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By Andrea Cannas

DATE

February 11, 2024

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Can Being Vegan Make Me Anxious?

Have you always followed a vegan diet?

Contemplating a post-festive or Easter detox? Perhaps it’s a one-week juice cleanse, or maybe you’re leaning towards a strict vegan regimen to shed those extra kilos gained during the celebrations. On the flip side, if veganism is already a cornerstone of your lifestyle, driven by ethical and sustainable choices, you might be wondering if it’s truly optimising your well-being. 

Undoubtedly, the impact of a vegan diet on anxiety can vary among individuals, influenced by factors such as diet composition, nutritional balance and diversity, and overall lifestyle. In this blog, we’ll explore the intricate relationship between veganism and anxiety, dissecting the nuances that make this dietary choice a potential benefit or challenge for mental health.

What we know about vegan and plant-based diets

Research has shown that following a vegan diet or having more plant-based than animal-based foods in your routine can help you to achieve:

  • Short-term weight loss
  • Healthy immune function
  • Improved heart health 
  • Improved blood lipid profile
  • Prevention of diabetic complications
  • Reduction of total dietary acidic load


Additionally, soluble fibre found in oats, beans and lentils is shown to improve blood sugar control and reduce blood cholesterol.

While various studies indicate that a vegan diet (VD) can reduce the risk of cardiometabolic diseases, such as cardiovascular disease, type 2 diabetes mellitus, obesity, and non-alcoholic fatty liver disease, it’s important to acknowledge that veganism has been associated with certain adverse health outcomes. These include nervous, skeletal, and immune system impairments, hematological disorders, and potential mental health problems arising from micro and macronutrient deficits. 

Several studies have highlighted the possibility of nutritional deficiencies in individuals abstaining from meat and other animal-based foods. A systematic review in 2021 revealed significantly higher rates or risks of depression, anxiety, and self-harm behaviors among those avoiding meat consumption. Similarly, a study involving German adults found notably elevated prevalence rates of anxiety disorders, more than twice as high in the completely vegetarian group compared to the non-vegetarian matched group. An earlier study also observed that women who abstained from meat had nearly twice the rate of prescription medication use for depression compared to women who included meat in their diets (8.0% vs. 4.2%).

The healthy vs. the non-healthy way

A health vegan diet emphasises whole, nutrient-dense plant foods, providing a well-rounded and balanced source of essential nutrients. This includes a variety of vegetables, fruits, whole grains, legumes, nuts, and seeds. A healthy vegan pays attention to obtaining sufficient protein, iron, calcium, vitamin B12, omega-3 fatty acids, and other essential nutrients through carefully planned food choices and, if necessary, supplements.

On the other hand, a non-healthy vegan might rely heavily on processed vegan alternatives, such as faux meats, sugary snacks, and refined carbohydrates, neglecting the nutritional richness found in whole plant foods. This dietary approach may lack the necessary diversity and micronutrient density, potentially leading to nutrient deficiencies and imbalances. A perfect example of a non-healthy vegan meal would be a traditional English breakfast with some Heinz baked beans, hash browns, fried mushrooms and a vegan sausage.

The key distinction lies in the focus on whole, minimally processed foods versus a dependence on convenient but less nutritious vegan substitutes. Admittedly, if you want to go vegan the healthy way, you’ll need to seriously consider your meal planning, food combinations and your cooking skills. 

Nutritional Considerations

Omega-3 Fatty Acids

A healthy vegan should regularly consume plant foods that are naturally rich in omega-3 fats such as walnuts, chia seeds and flaxseeds. The role of omega-3 polyunsaturated fatty acids (PUFAs) in mood disorders and neurobehavioural conditions is well-established. In fact, research has shown that children and adolescents with ADHD have significantly lower omega-3 PUFA status.

However, the conversion of plant fats (nuts, seeds) to the biologically active EPA is less efficient than that from animal fats (fish, eggs etc). You can easily supplement your meals by sprinkling omega-3 rich nuts and seeds over them. But in most cases, this is not enough in which case you would benefit from a cold-pressed high quality fish oil supplement. In fact, supplements containing a specific type of omega-3 fatty acid called EPA, making up at least 60% of the total EPA and DHA (another type of omega-3), were shown to be effective in treating primary depression. Weaker evidence suggests PUFA supplementation may improve symptoms of ADHD in children and adolescents. The effective dosage range was found to be between 200 to 2200mg per day of EPA, with more EPA than DHA. 

There is also lower quality evidence from animal trials and case studies that suggest a ketogenic diet may exert anti-anxiolytic effects. It may be therefore worth speaking with a suitable health professional to assess the macronutrient composition of your vegan diet and see whether you’d be better off following a higher fat lower carb vegan diet for your health concerns. 

