Being vegetarian: A healthy alternative?

Some believe vegetarians eat nothing but 'rabbit food' and lentils. But a vegetarian diet can be both varied and healthy.

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Vegetarian eating has been around for over 2000 years. In many countries (such as India) and for several religions (Buddhist, Muslim), vegetarian eating is the dominant eating pattern. On a pure numbers basis there may even be more non-meat eaters worldwide than meat eaters.

The 1997 NZ National Nutrition Survey showed 94% of us eat a 'mixed' diet, while 6% of New Zealanders have 'other' eating styles including vegetarian eating patterns. A sub-group who 'avoid meat but eat chicken' made up 2% of this group (more women appeared in this group).

Types of vegetarian

A vegetarian diet usually involves removing animal flesh (red meat, poultry, fish and seafood) from the diet, but can also exclude animal milk and eggs. There are several variations:

• Lacto-ovo vegetarians add milk and eggs to a base of cereal, grains, nuts, seeds, legumes, fruit and vegetables.
• Lacto vegetarians do not consume eggs but will drink milk in addition to a base of cereal, grains, nuts, seeds, legumes, fruit and vegetables.
• Vegans or total vegetarians exclude milk and eggs. Protein comes from plant sources. Vegans will often not use honey, leather, wool and foods containing gelatine (jelly beans, jelly and marshmallow). Some will not wear silk or pearls and may have a philosophy to protect animals from suffering and exploitation.
• Semi vegetarians usually avoid red meats, but may also exclude fish, shellfish and/or chicken or may only exclude red meat. Eat whole grains, legumes, dairy, eggs, fruit and vegetables.

Less common forms of vegetarian eating include: ovo vegetarian (will eat eggs but not dairy), and pisco vegetarian (includes fish while excluding chicken and red meat).

Three other forms of eating, often believed to be vegetarian, are in fact unhealthy and inadequate eating patterns. These are fruit-only eating patterns (fruitarians), grain-only diets (grainarians) and eating styles based on only rice.

Why do people become vegetarian?

Common reasons for becoming vegetarian include:

• to improve overall health
• to improve specific disease state (heart disease, diabetes)
• to save money
• religious reasons (Hindu, Muslim, Bahai, 7th Day Adventist)
• environmental concerns
• moral and ethical issues
• concern for animal welfare
• weight control
• limited availability of animal foods

At some stage in life everyone makes the connection about where meat actually comes from. This may promote a change to a non-meat diet for a time.

Teenage vegetarianism is largely a female issue. In New Zealand, 13% of 15-18-year-old females reported eating a vegetarian diet or avoiding red meat, compared to 1% of males in this age group. Older girls (11-14 years) showed a tendency to 'avoid red meat' in greater numbers than boys (5.6% compared to 2.7%).

For some people, becoming vegetarian may be a way of getting some control over their lives. There is currently conflicting research regarding the incidence of eating disorders and a possible link with vegetarian eating.  Some reports suggest no link while others have found an association. This appears very individual and there are many factors involved in disordered eating. If you're concerned as a parent, discuss the issue with your doctor or dietitian.

Are vegetarians healthier?

A well-planned and balanced vegetarian diet can meet all your nutritional needs

Vegetarian diets offer a number of health advantages, including lower levels of saturated fat and cholesterol and higher levels of complex carbohydrates, fibre, folate and antioxidants (vitamins C and E). The vegetarian diet also tends to be lower in glycaemic index, assisting blood glucose control and weight maintenance.

Studies report many health professionals are unaware of the benefits of a vegetarian eating pattern and can be unsupportive of the eating style (perhaps this is because they see the effects of the unhealthy or poorly balanced vegetarian eating patterns).

In fact, following a vegetarian lifestyle leads to less risk of developing a number of Western diseases such as obesity, diabetes, hypertension and diet-related cancers. This has been supported by many research studies.

Vegetarians are also known to smoke less, consume less alcohol (if at all) and tend to follow other beneficial lifestyle patterns.

Vegetarians tend to have lower body fat, lower body weight and lower blood pressure. Energy (kilojoule) intakes are reported at adequate or lower levels. These all combine to produce lower rates of overweight and obesity. Protein, cholesterol and fat intakes appear generally adequate, and for lacto ovo and vegan vegetarians, protein does not appear to be a concern.

