Nutritional considerations for dietitians

Vitamin B12 is needed to prevent megaloblastic anaemia. It is only found naturally in meat, eggs and dairy products, although some plant foods are now fortified with the vitamin.

How much do we need?

Intakes

Adopting the BDA’s environmentally sustainable diet will not compromise vitamin B12 status as the key food sources (meat and dairy products) are included, be it in smaller quantities.

Individuals at risk of vitamin B12 deficiency are those wishing to follow a vegan diet (<1% of the UK population) or individuals who avoid eggs, dairy and meat over a long period (five years or more) will need to rely on fortified plant foods and supplements to ensure adequate status.

Lacto-ovo-vegetarians despite consuming vitamin B12 sources still display lower status. Of paramount importance is adequate vitamin B12 status during pregnancy and breast feeding when demands are greater and in the elderly where absorption is significantly reduced.

Assessment of vitamin B12 status amongst vegetarians and vegans demonstrates low status to be common in the absence of supplement use.6,7 Additionally, care should be taken with regard to the choice of supplement and dose used to ensure optimum vitamin B12 absorption.

Multivitamin/mineral supplements may not be appropriate as vitamin B12 is degraded in the presence of vitamin C and copper.

Absorption of vitamin B12 is limiting, therefore small frequent doses may be more beneficial than single large less frequent doses. The higher the dose of vitamin B12 the lower the absorption rate.

If a vitamin B12 supplement is needed, the BDA recommends a 10mcg daily supplement or at least 2mg per week.

Long-term vegetarians and vegans should have their vitamin B12 status checked, especially as high folate levels can mask vitamin B12 deficiency, encouraged to consume B12 fortified foods and if required, recommended supplements of around 10mcg per day to ensure adequate status.

Other sources of B12

Vitamin B12 is needed to prevent megaloblastic anaemia. It is only found naturally in meat, eggs and dairy products, although some plant foods are now fortified with the vitamin. 

Top tips for meeting Vitamin B12 needs

Individuals following a healthy environmentally sustainable diet who include meat, egg and dairy products will have adequate intakes. Long-term vegetarians and vegans:

• Should have their vitamin B12 status checked, especially as high folate levels can mask vitamin B12 deficiency
• Encouraged to consume vitamin B12 fortified foods
• Take an oral dietary supplement of at least 10mcg per day (and no more than 2mg per day)
• Vitamin B12 fortified plant foods: yeast extract, fortified plant-based drinks and alternatives to yogurt and most fortified breakfast cereals

Meeting daily vitamin B12 recommended intakes with fortified foods

Vitamin B12 fortified plant foods

Animal protein comparisons

70g serving of beef = 1.4 – 2.1mcg Vitamin B12

200ml semi skimmed milk = 1.8mcg Vitamin B12

Calcium is the key nutrient for bone and dental health and adequate intakes are most critical during peak bone mass development – from birth to our mid-twenties. Calcium is additionally needed for numerous metabolic and physiological processes including muscle function, blood clotting and energy metabolism.

Intakes

Calcium intakes in the UK are relatively good in most age groups with the exception of teenage boys and more so, teenage girls and women with a significant proportion consuming below the LRNI: 11%, 22% and 11% respectively.

Calcium should not be an issue in the diet even for those choosing to avoid dairy altogether as demonstrated by findings from population studies comparing vegetarian, vegan and meat eaters.

Calcium is now ubiquitous in the diet present in many plant foods and, since the mandatory fortification of white and brown flour milled in the UK (alongside thiamine, nicotinic acid and iron), is abundant in the majority of cereal products consumed. Thus, in the UK, cereal products and dairy are the main contributors to calcium intakes.

More importantly, those wishing to avoid dairy are very likely to switch to plant-based alternatives to milk and yogurt which, for the non-organic variants, are fortified with calcium to a level and bioavailability comparable to dairy and vitamin D. Additionally, although high oxalate containing plant foods may hinder the absorption of calcium, it is well established that low oxalate green leafy vegetables such as pak choi, broccoli and kale have a calcium bioavailability almost double that of dairy calcium.

