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Fruit and vegetables Healthy eating for vegetarians and vegans Did you know? The sugars we need to reduce are called ‘Free sugars’. Free sugars include all added sugars in foods and drinks in whatever form including table sugar, honey, syrups, and nectars, as well as the sugars naturally present in fruit, vegetable and pulses (e.g. soy, chickpeas) that have been juiced, pureed or made into pastes. Ingredients added such as lactose and galactose are also considered to be free sugars. What is a vegetarian diet? A vegetarian is usually described as someone who doesn’t eat meat, poultry, fish, shellfish or any by-products of slaughter. However there is no single, accepted definition of ‘vegetarian’. People may define themselves as vegetarians because they largely choose plant based diets, will include some fish (pescetarian), or are what has been popularly described as flexitarian or ‘semi-vegetarian’ (someone who is mostly vegetarian but occasionally eats meat or poultry). Some of the common types of vegetarians are: - Lacto-ovo-vegetarians (the most common type) – eats dairy products and eggs - Lacto-vegetarians – eats dairy products but not eggs - Ovo-vegetarian – eats eggs but not dairy products - Vegan – does not eat any products of animal origin so does not eat any dairy products, eggs or honey How many people in the UK are vegetarian? From recent dietary surveys (National Diet and Nutrition Survey 2008/9-2011/12) we can estimate that around 2% of adults and children living in the UK are vegetarian. This equates to more than 1.2 million people. In the survey, less than 1% reported following a vegan diet. Why do people choose to follow a vegetarian diet? There are many reasons why people choose to be vegetarian including parental preferences, health reasons, religious or cultural beliefs as well as concern for animal rights and the environment. If you would like information on vegetarianism and veganism in pregnancy you can find this here. Choosing a healthy balanced diet Do remember that vegetarian options can also be high in saturated fat, salt and sugar. Eating plenty of fruit and vegetables, reducing your salt and free sugars intake, keeping your alcohol consumption within government guidelines, maintaining a healthy body weight and leading an active lifestyle are all important. The Eatwell Guide is the UK dietary recommendations and applies to vegetarians and vegans; you can use it to help you make good choices for a balanced and varied diet. Suitable choices for vegetarians and vegans - Potatoes, bread, rice, pasta and other starchy carbohydrates - Fruit and vegetables - Dairy and alternatives - Beans, pulses, eggs and other proteins* - Oils and spreads *The full name of this group within the Eatwell Guide is "Beans, pulses, fish, eggs, meat and other proteins". The reference to meat and fish was removed on the basis that these are not suitable for vegetarian or vegan diets. The Eatwell Guide also contains information regarding the foods to eat less often and in small amounts. If you would like more information on the Eatwell Guide you can find this here. - Base your meals on starchy carbohydrates, choosing wholegrain or higher fibre versions – these include brown rice, whole-wheat pasta, quinoa, whole-wheat chapatti's, buckwheat, porridge oats and potatoes with skin Tips - Try to avoid adding too much fat (e.g. butter or cream in mashed potatoes or cream based pasta sauces) as these can considerably increase the calories and saturated fat content of the dish - Remember to check the labels and choose products low in fat, salt and sugars - If you are thinking of having chips, why not try baking wedges using a small amount of unsaturated oil or choose oven chips lower in fat and salt - You can mix white and wholegrain versions to increase fibre content – like mixing white and wild rice or baking with half wholemeal and half white flour - Eat at least five portions of a variety of different types fruit and vegetables every day - All fruit and vegetables including fresh, frozen, canned (not in brine or syrups) and dried (with no added sugars) count! - Fruit/vegetable juices and smoothies can count as one portion but this should be limited to a maximum of 150ml a day Tips - Be careful when choosing canned fruit like lychee, pineapple and mango that they are not canned in syrup - Add more vegetables to your main meals (e.g. add grated carrot, mushrooms or peppers to your bean chilli or veggie bolognese) - Try and keep fruit in your bag (and your fridge) ready to eat as a healthy, convenient snack - Keeping vegetables in your freezer is a good way to ensure you don’t run out - Avoid adding salt to cooking water or adding sugars to fruit (like honey) - Seasonal vegetables are delicious as they are – why not steam them? - If you want to add dressings to vegetables or salads why not try lemon juice, chilli and olive oil, some of the less used unsaturated oils like walnut or sesame oil or dressings made from avocado or tahini? Dairy and alternatives - Include some dairy or dairy alternatives. Choose lower fat and lower sugar options where possible - Many vegetarians consume dairy foods like milk, cheese and yogurt. Calcium