Heart Healthy Diets: The Vegetarian Way

Heart Healthy Diets

Heart healthy diets are low in saturated fat, low in cholesterol, low to moderate in fat, and high in fiber. A vegetarian diet can easily meet these guidelines. Vegetarians do not eat meat, fish, or poultry.

Heart-Healthy Cooking

* Here are guidlelines for heart-healthy cooking:

• Sauté in water instead of oil or use small amounts of olive or canola oil.

• Use low-fat cooking methods like:
  • broiling
  • steaming
  • roasting
  • baking
  • poaching
  • boiling
  • stir-frying with little or no oil.

• When baking, cut the oil, butter, or margarine in half and replace it with water, juice, applesauce, or puréed prunes.

• Replace whole eggs with bananas, tofu, applesauce, or egg replacers (such as Ener-G Egg Replacer).

Heart-Healthy Shopping

* Here are guidelines for heart-healthy shopping:

• Buy more fruits, vegetables, whole grains, legumes, and, if desired, fat-free milk products.
• Buy snacks like popcorn (air pop and serve plain or with a drizzle of olive oil or melted margarine), fresh fruits and vegetables, rice cakes, and pretzels instead of chips, crackers, and cookies that are high in hydrogenated fats.
• Buy whole grain breads and cereals that are high fiber. Limit low fiber refined breads and cereals and high fat products like most croissants, muffins, and granola cereal.
• Buy fat-free or low-fat milk instead of reduced fat (2%) or whole milk, if you use milk.
• Buy plain fresh or frozen vegetables instead of vegetables in cheese, cream, or butter sauces.
• Use nutrition labels to help choose foods lower in saturated fat, cholesterol, and fat.

Heart Healthy Eating Out

* Here are guidelines for heart-healthy eating out:

• Choose foods like pizza without cheese, stir-fried dinners (request that they be made with little oil), steamed vegetables, pasta and tomato sauce, plain baked potatoes, vegetable-based soups, low-fat cottage cheese, and fruit or sorbet for dessert. At salad bars, choose lots of fresh vegetables and fruits; avoid mayonnaise-based salads such as most potato salads and coleslaw, salad dressings unless low-fat, cheese, and regular creamed cottage cheese.
• Ask that dressings and sauces be served on the side so you can control the amount you eat.
• Talk to the chef and explain that you want foods prepared with little fat.

Saturated vs. Unsaturated Fats

Saturated fats and trans fatty acids are the kinds of fats most likely to cause heart disease. Saturated fats are found mainly in animal products (eggs, butter, cheese, whole milk, and whole milk products), and in coconut, palm, and palm kernel oil. Trans fatty acids appear in foods containing hydrogenated fats like margarine and crackers. To reduce the risk of heart disease, replace saturated fats with unsaturated fats like canola oil, olive oil, flax seed oil, nuts, avocado, soy products, and nut butters. Choose margarine, cookies, crackers, and snack foods that do not contain hydro-genated fats (read the label).

Is Cholesterol Found in Foods Vegetarians Eat?

Cholesterol is found in foods from animals. Eggs and dairy products do have cholesterol. Grains, legumes, nuts, fruits, vegetables, and vegetable oils do not have cholesterol or only contain insignificant amounts. We do not need any cholesterol in our diets since our bodies can make all the cholesterol we need. High blood cholesterol levels are associated with diets high in saturated fat and cholesterol.

Fiber

Fiber is found only in plant foods. A vege-tarian diet featuring fruits, vegetables, whole grain breads and cereals, and dried beans will be high in fiber. Oats, carrots, fruits, and beans are especially high in one kind of fiber that helps to lower blood cholesterol.

Saturated fat, cholesterol, fiber — Does this sound like too much to think about? Try to make food choices that emphasize whole grains, dried beans, vegetables, and fruit. If you do this and follow a vegetarian diet, you'll find that, without much effort, your diet will be low in saturated fat and cholesterol and high in fiber.

How Much Fat Should We Eat?

Experts do not agree about the ideal level of dietary fat and, in fact, there may not be just one ideal level. A reasonable goal for most people would be to have saturated fat pro-viding no more than 8-10% of calories and a total fat intake between 15 and 30% of total calories. Fat intakes at the higher end of this range, when the fat is monounsaturated fat (nuts, seeds, olive oil, canola oil, avocado), may be a better choice than restriction of all types of dietary fat. Fat should not be limited in children less than 2 years. After 2 years, children should gradually limit dietary fat so that by around age 5, between 20 and 30 per-cent of calories come from fat. This type of diet should be used throughout childhood and adolescence.

In practical terms, what does 30% or less of calories from fat mean?

If you usually eat this many calories:	Your fat intake should be no more than:	Your saturated fat intake should be no more than:(gms)
1600	53 grams	17 grams
2000	66 grams	22 grams
2200	73 grams	24 grams

The following table shows the amount of fat in many foods vegetarians eat. To find out how much fat is in other foods you buy, you will need to read labels.

Keep a record of how much fat you eat for a week or two. Do you need to change your eating habits?

FAT IN SELECTED VEGETARIAN FOODS

Food	Saturated fat (gm)	Fat (gm)
Butter, 1 pat	2.5	4
Margarine, soft, 1 pat	0-1	4
Salad dressing, creamy, 2 Tbsp	1-2	10
Vegetable oil, 1 Tbsp	1	14
Nuts and Seeds, 1 oz	2	16
Peanut butter, 1 Tbsp	1	8
Cooked beans, 1 cup	0	1
Egg, 1 large	1.5	5
Fat-free milk, 1 cup	Trace	Trace
Soy milk, 1 cup	0	3-5
Whole milk, 1 cup	5	8
Cheese, 3 ounces	18	28
Fruit, 1 medium	0	0
Grains, cooked, 1 cup	0	1
Vegetables, 1 cup	0	0-1
Bread, 1 slice	Trace	1
Potato Chips, 1 oz	3	10
French fries, 10	2	8
Olive, 1 large	Trace	<1
Avocado, half	2	15

CHOLESTEROL IN VEGETARIAN FOODS

Food	Cholesterol (mg)
Butter, 1 pat	11
Egg, 1 large	212
Nonfat milk, 1 cup	4
Whole milk, 1 cup	33
Cheese, 3 oz	90
Soy milk, fruit, vegetables, grains dried beans, nuts	0

What About Soy?

Soy foods like tofu, tempeh, meat analogs, soy milk, and other products appear to help reduce the risk of heart disease. This may be because of plant estrogens, called isoflavones, found in soy products or may be due to the cholesterol-lowering effect of soy protein. In any case, in-cluding a serving or two of soy products daily can enhance a heart healthy vegetarian diet.

Vitamin B12 and Heart Disease

Adequacy of vitamin B12 appears to be important in reducing heart disease risk. Vegetarians with low blood vitamin B12 levels appear to have higher levels of a substance called homocysteine, associated with in-creased risk of heart disease. To insure adequate intakes of vitamin B12, vegetarians who eat little or no animal-derived products should use a reliable source of vitamin B12 like fortified soymilk, Vegetarian Support Formula nutritional yeast, fortified breakfast cereal, or a vitamin B12 supplement daily.

Anything Else?

Vitamin C, vitamin E, beta-carotene, and flavonoids also appear to be important in the prevention of heart disease. Vitamin C is found in citrus fruits and juices, cantaloupe, broccoli, and tomatoes. Vegetable oils, dark green vegetables, nuts, avocados, and whole grains provide generous amounts of vitamin E. Good sources of beta-carotene include orange and dark yellow vegetables like carrots, winter squash, and pumpkin. Flavonoids are found in fruits, vegetables, grape juice, and tea. Nuts appear to reduce risk of heart disease.

Sacred Heart Medical Diet

This 7-day eating plan can be used as often as you like. If correctly followed, it will clean out your system of impurities and give you a feeling of well-being. After only 7 days of this process, you will begin to feel lighter by at least 10 pounds and possibly 17 pounds, and experience an abundance of energy.

SOUP:

• 1 or 2 cans of stewed tomatoes
• 3 plus large green onions
• 1 large can of beef broth (no fat)
• 1 pkg. Lipton Soup mix (chicken noodle)
• 1 bunch of celery
• 2 cans green beans
• 2 lbs. Carrots
• 2 Green Peppers

Season with salt, pepper curry, parsley, if desired, or bouillon, hot or Worcestershire sauce. Cut veggies in small to medium pieces. Cover with water. Boil fast for 10 minutes. Reduce to simmer and continue to cook until veggies are tender.

