Vegetarian Diet

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

If well-planned and fortified to balance possible deficiencies, vegetarian diets can become nutritionally adequate and can be appropriate for all stages of the human life cycle, including during pregnancy, lactation, infancy, childhood, and adolescence.[1] When fortified, a vegetarian diet can provide adequate protein, iron, zinc, vitamin B12, and calcium intake. However, in non-fortified vegetarian diets, or when not enough calories are consumed, these nutrients can be dangerously low and may compromise children’s health and development.[1][2]

Evidence suggests that vegetarians generally have lower rates of coronary heart disease, obesity, hypertension, type 2 diabetes,[1] and osteoporosis.[3] 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.

The Oxford Vegetarian Study showed that the health of vegetarians compares favourably with those who eat meat (except for pescetarians).[4] British vegetarians have lower death rates than those who eat meat,[4] although this is at least partly due to lifestyle factors beyond diet, such as a low prevalence of smoking, and the generally high socioeconomic status of vegetarians, or to certain aspects of the diet other than the specific avoidance of meat and fish.[5]

The School of Public Health at Loma Linda University has conducted three cohort studies that identify the health benefits of a vegetarian diet.[6] The University is a Seventh-day Adventist health science institution. The first study, funded by the US Public Health Service in 1958 and limited to Adventists in California, included many vegetarians. The next cohort of California Adventists, the Adventist Health Study-1 (AHS-1), collected data from 1974 to 1976. Then, from 2002 to 2007, the Adventist Health Study-2 (AHS-2) collected dietary data from 96,000 church members from the United States and Canada. Many scientific articles have been published on the health and nutrition properties of a vegetarian diet from these cohort studies.[7] The most recent AHS-2 study includes findings on metabolic syndrome,[8] Vitamin Dabsorption,[9] and type-2 diabetes.[10]

The 2010 version of Dietary Guidelines for Americans, a report issued by the U.S. Department of Agriculture and the U.S. Department of Health and Human Servicesevery five years, states that:

Vegetarians may avoid the negative health effects of red meat in the form of processed meats: A 1999 meta-study of five studies comparing vegetarian and non-vegetarian mortality rates in Western countries found that, in comparison with regular meat eaters, mortality from ischemic heart disease was 34% lower in people who ate fish but not meat (pescetarians), 34% lower in ovo-lacto vegetarians, 26% lower in vegans, and 20% lower in occasional meat eaters.[12] A 2010 study found that heart disease is not linked with unprocessed red meat.[13]

Studies of cancer have not shown clear differences in cancer rates between vegetarians and non-vegetarians.[14] There is, however, evidence that vegetarians tend to have some positive health attributes: a lower body mass index (BMI),[1][14] lower risk of obesity,[15] lower blood cholesterol levels,[1][14] lower homocysteine levels,[14] lower risk of high blood pressure,[1][15] and lower risk of type 2 diabetes.[1][15]

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.[16] In later editions of the book, starting in 1981, Lappé withdrew her contention that protein combining is necessary.[17]

Plant foods rich in protein include soy beans and soy products such as tofu, veggie burgers, and soy milk; other legumes; nutsand seeds; and cereal grains.[18]

Vitamin B12 deficiency can be extremely serious and lead to megaloblastic anemia, nerve degeneration and irreversible neurological damage.[19]

Vegetarians may get vitamin B12 from eggs and dairy products (milk, cheese, etc.);[20] 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.[20] Although some argue that developing a disease from B12 deficiency by following a sensible diet is extremely rare (less than one chance in a million),[21][22][23] 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.[24][25][26] 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 nutritional yeast or other yeast extracts, vegetable stock, veggie burger mixes, textured vegetable protein, soy milks, vegetable and sunflower margarines, and breakfast cereals.[19] 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.[27] There is a patent for cultivating plants in a solution containing vitamin B12 so that the plant contains more B12.[28]

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.