fortified dairy alternatives like soya, oat and nut drinks are suitable for vegans and others who don’t consume dairy. Check the labels to ensure they are fortified - Cheese can be high in saturated fat and salt so try to use reduced fat varieties, a smaller amount of stronger varieties or lower fat cheeses like quark or cottage cheese - Free from cheese alternatives are available in some retailers but these are typically not fortified with calcium Tips - Grating cheese instead of freely slicing it is a good method to avoid using more than you need! - Try to use low fat plain yogurt or fromage frais instead of cream, crème fraiche or mayonnaise Beans, pulses, fish, eggs, meat and other proteins - Eat some beans, pulses, eggs and other proteins - There are many options for vegetarians including Quorn™ (mycoprotein), tofu, soya products, TVP, pulses (like lentils, kidney beans and peas), as well as eggs (if you eat them) - An 80g portion of pulses (lentils, beans and peas) can count as 1 of your 5 A Day! Tip - Why not try a spicy dal or a chickpea curry served with brown rice or flatbreads like a chapatti or a roti? Oils and spreads - Choose oils high in unsaturated fat and low in saturated fat - Don’t forget all oils are high in fat so use sparingly - Choose lower fat spreads where possible– check the labels - Most of the oils sold as standard vegetable oil in supermarkets is rapeseed oil, an oil high in monounsaturated fats Tips - When heated, oils expand so heating oil in the pan before you use it will make it go further so you don’t need to use as much - You could also use spray oils to reduce the amount of oil you use for cooking - Remember fats like coconut oil, palm oil and ghee are high in saturated fat Foods to eat less often and in small amounts - Foods such as cakes, biscuits, chocolates, pastries, ice cream, fried crisps, cream and sugars-sweetened beverages are not required as part of a healthy balanced diet. If you want to include these in your diet, have them infrequently or in small amounts Tip - If you add sugar to your food or drinks, such as tea, gradually reduce the amount you add until you may be able to cut it out completely Composite dishes The Eatwell Guide puts foods into distinct groups. However, we mostly eat dishes and meals like curries, stews and sandwiches which are made of foods from multiple groups - these are called ‘composite dishes’. Here is an example of a vegan and vegetarian composite dish showing how the main ingredients fit with the food groups of the Eatwell Guide. Spinach, chickpea and aubergine curry with brown rice (vegan) You could also add a raita made with plain soy yogurt (dairy and alternative group), just add some finely chopped cucumber and a good pinch of cumin. Whole wheat vegetarian Spaghetti Bolognese Some important nutrients to consider A well planned vegetarian or vegan diet can provide the nutrients we need. However, some nutrients may come from different sources. For example over a third of calcium in the average UK diet comes from milk and dairy foods but in vegans calcium will be obtained from non-dairy foods and drinks. In the next section we will look at: If you would like more information on nutrient functions, sources and requirements you can find this here. Protein Proteins are needed for many of the important functions that make our body work properly. A common misconception is that those who do not eat any meat or fish will not consume enough protein. However, vegans and vegetarians typically do get enough protein from their diet. Proteins are made up of substances called amino acids. Our bodies can make some of these amino acids, but others known as ‘essential’ amino acids, are needed from the diet. Consuming a range of plant protein sources will help ensure you are getting enough of all the essential amino acids. Good sources of protein - Eggs (vegetarians, not vegans) - Pulses (such as chickpeas, kidney beans, soya beans and lentils) - Tofu or bean curd - Quorn™ (mycoprotein), until recently, Quorn™ was not suitable for vegans as all products contained a small amount of egg. However, a new vegan range is now available - Nuts (choose plain, unsalted, varieties) Although not considered in the ‘protein’ food group, cheese is often a popular choice for people following vegetarian diets. Cheese is a good source of protein, calcium and other nutrients. However some varieties can be high in saturated fat and salt. Check the label and try and choose reduced fat varieties or use stronger varieties in smaller amounts. Some examples of meals/snacks that are sources of protein suitable for vegetarians and vegans - Baked beans on wholegrain toast - Vegetable soup with lentils and barley - Bean chilli with rice - Spicy chickpea stew with couscous - Humous and pitta bread - Rye cracker and nut butter (e.g. peanut/almond/cashew butter) Iron Iron is essential for transporting oxygen around the body, brain function and the immune system. According to dietary surveys, 46% of girls aged 11 to 18 years and 23% of women aged 19 to 64 have inadequate intakes of iron. Females who are premenopausal (those who have a monthly cycle) are more at risk of iron deficiency. The iron found in plant foods (called non-haem iron) is