Vegetarian Nutrition

Reed Mangels, PhD, RD, LDN October 4, 2012

Plan for Today

Introduction and Definitions Health Effects of Vegetarian Diets Key Nutrients for Vegetarians Meal Planning Tools

What is a Vegetarian?

What Is a Vegetarian?
Vegetarians do not eat meat, poultry, or fish.
Lacto-ovo vegetarians eat dairy products and eggs. Lacto vegetarians use dairy products but not eggs. Vegans are vegetarians who avoid all animal products including dairy products and eggs.

Other Types of Vegetarian or NearVegetarian Diets

Raw foods Fruitarian Macrobiotic diet may include limited amounts of fish. Diet based on grains, vegetables, soups. Semi-vegetarian (poorly defined)

Some Foods Excluded from Vegetarian Menus

Products containing meat, poultry and fish Gelatin Chicken or beef broth Worcestershire sauce (contains anchovies) Lard Animal-derived flavoring Oyster sauce

How Many Adults are Vegetarian?

How Many Adults are Vegetarian?

About 3% of adults in the United States are vegetarian. 5% of women, ages 18-34 are vegetarian. 1% of US adults are vegan. An additional 1% of US adults are vegan except for honey.
2009 Harris poll, VRG

How Many Children Are Vegetarian?

8-18 year olds in the United States: 3% are vegetarian 1% are vegan An additional 1% would be vegan, except for honey

Based on 2010 Harris poll: http://www.vrg.org/press/youth_poll_2010.php

Reasons For Vegetarianism

Reasons For Vegetarianism

Health benefits Ecological Religious concerns & spiritual beliefs Dislike of meat Compassion for animals Belief in non-violence Economics

Vegetarianism and Religion

Seventh-day Adventists Widely studied ~40-50% are vegetarian No smoking, alcohol Emphasize healthy lifestyle Jains Only religion unconditionally vegetarian Frequently lacto vegetarian; may be vegan

Health Effects of Vegetarian Diets

Life Expectancy at Birth

86 84 82 80 78 76 74 72 70 68 66 Female
Arch Intern Med 2001;161:1645-52.

Age (years)

SDA Veg SDA US

Male

15

Diet, BMI, DM, Htn: Results from AHS-2

Diet group Mean BMI 28.26 Diabetes (RR) 1.00 Hypertension (RR)

Nonvegetarian

1.00

Red meat, fish, poultry < once/wk

Fish Lacto-ovo Vegan

27.00 25.73 25.48 23.13

0.72 0.49 0.39 0.22

0.77 0.62 0.45 0.25

Results are based on preliminary analyses adjusted for age, gender, and race. Am J Clin Nutr. 2009;89(suppl):1607S-12S.

Health Benefits of Vegetarian Diets

Decreased mortality from CHD Lower blood total and LDL cholesterol Reduced risk of: Obesity Hypertension Type 2 diabetes Colon and prostate cancer

Vegetarian Status and Obesity among SDAs

26.5 26 25.5 25 24.5 24 23.5 23 22.5 22 Female
Am J Clin Nutr 1999;70:532S-8S.

Veg Semi-Veg Non-Veg

BMI

Male

Why do you think vegetarians have a lower risk for many chronic diseases?

20

Potential Health Benefits of Vegetarian Diets

HIGHER IN: Fiber Magnesium and potassium Vitamin C, vitamin E, and folate Carotenoids, flavonoids, plant sterols, and other phytochemicals LOWER IN: Saturated fat Cholesterol

Potential Concerns with Lacto-ovo Vegetarian Diets

Bioavailability of iron and zinc Excess intake of saturated fat and cholesterol (if over-reliant on high-fat dairy products and eggs) Vitamin B12? DHA/EPA (omega-3 fatty acids)

Potential Concerns with Vegan Diets

Bioavailability of iron and zinc Vitamin B12 Calcium Vitamin D DHA/EPA (omega-3 fatty acids) Calories (pregnancy and childhood)

Key Nutrients for Vegetarians

Protein

Myths about Vegetarians and Protein

We need meat to get enough protein Plant protein lacks essential amino acids and is poor quality Vegetarians must carefully complement protein at each meal Athletes cannot be vegetarian because of their high protein needs Vegetarian diets cannot meet needs of pregnant/lactating women or of children

