Healthy eating for vegetarians and vegans

Key messages

• Well-planned vegetarian and vegan diets can be nutritious and healthy.
• The UK government suggests a vegetarian diet should be based on the Eatwell Guide.
  • Have at least five portions of fruit and vegetables a day.
  • Base your meals on starchy carbohydrates– especially wholegrains 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 like 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 fats, salts 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 (such as 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.

What is a vegetarian diet?

A vegetarian is usually described as someone who does not 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?

• Eat at least five portions of a variety of different types of 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.

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.

Wholewheat 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:

• Protein
• Iron
• Calcium
• Vitamin B12
• Omega-3 fats 
• Other nutrients - iodine, selenium, vitamin D

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
• Houmous and pitta bread
• Rye cracker and nut butter (such as 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 years have inadequate intakes of iron.

Females who are pre-menopausal (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 (such as 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 do not 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 B12 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. Do not take more than the recommended amount. You can always talk to a health professional if you are unsure.

Omega-3 fats

Omega-3 fats are essential to our health. Long-chain omega-3 fats 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 fats.

If you do not eat fish, you can get omega-3 fats from other foods (see list below). However, these are short-chain omega-3 fats 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 like 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 sugar-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.

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 cannot 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 bodyweight 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.

For more information read our page on reducing the risk of cancer.

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, sugar-sweetened foods and beverages, salt and saturated fat.

For more information on vegetarian diets see the Vegetarian Society website.

For more information on vegan diets see the Vegan Society website.  

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

Information reviewed March 2017. Revised July 2018.