Ask the Expert: As a vegetarian, am I getting the right vitamins and minerals?

Q. As a vegetarian, am I getting the right vitamins and minerals?

A. First of all, it is important to define what a “vegetarian diet” actually is. Are you eating a vegan diet, which excludes all animal products including dairy and eggs? Or are you on a lacto-ovo-vegetarian diet which does incorporate dairy products and eggs while excluding meat, fish, and poultry? It is important to realize what is missing from your diet before deciding on what nutritional supplements to take. The American Dietetic Association recommends eating a wide variety of foods, including whole grains, fruits, vegetables, beans, seeds, nuts, and dairy and eggs (the last two only if not on a vegan diet). In terms of possible vitamin deficiencies, the iron from plant sources is more poorly absorbed than that found in animal products, but the higher levels of vitamin C found in vegetarian diets may help increase iron absorption. Studies have shown that iron deficient anemia is not more common in vegetarians, so iron supplementation is probably not necessary.

Vegetarians should be sure to include foods rich in vitamin B12 (fortified cereals or soymilk, meat substitutes, or nutritional yeast) or take it as a supplement, since studies have shown that they have low blood levels of this vitamin. There is even a case of a 33 year old man who had been on a strict vegan diet since the age of 20 who presented with severe nerve damage in both eyes due to vitamin B12 deficiency. He had never taken any supplements. Even after he was given vitamin B12, the nerve damage did not improve. Therefore, it is important to be conscious of the need for adequate dietary or supplemental vitamin B12 intake if one is on a vegetarian diet, especially as one ages when absorption of this vitamin decreases.

If one does not drink milk, then vitamin D levels may also be deficient, as fortified milk is the most common dietary source of vitamin D. As long as there is adequate strong sunlight exposure (at least 15 minutes of sunlight on the upper extremities and face every day), supplementation should not be necessary. However, there are vegetarian products such as soymilk that are fortified with vitamin D that can be consumed if sunlight exposure is inadequate. Calcium is a mineral that usually is not deficient in vegetarians who eat calcium rich dairy products or calcium-rich vegetarian foods (i.e. tofu, beans, green, leafy vegetables). Vegans should make sure they get the daily recommended requirements for calcium from their diets, and if they do not, they should take a calcium supplement. The other two nutrients that the American Dietetic Association advises vegetarians to be aware of are zinc and linolenic acid. Zinc levels in vegetarians tend to be lower than in non-vegetarians, so it is a good idea to make sure to eat enough zinc-rich foods (whole grains, legumes, corn, tofu) to meet or exceed the daily recommended requirement. Linolenic acid is an essential fatty acid found in fish or eggs. If these foods are not consumed, it is important to include other linolenic acid-containing foods in the diet, such as walnuts, flaxseed oil, soybeans, and canola oil. In general, a healthy vegetarian diet should include up to three servings of calcium rich foods, 2-3 servings of legumes, nuts, eggs, and meat substitutes, 3-5 servings of vegetables, 2-4 servings of fruit, 6-11 servings of grains, and sparing use of fats, oils, and sweets.

Q. Is soy milk a good source of calcium?

A. When choosing a brand of soy milk, it is important to select one that is calcium (and ideally Vitamin D) fortified, as soy milk itself is not rich in calcium. However, even when fortified, soy milk contains less calcium than regular milk. Eight ounces of skim milk contain 300 mg of calcium, while eight ounces of calcium fortified soy milk contains about 200 mg. Unfortified soy milk can contain much less calcium. Another soy product, tofu, usually has more calcium than soy milk depending on how it is processed. One method of making tofu involves the addition of calcium sulfate to the processed soy beans in order to solidify the bean mixture. One should look for calcium sulfate in the ingredient list in order to buy tofu with the highest calcium content. If a person wants to replace cow’s milk with soy milk, it is important to consume more to make up for the reduced calcium content, or add other calcium-rich foods or calcium supplements to the daily diet. In 1997, the Institute of Medicine released new recommendations for recommended calcium intake: 1300 mg for people aged 9-18 years and pregnant women under 19 years of age, 1000 mg for those aged 19-50 years including pregnant women over 19, and 1200 mg for those over fifty-one. These recommendations should be kept in mind when one seeks to replace dairy products with other foods, in order to ensure adequate calcium intake on a new diet.

The Right Multivitamin

Women, men, those over 50, those with chronic illness, and vegetarians have special needs to consider when choosing a multivitamin. Review your special needs below.

Why Everyone should Take a Multivitamin

There's nothing like a sound, low-fat diet full of fruits, vegetables, and whole grains to supply the vitamins and minerals we need to stay healthy. Unfortunately, we don't always eat well. Add to that the possible harmful effects of stress, aging, lack of exercise, pollution, and illness, and supplements become even more important. That's why so many experts now recommend that everyone take a daily multivitamin.

