Vege? Flexi? or Omni-tarians? Oh My!

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By David Grotto, RDN, LDN

Have you contemplated going on a vegetarian diet for health reasons? According to the Academy of Nutrition and Dietetics, all versions of vegetarianism can be healthy if well planned. But what version is right for you, if any? Before you test the waters out, lets review what a vegetarian diet is and isn’t and what may be the potential health benefits and pitfalls of following one might be.

What is a vegetarian diet? Simply put, a vegetarian diet, in its truest sense, is plant-based and does not include any meat, fish or poultry products. There are various levels of vegetarianism which fall into three classifications:
• Vegan (no animal products what-so-ever, including eggs and dairy)
• Lacto-ovo vegetarian (consumes eggs and dairy products)
• Lacto vegetarian (consumes dairy products).
There are those who eat a plant-based diet that includes fish, chicken or both or those who occasionally eat meat. People who follow this dietary approach often refer to themselves as “semi-vegetarian” or “flexitarian”. Purists might argue that these aren’t “true” vegetarians but more importantly, do you need to fall into the three aforementioned categories only to derive health benefits?

Why should you follow a vegetarian diet? Common reasons for choosing a vegetarian lifestyle include religious, cultural or concerns about animal welfare, the environment or health. An evidence-based review of the literature suggests that there may be health advantages to adopting a well-planned vegetarian diet when compared to non-vegetarians including:
• healthier body weight
• lower overall cancer rates
• lower risk of death from heart disease
• lower low-density lipoprotein (LDL) cholesterol levels
• lower blood pressure and lower rates of hypertension
• lower rates of type 2 diabetes and kidney disease
These observations were made mainly from association studies that provided little insight as to the overall quality of both diets. Meaning? “Vegetarian” does not automatically mean that healthy choices were made. The same holds true with non-vegetarian diets.

Weight management: Studies have shown that healthy vegetarian diets are often lower in calories and associated with reduced body weight because what is mainly eaten are low calorie dense foods. Maintaining a healthy weight reduces the risk for multiple chronic diseases. However, even healthy plant based fats such as nuts, seeds, coconut, oils and avocados can contribute to weight gain if not consumed in moderation.

Heart health & Diabetes: A vegetarian diet that is low in saturated fat, cholesterol and sodium has been associated with reduced cholesterol levels & blood pressure – which are risk factors for heart disease. Diets high in soluble fiber and phytosterols can help prevent cholesterol from being absorbed and may also benefit blood glucose management in diabetes. However, a review study found that low-carbohydrate, low-glycemic, Mediterranean, and high-protein diets have also demonstrated effectiveness in improving risk and management of cardiovascular risk and diabetes.

Kidney Disease: The National Kidney Foundation suggests that a reduction of animal protein intake and increased consumption of plant-based foods not only may reduce cardiovascular risk, mortality rate from heart disease and kidney disease but also by reducing animal protein intake, phosphate content of the diet would also be reduced benefiting those already diagnosed with chronic kidney disease.

Potential Pitfalls: While a plant-based diet can offer various health advantages, it should be planned carefully (preferably with a dietitian) to ensure adequate nutrition. Many vegans and even some vegetarians do not meet the proper nutrient needs in vitamin B12, vitamin D, omega 3’s, and iron. Some research suggests that homocysteine levels, platelet volume and stickiness of platelets can be a concern in those vegetarians who do not commune adequate levels of vitamin B12 and Omega 3 fats.

Vitamin B12: Since plant based foods do not contain significant amounts of vitamin B12, vegans must consume foods fortified with B12 and/or via a supplement. However lacto-ovo or lacto vegetarians can meet their B12 needs through the consumption of dairy products.

Vitamin D: Vitamin D levels can be affected by sun exposure, diet, supplement use, , and skin pigmentation. Low vitamin D status has been associated with reduced bone mass and other health challenges. Regular consumption of vitamin D fortified foods like milk, soy beverages, orange juice, and cereals, along with dietary supplementation, can help improve vitamin D status.

