Nutrition Matters by Rebecca Kourmouzi

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7 nutrients you may be lacking if your plant-based diet is not well planned

7 nutrients you may be lacking if your plant-based diet is not well planned

It is now widely accepted that well-planned vegetarian,  including vegan diets, are nutritionally adequate and can support healthy living at all stages of life including pregnancy, lactation, infancy, childhood, adolescence and older adulthood. Such diets are also suitable for, and can meet the individual needs of athletes. A broad range of evidence suggests that plant based diets may provide health benefits for the prevention and treatment of certain chronic diseases. Specifically, vegetarians and vegans are at reduced risk of ischemic heart disease, type 2 diabetes, hypertension, certain types of cancer and obesity, mainly due to the low intake of saturated fat and high intakes of vegetables, fruits, whole grains, legumes, soy products, nuts, and seeds (all rich in fiber and phytochemicals). These characteristics of vegetarian and vegan diets produce lower total and LDL (bad) cholesterol levels and allow for better serum glucose control. Plant-based diets are also more environmentally sustainable than diets rich in animal products, since they use fewer natural resources and are associated with much less environmental damage. Click here for a guide to get you started.

Any type of diet – whether omnivorous, vegetarian or vegan – if not appropriately planned, increases the risk of developing nutritional deficiencies, and this may be of particular importance for people who have increased needs of certain nutrients, i.e. pregnant women and infants. The most common deficiencies observed among vegans include protein, calcium, iron, zinc, vitamin B12, riboflavin (vitamin B2) and omega-3 fatty acid deficiencies. If you are vegan, or are planning to embrace a completely plant-based diet in the near future, you need to make sure your diet provides adequate amounts of these nutrients.

Here is a brief explanation of the function of these nutrients, the consequences of their deficiencies and a list of their main plant based sources. 

➔ Protein

Function

  • Required for the structure, function and regulation of the body’s tissues and organs

  • Antibodies (Immunoglobulin igG)

  • Enzymes (Phenylalanine)

  • Chemical messengers (Growth Hormone)

  • Structural components (Actin)

  • Transport/storage (Ferritin)

Consequences of deficiency

  • Reduced lean body mass, muscle strength, and function

  • Muscle cramping, weakness, and soreness

  • Muscle wasting or atrophy, as a direct result of chronic, low dietary protein

  • Low wound healing rates and reduced collagen formation

  • Impaired immune system and increased risk of infections

Plant- based sources:

  1. tofu, tempeh, edamame

  2. beans, lentils and other legumes

  3. nuts, seeds and nut butters

  4. protein-rich whole grains like quinoa, amaranth, buckwheat, millet and kamut

  5. soy, pea or rice protein powders

  6. nutritional yeast

Proteins are made up of smaller units called amino acids, and there are 20 different types of amino acids that can be combined to make a protein. Our body can synthesize most -11 in total- of these 20 amino acids, but we must get 9 of them from food. Those 9 amino acids, also known as essential amino acids, are found in meat, dairy products, and eggs, as well as many plant-based foods, such as quinoa. Essential amino acids can also be obtained by eating certain combinations of plant-based foods. Examples include brown rice with beans or lentils, and hummus with whole wheat bread. By combining plant based foods including nuts, seeds, legumes and whole-grains in adequate amounts and on a daily basis, you make sure you get adequate amounts of all the amino acids that your body cannot synthesize, in order to prevent protein deficiency.

