Healthy vegan eating By Caroline Dawn RD BSc MA MBA

Caroline Dawn, registered dietitian, is a leader in her field and nationally acclaimed speaker. Caroline is currently the AHP Clinical Lead at Liverpool Community Health NHS Trust; her previous role as Clinical Lead Dietitian at Central Manchester University Hospitals NHS Foundation Trust specialised in allergy, intolerances, specialised diets and disordered eating.

Vegan diets have recently been increasing in popularity; they have been linked to many health benefits including increased longevity, lower body mass index, lower serum cholesterol, lower blood pressure, reduced risk of heart disease and improved vitality. These health benefits are associated with the higher fibre, folic acid, vitamin C & E, potassium, magnesium, phytochemicals and reduced saturated fat and calories (1). It is important to understand though that eliminating all animal products from the diet without careful dietary management could increase the risk of some nutritional deficiencies. Vitamin B12, calcium and long-chain omega 3 fatty acids require particular attention within vegan diets and regular consumption of foods that are fortified with these nutrients or appropriate supplementation is recommended to prevent deficiencies occurring. Attention is also required to iron and zinc status as there is limited bioavailability of these minerals in plant only diets.

Generally speaking those that consume a plant-based diet have a lower risk of cardiovascular disease (CVD), obesity, type 2 diabetes and some cancers (9). A vegan diet in particular has been noted for increasing the uptake of protective nutrients and phytochemicals and for decreasing consumption of dietary factors associated with numerous chronic diseases (3).

Top Tips for the Optimal Vegan Diet

1. Adequate calcium intake is important. Traditional calcium sources in a vegan diet include green leafy vegetables, dried fruit, nuts, broccoli, tofu, tahini, as well as calcium fortified foods, for example, breakfast cereals, calcium fortified soya milk, and calcium fortified fruit juices. 
2. It is important to remember that it is hard to obtain adequate amounts of active vitamin B12 from plant foods alone, therefore regular consumption of vitamin B12 fortified food is required to prevent deficiency, for example, fortified soya milk or breakfast cereals. If this is not achievable in the diet a daily vitamin B12 supplement would be recommended.
3. Obtaining adequate vitamin D during the winter months can be difficult; it important to consume vitamin D-fortified foods such as soya milk, breakfast cereals and vitamin D fortified non-dairy margarines. Alternatively a daily supplement may be of benefit during the winter months. This would be beneficial for older age groups.
4. Regular intake of foods high in omega-3 fatty acid ALA, for example, flaxseed, walnuts, soy products, and hemp seeds are important for general health. It is also beneficial to consume foods fortified with the long-chain fatty acid DHA, for example some soya milks and cereal bars. Pregnant and lactating women have increased requirements of the long-chain omega-3 fatty acid so would benefit from supplementation. 
5. Consuming foods rich in zinc, for example whole grains, legumes and soy products is important to counteract the high phytate content of the vegan diet (which can inhibit absorption of Zinc). Fortified cereals are another useful source of Zinc and it is beneficial to consume these regularly.
   

Conclusion

Well-planned vegan diets are completely healthy and nutritionally adequate. People who follow vegan diets tend to consume lower intakes of saturated fat and cholesterol, higher levels of dietary fibre, magnesium, potassium, vitamin C& E, folate, carotenoids, flavonoids, and other phytochemicals. Overall following a vegan diet can be seen to have number of health advantages such as having a lower body weight, reduced overall cancer rates, lower blood cholesterol levels, lower risk of heart disease, lower blood pressure levels, reduced risk of hypertension, and lower incidence of type 2 diabetes. 

Registered Dietitians can help support understanding of the specific requirements to support a balanced approach to the vegan diet and adoption of plant-based eating strategies.

References 

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2. De Biase SG, Fernandes SF, Gianini RJ, Duarte JL. Vegetarian diet and cholesterol and triglyceride levels. Arq Bras Cardiol 2007;88:35–9.
3. Dewell A, Weidner G, Sumner MD, Chi CS, Ornish D. A very-low fat vegan diet increases intake of protective dietary factors and decreases intake of pathogenic dietary factors. J Am Diet Assoc 2008;108:347–56.
4. Fraser G. Risk factors and disease among vegans. In: Fraser G ed. Diet, life expectancy, and chronic disease. Studies of Seventh-day Adventists and other vegetarians. New York, NY: Oxford University Press, 2003:231–9.
5. Haddad EH, Berk LS, Kettering JD, Hubbard RW, Peters WR. Dietary intake and biochemical, hematologic, and immune status of vegans compared with nonvegetarians. Am J Clin Nutr 1999;70(suppl):586S–93S.
6. Key TJ, Appleby PN, Rosell MS. Health effects of vegetarian and vegan diets. Proc Nutr Soc 2006;65:35–41.
7. Strohle A, Waldmann A, Wolters M, Hahn A. Vegetarian nutrition: preventive potential and possible risks. Part 1: plant foods. Wien Klin Wochenschr 2006;118:580–93.
8. 8.     Toohey ML, Harris MA, Williams D, Foster G, Schmidt WD, Melby CL. Cardiovascular disease risk factors are lower in African-American vegans compared to lacto-ovo-vegetarians. J Am Coll Nutr 1998;17:425–34.
9. Tuso PJ, Ismail MH, Ha BP, Bartolotto C. Nutritional Update for Physicians: Plant-Based Diets. The Permanente Journal. 2013;17(2):61-66. doi:10.7812/TPP/12-085.