151.

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Learning objectives

Vegetarian

To

describe the different types of vegetarian

diets

To

understand the reasons why people follow

vegetarian diets

To

identify the nutrients most likely to be

lacking from vegetarian diets

To

identify issues for vegetarians at different life

stages

To

understand how the health of vegetarians

or vegans differs from that of omnivores

Dr Cath Conlon
IFNHH, 2015

Vegetarianism
Appropriately planned vegetarian diets are
healthful, nutritionally adequate, and provide
health benefits in the prevention and
treatment of certain diseases
(American Dietetic Association & Dietitians of Canada, 2009)

How many people are vegetarian?

94% of all NZers ate a regular diet including animal

products (NNS 2008/9)

Females 15-18 years most likely to report eating a

vegetarian diet or avoid eating red meat (13%) (NNS
1997 no data 2008/9)

Estimated that, in 2000, between 3 and 7% of the

population were vegetarian??

UK (Food Standards survey 2009) 3% completely

vegetarian, additional 5% partly were partly vegetarian

Australian Survey in 2010 - 5% of people said they were

vegetarian, but only 2% actually ate a vegetarian diet.

Is it a challenge to define vegetarism? WHY?

Dietary characteristics

Reasons for choosing a vegetarian diet

Relatively large amounts of cereals, pulses, nuts,

fruits and vegetables.
Relatively rich in:
Carbohydrates
n-6 fatty acids
Dietary fibre
Carotenoids
Folic acid
Vitamins C & E
Magnesium
Phytochemicals

Relatively low in:

Protein
Saturated fat
LC n-3 fatty acids
Retinol
Vitamin B12*
Iron (?) & Zinc*
Calcium*
* Especially vegans

Vegetarian Food Pyramid

Oils
2-3 teaspoons
Nuts and Seeds
1-2 servings
Dairy
Vegan: fortified
non-dairy substitutes
3 servings
Vegetables
2-4 servings
Green Leafy
Vegetables
2-3 servings

New Zealand Food & Nutrition Guidelines

Vegan:
Vitamin B 12 : 2.4 g/d
Vitamin D: 200 IU/d
Calcium: 600 mg/d

Beans and Protein Foods

2-3 servings

Fruits
1-2 servings
Dried Fruit
1-2 servings
Bread, Pasta, Rice,
Fortified Cereals
6-10 servings

Eat well by including a variety of healthy foods

from each of the 4 major food groups
Prepare foods or choose pre-prepared foods,
drinks and snacks:

With minimal added fat, especially saturated fat

That are low in salt: if you choose salt, choose iodised salt
With little added sugar; limit your intake of high-sugar foods

Drink plenty of liquids each day, especially water

If choosing to drink alcohol, limit intake
Purchase, prepare, cook & store food to ensure
food safety
Maintain a healthy body weight by eating well
and by daily physical activity

http://www.healthed.govt.nz/resources/eatingforhealthyvegetarianstekaito.aspx

Vegetarians: benefits
Vegetarians in affluent Western countries
more likely to achieve targets for:
Fruit and vegetables
Saturated fats
Non-starch polysaccharide (fibre)

50-100% higher
faster faecal transit time and larger faecal bulk

Complex carbohydrates

but sugar consumption usually similar

Protein

Protein intakes

Plant proteins:

12% of energy vegetarians

15% energy - omnivores
lower biological value than animal
constituent amino acids in different proteins
complement each other

Many legumes contain protease inhibitors

digestibility of proteins
but inactivated heat treatment

LC n-3 fatty acids

Diets that exclude fish / eggs lack long chain n-3 fatty
acid docosahexanoic acid (DHA)
Some studies show that vegetarians have lower blood
levels of DHA
Linolenic acid (18:3n-3) can be converted to DHA; high
intakes of linoleic acid (18:2n-6) interfere with
conversion
Implications low DHA levels unclear
Recommended that vegetarians include good sources
of linolenic acid in their diet
Range of vegetarian LC n-3 fatty acid (algae)
supplements now available

Vitamin B12
Plant foods do not contain vitamin B12
Reliable sources are dairy products, eggs, fortified
foods, dietary supplements (?seaweed)
Intake and plasma concentrations of vitamin B12 are
lower in vegetarians cf meat eaters

