Vegetarian nutrition

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Vegetarian nutrition is the set of health-related challenges and advantages of vegetarian diets.

Appropriately planned vegetarian diets are healthful and nutritionally adequate for all stages of the human life cycle, including during pregnancy, lactation, infancy, childhood, and adolescence.[1] However, vegetarian diets deficient in vitamin B12 or calories may compromise children's health and development.[1][2] The UK National Health Service recommends that vegetarian diets should also follow the general recommendations for healthy diets, such as low fat, salt and sugar intakes and 5 fruits or vegetables a day.[3] Qatar's public health ministry states, "One cannot be a healthy vegetarian by going to a fast food restaurant and ordering french fries and soda!".[4]

Vegetarian diets tend to be rich in carbohydrates, omega-6 fatty acids, dietary fibre, carotenoids, folic acid, vitamin C, vitamin E, potassium and magnesium. They are possibly low in saturated fat, cholesterol, and animal protein.

Critical nutrients

Protein

Red beans and rice

Despite the long-standing, widespread belief that vegetarians must consume grains and beans within a short time to make a complete protein that contains all 9 essential amino acids that must be supplied through diet, this has never been substantiated by research. The protein-combining theory was brought to popular attention after being promoted in Frances Moore Lappé's 1971 bestselling book Diet for a Small Planet. In later editions of the book, starting in 1981, Lappé withdrew her contention that protein combining is necessary.[5]

Plant foods rich in protein include soy beans and soy products such as tofu, veggie burgers, and soy milk; other legumes; nuts and seeds; and cereal grains.[6]

Vitamin B12

Vitamin B12 deficiency can be extremely serious and lead to megaloblastic anemia, nerve degeneration and irreversible neurological damage.[7]

Vegetarians may get vitamin B12 from eggs and dairy products (milk, cheese, etc.);[8] for some, this is adequate, while others may still remain B12-deficient.[1] More broadly, according to the Academy of Nutrition and Dietetics, even the form of vitamin B12 sourced from animal products is protein-bound and not as easily digested as supplements, especially as people age, and therefore B12 supplementation is recommended for everyone over the age of 50.[1] Pregnant and lactating vegetarian mothers—and breastfed infants if the vegetarian mother's diet is not supplemented—should also use supplements, whether B12-pills, B12-injections, or B12-fortified foods, if they don't get adequate vitamin B12 from animal products like eggs or dairy.

Eggs are a source of vitamin B12 for vegetarians.

Generally, humans need 2.4 to 3 micrograms of vitamin B12 each day.[8] There are cases to suggest that vegetarians and vegans who are not taking vitamin B12 supplements or food fortified with B12 do not consume sufficient servings of B12 and have abnormally low blood concentrations of vitamin B12.[9] This is because, unless fortified, plant foods do not contain reliable amounts of active vitamin B12.[1]

It is essential, therefore, that vegetarians consume adequate amounts of dietary supplements or foods that have been fortified with B12, such as vegetable stock, veggie burger mixes, textured vegetable protein, soy milks, vegetable and sunflower margarines, and breakfast cereals.[7] B12 used in these foods or supplements is typically grown from vegan sources (such as bacteria). Soybeans and barley seeds from plants grown in soils amended either with cow dung (which is rich in B12) or with pure B12 had a higher B12 content than those grown without this supplementation.[10]

Omega-3 fatty acids

Flaxseeds are a rich source of ALA, but contains negligible amounts of DHA and EPA, the long-chain omega-3 fatty acids the FDA considers to be healthful.

