Plant-Based Nutrition

Question 1

Any eating pattern that excludes animal-derived foods to some degree
Increasing in popularity among all age groups for various reasons

Answer 1

Plant-Based Diet

Question 2

Reasons for Choosing a Plant-Based Diet

Answer 2

1. Religious or Cultural Beliefs: Hinduism, Jainism, Buddhism
2. Health Reasons: CVD, HLD, DM, CKD, chronic acidosis, inflammatory disorders
3. Animal welfare
4. Environmental concerns
5. Any combination of the above

Question 3

Major Categories of Plant-Based Diets

Answer 3

1. Vegetarian - Umbrella term; diet focused on plant-based foods
   - Generally avoid meat, poultry, and seafood
2. Vegan - excludes all animal-derived foods
   - Including meat, poultry, fish/seafood, eggs, dairy, and honey
3. Ovo-vegetarian - Permits consumption of eggs
   - Otherwise avoids animal-derived food products
4. Lacto-vegetarian - Permits consumption of dairy products
   - Otherwise avoids animal-derived food products
5. Ovo-lacto vegetarian - Permits consumption of both eggs and dairy products
   - Otherwise avoids animal-derived food products
6. Pescetarianism (Pesco-vegetarianism) - Permits consumption of fish and other seafood, and often eggs and dairy
   - Otherwise avoids animal-derived food products
7. Pollotarianism (Pollo-vegetarianism) - Permits consumption of chicken (+/- other poultry), and often eggs and dairy
   - Otherwise avoids animal-derived food products
8. Plant-Based (“Flexitarian”) - Dietary pattern that is predominantly, but not exclusively, based on plant foods
   - May consume meat, but encouraged to minimize
   - No universal limit; some sources say 85-90% plant-based foods

Question 4

how to Assess Plant-Based Diets

Answer 4

1. Food Diary - retrospective or prospective
   - Allows assessment of variety of foods ingested
   - Allows assessment of processed food intake
2. Dietary Calculators - numerous tools to use
   - Basic nutrient intake calculator
   - Nutrients per food item calculator
   - Recipe nutrition calculator
   - Numerous food tracker apps

Question 5

Allows classification of whether a plant-based food is healthy or unhealthy

Answer 5

Plant-Based Dietary Index

Question 6

what are some Healthy Plant-Based Foods

Answer 6

vegetables, fruits, legumes, whole grains, nuts, seeds

Question 7

what are some Unhealthy Plant-Based Foods

Answer 7

sugar, refined grains, juices, potatoes, desserts, highly processed foods

Question 8

Traditional Plant-Based Meat Alternatives

Answer 8

historically made from tofu, tempeh, or “veggie blends” like legumes, grains, and vegetables

Question 9

Newer Plant-Based Meat Alternatives

Answer 9

1. more varied ingredients and generally found to be closer to meat products with regard to texture and taste
   - Seitan - made from vital wheat gluten
   - Beyond Meats - made from pea protein, rice protein, cocoa butter, coconut oil, yeast
   - Impossible Meats - made from potato and soy proteins, yeast; contain vegan heme iron
   - Jackfruit - naturally occurring fruit; often used in recipes to replace pulled beef or pork
   - Soy-based foods - tofu, tempeh, edamame still often used
   - Not enough clinical data to say if these products are healthier than meat!

Question 10

what vitamin is found to be highest amounts in animal-based foods

Answer 10

vit B12 (cobalamin)
Meats, eggs, dairy, and seafood products

Question 11

Vegetarian-Friendly Sources for vit B12

Answer 11

1. fortified cereals, fortified plant-based milks, dairy, eggs
   - Not usually enough to meet dietary needs alone

Question 12

Most vegetarian patients should be on what vitamin supplement

Answer 12

B12 supplement

Question 13

GI absorption declines after what age

Answer 13

50

Question 14

Supplement forms of vit B12

Answer 14

• Cyanocobalamin - most common, synthetic, more stable
• Methylcobalamin - naturally occurring

Question 15

what type of vitamin can only found in animal-based foods

Answer 15

preformed vit A
Meats, eggs, dairy, and seafood products

Question 16

what type of vit A is found in many fruits and vegetables

Answer 16

Provitamin A carotenoids
Alpha-carotene, beta-carotene, beta-cryptoxanthin
Converted to retinol in the body

