The term ’vegetarian’ is non-specific. It is used to describe a whole range of diets, practiced with differing degrees of restrictio9n. Vegetarians are sometimes referred to as ’semi-’ of ’demi-’ vegetarian, if they merely exclude meat. Then more widely accepted classifications are listed below.

Semi/Demi- vegetarian: refers to individuals who exclude red meat or all meat, but fish and other animal products are still consumed. Some people also exclude poultry.

Lacto-ovo-vegetarian: this term refers to individuals who consume dairy produce and eggs but who exclude all meat, fish and poultry. This is the most common type of vegetarian diet adopted in modern society.

Lacto-vegetarian: this term refers to individuals who adopt similar eating patterns to lacto-ovo-vegetarians however, lacto-vegetarians do not consume eggs.

Vegan: this term refers to individuals who will not consume foods of animal origin.

Fruitarian: is an extreme form of veganism which excludes all food of animal origin but also excludes pulses and cereals.

Macrobiotic: is an extreme diet which dictates that bodily spiritual well-being is dependent on the balance between Yin and Yang, representing the positive and negative aspects of life. The diet progresses thorough ten levels, becoming increasingly restrictive and gradually eliminating foods of animal origin, fruit and vegetables. At the final levels only cereal (brown rice) is eaten. Although the earlier levels of the diet may be sufficiently varied to permit a nutritionally complete status this is unlikely in the final stages.

The above classification system has developed over the years to help reflect the differing degrees of adoption of vegetarianism It is lacto-vegetarianism, which is discussed here.

Origins

Vegetarianism has been practised throughout history for a variety of religious, cultural, philosophical, social and economic reasons. Similarly, for centuries, people have expressed concerns about animal welfare, environmental, ethical and proposed health benefits associated with the consumption of animals and animal-based products. Consequently, many individuals over the years have chosen to either exclude or reduce their consumption of animal meats and associated products. Many followers of religions faiths have similarly adopted differing degrees of vegetarian-type eating patterns including Buddhism, Jainism and Hindus.

Vegetarian eating patterns are not a recent phenomenon, but rather date back over hundreds of years. Interestingly, famous vegetarians include, Plato, Socrates, Pythagoras plus writers Pope and Shelley. The following of the vegetarian movement over the years has lead to the creation of many different societies. The majority of these societies aim to provide forums for people to increase their knowledge and make informed choice in terms of commencing or maintaining vegetarian eating patterns.

In the earlier stages of the vegetarian movement there was a scarcity of evidence and knowledge to help support people making the decision to adopt vegetarian eating patterns. Over the years, however, a wealth of evidence-based research has provided the public with information about how to go about ensuring that dietary intake is balanced despite the exclusion of animal products. Research has also suggested health benefits associated with vegetarianism.

Description

A varied lacto-vegetarian diet aims to provide all of the essential nutrients that the body requires in suitable amounts to help ensure nutritional adequacy and minimise the risk of deficiencies of nutrients.

As with any pattern of eating, it is difficult to make generalisations about the pros and cons of vegetarianism as the diet adopted by each individual will vary considerably depending on the reasons for adopting vegetarianism and consequently the restrictions practised. Whether or not a vegetarian diet is nutritionally balanced is dependent on the range and amounts of foods selected.

The general dietary recommendations are that the general healthy eating guidelines as applied to the general meat-eating population also apply to vegetarians. As with all diets, care needs to be taken to ensure that foods are selected with a view to ensuring a nutritionally balanced mix. Consequently, for lacto-vege-tarians the principles of healthy eating as illustrated by the food pyramid can be adapted to reflect the dietary needs of this cohort of individuals. Ensuring that substitute foods of similar nutritional value are introduced helps achieve an adequate dietary intake. The principles of healthy diet suggest:

Eating regular meals (and snacks if required) throughout the day based on starchy carbohydrates (bread, potatoes, pasta, rice, cereals) at each mealtime.

Large intake of fruit and vegetables to help ensure micronutrient (vitamins and minerals) intake is adequate to help reduce the risk of cancer and heart disease. This includes fresh, dried, frozen and juiced fruit and vegetables.