Vegetarians tend to score much higher on general nutrition tests than non-vegetarians. Nutrition knowledge is helpful when planning a well-balanced vegetarian diet.

Becoming vegetarian... the healthy way

If you decide a vegetarian diet is the way you want to go, it's not simply a matter of removing the meat from your current diet. You can transition from meat-eating to a meatless diet over several months. Too often the portion of meat is replaced by high-fat dairy foods such as cheese or quiche, which results in a less healthy dietary change (high in saturated fat and cholesterol, with total fat increased dramatically).

Here are some guidelines to becoming a vegetarian:

• Improve your current diet first (eat healthier fats, whole grains, fruit and vegetables, and leaner protein foods).
• Make changes slowly and begin by eating less meat rather than cutting it out completely.
• Replace some of the meat with other protein and increase your intake of whole grains, nuts, seeds, legumes, fruit and vegetables.
• Make changes without compromising your overall nutrition.
• When removing a food or food group, replace the nutrients with something else, eg. soy milk replaces cows' milk, lentils replace chicken.
• Follow the food pyramid for vegetarians (see image at right); eat the recommended servings from all the food groups (not just fruit and vegetables).
• Eat a wide variety of foods and learn to cook new recipes and dishes.
• Use canned, cooked legumes (chilli beans, kidney beans etc) to assist with quick meal preparation.

Healthy eating guidelines for vegetarians

Get enough energy

When people remove meat from the diet there can be a reduction in total energy (kilojoule) levels which must be replaced from other sources. If the diet includes a wide variety of foods, nutrient and energy deficiencies are unlikely; however, if vegetarians don't get enough energy then weight-loss and fatigue can occur. Because a vegetarian diet is high in fibre, making it quite bulky, it can sometimes be hard to eat enough food to get the energy you need. A grazing pattern may help vegetarians who are active to consume an adequate energy intake. Have more frequent, smaller meals and larger snacks with higher-energy foods like nuts, peanut butter or other nut spreads.

Eat enough carbohydrate

Especially for active vegetarians, it's important to eat enough food rich in carbohydrate to sustain you or you'll suffer fatigue. Grains (rice, breads and pasta), dried beans, starchy vegetables (potato, kumara) and fruit are all good carbohydrate sources. Many vegetarians tend to eat a high-carbohydrate diet naturally. Vegetarian endurance athletes may find the higher carbohydrate intake of a vegetarian diet helps them to refuel muscle glycogen stores. Vegetarian endurance event athletes were leaders in eating a high-carbohydrate diet, as far back as the 1970s. Research has suggested a well-balanced vegetarian diet has no harmful effect on sports performance. All New Zealanders are encouraged to consume more whole grains in their diet for overall good health; vegetarians may actually be a slice or two ahead of the rest of us.

Eat enough essential fats

Consuming enough essential fat can be a concern for vegetarians as our bodies can't make these fats.  It's not difficult for vegetarians to get enough omega-6 (this comes from seed and nut oils) but getting enough omega-3 can be trickier, as this is most commonly found in fish oils, seafood and lean red meats. Limiting fats unnecessarily may also restrict the intake of fat-soluble vitamins (especially vitamins D and E). Walnuts, walnut oil, flaxseed, flaxseed oil and soybeans are useful sources of omega-3 for vegetarians. Fish oil supplements may be beneficial for some vegetarians (especially vegans) but there may also be some ethical issues with these as they are derived from a living form.

Eat enough protein

Most New Zealanders eat more protein than needed for general health. The recommended dietary intake (RDI) is between 0.8g to 1.0g per kilogram of body weight – so for a 70kg person that's 56-70g of protein daily.

Vegetarians need to keep in mind that plant proteins are not as well digested and processed by the body as animal proteins, and are not as 'complete' as protein from meat.  However, a well-planned vegetarian diet can provide plenty of protein, especially when eggs, milk and dairy foods are included. It's important to eat a wide variety of food to make sure of this. It is recommended vegetarians eat 10% more protein than meat-eaters, and because vegans don't eat eggs, milk or dairy products, they may need even more.

