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Vegetarian diets

July 5th, 2005

Abstract

It is the position of the American Dietetic Association and Dietitians of Canada that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases. Approximately 2.5% of adults in the United States and 4% of adults in Canada follow vegetarian diets. A vegetarian diet is defined as one that does not include meat, fish, or fowl. Interest in vegetarianism appears to be increasing, with many restaurants and college foodservices offering vegetarian meals routinely. Substantial growth in sales of foods attractive to vegetarians has occurred, and these foods appear in many supermarkets. This position paper reviews the current scientific data related to key nutrients for vegetarians, including protein, iron, zinc, calcium, vitamin D, riboflavin, vitamin B-12, vitamin A, n-3 fatty acids, and iodine. A vegetarian, including vegan, diet can meet current recommendations for all of these nutrients. In some cases, use of fortified foods or supplements can be helpful in meeting recommendations for individual nutrients. Well-planned vegan and other types of vegetarian diets are appropriate for all stages of the life cycle, including during pregnancy, lactation, infancy, childhood, and adolescence. Vegetarian diets offer a number of nutritional benefits, including lower levels of saturated fat, cholesterol, and animal protein as well as higher levels of carbohydrates, fiber, magnesium, potassium, folate, and antioxidants such as vitamins C and E and phytochemicals. Vegetarians have been reported to have lower body mass indices than nonvegetarians, as well as lower rates of death from ischemic heart disease; vegetarians also show lower blood cholesterol levels; lower blood pressure; and lower rates of hypertension, type 2 diabetes, and prostate and colon cancer. Although a number of federally funded and institutional feeding programs can accommodate vegetarians, few have foods suitable for vegans at this time. Because of the variability of dietary practices among vegetarians, individual assessment of dietary intakes of vegetarians is required. Dietetics professionals have a responsibility to support and encourage those who express an interest in consuming a vegetarian diet. They can play key roles in educating vegetarian clients about food sources of specific nutrients, food purchase and preparation, and any dietary modifications that may be necessary to meet individual needs. Menu planning for vegetarians can be simplified by use of a food guide that specifies food groups and serving sizes. J Am Diet Assoc. 2003;103:748-765.

Vegetarianism in perspective

A vegetarian is a person who does not eat meat, fish, or fowl or products containing these foods. The eating patterns of vegetarians may vary considerably. The lacto-ovo-vegetarian eating pattern is based on grains, vegetables, fruits, legumes, seeds, nuts, dairy products, and eggs but excludes meat, fish, and fowl. The lacto-vegetarian excludes eggs as well as meat, fish, and fowl. The vegan, or total vegetarian, eating pattern is similar to the lacto-vegetarian pattern, with the additional exclusion of dairy and other animal products. Even within these patterns, considerable variation may exist in the extent to which animal products are avoided.

People choosing macrobiotic diets are frequently identified as following a vegetarian diet. The macrobiotic diet is based largely on grains, legumes, and vegetables. Fruits, nuts, and seeds are used to a lesser extent. Some people following a macrobiotic diet are not truly vegetarian because they use limited amounts of fish. Some “self-described” vegetarians, who are not vegetarians at all, will eat fish, chicken, or even meat. Some research studies have identified these “self-described” vegetarians as semivegetarians and have defined semivegetarian as occasional meat eaters who predominately practice a vegetarian diet or those who eat fish and poultry but less than 1 time per week. Individual assessment is required to accurately evaluate the nutritional quality of the diet of a vegetarian or someone who says that they are vegetarian.

Common reasons for choosing a vegetarian diet include health considerations, concern for the environment, and animal welfare factors (5,6). Vegetarians also cite economic reasons, ethical considerations, world hunger issues, and religious beliefs as their reasons for following their chosen eating pattern.

Consumer trends

In 2000, approximately 2.5% of the US adult population (4.8 million people) consistently followed a vegetarian diet and affirmed that they never ate meat, fish, or poultry. Slightly less than 1% of those polled were vegans. According to this poll, vegetarians are most likely to live on the east or west coast, in large cities, and to be female. Approximately 2% of 6- to 17-year-old children and adolescents in the United States are vegetarians, and around 0.5% of this age group are vegan. According to a 2002 survey, about 4% of Canadian adults are vegetarian; this represents an estimated 900,000 people.

