Alimentacion Vegetariana

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vegetarian diet
PID_00268138
Maria Manera Bassols

Maria Jesús Blanquert Genovart
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© FUOC • PID_00268138 vegetarian diet
Maria Manera Bassols Maria Jesus Blanquert

Genovart
The commission and creation of this UOC learning resource have been coordinated
by the professor: Marta Massip Salcedo (2019)
First edition: October 2019 © Maria

Manera Bassols, Maria Jesús Blanquert Genovart All rights reserved © of
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Index
Introduction................................................. .................................................. 5
1. Key nutrients in the vegetarian diet................................................ 15

1.1. Proteins................................................. ..................................... fifteen
1.2. Iron ................................................. ............................................ 16
1.3. Zinc................................................. ............................................ 17
1.4. Iodine ................................................. ............................................ 17
1.5. Calcium ................................................. ............................................ 17
1.6. Vitamin D ................................................ ................................... 18
1.7. B12 vitamin ................................................ .................................... 19
1.8. Omega 3 ............................................... ....................................... twenty
2. Foods of interest in a vegetarian diet ................... twenty-one
2.1. Composition of food ................................................ ..... twenty-one
2.1.1. Legumes and derivatives................................................. ... twenty-one
2.1.2. Other meat substitutes ........................................... 22
2.1.3. Nuts and seeds ................................................ ..... 2. 3

2.1.4. Dairy substitutes ................................................ ... 2. 3
2.1.5. Algae ................................................. ................................. 24
2.2. Food guides: pyramids, plates and wheels ........................... 24

23. Food portions ................................................ ............. 27
2.3.1. Vegetables and greens ............................................... ......28

2.3.2. Fruit ................................................. ............................ 28
2.3.3. Farinaceous ................................................... .................... 29
2.3.4. Protein foods ................................................ ....... 29

2.3.5. Dairy and substitutes ................................................. ......... 29
2.3.6. Oils and fatty foods ........................................................... 30
3. General recommendations on vegetarianism in

healthy adults ................................................... .................... 31
3.1. Design of dietary guidelines ................................................ ...... 31
3.2. Recipes and gastronomic adaptations ....................................... 3. 4
3.2.1. Meats and derivatives................................................. ......... 3. 4
3.2.2. Eggs ................................................. ........................... 3. 4
3.2.3. Dairy ................................................. ........................... 35

3.2.4. Fish ................................................. ........................... 35
3.2.5. Condiments that provide umami flavor, typical of

the meat ................................................ ........................... 36
3.3. General recommendations on vegetarian nutrition and

vegan ................................................. ............................................ 36
4. Food, nutritional and dietary recommendations

in vegetarianism and different stages of life.................... 39
4.1. Pregnancy and breastfeeding ................................................ ................... 39
4.2. Childhood ................................................. ....................................... 41
4.2.1. Key nutrients and strategies to cover their

requirements................................................. .............. 42
4.2.2. Food advice on vegetarianism in the

childhood and adolescence................................................. ... 44
4.3. Old age ................................................. ............................................ Four. Five
5. Food, nutritional and dietary recommendations

in vegetarianism in special situations.......................... 46
5.1. Sport ................................................. ....................................... 46

5.1.1. Protein................................................. ......................... 46
5.1.2. Supplements................................................. .................. 47
5.2. Food allergies and intolerances................................................ 47

5.2.1. Milk ................................................. ............................ 47
5.2.2. Egg ................................................. ............................ 48
5.2.3. Legumes ................................................. ..................... 48

5.2.4. Nuts ................................................ .................... 48
5.2.5. Gluten................................................. ........................... 49
5.2.6. Wheat ................................................. ................................. 49
5.3. Eating disorders ........................................... 50

5.3.1. Recommendations for suspected eating disorders.................... 50
6. Vegetarian diet in pathologies................................................ ........ 51

6.1. Obesity ................................................. ........................................ 51
6.1.1. Dietary recommendations in the treatment of
obesity ................................................. ........................ 51
6.2. Arterial hypertension ................................................ ................... 52
6.2.1. Dietary recommendations in hypertension

arterial ................................................. ........................... 52
6.3. Mellitus diabetes ................................................ ........................... 52
6.3.1. Dietary recommendations in diabetes mellitus...... 53
6.4. Cancer ................................................. ............................................ 53
6.4.1. Tips to increase calories and protein ........... 54

6.5. Rheumatoid arthritis ................................................ .................... 54
6.6. Renal insufficiency ................................................ ....................... 55
6.6.1. Diet planning in kidney failure ......... 56
Bibliography................................................. ................................................ 57
© FUOC • PID_00268138 5 vegetarian diet
Introduction
Brief history of vegetarianism
The history of vegetarianism has an astonishing diversity of characters and events.

Far from being a relatively new phenomenon, vegetarianism has enjoyed a long
history and has been preserved in most
of cultures around the world since the beginning of time.
Throughout history, forced by necessity or choice, part of the

world population has advanced thanks to plant-based diets. In it
In the past, meatless diets were based on religious, economic, ethical or philosophical
criteria, not science. It has been in the last 150 years when the
Empirical evidence has yielded dietary recommendations.
In ancient times, in Egypt (3200 BC), there were religious groups with a vegetarian
ideology that abstained from eating meat and wearing clothing derived from
animals. In the Book of Genesis (950-450 BC) the diet without
meat.
In Greece there were thinkers, like Pythagoras or Plato, who postulated against
animal cruelty and in favor of abstinence from meat, and who spoke of the
health advantages of vegetarianism.
In Asia, religious philosophies such as Hinduism, Jainism and Buddhism,

among others, they proclaimed abstention from meat and compassion for all
the living creatures. Asoka (264 BC), king converted to Buddhism, prohibited
animal sacrifices throughout the kingdom.
Later, Christianity imposed ideas of human supremacy on

all living things. Although there were currents against it, such as Manichaeism
(3rd-10th centuries), a philosophy against the slaughter of animals, in most cases
part of Europe during this period many vegetarian people were
persecuted by the Church and later murdered. The Bogomils, vegetarian Christians
from Bulgaria, were burned at the stake. Two notable
Vegetarians escaped: Saint David, patron saint of Wales, and Saint Francis of Assisi.
During the Renaissance, there was a time of famine and meat was a luxury for the
rich. Later, with the importation of vegetables from the new continent, the benefits of
eating vegetables for health were seen.
Cornaro (1465-1566), a long-lived nutritionist, criticized the excesses of the class

high and recommended a vegetarian diet. Erasmus wrote in defense of animals,
and Leonardo da Vinci was against the consumption of meat.
In the 17th century , some European philosophers considered God and nature
as a unity, and in Western religions the idea that the
Meat consumption was an aberration of the will of God and nature
genuine of humanity.
Dr. Cheyne suggests the "vegetable diet" to combat obesity and influences
in medical reformers, such as Lambe and Newton, who, later, founded the
Vegetarian Society.
In the Enlightenment (18th century) Descartes grants a new assessment of

man's place in the order of creation and thus regains control over
the animal kingdom. At the same time, Voltaire and Rousseau question man's
inhumanity towards animals, while Thomas Paine writes The
rights of man (1791) and raises the rights of animals.
Figure 1. Summary of the history of vegetarianism (I)
Source: self made.
In Romanticism, the vegetarian figures of the 19th century represent the range of
cultural expression of the time: the humanist perspective, a religious, social or
medical reforming zeal.
In the 19th century, a branch of the English Church began vegetarianism as

expression of the Christian faith. The American Vegetarian Society is established in
United States and The Vegetarian Society in England. The influence of radical
Christianity gives great importance to vegetarianism and the Seventh-day
Adventists emerge. In Germany, the Vegetarian Society of
Germany.
In the 20th century, during the Second World War, the British population
She was almost vegetarian, and there was an improvement in her health. Mahatma Gandhi
he wrote extensively on vegetarianism.
In Spain, the Spanish Vegetarian Society and the Lliga were founded in Madrid.
Vegetarian from Catalonia in Barcelona. In 1925, in Spain there were 17
societies, 38 naturist groups, 12 publications (Helios, Naturismo, Iniciales,
Naturist Action, La Fisiatría, etc.), 28 medical offices, 14 restaurants, 35
health food stores... Vegetarianism is linked to naturism, libertarian and feminist
movements. However, with the arrival of the war, in
the first moments of the fascist uprising, were pursued with great viciousness
to vegetarians and naturists just for the fact of being so.
In the 1950s and 1960s, people became aware of the intensification of

industrial production, introduced after the war. In the seventies, with Peter
Singer's seminal book Animal Liberation (1975), the movement against animal
experimentation and intensive agriculture emerged.
During the eighties and nineties, vegetarianism was chosen as part
of the process of change and conservation of resources. In the mid-nineties,
health problems linked to food crises, such as "mad cow disease," increased
popular awareness of the relationship
between food and health, environment and animal rights.
As we will see later, currently, ethical values,

environmental, health and animal welfare the main reasons for
the choice of vegetarianism as a dietary pattern.
Vegetarianism is not a new phenomenon, but it has a

long and diverse history, and has been preserved in most cultures
from all over the world since the beginning of time.
Figure 2. Summary of the history of vegetarianism (II)
Source: self made.
Number of vegetarian people
The number of people following a vegetarian diet is increasing.

ment.
We must bear in mind that the available data is approximate, since

There are no recent surveys available, and there are differences in the definitions
of vegetarianism and veganism used in the surveys, which may imply a wide margin
of error.
In the selection of countries shown in table 1, India stands out, with

about half a billion vegetarians, of which 27% are
vegan, and Mexico, Switzerland or Israel, where for different reasons the prevalence
Vegetarian population is high. According to a 2010 study, it is estimated that
There are 1.45 billion vegetarians who are vegetarians out of necessity and others
75 million who are by choice. In total, they account for nearly 22% of the
world population.
Table 1. Number of vegetarian people in the world
Country Survey year Vegetarian population (including vegan)
2016 9.4% population: 3,411,000 people
2016 11% population: 2,100,000 people
2018 31-42% population: 375,000,000-500,000,000 people
Source: adapted from https://en.wikipedia.org/wiki/Vegetarianism_by_country.

2018 5-8% population: 12,646,000-20,233,000 people
Regarding Europe and the European countries, in table 2 we observe that

Germany, Italy and Great Britain are where there is the largest vegetarian
population, while in Spain, according to the 2011 ENIDE survey, the vegetarian
population it would only amount to 700,000 people.
Table 2. Number of vegetarian people in Europe and European countries
2015 5% population: 37 million people in Europe
2015 7-10% population: 4,246,000 people
2011 1.5% population: 700,000 people
Motivations for a vegetarian diet
The reasons for adopting vegetarian eating patterns are diverse:
• religious prescriptions.
• health considerations.
• economic reasons.
• sustainability or environmental reasons.
• respect for animals.
Currently, and in our environment, the majority of people who choose to

vegetarianism has animal welfare as its main motivation (for example
the conditions in which animals intended for human consumption or from which
food is obtained – milk, eggs and honey – live and die) and the
concern for the environment, for the environmental impact it entails
the production of meat or dairy products, for example:
• Deforestation and destruction of grasslands: cattle raising produces more

greenhouse gases than all means of transportation together.
Furthermore, according to the FAO, the first cause of deforestation in the Amazon is
the production of food for livestock.
• Hyperconsumption and water pollution.
• Energy consumption: the production of 1 kcal of animal protein requires 25

kcal of fossil energy, while the production of 1 kcal of vegetable protein
requires 2.2 kcal.
• The generation of waste.
• The emission of CO2.
• The depletion of marine biomass, etc.
The current food production system is considered one of the Reflection

main causes that cause environmental damage, such as climate change
«Avoid proteins of origin
and the loss of natural resources. Oxford University and the Swiss Institute animal is probably what
agricultural research organization, Agroscope, have carried out the most complete study best thing to do for
the planet".
to date on the environmental impact of food production,
which provides new evidence of the importance of dietary change.
For some people, ethical concerns about world hunger predominate (animal
food represents a large consumption of cereals that could be used for human
consumption).
Another important motivation is health considerations: vegetarian diets, in

general, provide less saturated fat,
cholesterol and animal protein, and on the other hand, they provide a greater
amount of fiber and micronutrients such as magnesium, potassium, folate, carotenoids,
vitamin C, vitamin E, flavonoids and other phytochemicals. In general,
Vegetarian people show:
• a lower risk of suffering from some pathologies.

