Vegetarian nutrition

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A variety of vegetarian, and more specifically vegan, foods Vegetarian diet.jpg
A variety of vegetarian, and more specifically vegan, foods

Vegetarian nutrition is the set of health-related challenges and advantages of vegetarian diets.

Contents

Appropriately planned vegetarian diets are healthful and nutritionally adequate for all stages of the human life cycle, including during pregnancy, lactation, infancy, childhood, and adolescence. [1] However, vegetarian diets deficient in vitamin B12 or calories may compromise children's health and development. [1] [2] The UK National Health Service recommends that vegetarian diets should also follow the general recommendations for healthy diets, such as low fat, salt and sugar intakes and 5 fruits or vegetables a day. [3] Qatar's public health ministry states, "One cannot be a healthy vegetarian by going to a fast food restaurant and ordering french fries and soda!". [4]

Vegetarian diets tend to be rich in carbohydrates, omega-6 fatty acids, dietary fibre, carotenoids, folic acid, vitamin C, vitamin E, potassium and magnesium. They are possibly low in saturated fat, cholesterol, and animal protein.

Critical nutrients

Protein

Red beans and rice Red Beans and Rice.jpg
Red beans and rice

Despite the long-standing, widespread belief that vegetarians must consume grains and beans within a short time to make a complete protein that contains all 9 essential amino acids that must be supplied through diet, this has never been substantiated by research. The protein-combining theory was brought to popular attention after being promoted in Frances Moore Lappé's 1971 bestselling book Diet for a Small Planet . In later editions of the book, starting in 1981, Lappé withdrew her contention that protein combining is necessary. [5]

Plant foods rich in protein include soy beans and soy products such as tofu, veggie burgers, and soy milk; other legumes; nuts and seeds; and cereal grains. [6]

Vitamin B12

Vitamin B12 deficiency can be extremely serious and lead to megaloblastic anemia, nerve degeneration and irreversible neurological damage. [7]

Vegetarians may get vitamin B12 from eggs and dairy products (milk, cheese, etc.); [8] for some, this is adequate, while others may still remain B12-deficient. [1] More broadly, according to the Academy of Nutrition and Dietetics, even the form of vitamin B12 sourced from animal products is protein-bound and not as easily digested as supplements, especially as people age, and therefore B12 supplementation is recommended for everyone over the age of 50. [1] Pregnant and lactating vegetarian mothers—and breastfed infants if the vegetarian mother's diet is not supplemented—should also use supplements, whether B12-pills, B12-injections, or B12-fortified foods, if they don't get adequate vitamin B12 from animal products like eggs or dairy.

Eggs are a source of vitamin B12 for vegetarians. Huehnereier 2989.jpg
Eggs are a source of vitamin B12 for vegetarians.

Generally, humans need 2.4 to 3 micrograms of vitamin B12 each day. [8] There are cases to suggest that vegetarians and vegans who are not taking vitamin B12 supplements or food fortified with B12 do not consume sufficient servings of B12 and have abnormally low blood concentrations of vitamin B12. [9] This is because, unless fortified, plant foods do not contain reliable amounts of active vitamin B12. [1]

It is essential, therefore, that vegetarians consume adequate amounts of dietary supplements or foods that have been fortified with B12, such as vegetable stock, veggie burger mixes, textured vegetable protein, soy milks, vegetable and sunflower margarines, and breakfast cereals. [7] B12 used in these foods or supplements is typically grown from vegan sources (such as bacteria). Soybeans and barley seeds from plants grown in soils amended either with cow dung (which is rich in B12) or with pure B12 had a higher B12 content than those grown without this supplementation. [10]

Omega-3 fatty acids

Flaxseeds are a rich source of ALA, but contains negligible amounts of DHA and EPA, the long-chain omega-3 fatty acids the FDA considers to be healthful. Flax seeds.jpg
Flaxseeds are a rich source of ALA, but contains negligible amounts of DHA and EPA, the long-chain omega-3 fatty acids the FDA considers to be healthful.

