vegan/ADA.position.html
From our old vegetarian information file archives. (Please note that web links inside this document may be broken.)
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From wheeler@super.org Wed Feb 24 17:29:57 1993
Date: Thu, 1 Oct 92 10:28:27 EDT
From: wheeler@super.org (Ferrell S. Wheeler)
To: tms@cs.umd.edu
Subject: ADA Vegetarian Position Paper
Position of the American Dietetic Association:
Vegetarian Diets -- technical support paper
Authors: Suzanne Havala, R.D. and Johanna Dwyer, D.SC., R.D.
Reviewers: Phyllis Acosta, Dr. P.H., R.D.; George Eisman, R.D.;
Alice Marsh, R.D.; Connie Metcalf, R.D.;
Patricia Mutch, Ph.D., R.D.; U. D. Register, Ph.D., R.D.
Kathleen Zolber, Ph.D., R.D.
From: Journal of the American Dietetic Association, March, 1988,
Volume 88, Number 3, pp. 352-355.
The attention focused today on personal health habits is unprecedented,
as more and more Americans adopt health-promoting life-styles that include
alterations in diet and exercise patterns. Simultaneously, there has
been a marked rise in interest in vegetarian diets. A considerable body
of scientific data suggests positive relationships between vegetarian
life-styles and risk reduction for several chronic degenerative diseases
and conditions, such as obesity, coronary artery disease, hypertension,
diabetes mellitus, colon cancer, and others. The high incidence of such
diseases in industrialized nations, as compared with other cultures,
warrants special attention to diet and other factors in life-styles that
may vary between vegetarians and nonvegetarians.
It is the position of The American Dietetic Association that
vegetarian diets are healthful and nutritionally adequate
when appropriately planned.
Both vegetarian and nonvegetarian diets have the potential to be either
beneficial or detrimental to health. Sound nutrition planning may result
in risk reduction and control of some diseases and conditions by dietary
measures, whereas poorly planned or haphazard diets increase the likelihood
of diet-related disorders of deficiency or excess. However, in addition
to the possible health benefits of some vegetarian diets, consideration
may also be given to ecological, economical, and philosophical or ethical
reasons for adopting such a diet. It may be easier, as well as more
acceptable, for some individuals to meet the Dietary Guidelines for
Americans by following a vegetarian diet rather than a nonvegetarian diet
(1).
VEGETARIANISM IN PERSPECTIVE
There is no single vegetarian eating pattern. From the standpoint of
nutritional health, vegetarian diets are distinguished from one another by
(a) the extent to which the foods included vary, (b) the degree to which
the diets are planned to correspond to the findings of nutritional sciences,
and (c) the health attitudes and practices that are associated with the
diets.
Vegetarian diets differ in the extent to which they avoid animal products.
Veganism, or total vegetarianism, completely excludes meat, fish, fowl,
eggs, and dairy products. Lacto-vegetarianism is the avoidance of meat,
fish, fowl and eggs, whereas ovo-lacto-vegetarianism involves avoidance of
only meat, fish, or fowl. Semi-vegetarian patterns allow limited amounts
of most animal foods.
In addition to proscriptions on animal foods, some vegetarian diets
also incorporate restrictions on other foods and beverages, such as honey,
alcohol, caffeinated beverages, highly processed foods, and foods that
are grown or processed nonorganically or with certain additives and
preservatives. Finally, some patterns include the addition of special
foods or practices that are thought to have unique health promotive or
curative properties. Included are vitamin-mineral supplements, dietary
fiber and essential fatty acid supplements, health foods, herbal teas,
and practices such as periodic fasting.
Since vegetarianism is a term that encompasses such a wide variety
of eating patterns, nutrition assessment of such diets is difficult
without information about specific food avoidances and health-related
attitudes and practices. The differences may have a significant impact
on nutritional status (2).
Studies of vegetarians indicate that this population generally has lower
mortality rates from several chronic degenerative diseases than do non-
vegetarians. It is likely that the effects are due not to diet alone but
also to a healthy life-style, including desirable weight, regular physical
activity, and abstinence from smoking, alcohol, and illicit drugs, with
adequate health monitoring (3-6).
