Vegetarian Diet And Health

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THE ROLE OF VEGETARIAN DIET IN HEALTH AND DISEASE By Dr. O. P. Kapoor

Foreword Dr. M.P.Birla

It is a great honour and privilege to contribute a foreword to this excellent monography on "The Role of Vegetarian Diet in Health and disease", a publication of the Bombay Hospital Institute of Medical Sciences. It is one of the first such books written by Medical Professionals of great repute. The book is remarkably complete as it deals with the role of a vegetarian Diet in Health as well as in a very large number of disease conditions, with each chapter contributed by the medical experts in their fields. Further it is heartening to learn that the vegetarian diet by itself can be balanced and complete if scientifically observed. This fact has a great bearing in our country where the poor masses cannot afford expensive non-vegetarian food. The preface should be read with care as it emphasises the evolution of the vegetarian diet in our hospitals. It further stresses the fact that vegetarianism is gaining great popularity in the western countries where such trends are adopted after prolonged observation supported by extensive research. It is also gratifying to note that contributions are made by the members of the medical faculty of the Bombay Hospital and Medical Research Centre as well as outstanding scholars from other hospitals and abroad. I have no doubt that this volume will not only be beneficial to the public but would also be appreciated by the members of the medical profession. Since primarily the book is published for the general public, the simple language in which most of the chapters are written makes the contents easily assimilable and the book easy to read To my knowledge, this book is the first of its kind to be compiled by medical experts and I have no doubt that it will serve to promote the cause of vegetarianism in our country and abroad.

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Preface O.P. Kapoor .

"You are what you eat" is an age old adage—and it is a fact that it is food that maketh a man. The food we eat, its quality, quantity, its timing and combinations is proven time and again to be of utmost importance in Health as well as in Disease. At the Bombay Hospital we have been serving vegetarian food from the inception of this institution and now we feel that the time has come to offer scientific justification for this. Not only on religious or moral grounds is this justifiable, but also on scientific grounds vegetarian food seems the more suitable diet for human beings. More scientific work has been done on vegetarianism in the last two decades than in the entire previous history of the world. Therefore, we felt that we should take the lead and bring to the fore all that there is to know on vegetarianism from the scientific angle and thereby justity the use of vegetarianism in health and in disease. There is a myth amongst people that consumption of meat would make them strong. It is also commonly believed that nonvegetarian food has more nutritive value. It is significant and embarrassing to note, that while in U.S.A. nearly 10 million people have adopted vegetarianism and more and more people in U.K., U.S.S.R., West Germany, Japan, Switzerland, Israel and Mexico are gradually turning to vegetarian diet not only on humanitarian grounds but more so on medical grounds, in India many vegetarians have started eating meat and eggs only on "wrong" beliefs of the supposedly good qualities of nonvegetarian diet. There are many books written for lay public on vegetarianism based on cruelty to animals, spirituality, cultural and philosophical values, economic, ecological, anthropological and humanitarian grounds. This book is being written by a team of specialists from various faculties of our institute and from other institutes in Bombay and abroad. Here they discuss and show that from the medical point of view the vegetarian diet is as good or is more suited to the human system than a nonvegetarian diet. Unlike other books written on vegetarianism which show that non-vegetarian food is bad for health, we have tried to prove, with medical evidence that vegetarian food is as nutritious or superior in some cases, to non-vegetarian food. If only this publication can remove the bias from the minds of the public; if only they could be convinced that they could not only live longer with vegetarian diet, but also not suffer from many crippling diseases, we would feel that we have been amply

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rewarded. Since this book is a joint effort of many scientists it has been difficult to prevent the overlap of views. In fact, at times, repetitions have intentionally been retained to maintain the individual readability of the chapter. To give this scientific publication a well rounded look, chapters on growth, immunity and microbiology have been included. Immunology for the general physician is, at best, complicated and so it is for the lay person. Hence the chapter on Immunity and Vegetarian Diet may make heavy reading. Similarly the chapter on microbiology has been written only to emphasize the fact that the kind of food we eat decides the kind of bacteria that are present within us. Facts of their functions are pouring in every day and their real importance will be evident to us very soon. Religion or spiritualism are not the field of doctors. But the Indian public should be enlightened about the good qualities of Vegetarian diet which are the high fibre content, low cholesterol content and low incidence of zoonotic disorders. Also, there is strong evidence that vegetarians are at a lesser risk for alcoholism. In this monograph we have reproduced a few articles from 'The Bombay Hospital Journal' which is the regular scientific publication of Bombay Hospital Institute of Medical Sciences. Vegetarianism can be divided into vegetarian, lacto-vegetarian and lacto-ovo-vegetarian diets. In this book lacto-vegetarian diet has been accepted as the Indian vegetarian diet. Similarly, many people, who eat fish, chicken and meat also eat vegetabies, fruits and cereals. Thus, really speaking scientifically they should be labelled as 'Omnivorous'. Instead for them, we have in this book used the colloquial term 'non-vegetarian'. The debate is wide open but it seems from the facts presented herein that the scales are tipped heavily in favour of vegetarianism.

We Acknowledge With Pleasure .

• • • • •

Dr. B.K. Goyal, Dean of the Bombay Hospital Institute of Medical Sciences for being a constant source of inspiration to us. Surg. Rear Admiral J.K. Suchdeva, Medical Director of the Bombay Hospital and Medical Research Centre for his invaluable guidance. Dr. D.C. Jain, Neurologist, New Delhi for initiating the idea of this monograph. Shri C.G. Joshi, Executive Director of the Bombay Hospital for all the co-operation extended during the accumulation and compilation of the data. Dr. P.M. Udani, Senior Paediatrician of the Bombay

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Hospital, who has been a constant source of guidance in the Editorial Committee. And all the contributors to this monograph who have helped to gather information on Vegetarianism under 'one roof'. Further we would like to express our sincere gratitude to .... • • • • • • • •

Shri P.R. Karve, Manager of the Bombay Hospital Journal. Dr. Ramesh Mehta, for carefully reading the proofs of the manuscript. Madhavrao Bhagwat of Mouj Printing Bureau. Shri Ashok Gokhale, cover artist. Jasra Graphics Shri Hemant Mistry, Photographer Dieticians: Miss Mariella Barreto, Miss Savita Dandekar for ferreting out references on Vegetarianism and compiling the data. Secretaries: Mrs. Rewa Nair, Miss Emily Rodrigues, Miss Stella Bastian and Miss Pratima, for typing the miles of manuscripts which went in the making of this monograph.

O.P. Kapoor Editor

Anand Gokani Assistant Editor

Food Values of A Vegetarian Diet Mariella L. Barreto .

The health of an individual depends on his nutrition. It is this wellknown fact that has led man to be more aware of the food he consumes. A large number of diseases are known to be diet related. A certain diet may itself be the cause of disease or alter the course of a known disorder such as diabetes or kidney disease. The food consumed by any individual or a community is determined by a number of factors viz. socio-economic status, religion, food availability and family traditions. Medical factors like food allergy, intolerance, diabetes and heart disease sometimes force a change in diet. Diet patterns may be classified broadly as vegetarian or nonvegetarian. Vegetarians can be further classified, depending

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on the food consumed, into fruitarians, vegans, lacto-vegetarians and lacto-ovo-vegetarians. The term vegetarian is generally used to refer to the lactovegetarian. The basic difference between the vegetarian and the non-vegetarian diet is the exclusion or inclusion of eggs, fish, meat and poultry. The difference in the nutritive value of the diets is dependent on the nutritive value of these foods. In general, the foods considered as non-vegetarian are high in protein and fat, low in fibre and are poor sources of carbohydrates, whereas vegetarian foods are rich in fibre, carbohydrate, vitamins, minerals and can be adequate in fat and protein as well. These differences in the nutritive value have given rise to the question - which diet is superior? All foods of animal origin are said to contain proteins of high biological value, viz. proteins that may be better utilized by the body. Proteins consist of amino acids, some of which can be synthetized by the body while some cannot. Amino acids that are not synthesized by the body are referred to as essential amino acids. Non-vegetarian foods contain all the essential amino acids unlike any single vegetarian protein source(except milk). However, all the essential amino acids can easily be obtained in a vegetarian meal by the judicious combinations of various foods. That a vegetarian diet is deficient in vitamin B12 is another bone of contention. Though most sources of vegetarian food are low in their vitamin B12 content, there are never any manifest deficiencies of this vitamin even in strict vegans. It is therefore likely that vitamin B12 is required in very minute quantities. Hence B12 cannot be the justification for resorting to foods of animal origin. It is widely believed that a vegetarian diet cannot provide adequate calories, but it is untrue. Balanced vegetarian diet can give adequate calories quite easily. Food may be divided into groups on the basis of the nutrient supplied: 1. Carbohydrates (energy) e.g. rice, sugar, honey etc. 2. Protein (building blocks) e.g. eggs, meat, fish, pulses, milk, nuts etc. 3. Vitamins and minerals e.g. fruits and vegetables. 4. Fat (energy and insulation) e.g. oils, nuts, red meats etci The main difference in the vegetarian and the non-vegetarian foods is the quantity and quality of proteins available in both. The non-vegetarian food is said to be rich in proteins but as mentioned earlier, vegetarian sources can supply the same if judiciously combined. Hence when a vegetarian seeks protein he

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has to focus his attention on pulses, nuts and milk. PULSES Pulses, the seeds of the leguminosae family are the main source of protein in a vegetarian diet. The major portion of the pulse cultivated is consumed after being dehusked and decorticated. This process not only shortens cooking time but also makes them more easily digestible. Whole pulses are best consumed after being soaked and sprouted. These sprouts have a high dietary fibre. Being live foods, they have the capacity and potential to create and generate new life. Seeds, grains, beans and even nuts can be sprouted. Sprouted food is easily accepted, digested and assimilated. Sprouting also gives a tremendous boost to the vitamin and enzyme content. In fact, in growing children, where extra proteins and vitamins are needed, lightly steamed sprouts are the best choice of food. A biogenic diet includes fruits, fresh vegetables, whole grains, nuts, beans and seeds which contain life-generating and cell renewal capacities for youth and life.

Sprouts (see fig. alongside) are living plant life, easily digested and invigorating in their effects.

Energy This group supplies 350 cats/ 100 gms and has a protein content of 20 % with the exception of soyabean (40%). To ensure the best utilization of this protein the first criterion is to meet the energy requirement. If the diet is deficient in calories the protein is used to make up this deficiency. Protein Proteins are made up of units called amino acids. The quality of a protein is dependent on the amount of essential amino acids available from it. A protein that has all the essential amino acids in the desirable amount is said to be of the best quality. Nonvegetarian sources of protein are complete in their amino acid contents whereas vegetarian sources of protein are not as complete. However, the combination of two food substances more than makes up for individual deficiencies e.g. pulses are deficient in sulphur containing aminoacids whereas cereals are

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rich in sulphur containing amino acids. This makes a cerealpulse combination a complete source of protein. Hence it is a mistaken belief that non-vegetarian food is essential to provide adequate proteins for growth and development. Looking into any of the traditional vegetarian meals of India we see that this is a practice that has been followed since ages. Not only is every meal a cereal-pulse combination, but in most cases, is accompanied by a complete protein source (milk or any of its products). The traditional idli-sambar, varan-bhat, thepla-dahi are some of the many examples of cereal-pulse, cereal-milk combinations. Carbohydrate Pulses have a carbohydrate content of 60%, most of which is in a complex form. Certain oligosaccharides present in pulses escape digestion and are responsible for flatulence in a few susceptible individuals. Common home processing methods like sprouting and germinating decrease the amount of flatulence producing oligosaccharides. Garlic is a bacteriostatic agent and aids in decreasing flatulence. Fat The fat present in pulses has a higher polyunsaturated fatty acid content (1.5%). This makes pulses not only qualitatively but also quantitatively better than meat. Minerals The minerals present in pulses are calcium, phosphorus, magnesium, sodium, potassium and iron. Of the phosphorus present, 80% is bound to phytate and is biologically unavailable. Soaking of pulses in water before preparation decreases some of the bound phytate, thus increasing the amount of available minerals. Vitamins The thiamine and carotene content of pulses is similar to that of cereals. Pulses are rich in niacin but devoid of vitamin C and poor in riboflavin. Once sprouted, pulses are excellent source of vitamin A, B complex, C, D and K. Sprouting dramatically increases the vitamin C content of the food. The vitamin E content of sprouted wheat increases 300% in four days. So much so, that because of the excess of vitamin E content, sprouted food administrated to patients of submucosal fibrosis of the mouth over two to three years, halts the progress of the disease and in some cases can cause actual regression.

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The vitamin C content also increases 600%. There is more carotene in sprouted wheat than in a carrot. The edible pulses contain two thermolabile factors that have been implicated in toxic effects. They are the trypsin inhibitors and haemagglutinins. The trypsin inhibitors suppress the release of amino acids making it unavailable and may also stimulate extra production of trypsin which leads to a loss of pancreatic activity. Sprouting of legumes causes a loss of this inhibitor and, if still present, it is then more susceptible to destruction by heat. Haemagglutinin present in pulses may combine with haem and result in destruction of haemoglobin. This constituent of pulse is generally not absorbed and is destroyed by cooking. Fermentation and sprouting help to speed up this destruction. Maximum utilization of pulses is thus obtained if the diet is adequate in calories and the whole pulses are soaked and sprouted prior to cooking. Soda, often added to pulses while cooking, decreases cooking time but also decreases the nutrients and is therefore best avoided. MILK Milk is considered as a perfect food because it constitutes the entire diet for the young of all mammals. Milk has a protein of excellent quality (second to that of an egg). The efficiency with which it is converted to body protein is second best to that of an egg The quantitative composition of milk varies with breed, season, stage of lactation etc. Fat is the most variable constituent, with protein following. The composition of the milk of a mammal is best for the young of that mammal. The milk having the closest similarity to that of human milk, with regards to composition, is that of goats, followed by that of cows (refer fig alongside)

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Protein The main protein of milk is casein (80%), the rest is lactalbumin and lactaglobulin which are the whey proteins. Most of the casein is bound to calcium. Casein is easily coagulated by acid or by enzyme renin while the other proteins are not. The milk protein contains all the essential amino acids and has a high digestibility co-efficient (97 - 98%). Fat Milk fat is also called butter fat and is characterised by the presence of short chain saturated fatty acids. The fat content of milk is variable (3 - 5%) and is present as an emulsion making it easily digestible. Carbohydrate Lactose is the carbohydrate in milk which is broken down by the enzyme lactase. An absence or insufficiency of lactase causes micro-organisms to act on lactose leading to the formation of gases and thus the cramping discomfort and diarrhoea in 'lactose intolerence'. The lactose content of the milk can be decreased by fermenting milk to form yogurt (curd) where the amount of lactic acid is higher. The lactose content of milk is 5%. Minerals The minerals present in milk are sodium, phosphorus, sulphur, magnesium, manganese, calcium and iron. Calcium is bound to phosphate which, with casein, forms a phosphoprotein. It is also present with fat. The quantity of iron is low in milk, but is of an excellent quality resulting in its ready absorption. Vitamins Vitamin A - carotene present gives the milk yellowish tinge and is obtained from plant feed. The amount varies with the breed, the amount present in the feed and the fat content of milk. Vitamin D, E & K - These nutrients are present in small amounts. As they are fat soluble, they are associated with the fat content of the milk. The skimmed milk has an even smaller amount of these vitamins. Thiamine - This nutrient is also dependent on the amount present in the feed but it is also synthetized by the lumen of the gut of the cow and is therefore present in fair amounts in cow's milk. Riboflavin - The colour of the whey is due to the presence of this

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nutrient. It is present in very small amount (0.05 -0.1%) and is dependent on the amount present in the feed. Niacin - Milk is a good source of tryptophane which is a precursor of niacin. Vitamin C - This vitamin is easily destroyed by application of heat and exposure to air. The small amount present in the milk is destroyed during pasteurisation. Milk is a food that is highly perishable. Thus processing it will help to store it. Spray drying of the milk to powder or condensing it are some examples. Processing, in most cases, involves high temperatures and this destroys some of the nutritive value. This loss can be overcome by fortification. There are a number of dairy products and these may be classified into 'fermented' & 'unfermented'. The most common in India is dahi (curd). This has a better nutritive value, not due to an increase in nutrients but an increase in digestibility. Fermentation increases the vitamin content and lactose is converted to lactic acid. The calcium and phosphorus of curd are more easily assimilated. NUTS AND OILSEEDS Nuts, which are the seeds of fruits, contain nutrients to aid in the growth of a new plant. This is why all nuts are not only a good source of nutrients quantitatively but also qualitatively. Nuts are classified, depending on their nutrient content (protein, fats and carbohydrates). The nuts with a high fat content, in most cases, are also high in protein, and this group includes most of the nuts. Those high in carbohydrate are few e.g. chestnut. On an average, nuts are found to contain 50% of fat and 25% of protein. Nuts are a rich source of essential fatty acids. This group of food thus supplies not only calories but also, weight

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for weight, twice as much protein as any other food crop (fig.2). Nuts are a good source of vitamin B complex in particular. Groundnuts are rich in thiamine and nicotinic acid. They have a mineral content of 2%, a large fraction of it being phosphorus and potassium. The most common complaint regarding nuts is indigestion. This, in a majority of the cases, is due to over-indulgence and poor mastication, both of which we can easily rectify. In order to get the maximum utilization, nuts must be consumed in limited amount. Nuts may also be soaked overnight. Humidity and unhygienic storage conditions cause food to get easily contaminated with fungi. Groundnuts are prone to such infestation which produces aflatoxin. This toxin causes damage to the liver and can be avoided by proper storage. Nuts are consumed in various forms. They may be had fresh, dried, dehydrated or roasted. Nuts are used for oil extraction. The meal left after the extraction of oil from nuts is rich in protein. Nuts are most often considered to be expensive and out of the common man's reach. Comparing the cost of almonds and cashewnuts per kg with that of eggs and meat, the cost of 10 gms of protein is similar, if not less, in the case of nuts. COCONUT Coconuts are botanically stone fruits and not nuts as they are termed. This stone fruit is largely used for oil extraction and it is thus classified as an oilseed. This fruit is consumed at different stages of maturity and its nutritive value varies accordingly. Tender Coconut: The most tender coconut contains only a liquid in it and no kernel meal. The tender coconut water is a common food in the sick room and this drink has the advantage of being sterile. This drink is a good source of electrolytes. As this- fruit matures the amount of water decreases and the amount of meal increases. The thin initial layer of meal has a high percentage of water and so is not a dense source of nutrients, this is one of the reasons that makes it an easily digestible food. Ripe Coconut: The thick layer of kernel is much lower in moisture and high in calories. The coconut kernel is high in oil content and is used for oil extraction. The coconut oil has a high

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percentage of medium chain triglycerides (M.C.T.). This M.C.T. is of great therapeutic value when other forms of fat are not tolerated. Another byproduct is the coconut milk which is obtained from the endosperm. This is grated, ground and squeezed to expel milk. The endosperm on grating can be air dried to reduce its moisture content to less than 2% to obtain the dessicated coconut. This is commonly used for the preparation of sweets and biscuits. Nutritive Value of The Coconut at Different Stages of Maturity per 100 Grns

Coconut Water Moisture (%) 93.8 C alories 24 Protein (gms) 1.4 Fat (gms) 0.1 Carbohydrate (gms) 4.4

Tender Coconut 90.8 41 0.9 1.4 6.3

Coconut Milk 42.8 430 3.4 41 11.9

Fresh Dry 36.3 444 4.5 41.6 13

4.3 662 6.8 62.3 18.4

Dry Coconut: This is the coconut at its maximum degree of maturity and thus with the lowest percentage of moisture. At this stage the coconut has only 4.3% of moisture as compared to the tender coconut that has 90.8%. This is also the most concentrated form of nutrients. It supplies 6.8 gms of proteins and 62.3 gms of fat per 100 gms. The above discussion on the nutritive value of pulses, nuts, milk and coconut makes it clear that the nutrients supplied by a nonvegetarian diet can be obtained from a vegetarian meal. All this calls for is an intelligent combination of the foods permitted. The vegetarian sources of protein are low in saturated fat and thus have an advantage over protein obtained from meats. Thus a vegetarian meal that is well balanced can be as nutritious, if not more, than a non-vegetarian meal.

Coronary Heart Disease and Vegetarian Diet B.k. Goyal .

'Heart attacks', which have become so common, occur due to involvement of coronary arteries, which carry the blood supply to the heart. An 'attack' results when one of the coronary arteries suddenly gets blocked and causes death of the muscle tissue of the heart supplied by that artery. This is clinically known as an 'attack' of myocardial infarction.

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Why do coronary arteries get blocked ? There are two reasons which have been detected on post-mortem examination: I. Blockage due to gradual narrowing of these arteries as a result of a degenerative disease known as atherosclerosis. Even as early as fifty to sixty years ago this atheroma was seen only in old people and was synonymous with the aging process. As the civilization has progressed, the time has come when the postmortems done on young children and young adults who have died due to accidents or other causes, have been showing atherosclerosis of the coronary arteries. Smoking, presence of long standing diabetes and high blood pressure, overweight and sedentary life are some of the known causes. However, the most important single biochemical abnormality which can be spotted and correlated with atheroma is the level of blood cholesterol. In the last few years the whole family of blood lipids has come to light. This consists of triglycerides, HDL and LDL cholesterol and a variety of apolipoproteins. It has been found that if the diet is rich in saturated fatty acids as in the case of non-vegetarian diets, the blood fat levels become highly abnormal and the process of atherosclerosis starts right from childhood. So striking was this association, that ten years back in the Western countries, the public was warned through the television and radio media, that their children should not be given more than two eggs per week. In fact such sensational discoveries have led many people in the West to take to vegetarianism. Vegetarians have low intakes of total fat, saturated fatty acids and cholesterol. Their intake of polyunsaturates is equal or slightly higher and dietary fibre intake is usually much higher than w that of nonvegetarians. Some evidence exists that protein or dietary fibre in vegetarians may be involved in reducing coronary heart disease. The type and amount of dietary fat and cholesterol are most strongly associated with changes in serum lipids, apolipoproteins and blood rheology, all of which are the causes of coronary heart disease and heart attacks and are discussed below: Blood Lipids (Fat) Cholesterol circulates in the blood in two forms. The high density lipoprotein (HDL) cholesterol is protective for the heart and reduces the risk of coronary artery disease. As against this the low density lipoprotein (LDL) cholesterol increases the risk of coronary artery disease. The blood cholesterol levels are affected by the type of dietary fat and the amount of cholesterol present in it, alcohol, smoking and physical activity. The consumption of high saturated fatty acids (as in ghee and coconut oil) and cholesterol increases the LDL cholesterol levels. On the other hand the consumption of polyunsaturated fatty acids lower the levels of LDL cholesterol and not only that, they also increase HDL cholesterol levels thereby protecting the patients from coronary artery disease.

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Apo-lipoprotein Levels Apo-lipoprotein levels may be better than serum lipid levels for predicting the risk of coronary heart disease. Table 1 shows that in most but not in all studies, lipid-modified vegetarian diets were found to change levels of apolipoprotein as well as lipoprotein composition and levels. II. The second reason for sudden blocking of the coronary arteries is the occurrence of a blood clot in an otherwise clean blood vessel. This type of blockage is specially seen in young people dying of heart attacks. Although there are a number of constituents in the blood responsible for this clotting, the role of platelets in blood seems to be outstanding. Table I Studies of Vegetarians and Coronar y Artery Disease Outcome Vanable

Study or Observations

Mortality from coronary artery disease

Negative association between vegetarianism and ischemic heart disease mortality, even after removing confounding effects of smoking, especially in males. 35-64-y-old Seventh-day Adventist vegetarian men had lower mortality than did nonvegetarians although in men over 65 and women differences were significant, even after taking smoking into account.

Serum cholesterol levels: comparisons of vegetarians and nonvegetarians

Total serum cholesterol, low-densitylipoprotein cholesterol, and to a lesser extent high-density-lipoprotein cholesterols are lower in vegetarians and especially vegans compared with lactovegetarians or omnivores. Vegetarian diets usually produce a selective lowering of LDL levels, with lowered total cholesterol: LDL or LDL:HDL ratios.

Serum cholesterol Groups such as Macrobiotics and Hare levels Krishnas with members eating vegan or very restrictive vegetarian diets low in fat, high in polyunsaturated: saturated fatty acid ratios, high in dietaty fiber, and low in cholesterol show decreased total cholesterol and LDL cholesterol than do omnivores. Vegetarians' LDL cholesterol levels are usually decreased but HDL cholesterol levels vary, some being higher than those of nonvegetarians, some lower.

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Serum cholesterol levels: feeding vegetarians animal foods

Feeding vegetarians beef, which is high in total fat and saturated fatty acids and cholesterol, causes 19% increases in total plasma cholesterol because of increase in LDL cholesterol whereas HDL cholesterol levels stay constant over a 2-wk period Feeding lactovegetarians eggs for 3 wks, which increases dietary cholesterol, increases total and plasma cholesterol.

Serum cholesterol Decreasing the amount and altering type of levels: feeding fat in Seventh-day Adventist vegetarians' vegetarians diets further decreases serum lipid levels. animal foods Serum cholesterol levels: feeding nonvegetarians vegetarian diets

Nonvegetarians have decreased total cholesterol and LDL and HDL cholesterols when they are fed vegetarian diets low in total fat, saturated fatty acids, cholesterol protein, and high polyunsaturated fatty acids, P: S ratios carbohydrate, and dietary fiber for several months, Decreases are only one-third of those observed in lifelong vegetarlans. Normolipidemic nonvegetarians fed a lowfat, semivegetarian diet for 3 mo have decreased total cholesterol, LDL cholesterol, and LDL: HDL ratios whereas HDL levels, weights, and plasma triglycerides stay constant.

Apoprotein levels

Nonvegetarians fed vegetarian diets exhibit declines in apoprotein Al levels when diet is low in total fat, saturated fatty acids, and cholesterol and moderate in polyunsaturates . Vegetarians on low fat, total fat, and saturated fatty acid diets show decreased apoprotein AI and B levels and elevated HDL cholesterol apoprotein Al and HDL: LDL cholesterol ratios increased. Addition of eggs high in cholesterol to the diet of lactovegetarians increases apolipoprotein B levels in 3 wk. Lactovegetarian diets fed to nonvegetarians for 6 wk led to no changes in apoprotein B levels although apoprotein B: total cholesterol and apoprotein B:LDL cholesterol ratios increased.

Platelet levels

Lactovegetarians have altered platelet linoleic and arachidonic acid concentrations in comparison with nonvegetarians. Vegans and vegetarians do not differ in serum thromboxane or prostacyclin levels or platelet aggregation .