Vegetarian diets can be low in omega-3 fatty acids (O3FAs). Major vegetarian O3FA sources include algae, hempseeds and hempseed oil, walnuts, flaxseeds and flaxseed oil, olive oil, canola oil, avocado, and chia seeds.[ citation needed ]

A potential problem is that vegetarian diets lacking eggs or generous amounts of edible seaweed generally lack a direct source of long-chain O3FAs such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Vegetarian diets may also have a high ratio of omega-6 fatty acids to O3FAs, which inhibits the conversion of short-chain fatty acids such as alpha-Linolenic acid (ALA), which is found in most vegetarian O3FA sources, to EPA and DHA. [1] Short-term supplemental ALA has been shown to increase EPA levels but not DHA levels, suggesting poor conversion of the intermediary EPA to DHA. [11] To remedy this, DHA and EPA supplements derived from microalgae are available. [1] [12]

A 2022 review found that microalgal oil supplementation is consistent in increasing DHA and EPA levels, whilst high dose flaxseed or echium seed oil supplements provide no increase despite significant increases in ALA levels. [12]

Walnuts are a source of omega-3 fatty acids. English Walnuts.jpg
Walnuts are a source of omega-3 fatty acids.

Calcium

In general, lacto-ovo-vegetarians have a relatively high intake of calcium that meet or exceed calcium recommendations. [13]

A 2022 review found no significant difference in calcium intake between vegetarians and omnivores. [14] Vegetarians can obtain calcium from dairy products, calcium-fortified plant milks, almonds, figs, oranges, calcium-set tofu as well as low-oxalate vegetables such as bok choy, kale and turnip greens. [13]

Compared with omnivores, vegetarians tend to have a lower bone mineral density (BMD) but not a higher fracture rate. [15] [16]

Iron

Vegetarians are more likely to have lower iron stores compared with non-vegetarians and have a higher risk of iron deficiency anemia. [17] [18] [19] Lacto-ovo-vegetarians that overly rely on dairy consumption may lead to an elevated calcium intake which can affect iron absorption. [20]

Tofu, a soy product, can be a valuable source of not only iron, but also protein, zinc and calcium for vegetarians. Tofu-beijingchina.jpg
Tofu, a soy product, can be a valuable source of not only iron, but also protein, zinc and calcium for vegetarians.

The recommended iron intake for vegetarians is 180% that of nonvegetarians due to the bioavailability of non-heme iron. [13] Although a lower percentage of non-heme iron is absorbed by the body, greater total amounts of non-heme iron are concentrated in many non-meat sources of iron, and therefore breakfast cereals, eggs, nuts, seeds, and legumes (including soy foods, peas, beans, chickpeas, and lentils) are significant sources of iron, and a well-planned vegetarian diet should not lead to iron deficiency. [13] [21] [22]

Non-heme iron is more sensitive to both inhibitors and enhancers of iron absorption: Vitamin C is an iron absorption enhancer; the main inhibitors for most people are phytates (e.g. legumes and cereal grains), but other inhibitors include tannins (from tea and wine), calcium, and polyphenols. [1]

Iron is an integral part in the chemical structure of many proteins and enzymes, which maintain good health. In humans, iron is an essential component of proteins involved in the transport of oxygen of red blood cells. Iron also helps regulate cell growth and cellular differentiation. [23]

Zinc

A 2013 review found that zinc intake and serum zinc concentrations were significantly lower in populations that follow vegetarian diets compared with non-vegetarians. [24]

Phytates in many whole grains, and dietary fiber in many plant foods may interfere with zinc absorption, and marginal zinc intake has poorly understood effects. Vegetarians may need more than the US Recommended Daily Allowance of 15 mg of zinc each day to compensate if their diet is high in phytates. [1] Major plant sources of zinc include cooked dried beans, edible seaweed, fortified breakfast cereals, soy products, nuts, peas, and seeds. [1]

Iodine

One study reported a "potential danger of [iodine] (I) deficiency disorders due to strict forms of vegetarian nutrition, especially when fruits and vegetables grown in soils with low [iodine] levels are ingested." [25] Iodine, however, is usually supplied by iodized salt and other sources in first world countries. Other significant vegetarian sources of iodine include edible seaweed and bread made with dough conditioners. [1]

Health effects

Evidence suggests that vegetarian diets have beneficial effects on blood lipids and that vegetarians have a reduced risk of cancer, cardiovascular disease, hypertension and type 2 diabetes. [19] [26] [27] [28]

See also

Related Research Articles

<span class="mw-page-title-main">Fruitarianism</span> Choosing to eat primarily fruits

Fruitarianism is a diet that consists primarily of consuming fruits and possibly nuts and seeds, but without any animal products. Fruitarian diets are subject to criticism and health concerns.

