Vegetarian 101


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Whether you already are a vegetarian or just exploring alternatives, this seminar is for you! Learn about the benefits of a vegetarian diet, the types of vegetarianism, the common nutrient deficiencies and how to be a healthy, well-nourished vegetarian at any age. We will also focus on the special needs of vegetarians during pregnancy, breast-feeding, infancy, childhood and adolescence.

Presented by Dr. Lisa Watson, a vegetarian for over 25 years and the mother of two vegetarian children.

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  • Heme iron is 15-40% absorbed. Non-heme iron is 1-15% absorbed.
  • Vegetarian 101

    1. 1. Vegetarian 101 Dr. Lisa Watson, ND
    2. 2. Vegetarian Terminology
    3. 3. Vegetarian TerminologyVegan – consumes NO animal products (includingmeat, poultry, fish, eggs, dairy, honey)Lacto-Ovo Vegetarian – consumes no meat, fish orpoultry but does consume dairy and/or eggsPescetarian– consumes no meat or poultry but doesconsume fish, dairy and/or eggsFlexitarian– consumes a predominantly vegetariandiet but consumes meat or poultry on occasion
    4. 4. Health Benefitsof a Vegetarian Diet
    5. 5. Benefit 1: Decreased risk of diabetes Vegetarian diets reduce the risk of developing diabetes and are associated with improved insulin sensitivity and decreased oxidative stress. Vegetarian diets are more successful than omnivore diets in managing existing diabetes.
    6. 6. Benefit 2: Decreased risk of heart disease Vegetarians have lower incidence of heart disease, lower LDL (bad) cholesterol, lower rates of obesity and lower rates of hypertension.
    7. 7. Benefit 3: Decreased risk of obesity On average, vegetarians have lower BMIs (body mass index) than omnivores with vegans having even lower BMIs. Obesity is the main risk factor for a number of chronic conditions including hypertension, heart disease, diabetes and reduced life expenctancy.
    8. 8. Benefit 4: Improved mood Vegetarians report less negative mood states than omnivores. When omnivores change over to a vegetarian diet self reported mood states improve. Beezhold BL, Johnston CS. Restriction of meat, fish, and poultry in omnivores improves mood: a pilot randomized controlled trial. Nutr J. 2012 Feb 14;11:9.
    9. 9. Benefit 5: Decreased risk of cancer A vegetarian diet is associated with a decreased incidence of cancer for two main reasons: • vegetarian diets are high in fiber, antioxidants and phytonutrients that are cancer-protective • vegetarian diets contain no red meats or processed meats – both of which have been linked to an increased incidence of cancer.
    10. 10. Nutritional Needs of Vegetarians
    11. 11. But some nutrients are more challenging to get…
    12. 12. Vitamin B12 Necessary for normal functioning of the brain and nervous system Also required by our body to produce energy and utilize fatty acids
    13. 13. Vitamin B12 Necessary for normal functioning of the brain and nervous system Also required by our body to produce energy and utilize fatty acids Did you know? No plant or animal can make their own B12 – Only bacteria can synthesize it.
    14. 14. Vitamin B12 Up to two-thirds of vegans and one-third of vegetarians are deficient. (Up to one-third of omnivores are also deficient) B12 deficiency can lead to anemia (low red blood cells) and nervous system damage. Because folic acid levels are high in vegans and vegetarians a B12 deficiency can be hidden until it is severe and causing symptoms.
    15. 15. Vitamin B12 Vegetarian sources of B12: • Eggs • Dairy products •Spirulina •Miso •Tempeh • Nutritional yeast • Fortified cereals, soy/ almond/ rice milk • Supplements • Healthy intestinal bacteria
    16. 16. Vegetarian Science Break Homocysteine– an amino acid found in the blood. High levels are associated with heart disease, stroke, dementia and early mortality. Elevated homocysteine concentration in plasma was observed in 66% of the vegans and about 45-50% of the omnivores and vegetarians. Vegan subjects had significantly higher mean plasma homocysteine levels than omnivores. B-vitamin status and concentrations of homocysteine in Austrian omnivores, vegetarians and vegans. Ann NutrMetab 2006. Why?