This soup can be eaten anytime you are hungry during the week. Eat as much as you want, whenever you want. This soup will not add calories. The more you eat, the more you will lose. You may want to fill a thermos in the morning if you will be away during the day.

DRINKS:

• Unsweetened juices
• Tea (also herbal)
• Coffee
• Cranberry juice
• Skim milk
• Water, water, water

DAY ONE

Any fruit (except bananas). Cantaloupes and watermelon are lower in calories than most other fruits. Eat only soup and fruit today.

DAY TWO

All vegetables. Eat until you are stuffed with fresh raw, cooked or canned veggies. Try to eat green leafy veggies and stay away from dry beans, peas or corn. Eat veggies along with the soup. At dinnertime tonight reward yourself with a big baked potato and butter. Don't eat any fruits through today.

DAY THREE

Eat all the soup, fruit and veggies you want. Do not have a baked potato. If you have eaten as above for three days and not cheated, you should find that you have lost 5-7 pounds.

DAY FOUR

Bananas and skim milk: Eat at least 3 bananas and drink as much milk as you can today, along with the soup. Bananas are high in calories and carbohydrates, as is the milk but on this particular day, your body will need the potassium and carbs. Proteins and calcium to lessen the cravings for sweets.

DAY FIVE

Beef and tomatoes: you may have 10 to 20 ounces of beef and a can of tomatoes, or as many as 6 tomatoes on this day. Eat the soup at least once today.

DAY SIX

Beef and veggies, eat to your heart's content of the beef and veggies today. You can even have 2-3 steaks if you like with green leafy veggies but no baked potato. Be sure to eat the soup at least once today.

DAY SEVEN

Brown rice, unsweetened fruit juice and veggies, again, be sure to stuff yourself and eat the soup. You can add cooked veggies to your rice if you wish.

By the end of the 7th day, if you have not cheated on this diet, you should have lost 10 to 17 pounds. If you have lost more than 17 pounds, stay off the diet for two days before resuming the diet again.

This diet is fast. The secret lies within the principle that you will burn more calories than you take in. It will flush your system of impurities and give you a feeling of well-being. This diet does not lend itself to drinking any alcoholic beverages at any time. Because of the fat build-up in your system. Go off the diet at least 14 hours before any intake of alcohol.

Due to the variety of digestive systems in individuals, this diet will affect everyone differently. After day three, you will have more energy than when you began, if you do not cheat. After being on the diet for several days, you will find that your bowel movements have changed. Eat a cup of bran or fiber. Although you can have black coffee with this diet, you may find that you don't need caffeine after the third day.

The basic fat burning soup can be eaten anytime you feel hungry during the seven days. Eat as much as you wish. Remember the more you eat, the more you will lose. You can eat broiled, boiled or baked chicken instead of the beef. Absolutely no skin on the chicken. If you prefer, you can substitute broiled fish for the beef on only one of the beef days. You need the high protein in the beef for the other days.

Continue on the diet as long as you wish and feel the difference both mentally and physically.

DO NOT - DO NOT

No bread, alcohol, carbonated drinks (including diet drinks). Remember, absolutely no fried foods.

DO - DO - DO - DO

Drink plenty - at least 6 to 8 glasses - of water a day, as well as any combination of the following beverages: black coffee, unsweetened fruit drinks, cranberry juice and skim milk.

This diet comes from the Sacred Heart Memorial Hospital that is used for overweight heart patients in order to lose weight rapidly, usually prior to surgery.

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Vitamin C

Vitamins, Health & Weight Loss
Good diet nutrition is essential for optimum health - including efficient metabolism, stable blood sugar levels and appetite, all of which affect weight control and how fast we lose weight. Vitamins play an essential role in diet nutrition and weight control.

Most animals make their own vitamin C.
Unfortunately, like guinea pigs and apes, we can't, so we have to get it from food.

How Vitamin C helps

Boosts immunity
Fights infection
Protects against cancer
Helps to protect against heart disease, arthritis and diabetes
Improves iron absorption from food
Good for bones and teeth
May help to overcome male infertility

Good food sources of Vitamin C

Blackcurrants, broccoli, green peppers, kiwi fruits, Brussels Sprouts, lemons, oranges, strawberries, cabbage. All other fruits and vegetables.

Enemies:
60 per cent destroyed by heat. Also lost in cooking water unless reused. So to maximise your intake of vitamin C, eat raw vegetables, fruits and salads.

Deficiency symptoms of Vitamin C

Bleeding gums. Loosening of teeth. Increase in colds and flu. Cuts/infections take longer to heal. Weakness and lethargy. Irritability. Insomnia.

People with an increased risk of Vitamin C deficiency include

Smokers (NB. each cigarettes robs us of approx 25 mg of vitamin C)
City dwellers or anyone subject to pollution
Heavy drinkers
Women on the pill
People who take aspirin, antibiotics, anti-arthritic drugs
Those under stress
Athletes
The elderly.

Recommended daily allowance for Vitamin C

US RDA: 60mg
EU RDA: 60mg

The Importance of a Balanced Diet
If you have been a regular follower of fad diets, regular fasting, single food diets, yo-yo dieting or diet/weight loss pills, you may already be deficient in vitamins and minerals. This may be why you find it difficult to lose weight, or sustain weight loss in the long term.

Solution: Follow a balanced diet that offers slow steady weight loss and includes advice on exercise. Anne Collins Weight Loss Diet Program is a good choice.

Vegetarian Diets

Vegetarians vs Meat Eaters

Which is Better?
Vegetarian diets typically consist of fruits, vegetables, and whole grains. If a vegetarian does not include vegetable proteins (soy, tofu, etc.) and does not carefully plan meals to ensure consumption of all essential nutrients, deficiencies may occur.

• Vegetarian diets are high in: vitamin C, fiber and folate.
• Vegetarian diets are low in: calcium, protein, iron, zinc and vitamin B-12

It is possible to obtain all essential nutrients by eating a completely plant-based diet, however the planning is critical to the health. Poorly planned diets can lead to nutrient deficiencies. As always, it is also important that we base our dietary decisions on scientific evidence rather than on myths and misconceptions.

What are the advantages and disadvantages to being a vegetarian (no animal products)?

Disadvantages:
Vegetarians (vegans) have difficulty consuming enough of the following nutrients:

• Vitamin B-12
  Found in animal products only, fortified cereals, soy products
• Vitamin D
  Found in milk, margarine, soy milk & cereals
• Iron & zinc
  Besides meats, poultry, chicken & fish, these nutrients are found in: whole grain foods, soy foods, beans, dried fruits, nuts and seeds. Consuming foods high in vitamin C with iron foods will help to increase the absorption of the iron.
• Calcium
  Studies have found that diets of vegetarian children are most likely deficient in calcium. Excellent sources of calcium include milk, yogurt and cheese. Plant products include: cereals, juices, beans, tofu, soy foods, dried figs and almonds.

Vegetarianism is not recommended for young children because it is extremely difficult for them to consume the nutrients they need in adequate amounts for optimal growth without consuming any animal products.

Advantages:

• Vegetarian diets are typically higher in fiber, lower in fat, saturated fat and cholesterol.
• Vegetarians typically have less risk of CHD, cancer, obesity, high cholesterol and hypertension.
• Vegetarian lifestyles are usually healthier (less smoking, exercise, less alcohol, etc.).

Amy Magnuson, MS, RD

WHAT EVERY VEGAN SHOULD KNOW ABOUT VITAMIN B12

• Very low B12 intakes can cause anaemia and nervous system damage.
  

• The only reliable vegan sources of B12 are foods fortified with B12 (including some plant milks, some soy products and some breakfast cereals) and B12 supplements. Vitamin B12, whether in supplements, fortified foods, or animal products, comes from micro-organisms.
  

• Most vegans consume enough B12 to avoid anaemia and nervous system damage, but many do not get enough to minimise potential risk of heart disease or pregnancy complications.
  

