Brooklynne Helbig

Writing Assignment 2
Advanced Nutrition I
11/5/18
Position of the American Dietetic Association: Vegetarian Diets

It is the position of the American Dietetic Association that appropriately planned

vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate,
and may provide health benefits in the prevention and treatment of certain diseases. Well-
planned vegetarian diets are appropriate for individuals during all stages of the lifecycle,
including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes.1
A vegetarians can be defined as a person who does not eat meat or seafood. There are
many different groups within the vegetarian diet that vary in eating patterns. The lacto-ovo-
vegetarian diet allows the consumption of dairy products and eggs, and the lacto-vegetarian diet
includes dairy products but excludes eggs. The vegan diet is the strictest of all the vegetarian
diets and excludes all meat and fish, as well as all other animal byproducts. Some other diets that
are not strictly considered vegetarian but often follow vegetarian practices with limited amounts
of meat and fish are the macrobiotic diet, the raw food diet, the fruitarian diet, and the semi-
vegetarian diet. Many reasons why vegetarian diets may be considered are environmental
concerns, health reasons, ethical reasons including animal welfare and world hunger issues, and
religious beliefs.
Vegetarian diets are continuously growing more popular and in 2006, about 2.3% of the
United States adult population was considered to be a vegetarian. As the vegetarian community
grows, so does the market for vegetarian products. In 2006, the market for processed vegetarian
foods was estimated at $1.17 billion and was estimated to grow to $1.6 billion by the year 2011.
The market for processed vegetarian foods includes convenience foods items and fortified food
items. The availability of fortified products greatly affect the nutrient intake of vegetarians,
because there are some areas of concern when excluding meat from the diet. The key nutrients
that vegetarians need to focus on are calcium, iron, zinc, vitamin B-12, vitamin D, riboflavin,
and long chain n-3 fatty acids. As vegetarian diets continue to grow in popularity, federal feeding
programs, correctional facilities, and the armed forces are starting to become more
accommodating. The Special Supplemental Nutrition Program for Women, Infants, and Children
and the federal Elderly Nutrition Program offer vegetarian options for those choosing to follow a
vegetarian diet and the US Army’s Combat Feeding Program offers a variety of vegetarian
menus and ready-to-eat meal options. While other programs such as The National School Lunch
Program and correctional facilities offer a limit amount of vegetarian options for people
following a vegetarian diet only due to medical or religious reasons.
It is important that vegetarian diets throughout the lifecycle are carefully planned
to meet the required intake of protein, n-3 fatty acids, iron, zinc, iodine, calcium, vitamin D and
vitamin B-12. Research has shown that it is possible to consume all the essential amino acids
through a variety of plant proteins throughout the day, without the need for complementary
proteins. According to the protein digestibility-corrected score used to evaluate the quality of
protein, some proteins are more effective than others. Vegetarians that consume proteins that are
less effective, such as wheat protein, may have a higher recommended dietary allowance than
those who consume more effective sources of protein, such as soy. It is important to consult a
nutrition professional to have the specific protein needs of individual vegetarians assessed.
 Vegetarian diets are generally higher in n-6 fatty acids, and lower in n-3 fatty acids. Diets
that do not consume fish or eggs are typically low in eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA). EPA and DHA are important for cardiovascular health, and eye
and brain development. There are some fortified foods available on the market, however, without
the regular consumption of fortified soy milk or breakfast bars, it may be necessary to take a
supplement to ensure the recommended intake is being met.
Iron is another area of concern for vegetarians due to the inhibitors associated with the
nonheme iron that is found in plant foods. Some inhibitors of iron absorption can include
phytates, calcium, and polyphenols. Cooking techniques such as soaking and sprouting beans,
grains and seeds can help to increase iron absorption by reducing phytate levels. Vitamin C and
other acids that are typically found in fruits and vegetables can also enhance the absorption of
iron by decreasing the effects of phytates. Due to the inhibitors associated with nonheme iron,
the recommended intake tends to be higher for vegetarians in comparison to non-vegetarians.
Women that are pregnant or lactating also have a higher iron recommended intake, and iron
supplements may be needed due to iron-deficiency anemia that is commonly associated with
pregnancy.
The high amounts of phytic acid that are associated with the vegetarian diet also decrease
the bioavailability of zinc. Good sources of zinc can include soy, legumes, grains, cheese and
nuts. The cooking techniques used to increase iron absorption, such as soaking and sprouting as
well as consumption of vitamin C, can also be used to increase the bioavailability of zinc.