    17. 17. Vegetarian Science Break Deficiency of vitamin B12, folic acid or vitamin B6 can all lead to elevated homocysteine levels. Folic acid and vitamin B6 levels in vegans are usually high compared to omnivores. So B12 deficiency is the most likely cause of high homocysteine in vegans.
    18. 18. Vegetarian Science Break In the body methionine (an amino acid) is turned into homocysteine. Vitamin B12 is used to turn the homocysteine back into methionine. If there is not enough vitamin B12, then homocysteine levels remain high. American vegans consume an average of 5.6mcg of vitamin B12 through fortified food daily. The recommended intake is 100mcg daily.
    19. 19. Vegetarian Science Break But don’t vegans have a lower risk of cardiovascular disease? Vegans have lower cholesterol levels and blood pressure than omnivores. However, studies looking at the negative effects of homocysteine adjusted for cholesterol levels and blood pressure and still found an increased incidence of heart disease, stroke, dementia and death.
    20. 20. Vegetarian Science Break Vitamin B12 offers a safe and effective way to lower homocysteine levels in vegans with no adverse effects. ALL vegans (and most vegetarians) should be taking a daily B12 supplement.
    21. 21. Riboflavin – Vitamin B2 Necessary for energy production and metabolism Used by the body to metabolize fats, carbohydrates and proteins Riboflavin is water-soluble and is not stored in the body. It must be consumed daily. Riboflavin is bright yellow in colour and causes yellowing of the urine when taken in supplements.
    22. 22. Riboflavin – Vitamin B2 Studies suggest that up to 30% of vegans are deficient in riboflavin due to inadequate daily consumption. Symptoms of deficiency include dry, cracked lips, mouth ulcers, cracks at the corner of the mouth and sore throat A diverse diet, supplementation or use of fortified foods is usually enough for most vegetarians and vegans to meet their daily needs.
    23. 23. Riboflavin – Vitamin B2 Vegetarian sources of riboflavin: • Milk, cheese • Fortified bread and cereals • Green leafy vegetables • Legumes • Yeast • Mushrooms • Almonds • Supplements
    24. 24. Vitamin D Produced in the skin from sun exposure. In Canada we are unable to produce vitamin D from sun rays during the months of October to April. Vitamin D is required for absorption of calcium, for proper functioning of the immune system and decreases the risk of developing over 16 different types of cancer.
    25. 25. Vitamin D In Canada all dairy products are fortified with vitamin D. Some milk alternatives are also fortified. Vitamin D supplements are recommended for ALL Canadians – infants, children, teens and adults – during the winter months.
    26. 26. Vitamin D Vegetarian sources of Vitamin D: • Fortified dairy products • Fortified soy, almond and rice milks • Sun exposure May-September • Supplements
    27. 27. Calcium Necessary for the function of muscles (including the heart), release of neurotransmitters and for calcification of the teeth and bones. Vitamin D is required for calcium absorption. Consumption of animal proteins increases calcium requirements, so vegans may have lower daily needs.
    28. 28. Calcium Dairy is a popular source of calcium, but this mineral is found in a wide variety of foods. A diverse vegan diet can be rich in calcium. Some plants contain oxalates and phytates, compounds that can inhibit calcium absorption. Eating a wide variety of calcium rich foods will result in better absorption and adequate calcium levels.
    29. 29. Calcium Vegetarian sources of calcium: • Dark green vegetables – kale, bok choy, spinach, collards, broccoli • Beans • Tofu and tempeh • Sesame seeds • Almonds and almond butter • Blackstrap molasses • Fortified soy, almond and rice milks • Figs • Dairy
    30. 30. Iron Iron is used by red blood cells to carry oxygen to tissues – less iron, less oxygen to our organs, muscles, skin and brain Iron is also necessary for energy production and proper functioning of the immune system.
