Veganism is experiencing massive growth with the number of people following a totally “plant-based” diet quadrupling in the UK in the last four years. I would like to explain here some of the health issues I'm seeing in clinical practice among some people following this diet, and why plant-based doesn't have to mean a plant-only diet, Evidence for a plant-heavy Mediterranean pattern diet is linked with good mental and heart health and may be more do-able and beneficial to many people in the long run.

As a nutritional therapist working in clinical practice in Harley Street in London, I have started to see the fall-out of veganism on mental health. I’m seeing anxiety, mood, and sleep disorders hitting some vegans 18-24 months into the conversion. I now find myself working with some of these people who want to learn a more diverse diet for their mental and overall health.

Many said they went vegan to help save the planet or because of animal cruelty. Since the Netflix film Game Changers, which focusses on a small number of elite athletes thriving on a “plant-based” diet, some said they went vegan believing it would be a more healthy option for them too, but have found that not to be the case in their personal cases.

The initial vegan high
Some people who become vegan report feeling much better in a couple of months, losing extra pounds in weight and feeling like they have more energy, yet no one has done a study which quite works out why this may be. (Food studies are immensely complex and difficult to fund).
If you are starting with a standard Western diet – very beige, and high in sugar, and start bringing lots of colourful veg into your diet you may feel better from this for a bit. But the total lack of dairy, eggs, meat and fish may have a negative impact longer term if you aren’t having enough natural plant protein substitutes or able to absorb B12 well from the supplements you take.

Misuse of the word “plant-based”
At this point I’d like to clarify the hijacking of the phrase “plant-based”, as use by the media. Plant-based should NOT mean plant-only. I would suggest that it should be interpreted as plant-heavy.

The Mediterranean diet is a real “plant-based” diet
We now know that diets which are plant-heavy are extremely beneficial to our health. A perfect example of this is the Mediterranean diet. The Mediterranean diet showers us with a diverse range of nutrients including: fresh vegetables, herbs, fruits, nuts, seeds, extra virgin olive oil, some meat and oily fish, artisanal dairy (eg raw Manchego cheese from Spain, or locally-made goat’s cheese in Greece) and genuine whole grains such as wild rice/oats.

A Mediterranean diet to reverse depression and heart disease
A plant-heavy Mediterranean diet, as used in the Australian SMILES study (a Mediterranean randomised control trial on subjects with depression) has been shown to reverse depression within three months. A genuine Mediterranean diet with lashings of extra virgin olive oil and nuts each day also protects/reverses heart disease as the famous Spanish PREDIMED study taught us. These studies have a lot of plants in them, but also some fish, meat, and dairy.

So what exactly did the subjects in the SMILES study eat?
The diet included:

• 6 vegetables, and 3 fruits each day (so pretty plant heavy!)

• Pulses 3-4 times a week (more plant heavy items)

• Dairy foods 2-3 times a day

• Nuts, once a day (more plants)

• Fish two times a week

• Red meats 3-4 times per week

• Chicken 2-3 times a week

• Whole grains 5-8 servings a day (more plants)

• Eggs – up to six a week

• 3 tablespoons of olive oil a day (also plant-based)

Subjects reduced junk foods such as sweets, refined cereals, fast food, processed meats and sugary drinks. The take home message from this is that it is likely that the gut and brain like natural foods very much and a Mediterranean style diet could be a safe, simple, and enjoyable way to support one’s mental health.

Do you dive or thrive on a vegan diet?
So why is it some people start to suffer mental health difficulties in the long-term on a vegan diet?
In my opinion, a lack of sufficient protein could be one of the reasons.

A real vegan diet in our busy real world
Below is a common diet I have come across amongst vegans in my office who are having difficulty with mental health and sleep. This is not every vegan of course, but an example of busy people struggling to get sufficient nutrition in the real world.

• A bowl of cornflakes with a cup of nut milk for breakfast. 2g of protein.

• A bowl of pasta with tomato sauce on it for lunch – almost no protein.

• A jacket potato with olive oil for dinner – almost no protein.

The protein problem
Most people acknowledge the need for protein to build muscle in the body, but what many people forget is it is essential for building hormones and neurotransmitters in the brain to support both mood and sleep. How can you achieve this long-term on 2g of protein a day instead of the 45g- 56g average needed? Stressed individuals may need much more.

Here are some examples of how you could be plant-HEAVY and have enough natural, real food to reach healthy levels of protein:

• 2 eggs for breakfast, (14g protein) plus some vegetables eg sautéed tomatoes, mushrooms, and spinach.

• A big bowl of vegetable soup followed by 150g of Greek yoghurt with fresh berries for lunch (15g)

• 200g piece of cod (36g of protein) for dinner with a wide selection of roast vegetables drizzled in olive oil.

