Though associated with lower risk of chronic diseases, most vegetarian diets are perceived to be nutritionally inadequate

Physicians often express concern about the adequacy of vegetarian diets in health and disease.Though associated with lower risk of chronic diseases, most vegetarian diets are perceived by physicians to be nutritionally inadequate. In a country like India, where vegetarianism is widespread and finds strong cultural roots, physicians find themselves at crossroads on recommending adequate diets. Here we discuss some common concerns about the impact of vegetarian or plant-based diets have on the essential nutrient intake. This should help the physicians to customize their advice to their patients.

The nutrients of concern in the diet of vegetarians include protein, iron, calcium, omega-3 fatty acids, vitamin B 12 and zinc. Here is a low down on tackling these issues.

Protein

Adequate protein intake is believed to be an area of concern for those on plant-based diet. But surprisingly, this isn’t the case.A vegetarian diet can easily meet human dietary protein requirements as long as energy needs are met and a variety of foods are eaten.  Essential amino acids, which cannot be synthesized by the body and must be obtained from food can also be obtained by eating certain combinations of plant-based foods. Examples include rice with dals or pulses and whole wheat roti with beans preparations. A well-designed plant-based diet can thus provide adequate amounts of essential amino acids and prevent protein deficiency.

Iron

It is known that the iron in plants has a lower bioavailability than the iron in meat and hence this is another area of concern. But including iron rich foods regularly in diets can provide adequate amounts of iron. Iron rich foods in Indian diets include green leafy vegetables such as amaranth greens, radish greens, spinach etc. ICMR studies suggest recommending Vitamin C - rich fruits like gooseberries (Amla), guava and citrus to improve iron absorption from plant foods.Patients should be warned against consumption of beverages like tea before or during meal times as these bind dietary iron and make it unavailable. 

Calcium

Calcium intake can be adequate in a well-balanced, carefully planned, plant-based diet. People who do not eat plants that contain high amounts of calcium may be at risk for impaired bone mineralization and fractures. Some significant sources of calcium foods in Indian diets are ragi (nachni), horsegram(kulith), mustard greens, gingelly (til) seeds etc. Spinach and some other plants also contain calcium that, although abundant, is bound to oxalate and therefore is poorly absorbed.

Omega 3 fatty acids- The fatty acids that vegetarians are most likely to be deficient in are omega 3.For adequate amounts of this essential fatty acid, recommendations should include foods such as flax seeds and walnuts.

Vitamin B 12- Individuals who follow a plant-based diet that includes no animal products may be vulnerable to B12 deficiency. For such individuals, supplements of B 12 may be considered. 

Zinc- Well-planned vegetarian diets can provide adequate amounts of zinc from plant sources. Good sources of zinc for vegetarians include whole grains,  legumes, nuts and seeds.

ICMR-Indian Council of Medical Research

 

References

1.Tuso, Philip J et al. “Nutritional Update for Physicians: Plant-Based Diets.” The Permanente Journal 17.2 (2013): 61–66. PMC. Web. 28 Sept. 2017.

2. ICMR- Dietary guidelines for Indians.pdf

This aarticle was originally published on 28.09.17