VEGETARIAN NUTRITIONFred Hardinge, DrPH, RD, FADA

SSD Nutrition Conference

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CONFLICTS OF INTEREST

• No contracts with any governmental agency.• Receive no grants from the livestock or

meat boards.• Not funded by the pharmaceutical industry.• However, I am a 2nd generation vegetarian

by choice!

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HISTORY OF VEGETARIANS

• Pythagoras 569 BC – 475BC • Plutarch 46-120 AD • Tertullian 160-225• Origen 185-254 • Leonardo da Vinci 1452-1519

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MORE VEGETARIANS• John Wesley 1703-1791 • Ben Franklin 1706-1790• Richard Wagner 1813–1883 • Leo Tolstoy 1828-1910• Henry Thoreau 1817-1862 • Ellen White 1827-1915

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MORE VEGETARIANS• William & Catherine Booth 1829-1912• George Bernard Shaw 1865-1950• H. G. Wells 1866-1946• Mahatma Gandhi 1869-1945• Albert Schweitzer 1875-1965 • Albert Einstein 1879-1955

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MANY GROUPS WITH VEGETARIAN BELIEFS

• Many Buddhists are vegetarians (except for oyster sauce)

• Moslems refuse pork.• Catholics used to recommend meatless Fridays.• Animal rights groups are often vegetarians.• Seventh-day Adventists – the only religious group

who do it for health reasons.• Resurgence of vegetarian eating in the 60s and 70s.

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CONFIRMATION OF ADEQUACY

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–World Cancer Fund/American Institute for Cancer Research

“Choose most of the foods you eat from plant sources. Eat five or more servings of fruits and vegetable each day. Include fruits or vegetables

in every meal. . . . Include grain products in every meal. . . . Choose beans as an alternative

to meat.”

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EXCESS MORTALITY FROM LACK OF PLANT FOODS

Low intake of fruit and vegetables is estimated to cause about 19% of gastrointestinal cancer, and about 31% of ischaemic heart disease and 11% of strokes worldwide. 2.7 million deaths are attributable to low fruit and vegetable intake. WHO Apr. 23, 2003

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METRICS• 3-4% of U.S. adults indicated they never eat meat, poultry and fish/

seafood. They were classified as vegetarian. • Of this group, one percent also never eat dairy, eggs, and

honey, and were classified as complete vegetarians. • Estimate there are approximately 6-8 million adult vegetarians in

the United States.• By region:

• 3% Northeast • 1% Midwest • 4% South • 5% West

10http://www.vrg.org/press/2009poll.htm

REASONS TO BE VEGETARIAN

• Religious• Ethical• Health• Environmental• Animal Welfare• Economics

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TYPES OF VEGETARIANS• Lacto-Ovo Vegetarian: does not eat meat,

fish or fowl. Eats dairy and egg products. Most popular.

• Ovo Vegetarian: does not eat meat, fish, fowl or dairy products. Eats egg products.

• Lacto Vegetarian: does not eat meat, fish, fowl or eggs. Eats dairy products.

• Complete Vegetarian: does not eat any animal products including meat, fish, fowl, eggs, dairy, honey, etc. Most complete vegetarians do not use any animal products such as silk, leather, wool, etc. as well.

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INTAKES OF PROTEIN, FAT, CARBOHYDRATES, CHOLESTEROL, AND

FIBERNutrient Non-vegetarian Lacto-ovo

vegetarian Complete

Fat (% total calories) 34-38 30-36 28-33

Cholesterol (total grams) 300-500 150-300 0

Carbohydrate (% total calories) <50 50-55 50-65

Dietary fiber (total grams)/day 10-12 20-35 25-50

Protein (% total calories) 14-18 12-14 10-12

Animal protein (% total protein) 60-70 40-60 0

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ADVANTAGES OF THE VEGETARIAN DIET

• Less Chronic Disease• Economic Benefits• Ecological & Environmental Reasons• Longer Life• Easy to Meet Dietary Recommendations

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LESS CHRONIC DISEASE

Heart diseaseCancerObesityDiabetes

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• Studies showed non-vegetarian vs. vegetarian men in their 40s and early 50s had 4Xs the death rate for heart disease. Prev Med 1984;13:450-500.

• Those in their late 50s and 60s had 2X the death rate. Am J Clin Nutr 1978;31:S191-8.

• When meat is used 1X or more/wk fatal CHD rate increased by 50%. Fraser.

