Vegetarian Research
published by JSVR・www.jsvr.jp

Review

Health Benefits and Precautions of The Vegetarian Diet
Kenji Fukunaga*
Faculty of Chemistry, Materials, and Bioengineering, Kansai University
3-3-35, Yamate-Cho, Suita, Osaka 564-8680, Japan
Abstract. Vegetarians are often pointed out to be deficient in protein, some vitamins, minerals, and n-3
polyunsaturated fatty acids. But vegetarians can also select appropriate food for necessary nutrients from plant foodand effectively improves and maintains health in many cases. A vegetarian diet reduces the prevalence of lifestylerelated diseases such as cardiovascular diseases and malignant neoplasms. On the other hand, there are alsobiased perspectives. Some people are swept away by populism, blindly believing that plant foods are suitable forthe body and the environment and that animal foods are harmful and unhealthy. There are various backgrounds toa vegetarian diet. Suppose you practice a vegetarian diet for health. In that case, you need to be interested in avegetarian diet, better understand nutrition and food science, and have a scientific perspective. This review outlines
vegetarianism's current state and the essential nutrients for vegetarians to practice a healthy vegetarian diet.
Key words: vegetarian, health, plant food, nutrient, benefit, lifestyle-related diseases

1. Introduction
The history of vegetarianism is ancient, and it
has reportedly originated from the Indus Valley
Civilization around the 7th century BC. After that,vegetarianism developed in various regions with
the influence of religions and philosophies. Ethicalvegetarianism has been spread among those who
oppose killing animals have rooted worldwide.
Early 20th century, the vegetarian diet's healthbecame known for Western developed countries'
therapeutic
aspect,attracting
widespreadattention. Nowadays, vegetarian food is being
adopted by people with various ideas and positions

due to ecological, environmental, and economic
burdens, religion, ethical aspects, and healthconcerns. Especially when it comes to health,vegetarian diets are often chosen based on thedesire to improve physical fitness, obesity, andreduce the risks of developing lifestyle-relateddiseases in different cultures, countries, andregions. However, in this case, many people takeit easy to adopt a vegetarian diet, even though
vegetarian cannot guarantee their health. No
matter what purpose you practice a vegetariandiet, it is a significant premise that you arehealthy, so we should be well aware of this and bevegetarian.

Vegetarian Research Vol. 21, 1－8 (2020)
Received & Accepted 30 December 2020
*Phone: +81-6-6368-0875, Fax: +81-6-6388-8609,
E-mail: fukunagk@kansai-u.ac.jpⒸ2020 The Japanese Society for Vegetarian Research

2. Background of vegetarian diet adoption
Today, the number of starved people who havedifficulty survival and social life for a long time1

Vegetarian Research Vol. 21 (2020)
due to chronic malnutrition reaches about 700
million people. On the other hand, in developed
western countries, the efficiency of agriculture
and livestock industry improved according toscience and technology development starting fromthe industrial revolution. Along with this, thelifestyle has changed. As a result, many people
suffering from lifestyle-related diseases such as
cancer and cardiovascular diseases increases.
Vegetarian
nutritionhas
anincreasing
international following and is increasingly
accepted. This trend's main reasons are healthconcerns, ecological, economic, religious, andethical aspects [1]. In the case of a health problem,
they arise from the desire to lose weight, tackle
obesity, improve physical fitness, and reduce therisk of acquiring certain diseases.
Vegetarian diets are generally low-calorie, lowglycemic index, rich in dietary fiber, folic acid,vitamins C and E, potassium, magnesium, andcontainfunctional
ingredients
calledphytochemicals such as polyphenols. It has beenshown that adequately applying a vegetarian dietis the most effective way to reduce body massindex, improving the plasma lipid profile. And
they are decreasing high arterial blood pressure,cardiovasculardisease,stroke,metabolicsyndrome, and arteriosclerosis. Besides, improved
insulin sensitivity and lower rates of diabetes andcancer have been found [2].
However, some studies also suggest thatvegetarian diets can harm the body. Concerns
include protein deficiency, anemia, decreased
creatinine content in muscles, and impaired
menstruation in women with increased physicalactivity.
These can also reduce your ability to perform
exercisesthatrequirephysicaleffort.
Nevertheless, with the right food choices, avegetarian diet's beneficial effects far outweighthe disadvantages and can be reasonably
concluded [3].

