A Practical Guide to Veganism During Pregnancy & Throughout Childhood
About This Guide
Whilst friends, family and health care professionals may periodically challenge the nutritional adequacy of a vegan diet, when it comes to feeding this diet to a mother-to-be or a child, those challenges can often turn into vociferous opposition quite unlike anything that has ever been experienced before! The important thing to remember is that a varied wholefood vegan diet will provide all the nutrients required for a healthy body during pregnancy, breast feeding, infancy and childhood, through the teenage years to adulthood. In fact, there is no known nutrient the vegan diet cannot provide. Several studies have shown that vegan women typically have healthy pregnancies and that their children thrive. Thousands of healthy children have now been reared on vegan diets and can expect to look forward to a healthier-than-average adulthood.
The following is a general introduction to pregnancy, children and the vegan diet. More detailed information should be sought from publications available for sale through the Vegan Society or organisations listed under Further Details.
One really comprehensive book devoted to this subject is Pregnancy, Children & the Vegan Diet by Dr Michael Klaper. This book provides information on meal plans for children and pregnant women - as well as recipes. The book is American so some parts will not be relevant to those living outside the country e.g. recommended infant milks will not be available. Testimonies from vegan families in Dr Klaper's book provide prospective vegans and even 'old hands' with the confidence and encouragement to raise their children on a compassionate and healthy diet. Note: current advice suggests that peanuts should be avoided during pregnancy and when breast feeding in order to reduce the incidence of allergies in children.
Section One - Pregnancy
The Importance of Good Nutrition
Research during the 1990s has revealed that a pregnant woman's diet, and that of her infant during the first year of life can affect the child's health 40, 50 or even 60 years later. This research establishes the importance of good nutrition during pregnancy and infancy. A pregnant woman requires extra nutrition to support the growing foetus and to allow for changes in her body. A series of studies at the Farm, a vegan community in the USA, show that vegans can have healthy pregnancies and that infants and children can safely follow a vegan diet.
The First Few Months
Recommendations for many vitamins and minerals are higher in pregnancy but the increase in energy (calorie) requirements is relatively small. The pattern of weight gain is different for every woman. General guidelines include a little weight gain in the first trimester (first 3 months). In the second and third trimesters a weight gain of a pound a week is common. If weight gain is slow or nonexistent then more food needs to be consumed. For example, eat more often or foods higher in fat and lower in bulk. If weight gain is high, then take a look at the types of foods eaten. Try to ensure that any sweet or fatty foods are replaced with fresh fruit, vegetables, pulses and grains (e.g. wholemeal bread, rice, etc). If the diet is already fairly healthy, then try to ensure more exercise is taken e.g. walking, swimming, etc. on a daily basis.
There is little, if any, increase in calorific needs during the first trimester. However, in order to support the recommended weight gain during the second and third trimesters, an extra 300 calories will be required. 300 calories is a fairly small increase compared to the increases required for other nutrients so it is important to use those calories in a wise manner. For example, instead of drinking 2 cans of cola, 300 calories worth of fruit and vegetables should be consumed which will also provide vitamin and mineral needs.
Several small meals should be eaten during the day. Don't miss breakfast and eat a huge lunch. It is important to provide a regular supply of nutrients to the growing foetus. Babies do not do well fasting for hours on end. The following chart gives examples of nutrients required for a healthy body and foods that provide these nutrients; aim to eat a varied wholefood diet and choose foods from the following food groups on a daily basis:
- Cereals e.g. barley, rice, wheat (bread, pasta, shredded wheat), oats, millet, corn, bulgur, cous cous, etc
- Pulses e.g. beans, peas, lentils (cooked or sprouted)
- Nuts & Seeds e.g. all types of nuts, nut butters (peanut butter, cashew nut butter etc), pumpkin, sunflower and sesame seeds and tahini (sesame seed spread)
- Vegetables (cooked and/or raw) Deep yellow & dark green leafy vegetables include carrots, green peppers, broccoli, spinach, endive and kale. Other vegetables include bean sprouts, potatoes, tomatoes, lettuce, cabbage, sweet corn, celery, onions, cucumbers, beetroot, marrows, courgettes and cauliflower.
