Serenity Aberdour, ND
Our supplement charts for vegetarian, lactose- and gluten-free, and athlete's diets identify possible nutritional deficiencies and how to address them.
We all have to eat. But just what ends up on the plate can be very different from one person to the next. From vegetarians and raw foodies to celiacs and diabetics, individual nutritional needs and limitations can vary greatly.
Whether a person's diet--and its accompanying restrictions--is a matter of choice or necessity, it is entirely possible to achieve a healthy lifestyle and still enjoy a large variety of foods. It just takes awareness of nutrient imbalances that may be introduced by restrictions, some careful menu planning, and appropriate supplementation to correct deficiencies.
The situations discussed in this article are just a few of the many in which people's special dietary needs should be properly balanced in order to avoid nutrient depletions and deficiency.
If you are planning to follow a special diet, consider consulting first with a health care practitioner who can help advise you about how to avoid potential nutrient deficiencies and monitor you as needed.
Vegetarian diet
Vegetarians generally avoid animal flesh (see sidebar above for description of different forms of vegetarian diets). Although a properly balanced vegetarian diet is associated with benefits such as increased antioxidant intake and reduced risk of cardiovascular disease, an unbalanced one can lead to deficiencies in several nutrients.
Nutrient deficiencies can develop due to inadequate intake in the diet and/or a reduced absorption of certain nutrients from plant-based diets. For example, some researchers have found B12 to be deficient in more than half of vegans assessed. This is not surprising, as it is very difficult to obtain adequate vitamin B12 from a vegan diet without the use of supplements.
It is a good idea for vegetarians and vegans to have periodic blood work run to assess their nutrient levels, particularly for iron and B12. This will help to detect early indications of deficiencies so they can be corrected before anemia or other complications arise.
Recognizing and addressing deficiencies in vegetarian diets
| Deficiency | Possible signs of deficiency | Eat these foods | Supplement recommendations |
| vitamin B12 | anemia, fatigue, weakness, constipation, loss of appetite, weight loss, numbness and tingling in the hands and feet, difficulty maintaining balance, depression, confusion, dementia, poor memory, soreness of the mouth or tongue | eggs, dairy foods (ovo-lacto), B12-fortified cereals, soy products, etc. | 1,000 mcg 2-3 times per week, or a lower dose daily as part of a B complex |
| iron | paleness, fatigue, reduced ability to exercise, frequent infections, brittle nails, decreased appetite, irritability, sore tongue or throat, thinning hair/hair loss | iron-fortified breads and cereals, beans, tofu, dried fruits, spinach and other dark green leafy vegetables | based on iron-status testing by your health care practitioner; recommended doses can be as low as 10 mg per day to maintain adequate intake to as high as 100 mg or more per day in the case of documented deficiency and anemia |
| protein | as a key building block for all of our tissues and cells, protein deficiency can affect all body systems; symptoms can include fatigue, poor healing, decreased immune function, swelling, muscle wasting | beans, legumes, nuts, seeds, | increased dietary protein intake; powdered protein supplements such as whey protein isolates may also be considered |
| zinc | loss of appetite, impaired immune function, mental lethargy | seeds, beans, legumes, whole grains | 10-35 mg per day |
| fatty acids | fatigue, dry skin/mouth/eyes/hair, depression | nuts, seeds, vegetable oils | 1-2 Tbsp (15-30 mL) per day of omega-3-rich vegetable oils |
| calcium | bone density loss, muscle spasm | green leafy vegetables, almonds, dairy products, tofu, tahini, sardines with bones | 500-1,200 mg per day depending on dietary intake |
| vitamin D | muscle pain and weakness, bone disease, increased risk of certain cancers and autoimmune diseases, immune dysfunction | sunshine, fortified dairy products, fortified soy/rice/almond beverages | 1,000 IU per day |
Vegetarian diet types
| Type | Description |
| ovo vegetarian | includes eggs but not dairy products |
| lacto vegetarian | includes dairy products but not eggs |
| ovo-lacto vegetarian | includes animal/dairy products such as eggs, milk, and honey |
| vegan | excludes all animal flesh and animal products, including milk, honey, and eggs, and may also exclude any products tested on animals, or any clothing from animals |
Vegetarian athletes take note: Though it is certainly possible to be a very healthy vegetarian athlete, you need to be especially mindful of what you eat. The higher physical demands placed on an athlete's body increase the risk of deficiency when dietary restrictions are imposed.