© FUOC • PID_00268138 eleven

vegetarian diet
• lower body mass index (BMI) values.

• lower rates of high blood pressure.
• lower levels of total and LDL cholesterol.
• better control of serum glucose.
• lower mortality rates due to cardiovascular accidents.
• lower risk of type 2 diabetes mellitus and some types of cancer, such as
the breast, the prostate and the colon.
The United States Academy of Nutrition and Dietetics postulates that

Vegetarian diets, including vegan diets, properly planned, are healthy, nutritionally
adequate, and may provide health benefits in the prevention and treatment of certain
diseases.
These diets are appropriate for all stages of the life cycle – including
pregnancy, breastfeeding, infancy, childhood, adolescence, adulthood,
as well as for athletes. They agree with this positioning, among others,
the United Kingdom National Health Service (NHS), the Dietitians Association of
Canada, the Australian Government Department of Health, the American College of
Gynecology and Obstetrics, the Surgeon General of
Portugal, the Canadian Pediatric Society, the European Society of Pediatric Gastroenterology,
Hepatology and Nutrition (ESPGHAN) and the American Academy of Pediatrics.
Currently, there is a convergence of opinion between academics, politicians and

non-governmental organizations in supporting, on the basis of an important body of
scientific evidence, the need for a transition towards a
diet based on foods of plant origin (fruits, vegetables, legumes, nuts, seeds and
whole grains) with a decrease in the consumption of
foods of animal origin, both for the health of the population and for the
of the planet.
Some countries have cultural traditions or religious prescriptions

deeply rooted (Sikhism, Hinduism, Buddhism, Jainism) that promote
vegetarianism, such as India, Pakistan or other regions of Asia.
Types of vegetarian diets
Vegetarianism is a diet based on foods derived from plants, with

or without dairy products, eggs and/or honey, according to the International Vegetarian
Union. The vegetarian diet or diet is based on the consumption of vegetables, fruits,
legumes (lentils, chickpeas, beans, soy, etc.) and derivatives (tofu, tempeh, etc.),
cereals and derivatives (pasta). , rice, bread, corn, etc.),
tubers (potato, sweet potato, cassava, etc.), seeds, nuts, oils and fats
vegetables, and excludes, to a greater or lesser extent, foods of animal origin.
Table 3. Different types of vegetarian diets
Diet type Food consumed Food not consumed
Lacto-ovovegetarian Legumes, cereals and tubers, Meat, fish, seafood and their
vegetables, fruits, nuts, derivatives
seeds, eggs, honey, dairy and
oil
Lactovegetarian Legumes, cereals and tubers, Meat, fish, seafood, eggs

vegetables, fruits, nuts, se-and their derivatives
miles, honey, dairy and oil
Ovovegetarian Legumes, cereals and tubers, Meat, fish, seafood, dairy

vegetables, fruits, nuts, se-and their derivatives
miles, eggs, honey and oil
Vegan Legumes, cereals and tubers, Meat, fish, seafood, eggs,

vegetables, fruits, nuts, dairy products, honey and its derivatives
miles and oil
Frugivore Fruit, vegetables that are Meat, fish, seafood, eggs,

botanically fruit (tomato, eggplant, dairy products, honey, tubers,
pepper, avocado, pumpkin), legumes and their derivatives and most
nuts, seeds and oil part of cereals
Raw food Vegetables, fruits, nuts, seeds, Meat, fish, seafood, dairy,
honey, oil, sprouted cereals, eggs and any plants cooked-two
sprouted legumes or heated above
(everything raw, dehydrated or 47 ºC
fermented); sometimes, dairy
products, eggs, raw meat and fish
Source: self made.
As we see in table 3, people who adopt the lacto- ovo-vegetarian dietary pattern
dispense with meat and its derivatives, fish and
seafood, while they include eggs, dairy products and honey; Dairy products are
included in the lactovegetarian diet ; the ovovegetarian pattern includes eggs;
while in strict vegetarianismpatternvegan
Any food of animal origin is excluded. The vegan diet, in turn, can be frugivorous,
which includes only fruit, a vegetable that botanically is fruit.
(tomato, eggplant, pepper, avocado, pumpkin...), nuts, seeds and
oil.
The vegan diet can also be raw vegan, which follows the same principles as the
vegan diet, that is, no foods of animal origin are consumed, and
adds another requirement: everything that is consumed will be raw or at most
dehydrated, without ever exceeding 40-42 ºC, which is, according to the precepts
of this diet, the maximum temperature that a food would reach
exposed to the sun.
Some people who choose a raw diet sometimes consume dairy products,
raw eggs, meat and fish, in which case it would not be a diet
vegetarian, like the flexitarian, whose pattern is comparable to a
healthy omnivorous diet.
We must keep in mind that there are few studies in relation to the safety of some
vegetarian diets, such as macrobiotics (in the most
restrictive), the fruit-eater or the raw-eater, so its effects and consequences
They are not clear, especially in babies, children, adolescents, pregnant and lactating
women, and, therefore, they are not recommended, especially during these stages.
© FUOC • PID_00268138 fifteen

vegetarian diet
1. Key nutrients in the vegetarian diet
Key nutrients in a vegetarian diet are considered to be those that in omnivorous

diets are obtained, above all, from foods of animal origin. It will be necessary to
know, therefore:
• What are the main sources of these nutrients in vegetarian diets?

tarianas.
• How much do plant foods contain.
• What is the bioavailability.
• What dietary techniques should be applied to increase it.
• If necessary, obtain them from supplements.
• Etc.
1.1. Proteins
The available data affirm that vegetarian and vegan diets, when
They include a wide variety of plant foods and the caloric intake is
adequate (not restricted), cover and even exceed the recommended intake
of protein.
Protein needs are the same in omnivorous people as in

lacto-ovo vegetarians (0.8 grams per kilo of weight per day), although in the
vegan, due to the lower protein digestibility of plant foods and their
lower lysine content, an increase of between 25
and 40%, so the recommended intake is 1-1.1g/kg/day.
This increase, however, depends largely on the type of protein foods chosen, Soy consumption and
cancer
since the digestibility of the legumes consumed as
This is less than when derivatives such as tofu, the protein According to the American Institute
For Cancer Research, the
textured soy or soy drink, for example. consumption of a moderate
amount (1-3 servings/day) of
soy and non-derivatives
All proteins, except some fibrous ones, contain all the essential amino acids. increases the risk of cancer
demama or any other
There are foods of plant origin with a complete amino acid profile, such as type, nor in women without cancer
nor in women who have suffered
chickpeas, soybeans, some varieties of beans,
from it. What's more, it could prevent it.
pistachios, quinoa, Quorn (mycoprotein), etc. However, there are other plant
foods with a lower content of some essential amino acids. For example, lentils
have less methionine than other foods,
while cereals usually have less lysine. This situation can be easily solved through Recommended reading
supplementation, so that the deficient amino acids in one food are found in the
For more information on the protein
other, and vice versa. supplementation of plant proteins
In the case of adults, this supplementation does not have to be given at the same and their coverage of requirements,
you can consult the following article:
meal, but can be done throughout the day (you could eat rice for lunch and lentils VRYoung;PLPellett (1994, May).
«Plant proteins in
for dinner, for example), since there is a reserve of amino acids in the body
relation to human protein and
available for protein synthesis. amino acid nutrition».
Therefore, complementary protein foods can be consumed throughout the day.

TheAmerican Journal of Clini-cal
Nutrition (vol. 59, suppl. 5, pp.
1203S-1212S).
In few situations there is a risk of protein deficiency:
• Deficient calorie intake (situation in which proteins would perform

an energetic function rather than a plastic and metabolic one).
• High consumption of unhealthy foods (rich in calories and low in
proteins).
• Very restrictive diets (which are practically made up of fruits, vegetables,
talizas and cereals).
• Avoidance of legume consumption (due to an allergy, for example).
1.2. Iron
Iron consumption by vegetarians is similar to that of omnivores, or even higher.

However, the iron consumed by vegetarians is of the nonheme type, with a much
lower bioavailability , which is why the ferritin reserves of vegetarians are often
below those of vegetarians. omnivorous (although in most cases within normal
limits). As for anemia, which is the most prevalent nutritional deficiency in the
world, it is no more frequent in vegetarians than in omnivores, surely due to
reasons of metabolic adaptation, where the body, faced with low intakes, high
needs or low reserves, responds with an increase in absorption (and also with a
decrease in losses).
The absorption of non-heme iron is also modulated by the presence, in the food
itself, of enhancers or inhibitors. Organic acids (citric acid, ascorbic acid, malic
acid, tartaric acid, etc.) maintain iron in a more soluble and more easily absorbable
medium and chemical form and can therefore increase the absorption of this
mineral by more than 25%. . On the contrary, the presence of inhibitors such as
phytates, tannins and other polyphenols can reduce iron absorption by up to 50%.
Soaking, cooking and germination of legumes largely inhibit the action of these
compounds, as does roasting of nuts.
Separating foods rich in tannins – such as wine, coffee or tea – from meals also
helps to increase iron absorption.
rich in iron.
1.3. Zinc
Vegetarians have a similar or slightly higher zinc intake.

lower than the omnivorous population, as well as blood concentrations
also lower (usually, within normal ranges). Without
However, neither zinc deficiency nor its symptoms are common in the population.
vegetarian.
Zinc absorption is reduced in the presence of phytates and oxalates, common in

foods that also contain zinc, while it increases
if ingested with foods with acids, sulfur amino acids or peptides
that contain cysteine. The same dietary and culinary techniques that made it
possible to reduce the presence of iron absorption inhibitors are
valid for zinc.
1.4. Iodine
According to the World Health Organization, Spain is a country in a situation

iodinedeficient, which is why it recommends the consumption of saliodinada to
the entire population. The recommended intakes of iodine are covered with the
consumption of one teaspoon of iodized salt per day.
It must be remembered that seaweed is not a safe source of iodine because it Iodine from algae
contains excessive amounts of this mineral (especially kombu, ara-me and hiziki
1 g of Kombu seaweed provides
seaweed). 2,330 mcg of iodine. Dietary reference
intakes recommend an intake of 150
1.5. Calcium mcg/day. The threshold from

which adverse effects may begin
to be observed is
1,100 mcg/day.
The calcium intake of lacto-ovo vegetarians is even
exceeds recommendations. On the other hand, in vegans there is more
heterogeneous data and in many cases they do not cover the recommended intakes.
It is worth clarifying that the dietary reference intakes for calcium are
very variable depending on the country that issues these recommendations: in Spain
range between 900 and 1,000 mg/day, in the United Kingdom they are 700 mg/day and
Harvard proposes 500-700 mg/day, so the recommendations for the consumption
of dairy products and foods rich in calcium are neither heterogeneous nor robust.
Some research that studies the relationship between a vegetarian diet and bone
health shows a lower bone density, without this translating into clinically significant
data, since the risk of fracture is similar (except
when calcium consumption is less than 500 mg per day in adults, where yes
increased risk is observed).
The availability of calcium from plant foods depends, above all,

of the presence of oxalates and phytates. The absorption of calcium from vegetables
green leafy greens rich in oxalates, such as spinach and chard, is very low (5
%), while that of other sources such as kale, bok choy or leaves
of turnip is 50%. Calcium from calcium-enriched soy beverage, as well

like tofu curdled with calcium salts, is absorbed in a similar percentage
that of cow's milk, that is, approximately 30%. With 20%
absorbable fraction are followed by white beans, almonds, tahini,
etc By taking into account both global content and usable content
According to the absorbable fraction, it is evident that milk is not the only source
of calcium that must be taken into consideration to cover the recommendations
of said nutrient (figure 3).
Figure 3. Total calcium and absorbed calcium content of different foods

