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At one time, vegetarians were on the fringes of society. Vegetarianism was considered the bailiwick of hippies, members of People for the Ethical Treatment of Animals, and fanatical little old ladies in tennis shoes. "Normal" people ate meat — lots of it, because it’s good for you.
But in the past few years, vegetarianism has been taken out of the hands of those once considered the lunatic fringe. Perhaps it has even vindicated some of the abuse longtime vegetarians suffered at the hands of society, and even family and friends. More people are embracing a vegetarian lifestyle — as many as 4% of the population, according to a Vegetarian Times survey — although there are admittedly numerous slants on what it means to be a vegetarian.
An increasingly large body of scientific evidence shows that a diet heavily reliant on plant materials offers such gigantic health benefits that even the most avid beefeaters must grudgingly acknowledge it. And increasing evidence shows that diets high in animal protein and fat are major contributors to obesity, heart disease, diabetes, and perhaps even certain types of cancer.
In fact, the Dallas-based American Heart Association dietary recommendations to limit meat intake to 6 ounces daily makes the local steakhouse’s 16-ounce cow-wrangler special seem almost obscene. At the least, most dietary experts agree, regular consumption of high amounts of animal protein is a recipe for a heart attack.
And — the ’60s hippie vegetarians are shocked to hear — the American Heart Association stops just short of endorsing the vegetarian diet as health promoting. The association’s web site (www.americanheart.org) quotes the Chicago-based American Dietetic Association’s endorsement without comment: "It is the position of the American Dietetic Association that vegetarian diets are healthful and nutritionally adequate when appropriately planned."
According to the American Dietetic Association, "Vegetarian diets that are low in animal products are typically lower than nonvegetarian diets in total fat, saturated fat, and cholesterol. . . . These factors are associated with increased risk of obesity; coronary heart disease, which causes heart attack; high blood pressure; diabetes mellitus; and some forms of cancer."
Vegetarianism has definitely come into the mainstream; you can get veggie burgers at your local burger joint, and steakhouses usually have a vegetarian option on the menu. "Everyone needs to know that vegetarianism is safe and healthy. There’s now plenty of data that show it is preventive of chronic disease," says Rose Stoia, RD, president of the Seventh Day Adventist Dietetic Association in Angwin, CA, and grandmother of a fourth-generation lacto-ovo vegetarian.
Stoia recalls her pregnancy with her son a generation ago and the challenge from her obstetricians that she couldn’t possibly be healthy or carry a healthy baby while she was practicing the vegetarianism prescribed by the Seventh Day Adventist Church. "I told him to take my blood, and I’d match it against his. I outshone him big time," says Stoia, who is nutrition director of the Miami Valley Hospital Dialysis Center in Dayton, OH.
Seventh Day Adventist vegetarian lifestyle and health have been the subject of more than 250 articles published in scientific journals since 1954. Data collected in the 1970s and 1980s by the National Cancer Institute and the National Institutes of Health show that Seventh Day Adventists in general have 50% less risk of heart disease, certain types of cancer, strokes, and diabetes than the general population.
Unfortunately, say Stoia and her colleagues, many health care professionals labor under misconceptions about vegetarianism and erroneously discourage their patients from pursuing increasing quantities of plant protein in their diets.
"You should answer, Terrific!’ when a patient tells you he wants to become a vegetarian," says Neal Barnard, MD, president of Physicians for Responsible Medicine in Washington, DC. "Why? Because that patient is going to be the easiest patient for you to deal with. He’ll need fewer medications, and he’ll do better in the short and long term."
Barnard says health care professionals on all levels need to arm themselves with information about the health benefits of the plant-based diet and pass them on to patients, especially to those at risk for or already developing diabetes, heart disease, and other chronic disease. "Meats and dairy products contain so many ingredients that accelerate free radical and chemical attacks, artery deterioration, hormone shifts, bone loss, and weight problems that there is no reason to include them," says Barnard.
Stoia and her colleague, Linda Kilby, RD, director of the federal Women, Infants, and Children’s (WIC) program in Philadelphia, prefer a stealth attack. They advise patients to dramatically increase fruit and vegetable consumption (to seven to 10 servings a day), which leaves little room for meat. "When I give workshops and seminars or in individual consultation, I don’t talk about meat until they bring it up. Invariably, someone will say, Hey, you’re telling us to eat all this stuff, and you’re not saying anything about meat,’ and I answer, right,’" says Kilby.
As WIC director, Kilby is highly concerned about nutrition and child health. She has worked as an advocate to urge the federal program to include vegetarian items on its list of foods that can be purchased with vouchers. "We are actively courting the U.S. Department of Agriculture (USDA) to provide soy and tofu, as well as cheese and milk and peanuts, instead of peanut butter," she says.
