I’ve been trying to figure out why I feel like I disagree with this post, despite broadly agreeing with your cruxes. I think it’s because it in the act of writing and posting this there is an implicit claim along the lines of:
Subtle nutritional issues that are specific to veganism can cause significant health harms, to a degree that it is worth spending time and energy thinking about this as ‘a problem’.
For context, I am both vegan and a doctor. Nutrient deficiencies are common and can cause anything ranging from no symptoms to vague symptoms to life-threatening diseases. (For simplicity, I’m going to focus on deficiencies only, although of course there are other ways diet can affect health.) They are generally well-understood, can be detected with cheap laboratory tests, and have cheap and effective treatments.
Veganism is a known risk factor for some nutrient deficiencies, particularly B12 and iron. Many vegans, including myself, will routinely get blood tests to monitor for these deficiencies. If detected, they can be treated with diet changes, fortified foods, oral supplementation, or intramuscular/intravenous supplementation.
Some vegans don't know about this, and they might end...
Beyond these well-known issues, is there any reason to expect veganism in particular to cause any health harms worth spending time worrying about?
I'm confused- the issues you mention seem both important and, in most cases, extremely easy to fix. If there's a large population that is going vegan without the steps you mention (and my informal survey says there is), it seems high value to alert them to the necessity.
Perhaps you expect this to be caught at regular physicals, but many people don't have those, or their doctors don't think to run the right tests for any number of reasons.
I mentioned my history of nutrition blogging above, but one thing I didn't get into was that I focus my efforts on things that are easy or have extremely good feedback loops, ideally both. People know Oreos are bad for them, but they taste good and the payoff for ceasing is ambiguous and years away. If I found a quick fix for that I would absolutely share it- like I did when I found an easy (if incomplete) way to eat more vegetables. Hell I've talked about reducing sugar cravings, but even if it works the method takes noticeable effort so I don't expect anyone to act on it.
I'm confused- the issues you mention seem both important and, in most cases, extremely easy to fix. If there's a large population that is going vegan without the steps you mention (and my informal survey says there is), it seems high value to alert them to the necessity.
I suspect we have different intuitions as a matter of degree for ‘important’, ‘high value’, and ‘necessity’ here. Despite that, I think we would probably agree on a statement like ‘vegans who are not aware that their diet increases the risk of nutrient deficiencies would benefit from learning about this’.
If you had posted something like ‘PSA: if you are vegan, you might not know you are at increased risk of certain nutrient deficiencies; read (this link) to find out more and see your doctor if you have (list of symptoms) or want to get tested’, I would have thought this was a good idea. What confuses me is why you wrote the post you did instead, which seems to be gesturing at a larger problem. As a specific example, in ‘Evidence I’m looking for’, you wrote:
The ideal study is a longitudinal RCT […] I’ve spent several hours looking for good studies on vegan nutrition.
While more high-quality evidence on veganism would be valuable in general, I’m confused by what you expect to learn from such an RCT or study. Do you think there is reason to believe there are significant health harms of veganism that we don’t know about yet? If so, why?
The Faunalytics data says, at a minimum, 20% of vegans develop a health issue that's cured when they quit. Do you disagree with their data (please elaborate) or not consider that important (in which case, what is your threshold for importance)?
I don’t doubt the Faunalytics data. If anything the number seems surprisingly low, considering it comes from self-reporting among people who went on to quit veganism.
I’m not sure how to weigh ‘importance’ other than subjectively, but I’ll attempt to at least put bounds on it. As a floor, some number of people experience health issues that are important enough to them that they are motivated to quit veganism. As a ceiling, the health risks of veganism are less important than those of other harms related to diet – for example, dyslipidaemia or diabetes – that increase mortality, given that veganism doesn't seem to increase mortality and may reduce it.
My stance at the moment is still more ‘generally confused about what you’re trying to communicate/achieve’ than ‘disagreeing with a particular claim you’re making’. I'd like to close the inferential distance if possible, but feel free to ignore this comment if you don’t think it’s leading anywhere useful.
I still don’t understand which of the following (if any) you would endorse:
[note: this comment was edited after people's replies.]
