EAT YOUR VEGGIES!
By Sally Squires, Washington Post

(Once Shunned Vegetarian Diet Gains Approval in New USDA Guidelines)

Vegetarianism, once considered a bit kooky, is becoming fashionable. Meatless meals are showing up in federal cafeterias as well as the president's table at the White House. Vegetable stir fry and soy burgers are served alongside chicken and steak at the training table of the Pittsburg Steelers Professional football team. Food, establishments from Sutton Place Gourmet to Taco Bell regularly offer vegetarian dishes. In fact, 8 percent of fast food restaurants long the stalwarts of hamburgers, fried chicken and deep fried fish fillets, feature such vegetarian options as salad bars and SOY burgers, according to the journal Topics in Clinical Nutrition.

On Jan. 2, the federal government is expected to take an official seat at the vegetarian table. Based on an advisory committee report issued last June, the U.S. Department of Agriculture's new version of its official Dietary Guidelines notes for the first time that meatless diets can meet the Recommended Dietary Allowances for nutrients. Vegetarians who eat dairy products and eggs "enjoy excellent health," the advisory committee concluded last year. The new guidelines will address one of the most controversial aspects of a vegetarian diet: Can vegetarians adequately meet the recommended daily intake of protein, iron, zinc and vitamin B12 from their diet alone? Yes, according to the advisory committee, ìas long as the variety and amounts of food consumed are adequate."

Adding vegetarianism to the govermnent's official Dietary Guidelines is a way ìto help educate the public in general about vegetarianism and to educate people interested in vegetarianismn about how it can relate to their health, said Richard Havel, co-chair of the USDA's Dietary Guidelines Advisory Committee that drafted the guidelines. When an appropriate variety of foods is eaten, a vegetarian lifestyle is quite consistent with good health, Havel said.

That conclusion won't come as news to the 12.4 million who say they already adhere to a vegetarian life-style, nearly double the number who labeled themselves as such in 1985, according to a report by the food industry journal Food Service Director. At that growth rate, the food industry estimates that the number of vegetarians will increase by 1 million per year. Projections suggest that by the millennium one in 10 Americans will no longer eat meat or poultry.

AN OLD IDEA

The idea of eating a diet sans meat, or fish, my have started in ancient India. The Greek mathematician and philosopher Pythagoras popularized the practice, who was exposed to the diet during an extended stay in Egypt. He believed that eating meat "interfered with the attainment of pure contemplation", as Rynn Berry explains in his book, "Famous Vegetarians" (Pythagorean Publishers; 1995). In honor of Pythagoras, people who avoided meat, poultry and fish thereafter were known as Pythagoreans until the late 19th century when the word vegetarian was coined.

Why people become vegetarians today varies nearly as much as the people themselves. Some cost-conscious vegetarians have cut out meat to save money. Others cite religious, ethical and ecological reasons. And increasingly, people talk about the health reasons, arguing that animal foods, especially high-fat food, can be harmful.

For example, DeWitt Williams, director of health and temperance for the Seventh-Day Adventists North American division in Silver Spring, stopped eating all animal products for religious reasons, a tenet begun by church founder Ellen G. White in 1863 and followed today by nearly half of all Adventists. "I had to pray, because I liked meat," he said. "I liked fish. But when I really became determined, it seemed like sort of a miracle happened, my taste for it was taken away."

Blocked coronary arteries and a family history of premature death from heart attack convinced Murlan Murphy of Shaker Heights, Ohio, to give up animal fats for a vegetarian diet a decade ago at age 67 as part of an experimental treatment program at the Cleveland Clinic. "I am convinced that it is a practical approach to heart disease, he said. It certainly beats open heart surgery.

Katherine Tallmadge, a registered dietitian in Washington, never cared much for meat. I'm also a vegetarian because it's so much cheaper and easier, said Tallmadge, who said she also finds it "more convenient not to eat meat. And John Easton of Chicago and his wife had already reduced their meat consumption drastically when their then 4-year-old daughter, Alice, returned from a trip to a farm and announced she was no longer eating meat. "Once she made the connection between lamb chops and lambs, she quit eating meat entirely, Easton said. We still eat eggs and dairy products, but nothing that has a face. My wife decided that it would be easier and more supportive for us all to switch than to cook two separate menus at each meal. The only obvious health benefit was that Alice, who was thin, gained weight and I lost weight."

