The document outlines various vegetarian dietary classifications and their health benefits, such as reduced risks of diabetes, heart disease, and cancer. It emphasizes the nutritional challenges faced by vegetarians, particularly concerning vitamin B12, iron, calcium, and omega-3 fatty acids, providing guidance on food sources and supplementation. Additionally, it discusses the dietary needs of pregnant women and young children following vegetarian diets.

1. Vegetarian 101
Dr. Lisa Watson, ND

2. Vegetarian Terminology

3. Vegetarian Terminology
Vegan – consumes NO animal products (including
meat, poultry, fish, eggs, dairy, honey)
Lacto-Ovo Vegetarian – consumes no meat, fish or
poultry but does consume dairy and/or eggs
Pescetarian– consumes no meat or poultry but does
consume fish, dairy and/or eggs
Flexitarian– consumes a predominantly vegetarian
diet but consumes meat or poultry on occasion

4. Health Benefits
of a Vegetarian Diet

5. Benefit 1: Decreased risk of diabetes
Vegetarian diets reduce the risk of developing
diabetes and are associated with improved insulin
sensitivity and decreased oxidative stress.
Vegetarian diets are more
successful than omnivore
diets in managing existing
diabetes.

6. Benefit 2: Decreased risk of heart
disease
Vegetarians have lower incidence of heart
disease, lower LDL (bad) cholesterol, lower rates of
obesity and lower rates of hypertension.

7. Benefit 3: Decreased risk of obesity
On average, vegetarians have lower BMIs (body
mass index) than omnivores with vegans having
even lower BMIs.
Obesity is the main risk factor
for a number of chronic conditions
including hypertension, heart
disease, diabetes and
reduced life expenctancy.

8. Benefit 4: Improved mood
Vegetarians report less negative mood states than
omnivores. When omnivores change over to a
vegetarian diet self reported mood states improve.
Beezhold BL, Johnston CS. Restriction of meat,
fish, and poultry in omnivores improves mood:
a pilot randomized controlled trial. Nutr J. 2012
Feb 14;11:9.

9. Benefit 5: Decreased risk of cancer
A vegetarian diet is associated with a decreased
incidence of cancer for two main reasons:
• vegetarian diets are high in fiber, antioxidants
and phytonutrients that are cancer-protective
• vegetarian diets contain
no red meats or processed
meats – both of which have
been linked to an increased
incidence of cancer.

10. Nutritional Needs
of Vegetarians

12. But some nutrients are more
challenging to get…

13. Vitamin B12
Necessary for normal functioning of the brain
and nervous system
Also required by our body to produce energy
and utilize fatty acids

14. Vitamin B12
Necessary for normal functioning of the brain
and nervous system
Also required by our body to produce energy
and utilize fatty acids
Did you
know?
No plant or animal
can make their
own B12 –
Only bacteria can
synthesize it.

15. Vitamin B12
Up to two-thirds of vegans and one-third of
vegetarians are deficient.
(Up to one-third of omnivores are also deficient)
B12 deficiency can lead to
anemia (low red blood cells)
and nervous system damage.
Because folic acid levels are
high in vegans and vegetarians
a B12 deficiency can be hidden
until it is severe and causing
symptoms.

16. Vitamin B12
Vegetarian sources of B12:
• Eggs
• Dairy products
•Spirulina
•Miso
•Tempeh
• Nutritional yeast
• Fortified cereals, soy/
almond/ rice milk
• Supplements
• Healthy intestinal bacteria

17. Vegetarian Science Break
Homocysteine– an amino acid found in the
blood. High levels are associated with heart
disease, stroke, dementia and early mortality.
Elevated homocysteine concentration in plasma was
observed in 66% of the vegans and about 45-50% of
the omnivores and vegetarians. Vegan subjects had
significantly higher mean plasma homocysteine levels
than omnivores.
B-vitamin status and concentrations of homocysteine in Austrian omnivores,
vegetarians and vegans. Ann NutrMetab 2006.
Why?

18. Vegetarian Science Break
Deficiency of vitamin B12, folic acid or vitamin
B6 can all lead to elevated homocysteine levels.
Folic acid and vitamin B6 levels in vegans are
usually high compared to omnivores. So B12
deficiency is the most likely cause of high
homocysteine in vegans.

19. Vegetarian Science Break
In the body methionine (an amino acid) is turned
into homocysteine. Vitamin B12 is used to turn
the homocysteine back into methionine.
If there is not enough vitamin B12, then
homocysteine levels remain high.
American vegans consume an average of
5.6mcg of vitamin B12 through fortified food
daily. The recommended intake is 100mcg daily.

