I thought that some people on this list might be interested in this
information, which is from the American Dietetic Association. It
states that dairy products are not needed for adequate calcium intake,
even when on a vegetarian diet. Listmembers may also find the other
dietary information helpful and/or of interest.
I have been a vegetarian for eight years and have essentially not
eaten dairy for about three years.
Laura
---------------------------------------------------------------------
Position of the American Dietetic Association: Vegetarian Diets (1997)
Scientific data suggest positive relationships between a vegetarian diet and
reduced risk for several chronic degenerative diseases and conditions,
including obesity, coronary artery disease, hypertension, diabetes mellitus,
and some types of cancer. Vegetarian diets, like all diets, need to be
planned appropriately to be nutritionally adequate.
POSITION STATEMENT
It is the position of The American Dietetic Association (ADA) that
appropriately planned vegetarian diets are healthful, are nutritionally
adequate, and provide health benefits in the prevention and treatment of
certain diseases.
Vegetarianism in Perspective
The eating patterns of vegetarians vary considerably. The
lacto-ovo-vegetarian eating pattern is based on grains, vegetables, fruits,
legumes, seeds, nuts, dairy products, and eggs, and excludes meat, fish, and
fowl. The vegan, or total vegetarian, eating pattern is similar to the
lacto-ovo-vegetarian pattern except for the additional exclusion of eggs,
dairy, and other animal products. Even within these patterns, considerable
variation may exist in the extent to which animal products are avoided.
Therefore, individual assessment is required to accurately evaluate the
nutritional quality of a vegetarian's dietary intake.
Studies indicate that vegetarians often have lower morbidity (1) and
mortality (2) rates from several chronic degenerative diseases than do
nonvegetarians. Although nondietary factors, including physical activity and
abstinence from smoking and alcohol, may play a role, diet is clearly a
contributing factor.
In addition to the health advantages, other considerations that may lead a
person to adopt a vegetarian diet pattern include concern for the
environment, ecology, and world hunger issues. Vegetarians also cite
economic reasons, ethical considerations, and religious beliefs as their
reasons for following this type of diet pattern. Consumer demand for
vegetarian options has resulted in increasing numbers of foodservices that
offer vegetarian options. Presently, most university foodservices offer
vegetarian options.
Health Implications of Vegetarianism
Vegetarian diets low in fat or saturated fat have been used successfully as
part of comprehensive health programs to reverse severe coronary artery
disease (3,4). Vegetarian diets offer disease protection benefits because of
their lower saturated fat, cholesterol, and animal protein content and often
higher concentration of folate (which reduces serum homocysteine levels)
(5), antioxidants such as vitamins C and E, carotenoids, and phytochemicals
(6). Not only is mortality from coronary artery disease lower in vegetarians
than in nonvegetarians (7), but vegetarian diets have also been successful
in arresting coronary artery disease (8,9). Total serum cholesterol and
low-density lipoprotein cholesterol levels are usually lower in vegetarians,
but high-density lipoprotein cholesterol and triglyceride levels vary
depending on the type of vegetarian diet followed (10).
Vegetarians tend to have a lower incidence of hypertension than
nonvegetarians (11). This effect appears to be independent of both body
weight and sodium intake. Type 2 diabetes mellitus is much less likely to be
a cause of death in vegetarians than nonvegetarians, perhaps because of
their higher intake of complex carbohydrates and lower body mass index (12).
Incidence of lung and colorectal cancer is lower in vegetarians than in
nonvegetarians (2,13). Reduced colorectal cancer risk is associated with
increased consumption of fiber, vegetables, and fruit (14,15). The
environment of the colon differs notably in vegetarians compared with
nonvegetarians in ways that could favorably affect colon cancer risk
(16,17). Lower breast cancer rates have not been observed in Western
vegetarians, but cross-cultural data indicate that breast cancer rates are
lower in populations that consume plant-based diets (18). The lower estrogen
levels in vegetarian women may be protective (19).
A well-planned vegetarian diet may be useful in the prevention and treatment
of renal disease. Studies using human being and animal models suggest that
some plant proteins may increase survival rates and decrease proteinuria,
glomerular filtration rate, renal blood flow, and histologic renal damage
compared with a nonvegetarian diet (20,21).