less readily absorbed in the body than the iron from animal sources (known as haem iron). Vegetarians may have lower iron stores so it is important to include good sources of iron in the diet. Good sources of iron for vegetarians - Pulses (lentils, beans and peas) - Green leafy vegetables (such as watercress and spinach) - Wholemeal, seeded or brown bread - Some fortified breakfast cereals (with added iron) - Dried fruits (such as apricots and figs) - Nuts and seeds (such as cashews, almonds, walnuts, sesame seeds, pumpkin seeds and sunflower seeds). Vitamin C helps your body absorb iron. Try and add some vitamin C rich vegetables to your meal. For example if you are making a vegetarian bean curry, add some peppers. You could also have a small glass of fruit juice with your meal (remember the dietary recommendation is a maximum of 150ml per day!) Some compounds in tea and coffee can actually make it harder to absorb iron, so try and avoid these when consuming plant sources of iron (e.g. pulses, kidney beans and chickpeas). Calcium Calcium is important for healthy bones and teeth as well as the functions of muscles and nerves. For vegetarians, dairy foods, such as milk, cheese and yogurt, are a good source of calcium. Try to select lower fat, lower sugar versions where possible. If you don’t eat dairy products, make sure you include other calcium-containing foods and drinks which include: - Bread (breads made with flour which does not contain the wholegrain, such as white and some brown breads in the UK, have to be fortified with calcium by law) - Some green leafy vegetables (such as kale, rocket and watercress) - Calcium-fortified breakfast cereals - Calcium-fortified dairy alternatives (such as soya, oat, rice or nut dairy-free alternative drinks and yogurts) - Calcium-set tofu (those prepared using calcium) Vitamin B12 Vitamin B12 is needed for healthy blood as well as our nervous system and immune system. Typically, vitamin B12 is only found naturally in foods from animal sources. So vegetarians who consume dairy products and eggs can get enough vitamin B12 from their diet; however vegans may not get enough of this vitamin, due to the lack of reliable sources. Studies have confirmed low vitamin B12 intake and blood concentrations (the level of vitamin B12 in the blood) in both vegans and vegetarians. Clinical symptoms from vitamin B12 deficiency because of poor dietary intake are rare; however cases have been reported in strict vegan diets, particularly in young children. Vegan sources of vitamin B12 - Vitamin B-12 fortified yeast extract - Vitamin B12 fortified breakfast cereals (with added vitamin B12) - Vitamin B12 fortified dairy-free alternatives (such as soya, oat and nut dairy-free alternative drinks or vegan spreads) Remember to look at food labels! Alternatively, as suggested by the Vegan Society, you could take a vitamin B12 supplement. Don’t take more than the recommended amount. You can always talk to a healthcare professional if you are unsure. Omega-3 fatty acids Omega-3 fatty acids are essential to our health. Long-chain omega-3 fatty acids like docosahexaenoic acid (DHA), the kind that you find in oily fish, may help lower our risk of heart disease, and contribute to normal visual and brain development. Oily fish such as salmon, mackerel and trout are rich sources of these long chain omega 3 fatty acids. If you don't eat fish, you can get omega-3 fatty acids from other foods (see list below). However, these are short chain omega-3 fatty acids known as a-linolenic acid (ALA). It has been shown that only a small proportion of these fats can be converted into long chain omega-3s. Although vegans and vegetarians have lower intakes of the important long-chain omega-3 fats than those consuming fish in their diets, there is no strong evidence that vegans and vegetarians have poorer health as a result. Supplements containing long chain omega-3 fats from microalgae are also available. Foods containing short-chain omega-3 fats (ALA) include some nuts, seeds and their oils - Some seeds (such as flax and chia seeds) - Walnuts and walnut oil - Soybeans and soybean oil - Oils (such as flaxseed, rapeseed) Other nutrients Iodine Sources of iodine include fish, eggs, milk and milk products, with dairy contributing around one third to average daily UK iodine adult intake. Vegetarians and particularly vegans are at risk of iodine deficiency as they do not eat rich iodine sources (fish and/or dairy products). Soya and dairy alternative drinks are not typically fortified with iodine (check label) and therefore sources are limited. Vegan sources of iodine include: - In some countries, iodine is added to salt. However, this does not occur in the UK and there is a government recommendation to reduce salt intakes. Therefore, iodised salt should not be relied upon as a means to increase iodine intakes. - Although seaweed is a concentrated source of iodine, it can provide excessive amounts (particularly brown seaweed e.g. kelp) and therefore eating it more than once a week is not recommended, especially during pregnancy or breastfeeding. - Iodine supplements. Selenium Selenium is needed for the normal function of the immune system and to help protect your body’s cells. Dietary