.

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.

1
 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

2
 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

3
 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 well-

known 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

4
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

5
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. Non-
vegetarian 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

6
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.

7
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)

8
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

9
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

10
 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

11
 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 Tender Coconut

Fresh Dry
Water Coconut Milk
Moisture (%) 93.8 90.8 42.8 36.3 4.3
C alories 24 41 430 444 662
Protein (gms) 1.4 0.9 3.4 4.5 6.8
Fat (gms) 0.1 1.4 41 41.6 62.3
Carbohydrate (gms) 4.4 6.3 11.9 13 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 non-
vegetarian 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.

12
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.

13
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 Negative association between
coronary artery vegetarianism and ischemic heart disease
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 Total serum cholesterol, low-density-
levels: lipoprotein cholesterol, and to a lesser
comparisons of extent high-density-lipoprotein cholesterols
vegetarians and are lower in vegetarians and especially
nonvegetarians 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.

14
Serum cholesterol Feeding vegetarians beef, which is high in
levels: feeding total fat and saturated fatty acids and
vegetarians cholesterol, causes 19% increases in total
animal foods 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 Nonvegetarians have decreased total
levels: feeding cholesterol and LDL and HDL cholesterols
nonvegetarians when they are fed vegetarian diets low in
vegetarian diets 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 low-
fat, 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 .

15
 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.

16
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 1976:87-
92.
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); 439-
43.
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.

17
 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.

18
 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 end-
products 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; 2S2:1353-
6.
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):11-
2.

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

Starch & Sugar

Total
Other & Protei Alcoho
Diet Carbohydrat Fat
polysacharid Dextrin n l
es
es s

36-
Normal 45
Western p/s*
25-35 20-30 45-50 12-19 0-10
diets in ratio
the Past abou
t 0.3
Tradition
al 40-
25-30 10-15 35-40 16-21 0
Diabetic 45
Diets
Newer
diabetic
25-
diets in 30-40 5-15 45-55 12-24 0-6
35
Western
countries
Diabetic 50-55 5-15 60-65 20- 15 0-5
Diets in 25
India p/s

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

100
Glucose
%
Comflakes, carrots, maltose, honey 80-

24
 90%
Bread (whole meal), millet, rice (white), broad beans (fresh), 70-
potato (new) 79%
Bread (white), rice (brown), shredded wheat, beetroot, 60-
bananas, raisins. 69%
Spaghetti (white), sweet com, peas (frozen), yam, cane 50-
sugar(sucrose), potato chips. 59%
Spaghetti (whole meal), porridge (oats), potato (sweet), 40-
beans(canned, navy), peas (dried), oranges, orange juice 49%
Black eyed peas, chick peas, apples, milk (skim), milk (whole), 30-
yogurt, tomato soup. 39%
20-
Kidney beans, lentils, fruit sugar (fructose)
29%
10-
Soyabeans, soyabeans (canned), Peanuts.
19%

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 non-
insulin 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

Noncellulose
Crud Total Cellulose
polysaccharid
e Dietary Lignin( insoluble
es
fibrea fibre fibre)
(soluble fibre)

Food (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
0.2 2.7 2.0 0.7 Tr
Bread, white
Bread, whole
1.6 8.5 6.0 1.3 1.2
wheat
Fruits
Apples 0.6 1.4c 0.9c 0.5c 0.1c
Oranges
0.5 0.29 0.22 0.04 0.03
(peeled)
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
Legumes
and Nuts
Kidney
1.8 7.3 5.7 1.4 0.2
beans
White beans 1.7 7.3 5.7 1.4 0.2
Peanuts
2.0 9.3 6.4 1.7 1.2
(roasted)
Peas 2.0 7.1 4.5 2.4 0.2
Vegetables
Beans, green 1.0 3.4 1.9 1.3 0.2
Carrots 1.0 3.7 2.2 1.5 Tr
Cabbage,
0.8 2.8 1.8 .07 Tr
white
Cauliflower 1.0 1.8 0.7 1.1 Tr
Lettuce,
0.6 1.5 0.5 1.0 Tr
romaine
Pepper,
1.4 0.9 0.6 0.3 Tr
green
Potatoes
0.05 3.5 2.5 1.0 Tr
svith skin
Corn, cooked 0.8 4.7 4.3 0.3 0.1
Tomatoes.
0.5 1.4 0.7 0.4 0.3
fresh
Turnips, raw 0.9 2.2 1.5 0.7 Tr

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

27
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 non-
vegetarians. It is advisable to derive half of the fat intake from
saturated fats and the other half from polyunsaturated fats.

28
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 non-

insulin 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 non-
vegetarian 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, 278:869-
76.

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. Vegetables and vegetable juices

b. Nuts (dry fruits)
c. Fruits and fruit juices
d. Coconut and its constituents
e. Garlic
f. Honey
g. Sprouted beans
h. Wheatgrass and sprouted wheat
i. 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

35
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

Vitamin
Vitamin
C
Cooking A
Starch Fat Proteins (Ascorbic Thiamine Riboflavin Niacin
Method &
Carotene
Acid)
Moderate Heavy
Loss Loss
Gelatinisation (Heavy (Heavy
Cooking in No Slight
and formation Denaturation Loss if Loss if Nil Nil
excess water Effect loss
of paste excess excess
water is water is
rejected) rejected)

36
 (Heavy Loss if excess water is
Cooking in No Slight Moderate Slight
Gelatinisation Denaturation Nil Nil
Steam Effect loss Loss Loss
Cooking in
No Slight Moderate Moderate
Pressure Gelatinisation Denaturation - Nil
Effect loss Loss loss
Cooker
Decrease in Moderate
Dry Bursting of Moderate Moderate
- nutritive to Heavy Slight loss Nil
Toasting Granules loss Loss
value Loss
Short
Periods
(upto 30
min) (no
effect);
Long Decrease in
Deep Fat Bursting of Heavy Heavy Heavy Moderate
periods nutritive Nil
Frying Granules loss loss loss loss
(1 hr or value
more)
Toxic
products
are
formed
Slight
Moderate Moderate
Shallow Pan Bursting of No decrease in
to Heavy to Heavy Moderate Slight Nil
Frying Granules Effect nutritive
loss loss
value
Effect of
Addition of
Decrease in
Cooking No Heavy Heavy Heavy
No Effect nutritive Nil Nil
Soda to Effect loss loss loss
value
Cooking
Water
Baking, Gelatinisation No Slight Moderate Slight
No Effect Slight loss Nil
bread of starch Effect loss Loss loss
Slight
Baking, Gelatinisation No decrease in Moderate Moderate Moderate Moderate
Nil
biscuits of starch Effect nutritive Loss Loss Loss Loss
value
Gelatinisation No Slight
Puffing Denaturation - - Nil Nil
of starch Effect loss
Slight
No Slight Slight Slight Slight
Germination Hydrolysis to No Effect -
Effect Increase Increase Increase Increase
Dextrins

37
 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. Through carcinogens produced by food processing or

cooking
ii. Through carcinogens in the body produced during
digestion, especially in the stomach, small or large
intestines
iii. From food constituents itself
iv. Through the indirect effects of undernutrition,
malnutrition and overnutrition and
v. 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
 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.
4. 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.
5. 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.
6. 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.
7. 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 non-
vegetarian 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
Grilled or smoked fish, meats or poultry
Protein Food
Meats cured by nitrates
2. Nitrosamines
Present in hard water and in vegetables
Nitrates
grown in nitrate fertilizers (inorganic farming)
Most meats, milk, eggs, fruits and root
3. Folate def.
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, 303:1246-
1248.
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, 20-
21.
18. Coronaro L.: How to live 100 years. Letch svorth, Herts-
fordshire, 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

43
 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. Hypertension
2. Diabetes mellitus
3. Hypercholesterolaemia
4. Alcoholism and cigarette smoking
5. Obesity
6. 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

46
 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.

47
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".

48
 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,

49
 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-ovo-
vegetarian 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

50
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

51
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.

52
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.

53
 REFERENCES

1. Sacks F.M., Rosner B., Kass E.H. Blood pressure in

vegetarians. Amer. J. Epidemiol. 1974, 100, 873-77 (390-
98).
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

54
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

Chemic
Protein al
Limiting
Foodstuff Conte Score of
Amino Acid
nt
%
Whole Egg 12.3 100 Tryptophan
Beef (lean,raw) 20.0 72 Lysine
Wheat (Wholemeal
13.0 38 Lysine
flour)
Tryptophan
Rice (Polished raw) 6.5 59
+Lysine
Cystine +
Maize (Cornflour) 0.6 -
Methionine
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

55
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

56
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

57
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.

58
 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

59
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 non-
vegetarian 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

60
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)

61
 5. Seeds especially Sesame (Til), Sunflower
6. Cheddar Cheese
7. Swiss Cheese
8. 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 80-
1983).
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

62
 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

63
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.

64
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.

66
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 vata-
related 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.

68
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

70
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

71
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.

72
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, pitha-
related 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

73
 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,

74
 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

75
 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

76
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 non-
vegetarian 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

77
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 7-
alphadehydroxylase, 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

78
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. Low-
residue 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,

79
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.

80
 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 open-
air 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

81
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.

82
 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

Factors
Found Correlation
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

Male Female
Problems
% %
Caries 31.8 43.9
Periodontal bone
absorption:
(a) Vertical 5.3 4.5
(b) Horizontal 10.7 15.4

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 Protein- Low Protein-
Low Calorie High Calorie

84
 Group Group
Protein Intake 60g Protein Intake 35g
Daily Calorie Intake Calorie Intake
1900 2500
% %
Caries 55 45
Periodontal Bone
45 55
Absorption

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 food-
habits 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

85
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 non-
vegetarian diet is given below.

Fluoride Content
Food
(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.

86
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 breast-
fed.

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
88
 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 sub-
populations 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

89
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

90
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 Response

1. Serum immunoglobulin levels Raised or Normal
2. Secretory IgA Decreased
3. Circulating B cells Decreased or Normal
4. Plaque forming cells Decreased
Cellular Immunity
Response
1. PHA
Decreased
2. Immunity to irltracellular
Decreased
organisms
Decreased
3. Circulating T Cells
Decreased
4. Lymphokine production

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. Beisel W.R. et al, JAMA 1981:245;53.

2. Beisel W.R. Am.J.Cl.Nut. 1982:35; 417.
3. Ballentine R. Diet & Nutrltion; 1982.
4. Chandra R.K. Can J. Physiol 1983:61; 290.
5. Chaman H.N. JAMA 1987:258; 2834.
6. Das K.C.; Hoffbrand A.V. British J. Haematol 1970:19, 459.
7. Moore S.T. & Bymes M.P. A Vegetarian Diet, 1975.
8. Shigzal H.M. Surgical Ana 1981:13; 15.
9. 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:

94
 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

95
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 Gram-
negative 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

96
 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 Wholly or Primarily Veg.

Matoke Rice Vega
Scotlan Englan Ugand Rice
Country of Origin USA Ugand Japa n
d d a India
a n Eng
Enterobacteria 7.4 7.6 7.9 7.4 7.9 8.0 9.4 7.0
Enterococci 5.9 5.3 5.8 5.3 7.3 7.0 8.1 4.8
Lactobacilli 6.5 7.7 6.5 5.3 7.6 7.2 7.4 7.4
Clostridia 5.4 5.6 5.7 4.7 5.7 5.1 5.6 5.4
Bacteroides 9.7 9.8 9.8 9.8 9.2 8.2 9.4 9.7
Gram Positive sporing
10.0 9.9 9.8 9.5 9.6 9.3 9.7 9.6
anaerobes

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 of Faeces

Entero
Entero Lacto Bacte Bifido-
- Clostridi Eubacteri
- - r- bacteriu
bacteri a a
cocci bacilli oides m
a

97
Largely India 7.9 7.3 7.6 5.7 9.2 9.6 9.5
Carbohydrat Japan 9.4 8.1 7.4 5.6 9.4 9.7 9.6
e Uganda 80 7.0 7.2 5.1 8.2 9.4 9.3
Englan
7.9 5.8 6.5 5.7 9.8 9.9 9.3
d
Mixed
Scotlan
Western 7.6 5.3 7.7 5.6 9.8 9.9 9.3
d
U.S.A. 7.4 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 &

98
 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 well-
cooked 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.

Amoun Iron(mg
Food
t )
Blood Sausage 3oz 17.0
Liver,Beef 3oz 7.5
Beef,sirloin 3oz 2.5
Fish(Halibut) 3oz 0.6
1(Large
Eggs 1.2
)
Milk(Whole) 1 cup 0.1
Kidney beans 1/2 cup 3.4
Lentils 1/2 cup 2.1
Navy beans 1/2 cup 2.1
Whole-wheat
1 piece 1.0
bread
Spinach* 3/4 cup 2.3
Kale* 3/4 cup 1.7
Collards* 3/4 cup 0.6
Raisins 2T 0.6
Molasses 2T 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 iron-
containing 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

Vitamin C
Food mg. per 1/2
cup
Onion 5
Green Beans 9
Potato 10
Tomato 25
Spinach 25
Mustard
38
Greens
Broccoli 50
Kale 75
Green Peppers 90
Lemon Juice 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 well-
documented, 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

105
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

106
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

107
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

108
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

Egg yolk 1 1

Fermented soy products:

Miso 1T c. 0.03 (variable)

Tempeh 3 oz c.3 (variable)

Seaweed - variable

Spirulina - variable

Yogurt 1c 0.3

* 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

110
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

111
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

112
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 self-

destructive 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

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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.
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113
 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,
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9. Underwood E.J.: Trace Elements in Human and Animal
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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
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15. Herbert V., Jacob E.: Destruction of vitamin Bl2 by ascorbic
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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
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Nutrition, 1978, 31: 253-58.

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