Eleanor R. Williams - The American Journal of Nursing (1975) Tags: nutrition
7
Lippincott Williams & Wilkins and Wolters Kluwer Health, Inc. are collaborating with JSTOR to digitize, preserve and extend access to The American Journal of Nursing. http://www.jstor.org Wolters Kluwer Health, Inc. Making Vegetarian Diets Nutritious Author(s): Eleanor R. Williams Source: The American Journal of Nursing, Vol. 75, No. 12 (Dec., 1975), pp. 2168-2173 Published by: Lippincott Williams & Wilkins Stable URL: http://www.jstor.org/stable/3423700 Accessed: 03-03-2015 22:27 UTC Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at http://www.jstor.org/page/info/about/policies/terms.jsp JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact [email protected]. This content downloaded from 128.235.251.160 on Tue, 03 Mar 2015 22:27:31 UTC All use subject to JSTOR Terms and Conditions
Transcript
Lippincott Williams & Wilkins and Wolters Kluwer Health, Inc. are collaborating with JSTOR to digitize, preserve and extend access to The American Journal of Nursing.
http://www.jstor.org
Wolters Kluwer Health, Inc.
Making Vegetarian Diets Nutritious Author(s): Eleanor R. Williams Source: The American Journal of Nursing, Vol. 75, No. 12 (Dec., 1975), pp. 2168-2173Published by: Lippincott Williams & WilkinsStable URL: http://www.jstor.org/stable/3423700Accessed: 03-03-2015 22:27 UTC
Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at http://www.jstor.org/page/info/about/policies/terms.jsp
JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of contentin a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship.For more information about JSTOR, please contact [email protected].
This content downloaded from 128.235.251.160 on Tue, 03 Mar 2015 22:27:31 UTCAll use subject to JSTOR Terms and Conditions
Their diets can be adequate, palatable, and appealing to the eye, but vegetarians need considerable information to choose foods that provide the essential amino acids, vitamin B12, and other nutrients.
ELEANOR R. WILLIAMS
Health professionals are encountering more and more vegetarians. In the
past, most vegetarians in the United States belonged to religious groups. Today, however, many young people, often living in communes, have
adopted vegetarianism as part of a life
philosophy(1-3). Other people have
adopted vegetarianism because they believe the United States and other af- fluent countries consume a dispropor- tionate share of the earth's resources to produce a high meat diet(4,5).
Most vegetarians believe that their
dietary practices are more healthful than eating large amounts of meat. There is some support in the scientific literature for this belief. Vegetarians
ELEANOR R. WILLIAMS, PH.D., R.D., is associate
professor, Department of Food, Nutrition, and Institutional Administration, College of Human Ecology, University of Maryland, College Park.
have been shown to have lower blood cholesterol levels than nonvegetarians, and the incidence of heart disease
among Seventh Day Adventist males has been reported to be 40 percent less than that of the average male popu- lation in California(6-9).
Part of this cholesterol-lowering ef- fect may be due to vegetarians' ten-
dency to consume less total fat, less saturated fat, more polyunsaturated fat, and less cholesterol than nonvege- tarians(10). But vegetarians may also consume much more fiber or roughage than nonvegetarians(11,12). The feed-
ing of legumes, which are high in fiber content, has lowered blood cholesterol levels in controlled studies(13,14).
Vegetarians have also been reported to experience a decreased incidence of cancer compared with nonvegeta- rians(15). A current question is whether the higher incidence of cancer of the colon in industrialized countries is related to the high fat intake (as in meat) or to the low fiber intake(16).
Often, nurses can help patients se- lect more nearly adequate diets. Be- cause vegetarians' dietary practices vary widely, the nurse should find out
exactly what foods a patient chooses. She also needs to know the reasons for certain food choices so that she can
judge what alternatives are possible. Food choices are highly personal,
and criticism of a patient's food habits
may be taken as criticism of the per- son. The nurse is in a good position to
help, if she is perceived as a nonjudg- mental person who is knowledgeable about food and nutrition or is able to
get expert help for the patient from a
qualified dietitian or nutritionist.
Vegetarians may be classified as those who avoid red meat only (beef, pork, or lamb) but eat poultry and fish; lacto-ovo-vegetarians, who avoid flesh foods but consume milk, cheese, and eggs; and strict or pure vegetar- ians, or vegans, who avoid all foods of animal origin.