NOT SIMPLY MEATLESS

What exactly is a vegetarian? The term is so liberally applied that it can describe a wide variety of eating patterns, from semi-vegetarians or occasional meat eaters to hardcore vegans who won't let any type of animal product cross their lips. Some vegans (pronounced vee-gans) are so strict that they won't eat honey.

Far more common and a lot less rigid are lacto-ovo-vegetarian-- individuals who consume dairy products and eggs, but eat no meat, fish or poultry. The USDA estimates that about 80 percent of vegetarians fall into this category. Pesco-vegetarians are people who eat fish and a largely vegetarian diet; pollo-vegetarians consume chicken and a vegetarian diet, but no other flesh. Lacto-vegetarians eat dairy products, but don't consume meat, poultry or fish or eggs. Exact numbers for these groups are not kept.

Where meat, poultry and fish are often the cornerstone of the non- vegetarian diet, cereal, grains, fruits, vegetables, legumes, nuts and seeds form the basis of vegetarian diets, notes Patricia Johnston, who heads the Department of Nutrition at Loma Linda University in Loma Linda, a school affiliated with the Adventist Church.

At least in theory. In practice, surveys suggest there may be a wide gap between those who label themselves vegetarian and those who actually put vegetarianism into practice. "A lot of people call themselves vegetarians who are not," said Havel, professor of medicine with the University of California at San Francisco.

One survey by the food industry publication Food Service Director found that 20 percent of those labeling themselves vegetarians reported eating meat at least once a month. In another, 50 percent of self- described vegetarians ate, meat at least occasionally and some consumed it as frequently as once or twice a month. "The fact that many people call themselves vegetarians even while they continue to consume meat to at least some degree suggests that there is some perceived advantage to being a vegetarian or being considered one," Johnston noted last year in Topics of Clinical Nutrition.

LINGERING CONCERNS

But "turning vegetarian doesn't automatically translate to good health. "A lot of my students subsist on Twinkies and Coke and say to me, I am a vegetarian," said Leslie Bonci, a registered dietitian at the University of Pittsburgh and a practicing vegetarian. "Well they are, but their nutritional needs are not being met."

In severe cases where people don't get adequate protein and other nutrients, vegetarian diets can lead to health and developmental problems, including growth retardation in children.

Nor does a vegetarian diet necessarily mean that foods will be low in fat and cholesterol. Those who continue to fry food or replace meat and poultry with cheese, sour cream, butter, oils, nuts, eggs and a lot of high-fat vegetables such as avocados, can wind up eating more fat and cholesterol than someone who drinks skim milk and eats small amounts of lean meat, fish and poultry without the skin. "You would think that your chance of being healthful and having a healthful diet is probably better on a vegetarian diet, but you can choose a vegetarian diet that is unhealthful too," Johnston said.

Even unwanted pounds don't magically melt away on vegetarian diets, although studies show vegetarians generally weigh less than nonvegetarians, said Ella Haddad, associate professor of nutrition at Loma Linda University and author of a food pyramid for vegetarians. Those who choose to eat too many high-calorie vegetarian foods will add pounds, just as they would on a nonvegetarian diet.

"If you are choosing a vegetarian diet to control weight, you need to be careful about the kinds of substitutions you make," said Janet Williams, vice president of scientific and technical affairs for the American Meat Institute in Arlington. If you are eating a lot of vegetables and in order to make them palatable are covering them with margarine, butter or oil, you will be increasing your fat intake.

A recent survey of eating patterns in 2,000 households conducted for the National Livestock and Meat Board found that there was little difference in the amount of fat consumed by three groups of consumers: meat avoiders, meat eaters and vegetarians. Meat eaters ate an average of 67 grams of fat per day; vegetarians ate 61 grams per day and meat avoiders ate the least amount of fat: 54 grams per day.

