This document summarizes the position of the American Dietetic Association and Dietitians of Canada on vegetarian diets. It finds that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits. The document reviews considerations for key nutrients in vegetarian diets and finds that a vegetarian diet can meet recommendations for proteins, iron, zinc, calcium, vitamins B12 and D, and other nutrients when planned properly, potentially with fortified foods or supplements. Vegetarian diets may help reduce risk for heart disease, diabetes, and cancer when based on a variety of plant foods.
Discuss the epidemiological burden of diabetes and rising food intakes, recognize insulin-glucose pathway effects by intramyocellular lipids, familiarize with clinical evidence and utilize guidelines by ACE/AACE, implement rapid assessment and practical application of plant-based nutrition and apply CPT billing codes for this intervention
This document discusses reversive medicine and immunity. It defines reversive medicine as the area of medicine that studies and demonstrates the reversal of human and planetary disease through the scientific evidence of a plant-based diet. It notes that human health is interdependent on planetary health, and that a plant-based diet is associated with well-being and reduces risks of chronic diseases. A whole food, plant-based diet accompanied by lifestyle factors is the basis for human health, and is also the most significant solution for reducing global warming and improving planetary health.
This document discusses vegetarian diets for athletes. It outlines different types of vegetarian diets including lacto-ovo vegetarian, lacto vegetarian, and vegan diets. It notes that lacto-ovo vegetarian and lacto vegetarian diets can meet protein and calcium needs through dairy, while vegan diets require more planning. The document also discusses nutrition considerations for vegetarian athletes including getting enough iron, omega-3s, zinc, vitamin B12, and calcium from plant sources. Overall, it concludes that well-planned vegetarian diets can meet athletes' nutritional needs.
This document defines different types of vegetarian diets and the reasons people adopt them. It begins by explaining that a vegetarian diet includes grains, pulses, nuts, seeds, vegetables and fruits but excludes meat, poultry, fish and byproducts. It then outlines several types of vegetarian diets including pescatarian, flexitarian, lacto-ovo vegetarian, vegan, raw vegan, and macrobiotic. Finally, it discusses some of the religious, health and environmental reasons people choose a vegetarian lifestyle.
This document defines different types of vegetarians and vegans based on their dietary practices. It begins by explaining that a vegetarian does not eat meat, poultry, fish or byproducts, and may consume dairy and eggs. Several types of vegetarian diets are then described, including pescatarian (fish but no other meat), flexitarian (mostly vegetarian but occasionally eats meat), lacto-ovo (dairy and eggs but no meat or fish), and vegan (no animal products at all). Raw vegan, macrobiotic, and religious-based diets like Jainism and Hinduism are also outlined. Finally, some popular vegetarian food companies and prohibited foods for vegans/
The document discusses the raw food diet as a potential intervention for obesity in New York City. It finds that the raw food diet is very restrictive and difficult to adhere to long-term due to its high costs and complex food preparation requirements. While the diet may promote short-term weight loss, it likely exposes dieters to increased risks of foodborne illness and nutritional deficiencies. The document concludes that the raw food diet is not well-suited for widespread implementation in NYC due to its prohibitive costs and challenges for low-income communities most affected by obesity.
This document analyzes and compares four major diets: Low-carb (Atkins), Low-Calorie (Weight Watchers), Low-Sodium (Dr. Ornish), and Diabetic. It finds that the Ornish diet is the safest and most medically proven, as it focuses on preventative lifestyle changes like a very low-fat vegetarian diet and has received funding and endorsements from major health organizations. However, dieting is difficult for most Americans to maintain long-term. Sustainable and local food is important to support health, and films like The Meatrix can raise awareness of these issues.
Let Food Be Thy Medicine and Medicine Be Thy Food: Improving Health by Fixing...Megan Grocki
This document discusses how modern food production and consumption practices are negatively impacting health. Genetically modified foods, pesticides, antibiotics in livestock, and artificial ingredients have made the food supply less nutritious. As a result, Americans suffer from higher rates of diet-related diseases like diabetes and cancer compared to other wealthy nations. Both individuals and healthcare professionals can help address this issue by making healthier food choices, supporting sustainable agriculture, and integrating nutrition into medical practices to emphasize prevention over sickness management.
Discuss the epidemiological burden of diabetes and rising food intakes, recognize insulin-glucose pathway effects by intramyocellular lipids, familiarize with clinical evidence and utilize guidelines by ACE/AACE, implement rapid assessment and practical application of plant-based nutrition and apply CPT billing codes for this intervention
This document discusses reversive medicine and immunity. It defines reversive medicine as the area of medicine that studies and demonstrates the reversal of human and planetary disease through the scientific evidence of a plant-based diet. It notes that human health is interdependent on planetary health, and that a plant-based diet is associated with well-being and reduces risks of chronic diseases. A whole food, plant-based diet accompanied by lifestyle factors is the basis for human health, and is also the most significant solution for reducing global warming and improving planetary health.
This document discusses vegetarian diets for athletes. It outlines different types of vegetarian diets including lacto-ovo vegetarian, lacto vegetarian, and vegan diets. It notes that lacto-ovo vegetarian and lacto vegetarian diets can meet protein and calcium needs through dairy, while vegan diets require more planning. The document also discusses nutrition considerations for vegetarian athletes including getting enough iron, omega-3s, zinc, vitamin B12, and calcium from plant sources. Overall, it concludes that well-planned vegetarian diets can meet athletes' nutritional needs.
This document defines different types of vegetarian diets and the reasons people adopt them. It begins by explaining that a vegetarian diet includes grains, pulses, nuts, seeds, vegetables and fruits but excludes meat, poultry, fish and byproducts. It then outlines several types of vegetarian diets including pescatarian, flexitarian, lacto-ovo vegetarian, vegan, raw vegan, and macrobiotic. Finally, it discusses some of the religious, health and environmental reasons people choose a vegetarian lifestyle.
This document defines different types of vegetarians and vegans based on their dietary practices. It begins by explaining that a vegetarian does not eat meat, poultry, fish or byproducts, and may consume dairy and eggs. Several types of vegetarian diets are then described, including pescatarian (fish but no other meat), flexitarian (mostly vegetarian but occasionally eats meat), lacto-ovo (dairy and eggs but no meat or fish), and vegan (no animal products at all). Raw vegan, macrobiotic, and religious-based diets like Jainism and Hinduism are also outlined. Finally, some popular vegetarian food companies and prohibited foods for vegans/
The document discusses the raw food diet as a potential intervention for obesity in New York City. It finds that the raw food diet is very restrictive and difficult to adhere to long-term due to its high costs and complex food preparation requirements. While the diet may promote short-term weight loss, it likely exposes dieters to increased risks of foodborne illness and nutritional deficiencies. The document concludes that the raw food diet is not well-suited for widespread implementation in NYC due to its prohibitive costs and challenges for low-income communities most affected by obesity.
This document analyzes and compares four major diets: Low-carb (Atkins), Low-Calorie (Weight Watchers), Low-Sodium (Dr. Ornish), and Diabetic. It finds that the Ornish diet is the safest and most medically proven, as it focuses on preventative lifestyle changes like a very low-fat vegetarian diet and has received funding and endorsements from major health organizations. However, dieting is difficult for most Americans to maintain long-term. Sustainable and local food is important to support health, and films like The Meatrix can raise awareness of these issues.
Let Food Be Thy Medicine and Medicine Be Thy Food: Improving Health by Fixing...Megan Grocki
This document discusses how modern food production and consumption practices are negatively impacting health. Genetically modified foods, pesticides, antibiotics in livestock, and artificial ingredients have made the food supply less nutritious. As a result, Americans suffer from higher rates of diet-related diseases like diabetes and cancer compared to other wealthy nations. Both individuals and healthcare professionals can help address this issue by making healthier food choices, supporting sustainable agriculture, and integrating nutrition into medical practices to emphasize prevention over sickness management.
This document presents information about vegetarian diets in a quiz format. It asks multiple choice questions under topics like who qualifies as a vegetarian, facts and fallacies about vegetarian diets, environmental benefits of vegetarianism, and famous vegetarian athletes. The questions cover topics such as the nutritional adequacy and healthfulness of vegetarian diets for all stages of life, the environmental impacts of meat production compared to plant agriculture, and famous athlete vegetarians like Edwin Moses and Carl Lewis.
This document discusses the position of the American Dietetic Association (ADA) on vegetarian diets. The ADA concludes that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits. Vegetarian diets have been shown to reduce the risk of heart disease, diabetes, obesity, and some cancers when planned properly. While vegetarian diets can meet nutritional needs, they require planning to ensure adequate intake of nutrients like protein, iron, zinc, vitamin B12, and omega-3 fatty acids. The ADA provides guidance on meeting nutritional needs at all stages of life with a vegetarian diet.
Dr. Alap Shah from La Grange Family Medicine Residency of Amita Health talks about the importance of plant-based nutrition and tips on billing for it at the 2019 Family Medicine Midwest educational meeting
Donna Weihofen, retired Senior Nutritionist spoke about Eating the Mediterranean Way at Wisconsin Women's Health Foundation's 2013 annual Gathering in Marshfield, WI. The Mediterranean diet emphasizes:
• Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts
• Replacing butter with healthy fats, such as olive oil
• Using herbs and spices instead of salt to flavor foods
• Limiting red meat to no more than a few times a month
• Eating fish and poultry at least twice a week
• Drinking red wine in moderation (optional)
Learn more about the risks of poor diet, and how changes in nutrition policy could better support the health of all Canadians. In this webinar Dr. Norman R.C. Campbell, MD, will review some of the issues Canadians face when trying to eat healthy food and what types of food policies are required to improve the food environment in Canada.
Watch the full webinar recording at https://explore.ucalgary.ca/let-food-be-thy-medicine-diet-and-disease
The document discusses the differences between vegetarian and non-vegetarian diets. It defines vegetarian diets as those that exclude meat but may include dairy and eggs, listing types like lacto-ovo vegetarian and vegan. Non-vegetarian diets include meat, eggs, fish, and seafood. The document examines the use of human teeth and digestive systems in comparison to carnivores and herbivores. It also reviews several studies that indicate vegetarian diets provide health benefits and are closer to human physiological needs.
America\'s Phytonutrient Report. This is a report focuses on the gap in plant based nutrients consumption among Americans and what is needed for the body to achieve optimal health. Dietary guidelines recommend an increase of fruits and vegetable intake to 5-13 servings per day.
This document discusses lifestyle medicine as a solution for chronic disease prevention and treatment. It defines lifestyle medicine as involving therapeutic lifestyle approaches like nutrition, exercise, stress management and tobacco cessation to prevent and sometimes reverse chronic diseases. The document outlines tools of lifestyle medicine including motivational interviewing, group medical visits, intensive lifestyle treatment, and residential treatment. It promotes a whole food, plant-based diet as the optimal fuel for the body and discusses evidence that such a diet can prevent and treat chronic conditions like heart disease and diabetes.
While average daily caloric intake in the US has remained stable over the past two decades, physical activity levels have declined. This has led to an increase in abdominal obesity, especially in younger women. Abdominal obesity, defined as a waist circumference over 34 inches for women or 40 inches for men, is an independent risk factor for health problems even for those who are not overweight overall. Increasing physical activity by 100 minutes per week was shown to reduce waist circumference in both men and women.
The document discusses several key nutrition tools: food groups, dietary standards, and food exchange lists. It provides details on each of these tools. Food groups organize foods into body-building foods, energy foods, and regulating foods. Dietary standards include recommended dietary allowances (RDAs) which establish minimum daily nutrient requirements. Food exchange lists allow for substitutions of similar foods within food categories like fruits or starches. The document also discusses nutrient density and food labeling requirements.
Presentation given at UN Institute Fund for Agricultural Development (IFAD) on March 3rd 2014 - why agricultural biodiversity and diet quality is important for nutrition.
Hungry and Heavy: What ingredients are needed for change?ghpc
Debra Kibbe, senior research associate with the Georgia Health Policy Center, recently presented "Hungry and Heavy: What ingredients are needed for change?" at the Southeastern Executive Chef’s Table in Georgia. This event was a twelve-state summit on nutrition in the south and included a focus on outdoor activity and the use of Georgia State Parks.
A doctor presented on the science of plant-based nutrition. He discussed the new paradigm of viewing nutrition as the synergistic effects of whole foods rather than their individual components. A whole food plant-based diet is recommended, as it is associated with reduced risk and potential reversal of various diseases like cancer, heart disease, diabetes and autoimmune conditions. Factors like phytonutrients, gut health, mindfulness and lifestyle habits were reviewed in relation to health outcomes. Billing codes were also presented to allow for nutrition counseling reimbursement.
International Journal of Engineering Research and Applications (IJERA) is an open access online peer reviewed international journal that publishes research and review articles in the fields of Computer Science, Neural Networks, Electrical Engineering, Software Engineering, Information Technology, Mechanical Engineering, Chemical Engineering, Plastic Engineering, Food Technology, Textile Engineering, Nano Technology & science, Power Electronics, Electronics & Communication Engineering, Computational mathematics, Image processing, Civil Engineering, Structural Engineering, Environmental Engineering, VLSI Testing & Low Power VLSI Design etc.
Dietitian Shubhra has listed the best Benefits Of Vegan Diet through which we’ll understand how green food is much more beneficial than carnivorous food.
