CAUTION: The questions and answers below aim to stimulate consideration and discussion of issues related to diet and nutrition. They are not meant to take the place of professionsl diagnosis and advice. Hence, do not change medicines or other medical practices without the advice of a physician knowledgable about the effects of dietary changes. ------------------- How can people get key facts about nutrition and improved diets? The more information one has about health and nutrition the better. Many books are very helpful, including: The Power of Your Plate , by Neal Barnard, M. D., The McDougall Plan and A Challenging Second Opinion , both by John A. McDougall, M. D, and MegaHealth, by Mark Sorensen, Ed. D.. Many medical studies are referred to in these books. Two excellent sources for nutritional information are the Physicians Committee for Responsible Medicine (PCRM), 5100 Wisconsin Avenue, NW, Suite 404, Washington, D. C. 20016; Web: , and the Vegetarian Resource Group (VRG), P. O. Box 1463, Baltimore, MD 21203; phone (410) 366-8343; Email address:; web: Magazines that give useful information on vegetarian nutrition include Vegetarian Times , Good Medicine, the publication of the PCRM, and Vegetarian Journal , the publication of VRG.

Can a vegetarian get sufficient nutrients? Absolutely! Nutritionists and dieticians have concluded that vegetarians can get all the essential nutrients without consuming meat, or any other animal products. The only question concerns Vitamin B12, and this can easily be handled, as indicated later.

What do professional dietitians say about vegetarian diets? The American Dietetic Association issued a pamphlet in 1992 entitled, "Eating Well - The Vegetarian Way". They concluded:

"Vegetarian foods are the prime source of nutrition for most of the world"

"Vegetarians have lower rates of heart disease and some forms of cancer than non-vegetarians".

"Vegetarian eating can be helpful for people of all ages".

" Vegetarian diets can be simple to plan".

What are the "Basic Four Food Groups?" Are there any health problems associated with it? The "Basic Four" involves (1) meats, poultry, and fish, dry beans and peas, eggs, and nuts; (2) dairy products, such as milk, cheese, and yogurt; (3) grains; (4) fruits and vegetables. This combination of foods has become the mainstay of nutrition education in the United States since 1956, when the U. S. Department of Agriculture promoted it" in its Leaflet No. 424, "Food For Fitness - A Daily Food Guide". . The dairy, meat, and egg lobbies have strongly promoted it, and American students have been presented it as gospel in classrooms throughout the country. The Physicians Committee for Responsible Medicine (PCRM), a non- profit health/nutrition advocacy group argues that the heavy emphasis on animal products in the Basic Four, with its high amounts of fat, cholesterol, and protein, is a prime factor in degenerative diseases, such as heart disease, stroke, various types of cancer, and osteoporosis, that afflict so many people. Other responses in this message discuss the negative health effects of meat/dairy -based diets.

What are the "New Four Food Groups?" On April 8, 1992, the Physicians Committee for Responsible Medicine unveiled its "New Four Food Groups", an action that could have great impact on the future of nutrition and health in the United States. Their new Four Food Groups are (1) whole grains, including bread, pasta, cereal, millet, barley, bulgur, buckwheat, groats, and tortillas; (2) vegetables; (3) legumes, such as beans, peas, lentils, soy milk, tofu, and tempeh; (4) fruit. While the PCRM believes that a wide variety of foods from these four groups provides all the necessary nutrients for good human health, they list meat, dairy products, nuts, seeds, and oil as "optional foods", for those who wish to use small amounts to supplement their diets. The New Four Food Groups was presented by Dr. Neal Barnard, M. D., director of PCRM, and author of The Power of Your Plate, at a press conference which was attended by journalists from many publications. Barnard asserted that the new proposal could have a major impact on diet-related diseases in the U. S., where heart attacks strike 4,000 people a day, and where a third of the U. S. population may get cancer. He added that the "Basic Four", which involves meat and other animal products at the center of the American diet is a recipe for disaster; he noted the shift in breast cancer rates from one in eleven American women (getting the disease at some point during their lives) when he was a medical student to one in nine in 1991. (A recent report indicated that it reached one in eight women in 1992.) Dr. Barnard, a vegetarian activist, was joined at the press conference by three prominent non-vegetarian doctors: Dennis Burkitt, M. D., whose pioneering research connected dietary fiber to the prevention of disease; T. Colin Campbell, M. D., head of the China Health Study (a major ground breaking study that the New York Times called "the grand prix of epidemiology"), which connected degenerative diseases to meat-based diets; Oliver Alabaster, M. D., Director of the Institute for Disease Prevention at George Washington University, and author of The Power of Prevention. . While feeling that it is acceptable to eat small amounts of animal products, the three doctors agreed that basing the major part of the diet on the New Four Food Groups would have major benefits on human health.tionale statement, posters, recipes, and other printed material. Hopefully the New Four Food Group proposal will stir up a comprehensive discussion on links between diet and health. Issues related to health care and related costs have become dominant in the economics and politics of our time. More information about the New Four Food Groups, as well as general information and educational material on healthier eating, can be obtained from the Physicians Committee for Responsible Medicine, P. O. Box 6322, Washington, D, C. 20015; phone: (202) 686-2210.