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 eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). 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.[29] To remedy this, DHA and EPA supplements derived from microalgae are available.[1]

Walnuts are a source of omega-3 fatty acids.

There is only weak evidence that O3FAs benefit cardiovascular health,[30] and although O3FAs have been thought useful for helping to alleviate dementia, as of 2016 there is no good evidence for their effectiveness in this regard.[31]

While there is little evidence of adverse health or cognitive effects caused by DHA deficiency in adult vegetarians, fetal and breast milk levels remain a concern for pregnant or lactating mothers.[29] EPA and DHA supplementation has been shown to reduce blood platelet aggregation in vegetarians, but a direct link to cardiovascular morbidityand mortality, which is already lower for vegetarians, has yet to be determined as of 2000.[32]

In several studies, vegetarians were not found to suffer from iron (Fe) deficiency more than those who ate meat.[33][34][35][36] However, while one study agreed that iron-deficiency anemia is not more common among vegetarians, they found “vegetarian children had … reduced levels of haemoglobin and iron compared to omnivores” due “to the absence of animal iron sources with high utilizability”.[37] Another study done in India found that “strict vegetarian mothers as well as their newborns have a greater incidence and risk of anemia and iron deficiency.”[38]

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,[1] because plants, dairy, and eggs contain only non-hemeiron, and this is absorbed less efficiently than heme iron.[37] 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,[39] and a well-planned vegetarian diet should not lead to iron deficiency, but fruitarianism and raw foods diets should not be pursued for infants or children.[1]

Meat, including fish and poultry, and not dairy or eggs, is the only source of heme iron; intake of heme iron may be associated with colon cancer.[40] 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.[41]

Western vegetarians and vegans have not been found to suffer from overt zinc (Zn) deficiencies any more than those who eat meat.[42]However, 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]

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.”[43] 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]