Omega-3’s: Vegetarian diets that don’t include fish are usually high in omega-6 fatty acids while lacking in omega-3 fats. There are 2 types of long chain omega-3 fatty acids that are essential to health: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These long chain omega-3’s are easily absorbed in the body and typically found in fatty fish and to a lesser extent in some shellfish. An alternative for vegans is to consume sea algae, which is rich in the DHA form of omega-3s. Aside from algae, all other plant sources contain the short chain omega-3 fat called alpha-linolenic acid (ALA). Even though ALA is beneficial to your health, it doesn’t convert as readily into the essential DHA or EPA form of omega-3 fatty acids. This means that vegetarians must consume more of the ALA-rich food to gain the same health benefits as one would from fatty fish.

Iron: Plant based foods contain non-heme iron which means that there are inhibitors that can impact the absorption of iron. However simple cooking preparation techniques can reduce inhibitors like phyates and enhance iron’s absorption. These techniques include soaking or sprouting beans, grains and seeds; leavening of breads and fermenting vegetables like cabbage to make sauerkraut or kimchee. Also, consuming foods that are rich in Vitamin C along with non-heme iron sources can enhance absorption.

Ultimately, it’s your choice! Due to the expanding popularity of plant-based foods, there are more and more options that are available for consumers, especially meat substitutes. To meet the increase in popularity, many restaurants have included vegetarian options to their menus. There has also been an increase of vegetarian products in supermarkets, which include products like soy products, meat substitutes, fortified vegetarians options, and vegetarian convenience foods. So trying vegetarian options in restaurants or cooking your own vegetarian meals at home has never been easier!

But what about those who want to continue to consume animal products and improve their health, too? Research also supports that well-planned plant-based (not “only”) diets that allow moderate intake of meat, fish poultry and dairy products have demonstrated significant improvements in health status as well. In fact, leading current dietary advice supports a total diet approach – which includes moderate animal protein consumption – such as the 2010 Dietary Guidelines for Americans, the DASH (Dietary Approaches to Stop Hypertension) Diet, MyPlate, Let’s Move, Nutrition Facts labels, Healthy People 2020, and the Dietary Reference Intakes.

If you do decide to embark on a vegetarian diet, consider chatting with a registered dietitian who can help guide you in choosing the right combination of foods and cooking methods for optimal health and nutrition. And if you are a seasoned vegetarian, please share your tips and health experiences in the comment section!

Pork: The Other Right Meat

As seen on WebMD
By David Grotto, RD, LDN

For those of you who know me or have recently become familiar with my work here through Real Life Nutrition, it will come as no surprise that I profess that I am a plant-forward, unapologetic omnivore. I love all food and feel that, when placed in proper perspective, you can eat just about anything and still enjoy/achieve good health. Many of you already know that we consume nowhere near the quantity of fruits, vegetables and whole grains currently recommended in the Dietary Guidelines for Americans. In an effort to change this trend, my first book, 101 Foods That Could Save Your Life, focused on increasing that portion of the plate dedicated to members of the plant kingdom. At the time that I wrote it, I didn’t feel Americans needed a book that encouraged more meat consumption. I thought then, as I do now, that our work is cut out for us with just boosting our veggie intake. However, I also think that lean meat has a place at the table and on the plate in a healthy diet, if you desire to eat it.

Like most Americans, when I think “lean”, what first comes to mind is the classic boneless, skinless chicken breast. Ho hum. The description alone leaves me culinarily unexcited– so much emphasis on the “less” part. The problem with lean meats is that they can be prone to dryness and “less” flavor. Growing up, we were exposed to less marbled meats with any visible fat trimmed away. That fat had a function – flavor! I remember my mom trying to make challenging cuts more tender and favorable by whacking it with a mallet and soaking it in marinades – so much work. Sometime she was successful and other times…well…you know.