Sample Menu Showing How Easy it is to Meet Protein Needs

Breakfast: 1 cup Oatmeal 1 cup Soymilk 1 Bagel 2 slices Whole Wheat Bread 1 cup Veg. Baked Beans 5 oz firm Tofu 1 cup Broccoli 1 cup Brown Rice 2 Tbsp Almonds 2 Tbsp Peanut Butter 6 Crackers 6 grams 7 grams 9 grams 5 grams 12 grams 11 grams 4 grams 5 grams 4 grams 8 grams 2 grams 73 grams 56-70 grams

Lunch: Dinner:

Snack:

TOTAL Protein recommendations for avg male:

Protein in Common Vegetarian Foods

Soybeans, 1 c Tofu, firm, 5 oz Dried beans, lentils, 1 c Tempeh, c Veggie burger, 1 Peanut butter, 2 T Soymilk or Cows milk, 8 oz Grains, cooked, 1 cup 29 g 24 g 10-18 g 15 g 13 g 8g 8g 4-8 g

Myths about Vegetarians and Protein

We need meat to get enough protein Plant protein lacks essential amino acids and is poor quality Vegetarians must carefully complement protein at each meal Athletes cannot be vegetarian because of their high protein needs Vegetarian diets cannot meet needs of pregnant/lactating women or of children

Amino Acids in Vegetarian Foods

80 70 60 50 Lysine Threonine

40
30 20 10 0 Kidney Beans Brown Rice Soybeans Broccoli Scoring Pattern

Sulfur Aas

If you only ate one food, how much would be needed to provide the recommended amount of all essential amino acids?
6-1/2 large potatoes OR 2-1/2 cups of tofu OR 15-1/2 cups of rice Any one of the above foods, eaten in the amount specified would provide the recommended amounts of all essential amino acids for an adult man. Women would need about 20% less of each food.

Myths about Vegetarians and Protein

We need meat to get enough protein Plant protein lacks essential amino acids and is poor quality Vegetarians must carefully complement protein at each meal Athletes cannot be vegetarian because of their high protein needs Vegetarian diets cannot meet needs of pregnant/lactating women or of children

How much protein do athletes need?

What is an athlete?

The average person needs 0.8 grams of protein per kilogram body weight or about 0.45 grams of protein per pound.

Protein for Athletes

Protein recommendations for athletes are controversial Endurance athletes involved in heavy training may need 1.2 to 1.4 grams of protein per kilogram body weight (0.5 to 0.6 grams per pound) Strength athletes involved in heavy training may need 1.6 to 1.7 grams of protein per kilogram body weight (0.7 to 0.8 grams per pound)

Myths about Vegetarians and Protein

We need meat to get enough protein Plant protein lacks essential amino acids and is poor quality Vegetarians must carefully complement protein at each meal Athletes cannot be vegetarian because of their high protein needs Vegetarian diets cannot meet needs of pregnant/lactating women or of children

Protein in Pregnancy and Lactation

RDA is 25 g higher in 2nd and 3rd trimesters and when lactating (1.1 g/kg) Many women have this amount of protein in their diet before becoming pregnant Additional calories (+340 calories 2nd trimester, +450 calories 3rd trimester) Focus on good sources of protein (soy, dairy, eggs, beans, nuts)

Sample Menu Showing How Easy it is to Meet Protein Needs

Breakfast: 6 grams 7 grams 9 grams Lunch: 5 grams 12 grams Dinner: 11 grams 4 grams 5 grams 4 grams Snack: 8 grams 2 grams TOTAL 73 grams Protein recommendations for pregnancy/lactation: 71 grams 1 cup Oatmeal 1 cup Soymilk 1 Bagel 2 slices Whole Wheat Bread 1 cup Veg. Baked Beans 5 oz firm Tofu 1 cup Broccoli 1 cup Brown Rice 2 Tbsp Almonds 2 Tbsp Peanut Butter 6 Crackers

Protein for Children

Vegan children may have somewhat higher protein needs than nonvegan children due to the amino acid composition and digestibility of plant proteins. A conservative estimate is a 30-35% increase for 1-2 year olds, 20-30% for 2-6 year olds, 15-20% for >6 years.

Protein for Children

Using these estimates, a 1-2 year old vegan would need 15-16 g of protein per day; a 2-3 year old would need 17-18 g/day. These foods together provide a total of 23-39 g of protein: 2-3 cups soymilk or breast milk 2 servings (1/4 cup each) beans, tofu 6 servings (1/2 slice bread or cup grains or pasta) 2 servings (1/4 cup each) vegetables.

