More and more Americans are choosing to follow vegetarian diets. For most families, a decision to adopt a vegetarian lifestyle can lead to a beneficially increased intake of fruits and vegetables. That’s wonderful news! While vegetarian diets can be made safe at any age, young children and adolescents need to be particularly careful to consume all the needed nutrients for rapid growth. In this article, I will examine the most common types of vegetarian diets and the potential risks of each.
I hope this will help guide you to making sound nutritional choices for your family.
Types of Vegetarian Diets
There are 5 major types of diets that restrict animal products and emphasize fruits of vegetables. In general, the more types of foods that a diet restricts, the more potential there is for deficiency of critical nutrients.
Common vegetarian diets, from the least to the most restrictive:
- Semi-vegetarian: meat intake is occasional. Red meat may be completely excluded.
- Lacto-ovo-vegetarian: Eggs and dairy are eaten but all animal meats are excluded.
- Lactovegetarian: Dairy is eaten but no meats or eggs.
- Macrobiotic: White meat or white fish is limited to 1-2 times weekly, no eggs or dairy; whole grains and locally grown fruits and vegetables are emphasized
- Vegan: No animal products are consumed (no eggs, no dairy, no fish, no seafood, no meat).
The greatest danger of compromised nutrition occurs during periods of rapid growth, namely during the first 2 years and adolescence. Vegetarians, like all eaters, should aim for as much variety as possible in the diet. One strategy for achieving this is to encourage kids to eat as more colors and textures as possible during the week. Aim for red, blue, green, yellow and orange foods. Encourage them to describe the different textures they eat. Try to eat foods that are smooth, crunchy, rough, hard, soft, or juicy every day. Also, make sure that kids are not just avoiding animal-based foods; vegetarians should be eating lots of vegetables too!
Specific nutrients to consider:
There are a number of specific nutrients that need to be monitored in vegetarian diets.
Omega-3 fatty acids
Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are critical for cardiovascular health and eye and brain development. In fact, deficiencies of these nutrients may place kids at risk for early heart disease as adults. These nutrients are likely to be inadequate in vegetarian diets unless children eat lots of fish, eggs, flaxseed, walnuts canola oil or soy products. Some packaged or processed foods are also fortified with DHA.
Protein and Amino acids
Growing children need protein. Smaller children need more protein. Below are suggested minimums:
- Children 1-3 years: 1.05 grams per kilogram of body weight per day
- Children 4-13 years: 0.95 grams per kilogram of body weight per day
- Children 13-18 years: 0.85 grams per kilogram of body weight per day
Proteins are made up of individual amino acids and humans need to regularly consume 9 essential amino acids to stay healthy. Animal products usually contain all 9 of these but plant-based products do not. Some plants contain some of the 9 and other plants can provide the remaining amino acids. Plants that provide all 9 when consumed together are known as “complementary foods.” A classic example is red beans and rice. These complementary foods do not need to be eaten at the same time. The idea is to consume a balance of different plant based proteins throughout the day or week.
Sufficient methionine is particularly difficult to achieve for children under 2 years who follow a vegan diet. Vegan sources of methionine include sunflower seeds, oats and Brazil nuts. Supplements are also available.
Adequate protein for growth is also affected by how easy it is to digest the protein you eat. Animal based proteins are more easily digestible than legume proteins which are more easily digested than other plant-based proteins. Vegan eaters aged 2-6 years may need to aim for 20-30% extra protein each day beyond the suggested amounts above; vegan eaters above age 6 years need 15-20% more.
Adequate iron intake is necessary for building of new red blood cells. Because children are growing and therefore making lots of new red blood cells, they require diets rich in iron or they can become anemia. Anemia can cause fatigue and diminished cognitive development. That’s a really good reason to ensure kids consume an iron-rich diet!