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Nonvegetarians show changes in platelet function when saturated fatty acids are decreased and P: S ratios are increased platelet aggregation to thromboxane and clot ting activity of platelets is decreased and response to adenosine diphosphate aggregation is enhanced. Saturated fatty acids increase thrombin aggregation and platelet function can be decreased by altering diets. Platelets are important in clotting and in the development of the arterial thrombi that underlie most 'heart attacks' due to acute myocardial infarctions. They may also modulate coronary artery disease independently of factors such as smoking, blood pressure and genetics. Platelet composition and functional changes can be induced by dietary fat modifications. Saturated fatty acids are most highly associated with the changes in platelet aggregation to thrombin and platelet clotting activity. One of the theories is that, by decreasing saturated fatty acids as in the vegetarian diet, platelet aggregation and blood clotting changes predisposing to thrombosis will decrease. Also clotting of a blood vessel depends on the blood fluidity known as "Blood Rheology". Possibly vegetarians have a better than average blood fluidity and this puts them at a lower risk of suffering coronary artery disease. Finally in vegetarians, factors other than the diet may also be involved in lowering the risk of heart disease. These include i) the nonsmoking and the non-alcoholic status of vegetarians, which may affect HDL-cholesterol levels, ii) their physically active lives, which may favourably alter apo-lipoproteins as well as HDL cholesterol, iii) their relatively low weights, which may decrease risks of hypertension and non-insulin dependent diabetes. It is also worth noting that the reduction in risks of coronary heart disease seem to be associated with the type of vegetarian diet that is followed rather than some genetic protective effect of vegetarianism per se. The fact that mortality and morbidity from coronary artery disease is lower in vegetarians than in non-vegetarians has also been confirmed at the Bombay Hospital. Although this hospital caters to all the communities the patients are strictly provided with vegetarian diet only. The studies are in progress at the Bombay Hospital Institute of Medical Sciences to go into the dietary causes of coronary artery disease and our initial data from these studies shows that out of the last hundred coronary heart disease patients, only thirty six patients were vegetarians.

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Are there any special substances in the vegetarian diet which give protection against coronary heart disease? In India a lot of work has already been done on the role of garlic and onion in lowering blood cholesterol. Maize bran has also been shown to have a protective effect on the cardiovascular status. Many other vegetarian foods, protective to the heart, have been discussed in another chapter. Hence it seems evident, that vegetarianism offers definite protection from coronary heart disease. REFERENCES 1. Burslem J. Schonfeld G. Howald MA, Weidman SW, Miller JP, Plasma apoprotein and lipoprotein lipid levels in vegetarians. Metabolism 1978, 27:711-9 2. Sacks FM, Ornish D, Rosner B. et al. Plasma lipoproteins in vegetarians: The effect of intake of dairy fat. JAMA 1985; 1337-41. 3. Ruys J. Hickie JB. Serum cholesterol and triglyceride levels in Australian adolescent vegetarians. Br. Med. J 1976:8792. 4. Fisher M, Levine PH, Weiner B. et al . The effect of vegetarian diets on plasma lipid and platelet levels. Arch Intern Med 1986; 146:1193-7. 5. Vessby B Boberg J. Gustafsson IB, et al. Reduction of high density lipoprotein cholesterol and apolipoprotein A I concentrations by a lipid lowering diet. Atherosclerosis 1980, 35:21-7. 6. Sacks F.M., Castellik W.P., Donner A. and Kass F.H., "Plasma Lipids and Lipoproteins in Vegetarians and Controls, The New England Journal of Medicine 1975, 292 (22):1148-51. 7. Ellis F.R. amd Sanders T.A.B., "Angina and vegan diet", The American Heart Journal June 1977, 93(6):803. 8. Lock DR, et al ApoA-I/ApoA-II ratios in plasma of vegetarians. Metabolism 1983 Dec; 32(2): 1142-5. 9. Masarei JR et al. Vegetarian diets, lipids and cardiovascular risk. Aust NZ J Med 1984 Aug; 14(4); 43943. 10. Ernst E et al. Blood rheology in vegetarians. Brit J Nutr 1986 Nov 56(3) 555-60. 11. Gupta O.P. et al, Role of Maize Bran on Cardiovascular status, lipid profile and glycaemic control in Diabetes Mellitus J. Ass. Phy. India 1987:35:353. 12. Burr ML, Sweetman PM. Vegetarianism, dietary fibre and mortality. Am J Clin Nutr 1982, 36:873-7. 13. Masarei JRL, Rouse IL, Lynch WJ, Robertson K, Vandongen R. Beiling LJ, Vegetarian diets, lipids and cardiovascular risk. Aust NZ J Med 1984; 14:400-4. 14. Sainani G.S., Desai P.B., Gorha N.H.. Natu S.M., Pise D V. and Sainani P.G. Effect of dietary garlic and onion on serum lipid profile Ind J. Med. Res. May 1979.

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15. Effect of Dietary garlic and onion on some coagulation parameters in Jain Community Jr. Asso. Phys. of India, June, 1979. 16. Jain, R.C., Effect of dietary garlic and onion on serum lipid profile: Lancet, 1975, 1:1240.

Vegetarian Food and The Gastro-Intestinal Tract O.P. Kapoor .

That man is a vegetarian animal is amply exemplified by his basic anatomy. Unlike carnivorous animals, man has teeth suited for biting and grinding and not for tearing. The intestines of man are longer as compared to their carnivorous counterparts. These are but the most basic of differences that exist between vegetarian and non-vegetarian 'animals'. The digestive tract of man starts in the mouth. The lips, the teeth and the tongue play an important role in the mastication and the softening of the food. Digestion commences in the mouth with the help of the saliva. The food, after due mastication is swallowed whence it enters the oesophagus (or food pipe). The food pipe empties into the stomach. The food in the stomach is acted upon by gastric acid and enzymes which help in digesting the food to its more basic constituents. The continuous churning of the stomach further helps in breaking down the food. From the stomach the food enters the intestines which are the longest part of the gastro-intestinal tract. Here various enzymes complete the digestive processes and absorption of the various elements of the food begins. What is undigested and unabsorbed enters the colon (large intestine). Here the faeces are formed which are gradually taken upto the rectum and anal canal and egested at periodic intervals (Refer figs. I and 2 below for anatomical topography) .

Fig. 1

Fig. 2

Let us now consider the advantages of a vegetarian diet in relation to each of the parts of the gastro-intestinal tract. 1. Vegetarian food being high in its fibre content increases the flow of saliva which enhances digestion and protects the teeth from caries.

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2. Cancer of the oesophagus is less common in vegetarians. This is because vegetarian foods like fresh fruit, vegetables, especially amla and citrus fruits contain large doses of vitamin C which has a protective action against malignant disease (cancer). 3. Hiatus hernia which occurs at the junction of the oesophagus and the stomach is less common in vegetarians. Though the cause of this phenomenon is unknown, it is postulated that, vegetarian food, particularly in the natural form, contains very little fat. The fat when present in the diet in excess delays emptying time of the stomach. This leads to pressure on the diaphragm which causes the hiatus hernia. 4. By virtue of the high vitamin C and fibre content the vegetarian food offers protection from stomach malignancy.

5. The intestines are the home of many parasites. The longest of them—taenia saginata and taenia solium (Fig alongside) are found almost exclusively in non-vegetarians, especially in those who eat beef and pork. These worms are almost never found in vegetarians. 6. There are clinical observations that suggest that appendicitis (attack of inflammation of the appendix) is less common in vegetarians. 7. The large intestine (the colon) is most susceptible to the kind of food eaten by us. The advantages of a vegetarian diet have been observed in following diseases of the colon: Constipation The larger undigestible matter present in fruits and vegetables provides bulk which enhances the forward passage of undigested waste matter from the caecum to the rectum and anal canal. It also reduces the transit time from caecum to rectum. This prevents stasis of poisonous endproducts of digestion and resulting diseases of the colon. Thus, while non-vegetarians pass small stools (on an average 100 gm), the vegetarians pass large bulky stools (on an average 300 gm). Also vegetarians pass less foul smelling stools. A few years ago, in my book on 'Common Chronic Disease Patterns in the Arabian Gulf, Saudi Arabia and Yemen', I mentioned that constipation is extremely common in the Arab popula tion. It has been noticed time and again that when these patients are given more vegetables and fruits (in addition to plenty of water to drink), their bowels move freely and they are relieved of their constipation. Diverticulosis of the Colon

19

In elderly subjects the incidence of constipation increases markedly due to the development of the above condition. Fig. alongside shows the small pouches looking like pseudopodia which appear on different sides of the colon. Not only do these pouches make the colon very sluggish, but they can get inflamed like the appendix or can bleed like an ulcer. The modern refined and non-vegetarian diet is responsible for this disease. The reduced faecal bulk causes narrowing of the colonic lumen and an increase in intraluminal pressure. This results in protrusion of these pouches known as diverticula. Diverticula may also develop due to the attempts of the proximal colon to overcome obstruction caused by the segmented and narrowed distal colon. Owing to the high fibre content of the vegetarian food, this disease is infrequent in a vegetarian population. Irritable Bowel Syndrome This illness is the most common cause of bowel irregularities and colonic gripes. Incidentally it is less frequent in vegetarians owing to the high fibre content of such a diet. Chronic Ulcerative Colitis Unlike amoebiasis and giardiasis which are easily treated with drugs, ulcerative colitis is a 'lifelong bloody dysentery'. The incidence of this disease is much less in vegetarians because of the high fibre content. Cancer of the Colon It has been proved all over the world that the incidence of the cancer of the colon is very low in vegetarians. It is postulated that the high fibre content of pulses, cereals, vegetables and fruits increases the amount of faeces and reduces the transit time through the colon. As mentioned earlier, the latter reduces the exposure to carcinogens responsible for the development of the cancer of the colon. These substances include tryptophane, tyrosine, methionine, basic amino acids, cholesterol and bile acids. The bile acids are the most important carcinogens. A number of epiderniological studies have shown and several authors have found a significant relationship between the faecal bile acid concentration and colonic cancer. 8. Rectum and anal canal—The diseases of the terminal end of the gastrointestinal tract e.g. fissure and piles are abundant in the normal population. In fact, the incidence of these diseases is highest in the Arab population as described by me in my book on

20

Arab diseases. The fact is that both are related to underlying severe constipation. The straining done to expel the hard stools from the rectum and anal canal, "keeps up" the piles and the fissures. In the medical world, it is a very common observation that these diseases are much less common in vegetarians. This seems to be related to the low incidence of constipation amongst vegetarians.

9. The liver and the gallbladder are also affected by the vegetarian diet. Fig. alongside shows the presence of stones in the gall-bladder which can occur in as much as 10% of the population above the age of 70 years. It is interesting to note that the incidence of gall-stones in vegetarians is significantly less. The high fibre content of the vegetarian diet causes reduced deoxycholate absorption which in turn increases the synthesis of chenodeoxycholate. The latter affects the cholesterol saturation of the bile resulting in less stone formation. In fact patients having gall-stones are prescribed high fibre vegetarian diets in order to reduce further gall-stone formation.

10. Liver is discussed in a separate chapter. 11. Pancreas—Pancreatic malignancies are known to be less common in vegetarians. All-in-all it appears that vegetarian food is beneficial in prevention as well as in the management of most of the gastro-intestinal diseases. REFERENCES 1. Bennion LJ, Grundy SM. Risk factors for the development of cholelithiasis in man. N Engl J Med 1978; 299:1221-7. 2. Pixley F. Wilson D, McPherson K, Mann 1. Effect of vegetarianism on developmenl of gallstones in women. Br Med J 1985; 291:11-2. 3. Gear JSS. Warc A, Fursdon P. et al. Symptomless divenicular disease and intake of dietary fiber. Lancet 1979, 1:511-4. 4. Ornstein MH, Littlewood ER, Baird IM, Fowler J. Nonh WRS, Cox AG. Are fibre supplements really necessary in divenicular disease of the colon ? A controlled clinical trial. Br Med J 1981; 2S2:13536. 5. Burkitt DP. Epidemiology of cancer of the colon and rectum. Cancer 1971; 28:3-13. 6. Bingham SA, Williams DRR, Cole TJ, James WPT. Dietary fibre consumption and regional large bowel cancer monality in Britain. Br J Cancer 1979; 40:456-63. 7. Graham S. Dayal H. Swanson M, et al. Diet in the epidemiology of

21

cancer of the colon and rectum. JNCI 1978; 61:790-814.

8. Glober GA, Nomura A. Kamiyama S~ Shimada A, Abba BC. Bowel transit time and stool weight in populations with different colon cancer risks. Lancet 1977; 2:110-1. 9. Rider A, Anhus RS, Calkins BM, Nair PP, Diet, nutrition intake and metabolism in populations at high and low risk for colon cancer; selected biochemical parametcrs in blood and urinc. Am J Clin Nutr 1984; 40:917-20. 10. Turnbull GK, Lennard-Jones JE, Bartraum CI. Failure of rectal expulsion as a cause of constipation: Why fiber and laxatives sometimes fail. Lancet 1986; I :767-9. 11. Preston DM, Lennard-Jones JE. Severe chronic constipation of young women. Idiopathic slow transit constipation. Gut 1986; 27:41-8. 12. J.F. Fraumeni, "Cancers of the Pancreas and Biliary Tract: Epidemiological Considerations", Cancer Research 1975: 35:343. 13. Pixley F. et al. Effect of vegetarianism on developmcnt of gall stones in women. Br. Med. J (Clin. Res) 1985 Jul 6, 291 (6487):112. 14. Kapoor O.P., Common chronic disease patterns in Arabian Gulf, Saudi Arabia and Yemen. S.S. Publishers Bombay 1983, Page 23.

Of Diabetes and Vegetarianism H.B. Chandalia

22

.

In order to evaluate the role of vegetarianism in diabetes we shall review the current dietary recommendations in diabetes. We shall further examine the suitability of vegetarian foods in composing such diets. Evolution of Principles of Diet in Diabetes Diets prescribed for diabetics have gone through remarkable changes in the insulin era, post-insulin era, and most importantly in the last two decades. Diets in the pre-insulin era consisted of a very low carbohydrate content. In insulin-dependent diabetics, the carbohydrate content was reduced to 10-20 gm/day. Thus, in order to provide the requisite amount of calories the fat content of the diet had to be proportionately increased. Such diets were highly unpalatable. Diabetic diets in the post-insulin era derived 40%, 20% and 40% of their calories from carbohydrates, proteins and fats respectively. This has further changed in the past two decades. The present day diabetic diets derive 50 - 60% of their calories from carbohydrates and proportionately reduced amount of calories from fats (Table 1). Diets in India, where vegetarianism is practised extensively, have always been high in carbohydrates and low in fats. Table 1 Distribution of Major Nutrients in Normal & Diabetic Diets Nutrients

Diet

Starch & Other polysacharid es

Sugar Total & Carbohydrat Fat Dextrin es s

Protei Alcoho n l

Normal Western diets in the Past

25-35

20-30

45-50

3645 p/s* 12-19 0-10 ratio abou t 0.3

Tradition al Diabetic Diets

25-30

10-15

35-40

4045

16-21 0

5-15

45-55

2535

12-24 0-6

5-15

60-65

Newer diabetic diets in 30-40 Western countries Diabetic Diets in India

50-55

2025 p/s

15

0-5

23

ratio abou t1 or mor e * p/s: is the total intake of polyunsaturated fat divided by the intake of saturated fat. Currently prescribed diabetic diets are high carbohydrate, high fibre, low fat diets. The amount of saturated fats is usually half of the total fat intake. We shall examine how an optimal diabetic diet can be derived from vegetarian sources. High Carbohydrate Diet Traditionally, diabetes mellitus has been treated with a low carbohydrate diet because of the misconception that carbohydrates will cause an increase in the blood glucose levels. As early as 1935, it was reported that carbohydrate tolerance in healthy adults was improved by an increase in the proportion of carbohydrate in the diet. By 1960, it was appreciated that rural Africans eating a traditional high carbohydrate diet had low fasting blood glucose levels and reduced plasma insulin responses to glucose loads as compared with a matched group of whites. Although all dietary carbohydrates provide the same amount of energy (as measured by kilocalories), they are not all handled with equal efficiency by the body. Initially, it was assumed that the blood glucose responses (glycaemic responses) after ingestion of various carbohydrate foods are directly correlated with their carbohydrate content. However, it was clearly disproved by Dr. David Jenkins and co-workers at the University of Toronto who introduced the concept of the glycaemic index: Glycaemic Index= 100 * (Blood glucose rises after ingestion of food under study) / (Blood glucose rise after ingestion of equivalent amount of standard carbohydrate glucose.) The blood glucose response to various foods of similar carbohydrate content varies widely (Table 2). These variations are attributed to the variable quantity and quality of fibre contained in these foods. Soluble fibre tends to lower the glycaemic index more effectively than insoluble fibre. Table 2 Glycaemic Indices of Selected Foods Glucose

100 %

Comflakes, carrots, maltose, honey

80-

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90% Bread (whole meal), millet, rice (white), broad beans (fresh), potato (new)

7079%

Bread (white), rice (brown), shredded wheat, beetroot, bananas, raisins.

6069%

Spaghetti (white), sweet com, peas (frozen), yam, cane sugar(sucrose), potato chips.

5059%

Spaghetti (whole meal), porridge (oats), potato (sweet), beans(canned, navy), peas (dried), oranges, orange juice

4049%

Black eyed peas, chick peas, apples, milk (skim), milk (whole), 30yogurt, tomato soup. 39% Kidney beans, lentils, fruit sugar (fructose)

2029%

Soyabeans, soyabeans (canned), Peanuts.

1019%

The glycaemic indices are further influenced by the processing and cooking methods. For example, ground rice has a higher glycaemic index than whole rice. Mixed meals produce variable glycaemic responses because of the interaction between starches and other nutrients. It is important to appreciate that 55-60 per cent of the energy requirements can be derived from the complex carbohydrates contained in cereals and pulses. This does not present any difficulty in achieving control of diabetes, both in insulin-independent and noninsulin dependent diabetics. This was well documented by many Indian investigators much before the resurgence of interest in high carbohydrate diets in the western countries. It is further advantageous to combine cereals and pulses, as is traditionally done in a vegetarian diet. our own data con firms that this produces a lower glycaemic index, partly due to the high dietary fibre content and partly due to an increases insulin secretion following ingestion of a pulse-based diet. The mixing of cereals and pulses also removes the imbalance of essential arnino-acids. Cereals are limiting in Iysine and pulses it methionine, thus, when both are taken together, their amino acid

25

compositions complement each other, producing a protein mixture of fairly high biological value. Not just cereals ant pulses, but proteins from all vegetable food sources also cornplement each other (Fig. 1).

High Fibre Diet The edible, but indigestible, component of plants contain two types of fibres: soluble and insoluble. Chemically, the fibre in plants is either cellulose and lignin which are insoluble or noncellulose polysaccharides like hemicellulose, gum and pectin, which are soluble. Although many diet plans take the crude fibre into account, it is important to study the total fibre content and its soluble and insoluble components(Table 3). Table 3 Comparison of Crude Fibre and Total Dietary Fibre Content of Vanous Foods Crud Total e Dietary fibrea fibre

Food

Noncellulose Cellulose polysaccharid Lignin( insoluble es fibre) (soluble fibre)

(g/100 g edible portion)

Cereals Flour, white

0.3

3.2

2.5

0.6

0.03

Flour. whole

2.3

9.5

6.3

2.5

0.8

Wheat Bread, white

0.2

2.7

2.0

0.7

Tr

Bread, whole 1.6 wheat

8.5

6.0

1.3

1.2

Fruits Apples

0.6

1.4c

0.9c

0.5c

0.1c

Oranges (peeled)

0.5

0.29

0.22

0.04

0.03

Pears

1.8

11.0c

5.04c

2.9c

3.0c

Banana

0.5

1.8

1.1

0.4

0.3

26

Peaches

0.6

2.3

1.5

0.2

0.6

Kidney beans

1.8

7.3

5.7

1.4

0.2

White beans

1.7

7.3

5.7

1.4

0.2

Peanuts (roasted)

2.0

9.3

6.4

1.7

1.2

Peas

2.0

7.1

4.5

2.4

0.2

Beans, green 1.0

3.4

1.9

1.3

0.2

Carrots

1.0

3.7

2.2

1.5

Tr

Cabbage, white

0.8

2.8

1.8

.07

Tr

Cauliflower

1.0

1.8

0.7

1.1

Tr

Lettuce, romaine

0.6

1.5

0.5

1.0

Tr

Pepper, green

1.4

0.9

0.6

0.3

Tr

Potatoes svith skin

0.05

3.5

2.5

1.0

Tr

Corn, cooked 0.8

4.7

4.3

0.3

0.1

Tomatoes. fresh

0.5

1.4

0.7

0.4

0.3

Turnips, raw

0.9

2.2

1.5

0.7

Tr

Legumes and Nuts

Vegetables

Tr = Traces a= Crude fibre,g/100 edible portion, method of Weende. in Composition of Foods (Agncultural Hand-book No.456'. Washington. D.C.: U.S. Department of Agriculture, 1975. b = Total dietary fibre. Southgate method. D.A.T. Southgate et al. J.Human Nutr. 30: 303 - 313, 1976. c = Flesh only. The soluble fibre forms a gel in the gut and retards the absorption of most nutrients. It effectively lowers the glycaemic indices of foods. Its prolonged use lowers the blood lipids. The insoluble fibre is fermented by the gut bacteria. It maintains normal gut flora and also contributes to the increased faecal bile excretion along with pectin and other soluble fibres. The fibre content of diets in western countries varies from 5-25

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gm/dav. In African countries the fibre content is as high as 75-150 gm/day. In Asian countries, usually 25-50 gm of fibre is ingested per day. Probably, an intake of 30 gm/day is adequate, which is easily achieved in vegetarian diets. This effectively lowers the blood glucose and lipids, and assists in weight loss. A high fibre diet also has important effects on metabolism in the liver, as it reduces the urea synthesis by the liver. The high fibre vegetarian foods also contain phytates and lectins. These substances reduce the rate of digestion of starch and thereby diminish post-meal hyperglycaemia. Tannins contained in these foods may have a similar effect. The vegetarian diet is generally a high carbohydrate-high fibre diet. It usually contains the recommended amount of fibre intake of 10 gm crude fibre or 50 - 60 gm of total fibre per day. It is unwarranted to supplement it with any other fibre. For research purposes, guar gum has been used extensively as a fibre supplement in diabetics. The results have mostly been gratifying in both insulin-dependent and non-insulin dependent diabetics, with an occasional study reporting the failure of guar gum in reducing post-prandial hyperglycaemia. It is always more pleasant to ingest a high fibre diet in the form of high fibre foods instead of a fibre supplement. Ingestion of fibre in excessive amounts can result in flatulence, abdominal distension and diarrhoea. It may also result in malabsorption of many micronutrients like calcium, iron, copper, magnesium, phosphorus and zinc. Low Fat Diet The currently prescribed diabetic diets are low fat diets; only about 25-30 per cent of the calories being derived from fat. The fat intake in our diet occurs from two sources; visible fat and invisible fat. It is easy to control the quantity of visible fat ingested. Most vegetarian foods contain intrinsically a very low quantity of fat except the nuts, seeds, whole milk and its products. It is easy to separate out the milk fat and hence control the overall amount of fat eaten in a vegetarian diet. The nonvegetarian foods carry various amounts of invisible fat with them; which progressively increases from lean meat (fish and chicken) to medium fat meat (ham, egg and beef) to high fat meat (corned beef, pork, cold cuts). One ounce (30 gm) of lean meat, medium fat meat and high fat meat contains 3, 5 and 8 gm of animal fat respectively. For a vegetarian, the only source of animal fat is milk products. By using skimmed milk and its products such as curds, cottage cheese or paneer made from skimmed milk, the vegetarian can minimise the amount of animal fat ingested. Vegetable fats are used for cooking by both the vegetarians and nonvegetarians. It is advisable to derive half of the fat intake from saturated fats and the other half from polyunsaturated fats.

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Alternatively, one-third of the fat intake can be derived from each group of fats, i.e. saturated, monounsaturated and polyunsaturated fats (Table 4). A vegetarian can easily accomplish this goal by using small amounts of butter or cream with bread or chapati and by using polyunsaturated oil for cooking. Such dietary approaches involving a low &t diet containing polyunsaturated fats have resulted in a hopeful trend towards lowering of the incidence of coronary artery disease in U.S.A.Such dietary trends are easy to achieve in vegetarian communities. Types of Fats 1. Fats rich in Saturated fatty acids: Animal fat (contained in meat products), dairy products (ghee, butter, cream), coconut oil. 2. Fats rich in Monounsaturated fatty acids: Olive oil, palm oil, groundnut oil 3. Fats rich in Polyunsaturated fatty acids: (per cent polyunsaturated fatty acid content is given in parenthesis) Safflower oil (74), soyabean oil (60), sunflower oil (58) corn oil (55), cotton seed oil (51), fish oil (50), sesame seed oil (43), groundnut oil (31) Other Advantages of a Vegetarian Diet in Diabetes Foods of vegetable origin also contain certain metabolically active compounds which act on specific tissues. One of such compounds is myoinositol, which is deficient in a diabetic with peripheral neuropathy. Hence, ingestion of vegetarian foods containing myoinositol can improve peripheral nerve function. The vascular complications of diabetes are ascribed to an increased generation or deficient removal of free oxygen radicals, which have the potential of damaging various tissues. Our own research shows that in uncontrolled diabetics, certain enzymes required for the removal of free oxygen radicals are functioning poorly. This situation improves with good control of diabetes. Treatment with known antioxidants, like vitamin E, which also has the potential of removing the free oxygen radicals has thus far produced disappointing results. Vegetarian foods like fruits, vegetables and spices contain large amount of bioflavonoids, which have the capacity to mop up the free oxygen radicals. Quantitative & Qualitative Aspects of Protein Intake The commonest misconcept regarding vegetarian diet is that it may be deficient in protein. It is important to appreciate that the quantity of protein intake will be sufficient if a diet of adequate caloric content is prescribed. On the other hand, a hypocaloric diet, irrespective of its high protein content will produce a negative nitrogen balance and loss of body proteins. Qualitatively, vegetable proteins from a single source possess a low biological value. A vegetarian diet obviates this

29

difficulty by incorporating about 10 gm of milk protein in diet. Alternatively, a cereal pulse mixture provides protein of a fairly high biological value, which approximates that of animal protein. To summarise, a vegetarian diet is eminently suitable for all noninsulin dependent and insulin-dependent diabetics. It is easy to provide a high carbohydrate, normal protein, low-fat diet through vegetarian foods. Such a diet is always high in fibre content and allows a highly selective and well regulated fat intake. This type of diet permits good metabolic control to be achieved. The hyperglycaemia, as well as hypercholesterolaemia, can be normalised or reduced significantly by such a dietary approach, thus minimising long-term complications of diabetes. REFERENCES 1. Chandalia H.B. and Sheth P.S. Conquest of Diabetes, Research Society,Grant Medical College, 1987 2. Krall Leo P. and Beasar Richard S. Joslin Diabetes Manual 12th ed. Lea & Febiger, 1989.

The Vegetarian's Kidneys Ashok L. Kirpalani .

