Eating Green:

Meeting Nutritional Needs

on Vegetarian Diet

Dr Kate Marsh
BSc, MNutrDiet, PhD, Grad Cert Diab Edn & Mgt
Advanced Accredited Practising Dietitian
Credentialled Diabetes Educator

Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Introduction
A vegetarian is someone who consumes a diet consisting mostly of plant-based foods
including fruit, vegetables, legumes, nuts, seeds and grains. Some vegetarians also consume
eggs and dairy products. While not true vegetarians, others follow a semi-vegetarian diet
where they restrict only certain animal foods or a pesco-vegetarian diet where they eat fish
but no other animal flesh.

Main types of vegetarian diets:

Lacto-ovo-vegetarian eats dairy foods and eggs but no meat, poultry or seafood. This is
the most common type of vegetarian diet.
Lacto-vegetarian eats dairy foods but not eggs, meat, poultry or seafood
Ovo-vegetarian eats eggs but no dairy foods, meat, poultry or seafood.
Vegan doesnt eat any animal products including meat, poultry, seafood, eggs and
dairy foods. Most vegans also wont use honey or other animal products.

While we dont have any good data on the number of vegetarians and vegans in Australia, A
2010 national Newspoll survey of 1200 adults indicated seven out of 10 Australians are
eating some plant based meals in the belief that eating less meat and more plant foods
improves overall health. The popularity of the Meat-Free Mondays movement, which began
in 2003 and has been adopted in many countries including the US, UK, Canada, Israel and
Australia, also reflects the increasing awareness of the health and environmental benefits of
eating less meat and adopting more plant-based meals.

If you are not already aware of the Meat-Free Mondays movement, take a look at the
website now to find out more. Why not join up and receive regular emails and tasty meatfree recipe to try every Monday? http://foodwise.com.au/meat-free-mondays/homepage/

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

The reasons for choosing a vegetarian diet are varied but include:
Health there is now a significant body of evidence to demonstrate the health benefits
of vegetarian and plant-based diets and this is a common reason someone might choose
to become vegetarian
Environment there is increasing awareness of the environmental benefits of eating
more plant foods and less meat for the environment, and this is becoming an
increasingly common reason for people choosing a vegetarian diet or eating more plantbased meals.
Animal rights many people choose to follow a vegetarian diet as they believe that
killing animals for food is inhumane, and there is an increased awareness of the
questionable treatment of farm animals in factory farming. Watch this video to
understand more about animal welfare.
Religion many religions advocate a vegetarian diet including Seventh-day Adventists,
Hindus, Jains and Buddhists. Others avoid certain meats or only allow the consumption
of meats which have been slaughtered in a particular way.
Food safety - outbreaks of food-borne disease (eg food poisoning, mad-cow disease)
from meat products, as well as increased concern over the additives in meat such as
hormones and antibiotics have led some people to be concerned over the safety of
eating meat.
Ethics this ties in with animal rights, with many vegetarians and vegans believing that it
is not ethical to unnecessarily kill another living creature for food. There is also the issue
of environmental ethics and food sustainability due to the fact that the production of
animal foods is far less efficient than the harvesting of plant-foods.

Not everyone needs to or wants to become vegetarian, but reducing our dependence on
meat is a good recipe for our own health and also that of our planet. Diets dominated by
plant foods are almost certainly the way of the future.
Rosemary Stanton
(Source: Stanton. A plant-based diet good for us and good for the planet (editorial). MJA
Open 2012; 1 Suppl 2: 5-6. Read the full paper here

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Health Benefits of a Vegetarian Diet

Improved health is one of the many reasons people choose to adopt a vegetarian diet and
there is now a wealth of evidence to support the health benefits of a vegetarian diet.
Vegetarians have been found to have lower rates of a number of health problems including
overweight and obesity, cardiovascular disease, hypertension, type 2 diabetes and some
cancers[1, 2]. A number of studies have also shown increased longevity among
vegetarians[3, 4].
While vegetarians generally have a lower body mass index (BMI) and tend to be more health
conscious than non-vegetarians[5], health outcomes remain better even when these factors
are taken into account.
It is likely that the benefits of a vegetarian diet are the result of both a reduced consumption
of potentially harmful dietary components and an increased consumption of beneficial
dietary components as outlined below[6].

Vegetarians generally eat less.

Saturated fat

Vegetarians generally eat more..

Dietary fibre/cereal fibre

Red meat

Nuts

Processed meats

Legumes

Animal protein

Fruit and vegetables

Haem iron

Wholegrains

Refined grains

Soy products

High GI carbs

Low GI carbs

As you can see above, vegetarian diets differ from non-vegetarian diets in many respects,
but the most significant difference is the absence of red meat intake in a vegetarian diet.
Research has linked higher intakes of red meat and processed meat with an increased risk of
obesity, type 2 diabetes, gestational diabetes, cardiovascular disease and some types of
cancer.
A large study investigating the association of a wide range of meat intakes with chronic
disease mortality found that both red and processed meat intakes were associated with
modest increases in total mortality, cancer mortality and cardiovascular disease mortality.
Low meat intake, on the other hand, has been associated with greater longevity.