Other sources of calcium

Did you know?

• Since the mandatory calcium-fortification of white flour, cereal products contribute significantly to calcium intakes
• Milk contributes to 34-44% and cereal products 30-39% of total calcium intakes in the UK
• Reducing dairy food consumption and using calcium fortified plant-based drinks and yogurt alternatives will ensure adequate calcium intakes
• Calcium bioavailability from fortified plant-based drinks and tofu is comparable to dairy milk
• Calcium bioavailability of low oxalate high calcium green vegetables such as broccoli, kale and pak choi is almost twice that of dairy calcium

How much do we need? 

Top tips for meeting calcium needs

• Calcium fortified plant-based drinks and plant-based alternatives to yogurt, calcium fortified tofu, nuts, sesame seeds, dried apricots and figs, dark green leafy vegetables and beans are great for calcium
• Breakfast time: alternate between dairy and calcium and vitamin D fortified plant-based milk or yogurt alternatives
• Lunch: include some beans, nuts or seeds with your meal, for your sandwich fillings go for hummous and / or falafel, or baked beans with a jacket potato
• Dinner: always include some beans, tofu, nuts and / or seeds with your meal and serve with dark green vegetables like broccoli, kale and pak choi
• Snacks and drinks: a handful of nuts and seeds, a pot of calcium and vitamin D fortified plant-based alternative to yogurt, dried apricots or figs, use calcium-fortified plant-based drinks for your coffees and tea

Plant food sources of calcium

Animal protein comparisons

200ml semi-skimmed milk = 248mg calcium 

Vitamin D is essential for bone development and strength especially during peak bone mass accretion (from foetal life to our mid-20’s). Vitamin D is also essential for dental and immune health, steroid hormone production, muscle function, regulation and absorption of calcium and has been associated with reduced falls in the elderly as well as cardiovascular, autoimmune and cancer risk.

Who needs to take vitamin D supplements?

• Under 5s
• Individuals with limited outdoor exposure e.g. institutionalised individuals and the elderly
• Dark skinned individuals (natural melanin in the skin blocks vitamin D production) especially South Asian women in the UK
• Those who cover up their skin
• Most of the population during the winter months

Intakes

Dietary sources of vitamin D are scarce. Oil rich fish, eggs and cod liver oil, which are not consumed in large amounts, are naturally rich in vitamin D whilst some margarines and a handful of breakfast cereals are fortified. Meat and liver provide very small quantities. Despite a common misconception, and unlike the US and some European countries, dairy is not fortified with vitamin D in the UK and therefore does not contribute to overall intakes.

Exposure of the skin to sunlight between the months of April and September in the UK is the main source of vitamin D and the government recommends that a daily 10mcg supplement should be considered by all especially during the months of October through to March. Additionally, for ‘at risk’ groups (under 5s, those with limited outdoor access, dark skinned individuals and those who cover up their skin) the government states that a 10mcg daily supplement should be taken throughout the year.

Vitamin D status is assessed by measuring serum 25-hydroxy vitamin D (25(OH)D) levels and values below 25nmol/L is indicative of deficiency. Vitamin D experts suggest that levels below 50nmol/L should be used as indicative of low status as vitamin D has now been found to be critical for many physiological processes beyond bone and dental health.

Assessment of the UK population has identified a significant proportion of the population to be deficient (<25nmol/L 25(OH)D) especially during the winter months: 26% of teenagers (39% teenage girls), 17% of 19-64 year olds.

Additionally, over half of South Asian women in the UK were identified as vitamin D deficient in the summer months whilst in winter over 80% were vitamin D deficient (<25nmol/L 25(OH)D). Caucasian women have a higher prevalence of suboptimal status (<50nmol/L) especially in the winter months.

Studies comparing vitamin D status between meat and vegetarian and / or vegans reflect lower intakes and status in vegans and vegetarians, however, vegans still maintain serum 25(OH)D levels above 50nmol/L. in winter and summer months.