20. Vegetarian Science Break
But don’t vegans have a lower risk of
cardiovascular disease?
Vegans have lower cholesterol levels and blood
pressure than omnivores.
However, studies looking at the negative effects
of homocysteine adjusted for cholesterol levels
and blood pressure and still found an increased
incidence of heart disease, stroke, dementia and
death.

21. Vegetarian Science Break
Vitamin B12 offers a safe and effective way to
lower homocysteine levels in vegans with no
adverse effects.
ALL vegans (and most vegetarians) should be
taking a daily B12 supplement.

22. Riboflavin – Vitamin B2
Necessary for energy production and
metabolism
Used by the body to metabolize
fats, carbohydrates and proteins
Riboflavin is water-soluble and is not
stored in the body. It must be
consumed daily.
Riboflavin is bright yellow in colour
and causes yellowing of the urine
when taken in supplements.

23. Riboflavin – Vitamin B2
Studies suggest that up to 30% of vegans are
deficient in riboflavin due to inadequate daily
consumption.
Symptoms of deficiency include dry,
cracked lips, mouth ulcers, cracks at
the corner of the mouth and sore
throat
A diverse diet, supplementation or use
of fortified foods is usually enough for
most vegetarians and vegans to meet
their daily needs.

24. Riboflavin – Vitamin B2
Vegetarian sources of riboflavin:
• Milk, cheese
• Fortified bread and cereals
• Green leafy vegetables
• Legumes
• Yeast
• Mushrooms
• Almonds
• Supplements

25. Vitamin D
Produced in the skin from sun exposure.
In Canada we are unable to produce vitamin D from
sun rays during the months of October to April.
Vitamin D is required for
absorption of calcium, for
proper functioning of the
immune system and
decreases the risk of developing
over 16 different types of cancer.

26. Vitamin D
In Canada all dairy products are fortified with
vitamin D. Some milk alternatives are also fortified.
Vitamin D supplements are recommended for ALL
Canadians – infants, children, teens and adults –
during the winter months.

27. Vitamin D
Vegetarian sources of Vitamin D:
• Fortified dairy products
• Fortified soy, almond and rice milks
• Sun exposure May-September
• Supplements

28. Calcium
Necessary for the function of muscles (including
the heart), release of neurotransmitters and for
calcification of the teeth and bones.
Vitamin D is required for calcium absorption.
Consumption of animal proteins
increases calcium requirements,
so vegans may have lower daily
needs.

29. Calcium
Dairy is a popular source of calcium, but this
mineral is found in a wide variety of foods.
A diverse vegan diet can be rich in calcium.
Some plants contain oxalates and
phytates, compounds that can
inhibit calcium absorption.
Eating a wide variety of calcium
rich foods will result in better
absorption and adequate
calcium levels.

30. Calcium
Vegetarian sources of calcium:
• Dark green vegetables – kale, bok
choy, spinach, collards, broccoli
• Beans
• Tofu and tempeh
• Sesame seeds
• Almonds and almond butter
• Blackstrap molasses
• Fortified soy, almond and rice milks
• Figs
• Dairy

31. Iron
Iron is used by red blood cells to carry oxygen to
tissues – less iron, less oxygen to our
organs, muscles, skin and brain
Iron is also necessary for energy
production and proper functioning
of the immune system.

32. Iron
Vegetarians typically consume as much iron in
their diet as omnivores.
However, the iron in vegetables is less
bioavailable. It is more difficult to absorb and it is
more sensitive to inhibitors of iron
absorption. Inhibitors include:
•Phytates
• Calcium
• Polyphenols – found in
coffee, tea and red wine

33. Science Break - Phytates
•Stores phosphorus in plants
• Is indigestible by humans
• Binds to minerals and makes
them unabsorbable
• Negatively impacts absorption
of iron, zinc and to a lesser
extent calcium and
magnesium

34. Science Break - Phytates
•Found in nuts, grains, beans
and seeds
• To decrease the impact of
phytates:
• Cook your food
• Fermentation
• Sprouting
• Vitamin C – decreases
impact of phytates on
iron absorption

35. Iron
Because of the lower bioavailability of iron from
a vegetarian diet, the recommended iron
intakes for vegetarians are 1.8 times that of
nonvegetarians.
Position of the American Dietetic Association:
Vegetarian Diets.
J Am Diet Assoc. 2009;109: 1266-1282.

36. Iron
Vegetarians adapt to lower absorption of iron
and have the same incidence of anemia as
non-vegetarians.
Women, children, teens, pregnant
and breast feeding mothers
should be diligent about maintaining
adequate iron levels and stores.