Omega−3 fatty acids, also called omega−3 oils, ω−3 fatty acids or n−3 fatty acids, are polyunsaturated fatty acids (PUFAs) characterized by the presence of a double bond three atoms away from the terminal methyl group in their chemical structure. They are widely distributed in nature, being important constituents of animal lipid metabolism, and they play an important role in the human diet and in human physiology. The three types of omega−3 fatty acids involved in human physiology are α-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). ALA can be found in plants, while DHA and EPA are found in algae and fish. Marine algae and phytoplankton are primary sources of omega−3 fatty acids. DHA and EPA accumulate in fish that eat these algae. Common sources of plant oils containing ALA include walnuts, edible seeds, and flaxseeds as well as hempseed oil, while sources of EPA and DHA include fish and fish oils, and algae oil.

<span class="mw-page-title-main">Vegetarianism</span> Abstaining from the consumption of meat

Vegetarianism is the practice of abstaining from the consumption of meat. It may also include abstaining from eating all by-products of animal slaughter. A person who practices vegetarianism is known as a vegetarian.

<span class="mw-page-title-main">Folate</span> Vitamin B9; nutrient essential for DNA synthesis

Folate, also known as vitamin B9 and folacin, is one of the B vitamins. Manufactured folic acid, which is converted into folate by the body, is used as a dietary supplement and in food fortification as it is more stable during processing and storage. Folate is required for the body to make DNA and RNA and metabolise amino acids necessary for cell division and maturation of blood cells. As the human body cannot make folate, it is required in the diet, making it an essential nutrient. It occurs naturally in many foods. The recommended adult daily intake of folate in the U.S. is 400 micrograms from foods or dietary supplements.

A nutrient is a substance used by an organism to survive, grow and reproduce. The requirement for dietary nutrient intake applies to animals, plants, fungi and protists. Nutrients can be incorporated into cells for metabolic purposes or excreted by cells to create non-cellular structures such as hair, scales, feathers, or exoskeletons. Some nutrients can be metabolically converted into smaller molecules in the process of releasing energy such as for carbohydrates, lipids, proteins and fermentation products leading to end-products of water and carbon dioxide. All organisms require water. Essential nutrients for animals are the energy sources, some of the amino acids that are combined to create proteins, a subset of fatty acids, vitamins and certain minerals. Plants require more diverse minerals absorbed through roots, plus carbon dioxide and oxygen absorbed through leaves. Fungi live on dead or living organic matter and meet nutrient needs from their host.

Vitamin deficiency is the condition of a long-term lack of a vitamin. When caused by not enough vitamin intake it is classified as a primary deficiency, whereas when due to an underlying disorder such as malabsorption it is called a secondary deficiency. An underlying disorder can have 2 main causes:

<span class="mw-page-title-main">Dietary supplement</span> Product providing additional nutrients

A dietary supplement is a manufactured product intended to supplement a person's diet by taking a pill, capsule, tablet, powder, or liquid. A supplement can provide nutrients either extracted from food sources, or that are synthetic. The classes of nutrient compounds in supplements include vitamins, minerals, fiber, fatty acids, and amino acids. Dietary supplements can also contain substances that have not been confirmed as being essential to life, and so are not nutrients per se, but are marketed as having a beneficial biological effect, such as plant pigments or polyphenols. Animals can also be a source of supplement ingredients, such as collagen from chickens or fish for example. These are also sold individually and in combination, and may be combined with nutrient ingredients. The European Commission has also established harmonized rules to help insure that food supplements are safe and appropriately labeled.

Essential fatty acids, or EFAs, are fatty acids that are required by humans and other animals for normal physiological function that cannot be synthesized in the body.⁠ As they are not synthesized in the body, the essential fatty acids – alpha-linolenic acid (ALA) and linoleic acid – must be obtained from food or from a dietary supplement. Essential fatty acids are needed for various cellular metabolic processes and for the maintenance and function of tissues and organs. These fatty acids also are precursors to vitamins, cofactors, and derivatives, including prostaglandins, leukotrienes, thromboxanes, lipoxins, and others.