Daily requirements are as follows:
- Children 1 to 3 years old: 7 mg
- 4 to 8 years old: 10 mg
- 9 to 13 years old: 8 mg
- Adolescent boys: 11 mg
- Adolescent girls: 15 mg
Unfortunately for vegetarians, iron is most plentiful and most easily absorbed from animal-based foods, not from plants. In fact, the iron in plants is 15% less easily digested than the iron in meats and much more likely to be affected by other stomach contents (especially tannin-rich teas). Milk and eggs are also not very good sources of iron. Eating foods rich in vitamin C (citrus, broccoli, strawberries, tomatoes) at the same time as iron-rich foods and avoiding tea can increase the amount of iron children absorb.
Zinc deficiency is associated with growth impairment, increased risk of infections, diarrhea and pneumonias. Because they are growing, children have proportionately greater zinc needs than adults. Dairy is particularly rich in zinc. For vegans and other who do not consume dairy, alternative sources include nuts, wheat germ, whole grains, and legumes
Adequate calcium intake in necessary to maintain cardiovascular health, to minimize the risk of fracture and to minimize osteoporosis later in life. Most children in the US received 75% of their calcium intake through dairy products which are extremely rich in calcium. Vegans can obtain adequate calcium through dark greens, dried figs, or molasses but they would need to consume these products in large volumes. For many vegans, Calcium fortified soy milk is a good alternative. The bio-availability of the calcium in fortified soy milk is only 75% of that found in cow’s milk. Parents should therefore take care that children following a dairy-free diet consume a calcium rich food at each meal and at several snacks. Any soy milk consumed should be vitamin D and calcium fortified. Calcium supplements are another alternative but they should not be taken at the same time as zinc or iron supplements.
Requirements are as follows:
- 1-3 years: 700mg
- 4-8 years: 1000mg
- 9-18 years: 1300mg
Vitamin D works together with calcium to contribute to healthy bones and teeth. Some evidence also suggests that it protects against disease like cancer, diabetes and multiple sclerosis. Most people acquire Vitamin D from a combination of sun-exposure and vitamin-D fortified dairy products. It is recommended that individuals receive 600IU from dietary sources and adequate sun exposure each day. This means about 15 minutes of sunlight on the face, arms and hands for fair-skinned individuals and up to 10 times as much for dark-skinned individuals. For individuals who avoid dairy products, alternative sources include vitamin-D fortified soy products and breakfast cereals, fatty fishes, cod liver oil, beef liver, cheese, or egg yolks. Calcium supplements typically also contain a vitamin-D supplement.
Vitamin B-12 is of particular importance to vegetarians. This is because this vital nutrient is ONLY found in animal products. For this reason, studies have shown that 92% of vegans who did not take supplemental B-12 were deficient. Compare this to 64% of lactovegetarians, 40% of lacto-ovo-vegetarians and 20% of semi-vegetarians who were deficient. For this reason, it is critical that vegans and lactovegetarians take a vitamin B-12 supplement each day. The supplement should provide 6-9 mcg of Cyanocobalamin, the active form of the vitamin, daily. Fortified soy milk is another good B-12 alternative for children.
In general, vegetarian diets provide a very healthy amount of fiber. However, for quickly growing children, too much fiber may compromise their overall energy (calorie) intake and reduce their absorption of iron, calcium and zinc. However, if children are gaining weight well, this is likely a small risk.
For general reference, the recommended daily fiber intake is as follows:
- 1-3 years: 19 grams
- 4-8 years: 25 grams
- 9-13 years: 26-31 grams
Vegetarian diets can provide well for the needs of a growing child or adolescent. However, the more restrictive the diet, the more care that should be taken to ensure daily requirements are met. While a vegan diet can be a healthy choice, a lactovegetarian diet has greater health benefits and fewer risks. Unless you are prepared to carefully monitor all of the above nutrients, consider including dairy, eggs and/or fish in your diet. Another alternative is to take a daily supplement that includes adequate amounts of EPA, DHA, iron, zinc, calcium, vitamin D and B12. As always, we are happy to discuss these and other nutritional issues with you in the office.