Whole grains contain antioxidants that rival or exceed those in fruits and vegetables. Research shows that eating whole grains may reduce the risk of heart disease, cancer, and diabetes by lowering triglycerides, improving insulin control, aiding weight management, and slowing arterial plaque buildup. All grains start as whole grains, and keeping all three parts - the bran, germ, and endosperm - qualifies it as a whole grain. The 2005 Dietary Guidelines recommend making at least half of daily grain servings whole grains.
The document discusses guidelines from major medical organizations that vegan and vegetarian diets can be healthy and nutritionally adequate for people of all ages. It provides tips for raising children on a vegan diet, including ensuring adequate nutrition from breastmilk or formula for infants and assembling meals with plant-based proteins, healthy fats, and nutrients of concern at different stages of child development. Position statements from organizations are presented to show that a vegan diet can be followed safely by children without compromising their nutrition or growth.
This document contains inspirational sayings about friendship and life lessons. Some key points include: there are people who you love and would die for; a smile can bring happiness even to people who don't like you; good friends are like stars in that you don't always see them but know they are there; and only friends can keep you going through life's ups and downs. The document encourages sharing the message with friends to appreciate life and friendship.
Los alumnos de 6oB le dan las gracias a sus maestros por todo lo que han hecho por ellos a lo largo de los años que han pasado en el colegio, desde pequeños hasta ahora que se gradúan. Les agradecen por cuidarlos, enseñarles, llevarlos de excursión, corregirlos, animarlos y apoyarlos, y por todos los buenos recuerdos y momentos compartidos.
This document presents information about vegetarian diets in a quiz format. It asks multiple choice questions under topics like who qualifies as a vegetarian, facts and fallacies about vegetarian diets, environmental benefits of vegetarianism, and famous vegetarian athletes. The questions cover topics such as the nutritional adequacy and healthfulness of vegetarian diets for all stages of life, the environmental impacts of meat production compared to plant agriculture, and famous athlete vegetarians like Edwin Moses and Carl Lewis.
This document discusses the position of the American Dietetic Association (ADA) on vegetarian diets. The ADA concludes that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits. Vegetarian diets have been shown to reduce the risk of heart disease, diabetes, obesity, and some cancers when planned properly. While vegetarian diets can meet nutritional needs, they require planning to ensure adequate intake of nutrients like protein, iron, zinc, vitamin B12, and omega-3 fatty acids. The ADA provides guidance on meeting nutritional needs at all stages of life with a vegetarian diet.
Dr. Alap Shah from La Grange Family Medicine Residency of Amita Health talks about the importance of plant-based nutrition and tips on billing for it at the 2019 Family Medicine Midwest educational meeting
Donna Weihofen, retired Senior Nutritionist spoke about Eating the Mediterranean Way at Wisconsin Women's Health Foundation's 2013 annual Gathering in Marshfield, WI. The Mediterranean diet emphasizes:
• Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts
• Replacing butter with healthy fats, such as olive oil
• Using herbs and spices instead of salt to flavor foods
• Limiting red meat to no more than a few times a month
• Eating fish and poultry at least twice a week
• Drinking red wine in moderation (optional)
Learn more about the risks of poor diet, and how changes in nutrition policy could better support the health of all Canadians. In this webinar Dr. Norman R.C. Campbell, MD, will review some of the issues Canadians face when trying to eat healthy food and what types of food policies are required to improve the food environment in Canada.
Watch the full webinar recording at https://explore.ucalgary.ca/let-food-be-thy-medicine-diet-and-disease
The document discusses the differences between vegetarian and non-vegetarian diets. It defines vegetarian diets as those that exclude meat but may include dairy and eggs, listing types like lacto-ovo vegetarian and vegan. Non-vegetarian diets include meat, eggs, fish, and seafood. The document examines the use of human teeth and digestive systems in comparison to carnivores and herbivores. It also reviews several studies that indicate vegetarian diets provide health benefits and are closer to human physiological needs.
America\'s Phytonutrient Report. This is a report focuses on the gap in plant based nutrients consumption among Americans and what is needed for the body to achieve optimal health. Dietary guidelines recommend an increase of fruits and vegetable intake to 5-13 servings per day.
This document discusses lifestyle medicine as a solution for chronic disease prevention and treatment. It defines lifestyle medicine as involving therapeutic lifestyle approaches like nutrition, exercise, stress management and tobacco cessation to prevent and sometimes reverse chronic diseases. The document outlines tools of lifestyle medicine including motivational interviewing, group medical visits, intensive lifestyle treatment, and residential treatment. It promotes a whole food, plant-based diet as the optimal fuel for the body and discusses evidence that such a diet can prevent and treat chronic conditions like heart disease and diabetes.
While average daily caloric intake in the US has remained stable over the past two decades, physical activity levels have declined. This has led to an increase in abdominal obesity, especially in younger women. Abdominal obesity, defined as a waist circumference over 34 inches for women or 40 inches for men, is an independent risk factor for health problems even for those who are not overweight overall. Increasing physical activity by 100 minutes per week was shown to reduce waist circumference in both men and women.
The document discusses several key nutrition tools: food groups, dietary standards, and food exchange lists. It provides details on each of these tools. Food groups organize foods into body-building foods, energy foods, and regulating foods. Dietary standards include recommended dietary allowances (RDAs) which establish minimum daily nutrient requirements. Food exchange lists allow for substitutions of similar foods within food categories like fruits or starches. The document also discusses nutrient density and food labeling requirements.
Presentation given at UN Institute Fund for Agricultural Development (IFAD) on March 3rd 2014 - why agricultural biodiversity and diet quality is important for nutrition.
Hungry and Heavy: What ingredients are needed for change?ghpc
Debra Kibbe, senior research associate with the Georgia Health Policy Center, recently presented "Hungry and Heavy: What ingredients are needed for change?" at the Southeastern Executive Chef’s Table in Georgia. This event was a twelve-state summit on nutrition in the south and included a focus on outdoor activity and the use of Georgia State Parks.
A doctor presented on the science of plant-based nutrition. He discussed the new paradigm of viewing nutrition as the synergistic effects of whole foods rather than their individual components. A whole food plant-based diet is recommended, as it is associated with reduced risk and potential reversal of various diseases like cancer, heart disease, diabetes and autoimmune conditions. Factors like phytonutrients, gut health, mindfulness and lifestyle habits were reviewed in relation to health outcomes. Billing codes were also presented to allow for nutrition counseling reimbursement.
International Journal of Engineering Research and Applications (IJERA) is an open access online peer reviewed international journal that publishes research and review articles in the fields of Computer Science, Neural Networks, Electrical Engineering, Software Engineering, Information Technology, Mechanical Engineering, Chemical Engineering, Plastic Engineering, Food Technology, Textile Engineering, Nano Technology & science, Power Electronics, Electronics & Communication Engineering, Computational mathematics, Image processing, Civil Engineering, Structural Engineering, Environmental Engineering, VLSI Testing & Low Power VLSI Design etc.
Dietitian Shubhra has listed the best Benefits Of Vegan Diet through which we’ll understand how green food is much more beneficial than carnivorous food.
Whole grains contain antioxidants that rival or exceed those in fruits and vegetables. Research shows that eating whole grains may reduce the risk of heart disease, cancer, and diabetes by lowering triglycerides, improving insulin control, aiding weight management, and slowing arterial plaque buildup. All grains start as whole grains, and keeping all three parts - the bran, germ, and endosperm - qualifies it as a whole grain. The 2005 Dietary Guidelines recommend making at least half of daily grain servings whole grains.
The document discusses guidelines from major medical organizations that vegan and vegetarian diets can be healthy and nutritionally adequate for people of all ages. It provides tips for raising children on a vegan diet, including ensuring adequate nutrition from breastmilk or formula for infants and assembling meals with plant-based proteins, healthy fats, and nutrients of concern at different stages of child development. Position statements from organizations are presented to show that a vegan diet can be followed safely by children without compromising their nutrition or growth.
This document contains inspirational sayings about friendship and life lessons. Some key points include: there are people who you love and would die for; a smile can bring happiness even to people who don't like you; good friends are like stars in that you don't always see them but know they are there; and only friends can keep you going through life's ups and downs. The document encourages sharing the message with friends to appreciate life and friendship.
Los alumnos de 6oB le dan las gracias a sus maestros por todo lo que han hecho por ellos a lo largo de los años que han pasado en el colegio, desde pequeños hasta ahora que se gradúan. Les agradecen por cuidarlos, enseñarles, llevarlos de excursión, corregirlos, animarlos y apoyarlos, y por todos los buenos recuerdos y momentos compartidos.
Gary Francione argues that animal welfare is misguided and will not lead to the abolition of animal exploitation. He believes animal rights requires recognizing that animals should not be treated as property and advocates for veganism. While some groups campaign for more humane treatment standards, Francione rejects this as it still views animals as commodities and reinforces speciesism. True progress requires promoting veganism as the moral baseline and normal position of the animal rights movement.
This document discusses iron and its sources. It debunks the myth that vegetarians and vegans are at higher risk of iron deficiency due to lack of meat consumption. There are two types of iron - haem iron found in meat which is more easily absorbed, and non-haem plant-based iron which is also well-absorbed. Many plant foods such as lentils, beans, leafy greens, and fortified cereals are excellent sources of iron. Factors like vitamin C can increase iron absorption from plants, while calcium, phytates, and tannins may decrease its absorption. A balanced vegetarian or vegan diet with attention to iron sources can meet or exceed iron needs.
St. Andrews University in Scotland is one of the oldest universities in the English-speaking world, having been founded in 1413. It is known for its history, beautiful campus located near the North Sea coast, and its role in developing the game of golf at the world's oldest golf course. The article provides background information about the history and features of St. Andrews University in Scotland.
Viriya is campaigning against global warming by promoting renewable energy and energy efficiency. The campaign aims to raise awareness of climate change issues and encourage individuals and organizations to reduce their carbon footprint. Viriya believes that collective action is needed to address the global threat of climate change.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
1. Most economic indicators show signs that the recession has bottomed out in major OECD economies. GDP growth is projected to return in the third quarter of 2009 for the US and Eurozone.
2. However, unemployment has continued to rise sharply in many countries. Inflation remains low, reflecting falling oil and commodity prices.
3. Central banks have expanded their balance sheets significantly through large bond purchase programs. Government bond rates have stabilized after substantial declines.
4. While recovery appears to have started, the outlook remains uncertain depending on the strength of the upturn in private demand. Policy support will be needed to foster job creation and sustainable growth.
The document summarizes a career planning master class presented by Amir Aisautov. It discusses the differences between career and extreme careerism, different types of careers, and how personality and preferences relate to career choices. It also profiles three successful business leaders in steel (Lakshmi Mittal, Alexey Mordashev, and Oleg Deripaska) and emphasizes the importance of planning one's career and life strategies based on priorities and preferences using frameworks like MBTI. The class covered topics like industries, companies, functions, and positions that could help individuals achieve their goals.
This short document provides the title of a Chopin piece, his Nocturne in D flat major. No other details are given about the composition. The document simply states the title and ends, providing only high-level identification of the musical work without any further descriptive information.
Este documento presenta la tercera clase de un diplomado sobre administración de centros educativos. Introduce conceptos clave como institución educativa, gestión educativa y administración educativa. Explica que existen instituciones oficiales, privadas y de carácter humanitario. Además, describe las cuatro dimensiones de la gestión educativa y cinco líneas de acción en este campo. El objetivo es desarrollar conocimientos básicos sobre administración educativa en Panamá.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help boost feelings of calmness and well-being.
Background: Vegetarian diets are associated with reduced risk for diseases such as diabetes and cardiovascular disease. We aimed to determine the nutritional adequacy of usual food intake in a cohort of young vegetarians and omnivores who regularly exercise.
Methods: Five vegetarian (aged 21.7±2.0 yrs), three vegan (aged 31.3±7.5 yrs) and eight age and sex matched omnivore participants (aged 21.1±1.9 yrs) volunteered for this project. Participants completed diet diaries to determine usual intake of macronutrients such as protein and fat and micronutrients such as vitamin C and iron.
Results: All participants met or exceeded the recommended dietary intake (RDI) of protein, thiamine, riboflavin, niacin, vitamin B6 phosphorus, and vitamin C. Vegetarians and vegans consumed insufficient quantities of vitamin B12 and vegans consumed less the half the amount that omnivores managed (1.7μg compared to 4.5μg). Folate consumption was adequate amongst vegetarians and vegans (510μg and 696μg respectively) and vitamin C consumption was highest among the vegan group (>400% of the RDI). Zinc intake was lowest among the vegetarians while low iron and copper intakes were reported by omnivores. Calcium consumption was poor overall.
Conclusions: Nutritional inadequacies can arise from consuming omnivore, vegetarian and vegan diets. Over time such inadequacies may result in nutrient deficiencies thus it is important to consume a variety of nutrient rich foods to ensure nutrition requirements are being met
WR 123Renjie WeiEssay 1.2Beneficial of Vegetarian DietIN.docxdunnramage
The document discusses the benefits of a vegetarian diet. It outlines several key benefits, including that a vegetarian diet is more ethical because it avoids harming animals, is nutritious and can reduce the risk of diseases like heart disease and cancer, and helps with weight loss. However, it also notes some contradictions, such as concerns about getting a balanced nutrition or that vegetarian diets can be inconvenient for others. Overall, the document examines the health impacts and social aspects of a vegetarian lifestyle.
