After 12 years on a vegan diet Healthista’s Yanar Alkayat thought she was super healthy – then she saw a gut specialist
There’s clearly no stopping the unprecedented rise of the vegan diet with more than 168,000 people across 165 countries signing up to Veganuary this year, the month-long initiative encouraging people to go vegan up from 60,000 in 2017 and just 3,300 when it first launched in 2014. Who would have thought this one-time hippie’s diet would be so popular?
Celebrities such as Ellie Goulding and Lucy Watson have helped push up the popularity of plant-based eating as well as millennials with a recent Vegan Life magazine survey reporting 42 per cent of all vegans are now aged between 15 and 34. But behind the gloss and glamour of vegan hashtags on Instagram I feel compelled to tell a gut health story that might save people from its potential pitfalls if not approached properly.
close friends will tell you I have a noisy, gassy tummy
Scientific studies on the importance of good gut health have exploded in recent years and it’s now emerging that the number and diversity of the bacteria living inside our gut, intestines, colon and stomach (called the microbiome) regulate almost every system in our body: from immune and skin to mental health and weight. Only recently results of a study published in Mucosal Immunology added to the evidence linking gut health to obesity.
From vegetarian to vegan
Remember the school playground rhyme ‘beans, beans, they’re good for your heart, the more you eat, the more you fart’ well, it’s one I’ve always identified with.
As a life-long vegetarian (since the age of nine), close friends will tell you I have a noisy, gassy tummy and it’s always been that way. It’s something I’ve simply had to live with and attributed it to my fibre-rich diet of vegetables, beans and pulses.
My diet evolved from vegetarian to fully-fledged vegan about 12 years ago for ethical and health reasons.
For several years I experienced only positive effects: an abundance of energy, easy weight management, a more balanced attitude towards food and for the first time in about 15 years, fewer symptoms of chronic candida which I had suffered with since I was a teenager. Candida is an infection that arises from an overgrowth of yeast in the gut.
But in the last couple of years signs of concern started emerging. Occasional flatulence had escalated to extreme bloating (yes, that is me, left) so bad that at the end of every day my belly looked about four months pregnant. I’d always noticed some mild bloating after eating foods such as rice or pasta, but it’s never been extreme and always temporary so I had never minded so much.
These new symptoms, however, were hard to ignore as my swollen belly would protrude from my clothes half way through the day and not deflate until the following morning. My stools were also no longer healthy solids but were loose and obviously imbalanced. Was this down to flatulence foods too? I had a feeling the problem lurked deeper inside my gut.
The rise of gut health and digestive concerns
Scientists are increasingly learning how much the trillion or so bacteria that exist in our bodies play a part in our top to toe health, from immunity and mental health, to skin, digestion and weight. When this microbiome balance is not right, symptoms such as bowel irregularity and gas occur.
Digestive disorders such as Irritable Bowel Syndrome (IBS), are now thought to afflict around 10 to 20 per cent of the UK population. IBS covers off a range of uncomfortable gut issues from excessive wind, bloating and swelling of the stomach to changes in bowel habits such as diarrhoea, constipation to pain and cramping. Further up the scale, Crohn’s and ulcerative colitis (both forms of Inflammatory Bowel Disease) are rapidly increasing among teenagers and children (worrying for the health of our future generations) and more common in women than in men. These conditions also have the highest incidences in northern Europe.
‘Gas and flatulence is a sign food is fermenting in the gut. This could be due an excess of undesirable bacteria in the gut or bacteria in the wrong part of the gut. As these bacteria feed on sugars and fibre, they produce gas,’ explains Stephanie Moore, Clinical Nutritionist at Grayshott Health Spa.
‘Gut bacteria affect our mental health as well and our ability to cope with stress. The right kind of gut bacteria can also help with metabolism and weight management so implications are very far reaching,’ she adds.
Getting the expert’s opinion on my gut health
I’d always considered my diet to be healthy and proudly plant-based, even when it was a fringe diet all those years ago, long before it became popular. I was also able to successfully support my active lifestyle which involves a lot of exercise.
I’ve run four marathons and now training for my fifth (a mountain race on Snowdonia, gulp!). Plus, the last three years I’ve been doing Crossfit and weight training, which both require plenty of fuel. So I’ve always been conscious of eating well and eating enough. People would always comment I was a healthy advertisement for being vegan but what was happening on the inside was not as healthy as the picture on the outside.
