Thanksgiving is a wonderful holiday for us to remember all our blessings!  For those of you who do not like eating poultry on thanksgiving, I suggest a veggie loaf.  It is easy to create with the “Magic Loaf Studio”!  Check it out at veganlunchbox.com. You can make your own loaf with whatever ingredients you have available.  In this episode, I show you how to navigate the website and then make my own loaf ! The Magic Loaf Studio makes it easy for everyone to make their own veggie loaf.

Happy thanksgiving!

Ingredient information:

Quinoa:

Quinoa is a versatile grain.  You can use it in the place of rice, and it is very high in protein.  Protein is made out of amino acids, some essential because we can not produce them and need to get them from the diet. Quinoa is a “complete” protein because it contains all the essential amino acids. It  is an excellent plant-based protein source.(1)

Another benefit of quinoa is that it is high in fiber.  Quinoa is also high in certain minerals which people lack such as Magnesium, Potassium, Zinc and Iron (for women).  By  soaking and/or sprouting the quinoa before cooking it, you can  reduce the phytic acid  (which binds the minerals and reduces absorption) and make these minerals more available.  Quinoa is also high in antioxidants which neutralize free radicals and fight aging and disease.  Allowing quinoa seeds to sprout increases the antioxidant content even more.(1)

Foods with a high glycemic index stimulate hunger and contribute to obesity and are linked to chronic western diseases like heart disease and diabetes.  Quinoa has a low glycemic index, which is a measure of how quickly foods raise blood sugar levels.(1)

Lentils:

Lentils have many health benefits.  Lentils are high in fiber, preventing constipation and other diseases in the colon such as diverticulosis and diverticulitis.   Fiber traps carbohydrates, slowing down digestion and stabilizing blood sugar levels.  Fiber also reduces blood cholesterol, which in turn reduces your risk of heart disease and stroke by keeping your arteries clean.   Lentils are also a good source of folate and magnesium.  Folate lowers your homocysteine levels, a risk factor for heart disease, and magnesium improves blood flow. Low levels of magnesium have been  associated with heart disease.  Lentils are also a good source of iron, which transports oxygen throughout your body and is key to energy production and metabolism. About one quarter percent of lentil’s calories are attributed to protein, which makes them a wonderful source of protein.  The most wonderful thing about lentils is that they are low in calories and contain virtually no fat, leaving you feeling full and satisfied.(2)

Mushrooms:

One cup of chopped or sliced raw white mushrooms contains 15 calories, no fat, 2 grams of protein, and 2 grams of carbs.  Mushrooms help prevent chronic disease due to the presence of antioxidants and beneficial dietary fibers such as chitin and beta-glucans.

Mushrooms have a high antioxidant capacity.  They are the only vegan, non-fortified dietary source of vitamin D. Vitamin D in mushrooms has been shown to inhibit the growth of cancer cells. Folate in mushrooms plays an important role in DNA synthesis and repair,  preventing the formation of cancer cells.  Mushrooms are rich in B vitamins such as riboflavin, folate, thiamine, pantothenic acid, and niacin. Mushrooms also provide minerals difficult to obtain in the diet, such as selenium, potassium, copper, iron, and phosphorus.  Selenium is not present in most fruits and vegetables but can be found in mushrooms. It helps detoxify some cancer-causing compounds in the body and prevents inflammation, decreasing tumor growth rates.  Mushrooms also contain choline, which helps with sleep, muscle movement, learning and memory. Choline assists in maintaining the structure of cellular membranes, aids in the transmission of nerve impulses, supports proper fat absorption and reduces inflammation.(3)

One cup of grilled portabella mushrooms provides about 3 grams of fiber.  Mushrooms contain two types of dietary fibers in their cell walls: beta-glucans and chitin which increase satiety and reduce appetite, making you feel fuller longer, lowering your calorie intake.  Beta-glucans have been shown in studies to improve insulin resistance and blood cholesterol levels, lowering the risk of obesity.  They also help lower blood cholesterol levels.  Since mushrooms are high in potassium and low in sodium, they help lower blood pressure, decreasing the risk of hypertension  and cardiovascular diseases.(3)

Carrots:

There are many health benefits of carrots.  Carrots contain beta carotene and other antioxidants.  Beta-carotene consumption has been linked to a reduced risk of cancer, notably lung cancer.  Beta-carotene improves eye health.  Research found that people who ate the most amount of beta-carotene had a lower risk of macular degeneration than those who consumed the least. Beta-carotene can also split itself via an enzymatic reaction to form provitamin A, associated with antioxidant capacity in relation to vision.  Carotenoids help lower blood sugar, helping diabetics. They regulate the amount of insulin and glucose that is being used and metabolized by the body, providing a more even fluctuation for diabetic patients.(4)

Carrots also contain vitamin A.  Vitamin A deficiency can cause difficulty seeing in dim light. Therefore, carrots are good for preventing conditions like night blindness.  Carrots contain Vitamin C,  which stimulates the activity of white blood cells, an important element in the immune system.   They also contain Vitamin K, vitamin B8, pantothenic acid, folate, potassium, iron, copper, and manganese.(4)

Eating carrots can help prevent heart disease.  Studies have shown that cholesterol levels drop when eating carrots .  Studies have found that root vegetables, such as carrots, can reduce the chances of having a heart attack as well.   Carrots are a good source of potassium, which can relax your blood vessels and arteries, increasing blood flow, boosting organ function throughout the body, and reducing the stress on the cardiovascular system.   Eating carrots reduces stroke as well.  In addition, stroke patients with highest levels of beta carotene had the highest survival rate.($)