There is a significant drive for vitamin D food fortification in many countries including the UK due to the prevalence of sub-optimal status and lack of dietary sources. Vitamin D comes in two forms, cholecalciferol (D3) and ergocalciferol (D2). The former is naturally produced in the skin by the sun’s rays and found in animal foods such as fish, eggs and red meat, whilst the latter is present in plant foods and has to be converted in the body to cholecalciferol. The debate continues with regard to the superiority between the two forms of vitamin D. The D2-D3 group from Surrey University is attempting to bring clarity to this point.

The most recent randomised controlled study investigating vitamin D impact in UK Caucasian and South Asian women found vitamin D3 to be 50% more efficient at increasing 25(OH)D status compared to vitamin D2. The group acknowledged that although higher doses of D2 are required to produce a similar D3 on 25(OH)D status, it may be a more acceptable format for food and drink fortification as, unlike D3, it is suitable for vegetarians.

Red meat although providing some vitamin D, its concentration is low at 0.2-0.8mcg per 70g serving. Additionally, unlike other countries like the US, UK dairy is not standardly fortified with vitamin D. Thus, reducing intakes of both meat and dairy will have little if any impact on vitamin D status or vitamin D related health outcomes.

Other sources of Vitamin D

Top tips for good Vitamin D status

• Reducing red meat and dairy (which in the UK does not contain vitamin D) will have little if any impact on vitamin D status
• Very few foods provide vitamin D naturally: oil-rich fish, eggs and cod liver oil are rich sources whilst meat, liver and fortified margarines, plant-based drinks and yogurt alternatives are good sources
• Exposure of the skin to sunlight during the months of March and September for 10-20 minutes is the best way to top up vitamin D levels

Plant food sources of Vitamin D

Animal protein comparisons

140g oily fish = 11 – 22.5mcg Vitamin D

1tsp cod liver oil = 6.3mcg Vitamin D

Iodine is a major component of thyroid hormones and is especially important during pregnancy as deficiency during foetal life can result in irreversible brain damage, therefore, the iodine status of those who are pregnant, especially within the first trimester is critical. Additionally, iodine deficient populations exhibit lower intelligence quotient (IQ) scores when compared to replete populations, whilst excessive iodine intakes will lead to thyroid dysfunction.

Measuring iodine status

Due to the significant iodine variability in food, urinary iodine concentrations (UIC) of 24-hour urine collections are most accurate, however, at population level this is highly impractical and median spot-check UIC are standardly used.

The WHO has set clear cut off points for deficiency for different age groups and specific levels for pregnant people (see table below). A median UIC between 150-249mcg/L is considered adequate status for pregnant people. Additionally, iodine to creatine ratio of spot-check UIC can be performed to reduce the intra-individual daily variability with mean levels at or above 150mcg iodine per 1g creatinine during pregnancy considered adequate.

WHO median UIC levels and associated iodine status / iodine intakes

Six years and older

Those who are pregnant, breastfeeding or below two years of age

Mean urinary iodine to creatine ratio for those who are pregnant

It is important to note that neither UIC or I-C ratio can be used to confirm individual iodine deficiency and only a 24-hour urinary assessment or at least 10 urinary spot-checks over a day need to be undertaken.

Status

The WHO classifies general populations with median UIC levels of 100-199µg/L and fewer than 20% below 50µg/L as replete. For pregnant women, a median UIC levels between 150-249µg/L is classified as adequate status.

The most recent NDNS found good iodine status (i.e. median UIC levels between 100-199µg/L and fewer than 20% of the population with values <50µg/L) across all age groups and sexes, including women of child-bearing age. Median UIC for women of childbearing age (16 to 49 years) was 102µg/L with 17% of the population below 50µg/L. While these values met the WHO criterion for adequate intake for the general population, they do not meet the criterion for iodine sufficiency in pregnant women. Unfortunately, a population sub-group the NDNS does not include is pregnant women. A handful of observational studies across the UK have investigated UIC in pregnant women and have found median UIC levels to be indicative of mild-moderate iodine deficiency – be it some studies’ methodologies were questionable. As iodine is critical to foetal brain and neurodevelopment, it is important for this population sub-group to be better assessed for status.