    31. 31. Iron Vegetarians typically consume as much iron in their diet as omnivores. However, the iron in vegetables is less bioavailable. It is more difficult to absorb and it is more sensitive to inhibitors of iron absorption. Inhibitors include: •Phytates • Calcium • Polyphenols – found in coffee, tea and red wine
    32. 32. Science Break - Phytates •Stores phosphorus in plants • Is indigestible by humans • Binds to minerals and makes them unabsorbable • Negatively impacts absorption of iron, zinc and to a lesser extent calcium and magnesium
    33. 33. Science Break - Phytates •Found in nuts, grains, beans and seeds • To decrease the impact of phytates: • Cook your food • Fermentation • Sprouting • Vitamin C – decreases impact of phytates on iron absorption
    34. 34. Iron Because of the lower bioavailability of iron from a vegetarian diet, the recommended iron intakes for vegetarians are 1.8 times that of nonvegetarians. Position of the American Dietetic Association: Vegetarian Diets. J Am Diet Assoc. 2009;109: 1266-1282.
    35. 35. Iron Vegetarians adapt to lower absorption of iron and have the same incidence of anemia as non-vegetarians. Women, children, teens, pregnant and breast feeding mothers should be diligent about maintaining adequate iron levels and stores.
    36. 36. Iron Vegetarian sources of iron: • Soy beans and tofu • Lentils • Spinach and dark green leafy vegetables • Sesame seeds • Chick peas (Garbanzo beans) • Lima beans and navy beans • Olives • Fortified cereals • Blackstrap molasses
    37. 37. Iodine Necessary for thyroid function and breast health. Vegans who do not consume table salt or sea vegetables are often deficient in iodine because plant-based diets are low in iodine. Iodine is added to many foods to ensure sufficient intake: • Table salt • Flour • Milk
    38. 38. Iodine The salt used in processed foods is NOT iodized Sea salt, pink salt, gray salt, etc are not iodized and may not contain adequate amounts of iodine. Vegetarian sources of iodine: • Iodized table salt • Sea vegetables (kelp, nori, wakame) • Dairy products • Eggs
    39. 39. Zinc Needed for immune functioning, protein synthesis, wound healing, DNA synthesis and cell division. Zinc is of particular importance during periods of growth (pregnancy, infancy, childhood, teens) and during sexual maturation (teens). Animal products provide the majority of zinc in North American diets.
    40. 40. Zinc Zinc may be deficient in vegan diets that are high in phytates. Zinc must be consumed daily because our bodies have no storage for this mineral. Vegetarians need up to 50% more zinc than the recommended daily allowance to compensate for the poor absorption of zinc from plant-based diets.
    41. 41. Zinc Vegetarian sources of zinc: • Soy beans and tofu • Lentils • Beans • Grains (especially oats) • Nuts • Pumpkin and sesame seeds • Mushrooms • Cheese and yogurt
    42. 42. Omega 3 Fatty Acids The omega 3 fatty acids, docosahexanoic acid (DHA) and eicosapentanoic acid (EPA) are necessary for cardiovascular health, mental health, brain health and eye health. Vegan diets that do not contain eggs, fish or abundant amounts of algae are often deficient in omega 3s.
    43. 43. Omega 3 Fatty Acids Vegan diets are rich in omega 6s (found in vegetable oils, canola oil, soybean oil, corn oil and sunflower oil) which can prevent utilization of omega 3s by our cells. The ideal balance of omega 6s to omega 3s is 1:1 to 4:1. Omnivores in North American average a ratio of 10:1, vegetarians 16:1 and vegans 20:1.
    44. 44. Omega 3 Fatty Acids Omega 6 fatty acids are pro-inflammatory, pro-thrombotic and pro-constrictive. An imbalance of omega 6 to omega 3 can contribute to cancer, arthritis, inflammation and heart disease.
    45. 45. Omega 3 Fatty AcidsThe omega 3 fatty acid found in plants, alpha-linolenic acid (ALA) can be converted into EPA and DHA. The conversion rate to EPA is typically 5-10%. The conversion rate to DHA is even worse (2-5%). Micro-algae can provide a vegan source of DHA and can increase EPA levels as well (through a process known as retroconversion).
