Educational resource
Practical tips for preparing healthy and delicious
plant-based meals
I
t is not only what a diet excludes, but what it includes, Sue Radd
BSc(Nutr), GradDipDiet,
that shapes health outcomes. This article is a practical APD,
guide for doctors to help them advise patients on Founding Director and
Lead Dietitian 1
nutrient-rich foods, which should form the basis of all
types of plant-based diets. Of the recognised types of Kate A Marsh
AdvAPD,
plant-based diets (Box 1), the most widely studied is the MNutrDiet, PhD,
lacto-ovo-vegetarian diet. Director and
Senior Dietitian 2
1 Nutrition and Wellbeing
Key points about plant-based diets Clinic, Sydney, NSW.
MJA Open ISSN: 0025-729X 4 June 2012 1 2 41- 2 Northside Nutrition and
Dietetics, Sydney, NSW.
• Plant-based
45 diets focus on fruits, vegetables, legumes,
nuts, ©MJA Opengrains.
seeds and 2012 www.mja.com.au
Some vegetarian diets also sradd@
ozemail.com.au
includeMJA Open
eggs and dairy, and a few traditional (eg,
Mediterranean and Asian) plant-based diets include
doi: 10.5694/mjao11.11511
limited amounts of meat and/or seafood.
• A varied and balanced plant-based diet can provide all
of the nutrients needed for good health (Box 2 ).2
• Plant-based diets may provide health benefits compared
with meat-centred diets, including reduced risks of
developing chronic diseases such as obesity, heart
disease, colorectal cancer and type 2 diabetes.1
• Plant-based diets more closely match recommended
dietary guidelines to eat plenty of fruits, vegetables,
legumes and wholegrains, and to limit intakes of
saturated fats and sugars.3
• A 2010 national Newspoll survey of 1200 adults
indicated that 70% of Australians consume some plant-
based meals in the belief that eating less meat and more
plant foods improves overall health (Newspoll
Research, Leaders in Nutrition, May 2010, com-
missioned by Sanitarium Health and Wellbeing).
• A vegetarian diet does not mean just cutting out meat.
Careful planning, along with knowledge of practical
ideas for using a variety of plant foods, is needed to
ensure nutritional requirements are met, particularly for
new vegetarians or those with special needs.
• Nutrients that may need more attention in a vegetarian
diet include iron, zinc, calcium, vitamin B12, vitamin D
and omega-3 fats. It may be beneficial to refer people to
an Accredited Practising Dietitian experienced in
vegetarian nutrition.
• Any dietary change can increase preparation time to
begin with, but cooking plant-based meals need not be
more time consuming after some training and regular
practice.
• A minimally processed plant-based diet, with limited (if
any) amounts of animal foods derived from animals
lower down the food chain, provides environmental
advantages over a Western-style meat-rich diet.4-6
MJA Open 1 Suppl 2 · 4 June 2012 41
Educational resource
1 Types of plant-based diets1
Semi-vegetarian: includes red meat, poultry and fish less than once a week.
Pesco-vegetarian: includes fish and seafood but no red meat or chicken.
Lacto-ovo-vegetarian: includes dairy foods, eggs, or both, but no red meat, poultry or
seafood. This is the most common type of vegetarian diet.
Vegan: excludes all animal products including meat, poultry, seafood, eggs and dairy foods.
Most vegans also won’t use honey or other animal products. ◆
2 Sources of key nutrients in a vegetarian or vegan diet*
Nutrient Food source
Protein Legumes, tofu, soy milk, tempeh, gluten, wholegrains (particularly
amaranth and quinoa), nuts, seeds, eggs, milk, yoghurt
Iron† Legumes/soybeans, wholegrains (particularly amaranth and quinoa),
iron-fortified cereals, tofu, tempeh, dried fruit, nuts, seeds, green leafy
vegetables
Zinc Wholegrains, legumes, tofu, nuts, seeds, tempeh, eggs, milk, yoghurt
Calcium Milk, yoghurt, cheese, calcium-fortified soy, rice or oat milk, calcium-set
tofu, unhulled tahini, kale, Asian green vegetables, almonds
Vitamin B12‡ Milk, yoghurt, cheese, eggs, vitamin B 12-fortified soy or rice milk, vitamin
B12-fortified meat analogues (eg, some vegetarian sausages and burgers)
Omega-3 fats Flaxseed oil,§ linseeds/flaxseeds,§ chia seeds,§ walnuts,§ soy foods,§
omega-3 eggs and DHA-fortified foods (eg, breads, yoghurts, orange
juice)
Vitamin D Milk, eggs, vitamin D-fortified soy milk, vitamin D mushrooms
DHA = docosahexaenoic acid.