2

3. Vegetarian health and risks and benefits
Vegetarians, who do not eat from animals,
poultry, fish, and dairy products, is constituted aminority of the world's population. Concerns about
the health, economic, and environmental impacts
of diets containing animal foods have excluded
some or all of these foods from the diet. This
chapter introduces the main findings from a large
cross-sectional and prospective cohort study inWestern countries with many vegetarian
participants to understand vegetarian health.
Vegetarians have a lower prevalence of obesityand a lower risk of ischemic heart disease thannon-vegetarians from a similar background,
whereas the data are equivocal for stroke. Thereis a piece of evidence that the risk for all cancer
sites combined is slightly lower in vegetarians
than in non-vegetarians. Still, findings forindividual cancer sites by gender are inconclusive.
Vegetarians have also been revealed to have lower
risks for diabetes, diverticular disease, and eye
cataract. Overall mortality is similar forvegetarians and non-vegetarians. The long- healthof vegetarians seems to be generally favorable,
and for some diseases and medical conditions, it
can be better than omnivores [4].
Since the Adventist Health Study 2 (AHS2) in
2013, several prospective dietary studies havedemonstrated and challenged the vegetarian
diet's health benefits and risks. Annual sales ofplant foods are on the rise. Still, a 2018 Gallup
survey indicates that the overall stagnation
proportion of self-reported vegetarians and vegans
compared to the ratio obtained with AHS2 six
years ago. The latest vegetarian studies show asignificant
reductioninmortalityfromcardiovascular disease, cerebrovascular disease,diabetes, and chronic kidney disease compared to
the Adventist Health Study. Recent studies havecorrelated certain food groups with early death
rates or increased longevity.

Fukunaga: Health Benefits and Precautions of The Vegetarian Diet

4. Nutrients of concern for vegetarians
Vegetarian health risks are explored protein
deficiencies, n-3 polyunsaturated fatty acids （ n3PUFA）, vitamin D, vitamin B12, iron, calcium,and zinc [5]. These eight nutrients have incommon that the diet is mainly from animal food.
Therefore, vegetarians are often deficient, and it
is a nutrient that can be confirmed in research
papers and other reports regarding insufficient
intake and malnutrition.
It is equally a fact that there are no nutrientsthat humans must from animals, as indicatedfrom the food composition table. However, avegetarian diet can lead to deficiency and chronic
deficiency [5-7]. The low bioavailability of vitamin
B12, iron, and zinc in vegetables can also affectvegetarians'
nutritional
status.
Further,vegetarian diets are usually deficient in the n3PUFA, such as EPA and DHA [8]. This chapter
reviews an overview of each of the eight nutrientsthat vegetarians have pointed out to be deficient.
4.1. Protein
Protein is one of the specific nutrients thatvegetarians are concerned about deficiency. To
take in enough protein containing nine essential
amino acids to maintain a healthy body is critical.
Depending on a research method and a standard
to adopt, uncertainty remains about the protein
requirements; in any case, the data of thevegetarian of recent adults indicate that the dietof the usual vegetarian supply quantity adequate
protein and amino acids. Suppose food supply
fluctuations are not large, as in the westerndeveloped countries. In that case, there is no
problem with adequate intake of individual
essential amino acids from a vegetarian diet as
long as lysine is sufficient. There is little evidenceof the adverse physiologic effects of the protein
intake low moderately to be seen in an adulttaking in a vegetable diet [9].
A vegetarian diet can quickly meet dietary
protein requirements as long as energy needs are
met and various foods are taken. Vegetarians
should obtain protein from different plant sources,