Supplementation / use of fortified foods (some soy

milks, textured vegetable protein, margarine,
yeast extracts) advised for vegans

B12 requirements small, is stored and recycled in

the body symptoms of deficiency may be
delayed for several years

Absorption of B12 less efficient as body ages supplements advised for all older vegetarians

Vitamin D & Calcium

Vegetarians consuming dairy products usually
have relatively high Ca intakes

Vegans tend to have low Ca intakes

Vegetarian diets may contain significant amounts

of phytic acid (from legumes and unrefined
cereals)

inhibits absorption of Ca

Vitamin D requirements depend on exposure to

UV light

Low calcium intake associated with osteoporosis

Fe content of vegetarian diets is typically similar to

non-vegetarian diets
Bioavailability of Fe is less

can result in severe neurological damage in infant of

asymptomatic mother

Iron

Vitamin B12

many vegetarians have sub-optimal status

Vitamin B12 deficiency can also be due to low intake

of meat due to poverty
Vitamin B12 deficiency causes megaloblastic
anaemia + hyperhomocysteinaemia

no haem-iron and MFP factor

more inhibitors of Fe absorption

As a result NRV recommend iron intakes 1.8 times

those of non-vegetarians
Vegans have higher Fe intakes than vegetarians
because dairy products have low Fe
Low Fe status (low serum ferritin) common in
premenopausal women especially vegetarians
Vitamin C aids absorption of Fe

Zinc

Zn bioavailability lower on vegetarian diets - no

animal products, phytate binds Zn, intakes below
RDIs (lower or comparable to non vegetarians)

Overt Zn deficiency has not been seen in Western

vegetarians

Effects of marginal intakes poorly understood

Dietary Adequacy

Dietary diversity is important in maintaining

adequacy

Growth flatering in vegetarian infants usually

associated with other factors e.g. poverty and
intestinal infestation

High fibre diets may restrict energy intake of young

children

Well-planned vegetarian diet = adequate for all

life-stages (ADA 2009)

no significant differences in height, age at menarche

etc.

Infants

Can expect normal growth if receive adequate

amounts of breast milk or IF and diets contain
good sources of nutrients and energy

Fruitarian / raw foods diets associated with

impaired growth, not recommended

Breast milk of vegetarian women similar in

composition to that of non vegetarians

Vegans soy formula

Guidelines for introduction of solids the same for

vegetarian and non vegetarian infants

Children
Risk of nutritional deficiency is greatest in children
requirements relative to body weight are greater

Vegetarianism throughout the lifecycle

Well planned vegan and lacto-ovo-vegetarian

diets are appropriate for all stages of the lifecycle
- infants, children, adolescents, pregnancy and
lactation

Dietary deficiencies more likely in those with very

restrictive diets

Vegetarian children and adolescents have lower

intakes of cholesterol, saturated fat, and total fat
and higher intakes of fruits, vegetables and fibre
than non vegetarians

Infants

Solids tofu, legumes, soy or dairy yoghurt,

cooked egg yolks, cottage cheese

Breastfed infants whose mothers do not consume

dairy products, B12 fortified foods or B12
supplements will need B12 supplements

Adolescents

Several reports of protein energy malnutrition as well as

deficiencies of iron, vit B12 and D in infants & toddlers fed
inappropriate diets

Studies suggest little difference in growth between

vegetarian and non vegetarian adolescents

Vegetarian adolescents reported to consume

more fibre, iron, folate, Vitamin A and C than non
vegetarians

Lacto-ovo-vegetarian children similar growth to non

vegetarian peers

Vegetarian diets more common among

adolescents with eating disorders (used to restrict
food intake)

Recent data - adopting a vegetarian diet does

not lead to eating disorders

Non-macrobiotic vegan children evidence lacking,

but slightly smaller (although within normal ranges)

Poor growth in children on very restricted diets

Vegetarian foods can be bulky small meals often

(energy density of some plants very low)

Pregnant and lactating women

Vegetarian diets can meet the nutrient / energy needs

of pregnant women similar birth weights; shorter
durations of pregnancy have been noted in vegan
women