Reflection
Although milk and dairy products

are often cited as the best source
of calcium,
The data available in relation
to content and absorption do not
place it as such,
as has been observed
in the previous graph.
Furthermore, according to the Authority
European Union on Food Safety
and Nutrition, it cannot be
affirm that the consumption of
lactose increases the absorption of
calcium (EFSA Journal, 2011, vol.
6, no. 9, p. 2234).
Source: self made.
1.6. Vitamin D
Some studies show low intakes of vitamin D in vegetarians, as well as plasma

levels lower than those recommended, especially in Nordic population samples.
However, it must be remembered that the
The problem with the coverage of vitamin D requirements and its clinical
significance is a hot topic today, and continues to be studied.
The physiological route of supply of vitamin D is sun exposure, and

This is very variable depending on the latitude in which you live, the season of the
year, time of day, air pollution, skin type, use
of sunscreens, etc. The general recommendation to meet vitamin D requirements
is the exposure of 25% of the body surface
(hands, arms, face, neck) for 10-15 minutes most days
of the week (5-7 days). If sun exposure exists but is not
sufficient, it can be complemented with the intake of cow's milk enriched with
vitamin D (for lacto vegetarians) or a fortified soy drink
convitaminD. Finally, if there is a risk of deficit, you can supplement
preventively with vitamin D2 or D3 of plant origin (synthesized from
of lichens). When the deficiency is established, it seems that vitamin D3
It is more effective in overcoming this deficiency.
1.7. B12 vitamin
Without a doubt, the most important and critical nutrient in a vegetarian diet
is vitamin B12, due to the severity of the symptoms of its deficiency (anemia
megaloblastic, fatigue, tingling in extremities, cognitive impairment,
etc.), and due to the impossibility of meeting requirements from food.
Studies and research indicate that vegetarians who do not

take supplements have a deficiency or decrease in vitamin B12,
whether they are lacto-ovovegetarian or vegan (milk and its derivatives and
Eggs do not contain sufficient amounts of this vitamin to cover
the needs). Therefore, any vegetarian person should guarantee
taking a vitamin B12 supplement in the form of cyanocobalamin in
the appropriate doses (table 4).
Table 4. Recommended doses of vitamin B12 supplementation depending on age
Age Daily dietary supplement Dietary supplement

(in micrograms) 2 times/week
(in micrograms)
0-5 months 0.4* —
6-11 months 5-20 200
1-3 years 10-40 375
4-8 years 13-50 500
9-13 years 20-75 750
14-64 years 25-100 1,000
ÿ65 years 500-1,000 No information
Pregnancy 25-100 1,000
Lactation 30-100 1,000
*Not applicable to babies who drink formula milk (which already provides vitamin B12) or to infants of mothers who take supplements.
with vitamin B12.
NOTE: the doses do not follow the mathematical correlation “weekly = daily × 7” because the amount absorbed varies depending on the
amount of dose administered.
It is important to clarify that, unless it is fortified (and in our environment Recommended reading
There are few foods fortified or enriched in vitamin B12), there is no

The text «Vitamin B12 in
no plant foods containing significant amounts of vitamin "vegetarian nutrition", prepared
B12 active. Foods such as algae, brewer's yeast or some fermented foods may by the group
of nutrition of the Spanish Vegetarian
contain inactive analogues of vitamin B12, which cannot be Union, contributes
useful information regarding
be considered a reliable source of active vitamin B12 , since they are not with the functions of vitamin B12 in
human physiology, the different
functional. In addition, these analogues have two more major drawbacks:
types of
falsify the analysis, since these do not differentiate between active vitamin B12 and this vitamin and its absorption
mechanisms, data related to the
inactive, and block true B12 (in case it is being taken from analytical determination of the
of foods such as milk and eggs). deficiency, the possible

signs of deficit, etc.
© FUOC • PID_00268138 twenty

vegetarian diet
1.8. Omega 3
The levels of omega 3 fatty acids (EPA and DHA) in the blood and tissues of
vegetarian people are lower than in the population that regularly consumes fish,
which is where this type of fatty acids are mainly found.
fats. However, the clinical relevance of this fact is unknown, since
that although we know that EPA and DHA are important for the development
and maintenance of the brain, retina and cell membranes, among others,
and contribute to the prevention of cardiovascular disease, vegetarian children
do not experience a deterioration in visual or mental development, and
Vegetarian adults have a lower risk of cardiovascular disease.
Therefore, minimum levels of this type of fats have not been established.
below which pathologies or symptoms associated with its deficiency occur.
However, there is an adequate intake of consumption, which in the case of
vegetarian population is made from alpha-linolenic acid (ALA), a
precursor of EPA and DHA that is transformed in the body into small
quantities but sufficient, in these essential fats.
Furthermore, and in order to avoid adding linoleic acid (LA) to the diet, which
shares a metabolic pathway with ALA and reduces the intrinsic synthesis of EPA and
DHA from ALA, the use of organic oils should be reduced as much as possible.
seeds rich in fatsomega6 (LA), prioritizing virgin olive oil
to season and to cook. An LA/ALA ratio no greater than 4:1 has been suggested
for optimal conversion.
There are DHA supplements made from microalgae and, therefore, of plant
origin. The European Food Safety Authority (EFSA)
proposes a supplement of 100 mg/day of DHA for children between 6 months
and 2 years, and 250 mg/day from this age, if reliable sources of omega 3 or its
precursors are not consumed.
© FUOC • PID_00268138 twenty-one
vegetarian diet
2. Foods of interest in the diet

vegetarian
2.1. Food composition
The basis of a vegetarian diet are fruits and vegetables, legumes, whole grains,
tubers, seeds, nuts and
virgin olive oil; In addition, some people also include dairy products,
eggs and honey.
The consumption recommendations for most of these foods are the

the same as for the omnivorous population, except in the case of legumes,
which, being the main source of proteins in the vegetarian diet, have much more
presence and importance than in the omnivorous diet. Besides,
Currently, the market offers many alternative foods to those of animal origin,
both for nutritional and gastronomic purposes, and that
They are less common in traditional food.
2.1.1. Legumes and derivatives
There are hundreds of varieties of legumes, although the most common in

Our environment is lentils, chickpeas, white, red, black, pinto beans and soybeans.
Of its composition, the protein content stands out,
slow absorption carbohydrates, minerals (calcium, iron, zinc...), vitamins (B1, B2
and folic acid), fiber, a small percentage of polyunsaturated lipids (except in the
case of soy, which is highest –18%–) and some
bioactive components.
Within the framework of a vegetarian diet, its interest lies, above all,
in its protein intake. The protein content in legumes is similar
(19-35%) than that of meat and fish, or even higher in the case of soy or
the chickpeas. The amino acid profile varies between different legumes; in
some is complete, as in soybeans, chickpeas and some varieties of
beans, and in other cases, such as lentils, are deficient in methionine.
Due to their richness and nutritional density, they are the basis of a vegetarian
diet, and a serving of legumes can be used as an alternative to a
portion of meat.
Furthermore, legumes have a lot of dietary, gastronomic and technological

versatility, so there are multiple derivatives of interest:
1) Legume flours: they have the same nutritional content as the dry legume from
which they come.
2)Tofu: it is made by curdling the soy drink, it is rich in proteins, with a good amino
acid profile (10-12 g/100 g), calcium (200 mg/100 g), zinc, etc. Its appearance is similar
to that of fresh cheese, although its flavor is neutral and its texture somewhat rubbery.
From a gastronomic point of view it is very versatile, since it can be combined and
cooked with countless recipes.
3) Tempeh: comes from the fermentation of soybeans or chickpeas by a fungus,

thanks to which the proteins become more digestible, and contains more fiber and
vitamins than tofu. The flavor is strong, and it is also available macerated with tamari
(soy sauce), which increases its content
in sodium.
4)Textured soy protein and other legumes, alone or combined with cereal flours.
They are made up of 50% protein, and offer many culinary and gastronomic
possibilities. They are available in various sizes and textures, and are normally
dehydrated: flours, granules, tacos, fillets, scallops, etc.
5)Natto: fermented soybeans, with an intense smell and taste. It's little
common in our environment.
6) Miso: paste of fermented soybeans, barley or rice. It is used as a condiment and is

very rich in salt.
7)Okara: residual product from making soy beverage. It is used in industry

food as an emulsifier.
2.1.2. Other meat substitutes
1)Quorn: it is made with mycoprotein, a type of protein obtained from a fungus. It is

rich in complete proteins (11.5 g/100 g) and also provides fiber. There are versions
with egg albumin (vegetarian) and others without eggs (vegan), and also processed
derivatives, such as nuggets, hamburgers, etc.
2)Seitan: it is a cooked gluten and tamari dough, so the salt content can be high.
Provides 20-25% protein; However, as it comes from wheat, it is a less complete
protein than that derived from legumes.
Due to its texture and flavor, it is usually very accepted and allows for very
similar to those of meat steaks.
2.1.3. Nuts and seeds
Nuts ( walnuts , almonds, hazelnuts, pistachios, cashews, peanuts, etc.) and seeds
(sesame, flax, pumpkin seeds, sunflower seeds, etc.), whole or in paste or cream form
(tahini, peanut butter, hazelnut butter, etc.) have a very interesting nutritional profile: they
contain significant amounts of fiber, proteins (10-25 g/100 g), vitamins, minerals
(calcium, iron, zinc...) and protective phytochemical substances and, above all,
unsaturated fats. They have a very healthy fatty acid profile:
• alphalinolenic acid (walnuts and flax seeds).