Lactose-free diet
For many people, the lactose component of dairy products causes gas, bloating, diarrhea, and other gastrointestinal upset. Although all nutrients available in milk products can be easily sourced from other foods, concerns about calcium and vitamin D intake do arise.
Recognizing and addressing deficiencies in lactose-free diets
| Deficiency | Possible signs of deficiency | Eat these foods | Supplement recommendations |
| calcium | bone density loss, muscle spasms | green leafy vegetables, almonds, tofu, tahini, sardines with bones | 500-1,000 mg per day, depending on dietary intake |
| vitamin D | muscle pain and weakness, bone disease, increased risk of certain cancers and autoimmune diseases, immune dysfunction | sunshine, fortified soy/rice/almond beverages, oily fish | 1,000 IU per day |
Gluten-free Diet
In celiac disease an immune reaction to gluten, which is a component of many grain products, impairs the intestine's ability to absorb nutrients. In untreated celiac disease, many nutrient deficiencies occur, including iron, magnesium, B vitamins (especially B12), and calcium.
Strict adherence to a gluten-free diet has been shown to eliminate many of the nutritional deficiencies in celiac disease and greatly improve nutritional status.
Even those on a gluten-free diet, however, may be at risk for ongoing nutrient deficiencies due to either ongoing malabsorption and/or lack of adequate variety in their diet. As a gluten-free diet eliminates many whole grains, which are a good source of fibre, magnesium, and B vitamins, these nutrients need to be replaced by other foods or through use of appropriate supplements.
Many grain flour products are also fortified with folic acid, and the avoidance of these products increases the risk of inadequate folic acid intake. In addition to a gluten-free diet, which is essential for improving the health of people with celiac disease, there are some supplements worth considering.
Even after going gluten free, some individuals with celiac experience persistent
diarrhea. This can have a big impact on nutrient status, as chronic diarrhea increases the risk of electrolyte depletion and can interfere with absorption of other nutrients. Research suggests that using supplemental pancreatic enzymes can help to reduce diarrhea in these cases.
Recognizing and addressing deficiencies in gluten-free diets
| Deficiency | Possible signs of deficiency | Eat these foods | Supplement recommendations |
| fibre | constipation, increased cholesterol levels | increased intake of vegetables and non-gluten grains | if constipation is a complaint, a fibre supplement may be helpful; recommended daily intake for adults is 21-38 g |
| magnesium | fatigue, muscle pain, restlessness, anxiety, sleep problems, abnormal heart rate | leafy greens, whole grains, nuts and seeds, beans, legumes | 300-500 mg per day or more as recommended by health care practitioner |
| B vitamins | anemia, fatigue, weakness, constipation, loss of appetite, weight loss, numbness and tingling in the hands and feet, difficulty maintaining balance, depression, confusion, dementia, poor memory, soreness of the mouth or tongue | whole non-gluten grains, dairy products, nuts, seeds, leafy green vegetables, beans, legumes | B complex, particularly folic acid (at least 0.8 mg), B12 (at least 0.5 mg), and B6 (at least 3 mg): this combination has been shown to help normalize elevated homocysteine levels and improve well-being in those on a gluten-free diet |
| folic acid | anemia, poor healing, low white blood cells, irritability, palpitations, weakness | leafy greens, some beans | up to 1 mg per day |
| iron | paleness, fatigue, reduced ability to exercise, frequent infections, brittle nails, decreased appetite, irritability, sore tongue or throat, thinning hair/hair loss | beans, tofu, dried fruits, spinach and other dark green leafy vegetables | based on iron-status testing by your health care practitioner; recommended doses can be as low as 10 mg per day to maintain adequate intake to as high as 100 mg per day in the case of documented deficiency and anemia |
| calcium | bone density loss, muscle spasm | green leafy vegetables, almonds, dairy products, tofu, tahini, sardines with bones | 500-1,200 mg per day depending on dietary intake |
| vitamin D | muscle pain and weakness, bone disease, increased risk of certain cancers and autoimmune diseases, immune dysfunction | sunshine, fortified dairy products, fortified soy/rice/almond beverages, oily fish | 1,000 IU per day |
Athlete's Diet
Highly active people put particularly high nutritional demands on their bodies and must be mindful of keeping up with this demand. Healthy whole food diets with plenty of variety in foods as well as eating frequently can go a long way toward covering the nutritional needs of most athletes. The charts below summarize some general nutritional recommendations.