Recently, I received an invitation to attend a pork “immersion” provided by the National Pork Board. Did you know that compared to any other animal protein , pork is the most consumed meat in the world? Could have sworn it would be chicken! Though meat consumption trends are on the downturn, it is estimated that pork is consumed by about 81% of Americans. Anyway, I decided to take them up on their offer because I had lots of questions about pork – more pressing, how could I make lean cuts of pork taste better? Mom was always in the back of my head saying “If you want to avoid trichinosis, you’d better cook the pink out of it.” I had always followed her advice though I had no idea what “trichinosis” was – sounded to me that I be better off without it. The end result was often a product akin to shoe leather. In dietetics school, I learned I had to cook pork to an internal temperature of at least 160 degrees for food safety measures. Translated? More shoe leather. More ho hum…

During the immersion event, many of my questions and concerns about pork were addressed. I’m happy to share the answers I received with you.

Food Safety: Good news #1. Last year, due to advances in food safety, the USDA lowered the internal cooking temp of pork to 145℉ with a three-minute rest period. This allows the meat to continue to cook, retain its temperature and also its moisture. No more shoe leather or my mom talking inside my head! Yay!

Nutrition: Good News #2. During the immersion, I attended a lecture given by Mary Murphy, MS, RD, senior managing scientist at Exponent, a scientific consulting firm, and learned how today’s pork nutrition has evolved over the past 20 years or so. A 3-ounce portion of roasted and trimmed pork contains only 120 calories and is 16% lower in total fat and 27% lower in saturated fat then pork of two decades ago. Seven cuts of pork now qualify for “lean” status which includes:
Tenderloin
Top loin chop
96% lean ground pork
Top loin roast
Center loin chop
Rib chop
Sirloin roast
And compared to skinless chicken breast, today’s pork tenderloin is just as lean! And by the way, according to the Food and Drug Administration, a product can be considered lean if it had less than 10g of total fat, 4.5g or less of saturated fat, and less that 95mg of cholesterol per serving. But did you know that “lean” is not the leanest cut that you can buy? The FDA considers “Extra Lean” to be any meat that contains less than 5g of total fat, less than 2g of saturated fat, and less than 95mg of cholesterol. This would apply to boneless, skinless chicken breast and the tenderloin cut of pork.

Health: Good News #3:
Fresh lean pork which is low in sodium, saturated fat and cholesterol can be part of diets geared towards managing elevated cholesterol and blood pressure, like the DASH (Dietary Approaches to Stopping Hypertension) diet. Out of all of the macronutrients – fat, carbohydrates and fat – protein provides greater feelings of fullness, keeps hunger at bay and may help manage our waistlines. The Journal Obesity found that when a study group included lean pork and other lean proteins in their diets on a regular basis, there were less desires to eat late at night, less distracting thoughts of food, less overall calories consumed and greater feelings of fullness and satisfaction.

Animal Welfare: Good News #4: Lastly as part of the immersion, I had an opportunity to visit Wakefield farm in Gaylord Minnesota, hosted by pork farmers Mary Langhorst and her son Lincoln. I must tell you – I had mixed feelings about seeing where my food comes from but am really grateful for having the opportunity to see a factory pork farm in operation. It was not the cold and sterile environment I once envisioned. I was impressed by the many caring employees who took great strides to treat their pigs with dignity and care. I was pleasantly surprised to see how clean of an operation they had. According to representatives from the National Pork Board, the cleanliness and care of animals seen at the Langhorst’s farm was representative of US pork farming in general. I had always heard that factory pig farms were absolutely horrible smelling. I wouldn’t say that it smelt like daisies around there but it was really no more odorous than many dairy farms I had visited before. I also learned that when pigs are stressed, this can actually change the ph of the meat to produce a less enjoyable dining experience. Apparently everyone benefits from less stressed and content pigs. Their pigs indeed appeared content, clean and well cared for.

Have any of you been to a pig farm? I would love to hear of your experiences. Happy to answer any other nutrition questions or concerns you may have.

Very special thanks go out to Kyle Dent, BS, a masters program intern from Loyola University and Medical Center, for helping me with this post.

I Was a Teenage Vegan Who Ate Them RAW!!