Luckily I found myself at Omniya Clinic in Knightsbridge asking Clinical Nutritionist, Peter Cox why my stomach was misbehaving when I had such a healthy diet? The first and most essential port of call he said is a diagnosis test.
‘The best tests depend on your symptoms. For many vegans a blood nutrient test would be my first port of call as some nutritional deficiencies are particularly common among vegans, such as iron, vitamins B12, B2 and D and omega 3 fatty acids. A stool test is often useful when there are gut symptoms but also when there is a history of auto-immunity.’
He requested I do a stool analysis – not an experience I’ll forget in a hurry – and to write a food diary for two weeks. I was disgruntled when he suggested a high sugar diet is probably to blame for my gut issues. How could I possibly have a high sugar diet when I don’t touch refined carbs, rarely eat pasta or bread, only occasionally eat sweet stuff and don’t drink fruit juice or pop? Slightly miffed, I set out to prove him wrong. I eagerly noted down my eating habits, convinced sugar can’t possibly be to blame.
What I’d typically eat in a day on a vegan diet
Breakfast: In the past it’s regularly been avocado on sourdough, rye bread or rice cakes. Last year I switched to overnight oats, protein powder and non-dairy milk to fuel my pre and post workouts particularly during marathon training months.
Lunch/Dinner: This has typically been a medley of beans and wholegrains such as quinoa, spelt, barley, perhaps with hummus or tahini and dinner usually something Indian or Asian inspired like a stir fried veg and tofu, a curry or a stew. My staple vegetables have always been aubergine, squash, courgette, cabbage, greens and tomatoes.
Snacks: I would snack on fruit, small squares of chocolate, nut or protein bars occasionally or those delicious hummus crisps everyone loves. Throughout the day I’d also have endless herbal teas and limited caffeine. So with such a seemingly healthy vegan diet what was the problem?
Gut health analysis – the results
The results of the stool analysis held the answers. In a bare, clinical room at Omniya, Peter went through the results and stopped at the crunch line. I had a very prominent yeast overgrowth and was completely deficient in lactobacillus, the bacteria strain commonly found in dairy and meat.
Peter explained each discovery and its implications in turn: ‘Your yeast overgrowth indicates your diet is sufficiently out of balance and contains enough sugar to feed it and your bacterial imbalance (formally known as dysbiosis) puts you at risk of further yeast related symptoms and a systemic candidiasis.’
‘A low yeast and low sugar diet would require you to minimise sources of sugar and, potentially, other carbohydrates, in favour of eating more protein and fat rich foods. It is enormously important for you to continue to avoid alcohol and refined sugars. It is also important you try to find additional sources of protein and fat to compensate for any reduction in carbohydrates,’ advises Peter.
Why a vegan diet MIGHT ruin your gut
‘A vegan diet can be problematic if you rely heavily on grains, sugar-based foods, an excess of fruit especially dried fruits. This is true for anyone, vegan or not. These will preferentially feed pathogenic and harmful bacteria and yeast in the gut, which then thrive causing issues such as bloating, bowel irregularities, potentially SIBO (small intestinal bacteria overgrowth) or SIFO (small intestinal fungal overgrowth) as well as loss of beneficial bacteria that become overwhelmed by the ‘bad’ bacteria,’ clarifies Stephanie.
So the finger was pointing at bacteria-feeding grains abundant in my diet which I’d always considered healthy. Oh the irony. Then there’s fibre.
‘Vegan diets can be high in fibre too which is generally a healthy situation but if an individual already has a poorly functioning digestive system and/or they do not eat slowly, chew well and manage their digestive health well, too much fibre can cause irritation, inflammation and more bloating,’ adds Stephanie.
‘Grains are one of your greater sources of sugar,’ confirms Peter. Deemed healthy and nutritious in normal circumstances, and the foundation of my vegan diet, they were now the root cause of my gut troubles.
Peter advised to shift the sources of my calorie intake from predominantly carbohydrates to proteins and fat. I was willing to make the change for my future health but I was committed to high volume training so how on earth was I going to fuel my sports if not morning oats and spelt and barley salads? This left me completely perplexed. Frustratingly Peter suggested I consider pulling back on training but this was a big and happy part of my life, and like vegan eating, not something I wanted to give up.