Someone on the EA Forum brought up an interesting study
...AHS-2 [the Adventist Health Study 2] does have some comparisons between omnivores to vegans. From the abstract: "the adjusted hazard ratio (HR) for all-cause mortality in all vegetarians combined vs non-vegetarians was 0.88 (95% CI, 0.80–0.97). The adjusted HR for all-cause mortality in vegans was 0.85 (95% CI, 0.73–1.01)". So depending on how strict you are being with statistical significance there's somewhere between a small signal and no signal that veganism is better with respect to all-cause mortality than omnivorism.
[...]
I think I would be confident enough in the AHS data to say that it shows that veg*nism does not entail a tradeoff on the 'years of life lived' axis. The most conservative reading of the data possible would be that a veg*n diet has no effect on years of life lived, and I think it is probably more reasonable to read the AHS study as likely underestimating the benefits a veg*n diet would give the average person. Obviously 'years of life lived' is not the same thing as 'health' so I'm not saying this is a knock-down argument against your main point - just
I love the Adventist study and hope to get to a deep dive soon. However since it focuses on vegetarians, not vegans
That's not true. The Adventist study I cited explicitly calculated the mortality hazard ratio for vegans, separately from non-vegan vegetarians.
(I’ll reply to the questions in your last paragraph soon).
I think, in full generality, "Nutrition is complicated and multidimensional, and the more you restrict along any axis for any reason the more tradeoffs you need to make and considerations you need to take to ensure you're getting what you need."
I'm also not sure if relying on traditional vegan dishes and cuisines is sufficient, if your metabolic context is very different otherwise? E.g. I suspect a farm worker who needs to eat 4000 kcal/day to do all his physical labor has to worry a lot less about specific food choices to ensure he gets enough of key micr...
The longer sentence would be “for most people veganism requires no sacrifice beyond occasional tests and vitamins, which is really not much work at all”.
I think you could add "and the more vegans there are, the easier it is". A huge part of it is adoption. Things like which foods are easily found, what restaurants offer, whether you have to bring vegan options from home if you're eating at a conference or other event, etc. will change a lot between cultures and times depending on how common the need is.
I'm pescatarian, trending towards vegetarian, live ...
I found this post very helpful in laying out a very good argument for weak claims that many truth seeking people with different values may be able to agree on. It clarifies a lot of the conversation about veganism so that misleading/confused arguments can be avoided.
The author says that her goal is to be clear and easy to argue with, and I think she succeeded in that goal.
Note for posterity: I've asked Portia to make her responses fewer, slower, and more concise. I'm very happy about her best comments on this post, but the volume, length, and muddledness of the lowest end was untenable.
While we're here: orthonomal has been doing some defense so I feel like I should note he's a personal friend and not an objective stranger, although I assure you he's not bending his epistemics out of friendship
I feel more EAs (or anyone who wants to eat ethically) should consider ameliatarianism if they find that veganism is too difficult, nutritionally or otherwise. It removes the vast majority of animal suffering from your diet, with very few nutritional concerns.
I'm also curious what you think about lacto-vegetarianism. It's a step between vegan and ameliatarian suffering-wise, but I'm not sure where it falls between the two in terms of nutritional difficulty. There's the example of the large and ancient lacto-vegetarian culture in India, but if you don't eat...
Thanks for writing this. I think it's all correct and appropriately nuanced, and as always I like your writing style. (To me this shouldn't be hard to talk about, although I guess I'm a fairly recent vegan convert and haven't been sucked into whatever bubble you're responding to!)
Thanks for writing this - it's exactly what I needed to be able to point people to. AnthonyC's comment that nutrition is multidimensional, and optimizing along any axis requires compromises in others sums up my feelings perfectly. I know the plural of anecdote isn't data, but here's my experience. Take with a pinch of salt:
For most of my adult life, I steadily reduced my consumption of animal products for ethical, health, and environmental reasons. I wasn't eating a lot of animal products when I went vegan for mostly ethical reasons 5.5 years ago. After a ...
Would a replication of your study of "in-office nutritional testing" in a different EA population [say EA Sydney, Australia] be helpful?
In the sense of knowing how many self-identified vegetarians/vegans are clinically deficient in iron, Vit B12, Vit D,... [maybe even compared to omnivores]. We can then advise people on supplementation. With maybe follow-up surveys in 3,6,12 months to see if the number actually improved and if they actually feel improvement.
