Going green? Pop a pill

A vegetarian diet is often lacking in proteins and vitamins, says Paromita Kar

By Paromita Kar
  • Published 25.10.17

What's for dinner? For Arsh Shah, a 23-year-old intern at a law firm in New York in the US, it's usually smoked fish or roast chicken and some greens. Odd, considering that Arsh belongs to the Jain community that is supposed to follow a strictly vegetarian diet. Actually, Arsh was born premature, in the seventh month of his mother's pregnancy, and did not receive the boost of the final weeks in the womb, which is crucial to foetal development. The prescribed diet, however, has helped him overcome many of the health troubles arising from it.

The veg vs non-veg debate is as old as the hills. Some say vegetarianism has its roots in the ancient civilisations of India and Greece. Pythagoras (570-495 BC) is one of the oldest celebrity proponents of vegetarianism. According to the Greek philosopher, a plant-based diet is not only healthier but also a way to avoid animal cruelty. Countless studies have shown that a well-planned, nutritious, vegetarian diet is associated with a lower risk of obesity, heart disease, diabetes, stroke, cholesterol and so on.

All that is true - but only if it is "well-planned and nutritious". A vegetarian diet must be stitched carefully so as to include enough proteins, vitamin B12, calcium, vitamin D and other nutrients.

"Most people are not aware that they could be lacking in nutrients," says Anuja Agarwala, senior dietician at AIIMS, Delhi. For many vegetarians, the primary source of protein is milk, that has first-class proteins. However, the intake is often not enough and protein deficiency is common. "Some of my patients do not even understand what proteins are. They think vegetables and expensive fruits give them proteins!"

A recent survey by the Indian Market Research Bureau, called "Understanding Protein Myths & Gaps among Indians", reveals that people across the country suffer from significant protein inadequacy. The shortfall is more alarming among vegetarians. "Indians suffer from several myths related to protein, one of the fundamental nutrients for the human body," the report said.

There are several vegetarian protein sources - rajma, gram, pulses, soya chunks. "The key is responsible eating," says Dr Sajal Haldar, a Delhi-based plastic surgeon. And vegetarians must take medicinal supplements along with food. "However, nothing compares to the protein quality found in animal flesh," he says. "Proteins are needed to maintain the muscles. Muscle mass decreases with age and this is more pronounced in vegetarians." A vegetarian since his MBBS days at AIIMS, Dr Haldar recently began eating poultry eggs. "That way I feel I am not killing a life," he quips.

Agarwala reveals a curious thing about soy nuggets - often called the vegetarian's meat. Soy contains "trypsin inhibitors" - trypsin is an enzyme that breaks down proteins. She warns that consumption of too much soy hamper the absorption of the very nutrient it is supposed to deliver. Most people are unaware of this.

Vitamin B12 or cobalamin is needed to keep the nerve and blood cells healthy, among other things. It is found naturally in animal products, including milk. "Vitamin B12 deficiency among vegetarians is rampant," says Agarwala, "more so because it has a lower bio-availability." Bioavailability is the proportion of nutrient that actually enters the circulation to be able to have an effect. Lack of vitamin B12 causes anaemia, nerve damage, fatigue, poor memory and confusion, especially in older people. "And if you let it continue, the problems become irreversible," adds Agarwala, who has a way of tackling deficiencies. "If proteins must constitute 12-15 per cent of the diet, for a vegetarian I prescribe 20, because I know the bio-availability is low."

"Vitamin B12 is essential for the maintenance of the myelin sheath -the nerve membrane," explains Dr Prateep Sen, a Calcutta-based medicine specialist. Severe deficiency of it may lead to neuropathy. "It has a similar function in maintaining the mucosal wall of the stomach. Deficiency may lead to thinning of the wall." Dr Sen believes that a deficiency could somewhere be responsible for gastrointestinal conditions like Crohn's disease and celiac disease.

Some, however, beg to disagree. Mayank Jain, who describes himself a "vegan diet fundamentalist", quotes the cases of Carl Lewis and Martina Navratilova who succeeded at the highest level of sports on a vegan diet. His documentary film, The Evidence - Meat Kills, cites medical sources that show the harm caused by eating meat. Jain also rubbishes the superiority of proteins and other nutrients from animal-based food as a myth. Ask him how a vegetarian who does not consume milk would get his or her vitamin B12, he replies, "It should be sufficient if they have chai and mithai," - meaning the milk in their tea and the occasional sweet.

That's quite impossible, refutes Agarwala of AIIMS. "One must take care to evolve an eating pattern that includes enough supplements," she says, adding that sometimes providing for all the nutrients within a person's specific food pattern becomes a challenge for nutritionists.

The general opinion is that vegetarians are less prone to coronary problems. "But they too can be at high risk if there is an excess intake of fatty foods like fried stuff and sweets," says Sheela Krishnaswamy, a diet, nutrition and wellness consultant in Bangalore.

The chorus is clear. The benefits of vegetarianism holds true only if one's diet is healthy and balanced.