- Fruits (fresh, dried and tinned) e.g. bananas, oranges, tangerines, grapefruit, apples, mangoes, cherries, grapes, apricots, pear, paw paws, kiwis, berries, currants, lemons and plums.
Vegan sources of key nutrients
Whole grains (e.g. whole-wheat flour and bread, brown rice), nuts (e.g. hazels, cashews, brazils, almonds), sunflower and other seeds, pulses (e.g. peas, lentils, beans), soya flour, soya milk, tofu.
Whole grains (e.g. wheat, oats, barley, rice), whole-wheat bread, pasta and other flour products, lentils, beans, potatoes, dried and fresh fruit.
Nuts and seeds, nut and seed oils, vegan margarine, avocados.
Essential Fatty Acids
Two polyunsaturated fatty acids not made by the body are linoleic acid (omega 6 group) and alpha-linolenic acid (omega 3 group). Linoleic acid - safflower, sunflower, corn, evening primrose & soya oils. Alpha-linolenic acid - linseed, pumpkin seed, walnut, soya & rapeseed (canola) oils.
A - Carrots, spinach, pumpkins, tomatoes, dark greens, vegan margarines.
B - Nuts, whole-grains, oats, muesli, pulses, yeast extract (e.g. Marmite), leafy green vegetables, potatoes, mushrooms and dried fruit. B12 - Fortified yeast extracts and soya milks, vegan margarines, packeted "veggie-burger" mixes. Possibly: Fermented foods (eg. tamari, miso and tempeh), sea vegetables (e.g. hijiki, wakame and spirulina).
C - Citrus fruits (e.g. oranges, lemons, grapefruit), red and blackcurrants, berries, green vegetables and potatoes.
D - Sunlight, some soya milks and vegan margarines.
E - Nuts, seeds, whole grains and flours, vegetable oils.
Folate - Wheatgerm, raw or lightly-cooked green leafy vegetables (e.g. watercress, broccoli, spinach), yeast, yeast extracts, nuts, peas, runner beans, oranges, dates, avocados, whole grains.
Calcium - Molasses, seeds, nuts, carob, pulses (e.g. soya beans, tofu, haricot beans, miso-fermented soya bean curd), parsley, figs (dried), sea vegetables, grains (e.g. oatmeal), fortified soya milk.
Iron - Seeds, nuts, pulses, miso, grains, dried fruit, molasses, sea vegetables, parsley, green leafy vegetables, using cast-iron cookware.
Zinc - Wheatgerm, wholegrains (wholemeal bread, rice, oats), nuts, pulses, tofu, soya protein, miso, peas, parsley, bean sprouts.
The state of pregnancy is a "watery" one, and the pregnant woman requires extra water for making additional blood for herself, the baby, and the three to six quarts of amniotic fluid in her uterus. She should try to drink at least four to six eight-ounce glasses per day in the form of pure water, fruit juices or vegetable juices. The balance of water needed (total 2-3 quarts daily) can be obtained from the watery fruits, vegetables, soups and salads, which are abundant in the vegan diet.
Further Information on Some Key Nutrients for Pregnant Women
Pregnant women must ensure adequate folate (folacin) consumption to protect their unborn children from neural tube defects such as spina bifida. Studies suggest this is plentiful in the diets of vegan adults. The Department of Health advises women considering having a baby and those who are pregnant to take a folate supplement as well as consuming foods rich in the vitamin. In the UK, 1991 recommendations for pregnant women were 300ug per day and for nursing mothers 260ug per day. All women wishing to conceive should take 400ug per day and continue this during the first 12 weeks.
Pregnant women do not require more than the average 1.5ug per day. Breast feeding women require 2ug per day. During pregnancy a woman's own laid-down body stores of B12 are not readily available to the foetus which builds up its own supply from the mother's current dietary intake of the vitamin. If B12 intake is low during pregnancy, the foetus will not have adequate stores of the vitamin and this may lead to a deficiency sometime after birth - even though the mother herself may have no clinical symptoms.