Photo credit: Angela Dansby

From my Real Life Nutrition blog on WebMD
By David Grotto, RD, LDN

Sounds like the latest title of a grizzly slasher film – just in time for Halloween! Not the case here. Rather, the title aptly describes the dietary advice de jour I was following at that particular time in my life. Scary or not, that is no longer true. I have become a middle-aged meat-eater who eats things cooked (with obvious exceptions)!

To clarify, I was on the distal end of my “teenage” years when I started dabbling with my diet. I was overweight and didn’t feel as good as I should for someone so young. Not surprising, I was the typical teenager that sustained himself on anything that came off a grill or out of a deep fat fryer. I paid the price.

Ironically, I worked at a health food store when I decided that something in my life needed to be changed. Many of my customers had suggested that I adopt some permutation of a vegetarian diet that was popular at the time: macrobiotics; natural hygiene diet or even a raw foods diet. So, I took them up on their advice and started reading – then toting around – Francis Moore Lappé’s veggie-forward book, Diet for a Small Planet – like it was the bible. I also was intrigued with the whole natural hygiene movement (Fit for Life) and Norman Walker’s books on juicing and immersed myself into their teachings and culture. So I decided to give up all animal products and pump up the volume on my veggie intake via raw juice, raw fruit and veggies.

My health transformation was astounding. In a very short time, I trimmed down and my energy levels were boosted. I didn’t have cooking facilities at the store so eating raw was quite appealing (pun intended) and “easy breezy” but admittedly, boring as hell. But I didn’t care because I felt great. That lasted for about a year until I attended a friend’s bar-b-que, tasted those sweet pork ribs and rekindled my inner paleo – slowly animal products crept back into my life. I though I was in trouble.

But I learned a valuable lesson from my teen years – veggies had to be front and center if I was to reintroduce meat back into my life. And the meat I ate needed to be lean and right sized. Yes, occasionally noshing on a small quantity of ribs continues to be part of my dietary M.O. But what I noticed is that when I struck a perfect balance, I still enjoyed great health and energy and found for me, that my lifestyle to be sustainable.

My purpose in recounting my dietary trials and tribulations is to illustrate that there are many paths to wellness: raw; vegan; Mediterranean and DASH diets, to name a few. It’s a personal choice and what works for one may not work for another. Buy what is inescapable is that all of the aforementioned diets have plants as the main focus. The good news is card-carrying omnivores like me no longer have a dilemma – moderate amounts of animal products fit well into a healthy diet…period. A recent study example that supports this premise was featured in the December issue of the American Journal of Clinical Nutrition. The study entitled Beef in an Optimal Lean Diet (BOLD) looked at the effects of including lean beef in a low saturated fat diet. The results were on par with what you would see in other effective diets for lowering total and LDL cholesterol such as the DASH diet.

“Even if you don’t want to be a complete vegetarian, you can gain benefits from eating a plant-based diet. By including more plant-based meals you can reduce your sat fat intake and increase your intake of nutrient and fiber rich foods linked with lower disease risk, “ says Sharon Palmer, RD, author of The Plant – Powered Diet. Dawn Jackson Blatner, RD, author of The Flexitarian Diet agrees. “You don’t need to go cold-turkey on meat to reap the benefits – you can get the health benefits of a vegetarian lifestyle while still enjoying meaningful meat moments. There are three steps that I use for getting people to eat & enjoy more plants,” says Jackson Blatner. She offers these helpful tips.

Reportion Your Plate. Downsize your meat and grain portions while pumping up the produce. Aim to have 25% of your plate meat/poultry/fish, 25% whole grains (such as brown rice or whole grain pasta) and 50% veggies!

Reinvent Old Favorites. Take your current favorite recipes and swap out the meat for fiber-rich beans. For every 1 ounce of meat substitute 1/4 cup beans instead.

Refresh Your Recipe Repertoire. Challenge yourself to try a new vegetarian recipe each week. Ask friends for their favorites or look through vegetarian magazines, cookbooks and websites for one that catches your eye.