• linoleic acid (pumpkin, sesame, sunflower seeds and Brazil nuts).
• oleic acid (almonds, hazelnuts and peanuts).
Actually, they are very caloric foods, since they provide between 200 and 700
kcal/100 g, but its consumption is not associated with weight gain; instead,
It is related to a reduced risk of suffering from chronic diseases, such as cardiovascular
disease, some types of cancer and diabetes.
2.1.4. Dairy substitutes
Vegetable drinks come from legumes, cereals, seeds or nuts Ingredients of the
(soy, rice, oats, almonds, etc.) and, due to its form of presentation (liquid) vegetable drinks
and due to their color (white), they are usually used as an alternative to milk, although In the ingredient list of
the nutritional composition is not equivalent. In fact, the only drink most vegetable drinks it can be
observed that
vegetable with an interesting nutritional composition (especially with respect to contain between 2 and 15
% soy, almonds, oats, rice,
to proteins and calcium) and similar to cow's milk is the soy drink etc.; the rest is made up of water,
stabilizers,
enriched with calcium. Oat, rice, almond, etc. drinks are
emulsifiers, salt, oil and sugar. In
basically composed of water and simple sugars (although they do not contain added this sense, the total sugar content
can vary from 0.1 to 13 g per 100 ml,
sugars, the cooking and blending process ends up degrading the
since, in addition to their own
starch into simple sugars), so they are not nutritious nor do they represent a sugars, they often contain sugars
or sweeteners
protein contribution or interesting vitamins or minerals. In relation to the
Added (white sugar, brown sugar,
calcium, for example, unless they are fortified, the content in this agave syrup,
fruit concentrates, molasses,
mineral is very low or none. When added in the form of calcium carbonate panela, etc.).
or calcium citrate, its absorption is similar or even higher than that of milk
cow.
Vegan cheeses made from nuts or legumes are the only ones
with an interesting nutritional profile. Still, you have to check the labeling
to check that they do not contain hydrogenated fats or palm oil,
refined coconut or palm kernel.
2.1.5. Algae
Seaweed are sea vegetables, with low calorie content and a good contribution
of fiber and minerals, especially iodine. In fact, the large amounts of
iodine contained in some seaweed, such as kombu, arame and hiziki, makes them
not recommended for regular consumption. In addition, there are publications that
describe contamination with heavy metals.
Some algae contain small amounts of vitamin B12, although in

In reality, these are analogues that are not functional, that block the true B12 and
that can falsify the analysis.
2.2. Food guides: pyramids, plates and wheels
Food guides are an educational instrument that adapts scientific knowledge

about nutritional requirements and food composition into practical messages,
which make it easier for people to select
food. They are based on the nutrient and energy requirements and
recommendations of the population, and, in their preparation, they are taken into account.
the anthropological-cultural, educational, social and economic factors that
They are closely related to diet and lifestyle.
of the population. The guidelines should be based on the usual diet of
the population and communicate through brief, clear and concrete messages, which
They are often completed with icons or graphic representations.
In the nineties, the figure of

a pyramid or triangle that showed foods in groups. Besides,
With its triangular shape, the pyramid suggests the frequency and proportion with
which different food groups should be consumed. Thus, those who
placed at the base are the ones that should have the most weight in the usual diet.
On the other hand, as one ascends towards the vertex of the triangle, one
You should reduce your consumption of the foods that appear in it. Several
entities and companies, as well as research groups and even companies,
They publish their own pyramids and food guides. In the case at hand,
one of the main and most current pyramids of vegetarian food
and vegan are those of the UniónVegetarianaEspañola (figures 4 and 5).
In recent years, a new graphic tool in the shape of a plate has begun to gain
relevance . Although it is also used as an educational instrument in isolation, it is
very useful to complement the
information provided by the pyramid, especially in relation to the structure
of main meals. You can find guides in the form of a plate for vegan eating, such
as the vegetable plate (figure 6) and the vegan plate
(figure 7) and also vegetarian, such as the Vegetarian Eatwell Guide ( figure 8),
an adaptation of the government guide
from United Kingdom.
Figure 4. Vegetarian food pyramid
Source: Spanish Vegetarian Union.
Figure 5. Vegan food pyramid
Source: Spanish Vegetarian Union.

Figure 6. The vegetable plate
Source: Virginia Messina, The Vegan Rd. Available at: https://www.theveganrd.com/vegan-nutrition-101/food-guide-for-

vegans/.
Figure 7. The vegan dish
Source: Brenda Davis; Vesanto Melina (2014). Becoming Vegan: Comprehensive Edition. Available at: http://
www.brendadavisrd.com/my-vegan-plate/.
Figure 8. Vegetarian Eatwell Guide
Source: The Vegetarian Society. Available at: http://vegsoc.org/wp-content/uploads/2019/02/

Eatwell_guide_veggie_MAR2018.pdf
23. Food portions
Nutritional balance is possible from numerous culinary options and dietary

habits and from the most varied and imaginative customs. Furthermore,
energy and nutrient requirements are highly variable, depending on
interindividual differences, due to sex, age, body weight, physiological state,
physical activity, etc., so it does not make sense to establish
establish closed and specific quantities of foods recommended for the entire
population. In this sense, dietary advice must be individualized
with specific recommendations made by professionals specialized in
human and dietary nutrition in general, and in vegetarian food in
particular.
Below are the usual consumption rations for each group.

of foods, with a generic consumption recommendation that must be
adapt based on the variables mentioned.
2.3.1. Vegetables and greens
Table 5. Consumption rations
Group of Food Ration Recommend-

food dation
vegetables and 1 salad plate 150-200 g 2 servings/day

vegetables
1 plate of cooked vegetables
1 large tomato
1 zucchini, eggplant
1-2 carrots
1 bowl of gazpacho, mashed vegetables
2.3.2. Fruit
Group of Food Ration

food Recommendation
Fresh fruit 1 apple, pear, orange… 120-200 g 3 servings/day
2-3 tangerines, figs, plums…
1-2 pieces of watermelon, melon
1 bowl of strawberries, cherries, grapes…
Fruit Raisins, figs, plums 30g

desiccated
2.3.3. Farinaceous

food (g/home measure) Recommendation
Farinaceous: Wholemeal bread 60 g (1 slice) In each meal

whole grains,
tubers and Pasta, rice and whole grain couscous, 60-80 g (1 plate)
darling…
legumes
Whole grain flakes 40g (1/2 bowl)

unsweetened
Potato, cassava, monato 150-200 g (1 large)
Legumes 60-75 g (1 plate)
2.3.4. Protein foods
Group of Food Ration Recommend-

food dation
Proteins Legumes 60-75 g (1 plate) 2-3/day
Eggs 75g (1 large)
Tofu 60-100 g (2 slices)
Textured soybeans 30-40 g (3-4 tbsp*)
Tempeh 60-100 g (2-3 pieces)
Seitan 60-80 g (2-3 pieces)
Hamburger, sausage 60-100 g (1-2 units)
*cs: tablespoon exceeds
2.3.5. Dairy and substitutes

food Recommendation
Dairy or Milk 200 ml (1 glass) 2/day*

substitutes
Soy drink with calcium 200 ml (1 glass)
Yogurts and fermented soybeans 250g (2 units)
Fresh cheese 80-125g
*If dairy products or substitutes are not consumed, it is necessary to include other foods rich in calcium, such as nuts (almonds),
legumes (beans), curdled tofu with calcium salts, vegetables such as cabbages, broccoli, etc.

food Recommendation
Semi-cured cheese 30 g (1 piece)
Grated dry cheese 2 cs
*If dairy products or substitutes are not consumed, it is necessary to include other foods rich in calcium, such as nuts (almonds),
legumes (beans), curdled tofu with calcium salts, vegetables such as cabbages, broccoli, etc.
2.3.6. Oils and fatty foods

food Recommendation
Fats, oils, Oils (preferably 10 ml (1 tbsp) 5-8 servings/day

fruits virgin olive)
dried and
seeds Walnuts, almonds, hazelnuts- 1 serving/day
20 g (1 handful)
na…
Seeds: sesame, pumpkin 20 g (1 handful)

seeds, sunflower...
Tahini, peanut paste, 20 g (1 cs)

hazelnut…
Avocado 70g
3. General recommendations on vegetarianism

in healthy adults
3.1. Design of dietary guidelines
The design of a vegetarian dietary pattern does not differ from the design of a
conventional or omnivorous dietary pattern. As in the latter, it is essential to take into
account:
• The person's eating habits (qualitative and quantitative data). • Their schedules and
habits (type of work, physical exercise, etc.).
• The type of diet you want (vegetarian, vegan...) and the reasons for choosing
tion.
• Your food preferences: preferred foods and rejected foods and the reasons why
they are avoided (allergies, intolerances, etc.). • Your physiological
and health status.
Likewise, it is recommended that the diet or eating plan be accompanied

of:
• General tips for following the diet. • Specific

advice to control the intake of certain nutrients.
tes.
• Foods and drinks that should be consumed frequently and those that are preferable
to consume occasionally. Graphic material can be provided, such as pyramids or
informative diptychs on vegetarian or vegan nutrition.
• Examples of daily and/or weekly menus and/or plans. • Recipes for

dishes or culinary preparations.
The following steps are recommended in planning the regimen:
1)Calculate energy needs using equations or programming programs.

nutritional calculation.
2)Determine the number of servings based on the recommendations proposed for

each food group. Although a minimum number of servings per day is recommended,
the specific amount in which farinaceous, oil and protein foods should be consumed
varies depending on body weight, condition,
physiological, age and physical activity performed, and, therefore, the

Dietary advice should be individualized by calculating energy needs
of the person and the energy contribution of said foods.
The portions of fruits, vegetables and nuts are established from

of the recommendations, which are the same for the entire population. In the
The following table shows a distribution as a guide:
Table 11. Food groups and recommended servings
Food group Recommended servings
Fresh fruits ÿ 3 servings/day
Vegetables ÿ 2 servings/day, lunch and dinner
Farinaceous In each meal
Nuts and seeds ÿ1 handful per day
Dairy or substitutes 2 servings/day
Protein foods 2-3 servings/day (vary type)
Oil 5-8 servings/day
3) Distribution of portions throughout the day. Once the number of servings of

each food group has been calculated, they are distributed along
of the day according to the person's schedules and preferences. Generally, in two
main meals and two or three complementary meals (breakfast, mid-morning
and snack). For example, as we see in the following table:
Table 12. Distribution of rations
Breakfast Rations
Fresh fruits 1
Vegetables
Farinaceous 1
Nuts and seeds
Dairy or substitutes 1
Protein foods
Oil
4) Convert portions into food and measurements (grams, ml and/or measurements

homemade), as appropriate in each situation. For example, as we see
in the next table:
Table 13. Conversion of rations into food
Breakfast Food
Fresh fruits 1 banana, pear, apple, 1 bowl of strawberries…
Farinaceous 1 slice of whole wheat bread, ½ bowl of rolled oats, 1

whole wheat bread, etc.
Dairy or substitutes 1 glass of milk, soy drink, 1 piece of fresh cheese, 1 natural yogurt,
etc.
Oil 1 tbsp extra virgin olive oil
5) Provide examples of menus: daily, weekly and/or biweekly.
For main meals, the healthy plate serves as a guide for planning
a balanced meal and suggests approximate proportions of each of
the food groups to include; most of the plate is taken up by
vegetables, and leave ¼ part for protein foods and the other ¼ part for
whole grains and tubers, olive oil for dressing, and water for
to drink. Both lunch and dinner can be structured as a first course,
main course and dessert, or as a single dish. In the following table we see
Some examples of main meals:
Table 14. Examples of main meals

NOTE
vegan meals Vegan Dinners

You can consult the information
about the healthy plate in the
Gazpacho Potato salad
section 3.2 of this assignment
Paella with garrofon beans Grilled seitan with seasoned tomato ra.
Watermelon Cherries
Varied salad with nuts Onion, oatmeal and thyme soup

Chickpeas with couscous Artichoke and onion omelette (garban-zo flour)
Tangerines
Apple
Pumpkin, monato and ginger cream Hummus with crudités and whole wheat bread with
Tofu and spinach quiche ces
Fruit salad of time Pear
Vegetarian meals Vegetarian dinners
Varied salad with hard-boiled egg Zucchini and fennel cream

Leek and mushroom lasagna Cherry tomato, mozzarella and basil pizza
Persimmon slices plums
Roasted pepper and black olive salad Chickpea cold cream

Little books of eggplant and cheese with seasoned
Potato and onion omelette tomato
Grapes Apricots
Sauteed vegetables Spinach, pine nut and parmesan salad

Seitan with cheese sauce and mashed potato Red bean burger with fresh bread
Peach ces
pear compote
© FUOC • PID_00268138 3. 4 vegetarian diet
In the breakfasts and snacks you can find the rations for the groups of NOTE
food according to the recommendations and taking into account the person's
You can consult the
preferences and habits. recommendations in section 4.3 of
this subject.
3.2. Recipes and gastronomic adaptations
The only difficulty in adapting recipes and culinary preparations of

The omnivorous vegetarian diet lies in the substitution of foods
of animal origin (fish, meat and derivatives, dairy products or eggs) by others that
can be compared from a nutritional and gastronomic point of view.
Since the greatest difficulty lies in the substitution of foods or ingredients

For the preparation of dishes or preparations suitable for vegan nutrition, this
section will focus on vegan nutrition.
Next, we will see examples of foods or ingredients that serve as substitutes for
meats and derivatives, eggs and dairy products for different preparations.
servings:
3.2.1. Meats and derivatives
• To replace minced meat (in the preparation of meatballs, hamburgers,

guesas, sausages, bolognese sauce...) you can choose:
– textured soy protein.
– grated seitan or tofu.
– cereal flakes and nuts.