  1. ^ Jump up to: a b c d e f g h i j k l m n o p q r 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”. US National Library of Medicine National Institutes of Health. 29 (2 Suppl): S126–31. PMC 3137939. PMID 18709887.
  3. ^ Incidence of osteoporosis in vegetarians and omnivores
  4. ^ Jump up to: a b Appleby, Paul N; Thorogood, Margaret; Mann, Jim I; Key, Timothy JA (1999). “The Oxford Vegetarian Study: An overview”. The American Journal of Clinical Nutrition. 70 (3 Suppl): 525S–531S. PMID 10479226.
  5. ^ Appleby, Paul N; Key, Timothy J; Thorogood, Margaret; Burr, Michael L; Mann, Jim (2007). “Mortality in British vegetarians”. Public Health Nutrition. 5 (1): 29–36. doi:10.1079/PHN2001248. PMID 12001975.
  6. ^ Adventist Health Studies
  7. ^ List of scientific publications from the Adventist Health Studies
  8. ^ Rizzo, N. S.; Sabate, J.; Jaceldo-Siegl, K.; Fraser, G. E. (2011). “Vegetarian Dietary Patterns Are Associated with a Lower Risk of Metabolic Syndrome: The Adventist Health Study 2”. Diabetes Care. 34 (5): 1225–7. doi:10.2337/dc10-1221. PMC 3114510. PMID 21411506.
  9. ^ Chan, J.; Jaceldo-Siegl, K.; Fraser, G. E (2009). “Serum 25-hydroxyvitamin D status of vegetarians, partial vegetarians, and nonvegetarians: The Adventist Health Study-2”. American Journal of Clinical Nutrition. 89 (5): 1686S. doi:10.3945/ajcn.2009.26736X. PMC 2677010. PMID 19339396.
  10. ^ Tonstad, S.; Butler, T.; Yan, R.; Fraser, G. E. (2009). “Type of Vegetarian Diet, Body Weight, and Prevalence of Type 2 Diabetes”. Diabetes Care. 32 (5): 791–6. doi:10.2337/dc08-1886. PMC 2671114. PMID 19351712.
  11. ^ United States Department of Agriculture; United States Department of Health and Human Services (December 2010). “Building Healthy Eating Patterns” (PDF). Dietary Guidelines for Americans, 2010 (PDF) (7th ed.). Washington, DC: U.S. Government Printing Office. pp. 43–54.
  12. ^ Key, T. J.; Fraser, G. E.; Thorogood, M; Appleby, P. N.; Beral, V; Reeves, G; Burr, M. L.; Chang-Claude, J; Frentzel-Beyme, R; Kuzma, J. W.; Mann, J; McPherson, K (1999). “Mortality in vegetarians and nonvegetarians: Detailed findings from a collaborative analysis of 5 prospective studies”. The American Journal of Clinical Nutrition. 70 (3 Suppl): 516S–524S. doi:10.1079/phn19980006. PMID 10479225.
  13. ^ Micha, R.; Wallace, S. K.; Mozaffarian, D. (2010). “Red and Processed Meat Consumption and Risk of Incident Coronary Heart Disease, Stroke, and Diabetes Mellitus: A Systematic Review and Meta-Analysis”. Circulation. 121 (21): 2271–83. doi:10.1161/CIRCULATIONAHA.109.924977. PMC 2885952. PMID 20479151. Lay summaryHarvard School of Public Health (May 17, 2010).
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  15. ^ Jump up to: a b c American Heart Association: Vegetarian Diets. Retrieved 4 January 2007.
  16. ^ Akers, Keith: But How Do You Get Enough Protein? Archived 28 October 2010 at the Wayback Machine.. Compassionate Spirit. Retrieved 25 June 2010.[unreliable medical source?]
  17. ^ Lappé, Frances Moore (1981). Diet for a Small Planet. p. 162. ISBN 0-345-32120-0.
  18. ^ Craig, Winston J.; Pinyan, Laura (2001). “Nutrients of Concern in Vegetarian Diets”. In Sabate, Joan. Vegetarian Nutrition. CRC Press. pp. 299–332. ISBN 978-1-4200-3683-1.
  19. ^ Jump up to: a b The Vegetarian Society. Information Sheet: Vitamin B12 Archived 22 August 2008 at the Wayback Machine.. Retrieved 26 April 2007.
  20. ^ Jump up to: a b “Dietary Supplement Fact Sheet: Vitamin B12”. Office of dietary supplements. Retrieved 14 March 2012.
  21. ^ “Vitamin B12 Deficiency—the Meat-eaters’ Last Stand”. McDougall Newsletter Archive Vol. 6, No. 11. Dr. McDougall. Retrieved 14 March2012.[unreliable medical source?]
  22. ^ “Vegans and the Vitamin B12 Deficiency Myth”. Vegetarianism. pamrotella. Retrieved 14 March 2012.[unreliable medical source?]
