saying "a well-planned vegan diet that includes some supplements" is perfectly safe.

You should read the entire position paper:

https://www.eatrightpro.org/practice/po ... rian-diets
It's clear about B-12 sources. Otherwise it is possible to plan one without supplements, but if you read more you'll find that overwhelmingly professionals recommend fortified foods and certain modest supplements.

Taking large amounts of a particular supplement can be a problem because even if your body down-regulates absorption it can interfere with another vitamin or mineral with a similar pathway.
The thing is, we know this already. It's not like we're flying blind here.

The benefit of supplementation isn't just vegan consensus, foods (and even tap water in some places) have been fortified for decades for everybody because of the overwhelming evidence for supplementation to improve public health. Look at refined grains (they're not great because they're lacking fiber, but fortifying them helped a lot).

Eating a diet that includes only small but regular amounts of animal products (I think it might be limited to two servings a week of fatty fish and seafood, though I'm not sure whether that would be enough for B12)

If you were set on it, you would want to eat oysters instead, since they are richer sources of the nutrients you're concerned with.

essentially eliminates both the need for supplements and the negative effects of animal products on health.

I'm not sure how you don't see the inconsistency here.

You think that even small amounts of supplements are bad because an overdose is harmful.
But a small amount of animal products aren't bad just because too much is harmful?

Regardless of the animal products you consume, you're going to get more heavy metals and other substances you don't want with the "whole package" than by selecting some purified supplements.
Also, in terms of the type of harm, you're totally backwards.
Substances like carcinogens are harmful (small harm) even in small amounts (since they can still cause DNA damage), while the deleterious effects of high doses of most supplements go away completely at reasonable amounts because these effects are only caused by the high dosage and are not innate to the substance itself.

I see how if you take no issue whatsoever with taking supplements the choice is easy, but what other solution there is for those of us who do take issue with that?

Then either:

A. Stop having issue with taking supplements. It's not rational. or:
B. Stop assuming you know everything about diet planning and accept help from people who have decades of practical experience and not just some basic theoretical knowledge.

If you have a phobia of supplements it may be easier said than done, but even if you have a hangup on supplements, we are here to help you.

I don't think Campbell is denying that we can track a single mineral or nutrient in the body per se, his point is exactly that this is a reductionist approach that does not take into consideration the complexity of human nutrition, and when it comes to it a wholistic approach is needed.

Maybe there's some state of ideal human nutrition that gives you superpowers that comes from eating 100% plants and getting all of your nutrients that way, but there's no evidence for it.

The epidemiological evidence for supplements is clear. Fortify food (that's a supplement) and your population has better health outcomes.
In terms of pills we have literally decades long studies like the nurses' health study that don't show any harm from modest supplements, and to the contrary often correlate to better health. It's reasonable to be skeptical of those correlations because people more likely to supplement may also be likely to have other healthier lifestyle factors that aren't well enough controlled for, but it's not credible to assume supplementation is harmful. To the contrary, the lack of evidence of harm in those studies is strong evidence that they're not harmful or if so they do so little harm that it's undetectable. The only harmful effects ever demonstrated have been from very high doses.

While we might be able to track the journey of one single nutrient in the body, we are currently unable to know exactly everything that is happening in our body when we eat an apple, a real food with a complexity of nutrients.

What I'm getting from this is "ignorance, therefore whatever I believe must be right".

In cases where we can't conclude something with certainty we don't get to just assume to answer to be whatever we prefer to believe.
It's every bit as likely that an artificial apple made from a number up supplements is healthier than a "natural" apple.

If we don't know which is better, you can't just assume based on personal dogma.

I hardly think that's very fair to dismiss someone as a quack just in virtue of his age.

It's not his age that makes him a quack, he's a fear monger and he advances speculation in favor of evidence.
Very young people are capable of being quacks too, his age may just be the only thing slightly in his defense because he likely has a better excuse for not knowing up-to-date science.

Yes, only supplements are not 'nutrition', they are effectively drugs in as much as they behave differently from anything that our body has evolved to process.

That's completely untrue. Why do you think that some conditions like iron deficiency stimulate pica?
Our bodies are both capable of processing raw mineral sources from rock and soil, as well as have evolved doing so when we experience deficiency.

Either way, appeal to evolution is a *terrible* argument for optimal nutrition since on our "natural" diets our ancestors didn't live anywhere nearly as long as us. There are any number of problems a "natural" diet can cause in old age that we wouldn't have evolved resistance against.
If something didn't kill us before reproduction in our 20s to 30s, then we wouldn't have adapted to it. We only have strong evolutionary pressure for resistance to things that kill us before reproduction.

otherwise it would be simply ridiculous to state the contrary for any doctor who would state otherwise, and it would be equally easy to produce scientific proof that they are wrong.

It is ridiculous, and it is easy. Look at the nurses' study. Look at public health and fortification. Look at TPN. Look at infant formula.

There's no credible reason to believe supplements in modest amounts are harmful in any way whatsoever. Neither mechanistic nor epidemiological.

Sure, but nutritional deficiencies should be avoided by eating the right foods. Taking a supplement means that you're not doing that,

Should? Why?

