Download Nutritional Aspectsof Vegetarianism, Health Foods,and Fad Diets

AMERICAN ACADEMY OF PEDIATRICS
Committee on Nutrition
Nutritional Aspects of Vegetarianism, Health Foods, and
Fad Diets
The
Commmittee on Nutrition
is concerned
about the recent increase in nutritional
that are potentially
hazardous
to the
children.
The
purpose
practices
health of
of this statememit
is to
discuss somne commmiiondietary patterns which may
be harmful and/or which may fail to provide the
@
promised
or anticipated
benefits. Such diets
imiclude those based on religion, life style, moral
its', or ecologic concerns (e.g., vegetarianism and
Zen macrobiotics),
and those in which special
virtues of a particular
food, foods, or nutrients are
exaggerated
(e.g. , organic,
natural,
and health
foods, or diets supplemented
with massive doses
of one or more vitamins).'
The Commmnittee urges
containing
meat.
The National
Academny
of
Sciences' Food and Nutrition
Board has empha
sized that even pure vegetarians
can be well
nourished if they select their diets carefully
provide sufficient calories, a good balance
essential
amino
calcium,
riboflavin,
by the medical community.
and
adequate
iron, vitamin
soumrces
D,
toward lower serum cholesterol levels.@ On the
other hand, the more stringent Zen macrobiotic
diet is likely to be hazardous
and leaves
less room
for modification.3
Pure Vegetarians and Vegans2367'°1'
A
problem
tendency
with
to be so high
vegetarian
diets
in bulk
they
that
is
the
may
not
mmeet caloric needs. Because of diminished
VEGETARIANDIETS
of
A, vitamin
and vitamin
Indeed, there are some nutri
tional benefits of a well-balanced
vegetarian
diet,
such as the rarity of obesity'
and a tendency
that claimms for benefit of special diets should be
subjected
to critical, scientific evaluation
before
acceptance
acids,
to
of
ries, protein
protein
is used as an energy
comitent equivalent
source;
cab
thus,
a
to the recommmended
Vegetarianism
with many individual
modifica
tions is popular, especially among adolescents
and
yoimng adults. Vegetarian
diets mmay be classified
as lactoovovegetarian
(plant
foods with dairy
daily allowance
(RDA) becomes mmarginal. There
are several ways to immprove protein
nutrition.
The quantity of protein in the diet is enhanced
by
products
using
and
eggs),
lactovegetarian
(plant
foods
with dairy products), or pure vegetarian (plant
foods only). The termn ‘¿
‘¿vegan'
‘¿
refers to a group of
individuals who not only eat pure vegetarian
diets
1)ut also share a philosophy
and life style.2 The
Zen macrobiotic
diet does not fit into this classi
fication and will be described
separately.
legumes
in
which
the
concentration
protein is high. The quality of vegetable
of
proteins
is immproved by combining
in each meal foods that
provide the essential amino acids in the optimmal
ratios. For example, cereal grains (such as wheat
and rice) are poor in the essential
amnino acid
lysine
and
can
be
effectively
combined
with
Many individuals and population groups have
practiced vegetarianism on a long-term basis and
legumes, such as varieties of dry beans, soybeans,
and peas, which have adequate lysine butt little
have
mnethionine.@l2
demmonstrated
diets supplemented
eggs
460
tend
to be
excellent
health . Plant-based
with milk or with milk amid
nutritionally
similar
to diets
When
the two foods are eaten
at
the same meal, they provide a miiixture of protein
that
is better
than
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PEDIATRICS Vol. 59 No. 3Downloaded
March 1977
either
alone.
The risk of other deficiencies
is decreased
if a
large variety of foods is used and undue reliance
are told of their
on a single cereal staple is avoided. An adequmate
mitmtrition, they
tiomially diverse
intake
of most vitamins,
minerals,
amid other
nutrients can be obtained with legumes (includimig
fortified soybeami formulas), whole-grain
products,
nuts,
seeds,
amid dark-green,
leafy
vegetables.
long-term
infant's
poor
consequences
growth
and of the
of protein-calorie
under
may adopt a lower, more numtri
and adequate
step of the diet.
Vitamin A
There are unsubstantiated
claims that extrenie
Legumes provide B vitaniins amid iron in additiomi
to relatively
concentrated
protein. Whole graimis
are a source of thiamine,
iron, and trace minerals
as well as carbohydrate
and protein.
Numts and
byhigh dosesof vitamin A (25,000to 50,000IU/
seeds
prevent
seriouts
contain
B
vitamimins
and
iron,
amid they
provide fat, which tends to be low in vegetarian
diets. Dark-green,
leafy vegetables
help to supply
adequate
calcium
and riboflavin,
which
are
lacking
when
dairy
products
are excluded.