Carrots, like most vegetables, have significant amounts of fiber.  Fiber protects your colon and stomach from illnesses, including colorectal cancer.  Another study shows that women who ate raw carrots were less likely to develop breast cancer than women who did not eat carrots. Further research into the application of both carrots and beta-carotene in relation to other forms of cancer is ongoing. It also boosts heart health by eliminating excess LDL cholesterol from the walls of blood vessels.(4)

Garlic:

The combination of anti-inflammatory and anti-oxidant compounds in garlic makes it a food for preventing atherosclerosis.  Garlic lowers blood triglycerides and total cholesterol.  Garlic has also been found to lower blood pressure.   Allicin in garlic blocks the activity of angiotensin II,  helping prevent unwanted contraction and increases in blood pressure. In addition, garlic is rich in sulfur-containing molecules called polysulfide, converted into hydrogen sulfide, once inside our red blood cells,  triggering dilation of our blood vessels, reducing blood pressure. (5)

In addition to the ability of garlic to help prevent our blood vessels from becoming blocked, it may also be able to help prevent clots from forming inside of our blood vessels.  Garlic contains Ajoene which can help prevent certain cells in our blood (called platelets) from becoming too sticky, lowering the risk of them clumping together and forming a clot.(5)

Garlic is also an excellent source of vitamin C, which protects protects LDL cholesterol from oxidation into free radicals in the bloodstream.  Garlic’s vitamin B6 helps prevent heart disease by  lowering levels of homocysteine, which can directly damage blood vessel walls.  Garlic is rich in selenium, a a cofactor of glutathione peroxidase, one of the body’s most important antioxidant enzymes. (5)

Our musculoskeletal system and respiratory system can also benefit from anti-inflammatory compounds in garlic, shown to have anti-arthritic properties. And in the case of allergic airway inflammation, aged garlic extract has been show to improve inflammatory conditions. Some inflammatory aspects of obesity may be altered by sulfur-containing compounds in garlic.   Recent research has shown the ability of crushed fresh garlic to help prevent infection by the bacteria, fungi, and yeast. (5)

Garlic has a consistent track record for general anti-cancer benefits. A high intake of garlic has been found to lower risk of virtually all cancer types except cancer of the prostate and breast cancer. (5)

Oregano:

Oregano is a great source of  antioxidants and Vitamin K, which promotes bone growth, the maintenance of bone density, and the production of blood clotting proteins.  It has been shown to have antimicrobial activity in several studies.  In one study, oregano oil even killed Methicillin Resistant Staph Aureus!  Beta-caryophyllin  (E-BCP) in oregano may possibly be of use against disorders such as osteoporis and arteriosclerosis.There has been research that shows components oregano may help slow down or prevent the progression of breast cancer in patients.  Oregano has been used to treat respiratory tract disorders, gastrointestinaldisorders, menstrual cramps, and urinary tract disorders.  It has also beenapplied topically to help treat a number of skin conditions, like acne and dandruff.  Other nutrients in oregano include: fiber, iron, manganese,  vitamin E, iron, calcium, omega fatty acids, manganese, and tryptophan.(6)

(1) Gunnars, Kris.  “11 Proven Health Benefits of Quinoa.”  Authority Nutrition:  An evidenced-based approach.  Authority Nutrition.com.  July 2014.  Web.  Accessed 28 November 2015.  <http://authoritynutrition.com/11-proven-benefits-of-quinoa/>.

(2) Wilcox, Julie.  “7 Health Benefits of Lentils.”  MindBodyGreen.  MindBodyGreen.com.  17 July 2012.  Web.  Accessed 28 November 2015. <http://www.mindbodygreen.com/0-5488/7-Health-Benefits-of-Lentils.html>.

(3) “Mushrooms: Health Benefits, Nutritional Information.”  Medical News Today.   Medilexicon International, Ltd.  14 September 2015.  Web. Accessed 28 November 2015. <http://www.medicalnewstoday.com/articles/278858.php>.

(4) “Health Benefits of Carrots.”  Organic Facts.  Organic Information Services Pvt. Ltd.  Web.  Accessed 28 November 2015.  <https://www.organicfacts.net/health-benefits/vegetable/carrots.html>.

(5) “Garlic.”  The World’s Healthiest Foods.  The George Matejian Foundation.  Web.  Accessed 28 November 2015.  <http://www.whfoods.com/genpage.php?tname=foodspice&dbid=60>.

(6)  “Oregano:  Health Benefits, Side Effects”  Medical News Today.  Medilexicon International, Ltd.  29 September 2015.  Web.  Accessed 28 November 2015.  <http://www.medicalnewstoday.com/articles/266259.php>.

Fish oil is the third most widely used dietary supplement in the United States.  People believe that the omega-3 fatty acids in the supplements will protect their cardiovascular health.   The belief originated from the research of Dr. Hans Olaf Bang and Dr. Jorn Dyerberg, Danish scientists.  They determined that Inuits living in northern Greenland had low rates of cardiovascular disease, which they thought was due to an omega-3-rich diet consisting mainly of fish, seal and whale blubber.  (However, Dr. George Fodor, a cardiologist at the University of Ottawa found that the rate of heart disease among the Inuit was vastly underestimated by them.) Then, in the 1990s, a study that found that heart attack survivors treated with a gram of fish oil daily had a drop in mortality, compared with patients taking vitamin E. (1)

Unfortunately, the most of the clinical trials involving fish oil show no evidence for lowered risk of heart attack and stroke. In a recent New York Times Article:

“From 2005 to 2012, at least two dozen rigorous studies of fish oil were published in leading medical journals, most of which looked at whether fish oil could prevent cardiovascular events in high-risk populations  (who had a history of heart disease or strong risk factors for it, like high cholesterol, hypertension or Type 2 diabetes)…All but two of these studies found that compared with a placebo, fish oil showed no benefit.”(1)

A lot of people take fish oil capsules to get their omega 3, but I suggest this delicious omega 3 smoothie instead! This omega 3 (fish oil free) smoothie is made with chia seeds:

Ingredients:

1 cup of mangos (chopped fresh or frozen)

+/- 1 banana

1 cup of spinach (or 1 large handful)

3 tsp of chia seeds (or flax seeds if you prefer)

1 sprig of mint

Directions:  Combine all in a high power blender (such as the vitamix) and mix until smoothie consistency…I like the taste of adding a banana, but it does have a slightly less favorable omega 6:3 ratio.  But with the other ingredients, this smoothie still has a favorable 6:3 ratio even with the banana.

