Little grabs the attention quite like the latest health scare and whether it is a website trying to create click bait or a magazine or newspaper seeking to increase sales, a story about X, Y or Z either killing us or conversely giving us near-eternal life is never far away. Given this fact, it is no surprise that there are lots of vegan-based medical scare stories and articles claiming links between veganism and various illnesses, diseases and health issues. But is there any truth in such stories and what are the real health risks of being vegan (or more accurately, the health risks of following a vegan diet)?
So many of the stories that feature in even respected news sources are based on questionable – at best – science. Indeed, even some articles in well-regarded scientific journals tend towards the sensational rather than the fact-based and so picking out the truth from all of these stories is far from easy. Also, it is often the case that solid scientific research can be misrepresented by a headline that oversimplifies a particular issue or an article that fails to explain the caveats or confounding variables.
But that’s why we’re here, so before you start panicking and calling for the doctor after reading the latest vegan health warning, read on as we consider the possible health risks of a vegan diet (and if indeed there are any at all).
Health Risks? I Thought Being Vegan Was Good For Me!
Many people choose to follow a plant-based diet because they are keen on the health benefits of being vegan. As such, to lots of people it will seem strange to suggest being vegan might actually be bad for their health. Nutritional science is a very complex area, with lots of interacting variables that mean it is very hard to categorically say one particular food, group of foods or even a wider diet of one sort or another is definitely giving health benefits or cause any health problems or nutritional deficits.
Unless we can clearly identify and understand the mechanism by which something is happening, the picture is often too unclear for any respectable scientist to make an absolute claim about a given food. For example, we know that vitamin C is essential for healthy skin and bones, wound healing and a number of other functions. But we also know exactly how this process works and the mechanics of how the body needs and uses vitamin C. And, it is also well understood what happens when someone has a vitamin C deficiency (that is, scurvy!).
No Such Thing as One Vegan Diet
In contrast, when it comes to a much broader issue such as “being vegan”, nobody at present can provide a detailed picture as to why exactly not eating meat, dairy, eggs and other animal-based products would be detrimental to health.
In essence, that is all we can say a vegan diet is: one without animal products. Beyond that, there is no such thing as a “vegan diet” because what one vegan eats can be so incredibly different to the diet of another vegan. The so-called vegan diet is actually an infinite number of different ways of eating non-animal foodstuffs. That spans everything from someone who lives on sweets, vegan ready meals and beer, right through to someone who is eating a meticulously planned and perfectly balanced diet packed with fresh fruit and veg, wholegrains, legumes and all the essential micronutrients the body needs.
Clearly, someone in the first camp has many more possible health risks than someone in the latter group. So, if we are asking the questions “what are the health risks of being vegan?” it is important to explain what we really mean and what sort of vegan diets are referring to.
Problems with Assessing Risk
As we have said, trying to get a clear picture of the pros and cons of any diet is very hard unless we understand what specific problems that way of eating has and understand exactly why they create a particular health problem.
There are various types of study that seek to look at this issue but all of them have problems. One report that recently made big headlines was about the idea that both vegetarians and vegans are at a greater risk of stroke. The study behind this was published in the British Medical Journal and showed that those following a plant-based diet had a 20% greater risk of having a stroke.
The study was an observational one that looked at almost 50,000 people over a period of up to 18 years. It analysed information from the EPIC-Oxford study and looked at health outcomes for the group, of whom around half ate meat, around a third were vegetarian or vegan and approximately a sixth were pescetarian.
Whilst it claimed that non-meat-eaters had three more strokes per 1,000 people, because it was an observational study it is impossible to understand what precisely caused the strokes. Dr Frankie Phillips, of the British Dietetic Association, highlighted the drawback of such (observational) studies by saying, “They looked at what people ate and followed them for years, so it’s an association, not cause-and-effect.”
Whilst the study did try to balance out factors, such as smoking, exercise and previous medical history, there was still no way of knowing what caused the higher incidence of strokes. As the BBC reported, “The association may have nothing to do with people’s diets and may just reflect other differences in the lives of people who do not eat meat.”