The normal diet consists of fat, carbohydrate and proteins. In structure, both fat and carbohydrate are very similar, in that they contain only carbon, hydrogen and oxygen; whereas the proteins differ by the extra content of nitrogen. When digested fats and carbohydrates are metabolised they breakdown into carbon dioxide and water, both of which are volatile and can be excreted by the lungs. Water is also excreted by the kidneys in urine and by the skin as sweat. The protein, however, metabolises to form non-volatile material called the 'nitrogenous waste', a mixture of many compounds of which urea and creatinine are most important and well known. One of the main functions of the kidney is to remove these poisons, urea and creatinine, from the body through the urine. It naturally follows that the greater the protein intake of a human being, the larger will be the nitrogenous waste load produced and greater the work demand on the kidneys to excrete it in the urine. Non-vegetarian diets have much larger protein content than the vegetarian diets. Eating a non-vegetarian diet produces a larger work demand on both kidneys. This has been clearly demonstrated by scientific methods. Until recently it was thought that in health, the kidneys are able to meet this extra demand quite well and perform satisfactorily, but recent animal experiments have revealed quite clearly that when healthy kidneys are constantly exposed to very large

30

protein loads, they seem to age much faster and may be tne cause of the development of high blood pressure in animals. With the appearance of this scientific data the whole world is now sitting up to realise that too much protein is deleterious to healthy kidneys. In fact the average adult western nonvegetarian diet consists of I - 1.5 gms/kg body weight of protein whereas the minimum requirement for good health is only 0.75 gms/kg body weight which is the requirement quite adequately met by the average Indian adult vegetarian diet. In Renal Failure, where the kidney's efficiency slowly and subtly reduces from 100% to 30% without even giving a slight warning to the patient, it is quite obvious that a greater work demand on the kidneys put by a non-vegetarian diet would further produce a great strain on the already diseased kidney. This has been very exhaustively proved in patients of renal disease such as glomerulonephritis, chronic renal failure, renal disease due to diabetes (diabetic nephropathy) and renal disease due to high blood pressure (hypertensive nephrosclerosis). In these diseases, the patient suffers an initial mild and prolonged phase of "azotaemia" wherein life is possible without dialysis before reaching the stage of "uraemia" at which stage life can only be maintained by doing dialysis. The phase of "azotaemia" is best treated by a very strict dietary protein restriction and this is best achieved by a vegetarian diet containing 30 gms proteins of which 20 gms are supplied by milk and milk products while the remaining 10 gms comes from vegetable, cereals etc. 'Azotaemia" is best tolerated this way and the "uraemia" phasc may be postponed by years by this dietary principle in conjunction with other dietary restrictions of salt, water, potassium and the usage of certain drugs. Gout is a disease affecting joints and causing kidney stones. It is due to deposition, in joints and kidneys, of uric acid which is both generated in the body and also derived from food products like all meats. Those suffering from gout and uric acid kidney stones benefit most by omitting meat from their diet and converting to a vegetarian diet. With proper adjuvant therapy the incidence of kidney stones reduces and the patient suffers less joint pains. In Conclusion The Nephrologist, like the diabetologist uses diet as a major part of his therapeutic armamentarium most effectively and must prescribe the total diet of his patient taking into consideration the calories, fluid intake vis-a-vis urine output, protein, carbohydrate and fat intake, potassium and salt intake. Each patient will be given a different diet prescription but the one universal advice that will apply to all will be "It is better for you to become a vegetarian ". Nephrologists have come to believe that this advice is applicable even to those who have no renal disease so as to prevent normal kidneys from overworking and aging rapidly. In fact, many nephrologists in western countries have become vegetarians due to this belief !

31

SUGGESTED FURTHER READING 1. Barry M. Brenner and Jay H. Stein. "The Progresslve Nature of Renal Disease" Churchill Livingstone Ed. Williarn E. Mitch, 1986 2. Brenner B.M., Meyer T.W. and Host setter T.H. Dietary Proteins Intake and the Progressive Nature of Kidney Disease. New Eng Journal Medicine 1982, 307, 652.

Vegetarianism and The Liver N.H.Banka .

The liver has been described as a chemical workshop of the human body. All the nutrients and other substances absorbed from the intestines pass through the liver before entering into the systemic circulation. Thus the liver is vulnerable to the damage caused by a host of infections and toxic agents. Several types of viruses and alcohol are by far the commonest of these agents. The impairment of the liver function usually manifests as jaundice. Persistent infection and continuing impairment of function may be followed by death unless these changes can be controlled. The morphological changes in liver damage can manifest as fatty liver, hepatitis, cirrhosis of the liver and cancer of the liver. A well planned dietary regimen is of utmost importance in the prevention and treatment of most hepatic disorders. It has been proved beyond doubt that some of the proteins derived from animals are responsible for producing persistent symptoms related to liver disease. Thus vegetarian diet, as mentioned below, has gained momentum in the treatment of hepatic disorders. Viral Hepatitis Since there are no antiviral agents against hepatitis,rest, abstinence from alcohol and dietary modifications form the mainstay of the treatment. Most patients have nausea and lack of appetite. They should be served with attractive and well cooked foods. Small meals served separately will be better tolerated than three large meals. A diet containing approximately 2000 kcal which can be provided by 20-25 gms fat, 80-90 gms pro teins and 400 gms carbohydrate is suitable. This requirement can be fulfilled by glucose, sugar, fruits, fruit juices, bread, cereals, vegetables, salads, jelly, jam, rice, boiled potatoes and puddings made with cereals and sugar. Though diets high in their fat content do not ultimately influence the course of the disease they are poorly tolerated by jaundiced

32

patients. Fried food, milk and butter cause dyspepsia and should be avoided. Thus a vegetarian diet is better tolerated by the patients suffering from viral hepatitis. Cirrhosis of Liver Most of the patients of cirrhosis of liver are severely malnourished and require a high calorie and high protein diet. A high protein diet, particularly if derived from animal proteins, carries a high risk of precipitating hepatic encephalopathy. The best source of vegetarian proteins is milk, its products and Casilan. Choline present in foods like wheat germ, soyabean, peanuts and skimmed milk may prevent the formation of a fatty liver. It is also believed that cerebral disturbances due to liver damage are caused by the type of protein in the diet. Cirrhotic diet prescribed in a standard Indian books on diet and nutrition does not contain proteins derived from animal sources. A diet high in carbohydrate and proteins low in fat and fortified with vitamins would be most suitable. Thus a vegetarian diet is more suited to patients having cirrhosis of liver. Ascites In terminal stages of cirrhosis fluid accumulates in the abdominal cavity due to failure of the liver to synthetize plasma albumin. For such patients, a high protein diet which is low in sodium would be most suitable. But since these patients have no appetite, milk is the only practical diet which can supply the above requirements. Finally when the liver fails - the condition is known as hepatic encephalopathy. There is a strong incidence of animal protein intake increasing the incidence of hepatic encephalopathy. The clinical features of this syndrome are sleep disturbances, restlessness, drowsiness, impaired intellectual function, confusion and stupor progressing to coma. Significant number of these patients develop chronic encephalopathy and can be managed successfully at home. They should be given 20 gms of protein in the diet. This should mainly be derived from skimmed milk. Thus, it is very obvious that a vegetarian diet is more useful in the treatment of all liver disorders including the last stage of liver failure. REFERENCES 1. Antia F.P. Clinical dietetics and nutrition—Oxford publication, 1975, page 416. 2. Anonymous, Diet and Hepatic Encephalopathy (editorial) Lancet 1983, 1:625-6. 3. Best C.H., Channon H.J. & Ridout J.H. Choline and Dietary

33

Production of Fatty Liver J. Physiol (Lon.), 1934, 81, 409. 4. Best C.H ., Lucas C.C. & Ridout J . H. Vitamins and the protection of the liver Br. Med. Bull, 1956, 12:9-13. 5. Hislop W.S., Bouchier I.A.D., Allan J.G. et al. Alcoholic liver disease in Scotland & Northeastern England—presenting features in 510 patients—Q.J. Med. 1983, 52:232-43 6. Himsworth H.P. The liver and its disease., 2nd edn. Blackwell, Oxford. 1950. 7. Mchabbat O. Srivasta R.N., Younos M.S. et al. An outbreak of hepatic venoocclusive disease in North-Western Afghanistan Lancet, 1976, 2:269-71. 8. Ramalingaswami V., Deo M.G., Sood S.K. Protein deficiency in Rhesus monkey In: Progress in meeting protein needs of infants and preschool children. Proceedings of an international conference. Publication no. 843. National Academy of Sciences, Washington D.C. 1967. 9. Ramalingaswami V., Nayak N.C. Liver Disease in India. Prog. Liver Dis. 1970, 10. Rubin E. Lieber E.S. Alcohol induced hepatic injury in nonalcoholic volunteers—N. Engl J. Med. 1968, 278:86976.

Raw Vegetarian Food -An Old View -A New Look Anand Gokani .

Looking at this suggestion from both the philosophical angle and the scientific angle, it is clear th there is enough to maintain a good quality of life. If Nature created life on Earth it also arranged f subsistence. This assumption is appealing because, in it, may lie the answer to a host of diseases Are we damaging our food unknowingly? Are we depriving our bodies of the essential, vital ingredients which go to make a healthy body?

Cooking, freezing, preserving, drying, salting, dehydrating etc. are processes which take away so from our food. It is that 'something' that we may be lacking—which makes us prone to so many d know of so many of the essential elements that go to constitute the human body,but do we know there is to know. . . ? We can never claim that we know it all because new discoveries are being m day.

With the ever increasing variety of illnesses and the grotesque statistics which show that disease increasing and life expectancy rapidly decreasing, it is clear that there is something wrong with o

There were times when reaching the late eighties was routine but now the approaching fifties brin them diabetes, hypertension, ischaemic heart disease and so many other problems.

Can we stem the rot? May be we can, with a volte-face in our attitude. Maybe in Nature itself lies the answer to our dise

34

A pilot study on the role of raw vegetarian foods (i.e. fresh fruits, nuts, and raw vegetables along other natural foods like honey, garlic and coconut) was conducted at the Bombay Hospital and Me Research Centre. The cases studied were those of bronchitis, asthma and other respiratory disord abdominal problems like hyperacidity, peptic ulcer, constipation, piles and flatulence, infections o metabolic problems like gout, hypercholesterolaemia and diabetes, hypertension, ischaemic hear and peripheral vascular disease and malignancy (cancer). These patients were advised to consume only the following foods: a. b. c. d. e. f. g. h. i.

Vegetables and vegetable juices Nuts (dry fruits) Fruits and fruit juices Coconut and its constituents Garlic Honey Sprouted beans Wheatgrass and sprouted wheat Milk and milk products (in some cases only)

The above items were used exclusively and no form of cooking, preserving etc. was attempted. The patients showed varied responses which can be discussed under the following heads: A. Bronchitis, Asthma and other Respiratory Disorders

Young patients in the early stage of the disease recovered very well and maintained good health. colds and sinusitis could be completely eradicated. Older patients with more permanent damage associated emphysema required supportive medications albeit in smaller doses. There was a unif improvement in the quality of life.

B. Abdominal Problems like Hyperacidity, Peptic Ulcer, Constipation, Piles and Flatulen

While the patient was on this kind of diet the symptoms of discomfort subsided completely. But o the original food habits, symptoms recurred in varying intensity, thereby demonstrating amply th symptoms are largely related to the kind of food we eat and when we eat it. C. Infections

Infections, however severe, improved very well on this diet obviating the need for antibiotics and even the need to incise and drain abscesses. D. Metabolic Problems like Gout, Hypercholesterolaemia and Diabetes

These patients showed remarkable improvement in the control of the respective lab parameters a subsequently on the re-introduction of cooked food (provided it was minimally cooked) along with share of uncooked food. They showed good control of these metabolic parameters and required m medication for the control of the disease. E. Hypertension, Ischaemic Heart Disease and Peripheral Vascular Disease

Patients on raw vegetarian food for these ailments showed easier control of hypertension, lesser symptoms and in the early stages even improvement in effort tolerance. This could be attributed

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concomitant weight loss, improvement in constipation, diabetes, salt retention and maybe the re reversible aspect of atherosclerosis. The toxaemia of pre-gangrenous conditions also reduced tremendously. F. Malignancy (Cancer)

The results in this category can always be debated and will continue to be debated. However, in b general sense, all patients with malignant disease consuming only raw foods had a better quality There may not have been improvement in quantity of Life but quality certainly was far superior w compared to those having the same disease and consuming a 'normal diet'.

Those who received raw vegetarian food tolerated chemotherapy much better than those on a no and those who had very early stage disease, and received no chemo- or radiotherapy, had an exc qualitative and quantitative prognosis.

In general, all malignancy cases treated without surgery, chemotherapy or radiotherapy showed improvement as far as quality of life was concerned. Only time will tell how much influence this tr has on quantity of life?

Whatever the problem be—be it a common cold and sinusitis or be it cancer, there is definite resp with raw vegetarian foods in the diet. Though no concrete proof is available as to how this therapy works it could, by logical deduction, up in two points:

a. Improvement in general nutrition in terms of vitamins, minerals and co-factors of metabol b. Improvement in the general functioning of every organ as a sequelae to the above point (t immunological apparatus inclusive).

Table I shows the effects of cooking on various nutrients present in food. It is small wonder that consume only cooked and overcooked food develop deficiencies of these elements which are vita body function. Raw vegetarian diet consists of all these substances in abundance and maybe mor substances which we yet don't know about. Table 1

Cooking Method

Starch

Fat

Gelatinisation Cooking in No and formation excess water Effect of paste

Vitamin Vitamin C A Proteins (Ascorbic Thiamine Riboflavin Niacin & Carotene Acid) Moderate Heavy Loss Loss (Heavy (Heavy Slight Denaturation Loss if Loss if Nil Nil loss excess excess water is water is rejected) rejected) 36

Cooking in No Gelatinisation Steam Effect Cooking in No Pressure Gelatinisation Effect Cooker Dry Toasting

Deep Fat Frying

Bursting of Granules

Bursting of Granules

Shallow Pan Bursting of Frying Granules

-

Gelatinisation No of starch Effect

Gelatinisation No of starch Effect Slight No Germination Hydrolysis to Effect Dextrins Puffing

Slight loss

Denaturation

Slight loss

Moderate Moderate Loss loss

-

Nil

Decrease in Moderate Moderate Moderate nutritive to Heavy Slight loss Nil loss Loss value Loss

Short Periods (upto 30 min) (no effect); Long Decrease in periods nutritive (1 hr or value more) Toxic products are formed Slight No decrease in Effect nutritive value

Effect of Addition of Cooking No No Effect Soda to Effect Cooking Water Baking, Gelatinisation No bread of starch Effect Baking, biscuits

Denaturation

(Heavy Loss if excess water is Moderate Slight Nil Nil Loss Loss

Heavy loss

Heavy loss

Heavy loss

Moderate Nil loss

Moderate Moderate to Heavy to Heavy Moderate Slight loss loss

Decrease in nutritive Nil value

Heavy loss

Heavy loss

Nil

No Effect

Slight loss

Slight decrease in nutritive value

Moderate Moderate Moderate Moderate Nil Loss Loss Loss Loss

Denaturation

-

No Effect

-

Moderate Slight Loss loss

Heavy loss

Nil

-

Slight loss

Slight loss Nil

Nil

Slight Slight Slight Increase Increase Increase

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Nil

Slight Increase

Hence we can conclude that raw vegetarian food has a deEnite role in the promotion of good hea prevention of disease. We do not claim that the use of raw vegetarian diets can cure all diseases certainly there is evidence that it improves quality of life.

It is impractical in our present society to live only on raw vegetarian foods on a permanent basis. always follow the middle path, i. e. the incorporation of both cooked and uncooked food in one's d observations only go to show that a vegetarian diet in its natural form has a lot to offer in health and using a fair amount of raw vegetarian food in our daily diet goes a long way in keeping us he mind, body and spirit. REFERENCES

1. Abramowski, Dr. O.L.M.—Doctor Saves Himself by Fruitarian Diet. 2. Ballentine, R. Diet & Nutrition. A holistic approach. Honesdale: The Himalayan International Institute of Yoga Science and Philosophy, 1984. 3. Carroll, K.K. Experimental evidence of dietary factors and hormone dependent cancers; Ca Research, November, 1975, 35:3374. 4. Nolfi, K. A Doctor's Victory Over Cancer: My Experience with Living Food.

Cancer - Are Vegetarians Better Off S.U. Nabarkatti .

Cancer, the most dreadful disease never fails to arouse fear, apprehension and anxiety in those who are associated with it— especially those who are affected by it—the patients and their near ones. Cancer has been the subject of much research, and every year new discoveries are being made which go to contribute to the patients' treatment. Newer drugs, newer investigations, newer procedures for treatment have changed the outlook of the disease today. However, thousands of people are still suffering and thousands are dying painful deaths every year. Research has been focussed on many aspects of this disease and one of the aspects has been nutrition. Diet Diet is one of the vital factors essential for sustenance of life. However in as much as food is vital for maintenance of various biological processes within our body, it is even more vital to know that the type of food we select as a diet can turn out to be the cause of our death. Diet could exert its effect on human cancers in a number of

38

different ways i. ii. iii. iv. v.

Through carcinogens produced by food processing or cooking Through carcinogens in the body produced during digestion, especially in the stomach, small or large intestines From food constituents itself Through the indirect effects of undernutrition, malnutrition and overnutrition and Through the protective effects of certain dietary factors.

The relationship of cancer with nutrition is one of the oldest known, but, perhaps one of the most neglected facts. Let us study the relationship of cancer of various organs and diet. Breast Cancer Data collected from 24 countries has concluded that the best correlation between the diet and cancer is in the case of the breast. Several other international correlation studies have been conducted with similar conclusions. Surveys on international incidence have shown that Asians and Africans have much lower incidence than Europeans and North Americans. Thus it is much more common in countries with a high level of affluence. It has been suggested that the over stimulation of the hormonal system by an 'affluent' diet might lead to growth of hormone dependent cancers such as carcinoma breast. In Japan dietary fat has increased from per capita consumption of 23 to 52 gm per day between 1957 and 1973. In this period of time the annual breast cancer mortality rate increased from 1572 to 3262. In the U.S. where already there is a high incidence of cancer of the breast, the incidence has further increased because the per capita dietary consumption of fat per day has risen from 125 gms in 1909 to 186 gms in 1972. Besides the relationship with high fat diet, mainly animal fat, breast cancer has also been associated with protein intake. Actually there has been a much stronger relationship between animal protein, rather than total protein and breast cancer. In fact it has been shown that cancer patients on high fat diet have a poorer prognosis than low fat diet patients. This all probably explains the high incidence of breast cancer in U.S. women.

39

Similarly breast cancer has also been associated with nonvegetarian diets and obesity. These associations have been seen in several epidemiological surveys and has also been our experience at the Bombay Hospital. Large Intestine Cancer Surveys of the incidence of gastro-intestinal cancers suggest that as total per capita food intake (i.e. caloric intake) increases, the incidence of colorectal cancer increases. It was further found that colorectal cancer has been frequently associated with the intake of animal protein. High intake of animal protein, particularly beef in Hawaii and pork in Japan have been clearly shown to be associated with a high incidence of cancer of the bowel. Stomach Cancer Certain data has shown that this cancer is very common amongst several fish eating communities particularly Japan, Iceland, Finland, Soviet Union (along the Baltic Sea) and South African Coast. Japan has a higher consumption of fish than that of the U. S. and has a five times higher incidence of the cancer of the stomach. Prostatic Cancer The association between dietary fat and prostatic carcinoma is seen in international comparison. Surveys conducted in U. S. by Blair and Fraumany identified the midwest and north central areas of the U. S. as those with the highest rate of prostatic carcinoma and this was related to the greatest consumption of beef. Other organ cancers in the body, like testes and corpus uteri have all shown a relationship with dietary factors which point mainly to the animal component of diet as carcinogens. The Rationale of Vegetarianism As has been discussed in various chapters throughout this book, vegetarian diet seems to be the diet more suited to man. Hence when a person is on a vegetarian diet he receives most of his nutrition in the optimal form and hence keeps the body going without imposing a load on the elimination systems. Consumption of a vegetarian diet particularly in the fresh and uncooked form supplies the body with all the carbohydrates, proteins, fats and especially the trace elements, vitamins, minerals, and other micronutrients. These go to enrich the

40

internal environment and enhance the functioning of all the organs of the body wherein the body is able to cope with any kind of foreign invasion or any kind of derangement like malignant disease. When a patient suffers a malignant disease he has probably no vitality or resistance to foreign invasion. A normal person is able to keep healthy inspite of such a diverse array of influences acting upon him because his immune system is competent and can quell any foreign invasion. In a patient suffering from cancer, the immune system is very weak due to chronic influences like poor nutrition, nutritional deficiencies (especially of micro nutrients), cigarette smoking, alcohol and tobacco abuse and mental stress, altogether or individually. This is the reason why the malignancy can flourish unchecked. However, if the patient is given nutrition which is natural to his system then gradually the deficiencies get corrected and the immune system gets rejuvenated. This assists in the fight against the disease process. And, it appears, that it is one of the causes of some patients responding very well to therapy and some not responding at all. Vegetarian nutrition definitely imposes a smaller load on the elimination systems, it also contains all the nutrients in their natural concentrations and combinations whereby digestion, absorption and assimilation are done easily. Due to the high fibre content, poisonous waste matter is propelled rapidly down the colon and egested intermittently—hence it serves a cleansing function. Vegetarian food—particularly in its natural, uncooked form possesses all these properties of nourishing and cleansing the system. It has also been established that eating of hypoealoric diets inhibit many tumours e.g. breast carcinoma, lung carcinoma, hepatoma, leukaemia, skin turnouts and sarcoma. This is possibly true due to the inhibition of mitotic activity due to limited carbohydrate and carbohydrate intermediates available for energy. Below given are suggestions which may help to reduce your chances of getting cancer. 1. Salt-pickling, smoke-curing, nitrate curing and frying or boiled meat products should be avoided. (These preservative or cooking procedures are mainly used for animal food) Said Dr. William Lifinsky, a cancer researcher at Oak Ridge National Laboratory in Tennessee, "I wouldn't even feed nitrate laden foods to my cat...." 2. Dietary intake of fat to be reduced. A solution offered by simple vegetable food. 3. Protein consumption in the form of non-veg. food should be substituted by vegetable protein. Nutritional experts say that a combination of pulses in the diet provides

41

4. 5.

6.

7.

adequate proteins of high biological value with all essential aminoacids and in a much more assimilable form. Thus the common excuse for consuming non-veg. diet as a rich source of protein is a myth, not backed up by any scientific observation. Additives, flavours and colouring agents e.g. nitric acid in red meat can be hazardous. In general, it is best to forego a preference for these. Consumption of fibre diet should be increased e.g. the present U.S. diet fibre intake averages to 20 gm per day. However the recommended is average 60 gms per day for human bemgs. Certain vegetables have a protective action against cancer, quite separate from their fibre and vitamin content. These are cruciferous vegetables mainly cabbages, cauliflower, brocoli, brussel sprouts, kohlrabi etc. They should be eaten frequently. Dark green and yellow leafy vegetables and fruits have protective value and should resnl rlv fissure in the diet. Besides dietary habits, alcohol, smoking, tea and coffee should be avoided.

Table below depicts a list of mutagens present in food, both vegetarian and non-vegetarian. The elimination of nonvegetarian food from the diet reduces the load of mutagens significantly hence placing the consumer at a lower risk level. Mutagens

Foods Containing the Mutagen

1. Charred Protein Food

Grilled or smoked fish, meats or poultry

2. Nitrosamines Nitrates

Meats cured by nitrates Present in hard water and in vegetables grown in nitrate fertilizers (inorganic farming)

3. Folate def.

Most meats, milk, eggs, fruits and root vegetables are poor sources of folicin

4. Alcohol Presently it is established that simply by applying the knowledge we have now, we could reduce the occurrence of new cancer cases by upto 40% but we are kept from realising this potential because of certain deficiencies, at the level of the individual and the society. It is clear that diet acts as a double edged razor. While right selection can promote health and well being a faulty choice of our diet can jeopardise our health. Unfortunately, there is a lack of organised and systematically collected data to show us the true status of cancer in our country. It may not te very long judging by the present rate of adopting the westernised life style, before India lands up high on the list of countries with major

42

cancer deaths. REFERENCES 1. Rilllen L.J., Hermon C, Smith P.G. A proportionate study of cancer mortality among members of a vegetarian society. Br. J. Cancer 1983; 48:355-61. 2. Lea, A.J. Dietary / factors associated with death rates for certain neoplasms in man. Lancet, 1966, 2:332-335. 3. Drasar, B.S. and Irvin D.: Environmental factors and cancer of breast. Br. J. Cancer, 1973, 27:167-172. 4. Hems, G.L.: The contributions of diet and child bearing to breast cancer rates. Br. J. Cancer, 1978, 37:974-982. 5. Gray, G.E., Pike, M.C. and Henderson B.E.: Breast cancer incidence and rnoriity rates in different countries in relation to known risk factors and dietary practices 6. Doll R. The geographical distribution of cancer, Br. J . Cancer, 1969, 23: 1-8. 7. Miller A.B. and Buldrook, R.D.: The epidemiology and etiology of breast cancer N. Engl. J. Med., 1980, 303:12461248. 8. National Research Council, National Academy of Sciences, Diet, Nutrition and Cancer. Washington D.C. National Academy Press, 1982. 9. Hiryama, T.: Epidemiology of breast cancer with special references to role of diet. Prev. Med., 1978, 7:173-175. 10. Hill M.: Mac Lennam R. and Newcombe, K.: Diet and large bowel cancer in three socioeconomic groups in Hongkong. Lancet, 1979, 1:436. 11. Haenszd, W. Berg, J .W. and Segi M. et. al.: Large bowel cancer in Hawaiian Japanese. J. Nat. Canca Int., 1973, 51:1765-1779. 12. Burkitt D.P., Walker A.R.P., Painter N.S.: Lancet, 1972, 2:1408-1412. 13. Bjelke, E. Dietary factors and epidemiology of cancer of stomach and large bowel Aktvel. Ernachrungsmed Klin. Prax. 2. (Suppl.), 1978, 10-17. 14. IARC Microecology group: Dietary fibres, Bacterial steroids and colon cancer in two Scandinavian population. Lancet, 1977, 2:207-211. 15. Graham S., Dayal H., Swanson M. et. al.: Diet in epidemiology of cancer of the colon and rectum. J. Natt. Cancer Inst., 1978, 61:709-714. 16. Wiburger J.H., Marquardt H., Hirsta N. et al.: Induction of glandular stomach cancer in rats with an extract of nitrite treated fish. J. Natt. Cancer Just, 1980, 64:163-167. 17. Murphy G.P.: Cancer—Signals and safeguards, 1981, 2021. 18. Coronaro L.: How to live 100 years. Letch svorth, Hertsfordshire, England, The Goroderi City Press, 1952. 19. National Research Council: Diet, Nutrition and cancer. Washington, National Academy Press, 1982. 20. Nutrition and Cancer: Cause and prevention. An American

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Cancer Society Report CA., 1984, 34:121-126. 21. Simone, C.U.: Cancer and Nutrition. New York, McGraw Hill, 1983; 190-205. 22. Creasy W.A.: Diet and Cancer. 1985; 206-208.

The Brain, The Nerves.... and Vegetarianism B.S. Singhal .