Vitamin B12 Deficiency

Low vitamin B12 status is a noteworthy concern in the context of veganism, as it has been linked to various adverse health outcomes, including declines in cognitive function, depressive symptoms and fatigue. This crucial nutrient is associated with haematologic and neurological disorders and may contribute to carcinogenesis. Evidence suggests that B12 hypovitaminosis is connected to an increased risk of neurodegenerative conditions like Alzheimer’s Disease. Clinical manifestations of B12 deficiency impact both the blood and nervous system, and it can result from inadequate intake of animal-sources or issues with absorption and genetic factors affecting transport throughout the body. 

Many vegans turn to B12- fortified nutritional foods, with B12-fortified fortified nutritional yeast being a popular choice. Supplementation studies have indicated that B12, either alone or in combination with other B vitamins may slow the rate of brain atrophy and reduce inflammation in individuals with mild cognitive impairment. However, its important to note that B12 supplementation seems to provide little to no benefit for those without advanced neurological disorders. Given the challenge for vegans to naturally obtain sufficient B12, regular checks and supplementation are advised.  To prevent B12 deficiency it’s recommended for vegans to consult health professionals and consider suitable supplements to meet their daily requirements effectively.

 

Other Nutritional Factors 

  • Calcium and Vitamin D

Calcium and vitamin D absorption is a problem in plant-based diets due to dairy avoidance. In fact, a study showed a 25% and 43% higher risk of fractures in vegetarians and vegans mainly as a result of a combination of factors such as low BMI and low calcium and protein intake.

Did you know that you can get calcium from non-dairy foods such as green leafy vegetables? There are many non-dairy calcium-fortified plant foods and this meal plan includes some of them such as tofu, tahini and green leafy vegetables such as kale, cauliflower and broccoli.

  • Complete plant-based protein

Vegan European adults have been shown to consume the least total protein and essential amino acids compared to other diet groups, particularly in those who limit legume, seed and nut consumption. In general, animal proteins are considered complete proteins and have higher biological value, protein efficiency and better digestibility compared to plant proteins.

There is a general rule that vegans should follow to make sure they are obtaining a good amount of amino acids from plant protein sources. As a basic rule:

Good amount of plant protein = Grains +/ Legumes +/ Nuts or Seeds

You must combine 2 out of the 3 plant food categories to obtain all the amino acids you are missing out from avoiding meat and animal products. Soy protein are an excellent protein source for vegans. 

  • Iron and zinc 

There is a greater need for iron and zinc in vegans than non-vegans, mainly because non-heme iron and zinc from plant foods is less bioavailable than the heme iron that you get from animal sources. The reason why iron and zinc absorption is poor is because plant foods such as wholegrains, legumes and nuts contain large amounts of phytic acid which competes with trace minerals for absorption.

 

Iron and ferritin deficiency is very common in my practice and is associated with mild symptoms such as low energy and mood fluctuations to a range of clinical conditions such as hypothyroidism. Anxiety can manifest as a result of hypothyroidism. Moreover, low zinc status is associated with mental health deficits such as depression and anxiety.

It is important to combine meals in a vegan regimen with vitamin C-rich vegetables and fruit to maximise nutrient absorption from meals eaten. Iron and zinc are crucial for immune health and the prevention of infectious diseases, fatigue and anemia. 

  • Iodine

 

  • Vitamin D 

 

Gut Microbiota

This may sound implausible to you, but the notion that good bacteria not only influence what your gut digests and absorbs, but that they also affect the degree of inflammation throughout your body, as well as your mood and energy level, is gaining traction among researchers.

 

Processed and pro-inflammatory foods

  • Vegetable Oils and processed plant-based products

Research on the relationship between vegetable oils, fake meat, and inflammation is an evolving field, and findings may vary. However, some studies suggest that certain aspects of vegetable oils and processed plant-based products may contribute to inflammation. 

Fake meat is classed as a processed and in cases where its a ready-to-eat meal, ultra-processed food. It is 8 times higher in salt than normal meat and contains a higher amount of carbohydrates and dietary fibre which are not found in meat.

