Achieving a healthy balance for optimal nutrition
It’s important to keep in mind that to be sustainable, diets must meet people’s nutrient needs. Research on how to strike the right balance between plant and animal foods to meet protein and other nutrient requirements is ongoing. Using an evidence-based approach can help you advise individuals to ensure nutrient and protein adequacy to support optimal health.
Survey of Canadian Finds
Messages encouraging people to follow a plant-based diet are misunderstood by many.1 Nearly half (48%) of Canadians surveyed believe a plant based diet needs to be entirely plant-based in origin.1 Only about one quarter (24%) disagrees, and the rest (27%) are unsure.
STRIKING THE RIGHT BALANCE
Confusion can lead to unintended nutritional consequences.
As a health professional, you know that balance matters when it comes to eating well. With messages to eat more plant-based diets, it’s vital to ensure that a healthy balance isn’t getting lost in the mix. Research reveals public misperceptions about plant-based diets are prevalent, and this could worsen existing nutrient inadequacies.
When coupled with a lack of information on how to meet their individual nutrient needs, this increases the risk of nutrient inadequacy. This is troubling given the already high prevalence of inadequate intakes of key nutrients of concern like calcium2,3 and iron4 among Canadians.5,6
Canadians need guidance to help them make healthy choices.
As Canadians look to include more plant-based foods in their diet, they often turn to highly processed, nutrient-poor alternatives to animal foods. This is clearly not what health professionals or Health Canada have in mind when encouraging people to eat a more plant-based diet.
You play a pivotal role in helping Canadians understand what a healthy, balanced, plant-based diet means in practice, through the enjoyment of more vegetables, fruit, legumes, whole grains, nuts, and seeds, rather than processed alternatives to animal protein foods.
It’s also important to help them understand that eating a plant-based diet does not mean they have to eat only plant foods. While plant-based diets include plenty of plant source foods, they can also include nutrient-rich animal source foods like milk, yogurt, cheese, meat, poultry, fish, and eggs.
Canadian Research Shows
“Balancing plant- with animal-based protein foods leads to healthier dietary patterns with more favourable nutritional properties”.7
Animal source foods help meet micronutrient and protein needs.
In 2023, the Food and Agriculture Organization of the United Nations (FAO) published the most comprehensive review to date of the nutrition evidence on terrestrial animal source foods.8 The FAO urges governments around the world to consider the contributions of meat, eggs, and milk to healthy diets for improved nutrition and health throughout life.
The FAO Report Concludes
“Meat, eggs and milk offer crucial sources of much-needed nutrients which cannot easily be obtained from plant-based foods.”9
The FAO emphasizes these animal source foods are nutrient rich. They provide many essential nutrients such as high-quality protein, essential fatty acids, vitamin B12, choline, and minerals such as calcium, iron, and zinc, as well as bioactive compounds to support optimal health.
The FAO Report Highlights
Evidence on milk product consumption shows favourable nutrition and health outcomes among:8
Pregnant Women: improved infant birth weights
School Age Children and Adolescents: increased height and reduced adiposity
Adults: reduced risk of obesity, hypertension, stroke, type 2 diabetes, osteoporosis, and certain cancers
Older Adults: mitigating sarcopenia, fractures, frailty, dementia, and Alzheimer's
Diets with both plant and animal foods provide better nutrition.
Canadian findings from University of Toronto researchers7 underscore the FAO conclusions8. They found that eating a balance of both plant and animal protein is the best way to optimize nutrient adequacy.7 Their research shows that dietary patterns, with more than 75% of protein from either plant or animal food sources, compromise nutritional adequacy and are not ideal.
Analysis published in the Lancet (2023)10 indicates at least 27% of daily calories should come from animal source foods to meet micronutrient requirements, as opposed to the 14% proposed by the EAT-Lancet diet.11
Canadian Research Shows
“Combinations of animal- and plant-based proteins improve nutrient quality of Canadian diets.”7
Many Canadians already fall short of key essential nutrients.
Based on data from the Canadian Community Health Survey (CCHS 2015), many Canadians already had inadequate intakes of key essential nutrients before the 2019 Food Guide was introduced.2-6 Health Canada recognizes calcium, iron, and potassium are nutrients of concern for Canadians.12 Many also have inadequate zinc, and vitamins B12 and D intakes from foods.5,6
Prevalence of inadequate calcium, iron, zinc, and vitamin B12 intakes below the Estimated Average Requirements based on the CCHS 2015 data 3,5,6
| Key Essential Nutrients | Prevalence of Inadequate Intakes from Foods |
| Calcium | > 80% of girls and 65% of boys 9-18 years > 70% of women 19-50 years > 90% of women 50+ and men 70+ years |
| Iron | 25% of girls 14-18 years nearly 30% of women 19-50 years |
| Zinc | 28% of girls 14-18 years, 20% of boys 14-18 years 23% of girls 9-13 years, 15% of boys 9-13 years at least 30% of women and 20% of men |
| Vitamin B12 | 13% of girls 14-18 years 21% of women |
The high prevalence of calcium and vitamin D inadequacy in Canada is especially concerning.2,3,7 The lower bioavailability of calcium, iron and zinc in diets containing predominantly plant source foods can further increase needs. For example, the Dietary Reference Intakes report estimates that requirements for iron and zinc in vegetarian diets are 1.8 and 1.5 times higher than otherwise recommended.13
Recent analyses of nutrient status in Canada show inadequacy.
