Vegetarian Diets

No Meat, Plenty of Benefits

Ruth Heidrich is arguably one of the world's healthiest women. A marathoner and Ironman triathlete, she competes in an average of 50 races annually. And she's broken at least one world fitness record.

She wasn't always so healthy.

"I used to think that I was one of the world's healthiest people--I had given up red meat, and I was running," says Heidrich, who has a Ph.D. in health management, nutrition and exercise. "But then, at age 47, I found out that I had breast cancer."

While recuperating from cancer surgery, Dr. Heidrich met John McDougall, M.D., tireless advocate of meatless eating and author of The McDougall Program and The New McDougall Cookbook, and she soon became a strict vegetarian, eating no animal food whatsoever. And that, she says, made all the difference. She set her sights on the triathlon shortly after and hasn't stopped moving since.

"The cancer never recurred and I've never felt this good in my life," says Dr. Heidrich.

On a typical day, she cycles, swims or runs for two to three hours, writes and lectures on the merits of the meatless life. She has published two books, A Race for Life: From Cancer to Ironman and A Race for Life Cookbook. "It's the healthiest way to eat," she says.

THE BENEFITS KICK IN IMMEDIATELY

The vegetarian way may well be the healthiest way for everyone to eat. By far, the best documented health benefit of vegetarianism is a reduced risk of heart disease, the number one cause of death among women. Numerous studies find that vegetarians run a lower risk of heart disease than meat-eaters do.

A number of factors seem to come into play: First, women who eat a vegetarian diet are less likely to be overweight. They have lower blood cholesterol levels because their diets tend to be lower in total fat, saturated fat and dietary cholesterol. And vegetarians eat more fiber, which has been shown to lower cholesterol levels.

Research also suggests that the plant protein on which vegetarians rely--found in soybeans and other legumes--has an edge over the animal protein that nonvegetarians eat, at least as far as heart protection goes. Why? Animal protein is high in lysine, an amino acid that speeds up cholesterol production in the body. Soybeans, on the other hand, are low in lysine and high in arginine and glycine, two different amino acids that don't have this effect.

Vegetarians also tend to have lower blood pressures than meat-eaters do. In one study, 500 men and women who enrolled in an intensive program--a low-fat vegetarian diet, moderate exercise and stress reduction--saw their blood cholesterol levels drop an average of 11 percent in just 12 days. That wasn't all. Their blood pressures sank 6 percent, and their weight fell an average of 2.2 pounds.

Even if you've been eating meat for 40 years, a switch to vegetarianism can do your heart good, says Erica Frank, M.D., assistant professor of family and preventive medicine at Emory University School of Medicine in Atlanta. In one study, a team of researchers at the University of California in San Francisco put men and women with heart disease on a very low fat vegetarian diet and an exercise and stress-reduction program. The regimen actually slowed or decreased the progression of the disease.

The benefits don't stop there. Some studies suggest that a vegetarian diet may offer protection against some cancers. An Asian study found that the Chinese, who eat an average of one ounce of meat per day and no dairy products, have a breast cancer death rate of 8.75 per 100,000 women (compared to 43.9 for American women) and 23.4 deaths per 100,000 people for lung cancer (compared to 80.4 for Americans). Research makes a strong case for protection against lung cancer. Some evidence shows that vegetarianism may protect against colon and breast cancer, too.

Again, a number of factors seem to play a part. Vegetarian diets are usually rich in fruits and vegetables, which in turn are rich in antioxidants--nutrients that protect cells from damage wrought by cancer-causing substances. Plus, vegetarian fare tends to be low in fat, and some research hints at a dangerous link between high fat intake and some cancers. Finally, there's the high fiber content of vegetarian meals. Fiber seems to reduce the risk of colon cancer, scientists speculate, by diluting potentially harmful bile acids in the digestive tract.

A vegetarian diet can also be kind to your bones. Research finds that vegetarians may run a lower risk of osteoporosis than carnivores. Why? They're less likely to overdo it on protein, says Randall White, M.D., adjunct assistant professor of human and natural ecology at Emory University. Excess protein prompts the body to excrete calcium, an important bone-building mineral, he explains.