Don't we need a balanced diet that includes meat and animal products? We do need a balanced diet, one that includes all the essential nutrients and vitamins. But all of these can be obtained from plant- based foods (fruits, vegetables, grains, and legumes), even without consuming dairy products and/or eggs. Actually meat unbalances diets by adding excessive amounts of cholesterol, fat, pesticides, hormones, and antibiotics.

How can a vegetarian get sufficient vitamin B12? This vitamin is produced by bacteria in soil and in animals. Since it is found in animal foods, it is not generally considered a concern for those vegetarians who have eggs and dairy products in their diets. However, while only a very small amount (about 4 micrograms daily) are required, there have been some reported cases of vitamin B12 deficiencies among vegans. Hence, to be on the safe side, people on such diets should add vitamin B12-fortified cereals or soy milk, or a vegetarian vitamin B12 (cobalamin) supplement to their diets, or have a tablespoon of nutritional yeast about once a month.

How can a vegetarian get sufficient protein? This is probably the question that is most frequently asked of vegetarians. As Dr. Neal Barnard, director of the Physicians Committee for Responsible Medicine, points out, protein has been regarded with great awe in our society, almost as a fourth color of the flag: red, white, blue, and protein. Most people get far too much protein, often two to three times the amount required. Some nutritionists indicate that only about 5% of calories from protein are adequate. And this can easily be obtained from vegetarian, even vegan (no animal products at all) diets. Protein is found in most plant foods as well as in animal foods. Potatoes, for example have 11% of their calories from protein, and spinach has 49%. One would almost have to try to get inadequate protein, providing that he or she was getting enough calories. While an average working man needs about 37 grams of protein per day, 3,000 calories of rice alone would provide 60 grams of highly usable protein (for 3,000 calories of potatoes, 80 grams of protein would be provided). People on meat-based diets are not only getting excessive protein, but also large amounts of hormones, fat, cholesterol, pesticides, antibiotics, and other harmful ingredients that place major burdens on the consumer's kidneys, liver, and digestive systems.

Do vegetarians have to "complement" proteins, that is, get a combination of different foods containing proteins, to make sure that they are getting complete protein? This is a theory first advocated by Frances Moore Lappe in her very influential book, Diet for a Small Planet . She felt that when people are not eating meat, they should combine proteins in order to get the same protein value that they previously got from meat. However, nutritionists no longer agree with that theory. For example, the American Dietary Association stated in its 1992 paper, "Eating Well - The Vegetarian Way", "Vegetarians do not need to combine specific foods within a meal as the old 'complementary protein' theory advised. The paper states: ""The body makes its own complete proteins if a variety of plant foods - fruits, vegetables, grains, legumes, nuts, and seeds - and enough calories are eaten during the day." Even Frances Moore Lappe agreed with this assessment in later editions of her book.

What are the negative effects of getting too much protein? Consuming excessive amounts of protein can seriously damage human health. It can result in a negative calcium balance, because when the excessive protein is excreted, minerals including calcium are lost in the urine. This results in calcium-deficient bones that easily break, a condition known as osteoporosis. Countries such as the United States, Sweden and Norway, with the highest consumption of dairy products, have the highest numbers of incidents of osteoporosis per person. Eskimos provide an excellent example of the effects of excessive protein. Their diet is extremely high in calcium (more than 2,000 milligrams, primarily from fish bones), but it is also very high in protein (250 to 400 grams a day). Even though they are physically active (an important factor in maintaining strong bones), the Eskimos have one of the highest rates of osteoporosis in the world. Calcium lost on high protein diets must be handled by the kidneys. This contributes to the formation of painful kidney stones. Excess protein causes destruction of kidney tissue and progressive deterioration of kidney function. Many people in affluent societies have lost 75 percent of their kidney function by the eighth decade of their lives. Extra kidney capacity enables the kidney to carry out its function in otherwise healthy people, but for people who suffer from additional disease of the kidney, such as diabetes, surgical loss, or injury from toxic substances, damage due to the excess protein may be fatal. When people with partial loss or damage to their kidneys are placed on low-protein diets, they are able to maintain much of their remaining kidney function.