Vegetarian diets can be low in omega-3 fatty acids (O3FAs). Major vegetarian O3FA sources include algae, hempseeds and hempseed oil, walnuts, flaxseeds and flaxseed oil, olive oil, canola oil, avocado, and chia seeds.[citation needed]

A potential problem is that vegetarian diets lacking eggs or generous amounts of edible seaweed generally lack a direct source of long-chain O3FAs such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Vegetarian diets may also have a high ratio of omega-6 fatty acids to O3FAs, which inhibits the conversion of short-chain fatty acids such as alpha-Linolenic acid (ALA), which is found in most vegetarian O3FA sources, to EPA and DHA.[1] Short-term supplemental ALA has been shown to increase EPA levels but not DHA levels, suggesting poor conversion of the intermediary EPA to DHA.[11] To remedy this, DHA and EPA supplements derived from microalgae are available.[1][12]

A 2022 review found that microalgal oil supplementation is consistent in increasing DHA and EPA levels, whilst high dose flaxseed or echium seed oil supplements provide no increase despite significant increases in ALA levels.[12]

Walnuts are a source of omega-3 fatty acids.

Calcium

In general, lacto-ovo-vegetarians have a relatively high intake of calcium that meet or exceed calcium recommendations.[13]

A 2022 review found no significant difference in calcium intake between vegetarians and omnivores.[14] Vegetarians can obtain calcium from dairy products, calcium-fortified plant milks, almonds, figs, oranges, calcium-set tofu as well as low-oxalate vegetables such as bok choy, kale and turnip greens.[13]

Compared with omnivores, vegetarians tend to have a lower bone mineral density (BMD) but not a higher fracture rate.[15][16]

Iron

Vegetarians are more likely to have lower iron stores compared with non-vegetarians and have a higher risk of iron deficiency anemia.[17][18][19] Lacto-ovo-vegetarians that overly rely on dairy consumption may lead to an elevated calcium intake which can affect iron absorption.[20]

Tofu, a soy product, can be a valuable source of not only iron, but also protein, zinc and calcium for vegetarians.

The recommended iron intake for vegetarians is 180% that of nonvegetarians due to the bioavailability of non-heme iron.[13] Although a lower percentage of non-heme iron is absorbed by the body, greater total amounts of non-heme iron are concentrated in many non-meat sources of iron, and therefore breakfast cereals, eggs, nuts, seeds, and legumes (including soy foods, peas, beans, chickpeas, and lentils) are significant sources of iron, and a well-planned vegetarian diet should not lead to iron deficiency.[13][21][22]

Non-heme iron is more sensitive to both inhibitors and enhancers of iron absorption: Vitamin C is an iron absorption enhancer; the main inhibitors for most people are phytates (e.g. legumes and cereal grains), but other inhibitors include tannins (from tea and wine), calcium, and polyphenols.[1]

Iron is an integral part in the chemical structure of many proteins and enzymes, which maintain good health. In humans, iron is an essential component of proteins involved in the transport of oxygen of red blood cells. Iron also helps regulate cell growth and cellular differentiation.[23]

Zinc

A 2013 review found that zinc intake and serum zinc concentrations were significantly lower in populations that follow vegetarian diets compared with non-vegetarians.[24]

Phytates in many whole grains, and dietary fiber in many plant foods may interfere with zinc absorption, and marginal zinc intake has poorly understood effects. Vegetarians may need more than the US Recommended Daily Allowance of 15 mg of zinc each day to compensate if their diet is high in phytates.[1] Major plant sources of zinc include cooked dried beans, edible seaweed, fortified breakfast cereals, soy products, nuts, peas, and seeds.[1]

Iodine

One study reported a "potential danger of [iodine] (I) deficiency disorders due to strict forms of vegetarian nutrition, especially when fruits and vegetables grown in soils with low [iodine] levels are ingested."[25] Iodine, however, is usually supplied by iodized salt and other sources in first world countries. Other significant vegetarian sources of iodine include edible seaweed and bread made with dough conditioners.[1]

Health effects

A variety of vegetarian, and more specifically vegan, foods

Evidence suggests that vegetarian diets have beneficial effects on blood lipids and that vegetarians have a reduced risk of cancer, cardiovascular disease, hypertension and type 2 diabetes.[19][26][27][28]