Finally, vegetarianism may help ease the symptoms of rheumatoid arthritis. In a few Scandinavian studies, people with arthritis who switched to vegetarian diets after brief fasts reported less pain, stiffness, joint tenderness and swelling than those eating meat.

Women who adopt a vegetarian diet seem to benefit whether they're lacto-ovo vegetarians--who eat eggs and dairy but no other animal food--or vegans (pronounced vay-gun or vee-gun)--who eat no animal products whatsoever. A lacto-ovo vegetarian diet can be just as healthy as a vegan one, as long as it includes only moderate amounts of eggs and dairy and not too much fat, says Reed Mangels, R.D., Ph.D., nutrition adviser to the Vegetarian Resource Group based in Baltimore.

"At virtually any age, if you decide to go on a lacto-ovo vegetarian or vegan diet, it will improve your health," Dr. Frank concludes.

BUSY WOMEN CAN GO MEATLESS

Estimates put the total number of adult American vegetarians--vegans plus lacto-ovo vegetarians--at roughly 12.4 million. According to one poll, nearly 70 percent of the total are women. Surprised? Dr. Mangels isn't.

"I think more women are vegetarians largely because they're usually the health care gatekeepers in families," she says. "In general, we tend to know more about food than our spouses, and we seem to be more health conscious."

Whether you take the vegan or lacto-ovo route, the vegetarian way is easier than ever, says Dr. Mangels. Responding to demand, food manufacturers offer all sorts of vegetarian fare. Many vegetarian foods are based on soybeans, a versatile legume that serves as a nutritious alternative to meat and dairy products. Today, most supermarkets carry not only soy milk and tofu (soybean curd) but also veggie burgers and meatless breakfast links (sometimes called soysage), soy lunchmeats, soy hot dogs, soy cheese and soy ice cream as well as egg substitutes and a wide selection of frozen vegetarian entrées.

"There are great resources out there--a huge supply of supermarket foods that simply didn't exist when I became a vegetarian years ago," marvels Jennie Collura, president of the North American Vegetarian Society in Dolgeville, New York.

Contrary to popular belief, it's easy to get the protein that you need from a vegetarian diet. In fact, the American Dietetic Association finds that vegetarians usually meet or exceed requirements for protein.

It is true, however, that only animal protein--found in meat, dairy, eggs and the like--contains a good ratio of the amino acids that your body needs to produce hormones and enzymes and build muscle. Individually, neither legumes nor grains nor seeds contain an ideal ratio of the necessary amino acids in sufficient quantity. Combine them, though, and they'll give you everything that you need. And you don't have to combine them in the same meal. Eating legumes and grains or nuts and legumes over the course of a day or two will do the trick, says Dr. White.

Here's how to get started.

Stock up on beans and peas. Look to staples such as chili, bean burritos, baked beans and split pea soup for the "meat" in your diet, says Dr. Mangels. The American Dietetic Association suggests that women who are vegetarians aim for two to three servings a day of high-protein legumes, namely beans, lentils, soy food and peas.

Serve soy. Make at least one of your servings of legumes a soy food, like tofu or soy milk, suggests Mark Messina, Ph.D., nutritionist in Port Townsend, Washington, author of The Simple Soybean and Your Health and co-author of The Vegetarian Way. Studies suggest that soy may offer added protection against heart disease and some types of cancer and may help alleviate menopausal symptoms, he explains.

Load up on grains, fruits and vegetables. Whether you elect a vegan diet or include eggs and dairy, try to eat at least six servings of grain products, four or more servings of vegetables and at least three servings of fruit daily, nutritionists advise.

Think variety. Every food brings its unique combination of nutrients to the table, say nutrition researchers. When choosing produce, be a colorful shopper--pick up dark leafy greens for bone-building calcium and the B vitamin folate, deep yellow fruits and vegetables for beta-carotene and related disease-fighting substances, and citrus fruits or other produce, like oranges, green peppers and strawberries, for vitamin C.