Information on ingredients:

Omega 6:3 ratio:

Mango 1:3

Banana 5:3

Spinach:  1:5

Chia Seeds: 1:3

Mint:1:6

*Please see mango salsa episode from August 2015 for information on mango nutritional value and Oatmeal raisin bites post from June 2015 for information on banana nutritional value.

Spinach:

I love spinach because it has so few calories and so much nutrition!  1 cup of spinach has 7 calories!  Another wonderful fact is that most of the calories in spinach come from protein!  Spinach contains a lot of vitamin A and vitamin K.  Vitamin A is important for the health of your eyes, and vitamin K is important for maintaining bone health, as well as calcium and magnesium, which is also contained in spinach.(2)

Spinach is also an excellent source of other nutrients including potassium, manganese, folate, andiron.  Potassium is an essential part of heart health. Many studies have linked it with lower blood pressure since it promotes widening of the blood vessels.  Spinach’s high levels of chlorophyll may have anti-cancer and anti-carcinogen effects. Studies have noted anti-cancer effects among breast and prostate cancers.  Folate helps prevent neural tube defects in pregnancy. (3)

Chia Seeds:

For all of you out there who have a problem with constipation, chia seeds are the food for you!   An ounce of chia seeds has 12 grams of carbohydrate, but 11 of those grams are fiber, which isn’t digested by the body.  Fiber does not require insulin to dispose of it and does not raise blood sugar.  Therefore, the carb content (excluding fiber) is only 1 gram per ounce, which is very low. Chia seeds can absorb up to 10-12 times their weight in water, becoming gel-like and expanding in your stomach, which increase satiety.  They are 40% fiber, by weight, which makes them one of the best sources of fiber in the world.(4)

By weight, chia seeds are 14% protein, which is high compared to most plants.  A high protein intake can reduce appetite and reduce thoughts about food and the desire for night time snacking.(3)

Chia seeds are high in several nutrients that are important for bone health, such as  calcium, phosphorus,and magnesium.  Chia seeds contain 18% of the recommended daily allowance of calcium in one ounce, which is higher than most dairy products per ounce(5).

Mint:

I love adding mint to my smoothies.  It has a great omega 6:3 ratio, plus it gives you minty fresh breath!  What more can a girl ask for?

Fresh mint leaves contain minimal protein and fat, and provide small amounts of carbohydrates. A serving of spearmint contains 2 grams of carbohydrates per serving, with 1.6 grams of fiber. Fiber helps reduce cholesterol and lowers risk of obesity. Spearmint is high in vitamin A, which promotes skin and immune system health and helps cells reproduce normally.  Mint also has small amounts of vitamin C and B-complex vitamins.(4)

(1) O’Connor, Anahad.  “Fish Oil Claims Not Supported by Research.”  The New York Times.  The New York Times Company.  30 March 2015.  Web.  18 November 2015.

(2) “Spinach.” The World’s Healthiest Foods. The Goerge Mateljian Foundation. Web. 15 November 2015.

(3) Szalay, Jessie.  “Spinach: Health Benefits, Nutrition Facts (& Popeye).”  Live science.  Purch.  24 June 2015.  Web. 15 November 2015.

(4) Gunnars, Kris.  “11 Proven Health Benefits of Chia Seeds (No. 3 is Best).”  Authority Nutrition:  An Evidence-Based Approach.  June 2014.  Web.  15 November 2015.

(5) Tremblay, Sylvie.  “Nutrition of Mint Leaves.”  Livestrong.com.  Demand Media, Inc.  04 May 2015.  Web.  15 November 2015.

This is a really easy recipe with no added sugar!  There is some saturated fat in coconut milk, however, so if you have some health problems such as heart disease or stroke, it may be best to avoid the saturated fat.

Ingredients:

1 pineapple (cut up in small pieces)

1 can of coconut milk (about 16 ounces)

Directions:

Mix both contents together in a high power blender until it makes a smoothie.  You can drink it as a smoothie or freeze it in the freezer and make the sorbet!

Nutritional Contents:

Pineapple:

Pineapples contain bromelain which can be extracted from the stem and core fruit of the pineapple.  Studies have shown that bromelain has health benefits including decreasing inflammation, excessive coagulation of the blood, and certain types of tumor growth.   Pineapples also contain vitamin C, which defends all aqueous areas of the body against free radicals that attack and damage normal cells.  Free radicals promote artery plaque build-up in atherosclerosis and diabetic heart disease, cause the airway spasm leading to asthma attacks, damage colon cells causing cancer, and contribute to the joint pain and disability. Vitamin C is also essential for the immune system.  Pineapple is also a great source manganese, an essential cofactor in a number of enzymes important in energy production and antioxidant defenses. In addition to manganese, pineapple is a good source of thiamin, a B vitamin which is cofactor in enzymatic reactions central to energy production.(1)

Coconut Milk:

Coconuts contain significant amounts of fat, but unlike other nuts, they provide fat that is mostly in the form of medium chain saturated fatty acids (MCFAs).  One is called auric acid, which is converted in the body into a beneficial compound called monolaurin, an antiviral and antibacterial substance.  Unlike other saturated fats, MCFAs are used up more quickly by the body and are less likely to be stored as fat. However, they do contribute to heart disease, since they are still a fat.(2)

(1) “Pineapple.”  The World’s Healthiest Foods.  George Mateljan Foundation. Web. Accessed 10 November 2015.