What does a lactobacillus deficiency mean?
The deficiency in lactobacillus was equally worrying. Lactobacillus is thought to be an important strain of beneficial bacteria in the gut that helps to break down fibre and protein-rich foods. ‘Lactobacillus is also important for the protection of the gut wall, for the immune system and for protection against other organisms, such as pathogenic bacteria and yeasts,’ explains Peter.
It appears my deficiency in lactobacillus was contributing to the yeast overgrowth and exasperating my boating and gassiness which was the bombshell moment.
‘Lactobacillus deficiency makes it more difficult to break down fibre (and lactose) leading to potentially further fermentation by other bacteria and an increased risk of gas and bloating. It also allows for a yeast overgrowth, as lactobacillus is typically one of the more populous and beneficial bacteria which would push out yeast and prevent an increase in the number of yeasts. And if left untreated symptoms can escalate into more serious conditions such as leaky gut.’
Leaky gut is when toxins and microbes are absorbed through the blood stream through a porous bowel (also known as ‘increased intestinal permeability‘) with gastroenterologists (gut specialists) agreeing it can lead to inflammation in parts of the bowels and other experts believing it’s can potentially cause greater health issues such as chronic fatigue syndrome and other auto-immune conditions.
my deficiency in lactobacillus [as a result of my vegan diet] was contributing to the yeast overgrowth and exasperating my boating and gassiness which was the bombshell moment
‘Increasingly I am seeing a decrease in all varieties of gut bacteria not just the lactobacillus bacteria. Diversity as well as high numbers of gut bacteria are essential for good health but as we lose diversity and numbers we are at risk of compromising our immune systems and our digestive capacity is weakened,’ warns Stephanie.
My gut health treatment plan – supplements
So how was I going to rebalance my gut ecology without abandoning my vegan diet and ethics?
Step one, supplementation. The stool analysis offered suggestions for natural and naturopathic remedies to help treat my problems such as garlic and caprylic acid that are well researched to tackle these symptoms. ‘But I eat loads of garlic!’ but Peter explained my gut needed therapeutic dosages to see improvements not just a few bulbs thrown into a curry.
I bought Biocare Garlic Plus (£21.35), to be taken twice a day. The most important supplement was acidophilus to feed my gut the all-important lactobaccilus. Staying on the vegan path meant I would probably have to take this supplement long term. I chose Biocare BioAcidophilus Forte, £33.60) but found cheaper and well recommended alternatives by Lifeplan.
I also stocked up on Pharma Nord Bio-Fiber (£7.95) which contains 70% dietary fibre of soluble and insoluble origin, from lemon peel and sugar beet. ‘Dietary fibre increases beneficial gut micro-flora, buffers glucose intake and reduces blood lipid levels. It is not just the overall level of fibre in the diet that is important but also the relative amounts of the main types of fibre, lignin, pectin, cellulose and hemicellulose,’ explains Frankie Brogan, senior nutritionist at Pharma Nord.
My gut health treatment plan – diet
Step two, diet. Peter’s top recommendation was to cut back on, if not eliminate, grains and carbs. This would be a huge change for me but I was willing to try.
The advice from Stephanie was the same: ‘Firstly greatly reduce or eliminate highly fermentable fibres, sugars and carbs, starving the nasty bugs, while fuelling the gut with beneficial bacteria in live foods and probiotic supplements.’
From the following day I started tweaking my diet…
Breakfast: I began weaning myself off oats in the morning (I wasn’t quite ready to go cold turkey!) so I cut down from one cup of oats in my smoothie to just a topping on my chia seed bowl (see pic). Within a week I had given them up completely.
To make up the calories and nutrition I replaced oats with chia seeds so my breakfast was still filling but also provided a good source of omega 3 fats, fibre and protein.
Breakfast became a tablespoon (or two) of chia seeds (soaked for an hour or overnight) mixed with a scoop of Healthista Lean Energy Vegan Protein in Creamy Vanilla and topped with a handful of soaked nuts and always a tablespoon of nut butter or coconut oil. This was super delicious, high energy re-fuel without any grains.