How can a vegetarian get sufficient calcium? Don't we need milk in our diets to make sure that we are getting adequate calcium? Many plant foods are good sources of calcium. Especially good sources are dark leafy greens (such as kale and mustard, collard, and turnip greens), broccoli, beans, dried figs, sunflower seeds, and calcium-fortified cereals and juices. Dairy products are good sources of calcium, but they also contain large amounts of fat and protein. As indicated above,the consumption of excessive protein results in the loss of calcium from the body and thus countries with the highest dairy consumption, such as the United States and Sweden, because of their high animal protein diets, have the highest rates of osteoporosis, a disease involving the weakening and potential breaking of bones. According to the American Dietary Association paper previously cited, vegans can usually obtain the calcium that they need from plant foods alone, and studies have shown that vegetarians can absorb and retain more calcium from foods and have lower rates of osteoporosis than non-vegetarians.

How can a vegetarian get sufficient iron? There are many good plant food sources of iron. They include dried green vegetables, such as spinach and green beans, dried beans, dried fruits, pumpkin seeds, sesame seeds, prune juice, black strap molasses, soybean nuts, and iron-fortified breads and cereals. Foods high in vitamin C, such as broccoli, citrus fruits and juices, tomatoes, and green pepper, help the body absorb iron from plant sources.

Is vegetarianism an effective approach to weight loss? Yes. Each gram of protein and carbohydrates has 4 calories, but each gram of fat has 9 calories. Since plant-based diets are lower in fat than animal-centered diets, they are generally effective at reaching and/or maintaining desired weights. Of course, there are other factors, including exercise, quantities of food eaten, and individual characteristics that should also be considered.

Does one have to carefully study nutrition when shifting to a vegetarian diet? Naturally, the more information a person has about nutrition, the better. But one need not be an expert on nutrition to be sure of getting adequate nutrition on a vegetarian diet. If one has a good balance of foods from PCRM's "New Four Food Groups", avoids empty calories, and gets adequate rest and exercise, one can be very healthy. The avoidance of the excessive fat, cholesterol, and protein associated with flesh/dairy centered diets is a major positive step toward improved health. Of course, once someone moves toward vegetarianism, he or she might wish to read books, such as the ones mentioned above, attend meetings, and speak to others including vegetarians about nutrition, recipes, and other diet-related matters.

Don't vegetarians have to be careful to make sure they get all the proper nutrients? Generally vegetarians are careful. As indicated in other responses, vegetarians can easily get all needed nutrients on a well- balanced vegetarian diet with some vitamin B12 supplementation from vegetarian sources. it is actually meat-eaters who have to be more careful, since it their diet that has excessive fat, cholesterol, and protein, and these have been associated with so many health problems.

Can a vegetarian diet be unhealthy? Yes. For example, if a person eats only or primarily fruits, or has a diet based almost completely on rice, or consumes a great deal of candy bars and other sweets and empty calories from diet sodas, one can have a diet that lacks some essential nutrients. But if the diet is well balanced and has an adequate mix of fruits, vegetables, grains, and legumes, there should be no problem. The prime problem in our society is the unhealthy nature of animal-based diets since they can lack essential nutrients, and have too much fat, protein, and cholesterol.

What health problems are associated with the consumption of milk? Researchers have found that the consumption of high-fat dairy products is a leading cause of atherosclerosis, heart attacks, and strokes. Hence, countries where there is high consumption of dairy products have high amounts of many degenerative diseases. Dairy products are also the leading culprits in food allergies.and have been linked to childhood illnesses such as frequent earaches. Dairy products are high in fat, high in cholesterol, and completely devoid of fiber. .While lower-fat dairy products represent an improvement, they are higher in protein, and this contributes to osteoporosis, kidney problems, and some forms of cancer. People can easily get enough calcium through non-dairy products such as broccoli and other green leafy vegetables. Actually, milk is a wonderful product, but it was designed for rapid weight gain in calves. Cow's milk is a perfect food -for calves. It is designed to take an infant calf, weighing 90 pounds at birth, to a weight of 2,000 pounds in only two years. Eating dairy products is eating a food designed to make one very big, very fast. One might wonder if drinking milk is natural to human beings when we recognize that no other mammal on earth consumes the milk of another species or consumes it after a weaning period. In addition, there is much cruelty to animals related to the dairy industry, contrary to Jewish mandates to treat animals kindly. Every year cows are artificially inseminated so that they will constantly be able to produce milk. Male calves are taken away from their mothers after one day of nursing, and then raised in cramped, closed spaces, where they are denied exercise, sunlight, fresh air, and any emotional stimulation, so that their eventually diseased bodies can be sold as veal.

