A balanced vegetarian diet will do wonders to the health and metabolism provided it does not contain a dirty bag of refined carbs and saturated fats, and care is taken to avoid possible deficiencies of vitamins and minerals, says Dr Anoop Misra, Chairman, Fortis CDOC Hospital for Diabetes and Allied Sciences
Written by Dr Anoop Misra
New Delhi | Updated: February 15, 2023 18:20 IS
The essence and goodness of vegetarian diets are in consumption of plants, nuts, legumes and fruits.
A 65-year-old frail man with diabetes and weak muscles asked me, “Doc, should I switch over to vegetarian diets in my condition as I am a non-vegetarian? People say vegetarian diets are better for me.” Another patient of mine, a 56-year-old woman with diabetes, deranged kidney functions and a family history of colon cancer asked, “Since I am a vegetarian, should I switch over to non-vegetarian diets in my condition?” So, I have decided to answer both their questions.
What are the various types of vegetarian diets?
There is an increasing popularity of vegetarian diets in countries, which are predominantly non-vegetarian. The reasons are endorsement by celebrities and protective sentiments for animals. Vegetarian diets, although lumped under a single name, are heterogenous.
Lacto-vegetarian diets: These exclude meat, fish, poultry and eggs as well as foods that contain them and include dairy products (milk, cheese, yogurt and butter).
Ovo-vegetarian diets: Eggs are allowed but exclude meat, poultry, seafood and dairy products.
Lacto-ovo vegetarian diets: Allow dairy products and eggs and exclude meat, fish and poultry.
Finally, vegan diets exclude meat, poultry, fish, eggs and dairy products — and foods that contain these products.
Most Indians are lacto-ovo vegetarians. The essence and goodness of vegetarian diets are in consumption of plants, nuts, legumes and fruits.
A plant-based vegetarian diet is good and has multiple benefits. It decreases the risk of heart disease, lowers blood cholesterol and weight. In addition, intestinal diseases (diverticulitis), kidney stones, cataracts and possibly some cancers are also lower in vegetarian/vegan diets. Curiously, these diets do not decrease the risk of stroke, and may even increase it. Even short-term (up to three months) use of vegan diets may decrease blood sugar levels in a patient with diabetes. Then why do many vegetarian Indians have diabetes, heart and liver disease?
Just taking a “vegetarian diet” is not good enough. Ingredients have to be balanced and should be conducive to metabolism. There are two major flaws in Indian vegetarian diets. First, there is a high intake of refined carbohydrates (rice, naan, etc), in major meals. This majorly upsets all metabolic elements (sugar, triglycerides) post-meal. Second, the high intake of saturated fat/trans fats (ghee, butter, high fat milk, coconut oil, oils derived from palm, partially hydrogenated vegetable oils), which get thickly layered in liver and arteries, prevent smooth functioning of cells and blood circulation, and even block it. Besides other problems (see below), these two issues alone can lead to diabetes, heart and liver disease.
What are the downsides of vegetarian diets and what can we do about them? Vegetarians are short of high-quality protein, especially if they do not take eggs and dairy products.
Several deficiencies may occur because of prolonged consumption of vegetarian diets. These include that of vitamin B12, which is primarily obtained from non-vegetarian diets. Its deficiency can cause nerve damage, which is also prevalent in diabetes. So, patients with diabetes who are vegetarians, should get their B12 levels checked, if possible. If they are low, or they are on a drug called Metformin, then supplementation with this vitamin is warranted.
There is a possibility of deficiency of iron, zinc, calcium (especially in those who do not take dairy), and Omega-3 fatty acids (primarily derived from fish). The latter are essential for nerves and blood triglycerides. To some extent, these micro-nutrients can be supplemented by using canola and soy oils in cooking, and walnuts, ground flaxseed and soybeans, but the body needs more. Some sources of iron include beans and dark leafy green vegetables, peas, lentils, enriched cereals and dried fruits. However, iron absorption from plant sources is inefficient. For better absorption of iron, foods rich in vitamin C are needed. This includes citrus fruits like oranges, cruciferous vegetables like cabbage and broccoli and tomatoes. These are to be taken at the time that iron-containing foods are being eaten. Zinc is essential for survival of cells and builds immunity. Like iron, it is poorly absorbed from vegetarian diets. Intake of cheese, whole grains, soy products, legumes, and nuts could improve zinc status in the body. Vegans may be at risk of iodine deficiency and may even develop goitre. Iodine could be obtained from iodised salt and from dairy, eggs, and some yoghurt. Finally, because of the absence of dairy in vegan/similar diets, their followers are prone to weakening of bone and fractures.
Importantly, vegetarians are short of high quality protein, especially if they do not take eggs and dairy products. In many Indians, whose muscles are weak (sarcopenia), this further causes low muscle functions and also affects bones. In selected individuals, especially elderly vegetarians whose food intake is low, protein supplementation is required. Good sources of protein include soybeans, lentils, cowpeas, peanuts, almonds, Bengal gram, flax seeds, oats, pumpkin seeds and so on.
So, my answer to the 65-year-old man with diabetes and weak muscles is that he should not give up non-vegetarian diets because these are good sources of protein. On top of it, he could add good vegetarian sources of protein. These would benefit his muscles and bones. Second, I told my 56-year-old woman patient to continue with her vegetarian diet and adjust protein intake (with the help of a nutritionist) according to her kidney functions. I discussed that she should avoid non-vegetarian foods, especially red meat, which has been linked to colon cancer.
A balanced vegetarian diet will do wonders to the health and metabolism provided it does not contain a dirty bag of refined carbs and saturated fats, and care is taken to avoid possible deficiencies of vitamins and minerals.