Nutrition Considerations for Vegetarians
Plant sources of protein alone can provide adequate amounts of essential
amino acids if a variety of plant foods are consumed and energy needs are
met. Research suggests that complementary proteins do not need to be
consumed at the same time and that consumption of various sources of amino
acids over the course of the day should ensure adequate nitrogen retention
and use in healthy persons (22). Although vegetarian diets are lower in
total protein and a vegetarian's protein needs may be somewhat elevated
because of the lower quality of some plant proteins, protein intake in both
lacto-ovo-vegetarians and vegans appears to be adequate (16).
Plant foods contain only nonheme iron, which is more sensitive than heme
iron to both inhibitors and enhancers of iron absorption. Although
vegetarian diets are higher in total iron content than nonvegetarian diets,
iron stores are lower in vegetarians because the iron from plant foods is
more poorly absorbed (23). The clinical importance of this, if any, is
unclear because iron deficiency anemia rates are similar in vegetarians and
nonvegetarians (23). The higher vitamin C content of vegetarian diets may
improve iron absorption.
Although plant foods can contain vitamin B-12 on their surface from soil
residues, this is not a reliable source of B-12 for vegetarians. Much of the
vitamin B-12 present in spirulina, sea vegetables, tempeh, and miso has been
shown to be inactive B-12 analog rather than the active vitamin. Although
dairy products and eggs contain vitamin B-12, research suggests that
lacto-ovo-vegetarians have low blood levels of vitamin B-12. Supplementation
or use of fortified foods is advised for vegetarians who avoid or limit
animal foods (24).
Because vitamin B-12 requirements are small, and it is both stored and
recycled in the body, symptoms of deficiency may be delayed for years.
Absorption of vitamin B-12 becomes less efficient as the body ages, so
supplements may be advised for all older vegetarians.
Lacto-ovo-vegetarians have calcium intakes that are comparable to or higher
than those of nonvegetarians (25,26). Calcium intakes of vegans, however,
are generally lower than those of both lacto-ovo-vegetarians and omnivores
(26). It should be noted that vegans may have lower calcium needs than
nonvegetarians because diets that are low in total protein and more alkaline
have been shown to have a calcium-sparing effect (27). Furthermore, when a
person's diet is low in both protein and sodium and regular weight-bearing
physical activity is engaged in, his or her calcium requirements may be
lower than those of a sedentary person who eats a standard Western diet.
These factors, and genetic influences, may help explain variations in bone
health that are independent of calcium intake.
Because calcium requirements of vegans have not been established and
inadequate calcium intakes are linked to risk for osteoporosis in all women,
vegans should meet the calcium requirements established for their age group
by the Institute of Medicine (28). Calcium is well absorbed from many plant
foods, and vegan diets can provide adequate calcium if the diet regularly
includes foods rich in calcium (29). In addition, many new vegetarian foods
are calcium-fortified. Dietary supplements are advised for vegans only if
they do not meet calcium requirements from food.
Vitamin D is poorly supplied in all diets unless vitamin D fortified foods
are consumed. Vegan diets may lack this nutrient because fortified cow's
milk is its most common dietary source. However, vegan foods supplemented
with vitamin D, such as soymilk and some cereals, are available.
Furthermore, findings indicate that sunlight exposure is a major factor
affecting vitamin D status and that dietary intake is important only when
sun exposure is inadequate (30). Sun exposure to hands, arms, and face for 5
to 15 minutes per day is believed to be adequate to provide sufficient
amounts of vitamin D (31). People with dark skin or those who live at
northern latitudes or in cloudy or smoggy areas may need increased exposure.
Use of sunscreen interferes with vitamin D synthesis. If sun exposure is
inadequate, vitamin D supplements are recommended for vegans. This is
especially true for older persons who synthesize vitamin D less efficiently
and who may have less sun exposure.
Studies show zinc intake to be lower or comparable in vegetarians compared
with nonvegetarians (16). Most studies show that zinc levels in hair, serum,
and saliva are in the normal range in vegetarians (32). Compensatory
mechanisms may help vegetarians adapt to diets that may be low in zinc (33).