37. Iron
Vegetarian sources of iron:
• Soy beans and tofu
• Lentils
• Spinach and dark green leafy
vegetables
• Sesame seeds
• Chick peas (Garbanzo beans)
• Lima beans and navy beans
• Olives
• Fortified cereals
• Blackstrap molasses

38. Iodine
Necessary for thyroid function and breast
health.
Vegans who do not consume table salt or sea
vegetables are often deficient in iodine because
plant-based diets are low in iodine.
Iodine is added to many foods to
ensure sufficient intake:
• Table salt
• Flour
• Milk

39. Iodine
The salt used in processed foods is NOT iodized
Sea salt, pink salt, gray salt, etc are not iodized
and may not contain adequate amounts of
iodine.
Vegetarian sources of iodine:
• Iodized table salt
• Sea vegetables (kelp,
nori, wakame)
• Dairy products
• Eggs

40. Zinc
Needed for immune functioning, protein
synthesis, wound healing, DNA synthesis and cell
division.
Zinc is of particular importance during periods of
growth (pregnancy, infancy, childhood, teens) and
during sexual maturation (teens).
Animal products provide
the majority of zinc in North
American diets.

41. Zinc
Zinc may be deficient in vegan diets that are high in
phytates.
Zinc must be consumed daily because our bodies
have no storage for this mineral.
Vegetarians need up to 50% more
zinc than the recommended
daily allowance to compensate
for the poor absorption of zinc
from plant-based diets.

42. Zinc
Vegetarian sources of zinc:
• Soy beans and tofu
• Lentils
• Beans
• Grains (especially oats)
• Nuts
• Pumpkin and sesame seeds
• Mushrooms
• Cheese and yogurt

43. Omega 3 Fatty Acids
The omega 3 fatty acids, docosahexanoic acid
(DHA) and eicosapentanoic acid (EPA) are
necessary for cardiovascular health, mental
health, brain health and eye health.
Vegan diets that do not contain
eggs, fish or abundant amounts of
algae are often deficient in omega 3s.

44. Omega 3 Fatty Acids
Vegan diets are rich in omega 6s (found in
vegetable oils, canola oil, soybean oil, corn oil and
sunflower oil) which can prevent utilization of
omega 3s by our cells.
The ideal balance of omega 6s to omega 3s is
1:1 to 4:1. Omnivores in North American
average a ratio of 10:1,
vegetarians 16:1 and vegans 20:1.

45. Omega 3 Fatty Acids
Omega 6 fatty acids are pro-inflammatory,
pro-thrombotic and pro-constrictive.
An imbalance of omega 6 to omega 3
can contribute to cancer, arthritis,
inflammation and heart disease.

46. Omega 3 Fatty Acids
The omega 3 fatty acid found in plants, alpha-linolenic
acid (ALA) can be converted into EPA and DHA.
The conversion rate to EPA is typically 5-10%.
The conversion rate to DHA is even worse (2-5%).
Micro-algae can provide a vegan
source of DHA and can increase
EPA levels as well (through a
process known as retroconversion).

47. Omega 3 Fatty Acids
Vegan requirements for ALA are DOUBLE that of
the recommended daily allowance in order to
compensate for the poor conversion rates.
Vegetarian sources of Omega 3s
• Flaxseeds
• Walnuts
• Soy
• Hempseeds
• DHA rich micro-algae
• Dark green leafy vegetables
• Eggs

48. Protein & Essential Amino Acids
Protein provides the body with amino acids which
are used as a source of energy and as building
blocks for muscles, skin, hormones, and enzymes.
Amino acids that can not be made by
our body are considered essential.
The essential amino acids are:
•Leucine •Tryptophan
•Isoleucine •Methionine
•Valine • Phenylalanine
• Lysine •Histidine
•Threonine

49. Protein & Essential Amino Acids
Eating a diverse selection of plant foods will
ensure you get enough essential amino acids in
your diet.
Legumes are high in lysine, but low
in methionine.
Grains are high in methionine but
low in lysine.
Eating both grains and legumes, as
well as vegetables and fruits will
provide all the essential amino acids.

50. Protein & Essential Amino Acids
Food Combining:
It is not necessary to consume both grains and
legumes in the same meal to meet your need
for essential amino acids. Eating them over
the course of a single day is adequate.
Vegetarians should aim to consume
1.0g of protein per kg of body weight
daily to meet their personal needs.