    46. 46. Omega 3 Fatty Acids Vegan requirements for ALA are DOUBLE that of the recommended daily allowance in order to compensate for the poor conversion rates. Vegetarian sources of Omega 3s • Flaxseeds • Walnuts • Soy • Hempseeds • DHA rich micro-algae • Dark green leafy vegetables • Eggs
    47. 47. Protein & Essential Amino Acids Protein provides the body with amino acids which are used as a source of energy and as building blocks for muscles, skin, hormones, and enzymes. Amino acids that can not be made by our body are considered essential. The essential amino acids are: •Leucine •Tryptophan •Isoleucine •Methionine •Valine • Phenylalanine • Lysine •Histidine •Threonine
    48. 48. Protein & Essential Amino Acids Eating a diverse selection of plant foods will ensure you get enough essential amino acids in your diet. Legumes are high in lysine, but low in methionine. Grains are high in methionine but low in lysine. Eating both grains and legumes, as well as vegetables and fruits will provide all the essential amino acids.
    49. 49. Protein & Essential Amino Acids Food Combining: It is not necessary to consume both grains and legumes in the same meal to meet your need for essential amino acids. Eating them over the course of a single day is adequate. Vegetarians should aim to consume 1.0g of protein per kg of body weight daily to meet their personal needs.
    50. 50. Protein & Essential Amino Acids Vegetarian Sources of Protein • Soy beans, tofu, tempeh • Legumes, lentils, peas • Beans (black, white, red, chick peas) • Quinoa • Nuts and nut butters • Seeds • Brown rice • Spinach • Broccoli • Eggs • Dairy
    51. 51. Don’t Think You Can Get Enough Protein?Bigger vegetarians than YOU: • Horses (1000 Lbs) • Cows (1650 Lbs) • Hippopotamus (7000 Lbs) • Elephants (16 000 Lbs) •Argentinosaurus (200 000 Lbs)
    52. 52. What about SOY?
    53. 53. What about SOY? Soy beans (Glycine max) are a legume that are: • High in protein • High in fat • Low in carbohydrates • A source of omega 3 ALA • A source of isoflavones
    54. 54. What about SOY? Isoflavones – The source of the soy controversy •Soy contains genistein, daidzein and glycitein •Isoflavones are mildly estrogenic – they are able to bind to estrogen receptors in the body •Isoflavones bind selectively to beta estrogen receptors and are classified as natural selective estrogen receptor modulators (SERMs) • SERMS have estrogen-like effects in some tissues, but not in others
    55. 55. What about SOY? Soy and Breast Cancer In mice studies, genistein can increase the growth of estrogen-sensitive tumours •The amount used in these studies was 20x normal human exposure •Mice also lack the ability to detoxify isoflavones, causing higher circulating amounts. Humans can detoxify isoflavones efficiently and
    56. 56. What about SOY? Soy and Breast Cancer In human studies soy has been found to NOT alter markers of breast cancer risk, including breast tissue density and breast cell proliferation. In fact, post-diagnosis consumption of soy food is associated with a better prognosis (measured by mortality and tumour recurrence)
    57. 57. What about SOY? Soy and Feminization of Boys Soy and soyfoods do not alter testosterone or dihydrotestosterone levels. Clinical studies have also found no impact of soy consumption on sperm count or motility.
    58. 58. What about SOY? Soy and Thyroid Function Soy can interfere with absorption of Synthroid, as can many other fiber-rich foods. Soy can worsen hypothyroid symptoms if iodine levels are not adequate.
    59. 59. SO… Should I eat soy? Yes. Soy is safe and is an easy and effective way to increase protein and fiber in your diet. How much? Research suggests 2-3 servings per day is enough to reap the benefits of soy. Choose less processed soy foods and incorporate them into a diverse vegetarian diet.
    60. 60. Vegetarian DietIn SpecialPopulations
    61. 61. Vegetarian Diet In Pregnancy& Breastfeeding
    62. 62. Nutrient Needs ofPregnant Vegetarians • Increased caloric intake • Increased protein • Increased iron • Increased vitamin B12 • Increased vitamin D • Increased folic acid • Increased zinc • Increased DHA • Increased calcium • Increased iodine
    63. 63. Nutrient Needs ofPregnant Vegetarians All of these nutrients can be found in a diverse vegetarian diet. Supplements may be recommended to ensure adequate levels in pregnancy.
