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12 maltatoday | SUNDAY • 15 NOVEMBER 2020 NEWS Veganism plants sturdy roots in island LAURA CALLEJA A nation of meat-eaters is slowly coming to terms with the benefits of plant-based diets, and chefs and TV presenters are influencing their choices, says vegan chef Mark Morales. Malta has been slow on the uptake but, as meat-free and vegan lifestyles take other parts of the world by storm, even a small is- land where meat-and-two-veg dinners are the norm is showing itself open to meat substi- tutes. "Veganism has become more mainstream. Social media and celebrities have made the public more aware of the growing trend, and shows such as Ninvestigaw x'Qed Nieklu on TVM have helped a lot," Morales says. Yet another "meat-free week" has passed in Malta, where a growing industry of foods and restaurants are promoting flexitarian con- cepts for people to be weaned off their regular consumption of meat. Even Facebook pages like Vegan Malta or Vegan Malta Eats have up to 16,500 followers, signalling a modest yet growing interest in veganism. "Funny story: back in 1986, when my moth- er first went vegetarian, it was difficult. She went to a restaurant and told them she was vegetarian, so they got her a piece of cauli- flower. Back in the day it was hard, because of people's mentality, but so much has changed now," he said. Today, restaurants have begun to accom- modate vegetarians and vegans and expanded their menus. "It's easier than ever to go meatless or choosing a vegan lifestyle. And the myth that it is an expensive choice, is false. What I'm finding is that it is being a meat-eater that has now become more expensive, even with fish and seafood. Buying fruit, vegetables and wholegrains, which is the diet every healthy vegan should follow, is cheap and affordable. I mean… if you're buying vegan cheese and meat substitutes it might be more expen- sive but not more than meat. I think you'll spend less money being a vegan than being a meat-eater," Morales says. But he admits that practised incorrectly, ve- ganism can be unhealthy – "however, no un- healthier than a meat-eater who does not look after themselves." "It can be an unhealthy lifestyle if the per- son is not paying attention to their diet. But it's the same for meat-eaters who don't pay attention to their diet and end up missing a lot of vitamins and minerals because they are just eating meat every day. Likewise, for a ve- gan who is just eating vegan cheese, vegan yo- ghurt, bread and pasta, and foods that do not contain much nutrition," Morales said. For example, Morales says it is especially unhealthy when a person stops eating meat, without a substitute to compensate for the protein, vitamin and mineral loss. "Meat needs to be substituted with nuts, vegetables and grains… it's very easy to get protein if you know where to look." He recommends when first starting out, that persons should take supplements. "I think if you are a heavy meat eater, and you switch to- tally to the vegan lifestyle, it's recommended for the first few months to take supplements to help with the body's transition." The human body is like a machine that grows accustomed to the intake of animal protein and B12 from meat, which means it will need the time to acclimatise to a radical dietary shift. "People will need meat substi- tutes. If you go cold turkey, cravings will set in, and you will not be able to keep up with the lifestyle. Everything needs to be done in steps." Morales also insists it is a misconception that human beings need milk, itself an animal protein. "People do not need to drink milk; spinach has more calcium than milk. You know a horse eats just grass, and I'm sure if a horse is eating fresh grass from the field, they're not lacking in calcium. It's very easy to get calcium, not from milk… that's just propa- ganda from the dairy industry," he insists. Morales advises that people should research a shift to a vegan lifestyle, and to come to their own conclusion before going meatless. "It's important they know why they're going down that path… to decide not to be part of that system or the pain and suffering of ani- mals. Even people who continue to eat meat should be researching exactly where their meat comes from. A lot of the time animals are not being fed properly, many of them are sick, and have a weak immune system, and the life they live is a poor one. So the quality of meat is also poor." NICOLE MEILAK THE provision of a free arthri- tis medication by the govern- mnet's Pharmacy of Your Choice (POYC) scheme has concerned sufferers who say a cheaper sub- stitute called Erelzi, is not as ef- fective as its biologic 'original'. A patient diagnosed with Pso- riatic Arthritis administered Enbrel for two years to ease her pain, had to switch to the bio- similar Erelzi in August. The primary difference is that Enbrel is a biologic medicine derived from living organisms, while Erelzi is a biosimilar – a cheaper and similar counterpart, which concerns about the inter- changeability between the two medications. Cheap as well as effective, bio- similars are increasingly replac- ing biologics in hospitals around the world. In the UK, patients switching to biosimilars receive a letter or a phone call explain- ing the switch, as well as a choice to speak to their doctor or spe- cialist before the medication is changed. Generally the switch should not have any noticable difference on the body, but side effects can occur. "I have now been on Erelzi for the past few weeks. It is a painful, nauseous, adaptation that comes with daily headaches and fatigue. It can take months for the body to adapt and for life to return to normal. It could also result in an adverse reaction that can cause flare ups and further bone deterioration which Enbrel had effectively stopped," the patient told MaltaToday. The Ministry for Health only sent out a circular announcing the switch on October 7, around two months after this patient's experience, informing consult- ants and pharmacists that Erelzi will be replacing Enbrel once the current stock is exhausted. "I need to apply once every two months to receive a supply of two boxes, with four injections per box, from the POYC. The treatment is in the form of an injection every Monday. Imagine my surprise one Saturday when upon picking up my usual supply of injections, I found out that my medication had been changed to a different one that I did not know anything about," the pa- tient told MaltaToday. "I even needed a prescription from my consultant in order to be able to switch. It being a Sat- urday, this was impossible and I needed to get an injection by Monday. Halting the medication can cause serious repercussions. In a panic I managed to get hold of the Arthritis Association and luckily for me they had a couple of spare injections which they could give me. This probably saved my life. It gave me enough time to manage to get an ap- pointment with my consultant." Erelzi is said to have no signif- icant difference from the origi- nator biologic. But the Europe- an League Against Rheumatism (EULAR) makes it clear in their 2019 recommendations that if a drug has proven to be effective and is tolerated by the affected patient, the drug should not be stopped. Mary Vella, president of the Arthritis and Rheumatism Asso- ciation of Malta, reiterated this during ARAM's annual general meeting held over the summer. She asserted that in switching medications between biologics and biosimilars at the pharmacy level, health authorities are go- ing against all recommendations from international bodies about the switching of medication, most especially during a pan- demic when many out-patient services have been suspended. The patient acknowledged that offering the switch could be beneficial for new patients or to those whose consultant recom- mends the medication – but said that readaptation was a stressful process, especially when it can take up to six months to adjust to the treatment. "After a long time of suffer- ing from severe pain which near- ly made me work redundant and clouded my enjoyment of life, I was finally diagnosed with Pso- riatic Arthritis. The medication took away much of the pain and life was colourful again. My doc- tors were very pleased with the results and so was I. And then one day your pharmacist hands you a completely different box which at the end of the day might work just as well or not. Would you take it?" Cheaper biosimilar drugs are ordeal for some patients Mark Morales at the Gourmet Challenge studios: "It's easier than ever to go meatless or choosing a vegan lifestyle. And the myth that it is an expensive choice, is false" "Veganism has become more mainstream. Shows such as Ninvestigaw x'Qed Nieklu on TVM have helped a lot."