Toddlers, children, and adolescents can substitute soy and other plant-based products for meat and dairy without missing most vital nutrients. I say "most" because a completely vegan diet (one with no animal foods at all) is missing one key nutrient. This is vitamin B12. However, many soy-based and other vegan foods are vitamin B12 fortified. This makes it very easy to get plenty of B12, even without meat and dairy. In addition to making sure a child gets enough B12, the most important thing for health when eliminating meat and dairy is to make sure the resulting diet is well-balanced and based around healthy, whole, minimally-processed foods. This is true for children as well as adults.

Many people in the U.S. eat a lot of processed foods and this includes vegans. To make sure you get the most out of a vegan diet, it's important to avoid relying too much on heavily processed foods such as snack foods, meat replacers (such as vegan hot dogs), sugary cereals, and the like. A vegan snack food is still a snack food and it won't give the body the good nutrition found in vegetables and fruit. Instead, aim to have most of your child's food come from unprocessed sources, including vegetables (especially green leafies, which are a great, non-dairy source of calcium), legumes (beans, tofu, tempeh, and soy milk) fruit, whole grains, and nuts and seeds. It's fine to have some processed vegan foods in the diet, but don't rely on them for all of your child's meals.

For children who are avoiding meat and dairy, there are a few other nutrients, beyond B12, that you may want to supplement. A healthy vegan diet can supply more than enough of these nutrients, but as we all know, children sometimes don't eat as well as we'd like them too! Keeping this in mind, it may be wise to supplement a few nutrients until you are certain your child is eating well on a vegan diet. Other nutrients to consider supplementing include iron, calcium, zinc, vitamin D, and omega-3 fatty acids. A vegan diet can supply these nutrients in sufficient quantities, but as I mentioned, a child who is a finicky eater may be more likely to miss out on them if there are no animal foods in the diet. To make sure a child does get enough B12 and other key nutrients, I suggest vegans use fortified soy milk and tofu products. For example, Tofu Plus is a product that is fortified with vitamins B6, B12, D, riboflavin (vitamin B2), and calcium. The vitamin D is from a plant source (vitamin D2), so this product is suitable for vegans. If you child enjoys these fortified soy foods on a regular basis, this will provide important nutrients to the diet.

The other benefit of including soy foods in a vegan diet is that soybeans are the one plant that contains all essential amino acids. Soy is considered a "complete" protein, unlike other plant proteins that are be missing one or more of the amino acids our bodies cannot make (the essential ones). In addition to using vitamin D fortified foods, it may be helpful to consider supplementing with vitamin D too. The recommended intake for vitamin D was recently raised by an Institutes of Medicine (IOM) expert panel. The recommended intake for vitamin D was tripled from 200 IU/day to 600 IU/day for all people between 1 and 70 years old. For infants under 1 year of age, the recommended intake is 400 IU/day. The safe upper limits for vitamin D intake have been raised as well, to the following levels:1,500 IU/day for infants six months to 1 year of age; 2,500 IU/day for children 1-3 years of age; 3,000 IU/day for children aged 4-8 years; 4,000 IU/day for all people 9 years of age and older. Breastfeeding does not supply enough vitamin D to an infant's diet, so be sure to supplement if your infant is exclusively breast fed.

To learn more about the new vitamin D recommendations, visit the National Institutes of Health website at: http://ods.od.nih.gov/factsheets/list-all/VitaminD/ Even with these higher recommended intakes, many people working in public health nutrition (myself included) feel these numbers are still a bit on the low side. Ask your doctor or dietitian if you or your child may benefit from a vitamin D supplement.

Congratulations on your decision to move toward a vegetarian diet. Numerous large studies have linked vegetarian diets with lower risk of heart disease, stroke, high blood pressure, and some types of cancer. The key to getting the most from your vegetarian diet is to make sure it's based around minimally processed plant foods. By minimally processed plant foods, I am referring to vegetables, fruit, legumes, whole grains, nuts, and seeds. Legumes refers to beans and peas, including soy beans and soy products such as tofu and tempeh.

When first going vegetarian, some people make the mistake of relying too much on processed foods and refined grains. It's easy to fall back on white pasta, bread, and bagels; microwave meals and frozen burritos; and vegetarian snack foods. None of these will give your body what it needs to be healthy. Instead, you can replace the meat in your diet with beans and soy foods including tofu and tempeh. It's fine to occasionally use fake meat products such as soy and grain-based "hot dogs," "sausages," and "lunch meats," but don't replace all of the meat in your diet with these foods. These fake meat products tend to be more processed and higher in sodium and fat. Use them a couple of times per week if you like, but replace the majority of your meat with beans, tofu, or tempeh.