surveys show that a substantial proportion of the population may not have an adequate intake of selenium. However the health implications of this are currently unclear. Meat and fish are really good sources of selenium, and eggs are also a good source. If you're a vegetarian or vegan, it's important to make sure you're eating other foods which contain a source of selenium (although the actual levels are variable dependent on the soil in which they are grown), these include: - Some nuts and seeds (especially Brazil nuts but also cashew nuts and sunflower seeds) - Some breakfast cereals (such as puffed wheat cereal, shredded wheat and cornflakes) - Some breads (such as seeded and wheatgerm bread) Vitamin D Vitamin D is needed for the absorption of calcium and phosphorus from foods to keep bones healthy. We get most of our vitamin D through the action of sunlight on our skin during the summers months but oily fish and eggs, fortified cereals and spreads also contain vitamin D. In addition to sunlight, good vegan sources of vitamin D are: - Vitamin D fortified fat spreads, breakfast cereals and unsweetened soya drinks - Vitamin D supplements When choosing vitamin D supplements, read the label to ensure they are suitable for vegans. Vitamin D2 and vitamin D3 from lichen are vegan-friendly options. Association of vegetarian diets and health It is important to remember that removing meat from your diet alone is no guarantee of a healthier diet. However, there is some evidence that shows vegetarian dietary patterns may have a health benefit when compared to more traditional dietary patterns. Vegetarian or more plant based diets are typically higher in fruit and vegetables, whole grains and dietary fibre while being lower in saturated fat, sweets and non-water beverages (such as sugars-sweetened beverages and alcohol). However, we also know that people who adopt vegetarian diets are often more health conscious overall and also adopt other healthier lifestyle factors. For instance, vegetarians are likely to be more physically active, less likely to smoke, consume less alcohol and are more likely to have a higher income and education. This may explain some of the observed health benefits. Health Conditions Systematic reviews have found associations between the consumption of vegetarian diets and a reduced incidence of obesity and coronary heart disease, as well as a reduced blood pressure and blood cholesterol, and a lower energy intake. Vegetarian diets and cancer Studies looking at the association between vegetarian diets and the risk of cancer are somewhat inconsistent. Cancer is a complex disease and the risk of developing cancer depends on a combination of factors, some of which you can’t change like your genes. Cancer Research UK have said 4 in 10 cancers can be prevented by adopting healthy lifestyle behaviours such as not smoking, eating a healthy, varied diet, keeping active, maintaining a healthy body weight and not drinking alcohol or reducing alcohol consumption to within government recommendations. World Cancer Research Fund recommendations for cancer prevention include eating more plant based foods such as wholegrains, fruit, vegetables, beans and eating less red and processed meat. If you would like more information about reducing the risk of cancer you can find this here. Plant based eating We also know that there is not a ‘one size fits all’ healthy diet, but that certain characteristics of dietary patterns are linked with better health. Such dietary patterns include higher consumption of fruit and vegetables, wholegrains, pulses, nuts and seeds as well as lower intakes of fatty/processed meat, refined grains, sugars-sweetened foods and beverages, salt and saturated fat. Key references British Dietetic Association, 2016. Food fact sheet – vegetarian diets. [Online]. Available from: https://www.bda.uk.com/foodfacts/vegetarianfoodfacts.pdf (Accessed 1st February 2017). Garbett, T.M., Garbett, D.L. and Wendrof, A., 2016. Vegetarian diet: a prescription for high blood pressure? A systematic review of the literature. The Journal for Nurse Practioners, 12(7), pp. 452-458. Dinu, M., Abbate, R., Gensini, G.F., Casini, A. and Sofi, F., 2015. Vegetarian, vegan diets and multiple health outcomes: a systematic review with meta-analysis of observational studies. Critical Reviews in Food Science and Nutrition. 6(0), Epub ahead of print. You can visit the Vegetarian Society and Vegan society for further information. For more information on the sources used in this text please contact postbox@nutrition.org.uk Last reviewed March 2017. Updated July 2018. Vegan diets - strengths and challenges For anybody interested in vegan diets and nutrition, BNF answers some of the most common questions. This is not a comprehensive guide to a vegan diet, but provides some useful nutrition information in this area. Last reviewed May 2018. Next review due May 2021. For more information on the sources used in this text, please contact postbox@nutrition.org.uk FAQ vegan diets: strengths and challenges A FAQ resource about following a vegan diet. Help us improve We'd love to hear your thoughts about this page below. If you have a more general query, please contact us. Please note that advice provided on our website about nutrition and health is general in nature. We do not provide any personal advice on prevention, treatment and management for patients or their family members.