Planning a nutritionally adequate diet is more difficult as food choices become more restrictive. Thus, the strict vegetarian diet, although the most restrictive, can be nutritionally adequate, but a greater knowledge of food composition is necessary to choose foods that contain the needed nutrients.
Ill-planned vegetarian diets have caused severe deficiencies(1,17).
The basic principles of planning any nutritionally adequate diet follow, and are applied to vegetarian diets with
special attention to strict vegetarian diets.
Calories and Protein
CALORIE intake should be adequate to maintain ideal body weight. "Ideal
body weight" is that weight for height and sex at which neither too little nor too much body fat is present. This
weight can be determined for patients by reference to standard weight tables and by using skin calipers to obtain the
2168 DECEMBER 1975 AMERICAN JOURNAL OF NURSING
This content downloaded from 128.235.251.160 on Tue, 03 Mar 2015 22:27:31 UTCAll use subject to JSTOR Terms and Conditions
appropriate skinfold measurements. Once ideal weight is attained, the
calorie intake must be adequate to maintain it, because this allows the body to use dietary protein for its unique function of building body pro- teins. If the calorie intake is too low, the body is forced to use much of the dietary protein for energy.
PROTEIN in the diet should supply all of the amino acids needed. Amino acids are basic units containing nitro- gen needed to synthesize body pro- teins. The human adult can manufac- ture all except eight of these amino acids, called the essential amino acids. These eight must be obtained from food. The body also requires some ad- ditional sources of nitrogen to synthe- size the nonessential amino acids.
Meat and other animal protein foods (eggs, milk, and cheese) contain all the essential amino acids in amounts and proportions to one an- other similar to those found in body proteins. Plant proteins, on the other hand, tend to be lacking or low in one or more of the essential amino acids relative to the body's need for them.
Two or more plant protein sources can be combined, however, in such a way that the amino acids low in one source are supplied by the second or third source. Alternatively, a plant food may be combined with an animal food to obtain a complete amino acid mixture.
This practice of combining foods is referred to as the mutual supplemen- tation of dietary proteins, or the com- plementary value of proteins. For ex- ample, wheat tends to be low in lysine and high in methionine relative to the body's needs, while beans tend to be high in lysine and low in methionine. Combining wheat and beans in one dish or one meal supplies both lysine and methionine. Lapp6 offers a guide to complementing proteins in Diet for a Small Planet(4).
Over centuries, human beings have survived, having learned to success- fully complement or supplement one protein with another. The corn or rice and bean dishes of Latin American countries, and the garbanzo bean- sesame seed dishes of Middle Eastern
as
SOME VEGETARIAN SOURCES OF CALCIUM, IRON AND ZINC
calciuma irona zinca food mg. mg. mg.
animal hamburger, lean, 3 oz. 10 3.0 3.8 protein liver, beef, 2 oz. 6 5.0 2.9 foods milk, fluid whole, 1 c. 288 0.1 0.9
milk, non-fat dry, 1/4 c. 219 0.1 0.8 cheese, cheddar, 1 oz. 213 0.3 0.5 cheese, cottage, 1/2 c. packed 115 0.3
beans navy beans, 1/ c. cooked 48 2.5 0.9 seeds mature soybeans, 1/2 c. cooked 37 1.3 - nuts sesame seeds, whole, 1/2 c. 1,160 10.5 -
sesame seeds, hulled, 1/2 c. 110 2.4 - sunflower seed kernels, 1/4 c. 36 2.1 - almonds, 1/2 c. 166 3.3 - soybean milk, 1 c. 60 1.5-
vegetables spinach, 1/2c. cooked *2.0 0.8 beet greens, 1/2c. cooked 1.4 - dandelion greens, 1/2 c. cooked 126 1.6 - kale, 1/2 c. cooked 74 0.6 - mustard greens, 1/2 c. cooked 97 1.3 - turnip greens, 1/2 c. cooked 126 0.8 - collards, 1/2 c. cooked 144 0.6 - broccoli, 1/2 c. cooked 68 0.6 - green peas, 1/2 c. cooked 19 1.5 - sweet potatoes, 1 sm. (110 Gm.) 44 1.0 -
a RDA for adult male or female for calcium-800 mg. RDA for adult male for iron-10 mg.; for adult female-18 mg. RDA for adult male or female for zinc-15 mg.
