Nutrition: Special cases

Nutrition: Special cases

The Academy of Nutrition and Dietetics and other organizations of nutrition professionals have stated that an appropriately planned vegan diet is appropriate for people at all stages of life, including pregnancy, lactation, infancy, and later in life, as well as for athletes. In the following sections we will look at the special nutritional needs of each of these groups, and we will present some recommendations nutritionist have made to people in those groups to keep their health at their absolute best.

Pregnant women

Pregnant women need 50% more protein. For this reason, they should have five or six servings of high protein foods every day.

Even though iron absorption is increased during pregnancy, it is necessary to consume double the amount. It is also common for pregnant women to have levels of zinc that are lower than recommended. It’s important to get sufficient vitamin D, through either sun exposure or supplementation. It is especially important for the health of the future baby to get enough vitamin B12 and iron.

Health professionals generally recommend that all pregnant women take a multivitamin and multi-mineral supplement in order to avoid possible nutritional deficiencies, even if they are already following a healthy diet.

In summary, the following daily supplements are recommended for pregnant women:

  • 25-100 μg of vitamin B12.
  • A prenatal supplement containing folic acid, zinc, iron and copper. If this supplement does not contain iodine, an additional 150 mg iodine supplement should be added.
  • 800 IU (20 μg) – 1,000 IU (25 μg) of vitamin D.
  • If at least 1,200 mg of calcium is not obtained from food, this nutrient should be supplemented as well.1

Supplementation is recommended not only for vegans but for all women during pregnancy.

The first years of life

During the first six months of life, the majority of babies are fed mainly with breast milk or infant formulas. Under most circumstances, babies develop normally whether they are fed breast milk or soy infant formula.2

An important clarification is useful here. We shouldn’t confuse macrobiotic and vegan diets. A macrobiotic diet is plant-based, and it can be followed in a vegan way, but macrobiotics is a system of eating and philosophy that is different from veganism. Some studies have indicated that infant growth is not adequate if the child is put on a strict macrobiotic diet.3 Based on the available evidence, it is recommended that children not be put on a macrobiotic diet due to the health risks it may pose. Fat-free and very low-fat diets—Engine 2 (E2) is one example–are also not advised for very young children. In addition to containing essential fatty acids like ALA, dietary fats provide calories for growth and brain development and aid in the absorption of fat-soluble vitamins. The Engine 2 diet is plant-based, but parents should be aware when dining out that some restaurants confuse gluten-free diets with vegan diets.

Lactating mothers need more calories in order to produce milk. It is recommended that they also supplement daily with vitamin B12 and iodine.

Babies begin eating solid foods at between four and six months old. There are different ways to make the transition. One is to start by feeding the baby a mixture of rice cereal and breast milk. Once the baby can eat a third of a cup of this per day, other mashed foods can be added, such as fruits and vegetables like apples, bananas, pears, sweet potatoes, carrots, green beans and avocado.

There are alternatives to breast milk, such as soy formula, but breast milk is preferable. The American Academy of Pediatrics (AAP) states that during the baby’s first year, the only acceptable substitute for breast milk is iron-fortified infant formula.4 The soy-based formulas are often not 100% vegan. However, in order to meet the specific needs of infants, it’s important to use only commercial infant formula manufactured to meet them should breast milk not be an option.5

At seven months of age, apple juice and protein-rich foods can be added, such as legumes (cooked and pureed), mashed tofu, soy yogurt and cabbage.

From birth to one year of age, experts recommend the following daily supplements for babies: 1 mg iron per kilo (.45 mg/lb) up until six months of age, and the same amount thereafter unless iron-rich foods are eaten, and 400 IU (10 μg) of vitamin D.

