Q: Is a vegetarian diet healthy?

Vegetarian diets can be just as variable as omnivore diets. When speaking with patients who want to follow a vegetarian diet, take time to discuss the foods to eat to help ensure nutritional adequacy. This discussion can start with a list of some of the common forms of vegetarianism.

A semivegetarian is someone who occasionally eats meat. A lacto-ovo vegetarian is someone who excludes meat from the diet but consumes eggs and dairy products; a lacto-vegetarian excludes both eggs and meat from the diet. A vegan is someone who abstains from eating all animal products, including gelatin and, sometimes, even honey.

Lacto-ovo is the most common type of vegetarian diet. This type of diet has the least amount of nutritional deficiencies because it includes eggs and dairy products. Patients who follow a strict vegan diet usually should also take supplements.

VEGETARIAN-FRIENDLY NUTRIENT SOURCES

The American Dietetic Association states that well-planned vegetarian diets are healthful and nutritionally adequate.¹ Below are some of the major nutritional components of a healthy diet and some common ways vegetarians may get them.

Calcium Nondairy sources of calcium include calcium-fortified cereals, orange juice, and soy drinks. Bok choy, legumes, broccoli, kale, and collard greens also contain calcium. Calcium supplements may still be needed, however, especially for women.

Iron There are two different types of iron: heme iron from meat and nonheme iron from fortified cereals, soybeans, legumes, potato skin, prune juice, raisins, and blackstrap molasses, among other foods. Nonheme iron is less bioavailable than iron from meat, and vegetarians require 1.8 times more iron daily than do carnivores because of this difference.² Vegetarians should consume foods rich in vitamin C to help with iron absorption.

Zinc Another mineral vegetarians may need more of in their diet is zinc, again because zinc from animal products is absorbed more easily than is zinc from plants. Vegetarians may need 50% more zinc to make up for the bioavailability differences.³ Good plant sources of zinc include fortified grains, legumes, nuts, and soy foods.

Vitamin B₁₂ This important nutrient is found naturally only in animal products, so vegans will need supplements. Vitamin B₁₂ can be found in fortified cereals, soymilk, yeast substitutes, and some sea vegetables. Vitamin B⁶ is found in fortified cereals, potato skin, legumes, and bananas.

Vitamin D Vegans may have low levels of vitamin D, as it is found naturally in dairy products; it can be found in fortified cereals and soymilk as well. Vegans may need to take vitamin D substitutes.

Riboflavin Good plant-based sources of riboflavin are almonds, asparagus, bananas, legumes, and sweet potatoes. Fortified cereals and soymilk also are sources of this nutrient.

Omega 3 fatty acids Also known as linolenic acid, omega-3 fatty acids are commonly found in fish and eggs. Vegetarians can get linolenic acid by including flaxseed oil, canola oil, walnuts, and soybeans in their diet.

Protein Cooked beans (legumes) are a very good and popular source of protein for vegetarians. One cup of cooked beans provides the same amount of protein as 2 ounces of meat. Legumes include all types of beans, lentils, and peas. Nuts are also high in protein, but they have much more fat than beans and so can be a significant source of calories.

VEGETARIAN AND VEGAN CHILDREN

Children who follow a vegetarian or vegan diet will grow and thrive the same as other children as long as their diet is a well-planned one. Parents should be counseled about the appropriate nutritional needs for the formative developmental years. Enlisting the help of a nutritionist may be beneficial. Younger children may feel full before they have eaten an adequate amount of calories. Children should eat frequent meals and snacks that contain high-energy, nutrient-dense foods.⁴

BOTTOM LINE

With the proper focus on nutrition, vegetarian and vegan diets are very healthy and beneficial. Many resources about vegetarian diets and menus are available at the local public library and online. JAAPA

For information that can be photocopied and handed to patients, please see the next section.

Katie Iverson is the department editor for When the Patient Asks and practices at the Emergency Trauma Center, University of Iowa Hospitals and Clinics, Iowa City. She has indicated no relationships to disclose relating to the content of this article.

1. Venderley AM, Campbell WW. Vegetarian diets: nutritional considerations for athletes. Sports Med. 2006:36(4):293-305.

2. National Academy of Sciences. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silver, vanadium and zinc. http://books.nap.edu/execsumm_pdf/10026.pdf. Accessed August 7, 2007.

3. Vegetarian diet. MDConsult Web site. http://www.mdconsult.com/das/patient/body/734215634/596565857/10002/15127.html. Accessed August 7, 2007.