51. Protein & Essential Amino Acids
Vegetarian Sources of Protein
• Soy beans, tofu, tempeh
• Legumes, lentils, peas
• Beans (black, white, red, chick peas)
• Quinoa
• Nuts and nut butters
• Seeds
• Brown rice
• Spinach
• Broccoli
• Eggs
• Dairy

52. Don’t Think You Can Get
Enough Protein?
Bigger vegetarians than YOU:
• Horses (1000 Lbs)
• Cows (1650 Lbs)
• Hippopotamus (7000 Lbs)
• Elephants (16 000 Lbs)
•Argentinosaurus (200 000 Lbs)

53. What about SOY?

54. What about SOY?
Soy beans (Glycine max) are a legume that are:
• High in protein
• High in fat
• Low in carbohydrates
• A source of omega 3 ALA
• A source of isoflavones

55. What about SOY?
Isoflavones – The source of the soy controversy
•Soy contains genistein, daidzein and glycitein
•Isoflavones are mildly estrogenic – they are
able to bind to estrogen receptors in the body
•Isoflavones bind selectively to beta estrogen
receptors and are classified as natural selective
estrogen receptor modulators (SERMs)
• SERMS have estrogen-like effects in some tissues,
but not in others

56. What about SOY?
Soy and Breast Cancer
In mice studies, genistein can increase the
growth of estrogen-sensitive tumours
•The amount used in these studies was 20x normal
human exposure
•Mice also lack the ability to detoxify
isoflavones, causing higher circulating amounts.
Humans can detoxify isoflavones efficiently and

57. What about SOY?
Soy and Breast Cancer
In human studies soy has been found to NOT
alter markers of breast cancer risk, including
breast tissue density and breast cell
proliferation.
In fact, post-diagnosis consumption of soy food
is associated with a better prognosis (measured
by mortality and tumour recurrence)

58. What about SOY?
Soy and Feminization of Boys
Soy and soyfoods do not alter testosterone
or dihydrotestosterone levels.
Clinical studies have also found no impact of
soy consumption on sperm count or
motility.

59. What about SOY?
Soy and Thyroid Function
Soy can interfere with absorption of
Synthroid, as can many other fiber-rich
foods.
Soy can worsen hypothyroid symptoms if
iodine levels are not adequate.

60. SO… Should I eat soy?
Yes.
Soy is safe and is an easy and effective way
to increase protein and fiber in your diet.
How much?
Research suggests 2-3 servings per day is
enough to reap the benefits of soy. Choose
less processed soy foods and incorporate
them into a diverse vegetarian diet.

61. Vegetarian Diet
In Special
Populations

62. Vegetarian Diet
In Pregnancy
& Breastfeeding

63. Nutrient Needs of
Pregnant Vegetarians
• Increased caloric intake
• Increased protein
• Increased iron
• Increased vitamin B12
• Increased vitamin D
• Increased folic acid
• Increased zinc
• Increased DHA
• Increased calcium
• Increased iodine

64. Nutrient Needs of
Pregnant Vegetarians
All of these nutrients can be found in a diverse
vegetarian diet. Supplements may be
recommended to ensure adequate levels in
pregnancy.

65. Nutrient Needs of
Pregnant Vegetarians
Iodine
Vegan women who are pregnant or
breastfeeding should take an iodine
supplement to prevent
hypothyroidism and potential mental
retardation in their infants.
Only 30% of prenatal vitamins contain
adequate amounts of iodine – choose
carefully

66. Nutrient Needs of
Pregnant Vegetarians
Vitamin B12
Low B12 in pregnancy is associated with an
increased risk of neural tube defects,
pre-eclampsia and other pregnancy
complications.
Vegans and lacto-ovo vegetarians
are at risk of deficiency during
pregnancy.

67. Nutrient Needs of
Pregnant Vegetarians
Recommended supplements:
• Iron (if developing anemia)
• Folic acid containing prenatal vitamin
• Vitamin B12
• Vitamin D (from October to May)
• Iodine
• DHA-rich algae
• Protein supplement and/ or
calcium supplement (diet
dependent)

68. Vegetarian Diet
in Infants and Toddlers

69. Vegetarian Babies and Toddlers
Breast feeding moms should pay attention
to getting adequate vitamin B12, vitamin
D, calcium, zinc, iron and DHA.
Babies breastfed by vegetarian mothers
have similar rates of growth and
development as babies of
omnivore moms.

70. Vegetarian Babies and Toddlers
Protein-rich foods should be among the first
foods introduced in infancy.
Pureed tofu, legumes, lentils, peas,
beans, chick peas, cooked egg yolk,
goat yogurt, and cottage cheese
can all be introduced in the
first year alongside
vegetables, fruits and grains.