The present study examines the difference in nutrition knowledge, attitudes, and dietary intake among college students based on the presence of vegetarianism. A Web-based survey using 702 college students at a Midwest university collected data about participants’ level of nutrition knowledge, attitudes toward nutrition and vegetarianism, and dietary patterns. Results showed vegetarians had a more positive attitude towards a vegetarian diet as opposed to non-vegetarians. Vegetarians also demonstrated greater nutrition knowledge specifically related to vegetarian nutrition as opposed to general nutrition, although their dietary intake did not prove to be of higher quality than nonvegetarians. Results from this study are applicable in the vegetarian community and those who work with vegetarians. Most notably, this study may be of great use to food service establishments, particularly college dining settings.
This document provides information about becoming a vegetarian, including the health, environmental, and ethical benefits. It defines what vegetarian means, discusses replacing meat with vegetarian protein sources, and debunks myths about getting enough protein and nutrition from a vegetarian diet. The document also outlines some of the cruel conditions faced by chickens, cows, and other farm animals in the industrial agriculture system.
Examville provides online study tools including practice tests, live classes, tutoring, and study guides to help students prepare for exams. The document discusses several key nutrition concepts including food groups, dietary standards, food exchange lists, nutrient density, and nutritional labeling formats. Food guides classify foods into groups to help people plan nutritious diets while dietary standards establish recommended nutrient allowances. Exchange lists group similar foods to allow for substitutions while maintaining nutritional balance. Nutrient density compares the nutrients a food provides relative to its calories. Standardized nutritional labels now provide consumers with information to make informed choices.
This document provides an overview of vegetarianism and its history and benefits. It discusses:
- Vegetarianism has existed for thousands of years in various cultures and religions, dating back to 7th century BCE India. It later emerged in parts of Europe during the Renaissance.
- Vegetarians abstain from eating meat and animal products for various reasons like health, ethics, environment. Vegetarian diets have been shown to reduce risks of diseases and increase longevity.
- The document reviews related literature on the history and philosophy of vegetarianism. It also discusses the health benefits of a vegetarian diet in reducing risks of chronic diseases.
- The conceptual framework outlines that vegetarianism provides a lifestyle choice
This document summarizes the benefits of a vegan diet compared to a non-vegan diet. It finds that vegans have lower body mass index and cholesterol levels. Vegans also consume more nutrients like fiber and vitamins C and E from fruits and vegetables. However, vegan diets require supplementation of nutrients like vitamin B12, vitamin D, calcium, and long-chain omega-3 fatty acids. With fortified foods and supplements, it is possible to meet nutritional needs on a vegan diet. Careful planning is needed to ensure vegans get all essential nutrients.
This document provides information to inform the development of a nutrition education program for college students at San Jose State University. It identifies key issues based on expert research findings, including the popularity of low-carbohydrate fad diets among college students which can lack important nutrients. Behavioral goals are to increase whole grain intake to meet dietary guidelines. The program will aim to educate students on benefits of whole grains, make them accessible on campus, and increase self-efficacy to incorporate them into daily eating.
This document provides information about vegetarians and vegetarianism. It defines vegetarians and vegans, and discusses some of the main reasons people choose these diets, including ethics, health, religion and the environment. Demographic data is presented on the number of vegetarians in the UK and US, broken down by age, gender and over time. Some popular vegetarian food companies and products are described. The document also notes foods and ingredients that may not be suitable for vegetarians due to containing animal products.
The document discusses several key nutrition tools: food groups, dietary standards, and food exchange lists. It provides details on each of these tools. Food groups organize foods into body-building foods, energy foods, and regulating foods. Dietary standards include recommended dietary allowances (RDAs) which provide minimum daily nutrient requirements. Food exchange lists allow for substitutions of similar foods within food categories like fruits or starches. The document also discusses nutrient density and food labeling requirements.
The document discusses several key nutrition tools: food groups, dietary standards, and food exchange lists. It provides details on each of these tools. Food groups organize foods into body-building foods, energy foods, and regulating foods. Dietary standards include recommended dietary allowances (RDAs) which provide minimum daily nutrient requirements. Food exchange lists allow for substitutions of similar foods within food lists based on calories, carbohydrates, proteins, and fats. The document also discusses nutrient density and food labeling requirements.
Accademical essay to be or not to be a vegetarian mla sem 2Acasa
The document discusses the debate around whether a vegetarian diet is healthy or harmful. It outlines arguments from both sides, with vegetarian diet supporters noting health and environmental benefits, while opponents argue a balanced omnivorous diet is healthier. Both sides cite scientific studies and anecdotal evidence to support their perspective. Spiritual and religious reasons for adopting a vegetarian lifestyle are also explored.
This document provides an overview of tips for beginning a vegetarian diet, including information on the health benefits and essential nutrients. It discusses that a vegetarian diet can help reduce the risk of heart disease, diabetes, cancer, and osteoporosis. It is low in saturated fat and cholesterol. The document also addresses common concerns about getting enough protein, calcium, and vitamins B12 and D on a vegetarian diet, and provides suggestions for meeting nutritional needs through plant-based foods and fortified products. A 3-step approach is given for transitioning to vegetarian eating.
Vegans eat no meat, fish, poultry, eggs, or dairy products. While there is a considerable advantage to a lacto-ovo vegetarian pattern, vegan diets are the most healthful of all, reducing risk of a broad range of health concerns.
Veggie lover eats less proposition a scope of medical advantages.
For individuals hoping to get thinner, a vegetarian diet can help. Eating vegetarian may likewise assist you with keeping up with your heart wellbeing. Likewise, this diet might offer a few securities against type 2 diabetes and certain tumors.
This article looks at the science behind the likely advantages of veggie lover eats less crabs. We'll feature some recipe thoughts that include the adaptability of plant-based, entire food eating. What's more, on the off chance that you're considering the way in which a veggie lover diet contrasts from a vegan one, that's what we'll cover, as well.
A veggie lover diet is more extravagant in specific supplements
Changing to a veggie lover diet from a common Western eating routine means you'll dispose of meat and creature items.
This will lead you to depend all the more vigorously on different food sources. On account of an entire food veggie lover diet, substitutions appear as:
• Entire grains
• Natural products
This document provides information about vegetarianism including definitions, demographics of vegetarians around the world, reasons people choose a vegetarian diet, companies that cater to vegetarians, and non-vegetarian products. Some key points include:
- A vegetarian does not eat meat or fish, while a vegan also avoids animal products like dairy and eggs.
- India has the highest percentage of vegetarians at 42% of the population, while the UK has the highest population of vegetarians in Europe at 3.5 million people.
- Animal welfare is the main reason cited for becoming vegetarian (54%), followed by environmental concerns and health reasons.
This document provides information about vegetarianism and veganism. It defines vegetarians as those who do not eat meat, fish, or animal products that cause harm to animals. Vegans are defined as those who do not eat any animal products, including dairy and eggs. A typical vegan meal may include foods like tofu, nuts, chickpeas, rice, lentils, soy and oat milk. Some reasons why people choose a vegetarian diet are concerns about animal welfare, health benefits, environmental impacts, and religious beliefs. The document also provides statistics about vegetarian demographics in the UK and US.
Analysis Of The Diet Of American BeaversKatie Parker
The document analyzes the American beaver's diet, finding it consists of 45.5% terrestrial and 55.5% aquatic vegetation. The proportions vary seasonally, with more floating leaf vegetation in winter and emergent aquatic vegetation in summer. Aquatic vegetation provides higher digestibility and nutrients. Beavers breed once per year and kits have highest mortality from August to March. Researchers observed beavers using logjams for escape cover and easier access to dens for kits. Beavers select habitats based on vegetation cover, stream gradient, bank slope, and proximity to other colonies.
This document provides tips and information for beginning a vegetarian diet, including the health benefits of a vegetarian diet and how to plan vegetarian meals. Key points include:
- A vegetarian diet can help reduce the risk of heart disease, diabetes, cancer and other diseases due to being lower in saturated fat and cholesterol and higher in fiber.
- Vegetarians get adequate protein and calcium from plant sources like beans, lentils, grains and vegetables.
- The document provides suggestions for making the switch to vegetarianism, including using convenience foods, eating at restaurants, and experimenting with new recipes.
This flyer discusses animal rights, how we can put animal rights into practice in our daily lives, and becoming a member of Animal Rights Advocates.
The flyer is produced by Animal Rights Advocates, who you can find online at: www.ara.org.au
You can find more presentations from Animal Rights Advocates at: http://www.slideshare.net/animalrightsadvocates/
A presentation from a forum organised by Animal Rights Advocates Inc. on the intersections of environmentalism and animal rights - where they converge and where they conflict and how we can move both forward ethically and responsibly.
Animal Rights Advocates Inc. (ARA) is hosting a free forum on May 23rd from 2-5PM at City West Lotteries House in West Perth to discuss how environmental protection and animal rights intersect and sometimes conflict. Representatives from ARA and The Wilderness Society will discuss issues like non-native species, overfishing, and the environmental impacts of animal agriculture, followed by an open discussion on balancing environmental and animal rights interests.
The document outlines the categories for an annual bake off fundraiser, including: Best in Show, Best Decorated Cake, Most Inspirational IDAHo Cake celebrating freedom from discrimination, Best Tasting Vegan Baked Good, Best Tasting Decadent Baked Good, and Best Tasting Healthy Choice Baked Good. Additional categories include Best Entry by a Community Group, student and kids cake decorating categories, and a Professional Cupcake Category for cake companies. Celebrity judges will include people from television and magazines, with entertainment provided.
A party for animal activists and their friends will be held on Saturday, January 2nd from 6-10PM at Earthwise located at 315 Bagot Rd in Subiaco. The event is a New Year's party where attendees are asked to bring a vegan plate to share. There will be live music, door prizes, games, and free stuff along with advocacy information from the animal rights organization ARA.
This document provides contact information for several vegetarian and vegan societies located across Australia. It lists their email addresses and websites to find out more information from these organizations that support and promote vegetarian and vegan lifestyles.
Gary Francione argues that animal welfare is misguided and will not lead to the abolition of animal exploitation. He believes animal rights requires recognizing that animals should not be treated as property and advocates for veganism. While some groups campaign for better treatment of farm animals, Francione rejects this as it suggests exploitation can be acceptable if humane. He also disagrees with those who say animals only care about suffering, not life, and believes they have a right to not be used as commodities like humans.
We treat animals how we used to treat human slaves, with no justification except religious superstition according to Gary Francione, a professor of law and philosopher. Francione argues that animals deserve rights similar to how we no longer accept the domination of humans. The article provides commentary and analysis of our treatment of animals from Francione's perspective.
- Pollutants in fish may cancel out the beneficial effects of the ‘good’ omega-3 fats they contain
- ALA (from plant foods) can be converted into EPA and DHA, and has a protective effect against heart disease
- Cutting down on dietary cholesterol (eggs, meat and dairy products), processed foods, and hydrogenated vegetable oils will help your body to make best use of the omega-3 from plant foods
The document discusses the health benefits and risks of consuming soya. It provides a long history of safe soya consumption dating back thousands of years. It examines soya's nutritional value as a protein and mineral source and its ability to lower cholesterol. Studies show that soya protein, through isoflavones and other components, can significantly reduce the frequency and severity of menopausal hot flashes when consumed as part of the diet.
- Proteins are needed to form muscles, hair, nails, and other molecules, but most diets containing enough calories also contain sufficient protein.
- The document argues that vegetarians and vegans can meet their protein needs through foods like soy, cereals, pulses, nuts and seeds as part of a calorie-sufficient diet.
- Excess protein intake, especially from animal sources, may increase risk of diseases, while plant-based diets use fewer resources and can help address global hunger issues.
This document provides an alphabetical glossary of animal-derived substances commonly found in food, cosmetics and other products. Each entry briefly explains what the substance is and which animals it comes from. The glossary aims to help consumers identify non-vegetarian ingredients and make ethical purchasing decisions. It also discusses various farming practices and their animal welfare implications.
The document discusses cardiovascular disease (CVD), which includes heart disease and stroke. CVD is the UK's number one killer. It occurs when fatty deposits build up in the arteries, restricting blood flow and oxygen to the heart and brain. A plant-based diet can help prevent and treat CVD in several ways. It is lower in saturated fat and cholesterol than the standard Western diet, and higher in nutrients that support heart health. Factors like high blood pressure, high cholesterol levels, obesity, and smoking increase CVD risk, but following a plant-based diet can help regulate these risk factors.
A plant-based diet is the healthiest option for children according to the author. Animal products promote diseases like cancer while vegetarian diets protect health. The document outlines how animal products can cause allergies, intolerances and diseases in children. It recommends encouraging children to adopt a plant-based diet from a young age to promote lifelong good health and reduce disease risk.
This document discusses the health benefits of plant oils compared to fish oils. It summarizes several studies that show plant oils are more effective than fish oils at reducing mortality from heart attacks. While fish contains omega-3 fatty acids, plant oils from seeds, nuts and their oils are richer sources. The document also notes concerns about toxins like mercury accumulating in fish and the failure of public health strategies to increase fish consumption in the UK. In conclusion, a plant-based diet is considered the best choice for long-term heart health and overall wellness.
