FROM THE ACADEMY Position Paper Position of the Academy of Nutrition and Dietetics: Vegetarian Diets ABSTRACT POSITION STATEMENT It is the position of the Academy of Nutrition and Dietetics that vegetarian diets can It is the position of the Academy of Nutrition provide health benefits in the prevention and treatment of certain health conditions, and Dietetics that vegetarian diets may pro- vide health benefits in the prevention and including atherosclerosis, type 2 diabetes, hypertension, and obesity. Well-designed treatment of certain health conditions, vegetarian diets that may include fortified foods or supplements meet current including atherosclerosis, type 2 diabetes, nutrient recommendations and are appropriate for all stages of the life cycle, including hypertension, and obesity. Well-designed fi pregnancy, lactation, infancy, childhood, and adolescence. Vegetarians must use special vegetarian diets that may include forti ed foods or supplements meet current nutrient care to ensure adequate intake of vitamin B-12. Vegetarian diets are primarily plant- recommendations and are appropriate for all based, comprised of grains, legumes, nuts, seeds, vegetables, and fruit; do not include stages of the life cycle, including pregnancy, flesh foods (beef, pork, poultry and fowl, wild game, and fish); and may or may not lactation, infancy, childhood, and adoles- include some animal products, such as dairy (milk and milk products), eggs, and pro- cence. Vegetarians must use special care to ensure an adequate intake of vitamin B-12. cessed foods that contain casein or whey. Although vegetarians may have a higher deficiency risk for some nutrients (eg, vitamin B-12) compared to nonvegetarians, nutritional deficiencies are not the main causes of mortality or morbidity in Western societies. Vegetarian diets are associated with a lower risk of ischemic heart disease, hypertension, type 2 diabetes, obesity, and some types of cancer; low-fat vegetarian diets, in combination with other healthy lifestyle factors, have been shown to be effective in the treatment of these diseases. Vegetarians have lower low-density lipoprotein, better serum glucose control, and lower oxidative stress. Low intake of foods containing saturated fat and cholesterol, and high intake of vegetables, fruits, whole grains, legumes, nuts and seeds, and soy products that are rich in fiber and phytochemicals are components of a vegetarian diet that contribute to reduction of chronic disease. J Acad Nutr Diet. 2015;115:801-810. EGETARIANISM, A GENERAL plant-based eating pattern can be limited or eliminated. Interest in and term given to plant-based appropriate for these purposes and commitment to a vegetarian diet may diets, is inherently complex in more as they deliver adequate nutrition fluctuate throughout the life cycle, V eating style, food choice, and to satisfy current recommendations. Yet, based on the previously mentioned the motivation that leads one to choose simply avoiding meat, dairy, or eggs factors as well as economics, moral a vegetarian lifestyle. Vegetarianism does not guarantee adequate nutrition, concern for the environment, and in the United States during the 16th and individuals who describe them- ethical support for animal rights. Mo- through 18th centuries may have been selves as vegetarian may not be eating tivations for choosing a vegetarian diet born from social, political, and religious healthfully. are not static. In fact, vegetarian adults concerns—complete with spiritual roots, Vegetarian dietary patterns are quite exhibit constant fluidity, as some have biblical prohibitions regarding eating diverse and variant due to food avail- dropped their initial motivation, added meat, and heated philosophical, psycho- ability, region, age, gustatory reasons, new ones, and modified their beliefs logical, and medical debate.1 Today, and religious and cultural beliefs. They over time. Of interest, vegetarian di- choosing to adopt a vegetarian diet encompass a wide array of plant foods etary patterns based on health may be may stem from a compassionate moral and food practices based on these fac- more flexible than those based on order to protect animals and our envi- tors and always begin with a plant- religious or moral reasons.2 Motiva- ronment, enhance quality of life, prevent based foundation. Vegetarian diets are tions influence dietary practices, health complications, or promote self- almost always comprised of plant which may impact nutrient intake. management strategies to therapeuti- foods, such as grains, legumes, nuts, Although there is some risk for cally treat disease. A well-designed, seeds, vegetables, and fruit; animal nutrient deficiencies in a vegetarian products, such as flesh foods (beef, diet compared to nonvegetarian diets, pork, poultry and fowl, wild game, and there are tremendous advantages 2212-2672/Copyright ª 2015 by the fish), dairy (milk and milk products) toward prevention of chronic health Academy of Nutrition and Dietetics. http://dx.doi.org/10.1016/j.jand.2015.02.033 and eggs, along