Even though the health benefits of a vegetarian diet make it attractive
>from a nutrition standpoint, this does not preclude the possibility of
obtaining similar health benefits from a prudent nonvegetarian diet if
it can be planned in accordance with the Dietary Guidelines for Americans.
However, in addition to health aspects, considerations that may lead to
the adoption of a vegetarian diet include: ecological implications of
eating low on the food chain with regard to preservation of the environ-
ment or for the perceived solution to world hunger problems by decreasing
the demand on the world's food resources; economic reasons, since diets
low in animal proteins are typically less expensive than meat-based
diets; and philosophical or ethical reasons, which include animal rights
issues and attitudes toward violence. Still other individuals
are motivated by religious beliefs.
IMPLICATIONS FOR HEALTH PROMOTION
Mortality from coronary artery disease is lower in vegetarians than in
nonvegetarians (7,8). Total serum cholesterol and LDL cholesterol levels
are usually lower, while HDL cholesterol and triglyceride levels vary
depending on the type of vegetarian diet that is followed (9-12).
Vegetarian diets that are typically very low in fat and cholesterol may
decrease levels of apoproteins A, B, and E (12). Platelet composition
and possible platelet functions may very, and plasma viscosity may be
decreased (13). Such effects may be attributed to the vegetarian's
lower intake of total fat, saturated fat, and cholesterol, along with
lower weight, increased physical activity, and abstinence from smoking (10,
14,15). Vegetarians generally have lower blood pressures and lower rates
of Type II diabetes than do nonvegetarians, which may decrease the risk
of coronary artery disease in the vegetarian population.
Vegetarians of the Seventh-Day Adventist faith have lower rates of
mortality from colon cancer than does the general population (4). That
may be due to dietary differences which include increased fiber intake,
decreased intake of total fat, cholesterol, and caffeine, increased
intakes of fruits and vegetables, and, in lacto-vegetarians, increased
intake of calcium (16). Although it is still speculative, the dietary
differences, especially in vegans, may produce physiological changes
that may inhibit the causal chain for colon cancer (16,17). Lung cancer
rates are lower in many types of vegetarians because they typically do
not smoke or, possibly, because of their increased intake of beta carotene
or other constituents of fruits and vegetables that may also lower lung
cancer risk (18). Preliminary evidence suggests that vegetarians may be
at lower risk for breast cancer, but further study is indicated (19).
Obesity is a complicating condition exacerbating many diseases.
Vegetarians, especially vegans, have weights that are closer to desirable
weights than do nonvegetarians (20). Several factors may be involved,
including moderation in energy intakes, increased physical activity, and
better regulation of food intake. The high-carbohydrate, low-fat vegetarian
diet, in combination with exercise, may decrease the risk of obesity (21).
Vegetarians are at lower risk for noninsulin-dependent diabetes, partly
because they are leaner than nonvegetarians (22,23). The vegetarians'
high intake of complex carbohydrates, with its relatively high fiber content,
improves carbohydrate metabolism, lowering basal glucose levels (24,25).
Finally, vegetarians have lower rates of osteoporosis, kidney stones,
gallstones, and diverticular disease (29-31). Studies documenting these
benefits, however, are inconclusive at this time, and reasons may be
related to aspects of life-style other than diet.
Vegetarians have lower rates of hypertension than do nonvegetarians,
which may be due to vegetarians' relative leanness (26,27). Other aspects
of life-style may also be involved (28), such as dietary habits, increased
physical activity, and abstinence from smoking.
NUTRITION CONSIDERATIONS
The body's need for essential amino acids can be met by consumption
of animal or plant sources of protein since, after absorption, amino
acids from exogenous and endogenous sources combine in the body's
protein pool (32). Plant foods contain less of the essential amino
acids than do equivalent quantities of animal food, but a plant-based
diet provides adequate amounts of amino acids when a varied diet is
consumed on a daily basis. A mixture of proteins from unrefined grains,
legumes, seeds, nuts, and vegetables will complement one another in
their amino acid profiles so that deficits in one are made up by another.