Factors that may affect the number of vegetarians in the United States and Canada in the future include an increased interest in vegetarianism and the arrival of immigrants from countries where vegetarianism is commonly practiced. Twenty to 25% of adults in the United States report that they eat 4 or more meatless meals weekly or “usually or sometimes maintain a vegetarian diet,” suggesting an interest in vegetarianism. Additional evidence for the increased interest in vegetarianism includes the emergence of animal rights/ethics courses on college and university campuses; the proliferation of Web sites, magazines and newsletters, and cookbooks with a vegetarian theme; and the public’s attitude toward ordering a vegetarian meal when eating away from home. More than 5% of those surveyed in 1999 said they always order a vegetarian meal when they eat out; close to 60% “sometimes, often, or always” order a vegetarian item at a restaurant.

Restaurants have responded to this interest in vegetarianism. The National Restaurant Association reports that 8 out of 10 restaurants in the United States with table service offer vegetarian entrees. Fast-food restaurants are beginning to offer salads, veggie burgers, and other vegetarian options. Many college students consider themselves vegetarians. In response to this, most university foodservices offer vegetarian options.

There has also been a growth in professional interest in vegetarian nutrition; the number of articles in the scientific literature related to vegetarianism has increased from less than 10 articles per year in the late 1960s to 76 articles per year in the 1990s. In addition, the main focus of the articles is changing. Twenty-five or more years ago, articles primarily had themes questioning the nutritional adequacy of vegetarian diets. More recently, the theme has been the use of vegetarian diets in the prevention and treatment of disease. More articles feature epidemiological studies, and fewer reports are case studies and letters to the editor.

There is a growing appreciation for the benefits of plant-based diets, defined as diets that include generous amounts of plant foods and limited amounts of animal foods. The American Institute for Cancer Research and the World Cancer Research Fund call for choosing predominantly plant-based diets rich in a variety of vegetables and fruits, legumes, and minimally processed starchy staple foods and limiting red meat consumption, if red meat is eaten at all. The American Cancer Society recommends choosing most food from plant sources. The American Heart Association recommends choosing a balanced diet with an emphasis on vegetables, grains, and fruits, and the Heart and Stroke Foundation of Canada recommends using grains and vegetables instead of meat as the centerpiece of meals. The Unified Dietary Guidelines developed by the American Cancer Society, the American Heart Association, the National Institutes of Health, and the American Academy of Pediatrics call for a diet based on a variety of plant foods, including grain products, vegetables, and fruits to reduce risk of major chronic diseases.

New product availability

The US market for vegetarian foods (foods like meat analogs, nondairy milks, and vegetarian entrees that directly replace meat or other animal products) was estimated to be $1.5 billion in 2002, up from $310 million in 1996. This market is expected to nearly double by 2006 to $2.8 billion. Canadian sales of meat analogs more than tripled between 1997 and 2001.

The ready availability of new products, including fortified foods and convenience foods would be expected to have a marked impact on nutrient intake of vegetarians. Fortified foods such as soymilks, meat analogs, juices, and breakfast cereals can add substantially to vegetarians’ intakes of calcium, iron, zinc, vitamin B-12, vitamin D, and riboflavin. Vegetarian convenience foods including veggie burgers and veggie dogs, frozen entrees, meals in a cup, and soymilk can make it much simpler to be a vegetarian today than in the past.

Vegetarian foods are readily available, both in supermarkets and in natural foods stores. About half of vegetarian foods volume is sold through supermarkets and about half through natural foods stores. Three-fourths of soymilk sales take place in supermarkets.

Public policy statements and vegetarian diets

The United States Dietary Guidelines state, “Vegetarian diets can be consistent with the Dietary Guidelines for Americans, and meet Recommended Dietary Allowances for nutrients.” They give recommendations on meeting nutrient requirements for those who choose to avoid all or most animal products. Some have said that implementation of the Dietary Guidelines can best be achieved by use of vegetarian and plant-rich diets. National food guides include some vegetarian options. Foods commonly eaten by vegetarians such as legumes, tofu, soyburgers, and soymilk with added calcium are included in a table accompanying the USDA’s Food Guide Pyramid. Canada’s Food Guide to Healthy Eating can be used by lacto and lacto-ovo-vegetarians. Health Canada has stated that well-planned vegetarian diets are supportive of good nutritional status and health.

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