On the 9th and 10th of September 2023 I attended the VegMed conference organised by Plant-Based Health Professionals (PBHP) UK, in association with ProVeg and the Physicians Association for Nutrition (PAN), at Imperial College London. This was a two-day event with the strapline ‘Bringing Plant-Based Nutrition into Healthcare’, and it was accredited for 12 continuing professional development (CPD) points by the British Society for Lifestyle Medicine (BSLM).
What can I tell you about this event? I could tell you which talks I went to and summarise what the main points of each speaker were. I could tell you about each of the stallholders and about what I had for lunch. I could tell you about the nice group breathwork session I attended on the Sunday morning.
I think, on reflection, I’m not going to do that (though some of the information provided might find its way into my writing elsewhere).
Instead, I’m going to tell you what the conference made me think, and feel, after the event.
We are with raw now where we were with vegan ten or more years ago. Raw is the future for serious health-seekers, but for most people it’s still just out of sight over the horizon, being regarded at best with suspicion and at worst with outright animosity. The scientific literature on the subject is sparse and where it does exist it is highly biased and badly misinterpreted.
In the session on the emerging discipline of ‘Lifestyle Medicine’ someone mentioned Ivan Illich (I have also written about him in my book) and asked a question about the medical appropriation of health, which is no more the domain of doctors than it is anybody else. Doctors may be useful if they are able to interpret the scientific evidence correctly and provide novel insights based on this, but medical history is littered with harmful conclusions and incorrect advice. As human beings we seem to have an uncanny knack for finding evidence in support of the health benefits of our most treasured addictive substances: cigarettes (really, they used to be prescribed by doctors to treat coughs), red wine, olive oil, coffee, chocolate, cooked foods…
I went to the conference wanting to learn, and wanting to belong, but my overwhelming experience of attending this event was of feeling like a complete outsider. Whole-food plant-based is where I was when I started my first vegan blog back in late 2011, when I was busy learning how to cook all sorts of vegan foods from scratch, but it isn’t where I am now. There are at least two more steps in the nutrition transition after that.
Actually, I will tell you what I had for lunch. On both days I had a big plate of salad leaves from the buffet, and a packet of Easy Peelers from Tesco. On the first day I also had some cucumber and tomato slices. On the second day there was nothing else I could eat. I’d like to say it didn’t matter but it did, because what it left me feeling was completely alone. This was a conference about plant-based nutrition. We simply can’t talk about achieving optimum nutrition from plants without talking about the benefits of raw.
As I write I am in communication with event organiser Dr Shireen Kassam about this, because what I hope is that PBHP as a professional organisation will be able to evolve to support, represent and even embrace all healthcare professionals who call themselves plant-based, irrespective of where their views sit under that broad umbrella. At the moment though, I do have to say that although I am a member, the views of this organisation do not fully accord with mine and so it does not represent or speak for me as a plant-based health professional of many years standing.
Dr Kassam has confirmed to me that PBHP does not recommend either a low fat or a raw vegan diet in childhood, and in her and her sister Zahra’s 2022 book Eating Plant-Based: Scientific Answers to your Nutrition Questions (p.150-152) she suggests that vegan children who have died have done so because of poor planning and excessive restriction, as occurs when children are fed a raw vegan diet. A well-planned vegan diet, they argue, is not dangerous, but a poorly planned raw vegan one which is deficient in micronutrients, and is insufficiently calorie-dense, is.
My concern is that while they refer to myths and factual inaccuracies that have long been discredited in relation to the vegan diet, they are simultaneously perpetuating the same myths and factual inaccuracies in relation to the raw vegan one. In the text at least, they do not seem to recognise that in making this statement they are falling prey to the same scientific error – that of over-reliance on highly biased case studies – that their anti-vegan predecessors did.
All this, of course, while the conference clarified that a contemporary vegan diet is itself definitely deficient in at least one micronutrient (vitamin B12) and that supplementation or fortification with several others (vitamin D, vitamin B2, selenium, iodine, zinc, calcium and omega-3s) is generally considered wise.
If I had not by now met several very healthy raw vegan children and seen them with my own eyes, I too might be inclined to believe these words. I have a great deal of respect for Shireen Kassam and what she has achieved in bringing plant-based nutrition into the healthcare mainstream in any form at all, but this section in her book is disappointing.