Keep track of milk and eggs. If you're a lacto-ovo vegetarian, nutritionists say, you can serve yourself up to three servings of dairy products, like skim milk and nonfat yogurt, each day and up to four whole eggs weekly. (All the fat and cholesterol in eggs are in the yolks, so use mostly whites). If you're a vegan, give yourself extra servings of breads, cereals, vegetables and fruits instead of those eggs and dairy.

NUTRIENTS TO WATCH OUT FOR

Women vegetarians need to take a few extra steps to make sure that they're getting all the nutrients they need, says Barbara Deskins, R.D., Ph.D., associate professor of clinical dietetics and nutrition at the University of Pittsburgh. If you swear off meat, follow this advice.

'C' that you get iron. Red meat is a particularly good source of heme iron, the most easily absorbed form. Spinach, beans and other plant food contain smaller amounts of iron, all in the form of nonheme iron, which is less easily absorbed. But research shows that vitamin C helps your body absorb nonheme iron. So if you don't eat meat, nutritionists recommend that you boost your absorption of nonheme iron by eating iron-rich plant food like soybeans, lentils or other dried beans, or dark leafy vegetables such as spinach or kale, as well as foods high in vitamin C, like peppers, tomatoes and citrus fruits.

Serve yourself some cereal. Ready-to-eat cereal is usually fortified with both iron and vitamin C. "So an easy way to get the iron that you need is to eat fortified cereal every day," says Dr. Deskins.

Keep tabs on iron intake. Before menopause, women need 15 milligrams of iron daily. So keep track of your intake, says Dr. Deskins. If tallying up your daily iron intake is inconvenient, ask your doctor whether you should take a multivitamin/mineral supplement with iron. Once you're past menopause, though, your iron needs and odds of developing a deficiency drop considerably, so you really don't have to keep tabs then, she says. But you'll want to consult your doctor to decide if you should continue taking a multivitamin.

Watch that zinc. You'll find zinc in both plant food, like cooked beans, and animal food, like roast beef and pork chops. Like iron, however, the zinc in plant food isn't nearly as plentiful or well-absorbed as the zinc in animal food. So you'll either have to keep a tally of the zinc that you get from the food you eat (something few of us have the time to do) or take a multivitamin/mineral supplement, says Dr. Deskins. Look for a supplement offering between 50 and 100 percent of the Recommended Dietary Allowance (RDA), which is 12 milligrams, for zinc.

FOR VEGANS ONLY

If you go the vegan route and steer clear of dairy and eggs, you'll have to keep track of a couple more nutrients.

Bank on tofu, orange juice and soy milk for calcium. A cup of skim milk (one of the richest sources of dietary calcium available) supplies 302 milligrams of calcium. In comparison, a 3 1/2-ounce serving of broccoli (one of the richest plant sources of calcium) contains 205 milligrams of calcium. So on a vegan diet, it's harder for women to consume the amount of calcium considered optimal for good health (1,000 milligrams a day for most women ages 25 to 50; 1,200 to 1,500 milligrams a day if you're pregnant or nursing; and 1,500 milligrams a day if you're past menopause).

Dr. Mangels recommends that vegans consume at least three servings of calcium-rich nondairy foods daily. Calcium-fortified tofu, calcium-fortified orange juice and calcium-fortified soy milk are particularly good sources. (Read labels for actual amounts.) In addition to broccoli, kale, collard and mustard greens can supply useful amounts of additional calcium. If you're worried that you may not be getting enough calcium from the food that you eat, consider a supplement, advises Dr. Mangels.

In the long run, though, you can probably keep your bones strong and healthy with less calcium than the average omnivore--a person who eats both plants and animals. Why? Because you're less likely to eat excess protein, which prompts your body to excrete calcium, explains Dr. Frank.

Look to fortified soy milk for vitamin D. As it turns out, fortified dairy products or fortified cereal are also reliable sources of vitamin D, needed for fracture-resistant bones. Your skin will synthesize this vitamin when exposed to the sun. (Full-strength sunscreen, however, prevents this synthesis.) Unless you live in a sunny locale and spend at least 15 to 30 minutes outside every day, you'll need a reliable food source, Dr. Mangels says. Or choose a multivitamin/mineral supplement.