with processed conditions by adhering to a vegetarian foods that contain casein or whey, are eating pattern. ª 2015 by the Academy of Nutrition and Dietetics. JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 801 FROM THE ACADEMY Being well informed of these issues nationwide poll, which is up by 2% societies formed from the offshoot of will enhance the counsel of registered from a similar poll taken in 2006.3 The the 1975 World Vegetarian Congress dietitian nutritionists (RDNs) and nu- same poll revealed 47% of Americans share the principles of and accessibility trition and dietetics technicians, regis- eat at least one vegetarian meal per to vegetarianism with conventional tered (NDTRs) regardless of clients’ week. More than half to nearly three- audiences. reasons, convictions, motivation, and fourths of vegetarians and vegans pol- Also, the outreach of vegetarian food nutrition knowledge. RDNs and NDTRs led seek healthier whole-food options festivals is growing and aims to extend should be aware of these considerable and would purchase a vegan deli compassion into the community. For health advantages of a vegetarian diet sandwich in a chain restaurant. Forty- instance, for more than 15 years, the to more effectively counsel and educate four percent of younger consumers free-admission Boston Vegetarian Food clients on the utility of plant-based di- choose meatless meals once weekly.4 Festival has grown from 1 to 2 days to ets for disease prevention and man- One in four US adults claim to be sample foods; attend presentations; agement. RDNs and NDTRs, along with meat reducers, those who continue to and learn about eco-friendly, sustain- assessing knowledge, beliefs, reasons, eat meat but for health reasons limit able vegetarian diets. This growth re- and motivations for choosing a vege- their intake. This is another growing sulted in selling tickets for prefestival tarian dietary pattern, should educate field moving toward plant-based diets hours to shop without crowds. New on the importance of including a variety of which to take note. York and San Francisco’s veggie food of colorful fresh or frozen foods that are There is a growing demand for fests have also added days and moved unrefined and minimally processed. products that are “meat-free,” have a to larger venues. This speaks well to This will promote self-management “meat-like texture,” are “suitable for substantiate the growing percentage of strategies that meet nutrition needs vegetarians,” and are for “meat and Americans experimenting with meat- and address specificnutrientconsider- veggie lovers alike.”5 Sales of alterna- free eating. ations to assure optimal nutrition. tive meat products, driven largely by A plant-based diet, which is the foun- What follows are some of the types health reasons and resemblance to dation of a vegetarian diet, is becoming of plant-based diets one may choose: meat, reached $553 million in 2012, an mainstream, as further evidenced by 8% increase in 2 years; 31% and 36% of many nonprofit and governmental in- Vegetarian diet: A vegetarian survey responders sought organic and stitutions highlighting this dietary diet is devoid of all flesh foods, vegan meat alternatives, respectively, choice. The American Institute for Can- but may include egg or dairy especially in the 18- to 44-year age cer Research encourages a plant-based products. group.5,6 This age group is more likely diet defined as two-thirds of our di- Ovo-vegetarian diet: A vegetarian to follow a strict diet, be interested in etary intake being comprised of vege- diet free from flesh foods and current dietary fads like gluten- and tables, fruits, whole grains, and beans.7 dairy foods but includes eggs. lactose-free diets, and tend toward so- In addition, the US Department of Lacto-ovo-vegetarian diet: A vege- cial media in a way the older popu- Agriculture modified meal plans for tarian diet free from flesh foods but lation does not. Thus, the high lacto-ovo-vegetarian and vegan dietary includes eggs and dairy products. availability of ready-to-eat, refined, patterns are listed as Appendices 8 and Vegan diet: A vegan dietary gluten-free, and faux-meat foods may 9 of the 2010 Dietary Guidelines for pattern is free from all flesh be enticing to this group who adopt Americans.8 And, the National School foods, eggs and dairy products, a vegetarian lifestyle. However, a diet Lunch Program, while not requiring and sometimes honey. heavy in nonanimal, meat-like prod- vegetarian options per se, requires Raw vegan diet: A strictly fresh ucts and refined and highly processed schools to increase availability of and uncooked food intake based vegetarian foods, while allowing the fruits, vegetables, and whole grains in on fruit, nuts, seeds, and client to remain committed to a moral, current meal patterns in the school vegetables. ethical, or health obligation to eat menu. These government-driven and Macrobiotic diet: A strict whole- vegetarian, may diminish or limit health institutional changes reflect a foods, plant-based diet that in- overall nutrition.