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Overweight and Obesity

Research has consistently shown that vegetarians, and particularly vegans, are leaner than
non-vegetarians.
The European Prospective Investigation in Cancer and Nutrition (EPIC) Oxford study
compared weight gain over 5 years in almost 22000 meat-eating, fish-eating, vegetarian, and
vegan men and women. Weight gain was lowest in the vegan group and those who, during
follow-up, had changed to a diet containing fewer animal foods. The study found that the
mean BMI of participants was highest in the meat-eaters and lowest in the vegans. Fisheaters and vegetarians had a mean BMI which fell between the meat-eaters and vegans.
The Adventist Health Study-2 similarly found that mean BMI was lowest in vegans and
incrementally higher in lacto-ovo vegetarians, pesco-vegetarians, semi-vegetarians, and nonvegetarians. See Figure 1.
Figure 1: Association between BMI and vegetarian diet status
29

28.2

28
26.8

27
25.9

25.6

26
25
24

23.8

23
22
21
Vegan

LOV

Pesco-vegetarian Semi-vegetarian

Non-vegetarian

Tonstad et al; Diabetes Care 2009; 32(5): 791-6.

There are a number of possible explanations for this association including the lower fat
intake, higher intake of dietary fibre, and lower energy density typical of a vegetarian diet.
Foods such as wholegrains and nuts are more regularly consumed by vegetarians and have
been independently associated with a reduced risk of obesity and weight gain. A higher
intake of red meat, on the other hand, has been associated with an increased risk of weight
gain.

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Cardiovascular Disease
The most consistent evidence for the health benefits of a vegetarian diet is for a reduced risk
of coronary heart disease (CHD) and coronary disease mortality. A combined analysis of 5
prospective studies reported a 24% lower risk of mortality from ischaemic heart disease
(IHD) in vegetarians compared to meat-eaters. Lacto-ovo vegetarians had a 34% reduced risk
and vegans a 26% reduced risk. The benefit was apparent in those who had followed their
diet for at least 5 years and was greater in younger age groups.
These findings are not surprising considering that vegetarians generally have a better
cardiovascular risk profile than non-vegetarians with lower total and low density lipoprotein
(LDL) cholesterol levels, a lower body weight, and a lower incidence of diabetes and
hypertension all of which contribute to CVD risk.
Specific aspects of a vegetarian diet likely to contribute to its cardiovascular benefits include:
A lower intake of saturated fat and greater proportion of unsaturated fats
A higher intake of wholegrains. Several studies have demonstrated an association
between wholegrain intake and cardiovascular disease risk and a recent meta-analysis
estimated that a greater intake of wholegrains was associated with a 21% lower risk of
CVD events.
A higher intake of legumes. The National Health and Nutrition Examination Survey
(NHANES) 1 Epidemiologic Follow-up Study found that consuming legumes at least 4
times per week, compared to less than once per week, was associated with a 22%
reduced risk of CHD and an 11% reduced risk of CVD.
A higher intake of nuts. Regular nut consumption has been found to protect against
CHD in both epidemiological and clinical trials. Nuts may protect against CHD through
effects on lipids, lipid oxidation, inflammation and vascular reactivity.
A higher intake of soy foods. Soy protein has been shown to reduce total and LDL
cholesterol levels and a meta-analysis of thirty studies demonstrated a small but
significant reduction in both total and LDL cholesterol with the consumption of 25g of
soy protein per day.
While individual components of a vegetarian diet may provide benefits for CVD risk, the
combination of these foods is likely to provide the greatest effect. For example a vegetarian
diet incorporating soluble fibre, soy protein, almonds and plant sterols (the Portfolio diet)
has been shown to reduce LDL cholesterol to a similar extent to a low dose of statins (the
most commonly prescribed cholesterol-lowering medication) over 4 weeks.
While some studies have linked red meat intake with coronary heart disease risk a recent
meta-analysis found that processed meat intake, but not red meat intake, was associated
with a higher risk of coronary heart disease. Several studies have demonstrated the benefits
of a Mediterranean diet, a mostly plant-based diet with low meat intake, with a reduced risk
of coronary heart disease.

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Hypertension
Evidence suggests that a vegetarian diet may help in both the prevention and management
of hypertension.
The EPIC-Oxford study found that non-meat eaters had a lower prevalence of hypertension
and lower systolic and diastolic blood pressures than meat eaters but this was largely due to
differences in body mass index. The age-adjusted prevalence of self-reported hypertension
was significantly different between the four diet groups, ranging from 15.0% in male meat
eaters to 5.8% in male vegans, and from 12.1% in female meat eaters to 7.7% in female
vegans. Fish eaters and vegetarians had a similar, intermediate prevalence of hypertension.
In the Adventist Health Study-2, a significant, graded association with blood pressure was
also observed. Compared with non-vegetarians, the odds ratio for hypertension (defined as
a systolic BP > 139 mmHg or diastolic BP > 89 mmHg or use of antihypertensive medications)
0.37 for vegans, 0.57 for lacto-ovo vegetarians and 0.92 for partial vegetarians. The
relationship remained but was attenuated after adjustment for BMI (see figure 2).
Figure 2: Risk of hypertension according to vegetarian diet status
1.4

1.22

1.2
1

0.86

0.92

0.8
0.53

0.6
0.4

0.57

0.37

0.2
0
Vegan

LOV

Partial vegetarian

Non-vegetarian

Petterson; Public Health Nutr. 2012; 15(10): 19091916.

