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FOOD FOR THOUGHT

Facing the unique challenge

Eat right Have a healthy diet

Vegetarian women face unique nutritional challenges during pregnancy and lactation. In theory, a vegetarian diet is adequate for pregnancy and lactation (the American Dietetic Association endorses this position).

In practice, vegetarian diets are often low in Vitamin D, calcium, Vitamin B-12, protein and iodine. Vegans, who avoid all dairy products, are the most nutritionally challenged.

Here is what a healthful daily diet for a pregnant/lactating woman looks like: two servings of nuts and seeds, two servings of dark green leafy vegetables, three cups of low-fat milk, four servings of bean and soy products, five servings of fresh fruit and vegetables and six or more servings of whole grains. Not many vegetarian women in India achieve such variety in their daily diet, and this is why antenatal nutritional counselling is important. A three-day food diary detailing every food item consumed within the three-day period will help a physician decide the adequacy of a particular diet and the need for supplements.

Calcium: 1000 mg/day is adequate during pregnancy and lactation, but that figure applies to omnivores. Vegetarians should take around 20 per cent more calcium than that recommended for omnivores because plant-based oxalate-rich foods decrease bioavailability of calcium.

Plant foods that are low in oxalate deliver more calcium, and include cabbage, okra, turnip greens and soy products. Vitamin D (5mcg or 200 IU/d) is necessary along with calcium, but vegetarians can get it only from sunlight (dark skinned people need longer exposure), milk, and fortified soy products and cereals. In practice, physicians routinely prescribe calcium and Vitamin D supplements to ensure adequate intake.

Iron: Requirement in pregnancy is 22/mg a day, and 6.5 mg/day during lactation. Phytates in plant foods decrease bioavailability of iron. Coffee, tea, calcium and dietary fibre inhibit iron absorption (hence the required gap of a few hours between calcium and iron supplements), while Vitamin C enhances absorption. Plant foods rich in iron include peas, beans, lentils, spinach, soy products, tofu, whole wheat bread, raisins and dried apricots. Many Indian vegetarians will require iron supplements.

Folic acid and Vitamin B12: Leafy green vegetables, fruits, dried beans, peas and nuts are rich plant sources of folic acid. Daily requirement in pregnancy and lactation are 600 mcg and 800 mcg respectively.

Since the greatest foetal need for folic acid is in the first few weeks of pregnancy, when most women do not even realise they are pregnant, it is prudent for all sexually active women of childbearing age to take a folic acid supplement daily. Among vegetarian foods, only milk contains Vitamin B 12. Fortified plant foods like soymilk, tofu, cereals, and nutritional yeast are alternative sources.

Vegans need Vitamin B12 supplements.

Protein: Plant foods are adequate as long as they are mixed judiciously. Cereals, for example, need the company of beans to make up for their lysine deficiency. Soy foods contain biologically complete protein.

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