(2) Lewin, Jo.  “The health benefits of…coconut milk.”  Good food.  BBC Worldwide.  Web.  Accessed 10 November 2015.

I took a recent vacation to Guadalupe Island to go cage diving with the great white sharks.

With the recent surge in shark attacks, this is an opportune moment for a blog post about sharks.  The media has been capitalizing on the shark attacks.  To put everything in perspective, for every human killed by a shark, humans kill approximately two million sharks.  According to National Geographic, in 1996, toilets injured 43,000 Americans a year,while sharks only injured 13.  (1)

Unfortunately, aggressive overfishing threatens to push some shark species to extinction.  Scientists say that the number of annual shark deaths is around 100 million. Sharks are fished for their meat, liver oil, cartilage and fins, which are used for shark fin soup. Since sharks have slow growth and reproductive rates, it can be tough for their populations to bounce back.(2)

In the practice of shark finning, the fins are kept and the shark’s body is usually thrown off the boat, often while the shark is still alive.  The shark is unable to swim or pass water across its gills and dies from suffocation, blood loss or predation by other species. Only the fins are kept because shark fins are among the most expensive seafood items in the world. The value of the shark fin is many times the value of the meat by weight, so economically, it makes sense to use the limited space on a vessel to store the high-priced fins rather than the low-priced meat of the sharks’ body.  Therefore, 95% of the carcass is wasted. (3)

Sharks are important apex predators and play an important role in the ecosystem by maintaining the species below them in the food chain.  Sharks remove the weak and the sick and  keep the balance with competitors helping to ensure species diversity. When sharks are taken out of the coral reef ecosystem, larger predatory fish, such as groupers, increase in abundance and feed on the herbivores. With less herbivores, macroalgae expands and coral can no longer compete, shifting the ecosystem to one of algae dominance, affecting the survival of the reef system.(4)

So how can you avoid a shark attack?  Here is some advice from the Florida Natural Museum of Ichthyology(5):

1. Swim in a group, since sharks most often attack people who are alone.
2. Do not wander too far offshore, since you may isolate yourself from people who can assist you.
3. Avoid the water at night, dawn, or dusk.
4. Don’t enter the water if bleeding.
5. Don’t wear shiny jewelry, since the reflected light looks like shining fish scales.
6. Don’t go into waters containing sewage which attracts bait fishes, which attract sharks.
7. Avoid waters being fished. Diving seabirds are good indicators of such activities.
8. Don’t enter the water if sharks are present, and leave if sharks are seen.
9. Avoid an uneven tan and brightly colored clothing.
10. Don’t splash a lot. Also, keep pets out of the water. Erratic movements can attract sharks.
11. Use care near sandbars or steep drop-offs, which are favorite hangouts for sharks.
12. Don’t try to touch a shark!

If you are attacked by a shark, how can you survive?  Here are recommendations in the order they should be tried: (6)

1.  Experts advise that you arm yourself with a weapon if one is available to you.  Any blunt object is a better option than smacking a shark with your edible body parts!
2. Try  to get away from the shark at the first opportunity.  However, do not lose sight of the shark during an attack.  Do not play dead because you  will present yourself as an easy meal.
3. If possible, move yourself into a position where your back is against a solid structure. This way you can decrease the angles at which the shark can strike.
4. Punch the shark in its face;  directly on its nose will deter it.   Try to make the best of the first jab and escape as subsequent jabs won’t be as effective.
5. Scratch and claw at the shark’s two most vulnerable features: the gills and the eyes.
6. If all else fails, thrash and splash and pound the creature in any way you can.

Have fun out there in the ocean and be safe ! You will likely never have to use these techniques since the chances of being attacked by a shark are just one in 11.5 million, according to the University of Florida’s International Shark Attack File.(7)  We are much more of a danger to sharks than sharks are to us!  I love the coral reef and do not want to see it overrun by algae, so I hope that we can take steps to conserve sharks by  improving  commercial fishing practices and banning shark finning.

(1)”Shark attack facts.”  National Geographic Channel.  National Geographic Channel.  Web.  Accessed 1 November 2015.  < http://natgeotv.com/ca/human-shark-bait/facts>.

(2) Gannon, Megan.  ” 100 million sharks killed each year, study finds.” Live Science.  Purch.  1 March 2013.  Web.  Accessed 1 November 2015.  <http://www.livescience.com/27575-100-million-sharks-killed-annually.html>.

(3)  “Finning and the Fin Trade.”  Shark Savers.  Wild Aid.  Web.  Accessed 1 November 2015 .  <http://www.sharksavers.org/en/education/sharks-are-in-trouble/finning-and-the-fin-trade/>.

(4) “The Importance of Sharks.”  Oceana: Protecting the World’s Oceans.  Oceana.  Web.  Accessed 1 November 2015.  <http://eu.oceana.org/en/importance-sharks>.

(5) Burgess, George.  “Just for Kids:  How to Avoid a Shark Attack.”  Ichthyology at the Florida Museum of Natural History.  Web.  Accessed 1 November 2015. <https://www.flmnh.ufl.edu/fish/kids/avoid/avoid.htm>.

(6) Wells, Jonathan.  “How to survive a Shark Attack.”  The Telegraph.  The Telegraph.  20 July 2015.  Web.   Accessed 1 November 2015.  <http://www.telegraph.co.uk/men/the-filter/11750497/How-to-survive-a-shark-attack.html>.