• To get the full benefit of a vegan diet, vegans should do one of the following:

1. eat fortified foods two or three times a day to get at least three micrograms (mcg or µg) of B12 a day or

2. take one B12 supplement daily providing at least 10 micrograms or

3. take a weekly B12 supplement providing at least 2000 micrograms.

• If relying on fortified foods check the labels carefully to make sure you are getting enough B12. For example, if a fortified plant milk contains 1 microgram of B12 per serving then consuming three servings a day will provide adequate vitamin B12. Others may find the use of B12 supplements more convenient and economical.
  

• The less frequently you obtain B12 the more B12 you need to take, as B12 is best absorbed in small amounts. The recommendations above take full account of this. There is no harm in exceeding the recommended amounts or combining more than one option.
  

• Good information supports vegan health, pass it around.

If you don’t read another word about B12 you already know all you need to know. If you want to know more, read on.

VITAMIN B12 AND VEGAN DIETS

Index to this page:
Lessons from history
Getting an adequate amount of B12
Symptoms of B12 deficiency
The homocysteine connection
Testing B12 status
Is there a vegan alternative to B12-fortified foods and supplements?
A natural, healthy and compassionate diet
Further information

Lessons from history

B12 is an exceptional vitamin. It is required in smaller amounts than any other known vitamin. Ten micrograms of B12 spread over a day appears to supply as much as the body can use. In the absence of any apparent dietary supply, deficiency symptoms usually take five years or more to develop in adults, though some people experience problems within a year. A very small number of individuals with no obvious reliable source appear to avoid clinical deficiency symptoms for twenty years or more. B12 is the only vitamin that is not recognised as being reliably supplied from a varied wholefood, plant-based diet with plenty of fruit and vegetables, together with exposure to sun. Many herbivorous mammals, including cattle and sheep, absorb B12 produced by bacteria in their own digestive system. B12 is found to some extent in soil and plants. These observations have led some vegans to suggest that B12 was an issue requiring no special attention, or even an elaborate hoax. Others have proposed specific foods, including spirulina, nori, tempeh, and barley grass, as suitable non-animal sources of B12. Such claims have not stood the test of time.

In over 60 years of vegan experimentation only B12 fortified foods and B12 supplements have proven themselves as reliable sources of B12, capable of supporting optimal health. It is very important that all vegans ensure they have an adequate intake of B12, from fortified foods or supplements. This will benefit our health and help to attract others to veganism through our example.

Getting an adequate amount of B12

National recommendations for B12 intakes vary significantly from country to country. The US recommended intake is 2.4 mcgs a day for ordinary adults rising to 2.8 mcgs for nursing mothers. The German recommendation is 3 mcgs a day. Recommended intakes are usually based on 50% absorption, as this is typical for small amounts from foods. To meet the US and German recommendations you need to obtain sufficient B12 to absorb 1.5 mcgs per day on average. This amount should be sufficient to avoid even the initial signs of inadequate B12 intake, such as slightly elevated homocysteine and MMA levels, in most people. Even slightly elevated homocysteine is associated with increased risk of many health problems including heart disease in adults, preeclampsia during pregnancy and neural tube defects in babies.

Achieving an adequate B12 intake is easy and there are several methods to suit individual preferences. Absorption of B12 varies from about 50%, if about 1 mcg or less is consumed, to about 0.5% for doses of 1000 mcgs (1 mg) or above. So the less frequently you consume B12, the higher the total amount needs to be to give the desired absorbed amount.

Frequent use of foods fortified with B12 so that about one microgram of B12 is consumed three times a day with a few hours in between will provide an adequate amount. Availability of fortified foods varies from country to country and amounts of B12 vary from brand to brand, so ensuring an adequate B12 supply from fortified foods requires some label reading and thought to work out an adequate pattern to suit individual tastes and local products.

Taking a B12 supplement containing ten mcgs or more daily provides a similar absorbed amount to consuming one mcg on three occasions through the day. This may be the most economical method as a single high potency tablet can be consumed bit by bit. 2000 mcgs of B12 consumed once a week would also provide an adequate intake. Any B12 supplement tablet should be chewed or allowed to dissolve in the mouth to enhance absorption. Tablets should be kept in an opaque container. As with any supplement it is prudent not to take more than is required for maximum benefit, so intakes above 5000 mcg per week should be avoided despite lack of evidence for toxicity from higher amounts.

All three options above should meet the needs of the vast majority of people with normal B12 metabolism. Individuals with impaired B12 absorption may find that the third method, 2000mcg once a week, works best as it does not rely on normal intrinsic factor in the gut. There are other, very rare, metabolic defects that require completely different approaches to meeting B12 requirements. If you have any reason to suspect a serious health problem seek medical advice promptly.

Symptoms of B12 deficiency

Clinical deficiency can cause anaemia or nervous system damage. Most vegans consume enough B12 to avoid clinical deficiency. Two subgroups of vegans are at particular risk of B12 deficiency: long-term vegans who avoid common fortified foods (such as raw food vegans or macrobiotic vegans) and breastfed infants of vegan mothers whose own intake of B12 is low.

In adults typical deficiency symptoms include loss of energy, tingling, numbness, reduced sensitivity to pain or pressure, blurred vision, abnormal gait, sore tongue, poor memory, confusion, hallucinations and personality changes. Often these symptoms develop gradually over several months to a year before being recognised as being due to B12 deficiency and they are usually reversible on administration of B12. There is however no entirely consistent and reliable set of symptoms and there are cases of permanent damage in adults from B12 deficiency. If you suspect a problem then get a skilled diagnosis from a medical practitioner as each of these symptoms can also be caused by problems other than B12 deficiency.

Infants typically show more rapid onset of symptoms than adults. B12 deficiency may lead to loss of energy and appetite and failure to thrive. If not promptly corrected this can progress to coma or death. Again there is no entirely consistent pattern of symptoms. Infants are more vulnerable to permanent damage than adults. Some make a full recovery, but others show retarded development.

The risk to these groups alone is reason enough to call on all vegans to give a consistent message as to the importance of B12 and to set a positive example. Every case of B12 deficiency in a vegan infant or an ill informed adult is a tragedy and brings veganism into disrepute.

The homocysteine connection

This is not however the end of the story. Most vegans show adequate B12 levels to make clinical deficiency unlikely but nonetheless show restricted activity of B12 related enzymes, leading to elevated homocysteine levels. Strong evidence has been gathered over the past decade that even slightly elevated homocysteine levels increase risk of heart disease and stroke and pregnancy complications. Homocysteine levels are also affected by other nutrients, most notably folate. General recommendations for increased intakes of folate are aimed at reducing levels of homocysteine and avoiding these risks. Vegan intakes of folate are generally good, particularly if plenty of green vegetables are eaten. However, repeated observations of elevated homocysteine in vegans, and to a lesser extent in other vegetarians, show conclusively that B12 intake needs to be adequate as well to avoid unnecessary risk.

Testing B12 status

A blood B12 level measurement is a very unreliable test for vegans, particularly for vegans using any form of algae. Algae and some other plant foods contain B12-analogues (false B12) that can imitate true B12 in blood tests while actually interfering with B12 metabolism. Blood counts are also unreliable as high folate intakes suppress the anaemia symptoms of B12 deficiency that can be detected by blood counts. Blood homocysteine testing is more reliable, with levels less than 10 m mol/litre being desirable. The most specific test for B12 status is methylmalonic acid (MMA) testing. If this is in the normal range in blood (<370>

Is there a vegan alternative to B12-fortified foods and supplements?

If for any reason you choose not to use fortified foods or supplements you should recognise that you are carrying out a dangerous experiment - one that many have tried before with consistently low levels of success. If you are an adult who is neither breast-feeding an infant, pregnant nor seeking to become pregnant, and wish to test a potential B12 source that has not already been shown to be inadequate, then this can be a reasonable course of action with appropriate precautions. For your own protection, you should arrange to have your B12 status checked annually. If homocysteine or MMA is even modestly elevated then you are endangering your health if you persist.

If you are breast feeding an infant, pregnant or seeking to become pregnant or are an adult contemplating carrying out such an experiment on a child, then don’t take the risk. It is simply unjustifiable.

Claimed sources of B12 that have been shown through direct studies of vegans to be inadequate include human gut bacteria, spirulina, dried nori, barley grass and most other seaweeds. Several studies of raw food vegans have shown that raw food offers no special protection.