* Amounts of each food required each day will vary for individuals depending on age and sex and,
for women, whether they are pregnant or breastfeeding. Various health conditions or the use
of certain medications may also affect requirements for particular nutrients. † Non-haem iron,
the absorption of which is improved in the presence of vitamin C and inhibited by phytates and tannins.
‡ Mushrooms are not a reliable source as they provide only trace amounts. § ␣-linolenic acid (ALA) is
converted to the long-chain omega-3 fatty acids in the body; this conversion is improved with a diet low in
omega-6 polyunsaturated fats and trans fats. ◆
MJA Open 1 Suppl 2 · 4 June 2012 41
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Box 3 Glossary of protein-rich plant food
There are many protein-rich plant foods available, including whole foods such as legumes, traditional products like tofu, and faux meats, which can make transition to
a plant-based diet easier and more convenient.
Food Description and additional information
Legumes Dry beans, peas or lentils available in hundreds of varieties (eg, chickpeas, borlotti beans, black beans, puy lentils, lima beans). Many
canned varieties are available from supermarkets.
Textured vegetable A good substitute for mince when making bolognaise sauce, shepherd’s pie or taco filling. Made from soy flour, TVP is dehydrated and
protein (TVP) resembles mince crumbles or chunks. It can be stored in the pantry for many months.
Tofu This is available in different textures (silken, soft and firm) and can be cut to desired size. It is excellent for curries, stir fries, burgers, creamy
dressings or dessert. Also known as bean curd, tofu is made by curdling soy milk.
Tempeh This is a savoury fermented soybean cake that can be sliced or diced then grilled, baked or pan fried.
Gluten Also known as seitan, gluten has a meaty texture and can be used in stir fries and casseroles or crumbed and cooked as schnitzel. It is
available canned or fresh from Asian stores or can be made at home from gluten flour.
Convenience vegetable These are made from soy, nuts, gluten and grains. They are available canned, chilled, frozen or shelf-stable. Most are ready to heat and
protein products serve or can be used as ingredients in other dishes. Many have high levels of sodium, and so are not ideal for everyday use. ◆
48 MJA Open 1 Suppl 2 · 4 June 2012
Common myths about vegetarian diets
Myth: it is difficult to get enough protein on a
vegetarian diet
Studies of Australian vegetarians have found that
although their protein intakes are significantly lower
than those of omnivores,7,8 their intakes still easily meet
recommended dietary intakes (RDIs) because most
omnivores eat much more protein than is required. Most
plant foods contain some protein, with the best sources
being legumes, soy foods (including soy milk, tofu and
tempeh), nuts and seeds. Grains and vegetables also
provide protein. A glossary of protein-rich plant-based
foods is provided in Box 3.
Myth: vegetarians need to combine proteins at meals
As most plant foods contain limited amounts of one or
more essential amino acids it was once thought certain
combinations had to be eaten at the same meal to
ensure sufficient essential amino acids. Research has
found that strict protein combining at each meal is
unnecessary, provided energy intake is adequate and a
variety of plant foods are eaten over the course of a day,
including legumes, wholegrains, nuts and seeds, soy
products and vegetables.9 Soy protein is a complete
protein as it has a Protein Digestibility-Corrected
Amino Acid Score (PDCAAS) equivalent to that of
eggwhite or dairy protein (casein). 10
to vegetarian mothers.18 The higher fibre content and
Myth: vegetarians need to take an iron supplement lower energy density of many vegetarian diets may offer
Vegetarian diets can contain as much or more total significant advantages, including a reduced risk of
(non-haem) iron as mixed diets; this iron comes excess weight gain.19 Further, some studies suggest that
primarily from wholegrain breads and cereals.11,12 Iron a lower intake of meat and dairy products reduces the
deficiency anaemia is not more common among pesticide content of breast milk.20,21
vegetarians, although their iron stores (serum ferritin
Myth: vegetarian diets are not suitable for children
levels) are often lower.7,12,13 Some studies have found
Vegetarian diets are appropriate for children of all ages.2
that lower iron stores are associated with reduced risk of
The growth of vegetarian and vegan children is similar
chronic diseases (such as cardiovascular disease and
to that of non-vegetarian children if meals are planned
type 2 diabetes), which may partly explain the lower risk
well, according to the American Academy of Pediatrics22
of these diseases in vegetarians. 14,15
and American Dietetic Association.2
Myth: dairy foods are the only good source of calcium.