Moderate portions of protein sources such as soy, a high quality protein (instead of meat, fish and eggs) and dairy produce (cheese, milk and yogurts).

Beans, pulses, legumes, and nuts—low quality proteins that need to be combined with other sources of protein to ensure adequate intakes of essential amino acids.

Inclusion of small portions of foods high in refined sugar and fat as large intakes of these foods can increase risk of obesity, cancer and heart disease.

In summary, eating a broad range of foods on a daily basis can help ensure that lacto-vegetarians achieve their full nutritional requirements daily. Therefore, discussing each of the shelves individually as applied to the lacto-vegetarians will help translate and apply the information from the food pyramid.

The Starchy Carbohydrate shelf

The bottom shelf, which is the largest shelf contains starchy carbohydrates and is relatively similar for both meat eaters and lacto-vegetarians. Foods on this shelf include, bread, cereals, rice, potatoes, yams, oats, corn, rye, millet, rye, barley, quinoa, buckwheat and cous cous. Foods including pasta made with egg are not an option for lacto-vegetarians but are for meat eaters. However, egg-free pasta is now readily available as a suitable substitute.

KEY TERMS

Amino Acids —These compounds are the building blocks of protein. Some amino acids can be synthes-ised by the body but some cannot. The latter are referred to as essential amino acids and therefore must be obtained from protein in the diet.

Anaemia —Anaemia refers to a reduction in the quantity of the oxygen-carrying pigment haemoglobin in the blood. The main symptoms of anaemia are excessive tiredness and fatigability, breathless-ness on exertion, pallor and poor resistance to infection.

Calcium —Calcium is a mineral present in large quantities in the body, mainly in the bones and teeth. A deficiency of calcium in the diet can increase risk of osteoporosis. Rich sources of calcium include mil, cheese, yoghurt and tofu. .

Carbohydrates —carbohydrates are a major source of energy. Carbohydrates in the diet are principally made up of starches, sugars and dietary fibre.

Fats —Fat is a concentrated source of energy. Foods that are high in fat provide a lot of energy and are good sources of vitamins, A, D, E, and K and provide essential fatty acids.

Fiber —Dietary fiber is a non-specific term for that fraction of dietary carbohydrate that cannot be digested in the human small intestine. An adequate intake of dietary fiber is required to maintain bowel function. Some types of fiber can help lower cholesterol.

Minerals —These are elements which are essential for the body’s normal function including calcium, iron, phosphorous, magnesium, sodium, chloride, iodine, manganese, copper, and zinc.

Proteins —These are large molecules which are made up of thousands of amino acids. The primary function of protein is growth and repair of body tissues.

Vitamins —These are compounds required by the body in small amounts to assist in energy production and in cell growth and maintenance. They are essential for life and with the exception of vitamin D, cannot be made in the body. They should ideally be consumed from food. However, individuals who struggle to eat can obtain their vitamin requirements from dietary supplements.

Vitamin B₁ (thiamin) —A vitamin which plays an important role in carbohydrate metabolism. A deficiency can lead to a disorder called Beri Beri, which results in a widespread nerve degeneration, which can damage the brain, spinal cord and heart. Good sources of this vitamin for lacto-vegetarians include cereals, beans, potatoes and nuts.

Vitamin B₂ (riboflavin) —A vitamin or co-enzyme, which functions by helping the enzymes in the body function correctly. A good source of this vitamin for lacto-vegetarians is milk.

This is the largest shelf because these foods are low in fat, are good sources of energy and provide varying amounts of fiber (not all starchy carb foods are broken down slowly). Therefore, these foods help us feel full quickly and for longer and reduce the risk of snacking throughout the day. Some of these foods are available in fiber-rich varieties, for example, brown rice, wholemeal pasta and bread. Fiber-rich options help enhance the sensation of fullness, further delay the rate at which the foods are broken down and again contribute to reducing the risk of snacking. They do this by helping to ensure that our energy levels (blood sugar levels) remain consistent throughout the day and reduce sensations of hunger. Fiber-containing foods also help to regulate bowels and reduce the risk of constipation In general, these foods provide energy, B vitamins and some contain fibre. For optimum benefits, food from this food group should be included at each mealtime.

