Why SOME people struggle with a vegan diet

Is a vegan diet for everyone?

If consciously crafted, a vegan diet has profound health advantages and allows us to best care for our environment and live in alignment with our innate compassion. So yes, a type of vegan dietary pattern could be ideal for the vast vast majority of humans. And yet, we can't deny that some people (read: the minority) struggle to make a vegan dietary pattern work for them.

Why do SOME people not thrive on a vegan diet? And what can you do about it.

Frankly, this question hasn't been well researched and is poorly understood. But here are a few hypotheses that are worth considering if you or someone you know is not doing well on a vegan diet.

1. Not Enough Calories

One great advantage of a vegan diet is lower calorie density.  People often lose weight when they go vegan. This is super awesome for the majority of people, but not necessarily for relatively-thin, highly-active young people who are also very health conscious. Chances are these people have less appetite-drive and don't absorb calories as well as others. They probably avoid food when they are anxious/stressed and avoid binging on calorie-rich foods. They tend to choose the least calorically dense foods possible because these are healthier - like raw veggies and brown rice.

For some of these folks, they simply will not always be meeting their caloric/energy needs and they might feel more fatigued then usual overtime. Perhaps this is the brain's way of saying "slow down, there just isn't that much food around to support all this extra activity". They might feel better when they return to eating animal products, simply because they begin eating more calories and have a less restricted diet.

Rather than adding back the animal products, a better solution is do some creative meal planning and figure out ways to add back the missing 500 or so calories. There are lots of ways to do this, from emphasizing fat rich foods (e.g avocado, nuts, seeds, coconut) to making food more dense (e.g. smoothies, dehydrated foods/food bars, nut butters, dried fruit) to even sometimes choosing more processed foods (e.g. white rice) and including more protein-concentrated foods (e.g. seiten).

2. Junk-Food Vegan

On the opposite side of the coin is the junk food vegan that lives off vegan pizza, tofutti, french fries, soda, vegan cupcakes, etc. This we know: just because it's vegan, doesn't mean it's healthy. Believe me, I <3 my vegan junk food on occasion. But the problem here is no different from the standard american diet: you are crowding out the nutritious life-sustaining food and stuffing yourself silly with crap.

3. Social Isolation Syndrome

It amazes me how poorly we appreciate the effects of social isolation. Watch this video to see how physiologically powerful physical and social isolation can be. Being vegan doesn't mean you have to be socially isolated, but for a few it can make them feel more isolated. This is not a recipe for optimum health.

Early adopters have to cope with a little isolation, but one idea how is to cultivate a greater sense of compassion for human-animals who eat other animals. They are just as flawed as you are and there's no reason they can't be your friend, share meals with you, be your lover, etc. In fact, if you really want to influence the world, the more you hang out with these creatures the better. (unless of course you're a miserable conspiracy-lover who refuses to shower and thus has the effect of decreasing the odds that other people will move to a vegan diet. Apologies for the rant.) 

4. It's Not The Food

Food makes a huge impact in health. Ok. But just because you're vegan doesn't mean that really bad stuff can't happen to you. And it doesn't mean that every health problem you have has something to do with your diet.

Genetics, horrific bad luck, mood/psychology, drugs, infections, and many other factors can trump diet. It's always wise to considering whether your diet caused the problem or can contribute to healing it, but you've got to be open to the idea that it might have nothing to do with what you eat.

Also remember that many people became vegan because their health was not optimal to begin with. Those same underlying issues might not go away on a vegan diet, and some might get worse over time.

5. Unmasking Effects & Rare Genetic Disorders

Changing your lifestyle can, in rare cases, unmask hidden problems. For example, fructose malabsorbtion - a not too uncommon issue whereby eating concentrated fruit sugar causes irritable-bowel like symptoms and is associated with depression. If you suddenly start eating fruit-juice sweetened desserts and more fruit and fruit juice, then these symptoms will get worse. The solution is a plant-based diet that favors vegetables over fruit and avoids concentrated fruit sugar and juice and minimizes refined sugars.

Another example is diabetes in a long-time Atkins-style eater. If you eat no carbohydrates but are very overweight and have insulin resistance, switching to a more carb rich plant-based diet may initially make blood sugar control worse.  The answer is weight loss, avoiding processed carb-rich foods, eating only healthy fats, exercise, minimizing/moderating fruit, along with a high-fiber vegan diet.

Finally, there is also at least one type of rare genetic disorder involving carnitine transport which can be mitigated by carnitine-rich foods (i.e. meat). However, this is better treated with high dose carnitine supplements then with meat. Dr. Greger has a great post on this. 