Cooking with tofu and tempeh takes a little practice, but it's very easy. Many people find that extra firm or firm tofu works best in stir fries, tacos, and formerly-meat based sauces. For ideas on what to do with tofu, tempeh, and beans, try the recipe section on the Nasoya website,

You can search their recipe database at http://www.vegetariantimes.com/recipes/. Also try browsing through the recipes in the back issues of their magazines, which are available online. They have a section on easy, quick (less than 30 minute) vegetarian meals that is a good place to start.

Tofu is an excellent food choice for people with diabetes. Tofu contains plenty of protein. As you may know, protein does not raise blood sugar levels. For this reason, including plenty of healthy, lean sources of protein, such as tofu, can help to lower A1c levels.

Tofu does contain some carbohydrates, but they are complex carbohydrates. This is the "good" type of carbohydrate. Complex carbohydrates do not raise blood sugar as much as simple carbohydrates. This means that tofu can be a healthy option for someone trying to lower A1c levels.

If you are following a carb counting or diabetes exchange program, a 3-4 ounce serving of tofu is most often considered to be a lean or low-fat protein choice (exchange). This means you can include it in place of other protein options.

Another benefit of tofu is the type of protein it provides. Tofu is made up of vegetable protein. This type of protein is different from animal protein sources, such as chicken, pork, or beef. This difference is important. Vegetable protein is easier on the kidneys than animal protein. Your kidneys have to work much harder to process the protein from animal foods than from vegetable and beans.

Diabetes itself can lead to kidney damage and kidney failure. So anything that can lessen the burden on the kidneys is a good thing. If you substitute tofu into your diet in place of animal protein, you will be helping your kidneys remain healthy for as long as possible.

One thing to watch out for is how you prepare and serve tofu. Many people eat tofu with lots of white rice. White rice is very high in carbohydrates. For some people, white rice will cause large increases in blood sugar levels. This can cause A1c to go up.

To summarize: Tofu itself is a very health, lean protein choice for people with diabetes. Tofu, in place of animal proteins, also can help preserve kidney function.

I hope this information is helpful!
Suzanne Dixon, MPH, MS, RD

Nayonaise is vegan. This means it contains no dairy or dairy whey. However, the description of how tofu is made does include the word whey, which is confusing.

When you make any type of non-dairy milk, you first grind the main ingredient. Next, you add water and heat the entire mixture. The final step is to add a curdling agent to the liquid mixture. The curdling agent is usually something acidic, such as vinegar. The acid causes the liquid and solid parts of the mixture to separate.

The term "whey" refers to the liquid component of the mixture. The term "curd" refers to the solid part. So, you can have soy whey, oat whey, almond whey, or in the case of cow's milk, dairy whey.

When the ingredient list on soy products uses the word whey, this generally refers to the soy liquid. The tofu is the soy curd. These product do not contain dairy whey.

So, the long and short of it is that "whey" is a general term used to describe the liquid component in the "milk" making process. The word curd refers to the solid part. This is cheese for dairy or tofu for soy.

Nayonaise does not contain any dairy, so it is safe for your daughter to eat. The word whey in this case refers to soy whey.

I hope this is helpful.

Happy Eating!
Suzanne Dixon, MPH, MS, RD

Nasoya tofu is cooked and pasterized. In reality, all tofu is cooked. In making tofu, soybeans are ground up and combined with water. The mixture is heated to a very high temperature. The solid portion is tofu. The liquid portion is soy milk.

Because the soybean mixture is heated to a high temperature in the manufacture of tofu, all tofu is essentially cooked. This means that "raw" tofu, straight out of the package, is fine to eat in terms of food safety.

I would not serve bulk-purchased unpasterized, uncooked tofu to children or adults because this type of tofu can sit in the store for an unknown period of time, it could become contaminated with bacteria or mold. As well, you have no way of knowing how often the water in which the bulk tofu sits has been changed.

Prepackaged tofu, however, which comes in sealed packages, should be fine. I would use up the whole package within a day or two, to be on the safe side.

Finally, a quick check of the tofu's appearance and smell is a good idea. Make sure it is not slippery/slimy or discolored. And if it smells strong or "off", do not use it, raw or cooked.

Happy Eating!
Suzanne Dixon, MPH, MS, RD

In Health,
Suzanne Dixon, MPH, MS, RD