I am not a reader of the Daily Mail, but yet again one of its headlines has caught my attention: “Woman who ate 20 bananas a day while pregnant hits back at critics and says her baby boy is ‘thriving’ at three months”.
This story relates to Australian mother Loni Jane Anthony, who follows The 80/10/10 Diet I have mentioned previously. Loni Jane has 252,012 followers on Instagram (not that I’m at all jealous about that) and a busy photographic blog where she posts pictures of herself and her son looking fabulously healthy and gorgeous.
According to The Daily Mail she has been branded as “deluded”, and critics have said that her “extreme vegan lifestyle could damage her child’s health”. The article states that her decision to continue her diet throughout pregnancy was “arguably risky” and apparently commentators have called her “irresponsible” and “narcissistic”, while one nutritionist has stated “this isn’t a diet I would recommend to a pregnant woman. Protein and fats are important in our diet especially during pregnancy”.
How should we respond to this story? Firstly, there is clearly no problem with mum’s health or baby’s development, which suggests that the diet they follow is at the very least capable under ideal circumstances of supporting normal fetal growth, without the maternal weight gain that is generally accepted as necessary during pregnancy. So there is no cause for concern regarding her or her baby as individuals.
Should this anecdotal scenario trigger further scientific enquiry? It certainly challenges many widespread beliefs about what constitutes an ideal diet for pregnant women. My approach is one of cautious curiosity: we simply do not have the scientific data required to draw any firm conclusions on which to base recommendations. However, when something comes along to challenge the prevailing worldview, then that is the time to review our hypotheses and design some new studies. This is how good science progresses, and humanity betters itself. Dismissing such anomalies as deluded, risky, irresponsible and narcissistic helps no-one.
I was interested to watch The World’s Best Diet (highly dubious from a scientific perspective, but entertaining and thought-provoking nonetheless) with Jimmy Doherty and Kate Quilton on Channel 4 this week. Clearly diets around the world are highly varied, with a wide range of different diets being able to support human survival and reproduction, including the almost entirely plant-based diet of the Ethiopians. They don’t suffer much in the way of obesity, heart disease or diabetes, but they generally die from other non-dietary diseases (infectious diseases and other diseases of poverty), so they don’t rank highly in the league tables for longevity unfortunately.
Examples of individuals following a wholly unprocessed plant-based diet in affluent settings remain relatively few and far between, and there are certainly no whole population examples that could be studied to ascertain whether or not this pattern of eating might offer the best opportunity for a long and healthy life for human beings. The Seventh Day Adventists mentioned in the programme are one group that have been extensively studied who might shed some light on this question, although they are mostly vegetarian or sometimes vegan, rather than low fat raw.
It might also be worth noting here that the diets of our closest living relatives, the chimpanzees and other great apes, consume a diet that is around 97% low fat raw vegan (mainly fruit and green leafy vegetables), with only a few percent of their total calories being derived from insects and (in the case of some chimpanzees) lean raw meat. And they seem to be able to grow normally sized babies too.
Conversely, is there any evidence that such a diet is actually harmful for human infants? Recently I came across an article by raw food writer Shazzie (author of Evie’s Kitchen) who claims that feeding young children an unsupplemented raw vegan diet is tantamount to child abuse (most vegans I have met do supplement their children at least with vitamin B12, so I suspect this refers to a very small minority of individuals anyway). At the same time I read a thread on the low fat raw vegan website 30 Bananas a Day, where a number of parents criticised her observations, claiming to have healthy children following this kind of diet.
There have undoubtedly been tragic examples of malnutrition in vegan and raw vegan children written up as case-reports in the scientific literature. However case-reports feature very low down in the hierarchy of what constitutes reliable scientific evidence, as they are extremely prone to bias. Healthy children do not generally feature, so there is no denominator from which to derive rates, and no ability to compare them with rates of malnutrition in the general population. There is also (and I appreciate that this may be a controversial statement) a significant potential for a confounding effect from maternal/parental mental health status. Confounding occurs when two variables appear to be associated with one another, but the relationship is not causal. A third, or “confounding”, factor that has not been adjusted for is in fact causally related to both variables being studied. An example might be a mother with a pre-existing eating disorder, who self-defines as vegan as a means to further restrict calories, and who also transfers some of her own issues around eating to her child, resulting in calorie restriction and malnutrition. My point here is that in these sorts of scenarios it is not the vegan diet that is at fault (and I am in NO WAY suggesting that veganism is a form of eating disorder OR that those who are vegan have mental health problems, by the way). Similar situations may well occur in cases where an omnivorous diet is being consumed, but as no-one would blame the diet itself in such scenarios, they would not be written up as case reports.
Lastly, it is insufficient to claim that all vegan diets are unsuitable for young children, when vegan diets, as I have mentioned previously, come in so many different shapes and forms. Children will not thrive if they are fed insufficient calories, no-matter what diet they are on, but for the most part if children are given access to plentiful and varied food options they will consume the calories they need. This is a very basic survival instinct that we all have. Healthy children will not starve because their diet contains a bit more fibre. They will simply adjust to eat a greater volume of food, like the beautiful Ethiopian children devouring teff injera flatbreads and lentils as their staple diet, for example.
[N.B. Genuine physical disorders of the gastrointestinal tract that may make eating difficult or painful (such as gastro-oesphageal reflux) should of course always be ruled out by a medical professional where there is concern over inadequate intake, and psychosomatic problems should also be considered in older children]
A while ago I came across a book entitled Infant, Child and Adolescent Nutrition: A Practical Handbook, by Judy More (CRC Press). Its two paragraphs on vegan diets go as follows:
“Vegan diets are unlikely to provide adequate calcium, vitamin B12, omega 3 fats unless they are extremely well planned. A calcium-enriched soya milk can be used as a substitute for foods in food group 3. However, an extra supplement may be needed for the key ‘at-risk’ nutrients, which are iron, zinc, calcium and vitamin B12. A vegan diet is not recommended for the under-fives.
Diets more restricted than a vegan diet, such as Zen macrobiotic, fruitarian or raw food diets, are not recommended for children as they cannot provide all the energy and nutrients for growth and development. A referral to social services and for a dietetic assessment are essential if parents reject this advice.”
It might take me some time to unpick this, and it certainly warrants at least one, if not several posts all of its own. But for now let me just say that NO DIET, IN AND OF ITSELF, WARRANTS REFERRAL TO SOCIAL SERVICES. Parents who are doing the best they can for their children, according to their own understanding of what that means, should never be accused of child abuse. However, when there are indications that something is wrong, to do nothing to rectify the situation may constitute neglect (of course the same could be said of any parent who, against everyone’s advice, continues to take their obese child to McDonalds). A social services referral may be appropriate in cases where a child shows demonstrable physical signs of malnutrition AND parents refuse to take corrective action. This is my opinion only, and does not constitute any form of official advice or guidance (sorry, had to put in the disclaimer at the end).
I’ll be picking up on some of the difficult issues raised here again in future posts, but in the meantime please do let me know your thoughts. And thank you for reading.