– mushrooms, cereal flakes and nuts.
• To replace steaks or large pieces: seitan, tofu, tempeh or chicken fillets.

Dehydrated textured soybeans.
There are commercial brands of meat substitute products and derivatives that are
can be found in specialized vegan food stores (Beyond
Meat®, Quorn®, Heura®, etc.).
3.2.2. Eggs
• To make tortillas: for a tortilla, use ½ kg of potato and an onion,

mix 1 cup of water for ½ of chickpea flour. Cook over low heat.
• To make mayonnaise: for 150 ml of oil, 50 ml of soy drink

or milk without sweeteners and at room temperature, juice of ½ lemon and
salt. Beat slowly.
• To make aioli: ¼ kg of cooked carrot, the juice of 1 lemon, 2 cloves of raw garlic, 2
tablespoons of oil and salt. Beat adding water little by little, if necessary.
• To bind sauces, meatballs, fillings, etc.: – bread

crumbs soaked in broth, milk or vegetable drink. – soy or chickpea
flour dissolved in water, in a 1/3 proportion. – breadcrumbs or mashed potato
flakes. – cereal flakes soaked in water.
• To coat:
– Pass the food through flour, followed by a mixture of water and

50% flour and, finally, breadcrumbs.
– You can also pass the food through flour, followed by a mixture of water and chickpea
flour, in a 1/3 proportion, and finally, through breadcrumbs.
• To make sponge cakes: one egg is equivalent to 2 tablespoons of flour + 2 tablespoons

of water, milk, vegetable drink or juice; ½ dessert spoon of baking powder and 1
dessert spoon of oil.
3.2.3. Dairy
• As a milk substitute: vegetable drinks (soy, oats, rice, etc.). • As a substitute for
yogurt: soy yogurt. • As a cheese substitute : vegan “cheese”
made from
nuts, soy yogurt or tofu.
• As a substitute for butter or margarine: avocado, nut creams, vegetable margarines. • As a
substitute for cream: pureed nuts with
water, vegetable "creams" (oats, rice, soy, etc.) or tofu beaten with oil and water. For cakes or pies
you can use tofu beaten with mild oil and water or coconut milk.
3.2.4. Fish
Generally, some seaweed is used to give fishy flavor to some preparations. In specialized
stores you can find processed and ultra-processed products as substitutes for fish or
seafood, in terms of flavor and appearance, although nutritionally they cannot be compared.
3.2.5. Condiments that provide umami flavor, typical of the

meat
Tamari or soy sauce, balsamic vinegar, dried mushroom powder, dried vegetables Website of interest
and powdered vegetables (onion, celery, garlic, etc.), brewer's yeast,
On the following website you can
garlic powder with La Vera paprika, etc. consult recipes for
Dishes suitable for vegetarian
and/or vegan food:
3.3. General recommendations for a vegetarian diet Spanish Vegetarian Union.
Recipes.
and vegan
1) Choose a wide variety of foods, avoiding superfluous or unhealthy foods,

which are foods that provide many calories (sugar, unhealthy fats, etc.), salt, etc.,
but very few nutrients. We refer to sugar
table, honey, sweets, juices (packaged and homemade), horchatas,
sugary drinks ("soft drinks"), homemade or industrial pastries (cakes,
muffins, donuts, etc.), chocolates, salty snacks (potato chips
and similar), margarines and butters, ice creams, dairy desserts,
cookies and most breakfast cereals.
2) Regularly consume a reliable source of vitamin B12 in the form NOTE

of cyanocobalamin.
Regarding vitamin B12, you can
see section 2.7 of this
3) Consume at least five servings a day of fruits, vegetables and greens. subject.
All, and preferably fresh, in season and locally produced. In some cases frozen
or dehydrated ones can be used.
In the case of seaweed, due to its high iodine content, it is advisable to consume it
only occasionally and in very small quantities.
It is preferable to consume whole fruits , in pieces, sliced or crushed, because

juices do not contain fiber, do not provide satiety and contain too much sugar.
Another option may be dried fruit (dried apricots,
raisins, dried figs, etc.).
4) Opt for whole grains and derivatives (bread, pasta, rice, barley, rye, etc.). It is
advisable to consume cereals and their whole grain derivatives,
unsalted breads and breakfast cereals without sugar, honey or syrups.
They are foods rich in starch, but also in fiber, vitamins of the group
B and other micronutrients that are concentrated, above all, in the outer layer
of the grain.
5) Eat foods rich in vitamin C at main meals (citrus fruits,

strawberries, pepper, tomato, etc.). These triple the absorption of non-heme iron
that foods of plant origin provide.
6) Use extra virgin olive oil for cooking and seasoning. Others
Less recommended options for daily consumption are olive oils,
soy, flax, rapeseed, etc. Do not use oils rich in omega-6 ("vegetable oil",
sesame oil, peanut). For cooking or frying it is preferable to use
olive oil (preferably virgin) or high oleic sunflower oil. If there are no dietary
contraindications (for example, calorie restriction), virgin olive oil
Extra and healthy fats can be consumed as desired.
7) Eat nuts and seeds daily. Other foods that provide

Healthy fats are nuts (walnuts, hazelnuts, almonds, etc.),
seeds (pumpkin seeds, sunflower seeds, sesame seeds, etc.) and avocado.
Take 1-1.5 grams of alpha-linolenic acid (ALA) daily: 1 g corresponds

approximately to 3-4 walnuts, 1 cp of ground flax, 1 cc-cp of oil
of flax, 1 tsp of rapeseed oil, soy, walnuts, hemp, 1.5 tsp of seeds
chia or flax. When in doubt, take 200-300 mg DHA.
8) Consume 2-3 servings of protein foods per day (legumes and/or derivatives,
soy drinks, nuts, etc.). Guarantee at each main meal
(lunch and dinner) the presence of a portion of protein foods.
The vegetarian diet includes legumes and their derivatives (lentils,

chickpeas, white, red and black beans, tofu, tempeh, etc.); the fermented ones
soybeans ("yogurts") and soy drinks, preferably enriched in calcium
and unsweetened (sugar, fructose, maple syrups, apple concentrate,
etc.); the eggs; seitan; whole nuts (walnuts, almonds, etc.) or
in paste form (tahini, peanut butter, etc.); dairy products, since they provide
proteins and also calcium. Dairy includes milk (without sugar or other
sweetening products), natural yogurt and other fermented milks (kefir,
sugar-free fermented milk drinks, etc.) and cheeses (preferably,
tender or fresh).
In the vegan diet it is limited to legumes and derivatives (lentils, chickpeas,

white, red and black beans, tofu, tempeh, soy drink, etc.), seitan and fruits.
dry.
9) Take farinaceous foods with every meal. They are cereals and whole grain derivatives.
(bread, pasta, rice, millet, cereal flakes, couscous, gofio, etc.) and tubers
fresh or in flakes (potatoes, sweet potato, cassava, etc.).
As they are a good source of energy, it is advisable to include them in each

main meal. The amounts that should be consumed depend on the person's
energy needs, which vary depending on the physical activity that is performed.
makes.
10) Drink water as your main drink. Consume drinking water as the main drink, and
depending on thirst, in any situation and time of day.
Sugary drinks (soft drinks and juices), and alcoholic drinks, the less the better.
11) Moderate the consumption of tea and coffee (maximum 2 a day), and better outside the
foods.
12) Use salt in moderation (maximum 5 g per day = 1 tablespoon of coffee), and
preferably salted.
13) To improve nutrient bioavailability :
• Soak, cook, sprout and/or ferment legumes and cereals. • Lightly toast
the nuts. • Grind flax and sesame seeds. •
Use sourdough for bread.
14) Expose yourself to sunlight for about 15 minutes a day on your hands, arms,
face and neck. If exposure to sunlight is limited (<15 min/d), consider taking
supplements or enriched vitamin D2 (25 mcg/d [1,000 IU] vit D2).
15) Do not take other supplements without a doctor's or DN's prescription. In

principle, it is only advisable to take vitamin B12 (2,000 mcg weekly), vitamin D2 (in
case of infrequent exposure to the sun) and iodized salt (no more than one teaspoon
per day). Other supplements of vitamins, minerals and other compounds (DHA, for
example) should only be taken in case of diagnosed deficiency and/or under the
advice of qualified professionals.
16) Avoid the consumption of alcohol, tobacco and other drugs.
17) Eat in a relaxed manner, chewing and savoring the food well, and better in good
company.
18) Perform physical exercise: walk, ride a bicycle, run, swim, dance, etc. It is recommended to
practice a minimum of 30 minutes of moderate physical activity, at least 5 days a week (150 minutes
a week), 75 minutes of intense physical activity during the week, or combine moderate and intense
physical activity.
4. Food, nutritional and

Diets in vegetarianism and different stages
of the life
4.1. Pregnancy and lactation
Pregnancy is a critical period during which the nutrition of the mother and
The choice of lifestyles has a great influence on the health of
the mother herself and the son or daughter. Therefore, complete, sufficient and
balanced nutrition, as well as healthy lifestyles (avoiding tobacco and
alcohol, avoiding a sedentary lifestyle and correct supplementation), contribute
to prevent the most common problems of newborns, such as congenital birth defects
and low birth weight.
Likewise, they also help reduce the baby's predisposition to future diseases, such
as cardiovascular diseases, immune system diseases,
diabetes, etc.
Pregnancy is a time when nutritional factors take on special importance, and it is

possible to meet the mother's nutritional requirements.
and baby with a diet that excludes foods of animal origin. This is stated by
professional and scientific associations, administrations and governments,
which issue recommendations for the vegetarian population in general, and
for pregnant vegetarians specifically. These include the United States Academy of
Nutrition and Dietetics, the American College of Gynecology and Obstetrics, the
Canadian Dietitians Association, the Health Service
of the United Kingdom, the Government of Australia and that of Portugal, among others.
There are few publications on the effects of vegetarian diets during

pregnancy, although a systematic review on the subject states that despite
that the evidence is heterogeneous and scarce, paying attention to the contribution
of vitamins and minerals, vegan diets can be considered safe
During pregnancy. The main indicators of maternal and child health,
such as birth weight and duration of pregnancy, are similar in pregnancies
vegetarians and omnivores. Furthermore, it even seems that following a vegetarian
diet during pregnancy can provide some advantages, such as less
risk of excessive body weight gain and gestational diabetes. A lower risk of
preeclampsia has also been observed.
The first recommendation that any pregnant vegetarian or vegan woman should
receive is to follow the same important advice that is given to
omnivorous pregnant women, that is:
• Take 400 mcg/day of folic acid. Recommended reading
• Do not consume any type of alcoholic beverage.