(note: hashed bars are after additional adjustment for weight)

A number of randomised clinical trials have shown that a vegetarian diet can lower blood
pressure in both normotensive and hypertensive individuals. While it is well accepted that
both weight loss and reducing sodium intake can lower blood pressure , the effect of a
vegetarian diet on blood pressure appears to be independent of these, suggesting that other
components of the diet are responsible. These findings are consistent with the results of the
DASH (Dietary Approaches to Stopping Hypertension) trial which found that a diet high in
fruit, vegetables, wholegrains, and low fat dairy products significantly reduced blood
pressure in those with normal blood pressure or mild hypertension.

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Diabetes
Observational studies have demonstrated a significantly lower risk of type 2 diabetes in
individuals following a vegetarian diet compared to non-vegetarians. The original Adventist
Health Study found that vegetarians had approximately half the risk of developing diabetes
while in the more recent Adventist Health Study-2, involving more than 60 000 men and
women, those following a vegan diet were found to have a diabetes prevalence
approximately one-third that of non-vegetarians, while the lacto-ovo vegetarians, pescovegetarians and semi-vegetarians had an intermediate diabetes prevalence. After adjusting
for confounding factors, those following a vegan diet had almost a 50% reduction in the risk
of developing type 2 diabetes compared to non-vegetarians and the risk reduction became
incrementally smaller as more animal products were consumed as shown in Figure 3.

Figure 3: Risk of diabetes according to vegetarian diet status

1.2
1

1
0.8

0.7

0.6

0.76

0.56

0.54

0.51

0.69

0.43
0.4

0.32

0.2
0
Vegan

LOV

Pesco-vegetarian Semi-vegetarian

Non-vegetarian

Tonstad et al; Diabetes Care 2009; 32(5): 791-6.

(note: hashed bars are after additional adjustment for weight)

Whether the reduction in risk of diabetes in vegetarians can be attributed to the absence of
meat or the higher intake of plant foods such as wholegrains, legumes and nuts is unclear.
However several studies have shown a positive association between dietary heme iron
intake and heme iron intake from red meat and the risk of type 2 diabetes. A positive
association between the intake of red meat, processed meats and animal protein and the
incidence of type 2 diabetes has also been shown. A recent systematic review and metaanalysis of cohort studies of meat consumption and type 2 diabetes risk estimated the
relative risk comparing high versus low intake was 1.17 for total meat, 1.21 for red meat and
1.41 for processed meat. The authors predict that a 120g per day increase in red meat
consumption increases the risk of diabetes by 20% and a 50g per day increase in processed
meat consumption increases the risk by 57%.

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

There are only a few intervention studies assessing the effects of a vegetarian diet in people
with diabetes, and weight loss has generally been greater on the vegetarian diets, making it
difficult to determine the independent effect of the diets. However, greater weight loss may
be one of the advantages of a vegetarian diet as even small amounts of weight loss can help
in both the prevention and management of type 2 diabetes. One study comparing a low fat
vegan diet with a diet based on the American Diabetes Association (ADA) guidelines found
that the vegan diet reduced HbA1c levels significantly more than the ADA diet (1.23 versus
0.38 percentage points in those who didnt change medication). Furthermore, 43% of
subjects were able to reduce their medication compared to only 26% in the ADA group.
Earlier studies of low fat vegan diets in patients with type 2 diabetes have also
demonstrated significant improvements in blood glucose control and blood fats, as well as
considerable reductions in medication use although the larger of these studies was not
controlled.

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Cancer
Overall, cancer rates in vegetarians appear to be moderately lower than non-vegetarians,
and life expectancy appears to be greater. However, results for specific cancers are less
convincing and require more study. Most of the research conducted on vegetarian diets and
cancer has involved lacto-ovo-vegetarians. Of the studies looking at vegan groups, most
only cover a short period of time or a small group.
The health benefits of protective compounds in a plant-based diet have been linked to the
prevention of cancer initiation and a reduction in cancer cell growth. Foods that are central
to vegetarian diets such as wholegrains, legumes, fruits, and vegetables are rich in fibre, folic
acid, phytochemicals and antioxidants which may protect against cancer. On the other hand,
eating red meat may contribute to cancer formation. The consumption of red meat cooked
at high temperatures, diets rich in animal fat and cholesterol or diets high in animal protein
have been associated with an increased risk of developing cancer.
The World Cancer Research Fund released their second expert report in 2007 Food,
Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective, which is a is a
comprehensive analysis of the literature on food, nutrition, physical activity and cancer. One
of the 10 recommendations they make for reducing cancer risk relates to animal foods and is
to limit intake of red meat and avoid processed meats. They recommend that individuals
who eat red meat should to consume less than 500g per week, with very little, if any, being
processed. They refer to 'red meat' as beef, pork, lamb, and goat from domesticated
animals including that contained in processed foods, and 'processed meat' as meat
preserved by smoking, curing or salting, or the addition of chemical preservatives, including
that contained in processed foods.
More details can be found here:
http://www.dietandcancerreport.org/expert_report/recommendations/recommendation_a
nimal_foods.php

Other diseases
Limited research has suggested that a vegetarian diet may also reduce the risk of other
health conditions including diverticular disease, gallstones, rheumatoid arthritis, gout and
kidney disease. While these findings are positive and add to the evidence of the health
benefits of a vegetarian diet, the small number of studies mean that further research is
required to confirm these benefits.