CARDIOVASCULAR: HEALTH BENEFITS OF VEGETARIAN DIETS

CARDIOVASCULAR: HEALTH BENEFITS OF VEGETARIAN DIETS

• Death from ischemic heart disease lower in vegetarians

• Lacto-ovo and complete vegetarians lower mean blood cholesterol

• Vegetarian diets are not low fat, but lower in saturated fat, higher fiber, higher consumption of soy protein, higher intakes of antioxidants

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HYPERTENSION:HEALTH BENEFITS OF VEGETARIAN DIETS

• Lower blood pressure (systolic and diastolic)

• Lower rates of hypertension• Possible collective effect of beneficial

compounds from plant foods

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• Meat increases the risk of colon cancer. Cancer Res 2005;166:177-211; JNCI 2005;97:906-16.

• Beans lower this risk in meat-users. Fraser

• Cruciferous vegetables lower the risk. Cancer Epidemiol Biomarkers Prev 1996;5:733-48.

• Meat increases prostate cancer risk. Acta Oncol 2005;44:277-81.

• Meat increases ovary cancer risk. Cancer Causes Control 2006, 133-46.

CANCER:HEALTH BENEFITS OF VEGETARIAN DIETS

– AJCN Jan. 2002

“People eating a ‘high-meat’ diet—abundant in red and processed meats– had nearly four times the risk of esophageal cancer and more than double the risk

of stomach cancer compared to those eating a ‘healthy” diet…”

CANCER RISK FACTORS• High calorie density foods – meat, desserts

• Lack of fiber• High animal fat – saturated fat, cholesterol• Lack of phytochemicals• Non-vegetarians produce more bile acids• Lack of vitamin C and the carotenoids• Carcinogenic substances such as nitrates

CANCER:HEALTH BENEFITS OF VEGETARIAN DIETS

• Vegetarians have lower overall cancer rate, not clear what extent is due to diet.

• Vegetarians have higher fiber intake; higher intake of phytochemicals and isoflavones, all of which have anticancer effects.

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OBESITY:HEALTH BENEFITS OF VEGETARIAN DIETS

• Lower Body Mass Index (BMI)• Mean BMI highest in meat eaters and lowest

in complete vegetarians• Vegetarians consume lower animal fat,

higher fiber, lower alcohol, greater amounts of vegetables

23Am J Clin Nutr 2005;81:1267-74

DIABETES:HEALTH BENEFITS OF VEGETARIAN DIETS

• Diets that are more plant-based reduce risk of type II diabetes. Am J Pub Health 1985;75:507-12

• Lower Body Mass Index (BMI) of vegetarians and higher fiber intake improve insulin sensitivity

• Heme iron of meat associated with the risk of diabetes. AJCN 2004;79:70-5

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ECONOMIC BENEFITS

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FOOD ECONOMICS• Grains and vegetables provide a greater amount of

nutrients for the dollar than any other food group.• The food groups which provide the fewest nutrients

(vitamins, minerals) for the dollar are sugar and then meat.

• Fruits and vegetables have a relatively high nutrient-to-cost ratio showing that they provide nutrients at a reasonable cost when compared with other foods.

26J Am Diet Assoc 2005;105:1881-7.

ECOLOGICAL AND

ENVIRONMENTAL

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ECOLOGICAL & ENVIRONMENTAL:HEALTH BENEFITS OF VEGETARIAN DIETS

• It takes more land to grow food for animals than that which is needed when producing food for man.

• Much of our agricultural land is used to grow grains for animal feed. 6.5X more grains are grown to feed livestock than people. David Pimental, Food, Land, Population and the

U.S. Economy 1994.

• It takes 15X the amount of water to produce a lb. of beef protein compared to a pound of grain protein. World Watch Paper- 103, 1991, p. 18.

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LONGER LIFE

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LONGEVITY:HEALTH BENEFITS OF VEGETARIAN DIETS

• Seventh-day Adventists are among the longest lived population group that has been well-studied scientifically.

• About half of this group in the United States are vegetarians.

• Those in this group who are vegetarians live longer than those who are not vegetarians.

30Gary Fraser : Diet, Life Expectancy, and Chronic Disease, 2003

EASIER TO MEET MOST

NUTRIENT NEEDS

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NUTRITION CONSIDERATIONS FOR VEGETARIANS

• Protein• Iron• Zinc• Calcium• Vitamin D• Vitamin B12• Vitamin A -- Beta carotene• Omega-3 fatty acids

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NUTRITION CONSIDERATIONS FOR VEGETARIANS PROTEIN

• Assortment of plant foods all essential amino acids.• Isolated soy protein can meet protein needs as

effectively as animal protein.• Wheat protein alone may be 50% less usable than

animal protein.• Typical intakes of protein for lacto-ovo and complete

appear to exceed requirements• Recommendations for protein intake are 46 grams

per day for women and 56 grams per day for men

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GOOD SOURCES OF PROTEIN

• Beans• Tofu• Veggie burger or other meat substitutes• Soymilk• Peanut butter and nuts• Dairy products