The nervous system is unique in that it has very specific demands to maintain normal function. Complex thinking processes, articulate movements, complicated tasks involving coordination, judgement and skill (both learned and innate) are performed by activity in the neurones of the brain, spinal cord and the peripheral nerves. Various neurotransmitters, hormones and other chemical mediators co-ordinate the activity of these neurones. Disturbance in the balance of these mediators is considered to be the basis of disease—be it inflammatory, metabolic, degenerative or neoplastic (cancerous). It is a well-known fact that nutrition plays a vital role in the maintenance of health and formation of disease. There are certain diseases where nutrition plays a direct role in altering the course of the disease e.g. peripheral neuropathy. There are other diseases e.g. cerebrovascular accidents where nutrition affects the risk factors significantly so as to change the entire prognosis of the disease. And there are still other diseases (like Parkinson's disease, motor neurone disease and multiple sclerosis) where good nutrition plays a vital role in supporting the patient through the chronic progressive course. Nutrition is also important in unconscious patients, who have either had a head injury or a cerebrovascular accident or have been operated for a brain tumour. Furthermore it is now commonly seen that even mentation i.e. our thinking processes, are governed by the kind of food we eat. The issue before us is—What kind of nutrition is good for the neurological patient—vegetarian or non-vegetarian? A difficult question to answer, indeed. There is scant research data implicating either vegetarian or non-vegetarian diets directly in any disease process concerned with the nervous system. Starting with the thinking process—mentation and intellectual activity—there is a long list of intellectuals in history who made an indelible mark in their times and who were vegetarians. They were Isaac Newton, George Bernard Shaw, Shelley, Milton, Voltaire and more closer to home, Mahatma Gandhi, Rajendra Prasad, Rajagopalachari, Lal Bahadur Shastri and many more. It is widely believed and it is probably true, that vegetarianism does promote intellectual activity of a very high order. Mahavira, Gautam Buddha and Saints of Hinduism all advocated

44

vegetarianism. Like intellectual activity, even physical functions seem to be better preserved in vegetarians as compared to non-vegetarians. For the sake of convenience the relationship of a vegetarian diet to specific neurological disease can be discussed individually. Migraine Headache is one of the commonest complaints in outdoor neurological practice. Migraine ranks second only to tension headaches. Migraine has a very close relationship to the kind of food we eat. The substance implicated in causing exacerbations is tyramine. Tyramine is formed by the decarboxylation of the amino-acid tyrosine by bacteria and enzymes. Hence it is best to avoid foods that contain tyrosine. These are aged meats and meat products, fish, cheese, brinjals, pods of beans, alcoholic beverages (wines, ale and beer). The entire range of nonvegetarian foods seems to be implicated thus suggesting that a vegetarian diet may be a more suitable diet for a migraine subject. Cerebrovascular Accidents (C.V.As.) It would not be wrong to say that this group of diseases comprises 40% of all hospital-based neurology practice. This is a significant disease as it is responsible for maximum morbidity and mortality. Its medical, social and economic implications are tremendous. C.V.A s . are situations that lead to paralysis of limbs and disturbed mental function. Though nutrition does not affect C.V.As. directly it affects each and every risk factor and hence plays a large role in preventing C.V.As. The main risk factors for C.V.A. are: 1. 2. 3. 4. 5. 6.

Hypertension Diabetes mellitus Hypercholesterolaemia Alcoholism and cigarette smoking Obesity Pre-existing heart disease

There is ample evidence in the nutritional literature that a vegetarian diet is beneficial in the treatment and the prevention of hypertension, diabetes mellitus, hypercholesterolaemia, obesity and that vegetarians are less inclined to tobacco and alcohol abuse. Hence the corollary is that vegetarian diet is beneficial for the prevention of cerebrovascular accidents. Multiple Sclerosis, Motor Neurone Disease, Parkinson's

45

Disease and Other Chronic Progressive Diseases of the brain and spinal cord have been found by some to have a nutritional basis. For instance, some workers have suggested that multiple sclerosis can be benefitted by a diet high in essential amino acids. The sources of essential amino acids e.g. safflower, sunflower, soyabean, corn oil, walnuts, peanuts, almonds are all vegetarian. Though no double blind trials can be quoted it is our observation that patients suffering from the above mentioned chronic neurological problems are more comfortable on vegetarian diets than on non-vegetarian diets. The significant relief in constipation, which is a serious problem in all these patients, is probably due to the high fibre content of the vegetarian diet. Those patients who consume more fruits and vegetables are also less prone to the chronic infections to which this group of patients are highly susceptible. This may be attributable to the rich supply of vitamins, minerals and trace elements obtained from fruits and vegetables, which are essential for the integrity of the immune system. Peripheral Neuropathies are said to improve with the help of foods containing high amounts of vitamins, minerals and essential fatty acids. These elements are in abundance in uncooked vegetarian food e.g. fresh fruits, raw vegetables (for vitamins and minerals) and nuts like almonds, walnuts, peanuts (for essential fatty acids). Though there is no significant proof of their efficiency by themselves, fresh fruits, raw vegetables and other similar foods improve the general well-being of the patient and thereby enhance overall recovery. These and many more instances in daily practice, and in the scientific literature, definitely suggest that a vegetarian life style is superior to a non-vegetarian life style from the angle of prevention of disease. Vegetarian diet also plays a good supportive role in the treatment of many chronic, progressive neurological diseases. Hence, taking into consideration the available data, it would not be incorrect to conclude that vegetarianism is beneficial not only for the prevention of many neurological diseases but also in the treatment and support of some of the diseases. REFERENCES 1. Alter A, Yamoor M & Marshe M:-Multiple Sclerosis & Nutrition, Arch, Neurol, 1974, 31:267. 2. Hanington E, Prelirninary report on tyrannine headache, Br. Med J. 1967, 2:550. 3. Kohlenberg R. J., Tyramine sensitivity in dietary migraine: a critical review. Headache, 19S2, 22:30. 4. Krause M.V. & Mahan L. K., Food, Migraine, Nutrition and Diet Therapy, 7th Edition, 1984 5. Mertin J. & Meade C. J., Reference of Fatty Acids in

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Multiple Sclerosis: Br. Med. Bull. 1987, 33:67. 6. Olson W. H., Diet & Multiple Sclerosis Postgrad Med. 1976, 59:219.

Vegetarianism- The Mind and its Health O.P. Kapoor .

Diet is always connected with health. But then, health is a combination of physical and mental health. It is a fact that without having a healthy soul or mind, there is no sense in having a healthy physical body (Mens sana corpora sana). It is our experience in clinical practice, that mental illnesses in our country are on the increase, as in all other parts of the world. In fact even people having a physical illness like an enlarged heart or cirrhosis of the liver or arthritis are being harassed more by associated complaints related to their abnormal mental health. Also straight forward psychiatric illnesses are increasing day by day. The public is being educated on the role of different diets and foods for maintaining health. Little does the public realise that this education and knowledge holds true only for physical health. The people should know that the recent knowledge about our body requirements of proteins, vitamins etc. has enlightened us to the fact that these requirements are much less than we ever thought of. It is so common to see people who are consuming a very rich diet supplemented by heavy doses of vitamins (which are all excreted in the urine or stools), are still very unhealthy and ill (because of poor mental health). As against this, even footpath dwellers enjoy good physical health (with the so-called poor food which they can obtain). They can walk and run faster than the affluent class. Surprisingly vitamin deficiencies are very rare in these people(because in adults the vitamin requirements are very little). Not only that, they are mentally very healthy. Thus their total health is better than the rich people. Also, they do not suffer from many chronic diseases which are related to an unhealthy mind brought about by the stresses of life. There are so many diseases related to stress. To quote a few, stomach ulcers, coronary heart disease, high blood pressure, irritable colon etc. These stresses are increasing in domestic life, in professional life or at work and even during commuting. In trying to deal with these stresses, people are turning to smoking, alcoholism, and socialising at parties - all of which increase the above illness.

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Then what is the food for good mental health? The people should understand that like a regular breakfast, lunch and dinner to maintain your physical health, this food will have to be consumed daily. Stresses cannot be reduced. You cannot change the pace of life in big cities or temporarily forget it by smoking or drinking. This is where spiritualism, religion or faith in God plays its role. This is being forgotten in this fast life. This is 'the' food for mental health. We doctors should be thankful to our present modern spiritual leaders - like Satya Saibaba, Radhoswami, Chinmayanand, the Pope, Aghakhan and many more-who are maintaining the mental health of our public without charging them any fees. But for them, our clinics would have been overflowing with patients. Of course others who have no spiritual leaders, get their 'food' from their religious 'Gurus' and Lords. Now the prime question which we have to consider is that can the 'food' for physical and mental health be correlated ? Is there a common food, beneficial to both ? Can we doctors answer this question ? Unfortunately since we, the medical scientists have not devoted any time to mental health, we will not be on the proper platform to advise. We spend all our time in diagnosing, treating and calculating the incidence of mental and stress-induced illness in our practice. Surely then, the people to answer the above question are those doctors (spiritual leaders) who have been quietly handling the mental health of our population. It happens to be true that many of the different saints, sages and perfect masters who have come at different times, in different parts of the world and spoken in various languages— have suggested that "Vegetarian diet is good for a peaceful mind". The following quotations and sayings from Mahabharat and Bible will possibly make you reflect on the above subject. A wise sage said in 'Mahabharata', "Those to possess good memory, beauty, long life with perfect health, and physical, moral and spiritual strength should abstain from animal food". Talking about Christianity and vegetarianism, there are many quotations in the Bible against flesh-eating e.g. (Chap VII V 23) "Ye shall eat no fat, of ox or sheep or goat. And the fat of which diet of itself and the fat of that which is torn of beast, may be used for any other service. But ye shall in no wise,eat it: For whosoever eateth the fat, of the beast, of which men offer an offering made by fire unto the lord, even the soul that eateth it shall be cut off from his people".

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If that is so, it is for us doctors to stop encouraging the use of sedatives and tranquillisers to treat the stress and mental component of illness, and to advise people on the benefits of vegetarian diet in maintaining good mental health. The public should know that statistically it has already been proved, that the incidence of alcoholism is markedly reduced in the vegetarian population. This may be the first scientific proof, because alcohol is certainly related to mental health. In another chapter in this book, the effect of various articles of vegetarian diet on mental health have been discussed. Whether scientifically proved or not (by allopathic standards), if in the age old literature food articles like "Amala " have been linked to a cleaner "mind ", sure enough there are no articles in the literature to suggest, that eating pork, beef or sausages keeps mental health in good shape !! In the meanwhile, it has been now shown, that drinking a glass of butter milk produces chemical substances in the stomach which act on the brain to induce drowsiness. Similarly it appears that the vegetarian food will stimulate formation of endorphins and enkephalins which are known to act on the brain to reduce anxiety and create a sense of well being. Finally it will not come as a surprise if in the future, research reveals that vegetarian food has a superior effect on the mind and the intellect.

High Blood Pressure and Vegetarian Diet R.D. Lele .

INTRODUCTION High blood pressure (B.P.) or hypertension (HT) has been described as a silent "killer." Apart from its own morbidity, HT facilitates and accelerates another killer viz. atherosclerosis.Naturally there has been world-wide concern about prevention of these diseases by dietary alterations or drugs. Currently there is an increasing scientific interest in vegetarian diets in the prevention of several diseases. The questions to be tackled here are: 1. Do vegetarians have significantly lower levels of blood pressure than appropriately matched omnivorous controls? ("Non-vegetarian" is not an appropriate term because those who eat fish, chicken and meat also eat vegetables, fruits and cereals). 2. If so, can such differences be attributed to the vegetarian diet per se or to other confounding factors such as abstinence from alcohol and tobacco, tea and coffee,

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deep religious commitment or other life style factors ? 3. Is it possible to use vegetarian diet as a therapeutic strategy, to reduce blood pressure in hypertensive patients on a long term basis ? 4. If a significant reduction in the level of blood pressure is indeed brought by vegetarian diet, what is the physiological and biochemical basis? EPIDEMIOLOGICAL STUDIES A number of vegetarian populations have been reported with lower blood pressure, serum cholesterol and body weight than omnivores, but there is a strong possibility that an effect of diet may be confounded by other lifestyle factors. A study in Western Australia was particularly commendable since it attempted to isolate the influence of vegetarian diet from other potentially confounding life style factors associated with hypertension and cardiovascular disease. Dietary Intervention Study In one of the studies 59 healthy omnivores were allocated to a control group (which ate an omnivorous diet for 14 weeks) or to one of two intervention groups whose members ate an omnivorous diet for the first two weeks and a lacto-ovovegetarian diet for one of two six-week experimental periods. Home, clinic, and laboratory blood pressures, dietary intake, body weight and lifestyle factors were carefully month bred throughout the project. Urine and blood collections were made for each experimental period. There were no appreciable differences between vegetarians and omnivores with respect to mean age and height. For weight and Quetelets' index, however, vegetarians of both sexes were lower than omnivores. Mean blood pressures adjusted for age, height and weight were significantly lower in vegetarians than omnivores, and were not related to past or present use of alcohol, tobacco, tea and coffee, physical activity, personality or religious observance. The prevalence of mild hypertension ( ' 140 mmHg systolic and/or 90 mmHg diastolic) was 10% in omnivores and 1% in vegetarians. Analysis of the diet records showed that the vegetarians ate significantly more dietary fibre, polyunsaturated fats, magnesium and potassium, and significantly less total fat, saturated fat and cholesterol than did the omnivores. There was a significant fall in mean systolic and diastolic pressures in both experimental groups during the period on vegetarian diet. Mean blood pressure in experimental group I rose after resumption of the omnivore diet (period 2) to the level

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which preceded the vegetarian diet. Considering both experimental groups together, the mean fall in blood pressure associated with a vegetarian diet was 6.8 mm Hg systolic (SD 8.8) and 2.7 mm Hg diastolic (SD 6.3). Multiple regression analysis showed that the change in B.P. was associated with eating a vegetarian diet independent of age, sex, Quetelet's index, blood pressure before dietary modification or change in body weight. Analysis of diet records indicated that intake of several nutrients changed with change to the vegetarian diet, particularly significant increases in polyunsaturated fat ( + 96%) dietary fibre (+75%), vitamin C (+80%), vitamin E (+ 85%) magnesium ( + 34%), calcium ( + 36%) and potassium ( + 18%) significant decreases were in protein (-27%), saturated fat (-16%), monounsaturated fat (-19%) and vitamin B12 (- 61%). The P:S ratio of the diet changed from 0.29 to 0.68, intake of sodium, calories and total fat did not change with change to the vegetarian diet. Factor analysis suggested that changes in polyunsaturated fat, fibre or protein were most likely to have mediated the observed changes in blood pressure. It would now be worthwhile to examine the following nutrients in relation to blood pressure—sodium, potassium, calcium and magnesium, dietary fibre, polyunsaturated fats and low proteins Sodium The recognition that modifying renal excretory capacity for sodium and thus changing sodium balance can induce high B.P. in experimental animals focussed attention on sodium as the principle nutritional factor in the development of high B.P. Epidemiological surveys are often cited as proof that excessive sodium intake increases the prevalence of high B.P. However, sodium does not meet a number of criteria listed above. Intrasocietal studies have not shown a difference in the sodium chloride consumption between normal and hypertensive subjects. Animal studies have not used levels of intake that reflect reasonable variations in the human diet. Adverse effects of excess sodium have not been shown in normal persons. We still do not understand how dietary sodium exerts its pressor effects, when it does so and why it does so only in certain people. Whether the action of sodium is a direct effect or an indirect effect through changing the activity of other ions such as potassium, magnesium and calcium is also not clear. The available scientific evidence does not allow a blanket recommendation of restriction of salt intake to 5 gm/day for the entire population. Potassium Clinical, experimental and epidemiological evidence suggests

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that a high dietary intake of potassium is associated with lower B.P. It is often overlooked that the Kempner rice fruit diet is not only a low sodium diet but.also a high Potassium diet. The vegetarian diet is significantly higher in potassium content. Low salt consuming populations also have high potassium intake. In Japanese villages, populations with similar sodium intake but different blood pressure levels have different potassium intake. It may therefore be a good idea to express the Na / K ratio in the diet as a major controlling factor in hypertension. Students of biology have long observed the reciprocity of function of Na and K on the tissues of animals in vitro. This reciprocity may also play an important role in the development and maintenance of high B.P. Increased consumption of fruits and vegetables as a rich source of potassium can be recommended as a public health measure in the prevention of high B.P. It is interesting to note that the protective effect of potassium in strokes may be mediated by mechanisms other than lowering B.P. A 10 mmol increase in the dietary potassium is associated with 40% reduction in risk. Calcium It has been observed in epidemiological studies that both potassium and calcium intake are significantly reduced in both white and non-white hypertensive subjects (27% less Ca and 17% less K in whites; 42% less Ca and 34% less K in nonwhites). It is postulated that an inadequate calcium intake may contribute to elevate B.P. Milk, peas, beans and cereal grains are a good source of calcium in the vegetarian diet. Drinking water can provide significant amount ranging from 75 mg to over 200 mg per day in water obtained from wells sunk in chalk or limestone. Magnesium Vegetarian diet is rich in magnesium, which could affect plasma and intracellular magnesium and hence influence cardiac or vascular smooth muscle contraction. Dietary Fibre The vegetarian diet is rich in fibre, which is not digested by the human digestive enzymes. Some types of dietary fibres, notably hemicellulose of wheat, increase the water-holding capacity of colonic contents and the bulk of the stools, thus relieving constipation. Other viscous indigestible polysaccharides such as pectin and gum guar slow gastric emptying, contribute to satiety, retard the absorption of glucose and cholesterol and reduce plasma cholesterol. Some dietary intervention studies in humans have been compatible with effects of dietary fibre on blood pressure but they do not have an entirely satisfactory experimental design.

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Polyunsaturated Fats Humans are unable to svnthetize fatty acids with double bonds more distal to the carboxyl end of the fatty acid than the 9th carbon atom. Thus linoleic acid (C18: 2 ~- 6) is an essential fatty acid which must be provided in the diet. It is also called X 6 or omega 6 fatty acid. It is the principle polyunsaturated fatty acid in oil from plant seeds (e.g. corn oil, safflower oil). Another essential fatty acid alpha linolenic acid, is present in green leaves, and some plant oils, notably linseed, rapeseed and soyabean oil. Elongation and further desaturation of alpha linolenic acid (C 18:3co3) occurs in animals and (slowly) in humans to yield eicosapentaenoic acid (EA) and docosahexaenoic acid (DA). These fatty acids enter the food chain with marine phytoplankton, which are eaten by fish, which are in turn eaten by seals, walruses and whales—the principle component of Eskimo diet in Greenland. The low prevalence of atherosclerosis and myocardial infarction in Eskirnos had been attributed to their daily dietary consumption of 5-10 g of the long chain n-3 polyunsaturated fatty acids EA (C20: Sco3) and DA (C22: 6a3). When s 3 fatty acids are introduced in the diet, their derivatives EA and DA compete with arachidonic acid in several ways. The net result is a change in the homeostatic balance towards a more vasodilatory state, with less platelet aggregation. They reduce the viscosity of whole blood by increasing the deformability of red blood cells. They cause a moderate reduction of blood pressure both in normal and mild hypertensive subjects. Further they reduce the vasospastic response to catecholamines and possibly to angiotensin. The anti-atherogenic properties of Go3 fatty acids have also been described. Vit. C and E The higher content of these vitamins in vegetarian diet is a great advantage in protecting against high concentrations of co3 fatty acids, which can increase the likelihood of lipid peroxidation, with its toxic effects on the cell. Those who ingest large amounts of fish oil would need added supplements of vit C and E for their anti-oxidant effects. It seems clear that vegetarians tend to have lower blood pressure than omnivores and that a shift in dietary pattern towards a lacto-ovo-vegetarian diet would result in reduced incidence of hypertension, strokes and cardiovascular disease in the community. The identification of specific nutrients responsible for this benefit is still not precise although a high potassium polyunsaturated fat and fbre content of the vegetarian diet seem to be significantly associated. The subject should be approached with an open mind with the realisation that newer knowledge will emerge with continued research.

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REFERENCES 1. Sacks F.M., Rosner B., Kass E.H. Blood pressure in vegetarians. Amer. J. Epidemiol. 1974, 100, 873-77 (39098). 2. Anholm A.C. The relationship of a vegetarian diet and blood pressure. Prev. Med. 1975, 4, 35. 3. Sacks F.M., Castelli W.P., Donner A., Kass E.H. Plasma lipids and lipoproteins in vegetarians and controls. N. Eng. J. Med. 1975, 292, 1148-51. 4. Haines A.P., Chakrabarti R., Fisher D. et al Haemostatic variables in vegetarians and nonvegetarians. Thromb. Res. 1980, 19, 139-48. 5. Rouse I.L. Beilin L.J. Armstrong BK, Vandongen R. Vegetarian diet, blood pressure and cardiovascular risk. Aust. NZ J. Med. 1984, 14, 439-443. 6. McCannon DA and Pucak G.J. (Ed.) Symposium on Nutrition and Blood pressure control—Current status of dietary factors and hypertension. Ann. Int. Med. 1983, 98, 701. 7. Dahl L.K. Salt and hypertension Amer. J. Clin. Nutr. 1972, 25, 231-44. 8. Khaw K.T., Barett-connon E. Dietary potassium and stroke-associated mortality—A 12 year prospective population study. NEJM 1987, 316, 235. 9. Altura B.M ., Altura, B.T. Magnesium ions and contraction of vascular stnooth muscle; relationship to vascular disease Fed. Proc. 1981, 40, 2672-79. 10. Wright A., Burstyn, P.G. Gibney M.J. Dietary fibre and blood pressure. BMJ 1979, 2, 1541-43. 11. Leaf A., Weber P.C. Cardiovascular effects of n-3 fatty acids. NEJM 1988, 318 page 549-557.

Sports Medicine- The Vegetarian Sportsman Anand Gokani .

Introduction Sports medicine is the science of treating sports-related diseases and the study of enhancing sporting performances. Largely it deals with sports injuries, diet in sportsmen and development of techniques to improve performance. The qualities required in a sportsman are strength, speed and endurance (stamina). These qualities are honed by vigorous training in the field, strict mental discipline and correct balanced nutrition. It is the latter that we are going to deal with in this chapter. A sportsman, however hard he works on his event, will not achieve his goal unless he is supported with the right kind of nutrition,both qualitative and quantitative. A sportman is considered to be under severe stress, both physical and mental. This

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combination of physical and mental stress does a lot to disturb the milieu intereur by releasing several hormones in very large quantities. The combination of extreme physical activity, severe mental stress, increased metabolic demands of the body associated with a high level of hormones in the blood creates a rather delicate situation which has to be balanced precisely to prevent a break down of the system. The Nutritional Needs of a Sportsman....... Simply stated - proteins, carbohydrates, fats, minerals and vitamins along with trace elements and micronutrients are needed. However, the nutrition of a sportsman is not so easy. These ingredients are required in very large quantities and this puts immense pressure on the digestive and assimilative processes and imposes a great strain on the elimination processes. This strain makes it quite possible for some link in the intricate metabolic chain to snap. All this indicates that the food must be very carefully selected so as to be adequate in quantity, appropriate in quality and of minimal toxic value. The important constituents required by sportsmen are: a. Proteins Generally it is said that a sportsman requires 2 gm/kg of Ideal Body Weight. This dictum is not always true in every case. Individual variations are always to be accounted for. Protein sources are indicated in Table I. Table I. Comparative Nutritive Value of Proteins

Foodstuff

Chemic Protein al Limiting Conte Score of Amino Acid nt %

Whole Egg

12.3

100

Tryptophan

Beef (lean,raw)

20.0

72

Lysine

Wheat (Wholemeal flour)

13.0

38

Lysine

Rice (Polished raw)

6.5

59

Tryptophan +Lysine

Maize (Cornflour)

0.6

Maize (Wholemeal)

9.5

36

Cystine

Soya flour (low fat)

45

58

Methionine

Beans (Haricot, raw)

21

39

Tryprophan

Fish

21.5

77.7

Tryptophan

Chicken

25.6

66.6

Tryptophan

-

Cystine + Methionine

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Pulses are deficient in amino acids which are present in cereals. Thus protein of cereals help supplement that of pulse and thereby improve the chemical score. A combination of nce and dal has a better quality of protein than either of them alone. The protein should not only be in abundance but it should also be utilizable by the body. It should be rich in essential amino acids which are the main building blocks of our body proteins. Furthermore, the availability of the protein should not be offset by the disadvantages imposed by putrefaction of the protein source—thus imposing a toxin load and stressing elimination processes. In this respect (Ref. Chart I), cottage cheese (paneer), cheddar cheese, indigenous traditional cereal pulse combinations and milk products like curd and butter-milk are far superior to meat and fish. The latter, non-vegetarian sources of protein—though being individually far superior to vegetarian sources of protein—offset this advantage by fermenting and putrefying in the gut and releasing toxins which are not easily eliminated.

b. Carbohydrates They should constitute 50% of the calories consumed daily. The sources of carbohydrates are fruits, vegetables, rice, wheat etc. These should be in the natural form preferably because in the natural form they are in combination with the appropriate vitamins which act as co-factors in their metabolism. Furthermore, natural carbohydrates are preferred to refined carbohydrates e.g. refined wheat and white sugar because the natural carbohydrates are closely enmeshed in the fibre of the parent food substance, in this way retarding their absorption and thus avoiding large fluctuations in blood sugars. c. Fats These are essential for the integrity of the body. For example metabolism of various vitamins (A,D,E,K), immune function, nerve myelination, repair of the body tissues

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and as a source of energy during periods of high demand associated with starvation (as in the marathon runner). In fats, of particular importance are essential fatty acids - viz. Iinoleic acid, linolenic acid and arachidonic acid. These are essential to the body, as their names indicate and are found in corn oil, almonds, walnuts, cashewnuts, and the kernels of apricots and other substances (see Chart 2). Weight for weight, the vegetarian sources of fats and fatty acids are far superior.

d. Vitamins, Minerals and Trace Elements These are required in abundance and are very sensitive to heat, cold, processing, storage and dehydration. Hence, in theory some foods may contain this ingredient but due to cooking and or storing processes it may no longer be present e.g.skimming milk takes away the vit. D, the fat and fat soluble nutrients and thus the most important elements of milk are lost by skimming. These are present in abundance in fruits of the season, fresh vegetables, nuts and other natural vegetarian food. e. Micronutrients These are an ever-increasing list of substances necessary for metabolism and are available mostly from raw vegetables. …. And Their Clinical Importance 1. Proteins These are needed in fair amount for both strength and bulk of muscles and are essential to sportsmen who undertake events like football, rugby, shotput, wrestling, boxing, etc. Vegetarian sources of protein are superior to non-vegetarian sources in that they contain all the necessary ingredients and in their utilizable forms. Due to

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the increased toxin load of non-vegetarian protein sources, their superior biological value is rendered less advantageous (in terms of net advantage) (Chart 2). 2. Carbohydrates These are fuel source for athletes wanting speed,as in short distance running, swimming and in fast field games like hockey, football, etc. The carbohydrate sources are rice, fruits, some group A vegetables like carrots, beetroots, potatoes, wheat to a certain extent and honey to a large extent. Non-vegetarian foods do not feature in this category at all. The most superior source of carbohydrates for stamina in sports is Honey which is quickly converted to glycogen and stored in the liver. This store of glycogen builds up rapidly because of the presence of all the vitamins and minerals present in honey. In India, rice and wheat are the main source of carbohydrates and this should be backed solidly with a fair share of fruits and their juices. Even though white sugar and glucose powder are vegetarian sources of food, they are detrimental to sportsmen because these substances decrease the pH of the blood, cause demineralisation of bone and 'steal' vitamins from the liver for their metabolism. 3. Fats The fats from vegetarian sources have the advantages that they contain poly and monounsaturated fatty acids and essential fatty acids whereas meat like beef, pork, mutton contain largely saturated fatty acids which are detrimental to health. 4. Vitarnins, Minerals and Micronutrients These are essential for the thousands of reactions in the body taking place in practically every organ. For instance calcium and potassium are essential for muscle function. Calcium and phosphates are essential for the strength and resilience of bones. Sodium chloride is essential for the maintenance of blood pressure and vitamins and minerals act as co-factors in practically every metabolic reaction of the body whether it be the conversion of glucose to glycogen or burning of fats to obtain energy. A slight deficiency of these constituents can prevent an athlete from achieving his maximum potential. It is clear from the data above and the illustrations that the nutrition of an athlete is not simply an 'eat-more' phenomenon. The quality is as important as the quantity, if not more. The timing of food and the changes of 'in-season' and 'off-season' nutrition are extremely important because that helps athletes to build up their reserves during off-season and hence have them prepared for in-season, high level energy expenditures. After observing the effects of putting young school athletes on a balanced vegetarian diet, I am convinced that in order to perform well in any sport it is not necessary to haves a predominantly non-vegetarian diet. In April, 1988, 60 athletes ranging from 9 to 16 years in age were counselled on vegetarian diets. Their performances were monitored throughout the year upto the competitive season. It was noted that these athletes had all improved as compared to previous years' performances. Many were convincing winners in their events. This however, has been an informal, nonrandomised study. The results are quite evident that, it is not necessary to have a predominantly non-vegetarian diet in order to perform well in sports.