    64. 64. Nutrient Needs ofPregnant Vegetarians Iodine Vegan women who are pregnant or breastfeeding should take an iodine supplement to prevent hypothyroidism and potential mental retardation in their infants. Only 30% of prenatal vitamins contain adequate amounts of iodine – choose carefully
    65. 65. Nutrient Needs ofPregnant Vegetarians Vitamin B12 Low B12 in pregnancy is associated with an increased risk of neural tube defects, pre-eclampsia and other pregnancy complications. Vegans and lacto-ovo vegetarians are at risk of deficiency during pregnancy.
    66. 66. Nutrient Needs ofPregnant Vegetarians Recommended supplements: • Iron (if developing anemia) • Folic acid containing prenatal vitamin • Vitamin B12 • Vitamin D (from October to May) • Iodine • DHA-rich algae • Protein supplement and/ or calcium supplement (diet dependent)
    67. 67. Vegetarian Dietin Infants and Toddlers
    68. 68. Vegetarian Babies and ToddlersBreast feeding moms should pay attention to getting adequate vitamin B12, vitamin D, calcium, zinc, iron and DHA. Babies breastfed by vegetarian mothers have similar rates of growth and development as babies of omnivore moms.
    69. 69. Vegetarian Babies and ToddlersProtein-rich foods should be among the first foods introduced in infancy. Pureed tofu, legumes, lentils, peas, beans, chick peas, cooked egg yolk, goat yogurt, and cottage cheese can all be introduced in the first year alongside vegetables, fruits and grains.
    70. 70. Vegetarian Babies and ToddlersBecause of the lower digestibility of plant protein, daily needs may be higher. 30% higher up to 2 years of age (1.5g/kg/day) 20-30% higher for 2-6 year olds (1.3g/kg/day) 15-20% higher for 6 and up (1.15g/kg/day)
    71. 71. Vegetarian Babies and Toddlers DHA is important for nervous system and eye development in infants and toddlers.Preterm infants may not be able to convert ALA into EPA and DHA and benefit from direct supplementation.
    72. 72. Vegetarian Babies and ToddlersAll breastfed babies (and all Canadian babies during the winter) should be supplemented with vitamin D regardless of being vegetarian or not. Toddlers not consuming fortified milk (or fortified alternative milk) products should continue year-round supplements.
    73. 73. Vegetarian Dietin Children
    74. 74. Vegetarian Kids Vegetarian kids have normal growth and development from infancy through to adulthood. Vegan children and teens may be shorter and lighter, but are still within the range of normal height and weight.
    75. 75. Vegetarian Kids Iron is the most common nutrient deficiency in childhood (usually associated with over-consumption of cows milk). Vegetarian kids require more iron to compensate for the poor absorption of plant-based iron (about 1.8x more).
    76. 76. Vegetarian Kids Recommended daily iron intake for vegetarian kids is: Age Daily Iron Intake 1-3 years 12mg 4-8 years 18mg 9-13 years 14mg Supplements may be necessary during periods of rapid growth.
    77. 77. Vegetarian Kids Calcium intakes in vegan children are often below daily recommended intakes. Children should consume adequate calcium to ensure healthy bone and teeth development. 8 or more servings of calcium-rich foods are recommended daily.
    78. 78. Vegetarian Diet in Teens
    79. 79. Vegetarian Teens Teens are one of the fastest growing populations of vegetarians.A well-executed vegetarian diet can provide all the calories and nutrients needed for the growth and development of adolescents.
    80. 80. Vegetarian TeensThere are concerns that a vegetarian diet may mask an eating disorder in teens. Education on healthy eating patterns is important to ensure a healthy vegetarian diet during the teen years.
    81. 81. Vegetarian TeensVitamin D, B12, calcium and iron are all important for proper growth during the teen years. Zinc is necessary for proper sexual development and adequate intake should be emphasized in all vegetarian teens.