* calcium in spinach and beet greens is present as insoluble calcium oxalate and cannot be absorbed.
- indicates values not reported. Values for calcium and iron calculated from US. Dept. of Agriculture Handbook No. 8, Composition of Foods, and U.S. Dept. of Agriculture Home and Garden Bulletin No. 72, Nutritive Value of Foods. Values for soybean milk obtained from REGISTER, U. D., AND SONNENBERG, L. M., "The Vegetarian Diet"
Equivalents of hamburger, liver, and beef are shown for contrast in this list of vegetarian mineral sources.
VOLUME 75, NUMBER 12 DECEMBER 1975 2169
This content downloaded from 128.235.251.160 on Tue, 03 Mar 2015 22:27:31 UTCAll use subject to JSTOR Terms and Conditions
*p.p.m.-parts per million *added to flour and called "enriched."
From SCHROEDER, H. A. "Losses of Vitamins and Trace Minerals Resulting from Processing and Preservation of Foods." (Modified from the American Journal of Clinical Nutrition 24:562, 1971, and reprinted with permission.)
NUTRIENTS IN SUGAR CANE, SUGAR, MOLASSES AND HONEY
Sugar Molasses Brown White Cane (Blackstrap) Sugar Sugar Honey
Values from Home and Garden Bulletin No. 72, Nutritive Value of Foods and SCHROEDER, H. A., "Losses of Vitamins and Trace Minerals Resulting from Processing and Preservation of Foods." 4SCHROEDER, H. A., AND OTHERS. Essential metals in man: Magnesium. J.Chronic Dis. 21:815-841, Apr. 1969.
sSCHROEDER, H. A. The role of chromium in mammalian nutrition. Am.J.Clin. Nutr.
21:230-244, Mar. 1968. 6SCHROEDER, H. A., AND OTHERS. Essential trace metals in man: Zinc. Relation to environmental cadmium. J.Chronic Dis. 20:179-210, Apr. 1967.
L
VEGETARIAN DIETS
countries are examples of such combi- nations. The North American prac- tices of eating cereal with milk, maca- roni with cheese, and a peanut butter sandwich with milk combine plant and animal sources of protein. The
objective is to obtain "complete" pro- tein or all of the essential amino acids in one meal. Meat, therefore, is not
necessary in the diet for protein. The daily allowance for protein set
by the Food and Nutrition Board in 1974 is 0.8 Gm./kg. body weight, oi 56 Gm. for a 70 kg. man, and 46 Gm. for a 58 kg. woman(18). This covers the basic needs and leaves a margin of
safety for all healthy adults. If foods of plant origin supply all the protein in the diet, a person should consume somewhat more protein than 0.8
Gm./kg. body weight to compensate for the fact that plant foods are less well digested than animal prod- ucts(18). Studies by Hardinge and Stare indicated, however, that the av-
erage daily protein intake of the strict
vegetarians in their study was 81.5 Gm. for males and 63.2 Gm. for fe- males, or about 1.1 Gm./kg., a gener- ous intake(19).
Obtaining the proper mixture of amino acids is no problem for vegetar- ians who avoid red meat only or who are lacto-ovo-vegetarians. Strict vege- tarisns will meet their needs for pro- tein, provided they consume enough food to meet their calorie needs, and
provided they eat a wide variety of foods with minimal sugar and other
"empty calorie" foods(20). Whenever
plant foods are used as sources of pro- tein, they should be combined so that one food complements the amino acid
pattern of the other.
All needed nutrients
A wide variety of foods should be consumed to increase the probability for obtaining all needed nutrients.
VITAMIN B12 is Of special concern for the strict vegetarian, since it is found only in foods of animal origin. Strict
2170 DECEMBER 1975 AMERICAN JOURNAL OF NURSING
This content downloaded from 128.235.251.160 on Tue, 03 Mar 2015 22:27:31 UTCAll use subject to JSTOR Terms and Conditions
vegetarians should plan to obtain vita- min B12 in fortified foods, such as some brands of soybean milk, or in tablet form.
