Healthy eating for vegetarians and vegans - British Nutrition Foundation

Healthy eating for vegetarians and vegans

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Healthy eating for vegetarians and vegans

Key Messages

  • Well planned vegetarian and vegan diets can be nutritious and healthy
  • The UK government suggest a vegetarian diet should be based on the Eatwell Guide
    • Have at least 5 portions of fruit and vegetables a day
    • Base your meals on starchy carbohydrates – especially whole grains and high fibre versions
    • Include some dairy or dairy alternatives (for example calcium-fortified soya, rice and oat drinks), choose lower fat and lower sugar products where possible
    • Choose a variety of protein sources, for example pulses (lentils, beans and peas), eggs, Quorn ™ (mycoprotein) and soya products e.g. soya mince or textured vegetable protein (TVP)
    • Choose unsaturated oils and spreads and eat in small amounts. Unsaturated fats are monounsaturated fats (found, for example, in olive and rapeseed oil) and polyunsaturated fats (found in for example sunflower and corn oil)
    • Drink plenty of fluids – the government recommends 6-8 cups/glasses a day
    • Remember that food high in fatssalts and sugars like cakes, biscuits, fried savoury snacks, pies, pastries and sugar sweetened soft drinks are not needed in the diet so if you include these, eat them less often and in small amounts
  • When eating a meal with plant sources of iron like pulses (e.g. kidney beans, chickpeas or lentils), dark green veg or an iron-fortified breakfast cereal try to include some vitamin C to increase iron absorption (by adding some vegetables such as peppers or broccoli to your meal or berries to your cereal)
  • For vegans who strictly avoid all animal products, other sources of vitamin B12 such as vitamin B12 fortified foods or supplements should be included.

Did you know?

The sugars we need to reduce are called ‘Free sugars’. Free sugars include all added sugars in foods and drinks in whatever form including table sugar, honey, syrups, and nectars, as well as the sugars naturally present in fruit, vegetable and pulses (e.g. soy, chickpeas) that have been juiced, pureed or made into pastes. Ingredients added such as lactose and galactose are also considered to be free sugars.

What is a vegetarian diet?

A vegetarian is usually described as someone who doesn’t eat meat, poultry, fish, shellfish or any by-products of slaughter.

However there is no single, accepted definition of ‘vegetarian’. People may define themselves as vegetarians because they largely choose plant based diets, will include some fish (pescetarian), or are what has been popularly described as flexitarian or ‘semi-vegetarian’ (someone who is mostly vegetarian but occasionally eats meat or poultry).

Some of the common types of vegetarians are:

  • Lacto-ovo-vegetarians (the most common type) – eats dairy products and eggs
  • Lacto-vegetarians – eats dairy products but not eggs
  • Ovo-vegetarian – eats eggs but not dairy products
  • Vegan – does not eat any products of animal origin so does not eat any dairy products, eggs or honey

 

How many people in the UK are vegetarian?

From recent dietary surveys (National Diet and Nutrition Survey 2008/9-2011/12) we can estimate that around 2% of adults and children living in the UK are vegetarian. This equates to more than 1.2 million people. In the survey, less than 1% reported following a vegan diet.

Why do people choose to follow a vegetarian diet?

There are many reasons why people choose to be vegetarian including parental preferences, health reasons, religious or cultural beliefs as well as concern for animal rights and the environment.

A healthy and balanced vegetarian diet
 
Appropriately planned vegetarian diets are nutritionally adequate across all life stages of the life cycle and can provide the nutrients we need.

If you would like information on vegetarianism and veganism in pregnancy you can find this here

Choosing a healthy balanced diet

Do remember that vegetarian options can also be high in saturated fat, salt and sugar. Eating plenty of fruit and vegetables, reducing your salt and free sugars intake, keeping your alcohol consumption within government guidelines, maintaining a healthy body weight and leading an active lifestyle are all important.

The Eatwell Guide is the UK dietary recommendations and applies to vegetarians and vegans; you can use it to help you make good choices for a balanced and varied diet.

Suitable choices for vegetarians and vegans

*The full name of this group within the Eatwell Guide is "Beans, pulses, fish, eggs, meat and other proteins". The reference to meat and fish was removed on the basis that these are not suitable for vegetarian or vegan diets.

The Eatwell Guide also contains information regarding the foods to eat less often and in small amounts

If you would like more information on the Eatwell Guide you can find this here.