Kilby, Stoia, and Barnard point out the essence of current research on vegetarianism: Vegetarians have reduced risks of certain diseases because of their increased consumption of whole grains, dried beans, nuts, fresh and dried fruits, and vegetables. Vegetarians are exposed to fewer carcinogens and mutagens because they do not eat meat. Fruits, vegetables, grains, legumes, and nuts often are less expensive than meat. Plant foods use fewer natural resources from the environment.
A significant correlation exists between the frequent and long-term consumption of high-fat, high-cholesterol, animal-based foods and the incidence of fatal heart disease, certain types of cancer, strokes, and diabetes. A vegetarian diet provides greater amounts of phytochemicals and fiber-rich foods, which help reduce the risk of heart disease, several types of cancer, diabetes, and hypertension.
Barnard has published several papers showing, among other things, that cardiac patients can accept, adhere to, and enjoy a low-fat vegetarian diet; a correlation between breast cancer and dairy product consumption; and the acceptability and desirability of low-fat vegetarian diets for treating dysmenorrhea and premenstrual and premenopausal symptoms. He also estimates that the direct medical costs of meat consumption in the United States were as high as $61.4 billion in 1992.1
In 1989, the National Academy of Sciences recommended that Americans eat five or more servings of fruits and vegetables every day and six or more servings of a combination of whole grains, cereals, and legumes. In 1991, the World Health Organization recommended the consumption of at least 14 ounces of fruits and vegetables daily, and in 1992, the USDA implemented its food guide pyramid in which the bulk of the diet was plant-based. The pyramid suggests a daily intake of 11-20 servings of breads, cereals, pasta, rice, fruits, and vegetables and only four to eight servings from the meat and dairy groups.
A year later, the General Conference Nutrition Council adapted USDA’s pyramid for a vegetarian dietary approach. In 1995, the USDA and the U.S. Department of Health and Human Services (HHS) stated for the first time ever that "vegetarian diets are consistent with the dietary guidelines for Americans and can meet the recommended daily intakes for nutrients" while noting that lacto-ovo vegetarians should give special attention to the intake of protein, iron, and zinc."
Further, the 1995 USDA-HHS recommendations specify that vegans (those who choose diets of plant origin only) should supplement their diets with vitamin B12 and be sure they have adequate intakes of vitamin D and calcium. True vegetarians, and particularly vegans, historically have had difficulties getting enough vitamin B12 and calcium, but Kilby says that is no longer an issue with the wide availability of fortified products, including soy milk and orange juice. And Barnard recommends a daily multivitamin. In addition, Stoia notes, a wide variety of taste-tempting meat analogs now is available.
While some nutrition experts recommend advising patients to taper off their meat consumption by adding meatless days each week, Barnard advocates a "Zero-a-Day" program to help patients eliminate meat and dairy consumption entirely. Barnard tells patients to go cold turkey (pun intended) eliminating all meat and dairy products for three weeks, based on his theory that meat and dairy consumption creates cravings for more high-fat foods. "I ask for a short-term commitment, not for the rest of their lives. You can do anything for three weeks. In that time, it will re-educate the taste buds; they’ll feel the difference; and you’ll begin to see the difference in their cholesterol and blood pressure," he says.
"It is a challenge," Barnard admits. "There are things they’ll miss — most noticeably cheese — and the food preparation is slightly more complex, but it helps to get the entire family involved." He offers a few tips to make the transition easier:
• Look for vegetarian convenience items at the supermarket, such as instant and canned soup — minestrone, black bean, and vegetarian vegetable — and flavored rice mixes, such as Rice-A-Roni that can be stretched into a meal with beans added. Plus there are increasing numbers of veggie meat analogs in cans and in the freezer section. Look for Morningstar Farms and Boca brands.
• Texturized vegetable protein (TVP) is fat-free, has a texture like ground beef, and tastes good used anywhere you might ordinarily use ground beef. Look for it in health food stores.
• When eating in restaurants, the best bets are ethnic foods. Italian, Chinese, Mexican, and Indian restaurants all offer a wide variety of vegetarian dishes. More steakhouses are even offering vegetarian entrees that far surpass the old fallback to a baked potato and a salad.
• Even restaurants that don’t offer vegetarian entrees usually can whip up a meatless pasta or vegetable plate, if you ask. Airlines offer vegetarian meals if you order in advance.
[For more information, contact:
• Physicians Committee for Responsible Medicine, Washington, DC. Telephone: (202) 686-2210. Web site: www.pcrm.org.
• Seventh Day Adventist Dietetic Association, One Angwin Road, Angwin, CA 94508. The association has a CD-ROM with detailed information on the vegetarian diet available through its web site at www.scada.org.]
1. Barnard ND, Nicholson A, Howard JL. The medical costs attributable to meat consumption. Prev Med 1995; 24:646-655.