There's been a huge surge of interest in veganism in recent years. It's no longer a niche diet.
The number of Brits eating a vegan diet has quadrupled over the past 4 years, reaching more than 600,000. It's a trend that is likely to continue as more and more people opt for a vegan diet driven by concerns about animal welfare, the environment, and possibly their health.
That's the question though. Is veganism good for health? As a doctor would you recommend it to your patients? What advice would you give?
Proponents of veganism say it has many health benefits. Others say a vegan diet is too strict and can lead to nutrient deficiencies and their consequent health problems.
"As the popularity of veganism increases, it becomes more and more important that it's well-understood by doctors and other health professionals. Some vegans report that their doctors do a great job taking into account their beliefs, which are protected by human rights and equality law. However, I've also spoken to many vegans who haven't experienced patient-centred care," says Heather Russell, dietitian at the Vegan Society.
Benefits of a Vegan Diet
Dr Rebecca Jones is a GP and a vegan. She set up a Facebook page for other vegan doctors which has more than 250 members.
"When done carefully, veganism has many benefits. A healthy vegan diet has been associated with reduced risk of many diseases including heart disease, type 2 diabetes, and various cancers including breast, stomach, colon and prostate. Many people report feeling a better sense of wellbeing, with greater energy levels, and peace of mind," she says.
"A plant-based diet has also been associated with lower incidence of obesity, lower BMI and smaller waist circumference," says Azmina Govindji, director at Azmina Nutrition, and spokesperson for the British Dietetic Association.
She adds: "Research shows that plant foods such as fruits and vegetables, legumes, nuts and whole grains help you keep to a healthy weight. These foods provide fibre, anti-oxidants and other phytochemicals, and most plant foods also tend to be low in calories and nutrient rich.
"Fruit and vegetables are rich sources of potassium which helps to regulate your blood pressure, and foods such as nuts and wholegrains have been shown to help lower your blood cholesterol," says Azmina Govindji.
A Bad Vegan Diet
However, a vegan diet isn't always a good diet. Eating white bread and chips is vegan but that doesn't make it healthy.
"If a patient is overweight, it might be wrongly assumed that a vegan diet could trigger maintenance of a healthy weight, this isn't necessarily true," says Azmina Govindji.
"Foods such as vegan dairy alternatives can have as many calories, weight-for-weight, as their dairy counterparts. Other foods like vegan pastry, sweets, and snacks can be calorie-rich, even though they are plant-based. Choosing vegan convenience foods like vegan sausages, cheese alternatives, and ready meals could mean you're hitting high salt and fat levels," she warns.
The best vegan foods, she says, are the wholesome ones that are less processed, such as pulses and beans, whole fruits, vegetables and wholegrains like quinoa, bulgur, and oats.
Nutritional Deficiencies
The main worry about a vegan diet from a health perspective is a deficiency of certain nutrients.
Vegans need to make sure they get enough protein, calcium, iron, zinc, iodine, and omega-3 in their diets.
A plant-based diet doesn't provide the body with vitamin B12 so B12 fortified foods or a supplement are needed. Vegans may also want to consider taking a vegan omega-3 supplement.
You may get patients coming to see you with a whole range of health concerns from tiredness to hair loss that may be down to their vegan diet.
"Every deficiency presents differently, and sometimes we aren't aware of low nutrient levels until blood tests are performed. But common symptoms of deficiency are fatigue, headaches, memory loss, body pains and feeling generally unwell," says Dr Jones.
She advises patents: "If you begin to feel unwell after following a vegan lifestyle, make sure to see your doctor and get a blood test."
A Well-Planned Diet
If a patient is considering becoming vegan it's best to recommend that they read up on it first to learn about the potential risks and deficiencies.
"Encourage them to set aside a bit of time for research and take things step by step. The resources available on the Vegan Society website help people to learn about balancing the main food groups and making good use of fortified foods and supplementation," advises Heather Russell.
"A well-planned vegan diet can provide all the nutrients you need (apart from B12) but the key is in the awareness and the planning. A badly planned vegan diet can be low in essential micronutrients," says Azmina Govindji.
She says don't simply cut out meat and dairy without thinking about where you'll get your nutrients from instead.
For example, make sure you have enough iodine which is an essential component of the thyroid hormone thyroxine, and also vital for foetal brain development.
"The World Health Organisation now classes the UK as mildly deficient in iodine. Over a third of the iodine we eat comes from milk and dairy foods, so a vegan diet can be low in iodine unless you look for fortified sources of milk alternatives," says Azmina Govindji,
"Also non-haem iron (iron from plants), is less well absorbed than iron from animal products, making patients at risk of tiredness and fatigue, and potentially iron deficiency anaemia," she adds.
If a vegan just stops eating animal products and continues with their old diet they'd just be eating salads, vegetables and fruit which is likely to be too low in calories and protein. It may make them feel weak and lacking in energy, not to mention hungry.
The best type of vegan diet to suggest to patients, the experts Medscape UK spoke to say, is one packed with high-protein plant foods like beans, nuts and pulses. The experts also recommend making sure they include fortified versions of dairy alternatives, and taking a B12 supplement, rather than relying on fortified food alone. Make sure the food they eat covers all bases and provides the rest of the nutrients. If it doesn't, suggest they take other supplements to compensate.
Children and Veganism
If parents are vegan they may decide to bring their children up vegan too.
Paediatric dietitian Judy More says: "Vegan diets for children need to be planned really well and include supplements."
The impact of a vegan diet is greater on children.
"There is good evidence that children won't grow as tall if they have a vegan diet," she adds.
She says if children don't get the right amount of iodine it can affect their mental development and performance.
"Also, children under the age of 5 are more prone to iron deficiency and anaemia than other age groups. Iron deficiency also impacts brain development," she adds.
Judy More recommends supplements are bought from a pharmacy rather than a health food shop as they'll have better quality control.
Growing Demand for Doctors’ Advice
Because of the growing popularity of veganism doctors are becoming more likely to be asked for their advice.
Doctors will also be more likely to see patients on a bad vegan diet presenting with deficiencies.
Azmina Govindji believes doctors need to be fully educated in the intricacies of veganism.
"The EAT-Lancet planetary diet as well as the increasing public awareness of plant-based diets being more sustainable, could mean there will be a growing demand for advice from a doctor. It is possible to eat well on a vegan diet but it does require the appropriate dietetic expertise if we are to minimise potential risks of nutrient inadequacy," she says.
What about the vegan doctor? "My decision to go vegan was completely based on an ethical and moral decision, but the more I read about the health benefits and the more I study, the more confident I become in recommending it to my patients who are struggling with chronic diseases related to lifestyle. I am not blind to the risks and it really does need to be done carefully," says Dr Jones.