The ultra-processed food problem
Some plant-only vegan eaters resort to loading the diet with ultra-processed protein powders and fake soya meats (think fast food vegan offerings). These often contain inflammatory emulsifiers, sugars, and artificial sugars - all of which can in the long term derange gut bacteria and impact mental health negatively.

Eat like a real Mediterranean
Eating a predominantly plant-based diet doesn’t mean NO meat, fish or dairy, it means eating piles of colourful fruit and vegetables ALONGISDE small portions of animal choices. The Mediterranean diet does this well. The heavy plant content and omega 3-rich oily fish are also ideal for creating a good microbiome (gut bacteria which) and gives you the building blocks of good brain health too.

Eat less, not no meat/fish for sustainability
Imagine if everyone – millions of us - only ate meat twice a week, and quality meat. The impact on the environment would be huge. You don’t need to go vegan to help save the planet.

Concentration camp chickens v holiday camp ones
Regarding animal welfare, I think in centuries to come we will look back in disbelief at the factory farming practices of today. I hope we go back to traditional, more humane ways to rear animals – eating them more as a treat than at every meal.

We can help the planet and animal welfare by choosing organic or wild wherever possible and loading your plate up with more veg. A chicken that costs £21 has had a holiday camp lifestyle compared to a £3 battery farmed chicken. If this matters to you and you need animals for your individual health – buy organic and stretch it over many days (like the Mediterraneans do – mixing meats with beans, pulses and vegetables in many dishes, boiling the bones to make broths for soups and stir fries). Or buy a box of six organic eggs for £2 and spread them over several days. Some of the recipe books I mention below show you how to spread expensive meat out over many meals and feed lots of people by putting them into plant heavy dishes.

Extremism
Extreme diets, whether it be Atkins (mainly animals) or veganism (no animals), are questionable to good health long term. The health evidence in the film Game Changers is superficial and cherry-picked. Here you can find Chris Kresser's analysis. The bit in the film that made me laugh was the assertion that gladiators are a model for going vegan. The film says gladiators in Ancient Rome had "a predominantly plant-based" diet. Then fast forwards to vegan athletes today. "Predominantly" - does that mean they sometimes had eggs, cheese, dairy? Maybe they had meat or fish once a month between all that healthy beans and barley?

Personalisation of diets
Of course, there is no one diet that fits every one and some people may thrive on what could be an extreme diet for others. You need to really find out what works for you and tweak the diet accordingly. Just because an elite athlete with a private chef is doing well on one diet doesn’t mean it will translate to everyone.

The reality of going vegan
The vegans I’m meeting in clinical practice admit they do sometimes give into cravings for meat, fish or dairy. Usually behind closed doors. While in the media it may seem that everyone is being the perfect plant-based follower, the reality can be very different in real life and people who aren’t thriving on a vegan diet tell me they feel afraid of the flack their friends will give them if they admit how they really feel. There can be a huge amount of judgementalism and shaming around food. Listen to your gut and do what feels best for you and your own health for the long term.

Learn how to look after your gut and brain with diet and movement
If you’d like to learn more about gut-brain health come to my workshops with psychiatrist Dr Judith Mohring in London.

Books to help you get into plant-heavy Mediterranean cooking
For a range of easy to make Mediterranean dishes, see my book The Gut Makeover Recipe Book.
Here are four of my favourite Mediterranean cookbooks:

1) Arabesque, a taste of Morocco, Turkey and Lebanon by Claudia Roden.
Easy and straight forward, plant-heavy recipes with little bits of meat/dairy - eg roast tomatoes stuffed with tuna, chickpeas and lentil soup, courgette fritters with a little feta crumbled into them, roast peppers and chickpeas with fresh goat's cheese.

2) Plenty by Yotam Ottolenghi.
Ottolenghi is master of the multi-ingredient plant-based dish. My favourite recipes in this book are the roasted parsnips and sweet potatoes with caper vinaigrette, the sweet winter slaw, shakshuka a smoky flavoured stewed tomato and pepper dish with eggs dropped in near the end. mushroom ragout with poached duck egg, lentils with tomatoes and Gorgonzola.

3) Eivissa, The Ibiza Cookbook by my friend Anne Sijmonsbergen
Anne runs an organic farm on the Balearic island of Ibiza and her recipes incorporate lots of Catalan and local Balearic cooking. See her wild mushrooms with brandy cream on toast, pumpkin soup with sage oil using chicken broth, or the spinach, chickpeas and butternut squash with couscous and walnut and sage picada.

4) Moro by Sam & Sam Clark
A mixture of Spanish and Moroccan cooking. Try their hummus with ground lamb and pinenuts or beetroot soup with black cumin and a little Greek yoghurt drizzled on top. The pea soup with a little Spanish ham (Jamon Serrano) in cubes is typical of how the Spanish flavour a plant dish with a little tiny bit of meat.