An adult who has eaten animal pro- tein all his life will have stored enough vitamin B12 in his liver to last many years. If he becomes a strict vegetar- ian, it may be years before he will show signs of a deficiency. However, because vitamin B12 deficiency can fa- tally damage the nervous system, a strict vegetarian is well advised to con- sume a source of B12.
MINERALS Since milk and milk prod- ucts supply most of the calcium in nonvegetarian diets, and since meat supplies significant amounts of iron and zinc, a conscious effort is needed to include sources of these minerals in vegetarian diets. Foods that might be included in vegetarian diets as sources of calcium, iron, and zinc, plus values for meat for comparison purposes, are listed in the table at the right.
A lacto-ovo-vegetarian would ob- tain most of the adult Recommended Dietary Allowance (RDA) for CAL-
CIUM from two servings of milk and cheese, but a strict vegetarian would need regular servings of cooked greens, dried beans, certain seeds such as sesame seeds, and certain nuts such as almonds to obtain the same amount of calcium. Soybean milk also contrib- utes calcium.
Many beans, seeds, nuts, green leafy vegetables, dried fruits, and grain products supply IRON. Although iron in meats seems to be better absorbed than iron in plant foods, studies of vegetarians have shown no greater in- cidence of iron deficiency anemia among strict vegetarians than among nonvegetarians(19,21).
There has been some concern that
phytates, the esters of phytic acid, present in the bran of whole grain ce- reals may decrease the absorption of iron from these foods. However, the
presence of phytases (enzymes) in
grains may actually prevent insoluble
iron-phytate from forming in the di-
gestive tract. The importance of phy- tates in human beings' absorption of iron has so far been almost impossible to assess(22).
Whole grain products are excellent sources of ZINC. There has been some
question about the possible inter- ference with zinc absorption by phy- tates in whole grains.
Reinhold has demonstrated, how- ever, that leavening whole wheat bread with yeast releases zinc from its binding with phytate(23). It appears that phytate in whole grains interferes with zinc absorption only in parts of the world where 95 to 100 percent ex- traction of the whole grain is used to make an unleavened bread, which constitutes a major part of the diet. Leavened whole wheat bread, as part of a varied diet, probably does not in- terfere with zinc absorption.
Strict vegetarians, then, should be able to obtain enough calcium, iron, and zinc, if they consistently make wise food choices.
Many vegetarians in the United States eat more vegetables, fruits, whole grain cereals, wheat germ, and bran than nonvegetarians. These pref- erences should be encouraged because these foods are excellent sources of vi- tamins, minerals, and fiber. Eating some vegetables and fruits raw en- sures adequate intake of such nutri- ents as vitamin C and folic acid, which are destroyed by cooking the food.
White enriched bread and flour do not have the same nutritive value as whole wheat bread and flour because the milling process removes far more nutrients than the iron, thiamin, ri- boflavin, and niacin which are re- placed in enriched flour and bread (see table at the left).
Little public attention has been fo- cused on trace minerals, but they are very important in human nutrition. Whole grain breads and cereals are much better sources of trace minerals than white breads and cereals. The use of wheat germ should be encouraged because its nutritive value is quite high. However, mistaken ideas about
any "magical" or "miraculous" effects of wheat germ should be corrected.
Proportions
Neither fat nor sugar should pro- vide too high a proportion of the total calories. Since the protein in vegetar- ian foods, especially in strict vegetar-
ian foods, is less concentrated than in a diet containing meat, vegetarians cannot afford to eat a diet high in "empty calorie" foods like sugar or fat.
The Food and Nutrition Board re- cently noted that reducing the present high intake of fat in the American nonvegetarian diet (about 45 percent of total calories) to 35 percent of calories or less "would probably provide a diet conducive to bet- ter health in the United States popu- lation"(24).
Fat is needed to provide the essen- tial fatty acid, linoleic acid, and to in- crease the palatability and satiety value of the diet. Only 1 to 2 percent of the calories is needed as linoleic acid, an amount easily supplied in small amounts of vegetable oils. For palatability, 20 to 25 percent of the calories should come from fat.
High amounts of sugar contribute only calories and no vitamins or min- erals. The incidence of dental decay is higher when sugar rather than starch makes up the carbohydrate com- ponent of the diet(25).