However, because of the low bioavailability of zinc from plant foods and
because the effects of marginal zinc status are poorly understood,
vegetarians should strive to meet or exceed the Recommended Dietary
Allowances for zinc.
Diets that do not include fish or eggs lack the long-chain n-3 fatty acid
docosahexanoic acid (DHA). Vegetarians may have lower blood lipid levels of
this fatty acid, although not all studies are in agreement with this finding
(34,35). The essential fatty acid linolenic acid can be converted to DHA,
although conversion rates appear to be inefficient and high intakes of
linoleic acid interfere with conversion (36). The implications of low levels
of DHA is not clear. However, it is recommended that vegetarians include
good sources of linolenic acid in their diet.
Figure 1 below presents food sources of nutrients that are often of concern
for vegetarians.
Iron Milligrams per Calcium Milligrams
serving per serving
Breads, cereals, Legumes (1 c cooked)
and grains Chickpeas 78
Whole wheat Great northern beans 121
bread, 1 slice 0.9 Navy beans 128
White bread, 1 Pinto beans 82
slice 0.7
Black beans 103
Bran flakes, 1 c 11.0
Vegetarian baked
Cream of wheat, beans 128
1/2 c cooked 5.5
Oatmeal, Soyfoods
instant, 1 6.3 Soybeans, 1 c cooked 175
packet Tofu, 1/2 c 120-350
Wheat germ, 2 Tempeh, 1/2 c 77
Tbsp 1.2 Textured vegetable
85
Vegetables (1/2 protein, 1/2 c
c cooked) Soymilk, 1 c 84
Beet greens 1.4 Soymilk, fortified, 1 250-300
Sea vegetables 18.1-42.0 c
Swiss chard 1.9 Soynuts, 1/2 c 252
Tomato juice, 1 Nuts and seeds (2
c 1.3 Tbsp)
Turnip greens 1.5 Almonds 50
Legumes (1/2 c Almond butter 86
cooked) Vegetables (1/2 c
Baked beans, cooked)
vegetarian 0.74 Bok choy 79
Black beans 1.8 Broccoli 89
Garbanzo beans 3.4 Collard greens 178
Kidney beans 1.5 Kale 90
Lentils 3.2 Mustard greens 75
Lima beans 2.2 Turnip greens 125
Navy beans 2.5
Fruits
Soyfoods (1/2 c Dried figs, 5 258
cooked)
Calcium-fortified
Soybeans 4.4 orange juice, 1 c 300
Tempeh 1.8
Tofu 6.6 Other Foods
Soymilk, 1 c 1.8 Blackstrap molasses, 187
1 Tbsp
Nuts/seeds (2 Cow's milk, 1 c 300
Tbsp) Yogurt, 1 c 275-400
Cashews 1.0
Pumpkin seeds 2.5 Micrograms
Tahini 1.2 Vitamin D per serving
Sunflower seeds 1.2 Fortified,
Other foods ready-to-eat cereals, 1.0-2.5
3/4 c
Blackstrap
molasses, 1 Tbsp 3.3 Fortified soymilk or
other nondairy milk, 1.0-2.5
1 c
Zinc Milligrams per
serving
Micrograms
Breads, grains, Vitamin B-12 per serving
and cereals
Ready-to-eat
Bran flakes, 1 c 5.0 breakfast cereals, 1.5-6.0
Wheat germ, 2 3/4 c
Tbsp 2.3 Meat analogs (1
Legumes (1/2 c burger or 1 serving 2.0-7.0
cooked) according to package)
Adzuki beans 2.0 Fortified soymilk or
Chickpeas 1.3 other nondairy milks, 0.2-5.0
8 oz
Lima beans 1.0
Nutritional yeast
Lentils 1.2 (Red Star Vegetarian
Soyfoods (1/2 c Support Formula, 4.0
cooked) formerly T6635a), 1
Soybeans 1.0 Tbsp
Tempeh 1.5
Tofu 1.0 Linolenic acid Grams per
Textured serving
vegetable 1.4 Flax seed, 2 Tbsp 4.3
protein Walnuts, 1 oz 1.9
Walnut oil, 1 Tbsp 1.5
Vegetables (1/2
c cooked) Canola oil, 1 Tbsp 1.6
Corn 0.9 Linseed oil, 1 Tbsp 7.6
Peas 1.0 Soybean oil, 1 Tbsp 0.9
Sea vegetables 1.1-2.0 Soybeans, 1/2 c 0.5
cooked
Dairy foods Tofu, 1/2 c 0.4
Cow's milk, 1 c 1.0
Cheddar cheese,
1 oz 0.9
Yogurt, 1 c 1.8
FIG 1. Food sources of nutrients. Sources: Package information and data
from: Pennington J. Bowe's and Church's Food Values of Portions Commonly
Used. 16th ed. Lippincott-Raven; 1994. Provisional Table on the Content
of Omega-3 Fatty Acids and Other Fat Components in Selected Foods, 1988.