including legumes, soy products, grains, nuts, andseeds. The human body has a functioning pool ofamino acids that can be used to supplement
dietary protein. If you are eating various foods
every day without being too biased, you do notneed to combine plant proteins. The intake ofvegetable protein by vegetarians can reduce therisk of chronic illnesses such as diabetes and heartdisease [10]. For a small proportion of vegans, therisk of underdose may be moderate.
Additionally, any evidence for a functional
impact and a higher absolute risk of sarcopenia in
the healthy elderly is currently concerned.
Children who consume energy to cover their
growth requirements should automatically obtainsufficient protein intake from vegetarian diets.
Further data are needed to evaluate people's
actual dietary patterns to an insufficient intake of
total energy and protein [9].
4.2. Vitamin B12
Vitamin B12 is an essential nutrient to consider
when practicing vegetarian diets. Even lacto- or
ovo-vegetarians run the risk of becoming deficientin B12. Since vegetarians have a lower intake ofvitamin B12 than non-vegetarians, they are at
greater risk of developing B12 deficiency.
Vitamin B12 deficiency contributes to theformation of red blood cells, which causes
megaloblastic anemia, spinal and brain whitematter disorders, and peripheral neuropathy. If
we are not careful about vitamin B12 intake, it will
gradually harm our body, and one day you may
suddenly have an abnormality in your body. A loss
of 0.1 to 0.2% of the body's vitamin B12 storage per
day is complicated. Even if you stop taking
vitamin B12 altogether today, the adverse effects
of deficiency may not be apparent for several years[11].
Besides, pseudo vitamin B12 in food cannot be
used as vitamin B12 by humans [12]. Vitamin B12contained in seaweed is analytically recognized,
but there is no nutritional basis for its
effectiveness. There is also the view that
supplements and fortified cereals are essential
only for vitamin B12 [13]. Vegetarians are3

Vegetarian Research Vol. 21 (2020)
recommended regularly to take supplements of
B12, and they should be kept informed of thelacking content of B12 of plant products and thehazards of B12 deficiency [14].
4.3. Calcium
Vegetarians consume more plant products that
contain oxalic acid and phytic acid, which can
result in lower calcium absorption than those who
eat anything [15]. Calcium intake is similar
between vegetarians (people who eat eggs anddairy products) and non-vegetarians [16].
However, vegetarians who do not eat any animal
products and ovo-vegetarians who eat eggs but notdairy products do not consume dairy products.
They may not have sufficient calcium intake [17].
The Oxford cohort of the European Prospective
Cohort Study on Cancer and Nutrition show
vegetarians probably average calcium intake.
However, in vegetarian, elevated fracture risk
[18]. On the other hand, dietary calcium intake is
not related to fractures' risk, and no evidence inclinical trials increasing dietary calcium intake
prevents fractures. Definitive proof that calcium
supplements prevent fractures is low, andinconsistent has been reported [19].
4.4. Vitamin D
Even omnivorous people who eat meat and fish
tend to be deficient in fat-soluble vitamins [20],but vegetarians need to be more careful. Vitamin
D deficiency may be more typical than omnivorous
animals, especially during the winter months
when UV exposure is reduced, and skin synthesis
is minimal. When commonly intake mushroom
species are irradiated to ultraviolet (UV) such as
sunlight or a UV lamp, they produce sufficientamounts of vitamin D. The most common form ofvitamin D in mushrooms is D2, with lesser
amounts of vitamins D3 and D4. In contrast,
vitamin D3 is the most common form of animal
foods. Worldwide, mushroom consumption has
increased markedly, and mushrooms have thepotential to be the only non-animal food source ofvitamin D, which can provide a sufficient amountof vitamin D2 in a single-serve. The levels of

4vitamin D2 in UV-exposed mushrooms may
decrease with storage and cooking. But vitamin D2
level in mushrooms is above 10μg/100g fresh
weight, which is higher than the level in mostvitamin D containing foods and similar to thedaily requirement of vitamin D recommended
internationally [21].
In adults, vitamin D deficiency causes
osteomalacia and bone weakness. Vitamin D
deficiency causes bone pain and weakness
symptoms, but the signs are so insignificant in theearly stages that they may be neglected [22].
Several recent studies have looked at plant-based
nutrition and bone health markers, using
measures such as bone mineral density, boneturnover markers, or fracture rates. Although
population-based and cross-sectional studies canbe prone to confounding effects, most did notindicate differences in bone health between
vegetarians or vegans and omnivores as long as
calcium and vitamin D intake was adequate. On
the other hand, a few longitudinal studies orprospective cohort even show few longitudinalstudies or prospective cohort benefit from plantfoods. Still, this claim has not been proven [23].
4.5. n-3 Polyunsaturated fatty acids
A vegetarian diet tends to have a lower total fat
intake, saturated fatty acids, and cholesterol thana non-vegetarian diet. Vegetarian, mostly vegan,
diets are deficient in EPA and DHA comparedwith linoleic acid (LA) and alpha-linolenic acid
(ALA) [24]. EPA and DHA, although synthesized
initially by microorganisms in the oceans, areprimarily obtained from the consumption of fish.
By definition, vegetarians do not eat fish and thus
intake virtually no EPA and DHA [25].
Clinical studies indicate that tissue contents of
n-3 PUFA are depressed in vegetarians,
particularly in vegans. n-3 PUFA has numerous
physiologic
benefits,
includingpotentcardioprotective effects. These effects have been
demonstrated for ALA and EPA and DHA,
although the physiologic effectiveness is inferior
for ALA than for EPA and DHA in most cases.
Conversion of ALA in the body to the more active