And again, supplementation and fortification can be part of your diet. It is for billions of people. All you're doing is employing circular reasoning here to define supplementation out of diet.

And again, appeals to nature. Why? It's very anti-scientific, particularly given the weight of evidence against those claims.
Believing that evolution is a reason to prefer a "natural" diet is just a complete misunderstanding of evolution and health.

in the same way that taking a drug means that there is something that needs to be fixed in your body.

You're appealing to the symptomatic treatment vs. root cause dichotomy?
First it's a false dichotomy and that's an alt-med pseudoscience talking point, but even in cases where there is a clear distinction there are MANY situations where symptomatic treatment is better for the patient.
Second, the "root cause" of most deficiencies is not consuming enough nutrients. Period. That's what's going on biologically with the body.
It doesn't matter what form those nutrients are in or where they came from as long as they resolve the deficiency. Humans have requirements for certain nutrients, not certain sources of nutrients. Adding fortification to diet DOES resolve the root cause by resulting in consuming enough nutrients. I know you're just going to want to define that out of the diet again and employ special-pleading to say it's different, but it's not. You might as well arbitrarily assert the root cause of a deficiency is not being a cannibal and that consuming anything other than another human being isn't addressing the root cause.

You know there are synthetic forms that are actually better absorbed, right? A diet containing man-made products can be healthier than a "natural" diet.

In circumstances in which your body is malfunctioning, sure.

No, in any and all circumstances. They are more reliable. And not just due to disease, but also natural variation in digestion like ageing.

But one thing is taking a supplement to fix a health problem which has come to be and would take very long to fix otherwise (if at all), another is to eternally keep the circumstances that generate that mistake in place, and to keep "fixing" the mistake with something that our body is not designed to use.

Again you're just defining this as a problem.
You have corrected the circumstances that generated the mistake by fortifying a diet. The diet is no longer deficient.

Again, drugs and supplements work short term,

Supplements do not stop working just because you take them indefinitely. In many cases they are and remain better than "natural" food sources.

but the idea of substituting in the long run natural sources of nutrition which are available and we know are healthy

No, we do not magically know these "natural" sources are 100% healthy. Again, see Minos' post. To the contrary.
We have more reason to believe that supplements are healthy than the "natural" sources of those things.

Not because everything natural is good and everything synthetic is bad and should be avoided at all cost, but because we know that our bodies have evolved to eat real food while we don't know for sure whether they will at all be able to evolve to survive on isolated nutrients.

Again, a misunderstanding of evolution. The supplements we're talking about are quite well studied. We know they're fine to a degree of certainty it is unreasonable to doubt. And by far to a degree of certainty that it's not justified to harm animals and the environment because a dogma says otherwise.

And since we are fortunate enough to know what animal products are actually bad for us (not unlike supplements, they are most likely sustainable if taken occasionally, but not so if taken systematically, as the "blue zones" show), we can avoid those.

Again, there's absolutely no reason to believe long term consumption of modest supplements is harmful at all. We've been doing it for a very long time on population-size scales.
Harm from supplements vs. animal products are quite different. Again, one has ONLY to do with having too much of something and is not innate to the substance, the other seems to carry some innately harmful substances. Having animal products less often, like smoking only occasionally, will surely lessen the harm, but there's no reason to believe that's better than just getting those nutrients from supplements.

The only argument health-care professionals can make for fish as better than Omega DHA/EPA supplements is that it acts to *displace* other less healthy food from the diet (e.g. fish instead of beef), not that it's inherently better. And in fact, there are good reasons to believe a serving of tofu + a DHA/EPA supplement is going to be better than fish in the long run.

Absolutely somebody on a standard american diet is better of eating fish than taking DHA/EPA, but that's because the consumption of fish will displace beef or other worse foods, not because the fish is better than tofu. That's the logic of essentially all public health advice.

Again, even if the Earth weren't flat, over which experts can't agree...

This seems to me to be hardly the same. Flat Earth theory started in the 19th century, after the publication of a book written by a random dude who got a lot of following. We have plenty of proofs that the Earth is a sphere, and the only way to deny it would be to imagine a ridiculous, world-wide conspiracy. Scientific studies, their validity and interpretation are quite a different thing, infinitely more complex.

It's quite the same. Supplementation has been practiced as fortification around the world because of the overwhelming evidence, and if to date there's no evidence for harm it's every bit as insane to propose it's a health sacrifice as to claim the Earth is flat. It WOULD require a world-wide conspiracy of governments intentionally hiding evidence and poisoning their populations with harmful supplements for some nefarious reason. It DOES require rejecting several of the most massive epidemiological studies ever done, and it requires rejecting ALL of the mechanistic evidence.

It's a serious epistemological blunder either way.
Remember, we're only talking about modest supplements here, on the order of that which are used in fortification.

as I said, I'm all for the ethics of avoiding animal products, but I'm not convinced that replacing food with supplements is not harmful, and I'm pretty sure nobody would choose ethics over health because at that point you might just kill yourself, that'd be definitely more effective.

