Types of and possible benefits of vegetarian diets.

1. Ruth Charles Consultant Paediatric Dietitian Types of and possible benefits of vegetarian diets. Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

2. Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

3. Key nutrition issues & vegetarianism • Irrespective of why the diet is being followed carefully planning is required. • By avoiding animal food sources several essential nutrients are compromised and need replacement. • Assess if any “special” nutrition background needs: Pregnancy, breastfeeding, weaning, childhood, puberty. Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

4. Potential positive health benefits of vegetarian diets With increased in take of Low GI foods: Wholegrains, fresh fruit, vegetables, pulses. Reducedrisks of : Heart disease NIDDM type 2 diabetes Obesity Certain cancers Lower blood cholesterol levels. Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

5. Glycaemicindex (GI) Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

6. Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

7. Metabolic syndrome Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

8. Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

9. Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

10. Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

11. Potential nutrition issues & vegetarianism Reduced availability of sources of: -high biological value (HBV) protein: muscle growth and repair. -haem Iron: healthy blood -vitamin B12: Healthy blood -reduced readily absorbed calcium & active Vitamin D: Bone and dental health -zinc: growth in infants & children -omega fats: cardiovascular health -selenium: brazil nuts, fish -iodine: thyroid function Compromised calorie (energy) intakes especially in those with special needs: bulk, high fibre, roughage, non starch polysaccharides Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

12. Potential nutrition issues & vegetarianism • Compromised calorie (energy) intakes if diet is high in bulk/high fibre/roughage/ non starch polysaccharides. • Vegetarianism ≠ healthy, unless food pyramid guidelines are followed. • Attention to top shelf of food pyramid Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

13. Protein Amino acids = building blocks of protein Some amino acids are essential. Protein from animal sources contain the complete mix of essential amino acids, few plants do. Soya, quinoa and hemp: plant foods containing all the essential amino acids. Most other plant proteins provide some, with each plant providing a different combination. A mixture of different plant proteins over the course of a days meals, is required to get all the essential amino acids the body needs. Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

14. Vegan sources of protein • Beans, lentils and chickpeas • Soya and soya products e.g. soya dairy alternatives, tofu, soya nuts and soya mince • Seeds • Nuts and nut butters (e.g. peanut butter) • Grains such as wheat (found in cereals, pasta and bread), rice and maize, quinoa and hemp Vegetarian sources: Milk, yogurt, cheese, eggs, mycoprotein such as Quorn (has added egg) Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

15. Vegan sources of Iron Non meat sources of iron =non haem iron = less easily absorbed Dried fruit Beans and lentils Leafy green vegetables Sesame seeds Nuts Wholemeal bread Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

16. Vitamin B12 Role: prevention of pernicious anaemia Sources: Eggs and dairy foods Vegans should consider including fortified foods containing Vitamin B12 and B2 (check the label). Yeast extract Soya milk, yoghurts and desserts Breakfast cereals Certain brands of rice drinks and oat drinks (check the label) Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

17. Calcium Sources: Dairy foods are a rich source of calcium(cows/sheep/goat milk, cheese, yogurt) Elemental calcium and is most readily absorbed Non dairy sources: Tofu Calcium-fortified foods e.g. soya milk, yoghurts and puddings; rice/ oat drinks; and fruit juice Green leafy vegetables, especially kale and pak-choi (spinach contains calcium bound to oxalate this greatly reduces its absorption making it a poor source of usable calcium) Brown and white bread Sesame seeds and tahini Nuts Dried fruit e.g. apricots and figs Note: Calcium supplements have lower levels of elemental calcium: calcium carbonate/citrate/phosphate. Divided doses are better than once daily. Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

18. Vitamin D-a hormone? Role: Low levels of vitamin D leads to weak bones, severe cases low levels of vitamin D can cause rickets in children and osteomalacia in adults. Plays an important role in helping the immune system. May help prevent illnesses like diabetes, heart disease, rheumatoid arthritis, multiple sclerosis as well as some forms of cancer. Sources: UVB radiation with a wavelength of 290–320 nanometers penetrates uncovered skin, Season, time of day, length of day, cloud cover, smog, skin melanin content, and sunscreen are among the factors that affect UV radiation  (>SPF 8) 5–30 minutes of sun exposure between 10 AM and 3 PM at least twice a week to the face, arms, legs, or back  Active form Vitamin D3 is required (cholecalciferol) Additional supplements: outside, have dark skin, elderly,infants. NEW RECOMMENDATION Vitamin D3 requirement: Children 0-1 year: 5µg/200 i.u. Dietary sources: Most margarines Some fortified brands of soya milks, yogurts and desserts – check the label A few fortified breakfast cereals – check the label If eaten:- Dried skimmed milk Fortified yoghurts Eggs Oily fish Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

19. Energy Cereals, grains, bread, potatoes Snacks: Popcorn, pretzels, crackers, oatcakes, peanut butter, soy milkshakes, smoothies made with soy yogurt, dried fruit, nuts, hummus, tahini, foods cooked in healthy oils like sunflower/olive/canola/rapeseed . Focus on Type of fat: PUFA/MUFA , reduced salt and sugar Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

20. Fat • Saturated • Polyunsaturated/ • Monounsaturated Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

21. Role of Omega fats ‘reduced risk of coronary heart disease’. Reduce the stickiness of blood Thin the blood Protect blood vessel walls Reduce Triglycerides Reduce Inflammation Correct electrical beats of the heart Healthy brain development in infants Maintain healthy bone joints Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

22. Omega-3 fats: 2 types long chain versions found in oily fish: salmon, mackerel, rainbow trout, fresh tuna, herring, shrimp, crab, sardines and pilchards. - docosahexaenoic acid LC-DHA and eicosapentaenoic acid LC-EPA short chain from flaxseed /linseed oil/rapeseed/canola/soya oils, walnuts & dark green vegetables. -alpha linolenic Acid SC-ALA Cod liver oil contains low amounts of Omega 3, unless the label indicated that it is supplemented. Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

23. Omega fat requirements 2 portions of fish per week, at least one of which must be oily 3-4 portions of oily fish per week if at high risk of or have heart disease Omega 3 flaxseed supplements, if the label quotes DHA and EPA content, add the 2 figures together to get total Omega 3 content. 500mg daily. 1000mg daily if at high risk of or have heart disease . no more than 2 g per day from a dietary supplement. Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

24. Selenium Role: glutathione peroxidase (GSH-Px) enzyme system →major antioxidant defense systems Sources: Meat & fish, Brazil nuts Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

25. Iodine Role: critical to the healthy functioning of your thyroid gland. Sources: seafood, eggs, dairy iodized salt, kelp Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

26. Zinc Role: • More than one hundred specific enzymes require zinc  • Zinc participates in all major biochemical pathways and plays multiple roles in the perpetuation of genetic material, including transcription of DNA, translation of RNA, and ultimately cell division. Sources: highest concentrations in animal sources, beef, pork, poultry and fish relatively high in nuts, legumes and whole grain cereals and is lower in fruits and vegetables Note:phytate and calcium inhibit zinc absorption, and protein enhances the absorption . Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

27. Vegetarian menu & meal planning →Same → Adapt → Adapt → Same → Same Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie

28. Menu planning

29. Vegetarian Meal planning checklist: • Protein • Iron • Vitamin B12 • Trace elements • Bone health • Heart Health • Food allergy or intolerance • Cultural food customs • Activity/exercise/sport • Top shelf food pyramid

30. Thank you Ruth Charles, Consultant Paediatric Dietitian.www.nutrikids.ie