The Right Choice: See Our Multivitamin Chart

This chart outlines the key vitamins and minerals your multivitamin should supply and the main benefits of each nutrient. It also gives what's called the daily value (DV) - a new government standard that generally corresponds to the RDA. The DV satisfies minimum daily requirements and helps prevent a deficiency disease, such as scurvy (lack of vitamin C). The higher levels of vitamins and minerals found in many multivitamins may actually help prevent disease, delay its onset, or lessen the severity of certain ailments.

Good Reason to Take an extra-strength Formula

If you eat an optimal diet of low-fat foods, at least five servings of fruits and vegetables daily, and chicken, lean meat, or fish several times a week, you can probably get away with a once-daily formula. But even those who consume a fairly well-rounded diet and yield to junk-food lapses only occasionally can benefit from an extra-strength formula. If your idea of lunch is a slice of pizza and a diet soda, look for a multivitamin in the upper ranges of our chart.

• Read the label carefully to see what you're getting. Many "high-potency" formulas provide only one
• Don't pay more for "timed-released" or "related" products. They're not worth the extra cost.
• Check the serving size. You may need to swallow up to six extra-strength pills a day to get the amounts listed on the label.
• Don't double up on one-a-days. You'll be getting too much of certain nutrients, and not enough of others. If you want an extra-strength formula, buy one.
• Avoid megadoses that greatly exceed the upper doses listed in our chart, especially with fat-soluble vitamins A, D, E, and K; the minerals iron and selenium; or when taking any supplements long term. Be sure to account for any vitamins and minerals you may also be taking as individual supplements or as part of an herbal formula.

Finding the Right Multivitamin for You

Vitamins	Main Benefits	DV	One-A-Day	Extra-Strength
Vitamin A	Fights infections; maintains eye and skin health. May be supplied in part as beta-carotene, which may lower the risk of cancer and heart disease and boost immunity. Pregnant women should not take more than 5,000 IU of vitamin A daily, but higher doses of beta-carotene are safe.	5,000 IU	5,000 IU	5,000-10,000 IU (up to 25,000 IU as beta- caratene
Vitamin C	Fights colds; may help prevent cancer, heart disease, cataracts. If your formula doesn't supply at least 500 mg, consider taking an extra supplement.	60 mg	60-100 mg	100-1,000 mg (up to 25,000 IU as beta- caratene
Vitamin D	Promotes healthy bones and teeth; may protect against cancer. Those over 50 should get at least 400 IU and those over 70 need at least 600 IU. Avoid daily doses exceeding 1,000 IU, which may be toxic.	400 IU	200-400 IU	400-600 IU
Vitamin E	May help prevent cancer, heart disease, cataracts. Everyone should get at least 200 IU daily. Avoid doses above 1,200 IU, which can cause headaches.	30 IU	30-100 IU	100-400 IU
Thiamin (B1)	Aids energy production; promotes nerve and heart health.	1.5 mg	1.5-25 mg	25-100 mg
Riboflavin (B2)	May prevent cataracts and migraines; helps heal rosacea.	1.7 mg	1.7-25 mg	25-100
Niacin (B2)	Helps lower cholesterol and improve circulation; fosters healthy nerve cells.	20 mg	20-25 mg	25-100 mg
Vitamin (B6)	May prevent heart disease and stroke; maintains nervous system health. Avoid taking more than 200 mg on a daily basis.	2 mg	2-25 mg	25-100 mg
Folic acid	Prevents birth defects, heart disease, possibly some cancers. Pregnant women and women planning to become pregnant should get at least 600 mcg daily.	400 mcg	400 mcg	400-800 mcg
Vitamin (B12)	Promotes nerve health; prevents heart disease. People over 50 and vegetarians should look for formulas that supply at least 100 mcg.	400 mcg	400 mcg	50-400 mcg
Vitamin K	Promotes blood clotting; helps strengthen bones.	80 mcg	0-80 mcg	60-300 mcg
Biotin	Promotes healthy nails, hair, and nerves.	300 mcg	0-100 mcg	100-300 mcg
Pantothenic acid B(5)	Strengthens nerves; promotes energy metabolism.	300 mcg	0-100 mcg	25-100 mcg
Minerals
Boron	Builds strong bones, teeth, and nails.	*	0-50 mcg	50 mcg-2 mg
Calcium	Prevents or slows osteoporosis. Women of all ages and men over 50 need at least 1,200 mg daily. A separate supplement is probably necessary. Avoid daily doses of 2,500 mg or higher.	1,000 mg	0-25 mg	25-400 mg
Chromium	Maintains healthy bolld sugar levels;helps break down fats.	120 mcg	0-100 mcg	100-200 mcg
Copper	Prevents cardiovascular disease; maintains bones, tendons, and nerves.	2 mg	1-2 mg	1-2 mg
Iron	Prevents anemia in younger women. Men and postmenopausal women should opt for iron-free formulas. Vegetarians who avoid all animal products and women with heavy periods should get at least 18 mg a day. Don't exceed 65 mg daily.	18 mg	0-18 mg	0 -18 mg
Magnesium	Protects against heart disease; may ease asthma and diabetes.	400 mg	100-200 mg	200-400 mg
Manganes	Strengthens bones; may be good for the heart and prevent seizures.	2 mg	2-5 mg	5-10 mg
Molybdenum	Helps the body use iron and burn fats.	75 mcg	25-65 mcg	65-100 mcg
Potasssium	May help prevent high blood pressure, heart disease, and stroke.	3,500 mg	5-100 mg	5-100 mg
Selenium	Helps prevent cancer, heart disease, cataracts, and macular degeneration; fights cold sores and shingles. Get at least 100 mcg a day, but avoid daily doses above 900 mcg, which can be dangerous.	70 mcg	0-100 mcg	100-200 mcg
Vanadium	Builds bones; may aid people with diabetes.	*	0-25 mcg	25-50 mcg
Zinc	May cure colds, relieve prostrate complaints, slow macular degeneration. Vegetarians who avoid all animal products, including dairy and eggs,should aim to get 30 mg. Don't exceed 60 mg daily, shich can be harmful.	15 mg	15 mg	15-30 mg