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The subject of vegetarianism has been a topic for hot debate ever since the ancient Greek athletes. Various theories were put forward perpetuating the 'veg'-'non-veg' tug-of-war. The vegetarian cause has been amply supported by many athletes. The athletes who excelled in cycling, long distance walking, marathon running, swimming, tennis and other athletic events like short and middle distance running,could perform these feats not only because they set their rrind to it, but because a vegetarian diet has every thing that a sportsman needs. In modern times many athletes have changed over to a vegetarian diet pattern. Prominent amongst ffie celebrities is Martina Navratilova who has dominated the world of tennis for so many years. Many more athletes are changing over and more will, in future. From the data presented, it is simple to note that for every need of the athlete there is an adequate vegetarian source. Hence it is not mandatory, as is widely believed, that for an athlete to be successful he must have a non-vegetarian diet. A carefully planned vegetarian diet can be as nutritious, if not more, for a sportsman.

Bones and Joints - Some Hard Facts In Vegetarianism K.T. Dholakia .

The locomotor system—consisting of bones and joints is the frame of our body. On it are anchored our muscles, with the help of which we are able to move around and perform tasks which would be impossible were it not due to the suppleness of our joints and their wide range of movements. Calcium, phosphorus, Vitamin D and a host of hormonal, dietary and emotional factors play a major role in the integrity of the locomotor system. The delicate balance between these factors permits many things to go wrong in this system—for instance a deficiency in calcium will cause the entire matrix of the bone to become weaker, or an upset in the Ca:P ratio/product can cause demineralisation of the bone. Under normal circumstances, if we adhere to the norms of Nature this system operates beautifully and permits us to achieve our life's ambitions with the utmost ease. However, when things go wrong, there are arthritis of various types like osteo-arthritis (OA), rheumatoid arthritis (RA), cervical and lumbar spondylosis, etc., osteoporosis (softening of bones) leading to pathological fractures of bones and resultant morbidity, osteomalacia and a host of other disorders. utmost importance that the correct food be consumed in order to maintain our bones and joints in a healthy condition. Various studies conducted on vegetarians, lacto-ovovegetarians, and omnivores have concluded that there are too many factors affecting bone mineral metabolism and hence it is not possible to state dogmatically the superiority of any one nutritional lifestyle over another. There are points in favour of both sides and both schools of thought have their disadvantages. The calcium content of vegetarian and non-vegetarian sources differs widely

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in quantity and the form in which it is present. There are many factors that affect calcium absorption and these factors determine the amount of calcium available. Hence the concensus is divided on the superiority of a vegetarian diet over a nonvegetarian diet. However, on examining the problem many important points surface and come to the fore. The most important observation is that when sulphur-containing foods (e.g. meats) are consumed they change the pH of the blood. So also do the fried foods, sour foods and the spicy foods in our diet. But, meat has the strongest acid load owing to its rich sulphur content. This increases the acidity of the blood which, in turn, demineralizes bones. This leads to osteoporosis. Many surveys have demonstrated that post-menopausal women who are vegetarians have a higher bone mineral content as compared to their non-vegetarian (omnivorous) counter parts. Similarly it has also been observed that though young Caucasian whites measure equally with young Eskimos in bone mineral density, the older Eskimos have a much lesser bone mineral density as compared to an age matched Caucasian white. The reason behind this seems to be the diet of the Eskimos, which is predominantly meat, the blubber of seals, and fish. The high sulphur content of these foods causes acidification of the blood which 'melts the bones' in an attempt to buffer this excess acid load. Furthermore, it has also been noticed that there is a very strong relationship between joint pains like 'frozen shoulder, cervical spondylosis and arthritis of other kinds and the kind of food eaten. Fried foods, spicy, oily foods, excessive meats and refined foods like sweets, confectionery, bread and other refined wheat products are the main incriminating factors in joint diseases. The kind of food leads to excess acid load in the blood which the kidneys are unable to cope with. Hence this acid causes inflammation of all joints. Constipation also initiates the formation of toxins in the gut, which get absorbed into the blood and increase its acidity. This, too, contributes, along with other factors, in the development of arthritis and bone demineralisation. Hormones like oestrogen, testosterone, adrenocortical hormones, thyroid and growth hormone also play a very major role in the maintenance of normal body structure and function. A strong link between hormonal activity and the kind of food we eat has been established in several studies. In perspective, a vegetarian diet, which is rich in fibre and, in the uncooked form, contains a lot of vitamins and minerals proves very beneficial as it prevents constipation, removes toxic matter

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from the gastrointestinal tract, thereby preventing increased acidity of the blood. The increased amounts of minerals and vitamins in vegetarian foods contribute richly to the smooth functioning of bone metabolism. The acidity (sulphur related) of a non-vegetarian diet initiates and perpetuates bone demineralisation as seen by serial bone mineral density studies done by direct photon absorptiometry. In contrast the vegetarian diet which contains predominantly uncooked food doesn't have this disadvantage. However, fried foods, spicy foods and excessively sour foods—whether vegetarian or non-vegetarian are detrimental to bone and joint integrity. It is a common conception that vegetarians lack calcium in their diet and as a result they suffer from bone demineralisation leading to osteoporosis and osteomalacia. This is not true in the case of a lacto-vegetarian because milk and its products are a very rich source of calcium which is easily available to man. However, there are reports and it is our experience that as age advances the digestion of milk becomes more and more difficult owing to decreased gastric acid,enzyme content. The maldigestion of milk not only gives gastrointestinal discomfort but also gives an increased acid burden to the body which leads to joint pains and aggravation of arthritis. Cottage cheese (also known as paneer, clabbered milk, kefir) and whey (the water obtained during the preparation of cottage cheese) are excellent calcium sources for a vegetarian and are much less toxic than the nonvegetarian sources of protein. Analysis of the available data shows that vegetarian diets by virtue of their: • • •

High fibre content, Low acid content, High vitamin and mineral content,

are helpful in preventing and, to a certain extent, relieving the pain and progression of arthritis and bone demineralisation. Owing to the high fibre content vegetarians are rarely constipated and this helps a lot in healthy bone and joint metabolism. Furthermore the reduced acid load and increased vitamin and mineral content of vegetarian food makes it the preferred food for preventing joint and bone complications. Vegetarian Sources of Calcium 1. Milk: in order of preference i. Goat's ii. Cow 's iii. Buffalo 's 2. Cottage cheese (paneer, clabbered rnilk) 3. Almonds 4. Pulses (though bound to phytate)

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5. 6. 7. 8.

Seeds especially Sesame (Til), Sunflower Cheddar Cheese Swiss Cheese Soya beans and their products like TOFU

Factors that Hinder or Block Calcium Absorption A. Foods containing oxalic acids e.g. spinach, lotus stem, horsegram B. Lack of Vit. D. C. Overuse of proteins e.g. excessive consumption of protein-rich foods like meat, fish, poultry, eggs, etc D. Excessive use of common salt E. Excessive use of alcohol F. Excessive use of coffee G. Excessive tobacco smoking H. Excessive use of soft drinks containing phosphorus I. Excessive use of fat Finally, an analysis of the risk factors of osteoporosis shows that statistically vegetarians have a lesser risk of bone disease because of certain traits e.g. the decreased incidence of tobacco use, alcoholism, obesity, constipation and hormonal (especially oestrogen) imbalance amongst them. Hence it is evident that vegetarian diets do offer substantial protection from bone and joint disease provided adequate care is taken to meet the daily calcium, protein and vitamin requirements. REFERENCES 1. Mazess R.B., Mather W. Bone mineral content of North Alaskan Eskimos. Am. J. Clin. Nutr. 1974 27: 916-25. 2. Sanchez T.V. Mickeisen O., Marsh A.G., Garn S.M., Mayor G.H. Bone mineral in elderly vegetarian and omnivorous females. In: Mazess RB, ed. Proceedings of the fourth international conference on bone measurement. Bethesda, MD : NIAMMD 1980: 94-8. (NIH Publication 801983). 3. Marsh A.G., Sanchez T.V., Mickelsen O., Keiser J. Mayor G. Cortical bone density of adult lacto-ovo-vegetarian and omnivorous women. J. Am. Diet Assoc. 1980, 76: 148-51. 4. Licata A.A., Bou E., Bartter F.C., West F. Acute effects of dietary protein on calcium metabolism in patients with osteoporosis. J. Gerontol 1981, 36: 14-9. 5. Wachman A., Bernstein D.S. Diet and osteoporosis. Lancet 1968, 1: 958-9. 6. Marsh A.G., et al: Vegetarian lifestyle and bone mineral density: Amer. J. Clin. Nutr. 1988: 48, 837-41. 7. Gopalan C. Nutritive value of Indian foods. National

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Institute of Nutrition, Hyderabad, 1982. 8. Jensen, Bernard. Arthritis, Rheumatism and Osteoporosis: Correction through Nutrition.

Ayurveda - In Depth Vegetarianism Suresh Chaturvedi .

Taking care of one's body is every man's primary duty. That is the reason why it is said in Ayurveda—'Only a person with a healthy body can accomplish the four basic principles of life, namely: Dharma (religion), Artha (money), Kama (sexual desires), Moksha (salvation). To attain good health it is essential to follow the rules of good nutrition, regular exercise and regulation in sexual activity. These are said to be the four pillars that keep the body in perfect harmony. Thus a nutritious diet, proper lifestyle, adequate sleep and exercise are instrumental in keeping the body free of all ailments. Human beings have four instincts i.e. appetite, sleep, fear and sexual desire. In life these instincts have played a prominent role.' In Ayurveda, it is believed that all living beings are a composite of the five basic elements i.e. Earth, Water, Fire, Air and Sky. In order to keep life going, it is important to replenish these elements through natural foods which are the sources of these elements. Natural foods, which are vegetables, fruits, nuts, cereals and other foodstuffs are essential to obtain these ingredients and these foods are all classed as vegetarian food sources. Grains like rice, wheat, pulses have been given a very special place in Ayurvedic literature as the main foods for man. It is said in the Sanskrit literature that within grains there is life and it is with grains only that life persists. It is only within the vegetarian diet that you find all these components of food. Similarly the milk obtained from buffalos, cows, goats and other animals and milk products like curd, butter, ghee, etc. are also obtainable within a vegetarian diet. These vegetarian foods supply nutrients in adequate quantity and quality right through life. Regular intake of these vegetarian foods ensures appropriate development, both mental and physical, and also protects the consumer from various diseases. Given below is a brief discussion on the values of individual food items: A. CEREALS Wheat In a vegetarian diet the various products made from wheat flour play an important role. Wheat strengthens the body and its use increases all the elements of the body. Wheat products like roti, broken wheat (dalia), sheera (halwa), bread, biscuits, etc. not

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only taste good but are also easy to digest. Rice Rice forms an important component of our diet. Rice, too, is light and easy to digest. The use of rice increases the enzymes, components of blood, muscles and other elements of the body. It is owing to rice that the body remains light and energetic. Rice and its products are useful in the treatment of constipation, fever, diarrhoea, dysentery, abdominal complaints and emaciation. Barley Barley helps to stimulate the digestive system and increases vitality and makes you alert. Barley is useful in the treatment of common colds, fever, asthma, sore throat, urinary tract infection and skin diseases. Barley water is used in various diseases. Bajra Bajra is useful for body building. Its consumption strengthens the body and forms all the elements of the body in the right proportions. Jawar Jawar reduces the heat in the body and is useful in pitha and Pitha-related diseases. This is easy to digest and is also used in curing abdominal diseases. Jawar increases strength and sexual potency. B. PULSES Bengal Gram (Chana) It is Bengal Gram dal and Gram flour (besan) that also improves health, gives strength and stimulates sexual potency. A fistful of gram soaked overnight and tied in a cloth will stimulate sprouting of gram. The use of these sprouts is very nourishing. Red Gram Dal (Toor Dal/Arhar) Toor dal is easy to digest, helps in the formation of stools, and is usefuL in piths and pitha-related diseases. Similarly green gram (moong) is also easy to digest and is useful in eliminating pitha and helps to ease burning sensations of the body anti stomach. It can also be consumed in diseases of bones and diarrhoea.

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Black Gram (Udad); Black Gram Dal (Udad Dal) Black Gram is useful in treating the various diseases caused by vata. It increases the muscle strength and sexual potency of the consumer. Lentil (Masoor and Masoor Dal) Masoor is light to digest and helps in the formation of well formed stools. It is also helpful in blood and skin diseases. C. OILS AND OILSEEDS White and Black Gingelly Seeds (Til Seeds) Both white and black gingelly seeds are useful. Consumption of these increases strength, eliminates worm infestation from the intestine, strengthens the roots of hair thereby making them healthy. They are useful in increasing the milk production in lactating mothers and is also used in treating complaints like polyuria. The presence of some sort of oil/fat in our diet is also essential. This can be obtained from milk and various oilseeds. Different types of oils are used in different regions of our country. Gingelly Oil (Til Oil) It strengthens the body and stimulates and improves the digestive system. A massage with this oil is beneficial to the skin and eyes. Mustard Oil (Sarso or Rai Oil) This oil is mainly consumed in the north-eastern region.Consumption of this brings about the elimination of Kapha and vata-related disorders. It also eliminates worm infestations from the intestine. A massage of the body with this oil removes dryness of the skin, makes it soft and smooth and strengthens the muscles. Groundnuts These nuts are predominantly used in the western coast of India and are useful in the elimination of abdominal and body vata. D. VEGETABLES Potato

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Potatoes are a very common constituent of our diet and they can be served in combination with many other vegetables. They are available in all seasons. Potatoes stimulate the formation of all the elements of the body and impart strength to the body. Beetroot Beetroots destroy vata and diseases arising from the formation of vata. They are also useful in kappa diseases. They increase the muscle and fat content of the body and thereby make it strong. Mustard (Sarson) Mustard is good for constipation and other abdominal diseases. Cabbage Cabbage is a sweet vegetable useful in kapha and pitha diseases. It helps in the treatment of diabetes, diseases of the urinary system, skin diseases, leucoderma, leprosy, asthma, bronchitis, infections of the skin like boils, cellulitis etc. Bitter Gourd (Karela) Karela is useful in the treatment of fever, diabetes and jaundice. In addition it is also useful in the treatment of intestinal worms, dysentery and some skin diseases. Amorphophallus (Jimikand Suran) Suran is useful in the treatment of piles and diseases related to an enlarged spleen. Brinjal (Baingan) Brinjal relieves diseases related to vata and kapha. It is a sexual stimulant and increases fertility. Beans (Same Phalli) Beans increase strength and are useful in diseases related to Vats and Pitha. White Gourd (Dudhi) Dudhi improves vision and is useful for all loose constipation, diseases of the female reproductive organs, fevers, bronchitis, asthma, dysentery and urinary infections.

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Snake Gourd (Padwal) Snake gourd is good for abdominal disorders like constipation and dysentery. It is good for fevers, liver and spleen disorders. Spinach (Palak) Spinach is a mild laxative. Thereby it serves to stimulate the appetite also. It stimulates the production of many enzymes in the gastrointestinal tract and also helps to enrich the blood with many minerals especially iron. Various abdominal problems, mild to moderate fever, swelling of the eyes and long-standing constipation are all the other indications for the use of spinach. Amaranth (Chaulai) Amaranth stimulates digestion, improves urinary flow and eases bowel movements It improves appetite and enriches the blood. This vegetable is very useful in constipation, some kinds of dysentery, liver disorders, enlarged spleen, eye diseases and long standing fevers. Fenugreek (Methi) Fenugreek improves the digestive power. It also helps in conditions where there is loss of appetite, bowel disorders (like dysentery) intestinal worm infestation, fever, swelling of the eyes, pain in the joints, distension of the abdomen and other vata-related disorders. (Its role in reducing blood sugar is acclaimed by some researchers). Ghosala (Turia) Turia increases milk production in lactating mothers. It is a sexual stimulant. Abdominal pain, distension, flatulence, fever and diseases of the uterus are relieved by the use of this vegetable. It also destroys intestinal worms and helps cure piles. Coriander (Dhania) and Mint Leaves (Phudina) Coriander improves the taste of food. They are useful in conditions like indigestion, piles, emaciation, intestinal worms and dysentery. Cucumber (Kakdi) Cucumber is beneficial in Pltha and various diseases related to it. It helps to cleanse the urine and is also useful in cases of renal stones. It has also been proved to be very useful in leprosy, burning paresthesiae and burning in the urine.

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Radish (Mulah /Muli) Radishes cure various abdominal disorders like stomach aches, abdominal distension, flatulence or gas formation, loss of appetite and constipation. They are also used in the treatment of piles, obstruction in urinary flow and renal stones. Chewing on a radish instantly cures hiccups. It is also used in skin diseases and leprosy. Onions (Pyaz / Kanda) Onions stimulate the digestive systems. They are nourishing and increase the elements of the body. Consumption of onions causes reduction in fever. They are used in epilepsy and in cases of hysterical unconsciousness where, if a person is made to smell it, he awakens. It is also helpful in the treatment of sun-stroke. Garlic (Lasoon) The daily consumption of garlic chutney cures abdominal pain, formation of flatulence/gas, abdominal cramps and other vatarelated diseases. Consumption of garlic juice frequently in small amounts is useful in cholera. It is used in disorders of the spleen, high blood-pressure, epilepsy, old wounds, scabies, persistent cough, boils in the ear and syphilis too. E. FRUITS Grapes (Angur) Grapes are consumed in various diseases as they are considered to protect health. They alleviate sour eructation, burning ulcers, heaviness in the stomach, constipation, head-ache, fever, weakness and giddiness. Mango (Aam, Amba) Mango increases strength and sexual potency and cleans and improves the colour of the skin. Besides carbohydrates, it also contains vitamin B and E in adequate amounts. It is beneficial in chronic abdominal disorders, diarrhoea, bowel disorders, tuberculosis, cough and deficiencies.in the blood. A beverage called Hannah which is made from raw mangoes helps in the prevention of sun-stroke. Banana Banana is a good source of energy. It finds use in the treatment of dysentery, burning in the stomach, piles and intestinal problems. Due to its 'cold' nature it finds use in bilious disorders and problems related to heat. It is useful in urinary disturbances.

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It is considered to be a complete food. Orange (Santra) Oranges are useful in the treatment of fever and constipation. Custard-Apple (Sitaphal) Custard Apple is beneficial in the treatment of nausea, vomiting and apathy. Sapota (Chikoo) Chikoo is used as an ideal food during an illness as it promotes strength and gives energy. Guava (Amrud, Peru) Guava is strengthening as well as it helps to increase the elements of the body. It is useful in treating abdominal pain, unconsciousness and worm infestation. Apple (Sev) Apples are useful in the formation of enzymes, blood, muscle and fat. They are also useful in the treatment of bowel disorders like constipation, dysentery and piles. Figs (Anjeer) Figs are beneficial in the treatment of constipation, piles, heart problems, jaundice and various diseases of the urinary tract. They also purify the blood. Musk Melon (Kharbooja) Musk Melon stops burning sensation of the skin and reduces excessive thirst. It has been proved to be useful in insanity and for development of neurons of the brain. Lichi Lichies are very nourishing. They are beneficial in overcoming weakness that follows an illness. They also purify the blood. They strengthen the digestive system. Lichi juice is useful in urinary disturbances. They have also been proved to be beneficial in regulating heart beats and improve the general resistance of the body.

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Pomegranate (Anar) Pomegranate is useful in the treatment of bowel disturbances, dysentery, nausea, vomiting, eructations and disorders of the stomach. It is very beneficial for the heart. It is useful in the treatment of burning sensation of the eyes, worm infestation in the intestine, fever and burning rnicturition. Water Melon (Tarbuj / Kalingad) Water Melon destroys various disorders caused by pitha and reduces the body heat. It tranquilizes the mind. Pear (Nashpati) Regular consumption of Pears has an aphrodisiac effect. Its use is beneficial in loss of appetite, excessive thirst, vomiting and chronic constipation. Plum (Aloobokhara) Plums are useful in the treatment of piles, body-ache, pain in the joints and in vata-related diseases. It is especially useful in jaundice. Wood-Apple (Kaith) Wood Apple is highly beneficial in the treatment of bowel disorders, hiccups, asthma, ear-ache, and in abdominal disorders of children. Pineapple (Ananas) Pineapple is very beneficial for the heart and in the treatment of worm infestation in the intestine, fever, diphtheria, swelling in the body, excess heat in the body, excessive thirst, giddiness and weakness. Dates (Khajur) Dates enrich the blood. They are also useful in the treatment of nausea, stomach-ache, fever, influenza, urinary obstruction, constipation and headache. Drinking milk after consuming dates makes the body healthy and strong. Dates are also sexual stimulants. Dried Dates (Chooara) Dried dates are beneficial in various abdominal disorders and also stimulate the digestive system. They also increase sexual

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potency. Bael Fruit (Bel Phal) Bael Fruit is beneficial in various abdominal disorders and it stimulates the digestive system. Zizyphus (Ber) Zizyphus is useful in fever, bowel disturbances, burning sensation of the body, burning sensation while urinating and urinary obstruction. It also helps in reducing excessive thirst and acts as a sexual stimulant. Almond (Badam) Almonds increase kapha and all the elements in the body, and are also essentially very nourishing. They also increase the memory. Makhana Consumption of makhana reduces the body heat, and is also ideal in bowel disturbances. It is very beneficial for the heart and is very nutritious and acts as a stimulant. F. MILK AND MILK PRODUCTS Milk (Dudh) Milk increases the elements of the body and their resistance power. It is a laxative. It is taken as a complete food by all animals. Its consumption is beneficial in the treatment of chronic fever, dizziness, weak-mindedness, tuberculosis, anaemia, fatigue and tiredness, leprosy, piles and complaints of the urinary organs. Curd / Yogurt (Dahi) Curd can be used as lassi and its use is beneficial in chronic fever, dizziness, weak-mindedness, tuberculosis, anaemia, when the body elements decrease, fatigue and tiredness, leprosy, piles and complaints of the urinary organs. Clarified Butter (Ghee) Consumption of ghee rids the body of dryness and the skin becomes soft and the face glows. It also strengthens the bones. It is useful in the treatment of body-ache, pain in the joints and various other vata-related disorders. Regular consumption of

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ghee wards off mental disorders. However, excessive consumption, too, is not advisable. G. SPICES In our diet we also use small quantities of spices which play a protective role. Salt (Nimak) It stimulates the digestive system and thus also improves the appetite. In cases of chest congestion, stomach-aches, abdominal distension and abdominal cramps and in other such discomforts, relief can be obtained by sucking on a pinch of salt. Turmeric (Haldi) Turmeric is useful in conditions of vats, pitha, and kapha. It has been proved to be beneficial in the treatment of cough, syphilis, fever, influenza, polyuria and worm infestation of the intestine. Asafoetida (Hing) Asafoetida has been proved to be beneficial in the treatment of flatulence / gas formation, high fever, hysteria, stomach-ache in children, indigestion, distension and toothache. Cumin Seeds (Jeera) They have been proved to be beneficial in loose motions, heart burn, chronic fever and eructations. Omum (Ajwain) Ajwain is used in the treatment of stomach-ache, loss of appetite, indigestion, distension, constipation, worm infestation of the intestine, asthma, for proper digestion of food and diseases of the uterus. Aniseeds (Saunf) Aniseeds are useful in the treatment of stomach-ache, piles, constipation, nausea ancvomltmg. Cloves (Lavang / Long) Cloves have been proved to help in the treatment of slight fever, influenza, chronic cold, vomiting during pregnancy and toothache.

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Cardamom (Elaichi) Cardamom is useful in fever, flatulence / gas formation, weak eyesight, aphthous ulcers, nausea and cough with mucus. Ginger (Adrak) Ginger should be regularly used to avoid flatulence/gas formation, stomach ache, indigestion, vata-related disorders and loss of appetite. It stimulates the digestive system. It is useful in the treatment of gout, pain in the joints, swelling, abdominal distension, diarrhoea, headache, earache, chronic bowel disorders, excess mucus, cold with a sore throat and cough. Black Pepper (Kali Mirch/Miri) Black Pepper is beneficial in the treatment of heart diseases, flatulence / gas disturbances, stomach-ache, abdominal distension, piles, bowel disturbances, diarrhoea and worm infestation of intestine, cholera, cold, cough, hiccups, pitharelated disorders, weak memory, sore throat and stammering. Nutmeg (Jaiphal) Nutrneg has been proved to be beneficial in treating headaches in children, cough, pain in the chest, influenzas pneumonia, bowel disturbances and vomiting. It is also helpful in the treatment of toothache and worm infestation. Cinnaznon (Dalchini) This helps in the digestion of food. It destroys flatulence. It is useful in bowel disturbances like diarrhoea. Bay Leaf (Tej Parta) Bay Leaf is beneficial in cold, cough, asthma, chronic cold, bodyache, pain in the joints, stomach ache and disorders of the uterus. Tarnarind (Imli) It is beneficial in the treatment of Pitha in the body, nausea, bleeding piles and tendency towards sun-stroke. Sugarcane (Ganna): Sugarcane is a good source of energy. It promotes the flow of urine,hence it is useful in urinary stones and urinary infections. It is also useful in jaundice, anaemia and constipation. It

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strengthens the heart muscle, it is a good source of minerals and it also is a mild sexual stimulant. It is also useful in the treatment of nasal bleeding, hiccups, headache and helps to quench thirst. Sugar (Shakkar) Sugar is a good source of energy and it provides relief in fatigue, nausea and vomiting. Honey (Shahad) It provides energy and is versatile in its qualities. It enhances the value of the food it is consumed with (e.g. milk). It is useful for treating sore throats, it also improves digestion and is useful in the treatment of cough, asthma, piles, leprosy, tuberculosis, blood disorders, urinary disorders, nausea, vomiting, hiccups, constipation. It is also food for the complexion. It helps in weight reduction when taken with water. It is very nutritious in combination with milk. Jaggery (Gur/Gud) If jaggery is regularly consumed along with the meals, it is highly beneficial to the heart and also helps to prevent various kinds of heart diseases. It also acts as a sex stimulant. Consumption of jaggery with dry fruits is very strengthening. It is beneficial in various vata-related disorders, gout and body ache. Jaggery water cleanses the urinary system and ensures a good flow of urine. From the above observations it is apparent that the vegetarian cuisine promotes quality of life. Vegetarian foods can also play a role in healing diseases, In fact in Ayurveda the medicine itself is vegetarian food.