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NUTRITION CONSIDERATIONS FOR VEGETARIANS IRON

• Plant foods contain only non-heme iron• Vitamin C enhances iron absorption• Calcium and dairy foods decrease iron absorption• Take calcium supplements between meals• Iron intake of complete vegetarians typically higher

than lacto-ovo; lacto-ovo; higher iron than non-vegetarians

• Iron deficiency anemia among vegetarians similar to that of non-vegetarians

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Vitamin C Melons

Citrus fruitsPineapple StrawberriesKiwi fruitBroccoliPeppersTomatoes

GOOD SOURCES OF IRON AND VITAMIN C

IronEnriched bread and cerealWhole wheat bread and other

whole grainsDried apricots, figs, prunesLeafy green vegetablesTomato juiceBeans NutsSoybeans and tofu

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NUTRITION CONSIDERATIONS FOR VEGETARIANS ZINC

• Animal protein believed to enhance zinc absorption though deficiency not seen in Western vegetarians

• Important for normal growth during adolescence and for a healthy immune system throughout life

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GOOD SOURCES OF ZINC• Soybeans and other beans• Whole grains (refined grains don't have it unless

they are fortified)• Nuts, seeds, fortified ready-to-eat cereals, and

nut and seed butters • Breads are better sources of zinc than crackers

or muffins because yeast makes zinc more absorbable

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NUTRITION CONSIDERATIONS FOR VEGETARIANS CALCIUM

• Present in many plant foods and fortified foods• Adequate vitamin D and protein enhance calcium

absorption• Calcium intake in lacto-ovo comparable to non-

vegetarians though complete vegetarians can be below recommended intake

• Most people don't get enough calcium unless they use fortified foods or supplements

• Calcium is well-absorbed from some leafy greens, soy products, dairy foods, fortified foods, and from supplements

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GOOD SOURCES OF CALCIUM

• Dairy products• Green leafy vegetables such as Bok choy,

Broccoli, Chinese/Napa cabbage, Collards, Kale, Okra, Turnip greens

• Calcium fortified orange juice• Calcium-fortified soymilk and calcium-set

tofu

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NUTRITION CONSIDERATIONS FOR VEGETARIANS VITAMIN D

• Depends on sunlight exposure and intake of fortified foods or supplements

• If insufficient sun or food, vitamin D supplements are recommended

• Sunscreen can interfere with vitamin D synthesis

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GOOD SOURCES OF VITAMIN D

• Fortified cereals• Fortified soy milk• Fortified orange juice• Egg yolks• Cow’s milk

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NUTRITION CONSIDERATIONS FOR VEGETARIANS

VITAMIN B12• Unless fortified, no plant foods contain significant

vitamin B12• Lacto-ovo can get enough from dairy/ eggs;

unsupplemented complete vegetarians are at fairly high risk for B12 deficiency

• Over age 50, lose ability to digest protein-bound form of B1212 present in animal products

• Diets low in B12 can raise risk for heart disease• All vegetarians should use supplements, fortified foods,

dairy products or eggs to meet recommended amount• Absorption is best in small amounts at frequent interval;

should be chewable or dissolvable under tongue

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GOOD SOURCES OF VITAMIN B12

• Fortified breakfast cereals and some brands of soymilk

• Some brands of nutritional yeast are rich in vitamin B12 (Red Star Vegetarian Support Formula)

• Cow’s milk• Eggs

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NUTRITION CONSIDERATIONS FOR VEGETARIANS VITAMIN A / BETA CAROTENE

• Preformed vitamin A only in animal foods• Complete vegetarians only get this from conversion

of beta carotene which may be less efficient• To meet requirements get 3 servings/ day of deeply

yellow or orange vegetables and fruits or leafy green vegetables

• Cooking with a small amount of fat may help beta carotene absorption

• Chopping/pureeing vegetables may also help

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GOOD SOURCES OF VITAMIN A / BETA CAROTENE• Apricots• Cantaloupe• Mango• Pumpkin• Butternut squash• Sweet potatoes• Spinach• Carrots

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JUST BECAUSE ITS VEGETARIAN ITS HEALTHY?• Cookies, chips and sweetened cereal are

not healthy!• Loading up on highly processed vegetarian

foods is not health?• Being a healthy vegetarian means loading up

on lots of fruits, vegetables, and whole grains.

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– Can J Diet Pract Res 2003;64:62-81

“Vegetarian diets offer a number of nutritional benefits including lower levels of saturated fat, cholesterol, and

animal protein as well as higher levels of carbohydrates, fibre, magnesium, potassium, folate,

antioxidants such as vitamins C and E, and phytochemicals.”

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DO YOU WANT TO...

• Experience less chronic disease?• Spent less on your food budget?• Be more ecologically sensitive?• Live longer?• Easily meet the dietary recommendations?

Enjoy the benefits and delightful tastes of a vegetarian diet!

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Questions?