Reports that B12 has been measured in a food are not enough to qualify that food as a reliable B12 source. It is difficult to distinguish true B12 from analogues that can disrupt B12 metabolism. Even if true B12 is present in a food, it may be rendered ineffective if analogues are present in comparable amounts to the true B12. There is only one reliable test for a B12 source – does it consistently prevent and correct deficiency? Anyone proposing a particular food as a B12 source should be challenged to present such evidence.

A natural, healthy and compassionate diet

To be truly healthful, a diet must be best not just for individuals in isolation but must allow all six billion people to thrive and achieve a sustainable coexistence with the many other species that form the "living earth". From this standpoint the natural adaptation for most (possibly all) humans in the modern world is a vegan diet. There is nothing natural about the abomination of modern factory farming and its attempt to reduce living, feeling beings to machines. In choosing to use fortified foods or B12 supplements, vegans are taking their B12 from the same source as every other animal on the planet – micro-organisms – without causing suffering to any sentient being or causing environmental damage.

Vegans using adequate amounts of fortified foods or B12 supplements are much less likely to suffer from B12 deficiency than the typical meat eater. The Institute of Medicine, in setting the US recommended intakes for B12 makes this very clear. "Because 10 to 30 percent of older people may be unable to absorb naturally occurring vitamin B12, it is advisable for those older than 50 years to meet their RDA mainly by consuming foods fortified with vitamin B12 or a vitamin B12-containing supplement." Vegans should take this advice about 50 years younger, to the benefit of both themselves and the animals. B12 need never be a problem for well-informed vegans.

Good information supports vegan health, pass it around.

Further information:

Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline, National Academy Press, 1998 ISBN 0-309-06554-2 (http://books.nap.edu/books/0309065542/html/306.html#pagetop).

Vitamin B12: Are you getting it?, by Jack Norris, www.veganoutreach.org/health/b12.html.

Homocysteine in health and disease, ed. Ralph Carmel and Donald W. Jacobsen, Cambridge University Press, 2001, ISBN 0-521-65319-3.

Vitamin K Regulated Diet

Purpose Vitamin K is essential for the proper formation of blood clots in the body. The K in vitamin K, which was discovered by a Danish scientist, comes from the Danish word, koagulering, which means "clotting." The liver makes a protein called prothrombin, which is a vital link in the clotting process. Vitamin K is used by the liver to make prothrombin. There are a number of medical conditions in which prevention of excessive clotting within the body is desirable. Blood clots within the heart, arteries and veins can lead to heart attacks, strokes and phlebitis. One of the drugs used to prevent clot formation is a blood thinner called warfarin (trade name Coumadin). Warfarin interferes with the formation of prothrombin in the liver. As everyone who takes warfarin knows, they must get a blood test called a prothrombin time (pro time or P.T.) to be sure of the correct dose of warfarin. Too much warfarin leads to unwanted bleeding. Too little means that clotting is not prevented. So why is vitamin K in the diet important to a patient on warfarin therapy? Simply because if too much vitamin K is eaten, it interferes with the action of warfarin, thus lowering the P.T. and making the blood more likely to clot. Nutrition Facts The recommended dietary allowance for vitamin K is 65 micrograms (mcg) for women and 80 mcg for men. Some of the vitamin K the body uses is produced by bacteria in the digestive tract, but most comes from food. With proper food selection, a vitamin K-regulated diet can be varied and adequate in all nutrients. Special Considerations While taking anti-clotting medications, it is not necessary to avoid vitamin K-containing foods altogether. Just keep consumption of vitamin K fairly consistent, rather than consuming a lot one day and very little the next. This will allow the medication to work and keep blood clotting function consistent. Regular blood tests to monitor blood clotting time for potential dangerous fluctuations is important. Keeping a food diary can be very helpful in monitoring the potential interaction between diet and medication. If the P.T. becomes too low, check with the physician and keep a record of your own food intake. It may be you are eating too much of vitamin K-containing foods. Foods High in Vitamin K The foods highest in vitamin K are green leafy vegetables Food Kale, 1 c. raw Swiss chard, 1 c. raw Collard greens, 1/2 c. cooked Spinach, 1/2 c. cooked Brussels sprouts, 5 sprouts Watercress, 3 c. raw Endive, 2 c. raw chopped Scallion, raw, 2/3 c. chopped Broccoli, 1/2 c. cooked Coleslaw with dressing, 3/4 c. Cabbage, 2/3 c. cooked Asparagus, 7 spears, cooked Vitamin K micrograms 540 500 440 360 289 250 231 207 113 100 98 80 Sample Menu Breakfast Lunch Dinner orange juice 1/2 cup oatmeal 1 cup whole wheat toast 2 slices butter 1 tsp sugar 1 tsp skim milk 1 cup banana 1 med spaghetti with marinara sauce 1 1/2 cups jello salad1/2 cup Italian bread1 slice butter 1 tsp apple 1 med grape juice1/2 cup skim milk 1 cup broiled chicken breast 3 oz. pasta salad 3 oz green peas 1/2 cup whole wheat roll 1 pumpernickel bread 1 slice butter 1 tsp peach cobbler 1/2 cup skim milk 1/2 cup Snack apple 1 med This Sample Diet Provides the Following Calories 1964 Fat 41 gm Protein 84 gm Sodium 66 mg Carbohydrates 324 gm Fiber 27 gm
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Reviewed by Gary D. Vogin, MD

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June 7, 2002 -- Need another reason to juice up your morning routine? As little as a half a glass of orange juice a day may be enough to help prevent a stroke. A new study shows not getting enough vitamin C in your diet can increase the risk of stroke, especially among men with high blood pressure or who are overweight.

Researchers found that men with the lowest levels of vitamin C in their blood were nearly two and half times more likely to have a stroke than were men who had the highest levels of vitamin C in their blood. And the risk grew if the man had high blood pressure or was overweight.

The complete report appears in the June issue of Stroke: Journal of the American Heart Association.

Although previous studies that looked at whether vitamin C protects against stroke have not been very convincing, study author Sudhir Kurl, MD, of the Research Institute of Public Health in Finland, says this study is different. Rather than measuring vitamin C intake from supplements and dietary sources as in prior studies, they measured the amount of vitamin C actually circulating in the blood in 2,419 men who were followed for about 10 years.

"Other studies analyzed on the basis of fruit and vegetable intake, but we did our study on the basis of [blood concentrations of] vitamin C, which we consider to be a better marker of the availability of vitamin C in the body," says Kurl.

Researchers say vitamin C is a potent antioxidant that may work to reduce the risk of stroke in a number of different ways. As an antioxidant, it reduces the effects of damaging substances in the body known as free radicals, which have been linked to heart disease, cancer, and stroke. In addition, vitamin C helps protect the arteries against damage and lowers blood pressure and cholesterol levels.

Kurl says older adults may benefit most from the findings of this study by increasing their daily dose of vitamin C and eating a well-balanced diet rich in fruits and vegetables.

"Stroke is a disease of older people, and they are the ones that are suffering the most. And many of them are not eating a well-balanced diet," says Kurl. "A minimum of a half glass of juice [that contains vitamin C, such as orange juice] per day could contribute to this reduction in risk."

Registered dietician Jo Ann Hattner, spokesperson for the American Dietetic Association, agrees that incorporating more vitamin C rich foods is the best way to get the most out of this powerful vitamin.

Both Hattner and Kurl say previous studies have shown that taking vitamin C supplements doesn't necessarily have the same protective effects as getting your daily dose of vitamin C from fruits and vegetables.

"We like to think that vitamin C in natural sources has some special synergy and works with other elements in the food to make it more effective in creating a line of defense," Hattner tells WebMD.

"The problem with the elderly is that they may not want the acidity in their diet and may avoid orange juice," says Hattner.

Acidic foods, such as citrus fruits, can cause heartburn or acid reflux (a back-up of stomach acids into the esophagus) in some people. But Hattner says eating or drinking citrus products with other foods can minimize this effect.

Even squeezing some lemon or lime juice on salads or vegetables can add an extra dose of vitamin C to your diet, suggests Hattner. Other, lesser-known sources of vitamin C that people often overlook include strawberries, cantaloupe, papaya, broccoli, and cabbage.