This document discusses calcium and bone health. It argues that cow's milk is not the best source of calcium and may actually be harmful. While calcium is important for bone health, the document asserts that physical activity and overall diet and lifestyle are more important factors. It provides numerous plant-based sources of calcium that are easily absorbed and beneficial for bone health, such as leafy greens, nuts, seeds, and beans.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
2. ADA REPORTS
17-year-old children and adolescents in the United States are from $310 million in 1996 (21). This market is expected to nearly
vegetarians, and around 0.5% of this age group are vegan (8). double by 2006 to $2.8 billion (21). Canadian sales of meat analogs
According to a 2002 survey (9), about 4% of Canadian adults more than tripled between 1997 and 2001 (22).
are vegetarian; this represents an estimated 900,000 people. The ready availability of new products, including fortified
Factors that may affect the number of vegetarians in the United foods and convenience foods would be expected to have a
States and Canada in the future include an increased interest in marked impact on nutrient intake of vegetarians. Fortified
vegetarianism and the arrival of immigrants from countries foods such as soymilks, meat analogs, juices, and breakfast
where vegetarianism is commonly practiced (10). Twenty to cereals can add substantially to vegetarians’ intakes of calcium,
25% of adults in the United States report that they eat 4 or iron, zinc, vitamin B-12, vitamin D, and riboflavin. Vegetarian
more meatless meals weekly or “usually or sometimes maintain convenience foods including veggie burgers and veggie dogs,
a vegetarian diet,” suggesting an interest in vegetarianism (11). frozen entrees, meals in a cup, and soymilk can make it much
Additional evidence for the increased interest in vegetarianism simpler to be a vegetarian today than in the past.
includes the emergence of animal rights/ethics courses on col- Vegetarian foods are readily available, both in supermarkets
lege and university campuses; the proliferation of Web sites, and in natural foods stores. About half of vegetarian foods vol-
magazines and newsletters, and cookbooks with a vegetarian ume is sold through supermarkets and about half through nat-
theme; and the public’s attitude toward ordering a vegetarian ural foods stores (21). Three-fourths of soymilk sales take
meal when eating away from home. More than 5% of those place in supermarkets (21).
surveyed in 1999 said they always order a vegetarian meal
when they eat out; close to 60% “sometimes, often, or always” Public Policy Statements and Vegetarian Diets
order a vegetarian item at a restaurant (12). The United States Dietary Guidelines (23) state, “Vegetarian
Restaurants have responded to this interest in vegetarian- diets can be consistent with the Dietary Guidelines for Amer-
ism. The National Restaurant Association reports that 8 out of icans, and meet Recommended Dietary Allowances for nutri-
10 restaurants in the United States with table service offer ents.” They give recommendations on meeting nutrient re-
vegetarian entrees (13). Fast-food restaurants are beginning to quirements for those who choose to avoid all or most animal
offer salads, veggie burgers, and other vegetarian options. products. Some have said that implementation of the Dietary
Many college students consider themselves vegetarians. In re- Guidelines can best be achieved by use of vegetarian and plant-
sponse to this, most university foodservices offer vegetarian rich diets (24). National food guides include some vegetarian
options (14). options. Foods commonly eaten by vegetarians such as le-
There has also been a growth in professional interest in veg- gumes, tofu, soyburgers, and soymilk with added calcium are
etarian nutrition; the number of articles in the scientific litera- included in a table accompanying the USDA’s Food Guide Pyr-
ture related to vegetarianism has increased from less than 10 amid (23). Canada’s Food Guide to Healthy Eating can be used
articles per year in the late 1960s to 76 articles per year in the by lacto and lacto-ovo-vegetarians (25). Health Canada has
1990s (15). In addition, the main focus of the articles is chang- stated that well-planned vegetarian diets are supportive of
ing. Twenty-five or more years ago, articles primarily had good nutritional status and health (26).
themes questioning the nutritional adequacy of vegetarian di-
ets. More recently, the theme has been the use of vegetarian HEALTH IMPLICATIONS OF VEGETARIANISM
diets in the prevention and treatment of disease. More articles Vegetarian diets offer a number of advantages, including lower
feature epidemiological studies, and fewer reports are case levels of saturated fat, cholesterol, and animal protein and
studies and letters to the editor (15). higher levels of carbohydrates, fiber, magnesium, boron, folate,
There is a growing appreciation for the benefits of plant- antioxidants such as vitamins C and E, carotenoids, and phyto-
based diets, defined as diets that include generous amounts of chemicals (27-30). Some vegans may have intakes for vitamin
plant foods and limited amounts of animal foods. The American B-12, vitamin D, calcium, zinc, and occasionally riboflavin that
Institute for Cancer Research and the World Cancer Research are lower than recommended (27,29,31).
Fund call for choosing predominantly plant-based diets rich in
a variety of vegetables and fruits, legumes, and minimally pro- NUTRITION CONSIDERATIONS FOR VEGETARIANS
cessed starchy staple foods and limiting red meat consumption,
if red meat is eaten at all (16). The American Cancer Society Protein
recommends choosing most food from plant sources (17). The Plant protein can meet requirements when a variety of plant foods
American Heart Association recommends choosing a balanced is consumed and energy needs are met. Research indicates that an
diet with an emphasis on vegetables, grains, and fruits (18), assortment of plant foods eaten over the course of a day can pro-
and the Heart and Stroke Foundation of Canada recommends vide all essential amino acids and ensure adequate nitrogen reten-
using grains and vegetables instead of meat as the centerpiece tion and use in healthy adults, thus complementary proteins do
of meals (19). The Unified Dietary Guidelines developed by the not need to be consumed at the same meal (32).
American Cancer Society, the American Heart Association, the Estimates of protein requirements of vegans vary, depending to
National Institutes of Health, and the American Academy of some degree on diet choices (33). A recent metaanalysis of nitro-
Pediatrics call for a diet based on a variety of plant foods, in- gen balance studies found no significant difference in protein
cluding grain products, vegetables, and fruits to reduce risk of needs due to the source of dietary protein (34,35). Based primar-
major chronic diseases (20). ily on the lower digestibility of plant proteins, other groups have
suggested that protein requirements of vegans may be increased
New Product Availability by 30% to 35% for infants up to the age of 2 years, 20% to 30% for
The US market for vegetarian foods (foods like meat analogs, non- 2- to 6-year-old children, and 15% to 20% for those 6 years and
dairy milks, and vegetarian entrees that directly replace meat or older, in comparison with those of nonvegetarians (36).
other animal products) was estimated to be $1.5 billion in 2002, up The quality of plant proteins varies. Based on the protein
Journal of THE AMERICAN DIETETIC ASSOCIATION / 749
3. ADA REPORTS
digestibility corrected amino acid score (PDCAAS), which is etarians, their serum ferritin levels are usually within the nor-
the standard method for determining protein quality, isolated mal range (58-62).
soy protein can meet protein needs as effectively as animal
protein, whereas wheat protein eaten alone, for example, may Zinc
be 50% less usable than animal protein (37). Nutrition care Because phytate binds zinc, and animal protein is believed to
professionals should be aware that protein needs might be enhance zinc absorption, total zinc bioavailability appears to be
higher than the RDA in vegetarians whose dietary protein lower on vegetarian diets (63). Also, some vegetarians have
sources are mainly those that are less well digested, such as diets that are significantly below recommended intakes for zinc
some cereals and legumes. (27,29,64,65). Although overt zinc deficiency has not been
Cereals tend to be low in lysine, an essential amino acid. This seen in Western vegetarians, the effects of marginal intakes are
may be relevant when evaluating diets of individuals who do poorly understood (66). Zinc requirements for vegetarians
not consume animal protein sources and are relatively low in whose diets are high in phytate may exceed the RDA (44). Zinc
protein (35). Dietary adjustments such as the use of more sources are shown in the Table.
beans and soy products in place of other protein sources that Compensatory mechanisms may help vegetarians adapt to
are lower in lysine or an increase in dietary protein from all lower intakes of zinc (65,67). Some food preparation tech-
sources can ensure an adequate intake of lysine. niques, such as soaking and sprouting beans, grains, and seeds
Although some vegan women have protein intakes that are mar- as well as leavening bread, can reduce binding of zinc by
ginal, typical protein intakes of lacto-ovo-vegetarians and of veg- phytate and increase zinc bioavailability (49,50,68).
ans appear to meet and exceed requirements (29). Athletes can
also meet their protein needs on plant-based diets (38,39). Calcium
Calcium is present in many plant foods and fortified foods (see
Iron Table). Low-oxalate greens (bok choy, broccoli, Chinese/Napa
Plant foods contain only nonheme iron, which is more sensitive cabbage, collards, kale, okra, turnip greens) provide calcium
than heme iron to both inhibitors and enhancers of iron absorp- with high bioavailability (49% to 61%), in comparison with cal-
tion. Inhibitors of iron absorption include phytate; calcium; cium-set tofu, fortified fruit juices, and cow’s milk (bioavailabil-
teas, including some herb teas; coffee; cocoa; some spices; and ity in the range of 31% to 32%) and with fortified soymilk,
fiber (40). Vitamin C and other organic acids found in fruits and sesame seeds, almonds, and red and white beans (bioavailabil-
vegetables can enhance iron absorption and can help to reduce ity of 21% to 24%) (69-71). Figs and soy foods such as cooked
effects of phytate (41-43). Studies show that iron absorption soybeans, soy nuts, and tempeh provide additional calcium.
would be significantly reduced if a diet were to be high in in- Calcium-fortified foods include fruit juices, tomato juice, and
hibitors and low in enhancers. Recommended iron intakes for breakfast cereals. Thus, various food groups contribute dietary
vegetarians are 1.8 times those of nonvegetarians because of calcium (72,73). Oxalates present in some foods can greatly
lower bioavailability of iron from a vegetarian diet (44). reduce calcium absorption, so vegetables that are very high in
The main inhibitor of iron absorption in vegetarian diets is these compounds, such as spinach, beet greens, and Swiss
phytate. Because iron intake increases as phytate intake in- chard, are not good sources of usable calcium despite their high
creases, effects on iron status are somewhat less than might be calcium content. Phytate may also inhibit calcium absorption.
expected. Fiber appears to have a minor effect on iron absorp- However, some foods with high contents of both phytate and
tion (45,46). Vitamin C, consumed at the same time as the iron oxalate, such as soy foods, still provide well-absorbed calcium
source, can help to reduce the inhibitory effects of phytate (71). Factors that enhance calcium absorption include ade-
(42,43), and some research links high vitamin C intake to im- quate vitamin D and protein.
proved iron status (47,48). The same is true for organic acids in Calcium intakes of lacto-vegetarians are comparable with or
fruits and vegetables (41). The higher intakes of vitamin C and higher than those of nonvegetarians (74,75), whereas intakes
of vegetables and fruits by vegetarians can favorably impact of vegans tend to be lower than both groups and often below
iron absorption (2). Some food preparation techniques such as recommended intakes (27,31,71,75). Diets high in sulfur-con-
soaking and sprouting beans, grains, and seeds can hydrolyze taining amino acids may increase losses of calcium from bone.
phytate (49-51) and may improve iron absorption (42,51,52). Foods with a relatively high ratio of sulfur-containing amino
Leavening of breads hydrolyzes phytate and enhances iron ab- acids to protein include eggs, meat, fish, poultry, dairy prod-
sorption (49-51,53,54). Other fermentation processes, such as ucts, nuts, and many grains. There is some evidence that the
those used to make soy foods like miso and tempeh, may also impact of sulfur-containing amino acids is only important with
make iron more available (55), although not all research sup- low calcium intakes. Excessive sodium intake may also pro-
ports this. Whereas many studies of iron absorption have been mote calcium losses. In addition, some studies show that the
short term, there is evidence that adaptation to low intakes ratio of dietary calcium to protein is more predictive of bone
takes place over the longer term and involves both increased health than calcium intake alone. Typically, this ratio is high in
absorption and decreased losses (56,57). It is likely that iron lacto-ovo-vegetarian diets and favors bone health, whereas
needs will depend on the make up of the overall diet and be vegans have a calcium to protein ratio that is similar to or lower
significantly lower for some vegetarians than for others. than that of nonvegetarians (71,76).
