Pregnancy dieting and #moderation: just don’t be extreme
"If you can’t absorb B12, no amount of steak will help you" (more on this below)

Just like practically everyone in the field, I’m uncomfortable with the word moderation, in part because one person’s moderation can be wildly different from another’s.

Remember the Motherwell studies? In brief, they asked a group of expecting women to ditch carbs and eat a ton of meat instead (about a pound per day), and compared them with a group not given diet advice. It was designed to compare an extreme diet to an average diet (note: they didn't assess the opposite extreme, ie, high carb vegan).

Tl;dr: babies were healthy at birth but developed a variety of health problems later in life. Perfect study design? No. Better than ALSPAC? Kinda, yeah.

In the context of today’s topic, I’ll define moderation as "not extreme" (bear with me here) (unless ALSPAC is retracted or something… which is possible given the study design)

Meat consumption during pregnancy and substance misuse among adolescent offspring (Hibbeln et al., 2017) (aka ALSPAC)

FFQ’s are flawed. It is known. They're OK if validated by biomarkers in a subset of participants, but that isn't the case here. However, I think a soon-to-be Mom can pretty accurately recall if she's vegan or not. It’s more fuzzy in between, but at least comparing average to extreme we may be able to see something, assuming the statisticians did a decent job.

Plus I get to rant about B12 again :)

What this story is lacking is a combination of Motherwell & ALSPAC: high meat low carb vs. high carb vegan vs. control. In the same study. A direct comparison with randomization and crossover for their next pregnancy (OK, maybe that last part is a bit of a stretch). 

In brief, they found expecting mothers who didn’t eat meat were more likely to produce offspring who would develop some sort of substance abuse disorder (most likely marijuana in this cohort) by 15 years of age. We can’t know if that's true (bc correlation =/= causation and all that jazz), but it’s what brought Motherwell and moderation to mind.

Basically, if you’re pregnant, don’t be vegan (ALSPAC) or eat ALL THE MEAT (Motherwell). If these are our choices, it’s easy to define moderation, because the comparison groups are polar opposites. There is a large gray area, and most of the progeny in ALSPAC and Motherwell grew to be healthy adults; the differences only appeared at the extremes. That may make it more likely to be confounded, Idk, but I’ll work with it for the time being.

I’m OK with moderation in this #context because doing the ideal study would be extremely expensive and probably unethical. And I think people can accurately recall of they're vegan or not, etc.

Now for a B12 rant!

Many vegans should and do supplement with B12 or eat oysters or nutritional yeast or something. When people say veganism is stupid because B12, uhm, supps bro. Nutritionally, I think the healthiest diets are in the large gray area (the "control" groups in Motherwell & ALSPAC). In this context, I’m not saying anything big or specific. It’s pretty vague and quite possibly useless, but I’m OK with that because it’s not extreme. It leaves room for many different healthy dietary patterns (which I believe is true).

The anti-vegan B12 argument is not a game-changer also because B12 malabsorption is rampant among vegans and omnivores, and especially old people. If you can’t absorb B12, no amount of steak will help you. B12 deficiency is treated with injections or supps that are like, 80000x the RDA and even then, sometimes also sublingual.

The cool part: given their findings, ALSPAC explored the obvious thing (which turned out to be two obvious things): B12. Because basically their findings were really only present in the extremes. In women who couldn’t absorb B12, it didn’t matter if they ate meat or not BECAUSE THEY COULDN’T ABSORB B12. The main finding was present for B12 high-absorbers, because in this context, ingesting B12 actually matters. Ha!

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