Potatoes, bread, rice, pasta and other starchy carbohydrates 
  • Base your meals on starchy carbohydrates, choosing wholegrain or higher fibre versions – these include brown rice, whole-wheat pasta, quinoa, whole-wheat chapatti's, buckwheat, porridge oats and potatoes with skin

Tips

  • Try to avoid adding too much fat (e.g. butter or cream in mashed potatoes or cream based pasta sauces) as these can considerably increase the calories and saturated fat content of the dish
  • Remember to check the labels and choose products low in fat, salt and sugars
  • If you are thinking of having chips, why not try baking wedges using a small amount of unsaturated oil or choose oven chips lower in fat and salt
  • You can mix white and wholegrain versions to increase fibre content – like mixing white and wild rice or baking with half wholemeal and half white flour 

Fruit and vegetables

  • Eat at least five portions of a variety of different types fruit and vegetables every day
  • All fruit and vegetables including fresh, frozen, canned (not in brine or syrups) and dried (with no added sugars) count!
  • Fruit/vegetable juices and smoothies can count as one portion but this should be limited to a maximum of 150ml a day

Tips

  • Be careful when choosing canned fruit like lychee, pineapple and mango that they are not canned in syrup
  • Add more vegetables to your main meals (e.g. add grated carrot, mushrooms or peppers to your bean chilli or veggie bolognese)
  • Try and keep fruit in your bag (and your fridge) ready to eat as a healthy, convenient snack
  • Keeping vegetables in your freezer is a good way to ensure you don’t run out
  • Avoid adding salt to cooking water or adding sugars to fruit (like honey)
  • Seasonal vegetables are delicious as they are – why not steam them?
  • If you want to add dressings to vegetables or salads why not try lemon juice, chilli and olive oil, some of the less used unsaturated oils like walnut or sesame oil or dressings made from avocado or tahini? 

Dairy and alternatives 

  • Include some dairy or dairy alternatives. Choose lower fat and lower sugar options where possible
  • Many vegetarians consume dairy foods like milk, cheese and yogurt. Calcium fortified dairy alternatives like soya, oat and nut drinks are suitable for vegans and others who don’t consume dairy. Check the labels to ensure they are fortified
  • Cheese can be high in saturated fat and salt so try to use reduced fat varieties, a smaller amount of stronger varieties or lower fat cheeses like quark or cottage cheese
  • Free from cheese alternatives are available in some retailers but these are typically not fortified with calcium

Tips

  • Grating cheese instead of freely slicing it is a good method to avoid using more than you need!
  • Try to use low fat plain yogurt or fromage frais instead of cream, crème fraiche or mayonnaise 

Beans, pulses, fish, eggs, meat and other proteins

  • Eat some beans, pulses, eggs and other proteins 
  • There are many options for vegetarians including Quorn™ (mycoprotein), tofu, soya products, TVP, pulses (like lentils, kidney beans and peas), as well as eggs (if you eat them)
  • An 80g portion of pulses (lentils, beans and peas) can count as 1 of your 5 A Day!

Tip

  • Why not try a spicy dal or a chickpea curry served with brown rice or flatbreads like a chapatti or a roti?

Oils and spreads

  • Choose oils high in unsaturated fat and low in saturated fat
  • Don’t forget all oils are high in fat so use sparingly
  • Choose lower fat spreads where possible– check the labels
  • Most of the oils sold as standard vegetable oil in supermarkets is rapeseed oil, an oil high in monounsaturated fats

Tips

  • When heated, oils expand so heating oil in the pan before you use it will make it go further so you don’t need to use as much
  • You could also use spray oils to reduce the amount of oil you use for cooking
  • Remember fats like coconut oil, palm oil and ghee are high in saturated fat

Foods to eat less often and in small amounts 

  • Foods such as cakes, biscuits, chocolates, pastries, ice cream, fried crisps, cream and sugars-sweetened beverages are not required as part of a healthy balanced diet. If you want to include these in your diet, have them infrequently or in small amounts

Tip

  • If you add sugar to your food or drinks, such as tea, gradually reduce the amount you add until you may be able to cut it out completely

 

 

 

 

Composite dishes

The Eatwell Guide puts foods into distinct groups. However, we mostly eat dishes and meals like curries, stews and sandwiches which are made of foods from multiple groups - these are called ‘composite dishes’.