What is an ideal cholesterol level? It has been found that heart problems do not occur when cholesterol levels are below 150 (milligram per deciliter, or mg. per dl.) unless the person's cholesterol level has decreased due to another illness. Lower values for cholesterol are not a problem. If a person has a reading higher than 150, say up to 170, this is still a good value, but a reading below 150 gives the best assurance of protection against heart-related problems. A very important thing to note is that for every decrease of one percent in the cholesterol level, there is a 2% decrease in the risk of heart attack. Hence a reduction in cholesterol level is a very effective way to reduce risk of heart problems. Cholesterol is only found in meat and other animal products. No plant- based product has any cholesterol at all.

Is a switch from beef to chicken and fish a positive step for improved health? There may be some improvement in terms of lower fat, but chicken and fish have high values for protein and cholesterol content. For example, 3.5 ounces of extra lean ground beef has 84 mg. of cholesterol per dl. and 3.5 ounces of chicken, without the skin has 85 mg. of cholesterol per dl. Many people feel a false sense of security when they switch from red meat to a primarily chicken and fish diet. A scientific study by Dr. Dean Ornish showed dramatic improvements in the condition of patients with severe heart problems who switched to vegetarian, almost vegan, very low fat diets, but those who switched to diets recommended by medical groups, such as the American Heart Association, which involve a switch to 30% of calories from fat, and includes chicken without the skin, fish, and an ample amount of dairy products, showed no improvement, and in most cases became worse.

Isn't it true that many people in nations that don't get enough meat suffer from malnutrition? Yes, but not because they don't eat meat, but because they don't get enough calories. It has been estimated that 20 million people are dying annually because of a lack of adequate nutrition. Meat- based diets contribute to this, since over 70% of the grain grown in the United States is fed to animals destined for slaughter (and over a - third of all grain worldwide) and the U. S. and other developed countries import food from countries where people are severely malnourished. Actually, there are two faces of malnutrition in the world today: one is in the developing countries, where people lack sufficient food; and the second in developed countries like the U. S., where people suffer from degenerative diseases due to too much rich food, such as meat and dairy products.

Isn't plant protein of inferior quality compared to animal-based protein? No. This mistaken idea is based on the mistaken premise that our protein intake needs to match the pattern of the eight essential amino acids in meat. Recent studies show that the human liver can extract all the essential amino acids it needs from plant protein and to form all the necessary protein molecules.

While vegetarianism may be fine for adults, don't our children need meat? Children can get all the protein, calcium, carbohydrates, vitamins, and other nutrients from plant-based foods. Meat is a good source of iron and protein, but it is also high in saturated fat and cholesterol and the high amount of protein that it contains depletes calcium from the bones. And as indicated in several other responses, there are many negative constituents in meat due to the way that animals are raised today. Children that are raised on strict vegetarian diets have generally turned out to be healthy. A good source for further information is Pregnancy, Children, and the Vegan Diet by Michael Klaper, M. D..

Are there any problems with taking a daily dose of aspirin to reduce the risk of a heart attack? This response is based on information in a book that I highly recommend, "Mega Health" by Marc sorenson, Ed.D.(page 151). Aspirin has the ability to decrease the risk of a blood clot and hence to decrease the risk of a heart attack. However, as with other drug therapies, there are significant side effects. One study showed regular aspirin usage assocaited with a 20% to 30% increase in the rate of stroke, a significant increasse in kidney cancer in men, and a significant increase in colon cancer and heart disease in men and women. Aspirin also causes considerable damage to the digestive tract. Like other drugs, aspirin may mask symptoms that could warn a person of a major health problem. In summary, "heart disease is not due to an aspirin deficiency", and alternative approaches to protecting the heart should certainly be considered.

- - - - - - - - - - - - - - - - - - - REPEATED CAUTION: The questions and answers above aim to stimulate consideration and discussion of issues related to diet and nutrition. They are not meant to take the place of professionsl diagnosis and advice. Hence, do not change medicines or other medical practices without the advice of a physician knowledgable about the effects of dietary and other lifestyle changes. ---------------------

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