Look for nutritional yeast with B₁₂. Found almost exclusively in animal products, B₁₂ is a key player in your body. It plays a role in the production of blood and DNA and helps keep your nervous system running well. You can find B₁₂ in fortified soy milk and cereals and a special cheesy-tasting yeast called Red Star Nutritional Yeast T6635. Use the yeast the way that you would Parmesan cheese, says Dr. Mangels. Two teaspoons a day should get you the RDA for vitamin B₁₂--two micrograms a day, for women.

"A lot of fermented soy food, like tempeh and miso (a soybean paste used for soup), are touted as having B₁₂, but they're not reliable sources," Dr. Mangels cautions. If you're not good at keeping tabs, take a multivi-tamin that gives you the RDA for B₁₂.

Pregnant? Pay attention. A well-planned lacto-ovo or vegan diet is fine during pregnancy, says Charles Mahan, M.D., professor of obstetrics and gynecology at the University of South Florida in Tampa. Just make sure that you talk to your obstetrician about what you're eating. If you're a vegan, have a registered dietitian analyze your diet and make sure that it includes everything you and your baby need, he says.

While you're pregnant and nursing, you'll need more protein, calcium and B vitamins (folate, riboflavin, thiamine and niacin), says Dr. Deskins. "Adding another glass of low-fat milk or calcium-fortified soy milk would be a good idea because that adds calcium, protein and thiamine," she says. "In addition, you might have another half-cup of legumes since most are excellent sources of folate (a B vitamin essential for normal fetal growth), or have another serving of vegetables or fruits (also rich in folate)."

AN EASY TRANSITION

If you'd like to try a vegetarian diet, here's some advice on making a smooth transition.

Jump in--or pace yourself. If you're the type who likes to make big changes all in one fell swoop, you can switch to a vegetarian diet overnight, says Dr. Frank. But if you like gradual transitions, take it slow.

Go slow. If you're used to eating a lot of refined foods, such as white bread, lunchmeat and chips, take it slow, suggests Dr. Deskins. Unlike most vegetarian fare, refined foods are low in fiber. Abruptly increasing your fiber intake may cause intestinal gas and bloating. By slowly increasing your consumption of high-fiber whole grains, legumes, seeds and nuts, you're less likely to feel uncomfortable, she says.

Start with a couple of meatless days each week. If you're accustomed to planning your menus around meat, get used to two meatless meals a week, then move to three and beyond, suggests Suzanne Havala, R.D., registered dietitian in Charlotte, North Carolina, and nutrition adviser to the Vegetarian Resource Group.

Make your favorite foods--without meat. Stumped for meatless meal ideas? "Make a list of meatless dishes that you already eat, like baked beans or pasta with tomato sauce, and make those more often," Havala suggests. Other popular options include vegetarian chili, meatless lasagna and pizza with mushrooms, onions and peppers instead of sausage or pepperoni.

Substitute. To diversify, start substituting vegetarian versions for other favorites. Trade veggie burgers for beef patties, soy franks for hot dogs, bean burritos for the beefy variety, "soysage" for sausage, and pasta with tomato and basil sauce for linguine bolognese, Dr. Mangels suggests.

Prepare dishes without fat. A vegetarian diet isn't automatically low in fat or cholesterol. Look for low-fat and nonfat cheese, tofu and tempeh and fat-free mayonnaise and other spreads. Don't fry your food--bake, broil and steam instead, says Dr. Mangels.

Go easy on nuts. Nuts, seeds and nut butters are good sources of protein, but they're also high in fat, so eat them in moderation, Dr. Deskins says. Use no more than two tablespoons of peanut butter on your sandwich. Eating nuts? Call it quits after a quarter-cup.

Avoid junk food. Loading up on baked goods, chips and sweet treats will pack on extra fat and calories, canceling some of the benefits of a vegetarian diet. So limit junk food, says Dr. Mangels.