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Meeting nutritional needs on a vegetarian diet.

In addition to their health benefits, well planned vegetarian diets, including vegan diets, are
nutritionally adequate and are appropriate for individuals during all stages of life. Some
nutrients can be more difficult to obtain on a vegetarian diet, but careful planning and in
some cases the use of fortified foods or supplements, can ensure that an individuals
nutrition needs are met while maximising the health benefits of a vegetarian or vegan diet.
The following table shows the main food sources of key nutrients in a vegetarian diet and
these are discussed in more detail in the following pages.

Food sources of important nutrients on a vegetarian diet

Dr Kate Marsh

Protein

Legumes, tofu, soy milk, tempeh, gluten, wholegrains

(particularly amaranth and quinoa) nuts, seeds, eggs, milk,
yoghurt.

Iron

Legumes/soybeans, wholegrains (particularly amaranth and

quinoa), iron fortified cereals, tofu, tempeh, dried fruit, nuts,
seeds, green leafy vegetables.

Zinc

Whole grains, legumes, tofu, nuts, seeds, tempeh, eggs, milk,

yoghurt.

Calcium

Milk, yoghurt, cheese, calcium-fortified soy, rice, almond or oat

milk, calcium set tofu, unhulled tahini, kale, Asian green
vegetables, almonds.

Vitamin B12

Milk, yoghurt, cheese, eggs, B12 fortified soy or rice milk, B12
fortified meat analogues (e.g. sausages and burgers). Note
mushrooms are not a reliable source as they provide only very
small amounts.

Omega-3 fats

Flaxseed oil, linseeds/flaxseeds, chia seeds, walnuts, soy foods,

omega-3 eggs, DHA-fortified foods (eg breads, yoghurts, orange
juice).

Vitamin D

Milk, eggs, vitamin D fortified soy milk.

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Protein
Protein is an essential nutrient that is required for many vital roles in the body. Proteins are
made up of amino acids some of these can be made by the body while others (known as
essential amino acids) must be supplied by the diet. A vegetarian can obtain of all the
essential amino acids they need by eating a variety of different types of protein-rich plant
foods each day. It was once thought that certain combinations of plant foods had to be
eaten at the same meal but it is now known that strict protein combining is not necessary as
long as a variety of protein-rich foods are eaten from day to day.
Food sources of protein on a vegetarian diet:
legumes including chickpeas, lentils and dried or canned beans
soy foods including tofu, tempeh, textured vegetable protein (TVP)
mycoprotien (Quorn)
seitan (gluten)
grains (particularly quinoa, amaranth)
nuts and seeds
soy milks and yoghurt
eggs and dairy products (for lacto-ovo vegetarians)

Daily protein requirements

Men under 70 years
Men over 70 years
Women under 70 years
Women over 70 years

64g
81g
46g
57g

Pregnancy
Breastfeeding

58-60g
63-67g

Practical tips for meeting protein needs:

Include a variety of protein foods each day
Dont just cut out the meat at meals replace it with alternatives including legumes,
tofu, tempeh or Quorn
Choose more wholegrains such as quinoa and amaranth in place of refined grains
Snack on nuts & seeds or add these to meals. Nut and seed spreads are also good
choices.
Soy milk has similar protein content to dairy but rice, oat and almond milk are low in
protein (and for this reason are not suitable alternatives for young children)

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Iron
Iron is an essential mineral which plays a vital role in forming haemoglobin, which transports
oxygen around the body, and assisting in energy-producing chemical reactions and
maintaining a healthy immune system. Low iron levels lead to anaemia.
There are two types of iron in food - haem iron is found in animal foods while non-haem iron
is found in eggs and plant foods such as legumes, cereal grains, nuts, seeds and dark green
leafy vegetables. Non-haem iron is not as well absorbed by the body but including foods high
in vitamin C at the same meal can improve absorption. Phytates (in wheat bran) and
polyphenols (in tea, coffee, cocoa and red wine) can inhibit the absorption of iron.
Food sources of iron on a vegetarian diet:
legumes
wholegrains (especially amaranth and quinoa)
iron fortified cereals
tofu, tempeh
dried fruit
nuts & seeds
dark green leafy vegetables

Daily iron requirements for vegetarians*

Men under 70 years
14mg
Women 19-50 years
32mg
Women over 51 years 14mg

Pregnancy
Breastfeeding

48mg
16-18mg

* set at 180% higher than RDI for non-vegetarians due to lower absorption of non-haem iron although
there is some question around the evidence for this recommendation read more about iron and
vegetarian diets here.