Washington, DC: US Dept of Agriculture: 1988: Publication No. HNIS/PT-103.
Hytowitz DB, Matthews RH. Composition of Foods: Legumes and Legume
Products. Washington, DC: US Dept of Agriculture; 1986. Agriculture
Handbook No. 8-16.
Red Star Yeast and Products, a division of Universal Foods Corp, Milwaukee,
Wisc.
Vegetarianism Throughout the Life Cycle
Well-planned vegan and lacto-ovo-vegetarian diets are appropriate for all
stages of the life cycle, including during pregnancy and lactation.
Appropriately planned vegan and lacto-ovo-vegetarian diets satisfy nutrient
needs of infants, children, and adolescents and promote normal growth (37).
Dietary deficiencies are most likely to be observed in populations with very
restrictive diets. All vegan children should have a reliable source of
vitamin B-12 and, if sun exposure is limited, vitamin D supplements or
fortified foods should be used. Foods rich in calcium, iron, and zinc should
be emphasized. Frequent meals and snacks and the use of some refined foods
and foods higher in fat can help vegetarian children meet energy needs.
Guidelines for iron and vitamin D supplements and for the introduction of
solid foods are the same for vegetarian and nonvegetarian infants. When it
is time for protein-rich foods to be introduced, vegetarian infants can have
pureed tofu, cottage cheese, and legumes (pureed and strained). Breast-fed
vegan infants should receive a source of vitamin B-12 if the mother's diet
is not supplemented and a source of vitamin D if sun exposure is inadequate.
Vegetarian diets are somewhat more common among adolescents with eating
disorders than in the general adolescent population; therefore, dietetics
professionals should be aware of young clients who greatly limit food
choices and who exhibit symptoms of eating disorders (38). However, recent
data suggest that adopting a vegetarian diet does not lead to eating
disorders (39). With guidance in meal planning, vegetarian diets are
appropriate and healthful choices for adolescents.
Vegetarian diets can also meet the needs of competitive athletes. Protein
needs may be elevated because training increases amino acid metabolism, but
vegetarian diets that meet energy needs and include good sources of protein
(eg, soyfoods, legumes) can provide adequate protein without use of special
foods or supplements. For adolescent athletes, special attention should be
given to meeting energy, protein, and iron needs. Amenorrhea may be more
common among vegetarian than nonvegetarian athletes, although not all
research supports this finding (40,41). Efforts to maintain normal menstrual
cycles might include increasing energy and fat intake, reducing fiber, and
reducing strenuous training.
Lacto-ovo-vegetarian and vegan diets can meet the nutrient and energy needs
of pregnant women. Birth weights of infants born to well nourished
vegetarian women have been shown to be similar to birth-weight norms and to
birth weights of infants of nonvegetarians (42). Diets of pregnant and
lactating vegans should be supplemented with 2.0 micrograms and 2.6
micrograms, respectively, of vitamin B-12 daily and, if sun exposure is
limited, with 10 micrograms vitamin D daily (43,44). Supplements of folate
are advised for all pregnant women, although vegetarian women typically have
higher intakes than nonvegetarians.