See also

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 American Dietetic, Association; Dietitians Of, Canada (2003). "Position of the American Dietetic Association and Dietitians of Canada: Vegetarian diets". Journal of the American Dietetic Association. 103 (6): 748–65. doi:10.1053/jada.2003.50142. PMID 12778049.
  2. Black, Maureen (June 2008). "Effects of vitamin B12 and folate deficiency on brain development in children". Food and Nutrition Bulletin. 29 (2 Suppl): S126–31. doi:10.1177/15648265080292S117. PMC 3137939. PMID 18709887.
  3. "The vegetarian diet". nhs.uk. 27 April 2018. Archived from the original on 26 January 2022. Retrieved 22 May 2021.
  4. "Qatar Dietary Guidelines" (PDF). Qatar MOPH. 2015. p. 18.
  5. Lappé, Frances Moore (1981). Diet for a Small Planet. p. 162. ISBN 978-0-345-32120-6.
  6. Craig, Winston J.; Pinyan, Laura (2001). "Nutrients of Concern in Vegetarian Diets". In Sabate, Joan (ed.). Vegetarian Nutrition. CRC Press. pp. 299–332. ISBN 978-1-4200-3683-1. Archived from the original on 26 October 2023. Retrieved 4 September 2023.
  7. 7.0 7.1 The Vegetarian Society. Information Sheet: Vitamin B12 Archived 22 August 2008 at the Wayback Machine. Retrieved 26 April 2007.
  8. 8.0 8.1 "Dietary Supplement Fact Sheet: Vitamin B12". USA.gov. Office of dietary supplements. Archived from the original on 11 March 2012. Retrieved 14 March 2012.
  9. Pawlak, Roman; Parrott, Scott James; Raj, Sudha; Cullum-Dugan, Diana; Lucus, Debbie (2013). "How prevalent is vitamin B12 deficiency among vegetarians?". Nutrition Reviews. 71 (2): 110–117. doi:10.1111/nure.12001. PMID 23356638. Archived from the original on 24 January 2023. Retrieved 4 September 2023.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. Mozafar, A. (1994). "Enrichment of some B-vitamins in plants with application of organic fertilizers". Plant and Soil. 167 (2): 305–311. doi:10.1007/BF00007957. S2CID 44300067.
  11. Sanders, Thomas A.B. (2009). "DHA status of vegetarians". Prostaglandins, Leukotrienes and Essential Fatty Acids. 81 (2–3): 137–141. doi:10.1016/j.plefa.2009.05.013. PMID 19500961.
  12. 12.0 12.1 Lane KE, Wilson M, Hellon TG, Davies IG. (2022). "Bioavailability and conversion of plant based sources of omega-3 fatty acids – a scoping review to update supplementation options for vegetarians and vegans". Critical Reviews in Food Science and Nutrition. 62 (18): 4982–4997. doi:10.1080/10408398.2021.1880364. PMID 33576691. S2CID 231899843. Archived from the original on 25 August 2023. Retrieved 4 September 2023.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. 13.0 13.1 13.2 13.3 Melina, Vesanto; Craig, Winston; Levin, Susan (2016). "Position of the Academy of Nutrition and Dietetics: Vegetarian Diets" (PDF). Journal of the Academy of Nutrition and Dietetics. 116 (12): 1970–1980. doi:10.1016/j.jand.2016.09.025. PMID 27886704. Archived (PDF) from the original on 22 March 2023. Retrieved 4 September 2023.
  14. Bickelmann, Franziska V.; Leitzmann, Michael F.; Keller, Markus; Baurecht, Hansjörg; Jochem, Carmen (6 June 2022). "Calcium intake in vegan and vegetarian diets: A systematic review and Meta-analysis". Critical Reviews in Food Science and Nutrition: 1–19. doi:10.1080/10408398.2022.2084027. ISSN 1040-8398. S2CID 249441078. Archived from the original on 26 October 2023. Retrieved 4 September 2023.
