Last updated on July 10th, 2020
Almost always, the answer is 'No'. There's too big a risk that the veganism is a cover for eating disorder restriction. Also, a vegan diet can make weight regain harder. But there are exceptions.
Nuts, nut butters, oil, ground almonds, coconut milk, coconut cream, ice-cream, shakes, chocolate, pizza, avocado, cereal bars, carbohydrates
'Can my child stay vegan when they have an eating disorder?' The standard answer is 'NO'
Most eating disorder specialists will tell you that it's not at all OK to let your child stay vegan (or far worse, become vegan) while they are suffering from an eating disorder. It goes against all principles of treatment because:
- We want to help our son or daughter recover any lost weight fast (and too often, we're not good at doing that with vegan food)
- We are concerned that a vegan diet may not be complete enough: a body that has been malnourished for a while may need generous quantities of nutrients not easily available to vegan eaters
- Eating disorders tend to involve rigidity and obsessive focus on a limited range of foods. They can start with orthorexia — a fixation on 'healthy eating'. For complete recovery, we coach our children to widen their range, not restrict it.
- Veganism may have triggered weight loss, which triggered the eating disorder — the young person and their parents just don't know how to make vegan meals nutritious.
- And of course the veganism could be all about avoiding higher calorie foods:
"Adoption of a vegan diet coinciding with the development of
anorexia nervosa could be part of the disorder, rather than a reflection
of the individual’s vegan beliefs, and this needs to be considered at
the point of assessment"
Yet sometimes it might be OK for your child to continue being vegan during eating disorder treatment
Yes, in some cases, veganism can work out. But please don't take this as a green light for veganism. Only in a few cautiously-managed cases is it a good idea to let your child stay vegan if they have an eating disorder.
Society is changing. It's become increasingly 'normal' and easy to be vegan. Veganism is the new vegetarianism! So we're going to see more youngsters for whom veganism has long been a way of life, unrelated to any eating disorder.
So I was really interested to talk with a smart, on-the-ball mother who supported her daughter to recover weight fast and to beat anorexia on a vegan lifestyle. The decision was not made lightly, and it was made with the cautious guidance of a dietitian specialised in eating disorders.
I am grateful to this mother for taking the time to write her story for us all here.
Veganism in eating-disorder recovery – A parent’s experience
Vegan / vegetarian a long time before the eating disorder
My daughter was diagnosed with anorexia nervosa in January 2019, and had begun restricting in October 2018. She had become a vegan 3 years prior to this, and a vegetarian for 2 years before that.
Her diet as a vegan and vegetarian had always been excellent. I had monitored her nutrition carefully, made sure she had blood tests regularly to check for any deficiencies. I was sympathetic to her reasons for wanting to omit animal products, having been vegetarian for several years myself.
For other parents wondering where to draw the line, I think something like a 2-year rule is reasonable – if the child had a clear two years not eating animal products prior to the illness then their motivation for veganism is likely ethical. But I would really urge anyone to find a good eating disorder dietitian to assess this fully as it seems so hard to know when an eating disorder begins to raise its head.
Once she was diagnosed, I sought as many resources as I could to explore the relationship between veganism and anorexia – most of these seemed to consider it as a way to restrict and should not be tolerated in recovery.
"In the early stages of my daughter’s illness, I was extremely conflicted about how to handle the vegan question and it was an extra source of anxiety"
My daughter commenced family-based treatment (FBT) immediately. Our therapist was ambivalent to the veganism at this point, as refeeding by any means necessary was key. We began 3 meals/3 snacks a day and focused on high fat foods such as avocado and nuts. We spent around 8 hours a day at the table [note from Eva: more options here], with the rest of the time spent trying to restrain her from exercising. After 3 months it was clear we were not making good progress, and we agreed that inpatient treatment was required.
Hunting for an inpatient unit that would treat her as a vegan
Obviously this was an extremely difficult time. Considering whether veganism had a causal relationship with her eating disorder was not the priority. That she would eat – anything at all – was our number one concern. I wanted to make sure that the inpatient unit she attended would accommodate her veganism – at least initially – just to get some food into her. As my daughter became very sick indeed, our GP and I were frantically ringing around to see what the various policies were. They all said they would accommodate vegetarianism but not veganism. I spoke to one private facility where the Clinical Director’s secretary said they would treat her as a vegan. Then the dietitian said they would not.
This added a layer of uncertainty to what was already a horrifically stressful time. In the end, we chose our local CAMHS (child and adolescent mental health service) inpatient unit, having met the team and decided that it was best for us to be near her. They were clear that they would not refeed as vegan but I had to trust that they had the expertise to take care of her.
'Food as medicine': accepting non-vegan
Unfortunately, on hearing she was to be admitted, my daughter ceased to eat and drink completely and she was admitted to hospital and was placed on a nasogastric (NG) feed. I felt extremely fortunate that she did not fight this as she knew well this was not vegan. Thankfully, in a hospital environment, she saw ‘food as medicine’.