The most recent study by Bath and colleagues using old ALSPAC data (from the 1990’s) found that children with lower IQ scores for verbal skills and lower reading ability were more likely to be the offsprings of mothers whose UIC was insufficient (<150mg/L). However, there was no correlation with the mother’s UIC and children’s overall IQ scores and despite considering numerous confounding factors, the children’s UIC was not measured nor was the level of ‘educational encouragement’ at home. Other studies investigating children’s IQ status with the mother’s UIC during pregnancy have yielded mixed results for mild-moderate iodine deficiency. Additionally, the value of IQ tests in children has been questioned. It is clear that more robust studies will need to be undertaken to identify causality and iodine status of pregnant women and very young children needs to be optimised and better assessed in the UK.

The WHO has established the iodised-salt programme across many countries to help eradicate iodine deficiency and results thus far demonstrate this to be a successful intervention. The UK did not subscribe to this practice, however, the use of iodised salt, especially by food manufacturers (key source of sodium intakes in the UK diet), may help reduce incidence of iodine deficiency whilst still achieving lower overall salt intake targets of 6g per day for adults. Recommended daily intakes of iodine in the UK increase progressively from 50mg/day in infants to 140mg from 15 years through to adulthood with no increase for pregnant or lactating women. This is contrary to WHO recommendations which are higher across all age groups and significantly heightened intakes are recommended during pregnancy and lactation.

In the UK intakes are exceptionally low (below the LRNI) in 27% of teenage girls and 15% of women aged 19-64 years old.

The key iodine source in the UK diet is milk due to the change in farming practice where iodine containing sterilisers and iodine-enriched feeds for cattle is now used. Fish and seaweed are rich sources of iodine and to a much lesser degree eggs, yogurt, cheese, meat and cereal products.

A number of plant-based drinks are now fortified with iodine, including those produced by leading manufacturers.

Other sources of iodine

Top tips for meeting iodine needs

• A sustainable diet which includes fish, some dairy products, and iodine-fortified plant-based alternatives should provide adequate iodine
• Individuals who choose to remove dairy from their diet will need to ensure that milk is replaced with an iodine-fortified plant-based alternative and adequate consumption of fish and / or seaweed. However, levels in fish and seaweed are extremely variable and care should be taken to consume seaweed in moderation (4-5g) as they may contain toxic levels
• Individuals avoiding both dairy and fish from their diet should take an iodine supplement (not from seaweed) of no more than 150mcg per day
• Seaweed is a concentrated source of iodine, but it can provide excessive amounts (particularly so in the case of brown seaweed such as kelp) and therefore eating seaweed more than once a week is not recommended, especially during pregnancy
• Opt for an iodine-enriched plant-based drink, including: Oatly oat drinks – Original, Barista Edition, Whole, Semi and Skinny, Alpro Soya Original Chilled, Alpro Growing Up Drink for one to three year olds and M&S Oat Drink (other brands are available, check the labelling to see if it's fortified). 

Plant food sources of iodine

Animal protein comparisons

140g pollock = 136mcg

75g crabmeat = 163mcg

Iron is critical for foetal brain development and cognition, the immune system as well as preventing iron-deficiency anaemia. Low iron stores (low serum ferritin concentrations) and low iron intakes have been an unresolved issue for teenage girls and young women in Westernised countries whilst iron deficiency anaemia (low haemoglobin levels) remains relatively low.

Iron deficiency anaemia in the UK affects 4-9% of 1.5 - 64-year-olds. There is a higher prevalence in the over 65 year olds but this is often a consequence of chronic disease, presence of inflammatory markers and / or reduced red blood cell production. In contrast, low iron stores are more common especially in teenage girls (24% with low ferritin levels) and women of childbearing age (12% with low ferritin levels).

The main source of iron in UK diets across all age groups is cereal foods (41-55% of total iron intake) and meat (12-21% contribution). The significant iron contribution from cereals is reflective of the UK regulation that white and brown flours milled in the UK have to be fortified with iron (as well as thiamin, nicotinic acid and calcium). Despite a lower iron contribution from meat, it is well established that iron from meat is significantly more bioavailable than iron from plant sources.