I am a nurse and I can take blood so that may help. I am willing to sink 40 hours into this if...
I think the consensus among nutritionists is that a well-planned vegan diet is among the healthiest possible diets. Almost everyone in the US would benefit from "going a bit more vegan". Nevertheless, it is probably not optimal on certain axes.
It would seem that the best diet to improve long-term health is a flexible pescolacto-vegetarian diet supplementing certain carninutrients, e.g. creatine. So not vegan.
Tradeoffs are real and you have to optimize for one thing over another. For example, a standard (unsupplemented) vegan diet may not be optimal for men...
I only read the title, not the post, but just wanted to leave a quick comment to say I agree that veganism entails trade-offs, and that health is one of the axes. Also note that I've been vegan since May 2019 and lacto-vegetarian since October 2017, for ethical reasons, not environmental or health or other preferences reasons.
It's long (since before I changed my diet) been obvious to me that your title statement is true since a prior it seems very unlikely that the optimal diet for health is one that contains exactly zero animal products, given that humans are omnivores. One doesn't need to be informed about nutrition to make that inference.
I am primarily a consequentialist, but when it comes to animal rights, my reasoning is not consequentialist first and foremost, which is why I am a vegan and not simply avoiding eggs and chicken (which might be better from a consequentialist perspective given the trade-offs explained here---my effort might be better spent on changing my lifestyle to donate more, etc.). I think "do not pay people to abuse and kill others on your behalf for the sake of convenience and pleasure" should be a strict rule. The ambiguity comes in once the justification changes fr...
How is health a trade-off when the longest living populations are the ones eating mostly plant based diets?
Sure, going vegan involved some things that were annoying for me in 2009, thought it has gotten a lot easier, and nowadays, no longer bothers me at all. And there are definitely people for whom the situation is much harder. (I have a friend who is severely allergic to soy, gluten, and a large number of vegetables, fruits, nuts and pulses. She is no longer vegan, despite being vegan before I was. The amount of grief I give her over it is exactly zero, the effort and danger for her were in no proportion to the gains.)
But compared to other changes I make to r...
"it’s deeply emotionally and morally charged for one side in a conversation, and often a vague irritant to the other."
Very true, as a vegan I find non-vegans can become highly emotionally volatile when they want to talk about why I want to do what I'm doing, and it gets pretty irritating.
Introduction
To me, it is obvious that veganism introduces challenges to most people. Solving the challenges is possible for most but not all people, and often requires trade-offs that may or may not be worth it. I’ve seen effective altruist vegan advocates deny outright that trade-offs exist, or more often imply it while making technically true statements. This got to the point that a generation of EAs went vegan without health research, some of whom are already paying health costs for it, and I tentatively believe it’s harming animals as well.
Discussions about the challenges of veganism and ensuing trade-offs tend to go poorly, but I think it’s too important to ignore. I’ve created this post so I can lay out my views as legibly as possible, and invite people to present evidence I’m wrong.
One reason discussions about this tend to go so poorly is that the topic is so deeply emotionally and morally charged. Actually, it’s worse than that: it’s deeply emotionally and morally charged for one side in a conversation, and often a vague irritant to the other. Having your deepest moral convictions treated as an annoyance to others is an awful feeling, maybe worse than them having opposing but strong feelings. So I want to be clear that I respect both the belief that animals can suffer and the work advocates put into reducing that suffering. I don’t prioritize it as highly as you do, but I am glad you are doing (parts of) it.
But it’s entirely possible for it to be simultaneously true that animal suffering is morally relevant, and veganism has trade-offs for most people. You can argue that the trade-offs don’t matter, that no cost would justify the consumption of animals, and I have a section discussing that, but even that wouldn’t mean the trade-offs don’t exist.
This post covers a lot of ground, and is targeted at a fairly small audience. If you already agree with me I expect you can skip most of this, maybe check out the comments if you want the counter-evidence. I have a section addressing potential counter-arguments, and probably most people don’t need to read my response to arguments they didn’t plan on making. Because I expect modular reading, some pieces of information show up in more than one section. Anyone reading the piece end to end has my apologies for that.