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Ključni dodaci prehrani za vegane i vegetarijance Više je vrsta vegetarijanske i veganske prehrane koje se razlikuju po stupnju apstinencije od hrane životinjskog porijekla, pa je edukacija o principima takve prehrane i suplementacije iznimno važna Konzumacija hrane biljnog porijekla i smanjenje životinjskih izvora, prehrambena su mjera koja se gotovo univerzalno može primijeniti na prevenciju i terapiju većine civilizacijskih bolesti. Opsežni sistematski pregledi znanstvenih istraživanja pokazuju da vegetarijanci, u usporedbi sa svejedima, imaju niže vrijednosti brojnih čimbenika rizika poput indeksa tjelesne mase, masnoća u krvi i šećera u krvi na tašte. Nadalje, postoje dokazi o manjoj učestalosti bolesti srca, pretilosti, povišenog krvnog tlaka, dijabetesa, artritisa i malignih bolesti kod osoba koje se hrane pretežito hranom biljnog porijekla. Vegetarijanska prehrana može osigurati sve potrebne nutrijente, no samo ako je pravilno isplanirana i izbalansirana. Stoga je edukacija o principima vegetarijanske prehrane i suplementacije iznimno bitna za sve osobe koje se odluče za takav oblik prehrane, a posebno za djecu, adolescente i trudnice. Razlozi za odabir vegetarijanske prehrane su raznoliki, od etičkih, kulturoloških i religijskih, pa sve do znanstveno utemeljenih zdravstvenih razloga. Malo po malo, tipične namirnice vegetarijanske prehrane postale su dio kulinarske svakodnevice i okorjelih svejeda, pa smo tako prigrlili raznovrsne mahunarke i njihove prerađevine, sjemenke, alge, raznovrsne žitarice i brojne druge zdrave i ukusne namirnice. Tome je zasigurno pridonijela i popularizacija zaboravljenih, ali i novootkrivenih namirnica, pa i sve veći broj spoznaja o tome da prehrana temeljena na biljnoj hrani ima povoljno djelovanje na zdravlje. O sve većoj popularnosti biljne prehrane svjedoči i pojava fleksitarijanstva. Naime, sve je više onih koji koketiraju s vegetarijanstvom, deklariraju se kao vegetarijanci, ali zapravo povremeno jedu meso ili ribu. To su fleksitarijanci. Fleksitarijanstvo je kovanica dvije riječi: fleksibilno i vegetarijanstvo. Pojednostavljeno, radi se o osobama koje uglavnom jedu hranu biljnog porijekla, no povremeno i prigodno jedu i meso. Prema nekim istraživanjima, fleksitarijanci teže 15% manje od svejeda, imaju nižu stopu bolesti srca, dijabetesa i karcinoma, te prosječno žive 3,5 godina duže. Kao i vegetarijanci, i fleksitarijanci moraju biti dobro educirani o prehrani, kombiniranju namirnica i planiranju dnevnih obroka te primjeni dodataka prehrani. Također, trebaju u svoj jelovnik uvesti brojne „nove“ namirnice poput mahunarki, tofua, seitana, orašastih plodova, sjemenki, klica te cjelovitih žitarica da bi njihova prehrana bila što raznovrsnija i uravnoteženija. Članak objavljen 2018. godine u časopisu Lancet pokazao je da je fleksitarijanstvo najbolji model prehrane za budućnost. Naime, međunarodna znanstvena skupina pod nazivom EAT koju čini 37 znanstvenika, tijekom tri godine radila je proračune i analize prehrambenih obrazaca u potrazi za takvim koji bi predstavljao rješenje za probleme povezane s opskrbom hrane i prehranom u cijelome svijetu. Skupina je istraživala na koji način osigurati dovoljno hrane za svijet 2050. godine te je tražila obrazac prehrane koji ostavlja najmanji ugljični otisak, ali istovremeno smanjuje učestalost bolesti povezanih s prehranom i smanjuje rizik od preuranjene smrti. Skupina EAT utvrdila je da prehrambeni obrazac zvan "fleksitarni" podržava održivost u proizvodnji hrane, smanjuje emisije stakleničkih plinova, poboljšava zdravlje i smanjuje rizik prijevremene smrti. U tom obrascu većina hrane trebala bi biti biljnog porijekla, a za one koji to žele, namirnice životinjskog porijekla su također dozvoljene u određenom opsegu. U Hrvatskoj je vegetarijanstvo marginalizirana pojava, na koju mnogi gledaju s gnušanjem. Istraživanja pokazuju da je samo 3,7% vegetarijanaca. Općenito, veći je broj vegetarijanaca među ženama nego muškarcima, te je više vegetarijanaca među mlađim osobama, primjerice, među studentima, nego u drugim dobnim skupinama. Ipak, globalni trendovi zahvaćaju i naše područje i izvjesno je da se sve veći broj ljudi, barem povremeno, odlučuje na pretežito biljnu prehranu. Google Trends tražilica neupitno upućuje na porast interesa za veganstvo u svijetu, ali i u Hrvatskoj, a čini se da je interes u posljednjih pet godina porastao za 250%. Također, uočljivo je da raste zanimanje upravo za veganstvo, jer se teme koje se odnose na vegetarijanstvo ne traže ništa više u odnosu na proteklih pet godina. Na primjer, u protekle tri godine, kada je riječ o hrani iz dostave, u Velikoj Britaniji trend veganske prehrane doživio je najveći rast, čak 388%. Vrste vegetarijanske prehrane i utjecaj na zdravlje Postoji širok raspon prehrambenih uzoraka koji se razlikuju po stupnju apstinencije od hrane životinjskog podrijetla. U užem smislu, razlikujemo semivegetarijance, lakto-ovo-vegetarijance, laktovegetarijance, pescovegetarijance, frutariane i vegane, a danas