Calcium, Vitamin D in Diet May Prevent PMS

Possible Cut in Risk of Premenstrual Syndrome Marks Another Good Reason to Eat Right

By Daniel J. DeNoon
WebMD Medical News

June 13, 2005 -- Now there's yet another reason for women to get plenty of calcium and vitamin D. The bone-building nutrients may prevent PMS.

PMS -- premenstrual syndrome PMS -- premenstrual syndrome -- is a collection of symptoms that come between ovulation and a woman's menstrual period. Symptoms include depression, irritability, fatigue, abdominal cramps, breast tenderness, and headaches. To qualify as PMS, the symptoms must be severe enough to interfere with normal life activities.

There are various ways to treat PMS, but no way to prevent it. Now a strong clue comes from University of Massachusetts researcher Elizabeth R. Bertone-Johnson, ScD, and her Harvard University colleagues. The researchers analyzed data collected over 10 years from nurses 27-44 years old participating in a long-term health study -- including more than 1,000 women with PMS.

"We found women with high intakes of both calcium and vitamin D did have significantly reduced PMS risk," Bertone-Johnson tells WebMD. "Those who ate about four servings a day of low-fat dairy or yogurt or fortified orange juice had a 40% lower risk of PMS than those who did not. That is about 1,200 milligrams of calcium or 400 international units (IU) of vitamin D each day."

The findings appear in the June 13 issue of Archives of Internal Medicine.

Women Not Getting Enough Calcium, Vitamin D

The recommended daily dose of vitamin D is 400 IU. Recommendations for calcium for adult women vary by age:

• Women 19 to 50 years old need 1,000 milligrams of calcium daily.
• Women 51 and over need 1,200 milligrams of calcium daily.

Women badly need this much calcium and vitamin D, says gynecologist Stephen Bashuk, MD, of Emory University.

"Women in the 18-30 age group at risk for PMS are in the prime of their bone mineralization years," Bashuk tells WebMD. "Every woman of childbearing age should be on calcium for her bones. Every women needs to be doing this to build up bones so she has less chance of dangerous fractures in her later years."

The women in Bertone-Johnson's study were all nurses. Yet only one in five was getting close to the recommended amount of calcium and vitamin D in her diet. Few were taking calcium supplements, so the study does not specifically address the issue of whether calcium and vitamin D supplements are needed. Yet Bashuk says the study gives women yet another reason to make sure they get enough calcium.

"What this study says is that if you take an 18-year-old woman without PMS -- who has a 20% lifetime chance of getting it -- if she takes her calcium she has less chance of getting PMS," Bashuk says.

"Whether to take calcium is a no-brainer. And if you get a side benefit that it may prevent PMS, that would be a wonderful thing. I certainly would recommend if a woman has PMS, and doesn't take calcium or doesn't have a good dairy intake, it is not an unreasonable thing for her to go on calcium supplements and see if it helps."

Best Calcium Sources

To give you an idea of how much calcium is in some calcium-rich foods, here are some examples:

• 1 cup of milk -- 300 milligrams
• 1/2 cup of broccoli -- 35 milligrams
• 1/2 cup of spinach -- 120 milligrams
• 1.5 ounces of cheddar cheese -- 300 milligrams
• 8 ounces of low-fat yogurt -- 300-415 milligrams
• 1 cup of calcium-fortified orange juice -- 300 milligrams

Bertone-Johnson and Bashuk both note that a study of this kind does not prove that calcium or vitamin D really prevents PMS. Only a clinical trial can do that. In the meantime, women may wish to consult their doctors about whether -- and how -- to get more calcium and vitamin D.

"I think it is something women can talk about with their doctors, whether they are thinking about increasing calcium and vitamin D to prevent PMS or to strengthen their bones," Bertone-Johnson says. "It is premature to suggest this is going to be the magic bullet to prevent PMS. But it is something women, after talking with their doctors, may want to incorporate into their diets."

SOURCES: Bertone-Johnson, E. Archives of Internal Medicine, June 13, 2005; vol 165: pp 1246-1252. Elizabeth R. Bertone-Johnson, ScD, assistant professor of epidemiology, University of Massachusetts, Amherst. Stephen Bashuk, MD, assistant professor of obstetrics and gynecology, Emory University, Atlanta.

Diet Rich in Vitamin C Decreases Stroke Risk

Laurie Barclay, MD

Nov. 10, 2003 — Vitamin C-containing foods are associated with reduced risk of stroke, according to the results of the Rotterdam Study published in the Nov. 11 issue of Neurology. The effect was most pronounced in smokers, and supplements did not have the same benefit in this study.

"Of course these study findings do not justify smoking. No one should smoke," senior author Monique Breteler, MD, PhD, from Erasmus Medical Center in Rotterdam, Netherlands, says in a news release. "But it is good news that high levels of antioxidants may help reduce the risk of stroke in smokers."

The 5,197 subjects in this observational study were aged 55 years or older, living independently in Rotterdam, with no cognitive problems and no previous stroke history. Dietary levels of vitamin C and other antioxidants were assessed with a checklist of all foods and drinks consumed at least twice a month during the past year, as well as with an interview by a dietician.

During an average follow-up of 6.4 years, 253 people had strokes, including 227 with ischemic stroke. After adjustment for potential confounders, participants in the lowest tertile of dietary vitamin C (less than 95 mg daily) were 34% more likely to have ischemic stroke than participants in the highest tertile (more than 133 mg daily). Among the smokers, diets high in vitamin C were associated with a 72% reduction in stroke risk compared with diets low in vitamin C.

Although smokers with diets high in vitamin E were 23% less likely to have a stroke than those with diets low in vitamin E, there was no similar protective advantage for nonsmokers.

Study limitations include those inherent in an observational design, notably the possibility of residual confounding.

The lack of protective effect of dietary supplements containing vitamins C and E and other antioxidants in this study does not mean that supplements have no potential benefit, according to Dr. Breteler. She attributed this finding to possible increased risk of stroke in people who take supplements, as well as differences in the use of supplements and dietary habits. Dietary intake typically reflects long-term habits, while supplement use is generally shorter term and higher dose.

"Supplement use and diet are different types of intake of antioxidants, and they may have different effects on cardiovascular disease," the authors write. "Our finding that high dietary intake of antioxidants but not supplement use is associated with a reduced risk of stroke should not be misinterpreted as evidence against a potential beneficial effect of vitamin supplements."

The Netherlands Organization for Scientific Research, the Netherlands Health and Development Research Council, and the city of Rotterdam supported this study. The Hungary Ministry of Health, the Netherlands Institute for Health Sciences, and Erasmus University supported one of the study coauthors.

Diet high in vitamin C decreases stroke risk, especially among smokers

ST. PAUL, MN – Eating a diet high in vitamin C may decrease your risk of stroke, particularly if you smoke, according to a study published in the November 11 issue of Neurology, the scientific journal of the American Academy of Neurology.

The study found that people with the lowest amount of vitamin C in their diets were 30 percent more likely to have a stroke than people with the highest amount of vitamin C in their diets. Smokers with diets high in vitamin C were more than 70 percent less likely to have a stroke than smokers with diets low in vitamin C.

Antioxidants such as vitamin C may protect cells from oxidative stress, which plays a role in stroke.

Vitamin E was also protective for smokers. Those with diets high in vitamin E were more than 20 percent less likely to have a stroke than those with diets low in vitamin E. No similar advantage was found in non-smokers whose diets were high in vitamin E.

"Of course these study findings do not justify smoking. No one should smoke," said study author Monique Breteler, MD, PhD, of Erasmus Medical Center in Rotterdam. "But it is good news that high levels of antioxidants may help reduce the risk of stroke in smokers."

The study involved 5,197 people age 55 or older in Rotterdam, the Netherlands. All of the participants had no cognitive problems, were living independently and had never had a stroke.

The participants were then tracked for an average of 6.4 years. During that time, 253 people had strokes.

People with the highest amount of vitamin C in their diets consumed greater than 133 mg of vitamin C per day. People with the lowest amount in their diets consumed less than 95 mg per day.

To determine their levels of vitamin C and other antioxidants, participants first indicated on a checklist all foods and drinks they had consumed at least twice a month during the past year. Then they were interviewed by a dietician about their diet.