(7)  Reilly, Michael.  “Shark Attacks:  What are the Odds?” Discovery News.  Discovery Communications, LLC.  20 August 2010.  Web.  Accessed 1 November 2015.  <http://news.discovery.com/animals/sharks/shark-attacks-what-are-the-odds-20100802.htm>

This is the fourth post in response to concerns raised in an article on the Weston A. Price Foundation’s site by Christopher Masterjohn titled “Vegetarianism and Nutrient Deficiencies.”  I decided to concentrate on cholesterol.  I find this section of his article the most disturbing.  As an emergency physician, I see people who have heart attacks every day, which can probably prevented through a healthier diet.  Unfortunately, this website is advocating just the opposite.  Masterjohn writes about the Smith-Lemli-Opitz Syndrome in which people are unable to make cholesterol and states it is necessary for these people to consume it.  He states, ” There are, however, millions of people with genetic defects in cholesterol synthesis for whom dietary cholesterol is likely an essential nutrient.”   This is a rare genetic condition.  Smith-Lemli-Opitz syndrome affects an estimated 1 in 20,000 to 60,000 newborns.(1)  For the vast majority of the population, consuming cholesterol is absolutely unnecessary because your body makes its own.  Most people in western countries, consume far too much cholesterol, which is a cause for heart disease, strokes, and many other maladies.(2)

Then, Masterjohn quotes Dr. Price saying  “As yet, I have not found a single group of primitive racial stock which was building and maintaining excellent bodies by living entirely on plant foods.”   Weston Price was making observations but did not do any rigorous studies.  He was probably not aware of the fact that most native people did not live long lives.  Innuit Greenlanders, who have limited access to fruits and vegetables, have the worst longevity in North America.(3)  Research shows that they die on average about 10 years younger and have a higher rate of cancer than the overall Canadian population. The  meat-consuming Masai in Kenya have the worst life expectancy. Life expectancy is 45 years for women and 42 for men.  African researchers report that Maasai rarely lived beyond age 60.(4)

In conclusion, I find the advocacy of saturated fat on the Weston A. Price Foundation website disturbing.  As a physician, I want to see my people improve their health through diet, and this website encourages eating habits that may bring about increased heart disease and stroke.  From a journal article on the stance of the American Dietetic Association’s position on vegetarian diets:

It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. 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…his article reviews the current data related to key nutrients for vegetarians including protein, n-3 fatty acids, iron, zinc, iodine, calcium, and vitamins D and B-12. A vegetarian diet can meet current recommendations for all of these nutrients. In some cases, supplements or fortified foods can provide useful amounts of important nutrients. An evidence- based review showed that vegetarian diets can be nutritionally adequate in pregnancy and result in positive maternal and infant health outcomes. The results of an evidence-based review showed that a vegetarian diet is associated with a lower risk of death from ischemic heart disease. Vegetarians also appear to have lower low-density lipoprotein cholesterol levels, lower blood pressure, and lower rates of hypertension and type 2 diabetes than nonvegetarians. Furthermore, vegetarians tend to have a lower body mass index and lower overall cancer rates. Features of a vegetarian diet that may reduce risk of chronic disease include lower intakes of saturated fat and cholesterol and higher intakes of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals.(5)

(1) “Smith-Lemli-Optiz Syndrome.”  Genetics Home Reference:  Your Guide for Understanding Genetic Conditions.  07 September 2015.  Web. 09 September 2015. <http://ghr.nlm.nih.gov/condition/smith-lemli-opitz-syndrome>

(2) “About cholesterol.”  American Heart Association.  31 July 2014.  Web.  09 September 2015.  <http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp>

(3)  Iburg KM, Brennum-Hansen H, Bjerregaard P. Health expectancy in Greenland. Scan J Public Health 2001;29(1):5-12.

(4) Joel Fuhrman, MD. “The Truth about the Weston Price Foundation.”  Vegsource.com 24 July 2010.  Web.  09 September 2015.  <http://www.vegsource.com/news/2010/07/the-truth-about-the-weston-price-foundation.html>

(5) Craig WJ, Mangels AR.  Position of the American Dietetic Association:  Vegetarian Diets.   J Am Diet Assoc 2009 Jul;109(7):1266-82.

I went to see this movie screening sponsored by the National Resources Defense Council on my trip to Los Angeles. If you have not seen this movie, you must see it! I did not realize how much the noise in our ocean affects whales and other larger marine mammals.

The movie begins in Bahama where whales have beached themselves, and many died. The whales were found to have subarachnoid hemorrhages (bleeding in the brain) and bleeding inside their auditory canal (ear) on CT scan when they brought the dead whales to Harvard Medical School to investigate.

Then, the movie tracks the trend of the rapidly growing shipping industry. Ships are getting larger and louder unfortunately, since larger ships need larger motors have to propel their motion. I thought about how I am guilty of shipping my car from the mainland and buying some groceries shipped from California to Hawaii at Costco! Sometimes it is unavoidable, but buying local can reduce the demand for shipping and probably somewhat ameliorate the situation. Also, the oil companies have been causing very loud underground explosions which wreak havoc on the wildlife since they cannot escape the noise in the ocean. Looking for alternative sources of energy will definitely take the focus away from finding more fossil fuel by drilling in the ocean. Apparently the Navy has also been using sonar to echolocate submarines from other countries which is also disturbing the whales.

It is explained in the movie that the whales become sick since the noise is so loud, and they cannot communicate with each other. They try to escape by going to the surface but in effect get “the bends” or decompression sickness, and that is how they get the hemorrhages in their brain and damage to other organs similar to the decompression sickness that divers get when ascending too quickly. The movie shows different circumstances in which whales beached themselves. In one instance, the oil company was drilling in the area, and in another case, a large navy ship passing through (using their sonar).