Protein
Vegetarian diets generally contain adequate amounts of protein if energy is adequate and a variety of foods are eaten. Choosing a variety of protein sources can ensure amino acid adequacy Combining complementary proteins at meals is not necessary to ensure adequate protein intake.

Meeting Protein Needs

Be sure to meet energy needs and get adequate carbohydrate. Generally, athletes meet or exceed protein requirements without supplements. Calculate protein intake vs protein needs. If necessary add 1 or more serving of proteinrich foods.

Iron

Iron Status
Studies report no significant difference in incidence of iron deficiency anemia in vegetarians compared to nonvegetarians Vegetarians typically have lower iron stores as indicated by serum ferritin levels

Iron
Heme vs. non-heme iron Inhibitors Enhancers Do vegetarians need more iron?

Inhibitors of Iron Absorption in Vegetarian Diets

Phytates (whole grains, legumes including soy, nuts, seeds, vegetables) Tea, coffee, cocoa (polyphenols) Calcium from foods and supplements

Enhancers of Iron Absorption in Vegetarian Diets

Vitamin C (ascorbic acid) Other organic acids including citric acid Fermented foods including sauerkraut, soy sauce, and sourdough bread

Iron RDA
Men, 19 and older 8 mg Women, 19-50 18 mg Women, 51 and older 8 mg Vegetarians may need as much as 1.8 times more iron because of factors in a vegetarian diet that interfere with iron absorption.

Vegetarian Sources of Iron

Food Tofu Instant oatmeal Fortified breakfast cereal Lentils, cooked Prunes Spinach, cooked Whole-wheat bread Portion cup 1 packet
1 oz cup cup cup 1 slice

Iron (mg) 6.6 8.2

<18 3.3 2.2 3.2 0.9

Zinc
Phytate inhibits zinc absorption. Vegetarians may require as much as 50% more zinc than non-vegetarians. Little is known about zinc status of vegetarians.

Calcium

Factors Affecting Calcium Absorption

Enhancers
Lactose

Inhibitors
Phytates (from beans, nuts, whole grains) Oxalates (from spinach, chard, beet greens, rhubarb) Excess Phosphorus and Magnesium (from supplements, usually)

Calcium Sources for Vegans

Tofu processed with calcium sulfate Calcium-fortified juice Calcium-fortified soymilk Collard greens, turnip greens, kale Broccoli Bok choy Soybeans

1 cup of milk has 96 mg absorbable calcium. So do these foods:

cup Chinese cabbage 0.6 - 1 cup calcium-fortified juice 1 cup bok choy 1-1/3 cups calcium-fortified soymilk 1-1/2 cups kale 5.4 ounces calcium-set tofu 2 cups white beans 2-1/4 cups broccoli

Vitamin B12 Status

Vegans

Vegetarians

Defiicient Depleted

Sufficient
Non Vegetarians

0%

20%

40%

60%

80%

100%

Vitamin B12
LOVs get vitamin B12 from dairy products and eggs Vegans get vitamin B12 from fortified foods Vitamin B12 supplements are another source of this vitamin Foods like tempeh, sea vegetables, and miso are not reliable sources of vitamin B12

Foods Reported to Provide Vitamin B12 That Dont

Algae Miso Rainwater Most sea vegetables Shiitake mushrooms Sourdough bread Soybeans Spirulina Tempeh Umeboshi plum

Vitamin B12 Content Of Selected Foods

Vegetarian Support Formula Nutritional yeast, 1 T Fortified soymilk, 8 oz Fortified ready-to-eat cereals, 1 oz Fortified meat analog, 1 oz Cows milk, 8 oz Large egg 1.5 g 0.8-3.2 g 0.6-6 g 0.5-1.2 g 1 g 0.6 g

Menu Planning

Appendix 8 Lacto-Ovo Vegetarian Adaptation of the USDA Food Patterns...........81 Appendix 9 Vegan Adaptation of the USDA Food Patterns .......................................82

http://health.gov/diet aryguidelines/

Position of the American Dietetic Association: Vegetarian Diets; 2009

It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the lifecycle, including during pregnancy, lactation, infancy, childhood, and adolescence, and for athletes.