Keto or Vegan: What’s a Girl to Eat? Part 2: The Vegan Diet

In my last post I assessed the benefits and pitfalls of a ketogenic diet. Today I’ll address another diet emerging to the forefront of pop culture: veganism. First, the pros: Ethics: There is no doubt that veganism is a far more ethical choice than a standard American diet. Nothing is more heinous and disgusting than how we raise our animals for food in this country, and we are absolutely paying the price for the Commercial Agricultural Feedlot Organization (CAFO) way of doing business. I’m not going to go into the details of the levels of torture and cruelty inflicted on sentient beings, but I will say that the majority of the animals raised for food in this country are pumped up full of antibiotics and cows also get an extra dose of hormones to grow bigger, faster. These animals are fed an unnatural diet of genetically modified corn, soy, and other grains rather than the grasses they are intended to thrive upon and, last I checked while feeding cows to cows had been banned due to mad cow disease,  chicken feces, and even shredded newspaper in feed to bulk them up had not been outlawed. These are not healthy animals, and we cannot expect optimal health when we eat them. The impact of widespread antibiotic use in milk and meat has impacted our waterways and our own gut flora. It is one of the ways our own digestive health is compromised. More Produce: Often times vegetarianism or veganism becomes a gateway to a healthier diet. This was true for me, as the concerns of my grandparents and great grandparents’ generations sent me to the library to justify my position. There I learned about the impact of food on health and that ultimately brought me to where I am today. When people explore veganism for health reasons they often become introduced to more produce and a wider selection of plants than they typically had as carnivores. This improves diet quality, especially if they had been coming from a standard American diet. While not many studies exist on long-term vegans (who avoid all animal products including eggs, dairy and even honey) multiple long-term studies confirm that vegetarians tend to be healthier and outlive those on a standard American diet (which, to be frank, is a really low bar to measure against). The most well studied vegetarians I am aware of are 7th Day Adventists here in the United States. Hands down, whatever diet increases produce consumption beyond 5 servings a day will demonstrate markedly improved health outcomes. Vegans and vegetarians who are concerned about health often fall into this category. Improve Diabetes: A vegan diet can improve insulin sensitivity and beta cell function in Type 2 Diabetics (note that the keto diet is beneficial as well; diabetics have many choices!), comparable to Mediterranean and low glycemic diets. A plant-based diet can be a great option for those who have blood sugar or blood pressure challenges. Keep Disease in Remission: there are some interesting case studies coming out of California demonstrating that medically supervised water fasting can put some autoimmunity and hypertension in remission and staying on a vegan diet after fasting can offer long-term remission. These case studies are essentially one-offs but show promise of a plant-based diet in sustaining health after a supervised fasting protocol to reduce disease severity or induce remission. When looking at larger studies on veganism and breast cancer remission, results remain inconclusive. The Cons (or debateable Pros): Veganism in and of itself isn’t healthier, or even automatically environmentally friendly. I meet many vegans who are not getting enough produce, but rather relying on grains and quick vegan foods like veggie burgers. Then there are ‘junk food vegans’ who eat Red Vines, tortilla chips and boxed vegan mac and chreeze. A vegan relying on processed foods won’t be getting much more fiber than a standard American diet. A vegan who doesn’t eat vegetables isn’t any healthier than someone on a standard American diet. In fact, junk food vegans are even less healthy than junk food omnivores, as they are missing several minerals present in animal foods. You can absolutely be healthy on a vegan diet, but it isn’t done by default. Here are some potential sources of concern on a completely animal-free diet: Low Vitamin A (found in eggs) can lead to poor thyroid function and impaired digestion. Long-term deficiency may lead to night blindness if left untreated. While the human body can convert beta-carotene to vitamin A, there are certain genetic SNPs which can inhibit this conversion to the extent that supplementation with preformed vitamin A would be necessary. Infertility, poor wound healing, poor immunity, and dry skin and eyes are also common symptoms. Omega 3 fats – I hate to say it, but just flax and walnut doesn’t cut it. Our bodies are terribly inefficient at converting omega-3 fatty acids from plant foods into DHA and EPA. The reason