Intakes of different types of protein that complement one another should
be eaten over the course of the day. However, since endogenous sources of
amino acids are also available, it is not necessary that complementation of
amino acid profiles be precise and at exactly the same meal, as the
recently popular "combined protein theory" suggested. This theory urged
conscious combining of proteins at every meal with the caveat that
malnutrition would ensue if this was not done within a strict time
interval (33).
Although vegetarian diets usually meet or exceed requirements for
protein, they typically provide less protein than nonvegetarian diets.
This lower protein intake may be beneficial, however, and may be
associated with a lower risk of osteoporosis in vegetarians and improved
kidney function in individuals with prior kidney damage (34,35). Further,
a lower protein intake generally translates into a lower fat diet with its
inherent advantages, since foods high in protein are frequently also high
in fat.
Plant carbohydrates are accompanied by liberal amounts of dietary fiber,
which has been shown to be important in the prevention and treatment of
disease. Foods derived from animal sources contain no fiber. Complex
carbohydrates from plants also improve glucose tolerance, as previously
noted.
Vegetarian diets that are low in animal foods are typically lower
than nonvegetarian diets in total fat, saturated fat, and cholesterol, an
important factor in risk reduction for heart disease and some forms of
cancer. The ratio of polyunsaturated and monounsaturated fats to
saturated fats is also more favorable in a largely plant-based diet.
Vegetarians and nonvegetarians alike may have difficulty meeting
recommendations for iron. Absorption of dietary iron is enhanced by
concurrent consumption of ascorbic acid or animal foods; it is inhibited
by the intake of tea, fiber, and phytates (36). Western vegetarians
generally have better iron status than those in developing countries.
The former have a relatively high intake of iron from plant foods,
such as dark green leafy vegetables, iron-fortified cereals, and whole
grains. They may take supplements of ascorbic acid or iron and have
a greater intake of ascorbic acid from plant foods. In contrast,
vegetarians in developing countries consume less ascorbic acid and
animal protein, rely on low-iron food staples, and consume more fiber
and tea than do Westerners (37).
The requirement for vitamin B-12 is minute, but there is no vitamin
B-12 in anything that grows from the soil. It is, however, contained
in all animal foods; hence, a diet that includes animal foods, such as
dairy products, is unlikely to be deficient in vitamin B-12. Bacteria
produce vitamin B-12 in the human gut, but it appears to be produced
beyond the ileum, the site of absorption in the intestine. Ninety-five
percent of what is produced is actually inactive vitamin B-12 analogs.
The need for vitamin B-12 is very small, and lack of intrinsic factor
is a more common cause of vitamin B-12 deficiency than lack of vitamin
B-12 in the diet.
Nevertheless, adequate vitamin B-12 intake is a legitimate concern
for Western vegans. In countries where sanitary conditions are poor,
contamination of foods with microbes and organisms that produce the
vitamin may contribute all that is needed. In Western countries,
however, where sanitary practices are better, the risk of vitamin
B-12 deficiency is greater. Vegans must include a reliable source of
vitamin B-12 in their diets or be at risk of eventually developing a
deficiency.
However, food labeling of vitamin B-12 can be misleading. The vitamin
B-12 content of most foods in the United States has been determined by
use of a microbiological assay which measures not only physiologically
active forms of vitamin B-12 for human subjects but also inactive vitamin
B-12 analogs. By microbiological assay, as much as 80% to 94% of the so-
called vitamin B-12 in fermented plant foods, such as tempeh, and in other
plant foods may be inactive vitamin B-12 analogs.
Some of the of vitamin B-12 analogs also compete with active
forms of vitamin B-12 for absorption. Thus, vegans should supplement
their diets with a source of vitamin B-12 such as a cobalamin supplement
or select appropriately fortified foods that meet the Recommended Dietary
Allowances to ensure an adequate intake of the active form of the nutrient.
Further research on vitamin B-12 is needed, as there is a great deal that
is not clearly understood regarding available sources of vitamin B-12 for
vegans.