Practical tips for meeting iron needs:

Include legumes and tofu or tempeh with meals daily
Choose more wholegrains such as quinoa and amaranth in place of refined grains
Eat plenty of dark green leafy vegetables
Snack on dried fruit & nuts
Include vitamin C-rich fruit & vegetables with all meals
Limit intake of tea and coffee to between meals rather than with meals.
Avoid large amounts of unprocessed bran

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Zinc
Zinc is needed for reproduction, growth, wound healing, sexual maturation and for
maintaining a healthy immune system. While it is found widely in plant foods, its absorption
is reduced by phytates found in wheat bran, wholegrains and legumes. Processing a food by
soaking, fermenting or sprouting can reduce the phytate level and make zinc more readily
available for example, the leavening and fermenting of grains in bread-making and the
soaking & sprouting of legumes and grains.
Food sources of zinc on a vegetarian diet:
legumes
wholegrains
tofu, tempeh
nuts & seeds
eggs
dairy foods (eg. milk and yoghurt)

Daily zinc requirements for vegetarians*

Men under 70 years
21mg
Women 19-50 years
12mg
Women over 51 years 14mg

Pregnancy
Breastfeeding

15-16.5mg
16.5-18mg

* set at 150% higher than RDI for non-vegetarians due to lower absorption of non-haem iron although
there is some question around the evidence for this recommendation read more about zinc and
vegetarian diets here.

Practical tips for meeting zinc needs:

Include legumes, tofu and tempeh in meals regularly
Choose wholegrain breads and cereals
Snack on nuts & seeds or add these to meals. Nut and seed spreads can also be used.
Use sprouted legumes (eg. mung beans) in salads and sandwiches
Avoid excessive intake of unprocessed wheat bran

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Calcium
Calcium is important for healthy bones and teeth and also plays a role in muscle contraction
and relaxation, blood clotting, nerve function and regulation of blood pressure. While dairy
products can provide plenty of calcium for lacto-ovo vegetarians, there are also many plant
sources of calcium. Vegans can obtain their calcium from fortified non-dairy milks (eg soy,
rice, oat or almond milks) or other plant foods rich in calcium. Calcium absorption is
improved in the presence of vitamin D but is reduced by sodium, caffeine, carbonated drinks
and phytates.
Food sources of calcium on a vegetarian diet:
calcium-fortified soy, rice or oat milk
hard tofu (particularly calcium-set)
unhulled tahini
kale, Asian green vegetables
almonds
milk
yoghurt
cheese

Daily calcium requirements for vegetarians

Men 19-70 years
Men over 70 years
Women 19-70 years
Women over 70 years

1000mg
1300mg
1000mg
1300mg

Pregnancy
Breastfeeding

1000mg
1000mg

Practical tips for meeting calcium needs:

Consume calcium-rich foods daily including dairy products or calcium-fortified products
(important to check labels as not all non-dairy milks are fortified with calcium)
Include other plant-based sources of calcium regularly such as hard tofu, almonds,
unhulled tahini (sesame seed paste), dried figs, kale, broccoli and Asian greens.
Limit salt intake
Limit caffeine found in tea, coffee, cola and energy drinks
Ensure adequate vitamin D from sensible sunlight exposure

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Vitamin B12 (cobalamin)

Vitamin B12 is an essential vitamin which is found almost exclusively in animal foods. We
need it to form red blood cells and to maintain a healthy nervous system. Deficiency can
cause a type of anaemia and may lead to irreversible nerve damage. It is particularly
important for women who are pregnant or breastfeeding as newborn babies have very little
of their own stores and rely on obtaining vitamin B12 from their mothers breastmilk.
Vitamin B12 is found in red meat, poultry, seafood, milk, yoghurt, eggs and cheese. Plant
foods are not a reliable source of this vitamin and some plant foods promoted as containing
vitamin B12 (such as tempeh and miso) contain an inactive form of B12, which interferes
with the normal absorption and metabolism of the active form in the body and will not
prevent a deficiency.
Food sources of vitamin B12 on a vegetarian diet
Milk
Yoghurt
Cheese
Eggs
B12 fortified soy or rice milk (check labels as only a few Australian brands have added
B12)
B12 fortified vegetarian sausages/burgers
B12 fortified yeast spread (eg Marmite)
Note: mushrooms are not a reliable source as they provide only trace amounts.

Daily vitamin B12 requirements for vegetarians

Men
Women

2.4mcg
2.4mcg

Pregnancy
Breastfeeding

2.6mcg
2.8mcg

Tips for meeting vitamin B12 needs:

For those who eat them, dairy products and eggs should be included in the diet regularly
Those following a vegan diet should choose soy milk fortified with vitamin B12 (only a
few brands currently have vitamin B12 added in Australia). Some vegetarian burgers,
sausages and yeast extracts (eg Marmite) are also fortified with vitamin B12.
For those who dont eat foods containing vitamin B12, it is important that they take a
vitamin B12 supplement