71. Vegetarian Babies and Toddlers
Because of the lower digestibility of plant
protein, daily needs may be higher.
30% higher up to 2 years of age
(1.5g/kg/day)
20-30% higher for 2-6 year olds
(1.3g/kg/day)
15-20% higher for 6 and up
(1.15g/kg/day)

72. Vegetarian Babies and Toddlers
DHA is important for nervous system and
eye development in infants and toddlers.
Preterm infants may not be able to convert
ALA into EPA and DHA and benefit
from direct supplementation.

73. Vegetarian Babies and Toddlers
All breastfed babies (and all Canadian babies
during the winter) should be supplemented
with vitamin D regardless of being
vegetarian or not.
Toddlers not consuming fortified
milk (or fortified alternative milk)
products should continue
year-round supplements.

74. Vegetarian Diet
in Children

75. Vegetarian Kids
Vegetarian kids have normal growth and
development from infancy through to
adulthood.
Vegan children and teens may be shorter and
lighter, but are still within the
range of normal height and weight.

76. Vegetarian Kids
Iron is the most common nutrient deficiency
in childhood (usually associated with
over-consumption of cows milk).
Vegetarian kids require more iron to
compensate for the poor absorption
of plant-based iron
(about 1.8x more).

77. Vegetarian Kids
Recommended daily iron intake for
vegetarian kids is:
Age Daily Iron Intake
1-3 years 12mg
4-8 years 18mg
9-13 years 14mg
Supplements may be necessary
during periods of rapid growth.

78. Vegetarian Kids
Calcium intakes in vegan children are often
below daily recommended intakes.
Children should consume adequate calcium
to ensure healthy bone and teeth
development.
8 or more servings of
calcium-rich foods are
recommended daily.

79. Vegetarian Diet
in Teens

80. Vegetarian Teens
Teens are one of the fastest growing
populations of vegetarians.
A well-executed vegetarian diet can provide
all the calories and nutrients needed
for the growth and development
of adolescents.

81. Vegetarian Teens
There are concerns that a vegetarian diet
may mask an eating disorder in teens.
Education on healthy eating patterns
is important to ensure a healthy
vegetarian diet during the
teen years.

82. Vegetarian Teens
Vitamin D, B12, calcium and iron are all
important for proper growth during
the teen years.
Zinc is necessary for proper
sexual development and
adequate intake should be
emphasized in all
vegetarian teens.

83. Vegetarian Teens
The high calorie needs of teens can be met
most efficiently by eating frequently.
Encouraging healthy snack habits
can help vegetarian teens meet
their nutritional needs and
caloric needs.

84. The Ideal
Vegetarian Diet

85. The Five Major Plant-Based Food Groups
• Whole grains
• Legumes and beans
• Vegetables
• Fruits
• Nuts and seeds

86. Whole Grains
Provide fiber, iron, complex carbohydrates,
B vitamins and minerals like zinc.
Choose 6 or more servings per day
• Oatmeal
• Cereals
• Rice (brown rice, wild rice)
• Quinoa
• Millet
• Barley
• Amaranth
• Teff

87. Legumes and beans
Provide protein, B vitamins, iron and trace minerals.
Choose five or more servings per day.
• White, black, red beans
• Peas, black eyed peas
• Lentils
• Chick peas
• Tofu or tempeh
• Processed soy products
(in moderation only!)

88. Fruits
Provide vitamins, fiber and phytonutrients.
Choose two or more servings per day.
• Apples, pears
• Bananas
• Oranges, grapefruit
• Berries, cherries
• Tropical fruit – mango, papaya
• Melons
• Plums, peaches
• Dates, figs
• Dehydrated fruits

89. Vegetables
Provide calcium, iron, phytonutrients and trace
minerals.
Choose four or more servings per day.
• Raw vegetables
• Cooked vegetables
• Vegetable juices
• Dark green leafy vegetables
• Yellow, orange, red and green
vegetables

90. Nuts and Seeds
Provide protein, fiber, fats, and antioxidants.
Choosetwo or more servings per day.
• Almonds, walnuts, hazelnuts,
brazil nuts, pecans, pistachios,
cashews
• Nut butters
• Pumpkin, sesame, sunflower
seeds
• Flax, hemp, chia seeds

91. Calcium
While not a food group, it is important to emphasize
calcium in the vegan diet to ensure adequate intake.
Eat eight or more calcium rich foods daily
• Dark green vegetables – kale, bokchoy,
spinach, collards, broccoli
• Beans
• Tofu and tempeh
• Sesame seeds
• Almonds and almond butter
• Blackstrap molasses
• Fortified soy, almond and rice milks
• Figs
• Dairy

92. Resources

93. The Vegetarian Resource Group – www.vrg.org
Toronto Vegetarian Association – www.veg.ca
American Dietetic Association – www.eatright.org
Veg Family Magazine – www.vegfamily.com

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