I hope to get the word out about this movie. Please see it if you get a chance. Recommend it to your friends. I had no idea about how much the sound we create as humans can affect these animals.

This is the third in my series of blog posts addressing possible nutrient deficiencies raised by the Weston Price Foundation article “Vegetarianism and Nutrient Deficiencies” by Christopher Masterjohn.

Essential Fatty Acids:

Two essential fatty acids, linolenic and linoleic acid, cannot be synthesized in the body and must be obtained from food. These basic fats, are used to build specialized fats called omega-3 and omega-6 fatty acids. Omega-3 and omega-6 fatty acids are important in the normal functioning of all tissues of the body.

Deficiencies in these fatty acids lead liver and the kidney problems, reduced growth rates, decreased immune function, depression, and dryness of the skin. Numerous health benefits of fatty acids include reduced heart disease, stroke and breast cancer, and improvement of ulcerative colitis, menstrual pain and joint pain.(1)

Omega-6 fats are derived from linoleic acid which are found in leafy vegetables, seeds, nuts, grains, and vegetable oils. Most diets provide adequate amounts of this fatty acid.  Omega-3 fatty acids are derived from linolenic acid. The principal omega-3 is alpha-linolenic acid (ALA), which is then converted into eicosapentaenoic acid (EPA) and docosahexaenonic acid (DHA) by the body. This makes ALA the only essential omega-3 fatty acid. ALA can be found in many vegetables, beans, nuts, seeds, and fruits.  Masterjohn states  that vegetarians have lower levels of EPA and DHA than omnivores, vegans have lower levels than vegetarians and cites a study by Rossell which compares British vegetarians and vegans to omnivores.(2)

Oily fish contain omega-3’s, but it also have high amounts of other fats and cholesterol and lacks fiber. Fish are also often high in mercury and other environmental toxins.  Fish oils are a popular omega-3 supplement option, but the omega-3s found in fish oils (EPA and DHA) are unstable and tend to decompose and unleash harmful free radicals. Research has demonstrated that taking fish oil supplements does not actually produce significant protection on cardiovascular health.(3)

Research has shown that omega-3s from plant sources are more beneficial for one’s health. Omega-3s are found in a more stable form, ALA, in vegetables, fruits, and beans.  Conversion of ALA to the longer chain omega-3s, DHA and EPA, is usually sufficient to maintain tissue function.  According to a European Prospective Investigation into Cancer and Nutrition (EPIC) study, women on vegan diets actually have more long-chain omega-3s in their blood compared with fish-eaters, meat-eaters, and lacto-ovo vegetarians.(4)

It is important to also consume these fatty acids in the proper ratio. Excessive intake of omega-6 fatty acids can inhibit omega-3s.  The ideal ratio of omega-6 to omega-3 fatty acids should be  1:1 to 4:1.8, but most Americans consume these fatty acids at a ratio of 10:1 to 25:1.  This is due to the high American intake of processed foods and oils. A low omega-6:omega-3 ratio is desirable for reducing the risk of many chronic diseases.  Grinding up flax seeds in your morning smoothie like I did in the Green Smoothie Episode 1, is a great way to get your omega 3’s! (1)

Amino Acids

Master john then goes through some non-essential amino acids.  He states that vegetarians may be deficient in carnitine because there is limited availability in plants.  The bioavailability of L-carnitine varies due to dietary composition. In fact, there has been more bioavailability found in vegetarians.(5)  The bioavailability of L-carnitine in  vegetarians who are adapted to low-carnitine diets is higher (66% to 86% of available carnitine) than regular red-meat eaters adapted to high-carnitine diets (54% to 72% of available carnitine).(6)   Carnitine is not an essential amino acid.  Carnitine can be made from two essential amino acids, lysine and methionine.  Carnitine influences carbohydrate metabolism.  Aberrations in carnitine regulation are implicated in complications of diabetes mellitus, hemodialysis, trauma, malnutrition, cardiomyopathy, obesity, fasting, drug interactions and endocrine imbalances.(5)

Master john states that taurine is particularly important for nursing infants, since the developing brain contains three to four times as high a concentration of taurine as the adult brain.   The serum concentrations of vegans and infants nursing from them are lower than that of their omnivore counterparts.(7)  Taurine is not an essential amino acid.  Adults produce taurine by a combination of cysteine with the help of pyridoxine (vitamin B6), methionine and vitamin C. Cysteine is found in red peppers, garlic, onions, broccoli, Brussel sprouts, oats, granola and wheat germ.  Methionine can be found in a lot of vegan foods including Brazil nuts, sunflower seeds and butter, sesame seeds, oats.(8)  I spoke about vitamin B6 in the last post.  Vegans can eat complete proteins like soy, hemp seed, quinoa, buckwheat, amaranth regularly to ensure they can synthesize taurine from amino acids in these foods.   A paper by Dr. Joel Fuhrman recommends possible supplementation of Taurine for vegan athletes to improve performance of 500 mg twice daily. (9)

Masterjohn then goes on to state that vegetarians have lower levels of creatine than meat-eaters, but vegetarians are not at risk for creatine deficiency anyway.  Creatine is another non-essential amino acid.  Creatine supplementation is common among athletes   Evidence from mostly healthy young adult male subjects shows that exercise performance involving short periods of extremely powerful activity can be enhanced.   Potential acute effects of high dose creatine  supplementation on body fluid balance has not been fully investigated.  An article written by the American College of Sports Medicine article states that  “Creatine supplementation exhibits small but significant physiological and performance changes.  Increases in performance are realized during very specific exercise conditions. This suggests that the apparent high expectations for performance enhancement, evident by the extensive use of Creatine supplementation, are inordinate.”(10)