Studies have shown that vegans' intake of calcium is adequate; there have been no reports of calcium deficiency. The high boron (rich in fruit and vegetables) content of the vegan diet and the exclusion of meat helps the body conserve calcium. Studies of the bones of vegans and vegetarians show that the likelihood of osteoporosis is no greater, and may be less, than for omnivores. In the UK, current recommendations for calcium consumption are 1250mg per day for breastfeeding women. Additional calcium during pregnancy is not thought necessary.
No extra iron is indicated in the UK for pregnant or breastfeeding women as it is assumed that increased requirements can be offset against the cessation of menstrual iron loss. However, the US recommended daily amount for pregnant women is 30mg which is double that of non-pregnant women.
There is evidence from the general population that malformations occurring in some infants may be linked to zinc insufficiency in their mothers. Human milk is not a rich source of this mineral and during breastfeeding infants draw on their body reserves laid down during the last 3 months of pregnancy. Thus premature babies may be at risk of zinc deficiency. Intakes of zinc by adult vegans are similar to those of omnivores. Women aged 19-50 years should take 7mg per day. There is no recommended increase during pregnancy.
Section Two - Breastfeeding
Breast is Best
The earliest food for a vegan baby should ideally be breast milk. For support and information on breast feeding please contact the La Leche League or The National Childbirth Trust (see Further Details for addresses). Many benefits are conveyed to the baby by breast feeding including some enhancement of the immune system, protection against infection, and reduced risk of allergies. In addition, breast milk is designed specifically for babies and quite probably contains substances needed by growing infants which are not even known to be essential and are not included in infant formulae.
Formula Milk & Soya Milk
If for any reason the baby is not being breast-fed or infant formula is used to supplement breast feeding, there is only one soya infant formula on the UK market suitable for vegans to use - Farley's Soya Formula made by Heinz. It is suitable to use from birth until adulthood! Available from chemists.
It is important that soya milk should not substituted for soya infant formula as it does not contain the proper ratio of protein, fat, carbohydrate, nor the vitamins and minerals required to be used as a sole food. Soya milk should not be fed to babies under 6 months of age because it has levels of protein which are too high and excessive protein intake is thought to be medically undesirable at this stage.
Plamil soya milk is fortified with calcium (to approximately the level of human milk) combined with the necessary vitamin D2 to enable the calcium to be absorbed, plus the essential vitamins B2 and B12. The sweetened version is suitable for infants during and beyond the weaning stage. Also, where a supplementary feed is required it may be diluted to bring it closer to human milk. Plamil Foods Ltd recommends that no such supplementary feeding takes place without (a) the parent or authorised representative notifying Plamil Foods Ltd in writing at the outset of the name and address of the doctor/medical advisor so the company may provide them with information relating to the product and (b) the parent undertakes to arrange regular medical supervision.
The Best Diet for Breastfeeding
The best diet for breast feeding is similar to that recommended for pregnancy. (See "Pregnancy"). Calories, protein and vitamin B12 are higher while recommendations for iron are lower than during pregnancy. The recommended calorie intake is 500 calories above the usual intake. Breastfeeding women should ensure 2.0mg per day of B12.
Protein requirements rise to 56g+ of protein per day for breastfeeding mothers from the birth of the baby until 6 months of age. From the age of 6 months it can be reduced to 53g+ of protein per day. A guide to the amount of food that should be eaten on a daily basis, are as follows: Portions of some vegan foods providing 10g of protein Type of food Weight of food providing 10g protein.
Section 3 - Children
Research Gives Veganism the Thumbs Up!
Studies carried out on life long vegan children in 1981 and 1992 showed that although generally lighter in weight than their omnivore peers, vegan children are within the normal ranges for height and weight. Infants and children raised on a varied vegan diet obtain adequate protein and energy, are healthy and grow normally. Reports in the medical press of vegan infants suffering protein and energy deficiencies are extremely rare. In some instances infants were weaned onto poorly planned fruitarian or macrobiotic regimes rather than vegan diets. In other cases parents had not adopted veganism but instead had eliminated foods from their infants' diets on a piecemeal basis and without seeking proper advice.