<span class="mw-page-title-main">Cat food</span> Food for consumption by cats

Cat food is food specifically formulated and designed for consumption by cats. As obligate carnivores, cats have specific requirements for their dietary nutrients, namely nutrients found only in meat or synthesised, such as taurine and Vitamin A. Certain nutrients, including many vitamins and amino acids, are degraded by the temperatures, pressures and chemical treatments used during manufacture, and hence must be added after manufacture to avoid nutritional deficiency. Cat food is typically sold as dry kibble, or as wet food in cans and pouches.

<span class="mw-page-title-main">Docosahexaenoic acid</span> Chemical compound

Docosahexaenoic acid (DHA) is an omega-3 fatty acid that is an important component of the human brain, cerebral cortex, skin, and retina. It is given the fatty acid notation 22:6(n-3). It can be synthesized from alpha-linolenic acid or obtained directly from maternal milk, fatty fish, fish oil, or algae oil. The consumption of DHA contributes to numerous physiological benefits, including cognition. As a component of neuronal membranes, the function of DHA is to support neuronal conduction and to allow the optimal functioning of neuronal membrane proteins.

<span class="mw-page-title-main">Nutritional yeast</span> Type of deactivated yeast

Nutritional yeast is a deactivated yeast, often a strain of Saccharomyces cerevisiae, that is sold commercially as a food product. It is sold in the form of yellow flakes, granules, or powder and can be found in the bulk aisle of most natural food stores. It is popular with vegans and vegetarians and may be used as an ingredient in recipes or as a condiment.

<span class="mw-page-title-main">Nutrition and pregnancy</span> Nutrient intake and dietary planning undertaken before, during and after pregnancy

Nutrition and pregnancy refers to the nutrient intake, and dietary planning that is undertaken before, during and after pregnancy. Nutrition of the fetus begins at conception. For this reason, the nutrition of the mother is important from before conception as well as throughout pregnancy and breastfeeding. An ever-increasing number of studies have shown that the nutrition of the mother will have an effect on the child, up to and including the risk for cancer, cardiovascular disease, hypertension and diabetes throughout life.

Vitamin B<sub><small>12</small></sub> Vitamin used in animal cells metabolism

Vitamin B12, also known as cobalamin, is a water-soluble vitamin involved in metabolism. It is one of eight B vitamins. It is required by animals, which use it as a cofactor in DNA synthesis, and in both fatty acid and amino acid metabolism. It is important in the normal functioning of the nervous system via its role in the synthesis of myelin, and in the circulatory system in the maturation of red blood cells in the bone marrow. Plants do not need cobalamin and carry out the reactions with enzymes that are not dependent on it.

<span class="mw-page-title-main">Animal source foods</span>

Animal source foods (ASF) include many food items that come from an animal source such as fish, meat, dairy, eggs and honey. Many individuals consume little ASF or even none for long periods of time by either personal choice or necessity, as ASF may not be accessible or available to these people.

<span class="mw-page-title-main">Nutritional neuroscience</span> Scientific discipline

Nutritional neuroscience is the scientific discipline that studies the effects various components of the diet such as minerals, vitamins, protein, carbohydrates, fats, dietary supplements, synthetic hormones, and food additives have on neurochemistry, neurobiology, behavior, and cognition.

<span class="mw-page-title-main">Vegan nutrition</span> Nutritional and human health aspects of vegan diets

Vegan nutrition refers to the nutritional and human health aspects of vegan diets. A well-planned vegan diet is suitable to meet all recommendations for nutrients in every stage of human life. Vegan diets tend to be higher in dietary fiber, magnesium, folic acid, vitamin C, vitamin E, and phytochemicals; and lower in calories, saturated fat, iron, cholesterol, long-chain omega-3 fatty acids, vitamin D, calcium, zinc, and vitamin B12.

Relatively speaking, the brain consumes an immense amount of energy in comparison to the rest of the body. The mechanisms involved in the transfer of energy from foods to neurons are likely to be fundamental to the control of brain function. Human bodily processes, including the brain, all require both macronutrients, as well as micronutrients.