There are lots of good sources of plant proteins: grains, legumes (dried beans, split peas, lentils etc), nuts and seeds, low-fat diary products, eggs and tofu. The body requires eight essential amino acids (the building blocks of protein) for growth and repair. Only soy protein and animal tissues contain the complete set of essential amino acids so in order to get complete protein, vegetarians need to combine different protein sources as well as eat a range of protein foods over the course of the day.

Tortillas and beans, rice and beans, rice and lentils, rice and peas or nuts with bread will all provide the complete set of essential amino acids. So if you had baked beans on toast for breakfast, peanut butter or egg sandwiches at lunch, lentil and dried bean-based soup with bread or toast, or bean burritos, nachos and tortillas (corn and rice or wheat) for dinner, you'd get all the complete protein you needed.

Eat enough foods that are good sources of vitamins

Of particular concern for vegetarians are vitamins B12, riboflavin (vitamin B2) and vitamin D.

Most New Zealanders produce enough vitamin D themselves – the only requirement is exposure to sun so our bodies can manufacture it. However, most food sources are of animal origin like egg yolk and some fatty fish, so for vegetarians who get little sun exposure this can be an issue.

We need riboflavin (vitamin B2) for the production of energy from the carbohydrate, protein and fat in our diet. We get this from foods such as broccoli, almonds and dairy foods.

Vitamin B12 is essential to the normal development of blood cells. B12 deficiency can be a problem for vegetarians and especially for vegans, where eggs and dairy are not eaten. Vegan children, teenagers and pregnant women are particularly susceptible. This vitamin is usually found in animal foods (meat, milk, cheese, yoghurt and eggs) with some available from vegetables containing soil particles such as mung beans, mung bean sprouts, peas and whole wheat, ground nuts, alfalfa, lettuce, and fermented soy bean products such as tempeh. Vegans or total vegetarians are encouraged to use foods fortified in vitamin B12 (breakfast cereal, Marmite and fortified soy milk) to make sure they get enough of this essential vitamin.

Eat enough foods that are good sources of a range of minerals

Intakes of some minerals, especially zinc, iron and calcium, can be at risk if vegetarians don't eat a well-balanced diet.

Iron: Iron is essential for transporting oxygen to the cells from the lungs and returning the carbon dioxide to be removed.  Low iron status leads to fatigue, reduced concentration, lower physical work output, slower recovery from exercise, increased risk of infection and cold intolerance. Plant-based iron (known as non-haem iron) is not as well absorbed by the body as the haem iron found in meat. Eating foods that are high in vitamin C as part of a meal enhances the absorption of non-haem iron. Plant-based sources of iron include tofu, some dried fruits (see table above), green leafy vegetables, oats and dried legumes (especially soy and chickpeas).

Get your iron levels checked through a blood test if you're concerned; for some vegetarians iron supplementation and a change in diet (high in iron and increased vitamin C) are required if iron levels fall.

Calcium: For the lacto vegetarian, calcium is less of a concern but vegans need to choose good sources of calcium such as vegetables (broccoli, greens), some nuts (almonds, nut pastes such as tahini) and soy-based food (soy milk and tofu, soy beans). Soy milk is fortified with calcium (flavoured milks are often more palatable for the young and teenagers). Soy smoothies, shellfish and nuts (almonds) are other good sources. Vegetarian cheese and soy yoghurt are also available. Hummus, a popular middle-eastern spread, provides a good source of calcium and iron when used regularly and in reasonable servings (spread thickly on toast, in sandwiches or use as dip) to boost intake of these two important minerals.

Zinc: Zinc plays an important role in a range of metabolic processes; it's an antioxidant and it's essential to the immune system.

Zinc intake is closely linked to protein intake and levels drop when protein intake is low. Sources of zinc for vegetarians include dairy foods and shellfish (if eaten), dried peas, legumes, wheat germ, whole grains, seeds and nuts.

The bottom line

Vegetarian eating is not a fad diet. It is a normal, mainstream way of eating and with the greater diversity in cultures in New Zealand, this style of eating now has a greater presence. You can eat a vegetarian diet and be healthy. Make sure you eat a wide variety of foods and are aware of your nutritional needs; there's more to being vegetarian than removing the meat off your plate.