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Omega-3 Fats
Omega-3 fatty acids are essential fats which are important in maintaining cell membranes,
and which help to regulate metabolism, reduce inflammation, lower blood pressure and
cholesterol, and may protect against heart disease. Omega-3 fatty acids are particularly
important during pregnancy and breastfeeding as they play a role in brain and eye
development. As the main source of these fats in the diet is fatty fish, vegetarians generally
have low intakes, however the implications of this is unclear particularly when vegetarians
generally have lower risk of chronic disease.
A number of plant foods contain omega-3 fats but in the short-chain form (known as alphalinoleic acid, or ALA) which must be converted to the longer chain fats that our body uses
(DHA and EPA). This conversion process may be inefficient in
some people but can be optimized by choosing the right balance
of fats in the diet.
Food sources of omega-3 fats on a vegetarian diet:
Chia seed (ALA)
Flaxseed (ALA)
Canola oil (ALA)
Walnut (ALA)
Hempseed (ALA)
Soybean (ALA)
Wheatgerm (ALA)
Green leafy vegetables (ALA)
Eggs (DHA)
Sea vegetables (DHA)
Microalgae (DHA)

Tips for optimizing omega-3 intake:

Regularly include good sources of ALA suggested intakes of at least 2.6g/d for men and
1.6g/d for women - this is double the recommended Adequate Intake (there is no RDI for
omega-3 fats) for the general population.
Limit intake of omega-6 (sunflower, corn, sesame and grapeseed oils and spreads)
Use MUFA (olive, canola, avocado) in place of PUFA oils and spreads
Limit alcohol and caffeine
Women who are pregnant or breastfeeding might consider a vegan DHA supplement
the recommended Adequate Intake is 110-115mg long-chain omega-3 in pregnancy and
140-145mg/day while breastfeeding.

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

For more details about the adequacy of vegetarian diets read this
supplement to the Medical Journal of Australia: Is a vegetarian diet
adequate? Concepts and controversies in plant-based nutrition.
Written by Australian Accredited Practising Dietitians and leading
researchers the supplement includes papers on protein, iron, zinc,
vitamin B12, omega-3 fats and meeting the Australian Nutrient
Reference Values (NRVs) on a vegetarian diet, as well as a paper on
the practical aspects of a vegetarian diet.

Activity:
Look up the content of key nutrients in some of the vegetarian foods mentioned above and
compare this to the current Recommended Dietary Intakes (RDIs) to get an idea of the
amount of these key foods needed to meet nutritional requirements for different ages and
genders.
The following websites are good for looking up nutrient details:
NUTTAB 2010 the official Australian nutrient database (all nutrients apart from
vitamin B12) http://www.foodstandards.gov.au/consumerinformation/nuttab2010/
Calorie King Australia search function for Australian foods including brand-name
items (protein and calcium) http://www.calorieking.com.au/
The papers in the supplement above also contain tables showing the amounts of key
nutrients in commonly-eaten vegetarian foods (protein, iron, zinc, vitamin B12,
omega-3) https://www.mja.com.au/open/2012/1/2

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Vegetarian athletes
While some may question the adequacy of a vegetarian diet for athletes, there are plenty of
well-known vegetarian and vegan athletes whose success would suggest otherwise. This
includes Olympian Carl Lewis, ultra-marathon runner Scott Jurek, tennis legend Martina
Navratilova, boxer Mike Tyson and football star Ricky Williams.
The American Dietetic Association, in their position paper on vegetarian diets, say that a
well-planned vegetarian diets, including total vegetarian or vegan diets, are appropriate for
individuals during all stages of the life cycle, and for athletes.
Read this interview from the New York Times with three experts (a professor of health and
exercise science, an associate professor of human nutrition and author of Vegetarian Sports
Nutrition, and a dietitian and the author of Nancy Clarks Food Guide for Marathoners) about
vegetarian diets for athletes.

If you work with vegetarian athletes, the following resources might also be helpful.
Australian Institute of Sport fact sheet on Vegetarian Eating
The Vegetarian Resource Group Athlete & Vegetarian/Vegan Diet resources
Vegetarian diets : nutritional considerations for athletes (Venderley & Campbell).
Sports Med 2006; 36 (4): 293-305.
Vegetarian Sports Nutrition by Enette Larson-Meyer
Thrive Fitness by Brendan Brazier
The No Meat Athlete Matt Frazier

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Vegetarian meal planning

As for all healthy diets, meal planning for vegetarian diets should focus on incorporating a
wide variety of minimally processed foods from each of the main groups to ensure a
plentiful supply of nutrients and phytonutrients. The Vegetarian Healthy Eating Plate
illustrated below provides a visual guide for planning vegetarian meals.

Vegies and/or salads should include a variety of colours and fill half of plate.
Wholegrains are preferred over refined grain foods (e.g. brown rice instead of
white rice) and occupy about one quarter of your plate.
Plant proteins legumes, nuts, seeds, soy products or vegetarian convenience
products should satisfy about one quarter of your plate.
Dairy or fortified soy these can be included as snack (eg a tub of yoghurt or fruit
smoothie) or incorporated into meals (eg yoghurt or milk with cereal, grated cheese
on pasta).
Fruit is best eaten mostly whole, rather than juiced, and enjoyed as a dessert or
snack.

While its important to try to include all these components in each meal, certain cooking
styles and cuisines may determine how you plate up your food and whether its eaten at
once or spread over the day.
Activity:
Using the information above on the key nutrients, and healthy eating plate guide above,
design yourself a 1-day vegetarian eating plan to meet your nutritional needs. Click here to
download some sample vegetarian meal plans for different age groups and genders.