Total calories among the three groups were very close, according to the survey. Meat eaters consumed an average of 1,649 calories per day; vegetarians ate 1,551 calories daily and meat avoiders consumed 1,417 calories a day.

POSSIBLE HEALTH ADVANTAGES

There is some evidence, however, that vegetarians who stick to a high fiber, low-fat diet may reap some important health rewards. "Why is a vegetarian diet good for you? asks Dean Ornish, a California physician best known as the lead investigator of one of the first studies to show that heart disease could be reversed by a low-fat diet. "We just keep finding more and more reasons.

People who eat vegetarian diets "seem to have a lower incidence of coronary heart disease and hypertension, of noninsulin dependent diabetes and also some types of cancer, particularly prostate, colon and breast cancer, said Wahada Karmally, director of nutrition at Columbia University's Irving Center for Clinical Research in New York. While population research suggests that many factors play a role in the development of disease, some recent studies have found health benefits for people following a vegetarian diet in these areas:

* CANCER. British, German and American studies show a reduction in the overall death rate from cancer for vegetarians as compared with meat-eaters, ranging from 20 to 40 percent, according to a review of the studies by Julia Swarner, associate professor of nutrition and dietetics at Loma Linda University. Among Adventists, (who already have a lower cancer death rate than the general population), lacto-ovo- vegetarians had an even lower death rate from cancer than Adventists who consumed meat four or more times per week, Swarner found. The reduced fat, higher fiber and greater consumption of soy products seen in vegetarian diets may help explain the protective effects, Swarner proposed in the journal Topics in Clinical Nutrition.

* Heart Disease. Long-term studies of small groups of patients by Ornish and his colleagues have shown that blocked coronary vessels can be opened by a combination of diet, exercise, meditation, stress reduction and yoga without having to resort to surgery. Study participants reduced total calories from fat to less than 15 percent-- about half what the traditional American diet provides. Another small study published last month in the Journal of family practice went a step further when Cleveland Clinic showed similar results with diet alone. Six patients who continued the program for 10 years showed reversal of their heart disease and no heart attacks or other "coronary events." Five dropouts who resumed their pre-study nonvegetarian diets reported 10 "coronary events."

* KIDNEY DISEASE. Studies suggest that vegetable protein seems to be easier on the kidney than animal protein, according to a review of the scientific literature by Joni Pagenkemper, an assistant professor of nutrition and dietetics at Loma Linda University. These effects have been seen both in healthy volunteers and in people suffering from diabetes-associated kidney disease. By switching to a lacto-vegetarian diet, patients with kidney disease reduced the amount of protein load on their kidneys without severely limiting the amount of protein they ate, Pagenkemper reported in Topics in Clinical Nutrition.

* OSTEOPOROSIS. There is a great deal of controversy--even within the ranks of vegetarians--about the effects of a meatless diet on this debilitating bone disease. Doctors have long counseled Americans-- especially women--to increase their consumption of calcium to stave off the disease, and most people get their calcium through dairy products. Some vegetarians argue that the incidence of osteoporosis appears to be reduced in those who follow vegetarian diets, especially those that consume dairy products such as milk, even though they often consume less calcium than the recommended dietary allowance. Some studies have shown that plant-based diets make the urine produced by the body more alkaline, which in turn increases the reasborption of calcium from the urine through the kidneys, making a more efficient system. "Consumption of milk in the lacto-vegetarian diet provides an excellent source of calcium and vitamin D to help increase bone mineral density, notes George E. Hodgldn of Loma Linda.

The link between diet and bone density is complex. Staunch proponents of an all-vegetable diet that does not include dairy products contend that all animal proteins--including dairy products--rob the body of calcium and thus should be avoided. It's a complicated story for the uninitiated," said Colin Campbell, of Cornell University, lead investigator of a long-term dietary study in China. But in areas of the world where calcium intake is low, such as China, rates of osteoporosis are also much lower than in countries where dairy food and meat consumption is high, he said.