Between one and three years of age, other foods should be introduced, such as grains, legumes, nuts, vegetables, fruits and oils.6

Too much fiber can be bad for young children. The AAP recommends that children consume no more than 0.22 grams of fiber per pound (0.1 grams per kilo) of body weight. Feeding children refined grains, peeled fruits and vegetables, and avoiding excessive amounts of other fiber-rich foods can prevent the overconsumption of fiber.7

Starting at one year of age, some experts recommend 200 mg of DHA daily.8 The AAP recommends that all babies, children and adolescents (vegans and non-vegans) take 400 IU (10 μg) of vitamin D daily.9 B12 supplementation is recommended as follows: from 1-3 years, 375 μg; from 4-8 years, 500 μg; from 9-13 years, 750 μg and from 14-20 years, 1,000 μg.10

From the 50s onwards

As we age, our caloric needs are reduced, while generally our nutritional needs remain the same or are even increased. The following section will discuss the different nutritional needs for people over 50.

The need for vitamin D and calcium increase over time, while vitamin D synthesis may decrease four-fold,11 and calcium absorption ability decreases as well. Currently 1,200 mg per day of calcium is recommended. A daily supplement or foods enriched with calcium can ensure that this need is met. To meet vitamin D needs, daily 30 minute sun exposure of the face and forearms to the sun, depending on skin tone, or a 800 IU (210 μg) supplement taken in the winter, should help ensure these needs are met.12 Supplements containing 1,000 IU (25 μg) to 2,000 IU (50 μg) may safely be taken, and this may be preferable to over exposure to sunlight.13

It’s important to consume protein-rich foods. This, together with resistance exercise, will help to slow the loss of muscle mass that occurs with time or even increase it.

To slow the cognitive decline that occurs with age, it is advisable to consume foods rich in antioxidants (such as β-Carotene and vitamin C), and obtain good levels of B vitamins. Two of the best sources of antioxidants are green leafy vegetables and berries. Some dietitians recommend to take a DHA supplement in the case of elderly vegans.14 It is under discussion now whether men over 50 should avoid excessive consumption of DHA (more than 300 mg per day), as a high level could be related to a greater chance of developing prostate cancer.15

As we age, it is especially important to consume a lot of fluids as well as water-rich fruits and vegetables unless suffering from a condition which requires that liquid intake be restricted. Many people over 50 do not consume enough liquids.16 The sensation of thirst may weaken as we age, and sometimes medications can affect hydration. It may also be the case that the kidneys become less efficient.17


Optimal health requires adequate nutrition and physical activity. A variety of fruits, vegetables, legumes, whole grains, nuts and seeds will fulfill the needs of most moderately active vegans. For the very active or those who engage in athletic competition, whether strength or endurance, a few targeted adjustments to both macronutrients and micronutrients can help ensure success.

It is crucial to consume enough calories in order to build muscle, reduce fatigue and train vigorously, and this can be challenging to a new vegan athlete accustomed to consuming small portions of low-fiber foods. High fiber diets may lead to additional calorie needs and most athletes will require 2,000-6,000 calories per day.18 Macronutrient percentage recommendations differ little from general guidelines. Carbohydrates are the body’s best source of fuel so 50-65% (up to 70%) of calories should come from starchy vegetables, fruits, whole grains and legumes. Refined foods like pastas can be used judiciously for high intensity training when quick energy is needed. Fats are both essential and beneficial for energy and should comprise 20-35% of the diet depending on total caloric needs.19 Nuts and seeds, their butters and avocados are excellent nutrient-dense fatty foods.

Increased calorie consumption inevitably leads to higher protein consumption, but athletes are advised to consume slightly more protein than the average active vegan. Endurance athletes require about .6 -.7 grams/lbs. (1.3-1.5 grams/k) aiming for the higher end during the early stages of training, and strength athletes should increase to about .06-.9 grams/lbs. (1.3-1.9 grams/k).20 Consuming plenty of legumes, tofu and tempeh is an easy way to ensure adequate protein intake. Some athletes appreciate the ease of protein powders, and a wide variety is available to help meet protein requirements.

Diligent adherence to recommended intakes and increased energy intake will meet the athlete’s needs for most micronutrients. Problems generally result only when calories are restricted.