Studies typically show iron intake by vegans to be higher All vegetarians should meet the recommended intakes for
than that of lacto-ovo-vegetarians and of nonvegetarians, and calcium, established for their age group by the Institute of Med-
most studies show iron intake by lacto-ovo-vegetarians to be icine (77). This can be accomplished, in nonpregnant, nonlac-
higher than that of nonvegetarians (29). Iron sources are tating adults, by consuming at least 8 servings per day of foods
shown in the Table. Incidence of iron deficiency anemia among that provide 10% to 15% of the Adequate Intake (AI) for cal-
vegetarians is similar to that of nonvegetarians (29,31,58). Al- cium, as indicated in the Vegetarian Food Guide Pyramid and
though vegetarian adults have lower iron stores than nonveg- Vegetarian Food Guide Rainbow (72,73). Adjustments for
750 / June 2003 Volume 103 Number 6
4. ADA REPORTS
Table
Vegetarian food sources of nutrients
Nutrient Amount per serving
Iron 4™™™™™™ mg ™™™™™™
3
Soyfoods
Soybeans, cooked, 1/2 c (125 mL) 4.4
Soybeans, dry roasted, (soy nuts), 1/4 c (60 mL) 1.7
Soymilk 1/2 c (125 mL) 0.4-1.0
Tempeh, 1/2 c (83 g) 2.2
Tofu, firm, 1/2 c (126 g) 6.6
Veggie “meats,” fortified, 1 oz (28 g) 0.5-1.9
Legumes (cooked, 1/2 c/125 mL)
Adzuki beans 2.3
Baked beans, canned, vegetarian 1.7
Black beans 1.8
Chickpeas, garbanzo beans 2.4
Great northern beans 1.9
Kidney beans 2.6
Lentils 3.3
Lima beans 2.2
Navy beans 2.3
Pinto beans 2.2
Nuts, peanuts, seeds, and their butters
Almonds, 1/4 c (60 mL) 1.5
Cashews, 1/4 c (60 mL) 2.1
Peanut butter, 2 tbsp (30 mL) 0.6
Peanuts, dry roast, 1/4 c (60 mL) 0.8
Pumpkin and squash seeds, dried, 1/4 c (60 mL) 5.2
Sesame tahini, 2 tbsp (30 mL) 2.7
Sunflower seeds, toasted, 1/4 c (60 mL) 2.3
Breads, cereals, and grains
Barley, pearled, cooked, 1/2 c (125 mL) 1.0
Cereal, ready-to-eat, fortified, 1 oz (28 g) 2.1-18
Cream of Wheat, cooked, 1/2 c (125 mL) 5.1
Oatmeal, instant, fortified, cooked, 1/2 c (125 mL) 4.2
Oatmeal, regular, quick or instant, cooked, 1/2 c (125 mL) 1.6
Quinoa, cooked, 1/2 c (125 mL) 2.1
Wheat germ, 2 tbsp (14 g) 0.9
Whole wheat or white enriched bread, 1 slice (28 g) 0.9
Fruits (dried, 1/4 c/60 mL)
Apricots 1.5
Currants 1.2
Figs 1.1
Prunes 1.1
Raisins 1.1
Vegetables (cooked, 1/2 c/125 mL unless indicated otherwise)
Bok choy (Chinese cabbage, pak choi) 0.9
Broccoli 0.7
Green or yellow beans 0.8
Kale 0.6
Mung bean sprouts 0.8
Mushrooms 1.4
Potato, baked, with skin, 1 medium (173 g) 2.3
Tomato juice 0.7
Turnip greens 0.6
Other foods
Blackstrap molasses, 1 tbsp (15 mL) 3.5
Zinc
Soyfoods
Soybeans, cooked, 1/2 c (125 mL) 1.0
Soybeans, dry roasted, 1/2 c (60 mL) 2.1
Soymilk, 1/2 c (125 mL) 0.3
Soymilk, fortified, 1/2 c (125 mL) 0.5-1.0
Tempeh, 1/2 c (83 g) 0.9
Tofu, firm, 1/2 c (126 g) 1.0
Veggie “meats,” fortified, 1 oz (28 g) 1.2-2.3
Journal of THE AMERICAN DIETETIC ASSOCIATION / 751
5. ADA REPORTS
Table cont’d
Vegetarian food sources of nutrients
Nutrient Amount per serving
Legumes (cooked, 1/2 c/125 mL) 4™™™™™™ mg ™™™™™™
3
Adzuki beans 2.0
Baked beans, canned, vegetarian 1.8
Black beans 1.0
Chickpeas, garbanzo beans 1.3
Great northern beans 0.8
Kidney beans 0.9
Lima beans 0.9
Lentils 1.2
Navy beans 2.3
Nuts, peanuts, seeds, and their butters
Almonds, 1/4 c (60 mL) 1.2
Cashews, 1/4 c (60 mL) 1.9
Peanut butter, 2 tbsp (30 mL) 0.9
Peanuts, dry roast, 1/4 c (60 mL) 1.2
Pumpkin and squash seeds, dried, 1/4 c (60 mL) 2.6
Sesame tahini, 2 tbsp (30 mL) 1.4
Sunflower seeds, toasted, 1/4 c (60 mL) 1.8
Breads, cereals, and grains
Barley, pearled, cooked, 1/2 c (125 mL) 0.6
Cereal, ready-to-eat, fortified, 1 oz (28 g) 0.7-15
Quinoa, cooked, 1/2 c (125 mL) 0.8
Wheat germ, 2 tbsp (14 g) 1.8
Whole wheat bread, 1 slice (28 g) 0.5
Vegetables (cooked, 1/2 cup/125 mL)
Mushrooms 0.7
Peas 1.0
Dairy foods and eggs
Cow’s milk, 1/2 c (125 mL) 0.5
Cheddar cheese, 3/4 oz (21 g) 0.7
Egg, large, 1 (50 g) 0.5
Yogurt, 1/2 c (125 mL) 0.8-1.1
Calcium
Soyfoods
Cultured soy yogurt, fortified, 1/2 c (125 mL) 367
Soybeans, cooked, 1/2 c (125 mL) 88
Soybeans, dry roasted, (soy nuts), 1/4 c (60 mL) 60
Soybeans, green, 1/2 c (125 mL) 130
Soymilk, fortified, 1/2 c (125 mL) 100-159
Tofu, firm, calcium-set, 1/2 c (126 g) 120-430
Tempeh, 1/2 c (83 g) 92
Legumes (cooked, 1/2 c/125 mL)
Black beans 46
Chickpeas, garbanzo beans 40
Great northern or navy beans 60-64
Pinto beans 41
Vegetarian baked beans 64
Nuts, seeds and their butters
Almonds, 1/4 c (60 mL) 88
Almond butter, 2 tbsp (30 mL) 86
Sesame tahini, 2 tbsp (30 mL) 128
Breads, cereals, and grains
Cereal, ready-to-eat, fortified, 1 oz (28 g) 55-315
Fruits
Figs, dried, 5 137
Orange, 1 large 74
Orange juice, fortified, 1/2 c (125 mL) 150
Vegetables (cooked, 1 c/250 mL)
Bok choy (Chinese cabbage, pak choi) 167-188
Broccoli 79
Collard greens 239
Kale 99
Kale, Scotch 181
Mustard greens 109
Okra 107
Turnip greens 208
752 / June 2003 Volume 103 Number 6
6. ADA REPORTS
Table cont’d
Vegetarian food sources of nutrients
Nutrient Amount per serving
Other foods 4™™™™™™ mg ™™™™™™
3
Blackstrap molasses, 1 tbsp (15 mL) 172
Dairy products
Cow’s milk, 1/2 c (125 mL) 137-158
Cheddar cheese, 3/4 oz (21 g) 153
Yogurt, plain, 1/2 c (125 mL) 137-230
Vitamin D 4™™™™™™ mcg ™™™™™™
3
Cereals, ready-to-eat, fortified, 1 oz (28 g) 0.5-1
Egg yolk, large, 1 (17 g) 0.6
Cow’s milk, fortified, 1/2 c (125 mL) 1.2-1.3
Soymilk or other nondairy milk, fortified, 1/2 c (125 mL) 0.5-1.5
Riboflavin 4™™™™™™ mg ™™™™™™
3
Almonds, 1/4 c (60 mL) 0.3
Cereal, ready-to-eat, fortified, 1 oz (28 g) 0.2-1.7
Cow’s milk, whole, 2% or skim, 1/2 c (125 mL) 0.2
Yogurt, 1/2 c (125 mL) 0.3
Egg, large, 1 (50 g) 0.6
Mushrooms, cooked, 1/2 c (125 mL) 0.2
Nutritional yeast miniflakes, 1 tbsp (3 g) 1.9
Soymilk, fortified, 1/2 c (125 mL) 0.2
Vitamin B-12 4™™™™™™ mcg ™™™™™™
3
Cereals, ready-to-eat, fortified, 1 oz (28 g) 0.6-6.0
Cow’s milk, 1/2 c (125 mL) 0.4-0.5
Egg, large, 1 (50 g) 0.5
Nutritional yeast (Red Star Vegetarian Support Formula), miniflakes, 1 tbsp (3 g) 1.5
Soymilk or other nondairy milks, fortified, 1/2 c (125 mL) 0.4-1.6
Veggie “meats,” fortified, 1 oz (28 g) 0.5-1.2
Linolenic acid 4™™™™™™™ g ™™™™™™™3
Canola oil, 1 tbsp (15 mL) 1.3-1.6
Flaxseed, ground, 1 tbsp (15 mL) 1.9-2.2
Flaxseed oil, 1 tsp (5 mL) 2.7
Soybean oil, 1 tbsp (15 mL) 0.9
Soybeans, cooked, 1/2 c (125 mL) 1.0
Tofu, 1/2 c (126 g) 0.7
Walnuts, 1/4 c (60 mL) 2.7
Walnut oil, 1 tbsp (15 mL) 1.4-1.7
NOTE. Sources: Package information and data from US Department of Agriculture, Agricultural Research Service, 2002; USDA Nutrient Database for Standard
Reference, Release 15; Nutrient Data Laboratory Home Page, http://www.nal.usda.gov/fnic/foodcomp; Bhatty RS. Nutrient composition of whole flaxseed and
flaxseed meal. In: Cunnane SC, Thompson LU, eds. Flaxseed and Human Nutrition. Champaign, IL: AOCS Press; 1995:22-42.
other stages of the life cycle are available (72,73). Many vegans children following macrobiotic diets and adult Asian vegetari-
may find that it is easier to meet needs if fortified foods or ans (29,83-85).
supplements are included (69-71,78). Foods that are fortified with vitamin D include cow’s milk,
some brands of soymilk and rice milk, and some breakfast ce-
Vitamin D reals and margarines (see Table). Vitamin D3 (cholecalciferol)
Vitamin D status depends on sunlight exposure and intake of is of animal origin, whereas vitamin D2 (ergocalciferol) is a
vitamin D fortified foods or supplements. Sun exposure to the form acceptable to vegans. Vitamin D2 may be less bioavailable
face, hands, and forearms for 5 to 15 minutes per day during the than vitamin D3, which could raise the requirements of vege-
summer at the 42nd latitude (Boston) is believed to provide tarians who depend on D2 supplements to meet vitamin D
sufficient amounts of vitamin D for light-skinned people (79). needs (86). If sun exposure and intake of fortified foods are
Those with dark skin require longer exposure (79). Sun expo- insufficient, vitamin D supplements are recommended.
sure may be inadequate for those living in Canada and at north-
ern latitudes in the United States, especially in winter months,
for those in smoggy regions, and for those whose sun exposure Riboflavin
is limited. Furthermore, infants, children, and older adults syn- Some studies have shown vegans to have lower intakes of ribo-
thesize vitamin D less efficiently (77,79,80). Sunscreen can flavin, compared with nonvegetarians; however, clinical ribofla-
interfere with vitamin D synthesis, although reports are incon- vin deficiency has not been observed (27,29,31). In addition to
sistent and may depend on amount of sunscreen applied foods shown in the Table, foods that provide about 1 mg of
(79,81,82). Low vitamin D levels and reduced bone mass have riboflavin per serving are asparagus, bananas, beans, broccoli,
been observed in some vegan populations at northern latitudes figs, kale, lentils, peas, seeds, sesame tahini, sweet potatoes,
who did not use supplements or fortified foods, particularly tofu, tempeh, wheat germ, and enriched bread (87).
Journal of THE AMERICAN DIETETIC ASSOCIATION / 753
7. ADA REPORTS
Vitamin B-12 N-3 Fatty Acids
Sources of vitamin B-12 that are not derived from animals in- Whereas vegetarian diets are generally rich in n-6 fatty acids
clude B-12 fortified foods (such as some brands of soymilk, (especifically linoleic acid), these diets can be low in n-3 fatty
breakfast cereals, and nutritional yeast) or supplements (see acids, resulting in an imbalance that can inhibit production of
Table). Unless fortified, no plant food contains significant the physiologically active long chain n-3 fatty acids, eicosapen-
amounts of active vitamin B-12. Foods such as sea vegetables taenoic acid (EPA), and docosahexaenoic acid (DHA). Diets
and spirulina may contain vitamin B-12 analogs; neither these that do not include fish, eggs, or generous amounts of sea veg-
nor fermented soy products can be counted on as reliable etables generally lack direct sources of EPA and DHA. Re-
sources of active vitamin B-12 (29,88). Lacto-ovo-vegetarians cently, vegan sources of DHA derived from microalgae have
can get adequate vitamin B-12 from dairy foods and eggs if become available as supplements in nongelatin capsules. Algae
these foods are consumed regularly. sources of DHA have been shown to positively affect blood
Vegetarian diets are typically high in folic acid, which can levels of DHA and of EPA through retroconversion (100).
mask the hematological symptoms of vitamin B-12 deficiency. Most studies show vegetarians, and particularly vegans, to
Therefore, some cases of deficiency may not be detected until have lower blood levels of EPA and DHA than nonvegetarians
after the onset of neurological symptoms (89). If there are (101-104). The new Dietary Reference Intakes recommend in-
concerns about vitamin B-12 status, serum homocysteine, takes of 1.6 and 1.1 grams of -linolenic acid per day for men
methylmalonic acid, and holotranscobalamin II should be mea- and women, respectively. These are designated as AIs rather
sured (90). than RDAs. These recommendations assume some intake of
A regular source of vitamin B-12 is crucial for pregnant and long-chain n-3 fatty acids and may not be optimal for vegetar-
lactating women and for breastfed infants if the mother’s diet is ians who consume little if any DHA and EPA (35). The Joint
not supplemented. Infants born to vegan mothers whose diets World Health Organization/Food Agriculture Organization
lack reliable sources of this vitamin are at especially high risk of (WHO/FAO) Expert Consultation on Diet, Nutrition and the
deficiency. Maternal vitamin B-12 intake and absorption during Prevention of Chronic Diseases (105) recommends 5% to 8% of
calories from n-6 fatty acids and 1% to 2% of calories from n-3
pregnancy appear to have a more important influence on vita-
fatty acids. Based on an energy intake of 2,000 kcal per day, this
min B-12 status of the infant than do maternal vitamin B-12
would suggest a daily intake of 2.2 to 4.4 grams of n-3 fatty
stores (91). Because 10% to 30% of those over the age of 50
acids. Those who do not receive a preformed source of EPA and
years, regardless of the type of diet they follow, lose their abil-
DHA require increased amounts of n-3 fatty acids. The recom-
ity to digest the protein-bound form of the vitamin that is mended ratio of n-6 to n-3 fatty acids is in the range of 2:1 to 4:1
present in eggs, dairy, and other animal products, all people (106-109).
over the age of 50 should use vitamin B-12 supplements or It is recommended that vegetarians include good sources of
fortified foods (92). -linolenic acid in their diet (106,110). These would include
Studies indicate that some vegans and other vegetarians do foods like flaxseed and flaxseed oil (see Table). Those with
not regularly consume reliable sources of vitamin B-12 and that increased requirements (eg, pregnant and lactating women or
this is reflected in less than adequate vitamin B-12 status those with diseases associated with poor essential fatty acid
(27,29,88,89,93-95). It is essential that all vegetarians use a status) or those at risk for poor conversion (eg, people with
supplement, fortified food, dairy products, or eggs to meet rec- diabetes) may benefit from direct sources of long-chain n-3
ommended intakes of vitamin B-12 (see Table). fatty acids, such as DHA-rich microalgae (100,106,111).