  • Stimulants

  

Lifestyle Factors

As the research on meat abstention is contradictory, it is important to encourage healthy lifestyle practices in combination with any dietary pattern. This is because to date, we are not sure whether the health benefits associated with vegetarianism are due to the avoidance of meat or due to other “lifestyle” factors such as:

  • More physical exercise
  • Avoidance of tobacco products
  • Low alcohol and drug consumption
  • Unwashed vegetables 

Individual Experiences

Individuals with mental
disorders may “choose a vegetarian diet as a form of
safety or self-protective behavior”

Summary

For psychological benefits, rather than avoiding meat entirely, it would be best to ensure your vegan diet is

Vegans  should be closely monitored and treated for nutritional deficiencies, in order to prevent these being sustained through life and creating health problems in later life. On the one hand, most vegans or vegetarians not supplementing micronutrients are
affected by a vitamin B12 deficiency, for which the negative aspects regarding AD have
been summarized before. On the other hand, plant-based diets are accompanied by a
healthy blood lipid profile, for example, due to low levels of saturated fats or cholesterols.
Moreover, they are enriched in dietary fiber, flavonoids, folic acid, magnesium or vitamin C,
and may be advocated to control energy.

Plant-based diets have shown to be favourable not only on pathological condition and diseases but also in the process ofThe ideal plant-based diet would be one with a high intake of omega-3 fatty acids or antioxidants and at the same time low intake of harmful fats and meat protein.

Contraindications to a vegan diet apply for individuals with an existing or history of disordered eating, pregnant or breastfeeding mothers, anemics and children. It may also be worth speaking with a qualified professional to ensure your are meeting your protein and nutrient needs through your diet and appropriate supplementation.

Disclaimer

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Please note this advice is not a replacement for women who have a medical indication for medical treatment such as those with dysmenorrhea, endometriosis and PCOS. Medication should always be discussed with your doctor and you may benefit from nutrition counselling to optimise your medical treatment.

References

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Craig, W. (2009) Health effects of vegan diets. The American Journal of Clinical Nutrition, 89(5), pp.1627S-1633S.

Gillies D, Leach MJ, Perez Algorta G. Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database Syst Rev. 2023 Apr 14;4(4):CD007986. doi: 10.1002/14651858.CD007986.pub3. PMID: 37058600; PMCID: PMC10103546.
 
Dietch DM, Kerr-Gaffney J, Hockey M, Marx W, Ruusunen A, Young AH, Berk M, Mondelli V. Efficacy of low carbohydrate and ketogenic diets in treating mood and anxiety disorders: systematic review and implications for clinical practice. BJPsych Open. 2023 Apr 17;9(3):e70. doi: 10.1192/bjo.2023.36. 
 
Urska Dobersek, Kelsey Teel, Sydney Altmeyer, Joshua Adkins, Gabrielle Wy & Jackson Peak. (2023) Meat and mental health: A meta-analysis of meat consumption, depression, and anxietyCritical Reviews in Food Science and Nutrition 63:19, pages 3556-3573.
 
Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY, Chung ST, Costa E, Courville A, Darcey V, Fletcher LA, Forde CG, Gharib AM, Guo J, Howard R, Joseph PV, McGehee S, Ouwerkerk R, Raisinger K, Rozga I, Stagliano M, Walter M, Walter PJ, Yang S, Zhou M. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metab. 2019 Jul 2;30(1):67-77.e3. doi: 10.1016/j.cmet.2019.05.008. Epub 2019 May 16. Erratum in: Cell Metab. 2019 Jul 2;30(1):226. Erratum in: Cell Metab. 2020 Oct 6;32(4):690. PMID: 31105044; PMCID: PMC7946062.
 
Health Quality Ontario. Vitamin B12 and cognitive function: an evidence-based analysis. Ont Health Technol Assess Ser. 2013 Nov 1;13(23):1-45. PMID: 24379897; PMCID: PMC3874776.
 
Lauer AA, Grimm HS, Apel B, Golobrodska N, Kruse L, Ratanski E, Schulten N, Schwarze L, Slawik T, Sperlich S, Vohla A, Grimm MOW. Mechanistic Link between Vitamin B12 and Alzheimer’s Disease. Biomolecules. 2022 Jan 14;12(1):129. doi: 10.3390/biom12010129. PMID: 35053277; PMCID: PMC8774227.
 
Markun S, Gravestock I, Jäger L, Rosemann T, Pichierri G, Burgstaller JM. Effects of Vitamin B12 Supplementation on Cognitive Function, Depressive Symptoms, and Fatigue: A Systematic Review, Meta-Analysis, and Meta-Regression. Nutrients. 2021 Mar 12;13(3):923. doi: 10.3390/nu13030923. PMID: 33809274; PMCID: PMC8000524.
 
Michalak, J., X. C. Zhang, and F. Jacobi. 2012. Vegetarian diet and
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Monica D. et al. (2017) Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis
of observational studies, Critical Reviews in Food Science and Nutrition, 57:17, 3640-3649, DOI:
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Müller, A. et al. (2021) A Vegan Diet Is Associated with a Significant Reduction in Dietary Acid Load: Post Hoc Analysis
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