However, I expect the best arguments to come from people who have read the entire thing, and at a minimum the “my cruxes” and “evidence I’m looking for” sections. I also ask you to check the preemptive response section for your argument, and engage with my response if it relates to your point. I realize that’s a long read, but I’ve spent hundreds of hours on this, including providing nutritional services to veg*ns directly, so I feel like this is a reasonable request.
My cruxes
Below are all of the cruxes I could identify for my conclusion that veganism has trade-offs, and they include health:
Those are my premises. Below are a few conclusions I draw from them. I originally didn’t plan on including a conclusion, but an early reader suggested my conclusions were milder than they expected and it might be good to share them. So:
My evidence
One is first principles. Animal products are incredibly nutrient dense. You can get a bit of all known nutrients from plants and fortified products, and you can find a vegan food that’s at least pretty good for every nutrient, but getting enough of all of them is a serious logic puzzle unless you have good genes. Short of medical issues it can be done, but for most people it will take some combination of more money, more planning, more work, and less joy from food.
“Short of medical issues” is burying the lede. Food allergies and digestion issues mean lots of people struggle to feed themselves even with animal products; giving up a valuable chunk of their remaining options comes at a huge cost.
[Of course some people have issues such that animal products are bad for them and giving them up is an improvement. Those raise veganism’s average health score but don’t cancel out the people who would suffer]
More empirically, there is this study from Faunalytics, which found 29% of ex-vegans and ex-vegetarians in their sample had nutritional issues, and 80% got better within three months of quitting. Their recorded attrition rate was 84%, so if you assume no current veg*ns have issues that implies a 24% of all current and former veg*ns develop health issues from the diet (19% if you only include issues meat products cured quickly). I’m really sad to only be giving you this one study, but most of the literature is terrible (see below).
The Faunalytics study has a fair number of limitations, which I went into more detail on here. My guess is that their number is a moderate underestimate of the real rate, and a severe underestimate of the value for naive vegans in particular, but 24% is high enough that I don’t think the difference matters so I’ll use that for the rest of the post.
Evidence I’m looking for
The ideal study is a longitudinal RCT where diet is randomly assigned, cost (across all dimensions, not just money) is held constant, and participants are studied over multiple years to track cumulative effects. I assume that doesn’t exist, but the closer we can get the better.
I’ve spent several hours looking for good studies on vegan nutrition, of which the only one that was even passable was the Faunalytics study. My search was by no means complete, but enough to spot some persistent flaws among multiple studies. I’ve also spent a fair amount of time checking citations made in support of vegan claims, only to find the study is either atrocious or doesn’t support the claim made (examples in the “This is a strawman…” section). There is also some history of goalpost moving, where an advocate cites a study, I criticize it, and they say it doesn’t matter and cite a new study. This is exhausting.
I ask that you only cite evidence you, personally, find compelling and are willing to stand by, and note its flaws in your initial citation. That doesn’t mean the study has to be perfect, that’s impossible, but you should know the flaws and be ready to explain why you still believe the study. If your belief rests on many studies instead of just one (a perfectly reasonable, nee admirable, state), please cite all of them. I am going to be pretty hard on people who link to seriously flawed studies without disclosing the flaws, or who retract citations without updating their own beliefs.
A non-exhaustive list of common flaws:
A non-exhaustive list of evidence I hope for:
Preemptive responses to counter-arguments
There are a few counter-arguments I’ve already gotten or expect to get shortly, so let me address them ahead of time.
“You’re singling out veganism”
Multiple people have suggested it’s wrong for me to focus on veganism. If I build enough trust and rapport with them they will often admit that veganism obviously involves some trade-offs, if only because any dietary change has trade-offs, but they think I’m unfairly singling veganism out.
First off, I’ve been writing about nutrition under this name since 2014. Earlier, if you count the pseudonymous livejournal. I talk about non-vegan nutrition all the time. I wrote a short unrelated nutrition post while this one was in editing. I understand the mistake if you’re unfamiliar with my work, but I assure you this is not a hobby I picked up to annoy you.
