Vegetarian and Vegan Diets Explained

The simplest definition of vegetarianism is a diet free of meat, fish, and fowl flesh. But eating habits of vegetarians cover a wide spectrum. At one end are lacto-ovo vegetarians, who avoid animal flesh but eat eggs and milk products. At the other end are vegans, who forgo eating (and often wearing) all animal-based products, including honey. Raw foodists are vegans who eat mainly raw fruits, vegetables, legumes, sprouts, and nuts.

There are also pescatarians, who eat fish and seafood; and lacto-vegetarians, who eat dairy products but not eggs. Fruitarians follow a diet that includes fruits, nuts, seeds, and other plant food. Those who follow a macrobiotic diet eat mostly grains but can also eat fish. They don't necessarily identify as vegetarians.

Flexitarians refer to vegetarians who occasionally eat meat and fish.

Reasons for Becoming a Vegetarian

Many adherents of vegetarianism and veganism – former Beatle Paul McCartney and actor Alec Baldwin are two celebrities who happily promote the cause -- regard a flesh-free diet not only as more healthful, but as a more ethical way to live. They point to the cruel practices and the high environmental cost of raising animals for food as reasons for excluding meat from the diet.

Most Americans, however, continue to eat some form of meat or fish. Ten percent of people consider themselves to be vegetarians, according to a 2013 Gallup poll.

Vegetarianism and Health

Most doctors and nutritionists agree that a low-fat diet high in fruits, vegetables, and nuts can be a boon to health. There’s also research suggesting that reducing or eliminating red meat from the diet may cut your risk of heart disease.

Research also has shown that a vegan or vegetarian diet may lower your risk of getting type 2 diabetes. And a 2011 study found that vegetarians had lower triglycerides, glucose levels, blood pressure, and body mass index (BMI).

Does Being a Vegetarian Lower Cancer Risk?

It’s difficult to say whether being a vegetarian or a vegan lowers cancer risk. This is mainly because of the diversity within the vegetarian population.

Many studies of the cancer-vegetarian relationship conclude that diets rich in fiber, vitamins, minerals, isoflavones (found in soybeans, chickpeas, peanuts, and more), and carotenoids (found in carrots, sweet potatoes, broccoli, kale, spinach, tomatoes, red peppers, and more), seem to protect against disease, including cancer, when part of a health-conscious lifestyle.

An 11-year study in Germany examined colon cancer among 1,900 vegetarians. Researchers noted fewer deaths from cancers of the stomach, colon, and lung in study participants than in the general population -- particularly among those who practiced some form of vegetarianism for at least 20 years. They suggested, however, that other factors, like body weight and amount of exercise, likely affected mortality rates in the vegetarians they studied.

Vegetarianism and Nutrition

A meatless diet can be healthy, but vegetarians -- especially vegans -- need to make sure they're getting enough vitamin B12, calcium, iron, and zinc.

The Academy of Nutrition and Dietetics warns of the risk of vitamin B12 deficiencies in vegetarians and vegans. Vitamin B12 is found naturally only in animal products. A lack of vitamin B12 can lead to anemia and blindness. It can also cause muscle weakness, tingling, and numbness. To counteract the increased risk, vegans should include B12 supplements, or fortified cereals and veggie burgers. Stay tuned for more information, but B12 has been found in varying amounts in mushrooms, particularly in the outer peel, but it's too soon to consider it a food source of the vitamin.

Vegans and ovo-vegetarians, who eat eggs but not dairy, need to find foods (dark green vegetables, tofu, edamame, soy nuts, butternut squash, calcium-fortified non-dairy beverages) or supplements that compensate for the missing calcium from their diets. Absorbable calcium is critical to protect against osteoporosis, or thinning bones.

Is a Vegan Diet Safe During Pregnancy?

