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I often get questions like this from worried parents: My 12-year-old daughter has decided to become a vegetarian. How do I ensure that she gets adequate nutrition and how do I prepare meals for her and the rest of us without spending all my time in the kitchen?

About 5% of the US population are vegetarians. Many believe that a vegetarian diet is healthier, some feel it would be ecologically healthier for our planet if there were no meat or poultry production, some have religious or economic motivations, and some simply do not approve of killing animals.

Over the years I have encountered many teenagers, especially but not exclusively girls, who decide to become vegetarians. Most, I will add, do not continue to follow vegetarianism after a year or two but some remain committed.

As a pediatrician I don’t worry about teen vegetarianism provided the parents and the teen have a good idea of the nutritional principles involved and provided the teen drinks milk and eats eggs. If a child of mine wanted to espouse a strict vegan diet (no animal products at all) I would not permit it without prior counseling with a trained and certified nutritionist.

What are the principles involved? Because animal protein is such a good source of many nutrients anyone who does not eat any meat must be concerned about the following:

o PROTEIN. Milk and cheese will provide protein. Plant protein is found in legumes, cereals, nuts, seeds, and some fruits and vegetables. Because some plant proteins lack one or more essential amino acids, it is vitally important that a variety of plant foods be included daily.

o VITAMIN B-12. Milk and eggs will provide enough vitamin B-12. The problem I have seen is that teens are notorious for skipping breakfast and some drink more soda pop than milk. Vitamin supplements may be in order for such teens.

o IRON. Because iron is found in many vegetables this is generally not a problem in vegetarian teens although I have seen girls with heavy menstrual flow need iron supplementation.

o CALCIUM. I worry about this nutrient in vegetarian teen girls who skip milk. Calcium is needed to build strong growing bones. Inadequate calcium in the teen years may cause lower bone density which can lead to osteoporosis in later life.

o CALORIES. Some teen girls become vegetarians to lose weight or prevent weight gain. It is very difficult to ensure adequate vegetarian nutrition if the total calorie intake is below optimal.

Savvy nutritionist don’t try to talk teens out of their vegetarian beliefs but tell them they have to do it right. A vegetarian diet does not mean you just stop eating meat. It takes work.

So if I had a 12-year-old girl who wanted to become a vegetarian I would say, OK but under two conditions:

1) You must keep track of essential nutrients. I would insist on seeing a food log so I would know that she ate at least three milk servings (yogurt and cheese count), a cup of beans, and a variety of nuts, seeds, cereal grains, vegetables, and fruits every day. I would also make sure she was eating enough calories.

2) You have to take responsibility, first under my supervision and then by yourself, for eating proper nutrition, especially during your growing years.

Then I would bring her into the kitchen. Vegetarians have to know how to cook. Anyone can throw a steak on the grill and have a tasty meal. It takes culinary skills to cook a balanced, tasty vegetarian meal.

My son is a vegetarian so I know from my own experience that it is relatively easy to cook for one vegetarian in the bunch and there are several strategies. Let the vegetarian cook her own meal. This requires some advance planning and a fairly big kitchen so you’re not both trying to use the wok at the same time. Add the meat at the end–you can easily make a big batch of meatless marinara sauce for pasta and add the browned meat to the sauce after the vegetarian has taken her portion. Develop a repertoire of vegetarian dishes the whole family likes, like meatless lasagna.