Some investigators believe that our present sugar consumption (20 to 25 percent of calories) is too high for good health(26,27). Many vegetarians use molasses, brown sugar, or honey in place of refined sugar. The nutritive values of these sweeteners are com- pared in the table at the right.
Molasses, brown sugar, and honey do contain more nutrients than white sugar. Although figures are not avail- able, brown sugar contains all the minerals listed because the crystals are coated with molasses. Molasses is a concentrated product and contains more nutrients than the sugar cane from which it is made.
A plan similar to the familiar Basic Four Food Plan can be a rough guide in planning vegetarian meals. The
vegetable and fruit group, bread and cereals group, and the milk group may be used by lacto-ovo-vegetarians just as by nonvegetarians. Strict vegetar- ians should take two cups per day of
soybean milk fortified with vitamin B12 as a substitute for milk(28). For both lacto-ovo- and strict vegetarians, dishes combining grains, legumes,
VOLUME 75, NUMBER 12 DECEMBER 1975 2171
This content downloaded from 128.235.251.160 on Tue, 03 Mar 2015 22:27:31 UTCAll use subject to JSTOR Terms and Conditions
raw green pepper, 1/2 pod 7 tr tr 2 1/ Tbs. mayonnaise 33 tr 3 1 raw apple 70 tr tr 18 2 lettuce leaves 10 1 tr 2 2 fig bars 100 2 2 22 10 potato chips 115 1 8 10 1 c. whole milk 160 9 9 12 1 choc. chip cookie 50 1 2 7
12 oz. soft drink 145 0 0 37 Total 760 34 28 103
Total 773 20 28 114 Spanish soybeans over 3 oz. ground beef 245 21 17 0
rice and bulgur* * 451 18 17 61 1/ c. mashed potatoes 93 2 4 12 spinach and mushroom salad 1/ c. green peas 58 5 1 10
1 c. raw spinach 13 1 tr 2 iceberg lettuce wedge 15 1 tr 3 1 Tbs. oil in dressing 125 0 14 0 1 Tbs. blue cheese dressing 75 1 8 1 1 c. skim milk yogurt 125 8 4 13 1 slice apple pie 350 3 15 51 1 raw peach 35 1 tr 10 1 c. coffee 1 c. apple juice 120 tr tr 30 (1 Tbs. cream) 30 1 3 1
1/3 c. mushrooms 9 1 tr 1 (1 tsp. sugar) 13 0 0 4 Total 878 29 35 117 Total 879 34 48 82
grand total . 2,095 85 74 291 grand total 2,100 71 100 243 % of total calories*** 16% 32% 55% % of total calories*** 13% 43% 45%
*Vegetarian breakfast from REGISTER, U. D., AND SONNENBERG, L. M., "The Vegetarian Diet" (28). **Recipe (Ye) from LAPPE, F. M., Diet for a Small Planet (4).
***Values total over 100% because figures are rounded.
nuts, and seeds may replace meat as sources of protein. In addition, lacto-
ovo-vegetarians may use eggs, cheese, and milk as sources of protein.
Some vegetarians prefer meat ana-
logs as entrees. These products are manufactured from soybeans and other plant sources and are made to resemble the flavor and texture of beef, ham, poultry, frankfurters, sau-
sage, or shellfish. Available canned, dehydrated, or frozen, the analogs support nitrogen balance in adults and adolescents(29,30).
Advantages of their use are that little change in menu planning is needed since they can be substituted for meat, are free of cholesterol, and often lower in fat than meat. Their
disadvantages are that they are ex-
pensive, they are not comparable to meat in vitamin and mineral content, and they are nearly all very high in so- dium.
Infant Feeding
A most difficult problem relates to infant feeding in strict vegetarian fam- ilies. Breast feeding is the method of choice but if this is not possible the in-
2172 DECEMBER 1975 AMERICAN JOURNAL OF NURSING
This content downloaded from 128.235.251.160 on Tue, 03 Mar 2015 22:27:31 UTCAll use subject to JSTOR Terms and Conditions
fant should receive a soybean formula that has been adequately tested. Not all soybean formulas are ade- quate(31). If the formula is nutri- tionally well balanced, the infant will need no supplements until he is three to four months old.