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Glossary of plant protein foods

There are many varieties of plant protein foods to suit different tastes and cuisines. These
include whole foods, such as legumes and nuts, traditional products like tofu and tempeh
and even faux meats, which can provide an easier transition for meat lovers and extra
convenience.
Legumes dry beans, peas or lentils available in many different
varieties including chickpeas, borlotti beans, black beans, kidney
beans, lima beans, cannellini beans and red, green or brown lentils.
These can be purchased dried or canned.

Tofu or bean curd, is made from soybeans, in a similar way that

cheese is made from dairy milk. It comes in silken, soft and firm
textures and can be cut to desired size depending on use. The firm
variety is great for stir-fries and curries while the soft and silken
varieties go well in burgers, creamy dressings or desserts.

TVP (textured vegetable protein) is a great substitute for mince when

making traditional meals like bolognaise, shepherds pie or tacos.
Made from soy flour, TVP is dehydrated to resemble mince. It can be
stored in the pantry for many months.

Tempeh is made from soybeans which are cooked and fermented and
then formed into a patty or cake. It has a firm texture and can be can be
grilled, baked or pan-fried, or diced and added into stir-fries. It can also
be sliced and used in place of meat in a wrap.

Gluten also known as seitan, it has a meaty texture and can be used
in stir fries, casseroles or crumbed and cooked as schnitzel. Buy it
canned or fresh from Asian stores or make your own from gluten flour.

Quorn is a protein derived from a fungus (mycoprotein), which is

available as a cooking ingredient in mince or strips to replace meat.
You can also buy Quorn sausages, schnitzels, fillets, burgers and
meatballs. Note - people sensitive to moulds may have an allergic
reaction.

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Convenience vegetarian products including burgers, patties, sausages and schnitzels. These
are generally made from soy, nuts, gluten and/or grains and are available in canned, chilled,
frozen or shelf stable options. Most are ready to heat and serve or can be used as
ingredients in various meals. Some are fortified with nutrients including iron, zinc and
vitamin B12 (mainly the Sanitarium range) which can be a useful way to boost intake of
these nutrients. However many are also high in sodium so not ideal for everyday use.

Common brands readily available in Australia include:

Sanitarium

http://www.sanitarium.com.au/products/vegetarian

Frys

http://www.frysvegetarian.co.za/product-category/our-food/

Australian Eatwell http://www.australianeatwell.com.au/products.php

Bean Supreme

http://www.beansupreme.co.nz/

Syndian

http://syndian.com.au/products/

Have a look at the products available from the companies above to get an idea of the
range of vegetarian options now on offer. Consider trying some of these yourself to see
what they taste like!

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Supplements
Vegetarians dont need to take supplements routinely. Depending on their individual
dietary restrictions, health, and stage of life however, certain supplements may be
beneficial.

Vitamin B12 - those who dont consume at least 2 serves of a food rich in vitamin
B12 each day should take a vitamin B12 supplement and have a blood test annually
to check vitamin B12 levels.
Omega 3 A microalgae DHA supplement may benefit pregnant women, children or
people with arthritis.
Vitamin D Those following a vegan diet and those who have little sun exposure
may need a supplement.
Iron an iron supplement should only be taken on the advice of a doctor or dietitian
if the individual has confirmed iron deficiency, as excess iron can cause harm.

For those who do need a supplement, not all supplements are suitable for
vegetarians as they can contain animal-derived ingredients including gelatine
and lactose this is most relevant for vegans. To determine whether they are
suitable, individuals can check labels carefully, check with the supplement
manufacturer or choosing brands specifically formulated for vegans (eg Deva
Vegan, Available online at www.devanutrition.com).

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Common myths about vegetarian diets

Myth: it is difficult to get enough protein on a vegetarian diet
Studies of Australian vegetarians have found that protein intakes are significantly lower than
for omnivores, however intakes still easily meet the recommended dietary intakes (RDIs) as
most omnivores eat much more protein than is required. Most plant foods contain some
protein, with the best sources being legumes, soy foods (including soy milk, tofu and
tempeh), nuts and seeds. Grains and vegetables also provide protein.
Myth: vegetarians need to combine proteins at meals
As most plant foods contain limited amounts of one or more essential amino acids it was
once thought certain combinations had to be eaten at the same meal to ensure sufficient
essential amino acids. It is now known strict protein combining is unnecessary, provided
energy intake is adequate and a variety of plant foods are eaten each day including legumes,
wholegrains, nuts and seeds, soy products and vegetables. Soy protein has a Protein
Digestibility Corrected Amino Acid Score (PDCAAS) equivalent to egg white or dairy protein
(casein), meaning it is considered a complete protein.
Myth: vegetarians need to take an iron supplement
Vegetarian diets can contain as much or more total iron (non-haem) compared to mixed
diets, primarily from wholegrain breads and cereals. Iron deficiency is not more common in
vegetarians, although iron stores (serum ferritin levels) are often lower. Some studies have
found lower iron stores are associated with reduced risk of chronic diseases (such as
cardiovascular disease and type 2 diabetes), which may partly explain the lower risk of these
diseases in vegetarians.
Myth: dairy foods are the only good source of calcium. While a convenient source for
many, dairy products are not the only, or best, source of calcium. Fortified soy milks, rice,
oat and almond milks, unhulled tahini, Asian greens, almonds and calcium set tofu can all
provide calcium for those who choose not to eat dairy.
Myth: vegetarian diets are not suitable for pregnancy
Vegetarian diets can be planned to supply the required levels of nutrients during pregnancy.
Research shows there are no significant health differences in babies born to vegetarian
mothers. The higher fibre content and lower energy density of many vegetarian diets may
offer significant advantages, including a reduced risk of excess weight gain]. Further, some
studies suggest that a lower intake of meat and dairy products reduces the pesticide content
of breastmilk.
Myth: vegetarian diets are not suitable for children
Vegetarian diets are appropriate for children of all ages. The growth rate of vegetarian and
vegan children is similar to non-vegetarian children if meals are planned well, according to
the American Academy of Pediatrics and American Dietetic Association.

