1. Vegetarian Diets Presented by Janice Hermann, PhD, RD/LD OCES Adult and Older Adult Nutrition Specialist

2. Types of Vegetarian Diets Vegetarians: exclude meat, poultry, fish, seafood and other animal products from their diets Lacto-ovo-vegetarians: include milk, milk products, and eggs, but exclude meat, poultry, fish and seafood Lactovegetarians: include milk and milk products, but exclude meat, poultry, fish, seafood, and eggs Vegans: exclude all animal and animal-derived foods (meat, poultry, fish, eggs, and dairy products) Macrobiotics Extremely restrictive diets limited to a grains and vegetables

3. Vegetarian Diets Vegetarian diets are classified based on what they exclude, but foods excluded not nearly as important as the foods included. Vegetarian diets that include a variety of whole grains, vegetables, legumes, seeds, nuts, and fruits offer complex carbohydrate, fiber, a variety of vitamins and minerals and low fat – all of which reflect the Dietary Guidelines.

4. Health Benefits Health impacts of vegetarian diets would be easy if the only difference was what they ate. Many vegetarians also have lifestyles differences: Maintain a healthy weight Do not use tobacco Use little (if any) alcohol Are physically active Make it difficult to determine if health benefits due to diet or other lifestyle factors.

5. Health Benefits Even when dietary effects are correlated with health benefits, this only means health effects go with diets, not that health effects are caused by diet. Still, even with cautions, research suggest well-planned vegetarian diets offer adults nutrition and health benefits.

6. Body Weight Vegetarians tend to have healthier body weight than non-vegetarians Vegetarians’ lower body weight is correlated with their higher fiber and lower fat intakes Since being overweight can increase many health risks, this gives vegetarians a health advantage

7. Blood Pressure Vegetarians tend to have lower blood pressure than non-vegetarian A healthy body weight along with a diet low in total fat and saturated fat and high in fiber, fruits and vegetables helps maintain a healthy blood pressure Other lifestyle factors, such as not using tobacco, little (if any) alcohol use, and being physically active help lower blood pressure

8. Heart Disease Vegetarians tend to have a lower incidence of heart disease than non-vegetarians Dietary factors related to heart disease risk are high total fat, saturated fat, and cholesterol Vegetarian diets tend to be lower in total fat, saturated fat, and cholesterol Vegetarian diets tend to supply monounsaturated fats from olives, seeds, and nuts and polyunsaturated fats from vegetable oils associated with decreased heart disease risk Vegetarian diets also tend to be higher in dietary fiber associated with lower heart disease risk

9. Heart Disease Many vegetarian diets include soy products, which offer additional benefits Even when calories, protein, carbohydrate, total fat, saturated fat, unsaturated fat, alcohol, and fiber intakes are similar, diets using soy as a protein result in lower blood cholesterol and triglyceride levels than those using muscle meats Soy products also contain phytochemicals which may also have a role in lowering blood cholesterol

10. Cancer Vegetarians tend to have lower rates of certain types of cancer, most notably colon cancer, than non-vegetarians Lower cancer rates may be due to the higher fruit and vegetable and lower fat intake Fruits and vegetables provide ample amounts of fiber, antioxidant nutrients and phytochemcials and low fat

11. Planning Vegetarian Diets Vegetarians and non-vegetarians have the same meal-planning challenge – utilizing a variety of foods to provide all the nutrients needed while staying within a calorie range that maintains a healthy weight.

12. Vegetarian Food Guide Most vegetarians consume adequate amounts of nutrients found in abundance in plant foods including thiamin, folate, and vitamins B6, C, A, and E Vegetarian food patterns help to ensure adequate intakes of nutrients vegetarian diets might otherwise lack including iron, zinc, calcium, vitamin B12, and vitamin D

13. Planning Vegetarian Diets The Dietary Guidelines for Americans, 2010 contains adaptations to the USDA Food Pattern for lacto-ovo vegetarians and vegans.

14. Protein Recommended protein intakes for vegetarians is the same as for non- vegetarians, although some have suggested that vegetarian protein requirements should be higher due to the lower digestibility of plant protein. Lacto-ovo-vegetarians who include milk and eggs receive high-quality proteins and are likely to meet protein needs.

15. Protein Even vegans, who exclude milk and eggs, able to meet protein needs if consume adequate calories and varied sources of protein Whole gains, legumes, seeds, nuts, and vegetables can provide adequate amounts of protein and all the amino acids. Many plant based protein foods tend to be lower in saturated fat and higher in fiber and some vitamins and minerals than animal based protein foods.

16. Vitamins and Minerals Getting enough iron can be a problem for both vegetarians and non-vegetarians. However, vegetarians must pay particular attention to iron intake. Iron is poorly absorbed from plant foods such as legumes, dark green leafy vegetables, iron-fortified cereals, and whole- grain breads and cereals.

17. Vitamins and Minerals Because iron is less available from plant sources, the iron DRI for vegetarians is higher than non-vegetarians. Fortunately, the body is more efficient at absorbing iron when dietary intake is low. In addition, vitamin C increases iron absorption, and vegetarian diets typically provide ample fruits and vegetables rich in vitamin C.

18. Vitamins and Minerals Zinc is similar to iron. Meat is a rich food source of zinc; and zinc is not well absorbed from plant sources. In addition, soy, which is commonly consumed as a meat alternate in vegetarian meals, interferes with zinc absorption. However, most adults who follow vegetarian adults are not deficient in zinc.

