Veganism and Eating Disorders: Physical health

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Is it physically possible to recover from an eating disorder while vegan?

The short answer is yes, but it requires careful planning. If you have a restrictive eating disorder and you are vegan, then you almost certainly require dietitian input, which unfortunately is not widely available on the NHS. Let’s dive into some of the factors that require thought.

A typical vegan diet is 100% derived from plant sources. Omitting all animal products (meat, dairy, fish, eggs, honey) from your diet can risk nutritional deficiencies if not planned well. To start with, a typical vegan diet is less energy dense than your typical omnivorous (normal) diet[1]. This means that a greater volume of food may have to be consumed to meet energy requirements. This can be an additional challenge when increasing food intake is already so difficult. Traditionally clinicians may be concerned about the protein intake of their vegan patients, however diet surveys evaluating nutrient intake have shown that vegans, on average, meet or exceed their protein requirement[1]. This is the case for both adults and children in the West, following a vegan diet[2]. During my experience as an eating disorder dietitian, I have observed trends of food avoidance and fear of certain foods that typically fall into carbohydrate and fat macronutrient categories, with protein being less of a concern in recovery than overall energy intake. Of course, there are exceptions to this, but I am speaking generally, based on my experience.

It worth paying attention to dietary calcium intake, as eating disorders can increase the risk of reduced bone mineral density. Having low calcium intake can further worsen this risk. In a typical western diet, the most common sources of calcium are dairy products, so it is important to include calcium-fortified dairy alternatives and other sources of calcium such as: calcium-set tofu (e.g. Cauldron), green vegetables and beans and pulses. There is also evidence to show that when surveyed vegan dietary intakes tend to be below nutrient requirement for calcium1.

In restrictive eating disorders, refeeding syndrome is a potentially fatal complication that health professionals tend to worry about. This occurs during re-feeding when an individual has been in a starved state for a long time, their body adapts, and if food is reintroduced too quickly this can result in harmful consequences. Electrolytes are involved in this process, and a particularly important one is phosphate. Phosphate is a mineral that is important for bone health, it is also involved in energy production. One of the main sources of dietary phosphate is dairy. Most non-dairy milks, unless fortified, are low in phosphate. Many teams prescribe prophylactic phosphate to minimise refeeding risk[3], this could be considered by health professionals if dietary intake is low in a vegan patient.

In cases of serious eating disorders, where someone has to be admitted to an inpatient unit, tube-feeding may be required. Through these tubes pre-prepared ‘feeds’ are passed to supply a balanced nutrient intake. There are a number of companies that supply the feeds, but unfortunately at the moment there is no nutritionally complete vegan feed. Although I understand that due to demand these are in development. The closest feed that we have available, is a soy-based feed, which is vegan except for Vitamin D sourced from lanolin.

There are several other nutrients that the vegan diet tends to be lower in than the regular omnivorous diet such as B12, Selenium and Iodine. There is now a trend towards improved and responsible fortification and many non-dairy milks are now fortified with these nutrients. Be aware that organic products will not be fortified, so it may be better to opt for the non-organic version. If you have disordered eating or an eating disorder it may be advisable to take a multi-vitamin and mineral supplement, there are several different vegan options available so please speak to your dietitian to point you to one that is best for you.

With good planning, it is physically possible to recover from an eating disorder while vegan, but having access to a dietitian and the ability to eat a great volume of food may not be possible for everyone. The Vegan Society states that “a dead vegan is no good to anyone”[4]. If your dietitian and medical team feel that for you to recover you need to include some animal products, then it is worth considering this. You can be vegan in other ways; through avoiding leather, supporting animal rights charities and choosing cruelty free beauty products. At the end of the day, you cannot care for anyone or any animal without caring for yourself first, I promise it doesn’t make you a bad person if that is what you need to do.

Summary:

–        It is phsyically possible to recover while being vegan, but requires careful planning and dietitian input.

–        It is important to have a well-planned vegan diet to ensure you are consuming enough energy and enough of certain nutrients.

–        Prophylactic phosphate supplementation may be advisable for vegan patients when at risk of refeeding syndrome.

–        There is a lack of vegan tube feeds available

–        It is not a moral failing if you need to include animal products in your diet to recover. There are other ways to be vegan such as using cruelty free products, supporting animal rights charities, and avoiding leather.

References:

1.     Clarys P, Deliens T, Huybrechts I, Deriemaeker P, Vanaelst B, De Keyzer W et al. Comparison of Nutritional Quality of the Vegan, Vegetarian, Semi-Vegetarian, Pesco-Vegetarian and Omnivorous Diet. Nutrients. 2014;6(3):1318-1332. 

2.     Weder S, Hoffmann M, Becker K, Alexy U, Keller M. Energy, Macronutrient Intake, and Anthropometrics of Vegetarian, Vegan, and Omnivorous Children (1–3 Years) in Germany (VeChi Diet Study). Nutrients. 2019;11(4):832. 

3.     Leitner M, Burstein B, Agostino H. Prophylactic Phosphate Supplementation for the Inpatient Treatment of Restrictive Eating Disorders. Journal of Adolescent Health. 2016;58(6):616-620. 

4.     Definition of veganism [Internet]. The Vegan Society. 2022 [cited 5 May 2022].

 

Take the First Step

Dietitian SophieIf you’re struggling with a disordered relationship with food and exercise, know that you don’t have to face it alone. Professional support is crucial for your journey towards recovery.
As a registered dietitian specialising in eating disorder recovery, I provide personalised guidance and support to help individuals like you establish a healthy relationship with food and exercise.

You can book a free call with me below or get in touch with me here.

Hugs,
Sophie x

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