E-News Exclusive

Common Nutrition Issues for Plant-Based Clients

By Sharon Palmer, MSFS, RDN

Plant-based eating may be a more mainstream lifestyle choice today, but it still comes with a variety of concerns among consumers. With more than one-half of Americans open to eating more plant-based foods, dietitians can expect to receive more questions about this eating style.1 This interest has prompted a flood of plant-based products; plant-based food sales grew 6.2% in 2021 over a record year of growth in 2020, bringing total sales to $7.4 billion.2 There are plant-based alternatives in just about every section of the supermarket: deli foods, prepared foods, canned foods, frozen foods, bakery, and even the meat counter. And plant-based foods, such as dairy and meat alternatives, can have vastly different nutritional contents. In addition, it’s vital to be in tune with non–evidence-based information on plant-based diets making rounds on the internet. Case in point: The claim that “dirt on carrots provides enough vitamin B12 to meet your needs” (The answer is “no” it doesn’t). So how do clients choose plant-based foods and supplements that will help them meet their nutritional needs for optimal health?

Research shows that well-planned plant-based diets, including vegetarian and vegan, offer many health benefits and even may reduce the environmental footprint associated with diet, but there are several key nutrition issues to consider. Dietitians must stay abreast of relevant nutrition information, which includes research on plant-based diets and health outcomes and new products hitting the market. Recommend clients new to a plant-based lifestyle see a dietitian familiar with plant-based diets to evaluate their nutrition status and create an individualized meal plan that meets their needs. One source of evidence-based information, as well as a list of plant-based dietitian experts in locations around the country, may be found at the Academy of Nutrition and Dietetics’ Vegetarian Nutrition Dietetic Practice Group (VNDPG).

Today’s Dietitian asked top plant-based dietitians to weigh in on some of the most common issues they see among clients who follow plant-based diets.

1. Balancing the Plate. Clients often lack knowledge on how to create a balanced, nutritious plant-based meal. “With people who are new to transitioning to a plant-based diet, I find that the issue I discuss most is the balance of the plate and increasing variety of foods. I have seen a lot of clients that do not understand how to put together a meal without the center of the plate being the meat portion,” says Parul Kharod, MS, RD, LD, clinical dietitian and past chair of the VNDPG. Explaining sources of plant protein, such as soyfoods, pulses, nuts, and seeds, in combination with whole grains, vegetables, and fruits, as well as simple meal ideas (ie, black bean veggie tacos, spaghetti with lentil marinara sauce, and tofu vegetable stir-fry) can help.

2. Getting Enough B12. While most vegans know about the importance of vitamin B12, fewer understand the complicated absorption pathway and higher amounts needed in supplementation, says Alex Caspero, MA, RD, founder of the blog Delish Knowledge. “B12 relies on a protein called intrinsic factor to aid in absorption; because of this, small amounts of B12 are able to bind to intrinsic factor at one time,” Caspero says. “For those consuming animal products or fortified foods often, the small amounts of B12 present in these foods are absorbed at a higher percentage. However, when you consume B12 in a single large dose, like a supplement, then you need much higher doses for absorption. Multivitamins that contain only the RDA of B12 are usually not enough for vegans. I prefer to go with the European Food Safety Authority recommendations of 100 mcg per day from a single B12 supplement.”

3. Meeting Iodine Needs. Iodine is an issue of possible concern for those following plant-based diets, according to Caspero. While plants do contain some iodine, the largest dietary sources are dairy foods, seafood, and eggs. Seaweed also contains iodine, but the amount varies greatly and depending on which type of seaweed is consumed, the upper limit for iodine quickly can be reached. “I like to call iodine a ‘Goldilocks’ nutrient because you don't want too much or too little, you need an amount that's just right,” Caspero adds. “Because of this, I recommend that my vegan clients supplement with half the RDA of iodine—150 mcg per day—or use an iodized salt in cooking.”

4. Avoiding Grains and Pulses. There may be misconceptions among consumers that lead them to restrict pulses and grains. Clients may think they can get enough fiber from vegetables alone, Kharod says. “If the diet is lacking in whole grains or beans because people may not be familiar or comfortable with incorporating them into their daily routine, then low fiber intake may be an issue,” Kharod says. It’s important to educate clients about the health benefits of including whole grains—even if they’re intolerant to gluten, there are multiple whole grain options they can incorporate, such as sorghum, quinoa, and brown rice.

5. Eating More Frequently. Switching to a more plant-based diet also can mean a decrease in calorically dense foods, says Alison Jordan, MMN, RDN, LMNT, CLC, CDCES, founder of the nutrition and wellness website Thinkgreenwell-being.com. “Clients may need to eat more often to meet their needs, such as three moderate meals and some small meals and/or snacks.”

6. Increased Fiber. Another issue is gastrointestinal discomfort related to rapid increases of fiber in the diet when moving from a Western-style diet to a plant-based diet. “I usually recommend slowly adding in plants, and starting with more fruits and vegetables before adding lots of pulses and whole grains,” Jordan says. “I recommend one meatless meal at a time to ease into the transition. I also discuss the ‘how’ of eating, such as slowing down, chewing food more thoroughly, sipping water, sitting up after eating, and light movement to support digestion.”

7. Getting Omega-3s. While plant foods provide short-chain omega-3 fatty acids in the form of ALA, the conversion to long-chain omega-3 fatty acids may be minimal. Jordan suggests her vegan clients supplement with a third-party tested algae-based EPA and DHA supplement to support adequate essential fatty acid needs.

8. Choosing the Right Plant-Based Milk. With dozens of options available in many supermarkets, consumers may have a hard time making the best choice of plant-based milk, says Sherene Chou, MS, RDN, past chair of VNDPG. “I always ask what each person is using the milk for,” Chou says. “For a milk equivalent, soy milk and pea milk are the best choices based on protein and fat content. Other milks have different flavor profiles and can be used in smoothies, cooking, or otherwise. Many plant-based milks are fortified with vitamin D, calcium, B12, and other micronutrients that can be a good and easy way to help bridge any gaps.”

— Sharon Palmer, MSFS, RDN, is The Plant-Powered Dietitian and author of The Plant-Powered Diet, Plant-Powered for Life, and California Vegan.

 

References
1. Climate change and the American diet. Earth Day Network website. https://www.earthday.org/foodprintsreport/. Accessed September 29, 2022.

2. 2021 US retail sales data for the plant-based foods industry. Plant Based Foods Association website. https://www.plantbasedfoods.org/2021-u-s-retail-sales-data-for-the-plant-based-foods-industry/. Accessed October 13, 2022.