The use of dietary supplements containing vitamins C and E and other antioxidants did not decrease the risk of stroke. Breteler said this finding does not mean that supplements have no potential to have a beneficial effect. Differences in the use of supplements and dietary habits – such as the fact that dietary intake reflects long-term habits and supplement use is generally shorter term and higher dose, as well as the possibility that people who take supplements may be already at greater risk of stroke – may explain why no effect was found, Breteler said.

Rich sources of vitamin C include oranges and other citrus fruits, strawberries, red and green peppers, broccoli and brussels sprouts. Sources of vitamin E include vegetable oils such as sunflower seed, cottonseed, safflower, palm and wheat germ oils, margarine and nuts.

###

The study was supported by the Netherlands Organization for Scientific Research, the Netherlands Health and Development Research Council and the city of Rotterdam. One of the study co-authors was supported by the Hungary Ministry of Health, the Netherlands Institute for Health Sciences and Erasmus University.

The American Academy of Neurology, an association of more than 18,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease, autism and multiple sclerosis.

For more information about the American Academy of Neurology, visit its web site at www.aan.com.

Satisfying Breakfast Shake

This shake is designed to get you going (with coffee, but you can use decaf) and keep you going through the morning (with the medium-chain fatty acids in the coconut milk). The flax seed meal adds fiber and lots of other good things, but you could also add fiber in the form of "Benefiber" or some similar preparation. If you're not a fan of coffee, try this similar Berry Shake.

INGREDIENTS:

• 1 cup coffee, cold (can use instant coffee and water to taste)
• 1 scoop low carb protein powder (I used "Designer Protein" for my calculations), vanilla or chocolate
• 1/2 cup coconut milk
• 2 Tablespoons Flax Seed Meal (or see above)
• Sweetener to taste (I like liquid forms of Splenda - no carbs)
• 3-4 ice cubes

PREPARATION:

Blend it all up together. You can do it in a shaker cup if you don't care about it being thicker or don't want to wash the blender.

Nutritional Information: Each serving has 5.5 grams effective carbohydrate plus 5 grams fiber, 23 grams protein, and 403 calories.

Low Carb Blueberry Cream Cheese Coffee Cake

This delicious low carb coffee cake is very filling, since it's made with almond meal. If you don't like cream cheese, you can leave out that layer, or use less cream cheese (see below). It is also delicious with raspberries instead of blueberries.

INGREDIENTS:

• 3 cups almond meal
• 1 ½ cups sugar substitute (liquid or powdered, see below)
• 3 eggs
• 1 teaspoon baking powder
• ½ teaspoon baking soda
• ¼ cup butter (4 Tablespoons), chilled and cut into small pieces
• ½ cup sour cream
• 2 teaspoons vanilla extract or 1 teaspoon each vanilla and almond extracts
• 2 Tablespoons oil
• 6 oz. cream cheese
• Salt
• 1 cup fresh or frozen (but not thawed) blueberries or raspberries

PREPARATION:

Preheat oven to 350°. Butter or oil 9X9 inch pan (cooking spray is fine).

Coffee cake is prepared in three layers. If you are using a standing mixer, you can use the same bowl if you make the layers in the order listed - just remove them to separate bowls until ready to assemble.

1)Streusel Topping: Mix 1 cup of the almond meal, 1 teaspoon cinnamon, ½ cup sweetener, a pinch of salt and the 4 Tablespoons butter.

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I find that the whisk type attachment on my standing mixer works well - you want the mixture to stay crumbly. You can use a pastry blender, knives - whatever works. But if it all clumps together, don't worry - just crumble it over the top when the time comes. This is one area where I used to use powdered sweetener, but I have found more recently that my beloved Sweetzfree liquid (zero carbs; no aftertaste) works fine.

2) Cream Cheese Layer: Mix cream cheese, 1 egg, and ¼ cup sweetener. If you want a thinner layer of cream cheese, you can use 4 oz. instead of 6. The mixture won't be as thick and will pour more evenly over the cake layer.

3) Cake layer: Mix dry ingredients: 2 cups of almond flour, baking powder, baking soda, ¼ ½ teaspoon cinnamon, teaspoon salt, and ¾ cup sweetener if you are using a powder. Then add the sour cream, oil, extracts, liquid sweetener if that's what you're using sour cream, and 2 eggs and mix well. At this point, you might want to add 1-2 Tablespoons of water, depending on the consistency. You want the batter to be thick enough to support the rest of it, but not too gloppy - you should be able to spread it easily in the pan. I usually end up adding about a Tablespoon of water.

4) Assembly: Spread the cake layer in the pan, and spread the cream cheese on top (if it's the larger amount of cream cheese, you won't be able to spread it evenly, but that's OK). Then sprinkle the blueberries on the cream cheese and the streusel on the top of that.

5) Bake for about half an hour, or until toothpick not inserted into a berry comes out clean. If you use a thermometer, it should be about 155° F. in the center.

6) Cool and slice. It is filling, so I usually cut it into 16 pieces.

Nutritional Information: For 16 servings, each serving has 3 grams effective carbohydrate plus 2.5 grams fiber, 6 grams protein, and 217 calories.

Low Carb Fruit: Lists of the Best and Worst

Choose Low Sugar Fruit

Fruit is an area where some of the low carb diets part company, as some depend more upon glycemic index or glycemic load (South Beach, Zone), while others just look at total carbs (Atkins, Protein Power). Also, some diets (Atkins, South Beach) don’t allow fruit at all in the first phase. In general, your best bet fruits are these, but do check carb counts. These are sort of arranged by sugar content, taking volume and weight, into account. This is not an exhaustive list.

Good news: the fruits lowest in sugar are some of the highest in nutritional value, including antioxidants and other phytonutrients.

If you are considering using organic vegetables, check out this list of which fruits and vegetables have the most and least pesticides to help you guide your choices.

Fruits lowest in sugar:

• Rhubarb
• Strawberries (more about berries on low carb diets)
• Cranberries
• Raspberries
• Blackberries
• Blueberries
• Grapefruit
• Melons
• Apricots
• Plums
• Peaches
• Pears
• Guava
• Cherries
• Apples
• Papaya

These are fairly high in sugar:

• Grapes
• Tangerine
• Oranges
• Pineapple
• Kiwi

The following fruits are very high in sugar and generally going to be very infrequent visitors to the low carb diet:

• Bananas
• Dried Fruit
• Mango

Low Carb Breakfast Menu Ideas

Quick and Easy Breakfasts

Especially for people new to low carb eating, it can be challenging to figure out what to make for breakfast. Especially if you’re used to reaching for the cereal box, the loaf of bread, or the packet of oatmeal, it can come as a bit of a shock to realize that you have to come up with a totally different breakfast plan. But don’t worry, there is a variety of low carb breakfast foods.

Eggs

I know what you’re thinking – “how can I possibly cook something first thing in the morning?” Well, eggs don’t have to be just for lazy Sunday mornings. Here are some ways to make them quick and easy.

1. Make a vegetable frittata and then freeze or refrigerate servings to pull out and heat in the microwave. A frittata is sort of a cross between an omelet and a quiche, made on the stove and sometimes finished in the oven.

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How to Make a Frittata They are a great way to use leftover vegetables, because you can put any vegetable you want in it. In Italy, it is a common item in a lunch brought from home. They don’t take long to make, and then you can use it for several meals.

2. Of course, it’s even easier to simply scramble leftover veggies and cheese with eggs. You can make a big batch of this, and save the extra; zip-type plastic bags work well.

3. Omelets are great vehicles for leftovers.

4. A serving of regular scrambled or fried eggs is quick to make. I recently mastered flipping fried eggs just with the pan. It’s fun, and cuts down on the cleanup. Serve with low-sugar fruit, and a flax muffin, and you’ve got a complete breakfast.

5. Eggs Florentine is an easy recipe using frozen spinach.

Cereals

Cereals are a hard one, because they are high in carbohydrate by their very nature. Here are some ways around it:

1. Some cold cereals, such as Special K, now come in a low-carb form. Even better are some of the high fiber cereals such as All Bran and Fiber One. (Check the labels, as formulations change. At this writing, there are three different kinds of All Bran, for example, all with different carb levels.)

2. There are some special low carb cereals, such as “Flax-O-Meal” that can be purchased online. Or make this flax cereal right in your bowl.