So if there's a child drowning in a pool and you only need to throw a life preserver, but in order to get the life preserver you have to walk out into the sun thus increasing your chance of getting skin cancer by 0.000001%, you should surely let the child drown because nobody would choose ethics over health?

I don't think I have to say that you're completely wrong here.
The most meaningful ethical choices we make involve sacrifices, and a risk to personal safety is heroic. However, you'd have to be a terrible person not to accept the most minute risk to save lives. And in the case of supplements, it's even worse than not walking out into the sun to throw a life preserver -- at least the risk from the sun is proven. Modest supplements not only have no proven risk, but overwhelming evidence suggests that they are not dangerous (epidemiologically) and could not even in theory pose a risk in those amounts (mechanistically). The only credible risk you're taking is one of choking, which is a risk you take any time you eat anything. You're taking more of a risk with fish than supplements.

Also, you wouldn't kill yourself if you favored ethics over health. Suicide is counter-productive. Better to use your life to do good and outweigh the small harms you can't prevent. But that's another issue (and another huge misconception about ethics).

The comparison with judgements over sexuality or the like don't seem to apply, to me, for the reasons explained above – there is evidently nothing wrong in loving whomever you want

You might be surprised to learn that a significant number and probably majority of the world's population believe homosexuality to be socially harmful, and some even believe it results in natural disasters. Interestingly, those beliefs have about the same amount of evidence behind them as your opposition to modest supplementation. So, it's a very good comparison.

[brimstoneSalad]

You posted this while I was writing (I guess you got it right away)

The status wrt multivitamins is not that they have no negative effects, but rather that their long term consumption effects are unknown (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241405/).

1. As I have explained, unknown does not equal negative, nor does it even mean a risk; it could be a net benefit too.

2. A benefit, although very small, is actually what studies have suggested.
See a more recent analysis than that you linked to: https://www.sciencedirect.com/science/a ... 9718345601

further studies on multivitamins, the most commonly used supplement, may still be useful, because of the marginal benefit seen in our analysis.

The only negative effects they found were with antioxidant mixtures, and niacin when taken with a statin.

3. The study you linked to says this:

Our recommendation is that taking high-dose supplements of vitamins A, E, D, C, and folic acid is not always effective for prevention of disease, and it can even be harmful to the health.

They don't clarify that everywhere, but the abstract has no doubt been scrutinized more carefully given the typos and grammatical errors elsewhere in the study.
I'm not, nor would I, recommend high dose vitamins and there's no point to them (risk without benefit). There's no reason to exceed the RDI. There are a number of speculative mechanisms by which excess vitamins can cause problems, from inhibiting absorption to feeding cancer (which needs a large pool of nutrients to grow), even to rare direct toxicity in very high amounts which can occur with fat soluble vitamins through bioaccumulation.
This isn't relevant to what I'm suggesting, and it's not what professional dietitians recommend. The study's authors you linked to were primarily concerned with people being stupid and taking too much. Here are their words:

It was implied that adverse effects of some vitamins such as vitamin E may be dose related. Due to the unlimited access of people to vitamins and also lack of patient's attention into multivitamins ingredients and their doses, it may be high probable that a patient use vitamins in higher doses. It can be suggested that vitamin administration should be under the control of health provider professionals like pharmacists and only be marketed by pharmacies in order to provide critical information for patients about appropriate vitamins use. In addition, labeling of vitamins should include information on recommended upper intake, safe dosing and possible toxicities.

My point was that there is no solution, I don't think vegans do a good service to others nor to the cause by encouraging the consumption of supplements or implying that they are perfectly safe, when it's simply not clear. I simply don't see an optimal way out of the woods.

It would be poor public health advice to just recommend people take vitamins instead of eating vegetables, which is why that isn't done. Veggies contain a lot of beneficial substances that can not typically be obtained from a multivitamin, and more importantly they fill people up and push out unhealthy foods.
However, vegans already eat considerable amounts of veggies, and at a certain point there are diminishing returns from the fiber and phytonutrient intake. There's no reason not to recommend modest supplements to make it easier to stick to, which is why dietitians readily recommend modest supplementation and fortified foods for vegans since they're not that worried about us not eating our veggies.

Would eating more vegetables instead of taking a vitamin be healthier? Probably, but we're talking about theoretical optimal nutrition here, not adequate nutrition. We're not talking about a difference in suffering ill health or anything even noticeable, but a fraction of a percentage reduction in the chance of getting certain cancers etc.

If you want to be as healthy as possible, by all means eat ALL the vegetables and get all of your nutrients that way, but it's a very small theoretical advantage and it's probably not worth the inconvenience. If you end up living a month longer but spend a cumulative 2-3 months more time over your life fretting about finding enough vegetables to eat and ALL the chewing and green smoothies that might not be worth it.

The only reason to think recommending vitamins could be "bad" is the same reason recommending fish is "good". Fish displaces worse things in the diet like meat. If people think they can take vitamins and eat junk food all day, likewise, that could be a problem. If vitamins displace healthy food that's an issue, but if you're eating a lot of veggies already and if they're just making it easier not to eat animal products there's no reason to think that's a problem. Vitamins are only an issue if you use them as a license to eat junk food all day instead of healthy food.