Recognizing and addressing deficiencies in athlete's diets
| Deficiency | Possible signs of deficiency | Eat these foods | Supplement recommendations |
| calories | weight loss, fatigue, reduced performance | increase intake of healthy, nutrient-rich foods | monitor weight, as exercise or training may increase calorie needs by as much as 1,000-1,500 calories a day; consider meal replacement bars that contain organic whole food ingredients, 300-400 calories per serving, at least 5 g of protein, at least 3 g of fibre, fortification with vitamins and minerals; avoid bars containing high-fructose corn syrup, chocolate or candy coatings, marshmallows or other candy-type ingredients, unpronounceable ingredients |
| hydration | weakness, dryness, loss of performance, thirst | all fluids and fluid-filled foods | hydrate before, during, and after endurance activities; aim for about 500 mL of fluid for every pound (0.5 kg) lost during exercise |
| carbohydrates | weakness, inability to continue endurance activity, irritability, weight loss | grains, vegetables, honey, dried fruits | replace carbohydrates during endurance exercise lasting more than an hour, and/or training in conditions that are very hot, very cold, or at higher elevations; recommended intake is 30-60 g per hour; for other athletes aim for carbohydrate intake of 6-10 g per kg of body weight per day; choose products (gels, drinks, or powders) that are 6-8 percent carbohydrates |
| protein | muscle wasting, fatigue, poor healing, frequent infections | meat, dairy, eggs, beans, | aim for 1.2-1.7 g per kg body weight per day, consumed through a variety of foods and/or supplements; choose pure protein supplements with very little else added--avoid artificial flavours, colours, or unnecessary additives |
| electrolytes | dizziness, weakness, fatigue, | mineral-rich foods such as nuts, seeds, leafy greens, bananas; sensible use of sea salt and other seasoning salts | electrolyte replacement mix or beverage; avoid unnecessary artificial flavour or colours; consider products that combine electrolyte and carbohydrate replacement in one |
| iron | paleness, fatigue, reduced ability to exercise, frequent infections, brittle nails, decreased appetite, irritability, sore tongue or throat, thinning hair/hair loss | meat, iron-fortified breads and cereals, beans, tofu, dried fruits, spinach and other dark green leafy vegetables | based on iron-status testing by your health care practitioner; recommended doses can be as low as 10 mg per day to maintain adequate intake to as high as 100 mg per day in the case of documented deficiency and anemia |
| fatty acids | fatigue, dry skin/mouth/eyes/hair, depression | foods such as nuts, seeds, and fish | essential fatty acid supplements such as fish oils, flax oils, or combinations of plant oils |
| magnesium | agitation/anxiety, restless leg syndrome, fatique, insomnia, poor memory, confusion | leafy greens, whole grains, nuts and seeds, beans, legumes | approximately 300 mg per day or as recommended by health care practitioner |
| B vitamins | anemia, fatigue, weakness, constipation, loss of appetite, weight loss, numbness and tingling in the hands and feet, difficulty maintaining balance, depression, confusion, dementia, poor memory, soreness of the mouth or tongue | whole grains, dairy products, nuts, seeds, leafy green vegetables, beans, legumes | B-complex supplement daily |
| Calcium | bone density loss, muscle spasm | green leafy vegetables, almonds, dairy products, tofu, tahini, sardines with bones | 1,200-1,500 mg per day |
Supplement recommendations for the average diet
A well-balanced whole foods diet should provide adequate intake of most nutrients. A few supplements can be considered to help provide an extra boost.
| Supplement | Dosage recommendation |
| vitamin D | 1,000 IU per day |
| multivitamin and mineral | General: B complex plus a wide spectrum of other vitamins and trace minerals, less than 400 IU of vitamin E, more than 400 IU of vitamin D, and mixed antioxidants. |
| essential fatty acids | 1-2 Tbsp (15-30 mL) per day of flax oil or mixed omega-3, vegetable-derived oil; or 1,000-2,000 mg per day of fish oil |
Neil Zevnik
Karli Petrovic
Alanna Man