postoje i različite suvremene interpretacije vegetarijanstva kao što su već spomenuti fleksitarijanci. • Vegani ili potpuni vegetarijanci jedu isključivo biljnu hranu, a ne unose meso, mlijeko, jaja niti bilo kakvu hranu životinjskog porijekla. Skupini vegana pripadaju makrobiotičari i frutariani (hrane se isključivo voćem, orašastim plodovima i zelenim lisnatim povrćem). • Laktovegetarijanci konzumiraju mlijeko i mliječne proizvode poput sira i jogurta. • Lakto-ovo vegetarijanci uz mlijeko i mliječne proizvode konzumiraju i jaja. • Pesco vegetarijanci iz prehrane isključuju meso, ali ne i ribu. • Semi-vegetarijanci ponekad uključuju ribu i/ili piletinu u svoju prehranu, ali ne jedu crveno meso. • Fleksiterijanci su osobe koje koketiraju s vegetarijanstvom, deklariraju se kao vegetarijanci, ali zapravo povremeno jedu meso ili ribu. Temelj vegetarijanske prehrane čine žitarice, mahunarke, povrće i voće, što ujedno znači i povišen unos zaštitnih tvari - prehrambenih vlakana, vitamina, minerala i fitokemikalija. Zbog smanjenog udjela namirnica životinjskog podrijetla, vegetarijanska prehrana je siromašnija zasićenim masnoćama, kolesterolom i proteinima životinjskog podrijetla. Najveća znanstvena studija koja je promatrala 60.000 adventista (među kojima je polovica vegetarijanaca) objavljena 2015. godine, pokazala je značajne razlike, odnosno gradaciju između vegana, fleksitarijanaca i svejeda. Među tim skupinama bilježi se stupnjevit porast indeksa tjelesne mase, krvnog tlaka, vrijednosti inzulina i glukoze, a vidljivo je i povećanje učestalosti dijabetesa i kardiovaskularnih bolesti. Smatra se da se među bitnim mehanizmima djelovanja vegetarijanske prehrane ističe povoljan utjecaj na lipide u krvi, te kontrolu glikemije. U prosjeku ima manje pretilih vegetarijanaca u odnosu na svejede, što i ne čudi, budući da pravilno isplanirana vegetarijanska prehrana obiluje namirnicama visoke nutritivne, a male energetske vrijednosti. Lakše održavanje idealne tjelesne mase vegetarijanci djelomično duguju i općenito zdravijem stilu života, koji uz poželjnu prehranu uključuje i redovitu tjelesnu aktivnost, nepušenje i razne druge zdrave navike. Naravno, to ne znači da među vegetarijancima nema i onih sa suvišnim kilogramima, jer će svaka prehrana koja osigurava više energije nego što se potroši (a kod vegetarijanaca je tome uzrok najčešće pretjeran unos ugljikohidrata) rezultirati nakupljanjem kilograma. Nutrijenti pod povećalom Nutrijenti na koje je potrebno obratiti posebnu pažnju prilikom pridržavanja veganske i vegetarijanske prehrane su proteini, omega-3 masne kiseline, vitamin D, vitamin B12, željezo, kalcij i cink. U pravilu, što je prehrana restriktivnija to je veći rizik za razvoj pojedinih prehrambenih nedostataka. S druge strane, budući da je vegetarijanska prehrana posebno bogata voćem, povrćem i cjelovitim žitaricama, vegetarijanci su u prednosti kada je riječ o brojnim nutrijentima s povoljnim učinkom na zdravlje. Primjerice, utvrđeno je da vegetarijanci imaju bolji status antioksidansa i više razine folne kiseline u krvi od svejeda. Dodaci prehrani pogodni za vegane i vegetarijance ponekad nose posebne oznake koje ih izdvajaju od konvencionalnih proizvoda. Prilikom dizajniranja takvih proizvoda, osim o porijeklu i vrsti aktivnih komponenti, potrebno je voditi računa i o sirovinama od kojih je izrađena kapsula (npr. celulozne kapsule biljnog porijekla) te o drugim sastojcima poput punila. Primjerice, brojne komponente koje se uobičajeno dobivaju iz životinjskih izvora poput probavnih enzima ili vitamina D3, moguće je proizvesti iz biljnih izvora, a pritom su najzanimljiviji izvori alge, kvasci i gljive, te mikrobna proizvodnja koja koristi bakterije producente nutrijenata ili drugih aktivnih komponenti. I odabir probiotika često je ograničen za vegane i neke vegetarijance, budući da se bakterije mliječnog vrenja obično uzgajaju na mliječnim hranjivim podlogama. Ipak, tijekom posljednjih godina dostupni su i probiotici temeljeni na biljnim izvorima, a možemo ih pronaći pod oznakama plant-based ili soil–based. Primjerice, veganima je dostupan Lactobacillus bulgaricus izoliran iz cvijeta visibabe, uzgojen na hranjivim podlogama temeljenim na povrtnim sokovima. Kategorija prirodnih dodataka prehrani poput plazmoliziranog kvasca, algi spiruline, klorele te klamatskih algi (Aphanizomenon flos aquae - AFA) također je više prepoznata među osobama koje ne konzumiraju ili tek povremeno konzumiraju hranu životinjskog porijekla. Vitamin B12 Najpoznatiji vegetarijanac iz doba renesanse je Leonardo da Vinci (1452.