Pregnancy vegetarianism is the practice of adhering to a vegetarian diet during pregnancy. Vegetarianism is "the principle or practice of excluding all meat and fish, and sometimes, in the case of vegans, all animal products from one's diet." Although some people frown upon pregnant women practicing vegetarianism, there is no evidence that vegetarianism—practiced properly—is unhealthful during pregnancy. There are millions of healthy babies born each year from vegetarian households.

<span class="mw-page-title-main">Senior dog diet</span> Pet foods catered toward senior pets

Senior dog food diets are pet foods that are catered toward the senior or mature pet population. The senior dog population consists of dogs that are over the age of seven for most dog breeds, though in general large and giant breed dogs tend to reach this life stage earlier when compared to smaller breed dogs. Senior dog foods contain nutrients and characteristics that are used to improve the health of the aging dog. Aging in dogs causes many changes to occur physiologically that will require a change in nutrient composition of their diet.

<span class="mw-page-title-main">Vegetarian and vegan dog diet</span> Adequate meat-free or animal-free nutrition

As in the human practice of veganism, vegan dog foods are those formulated with the exclusion of ingredients that contain or were processed with any part of an animal, or any animal byproduct. Vegan dog food may incorporate the use of fruits, vegetables, cereals, legumes including soya, nuts, vegetable oils, as well as any other non-animal based foods.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 American Dietetic, Association; Dietitians Of, Canada (2003). "Position of the American Dietetic Association and Dietitians of Canada: Vegetarian diets". Journal of the American Dietetic Association. 103 (6): 748–65. doi:10.1053/jada.2003.50142. PMID   12778049.
  2. ↑ Black, Maureen (June 2008). "Effects of vitamin B12 and folate deficiency on brain development in children". Food and Nutrition Bulletin. 29 (2 Suppl): S126–31. doi:10.1177/15648265080292S117. PMC   3137939 . PMID   18709887.
  3. ↑ "The vegetarian diet". nhs.uk. 27 April 2018. Retrieved 22 May 2021.
  4. ↑ "Qatar Dietary Guidelines" (PDF). Qatar MOPH. 2015. p. 18.
  5. ↑ Lappé, Frances Moore (1981). Diet for a Small Planet. Ballantine Books. p. 162. ISBN   978-0-345-32120-6.
  6. ↑ Craig, Winston J.; Pinyan, Laura (2001). "Nutrients of Concern in Vegetarian Diets". In Sabate, Joan (ed.). Vegetarian Nutrition. CRC Press. pp. 299–332. ISBN   978-1-4200-3683-1.
  7. 1 2 The Vegetarian Society. Information Sheet: Vitamin B12 Archived 22 August 2008 at the Wayback Machine . Retrieved 26 April 2007.
  8. 1 2 "Dietary Supplement Fact Sheet: Vitamin B12". USA.gov. Office of dietary supplements. Retrieved 14 March 2012.
  9. ↑ Pawlak, Roman; Parrott, Scott James; Raj, Sudha; Cullum-Dugan, Diana; Lucus, Debbie (2013). "How prevalent is vitamin B12 deficiency among vegetarians?". Nutrition Reviews. 71 (2): 110–117. doi: 10.1111/nure.12001 . PMID   23356638.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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  11. ↑ Sanders, Thomas A.B. (2009). "DHA status of vegetarians". Prostaglandins, Leukotrienes and Essential Fatty Acids. 81 (2–3): 137–141. doi:10.1016/j.plefa.2009.05.013. PMID   19500961.
  12. 1 2 Lane KE, Wilson M, Hellon TG, Davies IG. (2022). "Bioavailability and conversion of plant based sources of omega-3 fatty acids – a scoping review to update supplementation options for vegetarians and vegans". Critical Reviews in Food Science and Nutrition. 62 (18): 4982–4997. doi: 10.1080/10408398.2021.1880364 . PMID   33576691. S2CID   231899843.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. 1 2 3 4 Melina, Vesanto; Craig, Winston; Levin, Susan (2016). "Position of the Academy of Nutrition and Dietetics: Vegetarian Diets" (PDF). Journal of the Academy of Nutrition and Dietetics. 116 (12): 1970–1980. doi:10.1016/j.jand.2016.09.025. PMID   27886704. S2CID   4984228.