I do understand that the desire to promote healthy as opposed to junk-food vegan diets, and the view that vegan diets can be healthy to people who believe they cannot, has led to the development of the whole food plant-based (WFPB) concept which has gained much traction in recent years, but it is important that these imperatives do not supercede any willingness to discuss nutritional science in an open-minded way. Good planning and judicious supplementation when necessary are important for children on any kind of diet: even omnivorous ones. It was not the raw vegan diet that was responsible for the deaths of those children – other things were certainly going on – and vilifying good and conscientious parents who are feeding their children raw out of love and a desire to do the best for their children’s health and futures does nobody any good at all.
I sincerely hope that Dr Kassam will begin to see that low fat, high raw, plant-based (LFHRPB) is a form of whole food plant-based diet worthy of further attention and formal study. In one sense, WFPB is arguably an umbrella term for a range of different diet-styles that can be grouped together, and LFHRPB is a subset under that umbrella that in turn encompasses a range of diet-styles.
The LFHRPB umbrella, in my head, encompasses a range of fat intakes from about 3-5% (about the lowest you can get) up to about 20% of total calories from unheated and unrefined (no oil) plant fats, and a range of raw intakes from about 50% all the way up to 100% of total calories from raw plant foods. It includes those who juice, sprout (grains and legumes), dehydrate, blend, forage, grow microgreens, eat seaweed, eat mushrooms, eat spices, eat roots, eat starchy vegetables, distil their water, walk barefoot, meditate, ground… and those who do not, who eat only fruit, or only raw vegetables, nuts, seeds and sprouted grains.
Personally, I prefer (and recommend) variety and the middle ground (some of all of these things), but what unites all of us is our common desire to undertake a health journey, and to keep learning and refining as we go. What is more important than anything else is to allow our bodies to feed back to us information on how we are getting on, and for us to listen to them and take action if things are not going so well.
As parents, it’s part of our job to tune in to the bodies of our children in the same embodied, intuitive way. Regular growth monitoring by a healthcare professional might be helpful, but only if it becomes apparent that there’s a problem. Healthy children who are running, jumping and climbing do not need to be medically objectivised, and they definitely don’t need to have their blood taken. All those cases of children who have died… they were not cases of children with these kinds of loving, caring parents. They were children who were being abused by parents whose own relationship with food was seriously distorted.
It is incredibly important to recognise that healthy children without an underlying feeding problem who are given free access to a variety of nutrient and calorie-dense, non-addictive raw foods (such as fruits, nuts and seeds) will take in exactly the number of calories they need. The involvement of a medical professional may be warranted if a feeding (or absorption) problem is suspected, but in the absence of such a problem, failure of growth and development is always going to be the result of inappropriate restriction of access to a range of appropriate foods. A varied raw vegan diet supplies plenty of such foods, and in just the same way as a cooked vegan diet, if well planned and appropriately supplemented can provide for the nutritional requirements of human beings across the lifespan.
How might well-meaning parents and carers inadvertently restrict a child’s access to adequate nutrients and calories? Well, the most common is likely to be limiting consumption of higher calorie categories of foods, such as fruits (because of fears around sugar) or nuts and seeds (because of fears around fat or allergies and intolerances). Offering large amounts of low-calorie-density foods like salad leaves, cucumber and tomatoes will leave children (and conference-goers) hungry.
The other way is by forcing children to eat according to a cooked food or carnivorous pattern. By this I mean making them eat three meals a day, especially if mealtimes are short, and then taking the food away in between. Discouraging snacking and restricting mealtime portion sizes (for example by only providing standard-sized plates) are also likely to have a detrimental effect on overall intake, making it impossible for children to take in adequate calories during the course of the day. Raw vegan children in mainstream nurseries or schools are likely to encounter this problem, but parents and carers may inadvertently implement this type of routine too because of cultural habits and practices.
‘High raw plant-based’ is just another word for herbivore, and all wild herbivores are grazers. They eat all day in order to take in enough calories. Carnivores eat more infrequently, with long periods of rest in between meals. Humans who eat cooked foods are able to take in many more calories in a given period of time, but if you eat raw plant foods you need time to chew. That doesn’t make the raw vegan diet wrong: it just makes it what it is (and you need to look after your teeth).
Once, a few years ago, a senior colleague of mine told me (when we were alone) that she considered it her responsibility to protect vulnerable patients from me (and, presumably, my dangerous vegan ideas). The PBHP conference was a beacon of hope for healthcare and a medical profession that still has a long, long way to go. We have, together (I hope), got a lot of work to do.
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