Vitamin B,2 deficiency
occurs in pure vegetariami
diets after a variable period because this vitamiiimi
is derived exclusively
from animnal products.
The
deficiemicy can l)e avoided if vitamin B,2 supple
mentation
is provided
in tablet
form or imi
fortified plant foods such as vitamiiimi B,2-fortified
soy or nut “¿milks―
that are usually available
in
health
food stores.
Vitamin
simpplemnents are
acceptable
to most vegans.
Zen MacrobioticDiet
The Zen macrobiotic
diet@ ‘¿Â°
is perhaps
the
roost dangerous
of the cumrremit diets for growimig
children. The goals of this rigid miutritiomial system
are largely spiritual. Ten stages of dietary restric
tion progress
fromn —¿3to + 7, with gradual
elimmination of aninial products, fruits, amidvegeta
bles. The lower-level
diets can meet nutritional
mieeds,@ bitt the highest-level
diet is composed
only of cereals amid restricts
nimtritiomial balance
that is iiiherent in mnore diverse diets. In addition,
caloric intake is usumally low. Strict adherence
to
the niore rigid diets cami result fri scurvy, anemiiia,
h@poproteinemia,
li@pocalcemimia, emaciation,
or
even death. Self-treatmnent
of disease is comnmomi
miiedical
is discour
of acne amid to
infection.
Sutch high doses can produce
toxic
effects
in children,
inclumding
amiorexia, desqutamation
of the skin, increased
imitracranial pressutre, and X-ray changes
in the
lomig bones.@1@I Sufficient
vitamin
A for infants
amid children
warned'5
that
is present
in most diets. Caffey has
the hazards
of vitamin
A poisoning
fromn the
routine
prophylactic
feeding
of
comicentrates
of vitamins
A and D to healthy
infants
and children
who eat good diets are
considerably greater than the hazards of vitamin
A deficiency in healthy infants and children not
fed vitamnin comicentrates. Ingestion of 20,000 IU/
day or miiore for one or two months is likely to be
toxic. A joimit statement
of this Committee
and the
Committee
on Drugs discusses the use and abumse
of vitamnin A in detail.―
Vitamin C
Pauling
recommmended
a daily
dose of vitamiiimi
C between 1 and 5 gm for the prophybaxis of the
common cold.―This book has resumbtednot only imi
a surge of interest in vitamin C but also in its umse
imi enormiioums quantities
to prevent
colds. The
Comnmittee on Drimgs of the American
Academy
of Pediatrics
stated in 1971 that there was no
scientific evidence
that vitammin C in the doses
recommmended
by Pautling was either
safe or
efficaciouts for the prevention
of the conimnomi
cold.'
Simice that
timiie,
comitrolled,
double-blind
a nummber
of carefumlly
suggest
that
in this group,
@
aged. In 1971, the Council of Foods and Nimtrition
of the Ammerican Medical Associatiomi pointed oumt
the dangers of the Zen miiacrobiotic
diet.
Poor
the use of vitammin C has, at best, a small effect on
severity and duration of symptoms of the commomi
cold. The report
of a recent
conference
on
growth
vitamnimi C points
miiaimi chimiical fimiding in infancy.
exemmplified in a recent
had been
consultation
A are also used for the treatment
@
is the
and
day) imiiprove visual acuity in people who work in
either bright or dim light. Large doses of vitamin
report
of two infants
fed Kokoh (a Zen macrobiotic
as
and 6 kg, respectively),
below
standards,
the
third
reflectimig
a caloric
of the RDA.
Experience
use
macrobiotic
the
Zen
with
diet
of the
intake
that
some
C have not been proven to have widespread
usefulness as a cold remedy.22 Clearly, much more
research is needed to confirm whether vitamiiin C
has
indicated
Iowa
and concludes
is umsefuil in preventing
that large doses of vitamin
the
common
cold
amid to
determine
what harmful consequences
daily doses of the vitamin may have.
sumch large
Large doses
who
of vitammimiC can interfere
with
vitamin
that
absorption
in
was 40%
parents
these
food
amid their body lengths
percentile
among
studies
mixture for infant feeding) from birth to 7 and 14
months.'