  15. Iguacel I, Miguel-Berges ML, Gómez-Bruton A, Moreno LA, Julián C. (2019). "Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis". Nutr Rev. 77 (1): 1–18. doi:10.1093/nutrit/nuy045. PMID 30376075. Archived from the original on 18 May 2023. Retrieved 4 September 2023.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. Ogilvie AR, McGuire BD, Meng L, Shapses SA. (2022). "Fracture Risk in Vegetarians and Vegans: the Role of Diet and Metabolic Factors". Curr Osteoporos Rep. 20 (6): 442–452. doi:10.1007/s11914-022-00754-7. PMID 36129610. S2CID 252405392.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  17. Pawlak R, Berger J, Hines I. (2016). "Iron Status of Vegetarian Adults: A Review of Literature". Am J Lifestyle Med. 12 (6): 486–498. doi:10.1177/1559827616682933. PMC 6367879. PMID 30783404.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  18. Haider LM, Schwingshackl L, Hoffmann G, Ekmekcioglu C. (2018). "The effect of vegetarian diets on iron status in adults: A systematic review and meta-analysis". Crit Rev Food Sci Nutr. 58 (8): 1359–1374. doi:10.1080/10408398.2016.1259210. PMID 27880062. S2CID 25792199.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  19. 19.0 19.1 Oussalah A, Levy J, Berthezène C, Alpers DH, Guéant JL. (2020). "Health outcomes associated with vegetarian diets: An umbrella review of systematic reviews and meta-analyses". Clinical Nutrition. 39 (11): 3283–3307. doi:10.1016/j.clnu.2020.02.037. PMID 32204974. S2CID 213892045. Archived from the original on 2 January 2023. Retrieved 4 September 2023.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  20. Bray, George A; Temple, Norman J; Wilson, Ted. (2022). Nutrition Guide for Physicians and Related Healthcare Professions. Springer. p. 182. ISBN 978-3-030-82515-7
  21. "Iron: Food Fact Sheet" Archived 5 October 2023 at the Wayback Machine. bda.uk.com. Retrieved 2 January 2023.
  22. "Vegetarian and vegan diets" Archived 28 March 2023 at the Wayback Machine. healthdirect.gov.au. Retrieved 2 January 2023.
  23. Ponka, Prem; Schulman, Herbert M.; Woodworth, Robert C.; Richter, Goetz W. (25 September 1990). Iron Transport and Storage. CRC Press. ISBN 9780849366772. Archived from the original on 26 October 2023. Retrieved 4 September 2023.
  24. Foster M, Chu A, Petocz P, Samman S. (2013). "Effect of vegetarian diets on zinc status: a systematic review and meta-analysis of studies in humans". Journal of the Science of Food and Agriculture. 93 (10): 2362–2371. doi:10.1002/jsfa.6179. PMID 23595983. S2CID 46474144.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  25. Remer, Thomas; Neubert, Annette; Manz, Friedrich (2007). "Increased risk of iodine deficiency with vegetarian nutrition". British Journal of Nutrition. 81 (1): 45–9. doi:10.1017/S0007114599000136. PMID 10341675.
  26. Wang F, Zheng J, Yang B, Jiang J, Fu Y, Li D. (2015). "Effects of Vegetarian Diets on Blood Lipids: A Systematic Review and Meta-Analysis of Randomized Controlled Trials". Journal of the American Heart Association. 4 (10): e002408. doi:10.1161/JAHA.115.002408. PMC 4845138. PMID 26508743.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  27. Dybvik, J.S., Svendsen, M. & Aune, D. (2022). "Vegetarian and vegan diets and the risk of cardiovascular disease, ischemic heart disease and stroke: a systematic review and meta-analysis of prospective cohort studies". European Journal of Nutrition. 62 (1): 51–69. doi:10.1007/s00394-022-02942-8. PMC 9899747. PMID 36030329. S2CID 251866952. {{cite journal}}: Check |pmc= value (help)CS1 maint: multiple names: authors list (link)
  28. Gibbs J, Gaskin E, Ji C, Miller MA, Cappuccio FP. (2021). "The effect of plant-based dietary patterns on blood pressure: a systematic review and meta-analysis of controlled intervention trials" (PDF). Journal of Hypertension. 39 (1): 23–37. doi:10.1097/HJH.0000000000002604. PMID 33275398. S2CID 225483653. Archived (PDF) from the original on 30 May 2023. Retrieved 4 September 2023.{{cite journal}}: CS1 maint: multiple names: authors list (link)

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