The nutrition warnings are a bit more urgent for pregnant and lactating women who are vegan. Having a vitamin B12 deficiency, particularly, has been shown to impair neurological development in infants nursed by vegetarian mothers. A lack of vitamin D and calcium also can result in bone demineralization in breastfeeding women.

Similarly, children under age 5 who are reared on vegetarian and vegan diets can suffer impaired growth. That's because of the potential for a vitamin B12 deficiency, which can also result in anemia and vitamin D deficiency which can cause rickets. DHA, an omega-3 fatty acid found mostly in fish, is important for optimal brain development the first 2 years of life. Consult a registered dietitian who can help design a well-planned diet that can meet all the nutritional needs.

Key Nutrients for Vegetarians and Vegans

The U.S. Department of Agriculture offers dietary guidelines for vegetarians on its web site. The Academy of Nutrition and Dietetics is another good source for dietary recommendations.

Regardless of the kind of meat-free diet practiced, vegetarians should focus on getting enough protein, iron, calcium, zinc, vitamin B12, riboflavin, alpha-linolenic acid, and vitamin D.

Here are some ways to incorporate these nutrients into a vegetarian diet:

• Protein: Choose tofu, edamame, tempeh, veggie burgers with 5 grams of protein or more, beans and other legumes, nuts, nut butters, eggs, and higher-protein whole grains such as quinoa, amaranth, and kamut.
• Iron: Eggs, fortified breakfast cereals, soy-based foods, dried prunes, dried apricots, nuts, beans, legumes, and fortified whole wheat bread are good choices.
• Calcium, which builds bone, is plentiful in cheese, yogurt, milk, edamame, tofu, almonds, sesame tahini, calcium-fortified orange juice, calcium-fortified non-dairy beverages like soy or almond milk, and dark green leafy vegetables like collard greens, spinach, and bok choy.
• Zinc, which boosts the immune system, is ample in soybeans, soy milk, veggie "meats," eggs, cheese and yogurt, fortified breakfast cereals, nuts, seeds, mushrooms, lentils, black-eyed peas, split peas, and wheat germ.
• Vitamin B12: Soy-based beverages, some breakfast cereals, and fortified veggie "meats."
• Riboflavin: Almonds, fortified cereals, cow's milk, yogurt, mushrooms, and soy milk are riboflavin-rich foods.
• Alpha-Linolenic Acid (Omega-3): Canola oil, ground flaxseeds, flaxseed oil, walnuts, walnut oil, soybeans, and tofu are good choices.

Source: WebMD

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Vietnam - Vietnamese diet: Too much salt and not enough fruit and veg

Cancer and heart disease are deadly threats to those who don't watch what they eat.

More than half of Vietnamese people don't meet the level of fruit and vegetable intake recommended by the World Health Organization (WHO), according to a recent survey conducted by the Ministry of Health.

The survey analyzed about 4,000 locals aged from 18 to 69 across the country.

The WHO says a person should eat at least five servings or 400 grams of fruit and vegetables per day. However, the survey found that over 57 percent of Vietnamese are failing to consume the recommended daily intake. According to the survey, Vietnamese men eat less fruit and vegetables than women.

Five servings of fruit and vegetables per day can help reduce the risk of cancer, cardiovascular diseases like heart attacks and strokes, diabetes and other non-infectious conditions, said Truong Dinh Bac, deputy head of the Preventive Medicine Department under the Health Ministry.

On top of that, Vietnamese also eat almost twice the recommended daily allowance of salt.

Researchers found that the average daily intake in Vietnam is 9.4 grams, while the WHO advises an adult should have no more than 5 grams of salt per day.

A salty diet can cause high blood pressure, strokes, stomach cancer, kidney failure, osteoporosis and other heart diseases.

Overall, most respondents said they knew eating too much salt is bad for their health, and about 70 percent said they don't exceed the daily intake of salt. However, the survey proved that many participants are unaware of the fact that they are eating too much salt.

Researchers also analyzed information from participants about how much time they spend exercising.