Here is an example of a vegan and vegetarian composite dish showing how the main ingredients fit with the food groups of the Eatwell Guide.

Spinach, chickpea and aubergine curry with brown rice (vegan)

You could also add a raita made with plain soy yogurt (dairy and alternative group), just add some finely chopped cucumber and a good pinch of cumin.

 

 

 

 

 

 

 

 

Whole wheat vegetarian Spaghetti Bolognese

Some important nutrients to consider

A well planned vegetarian or vegan diet can provide the nutrients we need. However, some nutrients may come from different sources. For example over a third of calcium in the average UK diet comes from milk and dairy foods but in vegans calcium will be obtained from non-dairy foods and drinks.

In the next section we will look at:

If you would like more information on nutrient functions, sources and requirements you can find this here.

Protein

Proteins are needed for many of the important functions that make our body work properly. A common misconception is that those who do not eat any meat or fish will not consume enough protein. However, vegans and vegetarians typically do get enough protein from their diet.

Proteins are made up of substances called amino acids. Our bodies can make some of these amino acids, but others known as ‘essential’ amino acids, are needed from the diet.

Consuming a range of plant protein sources will help ensure you are getting enough of all the essential amino acids. 

Good sources of protein

  • Eggs (vegetarians, not vegans)
  • Pulses (such as chickpeas, kidney beans, soya beans and lentils)
  • Tofu or bean curd
  • Quorn™ (mycoprotein), until recently, Quorn™ was not suitable for vegans as all products contained a small amount of egg. However, a new vegan range is now available 
  • Nuts (choose plain, unsalted, varieties)

Although not considered in the ‘protein’ food group, cheese is often a popular choice for people following vegetarian diets. Cheese is a good source of protein, calcium and other nutrients. However some varieties can be high in saturated fat and salt. Check the label and try and choose reduced fat varieties or use stronger varieties in smaller amounts.

Some examples of meals/snacks that are sources of protein suitable for vegetarians and vegans

  • Baked beans on wholegrain toast
  • Vegetable soup with lentils and barley
  • Bean chilli with rice
  • Spicy chickpea stew with couscous
  • Humous and pitta bread
  • Rye cracker and nut butter (e.g. peanut/almond/cashew butter)

Iron

Iron is essential for transporting oxygen around the body, brain function and the immune system. According to dietary surveys, 46% of girls aged 11 to 18 years and 23% of women aged 19 to 64 have inadequate intakes of iron.

Females who are premenopausal (those who have a monthly cycle) are more at risk of iron deficiency.

The iron found in plant foods (called non-haem iron) is less readily absorbed in the body than the iron from animal sources (known as haem iron). Vegetarians may have lower iron stores so it is important to include good sources of iron in the diet.

Good sources of iron for vegetarians

  • Pulses (lentils, beans and peas)
  • Green leafy vegetables (such as watercress and spinach)
  • Wholemeal, seeded or brown bread
  • Some fortified breakfast cereals (with added iron)
  • Dried fruits (such as apricots and figs)
  • Nuts and seeds (such as cashews, almonds, walnuts, sesame seeds, pumpkin seeds and sunflower seeds). 

Vitamin C helps your body absorb iron. Try and add some vitamin C rich vegetables to your meal. For example if you are making a vegetarian bean curry, add some peppers. You could also have a small glass of fruit juice with your meal (remember the dietary recommendation is a maximum of 150ml per day!)

Some compounds in tea and coffee can actually make it harder to absorb iron, so try and avoid these when consuming plant sources of iron (e.g. pulses, kidney beans and chickpeas).

Calcium 

Calcium is important for healthy bones and teeth as well as the functions of muscles and nerves. For vegetarians, dairy foods, such as milk, cheese and yogurt, are a good source of calcium. Try to select lower fat, lower sugar versions where possible.

If you don’t eat dairy products, make sure you include other calcium-containing foods and drinks which include:

  • Bread (breads made with flour which does not contain the wholegrain, such as white and some brown breads in the UK, have to be fortified with calcium by law)
  • Some green leafy vegetables (such as kale, rocket and watercress)
  • Calcium-fortified breakfast cereals
  • Calcium-fortified dairy alternatives (such as soya, oat, rice or nut dairy-free alternative drinks and yogurts)
  • Calcium-set tofu (those prepared using calcium)

Vitamin B12

Vitamin B12 is needed for healthy blood as well as our nervous system and immune system.