  23. ^ “Worried About Vitamin B12 Deficiency?”. Raw Food Health. RAW FOOD HEALTH. Retrieved 14 March 2012.[unreliable medical source?]
  24. ^ Hokin, B. D.; Butler, T (1999). “Cyanocobalamin (vitamin B-12) status in Seventh-day Adventist ministers in Australia”. The American Journal of Clinical Nutrition. 70 (3 Suppl): 576S–578S. PMID 10479234.
  25. ^ Krajčovičová-Kudláčková, M.; Blažíček, P.; Kopčová, J.; Béderová, A.; Babinská, K. (2000). “Homocysteine Levels in Vegetarians versus Omnivores”. Annals of Nutrition and Metabolism. 44 (3): 135–8. doi:10.1159/000012827. PMID 11053901.
  26. ^ B12 and Chronic Disease: Homocysteine. Retrieved 26 April 2007.
  27. ^ 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.
  28. ^ Seed and plant containing vitamin B12 and method of producing the same
  29. ^ Jump up to: a b 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.
  30. ^ Colussi G, Catena C, Novello M, Bertin N, Sechi LA (2016). “Impact of omega-3 polyunsaturated fatty acids on vascular function and blood pressure: Relevance for cardiovascular outcomes”. Nutr Metab Cardiovasc Dis (Review). doi:10.1016/j.numecd.2016.07.011. PMID 27692558.
  31. ^ Burckhardt M, Herke M, Wustmann T, Watzke S, Langer G, Fink A (2016). “Omega-3 fatty acids for the treatment of dementia”. Cochrane Database Syst Rev(Systematic review). 4: CD009002. doi:10.1002/14651858.CD009002.pub3. PMID 27063583.
  32. ^ Mezzano, Diego; Kosiel, Karin; Martínez, Carlos; Cuevas, Ada; Panes, Olga; Aranda, Eduardo; Strobel, Pablo; Pérez, Druso D; Pereira, Jaime; et al. (2000). “Cardiovascular Risk Factors in Vegetarians: Normalization of Hyperhomocysteinemia with Vitamin B12 and Reduction of Platelet Aggregation with n-3 Fatty Acids”. Thrombosis Research. 100 (3): 153–60. doi:10.1016/S0049-3848(00)00313-3. PMID 11108902.
  33. ^ Larsson, C. L.; Johansson, G. K. (2002). “Dietary intake and nutritional status of young vegans and omnivores in Sweden”. The American Journal of Clinical Nutrition. 76 (1): 100–6. PMID 12081822.
  34. ^ Messina MJ, Messina VL. The Dietitian’s Guide to Vegetarian Diets: Issues and Applications. Gaithersburg, MD: Aspen Publishers; 1996.[page needed]
  35. ^ Craig, W. J. (1994). “Iron status of vegetarians”. The American Journal of Clinical Nutrition. 59 (5 Suppl): 1233S–1237S. PMID 8172127.
  36. ^ Ball, M. J.; Bartlett, M. A. (1999). “Dietary intake and iron status of Australian vegetarian women”. The American Journal of Clinical Nutrition. 70 (3): 353–8. PMID 10479197.
  37. ^ Jump up to: a b Krajcovicová-Kudlácková, M; Simoncic, R; Béderová, A; Grancicová, E; Magálová, T (1997). “Influence of vegetarian and mixed nutrition on selected haematological and biochemical parameters in children”. Die Nahrung. 41 (5): 311–4. doi:10.1002/food.19970410513. PMID 9399258.
  38. ^ Sharma, D. C.; Kiran, Raj; Ramnath, Vijaywantee; Khushiani, Krishna; Singh, P. P. (1994). “Iron deficiency and anemia in vegetarian mothers and their newborns”. Indian Journal of Clinical Biochemistry. 9 (2): 100–2. doi:10.1007/BF02869583.
  39. ^ Nutrition Australia: FAQ on Vegetarian Diets‘.’ Retrieved 11 April 2007.
  40. ^ Pierre, Fabrice; Peiro, Géraldine; Taché, Sylviane; Cross, Amanda J.; Bingham, Sheila A.; Gasc, Nicole; Gottardi, Gaëlle; Corpet, Denis E.; Guéraud, Françoise (2006). “New Marker of Colon Cancer Risk Associated with Heme Intake: 1,4-Dihydroxynonane Mercapturic Acid”. Cancer Epidemiology, Biomarkers & Prevention. 15 (11): 2274–9. doi:10.1158/1055-9965.EPI-06-0085. PMID 17119057.
  41. ^ Ponka, Prem; Schulman, Herbert M.; Woodworth, Robert C.; Richter, Goetz W. (1990-09-25). Iron Transport and Storage. CRC Press. ISBN 9780849366772.
  42. ^ Freeland-Graves, J. H.; Bodzy, P. W.; Eppright, M. A. (1980). “Zinc status of vegetarians”. Journal of the American Dietetic Association. 77 (6): 655–61. PMID 7440860.
  43. ^ 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.

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