The Fruit and Vegetable shelf

The second shelf from the bottom, includes fruit and vegetables. This shelf is again similar for meat eaters and lacto-vegetarians. These foods aim to provide essential vitamins and minerals, which can help reduce our risk of cancer, stroke and heart disease and contribute to the maintenance of general good health. These foods supply nutrients including, vitamin A, vitamin C, folate and are a good source of fiber. The worldwide recommendations for fruit and vegetables vary somewhat, however, the general consensus encourages a minimum of 5 portions of fruit and vegetables per day.

The Milk and Dairy Foods shelf

The middle shelf, contains dairy produce including, milk, cheese, yogurt, fromage frais, soya products. Lacto-vegetarians include dairy produce as part of their intake. Nonetheless, some lacto-vegetarians may still choose to include some dairy-free options such as soya-based products as part of their dietary intake. It is important to note that soya-based products are typically low in calcium and individuals are encouraged to opt for brands, which indicate on the food labels that they are fortified with calcium.

The main nutrient that these foods provide is calcium, which is a mineral essential for healthy bones and teeth. These foods are also a rich source of protein, energy, vitamin B₂ (riboflavin), vitamin A and vitamin B₁₂. Calcium requirements vary greatly from one individual to the next depending on age and gender. However, for adults, a minimum of three portions is recommended per day from this shelf to help achieve an adequate calcium intake. Low fat versions of the foods from this group are encouraged, as some of the foods on this shelf can be naturally high in fat.

The Protein shelf

This shelf for Lacto-vegetarians, aims to help achieve protein requirements. The foods on this shelf include pulses, lentils, vegetarian cheese, nuts, quorn, textured vegetable protein and meat analogues, seeds, tofu and peas, for example, gungo and chick peas.

The main nutrient provided by this food group is protein. Protein is a very important nutrient because it makes up part of the structure of every cell in our bodies. There is a constant turnover of cells in the body, therefore an adequate supply of protein is essential for good health. Protein foods should not be the main source of fuel for the body; this should come from starchy carbohydrates. Protein can only be used efficiently if there is sufficient energy (calories) in the diet; for example, someone consuming large intakes of protein and only small amounts of starchy carbohydrates will end up using protein as their main energy source. This means there may be insufficient amounts to meet the daily protein needs of the body. Following diets, which suggest this regimen, should be discussed with a qualified doctor or dietitian, in advance of commencing such restrictive patterns, as this type of diet is generally not advisable and may be dangerous.

The foods on this shelf also provide energy, B vitamins, iron and some calcium. The recommended daily intake from this food group varies from one individual to the next but, in general, two to three portions are required from this food group per day for children and adults.

The Top Shelf

This shelf contains food high in fat and sugar. It includes oils, sugar (including sugary drinks), honey, fruit spreads, pastries, croissants, pies, cream, vegetarian spreads, mayonnaise, confectionery including sweets, chocolate and cakes, and biscuits and crisps. Alcoholic beverages are also included as part of this group. These foods should be seen as occasional foods. They are typically high in calories, sugar or fat and very low in vitamins and minerals. It is acceptable to include foods from this group on a daily basis however most of your daily food intake should not come from this shelf.

Benefits

A well planned lacto-vegetarian diet can be nutritionally balanced and health promoting for both adults and children. However, it is essential to ensure if certain foods are excluded from the diet that these are replaced with suitable nutritionally equivalent foods. The secret of a good diet is to eat a wide variety of foods and people need to avoid the temptation to choose the same meals and foods when grocery shopping.

Much research suggests that individuals who adopt vegetarian eating patterns are less likely to suffer from Obesity, Coronary Heart Disease (CHD), high blood pressure, type 2 Diabetes, certain nutrition-related cancers and constipation. Other research indicates that vegetarians tend to be of lower body weight and consequently they have a lower risk of the aforementioned illnesses. However, it is important to note that risks of these illnesses in meat eaters are also reduced if dietary intake is based on the recommended food pyramid. In general, however, people who choose vegetarian diets tend to be more healthy in their lifestyles and other food choices.