It’s true that I am paying more attention to veganism than I am to, say, the trad carnivore idiots, even though I think that diet is worse. But veganism is where the people are, both near me and in the US as a whole. Dietary change is so synonymous with animal protection within Effective Altruism that the EAForum tag is a wholly-owned subsidiary of the animal suffering tag. At a young-EA-organizer conference I mentored at last year, something like half of attendees were vegan, and only a handful had no animal-protecting diet considerations. If keto gets anywhere near this kind of numbers I assure you I will say something.
“The costs of misinformation are small relative to the benefits of animals”
One possible argument for downplaying or dismissing the costs of veganism is that factory farming is so bad anything is justified in stopping it. I’m open to that argument in the abstract, but empirically I think this isn’t working and animals would be better off if people were given proper information.
First, it’s not clear to me the costs of acknowledging vegan nutrition issues are that high. I’ve gotten a few dozen comments/emails/etc on my vegan nutrition project of the form “This inspired me to get tested, here are my supplements, here are my results”. No one has told me they’ve restarted consuming meat or even milk. It is possible people are less likely to volunteer diet changes, although I do note I’m not vegan.
But even if education causes many people to bounce off, the alternative may be worse.
That Faunalytics study says 24% of people leave veg*nism due to health reasons. If you use really naive math, that suggests that ignoring nutrition issues would need to increase recruitment by 33%, just to break even. But people who quit veganism due to health issues tend to do so with a vitriol not seen in people leaving for other reasons. I don’t have numbers for this, but r/exvegans is mostly people who left for health reasons (with a smattering of people compelled by parents), as are the ex-vegans angry enough to start blogs. Even if they don’t make a lifestyle out of it, people who feel harmed are less likely to retry veganism, and more likely to discourage their friends.
I made a toy model comparing the trade off of education (which may lead people to bounce off) vs. lack of education (which leads people to quit and discourage others). The result is very sensitive to assumptions, especially “how many counterfactual vegans do angry ex-vegans prevent?”. If you put the attrition rate as low as I do, education is clearly the best decision from an animal suffering perspective. If you put it higher it becomes very sensitive to other assumptions. It is fairly hard to make a slam-dunk case against nutritional awareness, but then, (points at years of nutrition blogging) I would say that.
“The human health gains are small relative to the harms to animals”
I think this is a fair argument to make, and the answer comes down to complicated math. To their credit, vegan EAs have done an enormous amount of math on the exact numeric suffering of farmed animals. But honest accounting requires looking at the costs as well.
“The health costs don’t matter, no benefit justifies the horror of farming animals”
This is a fair argument for veganism. But it’s not grounds to declare the health costs to be zero.
It’s also not grounds to ignore nutrition within a plant-based diet. Even if veganism is healthy for everyone and no harder a switch than other diets, it is very normal for dietary changes to entail trade-offs and have some upfront costs. The push to deny trade-offs and punish those who investigate them (see below) is hurting your own people.
“This is a strawman, vegans already address nutrition”
I fully acknowledge that there are a lot of resources on vegan nutrition, and that a lot of the outreach literature at least name-checks dietary planning. But I talk to a lot of people (primarily young EAs focused on non-animal projects) with stories like this one, of people going vegan as a group without remembering a single mention of B12 or iron. I would consider that a serious problem even if I couldn’t point to anything the movement was doing to cause it.
But I absolutely can point to things within the movement that create the problem. There are some outright lies, and a lot more well-crafted sentences that are technically correct but in aggregate leave people with deeply misleading impressions.
While reading, please keep in mind that these are formal statements by respected vegans and animal protection organizations (to the best of my ability to determine). All movements have idiots saying horrible things on reddit, and it’s not fair to judge the whole movement by them. But please keep that context in mind while reading: these were not off-the-cuff statements or quick tweets, but things a movement leader thought about and wrote down.
The piece ends with “When people tell me they want to feed [their pet] a vegan diet, I say, ‘Get a goat, get a rabbit”.
While this can be useful, as in the case of a planned non-vegan diet, it is not necessary. A vegan diet is suitable for people of all ages and conditions. A vegan nutritionist may help plan custom menus to meet specific requirements – for instance, if you are an athlete or if you want to gain or lose a lot of weight as a vegan. It is always advised to consult a nutritionist regularly for a check-up. However, it is important to note that some nutritionists are biased and don’t know a lot about vegan nutrition. Note also that medical doctors are often not experts on nutrition.”
