Vegan and vegetarian protein

The specific difficulty

Plant protein tends to arrive with more volume and more fibre attached than animal protein does. In ordinary life that is largely a benefit. On a medicine that slows the stomach and reduces how much fits into it, volume and fibre are exactly the two things in short supply.

So the vegetarian and vegan problem on these medicines is not that plant protein is inadequate. It is a logistics problem: how to get enough of it through a narrower door, without the bloating and wind that a sudden increase in pulses reliably produces.

Members in our vegan-and-vegetarian circle have solved this in a fairly consistent set of ways, and this guide is mostly their work. Ren reviews it and adds the usual framing: protein plus continued loading of your muscles is what protects strength during a phase of change, and that is imported from the general weight-management and resistance-training literature rather than from the GLP-1 trials, which did not study diet composition.

The dense options, ranked by how little room they take

What the circle actually relies on.

• Tofu, especially firm or extra-firm. Dense, neutral, and takes whatever flavour you give it. Silken tofu blends into soups and smoothies invisibly and is the version members use when chewing is the problem.
• Edamame. Frozen, boiled for five minutes, protein-dense for the volume, and easy to eat a handful at a time.
• Tempeh. Denser than tofu and fermented, which some members find sits better than beans.
• Seitan, if you eat gluten. The most protein-dense plant option most people can buy.
• Soya milk and soya yoghurt. The plant milks are not equivalent — soya and pea are protein-comparable to dairy, while almond, oat and rice contribute very little. This is the swap that solves the most problems for the least effort.
• Lentils, especially red. They collapse into things, which gets round the volume problem, and they are gentler on most guts than whole beans.
• Plant protein powders. Pea, soya, or a blend. Useful when the stomach is at its smallest, and worth buying a single serving before a tub.
• Nutritional yeast, seeds, nut butters. Small contributions that stack up when stirred into things you are already eating.

For vegetarians who eat dairy and eggs, those two categories do a great deal of work: Greek yoghurt, skyr, cottage cheese, cheese, milk in things, boiled eggs in the fridge. Several members who thought they had a protein problem discovered they had a dairy-underuse problem.

The wind and bloating problem, solved slowly

Beans and lentils in quantity produce wind in almost everybody, and on a slow gut it is worse. This is the single most common reason members abandon a plant-based approach on these medicines, and it is avoidable.

• Increase over weeks, not days. The gut adapts, but only if you give it time.
• Rinse tinned pulses thoroughly. Removes a meaningful amount of what ferments.
• Start with the gentler end. Red lentils, split peas, tofu and tempeh are generally better tolerated than chickpeas, kidney beans and baked beans.
• Cook them properly and, if cooking from dry, soak them.
• Try fermented forms. Tempeh and miso sit better with some people.
• Notice the sulphur connection. Brassicas, onions, garlic and a large protein hit all feed into the rotten-egg burping described in that guide. Spreading protein across the day helps more than avoiding a food.
• Consider a digestive enzyme preparation. Some members find the alpha-galactosidase products help with beans. Mention it to a pharmacist rather than assuming.

The nutrients worth actually watching

Reduced intake sharpens every existing risk in a plant-based diet, and this is where a dietitian earns their fee. Ask your prescriber for a referral — many services have one and do not offer.

• B12. Not optional to think about on a vegan diet, supplemented or fortified, and now more important because you are eating less of everything. Deficiency causes fatigue, which is easy to misattribute to the medicine.
• Iron. Plant iron is absorbed less readily. Vitamin C alongside helps; tea and coffee with a meal hinder it. Low iron also shows up in hair shedding and in fatigue, and it is measurable — ask for ferritin rather than guessing.
• Calcium and vitamin D. Relevant to bone, and bone is worth thinking about during any phase of substantial weight loss.
• Iodine. Easily missed without dairy or fish, and thyroid-relevant. Our thyroid guide is nearby.
• Omega-3. Algal oil is the direct route if you do not eat fish.
• Zinc and selenium. Worth a thought; do not take high-dose selenium casually.

Reading your bloodwork without panic covers what to do with the results, and bloodwork-buddies is where members bring the printout.

Practical days that members report working

Not meal plans — nobody here is writing you a meal plan. Shapes that members described in circle, offered because seeing somebody else’s arrangement is often more useful than a principle.

One member in Utrecht, who is vegan and works long shifts, front-loads: soya yoghurt with ground linseed early, a tofu thing at lunch when her stomach is at its most cooperative, and something small and liquid in the evening, because evenings are her worst window. She stopped trying to have a substantial dinner and says it removed most of her difficulty in one decision.

A vegetarian member in Reading keeps boiled eggs and cottage cheese in the fridge permanently on the grounds that protein should never require a decision, and cooks properly only when she feels like it.

A member in Pune who runs relies on soya milk in everything — porridge, coffee, a shake after a session — because liquid is what fits, and had to be talked out of using almond milk for the same purpose when he realised what the difference was.

Rohan’s discovery is the one we would highlight: the swap that solves the most for the least effort in this whole guide is the plant milk you use by default. Everything else is optional.

The evidence, and the bits people overclaim

Honest positions on the questions that come up.

Is plant protein worse? Individual plant sources have different amino acid profiles, and soya is complete on its own. Across a varied day the profile question largely resolves itself — the old business about carefully combining at every meal has not held up. What does matter is total amount, and on these medicines the total is the hard part regardless of source.

Is there evidence for a plant-based diet on GLP-1 medicines? No. The trials did not test diet composition, and nothing in STEP 1 (Wilding, NEJM, 2021) or SURMOUNT-1 (Jastreboff, NEJM, 2022) speaks to it. Anyone telling you plant-based improves or impairs your results on these drugs is going well beyond what exists.

Do plant eaters do better with the gut side effects? Unknown, and our circles report both directions — some members find plant-heavy eating gentler, others find the fibre load harder on a slow stomach. Both experiences are real.

Ren’s closing note: whatever you eat, keep loading your muscles. Protein and strength, the basics and eight minutes and a chair apply identically here, and a plant-based diet has never been the reason anybody lost strength — stopping training in a bad month is.