If a diet needs supplementation, it is a poor diet and not a healthy diet. It is the strong response of the Italian Society of Paediatrics to veg “nutritionists” that leaves no room for doubt about the position of Italian pediatricians on vegetarian and vegan diets for children.

The position of the Italian Society of Preventive and Social Paediatrics (SIPPS) and its president on vegetarian and vegan diets for children is firm: “If a diet needs pharmacological supplementation, it is a deficient diet and not a healthy diet.” Pediatricians firmly reiterate it during the unceasing debate on the possibility of adopting an entirely plant-based diet for children, already harshly criticized in the past and not recommended by authoritative international nutrition societies.

The president of SIPPS, Dr. Giuseppe Di Mauro, and Dr. Margherita Caroli, coordinators of the Position paper on “Vegetarian Diets in Pregnancy and Developmental Age“, published in 2017 with the contribution of other Scientific Societies and Federations of the pediatric field (Italian Society of Adolescent Medicine, Italian Federation of Paediatricians, Italian Society of Perinatal Medicine) wrote on “Il Fatto Alimentare” in response to the president of the Scientific Society of Vegetarian Nutrition (SSNV), Luciana Baroni: “The Position paper is a scientific document for health professionals and pediatricians, to answer the main questions in the clinical field, only based on the latest scientific evidence.

As pediatricians, we noted that it was necessary to give an objective answer, free from interests and ideologies, given the change in the social impact and connotation of the “veg world”, with the structuring of companies and associations and the exponential increase of vital economic interests: publications, books, restaurants, nutritional advice of professionals trained “ad hoc“, sale of veg-tailored supplements, etc. Interests, moreover, never declared”.

“It is often said that vegetarian diets are healthy “if properly planned and supplemented”. That’s not right. If a diet needs supplementation, it is a poor diet and not a healthy diet. The addition of vitamin B12, iron, DHA, zinc, and calcium in vegetarian diets is necessary. In contrast, an omnivorous healthy diet, like the Mediterranean eating pattern, does not require any pharmacological supplementation because all the macro and micronutrients required for the organism are taken naturally with food“.

“People who follow a vegetarian diet must buy and take supplements – the pediatricians explain – and this is also a considerable cost for the whole family and extended for years. We know very well that it is often not followed when therapy is prolonged over time, even if necessary. Who can guarantee that the child will constantly take for years the supplements necessary in a poor diet such as the vegetarian one? And if he doesn’t take them constantly, what are the consequences?”

Besides, pediatricians point out the severe limitations of the scientific articles in favor of vegetarian diets, including those reported by Dr. Baroni, for their low methodological quality: “A revision of the literature, to be considered reliable must meet certain international criteria. Studies often compare vegetarian diets with the western-type diet full of junk foods that pediatricians and nutritionists have been fighting for decades. The comparison doesn’t have to be that, but it should show if vegetarian diets are better than the Mediterranean diet. Can we tell a parent to abandon the Mediterranean diet, with its balanced animal proteins, stating that the vegetarian diet is better, even if this is deficient and its need for integration has been documented?”

“There has never been any study – pediatricians repeat and emphasize none – that has shown that vegetarian diets are better than the Mediterranean diet in the age of development.  There is no official document from international institutions and organizations, including the WHO and the World Cancer Research Fund International, excluding animal proteins. In contrast, all recommend moderate use of food of animal origin. In many studies, there is also no certainty that “vegetarians” are such: many people answer questionnaires, and what they eat or do not eat cannot be verified, while it is known that many of them call themselves “vegetarians” simply because they eat meat only occasionally.”

“We would like to remind that any eating style that excludes entire categories of food is “restrictive” in an omnivorous species as we are since Homo erectus, that is 1.7 million years, and there are many wrong things reported as truths, such as that vegetarian diets “can avoid the harmful effects on the organism of certain nutrients contained in animal foods (saturated fats, cholesterol, animal proteins, and heme iron, as well as environmental toxicants).” We would like to know from which study of high methodological value the SSNV has taken the information that animal proteins, in adequate quantities, and heme iron have harmful effects on the human organism. We would also like to specify which and how many “environmental toxicants” there are in plant foods.

The SSNV website states that a “veg” diet “also reduces the risk of developing iron deficiency.” This statement does not have a scientific basis, and it is even exactly the opposite of what happens, since vegetarian diets, and in particular vegan diets, place children at greater risk of deficiency up to severe anemia“.

“We want to point out that there is not a category of ‘experts in a vegetarian or vegan diet.’ People who specialize or nutrition expert must have all the necessary skills to evaluate any diet according to needs (e.g., protein-free, gluten-free, low-calorie, low-fat diets), and therefore also vegetarian diets”, the pediatricians conclude: “Wanting to create a lobby of the veg world does not bring any advantage to children, especially in light of the ideological approach, growing interests, incorrect information and the lack of well-conducted clinical studies.

The recommendations of the Position paper, in line with the WHO, have recently been revised, presented to both a conference and the press, and are to be published in an international journal. As recommended by international organizations, the gold standard for our children and the dietary pattern that pediatricians will continue to recommend is the Mediterranean diet, which is a balanced diet, well adapted to their needs, based on foods of our territory readily available “at 0Km”, which does not exclude animal source foods and does not need supplements, nor nutritional advice.”