Precautions

A Lacto-vegetarian diet is generally lower in fat and higher in both fibre and antioxidants than a meat-based diet. People wishing to adopt lacto-vegetarian-eating habits need to know how to go about it safely. It requires a good deal of thought in the early stages. Therefore it is worthwhile briefly touching on some of the nutrients that may require additional care to ensure intake is adequate as a lacto-vegetarian.

Iron

Iron is essential for the formation of red blood cells, which carry oxygen to all parts of the body. A low body iron level can result in anaemia. Iron from non-meat sources is referred to as non-haem iron whereas iron from meat sources is haem iron. The body is able to absorb haem iron better than non-haem iron. Consequently, in the past individuals were concerned about ability to achieve sufficient iron intakes owing to the exclusion of iron-rich (haem) sources of meat, poultry and fish and therefore the increased risk of iron-deficiency anaemia. However, it is now recognised that iron (non-haem) is also found in green leafy vegetables, pulses, wholemeal bread, fortified cereals, dried fruit and nuts and seeds including sesame, pumpkin and sunflower seeds. It is recommended that to aid the absorption of non-haem iron from food that individuals aim to include a vitamin C source when consuming food rich in non-haem iron as vitamin C help to enhance the absorption of the iron in this form, for example, having a glass of pure orange juice with a bowl of breakfast cereal or an egg sandwich can help aid absorption.

Vitamin B₁₂

Vitamin B₁₂ is essential for healthy blood and nerve cells. This vitamin is not naturally found in plant foods and the main sources of this vitamin are from animal based foods. Alternative sources for lacto-vegetarians include dairy produce, yeast extracts, some vegetable stocks, soya milks, fortified breakfast cereals and textured vegetable protein.

Fatty Acids

The omega-3 essential fatty acids found in oily fish are also found in vegetarian foods such as rape-seed oil, flax sees and walnuts. It is now recognized that these oils play an important role in the development of the baby’s brain whilst in the womb. Therefore, pregnant women should aim to include sources of omega-3 in their diet.

Calcium

Calcium is essential for the formation of strong bones and teeth. During childhood, bones develop and become more dense until mid thirties. The combination of adequate dietary calcium intake and vitamin D levels in conjunction with regular exercise is essential to the development of bone mineral density and helping to safeguard against the development of osteoporosis (brittle bones) in later life.

Lacto-vegetarians typically consume dairy produce and receive most of their calcium intake from this source. Other sources of calcium include tofu, dried figs, pulses, tahini, sesame seeds, and some green vegetables for example, curly kale and white bread. It is important to note for people who consume soya-based dairy produce that they are typically low in calcium. Individuals are therefore encouraged to either opt for brands, which are fortified with calcium or ensure that calcium intake from other foods is sufficient.

Zinc

Zinc is an essential nutrient for health, growth, male fertility and wound healing. Vegetarian diets in general may not always provide adequate intake therefore it is important for Lacto-vegetarians to be aware of zinc-rich foods. These include cheese, pulses, nuts, seeds and wholegrain cereals.

Risks

Risks associated with Lacto-vegetarian eating patterns are minimal as long as eating patterns are based on the basic healthy eating principles outlined above. Attention should be paid to the above nutrients to ensure adequate intakes. It is questionable whether vegetarians live longer than non-vegetarians. It is a challenge to take all of the factors that impact on longevity into account in a research trial and to categorically suggest that vegetarians live longer.

Nonetheless, it is important to note that is a vegetarian diet is too restrictive it may be that the individuals may become malnourished and deficient in certain essential nutrients. Consequently, this would not be beneficial for overall health. Therefore, care is needed when making statement s on the healthy’ nature of vegetarian eating patterns.

Research and general acceptance

Further research is required to equivocally suggest if vegetarian eating patterns have additional health benefits over and above meat eating dietary habits. Such research would need to consider all factors that may impact on health and lifestyle including, genetic susceptibility, social, dietary, economic and social factors and so on.