For more information on
• Avoid tobacco. nutritional recommendations during
• Follow hygienic measures that avoid the risk of food poisoning. pregnancy, you can read the
Scientific Review on Food and
you would
Nutrition in Pregnant Women,
• Perform physical activity daily. prepared by the Center
• Moderate caffeine consumption (there is not enough evidence to recommend Evidence Analysis
Scientific Spanish Academy of
abstaining from caffeine during pregnancy, but Nutrition and Dietetics, and available
Because no safe threshold is detected, at: http://
worlddietistanutritionistday.org/
recommends keeping consumption as low as possible). wp-con-
tent/uploads/2017/05/
baladia_evidencias_new.pdf.
Below are the particularities in relation to the nutrients that
have special interest in a vegetarian pregnancy and whose recommendations
They vary with respect to other stages of life:
1) Proteins: protein needs increase during pregnancy and lactation (they go from 46
g/day to 71 g/day); However, the spontaneous ingestion of the
Spanish population would cover this increase in demand without problem, also
in the case of vegetarians (as long as there is a wide availability of
foods of plant origin and the caloric intake is not restricted (something that does not
should happen during pregnancy).
2) Iron: anemia is the most prevalent nutritional deficiency in the world. HE

It is estimated that up to 17.5% of women in industrialized countries suffer from
anemia. During pregnancy, recommended dietary intakes of iron
they go from 18 mg/d to 27 mg/d; Therefore, pregnant women, vegetarians or
omnivores, they need more iron. On the other hand, during breastfeeding, due to
amenorrhea, the dietary reference intakes become 9 mg/day. The
metabolic adaptation of the body to low intakes or high needs, together with the
recommendations already described to increase consumption
of iron and its absorption are usually sufficient to guarantee coverage
of requirements. However, a preventive measure is being considered
intermittent supplementation in omnivorous pregnant women, although
Today it is neither justified nor implemented. In pregnant vegetarian women, the United
States Academy of Nutrition and Dietetics recommends intermittent or daily low-dose
iron supplementation (30 mg/d). In
In any case, the woman's diet should be studied and evaluated if there is a risk of
deficit, also through the usual control analyzes of the pregnant woman.
raced.
3)Calcium: the dietary reference intake of calcium during pregnancy and

Breastfeeding is the same as in non-pregnant women and is also the same as for
vegetarian women, due to adaptation factors (greater absorption, less loss, etc.).
Women with intakes less than 500 mg/day
They may need supplementation to meet their needs and requirements.
fetal bone formations.
4)Iodine: if the pregnant or lactating woman does not consume three servings of
dairy a day (or consumes organic), she should take a supplement of 200
mcg of iodine (potassium iodide), plus 2 g of saliodine. The vegans
Pregnant women should therefore take the supplement.
5)Omega3: given the importance of an adequate supply of fatty acids

essential in this phase of the life cycle, it is advisable to guarantee the intake of
1.4 g/day of alpha-linolenic acid (ALA) in pregnancy and 1.3 g/day during
lactation, in order to guarantee the endogenous synthesis of EPA and DHA.
It is possible that in vegetarians these amounts should be higher to
ensure efficient conversion. If adequate amounts are not consumed
of foods rich in ALA, a supplement of 200-250 may be indicated
mg/day of DHA.
6)Vitamin B12: a study carried out in lacto-ovo-vegetarian pregnant women

concluded that 22% had B12 deficiency. The vitamin
B12 crosses the placenta, meets the requirements of the fetus and is present in
breast milk, so it also contributes to the baby's needs
breastfed. If the mother's vitamin B12 stores are low, the baby will not
Not only will you be born with low levels of B12 in your body, but you will not receive the
necessary amount of B12 from your mother's milk, and you could develop
symptoms of B12 deficiency a few months after birth. It is essential that pregnant
vegetarian women (lacto-ovo vegetarian or vegan) take a supplement of 25-100
mcg/day or 1,000 mcg three days per
week. No studies have observed toxicity of B12 supplements in
the general population or pregnant women.
4.2. Childhood
According to the United States Academy of Nutrition and Dietetics, diets

Vegetarian, including vegan, properly planned, are
appropriate for all stages of the life cycle, including pregnancy, lactation,
childhood, adolescence and adulthood ; as well as for athletes. The American
Academy of Sciences also agrees on this position.
Pediatrics, the National Health Services of the United Kingdom, the Association of
Dietitians of Canada and the Pediatric Society of Canada,
the European Society of Pediatric Gatroenterology, Hepatology and Nutrition
(ESPGHAN), the Australian Government Department of Health, the Directorate
General Health of Portugal, etc.
Studies that analyze the nutritional adequacy of vegetarian children in Western

countries generally find an intake, a pattern
growth and adequate nutritional status. The growth of babies and
vegetarian children is similar to that of omnivores and is within the normal range
for weight and height, although it seems that vegans
They are initially shorter and thinner.
The dietary pattern is closer to health objectives than that of omnivores, with
a higher consumption of fruits and vegetables and lower in
sweets and in salty snacks, which results in a higher intake of
fiber and vitamins and lower cholesterol, saturated fat, total fat and sodium.
Also the BMI and overweight rates are lower. However, it is important to mention
that there are few studies regarding the safety of some
less common or atypical vegetarian diets, such as macrobiotics in
more restrictive phases, the frugivorous or the raw-eating, so its effects and
consequences are unclear, particularly in infants, children, adolescents,
pregnant and lactating women. In this sense, and due to the fact that they are
extremely restrictive, they can be poor in calories, proteins and some
vitamins and minerals, and therefore pose a risk of iron deficiency anemia,
rickets, megaloblastic anemia due to vitamin B12 deficiency, deterioration
in growth and, although rare, protein-calorie malnutrition.
For this reason, both the United States Academy of Nutrition and Dietetics and
The Academy of Pediatrics advises against them in childhood.
4.2.1. Key nutrients and strategies to cover their

requirements
Due to the great growth and development of babies and children, their needs
of nutrients are proportionally higher than other stages of the life cycle.
Therefore, we must pay attention to planning and dietary advice,
especially when some foods are restricted from the usual diet.
tual.
1)Energy (calories): to cover energy needs (and also

nutrients) of vegetarian children, and especially vegans, it is recommended
that they have frequent meals, that is, offer healthy foods to
often, respecting your feeling of hunger and satiety, especially when
smaller they are. It is advisable to offer foods rich in energy and healthy fats,
such as virgin olive oil, nuts (up to three
years crushed or in cream), avocado, etc. In some cases of less appetite or
early satiety, it may be appropriate to offer some of the farinaceous foods
(bread, pasta, rice...) in their refined forms (not whole grains), since
that fiber consumption is high and this contributes to increasing the sensation
of satiety. In addition, it is important to avoid unhealthy foods, with high
energy density and low nutritional quality (cookies, breakfast cereals,
sugar and honey, juices and sugary drinks, potato chips and similar, desserts
sugary dairy…).
2) Protein: available data confirm that the protein needs of vegetarian children
are easily met when the diet includes a wide variety of plant foods and
adequate caloric intake ( not restricted). Protein needs are the same in
omnivorous children as in lacto-ovovegetarians, although in vegans, due to the
lower protein digestibility of plant foods, an increase of 15-35% in protein intake
is indicated (30 -35% more in <2 years, 20-30% more in 2-6 years and 15-20%
more in >6 years). In the child population, it is recommended that protein
complementation between proteins with some limiting amino acid
whether it is given with the same meal or not beyond six hours. Within the framework of a
wide and varied availability of foods of plant origin, coverage of protein needs is
guaranteed with the consumption of 2-3 portions of protein foods per day (2 in
lacto-ovo vegetarians and 3 in vegans).
3) Iron: it is recommended to consider the same recommendations to cover the

requirements that have been written for the general population. These dietary
measures, together with the monitoring that is routinely carried out on children in
the primary care consultation, should be sufficient to control a possible situation
of anemia. That is, vegetarian or vegan children without a diagnosis of anemia
should not receive preventive supplementation or preventive tests. Systematic
supplementation (1 mg/kg/day) is only proposed for children under one year of
age who follow very restrictive diets.
4)Calcium: up to one year of age, breast milk (or, failing that, artificial milk) will NOTE
be the main source of calcium. From one year onwards, whole cow's milk is
You can consult section 2.5 of this
recommended for omnivorous and lacto-ovo vegetarian children, and calcium- subject to remember the information
about calcium.
enriched soy drink for vegans. This drink is not essential, since calcium
requirements can be met without it, including other plant foods rich in calcium.
5)Vitamin D: all children under one year old, including vegetarians, should
receive a supplement of 400 IU/day of vitamin D (in the case of vegan children,
the supplement must be D2 or D3 of plant origin). After one year, the need for
supplementation will depend on the degree of sun exposure. If this is not enough,
it can be supplemented with the intake of cow's milk enriched with vitamin D (for
lactovegetarians) or a soy drink enriched with vitamin D. If there is a risk of
deficiency, you can supplement with vitamin D2 or D3 from vegetable origin.
6)Iodine: vegetarian children, like omnivores, should take iodized salt as a safe
source of iodine (half a teaspoon of iodized salt per day).
7)Somega3 fatty acids: adequate intake of ALA (precursor of EPA and DHA)
must be guaranteed through walnuts, flax (ground or in oil), rapeseed, soy,
walnut oils, etc. If not, the European Safety Authority
Alimentaria (EFSA) proposes a supplement of 100 mg/day of DHA from micro-algae for children
between 6 months and 2 years and 250 mg/day from

this age.
8)VitaminB12: Vegetarian mothers should take a vitamin B12 supplement during pregnancy and NOTE
lactation. Symptoms of B12 deficiency in babies of vegan mothers who do not take B12 supplements
In section 2.7 of this subject you
are seen within a few months of life, and examples include megaloblastic anemia, food refusal, can consult the appropriate dose
according to age.
hypotonia, developmental delay, and lethargy. It is true that treatment with therapeutic doses of
the deficit improves clinical and radiological symptoms, but some suffer severe cognitive and
developmental delay in the long term (approximately 50%). From six months onwards, when the
baby may reduce the amount of breast milk he drinks, he needs to receive vitamin B12 supplements
in the form of
cyanocobalamin.
4.2.2. Food advice on vegetarianism in childhood and

adolescence
If babies are not breastfed or are weaned before one year of age, formula milk should be used
Soybeans and growth
(starter or follow-on, depending on their age). For non-breastfed vegan babies, adapted soy or rice
There is no evidence that soy can
formulas will be indicated, although as of today in Spain there are no commercial brands that harm the growth, development,
incorporate vitamin D and DHA of plant origin. bone, metabolic, reproductive,
endocrine, immunological and
neurological health of children.
Therefore, children can consume
soy formula milk from birth, as well as
soy and foods derived from it from six
months of age.
The schedule for introducing new solid foods is similar to that of non-vegetarian babies. From
approximately six months of age, children can begin to drink foods other than breast milk (or
formula), maintaining milk as the main source of energy and calories. To guarantee the contribution
of proteins, zinc, iron, etc., instead of meat and fish, the following will be offered:
• well-cooked legumes and their derivatives (tofu, tempeh, textured soybeans,

etc.).
• seitan (boiled gluten dough). • Quorn.
• egg (in the case of ovovegetarians). • unsweetened

fermented soy drink (soy “yogurt”).
• crushed or creamed nuts .
• etc
Later, around 9-10 months, if the baby is lactovegetarian, you can start offering small amounts of
unsweetened yogurt and fresh, soft cheese .