6. Under Supplemented

Yes, it would be ideal if we got all our nutrients from our diet. Frankly, there are just some cases where this is not possible (vitamin D, vitamin B12). And there are some individuals who need higher levels of some nutrients (iron, zinc, omega-3s) because they don't absorb them well for whatever reason. This is true for meat-eaters too.

Sometimes, you've just got to add some supplements to your diet. Some vegans have a ridiculous hang-up about taking an "unnatural" supplement. While I applaud their idealism, they are doing themselves and our movement a huge disservice.

People ask me what I take: Vitamin D 1000 IU to 2000IU with food (most days, but especially in the winter); B12 (I buy a bottle a few times a year to boost my body stores); occasionally I get paranoid and buy a bottle of algae-based DHA/EPA. And I regularly eat some nutritional supplements: flax oil, fortified soy milk, chia seeds, flax meal, hemp seeds, nutritional yeast, marmite (because I was born in South Africa and it's delicious ok!).

At the same time, I'm super skeptical of the functional/orthomolecular medicine folks who advocate massive supplement regiments to cure everything.

7. High-Fiber Exercise-Deficiency

We did not evolve to blog. Or read blogs or work at a desk. Sitting is one of the worst things for your health, and we do it all day. My sense is that our guts function way better when we are regularly active and that exercise becomes even more important when you increase your fiber intake.

A very high-fiber diet with a sedentary high-stress lifestyle can set you up for a lot of bloating and gas pain. The solution is daily movement/exercise and plenty of water.

8. Beat By Cravings

Our understanding of cravings is amateur. Just because your brain craves something doesn't mean you have a deficiency. Craving chocolate does not mean you are magnesium deficient. Craving meat does not mean you are iron deficient and need to go back to killing animals for sustenance.

It's not to say that cravings can't have true information embedded in them, it's just that it's complex. For example, we make psychological associations with food. When we are stressed, we seek comfort, and food is one way to get comfort. Thus when stressed I might crave my comfort food, not because I need the nutrients in the food but because I need to be comforted. Your comfort food is probably different from mine - not because we have different blood types (or other such nonsense) but because of the different exposure to comforting food we had as kids.

Another random psychological nuance: the more one tries to avoid thinking about something, the more likely one is to think about it. If you are obsessed with avoiding meat, you are more likely to think about it and to crave it. We are funny creatures that way.

One last example, dissection lab -- the formaldehyde has been known to illicit cravings for meat. You can imagine how disturbing that is to an unaware vegan med student, on many levels.

Point being -- cravings are complex and often misinterpreted. Take them with a grain of salt. Roll with them and focus your attention elsewhere when the craving defies common sense.

What Else? & What if My Problem isn't on this list?

This is not an exhaustive list, and admittedly it is a list of hypotheses, but chances are the reasons people don't thrive on a vegan diet are fairly small in number and have a feasible solution if there is a will, an understanding and a few good measures of creativity.

Sometimes it can be hard to figure out (or you lack a doctor who can help you figure it out), and sometimes adding back some animal-products seems to make the difference and provide a sense of well-being that was missing. In that case, think of the animal-products as supplements - not to be eaten at every meal, but in the smallest dose possible. You'll still be eating a predominantly plant-based diet and doing a lot for your health and the world.

What happened when I nuked my spinach?

Tonight out of shear boredom I nuked a large bowl of spinach leaves.

Initially I was going to make a hearty salad to accompany my dinner. But I had the same meal last night and felt like a change. Plus the spinach was a touch too woody for my liking.

What happened when I nuked my spinach?

60 seconds later I reduced a large bowl of spinach into a very small pile. I added some lemon juice, salt and extra virgin olive oil. 5 bites and 60 seconds later it was in my stomach and I was still quite hungry.

The same bowl of raw spinach last night took me 10 minutes to eat and helped to tip me over into "I'm a little too full to do anything productive" land.

Why did this happen?

Clearly the nuking started digesting the leaves, extracting the water, breaking down some of the structure, freeing up some nutrients to be better absorbed and destroying others.

What's the point?

There is both value and detriment to cooking or processing food.

The value is that cooking and processing allow us to make food more dense and easier to consume. This can be critically valuable to people who struggle for whatever reason to get enough calories or nutrients. You might know a few of these folks.

This is why the processing and cooking of grains are credited for rapid expansion of the human population. It's one reason why we feed frail people liquid diets. And it's why cooked or processed foods can be important for highly active thin or growing folk.

The detriment is that it makes food more dense and easier to consume. This can be harmful to people who are sedentary and live near an over abundance of food. You might know many of these folks.

This is why cutting out soda, juices, smoothies, breads, baked goods, white rice, etc. tends to lead to weight loss. It's yet another reason why increasing our intake of fresh raw fruits and veggies is a good idea.