Some Key Points for Feeding Vegan Children
Infants need plenty of energy. Home-prepared cereals should be made as a thick porridge, not as a thin gruel. Adding a little vegetable oil to the cooked grains, increases their calorie content, and improves palatability by making them less glutinous as they cool. Use more soya bean oil or rapeseed (canola) oil, and less sunflower, safflower or corn oils. The former may encourage the production of fatty acids which are important for the development of the brain and vision. Don't let infants fill up with liquids before eating their meals. Spread breads with margarine fortified with D2 and B12 or with seed or nut butters to increase energy density. Low salt yeast extract is a good source of vitamins and minerals. Well cooked and mashed pulses provide energy and protein. Use black molasses to boost iron and calcium intakes. Tofu prepared with calcium salt (usually calcium sulphate) contains more calcium than cow's milk. It is also rich in protein. Make sure children have access to sunshine regularly and give vitamin D2 supplements in winter. Use soya milk which is fortified with calcium, vitamin D2 and vitamin B12.
Information on Some Key Nutrients for Children
What children primarily require is sufficient food energy i.e. calories rather than protein per se. With adequate calories an individual will be in positive nitrogen balance and will thrive on a diet in which protein is available from a mix of plant-based foods.
After birth, if a woman's breast milk contains too little B12, deficiency can then occur in her infant - not in the first few weeks of life but after a few months when his or her own stores have run down. B12 problems in breastfeeding infants of vegan mothers remain very rare. Requirements include 0.3ug per day for infants aged 0-6 months and 0.4ug for infants aged 6-12 months. Children from 1-10 years of age should consume 0.5ug increasing to 1ug per day. B12 deficiency in infancy and childhood is rare. However, because deficiency can have severe effects, and because natural plant sources of the vitamin are in doubt it is prudent for vegan families to use and give their children fortified foods or supplements.
Except in northern latitudes, most people obtain vitamin D from exposure to sunshine, rather than food. Consequently the UK hasa set Reference Nutrient Intake (RNI) only for people most at risk from deficiency - that is infants from 8.5ug dropping to 7ug per day. Formula feeds contain sufficient vitamin D for infants but breast milk may not supply adequate amounts after 4-6 months of age especially in northern countries in the winter. Even in the general population, some autumn-born babies who are solely breast fed throughout winter may develop a deficiency, because the vitamin D content of their mother's breast milk is low. Nutritional rickets is more likely to occur under these conditions in dark-skinned people, especially if traditional clothing limits exposure to sunshine. Brief daily exposure of the skin to daylight in spring, summer and autumn, although not at the hottest times of the day, nor necessarily in direct sunshine, will ensure adequate vitamin D. Alternatively vitamin D fortified foods or supplements are an option for solely breast-fed infants and at weaning.
Calcium deficiency has not been reported in vegan children. Given the importance of calcium intake during youth on the future risk of osteoporosis, vegan parents like any others should ensure calcium-rich foods in the diet. The RNIs are: 350-550mg per day for infants and children to the age of 10 years, 800mg per day for teenage girls, 1000mg per day for teenage boys.
Infants can absorb up to 50% of the iron in human breast milk but it is calculated that only 10% of the iron in formula milks is absorbed. A 1981 survey of British vegan children aged 1-4.6 years found an average iron intake of 10mg per day, mainly from wheat and pulses, which considerably exceeds the British RNI of 6.1-6.9mg per day. A follow up study at the ages of 5.8-12.8 years confirmed that all the children were still consuming the RNI for iron. The 1991 UK RNI is: 0-3 months - 1.7mg per day; 4-6 months - 4.3mg per day; 7-12 months - 7.8mg per day; children up to 10 years - 6.1-8.7mg per day (depending on age); and teenagers from 11.3-14.8mg per day. Zinc There is evidence from the general population that malformations occurring in some infants may be linked to zinc insufficiency in their mothers. Human milk is not a rich source of this mineral and during breastfeeding infants draw on their body reserves laid down during the last 3 months of pregnancy. Thus premature babies may be at risk of zinc deficiency. UK recommendations are 0-6 months - 4mg/day; 7 months-3 years - 5mg/day; 4-6 years - 6mg/day; 7-10 years - 7 mg/day.