The results showed that about a third of Vietnamese adults do less physical exercise than the level recommended by the WHO, which says that a person who is sufficiently active should get at least 150 minutes of moderate physical activity per week, or 75 minutes of vigorous physical activity.

According to the study, most respondents meet the recommended level because they have physically demanding jobs. That means Vietnamese have little involvement in physical activity during their leisure time such as playing sports.

A lack of physical activity is the fourth most common cause of deaths as it can increases the risk of cardiovascular diseases, diabetes and some cancers, said health experts, adding that it can control weight and prevent non-communicable diseases.

Vietnam is grappling with a surge in non-transmissible diseases, said Nguyen Thanh Long, deputy health minister, adding that medical costs for the treatment of non-communicable diseases are 40-50 times higher than the costs of infectious diseases.

Official statistics show that non-communicable diseases, mostly cardiovascular disease, cancer and diabetes, cause 73 percent of deaths in Vietnam.

In Vietnam, about 160,000 people aged between 30 and 70 die of non-communicable diseases a year.

Nam Phuong 

vnexpress.net

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Does a High-Fat Mediterranean Diet Lead to Weight Gain?

CLINICAL CONTEXT

Good evidence exists that the Mediterranean diet is associated with salutary outcomes, including results from the Prevención con Dieta Mediterránea (PREDIMED) study.[1] This study was a randomized trial of the Mediterranean diet vs a control condition of advice to reduce dietary fat alone among patients at elevated risk for cardiovascular events. The main study outcome was the incidence of major cardiovascular events, and the trial was stopped after a median follow-up period of 4.8 years because of a preponderance of positive results.

Compared with the control group, the hazard ratio for cardiovascular events among the Mediterranean diet group supplemented with extra-virgin olive oil was 0.70 (95% confidence interval [CI], 0.54-0.92), and the respective hazard ratio for participants randomly assigned to the Mediterranean diet supplemented with nuts was 0.72 (95% CI, 0.54-0.96). The Mediterranean diet appeared effective for these outcomes regardless of sex, age, and the presence of diabetes.

Nonetheless, concerns remain about the effects of the Mediterranean diet on obesity and central adiposity, despite previous research suggesting that the diet can be effective for weight loss. The current study by Estruch and colleagues revisits the PREDIMED cohort to investigate how the prescribed Mediterranean diet, which was not associated with a limitation on calories nor a recommendation for physical activity, compared with the control diet in the outcomes of body weight and waist circumference.

STUDY SYNOPSIS AND PERSPECTIVE

Following a Mediterranean diet that is not calorie restricted and is high in healthy fats from olive oil or nuts does not cause weight gain at 5 years compared with a low-fat diet, according to results from the Spanish PREDIMED randomized controlled trial.

"These results have practical implications, because the fear of weight gain from high-fat foods need no longer be an obstacle to adherence to a dietary pattern such as the Mediterranean diet, which is known to provide much clinical and metabolic benefit," write Ramon Estruch, MD, PhD, from CIBER OBN-University, Barcelona, Spain, and colleagues.

"They are also relevant for public health, because they lend support to not restricting intake of healthy fats in advice for bodyweight maintenance and overall cardiometabolic health, as acknowledged by the Dietary Guidelines for Americans 2015 Advisory Committee," they add.

The study was published online June 6 in Lancet Diabetes & Endocrinology.[2]

The study is the first randomized trial to evaluate the long-term effects of an unrestricted-calorie Mediterranean diet on weight and waist circumference.

Much evidence has linked a Mediterranean-style diet high in vegetable fats such as nuts and olive oil to decreased risks for all-cause mortality, cardiovascular disease, and cancer.

For the past 40 years, however, standard dietary advice for preventing or treating obesity has called for calorie restriction and increased physical activity, with a persistent belief that high fat intake promotes weight gain. Such recommendations, however, have not necessarily taken into account the different types of fat. Nonetheless, certain scientific societies -- including the World Health Organization[3] -- continue to advise limiting fat in the diet.