3. Cream of “Wheat” is a hot “cereal” developed by innovative low carbers using eggs and ricotta cheese: Recipe for Pumpkin Version

4. Unlikely as it sounds, TVP “Oatmeal” is surprisingly like the real thing.

Breakfast Breads

1. Muffins, biscuits and other breads can be made from flax meal, almond meal, and other low carb ingredients. Low Carb Bread Recipes

2. Buy a low carb pancake mix, or make them from scratch.

3. Microwave "breakfast puddings." I don't know what else to call this. Put flax meal and/or almond meal in a bowl with water, egg, and flavorings such as berries, cream cheese, peanut butter...use your imagination. Two examples:

Blueberry Almond Breakfast Pudding

Easy Flax Breakfast Pudding

Yogurt, Cottage Cheese, Ricotta, Tofu

1. “Spoonable Dairy” can be combined with fruit such as frozen berries, and nuts or flax seed to make a quick breakfast.
   
   
2. Shakes: Any of the above can be used to make a shake with protein powder and fruit or flavorings. Or the shake can be made with just the protein powder and unsweetened soy milk, kefir, or water. For example:
   
   Satisfying Breakfast Shake
   
   Berry Protein Shake
   
3. Use tofu as the central protein. A shake can be made from soft tofu, while the firmer types can be used in tofu scrambles and other dishes.

LOW SUGAR

About diabetes

Diabetes is an inability to metabolize carbohydrates resulting from inadequate production or utilization of insulin.

People with diabetes cannot properly process glucose, a sugar the body uses for energy. As a result, glucose stays in the blood, causing blood glucose to rise. At the same time, however, the cells of the body can be starved for glucose. Diabetes can lead to poor wound healing, higher risk of infection , and many other problems involving the eyes, kidneys, nerves, and heart.

Dietary changes that may be helpful

Most doctors recommend that people with diabetes cut intake of sugar from snacks and processed foods, and replace these foods with high-fiber, whole foods. This tends to lower the glycemic index of the overall diet and has the additional benefit of increasing vitamin, mineral, and fiber intake. Other authorities also recommend lowering the glycemic index of the diet to improve the control of diabetes.

A high-fiber diet has been shown to work better in controlling diabetes than the diet recommended by the ADA, and may control blood sugar levels as well as oral diabetes drugs. 21 In this study, the increase in dietary fiber was accomplished exclusively through the consumption of foods naturally high in fiber such as leafy green vegetables, granola, and fruit to a level beyond that recommended by the ADA.

Nutritional supplements that may be helpful

A variety of vitamins, minerals, amino acids, and other supplements may help with symptoms and deficiencies associated with diabetes. The Boise Co-op Vitamin and Supplement Department carry several of the recommended types including| Nutritional supplements that may be helpful

Chromium Magnesium Alpha lipoic acid Evening primrose oil Glucomannan Vitamin E Vitamin C B Vitamins Coenzynme Q10 L-carnitine Zinc Vitamin D Inositol Taurine Fish oil Vanadium Fructo-oligosaccharides Manganese Medium chain triglycerides Starch blockers Herbs that may be helpful

Cayenne Psyllium Asian ginseng American ginseng Basil Gymnema Bitter melon Cinnamon Crepe myrtle Onion Bilberry Ginkgo biloba Mistletoe Olive leaf Reishl

For a complete guide of foods that would be useful in keeping with a high-fiber low sugar diet you can go to www.healthnotes.com or to www.diabetes.org.

The information contained in this article was referenced from A Healthnotes, Inc. (HNI), the premier provider of credible, easy-to-use health and lifestyle information. Incorporating research gathered from scientific studies.

Nutritional supplements that may be helpful

A variety of vitamins, minerals, amino acids, and other supplements may help with symptoms and deficiencies associated with diabetes.

Multiple Vitamin Mineral Supplement
In a double-blind study, supplementation of middle-aged and elderly diabetics with a multiple vitamin and mineral preparation for one year reduced the risk of infection by more than 80%, compared with a placebo. 104

Chromium
Medical reports dating back to 1853, as well as modern research, indicate that chromium-rich brewer's yeast (9 grams per day) can be useful in treating diabetes. In recent years, chromium has been shown to improve glucose and related variables in people with glucose intolerance and type 1, type 2, gestational, and steroid-induced diabetes. Improved glucose tolerance with lower or similar levels of insulin have been reported in more than ten trials of chromium supplementation in people with varying degrees of glucose intolerance. Chromium supplements improve glucose tolerance in people with both type 2 and type 1 diabetes, apparently by increasing sensitivity to insulin. Chromium improves the processing of glucose in people with prediabetic glucose intolerance and in women with diabetes associated with pregnancy. Chromium even helps healthy people, 1although one such report found chromium useful only when accompanied by 100 mg of niacin. Chromium may also lower total cholesterol, LDL cholesterol, and triglycerides (risk factors in heart disease).

A few trials have reported no beneficial effects from chromium supplementation. 117 118 119 All of these trials used 200 mcg or less of supplemental chromium, which is often not adequate for people with diabetes, especially if it is in a form that is poorly absorbed. The typical amount of chromium used in research trials is 200 mcg per day, although as much as 1,000 mcg per day has been used. 120 Many doctors recommend up to 1,000 mcg per day for people with diabetes. 121

Supplementation with chromium or brewer's yeast could potentially enhance the effects of drugs for diabetes (e.g., insulin or other blood sugar-lowering agents) and possibly lead to hypoglycemia. Therefore, people with diabetes taking these medications should supplement chromium or brewer's yeast only under the supervision of a doctor.

Magnesium
People with diabetes tend to have low magnesium levels. Double-blind research indicates that supplementing with magnesium overcomes this problem. Magnesium supplementation has improved insulin production in elderly people with type 2 diabetes. However, one double-blind trial found no effect from 500 mg magnesium per day in people with type 2 diabetes, although twice that amount led to some improvement. Elders without diabetes can also produce more insulin as a result of magnesium supplements, according to some, but not all, trials. In some trials, insulin requirements are lower in people with type 1 diabetes who supplement with magnesium. However, in people with type 2 diabetes who nonetheless require insulin, Dutch researchers have reported no improvement in blood sugar levels.

Diabetes-induced damage to the eyes is more likely to occur in magnesium-deficient people with type 1 diabetes. In magnesium-deficient pregnant women with type 1 diabetes, the lack of magnesium may even account for the high rate of spontaneous abortion and birth defects associated with type 1 diabetes. The American Diabetes Association admits strong associations...between magnesium deficiency and insulin resistance but will not say magnesium deficiency is a risk factor. 132 Many doctors, however, recommend that people with diabetes and normal kidney function supplement with 200-600 mg of magnesium per day.

Alpha lipoic acid
Alpha lipoic acid is a powerful natural antioxidant. Preliminary and double-blind trials have found that supplementing 600-1,200 mg of lipoic acid per day improves insulin sensitivity and the symptoms of diabetic neuropathy. In a preliminary study, supplementation with 600 mg of alpha-lipoic acid per day for 18 months slowed the progression of kidney damage in patients with type 1 and type 2 diabetes.

Evening primrose oil
Supplementing with 4 grams of evening primrose oil per day for six months has been found in double-blind research to improve nerve function and to relieve pain symptoms of diabetic neuropathy.

Glucomannan
Glucomannan is a water-soluble dietary fiber that is derived from konjac root (Amorphophallus konjac). Glucomannan delays stomach emptying, leading to a more gradual absorption of dietary sugar. This effect can reduce the elevation of blood sugar levels that is typical after a meal. After-meal blood sugar levels are lower in people with diabetes given glucomannan in their food, and overall diabetic control is improved with glucomannan-enriched diets, according to preliminary and controlled clinical trials. One preliminary report suggested that glucomannan may also be helpful in pregnancy-related diabetes. For controlling blood sugar, 500-700 mg of glucomannan per 100 calories in the diet has been used successfully in controlled research.

Vitamin E
People with low blood levels of vitamin E are more likely to develop type 1 and type 2 diabetes. Vitamin E supplementation has improved glucose tolerance in people with type 2 diabetes in most, but not all, 153 double-blind trials. Vitamin E has also improved glucose tolerance in elderly people without diabetes. Three months or more of supplementation may be required for benefits to become apparent. The amount used is at least 900 IU of vitamin E per day.