    82. 82. Vegetarian TeensThe high calorie needs of teens can be met most efficiently by eating frequently. Encouraging healthy snack habits can help vegetarian teens meet their nutritional needs and caloric needs.
    83. 83. The IdealVegetarian Diet
    84. 84. The Five Major Plant-Based Food Groups • Whole grains • Legumes and beans • Vegetables • Fruits • Nuts and seeds
    85. 85. Whole Grains Provide fiber, iron, complex carbohydrates, B vitamins and minerals like zinc. Choose 6 or more servings per day • Oatmeal • Cereals • Rice (brown rice, wild rice) • Quinoa • Millet • Barley • Amaranth • Teff
    86. 86. Legumes and beans Provide protein, B vitamins, iron and trace minerals. Choose five or more servings per day. • White, black, red beans • Peas, black eyed peas • Lentils • Chick peas • Tofu or tempeh • Processed soy products (in moderation only!)
    87. 87. Fruits Provide vitamins, fiber and phytonutrients. Choose two or more servings per day. • Apples, pears • Bananas • Oranges, grapefruit • Berries, cherries • Tropical fruit – mango, papaya • Melons • Plums, peaches • Dates, figs • Dehydrated fruits
    88. 88. Vegetables Provide calcium, iron, phytonutrients and trace minerals. Choose four or more servings per day. • Raw vegetables • Cooked vegetables • Vegetable juices • Dark green leafy vegetables • Yellow, orange, red and green vegetables
    89. 89. Nuts and Seeds Provide protein, fiber, fats, and antioxidants. Choosetwo or more servings per day. • Almonds, walnuts, hazelnuts, brazil nuts, pecans, pistachios, cashews • Nut butters • Pumpkin, sesame, sunflower seeds • Flax, hemp, chia seeds
    90. 90. Calcium While not a food group, it is important to emphasize calcium in the vegan diet to ensure adequate intake. Eat eight or more calcium rich foods daily • Dark green vegetables – kale, bokchoy, spinach, collards, broccoli • Beans • Tofu and tempeh • Sesame seeds • Almonds and almond butter • Blackstrap molasses • Fortified soy, almond and rice milks • Figs • Dairy
    91. 91. Resources
    92. 92. The Vegetarian Resource Group – www.vrg.orgToronto Vegetarian Association – www.veg.caAmerican Dietetic Association – www.eatright.orgVeg Family Magazine –
    93. 93. References1. Van Winckel M, VandeVelde S, De Bruyne R, Van Biervliet S. Clinical practice: vegetarian infant and child nutrition. Eur J Pediatr 2011; 170:1489-1494.2. Amit M; Canadian Paediatric Society, Community Paediatrics Committee. Vegetarian diets in children and adolescents. Paediatr Child Health 20120; 15(5):303-314.3. American Dietetic Association. Position of the American Dietetic Association: Vegetarian Diets. J Am Diet Assoc 2009; 109(7):1266-1282.4. Davis BC, Kris-Etherton PM. Achieving optimal essential fatty acid status in vegetarians: current knowledge and practical implications. Am J Clin Nutr 2003;78(suppl):640S–6S.5. Hunt, JR. Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. Am J ClinNutr 2003; 78(suppl):633S-9S.6. Leung AM, LaMar A, He X, Braverman LE, Pearce EN. Iodine status and thyroid function of Boston-area vegetarians and vegans. J ClinEndocrinolMetab 2011; 96: E1303-E1307.7. Koebnick C, Hoffmann I, Dagnelie PC, Heins UA, et al. Long-term ovo-lacto vegetarian diet impairs vitamin B-12 status in pregnant women. J Nutr 2004; 134: 3319-3326.8. Appleby PN, Thorogood M, Mann JI, Key TJA. The Oxford Vegetarian Study: an overview. Am J ClinNutr 1999; 70(suppl):525S-531S.9. Waldmann A, Koschizke JW, Leitzmann C, Hahn A. Dietary iron intake and iron status of German female vegans: Results of the German vegan study. Ann NutrMetab 2004; 48:103-108.
