I recently wrote an article on whether veganism can save the world. How we need an overhaul in how we farm and how we eat. How if everyone went vegan we would achieve a lot of good, but how not everyone can be vegan due to a number of intersectional factors.
I wrote the article after a personal health journey that included trying to be vegan for some time. I have a severe hormone imbalance, food intolerances and an anxiety disorder. Following the guidance of health experts, I now maintain a predominantly plant-based diet, but have switched to low-carbohydrate and high fat with small amounts of sustainably farmed animal products. I am finally healthier than I have ever been.
My research in trying to find a diet that could keep me well lead me to Dr Georgia Ede and her talk Our Descent into Madness: Modern Diets and the Global Mental Health Crisis’.  Ede’s raises questions about diets that are not optimal for our mental health – including concerns around plant based diets. I’d recommend anyone watch her talk! Specifically, Ede makes reference to a subject I haven’t often heard in the conversation on veganism – the fact that DHA, a molecule essential for brain and heart health was found to be 59% lower in vegans than omnivores.
In preparing for the article and having listened to Dr Ede’s talk, I consulted Cape Town’s Green Dietitian, Jessica Kotlowitz, to get another perspective on a few of my questions around the health aspect of veganism:

What is your take on DHA in vegans being significantly lower than omnivores. Do you think it is essential to take a omega-3/DHA supplement as a vegan? Especially if you are prone to degenerative diseases/mental issues? 

Yes, I do think that it is essential that all vegans take a DHA supplement in order to ensure long-term health. DHA is important for cognitive functioning, cardiac health and is extremely important for brain development in infants and children. Therefore, I think it is best to not take any risks and to rather take a supplement. Vegans can get plenty of ALA from their diet (ALA is the precursor for DHA) and the body can convert this ALA into DHA, however conversion rates are sometimes low (depending on age, sex, ethnicity, etc.) and therefore some vegans wouldn’t get enough DHA just from eating ALA-rich foods. For this reason, I recommend a DHA supplement as “insurance” for those vegans who may not get enough through their diet.
The vegan DHA supplements are made from Algae oil (instead of fish oil). The price would depend on the dosage needed for the individual. In general though, it would be around R65.00 a month for young healthy vegans who are eating enough ALA rich foods. For older vegans, pregnant/ breastfeeding women, children or those with certain health conditions, the dosage would need to be higher and would cost R165.00 a month.
DHA is a chemical arrangement of omega 3 fatty acids. Whether it comes from plants or animals does not affect the absorption as the chemical composition would be exactly the same. Remember that the DHA in fish originally comes from algae so there really is no difference in the chemical composition.

Do you think that omnivores need supplements as much as vegans do, considering nutrient depleted soils?

I think it depends on their dietary intake of nutrients and their individual health circumstances. We can easily counteract the effects of nutrient depleted soils by just eating bigger quantities of fruits and vegetables, however for some people this wouldn’t be a viable option and supplements may be necessary. It’s also important to note that nutrient depletion affects factory farmed animals which can in turn mean that the people eating these animals are not getting the nutrients they should be getting from animal products.
Vitamin B12 is a great example. Animals get Vitamin B12 from bacteria in soil but factory farmed animals eating out of feeding lots would not get sufficient Vitamin B12 and so farmers need to inject their cattle with Vitamin B12 supplements. This is of course an added cost to the farmer and so they may try to minimize the amount of supplemental B12 given to cattle or forego the supplements altogether. Their is nobody to regulate these kinds of practices and we are seeing Vitamin B12 deficiencies more and more in meat-eaters. I always check my meat-eating patients for Vitamin B12 deficiency and often advise them to take supplements just as vegans need to.

For people who need to keep a low-carb diet, do you think it is realistic to keep a vegan diet?

Some people with certain digestive conditions do struggle to digest certain cabohydrate-rich foods or do struggle to process large amounts of dietary fibre. For these people, they may have to stick to a limited amount or certain types of carbohydrate-rich foods or prepare these foods in certain ways to make them more digestible.
Other people may have certain food intolerances or allergies which can limit their intake of carbohydrate-rich foods (e.g. gluten intolerances). Lastly, people with certain health conditions such as diabetes, PCOS, insulin-resistance, epilepsy, etc. may benefit from a lower carbohydrate diet (NOT a no-carbohydrate diet!) and would definitely need to limit themselves to more complex types of carbohydrates and cut out refined carbohydrates.
For all of these groups of people, it is definitely still possible to be vegan but any diet which limits or eliminates certain foods/ food groups can limit nutrient intake and put an individual at risk of nutrient deficiencies. These types of diets can also limit the individual in terms of food choices, social functioning around food, foods costs, and much more. Considering that veganism is already a diet which eliminates a large amount of foods and limits social functioning around food, adding additional food restrictions can certainly make it difficult but not impossible to remain vegan. If one is steadfast in their commitment to veganism under these circumstances, I would suggest consulting with a Dietitian to ensure that you are getting all of your nutrients in and preventing any deficiencies.
However, if one can’t afford/ doesn’t have access to a Dietitian, doesn’t have access to supplements, has time, cost, and/or social constraints in terms of food procurement and preparation I do believe it can be unrealistic to remain vegan and preserve one’s health at the same time. In this case, the person may decide to add in small amount of animal products but still eat a largely plant-centered diet.

If there is anything you want to add based on our conversation?

I would just like to point people to the ADA position statement which is considered the current scientifically accepted stand point on vegan and vegetarian diets based on extensive evidence. This position paper was developed by a group of top experts in the field of nutrition (the largest group of nutrition experts in the world) after a full review of all the available high-quality evidence regarding Vegan/ Vegetarian diets. If anyone, especially a health professional ever tells you that a Vegan diet is inadequate in terms of protein, iron, etc. it means that they are not up to date with the evidence and are not practicing evidence-based medicine.

 “It is the position of the American Dietetic Association and Dietitians of Canada that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases… Well-planned vegan and other types of vegetarian diets are appropriate for all stages of the life cycle, including during pregnancy, lactation, infancy, childhood, and adolescence. Vegetarian diets offer a number of nutritional benefits, including lower levels of saturated fat, cholesterol, and animal protein as well as higher levels of carbohydrates, fiber, magnesium, potassium, folate, and antioxidants such as vitamins C and E and phytochemicals. Vegetarians have been reported to have lower body mass indices than non-vegetarians, as well as lower rates of death from ischemic heart disease; vegetarians also show lower blood cholesterol levels; lower blood pressure; and lower rates of hypertension, type 2 diabetes, and prostate and colon cancer.”

In closing

I am thankful to have had access to such important information from two nutritional experts. It certainly is possible to be vegan and be healthy. But it is important to acknowledge that to do so, one must have access to a wide variety of plant foods, supplements and nutritional information and not have a disease that prevents them from eating this way. Whether we decide to include a few animal products in our diet or not, globally we need to focus on eating plant-centred diets and looking to means of regenerative agriculture to grow our food.