Fukunaga: Health Benefits and Precautions of The Vegetarian Diet
longer-chain fatty acids is inefficient; < 5-10% for
EPA and 2-5% for DHA. Because of the beneficial
effects of n-3 fatty acid, ALA required amount canbe higher for vegetarians than for non-vegetarians,
as vegetarians must rely on the conversion of ALA
to EPA and DHA [24].
While intake of the ALA is similar invegetarians and non-vegetarians, intakes of EPA
and DHA are low in vegetarians. Blood, plasma,
and tissue levels of EPA and DHA are more
deficient in vegetarians than in non-vegetarians.
Vegetarians do not have clinical signs of DHA
deficiency, but further research is needed toascertain whether vegetarians' levels are
sufficient to support optimal health. Vegetarians
with increased require or reduced conversion
ability can obtain some advantage from DHA andEPA supplements derived from microalgae. A
supplement is suggested for high requirements,
such as pregnant and lactating women, and thosewith decrease conversion ability, such as older
people or chronic disease diabetes [26].
Vegetarian diets have a specific possible
concern: vegetarians have high intakes of LA
compared to omnivore/non-vegetarian diets. Highintakes of LA competitively interfere with theendogenous conversion of ALA to EPA and DHA.
High somatic levels of LA and low ALA indicate adecreased ALA conversion to EPA and DHA.
Besides, vegetarian diets are rich in dietary fiber,
possibly interfering with fat absorption [27].
4.6. Iron
Vegetarians do not feed meat, seafood, andrelated products. Although the vegetarian lifestyle
could lead to better health status in adults, it may
also bear certain nutritional deficiencies. Crosssectional studies and vegetarian reviews showthat a meatless diet does not contain bio efficient
haem iron. Vegetarian foods are not well suited forthe supply of vegetarian iron because they contain
substances that impair non-haem iron'sbioavailability [28]. Therefore, a vegetarian dietabsorbs less iron than a diet containing meat. Dueto the low intestinal absorption of non-haem ironin vegetable foods, vegetarians who do notconsume any animal products from their diet needabout twice as much dietary iron as nonvegetarians per day [29]. Also, vegetarians havelower iron stores in their bodies, and compared to
non-vegetarians, had iron deficiency anemia. This
fact is especially actual for premenopausal
vegetarian women [30].
Vegetarians will improve non-haem ironabsorption by simultaneously taking non-haemiron sources as abundant vitamin C sources suchas citrus fruit. A diet rich in whole grains, legumes,
nuts, seeds, dried fruits, iron-fortified cereals, andgreen leafy vegetables provides an adequate ironintake. Vitamin C and other organic acids enhance
non-haem iron absorption, a process that isregulated by the gut. People with depleted ironstores or higher physiological need for iron will
absorb more iron and excrete less [31]. However,vegetarians who eat a varied and well-balanced
diet are out of any more significant iron deficiency
anemia risk than non-vegetarians.
4.7. Zinc
Zinc is the abundant trace mineral in the bodyafter iron, the essential trace element [32]. Zinc
has many physiologic roles, particularly being
required for the growth and functioning of theimmune system. Deficiency impairs physiologic
processes, leading to clinical consequences that
include failure to thrive, skin rash, and impaired
wound healing. The mild lack that is not clinicallyovert may still cause nonspecific results, such as
susceptibility to infection and low growth [33].
Zinc is also contained in plant foods, but theefficiency of zinc absorption decreases due to zincabsorption inhibitors in plant food such as phyticacid reduces zinc effectiveness [34].
The results of studies investigating zinc intake
and zinc status in vegetarian populations areinconsistent. Because vegetarians high phytic acidintake as a zinc absorption inhibitor, zincbioavailability is lower in vegetarian diets [35].
Vegetarians should have a strategy for optimizing
this by appropriate food intake. It is more
beneficial to use food recipes that suppress
phytate binding to zinc and increase zinc