    94. 94. References10. Obeid R, Geisel J, Schorr H, Hubner U, Herrmann W. The impact of vegetarianism on some haematologicalparamaters. Eur J Haematol 2002; 69:275-279.11. Krajcovicova-Kudlackova M, Buckova K, Klimes I, Sebokova E. Iodine deficiency in vegetarians and vegans. Ann NutrMetab 2003; 47:183-185.12. Kim MK, Cho SW, Park YK. Long-term vegetarians have low oxidative stress, body fat, and cholesterol levels. Nutr Res Pract 2012; 6(2):155-161.13. Messina V, Melina V, Mangels AR. A new food guide for North American vegetarians. Can J Diet Pract Res. 2003 Summmer; 64(2):82-86.14. Kniskern MA, Johnston CS. Protein dietary reference intakes may be inadequate for vegetarians if low amounts of animal protein are consumed. Nutrition. 2011 Jun; 27(6):727-730.15. Pribis P, Pencak RC, Grajales T. Beliefs and attitudes toward vegetarian lifestyle across generations. Nutrients. 2010 May; 2(5):523-531.16. Messina M, Messina V. The role of soy in vegetarian diets. Nutrients. 2010 Aug; 2(8):855-888.17. Jacobs DR, Haddad EH, Lanou AJ, Messina MJ. Food, plant food, and vegetarian diets in the US dietary guidelines: conclusions of an expert panel. Am J ClinNutr. 2009 May; 89(5):1549S-1552S.18. Haddad EH, Sabate J, Whitten CG. Vegetarian food guide pyramid: a conceptual framework. Am J ClinNutr. 1999 Sep; 70(3 Suppl):615S-619S.
    95. 95. References19. Laskowska-Klita T, Chelchowska M, Ambroszkiewicz J, Gajewska J, Klemarczyk W. The effect of vegetarian diet on selected essential nutrients in children. Med WiekuRozwoj. 2011; 15(3):318-325.20. Kawade R. Zinc status and its association with the health of adolescents: a review of studies in India. Glob Health Action. 2012; 5:7353.21. Chiplonkar SA, Tupe R. Development of a diet quality index with special reference to micronutrient adequacy for adolescent girls consuming a lacto-vegetarian diet. J Am Diet Assoc. 2010 Jun; 110(6):926-931.22. Tupe R, Chiplonkar SA. Diet patterns of lactovegetarian adolescent girls: need for devising recipes with high zinc bioavailability. Nutrition. 2010 Apr; 26(4):390-398.23. Health Canada. Dietary Reference Intake Tables. Available online at: Lanou AJ, Svenson B. Reduced cancer risk in vegetarians: an analysis of recent reports. Cancer Manag Res. 2011; 3:1-8.25. Tonstad S, Butler T, Fraser GE. Type of vegetarian diet, body weight, and prevalence of Type 2 diabetes. Diabetes Care. 2009 May; 32(5):791-796.26. Fraser GE. Vegetarian diets: what do we know of their effects on common chronic diseases? Am J ClinNutr 2009 May; 98(5):1607S-1612S.
    96. 96. References27. Beezhold BL, Johnston CS. Restriction of meat, fish, and poultry in omnivores improves mood: a pilot randomized controlled trial. Nutr J. 2012 Feb 14; 11:9.28. Beezhold BL, Johnston CS, Daigle DR. Vegetarian diets are associated with healthy mood states: a cross-sectional study in Seventh Day Adventist adults. Nutr J. 2010; 9:26.29. Craig WJ. Nutritional concerns and health effects of vegetarian diets. NutrClinPract. 2010 Dec; 25(6):613-620.30. Kahleova H, Matoulek M, Malinska H, Oliyarnik O, Kazdova L, Neskudla T, et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with Type 2 diabetes. Diabet Med. 2011 May; 28(5):549-559.31. McEvoy CT, Temple N, Woodside JV. Vegetarian diets, low-meat diets and health: a review. Public Health Nutr. 2012 Dec; 15(12):2287-2294.