They were sutbstantially
umnderweight (5
were
oumt discrepancies
who
they milaybe mnore acceptimig of nutritional advice
for their childreti than for themselves. If paretits
and
miietabolism
problemn may not be overcome
B,.
supplementation.23
man,
and
B,.
this
by extra vitamin
Healthy
adults
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AMERICAN ACADEMY OF PEDIATRICS
can
461
become
conditioned
to high
doses
of ascorbate
(0.5 to 1.5 gm/day) over a two-week period with
the result that they develop lower-than-normal
serum and leukocyte ascorbic acid values on
returning
to a normal
intake)4
A similar
phenom
enon in the fetus may explain the development
scurvy
in normally
fed offspring
of mothers
of
who
have ingested 400 mg of ascorbic acid daily
throughout pregnancy.25 Until more information
is
available,
people
substantially
should
be
cautious
in
exceeding the RDA for vitamin C.
D in amounts
much
greater
than the
RDA of 400 IU daily has been claimed to build
stronger bones, especially when the vitamin is
taken in its “¿natural―
form in fish liver oil. We
know of no evidence to support such claims. The
RDA is adequate for most infants and children
and provides an ample margin of safety, even
without
exposure
products
from animals
raised
on “¿natural―
feeds
and not treated with drugs such as hormones or
antibiotics. Natural foods are those made from
ingredients of plant or animal origin which are
altered as little as possible, and which contain no
synthetic
or artificial
ingredients
or additives.
Health food is a general term which seems to
encompass natural and organic foods. The term
Vitamin D
Vitamin
foods generally carry the following connotations.
Organic foods are plant products grown in soil
enriched with humus and compost on which no
pesticides, herbicides, or inorganic fertilizers
have been used, or they are meat and dairy
to sunlight.
Overuse
includes
conventional
foods
which
have
been
subjected to less processing than usual (such as
unhydrogenated
nut butters and whole-grain
flours) and less conventional
foods such as brew
er's yeast, pumpkin seeds, wheat germ, and herb
teas.
Nutritional Aspects
of vitamin
D in Britain and the European continent, with
intakes between 3,000 and 4,000 IU daily, is
believed to be rebated to the idiopathic hypercal
The nutritional value of foods that reach the
consumer depends not only on the composition of
the raw materials but also on various changes
cemia of infancy
which
seen relatively
frequently
during
and after World War 11.2 The disease became
quite
rare after
the dietary
intake
of vitamin
D
was reduced to less than 1,500 IU daily)'
stored
Vitamin E
Vitamin E has commanded much public atten
tion and controversy. High dietary intakes of
vitamin E have been claimed to prolong life,
increase sexual potency,
and prevent
such
diseases as mental retardation, heart disease, and
cancer. There is little or no basis for these claims.
The wide distribution of vitamin E in vegetable
oils and cereal grains makes deficiency in humans
unlikely.27 Vitamin
E supplementation
may be
necessary for persons with intestinal
malabsorp
tion, such as low-birth-weight
infants whose
absorption of the vitamin is often decreased for
the first 12 months of bife.2@In other situations, an
excess of vitamin E may be harmful, although the
evidence for this is scant. There is evidence, both
in man
excess
vitamin
and
in the
vitamin
experimental
E intake
K metabolism,
can
result
animal,
interfere
that
with
in a prolonged
prothrombin time, and predispose to bleeding)'
Excessive vitamin E intake in the experimental
animal decreases the rate of wound healing,'0 and
in man it has resulted in gastrointestinal symp
torus and creatinuria.°
HEALTH FOODS
The terms
462
SPECIAL DIETS
during
processing,
storage,
and
in an unprocessed
state.―― Variations
in
the nutrient content of raw foodstuffs will affect
the content of vitamins and minerals in the final
food product as much as, and sometimes more
than, the processing itself. For example, carrots
may vary 100-fold
in their concentration
of caro
tene (provitamin A), and samples of fresh tomato
juice have shown 16-fold differences in vitamin C
per serving. Although the data are somewhat
sketchy,
the raw foods being
produced
today
are
not significantly different in terms of vitamin
content from those produced two or more dec
ades ago.'4 The food preservation techniques in
greatest use today minimize the loss of nutritive
value of foods and are safe and well standard
ized.
There is no test to differentiate organically
grown and organically
processed food from
similar commercial products. Long-term studies
have failed to show the nutritional superiority of
organically grown crops in comparison with those
grown tinder standard agricultural
conditions
with chemical fertilizers.'@ If the soil is deficient
in nutrients, crop yield rather than the nutritional
quality of the plant will be primarily affected.
Other concerns about agricultural
practices
and food processing procedures may have more
validity
“¿organic,―
“¿natural,―
and “¿health―
occur
distribution. @2Nutritional losses occur whether
food is processed commercially or at home or is
(e.g., residual
meat, and pesticide
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hormones
and antibiotics
in
residue on dairy, fruit, and
vegetable products).'― In addition, the variety of
food additives in comniercial use is large, which
miiakes complete
screening
of such products
for
safety difficult for industry and federal agencies.'7
Each of these issues is complicated, unresolved,
and beyond the scope of this discussion. It is
apparemit
that concern
about
these issues is often
the basis for use of health foods despite their high
cost.