Absorption is most efficient when small amounts of vitamin
B-12 are consumed at frequent intervals. This could be Iodine
achieved through use of fortified foods. When less than 5 g of Some studies suggest that vegans who do not consume iodized
crystalline vitamin B-12 is consumed at one time, approxi- salt may be at risk for iodine deficiency; this appears to be
mately 60% is absorbed, whereas 1% of a dose of 500 g or particularly true for those living in iodine-poor areas
higher of vitamin B-12 is absorbed (92). (29,112,113). Bread can be a source of iodine because some
dough stabilizers contain iodine. In the United States, about
50% of the general population uses iodized salt, whereas, in
Vitamin A/Beta Carotene Canada, all table salt is fortified with iodine. Sea salt and kosher
Because preformed vitamin A is found only in animal foods, salt are generally not iodized nor are salty seasonings such as
vegans get all of their vitamin A from conversion of dietary tamari. Concern has been raised about vegetarian diets that
carotenoids, particularly beta carotene. Research suggests that include foods, such as soybeans, cruciferous vegetables, and
absorption of beta carotene from plant foods is less efficient sweet potatoes, that contain natural goitrogens. However,
than previously believed (44,96). This suggests that vegans these foods have not been associated with thyroid insufficiency
intake of vitamin A is about half of what previous studies have in healthy people provided iodine intake is adequate. The adult
suggested, and intake by lacto-ovo-vegetarians may be 25% RDA for iodine is easily met by one-half teaspoon of iodized salt
lower than previously shown. Despite this, vegetarians have daily (44). Some vegetarians may have very high intakes of
been reported to have higher serum carotenoid levels than iodine because of consumption of sea vegetables.
nonvegetarians (29). Vitamin A requirements can be met with
the inclusion of three servings per day of deeply yellow or VEGETARIANISM THROUGHOUT THE LIFE CYCLE
orange vegetables, leafy green vegetables, or fruits that are rich Well-planned vegan, lacto-vegetarian, and lacto-ovo-vegetar-
in beta carotene (apricots, cantaloupe, mango, pumpkin). ian diets are appropriate for all stages of the life cycle, including
Cooking increases beta carotene absorption, as does the addi- pregnancy and lactation. Appropriately planned vegan, lacto-
tion of small amounts of fat to meals (97). Chopping and pu- vegetarian, and lacto-ovo-vegetarian diets satisfy nutrient
reeing vegetables may also increase bioavailability (98,99). needs of infants, children, and adolescents and promote normal
754 / June 2003 Volume 103 Number 6
8. ADA REPORTS
growth (36,114,115). Vegetarian diets in childhood and adoles- Frequent meals and snacks and the use of some refined foods
cence can aid in the establishment of lifelong healthy eating (such as fortified breakfast cereals, breads, and pasta) and
patterns and can offer some important nutritional advantages. foods higher in unsaturated fat can help vegetarian children
Vegetarian children and adolescents have lower intakes of cho- meet energy and nutrient needs. Average protein intake of
lesterol, saturated fat, and total fat and higher intakes of fruits, vegetarian children (lacto-ovo, vegan, and macrobiotic) gener-
vegetables, and fiber than nonvegetarians (2,116-118). Vege- ally meets or exceeds recommendations, although vegetarian
tarian children have also been reported to be leaner and to have children may consume less protein than nonvegetarian chil-
lower serum cholesterol levels (119-121). dren (116,128). Vegan children may have protein needs that
are slightly higher than those of nonvegan children because of
Infants differences in protein digestibility and amino acid composition
When vegetarian infants receive adequate amounts of breast of plant food proteins (36,129), but these protein needs are
milk or commercial infant formula and their diets contain good generally met when diets contain adequate energy and a vari-
sources of energy and nutrients such as iron, vitamin B-12, and ety of plant foods (35). Good sources of calcium, iron, and zinc
vitamin D, growth throughout infancy is normal. Extremely should be emphasized for vegetarian children along with di-
restrictive diets such as fruitarian and raw foods diets have etary practices that enhance absorption of zinc and iron from
been associated with impaired growth and therefore cannot be plant foods. A reliable source of vitamin B-12 is important for
recommended for infants and children (29). vegan children. If there is concern about vitamin D synthesis
Many vegetarian women choose to breastfeed their infants owing to limited sunlight exposure, skin tone, season, or sun-
(122), and this practice should be encouraged and supported. screen use, vitamin D supplements or fortified foods should be
The breast milk of vegetarian women is similar in composition used. The Table provides information about food sources of
to that of nonvegetarians and is nutritionally adequate. Com- nutrients. Food guides for vegetarian children under 4 years of
mercial infant formulas should be used if infants are not breast- age (36,130) and for older children (72,73) have been pub-
fed or are weaned before 1 year of age. Soy formula is the only lished elsewhere.
option for vegan infants who are not being breastfed.
Soymilk, rice milk, homemade formulas, cow’s milk, and Adolescents
goat’s milk should not be used to replace breast milk or com- There are limited data available on the growth of vegetarian
mercial infant formula during the first year because these foods adolescents, although studies suggest there is little difference
do not contain the proper ratio of macronutrients nor do they between vegetarians and nonvegetarians (131). In the West,
have appropriate micronutrient levels for the young infant. vegetarian girls tend to reach menarche at a slightly later age
Guidelines for the introduction of solid foods are the same for than nonvegetarians (132,133), although not all research sup-
vegetarian and nonvegetarian infants (115). When it is time for ports this finding (134,135). If slightly later menarche does
protein-rich foods to be introduced, vegetarian infants can occur, it may offer health advantages, including lower risk of
have mashed or pureed tofu, legumes (pureed and strained if developing breast cancer and obesity (136,137). Vegetarian
necessary), soy or dairy yogurt, cooked egg yolks, and cottage diets appear to offer some nutritional advantages for adoles-
cheese. Later, foods such as cubes of tofu, cheese or soy cents. Vegetarian adolescents are reported to consume more
cheese, and bite-size pieces of soy burger can be started. Com- fiber, iron, folate, vitamin A, and vitamin C than nonvegetarians
mercial, full-fat, fortified soymilk, or cow’s milk can be used as (2,60). Vegetarian adolescents also consume more fruits and
a primary beverage starting at age 1 year or older for a child vegetables and fewer sweets, fast foods, and salty snacks com-
who is growing normally and is eating a variety of foods (115). pared with nonvegetarian adolescents (2,118). Key nutrients
Foods that are rich in energy and nutrients such as legume for adolescent vegetarians include calcium, vitamin D, iron,
spreads, tofu, and mashed avocado should be used when the zinc, and vitamin B-12.
infant is being weaned. Dietary fat should not be restricted in Vegetarian diets are somewhat more common among adoles-
children younger than 2 years. cents with eating disorders than in the general adolescent pop-
Breastfed infants whose mothers do not consume dairy prod- ulation; therefore, dietetics professionals should be aware of
ucts, foods fortified with vitamin B-12, or B-12 supplements young clients who greatly limit food choices and who exhibit
regularly will need vitamin B-12 supplements (115). Guidelines symptoms of eating disorders (138,139). However, recent data
for the use of iron and vitamin D supplements in vegetarian suggest that adopting a vegetarian diet does not lead to eating
infants do not differ from guidelines for nonvegetarian infants. disorders, rather that vegetarian diets may be selected to cam-
Zinc supplements are not routinely recommended for vegetar- ouflage an existing eating disorder (27,140,141). With guid-
ian infants because zinc deficiency is rarely seen (123). Zinc ance in meal planning, vegetarian diets are appropriate and
intake should be individually assessed and zinc supplements or healthful choices for adolescents.
zinc-fortified foods used during the time when complementary
foods are being introduced if the diet is low in zinc or mainly Pregnant and Lactating Women
consists of foods with low zinc bioavailability (124,125). Lacto-ovo-vegetarian and vegan diets can meet the nutrient
and energy needs of pregnant women. Infants of vegetarian
Children mothers generally have birth weights that are similar to those
Lacto-ovo-vegetarian children exhibit growth similar to that of of infants born to nonvegetarians and to birth weight norms
their nonvegetarian peers (114,119,126). Little information (122,142,143). Diets of pregnant and lactating vegans should
about the growth of nonmacrobiotic vegan children is available, contain reliable sources of vitamin B-12 daily. If there is con-
although findings suggest that children tend to be slightly cern about vitamin D synthesis because of limited sunlight ex-
smaller but within the normal ranges of the standards for posure, skin tone, season, or sunscreen use, pregnant and lac-
weight and height (114,122). Poor growth in children has been tating women should use vitamin D supplements or fortified
seen primarily in those on very restricted diets (127). foods. Iron supplements may be needed to prevent or treat
Journal of THE AMERICAN DIETETIC ASSOCIATION / 755
9. ADA REPORTS
iron-deficiency anemia, which is commonly seen during preg- foods, such as soy products, other legumes, grains, nuts, and
nancy. Women capable of becoming pregnant and women in seeds, can provide adequate protein without the use of special
the periconceptional period are advised to consume 400 g of foods or supplements (150). For adolescent athletes, special
folate daily from supplements, fortified foods, or both in addi- attention should be given to meeting energy, protein, calcium,
tion to consuming food folate from a varied diet (92). and iron needs. Amenorrhea may be more common among veg-
Infants of vegetarian mothers have been reported to have etarian than nonvegetarian athletes, although not all research
lower cord and plasma DHA than do infants of nonvegetarians, supports this finding (151,152). Female vegetarian athletes
although the functional significance of this is not known may benefit from diets that include adequate energy, higher
(104,143). Breast milk DHA levels in vegan and lacto-ovo-veg- levels of fat, and generous amounts of calcium and iron.
etarian women appear to be lower than levels in nonvegetarians
(144). Because DHA seems to play a role in the development of VEGETARIAN DIETS AND CHRONIC DISEASE
the brain and the eye and because a dietary supply of DHA may
be important for the fetus and newborn, pregnant and lactating Obesity
vegans and vegetarians (unless eggs are eaten regularly) Among Seventh-day Adventists (SDA), 40% of whom follow a
should include sources of the DHA precursor linolenic acid in meatless diet, vegetarian eating patterns have been associated
their diet (ground flaxseed, flaxseed oil, canola oil, soybean oil) with lower body mass index (BMI). In the Adventist Health
or use a vegetarian DHA supplement (from microalgae). Foods Study, which compared vegetarians and nonvegetarians within
containing linoleic acid (corn, safflower, and sunflower oil) and the Adventist population, BMI increased as the frequency of
trans-fatty acids (stick margarine, foods with hydrogenated meat consumption increased in both men and women (4). In
fats) should be limited because these fatty acids can inhibit the Oxford Vegetarian Study, BMI values were higher in non-
DHA production from linolenic acid (145). vegetarians compared with vegetarians in all age groups and for
both men and women (112).