A few micronutrients do warrant special attention. All vegans require vitamin B12 through fortification or supplementation, and the need for B2, riboflavin, increases with training. An excellent source of both is nutritional yeast (check labels). Moderately good sources of B2 include almonds, avocados, bananas, broccoli and leafy greens.22

Vitamin C needs increase with prolonged and strenuous exercise, so it is advisable to consume 100-1,000 mg per day through foods or in combination with supplementation. Some vitamin C-rich foods are citrus fruits, broccoli, leafy greens, mangos and red bell peppers. When consumed together, vitamin C-rich foods increase the absorption of iron, the most commonly deficient mineral in athletes, especially females. Inadequate intakes and reduced absorption compromise overall performance, work capacity and endurance. In particular, iron requirements for endurance athletes are increased by about 70%. Intakes should exceed 8 mg for men and post-menopausal women and 18 mg for women of childbearing age.

The electrolyte minerals potassium, sodium and chloride may be of concern to athletes depending on fluid losses. Potassium is usually plentiful in vegan diets (actually more than in non-vegan diets), but sodium and chloride can become quickly depleted during endurance sports. For events lasting longer than two hours, sports drinks are recommended to maintain adequate levels.22

Further readings

Adams, C. J.; Breitman, P. & Messina, V. (2014) Never too late to go vegan: The over-50 guide to adopting and thriving on a plant-based diet, New York: The Experiment.

Alexy, U.; Fischer, M.; Weder, S.; Längler, A.; Michalsen, A.; Sputtek, A. & Keller, M. (2021) “Nutrient intake and status of German children and adolescents consuming vegetarian, vegan or omnivore diets: Results of the VeChi Youth Study”, Nutrients, 13 (5) [accessed on 26 June 2021].

Attini, R.; Leone, F.; Parisi, S.; Fassio, F.; Capizzi, I.; Loi, V.; Colla, L.; Rossetti, M.; Gerbino, M.; Maxia, S.; Alemanno, M. G.; Minelli, F.; Piccoli, E.; Versino, E.; Biolcati, M.; Avagnina, P.; Pani, A.; Cabiddu, G.; Todros, T. & Piccoli, G. B. (2016) “Vegan-vegetarian low-protein supplemented diets in pregnant CKD patients: Fifteen years of experience”, BMC Nephrology, 17 [accessed on 28 April 2017].

Gould, J. F.; Roberts, R. M. & Makrides, M. (2021) “The influence of Omega-3 long-chain polyunsaturated fatty acid, docosahexaenoic acid, on child behavioral functioning: A review of randomized controlled trials of DHA supplementation in pregnancy, the neonatal period and infancy”, Nutrients, 13 (2) [accessed on 30 April 2021].

Hood, S. (2021) Feeding your vegan child, London: Hammersmith Health.

Koeder, C. (2020) Vegan baby: A guide to complementary feeding: For vegans between the ages of 4 and 12 months, [s. l.]: Christian Koeder [accessed on 8 February 2023].

Mangels, R. (2019) Your complete vegan pregnancy, Avon: Adams Media.

Melina, V.; Craig, W. & Levin, S. (2016) “Position of the Academy of Nutrition and Dietetics: Vegetarian diets”, Journal of the Academy of Nutrition and Dietetics, 116, pp. 1970-1980 [accessed on 21 January 2017].

Messina, V. & Fields, J. L. (2013) Vegan for her: The women’s guide to being healthy and fit on a plant-based diet, Boston: Da Capo.

Panigrahi, G. (2023) “Remission of type 2 diabetes with high-fiber, low-fat, and calorie restricted plant-based diet study”, Clinical Research, 10 (1) [accessed on 28 June 2023].

Pavlina, E. (2003) Raising vegan children in a non-vegan world: A complete guide for parents, Tarzana: VegFamily.


