Can you be a vegan or vegetarian and still follow the Wahls Protocol®?
I am often asked this question.
Many also ask if they should follow a plant-based diet (which is another way of saying vegetarian or vegan) to lower their risk of heart disease and atherosclerosis.
The answer to those questions depends on your spiritual beliefs and health and nutrition goals. When I meet a patient, we talk about their family history, health and life timeline, medical history, current medications, and what symptoms are troublesome to them. Then we have a conversation about food and lifestyle choices that will help them meet their goals.
If a person’s spiritual identity is linked to being a vegan or vegetarian, I focus on whether nutrient insufficiencies or deficiencies may be contributing to current symptoms or if there is an increased risk for nutrient insufficiencies or deficiencies. Some vegans and vegetarians removed animal products from their diet but did not learn how to get enough nutrients from their plant-based diet.
You can be a vegetarian or vegan and still have a diet high in added sugars, processed foods, and fast foods, eating lots of pastries, treats, and sugar-sweetened beverages, with very few vegetables and little protein, essential fatty acids, or essential vitamins and minerals.
My first step for vegans and vegetarians is to be sure that they know how to create a nutrient-dense diet with sufficient protein, essential fatty acids, and vitamins, especially cobalamin. Cobalamin (vitamin B12) is an essential nutrient for humans, helping us manage fatty acids in our brains and bodies. It is also essential for children’s brain development.
Because plants are not a good source for cobalamin, vegetarians and vegans are at increased risk for cobalamin deficiency, which can cause developing brain and blood-related symptoms . This is particularly critical for children as well as women who wish to become pregnant. Cobalamin insufficiency or deficiency in the developing fetus or young child increases the risk of permanent cognitive compromise. Subtle signs of inadequate cobalamin include decreased or absent sense of smell, problems with mood, memory, or focus, reliance on energy drinks or caffeine to get through the day, and mild anemia. I check cobalamin levels and methylation (B vitamin function as a whole) for all my vegetarian and vegan patients and address any deficiencies those tests uncover.
Rizzo G. Vitamin B12 among Vegetarians: Status, Assessment and Supplementation.Nutrients.2016 Nov 29;8(12):767.doi: 10.3390/nu8120767. https://pubmed.ncbi.nlm.nih.gov/27916823/
Vegans, vegetarians, and protein
Can a vegetarian or vegan diet offer sufficient protein for health? Protein is essential for the human body to function well. Our cells need amino acids to conduct the biology of daily life. We need proteins to create the enzymes our cells use to digest the food we eat and facilitate necessary chemical reactions.
We can make some of the amino acids that are the building blocks for the proteins our cells need. The ones our cells cannot make are called essential amino acids. We need to get those from our food. Animal proteins contain all the essential amino acids.
Vegetarians are at increased risk of protein malnutrition . Grains or legumes alone are missing essential amino acids and are not considered complete proteins. Plant proteins need to be combined so that our cells can make protein correctly. By adding a small amount of meat or by combining grains and legumes, vegans and vegetarians can get all the amino acids their cells need to make proteins.
There is a growing body of research investigating the benefits of a protein-restricted diet on longevity and health. These studies have demonstrated that a methionine- or protein-restricted diet increased longevity in animal models of aging, meaning that type of diet may be beneficial. A vegan diet is low in methionine, and a diet with less meat, especially less red meat, is also lower in methionine, providing some health benefits in terms of aging. However, long-term inadequate protein intake leads to more muscle loss, particularly as we age, which leads to increased frailty . Further study will be needed to determine the optimal protein intake for healthy aging.
Once a person is 60 or older, I recommend a higher intake of protein–1.2 g/kg. I also recommend adding strength training to reduce the risk of muscle loss. This is particularly important for vegans and vegetarians.
Pills W et al. Health benefits and risk associated with adopting a vegetarian diet. Rocz Panstw Zakl Hig. 2014;65(1):9-14. https://pubmed.ncbi.nlm.nih.gov/24964573/
2Kitada.M et al. EBioMedicine.019 May;43:632-640.doi: 10.1016/j.ebiom.2019.04.005. Epub 2019 Apr 8. https://pubmed.ncbi.nlm.nih.gov/30975545/
Simson SJ et al.Dietary protein, aging and nutritional geometry.Ageing Res Rev.2017 Oct;39:78-86.doi: 10.1016/j.arr.2017.03.001.pub 2017 Mar 6. https://pubmed.ncbi.nlm.nih.gov/28274839/
Vegetarians, vegans, and essential fatty acids
All of our cells have cell membranes or fat wrappers that keep the cell intact. These fats are essential to the health of the cells. Omega-3 fats, which our bodies use to make eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), as well as omega-6 fats, which our bodies use to make arachidonic acid (AA), are essential–we have to eat them because our body cannot make them. And we need to eat a balance of omega-3 and -6 fats to have the right balance of AA and EPA/DHA in our brains and bodies.
The standard American diet has too much omega-6 fats, skewing the balance too sharply towards AA, which increases the risk of cardiovascular and neurological disease . The vegetarian sources of omega-3 and omega-6 fats need additional carbons to make eicosapentanoic acid (EPA) and docosahexanoic acid (DHA), and arachidonic acid (AA). These acids are essential for brain and heart health.