Vegetarianism- Naturally Speaking M.M. Bhamgara .

Yoga per se, does not say much about diet, except that we should be 'Mitahari' (Mita-Ahar-ee), 'Mita' meaning 'proportionate' or 'enough to nourish', and 'Ahar' meaning 'food'. 'Mitahar therefore, has come to mean 'moderation in eating'. But, we know, it is not enough to be moderate in intake of pebulum. It is not enough to mind the quantity of food; quality of food ingested is of even greater importance. In Yoga shastras, Mitahar has been described as diet that is 1. Palatable, 2. Nutritious,

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3. Providing various 'Dhatu' (literally meaning 'Minerals'), 4. Containing dairy produce such as milk, yogurt, butter or butter-milk, 5. Eaten in moderation, and 6. Eaten in a spirit of dedication to the Divine. The last aspect is akin to the saying of grace at the dinner table by devout Christians. Hindu shastras also speak about the three 'Guna' of food, 'Guns' meaning quality. 'Sattwic' food is variously understood as 'contributing to serenity', 'providing the essentials', Keeping the human organism sweet and clean', etc. 'Rajasic' food contributes to dynamism and other requisite qualities needed by a householder or housewife. 'Tamasic' food is strong in taste or smell and can be 'heaty' or 'exciting passions'. Revelations of Science In the light of modern nutritional researches, we have to find out the ideal diet which is both 'Mita and Sattwic, so that the Yoga practitioner benefits therefrom both physically and mentally. Let us find out whether Yoga should favour the intake of flesh, fish or fowl. What does human anatomy and physiology tell us? It may be news to many that structurally and functionally, we are vegetarian animals in the same class as the primates, the higher apes, such as gorilla, chimpanzee or orangutan. Here are some of the salient similarities: 1. Our hands are like these apes', meant for plucking food such as fruits, vegetables, leaves, flowers, barks, shoots, etc., and not for tearing flesh: we do not have claws. 2. Like the primates', our lower jaw or mandible can move both up and down and side to side, whereas the carnivore's moves only up and down. 3. Like the higher species of apes, our saliva is alkaline, containing ptyalin to digest carbohydrates, whereas in carnivores it is acidic. 4. We do not have fangs which carnivores have, for biting into flesh. our so-called canine teeth are not truly canine (like dogs); they are not longer than other teeth. Apparently, we are not constituted to prey upon animals' bite into their flesh, or rip apart their bodies. We are made for gentler manoeuvres in gathering our food. 5. Our gastric secretions are acidic; so are carnivores'. But the carnivores' stomachs have four times as much acid; this strong acidic milieu is needed to digest the highly proteinous flesh diet. 6. Like the primates' our small and large intestines measure four times as long as our own height, whereas, in case of carnivores, it is about the same as their body length. 7. Liver and kidneys of carnivores are proportionately larger to handle the excessive nitrogenous waste. which is a residue from the flesh diet. 8. The carnivore's liver secretes a much larger quantity of

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bile into the gut to deal with the high-fat meat diet. These facts are convincingly in favour of vegetarianism for all of us. But just any type of vegetarian diet is not alright for our systems. For example, we do not have several stomachs that a ruminating cow has, and we do not chew the cud as she does; therefore, we cannot live off pasture-lands. We are frugivores like gorilla (diet 15% fruits), or chimps (67% fruits), or orang (50% fruits), who besides fruits eat some vegetables, shoots, flowers, seeds, etc. Adaptability of the Human System Of course the human system does adapt itself to non-vegetarian foods, but this is not without certain drawbacks. Eskimos, for example may live on reindeer and seal meat, but they die early, their average life span being about thirty years. What our human system can easily and profitably utilise, digest, absorb and assirnilate, is a diet consisting of fresh fruits, leafy and other vegetables, seeds, nuts, cereals and legumes. We have domesticated certain animals whose milk we use— and justify the use. However we should bear in mind that no adult drinks other animal's milk and no animal continues to drink milk after it is weaned ! In this discussion, we have included dairy products in vegetarian diet, though it must be pointed out that there are vegans who maintain excellent health on a vegetarian diet excluding dairy produce. Chinese and Japanese vegetarians too, do not take dairy products. Cholesterol versus Chlorophyll Nowadays, flesh diet is increasingly incriminated by discerning medical men for creating pathological disturbances in the human body. Animal fats are a well-known cause of increase in cholesterol in our blood. This increase may result in the narrowing of the lumen of arteries by fatty deposits; if this happens in coronary arteries, the blood supply to heart muscle itself may be affected, thus causing a heart attack. When several major arteries and arterioles develop atherosclerosis, blood pressure may increase; and with high blood pressure, several pathological conditions may develop in various organs. Cerebral haemorrhage, too, can occur, resulting in paralysis. Since half of the fat in all meats is saturated and cholesterol producing, and since even the most lean part of meat also has some fat in it, all types of meat should be prohibited in persons suffering from cardiovascular disorders. Non-flesh foods except eggs, hydrogenated oils and dairy products have no cholesterol producing fats. Coconut oil has no cholesterol, though it is high in

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saturated fats. Cardiologists now increasingly advise their patients against meat. As early as 1961, the Journal ofAmerican Medical Association conceded that a strict vegetarzan diet could prevent ninety seven per cent of coronary occlusions ! Dr. Donald Ross, Director of Surgery in the National Heart Hospital, London, advocates a study of vegetarian communities, since the incidence of heart disease in them is much lower than nonvegetarian communities. He advises his patients to halve their meat intake, and double their vegetable intake, also cautioning at the same time to restrict dairy fats. He also moots the possibility that the human race has not yet adapted to meat protein; in fact, he believes that atheroma could be a process of the body's rejection of meat proteins taken over a long period of time. It is also to be noted that gall-stones are usually composed of cholesterol; hence, the less one takes of animal fat, the less one is likely to suffer from stone formation in the gall-bladder (cholelithiasis ) . The Nature Cure dietetic injunction is on sound footings; Nature Cure suggests that chlorophyll which is present in leafy and other greens, be eaten in large enough quantities to keep the blood stream free of cholesterol deposits, so that neither the clots, known as thrombi, form in the blood, nor are the arteries affected. Vitamins C and E derived from uncooked (really speaking sun-cooked) fruits and vegetables, including the inner rind of citrus fruits, are also Nature's anti-thrombosis agents. Vitamin C is important for inter-cellular respiration, fighting infections and healing inflammations. Dr. Linus Pauling, the champion advocate of Vitamin C in mega doses, avers that man once lived mainly on vegetables and fruits, consuming up to three grams of vitamin C daily. Later, with the inventions of fire, and cooking of food, and also with man becoming a hunter and flesh eater his intake of vitamin C was greatly reduced; the aftermath was loss of health and vigour. Flesh eaters should note that meat mostly lacks vitamin C. Vegetarian diet Spares Kidneys Another drawback of the meat diet is that it has a high uric acid content. In the last throes of death, all animals produce acids in their tissues; these are not drained offwith blood. Mutton, beef, pork, etc. contain fourteen to sixteen grains (1 grain=60 grams) of uric acid per pound of meat. Human kidneys not being made for excretion of fleshy toxins, cannot easily cope with excretion of more than seven grains of uric acid per day. No wonder then, that large flesh eaters who consume more than half a pound of meat daily, over-load their kidneys. Result may be kidney stones

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or inflammation in kidney tissue, to start with; and kidney failure in the long run. Dialysers and surgical transplants do not solve the problem of increase in kidney diseases. Research has shown that the flesh-eater has also to eliminate tissue wastes in the meat, which the animal's kidneys would have excreted if it had not been slaughtered. Nephritis is often the result of these excess fleshy wastes. Seventh Day Adventist doctors who advocate vegetarianism, rightly feel that the meatless diet spares the kidneys, for they have seen quite often that meat acts like a poison to Bright's disease or nephritis patients. In cases that show albumin in appreciable amount in their urine, they advise a diet free of all meat, fish, fowl and eggs; the result is clear urine in a week or two. Uric acid also leads to troubles such as gout and to a lesser extent, all types of fibrositis, neuritis and neuralgia, including what are called lumbago and sciatica, besides arthritis or inflammation of the joints. Meat and Cancer Another drawback of meat is that it has no fibre content; it lacks cellulose or roughage, which is a must in the human diet; without roughage, bowels cannot move properly, and we suffer from constipation. Unfortunately, most medical men believe that constipation is not a health problem; they think it is alright even if stools are voided once in two or three days or even a week ! But those who know better, lift a cautionary finger against constipation, calling it 'the fertile mother of many diseases'. Comparing our system again to the organism of our arboreal ancestors, the apes, we find that they eliminate faeces at least twice a day; so should we! Now, however, the orthodox medical view is also changing. Bowel cancer is on the rise in countries which are traditionally non-vegetarian, and where, therefore, constipation is rife. Australia which consumes 130 kilograms of beef per year per head, suffers more from bowel cancer than other countries; no other country eats so much of flesh food, though Scotland, Finland and USA are very near the mark. Incidence of cancer of colon is high in these countries too. Dr. Alan Lorg, writing for 'The Vegetarian' magazine of U.K. says "Intestinal flora of vegetarians differ from flesh-eaters; they contain more aerobic bacteria. The flesheaters' anaerobic bacteria include bacteroides containing the enzyme 7alphadehydroxylase, which converts components in the bile juices into deoxycholates, known to be carcinogenic in animals. Concentration of deoxycholates in the faeces is related to the prevalence of colonic cancer. A survey published in 1973 in the Journal of the National Cancer Institute compared the faeces of people on a normal high-protein-high-fat U. S. diet with those

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from vegetarians, Seventh Day Adventists and recent Chinese and Japanese immigrants. Excretion of the degradation products of cholesterol and of total and degraded bile acid was higher in the flesh-eating group, which bore out earlier contentions. Lowresidue diets (deficient in fibre) with correspondingly prolonged transit-tirnes (constipation) and greater opportunities for the action of 7-alpha-dehydroxylases were incriminated in 1971 by Dr. Burkitt. Reports in the 'Gut' Journal in 1969, and in the British Journal of Cancer in 1973, remark that rates of mortality from cancer of the colon relate with consumption of animal protein. " Let alone the fell disease cancer, the less serious conditions of appendicitis and haemorrhoids—commonly called piles—are always due to constipation, whether latent or patent. ....And Diabetes Too! Diabetes is generally associated with too much intake of refined carbohydrates, i.e. starches and sugars. In Bombay, the incidence of diabetes is twice as high among vegetarians than among non-vegetarians. Medical men recommend a high-protein meat diet to their diabetic patients, under the notion that this would not tax the pancreas to secrete insulin, because, with increase in meat intake, carbohydrate intake would ipso facto decrease. Here, the surmise is correct, but it is a very myopic view of total metabolism. A study by a medical team led by Prof. N.S.P. Verma, Associate Professor of Medicine at the Maulana Azad Medical College, New Delhi, has found that the fibre content of vegetables acts as a protection against diabetes in many cases. Dr. Verma said at a seminar on 'Diabetes and Cardio-vascular Diseases' on 23rd October, 1975, that the best way to reduce chances of 'catching' diabetes was to eat more vegetables and unpolished cereals. Since meat constipates, it dams excretion, throwing extra burden on kidneys and liver, the two important depurative organs, which often are involved in the genesis of diabetes. A better plan is to keep the diabetic on a vegetarian diet, induding whole-grain cereals, sprouted legumes and plenty of non-starchy vegetables, leafy greens and fruits. Papaya, oranges, grape-fruits, amalas, apples, peaches, plums and pears are especially prescribed. A detailed study of diabetes reveals that it is not only an excess carbohydrate disease; it can be a high-protein or even high-fat disease. Since there is too much fat in some meats—mutton has 13% fat though it may look all muscle; beef meat has 10% fat—it can result in obesity. Dr. O.S. Parrett, M.D., has pointed out that in fat people, some fat infiltrates the liver tissues. The liver is the store-house of glycogen (liver carbohydrate), but in the obese,

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the extra useless fat cells in the liver impede the function of the healthy liver cells; this results in poor storage of sugar and starch in liver, thereby the blood being over-loaded with sugar. The kidneys have to do the job of eliminating this sweet burden of the blood; thus sugar makes its appearance in the urine. It will be seen, then, that in obese diabetics, the fault may not lie with the pancreas, but with the liver. The cure results when the sufferer reduces weight. Regarding the prescription of a meat diet by medical men to their diabetic patient, Dr. Parrett explains: "Foods to be avoided in diabetes are starch and sugar in excess. When the blood which normally carries a maximum of 120 mg of sugar, reaches 175 mg or so, there is spill-over of sugar into the urine through the kidneys. We then seek a diet for the patient that yields its carbohydrates as slowly as possible, lest the blood stream too quickly reach the spill-over level, and it appears in the urine .... Meat which is mostly protein with little carbohydrate—glycogen— would seem to answer this diet need admirably, except for two important reasons. " These two important reasons are: 1. The diabetic has to get rid of nitrogen and sulphur wastes of meat protein metabolism, and 2. In meat are the tissue toxins of the slaughtered animal; they are ingested by the diabetic when he eats meat. As it is, even the vegetarian diabetic's system is usually burdened with toxins; the non-vegetarian's would be all the more loaded, increasing the risk of acidosis. Dr. Parett suggests a diet programme of low proteins for the diabetic. He also suggests low starch vegetables which add carbohydrates slowly to the blood stream. He considers tomatoes as ideal because of their low starch and high vitamin and mineral content. Dr. Andrew Gold in his book 'Diabetes: Its Causes and Treatment' suggests vegetarian diet, because he also has noticed that "the ingestion of butcher meat increases the toxaemic condition underlying the diabetic state and reduces sugar tolerances On the other hand, the non flesh, non-stimulating and especially unfried vegetarian diet promotes and increases sugar tolerance, " Meat is Not Mita Now if we revert to the definitions of Mita and Sattwic diet, we find meat totally contra-indicated in Yoga. 1. Meat is not palatable. Whatever taste it seemingly has, is that of salt and spices. 2. It is not nutritious in the sense that whole-wheat bread or apple is nutritious. Meat does have protein and fat but we have seen that it also has harmful acids, cholesterol, etc.

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3. It may provide some iron, calcium and phosphorus, but there are better vegetarian sources to obtain these minerals, besides the other minerals which meat lacks. 4. Though dairy produce have animal proteins and animal fats, these in moderation, do no harm. They definitely contribute to growth especially in children. Adults can take cream-free milk or yogurt or buttermilk. Skimmed cow's milk or yogurt contains only 3.2 per cent protein, and 2 per cent fat, unlike mutton which is 19 per cent protein and 13 per cent fat. Again, uric acid is absent in milk. Some research being done at present actually attributes anti-cholesterolaemia virtues to yogurt and buttermilk. The diet of Masai tribesmen is preponderantly animal blood and fat, and yet these people are remarkably immune to heart disease. This is attributed to their openair living and walking long distances but the inclusion of home-made curds i.e. yogurt in their diet also perhaps is a factor in this immunity. As per a study conducted by Dr. Mann and Dr. Anna Spoerry of the African Research Foundation, the Masais' cholesterol level dropped more if they ate more of curds. Dr. Mann opines that some of the bacteria in yogurt produce a substance which blocks or inhibits liver's own cholesterol production. Taking these facts into consideration, therefore, milk and primary milk products with lessened fat content are 'passe' for Yoga practitioners. 5. We skip the fifth point of moderation, for that is applicable to vegetarians and flesh eaters alike. 6. It is irreverence of the highest order to thank God for 'our daily bread', if the 'bread' includes the mangled limbs and organs of a once-living creature—a creation of the same Creator that is being worshipped ! It is doubtful if God's grace would descend on the table laid out with camouflaged corpses of the butchered pieces of the same. Would not the name of the Lord be a sacrilege at such a table ? We conclude from the above that meat does not qualify as Mita-Ahar. We cannot help coming to the conclusion also that meat is not Sattwic; it is disease-producing and can only be branded as Tamasic. Be a Vegetarian—But Eat Wisely Meat diet is wrong; but vegetarian diet can also be wrong. It is good to be a vegetarian, but not enough. Many vegetarian items are Tamasic, unhealthy, even poisonous to the system. We know alcohol is not Sattwic; we ought to know also that tea, coffee and cocoa, containing harmful alkaloids such as theine, caffeine and theobromine, are also not Sattwic, Chocolate made out of cocoa, and Coca which contains caffeine, and therefore can be addictive, are also not for Yoga Practitioners. Tobacco is unhealthy on all counts, whichever way it is used. All these are proscribed items, though there is nothing nonvegetarian about

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them. Few, however, even among vegetarians know about the harm of refined carbohydrates, i.e. sugars and starches. Refined sugar, which is, chemically speaking 99 per cent sugar, and is devoid of all vitamins and minerals originally contained in sugarcane from which it is made, is a very harmful substance. Not only does it contribute to dental cavities and diabetes, but also to osteoporosis and arthritis. Though by chemical reaction it is neutral, it is acidic in our system, and may cause hyperacidity and peptic ulcers. According to Prof. John Yudkin, it also leads to heart disease, as much as animal fats do. Moreover, a research project in USA has traced the connection between anterior poliomyelitis and much sugar intake. Links between hypersucrophagy (too much eating of sugar) and psychological disturbances also have been established. For some years of his life, Adolf Hitler was a vegetarian under medical advice but he was too fond of sugar, putting sugar in everything he ate or drank. Nutritionists are of the opinion that he was sugar-drunk, time and again, which affected his psyche. Even in children, it is observed that hyper-sucrophagy tends to make them peevish or cantankerous. We all need sugar, but it has to come from naturally sweet fruits; if these are not easily available, dry fruits are a good substitute. Vegetarians also need to avoid fried items. Boiling, baking and steaming are conservative modes of cooking to recommend. Spicy Yoga A word about strong spices and condiments. Yoga tradition is to avoid onion and garlic, as these are strong smelling and therefore in the category of Tamasic; chillies and pepper though a greater irritant to the mucous lining of the gastrointestinal tract, get a clean chit from Yoga practitioners because they do not have a strong odour. In the light of new discoveries, however we may have to include onions and garlic in a health promoting Yogic diet, as these two have been variously ascribed the virtues of lowering high blood pressure, disinfecting bowels and curbing tuberculosis. On the other hand, chillies have no such merits, though they are high in vitamin C if taken fresh. The demerit is that chillies cannot only set the so-called delicate but in reality tough inner walls of the alimentary canal aflame, their irritating factor can similarly cauterise or scorch the cells of the liver and the kidneys. Indians in England are said to suffer from 'Curry Kidneys' due to an excess of chillies. Here, the plea for onions and garlic is only as herbs and to add flavour and taste to other dishes; these need not be taken to the extent that one smells of them.

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Thou Shalt not Kill This study of a non-vegetarian diet is made from a medical n~e. However, since Hatha Yoga cons sts of eight facets (Ashes Anga), one of which is Yama which again includes Ahimsa, Yogic diet may be studied from the angle of Ahimsa also. Ahimsa means non-violence, or non-killing. It is wrongly believed that the intention not to kill implies not killing other human beings. This is a very narrow view. Non-killing means not killing any animal, whether for food, clothing or sport. Under this broad definition of Ahimsa therefore, Yoga indirectly proscribes and prohibits meat diet. Vedic Rishis may have partaken of meat under some dire circumstances, but these do not exist for us in modern times. From the humanitarian angle, the spiritual angle, the nutritional angle as well as the ecological angle, meat diet has no locus standi; it had better be eschewed.

Vegetarianism- From The Dentist's Chair N. C. Sharma .

It appears that nutritional factors have definite influence on the incidence of periodontal problems (Table 1). Table 1 Summary of Literature Pertaining to the Influence of Nutritional Factors on the Incidence of Periodontal Problems Positive Correlation Absence of any Positive Found Correlation

Factors Good Nutrition

22

-

Protein

4

1

Minerals

3

-

Calcium & Phosphorus

1

-

Iron

-

1

Vitamins (general)

5

1

A

4

3

B

9

1

83

C

29

11

D

3

-

For more than 37 years we have been treating people from all walks of life and from practically all economic groups for their dental problems. From our records, using a random sampling technique, we have analysed these data. Table 2 shows the incidence of dental problems in Bombay Hospital. Bombay's population being so cosmopolitan in caste, creed, hygienic habits, nutritional behaviour and income groups that the figures might as well be taken as representative of the entire country (except, of courses for climatic and hereditary condition). Table 2 Incidence of Dental Problems in Bombay Problems

Male %

Female %

Caries

31.8

43.9

(a) Vertical

5.3

4.5

(b) Horizontal

10.7

15.4

Periodontal bone absorption:

The Relationship of Nutrition with the Incidence of Dental Problems To examine the effect of nutritional factors, the patients were divided in two main groups on the basis of inquiry regarding their food habits. These were classified into a. Non-vegetarian and b. Vegetarian The protein and caloric groups were determined on the basis of average daily intake of food and on the basis of standard food value tables showing the nutritional values of various Indian foods. It could be summarised from these data (Table 3) that the incidence of caries is lower in vegetarians. Table 3 Incidence of Dental Problems in Bombay in Relation to General Nutrition

Problems

Mixed Diet

Vegetarian Diet

High ProteinLow Calorie

Low ProteinHigh Calorie

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Group Daily

Group

Protein Intake 60g Protein Intake 35g Calorie Intake Calorie Intake 1900 2500 %

%

Caries

55

45

Periodontal Bone Absorption

45

55

The following ingredients in the food are connected with dental problems. Vitamin C Vitamin C has been implicated in various physiological and biochemical functions of the body. Besides its involvement in the functions like electron transport, metabolism of tyrosine, absorption of iron and incorporation of plasma iron in ferritin, adrenal cortex functions and formation of collagen and intercellular cement substance, it has also been shown to exert its influence on bone formation. It was therefore well within the context to examine intake of this vitamin in relation to the occurrence of periodontal problems. The sufficient and low vitamin C intakes were arbitrarily grouped according to the standard food-value tables and the inquiries regarding foodhabits with the subjects. There seems an apparent influence of the high vitamin C intake in vegetarians on the occurrence of periodontosis. Fluorides and Other Allied Agents Aminoacids and proteins have potential of being classified as anti-caries nutrients, like fluorides and phosphates. Both the amount and quality of protein are important factors in influencing dental caries. In vegetarian diet, a large proportion of the ingested protein is digestible and therefore, utilizable. This is not so in the non-vegetarian diet. Only 6-8% of the protein from a steak is digestible whereas over 70-80% of the protein in pulses (dal) is digestible. The other important aspect of the vegetarian food is its fibre content. Since almost 30-40% of the vegetarian food is cellulose and therefore non-digestible, it forms the major part of the roughage. This acts as a bolus and in turn helps in maintaining regular bowel movements. A stomach upset or constipation results in the formation of various organic acids such as lactic acid, pyruvic acid, citric acid etc. in the mouth. These organic acids are known to form dental plaque which is responsible for

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the formation of caries. Total daily dietary fluoride in various countries ranges from 0.2 to 2.7 mg. Absorbed fluoride ions are transported in the blood in both exchangeable and bound forms. Soft tissues do not store fluoride other than in sites of ectopic calcification. Excretion of absorbed fluoride is chiefly by way of urine. Levels of skeletal fluoride are directly related to the levels of fluoride found in drinking water and to age. Fluoride is well known for its anti caries properties. The fluoride content of vegetarian and nonvegetarian diet is given below. Food

Fluoride Content (PPM)

Meats

0.14-2.0

Fish

1.00-1.86

Citrus fruits

0.07-0.17

Noncitrus fruits

0.03-0.84

Cereals

0.18-2.8

Vegetables and tubers

0.02-0.9

It can be seen from the table that vegetarian diet does not show wide variation in terms of its fluoride content and therefore in turn provides a constant dose of fluoride. A daily dose of 1-2 ppm seems optimal for the prevention of dental caries. Other Considerations The traditional belief and recent interest in 'natural food' suggests that fruits and vegetable make a positive contribution in dental health by inhibiting caries and increasing the resistance of the periodontal tissues. Human dentition is better suited for vegetarian diet. Broad surface molars are specially suited to chew coarse fibrous food. Most vegetarian foods have a cleansing action. A few gargles after a meal may be enough to clean the mouth. However, if some fibrous particle remains in between the teeth (inter dental space) unlike meat fibres, they do not ferment or traumatise the tissue. Thus brushing morning and night may be enough to prevent dental problems. Vegetables and fruits are a very healthy source of natural vitamins like vitamin C and other minerals.

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Salivary pH does not change fast and therefore vegetarian food does not decompose. Salivary pH has an important role to play in oral health. Most dairy products like milk, butter, and vegetable oil keep saliva almost neutral. Most vegetables, dry fruits, apples, grapes and bananas may keep saliva slightly alkaline. Meat, sea food and chicken are acid forming foods. Acidic saliva normally helps causing dental decay. Hence, it appears that evidence is strongly in favour of a vegetarian diet. There seems to be no doubt that the incidence of dental problems is less in a vegetarian population. REFERENCES

1. Thomson M.E., et al. Influence of nutritional factore, in periodontal diseases, J. NZ Soc.Periodontal diseases 1981, 51, 15-9. 2. Eeva Lukosalo et al. Caries, periodontal status and some salivary factore, in Lacto vegetarians Dept. of Community Health, University of Kupio, Finland. 3. Geddes D.A. et al. Apples, salted peanuts and plaque. PH British Dent J. 1977: 142, 317-9. ACKNOWLEDGMENT I am very thankful to:— 1. Dr. P. R. Sharma, M.Sc. D.Sc. Geneve Institute Des Science, II, 1211 Geneve 4 2. Dr. C.D.S. Laxmanan, L.D.S. RCS, England, Consultant, Dental Surgeon, Bombay Hospital. 3. Dr. H. M. Dholakia, L.D.S. RCS, England. Visiting Professor, Belgaum Dental College. 4. Dr. B. N. Apte, M.Sc., Ph.D, Consultant Molecular Geneticist. Bombay Hospital Institute of Medical Sciences. Part of the article is from the paper read by Dr. N. C. Sharma in the Ist Int. Conference of the surgery in Tropics January 1978 at Bombay Hospital.

Growth Children and Vegetarian Diet P.M. Udani

87

.