-1519.) koji se smatra jednim od najvećih univerzalnih genija. Legenda kaže da je od trgovaca na ulicama Firence kupovao ptice u kavezima i puštao ih na slobodu. Posljednjih pet godina života patio je od hemipareze kao posljedice moždanog udara čemu je - smatraju neki autori - pridonijela upravo dugogodišnja vegetarijanska prehrana deficitarna vitaminom B12, koja rezultira čimbenikom rizika - povišenom razinom homocisteina. I najnovije znanstvene studije upućuju na veći rizik pojave moždanog udara kod vegana i vegetarijanaca u odnosu na svejede. Stoga je važno naglasiti da je prehranu isključivo biljnog porijekla nužno nadopuniti dodatkom vitamina B12 da bi bila potpuna i blagotvorna za zdravlje. Vitamin B12 jedinstven je među vitaminima po tome što se gotovo isključivo nalazi u namirnicama životinjskog podrijetla. Stoga veganstvo i loše planirana vegetarijanska prehrana mogu rezultirati nedostatkom tog vitamina. Nadalje, novorođenčad čije majke duže vrijeme nisu hranom (ili dodacima prehrani) unosile vitamin B12, imaju niže razine tog vitamina u krvi i manje ga dobiju mlijekom. Unos manjih količina mesa ili drugih životinjskih izvora osigurava adekvatan unos vitamina B12, pa su fleksitarijanci te vegetarijanci koji koriste mliječne proizvode ili jaja zaštićeni od manjka. Fermentirani proizvodi od soje, npr. miso, i morske alge poput spiruline ne osiguravaju vitamin B12 u njegovoj aktivnoj formi. Zato su veganima potrebni vitaminom B12 obogaćeno sojino mlijeko, zamjene za meso ili dodaci prehrani. Kvasac uzgojen na podlozi obogaćenoj vitaminom B12 u smjesi s tom podlogom osigurava određene količine vitamina B12, ali sam kvasac ne sadrži aktivni oblik vitamina B12. Kod ljudi koji su prestali jesti namirnice koje sadrže vitamin B12 moguće je da se zahvaljujući kruženju i resorpciji njegov manjak razvije tek nakon pet godina. Najčešći simptomi deficita vitamina B12 su nedostatak energije, zujanje u ušima, smanjena osjetljivost na bol, zamagljen vid, oslabljeno pamćenje, konfuzija i halucinacije. Iako nema pravila, simptomi se razvijaju postupno, mjesecima prije nego što se prepozna deficit i najčešće u potpunosti nestaju davanjem vitamina B12. Klinički deficit može uzrokovati anemiju i oštećenje živčanog sustava. Vitamin D Nedostatak vitamina D bilježi se približno kod 50% populacije sjeverne hemisfere. Poznato je da su namirnice bogate vitaminom D vrlo rijetke i one koje predstavljaju najkoncentriranije izvore uglavnom su životinjskog porijekla (masna riba, jetra, žumanjak). Stoga su vegani, a i neke skupine vegetarijanaca u riziku od nastanka nedostatka vitamina D, što se dugoročno može negativno odraziti na gustoću koštane mase, ali i brojne druge bolesti poput autoimunih, malignih, neuroloških i infektivnih. Ipak, treba imati na umu da vegetarijanci i vegani nisu u značajno većem riziku razvoja nedostatka vitamina D u odnosu na opću populaciju, jer najznačajniji utjecaj na status vitamina D ima izlaganje sunčevom zračenju. Stavovi stručnjaka suglasni su da veganima i vegetarijancima, slično kao i ostatku populacije, treba savjetovati dodatnu primjenu vitamina D u jesenskim i zimskim mjesecima. Razlika u pristupu suplementaciji je u vrsti i izvorima vitamina D koji se primjenjuje. Godine 1924. dvije su skupine znanstvenika otkrile da izlaganje određene hrane biljnog podrijetla svjetlosti može djelovati protiv rahitisa. Tada se postavilo pitanje: "Koja bi to tvar u povrću i usjevima mogla biti aktivirana izlaganjem svjetlosti?" Kasnije se utvrdilo da je riječ o vitaminu D2 identificiranom iz otopine zračenog ergosterola. Ergosterol je komponenta stanične membrane gljiva i kvasaca, ali čini i preteču vitamina D2 – provitamin D2. Naime, visoke koncentracije ergosterola u gljivama, i kao rezultat u biljkama kontaminiranim gljivicama, dovele su do opće percepcije vitamina D2 kao biljnog oblika vitamina D. Dokazano je da vitamin D2, osim u gljivama, nastaje i u kvascima kada je provitamin D2 izložen UVB-zrakama. To je zapravo slično procesu sinteze vitamina D3 koji se proizvodi u ljudskom organizmu, kada je provitamin D3 u koži izložen UVB-zrakama. Prirodni proces stvaranja vitamina D u kvascu pod utjecajem izlaganja UV-zračenju patentirani je postupak, a Europska agencija za sigurnost hrane (EFSA) takav oblik vitamina D klasificirala je kao novu hranu. Vitamin D u kvascu poznat je i kao D2 ili „biljni oblik“ vitamina D, te je stoga pogodan i za vegetarijance. Učinkovitost vitamina D iz kvasca dokazana je i u znanstvenim istraživanjima. Naime, u jednoj studiji pokazano je da konzumacija kvasca bogatog vitaminom D2 kao sastojka kruha, rezultira povećanjem koncentracije vitamina D u krvi i poboljšanom kvalitetom kostiju kod laboratorijskih životinja s nedostatkom vitamina D. Osim vitamina D2, za vegane i vegetarijance dostupan je i vitamin D3 iz mikroalgi (npr. Nannochloropsis oceanica) i lišaja. Vitamin D3 iz lišaja dostupan je unatrag desetak godina, no snažnije stupa na scenu tek posljednjih nekoliko godina. Radi se o kombinaciji alge i gljive koja prirodno raste na stijenama i drveću u Sjevernoj Americi, Aziji i Skandinaviji, a može se uzgajati i u svrhu mikrobne proizvodnje uz prihranjivanje jednostavnim šećerima. Imajući na umu da se većina vitamina D3 dobiva od lanolina iz ovčje vune, dobro je znati da postoje alternative koje su u potpunosti biljnog porijekla. Štoviše, koncentracija koja se dobiva iz lišaja približno je jednaka onoj iz ovčje vune, no cijena je još uvijek veća za vegansku opciju vitamina D3. Omega-3 masne kiseline Za osobe koje ne konzumiraju ribu, jedini izvor dugolančanih masnih kiselina eikozapentaenske i dokozaheksaenske (EPA i DHA) je hrana koja sadrži alfa-linolensku masnu kiselinu (ALA). ALA je zapravo preteča tih molekula, a konverzija ALA u EPA i DHA odvija se u organizmu, nekada učinkovito, a nekada manje učinkovito. Najbolji izvori alfa-linolenske masne kiseline u prehrani vegetarijanaca i vegana su sjemenke, orašasti