But many experts also caution that the strictest vegetarian diets, the ones that cut out all animal flesh and dairy products, may not always be palatable--or necessarily safe and appropriate--for everyone. Special care is needed for example to make sure that infants and children on these diets get enough calories. Infants and children as well as pregnant and lactating women may also require supplements to meet nutritional needs for proper growth and development.

"Vegans eat only food of plant origin, the new federal Dietary Guidelines note. "Because animal products are the only sources of vitamin B12, vegans must supplement their diets with a source of this vitamin. In addition, vegan diets, particularly those of children, require care to assure adequacy of vitamin D and calcium, which most Americans obtain from milk products."

DOING IT RIGHT

Both practicing vegetarians and nutritional experts emphasize that being a vegetarian takes planning and some good, basic nutritional education. It's not so much what you don't eat, but what you do eat, said Ella Haddad, associate professor of nutrition at Loma Linda University.

That means replacing whatever animal based foods are eliminated from the diet with fruit, vegetables and whole grain foods as well as eating high protein foods, such as beans, rice, soy, legumes and small amounts of nuts or eggs. You can't just cut out a whole food group and have a healthy diet, said Elmbeth Ward, a registered dietitan with the Harvard Community Health Plan in Boston.

But knowing what foods to eat, and how much, can be tricky. Haddad and others recommend six to 11 servings a day of whole grain bread, cereal, pasta and rice; three to five servings of vegetables; two to four of fruit; and two to three servings of low-fat dairy products and legumes, nuts, seeds and meat alternatives. Foods with vegetable fats and oils, and sweets, including honey, and salt should be eaten sparingly.

Sometimes, the switch can be relatively easy. For instance, a vegetarian might replace the ricotta cheese in lasagna with soft silken tofu, a soybean product, order only pizza with vegetables, or stuff peppers with rice, tomatoes and beans instead of meat. Other times, it is quite different from a conventional diet--such as using meat analogues, which are soy-based products developed to look look like meat.

The key to a successful vegetarian diet is balance because vegetarians have to be vigilant about their intake of protein, iron, zinc and vitamins B2, B12, and D. Those who fail to eat a well-balanced diet can run into some serious health problems, including anemia and malnutrition, and in children, growth retardation. Special care also needs to be paid by pregnant and lactating women who choose to give up meat.

It's a little more difficult to get all the nutrients on a vegetarian diet, said Wahada Karmally, director of nutrition at Columbia University Irving Center for Clinical Research in New York.

One of the biggest mistakes that rookie vegetarians make is to simply eliminate meat from their diets without replacing it with other food. Where they get into difficulty is that they have no idea about nutrition and vegetable protein," said Jane White, who teaches nutrition to nurses at Catholic University and counsels individuals about their diets.

All protein is made from amino acids, chemical building blocks that are needed by the body to carry out a myriad of activities, from tissue growth and wound healing to maintenance of blood, muscles, skin and body organs. Amino acids are also needed to produce hormones, enzymes and other key regulating substances in the body. There are 11 nonessential amino acids, substances that can be made by the body, and nine essential amino acids, which cannot be manufactured by the human body and thus must be obtained from food.

(Note: The following is a MYTH!)
Animal protein is complete, meaning that it contains all the essential amino acids. Plant protein is incomplete, meaning that it contains some, but not all of the essential amino acids. For this reason, vegetarians must be sure to eat protein from complementary sources. The best example is a bowl of rice and beans. Rice is missing certain amino acids, but beans contain them. So together they provide a "complete" protein, all from vegetable sources.

Experts used to think that vegetarians needed to eat complementary proteins at every meal. But the latest evidence suggests that the body pools amino acids, making it possible to stretch the consumption of complementary proteins throughout the day and perhaps even longer.

Eating insufficient amounts of protein can be detrimental. One 14- year-old patient of White's first noticed thinning hair. Then she started feeling "absolutely hyperkinetic, very irritable, short- tempered and had difficulty sleeping," White said. "She was missing some of the essential amino acids." Switching to a better balanced vegetarian diet corrected the problem.