For sustainable eating, simply reducing red meat consumption to recommendations (70g per day – rather than complete omission) will result in significant environmental benefits11-18 and would not compromise iron status.

If, however, someone wishes to omit meat altogether from the diet, once again, the evidence is clear that as long as the diet is balanced, there is no reason why iron status should not be sufficient. Research repeatedly shows that compared to omnivores, non-meat eaters tend to have higher total iron intakes, and despite significantly lower iron stores they remain within the normal range and iron deficiency anaemia prevalence is similar.

Dietary and endogenous influencers of iron status

Iron absorption and bioavailability is highly influenced by iron status and the presence of iron enhancers and inhibitors in the diet. Iron status is tightly regulated and non-haem iron absorption is significantly increased when iron status is low and / or when iron requirements are elevated.

Dietary iron inhibitors

• Iron in plant foods is in the form of non-haem iron which is not as bioavailable as haem iron. Non-haem iron needs to be converted to haem iron (Fe2+) endogenously or with the addition of vitamin C in the diet before it can be utilised.
• Plants foods are high in phytates which are one of the biggest inhibitors of non-haem iron. However, food preparation techniques such as boiling, soaking, fermentation, germination, milling and heat processes can reduce phytate content significantly and improve non-haem iron bioavailability. Furthermore, clinical evidence indicates that the body can adapt to longterm habitual consumption of high phytate diets by more efficient utilisation of the iron absorbed and reduced excretion rates.
• Polyphenols and tannins found in tea, coffee, some vegetables such as spinach and some cereals will bind to non-haem iron making it insoluble and unavailable for absorption. The effect can be mitigated by ensuing high polyphenol and tannin foods and drinks are consumed away from iron rich meals and snacks.
• Calcium is a divalent metal which competes with iron in the gut. Calcium consumption alongside non-heam iron foods has been shown to reduce bioavailability.
• High dose iron and zinc oral dietary supplements whether taken with or away from meals will reduce dietary iron absorption and their recommendation should be considered carefully especially when iron deficiency anaemia is not present.

Non-haem dietary iron enhancers

Individuals with lower iron status will be more receptive to dietary iron enhancers.

• Inclusion of some meat, poultry or fish. Although the mechanism has yet to be identified, it is well established that the presence of some flesh proteins enhances iron absorption. Therefore, the sustainable dietary recommendations to reduce rather than omit meat altogether will go a long-way to help optimise iron intakes and status.
• Vitamin C / Ascorbic Acid remains the biggest enhancer of non-haem iron absorption and should be included with all iron-containing meals and snacks.
• Vitamin A and Carotene have also been associated with improved non-haem iron absorption.
• Enhancers mitigating the effect of phytates:
  • Promoting plant-based diets for the long term and future generations. There is evidence to demonstrate that habitual consumption of high phytate diets does result in a more efficient utilisation of absorbed iron by the body and reduced rates of excretion.
  • This also helps explain why vegetarians and vegans do not have higher rates of anaemia than omnivores and maintain iron stores within normal ranges be it at significantly lower levels than meat eaters.
  • Fermentation of high phytate foods. Fermentation of plant foods results in the breakdown of phytic acids. Therefore fermented plant-based products such as tempeh and miso and yeast leavened bread (microbial fermentation) will enhance the bioavailability of iron.
  • Soaking of legumes and beans will diffuse phytic acid into the water.
  • Sprouting of beans and legumes enhances the activity of naturally occurring phytase enzymes in plants. Some studies demonstrating a reduction in phytates by up to 50%.
  • High temperature food preparation e.g. canning can reduce phytic acid content of legumes and beans, however, the effect is highly variable.
  • Milling and refined cereal. For the majority of cereals e.g. wheat, rice and rye, phytates are present on the outer layers, therefore extraction of the outer layer e.g. production of white flour significantly lowers phytates but at the same time reduces the iron content.

Other sources of iron 

Did you know?