Typically, vitamin B12 is only found naturally in foods from animal sources. So vegetarians who consume dairy products and eggs can get enough vitamin B12 from their diet; however vegans may not get enough of this vitamin, due to the lack of reliable sources. Studies have confirmed low vitamin B12 intake and blood concentrations (the level of vitamin B12 in the blood) in both vegans and vegetarians. Clinical symptoms from vitamin B12 deficiency because of poor dietary intake are rare; however cases have been reported in strict vegan diets, particularly in young children.

Vegan sources of vitamin B12

  • Vitamin B-12 fortified yeast extract
  • Vitamin B12 fortified breakfast cereals (with added vitamin B12)
  • Vitamin B12 fortified dairy-free alternatives (such as soya, oat and nut dairy-free alternative drinks or vegan spreads)

Remember to look at food labels!

Alternatively, as suggested by the Vegan Society, you could take a vitamin B12 supplement. Don’t take more than the recommended amount. You can always talk to a healthcare professional if you are unsure.

Omega-3 fatty acids

Omega-3 fatty acids are essential to our health. Long-chain omega-3 fatty acids like docosahexaenoic acid (DHA), the kind that you find in oily fish, may help lower our risk of heart disease, and contribute to normal visual and brain development. Oily fish such as salmon, mackerel and trout are rich sources of these long chain omega 3 fatty acids.

If you don't eat fish, you can get omega-3 fatty acids from other foods (see list below). However, these are short chain omega-3 fatty acids known as α-linolenic acid (ALA). It has been shown that only a small proportion of these fats can be converted into long chain omega-3s.

Although vegans and vegetarians have lower intakes of the important long-chain omega-3 fats than those consuming fish in their diets, there is no strong evidence that vegans and vegetarians have poorer health as a result.

Supplements containing long chain omega-3 fats from microalgae are also available.

Foods containing short-chain omega-3 fats (ALA) include some nuts, seeds and their oils

  • Some seeds (such as flax and chia seeds)
  • Walnuts and walnut oil
  • Soybeans and soybean oil
  • Oils (such as flaxseed, rapeseed)

Other nutrients

Iodine

Sources of iodine include fish, eggs, milk and milk products, with dairy contributing around one third to average daily UK iodine adult intake. Vegetarians and particularly vegans are at risk of iodine deficiency as they do not eat rich iodine sources (fish and/or dairy products). Soya and dairy alternative drinks are not typically fortified with iodine (check label) and therefore sources are limited.

Vegan sources of iodine include:

  • In some countries, iodine is added to salt. However, this does not occur in the UK and there is a government recommendation to reduce salt intakes. Therefore, iodised salt should not be relied upon as a means to increase iodine intakes.
  • Although seaweed is a concentrated source of iodine, it can provide excessive amounts (particularly brown seaweed e.g. kelp) and therefore eating it more than once a week is not recommended, especially during pregnancy or breastfeeding.
  • Iodine supplements.

Selenium

Selenium is needed for the normal function of the immune system and to help protect your body’s cells. Dietary surveys show that a substantial proportion of the population may not have an adequate intake of selenium. However the health implications of this are currently unclear. Meat and fish are really good sources of selenium, and eggs are also a good source. If you're a vegetarian or vegan, it's important to make sure you're eating other foods which contain a source of selenium (although the actual levels are variable dependent on the soil in which they are grown), these include: 

  • Some nuts and seeds (especially Brazil nuts but also cashew nuts and sunflower seeds)
  • Some breakfast cereals (such as puffed wheat cereal, shredded wheat and cornflakes)
  • Some breads (such as seeded and wheatgerm bread)

Vitamin D

Vitamin D is needed for the absorption of calcium and phosphorus from foods to keep bones healthy. We get most of our vitamin D through the action of sunlight on our skin during the summers months but oily fish and eggs, fortified cereals and spreads also contain vitamin D.

In addition to sunlight, good vegan sources of vitamin D are:

  • Vitamin D fortified fat spreads, breakfast cereals and unsweetened soya drinks
  • Vitamin D supplements

When choosing vitamin D supplements, read the label to ensure they are suitable for vegans. Vitamin D2 and vitamin D3 from lichen are vegan-friendly options.

