Q: I’m a vegetarian. How can I stay healthy? What supplements do you recommend?

A: Full disclosure: I’m a meat eater. And in my almost seven decades on the planet, I’ve picked up a few morsels of what we might call “wisdom,” or nuggets of truth that I’d feel confident passing on to future generations. One: There is no good answer to “Do I look fat in this?” Two: There is no way to win an argument about vegetarianism.


Let me explain. I’ve found that the decision to be a vegetarian—or not to be—is often influenced by feelings—either about animals, the environment, the planet, or some combination of all three. Which brings us to wisdom nugget No. Three: There’s no way to argue feelings. If a person tells me they simply cannot abide the idea of eating a creature that was once living, or if they are morally and ethically opposed to the treatment of factory farmed animals, I have no argument. I might personally choose another path, but I can’t—and wouldn’t want to—talk someone out of this kind of personal decision, particularly when we’re talking about feelings like compassion, empathy, and social concern.

Health-wise, however, the research on vegetarianism vs. meat-eating is all over the map, and made even muddier by what statisticians call “confounding variables.” Take a recent study, published in JAMA in July, 2013, which reported that vegetarians live longer than meat eaters. That study tracked 73,308 members of the Seventh-day Adventist Church and found that vegetarians in the study experienced 12% fewer deaths over the six years of the study.

Sounds good. But I question the quality of the meat eaten by the meat-eating people in these studies. I can’t recommend factory farmed meat to anyone, and that’s undoubtedly what the meat eaters in these studies were eating. Modern, feedlot farmed meat is a horrific affair. The animals are treated unspeakably, they’re fed a diet that makes their stomachs acidic, and they’re given antibiotics, steroids, and hormones. All the pesticides and chemicals they’re exposed to are stored in their fat and transferred to you when you eat them. This meat is even worse when it’s processed with nitrates and tons of sodium and transformed into the “luncheon” meats—baloney, hot dogs, sausages, pastrami. And the same folks who eat this stuff tend not to eat a lot of vegetables and to eat a low-fiber, high-sugar diet. No wonder they don’t do as well as vegetarians in some studies!

However, I’m assuming you’ve made the decision to be a vegetarian and you have your reasons for doing so. So the question is, are you missing any important nutrients in your diet?

Glad you asked. Four nutrients in particular are likely to be lacking in a vegetarian diet: vitamin B12, vitamin D, iron, and omega-3 fats (or at least two of them, DHA and EPA, which are only found in animal foods). Vegans are at the greatest risk for low levels of these nutrients, but vegetarians still need to watch it.
There are no good plant sources of vitamin B12. And though there’s iron in spinach, the most absorbable form of iron that the body can use is heme iron, found only in animal products.

Vitamin D can be obtained from fortified milk. Plant foods like flax seeds, flax oil, chia seeds, and hemp all have a plant based omega-3 called ALA (alpha linolenic acid). The body converts some ALA to DHA and EPA. However, you need to take more ALA than you would DHA and EPA from fish oil. I recommend one tablespoon of flaxseed oil for every 100 pounds of body weight.

It’s possible to get adequate protein from plant foods including combinations like beans and rice; eggs; and whey protein. But if those foods are off the menu, you need to be very conscious of getting enough high-quality protein. Since few foods on a vegetarian diet are pure protein (in the way that meat is), vegetarians need to be careful about getting enough protein and about making sure it’s from high-quality sources. Examples are avocados; legumes like lentils; nuts; seeds; and even oatmeal. It’s also a good idea to supplement with protein powder. I recommend that vegetarians get a minimum of 60 gm of
protein a day, although I’m more comfortable recommending 90 gm.

In general, I recommend that vegetar-ians take vitamin B12, vitamin D, iron (only for pre-menopausal women), and omega 3s. Remember, however, that there are other supplements that are good for everyone, whether you eat meat or not—my top recommendations are probiotics, magnesium, resveratrol, curcumin, CoQ10, green tea extract, and vitamin C.

Keep in mind that vegetarianism isn’t a synonym for “healthy.” It’s entirely possible to be a “Twinkie vegetarian,” existing on empty calories such as sweetened cereal and donuts. Choose healthy, whole foods, and supplement if necessary to fill in any gaps.

Jonny Bowden PhD, CNS, is a board-certified nutritionist and best-selling author of more than 13 books on health, most recently The Great Cholesterol Myth (FairWinds Press, 2012). Do you have a question for Jonny? Send it to Write “Health Q&A” in the subject line.

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