© FUOC • PID_00268138 Four. Five

vegetarian diet
Ultra-processed vegetable products such as "hamburgers", "sausages",

"nuggets", etc., are not recommended at any age, since the protein content is
low, the fats they usually incorporate are not of good quality, they are very rich in
salt and contain other less nutritious ingredients.
There is a growing trend towards vegetarianism in the adolescent population. NOTE

On the one hand, in the case of boys and girls who live in non-vegetarian
You will find more information
families, it is likely that neither the family nor the adolescent themselves have about this in section 6.3 of this
knowledge or skills about potentially critical nutrients, food sources, and dietary subject.
and nutrition strategies. supplementation that guarantees optimal nutrition.

Therefore, these families will need information and support. On the other hand,
there is some concern among families and also among health professionals,
regarding the possible relationship between vegetarianism and eating disorders
(ED).
4.3. Old age
Studies carried out with a vegetarian population in old age show similar intakes
and blood levels of critical nutrients in elderly vegetarians and omnivores, except
in the case of zinc intakes and blood levels of iron, which seem to be lower in
vegetarians.
In old age in general, some nutrient requirements are increased, either because
the necessary quantities are higher, or because, with age, utilization and
exploitation are less efficient. If we add to this the fact that caloric needs
decrease, the need to guarantee nutritious diets becomes essential , since with
a lower intake, more nutrients must be provided. In this sense, the consumption
of unhealthy foods should be as low as possible.
The nutrients that must be paid special attention to at this stage, especially when
following some type of vegetarian diet, are:
• Proteins ( guaranteeing the contribution of protein foods).
• Vitamin D (if the elderly person lives in an environment that does not guarantee
sun exposure, supplementation should be considered).
• Calcium ( some sources cite that calcium needs are greater after the age of
50, while others consider that they do not vary with age; in any case, it is
necessary to ensure that 500 mg of calcium per day are covered).
• Obviously, supplementation with vitamin B12 is essential.

5. Food, nutritional and

dietetics in vegetarianism in situations
specials
5.1. Sport
In section 1.3, we pointed out that according to the United States Academy of
Nutrition and Dietetics and other institutions of nutrition specialists,
Vegetarian diets, including vegan diets, properly planned, are healthy, nutritionally
adequate, and may provide health benefits in the prevention and treatment of
certain diseases.
These diets are appropriate for all stages of the life cycle, including
the athletes.
The available evidence indicates that a vegetarian diet has a neutral effect on
fitness, aerobic endurance during running, function
lung function, aerobic and anaerobic exercise, leg circumference and
arms, hand grip, back strength, hemoglobin and total serum protein. Well-planned
vegetarian diets are compatible with
athletic performance and success.
5.1.1. Protein
The suggested daily protein requirement for athletes who practice aerobic sports
is 1.2-1.4 g/kg body weight/day, while for athletes
strength sports is 1.6-1.7 g/kg body weight/day. For vegetarian athletes, it is
advisable to increase protein intake by 10%. In
Table 15 we see the recommendation for different situations:
Table 5. Protein intake recommendations according to the type of exercise
Type of exercise protein intake
Increased muscle mass 1.7 – 2 g/kg/day
Endurance sports 1.2 – 1.5 g/kg/day
strength sports 1.6 – 1.8 g/kg/day
aerobic sports 1.3 g/kg/day
Source: self made. Adapted from Rogerson, 2017.

5.1.2. Supplements
With correct diet planning that ensures the required energy intake and a wide
variety of foods of plant origin, you can cover
the requirements of all amino acids and most nutrients.
Although no special supplements are needed in the athletic population,
You can individually assess the following:
• whey protein in a lactovegetarian diet, and pea protein in a vegan diet.

• creatine monohydrate (3-5 g per day for 4 weeks).
• omega 3 of plant origin.
• vitamin D of plant origin, in case of deficiency.
5.2. Food allergies and intolerances
In this section we will focus on the foods that within a vegetarian diet are most
likely to cause allergies or intolerances, explaining how to avoid them and how
to replace them, if applicable, in order to maintain
a healthy diet.
5.2.1. Milk
1) Allergy: caused by casein, lactoglobulin and lactalbumin. HE

should avoid:
• all dairy products (yogurts, cheeses, butters, curds, custards, ice cream, 100%
non-vegetable margarine, fermented milk, whey
milk).
• pastries and pastries, sliced bread, baguettes, candies, chocolate, cocoa

powder, nougat, cocoa creams, some baby food, baby food, cereals,
smoothies, juices, horchatas.
2) Lactose intolerance: depending on the degree of tolerance, you must

avoid milk, fermented milks (yogurt, kefir, etc.), some cheeses and
foods that contain them. Switch for:
• milk: vegetable drinks (preferably soy).

• yogurts: soy yogurts.
• cheeses: vegan “cheeses” based on nuts, soy yogurt or tofu.
• butter: avocado, nut creams, occasionally, margari-
vegetables.
• cream: puree of nuts with liquid or oil, vegetable "creams" (soy,
rice, oats, etc.).
5.2.2. Egg
1)Egg allergy: it is due to an allergic reaction generally caused by ovalbumin and

ovomucoid, characteristic proteins of the egg that are present in the white. They
should be avoided:
• Eggs and derivatives. NOTE
To remember which foods

• Battered and breaded with eggs, cakes, cookies, pastries, puff pastries, you can replace the egg
empanadas, dumplings, custards, creams, ice cream, meringue, custard, with, you can see section 4.4.2
of this subject.
margarines, mayonnaise and other sauces, salad creams, egg and semolina
pasta, bread grated and any baked with egg white.
• Packaged foods whose label states that they contain eggs.
5.2.3. Legumes
1) Allergy to legumes: in general all are allergenic, especially lentils and soy. In
the food industry, legume gums are used as thickeners (guar gum, locust bean
gum). Soy is widely used in food and is difficult to avoid. Up to 60% of manufactured
foods contain soy. They should be avoided:
• All legumes and their derivatives (as long as tolerance is not demonstrated). •
Packaged foods whose label states that they contain soy or milk.
Gums.
Switch for:
• Alternative sources of protein, including: nuts and seeds (pistachios, cashews,

pumpkin seeds, etc.), quinoa and other whole grains, seitan.
• Another resource is commercial preparations made from isolated vegetable

protein (rice, wheat, hemp, etc.).
5.2.4. Nuts
1) Nut allergy: peanuts and almonds have a high risk of causing anaphylactic
shock , although if it is mild it only produces nausea, headache and swelling of
the lips and tongue. They should be avoided:
• All nuts, as long as tolerance is not demonstrated. • Desserts, cakes

and industrial pastries, hamburger bread, drinks and pasta
of almonds, nougat, Polvorones, marzipan, etc.
• Packaged foods whose label states that they contain nuts.
5.2.5. Gluten
1) Gluten allergy: celiac disease (CD) is a chronic disease

Systemic autoimmune disease triggered by gluten ingestion.
2) Non-celiac gluten sensitivity (NCGS): different

components: gluten, other wheat proteins and FODMAPs, but they are not
associated with small intestinal atrophy or abnormal serologies.
In both cases you should avoid:
• Any product containing wheat, spelled, barley, rye, kamut, triti-

cale and oats (if not in pure form).
• Derivatives of these cereals: starch, flour, semolina, bread, pasta and baked goods.
teria.
• Products that may contain them as an ingredient: hamburgers, salt-
chichas, pre-cooked dishes, sauces, pâtés, batters, etc.
Replace with other cereals: rice, buckwheat, millet, sorghum, corn, quinoa,
amaranth, teff and its derivatives (flour, pasta, breads, semolina, flakes, etc.) and
tubers: potato, cassava or cassava (tapioca) and sweet potato.
5.2.6. Wheat
1)Wheat allergy: the immune system reacts abnormally

against wheat proteins; can be deadly.
2) Wheat intolerance syndrome: combination of intestinal symptoms

and extraintestinal that occur after ingestion of foods that
They contain wheat.
In both cases you should avoid:
• Any product containing wheat, spelled, kamut and triticale.

• Derivatives of these cereals: starch, flour, semolina, bread, pasta and baked goods.
teria.
• Products that may contain them as an ingredient: hamburgers, salt-chichas, pre-
cooked dishes, sauces, pates, batters, etc.
Replace with other cereals: rice, buckwheat, millet, sorghum, corn, quinoa,
amaranth, teff, barley, rye and oats, and their derivatives (flour, pasta, breads,
semolina, flakes, etc.), as well as tubers: potato, cassava or cassava (ta-pioca) and
sweet potato.
© FUOC • PID_00268138 fifty vegetarian diet
5.3. Eating disorders
Some research has suggested that vegetarianism can mask the presence of an
eating disorder (ED), that is
That is, it can be used as a way to mask attempts to
lose weight or avoid eating certain foods, becoming the prelude to
a TCA.
In several studies it has been seen that 50% of people seeking treatment for
anorexia nervosa report having practiced some form of
vegetarian diet. Other authors found that 61% of people with
EDs who followed a vegetarian diet said they believe there is a relationship
between their ED and choosing to be vegetarian. In another study with women
and adolescent women, it was observed that those who use vegetarianism to
lose weight are more likely to experience EDs compared
with those who adopt vegetarian diets for other reasons.
Since weight loss itself can trigger an eating disorder,

and since vegetarian diets are often promoted for weight loss
weight, it is not surprising to see women with ED who avoid foods from
Animal origin.
Most authors suggest that although people with eating disorders are more
likely to be vegetarians, it seems that vegetarianism is not usually a
specific precedent of an ATT. Rather, it seems to be the other way around.
In conclusion, longitudinal studies are necessary to examine the temporal

relationship between all the underlying factors that may contribute to the
coexistence of ED and vegetarianism.
5.3.1. Recommendations for suspected eating disorders
When faced with a person who chooses a vegetarian diet, to find out if
If it is a case of ED, the medical team and nutritionists should ask about:
• the degree of food restriction.

