FOR DREW RAMSEY, M.D., brain health is serious business.
The 42-year-old assistant clinical professor of psychiatry at Columbia
University College of Physicians and Surgeons specializes in nutritional psychiatry. If you ask him how a vegan diet benefits brain health you might be surprised to learn that, for Ramsey, the ultimate brain foods are not found in fruits and vegetables but in animal sources like fish, meat and dairy. With all the cultural discussion about the environmental and health benefits of a vegan diet, this may seem counterintuitive, especially with the popularity of documentaries like Forks over Knives and the Leonardo DiCaprioproduced Cowspiracy, not to mention the Herculean achievements of vegan athletes, vegan diet endorsements from revered medical institutions like The Cleveland Clinic and the vegan zeitgeist of celebrities like Ellen Degeneres, Alicia Silverstone and Moby. “Don’t get me wrong,” Ramsey said. “I love what vegans are doing. They are the Jedi Knights of the food movement, and they’re doing wonderful work to help us eat more plant-based foods.
But there’s a big difference between a plant-based diet and a vegan diet. Ultimately, it doesn’t feel good to me as physician to prescribe a diet that doesn’t contain the top two nutrients for brain health.” According to Ramsey, those two nutrients are vitamin B12 and DHA (long chain omega fatty acids). Ramsey is the fi rst to admit there’s a lot of polarization in the nutrition world about whether it’s best to get these two important nutrients from animal sources or supplements, so it’s no surprise that physicians like Neal Barnard, the founder of Physicians Committee for Responsible Medicine say the brain can function just as effi ciently or even better on a vegan diet using non-animal sources of omega-3s—from algae, hemp, chia or fl ax and synthetic B12 supplementation.
Yet, Ramsey is happy to jump into the fray and declare vegan diets cause brain damage. “I say that not to be provocative,” he says, “I say it because it’s sound science and because most patients aren’t compliant when it comes to supplements.” In his new book, Eat Complete: Th e 21 Nutrients at Fuel Brainpower, Boost Weight Loss, and Transform Your Health, Ramsey explains that B12 can only be found naturally in animal sources like bivalves and in meat, dairy and eggs. Vitamin B12, he writes, is important because it maintains nervous system function, and prevents brain cell death and brain shrinkage. Plus, B12 defi ciencies can increase the risk of depression and dementia. However, since he’s also concerned about the environmental impact of industrial farming and over fi shing, he recommends eating pasture-raised, grass-fed animal products and sustainable seafood.
As for DHA, Ramsey explains that it’s the most abundant omega-3 fat found in the brain. DHA helps brain cells communicate and function better. More importantly, DHA combats in infl ammation that can cause brain cell death. Low DHA levels have been linked to depression, bipolar disorder, ADHD and Alzheimer’s disease. Th e most concentrated sources of DHA come from fatty fi sh, such as wild salmon, mackerel and sardines. Ramsey boosts his argument by rattling off studies published in peer-reviewed journals that support his thesis that vegan are often defi cient in both DHA and B12. One he fi nds troubling is a 2008 article published in Nutrition Reviews that looked at 30 case reports of B12 defi cient vegan mothers. Th eir infants had developmental delays, small brains or cerebral atrophy. “Yes, this is a small study but we have a lot of other studies that show low levels of B12 and DHA in vegans,” Ramsey says. “With supplements and medical monitoring, it’s possible for vegan women to heave a healthy pregnancy but there are risks. I’m concerned that many people who like the idea of veganism don’t know they need supplements. Th is is simply dangerous, especially during pregnancy.” He also cites a large 2012 epidemiological German study published in the International Journal of Behavioral Nutrition and Physical Activity that concludes vegetarians have more depressive and anxiety disorders. But physicians like James Loomis, M.D. Medical Director of the Barnard Medical Center, founded by Physicians Committee for Responsible Medicine (PCRM) founder Barnard, are quick to point out that the latter study does not specifi cally state vegetarianism causes mental health problems. In fact, the study authors write that the adoption of the vegetarian diet followed the onset of the mental disorders, making it tough to determine cause or eff ect.