Master john states that carnosine is exclusively found in animal products and cites one study showing  vegetarians with higher levels of AGEs than omnivores.(11)   Carnosine is found in several tissues most notably in muscle.  Studies have demonstrated that they possess strong and specific antioxidant properties:  preventing peroxidation of model membrane systems and protecting cell membranes from oxidative damage. Other roles  include actions as neurotransmitters, modulation of enzymic activities and chelation of heavy metals.(12)

Carnosine is another non-essential amino-acid.  It is formed from amino acids beta-alanine and histidine. Carnosine is only found in meat, but both of its constituents are found in a wide variety of plant foods. This is why vegetarian animals like cows have so much in their tissues.(13)

To summarize this week’s blog, basically essential fatty acids can be obtained with a plant-based diet, and none of the amino acids he listed in his article are essential.  Therefore, they can be formed from other amino acids that are obtainable on a plant based diet.  Stay tuned for next week’s blog post where I will talk about his last concern, cholesterol.

(1) “Essential Fatty Acids.”  Physicians Committee of Responsible Medicine.  Web.  08 September 2015.  <http://www.pcrm.org/health/health-topics/essential-fatty-acids>

(2) Rosell MS, Lloyd-Wright Z, Appleby PN, Sanders TA, Allen NE, Key TJ. Long-chain n-3 polyunsaturated fatty acids in plasma in British meat-eating, vegetarian, and vegan men. Am J Clin Nutr. 2005;82(2):327-34.

(3)  Kwak SM, Myung SK, Lee YJ. Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials. Arch Intern Med. 2012;172:986-994.

(4) Welch AA, Shakya-Shrestha S, Lentjes MAH, Wareham NJ, Khaw KT. Dietary intake and status of n-3 polyunsaturated fatty acids in a population of fish-eating and non-fish-eating meat-eaters, vegetarians, and vegans and the precursor-product ratio of a-linolenic acid to long-chain n-3 polyunsaturated fatty acids: results from the EPIC-Norfolk cohort. Am J Clin Nutr. 2010;92:1040-1051.

(5) Flanagan J, Simmons PA, Vehige J, Willcox MDP^,,Garrett Qian.  “Role of Carnitine in Disease.”  Nutrition & Metabolism 2010, 7:30.

(6)  Rebouche CJ, Chenard CA.  “Metabolic fate of dietary carnitine in human adults: identification and quantification of urinary and fecal metabolites.” J Nutr 1991,  121:539-546.

(7) Bender DA. Nutritional Biochemistry of the Vitamins: Second Edition. Cambridge: Cambridge University Press (2003).

(8)  Butterflies Katz.  “What every vegan needs to know to optimize their diet.”  Veganism: A truth whose time has come.  03 June 2014.  Web.  08 September 2015.  <http://thevegantruth.blogspot.com/2014/06/what-every-vegan-needs-to-know-about.html>

(9) Fuhrman J, Ferreri DM.  “Fueling the Vegan Athlete.”  Curr. Sports Med 2010. 9 (4) 233-241.

(10) Terjung RL, Clarkson P, Eichner ER, Greenhaff PL, Hespel PJ, Israel RG, Kraemer WJ, Meyer RA, Spriet LL, Tarnopolsky MA, Wegenmakers AJ, Williams MH.  Medicine and Science in Sports and Exercise 2000.  32(3):706-717.

(11) Sebeková K, Krajcoviová-Kudlácková M, Schinzel R, Faist V, Klavanová J, Heidland A. Plasma levels of advanced glycation end products in healthy, long-term vegetarians and subjects on a western mixed diet. Eur J Nutr. 2001;40(6):275-81.

(12) Quinn PJ, Boldyrev AA, Formazuyk VE.  Carnosine:  its properties, functions and potential therapeutic applications.  Mol Aspects Med. 1992;13(5):379-444.

(13) Andrea Lewis.  “Carnosine and Raw Veganism.”  Skinny Limits.  02 April 2015.  Web.  09 September 2015.  <http://www.skinnylimits.com/blog/carnosine-and-raw-veganism/>

This is a continuation of the series of posts regarding concerns of vitamin deficiency raised in the article posted on the Weston A. Price Foundation’s web page titled “Vegetarianism and Nutrient Deficiencies” by Christopher Masterjohn.

In the first article I wrote about how vegetarians or vegans who eat a varied plant-based diet are not at risk for deficiencies in fat soluble vitamins A, D, and K.  Today I am going to talk about Vitamin B deficiencies.

Vitamin B12:

Vegans are indeed at risk for B12 deficiency. In the past, most people lived in close contact with their farm animals and consumed B12 left as residues by bacteria living on their un-sanitized vegetable foods.  Because this is no longer the case, those eating a plant-based diet are now at risk for B12 deficiency.  Vitamin B12 is found in animal foods, but it is not synthesized by plants or animals.  Bacteria make biologically active vitamin B12, and animal tissues store it and  pass it to other animals eating those animals tissues.  Ruminants, like cows or goats, have bacteria in their stomachs that synthesize vitamin B12, which is then passed down and absorbed by their small intestines.  Other carnivores get their B12 from eating these grazers.