Why is this so hard to talk about?
This is probably the least important section. I’m including it mostly in the hope it lowers friction in the object-level conversation.
The stakes are so high
Hardcore vegan advocates believe we are surrounded by mass torture and slaughter facilities killing thousands of beings every day. That’s the kind of crisis that makes it hard to do really nuanced math people may use to justify ignoring you.
Vegans are sick of concern trolls
Vegans frequently have to deal with bad-faith interrogation of their choices (“wHxt ABuoT proTEIn?!?!”). I imagine this is infuriating, and I’ve worked really hard to set myself apart by things like investing hundreds of hours of my time, much of which was unpaid, and working to get vegans the nutrition they needed to stay healthy and vegan.
Typical minding/failure of imagination
People who find veganism easier are disproportionately likely to become and stay vegan. That’s what the word “easy” means. Then some of them assume their experiences are more representative than they are, and that people who report more difficulty are lying.
E.g. this comment on an earlier post (not even by a vegan- he was a vegan’s partner) said “there is nothing special one needs to do to stay healthy [while eating vegan]” because “most processed products like oat milk, soy milk, impossible meat, beyond meat, daiya cheese are enriched with whatever supplements are needed”. Which I would describe as “all you need to do to stay healthy while vegan is eat fortified products”. That’s indeed pretty easy, and some people will do it without thinking. But it’s not nothing, especially when “no processed foods” is such a common restriction. Sure enough, Faunalytics found that veg*ns who quit were less likely (relative to current veg*ns) to eat fortified foods.
That same person later left another comment, conceding this point and also that there were people the fortified foods didn’t work for. Which is great, but it belonged in the first comment.
Or this commenter, who couldn’t imagine a naive vegan until an ex-vegan described the total ignorance they and their entire college EA group operated under.
Lies we tell omnivores
Ozy Brennan has a post “Lies to cis people”. They posit that trans advocates, faced with a hostile public, give a story of gender that is simplified (because most people won’t hear the nuance anyway), and prioritizes being treated well over conveying the most possible truth. The intention is that an actual trans person or deeply invested ally will go deeper into the culture and get a more nuanced view. This can lead to some conflict when a person tries to explore gender with only the official literature as their guide.
Similarly, “veganism requires no sacrifice on any front, for anyone” is a lie vegans tell current omnivores. I suspect the expectation, perhaps subconscious, is that once they convert to veganism they’ll hang around other vegans and pick up some recipes, know what tests to get, and hear recommendations for vegan vitamins without doing anything deliberately. The longer sentence would be “for most people veganism requires no sacrifice beyond occasional tests and vitamins, which is really not much work at all”.
But this screws over new vegans who don’t end up in those subcultures. It’s especially bad if they’re surrounded by enough other vegans that it feels like they should get the knowledge, but the transmission was somehow cut off. I think this has happened with x-risk focused EA vegans, and two friends described a similar phenomenon in the straight-edge punk scene.
Failure to hear distinctions, on both sides
I imagine many people do overestimate the sacrifice involved in becoming vegan. The tradeoff is often less than they think, especially once they get over the initial hump. If omnivores are literally unable to hear “well yes, but for most people only a bit”, it’s very tempting to tell them “not at all”. But this can lead even the average person to do less work than they should, and leaves vegans unable to recognize people for whom plant based diets are genuinely very difficult, if not impossible.
Conclusion
I think veganism comes with trade-offs, health is one of the axes, and that the health issues are often but not always solvable. This is orthogonal to the moral issue of animal suffering. If I’m right, animal EAs need to change their messaging around vegan diets, and start self-policing misinformation. If I’m wrong, I need to write some retractions and/or shut the hell up.
Discussions like this are really hard, and have gone poorly in the past. But I’m still hopeful, because animal EAs have exemplified some of the best parts of effective altruism, like taking weird ideas seriously, moral math, and checking to see if a program actually worked. I want that same epistemic rigor applied to nutrition, and I’m hopeful about what will happen if it is.
Thanks to Patrick La Victoire and Raymond Arnold for long discussions and beta-reading, and Sam Cottrell for research assistance.