Dairy products are not the only sources of calcium in the Meal planning
diet. Fortified soy, rice and oat milks, unhulled tahini,
Asian greens, almonds and calcium-set tofu are good As for all healthy diets, meal planning for plant-based diets
sources of bioavailable calcium in non-dairy diets.16,17 should focus on incorporating a wide variety of minimally
Calcium needs can be met using plant foods as long as processed foods from each of the main food groups to
adequate amounts of these foods are consumed each day. ensure a plentiful supply of nutrients and phytonutrients.
The Healthy Eating Plate device (Box 4) has been created
Myth: vegetarian diets are not suitable during as a visual guide for planning plant-based meals at home.
pregnancy Vegetables and/or salads: these should include
Vegetarian diets can be planned to supply the required vegetables of a variety of colours, and should fill half of a
levels of nutrients during pregnancy. Research shows main meal plate.
there are no significant health differences in babies born
42 MJA Open 1 Suppl 2 · 4 June 2012
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46 MJA Open 1 Suppl 2 · 4 June 2012
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MJA Open 1 Suppl 2 · 4 June 2012 47
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4 The Healthy Eating Plate device 5 Some delicious plant-based meal and snack ideas
Breakfast ideas
• Bircher muesli with yoghurt and berries
Healthy Eating Plate • Soy and linseed bread with almond spread
• Fruit salad with low-fat yoghurt and a sprinkle of natural muesli
• Toasted rye sourdough with ricotta, fresh tomato and oregano
Dairy
Fruit or fortified • Smooth polenta porridge with soy milk
mostly whole Soy • Baked beans on wholegrain English muffins
• Homemade carrot, rosemary and zucchini muffins with chia
seeds
Whole
grains • Millet with macadamia nuts, currants and low-fat milk
Veges or
Salads Plant Lunch ideas
Proteins • Vietnamese rice paper rolls filled with vegetables, tofu and
fresh herbs
• Vegetable frittata with mixed green leaves
• Falafel roll with hummus, tabouli, tomato and lettuce
• Mixed bean and pasta salad with lemon
• Homemade mini pizzas with Mediterranean vegetables
• Wholegrain egg and lettuce sandwich
Wholegrains: these are preferred over refined grain foods • Lentil burger with baby spinach, tomato, beetroot and
(eg, brown rice instead of white rice), and can occupy caramelised onion
about a quarter of a main meal plate. When choosing grain • Jacket potato with spicy bean mix, coleslaw and fresh avocado
topping
foods, choose those with a low glycaemic index (GI). Low
GI carbohydrates help to regulate blood glucose and Dinner ideas
insulin levels, lower the levels of low-density lipoproteins • Vegetable stir fry with tempeh, hokkien noodles and satay
and triglycerides and raise the high-density lipoprotein sauce
level, and can assist with weight management.23-25 • Spaghetti with red wine and cinnamon bolognaise sauce (made
with textured vegetable protein)
Plant proteins: from sources such as legumes, nuts, seeds, • Three-bean dhal with steamed brown rice and minted cucumber
soy products or vegetarian convenience products should raita
occupy about a quarter of a main meal plate. Semi-vegetarians • Spinach and ricotta cannelloni with fresh cabbage, carrot and
may sometimes substitute fish, poultry or red meat. shallot salad
• Lentil shepherd’s pie with tossed salad
Dairy or calcium-fortified soy, rice or oat products: • BBQ tofu and vegetable kebabs with wild rice salad and wasabi
these may be liquids or solids, and consumed as a side dish dressing
or integrated into the contents of a main meal plate. Lower • Moroccan chickpea and vegetable tajine with quinoa
fat varieties are preferable. The lower protein content of • Crumbed gluten (seitan) schnitzel with cauliflower mash,
rice and oat beverages may not be suitable for infants and pumpkin and broccolini with almonds
young children. Snack ideas
Fruit: this is best eaten whole with the skin (rather than • Fresh fruit in season
juiced), and consumed as a dessert or snack. • Low-fat dairy or calcium-fortified soy yoghurt
While it is desirable to plan to include all of these • Handful of almonds or cashews
components in each meal, different cooking styles and • Few dried figs or prunes
cuisines may determine the composition of a meal and • Milo made with low fat milk
• Fresh cob of corn or popcorn
whether the recommended balance of nutrients is eaten at
• Roasted soy nuts or chic nuts (roasted chickpeas)
each meal or spread over the meals for the day. • Wholemeal pita pocket with hummus and cherry tomatoes
Easy meal ideas for main plates and snacks are provided • Berry and banana soy smoothie with ground linseeds/flaxseeds
in Box 5, and Healthy Eating Plate images for main courses • Sweet potato in its jacket ◆
are shown in Box 6.