Vegetarian diets tend to be low in iodine and the regular consumption of iodized salt, sea
vegetables, soybeans, cruciferous vegetables and sweet potatoes are recommended for the
avoidance of iodine deficiency.
The calcium intake of lacto-ovo-vegetarians tend to be higher than non-vegetarians,
however, people following a vegan diet tend to be lower than the recommended intake, and
studies have shown a higher risk for bone fractures in vegans. Foods fortified with calcium are
available on the market, making it easier for vegans to reach their daily recommended intake.
Without the regular consumption of fortified foods or foods with a high amount of bioavailable
calcium, supplementation may be necessary to protect bone health. Some vitamins can also be an
area of concern for vegetarians. In addition to calcium, Vitamin D, is also important for bone
health. The consumption of vitamin D fortified foods or supplementation may be necessary to
avoid a vitamin D deficiency. Many factors can affect vitamin D synthesis such as the time of
year and sun exposure.
Vitamin B-12 is another vitamin of concern. Lacto-ovo-vegetarians tend to consume an
adequate amount of B-12 through dairy foods and eggs, however, vegans must consume B-12
through fortified foods or supplements. Vitamin B-12 deficiencies can lead to an increased risk
of many different chronic diseases and it is important for vegetarians to have their vitamin B-12
intake assessed, to ensure an adequate amount is being consumed or supplemented.
Women that are pregnant or lactating have a higher iron recommendation and iron
supplements may be needed due to iron-deficiency anemia that is common during pregnancy.
Depending on environmental factors such as exposure to sun, vitamin D fortified food should be
consumed during pregnancy and lactation. Zinc, calcium, folate, and DHA’s are also important
during pregnancy and should be consumed through fortified foods or supplements. DHA’s are
have gestational benefits on length, visual function and neurodevelopment of infants.
Breastfeeding should be supported in women following a vegetarian diet, and the breastmilk is
considered nutritionally adequate for the infant. Infants can follow a vegetarian diet but intake of
vitamin B-12 and zinc should be assessed by a nutrition professional to ensure the infant is
receiving adequate amount of these micronutrients.
The growth of children following a lacto-ovo-vegetarian diet are similar to non-
vegetarian children, however, according to some studies, vegan children tend to be smaller but
still within the normal range. Lacto-ovo-vegetarian adolescents are similar in growth to non-
vegetarian adolescents and generally consume more fruits and vegetables, fiber, iron, folate,
vitamin A and C. Vegetarian diets are often used to mask eating disorders and nutrition
professionals should be aware of the signs and be able to identify the symptoms of eating
disorders. Older adults have a higher recommendation for many nutrients, some included in the
areas of concern for vegetarians. Absorption of vitamin B-12 tends to lessen in older adults, as
well as vitamin D production. The need for supplementation of vitamin D increases for people
following a vegetarian diet as they age. Competitive athletes can also follow a vegetarian diet, as
long as the diet meets the energy, fat, calcium and iron requirements, although, they may have
lower muscle creatine levels and may benefit from the supplementation of creatine.
Research shows that a vegetarian diet can help reduce the risk of chronic diseases such as
cardiovascular disease, hypertension, diabetes, obesity and some cancers. The reduced risk of
cardiovascular diseases is thought to be because of the lower BMI and lower total cholesterol
that is seen in vegetarians. The vegetarian diet is associated with a lower LDL cholesterol level,
higher HDL cholesterol level and lower triglyceride levels. This is thought to be because of the
higher amounts of fiber, fruits, vegetables, nuts, soy, and plant sterols. A vegetarian diet can also
reduce the risk of hypertension due to the associated of a lower BMI and lower blood pressure
thought to be because of the high amounts of potassium, magnesium, antioxidants, dietary fat
and fiber found in plant foods. A lower blood pressure is also thought to protect against
developing dementia. The lower BMI in vegetarians is also associated with the reduced risk of
obesity. The vegetarian diet is also thought to reduce the disk of diabetes because of the high
intake of fruits, vegetables, fiber, whole-grain foods, nuts and legumes. These factors are thought
to help reduce insulin sensitivity and improve glycemic control. Vegetarian diets are also
associated with the reduced risk of certain cancers such as prostate, stomach, lung, mouth, and
esophageal cancers because of their phytochemical content. The regular consumption of whole
grains are also associated with protection against many different cancers.