After that, the infant should be gradually introduced to other foods in the usual manner so that he learns to eat a wide variety. Good sources of iron, vitamin C, protein, vitamin A, and the B vitamins should be chosen.
At weaning, the child should con- tinue to receive by cup either soybean formula or a soybean milk fortified with vitamin B12. The chief problem at weaning is that a small child has a limited capacity for food, yet his pro- tein needs per kilogram of body weight are greater than an adult's.
Since the protein in plant foods is less concentrated than in animal foods, it is important that the mother realize the necessity of feeding mix- tures of dried beans and cereals as sources of protein, in addition to soy- bean milk. Cereals alone are not likely to supply enough protein for the child's needs.
Comparisons
Many people believe that a vegetar- ian diet must be fattening because it is high in starch. Body fat, however, ac- cumulates only when the diet contains excessive calories, regardless of whether they come from starch, sugar, fat, or protein. The percentage of total calories from protein, fat, and car- bohydrate in a sample lacto-ovo-vege- tarian menu are compared with a typi- cal nonvegetarian menu in the table at the left.
The total calories and calories per meal are essentially the same in both menus shown. Although the per- centage of the calories from carbohy- drate is higher in the vegetarian menu (55 percent versus 45 percent), the per- centage of calories from fat is higher in the nonvegetarian menu (43 percent versus 32 percent).
There are far more reasons to ques- tion the high fat content of the non- vegetarian menu than the high car-
bohydrate content of the vegetarian menu, particularly since most of the
carbohydrate comes from starch rather than sugar. Neither diet would be fattening if the person's energy need were about 2,100 calories per day.
The protein in this vegetarian menu is actually higher than in the nonvege- tarian, although the amount in both menus is much higher than the RDA for protein. However, there is no milk in the nonvegetarian menu. Two cups of milk would have added 18 Gm. of protein, as well as many other nutri- ents. No attempt was made to plan the nonvegetarian menu according to the rules for planning an adequate diet
outlined in this article. Instead, the menu is patterned after the choices that many Americans make every day. It is high in fat and sugar and low in many nutrients, such as calcium, some vitamins, and trace minerals.
Vegetarian diets can be nutri- tionally adequate and appealing to the eye and palate. An interest in cooking increases the chance that a vegetarian will consume a wide variety of foods and thus obtain a nutritious diet. Health professionals should be ready and willing to help vegetarians obtain information to plan adequate diets.
References 1. ERHARD, DARLA. The new vegetarians. Part I.
Vegetarianism and its medical consequences. Nutr. Today 8:4-12, Nov.-Dec. 1973.
2. _ . The new vegetarians. Part 2. The Zen macrobiotic movement and other cults based on vegetarianism. Nutr. Today 9:20-25, Jan.- Feb. 1974.
3. DWYER, J. T., AND OTHERS. The new vegetar- ians. Who are they? J.Am.Diet.Assoc. 62:503- 509, May 1973.
4. LAPPt, F. M. Diet For A Small Planet. rev. ed. New York, Ballantine Books, 1975.
5. BROWN, L. R. By Bread Alone. New York, Praeger, Published for the Overseas Devel- opment Council, 1974.
6. HARDINGE, M. G., AND STARE, F. J. Nutritional studies of vegetarians. 2. Dietary and serum levels of cholesterol. J.Clin.Nutr. 2:83-88, Mar.-Apr. 1954.
7. GROEN, J. J., AND OTHERS. The influence of nutrition and ways of life on blood choles- terol and the prevalence of hypertension and coronary heart disease among Trappist and Benedictine monks. Am.J.Clin.Nutr. 10:456- 470, June 1962.
8. WEST, R. O., AND HAYES, O0 B. Diet and serum cholesterol levels. A comparison between vegetarians and non-vegetarians in a Sev- enth-Day Adventist group. Am. J.Clin.Nutr. 21:853-862 Aug. 1968.
9. LEMON, F. R., AND WALDEN, R. T. Death from respiratory system disease among Seventh- Day Adventist men. JAMA 198:117-126, Oct. 10, 1966.
10. HARDINGE, M. G., AND OTHERS. Nutritional studies of vegetarians. 4. Dietary fatty acids and serum cholesterol levels. Am.J. Clin.Nutr. 10:516-524, June 1962.