• Vegetarian cheese, dairy-free margarine/chocolate or
Shopping tips frozen convenience meals may sound healthy, but many
can hide excess kilojoules, fat, sugar or salt.
• When choosing alternatives to dairy foods (eg, soy or
rice milk), look for products enriched with calcium and
Seven cooking tips
vitamin B12.
• Tofu, tempeh, Quorn (meat-free, soy-free products
1. Enrol in a cooking class to improve your culinary skills
based on high-quality mycoprotein), textured vegetable
and increase dietary variety.
protein, canned and frozen or chilled convenience
products (eg, Sanitarium Vegie Delights, Fry’s 2. Plan meals that you know you can easily prepare for
Vegetarian foods and Syndian Natural Food Products) several days of each week to help you avoid buying
are available in most supermarkets. takeaway meals.
• Many varieties of legumes and wholegrains are available 3. Stock your pantry with a flexible range of ingredients, with
in Asian, Indian and health food shops. an emphasis on whole foods to make it easy to prepare a
MJA Open 1 Suppl 2 · 4 June 2012 43
Educational resource
6 Healthy Eating Plate images for main courses
meal (eg, wholegrain spaghetti, canned brown lentils and 7. Choose cooking oils that have high levels of omega-9
a tomato-based pasta sauce for spaghetti bolognaise). (eg, extra virgin olive oil, macadamia oil) or omega-3
4. Invest in a pressure cooker to cook legumes and (eg, canola oil) fatty acids. Do not heat flaxseed oil or
wholegrains quickly, or a slow cooker to cook them chia oil (because they have a very high omega-3 fatty
overnight on low heat. acid content making them highly prone to oxidation),
and store in the fridge.
5. Freeze portion-sized quantities of homemade leftover
soups, stews and curries for easy lunches.
6. Shell your own walnuts (these are rich in ␣-linolenic Supplements
acid, making them highly prone to oxidation on
exposure to oxygen) and store nuts and seeds in the It is not necessary for people to take supplements routinely
fridge or freezer to extend shelf life. just because they follow a plant-based diet. However,
44 MJA Open 1 Suppl 2 · 4 June 2012
Educational resource
8 Wilson AK, Ball MJ. Nutrient intake and iron status of Australian male
7 Resources vegetarians. Eur J Clin Nutr 1999; 53: 189-194.
9 Young VR, Pellett PL. Plant proteins in relation to human protein and amino
• Free images of the Healthy Eating Plate device and sample plant-based food plates acid nutrition. Am J Clin Nutr 1994; 59 (5 Suppl): 1203S-1212S.
developed by the first author can be downloaded in full colour and high-resolution for 10 Sarwar G, McDonough FE. Evaluation of protein digestibility — corrected
educational purposes (www.sueradd.com/resources/healthyeatingplate.html). amino acid score method for assessing protein quality of foods. J Assoc
Off Anal Chem 1990; 73: 347-356.
• For one-on-one dietary advice, find an Accredited Practising Dietitian with expertise in 11 Davey GK, Spencer EA, Appleby PN, et al. EPIC-Oxford: lifestyle
vegetarian nutrition (www.daa.asn.au). characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and
31 546 non meat-eaters in the UK. Public Health Nutr 2003; 6: 259-269.
• Nutrition information, recipes, cooking classes and forums can be found at the Australian 12 Hunt JR. Bioavailability of iron, zinc, and other trace minerals from
Vegetarian Society (www.veg-soc.org). vegetarian diets. Am J Clin Nutr 2003; 78 (3 Suppl): 633S-639S.
13 Alexander D, Ball MJ, Mann J. Nutrient intake and haematological status
• Sanitarium Health & Wellbeing Australia website (www.sanitarium.com.au) provides an
of vegetarians and age–sex matched omnivores. Eur J Clin Nutr 1994; 48:
abundance of free vegetarian recipes and other practical information. ◆ 538-546.
14 Rajpathak SN, Crandall JP, Wylie-Rosett J, et al. The role of iron in type 2
diabetes in humans. Biochim Biophys Acta 2009; 1790: 671-681. Epub 2008
depending on dietary restrictions, health, and stage of life, May 2003.
certain supplements may be beneficial. For example, those 15 Sun L, Franco OH, Hu FB, et al. Ferritin concentrations, metabolic
syndrome, and type 2 diabetes in middle-aged and elderly chinese.
eating a vegan or low-dairy diet should ensure a sufficient J Clin Endocrinol Metab 2008; 93: 4690-4696. Epub 2008 Sep 16.
intake of foods fortified with vitamin B12 or take a 16 Weaver CM, Proulx WR, Heaney R. Choices for achieving adequate dietary
supplement that provides at least the RDI of vitamin B12. calcium with a vegetarian diet. Am J Clin Nutr 1999; 70: 543S-548S.