Older Adults In a study of 4,000 men and women in England comparing
Studies indicate that most older vegetarians have dietary in- the relationship between meat consumption and obesity
takes that are similar to nonvegetarians (146,147). With aging, among meat eaters, fish eaters, lacto-ovo-vegetarians, and veg-
energy needs decrease, but recommendations for several nu- ans, mean BMI was highest in the meat eaters and lowest in the
trients, including calcium, vitamin D, vitamin B6, and possibly vegans (153). BMI was lowest in those lacto-ovo-vegetarians
protein, are higher. Sunlight exposure is often limited, and vi- and vegans who had adhered to their diet for 5 years or longer.
tamin D synthesis is decreased in older adults so that dietary or Factors that may help to explain the lower BMI among vegetar-
supplemental sources of vitamin D are especially important. ians include differences in macronutrient content (lower protein,
Older adults may have difficulty with vitamin B-12 absorp- fat, and animal fat intake), higher fiber consumption, decreased
tion from food so vitamin B-12-fortified foods or supplements alcohol intake, and greater consumption of vegetables.
should be used because the vitamin B-12 in fortified foods and
supplements is usually well absorbed (92). Protein require- Cardiovascular Disease
ments for older adults are controversial. The current DRIs do An analysis of five prospective studies involving more than
not recommend additional protein for older adults (35). A 76,000 subjects showed that death from ischemic heart disease
metaanalysis of nitrogen balance studies concluded that there was 31% lower among vegetarian men compared with nonveg-
is not enough evidence to recommend different protein intakes etarian men and 20% lower among vegetarian women com-
for older adults but pointed out that the data are limited and pared with nonvegetarian women (154). Death rates were also
contradictory (34). Others have concluded that protein re- lower for vegetarian men and women compared with semiveg-
quirements of older adults may be around 1 to 1.25 g/kg body etarians, those who ate fish only or ate meat less than once per
weight (148,149). Older adults can easily meet protein needs week. Among SDA, vegetarian men had a 37% reduction in risk
on a vegetarian diet if a variety of protein-rich plant foods, of developing ischemic heart disease compared with nonveg-
including legumes and soy products, are eaten daily. etarian men (4). In the only study to include vegan subjects,
Vegetarian diets, which are high in fiber, may be beneficial for risk for developing heart disease was even lower among SDA
older adults with constipation. Older vegetarians may benefit from vegan men than in the SDA lacto-ovo-vegetarians (155).
nutritional counseling on foods that are easy to chew, require The lower rates of heart disease among vegetarians are ex-
minimal preparation, or are appropriate for therapeutic diets. plained in part by their lower blood cholesterol levels. A review
of 9 studies found that, in comparison to nonvegetarians, lacto-
Athletes ovo-vegetarians and vegans had mean blood cholesterol levels
Vegetarian diets can also meet the needs of competitive ath- that were 14% and 35% lower, respectively (156). Although the
letes. Nutrition recommendations for vegetarian athletes lower average BMI of vegetarians may help to explain this,
should be formulated with consideration of the effects of both Sacks and colleagues found that, even when vegetarian sub-
vegetarianism and exercise. The position of the American Die- jects were heavier than nonvegetarian subjects, the vegetari-
tetic Association and Dietitians of Canada on nutrition and ath- ans had markedly lower plasma lipoprotein values (157), and
letic performance (39) provides appropriate dietary guidance Thorogood and colleagues found that differences in plasma
for athletes, although some modification may be needed to lipids in vegetarians, vegans, and meat eaters persisted, even
address vegetarians’ needs. Protein recommendations for en- following adjustment for BMI (158). Some, but not all, studies
durance athletes are 1.2 to 1.4 g/kg body weight, whereas re- have shown lower high-density lipoprotein (HDL) levels in veg-
sistance and strength-trained athletes may need as much as 1.6 etarian subjects (29). Lower HDL levels may be due to the type
to 1.7 g/kg body weight (39). Not all groups support an in- or amount of dietary fat or to lower alcohol intake. This may
creased protein need for athletes (35). Vegetarian diets that help to explain the smaller differences in heart disease rates
meet energy needs and contain a variety of plant-based protein between vegetarian and nonvegetarian women because HDL
756 / June 2003 Volume 103 Number 6
10. ADA REPORTS
may be a more important risk factor than LDL levels for women Hypertension
(159). Average triglyceride levels tend to be similar in vegetar- Many studies show that vegetarians have both lower systolic
ians and nonvegetarians. and diastolic pressures with differences between vegetarians
A number of factors in vegetarian diets may affect choles- and nonvegetarians generally falling between 5 and 10 mm Hg
terol levels. Although studies show that most vegetarians do (29). In the Hypertension Detection and Follow-Up Program,
not typically consume low-fat diets, saturated fat intake is con- blood pressure reduction of just 4 mm Hg caused marked re-
siderably lower among vegetarians than nonvegetarians, and duction in mortality from all causes (174).
vegans have a lower ratio of saturated to unsaturated fat in In addition to having lower blood pressures in general, veg-
their diets (29). Vegetarians also consume less cholesterol than etarians have markedly lower rates of hypertension than meat
nonvegetarians, although the range of intake varies consider- eaters (175,176). In one study, 42% of nonvegetarians had hy-
ably across studies. Vegan diets are free of cholesterol. pertension (defined as 140/90 mm Hg) compared with only
Vegetarians consume between 50% and 100% more fiber 13% of vegetarians. Even semivegetarians are 50% more likely
than nonvegetarians, and vegans have higher intakes than to have hypertension than vegetarians (4). Even when body
lacto-ovo-vegetarians (29). Soluble fiber may lower risk for car- weights were similar between subjects, vegetarians had lower
diovascular disease by reducing blood cholesterol levels (160). blood pressures. Placing nonvegetarian subjects on a vegetar-
Limited research suggests that animal protein is directly asso- ian diet led to reduced blood pressure in normotensive (177)
ciated with higher serum cholesterol levels even when other and hypertensive subjects (178).
dietary factors are controlled (161). Lacto-ovo-vegetarians A number of studies have controlled for various factors that
consume less animal protein than nonvegetarians, and vegans might help to explain the lower blood pressures of vegetarians
consume no animal protein. Research shows that consumption and the hypotensive effects of changing to a vegetarian diet.
of at least 25 g per day of soy protein, either in place of animal The lower blood pressures do not appear to be due to lower
protein or in addition to the usual diet, reduces cholesterol BMI (175), exercise habits (179), absence of meat (180), milk
levels in people with hypercholesterolemia (162). Soy protein protein (181), fat content of diet (182), fiber (183) or differ-
may also raise HDL levels (162). Vegetarians are likely to con- ences in potassium, magnesium, or calcium intakes (184). Be-
sume more soy protein than the general population. cause sodium intake of vegetarians is comparable or only mod-
Other factors in vegetarian diets may impact cardiovascular estly lower than that of nonvegetarians, sodium does not
disease risk independent of effects on cholesterol levels. Veg- explain the differences either. Suggested explanations include
etarians have higher intakes of the vitamin antioxidants vita- a difference in blood glucose-insulin response because of a
mins C and E, which may reduce oxidation of LDL cholesterol. lower glycemic index of vegetarian diets (185) or a collective
Isoflavones, which are phytoestrogens found in soy foods, may effect of beneficial compounds from plant foods (186).
also have antioxidant properties (163) as well as enhancing
endothelial function and arterial compliance (164). Although Diabetes
there is limited information available about intake of specific Vegetarian diets can meet guidelines for the treatment of dia-
phytochemicals among population groups, vegetarians appear betes (187), and some research suggests that diets that are
to consume more phytochemicals than nonvegetarians be- more plant-based reduce risk for type 2 diabetes. Rates of self-
cause a greater percentage of their energy comes from plant reported diabetes among Seventh-day Adventists (SDA) were
foods. Some phytochemicals may affect plaque formation less than half those of the general population, and, among SDA,
through effects on signal transduction and cell proliferation vegetarians had lower rates of diabetes than nonvegetarians
(165) and may exert antiinflammatory effects (166). Research (188). In the Adventist Health Study, age-adjusted risk for de-
from Taiwan found that vegetarians had significantly better veloping diabetes for vegetarian, semivegetarian, and nonveg-
vasodilation responses, which correlated directly with years on etarian men was 1.00, 1.35, and 1.97, respectively, and, for
a vegetarian diet, suggesting a direct beneficial effect of vege- women, it was 1.00, 1.08, and 1.93 (4). Among the possible
tarian diet on vascular endothelial function (167). explanations for a protective effect of vegetarian diet are the
Not all aspects of vegetarian diets are associated with re- lower BMI of vegetarians and higher fiber intake, both of which
duced risk for heart disease. Some (89,103,168-171) but not all improve insulin sensitivity. However, among men in the Ad-
(62,172) studies have found higher serum homocysteine levels ventist Health Study, risk for diabetes was still 80% higher in
in vegetarians compared to nonvegetarians. Homocysteine is nonvegetarian men after adjustment for weight. In men, meat
believed to be an independent risk factor for heart disease. consumption was directly associated with increased risk of di-
Inadequate intake of vitamin B-12 may be the explanation. Vi- abetes. Among women, risk increased only when meat con-
tamin B-12 injections lowered homocysteine levels in vegetar- sumption exceeded five servings per week (188).
ians, many of whom had low B-12 levels and high serum homo-
cysteine (173). In addition, low intakes of n-3 fatty acids and a Cancer
high ratio of n-6 to n-3 fatty acids in the diet may raise risk of Vegetarians have an overall lower cancer rate compared with
heart disease among some vegetarians (173). the general population, but it is not clear to what extent this is
There are only limited data on the role of vegetarian diets as due to diet. When nondietary cancer risk factors are controlled
intervention for heart disease. Vegetarian diets used in these for, differences in overall cancer rates between vegetarians and
studies have usually been very low in fat. Because these diets nonvegetarians are greatly reduced, although marked differ-
have been used along with other lifestyle changes and they ences remain in rates of certain cancers. An analysis from the
have produced weight loss, it has not been possible to ascertain Adventist Health Study that controlled for age, sex, and smok-
any direct effect of adoption of vegetarian diet on risk factors ing found no differences between vegetarians and nonvegetar-
for heart disease or mortality. Vegetarian diets can be planned ians for lung, breast, uterine, or stomach cancer but did find
to conform to standard recommendations for the treatment of that nonvegetarians had a 54% increased risk for prostate can-
hypercholesterolemia. cer and an 88% increased risk for colorectal cancer (4). Other
Journal of THE AMERICAN DIETETIC ASSOCIATION / 757
11. ADA REPORTS
research has shown lower rates of colon cell proliferation in of hip fracture (211). Although excessive protein intake may
vegetarians compared with nonvegetarians (189) and lower compromise bone health, there is evidence that low protein
levels of serum insulin-like growth factor-I, thought to be in- intakes could raise risk for poorer bone health (212). Although
volved in the etiology of several cancers in vegans compared there are very little reliable data on bone health of vegans, some
with both nonvegetarians and lacto-ovo-vegetarians (190). studies suggest that bone density is lower among vegans com-
Both red and white meat have been independently linked to pared with nonvegetarians (213-215). Vegan women, like other
increased risk for colon cancer (4). Observational studies have women, may have low calcium intakes despite the availability of
found an association between high intake of dairy foods and nondairy sources of well-absorbed calcium. Some vegan
calcium with increased risk for prostate cancer (191-193), al- women may also have protein intakes that are marginal, and
though not all studies support this finding (194). A pooled vitamin D status has shown to be compromised in some vegans
analysis of 8 observational studies found no link between meat (216-218). The lower serum estrogen levels of vegetarians may
or dairy consumption and breast cancer (195). be a risk factor for osteoporosis. In contrast, short-term clinical
Research suggests that a number of factors in vegetarian studies suggest that soy protein rich in isoflavones decreases
diets may impact cancer risk. Vegetarian diets come closer to spinal bone loss in postmenopausal women (219). Higher in-
matching the dietary guidelines issued by the National Cancer take of potassium and vitamin K among vegetarians may also
Institute than do nonvegetarian diets, particularly in regard to help to protect bone health. However, the data suggest that a
fat and fiber intakes (196). Although data on fruit and vegeta- vegetarian diet does not necessarily protect against osteoporo-
ble intake of vegetarians are limited, a recent study found that sis despite lower animal protein content.
intake was considerably higher among vegans compared with
nonvegetarians (62). High lifetime exposure to estrogen has Renal Disease
been linked to increased breast cancer risk. Some research High intake of dietary protein may worsen existing kidney dis-
shows that vegetarians have lower serum and urinary estrogen ease or increase risk for those who are susceptible to this dis-
levels (197). There is also some evidence that vegetarian girls ease because protein intake is associated with a higher glomer-
begin menstruation at a later age, which may reduce cancer ular filtration rate (GFR) (220). The GFR of healthy
risk because of lower lifetime estrogen exposure (132,133). vegetarians is lower than that of nonvegetarians and even lower
High fiber intake is believed to protect against colon cancer, in vegans (221). The type of protein consumed may also have
although not all research supports this (198,199). The environ- an effect, with plant foods having a more beneficial effect on
ment of the colon of vegetarians is strikingly different from that GFR than animal protein (222, 223). GFR was 16% higher in
of nonvegetarians. Vegetarians have a lower concentration of healthy subjects after eating a meal containing animal protein
potentially carcinogenic bile acids (200) and fewer intestinal compared with a meal with soy protein (222). Because the
bacteria that convert the primary bile acids into carcinogenic pathology of renal disease is similar to that of atherosclerosis,
secondary bile acids (201). More frequent elimination and the the lower serum cholesterol levels and reduced cholesterol ox-
levels of certain enzymes in the colon enhance elimination of idation resulting from a vegetarian diet may be beneficial for
potential colon carcinogens (200,202). Most research shows those with kidney disease.
that vegetarians have lower levels of fecal mutagens (203).
