Between Veganuary and people watching The Game Changers movie on Netflix, I’ve had several people ask me recently whether we should be recommending a vegan diet for clients after a catastrophic injury.

The short answer to that question is “no” — I don’t think every single client after a catastrophic injury would benefit from a vegan diet.  That answer may surprise you, but here are the top four reasons why I think that:

1.  “Vegan” does not always equate to “healthy.”

“Vegan” means not eating or using animal products of any kind (eg. no meat/chicken/fish, no dairy products, no honey, no gelatin).  However, eating a “vegan” sausage roll, “vegan” chocolate, or going to a fast food restaurant for a “vegan” burger, chips and fizzy drink, would only be marginally healthier than choosing the non-vegan options.  Crisps and energy drinks are also technically “vegan” – it doesn’t mean those are healthy either.  You need to be extremely careful about the terminology used here – “plant-rich” or “plant based” are very, very different to “vegan.”  People use the phrases interchangeably but they mean very different things.  See below why I most definitely DO promote plant-rich eating and how that’s different.

2.  There is currently more research supporting a Mediterranean diet for brain health over a vegan diet.(1, 2, 3)

There was a great article published in 2019 on “The effects of plant-based diets on the body and the brain: a systematic review” which discussed this very issue.  The researchers concluded that while there is evidence that a vegan/plant based diet (the terms are used interchangeably in this study) is helpful for reducing weight and improving blood sugar and cholesterol levels, there isn’t currently enough research to promote a vegan/plant-based diet for cognitive function or mental and neurological health.

3.  While it is possible to meet all of your protein requirements while eating a vegan diet, many clients after a catastrophic injury have very low energy requirements (often under 1500 calories per day). 

This makes it incredibly tricky to meet their protein requirements while keeping their calorie intake low enough that they don’t gain weight (compare this to The Game Changers movie which focused on athletes — a completely different population).  If clients have pressure sores or anything which increases their protein needs even further, we are really going to struggle to meet these elevated protein requirements on a vegan diet without the use of some type of vegan protein powder or other supplement.

4.   Vegan diets requires sufficient cooking skills, knowledge and motivation. 

Vegan diets require a lot of nutrition knowledge, meal planning and cooking skills, otherwise they risk being low in protein, calcium, omega 3, iodine, vitamin B12, iron, zinc, selenium and vitamin D.(4) When I first start working with clients, many are only eating vegetables and fruit maybe a few times per week.  Some also have support workers with limited cooking skills and/or limited nutrition knowledge. In a situation like this, not only is a vegan diet unrealistic, but it could potentially compromise a client’s health.  Yes, vegan diets are totally do-able, but you need the correct skills and knowledge in order to do it right.

That’s my overview as it applies to catastrophic injuries.  Now if you are looking for a longer and more detailed critique of The Game Changers movie in general, you can check out reviews by other dietitians HERE and HERE.

It should go without saying that if clients are choosing a vegan diet for moral, ethical or environmental reasons, then I 100% support that decision and it’s my job to work with them to make sure that all of their nutritional needs are met while doing so.

But if I’m not going out of my way to specifically promote a vegan diet, then what type of eating habits should we be promoting?  Here are my recommendations based on current research:

We definitely need to be promoting more (but not exclusively) whole, plant-based foods – whether that is through plant-rich eating habits or a Mediterranean diet.

This means focusing on vegetables, fruit, nuts, seeds, legumes and whole grains (all adapted for any swallowing issues).  These foods help to repair cell damage, reduce inflammation, reduce chronic disease and promote a healthy gut microbiome. (2, 3, 5, 6)  Clients can enjoy some vegetarian/vegan recipes without their entire diet being vegetarian/vegan.  Would they consider one meat-less meal per week (with beans, chickpeas, lentils, Quorn, nuts, seed or tofu as a protein alternative)?  Can they have fruit for a snack or dessert instead of biscuits?  Can they have one or two vegetables at both their lunch and evening meals?  To read more about the type of diet recommended after a brain injury, please click HERE. 

We need to work together to reduce a client’s intake of food and drink with low nutritional value — such as biscuits, chocolate, crisps, sweets, fizzy drinks, energy drinks, fast food and take aways. 

Eating excessive calories and choosing foods/drinks high in saturated fat and refined carbohydrates increases inflammation in the body which affects mood, recovery and risk of chronic disease.(7,8)  However, instead of just telling clients to cut back on these foods/drinks, I find it far more effective to find out WHY they are eating these items.  Are these foods being eaten because the client is hungry or for some other reason?  Are energy drinks being consumed because they aren’t sleeping well and suffer with fatigue? Solutions will usually follow from this discussion.

We need to focus on healthy fats. 

Oily fish, olives/olive oil, rapeseed oil, milled linseed, avocado, nuts and seeds are incredibly important for brain function and some of the best ways to reduce inflammation in the body and brain.(9)  Would your clients eat fish once or twice per week?  Could they switch from butter and hard margarine to rapeseed oil in cooking and baking?

Let’s make food fun by getting clients involved in meal preparation and eating with others. 

The social aspects of eating are one of life’s many pleasures yet sadly after a catastrophic injury, I’ve observed that many clients end up eating most meals by themselves.  This limits their social interactions and the variety of foods that they are exposed to. Food selection, preparation/cooking and even gardening, are great ways to promote independence and a perfect way get people excited about food and trying new things.

In Summary

There is no one-size-fits-all approach to eating.  Which foods does the person like?  What is their appetite like?  What other medical conditions do they have?  A client with dysphagia and a pressure sore who is also underweight and struggling to gain weight will have very different dietary requirements compared to a client who is overweight with type 2 diabetes.  Personalised advice is needed and a vegan diet is not always the best option.

If you have a client who would benefit from assessment and advice by a dietitian specialising in catastrophic injuries, please get in touch with Sheri Taylor, Specialist Rehab Dietitian at 07787 603863 or info@specialistnutritionrehab.co.uk.  For more articles like this straight to your inbox each month, please sign up for my monthly newsletter below.