In one of the few trials to find vitamin E supplementation ineffective for glucose intolerance in people with type 2 diabetes, damage to nerves caused by the diabetes was nonetheless partially reversed by supplementing with vitamin E for six months. 156 Animal and preliminary human data indicate that vitamin E supplementation may protect against diabetic retinopathy and nephropathy, serious complications of diabetes involving the eyes and kidneys, respectively, though no long-term trials in humans have confirmed this preliminary evidence.

Glycosylation is an important measurement of diabetes; it refers to how much sugar attaches abnormally to proteins. Vitamin E supplementation reduces this problem in many, although not all, studies.

In one report, vitamin E was found to impair glucose tolerance in obese patients with diabetes. The reason for the discrepancy between reports is not known.

Vitamin E appears to lower the risk of cerebral infarction, a type of stroke, in people with diabetes who smoke. A review of a large Finnish study of smokers concluded that smokers with diabetes (or hypertension) represent a subset population that can benefit from small amounts of vitamin E (50 IU per day) without experiencing an increased risk of bleeding. 168

Vitamin C
People with type 1 diabetes appear to have low vitamin C levels. As with vitamin E, vitamin C may reduce glycosylation. Vitamin C also lowers sorbitol in people with diabetes. Sorbitol is a sugar that can accumulate and damage the eyes, nerves, and kidneys of people with diabetes. Vitamin C may improve glucose tolerance in type 2 diabetes, although not every study confirms this benefit. Vitamin C supplementation (500 mg twice daily for one year) has significantly reduced urinary protein loss in people with diabetes. Urinary protein loss (also called proteinuria) is associated with poor prognosis in diabetes. Many doctors suggest that people with diabetes supplement with 1-3 grams per day of vitamin C. Higher amounts could be problematic, however. In one person, 4.5 grams per day was reported to increase blood sugar levels.

One study examined antioxidant supplement intake, including both vitamins E and C, and the incidence of diabetic retinopathy (damage to the eyes caused by diabetes). Surprisingly, people with extensive retinopathy had a greater likelihood of having taken vitamin C and vitamin E supplements. The outcome of this trial, however, does not fit with most other published data and might simply reflect the fact that sicker people are more likely to take supplements in hopes of getting better. For the present, most doctors remain relatively unconcerned about the unexpected outcome of this isolated report.

B Vitamins
Many people with diabetes have low blood levels of vitamin B6. Levels are even lower in people with diabetes who also have nerve damage (neuropathy). 180 Vitamin B6 supplementation has improved glucose tolerance in women with diabetes caused by pregnancy. Vitamin B6 supplementation is also effective for glucose intolerance induced by birth control pills. For other people with diabetes, 1,800 mg per day of a special form of vitamin B6 pyridoxine alpha-ketoglutarate has improved glucose tolerance dramatically in some research. Standard vitamin B6 has helped in some, 185 but not all, trials.

Biotin is a B vitamin needed to process glucose. When people with type 1 diabetes were given 16 mg of biotin per day for one week, their fasting glucose levels dropped by 50%. Similar results have been reported using 9 mg per day for two months in people with type 2 diabetes. Biotin may also reduce pain from diabetic nerve damage. Some doctors try 16 mg of biotin for a few weeks to see if blood sugar levels will fall.

Blood levels of vitamin B1 (thiamine) have been found to be low in people with type 1 diabetes. In the 1930s, a trial using 10 mg of vitamin B1 per day for four weeks reported reduced blood sugar levels in six of eleven people with diabetes. More recently, administration of both vitamin B1 (25 mg per day) and vitamin B6 (50 mg per day) led to significant improvement of symptoms of diabetic neuropathy after four weeks. However, this was a trial conducted among people in a vitamin B1-deficient developing country. Therefore, these improvements might not occur in other people with diabetes. Another trial found that combining vitamin B1 (in a special fat-soluble form) and vitamin B6 plus vitamin B12 in high but variable amounts led to improvement in some aspects of diabetic neuropathy in 12 weeks. As a result, some doctors recommend that people with diabetic neuropathy supplement with vitamin B1, though the optimal level of intake remains unknown.

Coenzyme Q10
Coenzyme Q10 (CoQ10) is needed for normal blood sugar metabolism. Animals with diabetes have been reported to be CoQ10 deficient. People with type 2 diabetes have been found to have significantly lower blood levels of CoQ10 compared with healthy people. In one trial, blood sugar levels fell substantially in 31% of people with diabetes after they supplemented with 120 mg per day of CoQ7, a substance similar to CoQ10. In people with type 1 diabetes, however, supplementation with 100 mg of CoQ10 per day for three months neither improved glucose control nor reduced the need for insulin. The importance of CoQ10 supplementation for people with diabetes remains an unresolved issue, though some doctors recommend approximately 50 mg per day as a way to protect against possible effects associated with diabetes-induced depletion.

L-carnitine
L-carnitine is an amino acid needed to properly utilize fat for energy. When people with diabetes were given L-carnitine (1 mg per 2.2 pounds of body weight), high blood levels of fats both cholesterol and triglycerides dropped 25-39% in just ten days in one trial. In higher amounts (1 gram per day by injection), L-carnitine has been reported to reduce pain from diabetic nerve damage as well.

Vitamin B12 is needed for normal functioning of nerve cells. Vitamin B12 taken orally, intravenously, or by injection has reduced nerve damage caused by diabetes in most people studied. 199 In a preliminary trial, people with nerve damage due to kidney disease or to diabetes plus kidney disease received intravenous injections of 500 mcg of methylcobalamin (the main form of vitamin B12 found in the blood) three times a day for six months in addition to kidney dialysis. Nerve pain was significantly reduced and nerve function significantly improved in those who received the injections. 200 Oral vitamin B12 up to 500 mcg three times per day is recommended by some practitioners.

The intake of large amounts of niacin (a form of vitamin B3), such as 2-3 grams per day, may impair glucose tolerance and should be used by people with diabetes only with medical supervision. 201 202 Smaller amounts (500-750 mg per day for one month followed by 250 mg per day) may help some people with type 2 diabetes, though this research remains preliminary.

Preliminary trials have shown that niacinamide (another form of vitamin B3) supplementation might be useful in the very early stages of type 1 diabetes, though not all trials support this claim. Although an analysis of research shows that niacinamide does help preserve some function of insulin-secreting cells in people recently diagnosed with type 1 diabetes, the amount of insulin required for those given niacinamide has remained essentially as high as for those given placebo. 208 A controlled trial found no beneficial effect of niacinamide supplementation (700 mg three times per day in addition to intensive insulin therapy) on pancreatic function and glucose tolerance in people newly diagnosed with type 1 diabetes.

Some, but not all, reports suggest that healthy children at high risk for type 1 diabetes (such as the healthy siblings of children with type 1 diabetes) may be protected from the disease by supplementing with niacinamide. Parents of children with type 1 diabetes should consult their doctor regarding niacinamide supplementation as a way to prevent diabetes in their other children. Although the optimal amount of niacinamide is not known, recent evidence suggests that 25 mg per 2.2 pounds of body weight per day may be as effective as higher amounts.

Zinc
People with type 1 diabetes tend to be zinc-deficient, which may impair immune function. Zinc supplements have lowered blood sugar levels in people with type 1 diabetes, though some evidence indicates that zinc supplementation in people with type 2 diabetes does not improve their ability to process sugar. Nonetheless, people with type 2 diabetes also have low zinc levels, caused by excess loss of zinc in their urine. Many doctors recommend that people with type 2 diabetes supplement with moderate amounts of zinc (15-25 mg per day) as a way to correct for the deficit.

Some doctors are concerned about having people with type 1 diabetes supplement with zinc because of a report that zinc supplementation increased glycosylation, 218 generally a sign of deterioration of the condition. This trial is hard to evaluate because zinc supplementation increases the life of blood cells and such an effect artificially increases the lab test results for glycosylation. Until this issue is resolved, those with type 1 diabetes should consult a doctor before considering supplementation with zinc.

Vitamin D
Vitamin D is needed to maintain adequate blood levels of insulin. Vitamin D receptors have been found in the pancreas where insulin is made and preliminary evidence suggests that supplementation can increase insulin levels in some people with type 2