Loomis easily points to other research like a 2010 Nutritional Journal study that looked at 138 Seventh-day Adventist vegetarians who, despite having a low intake of long-chain omega-3 fatty acids, had healthy mood states and low incidence of depression. And in a 2014 randomized control trial that was published in the American Journal for Healthy Promotion, the PCRM introduced a vegan diet to employees of GEICO who were overweight or struggling with type 2 diabetes. Th e study did not monitor B12 or DHA levels, but it concluded that employees who got the vegan diet intervention not only lost weight but reported alleviated symptoms of anxiety, depression, and fatigue as well as increased work productivity. Loomis is personally invested in the benefi ts of a vegan diet. Th e 56-year old physician started eating a 100% plant-based diet in 2011 when what he considered to be a healthy American diet failed him. He had high cholesterol and sleep apnea, and he was moderately obese. One evening while lying on the couch recovering from knee surgery, he watched Forks Over Knives. “I was dumbfounded that the solution could be so simple,” he says. He never learned anything about nutrition in medical school and quickly began to question the conventional medical model that focuses on treating disease rather than preventing it. As an experiment, he adopted a vegan diet for three months. He never looked back. “I lost 65 pounds,” he says. “It was like a miracle. I realized what I had been calling healthcare was really sick care—and it didn’t have to be that way.” Now Loomis runs both half marathons and half Ironmans.
Physicians like Loomis and the PCRM’s Barnard evangelize their belief that a properly planned low-fat vegan diet with B12 supplementation and DHA from sources like hemp, flax and pumpkin seeds can optimize brain health and even prevent cognitive decline like Alzheimer’s. Barnard, for example, points to a 2014 study from the Journal of Alzheimer’s Disease which observed that people 65 years and older in developing countries who had in recent years adopted a more “Western” diet— including consuming more animal fat—were at greater risk for Alzheimer’s disease. And a 2016 JAMA Neurology study found those struggling with obesity, diabetes and cardiovascular disease were four times more likely to experience cognitive decline compared to those who maintain a healthful weight with normal cholesterol and blood pressure. “When you talk about brain health you can’t just concentrate on that one organ,” Loomis explains. “Eating a vegan diet is good for the heart, the kidneys, for weight and blood pressure management, and for cholesterol and cancer prevention. The tie that binds all these things together is chronic inflammation, and a vegan diet [is the best way to avoid inflammation].” While these views may seem oppositional, Loomis and Ramsey agree about more than you’d think. They’re both concerned about the environmental impact of animal farming—greenhouse gasses, water use, and pollution from our voracious demand for meat (the average American eats 270 pounds a year)—and the animal welfare issues associated with industrial farming. Both physicians say that any healthy diet is comprised mostly (Ramsey says 80%) of fruits, vegetables, legumes nuts, grains and seeds.
David Katz, M.D., founding director of the Prevention Research Center at Yale University, puts a finer point on it: “Very often these discussions about veganism and vegetarianism take on ideological overtones—that folks who don’t eat animals are going to be frail, weak and sickly. Then my inclination is to point to gorillas and my horse. Both are vegan.” Katz, who takes a B12 supplement and is personally moving toward a vegan diet, feels a problem with these kinds of arguments is: “People fall into their own vat of Kool-Aid, vegan or otherwise—they can cite research selectively to back their claims and then it becomes the stuff of best sellers.” So what’s the bottom line: Is a supplemented vegan diet or a mostly plant-based diet with animal sources of B12 or DHA better for brain health? Katz says, “The truth is probably somewhere in the middle. More importantly, when it comes to diet and nutrition, one size fits all is never the answer.” That’s how registered dietician Ashley Koff approaches her clients. “While I think it’s an oversimplification to say that diets that include animals better support brain health,” she says, “you have to meet people where they are in their own health continuum.” So we might say, eating healthy is like picking out the best outfit for an occasion. Whether you choose to embellish your plant-based plate with bivalves, fish, grass-fed meat or dairy, or no animal at all, it’s all-good as long as you achieve your signature look. As Koff says, “Everyone agrees a plant-based diet is the healthiest approach to make sure you get the nutrients you need to keep your body and brain healthy. The most important thing is how you choose to accessorize.”