• Eating more sustainably, as per the Eatwell guide where red meat is reduced to no more than 70g per person per day, will not compromise current iron status.
• Iron deficiency anaemia (low haemoglobin levels) is no greater in vegetarians and vegans compared to meat eaters.
• Although iron stores (ferritin levels) in vegetarians and vegans is significantly lower when compared to meat eaters, they are still within the normal range.
• The body increases dietary iron absorption when status is low and / or at times of higher demand e.g. pregnancy.
• Iron from high phytate plant sources, is less bioavailable, but over time, the body optimises iron utilisation and reduces excretion.
• Phytates iron inhibitory factors can be reduced by including a vitamin C food or drink alongside plant iron sources. Additionally, food processes such as soaking, sprouting, high temperature treatments (e.g. canning), milling and yeast leavening helps to reduce phytate content of food and therefore improve plant iron absorption.

Top tips for optimising iron status

• Include iron rich plant foods with all meals and snacks.
• Include a source of vitamin C with meals in the form of salad, fruit or fruit juice.
• Include starchy root vegetables, tubers or fruit with your meals – lower in phytates but high in fibre.
• Use canned beans and pulses and rinse well or soak dried beans and discard water.
• Avoid tea and coffee around mealtimes (around two hours either side).
• Iron or zinc dietary supplements should only be recommended to individuals who have iron deficient anaemia or at high risk and dietary iron intakes will not suffice.
• How to add an iron boost to meals and snack times:
  • Breakfast time: fortified breakfast cereals, wheatgerm toast, beans on toast. Serve with a small glass of fruit juice.
  • Lunch: falafel, humous, bean salad, jacket potato and baked beans, peanut butter on toast. Accompany your lunch with lots of salads or a piece of fruit.
  • Dinner: Add beans, nuts and/or seeds to your main meal, serve with a salad or glass of fruit juice and some green vegetables like kale, peas or baby spinach.
  • Snacks: nuts, seeds and dried fruit like apricots are a great choice.

Plant food sources of iron

Animal protein comparisons

70g serving of beef = 2 - 2.5mg iron

70g serving of lamb = 1.3 - 1.8mg iron

Large egg = 1.3mg iron 

Protein is essential for the growth, maintenance and repair of all body cells. In the UK, overconsumption of protein is common across all age groups and sexes, therefore advice to reduce meat and dairy whilst increasing plant food sources of protein will have little if any impact on overall protein intakes.

Current intakes of protein

• 2-10 year olds are consuming two to three times more than recommended
• Teens (11-18 year olds) are consuming 29-70% excess protein
• 19-74 year olds exceed recommendations by 38-57% whilst over 75 year olds are consuming 22% and 33% above recommendations for females and males respectively

Protein quality

Protein quality is dependent on the ability of a diet to provide all essential (indispensable) amino acids (EAAs) in the correct quantity to meet human needs. The protein quality of individual foods can be assessed by the established scoring systems Protein Digestibility-Corrected Amino Acid Score (PDCAAS) and the more recently proposed Digestibility Indispensable Amino Acid Score (DIAAS). Both systems assess the protein digestibility and quantity of EAAs in relation to a reference protein which meets all human needs. The latter scoring system is thought to be more accurate as it takes into consideration the presence of inhibitory factors such as phytates and trypsin when assessing digestibility. Although these measurements are useful, they do not reflect the ability of the overall diet to meet EAAs needs, and they have led to a number of misunderstandings about the quality of plant proteins and how they should be consumed.

On a weight by weight basis, plant foods compared to animal foods do contain less protein but this is due to their more rounded macronutrient content: low in saturated fat, lower energy density, provide complex carbohydrates and are an excellent source of fibre. Research has repeatedly demonstrated that even if individuals decide to exclude meat and fish from the diet altogether (vegan and vegetarian diets), they still exceed their protein needs. Plant proteins are neither
‘incomplete’ or of ‘low in biological value’ and such terms should be used with care. Additionally, there is no need to ‘combine’ plant foods at each meal in order to ‘complement the different EAA’ profiles.