Special Needs

Women
of all ages need at least 1,200 mg of calcium daily, through supplements or diet, to slow bone loss. Most multivitamins don't supply this much: A separate calcium supplement is probably your best bet. Younger women, especially those with heavy menstrual periods , need plenty of iron (18 mg a day ). Those considering pregnancy should get extra folic acid and avoid high-dose vitamin A. Special "women's formulas" may contain expensive herbs you may not need.

Men
should avoid multivitamins containing iron: Iron build-up has been linked to heart disease. Be wary of "men's formulas that tout ingredients like saw palmetto for prostate complaints : Many of these high-profile "extras" are present in such small amounts that they provide little or no therapeutic benefit.

Over 50,
opt for iron-free formulas: Too much of the minerals can cause heart problems. Look for vitamins B6 and B12 in the higher ranges, because as people age, they often have trouble absorbing these nutrients. Older women and men can benefit from the bone-strengthening effects of extra calcium (1,200 mg a day) and vitamin D (400 to 600 IU a day).

Chronic Illness
can lead to poor eating habits or deplete nutrient stores. Extra-strength formulas are especially important if you suffer from a long-term digestive ailment or have liver or gallbladder problems. Consult your doctor before taking supplements.

Vegetarians
who avoid all animal foods, including dairy and egg products, need at least 100 mcg daily of vitamin B12. Zinc, iron, and calcium are also very important minerals for strict vegetarians.

Vegetarianism is Healthy

If you are a vegetarian, you have company. In fact, lots of it. Currently, even in America the land of meat and ham, more than 12.4 million individuals are vegetarians by choice. Mahatma Gandhi, George Bernard Shaw and Albert Einstein were all veggies. So you are in hallowed company too. Vegetarianism, or the practice of excluding one or more type of animal products from your diet, is more than just a food habit – it’s a lifestyle that is here to stay.

Do you know why more and more people are embracing vegetarianism? Because it permits you to lead a healthier, disease-free lifestyle. Check out these amazing health benefits of vegetarianism:

• Veggies have lower mortality rates because they are less prone to certain cancers and heart diseases.
• Vegetarians have less chances of getting colon cancer.
• Vegetarianism is a natural substitute for anti-impotency drugs. In most cases of impotency, blocked arteries are to blame. Reducing or eliminating meat could help with this problem.
• Veggies have lower rates of coronary artery disease, hypertension and non-insulin dependent diabetes than non-vegetarians.
• They also have fewer kidney and gall stones.
• Recent research has shown that plant food diets or veggie diets are the best way of controlling diabetes

Did you know that vegetarians are of four kinds? Puzzled, then read on:

A vegan is someone who does not eat any animal flesh or products, meaning no milk or eggs either.
An ovo vegetarian is someone who doesn’t eat any animal flesh, does eat eggs but not dairy products.
Lacto-ovo vegetarians eat eggs and dairy products but abstain from animal flesh. And lastly, there are Lacto vegetarians who eat dairy products but avoid animal products and eggs.

A standard Indian balanced diet for a sedentary worker is a lacto vegetarian diet, where the nutrient composition of the diet fully meets with the recommended dietary allowance. An Indian vegetarian diet generally includes milk, legumes and pulses, nuts, vegetable oils, vegetables, fruits. And if you thought that vegetarians were lacking in any nutrient, you were wrong. A vegetarian diet is complete and able to meet all the nutritional requirements of your body more satisfactorily than a non-vegetarian diet.

People choose to be vegetarians for different reasons. It could be for ethical reasons, health benefits, religious reasons or simply a matter of food habits and preferences. Whatever be the reason, a vegetarian diet is a good safeguard against chronic diseases and definitely healthy, hip and happening.