Vegetarians do not consume heme iron, which has been Dementia
shown to lead to the formation of highly cytotoxic factors in the Although rates of dementia differ markedly throughout the
colon increasing colon cancer risk (204). Finally, vegetarians world, differences in diagnostic criteria make cross-cultural
most likely have higher intakes of phytochemicals, many of comparisons difficult. In the United States, among SDA, those
which have anticancer activity. Isoflavones in soy foods have who ate meat were more than twice as likely to develop demen-
been shown to have anticancer effects, particularly in regard to tia (224). Those who had eaten meat for many years were more
breast and prostate cancer, although this is not supported by all than three times as likely to develop signs of dementia. Diets
research (205,206). high in antioxidants have been found to protect cognitive func-
tion (225-227). The lower blood pressure of vegetarians may
Osteoporosis also be protective. There is also some evidence that lower blood
Osteoporosis is a complex disease affected by a variety of life- cholesterol protects against dementia (228). Higher homocys-
style, dietary, and genetic factors. Although some data indicate teine levels are linked to increased risk of dementia, and this
that osteoporosis is less common in developing countries with a may present one risk factor for vegetarians who do not get
mostly plant-based diet, these studies have relied on hip frac- adequate vitamin B-12 (229-232). Although one observational
ture data, which has been found to be unreliable for comparing study found an increased rate of dementia among Japanese
bone health across cultures. There is little evidence to suggest American men who ate tofu regularly (233), the study had a
that bone mineral density differs between western nonvegetar- number of methodological limitations, and other research has
ians and lacto-ovo-vegetarians. not supported these findings (234).
A number of studies have shown that high protein intake,
from animal foods in particular, causes increased excretion of
Other Health Effects of Vegetarian Diets
calcium and raises calcium needs (207-209). The effect is be-
lieved to be due to the increased acid load from metabolism of Diverticular disease
sulfur-containing amino acids (SAA). However, grains are also Gear and colleagues found that both male and female vegetar-
high in these amino acids, and some research shows that SAA ians aged 45 to 59 years were 50% as likely to have diverticulitis
intake was similar between nonvegetarians and vegetarians compared with nonvegetarians (235). Although fiber is be-
(210). Despite this, there is some evidence that postmeno- lieved to be the most important reason for this difference, other
pausal women with diets high in animal protein and low in plant factors may have an effect as well. High-fat diets, independent
protein had a high rate of bone loss and a greatly increased risk of fiber intake, have been associated with increased risk of
758 / June 2003 Volume 103 Number 6
12. ADA REPORTS
diverticulitis (236). Meat intake may also increase risk (236). In Canada, school lunch, breakfast, and snack programs;
Older research suggests that meat consumption may promote food selection standards; and provision for vegetarian meals
growth of bacteria that produce a toxic metabolite that weak- vary from one region to another. Nationally, the Canadian Liv-
ens the wall of the colon (237). ing Foundation’s Breakfast for Learning program is developing
Best Practice Program Standards for breakfast, snack, and
Gallstones lunch programs. Vegetarian meals based on Canada’s Food
In a study of 800 women aged 40 to 69 years, nonvegetarians were Guide to Healthy Eating fit within this framework (248).
more than twice as likely as vegetarians to suffer from gallstones
(238). The relationship held even after controlling for the three Feeding Programs for the Elderly
known risk factors for gallstones: obesity, gender, and aging. The federal Elderly Nutrition Program (ENP) distributes funds
to states, territories, and tribal organizations for a national net-
Rheumatoid arthritis work of programs that provide congregate and home-delivered
Rheumatoid arthritis (RA), believed to be an autoimmune dis- meals (often known as Meals on Wheels) for older Americans.
ease, involves inflammation of the joints. Several studies from one Meals served under this program must provide at least one-
group of researchers in Finland suggest that fasting, followed by third of the RDAs (249). Meals are often provided by local
vegan diet, may be useful in treatment of RA (239,240). Meals on Wheels agencies. A 4-week set of vegetarian menus
has been developed for use by the National Meals on Wheels
Although data are very limited and more follow-up is needed Foundation (250,251).
before conclusions can be drawn, some studies suggest that a
mostly raw foods vegan diet reduces symptoms of fibromyalgia Corrections Facilities
(241) and that a vegetarian diet may reduce symptoms of top- Court rulings in the United States and Canada have granted
ical dermatitis (242). prison inmates the right to have vegetarian meals for religious
and medical reasons (and in Canada, by choice, as well)
PROGRAMS AND AUDIENCES IMPACTED (252,253). Federal institutions and those for many states and
provinces provide vegetarian options for meals. The Canadian
Special Supplemental Nutrition Program for Women, federal court has ruled that prison inmates who are opposed to
Infants, and Children eating meat have a constitutional right to be served vegetarian
In the United States, the Special Supplemental Nutrition Pro- meals. The Freedom of Conscience provisions in the Charter of
gram for Women, Infants, and Children (WIC) is a federal grant Rights allow prisoners to demand vegetarian fare for moral
program that serves pregnant, postpartum, and breastfeeding reasons, just as other inmates may request special meals on
women and infants and children up to 5 years of age who are religious or medical grounds (252).
documented as being at nutritional risk and with family income
below state standards. This program provides checks or cou- Military/Armed Forces
pons to purchase some foods suitable for vegetarians, including The US Army’s Combat Feeding Program, which oversees all
infant formula, iron-fortified infant cereal, vitamin C-rich fruit food regulations, provides a choice of vegetarian menus (254).
or vegetable juice, carrots, cow’s milk, cheese, eggs, iron-forti- Canadian Forces Food Services offers one or more vegetarian
fied ready-to-eat cereal, dried beans or peas, and peanut but- options at every meal (255). An estimated 10% to 15% of Ca-
ter. Individual state agencies are allowed to submit a plan to nadian Forces members choose vegetarian meals for combat
USDA’s Food and Nutrition Service for substitution of foods to rations (individual meal packs) (256).
allow for different cultural eating patterns, provided the pro-
posed substitute food is nutritionally equivalent or superior to Other Institutions and Quantity Food Service
the food it replaces, is widely available, and does not cost more Organizations
than the food it is to replace (243). This provision could possi- Other institutions, including colleges, universities, hospitals,
bly allow more foods suitable for vegans to be purchased. restaurants, and publicly funded museums and parks offer
Canada Prenatal Nutrition Program (CPNP), federally varying amounts and types of vegetarian selections. Resources
funded by Health Canada, and perinatal community programs are available for vegetarian quantity food preparation (Figure
provide vouchers, coupons, or groceries to those who meet the 1). As interest in vegetarianism grows and because of the nu-
income and nutritional risk criteria for the program. Vouchers tritional and health benefits of choosing a vegetarian diet, in-
can be used for some foods acceptable to vegetarians, including creased provision of vegetarian meals on a daily basis should be
milk, juice, cheese, eggs, fortified soymilk, and other foods (244). encouraged.
Child Nutrition Programs ROLE OF DIETETICS PROFESSIONALS
In the United States, the National School Lunch Program Vegetarian clients may seek nutrition counseling services for a
(NSLP) allows nonmeat protein products, including certain soy specific clinical condition or for assistance in planning healthful
products, cheese, eggs, cooked dried beans or peas, yogurt, vegetarian diets. They may sometimes be referred because of
peanut butter, other nut or seed butters, peanuts, tree nuts, problems related to poor diet choices. Dietetics professionals
and seeds to be used (245,246). USDA information for school have an important role in supporting clients who express an
foodservice personnel includes several vegetarian and vegan interest in adopting vegetarian diets or who already eat a veg-
quantity recipes (247). Few public schools regularly feature etarian diet. It is important for dietetics professionals to sup-
vegetarian menu items. School lunches are not adequate for port any client who chooses this style of eating and to be able to
vegans even when some vegan options are available because give current accurate information about vegetarian nutrition.
soymilk can only be served as a part of school lunch in cases of Information should be individualized depending on type of veg-
documented lactose intolerance. etarian diet, age of the client, food preparation skills, and ac-
Journal of THE AMERICAN DIETETIC ASSOCIATION / 759
13. ADA REPORTS
tivity level. It is important to listen to the client’s own descrip-
tion of his or her diet to ascertain which foods can play a role in A variety of menu planning approaches can provide adequate
meal planning. Figure 1 provides a listing of Web resources on nutrition for vegetarians. The Vegetarian Food Guide Pyramid
vegetarianism. Figure 2 includes meal planning tips. and Vegetarian Food Guide Rainbow (72,73) suggest one ap-
Qualified dietetics professionals can help vegetarian clients proach. In addition, the following guidelines can help vegetari-
in the following ways: ans plan healthful diets:
s Choose a variety of foods including whole grains, vegetables,
s provide information about meeting requirements for vitamin
fruits, legumes, nuts, seeds, and if desired, dairy products,
B-12, calcium, vitamin D, zinc, iron, and n-3 fatty acids because and eggs.
poorly planned vegetarian diets may sometimes fall short of s Choose whole, unrefined foods often and minimize the intake
these nutrients; of highly sweetened, fatty and heavily refined foods.
s give specific guidelines for planning balanced lacto-ovo-veg- s Choose a variety of fruits and vegetables.
etarian or vegan meals for all stages of the life cycle; s If animal foods such as dairy products and eggs are used,
s adapt guidelines for planning balanced lacto-ovo-vegetarian choose lower-fat dairy products and use both eggs and dairy
or vegan meals for clients with special dietary needs because of products in moderation.
s Use a regular source of vitamin B-12 and, if sunlight expo-
allergies or chronic disease or other restrictions;
sure is limited, of vitamin D.
s be familiar with vegetarian options at local restaurants;
s provide ideas for planning optimal vegetarian meals while FIG 2. Meal planning.
traveling;
s instruct clients about the preparation and use of foods that
frequently are part of vegetarian diets; the growing selection of knowledgeable about all such products. However, practitioners
products aimed at vegetarians may make it impossible to be working with vegetarian clients should have a basic knowledge
of preparation, use, and nutrient content of a variety of grains,
beans, soy products, meat analogs and fortified foods.
General Vegetarian Nutrition: s be familiar with local sources for purchase of vegetarian foods.
Food and Nutrition Information Center, USDA In some communities, mail order sources may be necessary.
http://www.nal.usda.gov/fnic/etext/000058.html s work with family members, particularly the parents of vege-
http://www.nal.usda.gov/fnic/pubs/bibs/gen/vegetarian.htm
tarian children, to help provide the best possible environment
for meeting nutrient needs on a vegetarian diet; and,
Loma Linda University Vegetarian Nutrition & Health Letter s if a practitioner is unfamiliar with vegetarian nutrition, he/she
http://www.llu.edu/llu/vegetarian/vegnews.htm should assist the individual in finding someone who is qualified
Seventh-day Adventist Dietetic Association to advise the client or should direct the client to reliable re-
http://www.sdada.org/facts&fiction.htm sources.
Vegan Outreach CONCLUSIONS
http://www.veganoutreach.org/whyvegan/health.html; Appropriately planned vegetarian diets have been shown to be
http://www.veganoutreach.org/health/stayinghealthy.html healthful, nutritionally adequate, and beneficial in the preven-
The Vegan Society (vitamin B-12) tion and treatment of certain diseases. Vegetarian diets are
www.vegansociety.com/html/info/b12sheet.htm appropriate for all stages of the life cycle. There are many
reasons for the rising interest in vegetarianism. The number of
Vegetarian Nutrition Dietetic Practice Group vegetarians in the United States and Canada is expected to
http://www.vegetariannutrition.net/ increase over the next decade. Dietetics professionals can as-
Vegetarian Resource Group sist vegetarian clients by providing current, accurate informa-
http://www.vrg.org/ tion about vegetarian nutrition, foods, and resources.
The Vegetarian Society of the United Kingdom
References
http://www.vegsoc.org/health/ 1. Barr SI, Chapman GE. Perceptions and practices of self-defined current
VegRD vegetarian, former vegetarian, and nonvegetarian women. J Am Diet Assoc.
2002;102:354-360.
http://vegrd.vegan.com/
2. Perry CL, McGuire MT, Neumark-Sztainer D, Story M. Adolescent vege-
Travel: tarians. How well do their dietary patterns meet the Healthy People 2010
objectives? Arch Pediatr Adolesc Med. 2002;156:431-437.
Happy Cow’s Global Guide to Vegetarian Restaurants 3. Sabate J, Ratzin-Turner RA, Brown JE. Vegetarian diets: descriptions and
www.happycow.net/ trends. In: Sabate J, ed. Vegetarian Nutrition. Boca Raton, FL: CRC Press;
2001:3-17.
VegDining.com 4. Fraser GE. Associations between diet and cancer, ischemic heart disease,
www.vegdining.com/Home.cfm and all-cause mortality in non-Hispanic white California Seventh-day Ad-
ventists. Am J Clin Nutr. 1999;70:532S-538S.
Vegetarian Resource Group 5. White RF, Seymour J, Frank E. Vegetarianism among US women physi-
www.vrg.org/travel/ cians. J Am Diet Assoc. 1999;99:595-598.
6. Lea E, Worsley A. The cognitive contexts of beliefs about the healthiness of
Quantity Food Preparation: meat. Public Health Nutr. 2002;5:37-45.
Vegetarian Resource Group 7. The Vegetarian Resource Group. How many vegetarians are there? Avail-
able at: http://www.vrg.org/nutshell/poll2000.htm. Accessed February 10, 2003.
http://www.vrg.org/fsupdate/
8. The Vegetarian Resource Group. How many teens are vegetarian? How
many kids don’t eat meat? Available at: http://www.vrg.org/journal/vj2001jan/
FIG 1. Useful Web sites. 2001janteen.htm. Accessed February 10, 2003.
9. National Institute of Nutrition. Tracking Nutrition Trends IV: An Update on
760 / June 2003 Volume 103 Number 6