So, what’s a meat lover to do? One option is to chomp on faux meat wanna-bes that often leave meat-loving folks like me wanting. Neither Palmer nor Jackson Blatner are huge fans of faux meats. Instead, they recommend focusing on including dishes (many featured in their fantastic books) that offer meaty flavor such as this recipe that Dawn suggests from her book.

TEMPEH TACOS
Servings: Makes 8 tacos

Ingredients

Taco Seasoning
1 Tablespoon chili powder
1 teaspoon each: onion powder, garlic powder, paprika, oregano, cumin
1/2 teaspoon sea salt
Dash cayenne pepper, to taste

“Meat”
1 Tablespoon olive oil
1 package (8 ounces) tempeh, crumbled to resemble ground beef
3/4 cup water
1/4 cup tomato paste
 
8 crunchy corn tortilla shells
Toppings such as: Shredded romaine lettuce, chopped tomatoes, sliced black olives, chopped green onions, salsa, sliced avocado, chopped fresh cilantro, lime wedges 

Directions
1) Combine taco seasoning ingredients together.
2) Sauté seasoning mix with olive oil for 1 minute to release flavor.
3) Add tempeh and sauté for 3 minutes.
4) Add water and tomato paste and sauté for another 5-6 minutes, until hot.
5) Serve tempeh “meat” in crunchy corn taco shells with toppings. 
Nutrition Info (1/4 cup tempeh only):
90 calories, 4.5g total fat, 1g saturated fat, 0g trans fat, 0mg cholesterol, 170mg sodium, 7g carbohydrate, 3g fiber, 1g sugar, 6g protein, vitamin A 10%, vitamin C 2%, calcium 4%, iron 8%

Love to hear you thoughts and suggestions on a healthy omnivore diet! Meanwhile, enjoy your tacos and thanks to Dawn Jackson Blatner, RD and Sharon Palmer, RD for their input!

Feeding Teenage Vegetarians in a Non-Vegetarian Family

So here’s the deal at my house. Two out of three daughters are lacto-ovo vegetarians while the rest of use are card-carrying omnivores. Read how we deal with this scenario in my weekly WebMD post.

By David Grotto, RD, LDN aka “The Guyatitian”

When she was eight years old, my oldest daughter Chloe went on a trip to Lisbon, Portugal with my wife Sharon and myself. She traveled well and was our adventurous eater until we stopped at the first restaurant outside of Lisbon. On the menu and in plain English, read “We serve filet of Kid”. Her jaw dropped, and she looked at us in a state of fright. “Do they really serve children here?” After we assured her that it was illegal to offer any part of a child or adult’s body as a menu item, she proceeded to ask, “Then what is kid?” Explaining that kid was just another name for a young goat, she then paused for just a moment and officially informed us that she was now a vegetarian. She decided from then on, eating animals wasn’t the way she was going to roll.

Now enter Madison (my youngest). Her favorite stuffed animal growing up was “Mr. Pig”. She took him everywhere…even to the dinner table. One day, while she was eating one of her favorite breakfast foods, bacon, she asked where bacon came from. My wife and I looked at each other. Fearing she’d be in therapy for the rest of her life if we lied to her, we decided to tell her the truth. She was not happy…not happy at all. She put 2 and 2 together and also swore off of any pork products from that day forward. But she also decided that eating any animal was ‘disgusting’ so joined the ranks of her sister. See where this is going?

First do no harm! Some of you may be asking, “Why didn’t you put your foot down and insist that your daughters continue to eat meat? Besides, isn’t that healthier for them?” Don’t forget…I wear two hats here: not only am I a concerned father, but I’m also a nutritionist. Like other dads, I only want the best for my ‘kids’. As a dietitian, I already knew what the science had to say about kids and a vegetarian diet:

“Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes.” American Dietetic Association Position Paper on Vegetarian Diets.

My vegetarian daughters were on solid ground, as far as the science went. But I also knew that my daughters had no clue what a “healthy” vegetarian consisted of. Though I have supported their decision to avoid meat, I have also watched over their
menu-planning, educating them about different vegetarian offerings to assure adequate nutrition. Admittedly, I have also prayed that they make better choices when on their own.

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