Introduction The most important aspect of paediatrics or childhood is growth and development, as they are the parameters of health and disease. Definition of Vegetarian Foods in Relation to Milk It should be emphasized that the milk which is produced by human and other animals is also one of the most important items of vegetarian diet even though it is of animal origin. For example, human milk produced by the baby's mother is the best and most suitable food for the baby and from every angle, it is vegetarian even though it is of animal (human) origin. God has provided specific milk for human babies. Its function is not bnly to provide essential nutrients of specific composition, so that it is easily digested by babies and utilized for their rapid growth but also to provide strong and special defence against various infections, infestations and allergens. It also leads to emotional bonding between the mother and child. When human milk is not available, we have to take recourse to animal milk like that of a cow, a buffalo or a goat.These animals' milk can be used for children, particularly infants, but in a modified manner, because of their relatively poor digestibility, lack of supply of defensive substances which a human new born or infant needs and absence of true emotional bonding between the mother and the child which occurs when the baby is breastfed. Basic Vegetarian Foods Cereals and Sugar These are mainly concerned with growth and tissue repair. They are particularly important in childhood when the body is growing rapidly. Fats It is essential to emphasize that the fat cells laid down in infancy and early childhood are very difficult to reduce even at a later age. Hence programmes of prevention of obesity and its various complications should be started in childhood by restricting too much fat in the diet as it is a rich source of calories. Pulses The combination of cereals and pulses makes very good food as it provides calories for energy, protein for growth in children and for repair of the tissues. Vegetables Vegetables are very important items of a child's diet. They are rich in minerals like iron and some vitamins particularly vitamin A and C and many other nutrients mentioned in the earlier chapters. Fruits

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Immunity and Vegetarianism Vrinda Trikannad .

In the ancient medical system in India there exists one of the oldest and most time tested approaches to nutrition. Science of food and diet became an integral part of the philosophy of rnan, of his consciousness and of his relation to the Universe The result was an approach to diet that was unsurpassed both in its profundity and sophistication as well as in its practicality and simplicity. Here the selection and preparation of food is seen as inseparable from the treatment of disease and cultivation of vibrant health. Both these goals are in fact a part of traditional Indian medicine. Immunity The body protects itself against the various diseases by: 1. Physical barriers like the skin and mucous membranes which form the security guards preventing the entry of foreign bodies like the micro organisms, 2. Systemic immunity by which specialized cells respond to the sensitization of foreign bodies like the bacteria, viruses, fungi, and neoplastic cells. The cells involved in the immune responses are located throughout the body. Some are in fixed tissues like the bone marrow, thymus, Iymph nodes, spleen, Kupffer cells of the liver and Peyer's patches of the small intestine, while the leucocytes are mobile and circulate in the blood stream and go to the site of infection when required. Imrnune responses are of two types, nonspecific and specific. The non-specific immune response involves a generalized defense to any foreign body. A specific immune response is acquired. Here the response is specific and selective, in that it is mediated by lymphocytes specifically for that particular foreign body or antigen. There are two types of such specific immune responses. One is known as Cell-Mediated Immunity and the other is termed as Humoral Immunity. Cell-Mediated Immunity It involves the thyrnus. Here the immunity is mediated by thymus-dependent lymphocytes designated as 'T' cells. These 'T' cells are produced by the bone marrow stem cells and are derived from the thymus after getting educated or mature there. So a cell-mediated immune response is triggered when 'T' cells are sensitized by an antigen. The 'T' cells respond to the antigen directly and produce certain substances or mediators called lymphokines. These lymphokines then proceed to kill or destroy the antigen. The 'T' cells are further divided into various subpopulations according to their functions in the immune response. They are mainly helper, suppressor, memory and cytotoxic or killer cells. Cellular immunity is measured by delayed hypersensitivity. In, for example, the Tuberculin test, a small amount of antigen is injected under the skin. Redness or

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erythema and hardening or induration in the skin is looked for after 24 to 48 hours. Presence of erythema and induration indicate a positive reaction which indicates that 'T' Iymphocytes and macrophages have migrated to the site of antigen injection. Humoral Immunity As shown in the figure illustrating Humoral Immunity, here the immunity is mediated by 'B' cells or 'B' Iymphocytes. Here the antigen is presented to the B Iymphocytes via the cooperation of the 'T' Iymphocytes and macrophages. Once the processed antigen is presented to the 'B' Iymphocytes, they are triggered and elicit an immune response by producing the various immunoglobulins or antibodies to the stimulating antigen. The various classes of immunoglobulins being designated as IgG, IgM, IgA, IgD and IgE according to their molecular weight and properties Antibodies or immunoglobulins activate yet another system, called the complement system. The complement system is made up of nine components, which are triggered sequentially in a cascading system bringing about antigen destruction.

Effects of Malnutrition on the Immune System

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Upto 1955, it was generally agreed that severe protein deficiencies suppressed antibody formation. In addition, deficiencies of pyridoxine, pantothenic acid, and pteroyl glutamic acid resulted in a suppressed antibody response. Deficiencies of components of the vitamin B complex also cause some depression in antibody formation. Some questions were debated regarding the role of malnutrition in defective release of antibody or increased destruction resulting in subnormal values. Naturally occurring states of malnutrition are difficult to interpret largely because deficiencies usually involve multiple dietary factors. This problem is further compounded by infection, anorexia, debilitation and a negative nitrogen balance. For example a marked reduction in food intake is seen commonly with vitamin and mineral deficiencies, thus contributing to the effects of protein-calorie undernutrition. Coming to protein and protein-calorie malnutrition, studies conducted by Cooper et al have revealed that the number of plaque-forming Iymphocytes became activated and the corresponding amount of antibody synthesized was directly correlated with protein or protein-calorie intake, when three levels of dietary protein were given (6%, 12%, 27%). In contrast, under conditions of chronic protein or protein calorie deprivation, some 'T' cell mediated immunologic functions were decreased e.g. proliferative responses to mitogens like Concanavalin A and Phytahaemagglutinin (PHA), development of delayed hypersensitivity and formation of migration inhibition factor (MIF). Studies on tumour immunity further illustrated the depression of B-cell system and sparing of the 'T' cell system when moderate protein-calorie restriction occurred. 'T' killer cell activity was also reduced in experimental tumour systems, so also the formation of cytotoxic and blocking antibodies in protein caloric malnutrition. Decline in the phagocytic function was also observed, and depression of opsonization was evident. Serum complement levels—C3, was significantly lower. So protein or calorie malnutrition in human beings results in marked impairment of both humoral and cell-mediated functions. Severe thymic atrophy and associated 'T' cell deficiencies were observed in undernourished children. A depression of 'T' helper cells and a possible increase in 'T' suppressor cells also could occur in protein-calorie malnutrition. Salimoner et al and Schlesinger et al reported decreased killer cell activity and decreased production of interferon in children with protein-calorie malnutrition, and patients with marasmus. Reduced levels of serum IgA in pharyngeal secretions, tears and saliva could be responsible for the compromised resistance to organisms that cause respiratory infections. Impairment of sIgA is thought to represent depression of IgA synthesis in the submucosa or impaired synthesis of secretory components or both. These observations are compatible with the findings in protein-calorie malnutrition, of the loss of intestinal epithelium, mucosal thinning and atrophy of

91

gut-associated lymphoid tissue (Tablel). Table 1 Protein Calorie Malnutrition Immune Function in Humans

Humoral Immunity 1. 2. 3. 4.

Serum immunoglobulin levels Secretory IgA Circulating B cells Plaque forming cells

Cellular Immunity 1. PHA 2. Immunity to irltracellular organisms 3. Circulating T Cells 4. Lymphokine production

Response Raised or Normal Decreased Decreased or Normal Decreased Response Decreased Decreased Decreased Decreased

Most clinical studies of nutrition-related immuno-deficiencies in humans involve multiple deficiency states complicated by infection. A summary is well elucidated in Table 2, as shown by Beisel et al. Ashkenasy noted that isoleucine and valine deficiencies impaired the recovery of both thymus and peripheral Iymphoid population after acute protein deficiency. In addition, deficiencies of methionine and cysteine—cystine also resulted in delayed effects on the recovery of the thymus, Iymph nodes and spleen. The above mentioned amino acids, when deficient also cause severe Iymphocyte depletion of gut-associated Iymphoid tissue similar to that seen in total protein malnutrition. Tryptophane is also vital in the maintenance of normal antibody production. Methionine appears to be essential for Iymphopoiesis. Deficiencies in minerals also have an effect on the immune systems. Zinc deficiency causes atrophy of lymphoid tissue and produces abnormalities in both cellular and humoral immunity. The average adult must obtain atleast 15 mg of zinc per day from the diet. Clinically zinc deficient children present with lymphopenia, reduced capacity to exhibit delayed hypersensitivity and increased susceptibility to disease. A similar pattern was observed in children with acrodermatitis enteropathica, a defect in intestinal absorption of zinc described in 1942. However, when zinc was supplemented, the children were cured. Zinc is also necessary for stored Vitamin A in the liver to be released in the blood. Iron deficiencies exhibit impaired delayed hypersensitivity reactions as well as defective neutrophil and macrophage killing functions. Vitamins play an important role in the immune response since they function as co-enzymes. Experiments were carried out by

92

several doctors on human beings with a pyridoxine and pantothenic acid deficient diet, and severe impairment in antibody response resulting in hypogammaglobulinaemia was observed. Pyridoxine deficiency markedly affects cell-mediated immunity. Vitamin C deficiency abolished tuberculin hypersensitivity, impaired the formation of collagen, the fibrous connective tissue that is so important in the repair and healing of wounds. It was shown as early as 1943 that proper levels of ascorbic acid maintained the activity of white cells—'the bacteria destroyers' of the blood stream. Large doses of Vitamin C inhibit the action of histamine released in an allergic reaction. Vitamin C may also be involved as a co-factor in the production of thymic humoral factors. Vitamin A maintains epithelial and mucosal surfaces and secretions as a form of primary defence. When vitamin A is deficient, the innermost, columnar, mucus-secreting epithelium may lose its ability to maintain itself and areas degenerate into their layered flattened cells called squamous metaplasia. Such cells may be seen in the glandular epithelium of the cervix in women. Teenagers whose diet is deficient in vitamin A tend to develop acne which may be treated with zinc. Zinc, as mentioned earlier, helps release the stored vitamin A from the liver to the blood. Furthermore vitamin A deficiency significantly reduces both cell-mediated immune responses and humoral immune responses. Vitamin B12 and folic acid deficiencies result in megaloblastic changes of replicating cells. Biotin deficiency results in impairment of both primary and secondary antibody responses.

Immunological deficiencies in some malnourished children are a result of thymic atrophy. Marked depression of cell mediated immune responses was noted in all severely malnourished children. The recovery of cell-mediated immune responses reverted to normal after nutritional rehabilitation. Serum complement levels are also markedly reduced in children with protein calorie malnutrition. Suppression upto 50% of lysozyme secretion into tears, so also the synthesis of secretory IgA is markedly reduced. So it can be concluded that protein-calorie malnutrition has a relatively greater effect on cell-mediated immunity than on humoral immunity. Besides an impairment of the B & T Iymphocyte network and defective afferent responses, it is possible that impaired phagocyte function may also result due to malnutrition. Phagocyte defects in protein calorie malnutrition could include impaired chemotaxis, phagocytosis, bacterial action and metabolic responses. Single vitamin deficiencies may also impair immune response. Of the so called trace elements, zinc undoubtedly plays an essential role in the lymphocyte and

93

mononuclear phagocyte systems. Vegetarian foods which are vegetables, fruits, nuts, cereals, sprouted pulses, milk and milk products contain all the essential nutrients required for maintaining the integerity of the immune systems. Vitamins and minerals which are so vital in the functioning of the immune system are best availed from fresh fruuts and vegetables. Hence a vegetarian diet is apparently adequate in all respects to maintain good immune function. In fact, if well balanced it may be more suitable to the efficient functioning of the immunological system. REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. 9.

Beisel W.R. et al, JAMA 1981:245;53. Beisel W.R. Am.J.Cl.Nut. 1982:35; 417. Ballentine R. Diet & Nutrltion; 1982. Chandra R.K. Can J. Physiol 1983:61; 290. Chaman H.N. JAMA 1987:258; 2834. Das K.C.; Hoffbrand A.V. British J. Haematol 1970:19, 459. Moore S.T. & Bymes M.P. A Vegetarian Diet, 1975. Shigzal H.M. Surgical Ana 1981:13; 15. Pilich S.M. Phys effects & health consequences in dietary fibres, l987. 10. Roitt, Ivan. Essential Immunology 6th ed. 1988. 11. Stites D.P.; Stobo J.D.; Fundenberg H H & Wella J.V. Basic & Clinical Immunology 1982.

Microbiology and Diet K. Dhunjibhoy .

The microflora of the gut varies according to the milieu intereur of the body. Various factors influence the microflora of the oral cavity and the gut. Let us first consider the normal microflora and the time in growth when the organisms start living in the host. Mouth: The bacteria present in the mouth are subject to great variation both in number and in kind. Even the fairly clean and healthy mouth contains a considerable amount of detritus and other organic matter derived from particles of food, desquamated epithelium, pharyngeal mucus and other sources; these provide nutrition to the flora which frequently change. The saliva as is initially secreted, is sterile but contains growth promoting substances for members of a few species such as lactobacilli, Shigella, salmonella, bacillus, vibrio. The following organisms are found in the mouth and saliva:

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a. Micrococci are the commonest—They can be pigrnented / non pigmented, aerobic / anaerobic. b. Staph. albus a common inhabitant, but staph. aureus also commonly inhabits the mouth. c. Streptococci—haemolytic streptococci are constantly present; haemolytic It streptococci are seen in 5%-10% of healthy throats. d. Gram positive bacilli in chains—they belong to the Lactobacilli group (some to the group of aerobic spore-bearers.) Lactobacilli are abundant in cases of dental caries. e. Gram negative bacilli including members of the coliform and proteus groups. f. Spirochaetes, which are almost invariably present between the gums and the teeth are Treponems buccalis, dentium, intermedium, microdentium, macrodentium, Vincent's Spirillum and Miller's spirillum. g. Actinomyces spp. h. Fusobacterium spp. i. Pleuropneumoniae-like organisms. j. Yeasts—mainly Candida albicans. k. Nocardia spp. l. Neisseriae spp. m. Corynebacterium spp n. Leptotrichia spp. Counts of organisms per ml of saliva are • • • • •

2.5 x 107 lactobacilli 1.2 x 107 proteolytic organisms 4 x I06 veillonella and fusobacterium spp. each 6.3 x 103 Staphylococci 30—Proteus

In infants the mouth becomes colonized shortly after birth; staphylococci, streptococci, lactobacilli and coliform bacteria being readily detectable. Within a few days the flora is largely that of the adult. The maternal vagina and later the upper respiratory tract appear to be the source of the colonizing organisms. The intestine, at birth contains at most a few bacteria, is colonized rapidly "per os" and to some extent "per anum". The intestinal flora of the breast-fed infant consists largely of anaerobic lactobacilli of the Bifidobacterium group. They may constitute 99% of total viable organisms in the faeces. Secliger and Werner record counts of 1010 per gm of stool as compared to 109 in adults and a predominance of 3 to 300 fold over the remainder of the flora. Coliforms, enterococci, staphylococci and aerobic lactobacilli are also present. With weaning, or in bottle-fed infants the flora tends to resemble that of the adult, the number of anaerobic lactobacilli declines slightly; bacteria of the fusobacterium group and proteolyiic bacilli appear in large numbers; and small numbers of aerobic and anaerobic spore-bearing organisms appear. In adults the empty stomach is generally sterile. Immediately after a meal it

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contains numerous organisms which have been ingested with food, but these with the exception of acid resistant vegetative bacilli and sporing bacteria, appear to be killed rapidly. If however the motility of the stomach is excessive or the acidity is less than normal, this sterilizing effect of gastric juice is incomplete. Thus, in cases of gastric disease particularly carcinoma, saranae, saprophytic bacilli and other organisms may multiply in the stomach. In the healthy adult the jejunum and upper ileum are practically sterile. The number of organisms mainly facultatively anaerobic Streptococci viridans, staphylococci, lactobacilli and fungi increase from the stomach to the ileocaecal valve beyond which the flora becomes much more abundant and qualitatively deficient. The duodenum may contain 100-1000 organisms per ml, the jejunum 1000-10,000, the upper ileum about 1,00,000 and the lower ileum 1,000,000, but there is a lot of variation from sample to sample. Coliform bacilli appear in the jejunum in certain diseases such as infantile gastroenteritis, hepatic cirrhosis after gastrectomy and in chronic debilitated states. The flora of the lower part of the ileum is relatively scanty but includes most of the organisms found in abundance in the large intestine. The flora of the large intestine and faeces is same. Anaerobic bacteria make up about 99% of the faecal flora. Most of the anaerobic bacteria belong to Gram-positive bifidobacteria and Gramnegative bacteroides (their number varies from 109 to 101° per gm of faeces). Lactobacilli, clostridia and fusobacterium, average each about 103 to 105 per gram; Enterobacteria 106 and enterococci 106 per gram. Less frequent are proteus spp., pseudomonas aeruginosa and spirochaetes. Among the entero bacteria E. coli is the commonest. Klebsiella and other enterobacters follow. Importance of Micro Organisms in the Intestine Presence of bacteria in the intestine is very essential for the life of the host for the following reasons. They assist in the digestive processes and without them much of the food taken in would be passed out of the body in an unassimilable condition. Production of vitamin K, biotin, folic acid and riboflavin by the gut flora is very well known. Also the gut flora prevents other intestinal pathogens from invading the mucosa. The factors which influence the intestinal flora are 1. Host-Physiology Intestinal secretion Intestinal mucosa

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Immune mechanisms 2. Environmental factors Bacterial contamination Diet Antibacterial drugs 3. Bacterial Interaction The faecal flora is a lot dependent on the diet and is different in different countries. For example bacteroides spp. are found in great numbers in subjects who consume mixed western diet that contains a large amount of fat and stimulates the production of a large volume of bile. In people consuming vegetarian diet, fewer bacteroides spp. are found. In people from Africa, Asia and Japan, who consume a vegetarian diet Gram positive anaerobes and enterococci are the predominant faecal organisms. However subjects who change to a vegetarian diet do not convert their faecal flora to a Gram positive predominance but retain their bacteroides organism. The following relationship between diet and the organisms isolated from the faeces has been found. Diet

Mixed Western

Country of Origin Enterobacteria Enterococci Lactobacilli Clostridia Bacteroides Gram Positive sporing anaerobes

Wholly or Primarily Veg. Matoke Rice Vega Scotlan Englan Ugand Rice USA Ugand Japa n d d a India a n Eng 7.4 7.6 7.9 7.4 7.9 8.0 9.4 7.0 5.9 5.3 5.8 5.3 7.3 7.0 8.1 4.8 6.5 7.7 6.5 5.3 7.6 7.2 7.4 7.4 5.4 5.6 5.7 4.7 5.7 5.1 5.6 5.4 9.7 9.8 9.8 9.8 9.2 8.2 9.4 9.7 10.0 9.9

9.8

9.5

9.6

9.3

9.7

9.6

subject living on strictly veg. diet. (Figures indicate loglO number of bacteria per gram of faeces. Western—Diet—rich in fat and animal proteins) (Matoke—boiled mashed banana) Tbe people living on the high carbobydrate diet had significantly fewer bacteroides and more enterococci in their faeces than did those on a Western diet; aerobic bacteria were also more prominent. Draser B.S. (1974) corroborated the previous study. His findings of faecal flora in different human populations are tabulated below: Faecal Flora of Different Human Population Diet

Country Mean Log10 number of Bacteria/gm Entero Entero Lacto Bacte Clostridi rbacteri a cocci bacilli oides a

of Faeces BifidoEubacteri bacteriu a m

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India 7.9 Largely Carbohydrat Japan 9.4 e Uganda 80 Englan 7.9 d Mixed Scotlan Western 7.6 d U.S.A. 7.4

7.3 8.1 7.0

7.6 7.4 7.2

5.7 5.6 5.1

9.2 9.4 8.2

9.6 9.7 9.4

9.5 9.6 9.3

5.8

6.5

5.7

9.8

9.9

9.3

5.3

7.7

5.6

9.8

9.9

9.3

5.9

6.5

5.4

9.7

9.9

9.3

Whereas Bacteroids occurred in greater number in (English, Scots & Americans) developed counties. Eubacteria was prominent in India & Japan. Enterococci-most numerous in India, Japan and Uganda. Streptococcus faecalis-dominant in English, Scots and Arnericans. Streptococcus faecium—dominant in India, Japan and Uganda Cl. perfringens & bifermentans—occurred in all groups. Cl. Paraputrificum—English. Scots & Americans but rare in other sources. Recently sarcina ventriculi, type of organism, has been isolated in the stools of vegetarian people. The.importance of this will be evident very soon. Thus it may be noted that since the bacterial flora appears to be strongly dependent on the kind of food we eat, it is obvious that we must select the food we eat very carefully. The bacterial population in our intestines is ultimately going to enhance .the value of the food by improving the efficiency of digestion and also by the manufacture of important vitamins as mentioned above. All this can occur only if the bacteria are congenial and not if they are pathogenic or non-contributory to the good health of the host. REFERENCES 1. Cregan J. and Harvard N. J. Brit Med. J. i 1356 from Normal bacterial flora of the human body in Topley & Wilson's principles of Bacteriology, Virology and Immunology, sixth edition Vol. 2 by Wilson G.S. & Miles A by Edward Arnold publishers Ltd. 1953, pg. 2604-2609. 2. Draser B.J., Crowther J.S., Goddard P., Hawks worth G., Hill M.J. Peach,S. and William R. E.O. The relation between diet and the gut microflora in man. Proc. Nutr. Soc. (1973) 32:59-63. 3. Draser B.S. in the normal microbial flora of man sym. Series soc. Appl Bacteriol, No. 3 Ed by Skinner F.A. and Carr J.G. Academic press London. 1974. 4. Duerden B.I., The Bacteriodaccea: Bacteriodes Fusobacterium & Leptotricha in Topley & Wilson's Principles of Bacteriology, Virology and Immunology seventh edition, Vol. 2 Systematic bacteriology ed by M.T. Parkar, Edward Arnold publishers Ltd. 1984, pg. 131. 5. Goodsir, Edinb. med. Surg J., 57, 430 from Normal Bacterial flora of the Human body in in Topley & Wilson's Principles of Bacteriology, Virology and Immunology sixth edition, Vol. 2 by Wilson G.S. & Miles A by Edward Arnold publishers Ltd. 1967a, pg. 2604-2609. 6. Gorbach S.L., Nahas L, Lerner P.I. and Weinstein L. Gastroenterology 53 845 from Normal bacterial flora of the Human body in Topley &

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Wilson's Principles of Bacteriology, Virology and Immunology sixth edition, Vol. 2 by Wilson G.S. & Miles A by Edward Arnold publishers Ltd. 1967a, pg. 2604-2609 7. Hill, M.J., Draser B.S., Aries V., Crowther J.S., Hawksworth G., Williams R.E.O, Bacteria and Aetiology of Cancer of large bowel Lancet 1971, 95-100.

Iron Zinc and B12 in Vegetarians Rudolph Ballentine .

Introduction While there are many well-documented advantages of a vegetarian diet, it is also true that a vegetarian diet must be done skilfully and with knowledge of how to provide complete nutrition for the body. If one eats a well-balanced and wellcooked diet of fresh and whole foods and avoids fats and refined sugars, most nutritional requirements will easily be met. There are a few nutrients which are likely to be deficient in vegetarians, however, especially in those vegetarians who are in transition from a meat-based diet. The purpose of this chapter is to discuss three of these common pitfalls: iron, zinc, and Bl2. Iron An appreciation of the importance of iron in the diet goes back further than perhaps that of any other mineral. The ancients thought of it as a carrier, and it was identified with the planet Mars, perhaps because of the distinctive redness of Mars. Iron has a tendency to take up oxygen readily, changing its colour to red. This is the basis for its function in the blood, where it is the carrier of oxygen to the tissues of the body. Iron's tendency to take up oxygen comes from its curious ability to change valences—it can have either two or three electrical charges. This means it can, by altering itself from one state to the other, take up or let go of an extra oxygen atom. Because of this ability, iron is the centre of the body's oxygen transport system, which is based on hemoglobin. Hemoglobin is a giant complex molecule which contains, like a tiny jewel in the centre of each of its four basic components, a single atom of iron. This iron in the centre of the hemoglobin molecule accepts the oxygen and as it does so develops the bright red colour which differentiates oxygenated blood from the dark red or bluish blood of the veins. Anemia, which is a relative lack of red blood cells, usually shows up as tiredness, fatigue, paleness, and a tendency to dizziness on standing. Although many other substances besides iron are also necessary to build red blood cells, iron deficiency is one of

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the most common causes of anemia. Many nutritionists are concerned that vegetarians may be at special risk for iron-deficiency anemia. These fears are not unfounded; in fact a number of cases of such anemia have been reported among vegetarians. Although iron has been shown by surveys to be low in diets of many populations, some groups within any population are at particular risk. These include infants, because of the low iron content of milk; children and adolescents, because of their rapid growth; and women during their reproductive years, both because of blood losses during menstruation and because of the demands of pregnancy. For such persons, moving toward a vegetarian diet requires special attention to the issue of iron. There is no question that red meat, such as beef, is richer in iron than many other foods. (See table below.) Yet it is also clear that many plant foods, such as beans and green leafy vegetables, may equal or surpass red meat in iron content. Food Blood Sausage Liver,Beef Beef,sirloin Fish(Halibut) Eggs Milk(Whole) Kidney beans Lentils Navy beans Whole-wheat bread Spinach* Kale* Collards* Raisins Molasses

Amoun Iron(mg t ) 3oz 17.0 3oz 7.5 3oz 2.5 3oz 0.6 1(Large 1.2 ) 1 cup 0.1 1/2 cup 3.4 1/2 cup 2.1 1/2 cup 2.1 1 piece

1.0

3/4 cup 3/4 cup 3/4 cup 2T 2T

2.3 1.7 0.6 0.6 2.0

* Cooked in own broth until water evaporates ( not drained ).

Sources : Truesdell et al: Nutrients in Vegetarian Foods. U.S. Dept of Agriculture: Nutritive value of American Foods. Davidson et al: Human Nutrition and Dietetics.