Question 17

most abundant provitamin A found in plant-based foods

Answer 17

Beta-Carotene
Spinach, broccoli, carrots, sweet potatoes, tomatoes, red peppers, mango, apricots, papaya, cantaloupe
Genetically modified foods - golden rice

Question 18

what vitamin is Found in orange, yellow, red, and green vegetables and fruits

Answer 18

Beta-Carotene

Question 19

Most vegetarians should be able to achieve what vitamin sufficiency

Answer 19

vit A

Question 20

widely distributed in ocean and soil, but usually not high concentrations in agricultural soil

Answer 20

iodine

Question 21

Most Iodine in Diet is prevalent in what foods

Answer 21

• iodized salt, fish, dairy produced by cows given supplements
• Also highly prevalent in sea vegetables (kelp, nori, etc.)
• Non-dairy milks now often fortified with iodine

Question 22

what plant based diet is higher at risk bc of using non-iodized salt

Answer 22

vegan

Question 23

widely distributed in plant foods, but absorption and bioavailability are limited by the presence of oxalates

Answer 23

calcium

Question 24

___ is a significant source of dietary calcium for most people

Answer 24

dairy

Question 25

Plant-based calcium-rich foods

Answer 25

• low-oxalate vegetables (cabbage, chives, cauliflower, cucumbers, water chestnuts); legumes, nuts, seeds
• Non-dairy milks now often fortified with calcium

Question 26

what occurs naturally in both plant-based and animal-derived foods

Answer 26

iron, zinc, protein

Question 27

how much heme iron is absorbed

Answer 27

40% of iron in animal-derived foods - 10-20% absorbed

Question 28

how much non-heme iron is absorbed

Answer 28

• 60% of iron in animal-derived foods; 100% of naturally occurring iron in plant-based foods - 1-5% absorbed

Question 29

what impacts non-heme iron absorption

Answer 29

absorption inhibitors (phytates and polyphenols)
enhancers (vitamin C, citric acids) that naturally occur in the plant foods

Question 30

why do vegetarians have a much higher risk of iron deficiency

Answer 30

Similar iron intake between vegetarians and omnivores, but because vegetarians primarily consume non-heme iron

Question 31

Dietary modifications or supplementation often indicated for plant-based diets of what mineral

Answer 31

iron
- Consuming “Impossible Meats,” with heme iron, may help - no real studies
- Consuming iron-rich foods (whole grain, nuts, legumes, seeds) with foods rich in vitamin C (fruit, vegetables) to enhance iron absorption

Question 32

zinc deficiency is usually only seen in what type of plant-based diet

Answer 32

very restricted plant-based diets

Question 33

Zinc-rich foods

Answer 33

• nuts, seeds, legumes, whole grains

Question 34

what can limit zinc absorption

Answer 34

Naturally occurring phytates

Question 35

Methods to reduce phytates include

Answer 35

soaking/sprouting of cereals and beans and fermentation methods
(used for tempeh, fermented tofu, miso, sourdough bread)

Question 36

Consider ordering zinc labs if signs of deficiency:

Answer 36

hair loss, diarrhea, anorexia, suppressed immune function, hypogonadism

Question 37

key omega-3 fatty acids include ?

Answer 37

alpha linolenic acid (ALA)
docosahexaenoic acid (DHA)
eicosapentaenoic acid (EPA)

Question 38

which Omega-3 Fatty Acid is found in plant-derived foods

Answer 38

ALA

Question 39

which Omega-3 Fatty Acids are typically found in fish/seafood

Answer 39

DHA and EPA
can be converted (in small amounts) from ALA

Question 40

what diet relies on ALA conversion to DHA/EPA, requiring higher amounts of ALA intake

Answer 40

Plant-Based Diet
Supplementation often recommended for vegans OR little/no DHA/EPA diet intake
Higher levels of supplementation needed if patient is trying to conceive, pregnant, or breastfeeding

Question 41

which protein is more easily digestible (90%), more closely align with all 9 essential amino acids needed to meet human requirements