There are many factors of a vegetarian diet that are associated with reduced risk of
chronic diseases, however, some factors are associated with an increased risk of disease. Not
consuming enough vitamin B-12 can lead to an increased risk of dementia and cardiovascular
disease due to high homocysteine levels. A high consumption of protein from animal sources or
plant sources can lead to renal disease and vegetarians should consume adequate amounts of
protein, but not to exceed the adequate protein intake long-term.
Cardiovascular disease affects many people in the United States and has been the leading
cause of death since the year 1950.2 Many people that suffer with cardiovascular disease are
treated with drug therapy to lower the risks by targeting lipid levels and blood pressure. It is
predicted that by the year 2030, 40% of the United States population may develop some form of
cardiovascular disease. It is suggested by the American Dietetic Association that a vegetarian
diet can reduce the risk of cardiovascular disease. Najjar et al2 suggests that a plant based diet
may be able to not only reduce the risk of cardiovascular disease, but also help to treat the
disease by reducing the amount of drug therapy used. A study was conducted to test the effects
of a plant-based diet on hypercholesterolemia, hypertension and the need for medication.
Participants consumed foods such as raw fruits and vegetables, seeds and avocado for four
weeks. The medication needs were assessed once a week. The study found that a plant-based diet
can significantly reduce systolic and diastolic blood pressure and serum lipids, as well as the
medications used to treat them. This evidence is in accordance with the position of the American
Dietetic Association and suggests a vegetarian diet has both a therapeutic strategy to reduce the
amount of drug therapy used in patients, and can effectively mitigate cardiovascular risk. A
similar study was conducted by Esselstyn et al3 to investigate the effects of a plant-based dietary
intervention on patients with cardiovascular disease. The participants in this study were
counseled in plant-based nutrition and were asked to continue with their regular treatment for
cardiovascular disease. The results showed that patients with cardiovascular disease that
participated in a plant-based diet for an average of 3.7 years, experienced less cardiac events and
suggests that a plant-based diet can help to reduce the cardiovascular epidemic.
Many studies have suggested that diabetes is 46-76% lower in individuals that adhere to a
vegetarian diet in comparison the with non-vegetation population.4 A study was conducted to
investigate the effects of a vegan dietary intervention on beta-cell function and insulin resistance
in overweight adults. The study included both men and women and the participants were
randomized into two intervention groups, one which followed a vegan diet and a control group
that were given no dietary instruction. The foods included in the dietary intervention were fruits,
vegetables, grains and legumes. The participants were also asked to avoid added fats. The
outcome of the study showed that a vegan dietary intervention increases the stimulation of
insulin secretion and the sensitivity to beta-cell glucose. The study suggests that a vegan diet can
aid in the prevention of diabetes through insulin resistance and beta-cell function. The outcome
of the study is in accordance with the position of the American Dietetic Association that
consuming a vegetarian diet can help to reduce the risk of type 2 diabetes.
Recent studies have further shown that a vegetarian diet has the potential to reduce the
risk of chronic diseases such as cardiovascular disease and type 2 diabetes.2,3,4 The current
studies are in accordance with the American Dietetic Association, and provide reason to believe
that implementing a vegetarian diet could positively impact the diseases that are greatly affecting
the United States population. It can be concluded that implementing an abundance of fruit,
vegetables, whole grains, legumes, nuts and seeds can provide many health benefits and a well-
planned vegetarian diet can be suitable and beneficial for all stages of the lifecycle.
1. Craig WJ, Mangels AR, American Dietetic Association. Position of the American Dietetic
Association: vegetarian diets. J Am Diet Assoc. 2009;109(7):1266-1282.
http://www.ncbi.nlm.nih.gov/pubmed/19562864. Accessed November 4, 2018.
2. Najjar RS, Moore CE, Montgomery BD. A defined, plant-based diet utilized in an
outpatient cardiovascular clinic effectively treats hypercholesterolemia and hypertension
and reduces medications. Clin Cardiol. 2018;41(3):307-313. doi:10.1002/clc.22863
3. Esselstyn CB, Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam
Pract. 2014;63(7):356-364b. http://www.ncbi.nlm.nih.gov/pubmed/25198208. Accessed
November 4, 2018.
4. Kahleova H, Tura A, Hill M, Holubkov R, Barnard ND. A Plant-Based Dietary
Intervention Improves Beta-Cell Function and Insulin Resistance in Overweight Adults: A
16-Week Randomized Clinical Trial. Nutrients. 2018;10(2). doi:10.3390/nu10020189