Organically
@
their
grown foodstuffs cost more than
nonorganic
counterparts.3s
In
survey i)y the U.S. Department
a
1976
of Agriculture
in
promoting, recreational
activity. Other nutri
tional practices of athletes may be harmful but
are not within the scope of this discussion.
CONCLUSION
Most individuals who adhere to unusual nutri
tional practices, except for balanced vegetariami
ism, are aware that their ideas run counter to the
mainstreamii of medical and nutritional
opinion.
Some adopt such diets as an expression of disilhm
sion with medicine or the “¿establishment.―
Physi
cians
amid other
the Washimigton, D.C., area, a market basket of 33
prepared
standard
foods bought
in a stmpermnarket cost
$17.49; :33 coumiterparts
labeled “¿organic―
cost
fromii $2:3.74 to $28.00 iii “¿natural―
food stores.―
The difference in cost (1½to 1% higher) for foods
pmmrchased in “¿health―
stores is of particular
concern for bow-inconie faniilies who miiay have to
skimp iii qttantity
or sacrifice other important
itenis iii the budget to afford health foods. At this
tinie, there is mio compelling
evidence
that the
high cost of these products results in concomitant
attempt
benefit to the comisumner.There are no standard
tests to identify
organic
foods; therefore,
the
consumiier is forced to rely on the integrity of the
fanner
and distributor
for assurance
that the
products were grown or prepared
as claimed.
athletes
diets
can
supplements
considered
for
as a separate
category of health foods.' ‘¿
There is a widespread
miiiscomiception that high-protein
diets improve
athletic performance.
This belief is the basis for
the imigestion of disproportionately
large amnotmnts
of rare red miieat amid milk by many athletes. In
additiomi, the belief has led to the use of special
protein
supplements,
spread
amiiong
which
is particularly
weight-lifters.
The
major
practices.
Parents
are
likely to resist the suggestion of major dietary
changes, and it is best to foctmson those features of
the diet that are of greatest potential harmii to
their childremi. However, even with the niore
extremne dietary
practices,
it is usually
possible
to
prevent serious harm by striving for dietary
variety and balance and working within the value
system
or philosophy
COMMITTEE
of the group
ON NUTRITION
LEWIS
A. BARNESS,
ALVIN
M.
ARNOLD
or individual.
(1976,
M.D.,
MAUER,
M.D.,
S. ANDERSON,
1977)
Clmainnan
Vice-Chairman
M.D.
PETER R. DALLMAN, M.D.
GILBERT
B. FORBES,
M.D.
ries
roughly
in
proportion
to
the
increased
expemiditure of energy. Ordinarily,
an
athlete will spontaneously
increase his food intake
to a degree that miieets caloric needs, that provides
niore than adequate protein, and that maintains a
relatively
constant weight. The requirement
for
protein does not increase with exercise, except to
a slight degree when niuscie mass increases. The
belief that honey has special merit as a carbohy
drate source for athletes has no scientific basis.
The intermittent
use of stringent diets for a
to miieet a lower weight
BUFORD
L. NICHOLS,
CHARLES
R. SCRIVER,
NATHAN
MYRON
JR.,
J. SMITH,
WINICK,
M.D.
M.D.
M.D.
M.D.
Consti itan ts
WmLLIA@I C.
HEIRD,
M.D.
0. L. KLINE,PH.D.
DONOUGH
O'BRIEN,
M.D.
dietary
is calories, and protein is rarely a
With exercise, the need for cab
wrestler
such
be
if they
wide
need of athletes
limriitimig factor.
increases
should
MARY JANE JESSE, M.D.
amid dietary
l)e briefly
to reverse
professionals
strong resistance
JAMESC. HAWORTH,
M.D.
Diets for Athletes
Special
health
to encounter
class is nutrition
ally unsound and seems unduly extreme if
comiipetitive athletics are to be viewed as a health
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Nutritional Aspects of Vegetarianism, Health Foods, and Fad Diets
Committee on Nutrition
Pediatrics 1977;59;460
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007.
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Nutritional Aspects of Vegetarianism, Health Foods, and Fad Diets
Committee on Nutrition
Pediatrics 1977;59;460
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication,
it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked
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Illinois, 60007. Copyright © 1977 by the American Academy of Pediatrics. All rights reserved. Print
ISSN: 0031-4005. Online ISSN: 1098-4275.
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