CPE COURSENUTRIENTS OF CONCERN FOR INDIVIDUALS FOLLOWING A PLANT-BASED DIETBy Sharon Palmer, RDThanks to a variety of influences, including vegan celebrities such as Bill Clinton and Ellen DeGeneres and popular plant-based eating blogs and websites, the public is becoming more familiar with the health and environmental benefits of eating a plant-based diet. In fact, meatless eating has landed on several food and diet trend lists for 2014 compiled by food gurus, maga-zines, and organizations such as the Food Network and NPR.1,2 And many people, as well as schools, workplaces, and entire cities, have embraced the Meatless Monday campaign, a non-profit initiative that works with the Johns Hopkins Bloomberg School of Public Health to promote the message of going meat free one day per week.3Mintel released a report in 2013 indicating that 7% of consumers identify as vegetarian, though 36% use meat alternatives, demonstrating that people appear to be more interested in a semivegetarian diet.4 A 2012 Vegetarian Resource Group poll of 2,030 adults identified a similar trend. In the poll, 4% of adults described themselves as vegetarian and 1% as vegans, yet 47% reported that they eat at least one vegetarian meal per week.5 This continuing education course reviews the current body of evidence regarding nutrients of concern for individuals following a plant-based diet as well as strategies to help clients meet their unique nutritional needs when following a vegetarian or vegan diet.Defining Plant-Based DietsThe Dietary Guidelines Advisory Committee says a plant-based diet emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds.6 Vegans don’t eat animal products, including dairy and eggs. Vegetarians (also known as lacto-ovo vegetarians) don’t eat meat but do eat dairy and eggs; pescatarians (or pesco-vegetarians) eat fish but no other meats; and semivegetarians (or flexitarians) occasionally eat fish, poultry, or meat. Of course, many people call themselves vegetarians but follow eating patterns that diverge from these definitions. For example, some people may be nearly vegan, eating dairy and eggs only on rare occasions, and some may call themselves vegetarians but still eat small amounts of meat. Since there are many variations of a plant-based diet, it’s important for health professionals, including dietitians, to establish a person’s true eating pattern to accurately assess nutritional intake and status.7Brief History of Plant-Based EatingWhile plant-based eating may appear to be a new trend, it actually dates back to ancient times. Claus Leitzmann, PhD, a retired professor from Justus Liebig Universitat in Germany, spoke on the history of vegetarianism at the Sixth Interna-tional Congress on Vegetarian Nutrition in February 2013. He reported that ancient cultures, including those in Egypt, China, India, Peru, and Mexico, ate a predominantly plant-based diet. In the sixth century BCE, the Orphics in Greek culture were the first documented vegetarians in Europe. According to Leitzmann, throughout history, there were important people who made strong arguments for vegetarian eating, including Greek philosopher Plato, Roman poet Ovid, and Greek essayist Plutarch. These arguments were based on issues such as health, economics, and morality. Other reasons people espoused vegetarian eating included believing that COURSE CREDIT: 1 CPEULEARNING OBJECTIVESAfter completing this continuing education course, nutrition professionals should be better able to: 1. Identify the nutrients of concern for people following a plant-based diet.2. Assess the nutritional status of plant-based eaters and their specific needs.3. Develop a nutritional plan of care that addresses all nutrients of concern for this population.Suggested CDR Learning Codes 2020, 2090, 4110; Level 22 today’s dietitian ce supplementkilling animals, which could think and feel, was unjust; that eating meat was harmful; that people may be reincarnated as animals; and that enough food already was available to eat without killing animals. Major world religions also advocated vegetarian eating, including Hinduism, Buddhism, Judaism, and Christianity. And from the Middle Ages through the Renaissance and beyond, leading minds such as da Vinci, Voltaire, Rousseau, and Percy Bysshe Shelley continued to promote vegetarianism, according to Leitzmann. In 1809, the first club for people who ate vegetarian diets was established in Manchester, England. The Vegetarian Society was introduced in England in 1847, which coined the term “vegetarian.” In 1850, the first Vegetarian Society was established in North America, and in 1944, the first Vegan Society was established in England. According to Leitzmann, opinion in the mid-20th century held that vegetarianism presented a nutritional risk and the possi-bility of nutrient deficiencies. However, in the late 20th century, with the development of an obesity epidemic, the risk of con-suming a high-meat diet became apparent.By the beginning of the 21st century, nutrition experts started praising the benefits of plant foods, further highlighting the positive aspects of a plant-based diet. Today, people’s top rea-sons for being vegetarian, according to Leitzmann, include con-sideration for ethical, moral, religious, spiritual, ecological, economical, political, and health issues. Health Benefits A growing body of evidence has linked plant-based diets to positive health outcomes. In fact, the Dietary Guidelines for Amer-icans now highlight vegetarian eating patterns, including vegan diets, lacto-ovo vegetarian diets, and diets that include small amounts of meat, poultry, and seafood. The guidelines state6:In prospective studies of adults, compared to non-vegetarian eating patterns, vegetarian-style eating patterns have been associated with improved health outcomes—lower levels of obesity, a reduced risk of cardiovascular disease, and lower total mortality. Several clinical trials have documented that vegetarian eating patterns lower blood pressure. On average, vegetarians consume a lower proportion of calories from fat (particularly saturated fatty acids); fewer overall calories; and more fiber, potassium, and vitamin C than do non-vegetarians. Vegetarians gen-erally have a lower body mass index. These characteris-tics and other lifestyle factors associated with a vegetarian diet may contribute to the positive health outcomes that have been identified among