1 Norris, J. & Messina, V. (2011) Vegan for life, Philadelphia: Da Capo, pp. 133-140.

2 Mendez, M. A.; Anthony, M. S. & Arab, L. (2002) “Soy-based formulae and infant growth and development: A review”, Journal of Nutrition, 132, pp. 2127-2130. Mangels, A. R. & Messina, V. (2001) “Considerations in planning vegan diets: Infants”, Journal of the American Dietetic Association, 101, pp. 670-677.

3 Dagnelie, P. C.; Staveren, W. A. van; Vergote, F. J.; Burema, J.; Hof, M. A. van’t ; Klaveren, J. D. van & Hautvast, J. G. (1989) “Nutritional status of infants aged 4 to 18 months on macrobiotic diets and matched omnivorous control infants: A population-based mixed-longitudinal study. II. Growth and psychomotor development”, European Journal of Clinical Nutrition, 43, pp. 325-338.

4 Davis, B. & Melina, V. (2014) Becoming vegan, comprehensive ed., Summertown: Book Publishing, p. 307.

5 Norris, J. & Messina, V. (2011) Vegan for life, op. cit., p. 147.

6 Ibid., pp. 140-149.

7 Mangels, A. R. & Messina, V. (2001) “Considerations in planning vegan diets: Infants”, op. cit.

8 Norris, J. (2022) “Omega-3s”, [accessed on 14 August 2022].

9 Wagner, C. L.; Greer, F. R. & Section on Breastfeeding and Committee on Nutrition (2008) “Prevention of rickets and vitamin D deficiency in infants, children, and adolescents”, Pediatrics, 122, pp. 1142-1152.

10 Norris, J. & Messina, V. (2011) Vegan for life, op. cit., p. 159.

11 Adams, C.; Breitman, P. & Messina, V. (2014) Never too to go vegan: The over-50 guide to adopting and thriving on a plant-based diet, op. cit, p. 95.

12 Toss, G.; Andersson, R.; Diffey, B. L.; Fall, P. A.; Larkö, O. & Larsson, L. (1982) “Oral vitamin D and ultraviolet radiation for the prevention of vitamin D deficiency in the elderly”, Acta Medica Scandinavica, 212, pp. 157-162. Reid, I. R.; Gallagher, D. J. & Bosworth, J. (1986) “Prophylaxis against vitamin D deficiency in the elderly by regular sunlight exposure”, Age and Ageing, 15, pp. 35-40.

13 Adams, C.; Breitman, P. & Messina, V. (2014) Never too to go vegan: The over-50 guide to adopting and thriving on a plant-based diet, op. cit., p. 95.

14 Norris, J. (2018) “Omega-3s”, op. cit.

15 Brasky, T. M.; Till, C.; White, E.; Neuhouser, M. L.; Song, X.; Goodman, P.; Thompson, I. M.; King, I. B.; Albanes, D. & Kristal, A. R. (2011) “Serum phospholipid fatty acids and prostate cancer risk: Results from the prostate cancer prevention trial”, American Journal of Epidemiology, 173, pp. 1429-1439. Norris, J. (2013) “DHA supplements and prostate cancer”,, July 25th [accessed on 14 April 2023].

16 Norris, J. & Messina, V. (2011) Vegan for life, op. cit., pp. 163-168.

17 Davis, B. & Melina, V. (2014) Becoming vegan, op. cit., p. 354.

18 Ibid., p. 407.

19 Ibid., p. 408. Frazier, M. & Rusigno, M. (2013) No meat athlete: Run on plants and discover your fittest, fastest, happiest self, Beverly: Fair Winds, p. 66.

20 Davis, B. & Melina, V. (2014) Becoming vegan, op. cit., p. 410.

21 Ibid., p. 242.

22 American Dietetic Association; Dietitians of Canada; American College of Sports Medicine; Rodriguez, N. R.; Di Marco, N. M. & Langley, S. (2009) “American college of sports medicine position stand. Nutrition and athletic performance”, Medicine and Science in Sports and Exercise, 41, pp. 709-731.