Diets of vegans need reliable sources of vit B12

Consider vit D, iron, folate

Infants of vegetarian mothers lower cord / plasma

DHA than infants of nonvegetarians - ? significance

Breast milk DHA levels in vegans and vegetarians lower

(DHA impt for brain / eyes) should include linolenic
acid (DHA precursor) in diet (flaxseed oil, canola oil,
soybean oil) or veg. friendly supplement

Older adults

Most older vegetarians appear to have dietary

intakes similar to non vegetarians

Energy needs decrease, but recommendations for

other nutrients higher (Ca, vit D, vit B6, ? protein)

May have difficulty with B12 absorption fortified

foods, supplements

Fibre in vegetarian diets may be beneficial for

constipation

Nutritional counseling chewing, minimal

preparation, therapeutic diets

Athletes

Health Benefits?

Vegetarian diets can meet the needs of

competitive athletes

Diets that meet energy needs and contain a

variety of plant based protein foods will provide
adequate protein

Large amount of research on the health benefits

of a vegetarian diet

Amenorrhea may be more common among

vegetarian than non vegetarian athletes, but not
all research supports this finding

However, correlations merely reveal what health

factors go with the vegetarian diets, not what
health effects may be caused by the diet.

Health Benefits?

Confounding factors e.g. SES, non-smoking and

alcohol status, health consciousness, exercise, etc

Obesity Western vegetarians found to have

lower BMI (I unit; 1 kg/m2)

Total mortality

similar in vegetarians and non-vegetarians

Health Benefits: Heart Disease

Plant foods contain

virtually no cholesterol

contain phytosterols which inhibit reabsorption of cholesterol

from GIT

Intake of PUFAs is higher

Slightly lower BP (2-10 mmHg)

Lower mortality from ischaemic heart disease

Death rate from stroke is slightly lower

May be due to lower saturated fat intake and higher intakes

of antioxidants from fruit & veg

especially linoleic acid (n-3) - LDL-cholesterol

probably associated with BMI (rather than salt and alcohol)
probably due to lower cholesterol + BMI

Hypertension

Many studies show V have lower systolic and

diastolic BP (5-10mmHg difference)

In one study, 42% of NV had hypertension

(140/90mmHg) cf only 13% of V

Effect independent of body weight and sodium

intake

Cancer

Reduced colorectal cancer risk associated with

inc fibre, F & V environment of colon different in
V cf NV

Lower breast cancer rates have not been

observed in Western vegetarians, but cross
cultural data indicate breast cancer rates are
lower in popns consuming plant based diets

Diabetes

Vegetarian diets can meet guidelines for the treatment

of diabetes

Some research suggests plant based diets reduce the

risk of Type 2 Diabetes

Rate of self reported diabetes among Seventh Day

Adventists were less than half those of the general
population, and among SDA, V had lower rates of
diabetes than NV

Explanation lower BMI, higher fibre intake, difference

in blood glucose-insulin response

Cancer

Vegetarians have a lower cancer rate cf the

general population, but it is not clear to what
extent this is due to diet

An analysis from the Adventist Health Study that

controlled for age, sex and smoking found no
differences b/t V and NV for lung, breast, uterine
or stomach cancer, but did find that NV had a
54% inc risk of prostate Ca and a 88% inc risk for
colorectal Ca

Red and white meat have been independently

linked to increased risk for colon cancer

Obesity

Seventh Day Adventist Health study compared V

and NV within the Adventist population, BMI
increased as the frequency of meat consumption
increased

Oxford Vegetarian Study BMI higher in NV cf V in

all age groups and in men and women

Why? V have a lower protein, alcohol, fat and

animal fat intake, higher consumption of fibre and
vegetables

Other health conditions

Gallstones In a study of 800 women (40-69 years),

NVs were more than 2x as likely to suffer from
gallstones (even after controlling for obesity,
gender and aging)

Rheumatoid arthritis some studies suggest

following a vegan diet may be useful in the
treatment of RA

Diverticular disease One study found Vs aged

45 to 59 years were 50% less likely to have
diverticulitis cf NVs

Vegetarian Diets - Conclusion

Positive aspects of a vegetarian diet

Negative aspects of a vegetarian diet

Should we advise the general popn to avoid

meat?