The more important reminder: food is context dependent.

There is rarely an absolute right or wrong when it comes to food.

Understanding our choices and the context we live in, however, can enable us to see what is right for us and those around us.

Inspiration from TED

I find myself a little short on time and inspiration for blogging these days, and so will try to experiment with some shorter posts.

I'm also going to cheat a little and borrow some inspiration, often from TED.

STEP 1 - Watch this awesome 15 min TED talk by Dan Ariely:
The first half is entertaining but somewhat less relevant...still, stick it out.



STEP 2. Pause for thought:

The cognitive problems Dan Ariely discusses apply completely to our choices about food and the habits that lead to obesity. As he says, we are "predictably irrational" creatures.

Although there is the prevailing idea that we actually "choose" what we eat, in reality the vast majority of food decisions are not a conscious rational choice.

The "food environment", that is the physical and experiential setting in which food is available to be eaten, is par none the strongest determinant of what we eat. If there is lots of food around, we will eat lots. If there is none, we will eat none. Give us a bigger box of cereal with a bigger bowl and spoon and we will eat more cereal, no matter how hungry we are. If the normal behavior is to finish our plate (or eat meat), we will be much more likely to do that.

Of course, the food and restaurant industry discovered this reality decades ago and has been exploiting it ever since.

Yes, highly motivated individuals can be taught strategies to overcome the influence of the food environment. This is why doctors and nutritionists write diet books and open clinics. This is something we are obligated to do! But, this strategy has and never will work for the majority of people.

To affect change in the majority, we must learn how to change the food environment and the social norms that operate in them. That is our great task.

Moving Beyond Carb Confusion

In this post we talk about the need to refresh our approach to carbohydrate rich foods; and more specifically to reduce intake of "simple" and "refined" carbs.


First, a little perspective.

Carbohydrates are not evil. They have been the backbone of humankind since the dawn of civilization. The large scale cultivation of carbohydrates (e.g. cereal grains) provided the vast amounts of energy (calories) that fueled the growth and eventual urbanization of humans. They have also been important sources of protein, fiber, vitamins, minerals and essential fatty acids.

Throughout our evolution, humans (like all herbivors) have needed sugar and other carbohydrates to survive. Funnily enough, we still do. Of course, the dominance of cereal grains as the provider of carbohydrates is a relatively new phenomenon (10-15 thousand years). And the advent and supremely high intake of refined carbohydrates is extremely recent (within the last 50 to 100 years).

With all the media attention carbs have gotten recently, you would think our grain intake had reached historics highs. Actually, we eating less grains then we did 100 years ago.

Per Capita Grain Consumption.
Source: Putnam & Allshouse. U.S. Per Capita Food Supply Trends. Food Review. Sept. 1998

So why all the bad press? The reason is that our intake of refined grains has indeed skyrocketed: see the recent upslope in the graph above (a 50% increase in grain intake since 1973), the vast majority of that increase is from refined grains.

And study after study continues to point a damming finger at people who eat the most refined grains - revealing they have higher rates of obesity, heart disease, diabetes and so on.


What is refined or processed?
Most grains come from grasses. Each stalk of grass yields numerous berries or seeds -these are the nutrient and energy dense bundles that can generate entire new grasses. Fortunately for us, they are also edible.

To a certain degree all grains require some "processing" - harvesting, removing the outer husks from the grainseed and then sprouting or cooking. Yes, some grains like corn can be eaten raw. But most become more digestible and valuable when soaked, sprouted or cooked.

However, when we talk about "refining" we're talking about processing the grain even further by removing the outer layers (the bran + germ) from the grainseeds.

Layers of a whole grain.
Image Source: http://www.nutricoach.net/Carbohydrates.html

Grains, either in whole or refined form, can also be crushed or milled into flour or ground into meal. However, refined grain flour has been stripped of so many nutrients that they sometimes add back a small handful of the vitamins and minerals lost to the end product, called enriched flour. (Depending on the grain, processing it into a flour or meal also further strips it of some protein, fiber and nutrients.)

What is wrong with refining and processing grains?

Well, as mentioned, it turns out that most of the valuable nutrients, fats, and fiber are in the outer parts of the grain. Refining leaves us mostly with starch (long chains of sugar), a bit of protein and a few nutrients - we call this package a refined carbohydrate. So if you eat only refined and processed grains then you're missing out on most of the beneficial properties of the whole grain.

In the absence of fiber, these refined "carbohydrates" are rapidly absorbed from your digestive system - giving you a blood sugar spike. Eating refined grains raises your risk for diabetes; eating more whole grains lowers it.

Because fiber is (by definition) not absorbed, fiber-free grain (i.e. refined grains) is also more energy-dense. You'll eat more calories of a bowl of white rice then you will brown rice. Eating more refined grain will make you heavier; eating more whole grain will help you stay leaner.