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

Conclusion
Well-planned vegetarian diets are not only nutritionally adequate, but also provide many
health benefits, particularly in the prevention and treatment of many chronic diseases. In
fact in Western countries, a vegetarian diet may present a significant advantage over meatbased diets and a number of studies have shown increased longevity in vegetarians. While
potentially lower in some nutrients, careful planning can help to ensure that both a
vegetarian or vegan diet meets all of the current recommended intakes for essential
nutrients as well as maximising the intake of protective components present widely in plant
foods. In fact, a vegetarian diet may well be one of the best ways to meet population
dietary guidelines.

Key Learning Points

Vegetarian diets focus on fruits, vegetables, legumes, nuts, seeds and grains. Some
vegetarian diets also include eggs and dairy foods.
A varied and balanced vegetarian diet can provide all the nutrients needed for good
health.
Vegetarian diets may provide additional health benefits compared to non-vegetarian
diets, such as reduced chronic disease risk.
Vegetarian diets more closely match recommended dietary guidelines to eat plenty
of fruits, vegetables, legumes, wholegrains and to limit saturated fats and sugars.
A vegetarian diet doesnt mean just cutting out meat. Careful planning along with
knowledge of practical ideas for using a variety of plant foods is needed to ensure
nutritional requirements are still met, particularly for the new vegetarian or those
who wish to reduce their meat intake.
Nutrients that may need more attention in a vegetarian diet include iron, zinc,
calcium, vitamin B12, vitamin D and omega-3 fats.
A minimally processed plant based diet with limited amounts of animal products
eaten lower down the food chain, if at all, provides environmental advantages over a
western style non-vegetarian diet.
Eat food. Mostly plants. Not too much.
Michael Pollan

Dr Kate Marsh

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Eating Green: Meeting Nutritional Needs on a Vegetarian Diet

References and Further Reading

Appleby et al. (1999). "The Oxford Vegetarian Study: an overview." Am J Clin Nutr 70(3
Suppl): 525S-531S.
Aune et al. (2009). "Meat consumption and the risk of type 2 diabetes: a systematic review
and meta-analysis of cohort studies." Diabetologia 7: 7.
Barnard et al. (2009). "A low-fat vegan diet and a conventional diabetes diet in the
treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial." Am J Clin Nutr.
89(5): 1588S-1596S.
Barnard et al. (2009). "Vegetarian and vegan diets in type 2 diabetes management." Nutr
Rev. 67(5): 255-263.
Craig, W.J. and A.R. Mangels, Position of the American Dietetic Association: vegetarian diets.
J Am Diet Assoc., 2009. 109(7): p. 1266-82.
Fraser (2009). "Vegetarian diets: what do we know of their effects on common chronic
diseases?" Am J Clin Nutr 89(5): 1607S-1612.
Key et al. (2003). "Mortality in British vegetarians: review and preliminary results from EPICOxford." Am J Clin Nutr 78(3 Suppl): 533S-538S.
Key, et al. (2006). "Health effects of vegetarian and vegan diets." Proc Nutr Soc 65(1): 35-41.
Key et al. (1999). "Health benefits of a vegetarian diet." Proc Nutr Soc 58(2): 271-275.
Key,et al. (1999). "Mortality in vegetarians and nonvegetarians: detailed findings from a
collaborative analysis of 5 prospective studies." Am J Clin Nutr 70(3 Suppl): 516S-524S.
Marsh K, Brand-Miller J. (2011). Vegetarian Diets and Diabetes. American Journal of
Lifestyle Medicine 5(2):135-143.
Marsh et al. (2012). "Health Implications of a Vegetarian Diet: A Review." American Journal
of Lifestyle Medicine 6(3): 250-267.
McEvoy et al. (2012). "Vegetarian diets, low-meat diets and health: a review." Public Health
Nutrition 15(12): 2287-2294.
Pan et al. (2011). "Red meat consumption and risk of type 2 diabetes: 3 cohorts of US adults
and an updated meta-analysis." Am J Clin Nutr. 94(4): 1088-1096. Epub 2011 Aug 1010.
Rizzo et al. (2011). "Vegetarian dietary patterns are associated with a lower risk of metabolic
syndrome: the adventist health study 2." Diabetes Care. 34(5): 1225-1227.
Sabate. (2003). "The contribution of vegetarian diets to health and disease: a paradigm
shift?" Am J Clin Nutr 78(3 Suppl): 502S-507S.

Dr Kate Marsh

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