why fish oil is so helpful is because the fish has done the converting for us. If we take 1000 mg. omega-3 fats from fish oil, we absorb most of it. If we get 1000 mg of omega 3s from a flax oil, our body can only convert about 3-5% of it into EPA and DHA. These fatty acids are precursors to anti-inflammatory compounds and are crucial for brain and heart health. B12 – B12 is abundant in animal foods. It can be made by the bacteria in the gut but this presumes one has those bacteria strains in sufficient quantities to do so. It is always recommended that one supplement with B12 on a vegan diet. Due to the prevalence of MTHFR variants, I see meat eaters who show signs of needing more B12 than they are getting through food, so B12 is something vegans should definitely not neglect. Iron – Sufficient iron can be a problem for some vegans, especially menstruating women. Pairing iron-rich beans and molasses with Vitamin C rich foods can increase absorption, as well as cooking in cast iron skillets. If these means alone do not work there may be an absorption issue that needs to be investigated further and supplementation is definitely required until root cause is addressed. Vegan athletes may need to supplement to get the best out of their sport. Creatine, b-alanine, and branched chain amino acids can help vegan athletes make up for specific nutrients that are found in meat. These supplements help retain and grow muscle mass, which is crucial for strength and endurance athletes. Unfortunately, being a vegan doesn’t automatically equate to an environmentally friendly diet, either. Grapes from Brazil in January are not a more sustainable choice than an omnivore purchasing local meat from a nearby ranch. The beloved avocado has become so popular that illegal deforestation is happening to plant more fruit trees, and prices for avocados and quinoa have become so high that some people in Peru and Mexico can no longer afford these traditional staple foods. These are important considerations to explore when you are using veganism as an environmental solution. Simply becoming vegan isn’t a carte blanche pass to feeling good about reducing your carbon footprint. We all can be better about reducing our carbon footprint with seasonal food and low carbon-emission lifestyle choices (including reducing consumerism overall). My experience: The pitfall of any diet is when one makes the blanket assumption that it is healthier without applying critical thinking to the situation. We are all being cleverly marketed to and our own biases (“I love bacon and cheese, and keto tells me it is healthy!” “I love animals and don’t want to eat them, veganism is the best answer for them and me!”) can get in the way of what our body needs. This certainly was the case for my own journey into meatless living. I became a vegetarian at age 13 and always held aspirations for veganism. I grew up in an animal-loving household, so to discover that I could be healthier if I went meat-free was something I enthusiastically embraced. I read the works of John McDougall, Francis Moore Lappe, John Robbins, and Dean Ornish to justify my position and make sure I was following a healthy plan. Whenever I went vegan, the cravings for eggs and cheese would inevitably, guiltily, pull me back to vegetarianism. However, for 13 years I never considered eating meat and believed I would not need to for the entirety of my life. Then – a year or so after I finished my nutrition degree and started coaching, I found myself realizing meat smelled good again. That was easy to dismiss and I did just that. Then I discovered it looked good, which was odd and troubling. Like Alex Jamieson, so much of my identity and value set was wrapped in my dietary choices that I could not face what my body was requesting. So I maintained a vegetarian diet. I had thoughts in college that the severity of my seasonal affective disorder in Alaska may have been alleviated if I had fish oil or vitamin D, but moving to Washington state took care of it so it was easy to dismiss. When I learned that cholesterol was the foundation for making all hormones, I again wondered if my total cholesterol of 97 at age 18 was actually a sign of dysfunction (despite the nurse’s amazement and congratulatory attitude about the result). Despite these historic red flags I wasn’t ready to consider meat for another year. In 2006 I had a sudden realization that I lived in an animal body that was very clearly asking for meat. My denial of this request was in and of itself a form of animal cruelty. I would never tell anyone who worked with me to ignore such cravings, yet I asked this of myself and my body. The lack of integrity around this was a pretty strong smack in the face. I knew what I had to do, and I was not looking forward to it. I decided to sample some beef at Whole Foods to see what would happen. This was 2006; I hadn’t eaten meat since 1992! I was desperately hoping it would make me violently ill or it would taste like blood