Types of Vegetarians

0 Vegan: no animal foods OF ANY KIND

0 Lacto-vegetarian: vegan diet, adding milk products

0 Lacto-ovo vegetarian: vegan diet, adding milk and egg products

0 Vegetarian: no meat

0 Pescetarian: vegetarian diet, adding fish

Reasons for being a Vegetarian

0 Lowers disease risk

0Environmental benefits

0Health condition necessitates it

0Religion

0 Limited access to meat, or quality meat products

0 Family members who are vegetarian

Recommendations

0 Per day:

0 6-11 servings of Grains

0 5-7 servings of legumes, nuts, seeds, dairy

0 4 servings of vegetables

0 2 servings of fruit

0 2+ servings of fats, oils, and sweets

0 Prenatal supplement

Important Considerations

0 It is very possible to have a healthy pregnancy while on a vegetarian/vegan diet

0 Pay attention to complementary proteins

0 Fortified foods can be an easy way to meet nutrient content

Most Common Deficiencies

0Vitamin B12

0Vitamin D

0 Calcium

0 Iron

0 Zinc

0Omega 3s: EPA, DHA

0What are some vegetarian options high in these nutrients?

Vitamin B12

0 Found only in animal sources

0Derived from bacteria

0 Found in plant sources ONLY if they are contaminated by bacteria (usually only external contamination)

(Herbert 1988)

Vitamin B12 Analogues

0Methylcobalamin

0 Active

0Adenosylcobalamin

0 Active

0Hydroxycobalamin

0 Inactive

0 Cyanocobalamin

0 Inactive

(Pawlak et al 2013)

Vitamin B12 Assessment

0 Urinary MMA0 Deficiency

0 Accurate

0 Holo-Transcobalamin II0 Carrier of active form in

blood

0 Depletion

0 Accurate

0 Total plasma B120 Unreliable

0 Standard in medical field

(Pawlak et al 2013)

Vitamin B12 Metabolism

Folate and B12

0B12 is necessary to metabolize dietary folate (not supplemental folate)

0B12 deficiency is often assessed by measuring intermediates (homocysteine)

0High amounts of folate can mask symptoms of B12 deficiency (anemia)

(Wadsworth Cengage Learning 2009)

B12 and Homocysteine (tHcy)

0 Low B12 High tHcy

0 Infant consequences:

0 low birth weight

0 premature delivery

0 neural tube defects

0Maternal consequences:

0 preeclampsia

(Vollset et al 2000)

B12 and Homocysteine (tHcy)

0B12 supplementation during pregnancy at 34 weeks

0 Decreased child’s tHcyat 2 years

0High tHcy can also be caused by folate deficiency

(Vollset et al 2000) (Lubree et al 2012)

B12 and Breastfeeding

0Vegetarian mothers who did not supplement

0 tHcy was higher at two years in those breastfeeding than in non-breastfed at two years

0 Infant B12 deficiency

0 intellectual delay

0 psychomotor delay

(Chalouchi 2008) (Lubree et al 2012)

B12 and Folate Recommendations

0 Pregnant Women0 B12: 2.6 μg/day

0 Folate (total): 600 μg/day

0 Lactating Women0 B12: 2.8 μg/day

0 Infants (0-6 mos)0 B12: 0.4 μg/day

0 Infants (6-12 mos)0 B12: 0.5 μg/day

(Wadsworth Cengage Learning 2009)

Vitamin B12 Supplements

(Carmel 2008)

Supplements

(usp.org)

Case Study #1

0 9 m/o female infant0 Almost exclusively

breastfed

0 Past 2 days0Vomiting, diarrhea,

decreased urine output

0 Past 3 months0Lethargy, reduced tone

0Mother of Southeast-Asian origin0 Strict, lifelong vegan

0 Pre-natal supplements

Case Study #1

0Megaloblastic erythrocytes

0B12: <37 pmol/L

0 Ideal (adults): 133-635 pmol

0 Folate: 14 nmol/L

0 Ideal: 7-36 pmol

0Bone marrow alterations

(Welch 2010)

Case Study #10Deficiency due to mother’s dietary habits

0Anemia managed with transfusion

0 Intramuscular B12 injections were administered over the course of one month

0Mother began taking oral vitamin B12 supplements

(Welch 2010)

Case Study #2

0 7 m/o male infant

0Exclusively breastfed0 Past 2 weeks

0Lethargy, loss of milestones

0 Past 2 months0Diarrhea, unwell

0 Treated by family doc with antibiotics

0Mother has no dietary restrictions

(Welch 2010)

Case Study #2

0 Loss of tone

0 Large red blood cells

0Alterations in bone marrow

0B12: <37 pmol/L

0 Folate: 30 nmol/L

0 Incomplete myelination

0No metabolic issues

0Mother found to have intrinsic factor antibodies

(Welch 2010)

Case Study #2

0Deficiency due to mother’s diagnosis of pernicious anemia

0 Consumption of solid food increased

0Both baby and mother received intramuscular injections

(Welch 2010)