The idea that all dietary fat is unhealthy has led many US adults to curb their fat consumption, often at the expense of eating empty calories from processed foods high in sugar, salt, and carbohydrates. The demonizing of all fat, though, has failed to stem the tide of the diabetes and obesity epidemic.

The PREDIMED randomized controlled trial took place in primary care centers connected to 11 hospitals in Spain between 2003 and 2010. It included 4282 women 60 to 80 years old and 3165 men 55 to 80 years old with type 2 diabetes or 3 or more cardiovascular risk factors. All patients were asymptomatic, and more than 90% were overweight or obese at baseline. They had a mean age of 67 years; 97% were of white European ethnicity.

Researchers randomly assigned participants to an unrestricted-calorie Mediterranean diet with extra-virgin olive oil (n=2543), an unrestricted-calorie Mediterranean diet with nuts (n=2454), or a low-fat control diet (n=2450). Trained dieticians gave dietary advice to all 3 groups. Participants were not advised to restrict calories or increase physical activity.

Participants received free polyphenol-rich extra-virgin olive oil and nuts (walnuts, almonds, or hazelnuts). Results showed good adherence in the olive oil and nut groups, based on self-reported questionnaires, and blood and urine samples in a random subgroup.

Five-year results showed that total fat increased in the 2 Mediterranean diet groups. Both Mediterranean diet groups actually had a slight increase in fat consumption -- from 40% to 41.8% in the olive oil group and 40.4% to 42.2% in the nut group (P <.0001 for all) -- while their consumption of protein and carbohydrate decreased (P <.0001).

All 3 groups lost a small amount of weight. At 5 years, the olive oil group lost the most weight (0.88 kg), followed by the low-fat control group (0.60 kg), and then the nut group (0.40 kg). Multivariable analyses adjusted for 12 potential confounders showed that the difference in weight change at 5 years was significant only for the olive oil group vs the control group (P =.044).

Likewise, all 3 groups had a slight increase in average waist circumference, but the increase was smaller for the Mediterranean diet groups (low-fat control group, 1.2 cm; olive oil group, 0.85 cm; nut group, 0.37 cm). Multivariable analyses adjusted for 12 potential confounders showed that the difference in change in weight circumference at 5 years was significant for both the olive oil and nut groups vs the control group (P =.048 and P =.006, respectively).

In a linked comment,[4] Dariush Mozaffarian, MD, DrPH, from the Friedman School of Nutrition Science and Policy at Tufts University, Boston, Massachusetts, writes that these results provide "further robust evidence that liberally adding healthy foods to the diet, including high-fat choices such as nuts and extra-virgin olive oil, does not increase weight gain."

"These important findings should be heralded around the world," he asserts, while calling for the revision of dietary guidelines.

Decades of dietary advice have ignored food quality and the different effects of specific fatty acids, he pointed out.

By emphasizing calorie and fat restriction, such advice has produced "paradoxical warnings and caveats about eating healthy, high-fat foods" and fostered the proliferation of low-fat foods -- often high in sugar and carbohydrates -- in the US diet.

"[M]odern scientific evidence supports an emphasis on eating more calories from fruits, nuts, vegetables, beans, fish, yoghurt, phenolic-rich vegetable oils, and minimally processed whole grains; and fewer calories from highly processed foods rich in starch, sugar, salt, or trans-fat. We ignore this evidence -- including these results from the PREDIMED trial -- at our own peril," he concludes.

CLINICAL IMPLICATIONS

• The PREDIMED trial demonstrated that a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the risk for incident cardiovascular events among high-risk patients, regardless of age, sex, or the presence of diabetes.
• The current study by Estruch and colleagues demonstrates that the Mediterranean diet was not associated with weight gain compared with a low-fat diet in older adults at high cardiovascular disease risk. The Mediterranean diet provided a slight benefit in waist circumference compared with the control diet.
• Implications for the Healthcare Team: The Mediterranean diet is not only effective in reducing the risk for cardiovascular disease, but the current study suggests that it may reduce central adiposity as well. Moreover, it is one the more palatable healthy diets for many patients. The healthcare team should focus on how to add elements of the Mediterranean diet among at-risk patients.

Veronica Hackethal, MD

medscape

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Liquid Diets: Is There a Healthy Way?

For the busy adult trying to stay healthy or drop a few pounds, liquid diets offer a quick and easy solution through calorie-counting and ready-to-drink bottles. But do they really provide a healthy alternative to cooking your own nutritious meals and eating responsibly?

To discuss the benefits and risks of liquid diets, we turned to Diana Sugiuchi, a registered dietitian nutritionist based in Baltimore who is also the founder of Nourish Family Nutrition and Vertical Drop Nutrition.

Liquid diets have become a pretty big health fad in recent years. What would you say started this craze?

Diana Sugiuchi: I think there are a couple reasons for this. First, people are increasingly busy with longer work hours, commutes, and obligations. 

People feel that it is time-consuming and complicated to make healthy food at home. Second, people have a genuine desire to get the right mix of nutrients and reach a healthy weight.

There is so much information and misinformation on the Internet about what is healthy and the best ways to lose weight, and much of it conflicts. 

People are confused. Liquid diets are nutritionally analyzed, portion controlled, and simple. And because they are manufactured by companies, there is a sense that they are guaranteed to be healthy.

What are the most popular liquid diets on the market?

Sugiuchi: There are the weight loss standbys, like Slim-Fast and Herbalife. Some liquid supplements that used to be used mostly in hospitals to help people gain or maintain weight when ill, like Ensure, are now marketing themselves as helping healthy people build muscle [and helping] picky children get in all their nutrients. Shakeology is one I am seeing more of. The one that has been receiving the most buzz lately is Soylent, which is marketed as a liquid diet that can be used in place of food.

What are most people looking for when they start a liquid diet?

Sugiuchi: People are looking for something easy that will help them to be healthy or lose weight. I believe that people want a guarantee that what they are putting in their mouth is healthy and something they should be eating, and these liquid diets are offering those guarantees, whether they are proven or not.

Do certain people benefit more from liquid diets than others?

Sugiuchi: People who cannot chew or swallow food benefit most from liquid diets. If you are looking to jumpstart weight loss, a couple days on a liquid diet will not hurt you, but aiming to do it for the long term will not lead to success.

Are liquid diets more effective than other kinds of diets?

Sugiuchi: Any diet where you are taking in fewer calories than you are burning will result in weight loss. But if you haven’t made lifestyle changes, you will not keep the weight off.

What are the benefits of liquid diets?

Sugiuchi: The convenience and regulating calories.

And what about the risks?

Sugiuchi: These supplements are not regulated like food. Some of them have harmful ingredients that are not listed on the label, such as lead. When used long term, nutritional deficiencies could occur if the supplement does not have all of the nutrients necessary or if the nutrients that it claims to have are not really in there. Our bodies were designed to chew and digest whole food, and if there is not a good reason why you cannot do this, a liquid diet is risky. If you don’t make healthy changes in your diet for the long term, you will not be successful with weight loss or sustained healthy eating.

What difference is there in the way the body absorbs calories through drinking versus eating whole foods?

Sugiuchi: Our bodies don’t register the calories that we drink in the same way that [they recognize] the calories that we eat. For example, if you drink something that has 250 calories, you will likely not feel as satisfied as if you ate something, like a sandwich, that had 250 calories. This can lead to taking in more calories and feelings of hunger even when you have had enough calories.

Why does the body not register calories the same way? Is there a way around this, or should those trying a liquid diet just be cautious of these risks?

Sugiuchi: Eating involves much more than just ingesting calories. The aroma of food, the act of chewing, and swallowing all play a part in how satisfied we feel after a meal. A liquid diet offers none of these benefits.

So which liquid diets are healthy? And how long should one stay on the diet?

Sugiuchi: I would not recommend anyone to stay on a liquid diet for more than a few days. Based on experience, most people will not want to stay on a liquid diet for any longer than this! If you are going to choose a supplement for a liquid diet, look for one that has 100 percent of your recommended vitamins and minerals, at least 60 grams of protein per day, and 25 grams of fiber per day, as well as healthy sources of fat.

Which liquid diets definitely aren't healthy?

Sugiuchi: Any liquid that has added caffeine or herbs. These can have interactions, and the substances may not actually be what they say they are.

What questions should a person ask a nutritionist when considering going on a liquid diet?

Sugiuchi: Ask a nutritionist if the supplement you are considering will meet 100 percent of your nutrition needs. Look for added caffeine or herbs that don’t need to be in there. You should also ask if this is something that would be helpful to you. And you always want to make sure that your supplement has been verified to be safe by an independent source outside the supplement manufacturer, such as Consumer Lab.

What about juice cleanses? How effective are they? And what are the benefits and risks?

Sugiuchi: Juice cleanses can backfire. Not only are these low in calories, but they are very low in protein. Because of this, much of the weight loss comes from loss of water and muscle, not from fat loss, and the weight is regained when normal diet is resumed.

There is nothing magical about juice that would help our bodies detox any better than a well-rounded diet focused on a variety of less-processed foods. And the very low calories can actually cause metabolism to slow down, which can make it harder to lose weight. Just like any liquid diet, if it helps you to make a break with poor eating habits and you are truly committed to long-term diet change, a couple days on a juice cleanse likely won’t hurt, but it certainly isn’t necessary.

Joe Bowman

healthline

Global push to make Mediterranean diet sexy again

It may be on the UNESCO heritage list, but global experts warn the Mediterranean diet, prized for its health benefits, is losing so much ground to the fast food culture that the decline may be irreversible.

Rich in vegetables, fruits, cereals and extra virgin olive oil, the Mediterranean diet is based on a moderate consumption of fish, dairy products, eggs, red wine, and a small amount of meat.

Found to varying degrees in all countries bordering the Mediterranean Sea, it was named in 2010 onto UNESCO's Intangible Cultural Heritage of Humanity list for seven countries, from Croatia to Cyprus, Greece, Italy, Morocco, Spain and Portugal.

But the diet, which the United Nations also praises for promoting hospitality, neighbourliness, intercultural dialogue and creativity, is going rapidly out of fashion.

"In Greece, it has decreased by 70 percent over the last 30 years, in Spain 50 percent", Lluis Serra-Majem, head of the International Foundation of Mediterranean Diet, told AFP at a recent conference in Milan.

The experts, from Israel to New Zealand to Sweden, explored ways to revive the diet, from making it appealing to teenagers, to persuading people to buy fresh and sometimes costlier food in a period of economic crisis.

In Spain, celebrities like actress Penelope Cruz may add some glamour with their love of Mediterranean cuisine, but ever fewer people are enticed.

Less than 15 percent of the Spanish population still eats a Mediterranean diet, while 50 to 60 percent do so sometimes. Between 20 to 30 percent have ditched it altogether, Serra-Majem said.

And it's the same in Greece, says Antonia Trichopoulou from the Hellenic Health Foundation.

Unsurprisingly, over 65-year- olds are the best at eating traditional dishes, while the youngest generations have succumbed to the lure of fast food.

"The decline has various causes. We are witnessing a globalization of eating habits, with (the spread of) the 'Western diet'", said Serra-Majem, pointing a finger of blame at the growth of the tourism sector in particular.

It has been more marked in coastal areas, particularly in Spain or on Italy's Adriatic coast.

"Uncontrolled tourism leads to high urbanization and... increased consumption of meat, refined flours and a reduction of the traditional diet, " he said.

medicalxpress