and repulse me but it did none of those things. I was surprised that I could not taste blood; it actually tasted okay! So I picked up a 3 oz portion to go home and make a taco in hopes that my body would reject it. Throughout all this, I kept telling myself I could go back to vegetarianism at any point in time. It turns out my body REALLY needed the animal protein. While I’ve heard more dramatic stories than mine,  a return to omnivorous dining improved my focus and concentration, suddenly alleviated the borderline anemia I danced with for over a decade, improved my running times, and gave me more stable, consistent energy I had not realized I was missing. About a year and a half after I began eating meat I discovered that my chronic digestive challenges were due to soy, dairy, and wheat sensitivities (my vegetarian staples!!); I do not know how I would have continued a healthy meatless diet as an endurance athlete with these items excluded from it. I’m really grateful I chose to bring meat back in before I discovered this; it would have been psychologically devastating had the sensitivities been discovered before I was ready to reintroduce meat. I can look back now and see that my body was not thriving. It was easy to overlook because all the telltale signs that I was told to look for were absent. My cycle remained regular, I was never sick, and I was running marathons with no injuries. I ate healthfully, but even with a degree in nutrition vegetarianism wasn’t suitable for me in the long run.  The 90’s was the era where cholesterol couldn’t be low enough, so traditional medicine applauded me for levels that would now be considered alarming. At the end of the day, when we assess nutrition among humans we see that the longest-lived, healthiest cultures in the world are not vegan. They aren’t eating paleo or high meat diets, but they aren’t exclusively animal-free diets. This tells me that humans as a species thrive on a plant-heavy (ie – produce heavy) omnivorous diet. This does not mean that you as a single person won’t do well as a vegan. You very well might! Or you may for 5 years and discover after having children, taking up soccer or going through menopause your body has different needs. Listen to what it asks for and it won’t let you down. If you embark on a dietary change like veganism (or keto, or paleo) get your labs done before you begin and have them checked a couple times a year for the first year or two to see how you respond. Some people feel great but labwork indicates they aren’t doing well at all. Markers like cholesterol, Vitamin D, iron stores and fatty acids are silent but significant indicators of health. If everything looks great after the first 18-24 months then just wisely monitor your health at annual check-ups and keep going so long as it feels good and labs remain optimal. The perfect diet is the one that works best for you. Your gut flora, genetics, and lifestyle are unique to you, so there is no one answer that will blanketly apply to all people. If you see a compelling documentary do some critical thinking and assess whether it was biased or balanced and explore both sides of the issue. Experiment and see how you feel, and if it feels too extreme consider a more middle-of-the-road approach (vegetarianism or pescatarianism instead of veganism; low carb or paleo instead of keto) and see if that works better for you. Have you ever been vegan? Done the keto diet? Gone paleo? How well did it work out?  
Resources: Crockart, H. M. (1995). Differences in nutritional status between vegans, vegetarians and omnivores. Asia Pacific J. of Clin. Nutr4, 228-32. Gallego-Narbón, A., Zapatera, B., Álvarez, I., & Vaquero, M. P. (2018). Methylmalonic Acid Levels and their Relation with Cobalamin Supplementation in Spanish Vegetarians. Plant Foods for Human Nutrition73(3), 166-171. Kahleova, H., Tura, A., Hill, M., Holubkov, R., & Barnard, N. D. (2018). A Plant-Based Dietary Intervention Improves Beta-Cell Function and Insulin Resistance in Overweight Adults: A 16-Week Randomized Clinical Trial. Nutrients10(2), 189. Emadian, A., Andrews, R. C., England, C. Y., Wallace, V., & Thompson, J. L. (2015). The effect of macronutrients on glycaemic control: a systematic review of dietary randomised controlled trials in overweight and obese adults with type 2 diabetes in which there was no difference in weight loss between treatment groups. British Journal of Nutrition114(10), 1656-1666. Rogerson, D. (2017). Vegan diets: practical advice for athletes and exercisers. Journal of the International Society of Sports Nutrition14(1), 36. Fuhrman, J., Sarter, B., & Calabro, D. J. (2002). Brief case reports of medically supervised, water-only fasting associated with remission of autoimmune diseaseAlternative therapies in health and medicine8(4), 112-112. Hauner, H., Weigl, J., & Hauner, D. (2018). Can Nutrition Lower the Risk of Recurrence in Breast Cancer. Breast Care13.
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