A Dietitian’s Perspective on Helping Vegan Patients with Nutrition Support

A Dietitian’s Perspective on Helping Vegan Patients with Nutrition Support


By Anne Wright, Registered Dietitian


About Louise Symington, RD

Louise Symington is a Registered Dietitian with a Masters (MSc) in Food Sustainability. Over her career, she has worked for a number of organisations such as Sustain, The National Trust and The Sustainable Restaurant Association. Louise has been a guest lecturer at London Metropolitan University and was on the advisory panel for DEFRA’s Green Food Project.

Louise currently works as a freelance Dietitian, providing nutritional advice to individuals and food companies. She is also leading the food sustainability module for Culinary Medicine UK.

If she's not behind her laptop, you’ll find her in her wellies, working at her local community allotment, where she coordinates and runs local food growing projects.


A Dietitian’s approach to a sustainable diet

When I spoke to Louise Symington, over the phone, she was cutting up vegetables to throw into her slow cooker. Using the end of the week’s left-overs to reduce food waste, she is definitely a Dietitian who practices what she preaches.

Louise is “The Sustainable Dietitian”. With an MSc in Sustainability in the Food Industry and having consulted on high-level government, charitable and food industry projects for organisations such as Sustain, and DEFRA (Department for Environmental, Food, and Rural Affairs), Louise is considered an industry expert in the field.

I asked Louise what made her decide to go into the field of food sustainability. “I have always been interested in food, nutrition, and health, but I think the trigger for me was the bovine spongiform encephalopathy (BSE) outbreak that occurred in the 1990s. I felt very strongly that there should be transparency and information about our food supply readily available to the public. Working as a Dietitian in clinical practice, I wanted to do more and looked for additional training in the area. Sustainability in the food industry was the closest match. From my work with my MSc, I have been able to try to make an impact by working on policy and awareness around the food chain and planetary health.”

When it comes to a “sustainable diet”, however, it seems there is a misunderstanding that this means a vegan diet for the whole population.“There is no universal definition of a sustainable diet”, Louise told me. “There is more to it than just being vegan. Eating sustainably depends on who you are, where you live, food supply and economic viability. In a broad context, it means eating in a way to support planetary health. There’s been a focus on what we can do to reduce CO2 emissions as, at the moment, this is one of the few measures we have for planetary health. But we also need to think about ethics, waste and overuse of resources. A sustainable diet takes all of this into account.”


The challenges facing malnourished vegan patients

Louise herself chooses to eat a mostly plant-based diet and has done so for many years. Even though there’s been increased awareness and more food choices available over the past few years, she recognises the challenges that people face when trying to eat sustainably. We talked more about how these challenges could be even greater for people under hospital care who require nutrition support.

“To date, I don’t feel that we’ve been doing enough to provide suitable nutrition support for patients on a vegan diet or to provide food in a more sustainable way. It’s important to recognise the pressure that hospitals are under to produce low cost, nutritious food, but I think we can do more. We are moving forward though, with some catering departments buying local and organic produce, providing plant-based or vegan menu options, and reducing use of plastics. When it comes to veganism, however, hospitals will have to change their ways now that ethical veganism qualifies as a philosophical belief under the Equality Act 2010. It’s now a humanitarian right to ask for vegan food.”


What can we do to help vegan patients?

“There are easy things dietitians can do when working with vegan patients. Meats, cheeses, and milk can be substituted for plant-based alternatives (although, where possible, choose fortified versions). We have been limited with oral nutrition supplement (ONS) options as they have historically been milk-based, so it’s wonderful to see vegan ONS feeds emerging into the market. As Dietitians, we should also adapt our advice, enabling us to provide food-first advice for vegan patients who are frail, elderly or malnourished.”


Louise’s top tips for a food-first approach with vegan patients

  • Watch the quality of milk alternatives. Some have 15-17Kcal/100ml and have very little fat or carbs and others (especially organic brands) aren’t fortified. We need to advise people to use some of the higher energy milks, for example, Oatley which has 40-50Kcal/100ml.
  • Emphasise the importance of protein. Elderly people, in particular, tend to have very few protein sources at breakfast and lunch so it’s important to ensure timing and spacing of good quality proteins.
  • Aim to have 2-3 different protein sources at each meal to ensure that an adequate amount of essential amino acids is provided.
  • Suitable vegan food sources may include lentils, quinoa, tofu, tempeh, beans, peanut butter, nuts and seeds.
  • Plant-based and sustainable oils such as hemp, olive or walnut oil, along with healthy fats such as avocado and nut butter should be added to meals to increase energy (calorie) density.
  • Seeds and nuts are great to add to meals or as a snack for a high-energy, high-protein snack. A portion is 30g (one ounce).
  • Coconut cream can be added to meals, desserts and fruit such as berries and bananas. It’s also a great addition to smoothies and curries.
  • Pulses, and other protein sources such as soy and tempeh should be added to meals. Pulses can be mashed, blended and added to foods as well.
  • There are some vegan protein powders on the market (hemp, pea etc). These can be used to make fortified milk and smoothies.
  • Watch out for the at-risk nutrients such as iodine (seaweed or iodized salt could be added), choline, B12, calcium, and iron. Use fortified products and consider supplements, if indicated.


We need to look out for the planet’s health too

When it comes to food sustainability, Louise's top tip would be to minimise food waste. “Cutting food waste and reducing plastic packaging is something you can do whether you're a vegan, veggie or a meat-eater. Try to encourage your patients to use up their leftovers by including them in curries, stews and old fashioned “use everything up” meals like bubble and squeak. Where possible, encourage them to recycle their ONS packaging too. Even small changes to the way we live and practice can have an impact.”

You can find out more about Louise via her website www.sustainabledietitian.co.uk and social media @sustainabledietitian