  14. ↑ Bickelmann, Franziska V.; Leitzmann, Michael F.; Keller, Markus; Baurecht, Hansjörg; Jochem, Carmen (6 June 2022). "Calcium intake in vegan and vegetarian diets: A systematic review and Meta-analysis". Critical Reviews in Food Science and Nutrition. 63 (31): 10659–10677. doi:10.1080/10408398.2022.2084027. ISSN   1040-8398. PMID   38054787. S2CID   249441078.
  15. ↑ Iguacel I, Miguel-Berges ML, Gómez-Bruton A, Moreno LA, Julián C. (2019). "Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis". Nutr Rev. 77 (1): 1–18. doi: 10.1093/nutrit/nuy045 . PMID   30376075.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. ↑ Ogilvie AR, McGuire BD, Meng L, Shapses SA. (2022). "Fracture Risk in Vegetarians and Vegans: the Role of Diet and Metabolic Factors". Curr Osteoporos Rep. 20 (6): 442–452. doi:10.1007/s11914-022-00754-7. PMID   36129610. S2CID   252405392.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  17. ↑ Pawlak R, Berger J, Hines I. (2016). "Iron Status of Vegetarian Adults: A Review of Literature". Am J Lifestyle Med. 12 (6): 486–498. doi:10.1177/1559827616682933. PMC   6367879 . PMID   30783404.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  18. ↑ Haider LM, Schwingshackl L, Hoffmann G, Ekmekcioglu C. (2018). "The effect of vegetarian diets on iron status in adults: A systematic review and meta-analysis". Crit Rev Food Sci Nutr. 58 (8): 1359–1374. doi:10.1080/10408398.2016.1259210. PMID   27880062. S2CID   25792199.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  19. 1 2 Oussalah A, Levy J, Berthezène C, Alpers DH, Guéant JL. (2020). "Health outcomes associated with vegetarian diets: An umbrella review of systematic reviews and meta-analyses". Clinical Nutrition. 39 (11): 3283–3307. doi: 10.1016/j.clnu.2020.02.037 . PMID   32204974. S2CID   213892045.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  20. ↑ Bray, George A; Temple, Norman J; Wilson, Ted. (2022). Nutrition Guide for Physicians and Related Healthcare Professions. Springer. p. 182. ISBN   978-3-030-82515-7
  21. ↑ "Iron: Food Fact Sheet". bda.uk.com. Retrieved 2 January 2023.
  22. ↑ "Vegetarian and vegan diets". healthdirect.gov.au. Retrieved 2 January 2023.
  23. ↑ Ponka, Prem; Schulman, Herbert M.; Woodworth, Robert C.; Richter, Goetz W. (25 September 1990). Iron Transport and Storage. CRC Press. ISBN   9780849366772.
  24. ↑ Foster M, Chu A, Petocz P, Samman S. (2013). "Effect of vegetarian diets on zinc status: a systematic review and meta-analysis of studies in humans". Journal of the Science of Food and Agriculture. 93 (10): 2362–2371. Bibcode:2013JSFA...93.2362F. doi:10.1002/jsfa.6179. PMID   23595983. S2CID   46474144.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  25. ↑ Remer, Thomas; Neubert, Annette; Manz, Friedrich (2007). "Increased risk of iodine deficiency with vegetarian nutrition". British Journal of Nutrition. 81 (1): 45–9. doi: 10.1017/S0007114599000136 . PMID   10341675.
  26. ↑ Wang F, Zheng J, Yang B, Jiang J, Fu Y, Li D. (2015). "Effects of Vegetarian Diets on Blood Lipids: A Systematic Review and Meta-Analysis of Randomized Controlled Trials". Journal of the American Heart Association. 4 (10): e002408. doi:10.1161/JAHA.115.002408. PMC   4845138 . PMID   26508743.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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  28. ↑ Gibbs J, Gaskin E, Ji C, Miller MA, Cappuccio FP. (2021). "The effect of plant-based dietary patterns on blood pressure: a systematic review and meta-analysis of controlled intervention trials" (PDF). Journal of Hypertension. 39 (1): 23–37. doi:10.1097/HJH.0000000000002604. PMID   33275398. S2CID   225483653.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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