plodovi, ulje lana i repice. Jedini izvor EPA i DHA prihvatljiv vegetarijancima su određene morske alge koje imaju sposobnost sinteze tih masnih kiselina, poput Crypthecodinium cohnii. Upravo se EPA i DHA iz algi koriste za obogaćivanje suvremenih funkcionalnih proizvoda namijenjenih vegetarijancima. Poznato je da je vegetarijanska prehrana bogata prekursorima omega-6 masnih kiselina, a može biti siromašna prekursorima omega-3 masnih kiselina. Kako je poželjan upravo obrnut omjer, vegetarijancima se preporučuje konzumirati što više prehrambenih izvora alfa-linolenske masne kiseline, prekursora omega-3 nezasićenih masnih kiselina. Najbolji izvor omega-3 je masna riba ili ulje račića krila, te ni u tom slučaju nisu ugroženi semivegetarijanci ni tzv. pescovegetarijanci koji konzumiraju ribu i morske plodove. Proteini Meso i mesni proizvodi "praktičan" su izvor proteina, a prehrana koja isključuje te namirnice zahtijeva malo više planiranja. Potrebe organizma za proteinima mogu se podmiriti putem biljnih izvora kada se konzumira raznovrsna biljna hrana i pritom podmiruju energetske potrebe. Dakle, bit je u komplementarnosti, odnosno kombinacijama raznih vrsta žitarica i mahunarki koje imaju različit aminokiselinski profil. Uz iznimku sojinog proteina, proteini biljnog porijekla su nepotpuni. To znači da im nedostaje jedna ili više esencijalnih aminokiselina, te stoga biljna hrana ne može jednako kao meso podmiriti potrebe organizma. Međutim, pravilnim kombiniranjem biljnih izvora proteina moguće je zaokružiti aminokiselinski profil. Ponekad, zadovoljavanje potreba za proteinima u veganskoj prehrani može biti izazovno i tada valja posegnuti za proteinskim dodacima prehrani iz biljnih izvora. Tu se posebno ističu izvori poput graška, spiruline, soje i konoplje. Željezo Anemija uzrokovana deficitom željeza može biti jednako česta i kod vegetarijanaca i kod nevegetarijanaca. Ipak, poznato je da se željezo iz biljnih izvora ne apsorbira toliko dobro kao željezo iz mesa. Važno je konzumirati dovoljno mahunarki i zelenog lisnatog povrća i pića te hranu bogatu vitaminom C (koji poboljšava apsorpciju željeza). Znanstvena podloga tih činjenica je u tome što biljna hrana sadrži isključivo ne-hem željezo, koje je osjetljivije na djelovanje tvari koje pospješuju apsorpciju željeza. Tvari koje pospješuju apsorpciju su vitamin C i organske kiseline porijeklom iz voća i povrća, a s obzirom da je voće i povrće dobro zastupljeno u prehrani vegetarijanaca, apsorpcija ne-hem željeza se pospješuje. U situacijama potvrđenog manjka željeza preporučuje se nadomjesna terapija u oblicima željeza prihvatljivim veganima i vegetarijancima. Jedan od inovativnih oblika za tu ciljnu skupinu je tzv. Koji željezo. Prirodnim postupkom u kojem Koji plijesan (Aspergillus oryzae) tijekom fermentacije u mediju bogatom željezom apsorbira i pohranjuje minerale željeza, dobiva se visoko bioraspoloživo željezo s produljenim otpuštanjem koje nema neželjene gastrointestinalne nuspojave. Proces fermentacije započinje uzgojem spora kulture Koji (Aspergillus oryzae) na kuhanoj riži. Spore se zatim sakupljaju i nacjepljuju u medij za fermentaciju koji je obogaćen željezom. Koji kultura prirodno preuzima željezo te ga pohranjuje u svojim vakuolama. Na kraju procesa fermentacije, Koji kultura je obogaćena željezom te se zagrijava da bi se dezaktivirala biomasa i nastalo Koji željezo u prahu. Kalcij Prehrana koja se temelji na velikim količinama povrća može smanjiti apsorpciju nekih nutrijenata, između ostalih i kalcija. Vegani koji ne unose mlijeko i mliječne proizvode, mogu se opskrbiti kalcijem putem zelenog lisnatog povrća (poput brokule, špinata, blitve) i sušenog voća, sjemenki i orašastih plodova te obogaćenih biljnih napitaka. Budući da zeleno lisnato povrće sadrži i neke neželjene spojeve – fitate i oksalate - koji ometaju apsorpciju kalcija, preporučuje se osigurati se adekvatnim dodatkom prehrani u odgovarajućoj dozi. Cink Kod vegana postoji povećani rizik od nedovoljnog unosa cinka, budući da su životinjske namirnice kao najbolji izvor cinka posve isključene iz jelovnika. Čak i malen deficit cinka može poremetiti aktivnost T-limfocita, a ozbiljan nedostatak nosi sa sobom oslabljeni imunitet i česte infekcije. Gubitak teka, slab rast i razvoj djece, znaci su nedostatka cinka kao i gubitak kose, slabije kognitivne sposobnosti, otežano cijeljenje rana. Probavni sustav, optimalna probava hrane kao i apsorpcija nutrijenata također bivaju pogođeni ukoliko se prehranom ili dodacima prehrani ne osiguraju adekvatne količine cinka. Literatura: Craig WJ. Nutrition concerns and health effects of vegetarian diets. Kwok CS, Mamas MA, Loke YK. Vegetarian diets and Adventists. Int J Cardiol. 2015 Jul 1;190:383. Springmann M, Wiebe K, Mason-D'Croz D, Sulser TB, Rayner M, Scarborough P. Health and nutritional aspects of sustainable diet strategies and their association with environmental impacts: a global modelling analysis with country-level detail. Lancet Planet Health. 2018;2(10):e451-e461. Willett, W.; Rockström, J.; Loken, B.; Springmann, M.; Lang, T.; Vermeulen, S.; Garnett, T.; Tilman, D.; DeClerck, F.; Wood, A.; etal. Food in th eAnthropocene: The EAT–Lancet Commission on healthy diets from sustainable food systems.