July 1, 2011
Dear Mayo Clinic:
My teenage daughter wants to become a vegetarian. Is it a safe choice for growing kids? Will she be able to get everything she needs from this type of diet?
When planned and managed well, becoming a vegetarian can be a safe, healthy choice for children and adolescents. Before your daughter changes the way she eats, however, you both should meet with her doctor or a dietitian who can help you understand what a healthy vegetarian diet involves.
The term vegetarian covers a variety of dietary choices. For many people, being a vegetarian means not eating meat, fish and poultry. But vegetarian diets can be further broken down into categories from less to more restrictive. Semi-vegetarians (a misnomer to some) are people who occasionally eat meat or fish or chicken while following a plant-based diet. Lacto-ovo ("lacto" meaning dairy; "ovo" referring to eggs) vegetarians don't eat meat, fish and poultry, but they do eat dairy products and eggs. Lacto-vegetarians include dairy products in their diet, but not meat, fish, poultry or eggs. Vegans don't consume any animal products. Finally, macrobiotics is a pattern of eating that includes rice and grain; sea vegetables; Asian condiments, locally grown fruit, and occasional white meat or white-meat fish. Vegetarian diets vary considerably, so it is important to understand the type, amount, and variety of nutrients that are consumed.
With some planning, a vegetarian child can have well-balanced meals. Getting enough protein is often listed as a concern for vegetarians. While meat, fish, dairy, rice and soy milks, and eggs are excellent sources of protein, many plants — particularly beans, legumes and nuts — can also supply the protein required in a healthy diet. So it's easy for vegetarian diets to provide adequate protein, as long as calorie intake is adequate and a variety of foods are consumed.
For children who exclude dairy products or eggs, more attention is required to make sure they get needed nutrients. Calcium is important for children because it plays a key role in nerve function, bone growth and bone mass accumulation. Much of a person's calcium usually comes from dairy products. If your daughter decides not to have dairy products, she needs to include other calcium-rich foods in her diet, such as green vegetables, and products fortified with calcium, such as some soy milks, cereals and juices.
If your daughter chooses a vegan diet, vitamins D and B12 also need to be considered. Vitamin D is necessary for proper growth, immune function and bone health, as well as intestinal absorption of calcium and phosphate. Few foods naturally contain adequate amounts of vitamin D, but foods that may be fortified with vitamin D include some soy milk, rice milk, juices and cereals. B12 is found only in animal products and is important for red blood cell and nerve function. Some foods may be fortified with vitamin B12, including soy and rice milks, cereals and yeasts.
There has been some concern over the observation that vegetarianism is somewhat more common in individuals with eating disorders. However, there is no evidence that vegetarianism is causally related to the tendency to develop an eating disorder.
While getting nutrients from foods is preferred, children on a vegan dietmay need calcium, vitamin D or vitamin B12 supplements. When you talk to your daughter's health care provider, ask if supplements are appropriate for her. Some may need advice about iron, zinc, and omega 3 fatty acids in their diet. Adolescent vegetarians who do not eat fish should include sources of alpha-linolenic acid (precursor to omega-3 fatty acids), such as flaxseed and flaxseed oil, walnuts, canola oil and soy. Omega-3-fatty acids are important for cardiovascular health and eye and brain development.
Overall, the best approach to a child's vegetarian diet is to be informed about food choices and plan accordingly. Getting your daughter involved is essential. She should know how to get the nutrients that may be missing from her diet and understand what's required to maintain a healthy vegetarian diet. Take her grocery shopping. Have her read food labels. Involve her in meal preparation. Discuss menu options when you're at restaurants.
A benefit for children who are vegetarians is that these diets are generally lower in saturated fat and cholesterol and higher in fruits, vegetables, grains and fiber than other diets. As a result, children on vegetarian diets tend to be leaner than other children. If she continues as a vegetarian, your daughter will also benefit from a diet that's associated with less obesity, type 2 diabetes, hypertension and heart disease in adults.
As long as she takes seriously the importance of healthy diet planning and management, and talks with a health care provider for advice before she switches her eating habits, I encourage you to support your daughter's choice to become a vegetarian.
— M. Molly McMahon, M.D., Endocrinology, Mayo Clinic, Rochester, Minn.