• the reasons for choosing a vegetarian diet.
• history of vegetarian diet.
• family history of vegetarian diet.
In addition, having a multidisciplinary team, with someone with training

In vegetarianism, it can be useful in working through the complexities associated
with vegetarianism and eating disorders. In any case, we must respect the diet
vegetarian or vegan that the person follows.
6. Vegetarian diet in pathologies
In previous sections we have seen how well-designed vegetarian diets can help reverse some of the
main chronic diseases, or limit the damage of these diseases. In any case, DN can help guide a diet
adapted to each case.
6.1. Obesity
Vegetarian diets are useful and safe for body weight control, and are effective in reducing body
weight, body mass index, and
fat mass.
The high fiber and nutrient density (more nutrients for fewer calories) of vegetarian diets can support
healthy weight loss.
Ingesting fiber can help slow down the speed of eating and food intake, which can produce more long-
term feelings of fullness after meals. Additionally, the nutrient density can help reduce hunger and
cravings.
6.1.1. Dietary recommendations in the treatment of
obesity
The treatment of obesity should integrate the achievement and maintenance of a healthy lifestyle that
includes increasing the level of physical activity or reducing sedentary lifestyle, improving eating
habits and diet quality, and reducing energy intake.
Excluding meat can lead to a decrease in the amount of fat consumed. In the case of the vegan diet,
by eliminating cheese, dairy and eggs, the calorie reduction can be even greater. However, a
vegetarian diet is not necessarily low-calorie: dietary planning is necessary to avoid eating unhealthy
foods. It is necessary to restrict the intake of superfluous foods, since this can lead to clinically
relevant weight loss in the medium and long term.
• Foods that must be restricted: any alcoholic beverage, sugary, isotonic, "sports" or "energy"
drinks, cheeses with a fat percentage greater than 15%, sauces, pre-cooked foods, dairy
desserts, pastries, pastries, sweets and any type of sweet food other than fruit. Meals in
restaurants, even if they are not fast food, since the caloric intake is usually high.
• Foods that must be promoted: vegetables, legumes, whole grains (whole bread,
whole wheat pasta, brown rice, etc.), fresh fruit, dried fruit, nuts and seeds.
Water as the main drink.
Fresh or dried aromatic herbs and spices for seasoning.
• Foods with a neutral effect: milk, yogurt and eggs.
6.2. Arterial hypertension
Scientific literature supports the usefulness and safety of vegetarian diets

for the control of high blood pressure (HTN). Likewise, there is evidence of
that vegetarian diets can be beneficial in controlling blood pressure
arterial.
A food is considered high in salt when it contains more than 1.1 g.

of salt per 100 g, in the case of solid foods, or more than 0.7 g of salt per 100
g, in the case of liquid foods.
The main sources of salt in our environment are bread, cheeses, sausages, pre-
cooked foods and ultra-processed foods. In the case of diets
vegetarian or vegan, instead of classic sausages, they are sausages
vegetarians or vegans.
6.2.1. Dietary recommendations for high blood pressure
Most fruits, vegetables and especially legumes are high in

potassium, magnesium and other compounds that help maintain blood pressure
healthy material.
Dietary guidelines in the treatment of HTN do not differ from those applied
to non-vegetarian people. Therefore, we must recommend:
• Avoid salt consumption (maximum 5 g per day).

• Avoid any food that contains salt: miso, soy sauce, cheese, etc.
• Choose unprocessed or minimally processed plant foods.
• Eat foods prepared at home, and avoid eating in restaurants.
tes.
6.3. Mellitus diabetes
Scientific literature supports the usefulness of vegetarian diets in the treatment of

type 2 diabetes mellitus (T2DM), since the vegetarian diet is
associated with a lower risk of developing DM2. The benefits are attributed to
a lower body weight, due to the effect of some food components

(fiber and low glycemic index of vegetables, legumes and whole grains),
no longer consume red or processed meats.
6.3.1. Dietary recommendations in diabetes mellitus
Dietary guidelines in the treatment of DM do not differ from those applied to non-vegetarian
people, with the exception of protein foods. To the
Just as in an omnivorous diet, it is necessary to carry out dietary planning adapted to the
person's habits and tastes, as well as the dietary pattern.
insulin (in the case of insulin-dependent DM), and advise weight loss
and the practice of physical activity.
You can use the healthy plate method to plan meals

main ones, as we can see in the figure:
• Option A: most of the plate is taken up by vegetables, a quarter

for protein foods (eggs, soft cheese, tofu, seitan, protein
textured soy, tempeh, heura or Quorn), and the other quarter for whole grains and
tubers; In addition, olive oil is recommended for
dressing, fresh fruit for dessert and water to drink.
• Option B: half of the plate is occupied by legumes (chickpeas, lentils,

beans, broad beans, etc.) and the other half of the plate, for vegetables; HE
recommends olive oil for dressing, fresh fruit for dessert and water
to drink.
Figure 9. Healthy plate in vegetarian diet and diabetes
Source: self made.
6.4. Cancer
A vegetarian diet reduces the incidence of many types of cancer, especially gastrointestinal
cancers. Recent studies suggest that vegetarians have a significant mortality from ischemic
heart disease.
tively lower (29%) and a lower incidence of cancer overall (18%)

than non-vegetarians. However, according to the National Cancer Institute, a
time a cancer has been diagnosed:
• No study has been published on the effectiveness of a vegetarian diet.

tariana for the treatment of cancer or its symptoms.
• There is no scientific evidence to suggest a benefit attributable to adopting

a vegetarian or vegan diet neither at the time of diagnosis nor during
during cancer treatment.
• There is also no scientific evidence to support that a person who follows

a vegetarian or vegan diet before cancer treatment should
abandon it when starting therapy.
A vegetarian diet may be safe for anyone receiving cancer treatment; However, it is
recommended to receive nutritional advice from a DN with training in vegetarianism,
since it is possible that the disease itself or the treatment makes it difficult to continue
healthy eating and nutritional deficiencies.
In general, nutritional recommendations during cancer treatment are the same as in

the case of an omnivorous diet, with the exception of
protein foods, which, in the case of a vegetarian diet, will be replaced by
legumes and derivatives, nuts, seitan and dairy products or eggs in the case of
vegetarian diet. As well as the vitamin B12 supplement.
6.4.1. Tips to increase calories and protein
• Add puree of legumes, miso or tofu to soups and vegetable creams.

• Add creams of nuts and seeds (tahini type) to smoothies, soups and
creams.
• Add avocado or extra virgin olive oil to foods and preparations.
• Add vegetable drinks and yogurts to enrich smoothies or creams.
vegetables.
• Use isolated vegetable protein to enrich smoothies, stews, purees, etc.
Currently, there are many nutritional shake options on the market.

vegans.
6.5. Rheumatoid arthritis
There is some evidence that a 7-10 day fast followed by a diet plan
Vegetarian diet improves some symptoms in people with arthritis
rheumatoid, such as pain, although not stiffness or physical function, compared to
an omnivorous diet.
The common denominators for most dietary interventions

are:
• an increase in fruits and vegetables and fiber.

• a reduction in cholesterol and saturated fat. • energy
restriction.
Factors such as antioxidant levels or weight loss have been proposed as possible
mechanisms. However, the possible adverse effects of this regimen (fasting followed
by a vegetarian or vegan diet) involve weight loss and an increased risk of
malnutrition.
It is possible that simply switching from an unhealthy diet to a healthy one during the
study period could explain some of the positive changes in RA symptoms.
Furthermore, when comparing a dietary intervention with a normal diet, the
possibility cannot be excluded that the beneficial effects on subjective outcomes
may be attributed to a placebo effect. Therefore, high-quality clinical trials are
required to determine the effectiveness and risk associated with vegan diets for
people with RA.
Possible trigger foods include: milk and derivatives, chocolate, eggs, citrus fruits,
meat, wheat, nuts, tomatoes, onion, corn, apples and bananas. Other triggering
products are alcoholic beverages (especially red wine), caffeinated beverages
(coffee, tea and colas), monosodium glutamate, aspartame and nitrites.
6.6. Renal insufficiency
A review that evaluated the benefits and harms of dietary interventions in adults
with CKD concluded that dietary interventions can increase health-related quality of
life, estimated glomerular filtration rate, serum albumin, blood pressure and serum
levels
of cholesterol.
A well-planned vegetarian diet is associated with cardiovascular benefits and the

correction of complications associated with CKD. Its benefits are attributed to a large
amount of fiber, n-6 fatty acids, folic acid, potassium, magnesium, vitamin E, vitamin
C and carotenoids, as well as the phytochemicals it contains.
As vegetarian diets can reduce blood glucose and blood pressure, the prognosis of
kidney disease improves, and even more so in the initial stages. A well-planned
vegetarian diet is lower in protein and sodium, and may slow the progression of the
disease. However, it has to cover the
protein requirements to provide adequate nutrition. It should also be taken into account that
the beneficial effects of a vegetarian or vegan diet can be confused with a healthier lifestyle.
6.6.1. Diet planning in kidney failure
The objectives for planning a diet in IR in the case of a vegetarian or vegan diet, as for any
other diet in the treatment of IR, are:
• Get the right amount of protein. • Maintain the balance

of sodium, potassium and phosphorus. • Avoid excessive fluid
intake to avoid overload. • Ensure adequate nutrition. • Monitor all kidney
patients through regular blood and urine tests
and an individualized dietary regimen.
In the case of a vegetarian diet, emphasis should be placed on:
• Protein: about 2/3 of the protein should be high quality. • Phosphorus: the
phosphorus contained in proteins of plant origin is absorbed less than that of animal origin,
but ultra-processed foods can contain large amounts, so it is advisable to avoid them.
– Low in phosphorus: egg white, lentils, peanut butter, soy drink, tempeh and tofu.
– High in phosphorus: cheese, beans, egg yolk, milk, yogurt, tahini, sunflower seeds.
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© FUOC • PID_00268138 vegetarian diet

Maria Manera Bassols Maria Jesus Blanquert

First edition: October 2019 © Maria

© FUOC • PID_00268138 vegetarian diet

1. Key nutrients in the vegetarian diet................................................ 15

1.7. B12 vitamin ................................................ .................................... 19

1.8. Omega 3 ............................................... ....................................... twenty

2. Foods of interest in a vegetarian diet ................... twenty-one

2.1. Composition of food ................................................ ..... twenty-one

2.1.1. Legumes and derivatives................................................. ... twenty-one

2.1.2. Other meat substitutes ........................................... 22

2.1.3. Nuts and seeds ................................................ ..... 2. 3

2.1.5. Algae ................................................. ................................. 24

2.2. Food guides: pyramids, plates and wheels ........................... 24

2.3.1. Vegetables and greens ............................................... ......28

2.3.4. Protein foods ................................................ ....... 29

3. General recommendations on vegetarianism in

3.1. Design of dietary guidelines ................................................ ...... 31

3.2. Recipes and gastronomic adaptations ....................................... 3. 4

3.2.1. Meats and derivatives................................................. ......... 3. 4

3.2.2. Eggs ................................................. ........................... 3. 4

3.2.3. Dairy ................................................. ........................... 35

3.2.5. Condiments that provide umami flavor, typical of

3.3. General recommendations on vegetarian nutrition and

© FUOC • PID_00268138 vegetarian diet

4. Food, nutritional and dietary recommendations

4.2.1. Key nutrients and strategies to cover their

4.2.2. Food advice on vegetarianism in the

4.3. Old age ................................................. ............................................ Four. Five

5. Food, nutritional and dietary recommendations

5.1. Sport ................................................. ....................................... 46

5.1.2. Supplements................................................. .................. 47

5.2. Food allergies and intolerances................................................ 47

5.2.3. Legumes ................................................. ..................... 48

5.2.6. Wheat ................................................. ................................. 49

5.3. Eating disorders ........................................... 50

6. Vegetarian diet in pathologies................................................ ........ 51

6.2. Arterial hypertension ................................................ ................... 52

6.2.1. Dietary recommendations in hypertension

6.4.1. Tips to increase calories and protein ........... 54

6.6.1. Diet planning in kidney failure ......... 56

© FUOC • PID_00268138 5 vegetarian diet

Brief history of vegetarianism

The history of vegetarianism has an astonishing diversity of characters and events.

Throughout history, forced by necessity or choice, part of the

In Asia, religious philosophies such as Hinduism, Jainism and Buddhism,

Later, Christianity imposed ideas of human supremacy on

© FUOC • PID_00268138 6 vegetarian diet

Cornaro (1465-1566), a long-lived nutritionist, criticized the excesses of the class

In the Enlightenment (18th century) Descartes grants a new assessment of

Figure 1. Summary of the history of vegetarianism (I)

Source: self made.

In the 19th century, a branch of the English Church began vegetarianism as

© FUOC • PID_00268138 7 vegetarian diet

In the 1950s and 1960s, people became aware of the intensification of

As we will see later, currently, ethical values,

Vegetarianism is not a new phenomenon, but it has a

© FUOC • PID_00268138 8 vegetarian diet

Figure 2. Summary of the history of vegetarianism (II)

Source: self made.