Plants do in fact contain all EAAs be it some at very low levels e.g. cereals and lysine content, but they do not lack any. It has been repeatedly demonstrated that human EAA needs do not need to be met at each meal time and it is the overall consumption of EAAs over the course of a day that is important.

The body holds a pool of EAAs which it can call upon to complement dietary intakes. It is important to note that the PDCAAS and DIAAS scoring systems only assess a single food protein’s ability to meet all EAAs at levels needed to meet human requirements. They do not reflect the ability of the overall diet through the course of a day to meet all EAAs.

Various metabolic studies have demonstrated nitrogen balance to be met irrespective of protein source and that diets based solely on plants and which meet energy requirements, will also meet all EAAs needs.

Other sources of protein 

Plant food sources of protein

Tofu, soya mince / chunks, Quorn™ (mycoprotein), soya beans – fresh, frozen or roasted (soya nuts), other beans, peas, pulses, nuts and seeds, plant-based alternatives to yogurt.

Did you know?

• An environmentally sustainable diet does not mean a vegetarian or vegan diet i.e. complete exclusion of dairy and meat proteins is not necessary.
• Cereal products are low in protein, however, due to the quantities they are consumed in they contribute significantly to protein intakes. Cereal products contribute to 22-29% of total protein intakes whilst meat contributes to 29-37% and milk and dairy 13-20%.
• All age groups and sexes are overconsuming protein. Therefore, the current government recommendations for a more sustainable diet to reduce red meat to no more than 70g per day per person and reduce dairy by a third, whilst increasing plant-food sources of protein will not compromise protein status.
• Plants contain all essential amino acids – be it some at lower levels compared to animal proteins.
• Terms ‘high biological’ and ‘low biological’ value and ‘complete’ and ‘incomplete’ proteins are misleading as they only reflect the ability of one food to meet all essential amino acid needs. It does not reflect the ability of a whole day’s consumption to meet essential amino acid needs.
• Studies have repeatedly shown that a diet based purely on plant foods that meets energy requirements will meet all essential amino acid needs.
• There is no need to compliment plant protein food sources at each meal – nitrogen balance is achieved over the course of a day’s essential amino acid intakes.
• Spread protein load evenly throughout the day: it is now well established that protein loads should be spread throughout the day to optimise muscle protein synthesis. Protein uptake and utilisation plateaus at around 20g of animal protein – for plant proteins this will be higher at around 30g and for elderly even higher. 

Tips for using plant proteins

• Have three helpings of plant protein foods daily.
• Tofu – 75-100g: Cut into bite size pieces added to curries and stir fries.
• Meat replacers – 100g: swap your meat or go half and half with soya or Quorn™ mince or chunks.
• Go meat free a couple of days a week.
• Beans – 100g: go for canned beans and add to your salads, to replace some meat in your dishes or how about beans on toast.
• Quinoa (40g dry weight): use in salads or instead of rice.
• Nuts (a handful) and seeds (1 tbsp): sprinkle over breakfast cereals, porridge and salads and add to main meals or have as a snack.
• Snack time: a handful (30g) of soya nuts (roasted edamame beans), a small pot (150g) of fortified plant-based yoghurt or Greek-style yogurt, a handful of nuts or a tbsp. of seeds.
• Starchy foods and wholegrain cereals: although low in protein content, due to the quantities they are consumed in, they will significantly contribute to an individual’s intake. 

How much do we need? 

Who needs to up their intakes? 

• All age groups and sexes are exceeding government protein recommendations (0.75g/kg body weight)

• Elderly & sarcopaenia. International and European groups are recommending that the elderly (>65 years) should aim for higher protein intakes to offset inflammatory and catabolic conditions

• At least 1 - 1.2g protein/kg body weight 1.2 - 1.5g/kg body weight for those regularly exercising or have an acute/chronic disease.

Plant food sources of protein

Selenium is an antioxidant and is involved with the normal function of the immune and thyroid system and sperm production.

Intakes

Although there is good selenium intake in the very young, intakes are exceptionally low in all other age groups for both males and females with 25-76% falling below the LRNI.