➔ Iron

Function

  • Important for making haemoglobin, a protein contained in red blood cells, which transports oxygen around the body

  • Essential for making myoglobin, a protein responsible for oxygen storage in muscles

  • Component of enzymes including those involved in immune functions, and of cytochromes, which are essential for energy production

Consequences of deficiency

  • Feeling tired

  • Lacking in energy

  • Increased susceptibility to infections

  • Iron deficiency anemia with symptoms such as heart palpitations, brittle nails, thinning hair, itchy skin (pruritus) and mouth sores or ulcers

Plant- based sources:

  1. fortified breakfast cereals

  2. soy-based foods such as tofu

  3. nuts and seeds (especially sesame and sunflower seeds)

  4. dried prunes and apricots

  5. figs

  6. beans and other legumes

  7. fortified whole wheat breads

  8. dark green leafy vegetables such as spinach, cabbage, and broccoli

Keep in mind that iron in plant foods is non-heme iron, which is sensitive to both inhibitors and enhancers of iron absorption. Inhibitors of iron absorption include phytates, calcium, and the polyphenolics in tea, coffee, herb teas, and cocoa. Fiber only slightly inhibits iron absorption. Food preparation such as soaking and sprouting beans, grains, and seeds, and the leavening of bread, can diminish phytate levels and thereby enhance iron absorption. Other fermentation processes, such as those used to make miso and tempeh, may also improve iron bioavailability. Vitamin C and other organic acids found in fruits and vegetables can substantially enhance iron absorption and reduce the inhibitory effects of phytates, and thereby improve iron status. Because of lower bioavailability of iron from a vegetarian diet, the recommended iron intakes for vegetarians are 1.8 times those of non-vegetarians. 

Rebecca Kourmouzi registered dietitian nutritionist nicosia cyprus - vegetarian/vegan diets

➔ Calcium

Function

  • Structural rigidity of bones and teeth

  • Supporting skeletal structure and function

  • Key roles in cell signalling, blood clotting, muscle contraction and nerve function

Consequences of deficiency

  • Stunted growth in childhood

  • Not reaching peak bone mass in early adulthood

  • Higher risk of developing osteoporosis in later life

Plant-based sources:

  1. low-oxalate greens like bok choy, broccoli, Chinese cabbage, collards, and kale, and fruit juices fortified with calcium citrate malate are good sources of highly bioavailable calcium

  2. edamame

  3. tofu

  4. almonds

  5. sesame tahini

  6. soy nuts

  7. butternut squash

  8. calcium-fortified non-dairy beverages and yogurts like soy, rice or almond milks

Many vegans may find it is easier to meet their calcium needs if calcium-fortified foods or dietary supplements are utilized. Oxalates in some foods, such as spinach and Swiss chard, greatly reduce calcium absorption, making these vegetables a poor source of usable calcium. Foods rich in phytates may also inhibit calcium absorption. 

➔ Zinc

Function

  • Essential for the synthesis of important enzymes including RNA polymerase

  • Involved in digestion, carbohydrate and bone metabolism and oxygen transportation

  • Plays an important role in the body’s immune system

  • Essential to stabilize the structure of DNA, RNA and ribosomes

Consequences of deficiency

  • Growth retardation

  • Failure to thrive

  • Delayed sexual maturation

  • Sore throat and immune defects

  • Circumoral and acral dermatitis

  • Diarrhoea

  • Alopecia and neuropsychiatric symptoms

Plant based sources:

  1. soybeans and soy products

  2. grains and fortified breakfast cereals

  3. nuts and seeds

  4. mushrooms

  5. legumes including lentils, black-eyed peas and split peas

  6. wheat germ

The bioavailability of zinc from vegetarian diets is lower than that from omnivorus diets, mainly due to the higher phytic acid content of vegetarian diets. Therefore, zinc requirements for some vegetarians whose diets consist mainly of phytate-rich unrefined grains and legumes may exceed the Recommended Dietary Intake. Food preparation techniques, such as soaking and sprouting beans, grains and seeds as well as leavening bread, can reduce binding of zinc by phytic acid and hence increase zinc bioavailability. Organic acids, such as vitamin C, can also enhance zinc absorption to some extent.