Answer 41

animal

Question 42

which protein is less digestible (80%) due to fiber-rich matrix, and often “incomplete” due to lower or absent levels of 1+ of the 9 essential amino acids

Answer 42

plant

Question 43

Complete plant protein sources

Answer 43

soybeans, quinoa, chia seeds, buckwheat

Question 44

Nutrients essential to bone health

Answer 44

calcium, potassium, magnesium, folate, vitamin K, vitamin D
Higher risk of deficiency in plant-derived foods
pay attention to BMI, other risk factors (like smoking or + family hx of bone disease), and intake of protein, calcium, and vitamin D

Question 45

what specific nutrients are especially deficient fir bone health

Answer 45

calcium and vitamin D

Question 46

Systematic review and meta-analysis with over 37,000 total participants found what in regards about bone health

Answer 46

lower bone mineral density and increased risk of fracture

Question 47

what type of plant-based diet is at highest risk about their bone health

Answer 47

vegans

Question 48

how does plant-based diets and anemia relate?

Answer 48

lower in absorbable vitamin B12 and iron
- Highest risk among vegan
- sx of B12 or iron deficiency can manifest before ever become anemic on their CBC
- special attention to sx of iron and B12 deficiency, educate on well-balanced dietary intake or vegetarian-friendly supplements, and consider annual screening labs

Question 49

how does plant-based diets and pregnancy/lactation relate

Answer 49

1. increased nutritional demands, especially for calcium, vitamin D, vitamin B12, iodine, and iron
   - Highest risk of deficiency is in vegans
   - If nutrition is well-balanced…similar health outcomes to omnivore mothers
   - encourage supplementation with several nutrients, including vitamin B12, vitamin D, iodine (if not using iodized salt), EPA/DHA Omega-3 fatty acids, iron, and calcium
   - If mother is unable to breastfeed and reluctant to use dairy-based formula = soy-based formulas

Question 50

Encourage increased protein-rich food intake during pregnancy, especially when?

Answer 50

third trimester

Question 51

how do Plant-Based Diets and Childhood Nutrition relate

Answer 51

1. overall higher metabolic rates and increased nutritional demands
   - Difficult to obtain accurate studies due to small sample sizes, bias towards patients of higher socioeconomic status
   - Limited data available suggests no major negative effects on height, weight, daily energy intake…as long as diet is well-balanced

Question 52

how does plant-based diets and Long-Term Outcomes and Overall Mortality relate?

Answer 52

1. Overall Disease Risk - weak suggestion of reduced risk of several chronic diseases
   - Inconsistent data - varies by country of study and study controlling for confounding factors
2. All-Cause Mortality Risk - weak suggestion of reduced risk of all-cause mortality
   - Depended heavily on quality of foods consumed, which varied a lot based on geography

Question 53

Several Favorable Effects of plant-based diets for CV disease

Answer 53

1. lower body mass index (BMI), lower serum lipid levels, lower fasting glucose, lower blood pressure
   - Higher intake of unsaturated fats
   - Healthier sources of protein
   - High fiber and plant sterol intake reduces absorption of dietary fat and cholesterol
   - May have an inflammation-reducing effect as well

Question 54

how does Gut Microbiome help with CV disease

Answer 54

Gut Microbiome like plant-based diets apparently

Question 55

how does plant-based diets help T2DM

Answer 55

1. benefit to all types of plant-based diet, with stepwise reduction in T2DM risk as more meat was removed from diet
   - Up to 45-50% reduced risk of diabetes compared to regular omnivore diet
   - Greatest benefit in patients who are overweight or obese
   - Several animal-derived foods contain compounds that promote insulin resistance
   - Plant-derived polyphenols thought to inhibit glucose absorption, stimulate insulin secretion, reduce hepatic glucose output, and enhance glucose uptake

Question 56

how does plant-based diets affect cancer risk

Answer 56

1. lower for pt consuming a plant-based diet, with variations in risk by site of cancer
   - Specific cancer types:
   - Reduced - stomach, bladder, lymphatic, hematopoietic
   - Inconsistent data - prostate, breast, colorectal

Overall: increased consumption of plant-based
foods generally is helpful or at the least not harmful