25th January 2017

Despite dementia, a vegetarian is still a vegetarian

There have been worrying reports that some staff in care homes may be giving food with meat to vegetarians because with dementia ‘they may not know the difference’.

Yet this is in direct contradiction of Regulation 14 Meeting nutritional and hydration needs ( Health and Social Care Act 2008 (Regulated Activities) Regulations 2014) which clearly states that people's preferences, religious and cultural backgrounds must be taken into account when providing food and drink.

It is currently estimated that there are over 6,500 vegetarians and vegans living in UK care homes. And as well as providing for vegetarian or vegan service users,  it is also important that their nutrient needs are met, and adequate vegetarian or vegan choices are provided.

What do vegetarians eat?

There are a number of reasons why someone chooses to be vegetarian or vegan. It could be because of a personal belief in supporting animal welfare and/or the environment or for health, religious, spiritual and moral beliefs.

There are different types of vegetarians, but all vegetarians avoid eating meat. Many avoid animal by-products such as gelatine and most will also avoid eating fish and seafood as well. Whilst vegetarians typically include eggs and dairy, vegans strictly do not eat any products of animal origin. This can even include honey.

Poorly planned vegan and vegetarian diets will be at risk of being inadequate as much as poorly planned non-vegetarian menus. One of the important concerns with vegetarian and vegan catering is that that the foods provided are a poor alternative to the meat or fish dish. When, for example, a shepherd’s pie is being served, rather than serving a cheese/houmous sandwich, a more appropriate vegetarian or vegan alternative could include the pie made with soy mince or with a variety of beans and veg.

Another consideration is to ensure vegetarian and vegan alternatives are nutritionally adequate, particularly in light of some of the prominent health concerns for residents in care homes such as ensuring bone and muscle strength.

Meeting Protein Needs

Although in the general vegetarian and vegan population, protein intake is adequate, for older frail populations with poor appetite, which is common in care homes, protein intake may be lower. There is emerging research that suggests protein intake should be increased in this vulnerable group.  Decreases in total body protein can lead to increased frailty, impaired wound healing, and decreased immune function.

In comparison to meat eaters, vegetarian and vegan service users in care homes may need to be careful about the quality and variety of plant protein they consume. There is a need to include plant protein sources like beans, lentils and peas, soy and nuts in such diets. Variety is important as consuming a range of different plant proteins (in grains and in legumes) will help ensure all the essential amino acids are provided. Amino acids are the building blocks of protein and essential amino acids are those that the body cannot make itself and so are needed from the diet.

If a varied diet is provided, vegetarian and vegan diets can provide all the nutrients needed to be healthy. However, there are some nutrients that may be harder to get from a vegetarian or vegan diet. These include calcium, omega-3 fatty acids and vitamin B12.

Bone Protection and Calcium

An important concern particularly among older women—vegetarians and non-vegetarians alike—is maintaining healthy bone. We lose bone mass as we age. After the menopause, women are at a higher risk of osteoporosis (thinning of the bones) and reduced bone density because less of the hormone oestrogen (which has a bone protective effect) is produced. As a result, it is particularly important that older women get plenty of calcium from their diets. For vegetarians who eat dairy, milk, cheese and yoghurt are rich sources of calcium, but there are also calcium sources appropriate for vegans including some green leafy vegetables like kale, calcium fortified soya, nut, rice and oat drinks, bread, dried fruit, dark and sesame seeds.

Plant-Based Omega-3 Fatty Acids

A body of evidence indicates that the long chain omega-3 fatty acids found in oily fish may have numerous potential health benefits, including helping to prevent heart disease and strokes. The intake of these omega-3 fatty acids may be low in vegetarians and vegans who avoid fish altogether. However, alpha-linolenic acid (ALA), a plant-based shorter omega-3 fatty acid found in rapeseed oils, walnuts, flaxseeds, and soy-based foods, can be converted to the longer chain omega-3 in the body, though at low levels. It should also be noted that a nutritious vegetarian/vegan diet with plenty of wholegrains, fruit and vegetables and pulses will contain heart-protective nutrients.

Vitamin B12 Boost

Vitamin B12 plays a major role in metabolism, maintenance of the nervous and immune system, cell division and psychological function. But this essential nutrient is found specifically in animal products, such as fish, meat, poultry, eggs, milk, and other dairy products; it is generally not naturally found in plant foods. Vitamin B12 is available in a few fortified foods like breakfast cereals and yeast extract but if service users are strictly vegan it may be prudent to ask a health professional about the potential benefit of including vitamin B12 supplements as part of their care.

Finding Balance

When we look at the scientific evidence on plant-based diets, vegetarian and vegan diets have been associated with health benefits but also with potential risks. A balanced diet is key, and this implies a diet plan that is not overly restrictive and encompasses variety from all the food groups. It is also important to ensure adequate calories are provided when vegetarian or vegan menus are planned.

*All information is correct at the time of publishing

Ayela Spiro

Nutrition Science Manager, British Nutrition Foundation

Ayela is a nutrition scientist at the British Nutrition Foundation, where her role involves providing expert advice on nutrition and health issues to a number of key audiences including consumers, health professionals, charities, the media and the food industry. At the heart of her work is the communication of nutrition science that promotes understanding of nutrition and health and contributes to the improved wellbeing of all.

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