This ultimately comes down to the issue raised earlier and unless we can very specifically isolate what it is about not eating animals that is a health risk and understand how that mechanism works, we cannot accurately say there are any health risks, per se, to being vegan.
The British Medical Journal piece may not prove any direct link between the vegan diet and, for example, increased stroke risk but what it can do is act as a good starting point for further investigation.
The scientists involved thought that the increased incidence of strokes might be down to lower levels of vitamin B12. They commented that further research was necessary to determine if this was the case but studying individual nutrients and establishing causality is far easier than when certain types of diet are being looked at in more general terms.
Moreover, whilst we cannot say there is a single entity that we can call a “vegan diet”, we can perhaps go as far as saying that there might be certain individual nutrients that vegans are more likely to be deficient in.
There are certain nutrients that are mostly present in animal-based foods or are best absorbed and utilised by the body in their animal-derived form. People are often concerned about protein but most people in the developed world probably eat too much, not too little, of this macronutrient and there are certainly so many great vegan sources of protein that it is rarely an issue.
But what are the nutrients vegans might not be getting enough of that could, in a badly planned vegan diet, potentially cause health problems?
Potential Risks of the Vegan Diet
We consider all nutrients that might be of interest or concern to vegans in the vegan health and fitness area of VeganFriendly.org.uk. It is worth noting that there are very few studies that clearly show vegans in general are lacking any nutrient and even fewer that demonstrate any sort of clear link between this deficiency and any specific health risk.
Despite that, there are almost countless scare stories suggesting vegans are certain to be deficient in just about every nutrient you care to think of. There are a number of reasons for this but it would be naïve to think that the desire to protect the meat, dairy and egg industries plays no part, with many of the studies behind these stories funded by what can only be viewed as vested interests.
The other interested party keen to suggest that vegans might not be able to meet their nutritional needs through a plant-based diet is the vitamins and supplements industry. We take a closer look at vegan supplements and whilst they can certainly be useful in some instances, some of the time, most people can live very healthily on a vegan diet. If it’s good enough for vegan sports stars, such as Serena Williams and Novak Djokovic, it’s good enough for us!
Indeed, the NHS states that, “With good planning and an understanding of what makes up a healthy, balanced vegan diet, you can get all the nutrients your body needs.” Perhaps the key things to note there are “good planning” and the concept of understanding what constitutes a good diet.
The NHS website also proffers that, “If you do not plan your diet properly, you could miss out on essential nutrients, such as calcium, iron and vitamin B12.” As said, if you believe everything you read in the papers you would worry about almost every nutrient. Whilst some, such as protein, can be fairly easily dismissed, there are others, including the ones listed above, that can be trickier for vegans. But, what are they?
Calcium is most associated with dairy milk and indeed this is an excellent source (for non-vegans) of this essential nutrient. However, as we explain in our article on vegan calcium sources there are lots of great ways for vegans to obtain calcium. It is plentiful in leafy green veg and nuts, as well as some tofu, but is also added to many vegan milk substitutes as a fortifier. It is a legal requirement that calcium is added to most UK flours, meaning that bread is also an excellent vegan source of calcium.
The UK population in general consumes more than enough calcium and a study by the Royal Osteoporosis Society showed no major difference in bone density between meat- and dairy-eaters and vegans. This, and the absence of any major studies indicating vegans are deficient in calcium, suggests that calcium isn’t likely to be a problem for most of those who follow a plant-based diet.
The body needs iron to help make red blood cells and in the same way that (dairy) milk is associated with calcium, meat tends to be linked with iron. However, as we discuss when looking more closely at iron, there are lots of plant-based ways to get iron into your diet. Iron is another nutrient that is added foods such as cereals, as well as to most flours; bread, many nuts and seeds, beans, wholegrains, greens and some dried fruit are all decent sources of vegan-friendly iron.
The picture with iron is complex though, because its absorption is heavily affected by other factors. Plant-based iron in particular is not always easily utilised by the body, especially when consumed alongside tannins, especially those found in tea.
In a nation of tea drinkers that can be problematic and there is a lot of evidence to suggest that many in the UK are not getting enough iron. Most men are getting enough but according to data from the National Diet and Nutrition Survey women, especially young women, are not.
Menstruating women need more iron and it seems many, both vegans and non-vegans, are not getting it. Whilst there is no evidence that vegans are particularly at risk of this it is certainly an issue worth being aware of. Depending on your diet, consumption of tannins and, for women of child-bearing age, heaviness of period, iron supplements could well be worth considering.
Vitamin B12 was highlighted by the researchers in the report mentioned above as a possible explanation for why vegans might suffer more strokes. True or not, this is definitely a nutrient that vegans should pay attention to.
Vitamin B12 cannot be made by the body and, by and large, is found in animal-based foods, such as meat, dairy, eggs and some fish. It is not found in fruit, veg or grains and so there are limited ways for vegans to get B12. Seaweed is probably the best vegan source of this vitamin, used by the body to release energy from food, utilise folic acid and make red blood cells. Some fortified breakfast cereals are also a good pick. Another great source of vitamin B12 for vegans is Marmite, as long as you’re a lover not a hater!
We only need a tiny amount of this micronutrient and research shows that most people in the UK consume enough for good health. However, it seems likely that vegans could be over-represented in the deficient group. Supplements are an option, with the NHS claiming that “vegans may not get enough of it”. However, if you’d prefer to get your nutrients from food this is easy enough for most vegans, with seaweed, yeast extract and fortified cereals and milks all good sources.
In the pecking order of vitamins and minerals iodine is pretty low down and does not get anywhere near the attention enjoyed by vitamin C, vitamin D, iron or zinc. That may be because it is a trace mineral, meaning we need only the tiniest amount to be healthy. To show how little, in our longer article on iodine and vegans we explain that “whilst you need 140μg of iodine each day to stay healthy, you need 30,000,000μg of fibre!”
But the key question is, are vegans getting their 140 micrograms of iodine and if not, are they experiencing any health problems because of it? Assessing iodine levels in food is very hard because, whilst it is present in some plants, chiefly grains, the amount varies a great deal dependent on the soil in which they were grown. Seafood is by far the most reliable way for non-vegans to get iodine but what about vegans?
Iodine is crucial for the thyroid and metabolic system to function properly and the UK Food Standards Agency believes that vegans do have lower intake than non-vegans. Teenage girls and pregnant women are of particular concern, although a US study did find that thyroid health was not impaired in vegans that they studied.
In short, of all the nutrients vegans should think about, iodine ranks highly in terms of the risk of deficiency. Such reduce intake is not a major health risk but vegans should consider introducing the occasional portion of seaweed into their diet or perhaps taking iodine supplements.
Selenium is an unusual nutrient for vegans to be concerned with because by far the best source is vegan. Brazil nuts are selenium super heroes, as we explain in our feature on vegan selenium. Whilst fish, meat and eggs all serve up a good amount of this mineral, essential for a healthy immune system, Brazil nuts are really packed with the stuff.
The levels of selenium can vary considerably depending on the growing conditions and handling of the nuts but taking a midrange figure, less than an ounce (28g) of Brazil nuts provides all the selenium you need. It is also present in other nuts, seeds and vegan foods such as some grains and dried fruits.
Some vegan supplements include selenium but for most vegans adding a few Brazil nuts into their diet alongside other healthy foods should probably suffice.
Zinc is another mineral that some vegans are concerned about. Zinc is vital for cell repair and production, as well as the metabolism and as we explain in our main zinc article, meat, shellfish and dairy products are where many in the UK obtain it.
That said, zinc can be obtained by vegans in a fairly wide range of foods, such as nuts, seeds, bread, grains including rice and quinoa, and many legumes and pulses. These are all foods that should be featuring in a healthy vegan diet and so many people eating a plant-based diet should not have an issue with zinc.
The National Diet and Nutrition Survey, undertaken by the UK government, suggests that zinc consumption is overall quite good. Only around one in 13 people are thought to be consuming less than the Lowest Reference Nutrient Intake value. That said, given the high levels of zinc in certain animal-based foods, it would seem reasonable to think that vegans may be lacking in zinc.
Not having enough of this mineral can cause a range of health issues, including hair loss, skin problems, a weak immune system and impaired cognitive function. However, the good news is that research (published in The Medical Journal of Australia) indicates that vegans and vegetarians can adapt to lower intake levels by absorbing and retaining more zinc.
What About Choline?
One of the more recent scare stories concerned what the BBC called, “The brain nutrient vegans need to know about”. A story in the highly respectable BMJ journal was reported in the more mainstream media as essentially stating that vegans were all going to suffer serious brain issues and as the Metro put it: “Meat-free diet ‘lacks vital nutrient for healthy brain’”.
This story was verging on the scandalous, with many headlines, including the Metro’s having highlighted (and quoted) comments that were never made. Moreover, it was ignored, at least at first, that the author of the BMJ article had previously worked with the following, far-from-disinterested, parties: The Meat Advisory Panel, Marlow Foods (Quorn), the Health Supplement Information Service, and the British Egg Information Service.
On top of that, the fact is that neither the NHS, nor the British Dietetic Association deem choline to be worthy of any real discussion. The latter did comment on the story but only really to say that vegans could obtain the required levels of choline (although there is no stated “required level”) easily enough through a well-planned diet.
Vegans can get choline from certain nuts, grains, legumes and vegetables, so this really was a brilliant example of vegan scaremongering. There was a substantial backlash against the story and the BMJ updated their copy to put the author’s background in the open. The Vegan Society and other vegan bodies also responded angrily to the story.
In short, at the present time, when it comes to choline there is absolutely no robust evidence to suggest vegans or anyone else are at risk of ill health due to a deficiency.
Vegan Benefits Outweigh Vegan Risks
Perhaps the key thing to note is that based on our current medical and nutritional understanding, for most people, the health benefits of eating plants will far outweigh the risks. If we go back to the beginning and the study that highlighted the increased stroke risk vegans may – or most definitely may not – have, what was far less widely reported was the health problems that were less prevalent among vegans.
Hidden mid-article in most reports of the research, well beneath headlines screaming about the stroke risk held by vegans, was information about coronary heart disease. It was found that pescetarians had a 13% lower risk of heart issues, whilst vegans and vegetarians had a 22% lower risk compared to meat eaters.
The increased risk of a stroke was put at 20% and in the cohort that was observed there were 2,820 cases of coronary heart disease (CHD) and 1,072 cases of stroke. Therefore, another way to look at this story is that CHD is almost three times more likely to affect us than a stroke and vegans are significantly less likely to suffer from such a problem.
On top of the issues raised in this report, there are many studies that trumpet the health benefits of being vegan. As we have said, being vegan will not in and of itself make you healthy but it will automatically cut out many foods that we know are a health risk (when not eaten in real moderation).
Processed meats and red meat are heavily linked with a whole host of cancers; saturated fats, most commonly found in animal-based foods such as meat, cheese, cream and butter are also largely considered to be unhealthy. Vegans, by definition, cut all of these out.
Moreover, the foods that will typically feature in many vegan diets are routinely linked with a range of major health benefits. Food, such as nuts, seeds, berries, wholegrains, legumes, fruit and vegetables may not be on every vegan’s menu every single day, but they are certainly mainstays for many.
In conclusion, we would say that whilst there are certain issues for vegans to be aware of, in general there are no major health risks that are faced specifically by vegans, assuming you eat a varied, healthy and well-planned diet. That is not to say vegans should become complacent, and we suspect that in the coming years as more and more people become vegan, there will be much more data and information to explore and hence guidelines to follow.
It would seem likely that this evidence will support the idea that a vegan diet can meet all our nutritional needs and, moreover, that it is generally a diet with no significant health risks and lots of benefits. However, if that turns out not to be the case we will certainly revisit and update this article. But right now, based on the evidence currently available, there are no significant health issues with following a plant-based diet.