➔ Vitamin B12

Function

  • Helps keep the body’s nerve cells healthy

  • Essential for good brain function

  • Important for the production of red blood cells

  • Aids in DNA synthesis

Consequences of deficiency

  • Malabsorption secondary to atrophy of the gastric mucosa, which leads to reduce intrinsic factor/ileum disease

  • Pernicious (megaloblastic anaemia) and/or neurological problems such as loss of sensation

  • Blindness

  • Muscle weakness, tingling, and numbness

Plant based sources:

  1. fortified soy or rice beverages and yogurts/desserts

  2. fortified breakfast cereals and meat analogs

  3. red star vegetarian support formula nutritional yeast

  4. daily vitamin B-12 supplements

It is very important to know that no unfortified plant food contains any significant amount of active vitamin B12. Fermented soy products cannot be considered a reliable source of active B12. Vegetarian diets are typically rich in folacin, which may mask the hematological symptoms of vitamin B12 deficiency, so that vitamin B12 deficiency may go undetected until after neurological signs and symptoms manifest. Vitamin B12 status is best determined by measuring serum levels of homocysteine, methylmalonic acid, or holotranscobalamin II.

➔ Riboflavin (Vitamin B2)

Function

  • Plays a role in metabolic pathways

  • Promotion of normal growth and development

  • Assists the synthesis of steroids, red blood cells and muscle glycogen

  • Aids in the maintenance of mucus membrane, skin, eyes and nervous system

  • Enhances iron absorption

Consequences of deficiency

  • Mucosal lesions of the mouth, angular stomatitis, cheilosis, glossitis and magenta tongue

  • Lesions of the genitalia, seborrhoeic skin lesions and vascularisation of the cornea

  • Poor growth in the young and neonates

Plant based sources:

  1. Almonds

  2. Fortified breakfast cereals

  3. Fortified plant based milks and yogurts

  4. Yeast extract

➔ Omega-3 fatty acids (including DHA, EPA and ALA)

Function

  • Improve risk factors for heart disease such as hypertension, elevated triglycerides, inflammation, blood clotting, low HDL cholesterol, and plaque formation.

  • Curb stiffness and joint pain

  • Important for visual and neurological development 

  • Improved brain function and may lower risk of depression

Consequences of deficiency

  • Poor concentration

  • Insomnia

  • Fatigue

  • Joint pain

  • Dry skin

  • Brittle nails

Plant based sources:

  1. Algae oil

  2. Canola oil

  3. Flaxseeds and flaxseed oil

  4. Chia seeds, rapeseeds, hemp seeds, pumpkin seeds

  5. Walnuts and walnut oil

  6. Soy and soy products such as tofu

  7. DHA supplements derived from microalgae

  8. Soy milk and breakfast bars fortified with DHA

Whereas vegetarian diets are generally rich in omega-6 fatty acids, they may be marginal in omega-3 fatty acids. Diets that do not include fish, eggs, or generous amounts of algae are low in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Vegetarians, and particularly vegans, tend to have lower blood levels of EPA and DHA than non-vegetarians. A-linolenic acid (ALA), a plant-based omega-3 fatty acid, can be partly converted to EPA and DHA, however it is questioned whether this conversion is enough to cover requirements. Good sources of ALA include flaxseeds, walnuts, canola oil, and soy. DHA supplements derived from microalgae are well absorbed and can positively influence blood levels of DHA and EPA.

The recommend intakes of ALA for men and women are 1.6 and 1.1 g per day, respectively. These recommendations may not be optimal for those who consume insufficient amounts of DHA and EPA, and thus may need additional ALA for conversion to DHA and EPA. Conversion rates for ALA tend to improve when dietary omega-6 levels are not excessive. Those with increased requirements of n-3 fatty acids, such as pregnant and lactating women, may benefit from DHA-rich microalgae.

Bibliography:

  1. Position of the American Dietetic Association: Vegetarian Diets

  2. Gandy, J. (2014). Manual of dietetic practice. (5th ed.). London: Wiley-Blackwell.

  3. Aung T, Halsey J, Kromhout D, et al. Associations of omega-3 fatty acid supplement use with cardiovascular disease risks. Meta-analysis of 10 trials involving 77,917 individuals. JAMA Cardiology. 2018;3(3):225-234.

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