There’s no question that nutrition trends and fads make great headlines. The appeal of a sure-fire fix to the daily task of healthy eating isn’t surprising. Wouldn’t it be great if we could just improve our health by eating the latest, greatest superfood or following the newest juicing regimen?
But the reality is that a healthy, balanced diet actually requires a bit more consideration. That’s the case with one topic that cycles through the headlines fairly regularly: Is a vegetarian diet healthy?
The answer is a (qualified) yes. Yes, “vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases,” according to the Academy of Nutrition and Dietetics 2016 position paper on vegetarian diets, which also notes that, “these diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes.” The qualification—and it’s significant—is that a healthy vegetarian diet is one that is “appropriately planned.”
According to Amy Kimberlain, RDN, CDCES, Academy of Nutrition and Dietetics Media Spokesperson, the planning involved is essential because “when removing certain foods, you want to make sure to incorporate foods that provide those same key nutrients.” Learning about the nutrients in the foods you’re choosing to eat and making educated selections to ensure you’re obtaining sufficient key nutrients will ensure you reap the benefits of a vegetarian diet and meet all of your nutritional needs, Kimberlain says.
If you’re considering a vegetarian diet and are interested in learning more to ensure it’s a healthy choice for you, understanding what this eating pattern includes and how to plan a healthy vegetarian diet will provide a good foundation.
Vegetarian Diet Defined
The first step in learning about what it means to embark on a healthy vegetarian eating pattern might just be understanding what “vegetarian” means.
A vegetarian diet is one that excludes meat, poultry, and seafood; but, Kimberlain says, the broader label includes three different categories: lacto-ovo vegetarian (allows dairy and eggs), lacto-vegetarian (allows dairy), and ovo-vegetarian (allows eggs).
Vegetarian diets fall under the umbrella term of “plant-based diet,” which can also include vegans, pescatarians (allow fish), and flexitarians (mostly plant-based, with occasional animal protein). But Kimberlain says, it’s important to note that “plant-based or plant-forward eating patterns focus on foods primarily from plants, but plant-based does not equate with vegetarian or vegan.”
As with most eating patterns, the choice to pursue a specific dietary plan is driven by a wide variety of personal motivations, ranging from health concerns to ethical considerations related to animal welfare and the environment to a person’s ethnic origin.
Research into the health benefits of a vegetarian diet is ongoing, but clear connections have been established between a vegetarian diet and reduced risk of heart disease, diabetes, and some cancers. A comprehensive review and meta-analysis of observational studies related to vegetarian and vegan diets revealed significant protection against heart disease and cancer, specifically, among vegetarians.
An observational study published in the British Medical Journal in December 2020 found that substituting whole grains or dairy products for total red meat and substituting eggs for processed red meat was associated with a lower risk of coronary heart disease. And, in a study that followed almost 100,000 men and women in North America over several years and compared diets with incidence of colorectal cancer, researchers found that people who followed any type of vegetarian diet had a lower incidence of colorectal cancer compared with nonvegetarians.
The desire to eat in this pattern can also be motivated by environmental priorities, a response to the impact of animal food production on the environment. In 2019, The EAT-Lancet Commission, a group of 37 leading scientists from 16 countries, published a report defining targets for healthy diets and sustainable food production, in which the authors noted that plant-based food production “causes fewer adverse environmental effects per unit weight, per serving, per unit of energy, or per protein weight than does animal source foods across various environmental indicators” and that vegetarian diets are more sustainable.
Kimberlain notes that the increasing trend toward sustainable eating —choosing foods that are healthy for our bodies and for the environment—can be a powerful motivator. “There is research that supports the fact that eating more plants is not just good for our health but also good for the health of the earth,” she says. She notes that results of a recent study show “a shift away from animal-based foods [could not only] add up to 49 percent to the global food supply without expanding croplands but would also significantly reduce carbon emissions and waste byproducts that end up in our oceans and as seafood byproducts.”
For those who opt to embrace a vegetarian eating pattern, following the Academy of Nutrition and Dietetics recommendation to plan appropriately to ensure this approach meets your nutritional needs is important. If you’re replacing animal protein with plant protein, you’ll want to consider nutrients you may be missing and make sure you are taking steps to replace them. Specifically, vegetarian diets should be planned to include adequate protein, vitamin B12, and iron, which research has found can be deficient in people who follow a vegetarian diet, potentially leading to significant health concerns.
A 2014 study found that vegans had a high risk of vitamin B12 deficiency. Vitamin B12 plays an important role in proper function and development of the brain, nerves, blood cells, and many other parts of the body. According to another 2014 study, although there were significant benefits of a vegetarian diet (including weight control and disease prevention), there were also risks, including protein deficiency, anemia, decreased creatinine content in muscles (an indicator of kidney health), and menstrual disruption in women who are physically active.,
To be sure you’re replacing the nutrients from that protein source. Kimberlain advises specific attention be paid to the following as part of a vegetarian diet plan, with an emphasis on connections to women’s health:
Protein: You can get sufficient protein from plants. The key is making sure to have some protein at each meal, spread throughout the day (vs having a meal that is mainly carbs with lesser amounts of protein). For women, protein is essential to keep our bones strong, minimize density loss that will come with aging, and support our immune system.
Iron: Research has shown that vegetarians may have the same iron intake as meat-eaters, but they still have a lower serum iron level. The non-heme sources (from plants) of iron are not as easily absorbed and are paired together with compounds that may inhibit iron absorption (for example, phytates found in beans inhibit iron absorption). Iron absorption can be increased by consuming a vitamin C-rich source at meals, such as beans and tomatoes; tofu and peppers; nuts/seeds and orange. And because tea and coffee have tannins (which inhibit absorption), it’s suggested to limit drinking these beverages 1-2 hours after a meal. Additionally, as calcium also inhibits absorption, aim to eat calcium-rich foods (milk, cheese) at meals with a lower iron content (if possible).