The problem is in the different absorption rates of iron from meat versus iron from plant foods. Half or more of the iron in muscle meats such as beef is of a sort that nutritionists refer to as "heme" iron. It is found in hemoglobin, the molecule in blood that

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turns red on picking up oxygen, and in myoglobin, the pigment that makes muscle tissues red. Heme iron, in the form of ironcontaining fragments of the hemoglobin and myoglobin molecules, crosses the intestinal wall intact. This seems both to accelerate the absorption of the iron and to protect it from being picked up by and bound to substances in the diet which form compounds with iron. For this reason heme iron is absorbed at a rate of from 25% to 35% of what is ingested. By contrast, iron absorption from plant foods usually runs in the 2% to 10 range. Certain iron-binding substances in plant foods, such as the fiber in fruits and vegetables, the phytates of grains, or the oxalic acid in spinach, have been observed to bind iron, and are thus thought to carry it out of the body, preventing the absorption of much of what is present. Happily, however, recent studies have taught us more about the subtleties of iron absorption from non-meat foods. Contrary to earlier opinions, new work has shown that oxalates and most of the fiber in fruits and vegetables, when taken in moderate amounts, do not interfere with iron absorption in the living body, though some of them may bind iron in the test tube. Phytates, indigestible substances especially concentrated in the bran layer of whole grains, remain controversial. It has been shown in the case of calcium that the intestine can develop the ability to break down phytates, thus freeing the mineral bound by them. Current research has not yet demonstrated conclusively whether the intestine can develop the ability to break down the phytate which binds iron, but is true that other components of bran such as its phosphates, do seem to inhibit iron absorption. However, the effects of one previously suspected inhibitor have definitely been confirmed: that of tea. Black tea is a very potent obstacle to the assimilation of iron. This effect comes from the tannic acid in the tea, which combines with the iron to form an insoluble compound. For this reasons tea probably should not be taken along with meals, although it is possible that some of the traditional additives such as mink or lemon may neutralize the tannic acid and reduce its interference with iron absorption. Boosting Available Vegetarian Iron One of the most interesting and important discoveries about iron is that its absorption from grains and legumes can be greatly enhanced by the presence of ascorbic acid (vitamin C). Vitamin C is plentiful in such foods as tomatoes, green peppers, turmeric, and lemons. A recent report states: "The effect of ascorbic acid on non-heme iron absorption has been tested in a number of dietary settings and in every case has been shown to be profound. It plays a particularly critical role in diets in which lithe or no meat is present. Non-heme iron absorption in one study was quadrupled by including in the meal enough vegetables to

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provide 65 milligrams of vitamin C. This amount is exceeded by a cup of broccoli or half a green pepper. Green leafy vegetables, which are often high in both iron and vitamin C, can be exceptionally good sources of dietary iron. Favourite non-meat recipes in many parts of the world make generous use of ingredients rich in vitamin C, such as tomatoes, green peppers, or hot chillies. This is especially true of bean dishes, and it is interesting to discover that legumes such as lentils, beans and peas have recently been recognized as being particularly rich in iron. The potential use of ascorbic acid to facilitate the assimilation of such iron makes it a valuable source of this mineral for the vegetarian. Lactic acid (in yogurt) has been thought to play a similar role, but other acids probably don't. Vitamin C Content of Foods Often Used in Vegetarian Meals

Food Onion Green Beans Potato Tomato Spinach Mustard Greens Broccoli Kale Green Peppers Lemon Juice

Vitamin C mg. per 1/2 cup 5 9 10 25 25 38 50 75 90 1T = 7mg.

Source : Nutritive value of American Foods. There are other tricks for boosting the iron available in non-meat foods. For example, it has been shown that the iron from pots and skillets can add significantly to absorbable iron in the diet. It is leached from the inside of the pot and combines with the food. Available iron in food can be increased by 100% to 400- when it is prepared in iron cookware. This effect might even be excessive when very acidic dishes, such as concentrated tomato sauce, are prepared in iron cookware. In that case, the inside of the cooking utensil will lose its shiny surface and the food will become darkened and develop an unpleasant metallic taste. Regular consumption of such food could eventually lead to iron overload. Although a certain amount of iron from cooking utensils is helpful, too much can cause iron to accumulate in tissues and cause illness. Very little iron is carried over into the food when non-acidic dishes are cooked in ironware, especially if some

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cooking fat is present. Thus, an appropriate rule of thumb for a vegetarian would be to cook about half his food, (an assortment of dishes, but not very acidic ones) in iron pots and pans. A heavy iron skillet with beans, peppers and tomatoes simmering away may be appetizing in part because of the satisfaction of iron that it suggests. Minerals often compete with one another for absorption. Foods very high in calcium can interfere with the absorption of other minerals, such as zinc. Too much milk, which is high in calcium and low in iron, can block iron intake. Researchers who have studied the iron levels of long-term vegetarians have demonstrated that iron and hemoglobin levels were within normal levels. These researchers termed the results "surprising", and suggested that the vegetarians had somehow adapted their diet in such a way as to enable them to increase their efficiency of iron absorption. It seems reasonable to postulate that long-term vegetarians can handle the iron in plant foods differently from persons accustomed to mixed meat and vegetable diets. In any case, it seems clear that one need not become iron deficient on a meat-free diet. Following are the main points to remember in obtaining optimum dietary iron: 1. The well-planned vegetarian diet (based on whole grains, beans and green vegetables) has as much iron as the average meat-based diet but it is less readily absorbed. 2. Absorption can be increased (up to five-fold), by including in the meals, fruits and vegetables rich in vitamin C. 3. The iron content of the diet can be doubled, tripled or quadrupled by using iron pots and skillets. 4. Diets or supplements excessively high in tea (or tannic acid), protein, calcium, phosphorus or fiber can interfere with iron absorption. ZINC Zinc is a trace mineral which is important for the health of the skin and perhaps the lining of the arteries. Veterinarians found that animals whose feed contained inadequate amounts of zinc developed red and cracked skin with loss of hair or wool, as well as other problems. In humans, zinc supplementation is a welldocumented, effective treatment for acne. Zinc is found in dramatically high concentrations in the prostate gland and semen, and we now know that adequate levels of zinc are required for the proper functioning of the sexual organs of the male. Zinc deficiencies have also been found in children who had a history of poor appetite and failure to gain in height and weight. One of the symptoms noticed among boys in one study was a loss of sense of taste. Loss of taste is important, since it tends to decrease appetite and the enjoyment of food, and this leads to further malnutrition and failure to grow properly. In every case, the sense of taste was restored by taking zinc, and

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other health improvements were dramatic. Meat, poultry and fish are by far the richest sources of zinc. Although some vegetable foods contain substantial amounts of it, fibre and phytates appear to carry much of it out of the body. Phytates are phosphorus compounds found in most plant foods but especially in whole grains, beans, and peas. They have the property of combining with minerals, especially calcium, iron, and zinc, to form insoluble compounds which are carried out in the stool. Though other minerals are well absorbed from plant foods, zinc—like iron or calcium—seems more problematic, and nutritionists have expressed concern over the availability of zinc in the vegetarian diet. There are recent research studies that indicate this concern may well be justified. For example, when a group of students were put on a vegetarian diet for three weeks, their tissue levels of zinc dropped and they responded to physiological tests in a way that suggested they had developed a mild zinc deficiency. But three weeks isn't long. As mentioned, we know that in the case of other minerals such as calcium, some adaptation to the presence of fibre and phytates occurs and that, over time, absorption improves. So the research team looked next at a group of 79 persons that had been vegetarian for a year or longer. They found that their body levels of zinc were also low,despite the fact that they had been vegetarian for a longer period of time. This is different from other minerals, where adaptation seems to take place and phytates and fibre seem to lose their tendency to interfere with mineral absorption. Why would zinc be different? The answer may lie in the fact that the enzyme that is developed to break down phytates—intestinal phytase—is itself zinc dependent. Zinc is needed for the manufacture of phytase, and when zinc is deficient the enzyme cannot be produced in adequate amounts. So a vicious circle ensues: less phytase means more phytate to interfere with the absorption of zinc, which in turn results in more severe zinc depletion and still less phytase. Therefore, once a zinc deficiency is established, it would appear that it would be difficult to climb out of it—even with adequate zinc intake was long as one's diet is rich in whole grains, which contain so much phytic acid. Once phytase production has been started, and zinc can be released from phytate and absorbed, handling a vegetarian diet is possible. But if a person's zinc stores are depleted during the transition phase, he won't be able to increase his output of phytase and adjust to the new diet. For such reasons, zinc supplements may be necessary during the time when one is changing over to a vegetarian diet.

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Though the transition period is always tricky and is a time when developing a zinc deficiency is especially likely, this risk is even higher if one starts out with a borderline zinc deficiency. There is evidence, such as low zinc levels in patients with retarded wound-healing, indicating that a significant percentage of the general, non-vegetarian population suffers from marginal zinc status. Girls and young women seem to have substandard intakes most often, though men and boys, who tend to eat more animal foods, may become deficient despite their larger intakes since the normal development and functioning of the male reproductive system requires a substantial intake of zinc. This is thought to be why it is mostly boys who have been found to be undersize as a result of zinc deficiency. In adult males, zinc deficiency can contribute to sterility and impotence. Zinc nutrition for pregnant and nursing women is of serious concern, since the infant must draw its supply of zinc from the mother. Materrial zinc deprivation in experimental animals has produced offspring with learning disabilities and abnormalities in the chemistry and structure of the brain, especially that part that is related to emotions. (In view of this it is interesting that some cases of schizophrenia seem to clear dramatically when given zinc.) There is also evidence that zinc deficiency during pregnancy can lead to later impairment of immune function. Low zinc later in life may also lead to a number of symptoms of immune deficiency as well as impairment of the capacity to heal quickly. Inadequate tissue repair has been suspected of playing a role in the earliest stages of the development of atherosclerosis, where failure to properly heal some form of injury to the arterial lining may set the stage for plaque formation. Getting Enough Zinc If one does decide to take zinc supplements while adjusting to a vegetarian diet, 15 to 20 milligrams a day should be sufficient, since the recommended daily intake is only 15. Since absorption is only partial on any diet, this amount would not be excessive, especially when fibre and phytate levels are substantial. In fact, zinc is one of the nutrients with the largest margin of safety. One would have to take vvell over 100 milligrams a day to cause any toxicity. Unfortunately, some physicians and laypersons recommend 135 milligrams per day for treatment of acne, much higher than what is necessary or desirable. Even at moderate doses zinc can compete with copper for absorption or utilization. Since vegetarian diets tend to be relatively rich in copper, this is not likely to be a problem. However, zinc can also interfere with selenium utilization, and though selenium, too, is generally ample in vegetarian diets, zinc

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doses should be kept at reasonable levels for this reason. Zinc Checklist 1. Keep fiber intake moderate. 2. Include tofu, beans, seeds, and nuts in your diet. 3. Watch for signs of zinc deficiency: white spots on nails, slow wound healing, poor resistance to infections, acne. 4. Consider supplementation-especially during transition phase. Besides milk and eggs, the non-meat foods richest in zinc are beans, tofu, seeds, nuts, and hard cheeses. If these foods are taken in the diet and the fibre intake is kept moderate, zinc should not be a problem. Those in transition, and pregnant or nursing women should consider supplementation. Because of its role in the sense of taste, it is a happy coincidence that those in need of zinc generally find its taste agreeable, and those who have adequate levels find the taste unpleasant. This has led to a simple taste test for deficiency. Other signs of zinc deficiency are: white spots on nails, slow wound healing, poor resistance to infections and acne. Vitamin B12 Vitamin Bl2 is unique in many ways. First of all, it is the vitamin which is needed by the body in the tiniest amounts. Only a few thousands of a milligram (3 or 4 micrograms) per day are necessary to prevent the symptoms of deficiency. Even more important for vegetarians is the fact that vitamin Bl2 is the only vitamin which is not found in strictly vegetarian diets, e.g. those without dairy products. Vitamin Bl2 is present in milk, eggs, and meat, and is manufactured by many bacteria and yeasts. Any food which is strictly of plant origin, not ferrnented, and free of all bacteria and insects, will be found to contain no vitamin Bl2 In cultures where food is grown organically and processed little or not at all, deficiencies of vitamin Bl2 are uncommon, even when there is no meat, milk, eggs or other animal food in the diet. This is thought to be due to the fact that organically grown foods will often contain traces of bacteria from the soil or even tiny bits of insects which are difficult to see or remove completely. These alone may be enough to provide the extremely small doses of vitamin Bl2that are necessary. When foods are grown with the use of pesticides, however, insects and bacteria are likely to have been thoroughly exterminated, and the processing of food to make it suitable for long storage or shelf-life will be even more likely to remove any traces of vitamin

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Bl2. Thus vegans who eat processed foods are at increased risk. It is often said that a vegetarian diet can supply everything except vitamin Bl2. Physicians and nutritionists are trained to caution those who are eliminating all animal foods about the grave consequences of Bl2 deficiency and to advise them that, at the very least, Bl2 supplements should be taken. This concern is understandable. Pernicious anemia, the disease connected with insufficient body stores of vitamin Bl2, is a serious disease. In the early stages of the illness there are numbness and tingling of the hands and feet with a loss of sensation. Blood tests done on such patients reveal low hemoglobin levels and large, pale, red bloods cells. Gradually a lack of motor coordination develops. These symptoms are now known to be due to an in ability to synthesize myelin, the fatty sheath that insulates nerve fibres. As a result, the nerves to the limbs degenerate. If allowed to proceed unchecked, the deterioration progresses into the spinal cord and ultimately to the brain. Moodiness, poor memory, and confusion give way gradually to delusions, hallucinations, and overt psychosis. For vitamin Bl2to be absorbed, the stomach wall must secrete a substance called intrinsic factor, which combines with the Bl2, forming a complex that can then be taken up by the lower end of the small intestine. Patients with pernicious anemia were found to lack intrinsic factor because of the destruction of stomach wall cells. Thus Bl2, even when present in the diet in ample quantities, cannot be absorbed. When originally described, the disease was observed to occur sporadically in most populations without regard to dietary practices. It was not considered to result from inadequate dietary intake of vitamin Bl2. Indeed there was no reason to assume that the disease had anything to do with the amount of vitamin Bl2 consumed, since amounts many times than ordinarily needed are of no use without intrinsic factor. Nevertheless, because it has long been known that vitamin Bl2 is absent from foods that are strictly of plant origin, when nutritionists and dieticians began to encounter growing numbers of strict vegetarians, they were alarmed. While vegetarians who used dairy products were generally thought to be on safe ground, vegans, who take no foods of animal origin, were a different matter. A diet with no Bl2) it was felt, was sure to produce vitamin Bl2 deficiency and ultimately pernicious anemia. Dietary Deficiency of Bl2: Myth or Reality ? In the 1960s and 1970s a large number of case reports in medical journals seemed to fulfill this dire prophecy: "Subacute combined degeneration of the spinal cord in a vegan", "Megaloblastic anemia in an adult vegan," and so on. Nutrition manuals warned of the danger of developing pernicious anemia

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from an inadequate intake of vitamin Bl2. But despite the ominous tone of such case reports, surveys of groups of vegans reported with some surprise that most of the subjects they studied seemed quite well, with no signs of anemia or neurological degeneration. The occurrence of symptoms was, at most, rare. one might expect, after all, to find some cases of the disease in any population. Were the cases of pernicious anemia that were reported merely persons with the disease who happened to be vegans, or were these cases caused by the all-plant diet? Of course, vegans argued the former in their magazines and newsletters, while nutritionists argued the latter in their books and scientific journals. As is usual with such debates, the ardour of the controversy yielded little in the way of illumination. Nevertheless, by the beginning of the 1980s there was enough published literature to make evident some of the oversights that had led to premature conclusions: many of the diagnoses of inadequate vitamin Bl2 in the diet had been hastily made. For example, problems that can interfere with absorption, such as a lack of intrinsic factor, had not been ruled out as causes of the low body level of Bl2. To establish firmly that a person is suffering from a dietary deficiency of vitamin Bl2, certain criteria must be met. A critical review of reports published up to 1980 on vegans showed that none of them met all these criteria. In each case, other explanations were possible, including deficiency of intrinsic factor, iron deficiency anemia, and neurological problems from other causes. In fact, in many of the published case reports, the authors noted that these alternative explanations seemed the most likely. Yet the cumulative weight of the first impressions created by numbers of such scientific papers is persuasive in itself and has tended to support the view not only that dietary deficiency of vitamin Bl2 is an actuality, but that it is common among vegetarians who use no animal foods. Despite this prevailing impression, in point of fact there is little incontrovertible evidence that a diet low in Bl2 can, in and of itself, cause problems. Vitamin B12 Vegan Sources If it's true that a purely dietary deficiency of Bl2 occurs rarely, if at all, the question is, Why? How could it be that vegans, who consistently consume no BI2-containing foods at all, might be perfectly healthy, with adequate tissue levels of the vitamin? At least part of the answer to this question becomes apparent when we look at the origin of vitamin Bl2. Though it is found in animal foods, it is not manufactured by animal cells. It must be absorbed from their food by most animals, as it must be by

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humans. All Bl2 is made by bacteria. Ruminants, such as cows, do quite well, because bacteria in an accessory stomach, or rumen, produce Bl2 as they break down the fibre of the animal's food. But bacteria aren't just in cows' stomachs; they're practically everywhere. Researchers studying B12 have complained that it is necessary to carefully clean all instruments to get meaningful measurements of Bl2 -since even tap water can contain substantial amounts. ("Substantial amounts" in the sense that they can approach the range of what is needed in the human diet.) It is for this reason that some batches of beans, bean sprouts, comfrey leaves, turnip greens, peanuts, lettuce, fermented soybeans, and whole wheat have been reported to contain significant amounts of Bl2—while other batches of the same foods have been found to have none at all. The presence of bacteria on such foods is incidental; that is, the presence or absence of the vitamin will depend on whether the plants were fertilized with manure or not, how well they were washed and with what, and so forth. So as sources of Bl2 any one of such foods must be considered unreliable, though on any average day several of them might happen to bring along some small but significant amounts of the vitamin. What's more, bacteria also grow on and in the body. In fact, it has been estimated that the microorganisms between the teeth and gums, around and in the crevices of the tonsils, in the folds at the base of the tongue, and in the upper respiratory passages will make up to half a microgram of B12 a day. This is at least half of the minimum requirement, though some nutritionists think this quantity may be all that is needed for most people. Official recommended intakes by the World Health Organization and the Food and Nutrition Board provide for generous margins of safety, and up the level to as high as 3 or 4 micrograms for adults, but it is unlikely that it is necessary or even useful to consume such large amounts. An egg or a cup of milk will contain 1 microgram of vitamin Bl2 (see table below). B12 Content of Common Foods Food

Amount

B12(mcg)

Organ meats(e.g., liver)

3 oz

>10

Bivalves (clams, oysters)

3 oz

>10

Milk

1 cup

1

Fish

3 oz

1-3

Beef

3 oz

1-3

Chicken

3 oz

1-3

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Cheese,hard

1 oz

0.3

1

1

Miso

1T

c. 0.03 (variable)

Tempeh

3 oz

c.3 (variable)

Seaweed

-

variable

Spirulina

-

variable

1c

0.3

Egg yolk Fermented soy products:

Yogurt * See p. 168

Sources : Goodman and Gillman : Pharmacological Basis of Therapeutics. U.S Dept. of Agriculture : Vitamin B12 in Foods. Shurtleff : Sources of B12 Other Complications in Vitamin B12 absorption There are countless bacteria in the human intestinal tract, too. Whether or not they make a contribution to the Bl2 needs of their human host is the subject of another long-standing controversy. Early studies on the bacterial flora of the gut focused on the colon, where the bulk of the intestinal microorganisms are found. Although producers of Bl2 were found there, there was a controversy around whether this would pass through the wall of the large intestine. More refined research techniques revealed that a smaller but still substantial community of bacteria inhabits the small intestine. Recent studies have demonstrated that these organisms do produce vitamin Bl2 and that they do so high enough in the intestinal tract to allow it to combine with intrinsic factor before it reaches the lower end of the small intestine, where the vitamin is absorbed. Another complication is that some bacteria will compete with their host for dietary B12 without contributing significant quantities in return. They can even deplete body stores, since Bl2 is constantly being secreted with the bile. Ordinarily much of this Bl2 is reabsorbed as the bile passes through the intestinal tract; but occasionally an unfriendly population of bacteria with an inclination for robbing their host of vitamins will prevent reabsorption. It's also known that B12 absorption is more thorough when intake is lower. In other words, the meat-eater who consumes 10 micrograms of vitamin Bl2 in a day will absorb only 16% of it, while the vegan who takes in a mere fraction of that will absorb 70%. All of these factors add up to a rather delicate balance, which can be disturbed by any major disruption, such as migration to a different culture, or the use of

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antibiotic medications. Other important factors:

1. Excess fat or protein. Too much in the diet can increase vitamin Bl2 needs.

2. Highly processed foods. Whereas boiling milk for two to five minutes only decreased its B12 content by 30%, sterilization in sealed containers for 13 minutes caused a loss of 77%. Canned milk, for example, might be an inadequate source of vitamin Bl2. 3. Drugs, Tobacco, coffee, alcohol, and birth control pills have all been implicated in increasing one's need for B12. 4. Pregnancy and nursing. Both pregnancy and nursing increase needs for vitamin Bl2. Low intake during nursing, for example, has resulted in breastmilk that is deficient even when the mother's levels remain normal, and has also resulted in symptoms such as apathy and retardation in the infant. 5. Chronic disease. Intestinal parasites, malaria, liver disease, chronic infections, and cancer will all disrupt normal mechanisms of Bl2 absorption and use, and increase needs. 6. Intestinal surgery. Removal of part of the stomach, where intrinsic factor is made and secreted, or removal of part of the lower small intestine, where it is absorbed, can drastically reduce uptake and may necessitate the use of injectable Bl2. 7. Use of megadoses of vitamin C, multiple vitamin/mineral preparations containing copper, and perhaps other food supplements such as spirulina (see below). Vitamin B12, Mega C, and other supplements Another ongoing controversy is that surrounding the effects of large doses of vitamin C on Bl2 availability. In 1974, one of the most respected authorities on vitamin Bl2 reported that mixing vitaniin C with vitamin Bl2 and incubating the combination in a way that would mimic digestion destroyed B12. Both the population news media and the medical literature were quickly filled with warnings about the danger of vitamin C. Two years later, however, a different author observed that the original had been done using methods of B12 measurement that were designed to test blood, not food. Since the B12 in food is more tightly bound to protiens he concluded that the tests used had failed to pick it up. Using more apporopriate techniques, no destruction of B12 was found. The researcher who had done the first study retaliated in 1978, demonstrating low blood levels of vitamin B12 in patients who took 2 grams of vitamin C in a day and noting that another study had reported similar results. Although the issue is still not completely resolved, it would appear that anyone taking more than 500 milligrams of vitamin

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C a day for a long period of time should have his or her vitamin Bl2 status monitored. An alternative that might provide some protection is to take vitamin C in high doses only for short periods of time, allowing intervals when it is stopped so that Bl2 stores can be replenished. A convenient regimen is one week on and one week off. Other nutritional supplements can cause trouble, too. It is well established that vitamin Bl2 is destroyed by oxygen in the presence of vitamin C, vitamin B. (thiarnine), and copper ions. This may affect the Bl2 present in multivitamin preparations. It has been reported that 20% to 90% of the vitamin present in such supplements can be degraded to vitamin B1, analogues. What to Do About Bl2. 1. If you use substantial amnounts of fish, milk, or eggs, you will have an extra margin of safety. If not: 2. Dont smoke, drink coffee, use alcohol regularly, or take birth control pills. 3. Beware of the use of Antibiotics or contaminated meat, poultry, or fish that can create havoc in the microbial population of the intestinal tract.

4. If you devolop an illness, especially a chronic one, pay perticular attention to your Bl2 intake, or better yet, find a physician knowledgeable about nutrition to help. These are Bl2-like molecules that are similar enough to the real thing to replace it in metabolic reactions, but different enough to lack the effectiveness of the vitamin. Some of them can thus block the activity of the Bl2 that is present, preventing it from being used normally. Spirulina, a dietary supplement widely acclaimed as an extraordinary source of Bl2, has also been found to contain many more Bl2 analogues than genuine Bl2—five to eight times as many. Whether or not these analogues are Bl2 antagonists and cause harm awaits investigation. Bl2 as an oral supplement, when taken separately from other nutrients that can degrade it, such as vitamin C, copper, and thiamine, can be of help, however. It can be used by those with inadequate dietary Bl2 or when illness may increase one's needs

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beyond what is a normally adequate dietary intake. It can even be effective in those cases where absorption is impaired by a lack of intrinsic factor, since somewhere between 1% and 3% of vitamin Bl2 passes across the intestinal wall by simple diffusion. But much higher doses must be used when the normal mechanisms of fictive uptake are missing. Nutritional yeast is sometimes used as a dietary supplement to supply vitamin Bl2 by those who are consuming only vegetable foods. Not all nutritional or brewer's yeast, however, will furnish the vitamin. In order to contain Bl2, the medium on which such yeast is grown must contain it or it must be added during the final processing. If one wishes to use yeast as a source, one must read labels carefully to be sure that the yeast in question does indeed contain the vitamin, and in adequate amounts (at least 1 microgram in 1 tablespoon, since a tablespoonful is a maximal appropriate regular daily dose of yeast). Thus with a little bit of care, vegetarians can have the best of both worlds—they can be certain of adequate nutrition, and avoid the atherosclerosis and cancer so common among meateaters. In addition, the transition to vegetarianism entails a transformation of consciousness as well. The resources expended by those who are eating in a selfdestructive way are not available for higher purposes such as creativity, self-development, and the exploration of the inner world. For us to progress to a new stage of development we must carefully examine our way of living and divest ourselves of those habits that are most limiting. A vegetarian diet which skilfillly includes all the necessary nutrients for human function appears more and more to be an evolutionary step that is inevitable. REFERENCES 1. Monsen E.R. , Hallberg L., Layrisse M., etal: Estimation of available dietary iron. American Journal of Clinical Nutrition, 1978, 31: 134-41. 2. Cook J.D. . Noble N.L., Morsk T.A., et al: Effect of fibre on non-heme iron absorption. Gastroenterology, 1983, 85: 1354-58. 3. Walker A.R.P., Walker B.F.: Effect of wholemeal and white bread on iron absorption. British Medical Journal 19Z7, 2: 771-2. 4. Michaelsson, G. et al.: Effects of oral zinc and vitamin A in acne. Journal of the American Medical Association, 1977, 237: 401. 5. Prasad A .: Zinc deficiency in man. American Journal of Diseases of the Child. 1976, 130: 357-361. 6. Freeland-Graves J.H., Bodzy P. W., Eppright M.A.: Zinc status of vegetarians. Journal of the American Dietetic

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Association, 1980, 77: 655-61. 7. Sandstead H.H.: Zinc nutntion in the United States. American Journal of Clinical Nutrition, 1973, 26: 151-60. 8. Patterson K.Y., Holbrook J.T., Bodner J.E., et. al.: Zinc, copper, and manganese intake and balance for adults consuming self-selected diets. American Journal of Clinical Nutrition, 1984, 50s: 1397-1403. 9. Underwood E.J.: Trace Elements in Human and Animal Nutrition, 4th ed., New York: Academic Press, 1977, pp. 219-20. 10. Sandstead H.H., Evans G. W.: Zinc, in Present Knowledge in Nutrition, pp. 479-505. 11. Jathar V.S., Inamdar-Deshmukh A.B., Rege D.V., Satoskar R.S.: Vitamm Bl2 and Vegetarianism in India. Acta Haemotologia, 1975, 53: 90-97. 12. Ellis F.R., Montegriffo V.M.E.: Veganism: Clinical findings and investigations. American Journal of Clinical Nutrition, 1970, 23: 249-55. 13. Albert M.J., Mathan V.I., Baker S. T.: Vitatnin Bl2 synthesis by human small intestine bacteria. Nature, 1980, 283: 781-82. 14. Siddens R.C.: The experimental production of vitamin Bl2 deficiency in the baboon (Papio cynocephalus), a 2-year study. British Journat of Nutrition, 1974, 32: 219-28. 15. Herbert V., Jacob E.: Destruction of vitamin Bl2 by ascorbic acid. Journal of the American Medical Association, 1974, 230: 241-42.

16. Herbert V., Jacob E., Wong K., et. al.: Low serum vitamin Bl2 levels in patients receiving ascorbic acid in megadoses: Studies concerning the effect of ascorbate on radioisotope vitamin Bl2 assay. American Journal of Clinic Nutrition, 1978, 31: 253-58.

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