* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Nutritional Aspectsof Vegetarianism, Health Foods,and Fad Diets
Survey
Document related concepts
Malnutrition wikipedia , lookup
Diet-induced obesity model wikipedia , lookup
Organic food wikipedia , lookup
Food studies wikipedia , lookup
Malnutrition in South Africa wikipedia , lookup
Food politics wikipedia , lookup
Academy of Nutrition and Dietetics wikipedia , lookup
Low-carbohydrate diet wikipedia , lookup
Food choice wikipedia , lookup
Vegetarianism wikipedia , lookup
Vitamin D deficiency wikipedia , lookup
Human nutrition wikipedia , lookup
Transcript
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 from by guest on June 16, 2017 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 Downloaded from by guest on June 16, 2017 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 Downloaded from by guest on June 16, 2017 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 REFERENCES 1. Nutrition misinformation and food faddism. Nutr Rev :32(sllppl 1):Julv 1974. 2. McKenzie J: Profile on vegans. Pla,' Foods Iltim Nutr 2:79,1971. 3. National Research Council, Food a;.@I Nutrition Board, Committee on Nutritional NIisinformation: Vege tarian diets. Am J Clin Nutr 27' 1095, 1974. 4. \Vest RO, Hayes OB: Diet and ser,@,icholesterol levels: A comparison between vegetarians and non-vege tarians in a Seventh-Day .\d' e'itist Group. Am J Cliii Niitr 21:853, 1968. 5. Council on Foods and Nutrition: ‘¿Len macrobiotic diets. JAM:@ 218:397. 1971. 6. Register UI), Sonnenberg LM: The vegetarian diet: Sctentific and practical considerations. J Am Diet Assoc 62:253, 197:3. 7. Miller DS, Mumford P: The nutritive value of \Vestern Downloaded from by guest onAMERICAN June 16, 2017ACADEMY OFPEDIATRICS 463 vegan and vegetarian diets. Plant Foods Hum Nutr 2:201, 1972. 8. Erhard D: The new vegetarians: I. Vegetarianism and its medical consequences. Nutr Today 8:4, November December 1973. 9. Erhard D: A starved child of the new vegetarians. Nutr Today 8:10, November-December 1973. 10. Robson JRK, Konlande JE, Larkin FA, et a!: Zen macrobiotic 25. Cochrane WA: Overnutrition imiprenatal amid neonatal life: A probleni? Can Med Assoc J 93:893, 1965. 26. National Research Council, Food and Nutrition Board: Hazards of overuse of vitamimiD. Am J Chin Nutr 28:512,1975. 27. National Research Council, Food and Nutrition Board: Supplementation of hiumami diets with vitamimi E. Nutr Rev 32(suppl):Jul@ the premature 53:326, 1974. gestational age 11. Brown PT, Bergan JG: The dietary status of “¿new― Pediatr 79:581, vegetarians. J Am Diet Assoc 67:455, 1975. 29. H@pervitaminosis E 12. Harper AE, Benevenga NJ, Wohlhueter RM: Effect of 1975. ingestion of disproportionate amounts of amino acids. Physiol Rev 50:428, 1970. 13. Commnittee on Drugs and Nutrition: The use and abuse of vitamin A. Pediatrics 48:655, 1971. 14. Canadian Paediatric Society, Nutrition Committee: The use and abuse of vitamin A. Can Med Assoc J 104:521, 1971. 15. Caffey J: Chronic poisoning due to excess of vitamin A: Description of the clinical and roentgen manifesta tions in seven infants and young children. Pediatrics 5:672, 1950. 16. Pauling LC: Vitamin C and the Common Cold. San Francisco, WH Freeman & Co. 1970. 17. Committee on Drugs: Vitamin C and the common cold. Am Acad Pediatr Newsletter, vol 22, November 1, 1971. the common cold: A double blind trial. Can Med Assoc J 107:503, 1972. 19. Wilson CWM, Loh HS: Common cold and vitamin C. Lancet 1:638, 1973. 20. Coulehan JL, Reisinger KS, Rogers KD, Bradley DW: Vitamin C prophylaxis in a boarding school. N Engl J Med 290:6, 1974. 21. Anderson TW, Beaton GH, Corey PN, Spero L: Winter illness and vitamin C: The effect of relatively low doses. Can Med Assoc J 112:823, 1975. 22. Second conference on vitamin C: VI. Ascorbic acid and respiratory illness. Ann NY Acad Sci 258:498, 1975. 23. Herbert V, Jacob E: Destruction of vitamin B,2 by acid. JAMA 230:241, 1974. 24. Rhead WJ, Schrauzer GN: Risks of long-term ascorbic acid overdosage. 464 anemia in infamit: II. Relationships 1)etweemi and absorption 1971. and coagulation. of vitamiiin E. J Nutr Rev :3:3:269, 30. Ehrlich HP, Tarver H, Hunt TK: Inhibitory effects of vitamin E on collagen synthesis amidwoumid repair. Ann Surg 175:235, 1972. 31. Hillman RW: Tocopherol excess iii mali: Creatinuria associated with prolonged ingestion. Am J Clin Nutr 5:597, 1957. 32. Instittmte of Food Technologists, Safety and Nutrition Expert Panel on Food amid the Comiimittee on Public Information: The effects of food processing omi nutritional values. Nutr Rev 33: 123, 1975. 33. Nesheim RO: Nutrient changes imifood processing: A current review. Fed Proc 33:2267, 1974. 34. Institute of Food Technologists, Expert Panel on Food Safety and Nutrition and the Committee on Pimblic Information: The effects of food processing on 18. Anderson TW, Reid DBW, Beaton GH: Vitamin C and ascorbic 1974. 28. Melhorn DK, Gross 5: Vitamin E-dependent dietary problems in infancy. Pediatrics Nutr Rev 29:262, 1971. SPECIAL DIETS nutritional values. Food Technol 28:77, 1974. 35. Alther L: Organic farmiiing omi trial. Natmmral History 81:16,1972. 36. Hayes \VJ: Recognized and possible exposure to 1)esti cides, in Toxicolog@' of Pesticides. Baltimore, Mary land, \Villiamiis& Wilkimis,1975, p 265. 37. Kerniode GO: Food additives. Sci Amii 226(No. :3(15, 1972. 38. Jukes TH: The orgamiic food nivth. JAMA 230:276, 1974. 39. Fomon SJ, AndersomiTA (eds): Practices of Low Imicomiie Families in Feeding Government Infamits. Washington, D.C., U.S. Printing Office, 1972. 40. Cromwell C: Organic Foods: An Update. Famiiily Economics Review. Agricultural Research Service, U.S. Department of Agriculture, 1976, pp 8-11. 41. Van Itallie TB, Sinisterra L, Stare FJ: Nutrition and athletic performiiance. JAMA 162:1 120, 1956. Downloaded from by guest on June 16, 2017 Nutritional Aspects of Vegetarianism, Health Foods, and Fad Diets Committee on Nutrition Pediatrics 1977;59;460 Updated Information & Services including high resolution figures, can be found at: /content/59/3/460 Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: /site/misc/Permissions.xhtml Reprints Information about ordering reprints can be found online: /site/misc/reprints.xhtml 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. Copyright © 1977 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275. Downloaded from by guest on June 16, 2017 Nutritional Aspects of Vegetarianism, Health Foods, and Fad Diets Committee on Nutrition Pediatrics 1977;59;460 The online version of this article, along with updated information and services, is located on the World Wide Web at: /content/59/3/460 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. Copyright © 1977 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275. Downloaded from by guest on June 16, 2017