Most cases of vitamin B12 deficiency seen in patients are due to diseases of the intestine.  Damage to the stomach’s parietal cells,  from disease or surgery, and damage to the intestine prevents absorption or reabsorption, causing the loss of B12. “Pernicious anemia” from B12 deficiency occurs once the body’s stores of vitamin B12 are depleted.   It can take up to 3 to 6 years for it to manifest (when the body’s stores of vitamin B12  become depleted).(1)

Master john states that ” even vegetarians who supplement with standard B12supplements could be at risk for deficiency. ”  This is simply untrue.  Blood levels of B12 can be measured directly in the blood.  I have been taking vitamin B12 supplements since I have been eating a plant-based diet for greater than 20 years and just had my B12 levels checked and they were high due to my supplementation.  As long as vegans take an over the counter supplement of  B12, there should be no problem with deficiency.  Requirements are pretty minimal and easy to get with supplementation.  I have a chart from the National Institutes of Health showing the different recommended amounts of B12 for different ages of people here: (2)

Vitamin B6:

In the article, Masterjohn asserts that  plant foods simply contain much less B6 than most animal foods and that the  plant form of vitamin B6 is inferior to the animal food form because its conversion to the active form depends on B2 status, and vitamin B2 levels tend to be higher in animal foods.  He states that plant foods contain much of their B6 bound up with sugars that make it difficult or impossible to absorb. He claims that plant foods require more cooking than animal products,  decreasing the yield of active B6 in vegetarian diets, since heat destroys B6.  He cites a study comparing lactating Nepalese women to their American omnivore counterparts The Nepalese women consumed more B6 but had lower serum levels of the active form.  They had equivalent levels in their breast milk, but their infants had lower levels of the active form.  It would be more fair to compare American vegans to American omnivores as Nepalese vegetarian women probably have less access to fresh fruits and vegetables containing B12.

That being said this article certainly does not prove that vegetarians will develop B6 deficiency as there are plenty of vegetarian sources of B6 including:  soy,  bananas, watermelon, peanut butter, almonds, sweet potatoes, green peas, avocados, hemp seeds, spirulina, chia seeds, beans, rice bran, chickpeas, sunflower seeds, pineapple, plantains, hearts of palm, artichokes, water chesnuts, all squash and pumpkin, Brussels sprouts, green beans, pistachios, figs, yeast, garlic, sage, peppers, kale, collards!(3)  In a study comparing Korean Buddhist vegetarians to non-vegetarians, the vegetarians actually had slightly higher B6 levels than the non-vegetarians. (4)

Zinc:

I am also going to address his concerns for zinc deficiency in this post.  Masterjohn states “Although [zinc is] present in grains, legumes, fruits and vegetables, it is found in much lower amounts compared to animal foods and is much less bioavailable…While a well planned vegetarian diet may escape overt zinc deficiency, it would be virtually impossible to maintain a truly robust zinc status without the inclusion of animal foods.”

An article by the American Dietetic Association addresses some of these concerns about zinc.  The article states that the bioavailability of zinc in vegetarians may be lower than non-vegetarians, due to the higher phytic acid content of vegetarian diets, but zinc deficiency is not evident in Western vegetarians. Zinc sources include soy products, legumes, grains, cheese, and nuts. You can reduce the binding of zinc by physic acid by soaking and sprouting beans, grains, and seeds as well as leavening bread, increasing zinc bioavailability. Citric acid can also enhance zinc absorption to some extent. (5)

In conclusion, a person eating a well-balanced plant-based diet in western countries should not have difficulty in obtaining adequate amounts of B6 and Zinc.  B12 will not be a problem with supplementation.  Next week I am going to address the concerns about essential fatty acids, amino acids, and cholesterol raised in this article.  Stay tuned!

(1) John McDougall.  “Vitamin B12 deficiency-The Meat- Eaters’ Last Stand.”  McDougall Newsletter.  November 2007.  Web.  07 September 2015.  <https://www.drmcdougall.com/misc/2007nl/nov/b12.htm>

(2) “Vitamin B12 Factsheet for Consumers.”  National Institutes of Health Office of Dietary Supplements.  Web.  07 September 2015.  <https://ods.od.nih.gov/factsheets/VitaminB12-Consumer/>

(3) Heather McClees.  “B Vitamins: How to get them in a Vegan Diet.”  One Green Planet.  11 July 2014.  Web.  07 September 2015.  <http://www.onegreenplanet.org/natural-health/b-vitamins-how-to-get-them-in-a-vegan-diet/>

(4) Lee, Yujin.  “The nutritional status of vegetarian Buddhist nuns compared to omnivorous women in South Korea.”  Web. 07 September 2015.  <http://geb.uni-giessen.de/geb/volltexte/2011/8061/pdf/LeeYujin_2011_03_14.pdf>

(5) Craig WJ, Mangels AR.  “Position of the American Dietetic Association.”  Journal of the American Dietetic Association 2009, 109(7):1266-1282.  

This is the 3rd episode in my interview series with Dr. Terrence Young, DDS.  Dr. Young talks about devices that bring the lower jaw forward to prevent snoring.  This is not for those people with sleep apnea, who should be using CPAP machines.  He has used the device himself and has found himself better rested.  He screens patients by placing a high resolution pulse oximeter on them while sleeping to see if the device will help them.

You can find Dr. Terrence Young at :1441 Kapiolani Blvd #1207, Honolulu, HI 96814.

This Week we are making lilikoi pie.  It is raw and has no added sugar!  :

Ingredients:

The pie crust is the same as the one for the Ulu pie that I made, for those of you who remember that episode!  For pie crust:

1 cup of dates

1 cup of almonds

1 cup of shredded coconut

For filling:

1 cup of cashews

4 apple bananas

8 lilikoi (passionfruit) -may use purple or yellow variety (purple variety tends to be sweeter), cut lilikoi in half and spoon out pulp

Directions:

Mix all ingredients for crust together in a food processor into they are shredded to fine pieces.  I use the pulse function on my Cuisinart food processor, but you can use any kind of food processor you want.  Then you can pour it into a pie pan and pat it down.  Then mix all ingredients for the filling in the food processor until it is a smoothie type consistency and pour it on top of the crust.  Freeze overnight!  When you are ready to eat it, you can either put it in the refrigerator to defrost for a few hours or bring it outside to thaw which is quicker.  Enjoy!

Lilikoi  nutritional benefits: