Diets With Flex Appeal
By Lynn Grieger, RD, CD, CDE
Today’s Dietitian
Vol. 8 No. 4 P. 44

The flexitarian diet may be the new wave of vegetarianism—a more lenient eating plan that emphasizes plant-based nutrition but allows occasional consumption of animal products.

According to Cooking Light magazine, one of the top new trends in 2006 is the flexitarian diet. Never heard of it? The American Dialect Society voted flexitarian the most useful word of the year in 2003. Flexitarian isn’t a new work schedule, yoga position, or outlook on life. Rather, it’s a term used to describe a person whose diet is primarily plant-based but who also consumes animal products on a limited basis. Other similar terms include partial vegetarian and semi-vegetarian.

What Is a Flexitarian?
Webster’s New Millennium Dictionary of English defines flexitarian as “a vegetarian who is flexible enough to occasionally eat meat or fish” and explains the etymology as a combination of flexible and vegetarian that developed in 1992. Dina Aronson’s article “Vegetarian Nutrition: What Every Dietitian Should Know” in the March 2005 issue of Today’s Dietitian describes flexitarian as “occasional vegetarian or partial vegetarian; a self-described ‘vegetarian’ who may opt to choose nonvegetarian foods, such as fish or poultry, on occasion.”

According to the American Dietetic Association (ADA), there are four main types of vegetarian eating plans: vegan, lacto-vegetarian, lacto-ovo-vegetarian, and semi-vegetarian. Yet, the Vegetarian Resource Group (VRG) and Seventh-Day Adventists define a vegetarian as someone who does not eat meat, fish, or fowl. By their definition, there’s no partial or semi to the term vegetarian.

Becoming Vegetarian by Vesanto Melina, RD, Brenda Davis, RD, and Victoria Harrison, RD, explains this dilemma in terminology by answering the question: What is a vegetarian? They write: “Over 15 million North Americans consider themselves ‘vegetarians.’ Of these, about a third completely eliminate meat, poultry and fish from their diets. The others generally include poultry or fish but avoid red meat. It may strike you as rather odd that so many people who eat meat choose to identify themselves as vegetarians. Perhaps it is an indication that vegetarianism is being viewed as a positive step by many people.”

A Change in Eating Habits and Concerns
Whereas vegetarians of the 1960s and 1970s were often motivated by animal rights and environmental concerns, today’s flexitarians choose a primarily plant-based diet out of concern for their health. They pay attention to the guidelines and include whole grains, vegetables, and fruits more often, yet they still enjoy their favorite types of animal protein—usually seafood or poultry, and very rarely red meat.

The updated MyPyramid puts the emphasis squarely on plant-based foods. Grains, vegetables, and fruits start off the guidelines, giving consumers a strong message that the basis of our food choices should come from these foods. MyPyramid also encourages a variety of protein foods, suggesting that we choose more fish, beans, peas, nuts, and seeds. The guidelines encourage greater use of fish, nuts, and seeds to increase our intake of omega-3 fatty acids, which may have a positive impact on cardiac health.

MyPyramid lists salmon, trout, and herring as high in omega-3 fatty acids. Although the pyramid promotes the use of walnuts and flax as excellent sources of omega-3 fatty acids, many consumers aren’t familiar with flax and may not be likely to search out food sources of flax. It may be more familiar and easier for consumers to choose seafood for omega-3 fatty acids instead of flax or walnuts.

According to the National Oceanic and Atmospheric Administration, a division of the U.S. Department of Commerce, Americans’ intake of fish rose for the third straight year in 2004, from an average intake of 14.8 pounds per person in 2001 to 16.6 pounds per person in 2004. Fillet, steak, and shrimp consumption has increased while canned tuna intake has decreased slightly. Even with the health advisories to avoid certain types of seafood due to mercury and other toxins, consumption continues to increase.

Consumers may also be more likely to increase their consumption of fish rather than nuts and seeds because of calories. Whenever I suggest ways to increase intake of omega-3 fatty acids, clients invariably choose fish first. It’s difficult for many people to limit portion sizes of nuts and seeds, and the calorie content is a primary concern for many weight-conscious consumers.

Making the Switch to Seafood
I spoke with numerous dietitians with similar histories: They became vegetarian in their teens or 20s, primarily for concerns about the environment, ethical treatment of animals, and a desire for a healthier food intake. After a few years, many started eating poultry or fish for various reasons: increased feeling of satiety with these foods, a need to eat similar foods with their family and friends, a concern about obtaining adequate vitamins and minerals, and often a desire to obtain sufficient amounts of omega-3 fatty acids from fish. Most still consider themselves primarily vegetarian. But Karin Hosenfeld, RD, LD, of Plano, Tex., calls herself a “low meat eater.” “A true vegetarian would be put off if they heard me say I’m a vegetarian, but meat eaters don’t seem to understand it unless I tell them I’m a vegetarian,” Hosenfeld says.

Elizabeth Vukovic Gartlan, RD, manager of nutrition education programs at City Harvest in New York City, says, “[My] primary reason for changing over had to do with the realization that I was not supporting those farmers who did raise and kill their animals in a respective, healthy manner.” She notes two other considerations: a desire to consume more omega-3 fatty acids from fish and her realization that it was hindering her professionally. “Because of my own lack of experiences with the preparation of meat, I could not identify with my clients—especially as I work with a low-income population where vegetarianism is not always an option.”

Elizabeth Brown, MS, RD, CDE, comments about these changes: “Makes you think that the idealistic nature of vegetarianism might be a commitment too great for the majority living in the real world. But I do feel that for so many health, cost, and environmental benefits, we can all benefit from a more plant-based diet with animal protein as a complement or an occasional add-on.”

Vegetarians in Training?
Charles Stahler, one of the VRG coordinators, notes that when the VRG conducts polls, they specifically ask whether people eat meat, poultry, or seafood to determine the number of vegetarians. When they simply question whether people don’t eat meat, they receive a far greater response.

Stahler believes vegetarians aren’t becoming flexitarians. While he acknowledges that there are always people who move back and forth between vegetarian and omnivore diets, overall the number of vegetarians stays stable through the years. Stahler points out that the number of vegans—the strictest form of vegetarians who don’t consume any form of animal products—is growing. Today, approximately one third of vegetarians identify themselves as vegan. What he sees as the real change is meat eaters choosing more plant-based foods and calling themselves vegetarians. Stahler notes that this growing group of people who enjoy and purchase plant-based foods expands the pool of people who may eventually decide to become strict vegetarians.

More Than One Way to Eat Healthy
The ADA promotes the “all-foods-can-fit” philosophy, while thousands of health professionals routinely and confidently state that there are no bad or good foods; food is food, and any type of food can be included in a healthy diet.

Eleanor B. Pella, MS, RD, LDN, public health nutrition consultant in the Bureau of Chronic Disease and Injury Prevention, Pennsylvania Department of Health, and past-chair of the Vegetarian Nutrition (VN) Dietetic Practice Group, says, “I have been in this profession for 25 years and have learned that there are as many ways to be healthy as there are people.”

Pella says she used to be embarrassed to be a meat eater within VN, but as the first meat-eating chair of this group started primarily by vegans, she embraces the idea of flexitarian diets. She joined VN due to an interest in soy and then slowly discovered the numerous health benefits of plants. There are no hard data available on the eating habits of VN members, but Pella believes that most aren’t vegans or vegetarians. Rather, they are nutrition professionals who “eat, teach, and preach a plant-based diet.”

Pella prefers the term plant-based to flexitarian, and through her research concludes that encouraging people to choose more plant foods gives them the benefit of increased phytochemical and fiber intake and less saturated fat. It’s getting easier for consumers to follow these guidelines with the explosion of new food products, but individuals still have to make a choice every time they eat.

Oldways Preservation Trust helps consumers make wise food and lifestyle choices, including the development of four different pyramid-based eating plans for Mediterranean, Asian, Latin American, and Vegetarian diets. Their Eatwise program is designed to simplify health and eating goals into doable, everyday strategies. The Eatwise program is flexitarian; based on the Mediterranean plan, fish and poultry are encouraged weekly, while meat is limited to monthly consumption. The bulk of the diet should come from whole grains, fruits, vegetables, legumes, olive oil, cheese, and nuts.

Courtney Davis, media relations manager at Oldways, is enthusiastic about the health benefits and taste of fish but notes that it’s possible to eat a healthy, balanced, strict vegetarian diet. Davis says, “It comes down to being careful with foods and nutrients when choosing what to eat,” no matter what type of eating plan someone follows.

Reed Mangels, PhD, RD, nutrition advisor for the VRG, cites the Oxford Vegetarian Study reported in the American Journal of Clinical Nutrition in 1999 as a strong reason to promote a complete vegetarian diet. The researchers who conducted the study estimated that, based on blood cholesterol levels, heart disease rates would be 24% lower in lifelong vegetarians and 57% lower in lifelong vegans than in meat eaters. Mangels notes that in this study, more than one half of the meat eaters didn’t consume meat on a daily basis, making the results even more amazing. The same study found that complete vegetarians have the lowest rates of hypertension, followed by partial vegetarians who eat fish, and then meat eaters.

Any type of diet—flexitarian, vegetarian, vegan, or even omnivore diet—can be healthy depending on the types and amounts of foods chosen. According to Suzanne Havala Hobbs, DrPH, MS, RD, clinical assistant professor and associate director of the doctoral program in health leadership at the McGavran-Greenberg School of Public Health, University of North Carolina at Chapel Hill, and a nutrition advisor for the VRG, “In general, it’s safe to say that people who get the calories they need, eat a reasonable variety of plant foods, and limit their intakes of sweets and junk foods are likely to enjoy better health.”

Mangels adds, “You can have a very nutritionally sound vegetarian diet or a vegetarian diet that isn’t that great; you can have a diet that includes some meat that is still nutritionally sound or you can have a meat-containing diet that is of poor quality. Certainly, the more meat, high-fat dairy products, and eggs one eats, the higher their dietary saturated fat and cholesterol will be.”

What RDs Should Recommend
Karen Chagnon, MEd, RD, relates a story: A woman’s husband was diagnosed with heart disease, so the couple decided to switch to a “vegetarian” diet. For them, this essentially means they don’t eat red meat and choose fish more often. They also don’t like vegetables and never eat plant-based sources of protein. In their vegetarian world, deep-fried fish is their entree of choice. I’m sure nutrition professionals cringe in horror at this honest misinterpretation of health guidelines and at the same time wonder why the cardiologist didn’t recommend a visit with the local RD.

The 2005 Dietary Guidelines actually describe a flexitarian eating plan in several ways. The guidance to base meals on fruits, vegetables, and whole grains promotes including more vegetarian options in meals. In the protein discussion, vegetarian protein choices such as beans and nuts are recommended along with flexitarian options such as poultry and fish. The recommendations to limit saturated fat and cholesterol promotes the use of vegetarian sources of protein while recognizing that skinless poultry and many types of fish are also low in saturated fat and cholesterol.

As nutrition professionals, we assess our clients’ starting points and help them set health goals. We most likely encourage clients to include more fruits, vegetables, and whole grains in their everyday food choices; recommend ways to decrease intake of saturated fat and cholesterol by swapping plant-based protein for animal protein a few times each week; and suggest ways to decrease reliance on heavily processed and/or fast foods. Some clients may decide to become vegetarian and possibly vegan. Others may not even think about what type of diet they eat, except that it’s healthier than their old eating habits.

Healthy eating may sound boring, flexitarian confusing, and semi-vegetarian an oxymoron. But we can all agree that whatever it’s called, it’s a plan we can feel confident recommending to our clients and families.

— Lynn Grieger, RD, CD, CDE, is a nutrition coach in southwestern Vermont and freelance writer who falls squarely into the partial-vegetarian camp.

Types of Vegetarian Eating Plans
• Semi-vegetarian: Follow a vegetarian eating plan but occasionally eat meat, fish, or poultry

• Lacto-ovo vegetarian: Include eggs and dairy products along with plant foods

• Lacto-vegetarian: Consume dairy products in addition to plant foods

• Vegan: Avoid eating all animal products

— Source: Vegetarian Eating Plans Contain Health Benefits. June 15, 2004. American Dietetic Association. Available at: http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/home_3979_ENU_HTML.htm

Mercury in Seafood
By following these recommendations for selecting and eating fish or shellfish, women and young children will receive the benefits of eating fish and shellfish and be confident that they have reduced their exposure to the harmful effects of mercury.

1. Do not eat shark, swordfish, king mackerel, or tilefish because they contain high levels of mercury.

2. Eat up to 12 ounces (two average meals) per week of a variety of fish and shellfish that are lower in mercury.

• Five of the most commonly eaten fish that are low in mercury are shrimp, canned light tuna, salmon, pollock, and catfish.

• Another commonly eaten fish, albacore (“white”) tuna has more mercury than canned light tuna. So, when choosing your two meals of fish and shellfish, you may eat up to 6 ounces (one average meal) of albacore tuna per week.

3. Check local advisories about the safety of fish caught by family and friends in your local lakes, rivers, and coastal areas. If no advice is available, eat up to 6 ounces (one average meal) per week of fish you catch from local waters, but don’t consume any other fish during that week.

Follow these same recommendations when feeding fish and shellfish to your young children, but serve smaller portions.

— Source: What You Need to Know About Mercury in Fish and Shellfish. U.S. Department of Health and Human Services and U.S. Environmental Protection Agency. Available at: http://www.cfsan.fda.gov/~dms/admehg3.html. Accessed January 7, 2005.

Resources
A Position Statement on the Vegetarian Diet, Seventh-Day Adventist Dietetic Association. Available at: http://www.sdada.org/position.htm. Accessed January 5, 2006.
Condo M. Food Trends Worth Following. In: Cooking Light. January/February 2006, p. 48.

Dietary Guidelines for Americans. Available at: http://www.healthierus.gov/dietaryguidelines/index.html. Accessed December 22, 2005.

Melina V, Davis B, Harrison V. Becoming Vegetarian. Book Publishing Company, Summertown, Tenn.: 1995.

Seafood Consumption Reaches Record Levels in 2004. NOAA Fisheries. November 9, 2005. Available at: http://www.noaanews.noaa.gov/stories2005/s2531.htm. Accessed January 7, 2006.

USDA MyPyramid.gov, Steps to a Healthier You. Available at: http://www.mypyramid.gov. Accessed December 20, 2005.

Vegetarian Eating Plans Contain Health Benefits. American Dietetic Association. Available at: http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/home_3979_ENU_HTML.htm.
Accessed January 5, 2006.

What are the Different Types of Vegetarians? Vegetarian Resource Group. Available at: http://www.vrg.org/nutshell/faq.htm#type. Accessed January 5, 2006.