17 Weaver C, Plawecki K. Dietary calcium: adequacy of a vegetarian diet.
Patients beginning a plant-based diet should see their Am J Clin Nutr 1994; 59: 1238S-1241S.
doctor or an Accredited Practising Dietitian for further 18 Mangels R, Messina V, Messina M. The dietitian’s guide to vegetarian diets:
issues and applications. 3rd ed. Sudbury, Mass: Jones & Bartlett Learning,
advice on their individual supplement needs. In some 2011.
cases, high doses of supplements may be harmful. 19 Stuebe AM, Oken E, Gillman MW. Associations of diet and physical activity
during pregnancy with risk for excessive gestational weight gain.
Am J Obstet Gynecol 2009; 201: 58.e1-8. Epub 2009 May 21.
20 Dagnelie PC, van Staveren WA, Roos AH, et al. Nutrients and contaminants
Conclusion in human milk from mothers on macrobiotic and omnivorous diets. Eur J
Clin Nutr 1992; 46: 355-366.
21 Patandin S, Dagnelie PC, Mulder PG, et al. Dietary exposure to
There are many health benefits from eating a plant-based polychlorinated biphenyls and dioxins from infancy until adulthood: a
diet, but, as with any eating plan, it is important that it is comparison between breast-feeding, toddler, and long-term exposure.
Environ Health Perspect 1999; 107: 45-51.
well planned to ensure that nutritional needs are met. In 22 Committee on Nutrition AAoP. Pediatric nutrition handbook. 6th ed. Elk
this article, we provide a basic guide to preparing healthy Grove Village, IL: American Academy of Pediatrics, 2009.
23 Livesey G, Taylor R, Hulshof T, Howlett J. Glycemic response and health — a
plant-based meals that incorporate key nutrients. It is systematic review and meta-analysis: relations between dietary glycemic
intended as a starting point, as individual needs will vary. properties and health outcomes. Am J Clin Nutr 2008; 87: 258S-268S.
24 Opperman AM, Venter CS, Oosthuizen W, et al. Meta-analysis of the health
An Accredited Practising Dietitian can help develop an effects of using the glycaemic index in meal-planning. Br J Nutr 2004; 92:
eating plan specific to individual needs. 367-381.
25 Thomas DE, Elliott EJ, Baur L. Low glycaemic index or low glycaemic load
This practical paper is intended for use in patient diets for overweight and obesity. Cochrane Database Syst Rev 2007; (3):
education and may be reproduced for this purpose. CD005105. ❏
Additional resources are shown in Box 7. For further details
on the scientific evidence behind these recommendations
please see the other articles in this supplement.
Acknowledgements: We thank Anna Minko for assistance with graphic
design and Greg Teschner for food photography.
Competing interests: Sue Radd previously consulted for Sanitarium
Health and Wellbeing, sponsor of this supplement. Kate Marsh previously
consulted for Nuts for Life (Horticulture Australia), who are providing a
contribution towards the cost of publishing this supplement.
Provenance: Commissioned by supplement editors; externally peer
reviewed.
1 Fraser GE. Vegetarian diets: what do we know of their effects on
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2 Craig WJ, Mangels AR. Position of the American Dietetic Association:
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3 Farmer B, Larson BT, Fulgoni VL 3rd, et al. A vegetarian dietary pattern
as a nutrient-dense approach to weight management: an analysis of the
national health and nutrition examination survey 1999–2004. J Am Diet
Assoc 2011; 111: 819-827.
4 Carlsson-Kanyama A, Gonzalez AD. Potential contributions of food
consumption patterns to climate change. Am J Clin Nutr 2009; 89:
1704S-1709S. Epub 2009 Apr 1.
5 Marlow HJ, Hayes WK, Soret S, et al. Diet and the environment: does what
you eat matter? Am J Clin Nutr 2009; 89: 1699S-1703S. Epub 2009 Apr 1.
6 McMichael AJ, Powles JW, Butler CD, Uauy R. Food, livestock production,
energy, climate change, and health. Lancet 2007; 370: 1253-1263.
7 Ball MJ, Bartlett MA. Dietary intake and iron status of Australian vegetarian
women. Am J Clin Nutr 1999; 70: 353-358.
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48 MJA Open 1 Suppl 2 · 4 June 2012