Calcium absorption appears to be inhibited by such plant consti-
tuents as phytic acid, oxalic acid, and fiber, but this effect may not be
significant. Calcium deficiency in vegetarians is rare, and there is
little evidence to show that low intakes of calcium give rise to major
health problems among the vegetarian population. One recent study has
shown that vegetarians absorb and retain more calcium from foods than do
nonvegetarians (38). Other studies cite lower rates of osteoporosis in
vegetarians than in nonvegetarians (29).
Reliance on sunshine alone, particularly in northern climates or in
cultures where most of the body is concealed in clothing, may not
provide all the vitamin D needed to protect children against rickets
(39). For those who do not use vitamin D-fortified milk products, a
vitamin D supplement may be necessary, especially for dark-skinned
individuals and for infants whose only source of vitamin D is breast
milk after 4 to 6 months of age.
GROUPS WITH SPECIAL NEEDS
Those whose nutrient needs are especially high because of growth,
lactation, or recovery from illness will find it especially helpful to consult
a registered dietitian or other qualified nutrition professional for expert
help in diet planning. Infants and children who consume well-planned
vegetarian diets including milk products or eggs can generally meet all
of their nutritional requirements for growth. Those who follow vegan or
vegan-like diets which include no animal products can be healthy, but more
care must be taken to ensure adequacy. Vitamin D and iron supplements, in
addition to vitamin B-12 at levels sufficient to meet the Recommended
Dietary Allowances, may need to be provided (40).
================================================================
Vegetarians are at lower risk for noninsulin-dependent diabetes
and have lower rates of hypertension, osteoporosis, kidney
stones, gallstones, and diverticular disease than nonvegetarians
----------------------------------------------------------------
Vegan diets tend to be high in bulk, which makes it more challenging to
meet energy needs, especially for infants, children and adolescents (41).
Further, care must be taken to obtain enough vitamins D and B-12. A
properly fortified soy product may be helpful. Both vegetarians and
nonvegetarians whose infants are premature or are breast fed exclusively
beyond 4 to 6 months of age should provide supplements of vitamin D and
iron from birth or at least by 4 to 6 months, as medical guidance suggests.
The guidelines of the American Academy of Pediatrics for supplementation
of infants are helpful (42).
Well-planned vegetarian diets are adequate for pregnant and lactating
women. With both vegetarian and nonvegetarian diets, iron and folate
supplements are usually necessary during pregnancy, although vegetarians
frequently have greater intakes of those nutrients than do nonvegetarians.
MEAL PLANNING
In planning vegetarian diets of any type, one should choose a wide variety
of foods, which may include fruits, vegetables, whole grain food products,
nuts, seeds, legumes, low-fat dairy products or fortified soy substitutes,
and a limited number of eggs. Additionally, the following recommendations
are made (43,44):
* Keep the intake of low nutrient-dense foods, such as sweets and fatty
foods, to a minimum
* Choose whole or unrefined grain products whenever possible, instead of
refined products.
* Use a variety of fruits and vegetables, including a good food source
of vitamin C to enhance iron absorption.
* If milk products are consumed, use low-fat varieties.
* Limit intake of eggs to two to three yolks per week to ensure
that cholesterol intakes are not excessive.
* For vegans, use a properly fortified food source of vitamin B-12, such
as fortified soy milks or breakfast cereals, or take a cobalamin
supplement.
* For infants and children, ensure adequate intakes of iron, vitamin D,
and energy.
* Consult a registered dietitian or other qualified nutrition professional.
The Dietary Guidelines for Americans recommend a reduction in fat intake
and an increased consumption of fruits and vegetables, and whole grains.
Well-planned vegetarian diets effectively meet these guidelines and the
Recommended Dietary Allowances and can be confidently embraced as a healthy
dietary alternative. However, vegetarians, particularly total vegetarians,
living in a nonvegetarian society such as the United States, must be
aware that foods most readily available in this culture may not be those
which are most appropriate for their eating patterns; thus, vegetarians
must pay special attention to ensuring nutrient adequacy. Additionally,
both vegetarians and nonvegetarians must obtain adequate health monitoring
throughout the life cycle.
REFERENCES
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(3) Kahn, R. H., Phillips, R. L., Snowdon, D. A., and Choi, W.: Association
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