Lunch/dinner: I knocked on the head my occasional slice of sourdough, spelt or rye bread for the sake of my gut health makeover and said goodbye to falafel to reduce my carb count. Lunches were now big salads (without quinoa or spelt as I used to have) topped with tofu, avocado and two tablespoons of olive oil. Dinners were similar stir-fries to before but without a side of grains. I would just drizzle a double dose of olive, sesame or argan oil instead to make up for the reduced carb.
For protein, tofu and nut butters filled the gap, plus I learnt one cup of pumpkin seeds contained 12g of protein, there were 4g of protein in a tablespoon of chia seeds and 9g of protein in hemp seeds – I bought Biona Organic Hemp Seeds and blitzed them into a sprinkle in my nutri-ninja for a healthy, omega-rich topping for breakfasts and salads. I was not quite ready to give up lentils and chickpeas so I still ate them in moderation.
I did surprisingly well without bread, except it left my beloved avocado in need of a new partner. What else do you eat avocado with if not on a slice of delicious sourdough toast? I’ve never fancied pulverising into a smoothie so I started adding an avo to salads and even stir fries for a hit of good fat.
Snacks: I started eating sauerkraut regularly, almost every other day, so I kept Biona in business with a regular supply of Biona Organic Sauerkraut (£1.89) in my fridge to snack on and add to lunches and dinners. I also tried Biona Organic Kefir, which actually tasted great as doesn’t have a strong or bitter taste as other kefirs so it’s a good entry-level kefir choice, but obviously this was breaking the vegan diet which I wasn’t in favour of but recommended if you are able to be flexible.
Oat cakes, rice cakes and crackers became a thing of the past, which I missed, so I found grain free flax seed crackers by Rawlicious. They’re not cheap but a tasty, occasional alternative, ticked all the dietary requirements and were a great fit with avos.
Within one to two weeks of cutting out morning oats I noticed the bloating and gassiness had gone down significantly which encouraged me to stick to the new diet rules. I couldn’t believe how quickly the changes took place. My usual flat stomach was back and remained flat from breakfast into lunch, which was a sure sign I had to say bye-bye to oats for good. Adios!
I’ve felt surprisingly well-fuelled after training and without any dip in energy and no hunger pangs until lunchtime, which is amazing, so I now recommend my new chia seed and protein powder bowl to everyone.
Supplement wise, the probiotics were also helping. I would take them last thing at night before bed and by morning my stools were solid. Things were definitely looking healthier.
Seeing this difference motivated me to continue – reminder notes around the house help me remember to take the probiotics and other supplements and sticking to a routine helps. According to Peter a three-month course is enough to see a marked difference in gut health and reduced symptoms.
The future of my gut health
I’ve been slowly transitioning from fewer grains to no grains in my daily diet and this difference this has made is truly remarkable. I’m now two to three months in and rarely bloated these days. Those nights where I would go to bed with a massively swollen stomach only happen after I’ve been with family eating a rice feast (we’re middle-eastern after all) but as this is only occasional it’s totally manageable.
The vegetables I eat provide natural plant-based carbohydrates and proteins so I’m by no means carb-free especially as I still love butternut squash and sweet potato which contain more starchy sugars than other veg but that’s a phase two transition which I’ve only just started thinking about. While I probably haven’t achieved near-perfect gut health yet the differences a few small tweaks have made in just a few months are enough for me for now and impressive in themselves.
I’m not saying don’t go vegan – after 12 years of vegan living I’m still a huge advocate – but it’s not a diet to be taken lightly and naive to assume no side effects. Cutting out two major food groups can’t happen without potential repercussions and when you replace these foods with convenient sources of high-carb energy that feeds the gut with unwelcome sugar, at some point there might be a knock on effects even if they don’t show for a few years.
So take heed of experts’ advice and support a vegan diet properly and healthily, with a daily intake of different fermented foods such as kefir, sauerkraut, kimchi, kombucha, pre-biotic rich foods such as onions, garlic, leeks, green leafy veg and swollen fibres such as soaked flax and chia seeds. ‘Reduce grains, avoid eating too quickly, chew well, avoid too much alcohol and processed foods, get good sleep,’ sums up Stephanie. It sounds so simple and it really is.
Healthista’s digital director is Yanar Alkayat also a health and beauty writer for the UK national press. She blogs on ethical beauty and lifestyle at brightershadeofgreen.co.uk and tweets at @YanarBeauty.