Analyses of nutrient status in Canada published in 2023, estimate:
- iron deficiency may affect up to 29% of females of childbearing age (14-50 years)14
- based on analysis of serum levels, vitamin D inadequacy affects 19% of people (3 to 79 years)15
Dietary protein quality and amounts also need attention.
The Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) for protein are based on the consumption of good quality (i.e., high-quality) protein.16 By definition, high-quality protein is complete protein, containing all nine essential amino acids in a pattern that closely matches human requirements, and is efficiently absorbed.
Canadian research shows protein intakes decrease as people eat more plant protein.17 In diets with 75% or more protein from plant food sources, protein quality decreases substantially.17
It’s especially important to consider this when working with vulnerable groups like children, pregnant women, and older adults, given higher protein needs for optimal health. In older adults for example, researchers found every 1% increase in animal protein intake was linked to a 7% decreased cardiovascular disease risk, and 4% reduced risk of mortality from all causes.18
Key Points from the Dietary Reference Intakes Report
“The quality of a source of dietary protein depends on its ability to provide the nitrogen and amino acid requirements that are necessary for the body’s growth, maintenance, and repair. This ability is determined by two factors: digestibility and amino acid composition. If amino acids are not present in the right balance, the body’s ability to use protein will be affected.”16
“Proteins found in animal sources such as meat, poultry, fish, eggs, milk, cheese, and yogurt provide all nine indispensable amino acids and are referred to as ‘complete proteins’.”16
“Proteins found in plants, legumes, grains, nuts, seeds, and vegetables tend to be deficient in one or more of the indispensable amino acids and are called ‘incomplete proteins’.”16
TAKE NOTE:
As you encourage individuals to eat healthy balanced diets, keep in mind that preventing micronutrient deficiencies is a key basic principle of sustainable healthy diets.19
3 KEY TAKEAWAYS FOR YOUR PRACTICE
Key takeaway #1
Ensure consumers know plant-based diets don’t mean avoiding animal source foods
Key takeaway #2
Encourage a healthy balance of plant and animal source foods for optimal nutrition
Key takeaway #3
Help them choose high-quality protein foods to meet their nutrient and protein needs
References
1. Leger. 2022. Plant-based foods: Canadian perceptions and consumption. Report for the Nutrient Rich Alliance.
2. Barr S. Is the 2019 Canada’s Food Guide Snapshot nutritionally adequate? Appl Physiol Nutr Metab 2019;44:1387-1390.
3. Vatanparast H et al. Calcium intake from food and supplemental sources decreased in the Canadian population from 2004 to 2015. J Nutr 2020;150(4):833-841.
4. Cooper M et al. Population iron status in Canada: Results from the Canadian Health Measures Survey 2012–2019. J Nutr 2023;153:1534–1543.
5. Ahmed M, Ng AP, and L’Abbe MR. Nutrient intakes of Canadian adults: results from the Canadian Community Health Survey (CCHS)-2015 Public Use Microdata File. Am J Clin Nutr 2021;114:1131-1140.
6. Ng A, Ahmed M and L’Abbe M. 2021. Nutrient intakes of Canadian children and adolescents: Results from the Canadian Community Health Survey (CCHS) 2015 – Nutrition public use microdata files. (https://doi.org/10.21203/rs.3.rs-1138934/v1. Accessed Jan.15, 2024)
7. Fabek H et al. An examination of contributions of animal- and plant-based dietary patterns on the nutrient quality of diets of adult Canadians. Appl Physiol Nutr Metab 2021;46:877-886.
8. FAO. 2023. Contribution of terrestrial animal source food to healthy diets for improved nutrition and health outcomes – An evidence and policy overview on the state of knowledge and gaps. Rome, FAO. (www.fao.org. Accessed Jan.15, 2024)
9. FAO. 2023. Meat, eggs and milk essential source of nutrients especially for most vulnerable groups, new FAO report says. (www.fao.org. Accessed Jan.15, 2024)
10. Beal T, Ortenzi F, Fanzo J. Estimated micronutrient shortfalls of the EAT-Lancet planetary health diet. Lancet 2023;7:E233-237.
11. Willet W et al. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. Lancet 2019;393:447-492.
12. Government of Canada. 2014. Health Canada’s proposed changes to the core nutrients declared in the Canadian Nutrition Facts table. (www.canada.ca. Accessed Jan.15, 2024)
13. Institute of Medicine. 2001. Dietary Reference Intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: The National Academies Press.
14. Cooper M et al. Population iron status in Canada: Results from the Canadian Health Measures Survey 2012–2019. J Nutr 2023;153(5):1534–1543.
15. Weiler HA et al. Vitamin D status of people 3 to 79 years of age from the Canadian Health Measures Survey 2012-2019. J Nutr 2023;153(4):1150-1161.
16. Institute of Medicine. 2005. Dietary Reference Intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: The National Academies Press.
17. Marinangeli CPF et al. The effect of increasing intakes of plant protein on the protein quality of Canadian diets. Appl Physiol Nutr Metab 2021;46(7):771-780.
18. Meroño T et al. Animal protein intake is inversely associated with mortality in older adults: The InCHIANTI Study. J Gerontol A Biol Sci Med Sci 2022;77(9):1866-1872.
19. FAO and WHO. 2019. Sustainable healthy diets – Guiding principles. Rome. (www.fao.org. Accessed Jan.15, 2024)