A brief tangent. What's the difference between simple sugar and refined carbohydrate?
Sugar can be called simple or complex depending on how it's packaged. One or two sugar molecules by themselves = simple sugar (e.g. table sugar). Many sugar molecules chained together = complex sugar (e.g. starch inside grains or potatoes). For reasons you might guess, it's not too useful to talk about simple vs. omplex sugars because complex sugars by themselves are easily broken down into simple sugars. What matters is the whether the sugar is packed in fiber and nutrients - i.e. is it refined or unrefined?

Finally, refining grains into sugar makes them more addictive. This may be true of both simple (e.g. high fructose corn syrup) and to a slightly lesser degree complex sugars (e.g white wheat flour) refined from grains. This is a controversial point, but the emerging evidence is pointing in this direction. Sugar acts on the brain in a manner similar to many drugs. And refining makes all drugs more addictive, for at least two basic reasons. First, the active ingredient is vastly more concentrated and second it gets to the brain quicker, setting up a stronger cycle of high-withdrawal-high. Think: cocaine vs whole coca leaf tea; intravenous morphine vs. opium poppy milk.

Of course, we can take this comparison too far, but it is certainly possible that the addictive properties of sugar explain why so many of us have a hard time 'moderating' our intake of refined grains.

But you said sugar wasn't evil.

It's not. We all need sugar. But too much is bad. And slow-release sugar (i.e. sugar coupled with fiber and healthy fat) is arguably much better for us.

Refined grains are everywhere.
Cereal. Pasta. Bagels. Muffins. Rice. Crackers. Candies. Soda. Cakes. Pastries. Bread. The majority of these foods are made with refined grains today. Take a close look around and you will see how dominant refined grains are in the food supply.

Most of us are eating several of these foods everyday. They fill us up, preventing us from eating more nutrient dense foods. And as everyone knows, it's very easy to eat too many of them.

How to spot refined grains:

Refined grains are now the norm, so you will never see the word "refined" or "processed" in the ingredient list. Instead you need to recognize all the terms that code for refined:
-flour (or enriched flour)
-rice (or rice syrup)
-corn syrup (or high-fructose corn syrup, aka HFCS)
-corn or rice starch
-wheat
....And so on.

Another route is to realize that if the grain is still in its whole form then it will be labeled as such: the words "whole" or "unrefined" will be put in front of the grain name. e.g. whole wheat.

There are a few exceptions to know about: corn and oats are always "whole" grain. But they can be processed to one degree or another. Oat groats are much less processed than the steamed and squashed "instant oats", and therefore better for you. Whole grain rice will usually be called "brown rice" or "whole grain brown rice".

How to eat more whole grains:
1/ Start with your staples: start by looking at the foods you eat almost everyday. For example, many people eat a grain based breakfast (e.g. cereal, toast, muffins). Making sure these breakfast staples are 100% whole grain is a great start.

Likewise, many people eat rice or pasta almost every day. Switch to brown rice (I suggest investing in a rice maker). Experiment with the large variety of whole grain pastas (brown rice, quinoa, spelt, whole wheat) - some taste better than others, so keep on trying different ones until you know which you like best.

2/ Give yourself a few weeks to acquire the taste and habit. For example, some people love brown rice the instant they eat it, but for others it takes 3-4 weeks (or more) of frequent attempts before it starts tasting good. But in time, most people come to prefer brown to white rice.

3/ Create demand. We are creatures of habit and convenience. Ask for whole grains at restaurants and stores and soon enough you will start seeing them everywhere. We're already seeing this happen...


How to eat less refined and processed grains:

The first step is to switch your staple foods to whole grain varieties, as above.

Beyond that you will probably need to cut back on foods you probably shouldn't be eating on a daily basis - cookies, pastries, cakes, muffins, crackers, pancakes, waffles, crepes. These are treats, not everyday foods.

Yes, you can and should look for whole grain varieties of these foods. But chances are you will find varieties that might have some (but not all) whole grains in them. For instance, let's talk about cake:

Cake, even if made with whole wheat flour, is going to have a good amount of sugar (essentially the equivalent of maximally refined and processed grains) - otherwise it's just not a cake! Sugar comes in many forms - honey, agave, concentrated fruit juice or jam, brown rice syrup, brown sugar, molasses, cane sugar, beet sugar, high fructose corn syrup, maple syrup. Yes, some of these are slightly "better" forms of sugar than others, but they are still sugar - a touch is good, a lot is not.
In summary, whole wheat vegan double chocolate cake is a fantastic creation when made well. It should be thoroughly enjoyed, but not everyday.