Who needs to up their intakes? 

The majority of the population, especially aged 11 years onwards.

Despite fish being an exceptionally good source of selenium, cereal products and meat are the key sources in the UK diet.

Good plant sources include Brazil nuts (an excellent source), brown rice, baked beans, sunflower seeds and whole oats.

Other sources of selenium

Top tips for meeting selenium needs 

• Five to six Brazil nuts daily will provide 64-76mcg selenium which will meet recommendations for older teens and adults. Whilst two to four will meet the needs of the younger age groups.
• Brazil nuts (an excellent source), brown rice, pasta, wheatgerm or seeded bread, baked beans, green and brown lentils, kidney beans, cashew nuts and pecans and sunflower, chia and flax/linseeds.
• Breakfast time: Sprinkle of seeds or nuts onto breakfast cereals, wheatgerm or seeded bread for toast.
• Lunch: opt for wheatgerm or seeded bread or rolls, kidney bean or lentil soup sprinkled with seeds, sprinkle nuts and seeds on salads. 
• Dinner: Add kidney beans, chickpeas, nuts and / or seeds to any of your main meals.
• Snacks and drinks: five to six Brazil nuts.
• The selenium content of foods can vary significantly according to the content of the soil, farming practice, fish species & season.

Animal protein comparisons

140g mackerel = 8.4mcg selenium

70g serving of turkey = 11.9 – 13.3mcg selenium

Zinc is involved in many physiological and metabolic processes in the body including immunity, fertility and reproduction, macronutrient metabolism, cognitive development, DNA synthesis, wound healing and bone metabolism.

Intakes

Zinc intakes are low in the UK for 4-10 year old girls, teenage boys and girls, and women aged over 75 years. Like iron, zinc absorption is affected by zinc status and anti-nutrients like phytates. Food processes such as soaking, canning, sprouting and fermenting can reduce the inhibitory effects of phytates whilst low stores and, at times of higher demand, zinc absorption is upregulated. Additionally, incidence of overt zinc deficiency has not been reported in Westernised countries and vegetarians have been shown to have similar zinc status as omnivores.

Fully understanding the impact of reduced zinc bioavailability and intake has been somewhat hindered by the lack of sensitive clinical measures for zinc status. A sustainable diet that contains small quantities of meat and plenty of zinc containing foods should be adequate to meet requirements. As with iron, for vulnerable groups consuming red meat below the SACN recommendations, supplements may need to be considered.

Food sources of Zinc

Red meat and animal foods more generally are a significant source of zinc in the UK diet and SACN modelling estimates that red and processed meat contributes 32% of men’s total zinc intake and 27% of women’s.

How much do we need?

Who needs to up their intakes?

Teenage boys and especially girls and women aged 19-64 years. 

Alternative sources of zinc

Top tips for meeting zinc needs

• A sustainable healthy balanced diet which includes recommended intakes of red meat (no more than 70g per day) and / or Quorn™ (mycoprotein) meat replacements should provide adequate zinc.
• Quorn™ (mycoprotein), All-bran type breakfast cereal, wheatgerm or wholemeal bread, beans, nuts, seeds especially sesame, pumpkin, chia and hemp seeds as well as flax/ linseeds.
• Breakfast time: All-bran fortified type cereal served with a sprinkle of nuts and seeds or wholemeal/wheatgerm toast spread with peanut butter.
• Lunch: opt for wheatgerm or wholemeal bread or rolls, bean soup sprinkled with seeds, sandwich fillings of peanut butter or humous, sprinkle nuts and seeds on salads.
• Dinner: replace meat with Quorn™ (mycoprotein) or replace half the meat with soya beans, kidney beans, chickpeas, nuts and / or seeds.
• Snacks and drinks: nuts and seeds on their own or sprinkled on a plant-based alternative to yogurt, a small pot of humous with wholemeal pitta bread.

Plant food sources of zinc

Animal protein comparisons

70g serving of beef = 5.3 – 6.7mg zinc

140g crab = 9.2mg zinc