4. Demory-Luce D, Motil KJ. Vegetarian diets for children. UptoDate Web site. http://patients.uptodate.com/topic.asp?file=nutri_ch/4288. Accessed August 7, 2007.

Vegetarians are people who do not eat meat. There are several types of vegetarians. A semivegetarian is someone who eats meat sometimes. A lacto-ovo vegetarian is someone who eats eggs and dairy products but does not eat any other animal-based foods. A lacto-vegetarian is someone who eats dairy products but not eggs. A vegan is someone who does not eat any food made from animals, including eggs and dairy foods. Some vegans also will not eat honey.

IS A VEGETARIAN DIET HEALTHY?

A vegetarian diet can be very healthy. But vegetarians may not get enough of some important nutrients because they do not eat certain foods. Vegetarians should make sure their diet includes the proper amounts of fruits, vegetables, grains, protein, and fats every day.

WHAT FOODS SHOULD I EAT AS PART OF A HEALTHY DIET?

Today, many fortified cereals and fruit juices help you to eat a balanced diet. Calcium, iron, zinc, omega-3 fatty acids, and protein are major nutrients in a healthy diet. Vitamins B₆, B₁₂, D, and riboflavin also are important nutrients. Here are some foods from a vegetarian diet that provide these nutrients.

Calcium Bok choy, broccoli, and collard greens are foods with a lot of calcium. Peas, beans, and lentils, also called legumes, also have a lot of calcium. Vegans may not get enough calcium because they don't eat dairy foods. Some nondairy foods with calcium include calcium-fortified cereals, orange juice, and soy drinks. You should talk to your PA or doctor about how to get enough calcium. If you are a woman, you may need to take calcium supplements.

Iron Most vegetarian diets provide enough iron. But, iron from plant foods is harder for your body to absorb than is iron from meat. You need to eat foods that are high in vitamin C with each meal. This will help your body to absorb the iron in your food. Some nonmeat foods that contain iron are fortified cereals, soybeans, legumes, potato skin, prune juice, raisins, and blackstrap molasses. Iron is a very important nutrient for children.

Zinc Some plant foods with zinc are fortified grains, legumes, nuts, and soy foods. Vegetarians need to eat more foods with zinc. Your body does not absorb zinc from plant foods very well. Vegetarians may need to consume two times more zinc than nonvegetarians.

Vitamins Your body needs several vitamins to be healthy. You can get vitamin B₆ from legumes, potato skin, bananas, and some fortified cereals. Vitamin B₁₂ is available naturally only from food made from animals. Vegans will need to take vitamin B₁₂ supplements. Fortified cereals, soy milks, and some yeast substitutes also have vitamin B₁₂. Vegans also may not get enough vitamin D. This vitamin is in fortified cereals and soy milk. Vitamin D also is made in the skin when a person is outside in the sunlight. Vegans may need to spend more time in the sun. They also may need to take vitamin D pills.

Riboflavin Some plant-based foods that have riboflavin are almonds, asparagus, bananas, legumes, and sweet potatoes. Fortified cereals and soy milk also provide this vitamin.

Omega-3 fatty acids Some oils and nuts provide omega 3 fatty acids. These are also called linolenic acid. Foods that contain linolenic acid are flaxseed oil, canola oil, walnuts, and soybeans.

Protein Most plant foods contain protein. Legumes are a very popular food vegetarians eat to get protein. Legumes include all types of beans, peas, and lentils. Many meat substitutes and tofu are made of soybeans. One cup of cooked beans has the same amount of protein as 2 ounces of meat. Nuts also are full of protein. But, nuts have a lot of fat in them. They can add calories to your diet quickly.

WHAT ABOUT MY KIDS?

Children can eat a vegetarian diet and be as healthy as other children. Just like adults, their diet needs to be planned carefully. A child's diet must provide enough protein, fat, iron, and calcium, as well as all the other nutrients, for the child to develop properly. Younger children may feel full quickly when eating high-fiber foods. They may need to eat a meal or have a snack often so they are getting enough calories to maintain their energy level. A nutritionist can provide important help with planning a vegetarian diet for a child.

HOW DO I KNOW IF MY DIET IS UNHEALTHY?

You can develop health problems if your diet does not provide balanced nutrition. You may develop skin rashes or have pale skin. You may feel tired or irritable. You may have difficulty breathing. Your tongue may become swollen and painful.

BOTTOM LINE

All types of vegetarian diets are healthy if they are planned well. If you are considering following a vegetarian diet, talk to your PA or doctor. They can help you make sure you are eating a balanced diet. This is very important when planning a vegetarian diet for a child. You can get a lot of information on vegetarian diets from your local public library and on the Internet. JAAPA