5

Vegetarian Research Vol. 21 (2020)
bioavailability. Also, vegetarians can relatively
easily supplement zinc through beans, seeds, nuts,
and grains.
4.8. Iodine
Today, the rise in vegetarians may increase theincidence of iodine deficiency [36]. Iodine is an
essential component of fetal neurodevelopment
and thyroid hormone synthesis. Iodine deficiency
causes goiter, hypothyroidism, cretinism, andcognitive
developmental
disorders.
Iodinedeficiency impairs thyroid hormone production,
adversely affects life, especially early in life, andimpairs cognition and growth [37].
Seaweed (such as kelp and wakame) is an
essential iodine source, but its content varies
considerably. Other iodine sources are dairy
products, cereal products, eggs, and significant
iodine source in the American diet [38]. Plant foodcontains a small amount of iodine. But its content
depends on the iodine content in the cultivated soil,
and the fertilizer used [39].

5. Conclusion
Vegetarians need to be aware of ingenuity byknowing nutrition, food science, and culinaryscience. Vegetarians should be mindful of what
nutrients can be deficient and how many nutrients
they can get from what ingredients they are low inby eliminating animal foods.
If you become a vegetarian because of anxiety
about your health, you may notice an
improvement in your physical condition after
eating a vegetarian diet. At that time,
vegetarianism = imprinting of good things may
occur, and it may become a more crude vegetarian
diet that corresponds to delusion. Vegetarians
have fewer smokers and drinkers than nonvegetarians and often develop a lifestyle in which
exercise habits, rest, sleep, and stressmanagement are desirable. Such daily life plays arole in expecting health to be maintained. If
vegetarians are obsessed with stoic psychology,
unaware of nutrients, and eat without meat, fish,
eggs, and dairy products, it can be unhealthy.

6

Continuing an unbalanced vegetarian diet for long
periods can lead to fatigue, weakened skin, hair,nails, and unknowingly developing physical upset.
It is essential to care that many physical changes
and health problems caused by malnutrition
rarely appear as immediate symptoms andgradually affect the body over months to years.
The risk of long-term malnutrition is different
between those who know the weaknesses ofvegetarian diets and how to cover them. The
effects of a vegetarian diet are closely related toyour constitution and past dietary habits.
Whether you are already a vegetarian or juststarting, truly understanding vegetarianism's
nutritional weaknesses helps support yourpositive beliefs and thoughts and get you closer toa better condition.

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Vegetarian Research Vol. 21, 1－8 (2020)
菜食の利点と注意事項
福永健治*
菜食主義者は、タンパク質、いくつかのビタミン、ミネラルおよびn-3系高度不飽和脂肪酸の摂取が不足していると指摘されることがよくある。しかし、菜食主義
者は植物性食品から摂取すべき栄養素に適した食品を選択することもでき、多くの場合、健康を効果的に改善および維持できる。菜食主義者の食事は、心血管疾
患や悪性新生物などの生活習慣病の有病率の低下につながるが、一方で偏った見方もある。一部の人々は、植物性食品が体と環境に適していること、そして動物性
食品は環境に悪く、不健康であると盲目的に信じて、ポピュリズムに流されている。菜食にはさまざまな背景がある。健康のために菜食を実践する場合は、菜食に興味を持ち、栄養学と食品科学についてより深く理解し、科学的な視点を持っている必要がある。 このレ
ビューでは、菜食主義の現状と、菜食主義者が健康的な菜食主義の食事療法を実践するために不可欠な栄養素について概説する。
キーワード：菜食主義・健康・植物性食品・栄養素・利益・生活習慣病*関西大学化学生命工学部 生命・生物工学科
TEL: 06-6368-0875 FAX: 06-6388-8609
E-mail: fukunagk@kansai-u.ac.jp8