11. _ . Nutritional studies of vegetarians. 3. Dietary levels of fiber. Am.J.Clin.Nutr. 6:523-525, Sept.-Oct. 1958.
13. GRANDE, F., AND OTHERS. Effect of carbohy- drates of leguminous seeds, wheat and po- tatoes on serum cholesterol concentration in man. J.Nutr. 86:313-317, July 1965.
14. MATHUR, K. S., AND OTHERS. Hypocholestero- laemic effect of Bengal gram: A long-term study in man. Brit.Med.J. 1:30-31, Jan. 1968.
15. LEMON, F. R., AND OTHERS. Cancer of the lung and mouth in Seventh-Day Adventists: pre- liminary report on a population study. Can- cer 17:486-497, Apr. 1964.
16. HILL, M. J. Steroid nuclear dehydrogenation
and colon cancer. Am.J.Clin.Nutr. 27:1475- 1480, Dec. 1974.
17. NATIONAL ACADEMY OF SCIENCES. NATIONAL RESEARCH COUNCIL. FOOD AND NUTRITION BOARD. COMMITTEE ON NUTRITIONAL MIS- INFORMATION. Vegetarian diets. J.Am.Diet.Assoc. 65:121-122, Aug. 1974.
18. NATIONAL ACADEMY OF SCIENCES. NATIONAL RESEARCH COUNCIL. FOOD AND NUTRITION BOARD. Recommended Dietary Allowances. rev. ed. Wash., D. C., The Academy, 1974, p.47.
19. HARDINGE, M. G., AND STARE, F. J. Nutritional studies of vegetarians. 1. Nutritional physical and laboratory studies. J. Clin.Nutr. 2:73-82, Mar.-Apr. 1954.
20. HEGSTED, D. M., AND OTHERS. Protein require- ments of adults. J.Lab.Clin.Med 31:261-284, Mar. 1946.
21. ELLIS, F. R., AND MUMFORD, P. The nutritional status of vegans and vegetarians. Proc.Nutr.Soc. 26:205-212. Mar. 1967.
22. HAWKINS, W. W. Iron, copper and cobalt. IN Nutrition: A Comprehensive Treatise. Vol IL Macronutrients and Nutrient Elements, ed. by G. H. Beaton and E. W. McHenry. New York, Academic Press, 1964, p. 339.
23. REINHOLD, J. G. Phytate destruction by yeast fermentation in whole wheat meals. J.Am.Diet.Assn. 66:38-41, Jan. 1975.
24. NATIONAL ACADEMY OF SCIENCES. NATIONAL RESEARCH COUNCIL. FOOD AND NUTRITION BOARD. Recommended Dietary Allowances. rev. ed. Washington, D.C., The Academy, 1974, p. 36.
25. NEWBRUN, E. Sucrose, the arch criminal of den- tal caries. Odont.Rev. 18(4):373-386, 1967. 26. AHRENS, R. A. Sucrose, hypertension, and heart disease: an historical perspective. Am.J.Clin.Nutr. 27:403-422, Apr. 1974.
27. YUDKIN, J. Sugar and disease. Nature 239:197-199, Sept. 22, 1972.
28. REGISTER, U. D., AND SONNENBERG, L. M. The vegetarian diet: scientific and practical con- siderations. J.Am.Diet.Assoc. 62:253-261, Mar. 1973.
29. KIES, C., AND FOX, H. M. Comparison of the protein nutritional value of TVP, methionine enriched TVP and beef at two levels of in- take for human adults. J.Food Sci. 36:841- 845, Sept.-Oct. 1971.
30. KORSLUND, M., AND OTHERS. Comparison of the protein nutritional value of TVP, meth- ionine-enriched TVP and beef for adolescent boys. J.Food Sci. 38:637-638, June 1973.
31. FOMON, S. J. Infant Nutrition. 2d ed. Phila- delphia, W. B. Saunders Co., 1974, pp. 136, 389-390.
VOLUME 75, NUMBER 12 DECEMBER 1975 2173
This content downloaded from 128.235.251.160 on Tue, 03 Mar 2015 22:27:31 UTCAll use subject to JSTOR Terms and Conditions