Calcium: Planning for adequate consumption of calcium is essential. If you opt to remove dairy milk, which has both calcium and vitamin D, it’s important to choose a plant-based milk that’s fortified with these nutrients (not all are). Calcium deficiencies can lead to osteopenia and thus an increased risk for osteoporosis and bone fractures. Vegans are at the highest risk of calcium deficiency out of all plant-based diets.
Vitamin D: Many Americans do not get enough Vitamin D, and vegetarians (depending on the type) may be at a greater risk of deficiency because foods providing the highest amount of vitamin D are from animals—unless fortified. Monitoring vitamin D is important because it aids in calcium absorption (the two go hand in hand), and a vitamin D deficiency can also contribute to osteoporosis. If adequate vitamin D consumption is a challenge in a vegetarian eating pattern, consideration of a dietary supplement could be considered.
Vitamin B12: Vegans are at a higher risk of inadequate intake of B12, as the best food sources are animal products. There are some foods that are fortified with B12, although they can vary in their formulation. Over time, deficiency in B12 can result in anemia. While careful planning would ideally help ensure that you would meet these nutritional requirements through food, supplements could be recommended—vitamin D and B12, specifically—to ensure adequate levels.
Stock your Vegetarian Pantry
As you plan a well-balanced, nutrient-dense vegetarian diet, Kimberlain notes, be aware that “not all vegan/plant-based/vegetarian items are created equal, nor are they all healthy. The best approach to planning your diet in this way is a common-sense approach that focuses on the basics: consuming lots of fruits, veggies, beans, nuts/seeds, and foods rich in fiber and low in saturated fat..”
If you’re starting from scratch and interested in planning tips for stocking your pantry and your fridge to align with a vegetarian diet, Kimberlain offers the following tips, which will obviously vary, she notes, depending on which category of vegetarian diet (lacto-ovo, ovo, or lacto) you choose to follow:
Grains: Aim to make half of the grains you consume whole grains, but keep a variety of grains on hand, including rice, quinoa, oats, barley, bread/pita/tortillas, different flours to make muffins, pasta, and crackers.
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Vegetables: Fresh, frozen, or canned vegetables can be a part of planning a nutritious vegetarian meal. Frozen spinach is great to add into soups, for example, whereas fresh tomatoes are good to have on hand for salads. Canned tomatoes work well for soup or chili. Keep your options open and choose a variety of veggies.
Fruits: Fresh, frozen, or canned fruit can be a part of planning a nutritious vegetarian meal. I love to choose fruit that’s in season and fresh.
Dairy: Milk (if including), or, if not including cow’s milk, a plant-based milk that is fortified with calcium and vitamin D; same goes for yogurt. Cheese, if including, or nut-based “cheeses,” which are increasingly common (check the labels to see if they have protein).
Protein: Nuts and nut butters (peanuts, almonds, cashews, walnuts, etc.); tahini (sesame seed-based); seeds (chia, hemp, flax, pumpkin, sesame); tofu; and edamame.
Condiments: Extravirgin olive oil; spices/herbs; vinegars, mustards, etc.
Shop Seasonally for Produce to Make Your Vegetarian Meals Sing
Planning and cooking to eat in a vegetarian pattern can be creative and fun, and making the most of seasonal produce can help inspire meals year-round. Here are a few ideas to optimize local and fresh fruits and vegetables.
Spring: Spring Sustenance
Fall: Rooting for Nutrition
Winter: Greens, Glorious Greens
Look to Vegetarian Cookbooks for Inspiration
With a well-stocked pantry and fresh produce inspiration, you’re ready to get into the kitchen. When you do, check out the following cookbooks, which highlight vegetarian cuisine:
 Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. Journal of the Academy of Dietetics. 2016; 116(12):1970-1980. doi: https://doi.org/10.1016/j.jand.2016.09.025
 Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Critical Reviews in Food Science and Nutrition. 57:17, 3640-3649, DOI: 10.1080/10408398.2016.1138447
 Al-Shaar L, Satija A, Wang D D, Rimm E B, Smith-Warner S A, Stampfer M J et al. Red meat intake and risk of coronary heart disease among US men: prospective cohort study. BMJ 2020; 371:m4141 doi:10.1136/bmj.m4141
 Orlich MJ, Singh PN, Sabaté J, et al. Vegetarian dietary patterns and the risk of colorectal cancers. JAMA Internal Medicine. 2015;175(5):767-76. doi: 10.1001/jamainternmed.2015.59.
 Willett W, Rockstrom J, Loken B, et al. Food in the anthropcene: the EAT-Lancet Commission on healthy diets from sustainable food systems. The Lancet. 393(10170): 447-492. doi: https://doi.org/10.1016/S0140-6736(18)31788-4
 Jalava M, Kummu M, Porkka M, Siebert S, and Varis O. Diet Change–a solution to reduce water use? Environ. Res. lett. 9(7):1-14.
 Woo KS, Kwok TCY, Celermajer DS. Vegan diet, subnormal vitamin B-12 status and cardiovascular health. Nutrients. 2014;6(8):3259-73. doi: 10.3390/nu6083259.
 Pilis W, Stec K, Zych M, Pilis A. Health benefits and risk associated with adopting a vegetarian diet. Annals of the National Institute of Hygiene. 2014;65(1):9-14.
 Pawlak R, Berger J, Hines I. Iron Status of Vegetarian Adults: A Review of Literature. Am J Lifestyle Med. 2016;12(6):486-498. Published 2016 Dec 16. doi:10.1177/1559827616682933.