From The New England Journal of Medicine
This book contains expert summaries of various aspects of plant-based, or meatless, diets. It provides not only ethical, moral, and religious viewpoints from different periods of history but also modern perspectives on health promotion and disease prevention. The editor, Joan Sabate, is a physician and nutrition specialist who for several decades has been a principal investigator in observational and intervention studies of health promotion among Seventh-Day Adventists. He has recruited an international group of authors and many of his colleagues at Loma Linda University for this collection. That the 26 contributors include only 2 physicians may indicate the need for this book, since the overall impression the book leaves is that vegetarian diets are safe, palatable, healthy, and at times curative.
The material is presented succinctly, with good use of tables, and is referenced appropriately. Vegetarian diets may be classified as lacto-vegetarian, ovo-vegetarian, lacto-ovo-vegetarian, or vegan, respectively, if they include dairy products, eggs, both dairy products and eggs, or no animal products at all. The macrobiotic diet is an extremely restrictive vegetarian diet that is not nutritionally adequate and leads to malnutrition, especially in children. The book’s synopsis of growth studies involving children and adolescents who are vegetarians provides data on children from birth to 18 years of age. Lacto-ovo- or lacto-vegetarians, as most Seventh-Day Adventists are, have normal physical growth, whereas children who are vegans may have slower growth even if they are in good health.
In a discussion of nutrients of concern in vegetarian diets, the authors conclude that appropriately planned vegan or lacto-ovo-vegetarian diets can be nutritionally adequate. There is concern about the adequacy of zinc intake in vegan women and about low intakes of vitamin B12 and iodine in vegans in general, but these needs can be met by fortified foods (such as breakfast cereal and salt). White and Asian vegan women may need to take calcium supplements in order to ensure that their intake is adequate, and those who live in northern climates may require vitamin D supplementation in winter, or year-round if they are elderly.
Tables of health-promoting phytochemicals (beyond the traditional nutrients) provide information about the food and herbal sources of approximately 20 compounds, ranging from carotenoids to tocotrienols. The author of the chapter on phytochemicals recommends that whole foods rather than phytochemical supplements be consumed for the best protection against disease, since the safety and health benefits of concentrated extracts of fruits and vegetables with high levels of phytochemicals are unknown.
The discussion of vegetarian diets in relation to the U.S. Dietary Guidelines and disease-specific guidelines (for heart disease, obesity, hypertension, diabetes, and cancer) concludes that these recommendations promote the eating of more unrefined grains, fruits, and vegetables and the reduction of the intake of saturated fat and cholesterol (present in all animal products and in no plants) — a diet that overlaps with vegetarian eating patterns. The author of the chapter on dietary guidelines concludes that “present knowledge suggests that diets rich in plant foods with small or minimal amounts of animal foods may be the remedy for modern life-style diseases.” Dietary guidelines for vegetarians could be developed with the aim of promoting the consumption of a variety and abundance of plant foods; primarily unrefined and minimally processed plant foods; optional dairy products, eggs, or both; and a generous amount of water and other fluids.
The concluding chapters on the historical context of vegetarianism and its relation to religion and spirituality are intriguing and provide new insights. Although the term “vegetarianism” was coined in the mid-1800s, the practice of abstinence from eating meat dates back, in Western society, at least to Pythagoras in southern Italy in the 6th century b.c. and to Zoroaster in Persia and Daniel in Babylon in the 7th century b.c. Prominent advocates of vegetarianism in America were Sylvester Graham, the leader of a 19th-century religious movement that called for temperance and the reform of health and hygiene practices, and John Harvey Kellogg, a 20th-century Seventh-Day Adventist who was trained as a physician and operated a Seventh-Day Adventist Sanitarium in Battle Creek, Michigan. He developed meat substitutes and other vegetarian health foods, including the breakfast cereals that have immortalized the family name worldwide.
Elaine B. Feldman, M.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.