Meal Planning for Vegetarian Diets
A variety of menu-planning approaches can provide vegetarians with adequate
nutrition. Figure 2 suggests one approach. In addition, the following
guidelines can help vegetarians plan healthful diets.
* Choose a variety of foods, including whole grains, vegetables, fruits,
legumes, nuts, seeds and, if desired, dairy products and eggs.
* Choose whole, unrefined foods often and minimize intake of highly
sweetened, fatty, and heavily refined foods.
* Choose a variety of fruits and vegetables.
* If animal foods such as dairy products and eggs are used, choose
lower-fat versions of these foods. Cheeses and other high-fat dairy
foods and eggs should be limited in the diet because of their saturated
fat content and because their frequent use displaces plant foods in
some vegetarian diets.
* Vegans should include a regular source of vitamin B-12 in their diets
along with a source of vitamin D if sun exposure is limited.
* Solely breast-fed infants should have supplements of iron after the age
of 4 to 6 months and, if sun exposure is limited, a source of vitamin
D. Breast-fed vegan infants should have vitamin B-12 supplements if the
mother's diet is not fortified.
* Do not restrict dietary fat in children younger than 2 years. For older
children, include some foods higher in unsaturated fats (eg, nuts,
seeds, nut and seed butters, avocado, and vegetable oils) to help meet
nutrient and energy needs.
FIG 2. Food Guide Pyramid for Vegetarian Meal Planning.
[ADA PYRAMID THUMBNAIL] The full size pyramid is a 91k file and takes
quite some time to download.
The text version of this Food Guide Pyramid follows:
Food Guide Pyramid for Vegetarian Meal Planning
FATS, OILS, AND SWEETS --use sparingly
candy, butter, margarine, salad dressing, cooking oil
MILK, YOGURT, AND CHEESE GROUP DRY BEANS, NUTS, SEEDS, EGGS, AND
0-3 servings daily* MEAT SUBSTITUTES GROUP
milk--1 cup 2-3 servings daily
yogurt--1 cup soy milk--1 cup
natural cheese--1 1/2 oz cooked dry beans or peas--1/2 cup
*Vegetarians who choose not to use 1 egg or 2 egg whites
milk, yogurt, or cheese need to nuts or seeds--2 Tbsp
select other food sources rich in tofu or tempeh--1/4 cup
calcium. For a list of calcium-rich peanut butter--2 Tbsp
foods, please see Figure 1.
VEGETABLE GROUP FRUIT GROUP
3-5 servings daily 2-4 servings daily
cooked or chopped raw juice--3/4 cup
vegetables--1/2 cup dried fruit--1/4 cup
raw leafy vegetables--1 cup chopped, raw fruit--1/2 cup
canned fruit--1/2 cup
1 medium-size piece of fruit, such as
banana, apple, or orange
BREAD, CEREAL, RICE, AND PASTA GROUP
6-11 servings daily
bread--1 slice
ready-to-eat--1 oz
cooked cereal--1/2 cup
cooked rice, pasta, or other grains--1/2 cup
bagel--1/2
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40. Pedersen AB, Bartholomew MJ, Dolence LA, Aljadir LP, Netteburg KL, Lloyd
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* ADA Position adopted by the House of Delegates on October 18, 1987, and
reaffirmed on September 12, 1992, and September 6, 1996. This position will
be in effect until December 31, 2001. ADA authorizes republication of the
position statement/support paper, in its entirety, provided full and proper
credit is given. Requests to use portions of the position must be directed
to ADA Headquarters at 800/877-1600, ext 4896, or [log in to unmask]
* Recognition is given to the following for their contributions:
Authors:
Virginia K. Messina, MPH, RD, and Kenneth I. Burke, PhD, RD
Reviewers:
Winston J. Craig, PhD, RD; Johanna Dwyer, DSc, RD; Suzanne Havala, MS, RD,
FADA; D. Enette Larson, MS, RD; A. Reed Mangels, PhD, RD, FADA; Vegetarian
Nutrition dietetic practice group (Lenore Hodges, PhD, RD; Cyndi Reeser,
MPH, RD)
This position paper appeared in the Journal of the American Dietetic
Association, November 1997, Volume 97, Number 11.
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