Our cells are relatively inefficient at converting the vegetarian sources of omega-3 fat (alpha linolenic acid, or ALA) into EPA and DHA. Vegetarians have to convert ALA into EPA and DHA, but we can only convert about 5 to 7% of ALA into EPA/DHA because the enzymes are inefficient. That means vegetarians have to consume 20 times the amount of omega-3 fat as compared to someone who is eating wild fish or grass-fed or grass-finished meat. The vegetarian source of omega-6 fat is linoleic acid (LA), which we will convert into AA. At present, the standard American diet is very high in omega-6 fat and low in omega-3 fat, which leads to too much AA, not enough EPA/ DHA, and a more inflammatory state in our bodies.
There is evidence that vegetarians are at increased risk of inadequate intake of essential fatty acids, especially omega-3 fatty acids. Because the essential fatty acid levels and ratios are so important to brain and cardiovascular health, I recommend evaluating fatty acid ratios for my patients. It is especially important for vegetarian and vegan patients to understand their fatty acid intake, levels, and ratios if they want to have the healthiest brain and heart and age optimally.
Simopulos AP The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases Exp Biol Med (Maywood). 2008 Jun;233(6):674-88. doi: 10.3181/0711-MR-311. Epub 2008 Apr 11. https://pubmed.ncbi.nlm.nih.gov/18408140/
Burns-Whitmore B et al. Alpha-Linolenic and Linoleic Fatty Acids in the Vegan Diet: Do They Require Dietary Reference Intake/Adequate Intake Special Consideration? Nutrients. 2019 Oct 4;11(10):2365. doi: 10.3390/nu11102365. https://pubmed.ncbi.nlm.nih.gov/31590264/
Iodine and Selenium for vegans and vegetarians
Iodine and selenium are minerals that have several functions in human health. Iodine and selenium are important co-factors for steps in the production of thyroid hormones. Inadequate iodine is associated with increased risk of retardation and stunted growth in children as well as cognitive decline in adults. Women with fibrocystic breast disease are more likely to be iodine deficient and have autoimmune thyroid disease . Selenium is important in cardiovascular health, reducing the risk of infection and cancer .
Vegetarians and vegans are at increased risk of inadequate iodine and selenium . I ask my vegetarian and vegan patients if they are eating seafood, seaweed, and brazil nuts, and if so, how often. I also ask if they want to investigate their iodine and selenium status to assess whether they might have insufficiency or deficiency of either of these two key micronutrients.
Both selenium and iodine have narrow therapeutic windows, meaning too little or too much of either can lead to a variety of symptoms and disease states. This is true for every nutrient, including water. Too little water can lead to severe dehydration, kidney damage, and death, and too much can lead to delirium, brain damage, and death. Too little iodine leads to problems related to the brain, thyroid, heart, and immune cell function. Too much can lead to autoimmune thyroid problems. The same is true for selenium. I want to teach people how to include seaweed and seafood in their diet to make sure they get enough of these important micronutrients.
Using food to create a balanced, nutrient-dense diet is always safer than relying on supplements. That is how I created the Wahls Protocol®—by identifying the key nutrients for mitochondria and cellular health and creating a dietary plan to meet those requirements. I tested the plan, analyzed the nutrient intake of the Wahls elimination diet using menus, and studied the people who were following the diet . In each case, the dietary intake was nutrient-dense, far superior to the nutrient density of the standard American Diet.
Nutrition is the foundation of the health we have or do not have. If you have health challenges, make sure the foods you are eating are increasing your health and vitality. Use food to create the best microenvironment for your cells. It is easier to do this as an omnivore, eating a combination of plants and animals, but it can also be done as a vegan or vegetarian.
For those who are spiritually committed to being vegan or vegetarian, I have provided guidance on how to implement my dietary concepts on a plant-based diet in my course, the Autoimmune Intervention Mastery Course, and in my book, the Wahls Protocol®. Properly designed, the vegan, vegetarian, or omnivore diet can lead to better health. Improperly done, your food choices can lead to steadily declining health. Let my team guide you in creating the eating plan that restores your health and vitality!
Triggiani V. et al. Role of iodine, selenium and other micronutrients in thyroid function and disorders Endocr Metab Immune Disord Drug Targets. 2009 Sep;9(3):277-94. doi: 10.2174/187153009789044392. Epub 2009 Sep 1 https://pubmed.ncbi.nlm.nih.gov/19594417/
Patrick L. Iodine: deficiency and therapeutic considerations Altern Med Rev. 2008 Jun;13(2):116-27. https://pubmed.ncbi.nlm.nih.gov/18590348/
Schomburg Dietary Selenium and Human Health Nutrients. 2016 Dec 30;9(1):22. doi: 10.3390/nu9010022. https://pubmed.ncbi.nlm.nih.gov/28042811/
Fallon N, Dillon S A. Low Intakes of Iodine and Selenium Amongst Vegan and Vegetarian Women Highlight a Potential Nutritional Vulnerability. Front Nutr. 2020 May 20;7:72. doi: 10.3389/fnut.2020.00072. eCollection 2020. https://pubmed.ncbi.nlm.nih.gov/32509798/
Chenard C. Nutrient Composition Comparison between a Modified Paleolithic Diet for Multiple Sclerosis and the Recommended Healthy U.S.-Style Eating Pattern Nutrients. 2019 Mar 1;11(3):537. doi: 10.3390/nu11030537. https://pubmed.ncbi.nlm.nih.gov/30832289/
Titcomb TJ. Eating Pattern and Nutritional Risks among People with Multiple Sclerosis Following a Modified Paleolithic Diet Nutrients. 2020 Jun 20;12(6):1844.doi: 10.3390/nu12061844. https://pubmed.ncbi.nlm.nih.gov/32575774/