Although increasing numbers of adolescents are switching to vegetarian diets, parents should beware that a child's sudden conversion might be an effort to mask an eating disorder, said Katherine Tallmadge, a practicing vegetarian and registered dietitian in Washington. "Sometimes when a teenager becomes a vegetarian you really have to wonder if they have an eating disorder, she said. "It's an easy way to stop their parents from serving them fattening stuff." She recommends that the teenager and parent have a consultation with a professional nutritionist or dietitian about the move to a vegetarian diet to help ensure that there are no hidden eating problems and that the adolescent understands the need for nutritious food in the new diet.

Given a little nutritional education, however, experts say that most people fare very well on vegetarian diets. In a position paper issued in 1993, the American Dietetic Association noted that "vegetarian diets are healthful and nutritionally adequate when appropriately planned."

And for some, "going vegetarian a few days a week may be enough. "There is not only one type of vegetarian diet, said Christina Stark of Cornell University. "You donít have to do all or nothing to get benefits. You can decrease the meat you eat, serve it once or twice a week. It doesn't mean that you have to give up meat altogether."

7 GRAMS OF PROTEIN ARE FOUND IN:
1 oz of meat, poultry, fish or 1 egg white
1/2 cup cooked beans
1-1/4 cup of cooked rice or whole grains
1-3/4 cup of cooked vegetables
1 cup of milk or yogurt
1.5 ounces of most nuts
2 Tbsp of peanut bufter

SOURCE: Katherine Tallmadge, RD., Washington, D.C.
and 1989 RDA from National Research Council.

Cindy Blum and her husband, Michael, of Westminster, Md., decided to become vegetarians on Christmas Day in 1977. "We had been married a year," Blum said. "I was 25 and had gained weight. And I thought, if this is how I feel at 25, what's it going to be like when I'm older?"

To prepare for their new style of eating, Blum spent the time between Christmas and New Year's Day at the University of Maryland Medical School library in Baltimore reading everything she could about vegetarianism. "I didn't want to do something stupid," she said. "I wanted to approach this with knowledge, but the medical literature wasn't terribly helpful."

After pouring over the latest books, Blum found the information she needed in medical textbooks so rare that the library wouldn't allow them to be checked out. But by Jan. 1, she felt as though she had learned enough to eat a healthy vegetarian diet. The couple gave themselves a month to try going without meat or poultry or fish, "and we noticed a difference in 30 days," said Blum who lives on a 42-acre farm with her family.

Eighteen years later, they're still vegetarians, although it wasn't always easy. "Back in those days, there wasn't the type of convenience foods that we have now," said Blum, who is a mezzo soprano opera singer and massage therapist. "We had to do everything from scratch. I made my own tofu. I did it all.

Three years after eliminating meat and poultry from their diets, the couple went a step further and became vegans--declining to eat animal products of any kind. "I honestly don't miss meat," Blum said. "But giving up dairy was'a little harder."

Blum has maintained a vegan lifestyle through two pregnancies, and the Blum children--Sarah, 13, and Erik, 11--have been vegans since birth. "They don,t really know or care about meat, although Sarah, I think, is curious about eating dairy products," said Blum, who grows her own foods without pesticides. "When she was in the fourth grade, she said she wanted to eat meat, but she was just pulling our chain. I told her to go ahead, that it was okay, but that I wasn't going to fix it for her."

Rearing vegan children has been challenging sometimes, Blum said, particularly when her kids were younger and were invited to birthday parties at fast food restaurants. "They could drink the orange juice," she said. "Or they ate before they went to the party. They've always accepted the fact that they were different."

Blum and her husband began their vegetarianism out of a concern for good health, but continue it for ethical and ecological reasons.

"We're concerned about the environment," she said, noting that huge areas of cropland must be used to grow food for animals that are then slaughtered to provide meat. "We live on a farm. Everything we do here is organic ... I would like to believe that I could live on this Earth with a minimal impact to its existence and hopefully with a positive impact."