19. Vitamins and Minerals The best advice in terms of zinc for vegetarians is to eat a variety of nutrient- dense foods; include whole grains, nuts, and legumes. Oysters, crabmeat, and shrimp are also rich in zinc for vegetarians who include seafood in their diets.

20. Vitamins and Minerals Calcium intake of lactovegetarians is similar to the general population. However, vegetarians who do not include milk and milk products are at risk for inadequate calcium intake.

21. Vitamins and Minerals If milk is not included in the diet, recommendations are to choose ample amounts of calcium-rich foods, such as calcium-fortified juices, soy milk, and breakfast cereals. Including plenty of these calcium rich foods is especially important for children and adolescents.

22. Vitamins and Minerals Some other good food sources of calcium include figs, some legumes, some green vegetables such as broccoli and turnip greens, some nuts such as almonds, certain seeds such as sesame seeds, and calcium-set tofu. Because plant sources of calcium can be limited, including a variety of calcium rich foods is important.

23. Vitamins and Minerals The DRI for vitamin B12 is low, but vitamin B12 is only found in animal foods. Bacteria used to ferment soy products such as tempeh may provide some vitamin B12, but much of the vitamin B12 may be an inactive form.

24. Vitamins and Minerals Seaweeds such as nori and chlorella supply only a very small amount of vitamin B12, and excessive intake of these foods can result in iodine toxicity. To protect against vitamin B12 deficiency, vegans must depend on foods fortified with vitamin B12 such as soy milk and breakfast cereals or dietary supplements.

25. Vitamins and Minerals Vitamin D is also a nutrient of concern for vegetarians to support bone growth and maintenance. Vegetarians who do not consume foods fortified with vitamin D and do not receive enough sunlight exposure to synthesize adequate vitamin D may need supplementation.

26. Vitamins and Minerals Adequate vitamin D intake is especially important for infants, children, and older adults. Young children following vegan diets who live in northern climates during winter months can easily develop rickets which is a vitamin D deficiency disease.

27. Omega-3 Fatty Acids Vegetarian diets typically provide adequate levels of omega-6 fatty acids, but provide inadequate levels of omega-3 fatty acids. The imbalance in omega-6 and omega-3 fatty acids can slow the production of EPA and DHA.

28. Omega-3 Fatty Acids If seafood and eggs are not included in the diet, dietary intake of EPA and DHA is low as well. To make up for this inadequacy, vegetarians need to include good sources of linolenic acids in their diet, such as flaxseed, walnuts, soybeans, and their oils.

29. Vegetarian Diets Through the Life Span Carefully planned vegetarian diets can provide adequate calories and nutrients to support good health. However, obtaining adequate calories and nutrients can be difficult for vegans who excludes all animal products; particularly for growing children and pregnant and lactating women.

30. Vegetarian Diets Through the Life Span Plant foods typically provide fewer calories than animal foods. Lower calorie intakes can be helpful for overweight adults, it can be harmful for growing infants, children and adolescences. Diet during pregnancy, lactation, infancy, childhood, and adolescence must provide adequate calories and nutrients for growth and development.

31. Healthy Food Choices In general, adults who follow vegetarian diets have lower risks of developing many chronic diseases, including obesity, high blood pressure, heart disease, and cancer. However, there is nothing magical about vegetarian diets. Vegetarianism is not a religion, but rather a pattern of eating that chooses plant foods to provide necessary nutrients.

32. Healthy Food Choices Diet quality doesn’t depend on whether meat is included, but on whether the other food selected are nutritionally sound. A diet that includes plenty of fruits, vegetables, whole grains, legumes, nuts, and seeds is higher in fiber, antioxidant vitamins and minerals, and phytochemcials, and lower in total and saturated fat.

33. Healthy Food Choices The key to nutritional adequacy of vegetarian diets is including a variety of foods. Restrictive vegetarian eating plans, such as macrobiotic diets that limit selections to a few grains and vegetables cannot possibly deliver a full variety of nutrients.

34. Healthy Food Choices Based on current research of the role of diet and chronic disease, the USDA Daily Food Plan also recommends a diet pattern that includes plenty of fruits, vegetables, whole grains and legumes. Such a diet plan provides the same health advantages of a vegetarian diet if lean meat intake is limited to the amounts recommended by the USDA Daily Food Plan.

35. Healthy Food Choices In general, vegetarian diets can promote good health. However, both vegetarian and non- vegetarian diets can be detrimental to health if fat intake is high. Vegetarians who consume large amounts of foods high in fat invite the same health concerns as non-vegetarians who consume high fat diets.

36. Healthy Food Choices In addition, both vegetarians and non- vegetarian diets can be low in some nutrients if poorly planned. Poorly planned vegetarian diets are often low in iron, zinc, calcium, vitamin B12, and vitamin D Poorly planned non-vegetarian diets are often low in vitamin A, vitamin D, folate, and fiber.

37. Healthy Food Choices In general, negative health aspects of any diet, including vegetarian diets, reflect poor diet planning. Careful planning to adequate calories and problem nutrients can ensure adequacy.

38. Healthy Food Choices It’s important to remember that diet is only one factor affecting health. In addition to diet, not smoking, moderate alcohol intake (if at all), regular physical activity, and adequate rest all contribute to health. Healthy lifestyles early in life seem to be the most important step one can take to reduce risk of disease later in life.