 

Association of vegetarian diets and health

It is important to remember that removing meat from your diet alone is no guarantee of a healthier diet. However, there is some evidence that shows vegetarian dietary patterns may have a health benefit when compared to more traditional dietary patterns. Vegetarian or more plant based diets are typically higher in fruit and vegetables, whole grains and dietary fibre while being lower in saturated fat, sweets and non-water beverages (such as sugars-sweetened beverages and alcohol).

However, we also know that people who adopt vegetarian diets are often more health conscious overall and also adopt other healthier lifestyle factors. For instance, vegetarians are likely to be more physically active, less likely to smoke, consume less alcohol and are more likely to have a higher income and education. This may explain some of the observed health benefits.

Health Conditions

Systematic reviews have found associations between the consumption of vegetarian diets and a reduced incidence of obesity and coronary heart disease, as well as a reduced blood pressure and blood cholesterol, and a lower energy intake.

Health condition

Modifiable risk factors

Overweight/obesity

High daily energy intake

Physical inactivity

Coronary heart disease

Being overweight/obese

High blood pressure

High cholesterol

Smoking

 

 Obesity

Obesity is classified as a BMI of 30kg/m² or higher and is associated with a range of health problems including type 2 diabetes, cardiovascular disease and some cancers.

 Cholesterol

Cholesterol is a fatty substance found in your blood. It is an essential part of cell membranes in the body, a component of some hormones and also needed to produce vitamin D. However, having too much cholesterol in the blood can increase your risk of getting heart disease.

Blood pressure

High blood pressure (also called hypertension) increases the risk of developing some health problems, such as heart attack or stroke. Blood pressure is recorded with two numbers. The systolic pressure (higher number) is the highest level your blood pressure reaches when your heart beats. The diastolic pressure (lower number) is the lowest level your blood pressure reaches as your heart relaxes between beats. They're both measured in millimetres of mercury (mmHg).

Coronary heart  disease

Coronary heart disease, previously called ischaemic heart disease, is when your coronary arteries become narrowed by a gradual build-up of fatty material within their walls. These arteries supply your heart muscle with oxygen-rich blood.

Vegetarian diets and cancer

Studies looking at the association between vegetarian diets and the risk of cancer are somewhat inconsistent.

Cancer is a complex disease and the risk of developing cancer depends on a combination of factors, some of which you can’t change like your genes. Cancer Research UK have said 4 in 10 cancers can be prevented by adopting healthy lifestyle behaviours such as not smoking, eating a healthy, varied diet, keeping active, maintaining a healthy body weight and not drinking alcohol or reducing alcohol consumption to within government recommendations.

World Cancer Research Fund recommendations for cancer prevention include eating more plant based foods such as wholegrains, fruit, vegetables, beans and eating less red and processed meat.

If you would like more information about reducing the risk of cancer you can find this here.

Plant based eating

We also know that there is not a ‘one size fits all’ healthy diet, but that certain characteristics of dietary patterns are linked with better health. Such dietary patterns include higher consumption of fruit and vegetables, wholegrains, pulses, nuts and seeds as well as lower intakes of fatty/processed meat, refined grains, sugars-sweetened foods and beverages, salt and saturated fat.

 

Key references

British Dietetic Association, 2016. Food fact sheet – vegetarian diets. [Online]. Available from: https://www.bda.uk.com/foodfacts/vegetarianfoodfacts.pdf (Accessed 1st February 2017).

Garbett, T.M., Garbett, D.L. and Wendrof, A., 2016. Vegetarian diet: a prescription for high blood pressure? A systematic review of the literature. The Journal for Nurse Practioners, 12(7), pp. 452-458.

Dinu, M., Abbate, R., Gensini, G.F., Casini, A. and Sofi, F., 2015. Vegetarian, vegan diets and multiple health outcomes: a systematic review with meta-analysis of observational studies. Critical Reviews in Food Science and Nutrition. 6(0), Epub ahead of print.

You can visit the Vegetarian Society and Vegan society for further information.

For more information on the sources used in this text please contact postbox@nutrition.org.uk 

Last reviewed March 2017. Updated July 2018. 

 

Vegan diets - strengths and challenges

For anybody interested in vegan diets and nutrition, BNF answers some of the most common questions. This is not a comprehensive guide to a vegan diet, but provides some useful nutrition information in this area.

Last reviewed May 2018. Next review due May 2021.

For more information on the sources used in this text, please contact postbox@nutrition.org.uk

FAQ vegan diets: strengths and challenges

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