Whilst in hospital, the CAMHS dietitian oversaw her NG feed and her transition to food once the threat of refeeding syndrome had passed. My daughter took toast, cereal bars and supplement drinks initially.
"There were no vegan supplement drinks so the ‘food as medicine’ mantra had to apply"
Our dietitian put together a vegetarian meal plan which allowed for a number of fear foods. This rendered the plan more or less vegan. She was also put on fish oils – again ‘food as medicine’.
Assessing my daughter's motivations for veganism
The dietitian took the time to get to know my daughter, and began to assess her motivations for veganism. She made it clear to her that refeeding as a vegan would require a larger volume of food than for others. Where the other ED patients had one dairy yoghurt as part of a snack, my daughter would be given two soya yoghurts. Once the dietitian had observed my daughter tolerating this meal plan, we began to discuss the role veganism would play in her long term recovery.
As a parent, I had tried to keep an open mind. I was not wedded to my daughter’s veganism; if it gave her an excuse to restrict and meant that she would struggle to recover from her eating disorder then we would have had to try and move her to an omnivorous diet. Would I rather my child ate animal products during her recovery? Yes. There is evidence that they are better for brain healing. But the point of my story is that recovery, for her, was possible without.
As well as observing my daughter, listening to her, to me and applying her knowledge of nutrition, the dietitian sought guidance from other professionals including her peers with expertise in eating disorders.
High-calorie vegan foods
Whilst my daughter was inpatient, the dietitian did require quite large volumes of carbs – there were a lot of oats, pasta, cereals and bread. There were limitations on some of the things I would feed at home simply because she was in a public hospital (she never got avocado there!) I also think it was one of the dietitian's tools to test my child's commitment to veganism. We gradually decreased volume in favour of higher calorie foods in our home meal plan.
Before my daughter was discharged, the dietitian produced a fantastically helpful report which examined her findings in detail.
"The dietitian concluded that my daughter’s reasons for veganism were wholly ethical. She supported us in devising a suitable home meal plan based on the foods she ate prior to the eating disorder"
Useful vegan foods for refeeding and weight gain
The majority of the foods in this plan were those that she ate prior to her illness but the ones we focused on to add some calories were:
- Nuts (roasted and salted for palatability!)
- Peanut butter
- Growing Up soya milk (used for toddlers)
- Olive oil/rapeseed oil for roasting
- Ground almonds in sauces
- Vegan ice cream
- Vegan pizza
- TREK and Clif bars (lots of similar ones on the market)
I think shakes are an excellent addition too – full fat coconut milk is a great one though I never used it as my daughter genuinely doesn’t like it. We haven’t used shakes since she was discharged as we relied on them before her inpatient stay and they are now quite triggering (and not her normal fare). But we used them a lot in the early stages.
Getting enough calories
As my daughter had been vegan for the previous 3 years, I already had plenty of experience in producing nourishing dairy-free meals. During the refeeding phase my daughter gained weight at a good rate on approximately 3,500 calories a day. I’m aware that some kids need a good bit more and I anticipate that this would be harder still on a vegan diet.
Veganism after weight-restoration
My daughter is now weight-restored and physically healthy.
Her recovery has not been linear and not without difficulty. We are 18 months in and still hit significant challenges. But I do believe that her veganism has not been causal in those difficulties.
Veganism is now a mainstream dietary choice full of ice cream, cakes, biscuits and fast foods. Every restaurant menu has a vegan option. My daughter now delights in finding a new brand of ice cream, or that a fast food restaurant has a new vegan choice.
We supplement her diet with a vegan multivitamin and omega 3.
How are treatment providers dealing with veganism?
Now that there are plenty of vegan options, it seems pretty arbitrary for service providers to refuse to refeed using a vegan diet, especially as vegetarian diets are allowed. That said, my daughter’s veganism allowed for a much more considered dialogue with my daughter’s dietitian. Perhaps if she’d been vegetarian it would have just been taken at face value and my daughter’s motivation unquestioned?
In the instances where supplementation/NG feeding is required, there are currently no non-vegan options available as far as I’m aware. During the acute phase of her illness, I am very thankful that my daughter tolerated non-vegan supplementation. This will not be the case for some patients.
I found this document from The Royal College of Psychiatrists, The British Dietetic Association and BEAT, very useful when I was doing my own research:
To close, I would like to reiterate that any kind of dietary ‘fad’ can all too often be used as an excuse to restrict. Veganism is high up there on the list! But for patients with a longer history of ethical eating, we owe it to them to acknowledge, assess and accommodate their beliefs.
"I’d always stress the use of a good eating-disorders dietician"
I am forever indebted to the dedicated, knowledgeable and thorough dietitian who helped us navigate my daughter’s recovery. I hope other parents in the same position can ask for and receive a similar level of support.
What about you?
[Back to Eva: ] I am so grateful to this parent for writing this fantastic piece. I am sure other parents researching this will be glad to read from others' experiences. Do write in the comments section below.
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