Dear Doctor Column, April 19, 2004

Vegetarian Diets Offer Health Benefits

Question:

I have several friends who are vegetarians, but some eat dairy foods, while others eat eggs or fish. Is a vegetarian diet safe, and is it possible to still get all the vitamins you need to stay healthy?

Answer:

The term "vegetarian" can mean different things, depending on the types of animal-based foods, if any, eaten. The common factor in all vegetarian diets is the emphasis on plant-based foods. The American Dietetic Association (ADA) describes three types of vegetarians:

• lacto-ovo-vegetarian — dairy foods and eggs, but no red meat, fish, or poultry
  
• lacto-vegetarian — dairy foods, but no eggs, meat, fish or poultry
  
• vegan — no animal foods of any type
  

The ADA also offers these "Veggie Facts:"

• Over 30 million Americans have explored a vegetarian eating pattern.
• Aging baby boomers are taking a proactive approach to their health by eating more meatless meals.
• About one-third of U.S. teenagers think being a vegetarian is "in."
• Health and taste are the top two reasons consumers are eating more meat-free meals.

Studies over the past decade have shown vegetarians have much lower rates of cancer, heart disease, high blood pressure, type 2 diabetes (noninsulin-dependent), and obesity than people whose diets center around animal products. According to one study, British scientists reported vegetarians are 20% less likely to die of heart disease and 40% less apt to die of cancer than people who eat meat.

Findings from a 20-year Harvard study show middle-age men who eat lots of fruits and vegetables are significantly less likely to suffer strokes, compared with men who do not consume many fruits and vegetables. In fact, these researchers found that every increase of three servings of produce a day correlates to a 20% drop in the risk of stroke. These results parallel earlier findings that women who ate a diet high in spinach, carrots, and other fruits and vegetables rich in antioxidant nutrients had a 54% lower risk of stroke, compared with women who did not have a diet high in fruits and vegetables.

Additional research found if soy fiber is added to the diet, a more consistent blood sugar level may be achieved, and studies also indicate that if women eat 1.5 ounces of soy foods daily, such as tofu, they may experience fewer hot flashes during menopause. Similarly, women lowered their risk of breast cancer when they consumed at least 3 ounces of tofu or 8 ounces of soy milk each day.

Although vegetarians tend to adopt healthier lifestyles, such as exercising regularly and avoiding tobacco, a large part of their health advantage is due to the foods they eat. One reason stems from the fact that plant-based diets tend to be low in fat and high in fiber.

According to UAB dietitians, a daily variety of plant foods can provide adequate protein, plus plenty of the vitamins and minerals needed to maintain good health. The ADA position is that "vegetarian diets are healthful and nutritionally adequate, when appropriately planned."

However, as a diet becomes more restrictive, it may be more difficult to get enough nutrients. For example, eating a strict vegetarian diet eliminates food sources of vitamin B-12, which are found only in animal products, including milk. Also, giving up red meat makes you more dependent on plant sources of iron, including legumes, dark green vegetables, and iron-fortified breakfast cereals. And those who avoid dairy products need to make sure they are getting enough calcium.

Therefore, say UAB dietitians, the more strict your vegetarian eating style, the more reason to talk to a registered dietitian about adequate food choices and whether you need a nutritional supplement. As with any diet, it is important for the vegetarian diet to include many different foods, since no one food, or group of foods, contains all the nutrients required for good health.

The bottom line is that everyone — vegetarian or not — should increase the amount of fruits and vegetables they eat. The U.S. Department of Agriculture's Food Guide Pyramid advises all healthy people aged 2 or older make a variety of cereal, grains, vegetables, and fruit the basis of their diets to ensure they are getting all the vitamins, minerals, and fiber they need. The National Cancer Institute, and other health agencies, recommends all Americans eat a minimum of 5 to 9 servings daily of fruits and vegetables. Yet, less than 25% of Americans follow this advice; most eat a mere two servings or less a day.

UAB dietitians recommend you choose nutrient-dense fruits and vegetables; best are the yellow or orange and the dark leafy green. Spinach, romaine, and watercress are richer in nutrients, for example, than iceberg lettuce, and carrots are more nutritious than celery.

For produce, try substituting a sweet potato or acorn squash for a white potato; try snow peas or sugar-snaps instead of shelled peas; sample different kinds of dried beans. And to spice up your dishes, experiment with various cooking methods; for instance, roast or grill vegetables, or poach fruits in juice.

For more information about vegetarian diets and how to successfully incorporate a healthy vegetarian diet into your lifestyle, visit UAB's Department of Nutrition Web site.