Knowing Our Dietary Onions. We’re Green, but not Behind the Ears. -
How to Treat Your Doctor when you’re ill was the title of an article a VEGAn wrote many years ago for a veggie newspaper. It sought a reduction of the misunderstandings and stress that took their toll in the consultation: the veggie shamed by resource to orthodox medicine when that “good” diet, “nature cure”, aversion to injections, vaccinations, and drugs (and the connotations of objectionable experiments on animals), failed and the doctor innocent of – or, probably, impatient with these quirks and delays in the succession of the ailing population awaiting their few moments in the surgery. 1. How to Treat Your Doctor when you’re ill was the title of an article a VEGAn wrote many years ago for a veggie newspaper. It sought a reduction of the misunderstandings and stress that took their toll in the consultation: the veggie shamed by resource to orthodox medicine when that “good” diet, “nature cure”, aversion to injections, vaccinations, and drugs (and the connotations of objectionable experiments on animals), failed and the doctor innocent of – or, probably, impatient with these quirks and delays in the succession of the ailing population awaiting their few moments in the surgery.
2. Things are much different now. Osteopathy is respectable: it is a great relief, at least temporarily, for doctors with back troubles (the patients’ not his or hers) and common problems with guts, reproduction, blood, prostates, and breasts, as well as the woes of the traveller’s return – malaria, hepatitis Giardia, HIV and sprue, and regimens of immunization for the young and the associations of smoking, diet, physical activity, nutrition, and degenerative diseases have reduced much of the apprehension between doctor and what was formerly the “difficult” patient. The “balanced diet” remains the objective that many doctors and nurses cultivate in the belief that their hurried recourse to the trough must demonstrate their opinion that squashes all the niceties of health faddists – as long as they have washed their hands first and the meat is cooked all through. The occasional veggy patient nowadays is likely to be a veggy-style nut and not even very healthy-food minded; probably s/he will be solving any deficiency problems with some of these multivitamin panaceas on offer at the chemists’, some actually specialized (and even approved) as “suitable” for vegetarians and vegans – and astounding versatility when the diversity of the young and the old, male and female (with further divisions of age and reproductive status) has to be accommodated. And how stable are these mixtures of chemicals and are they tested for the apparent bioactivities?
Pills, Panaceas, Nostra 3. Polypill nostra are spreading from supplments to drugs. Already the NHS is being urged to provide a polypill of 5 or so common drugs for general use in a population afflicted with the cardiovascular ailments of syndrome X (or metabolic syndrome); and over-the-counter statins will be coming up vitamin-like with the rations aimed at a population who may or may not need them. The vast market in supplements and other drugs – some of which may be prudent for a post-operative existence – may nurture dietary indulgence and optimal nutrition, just as sexual concupiscence presaged a regimen, albeit more crudely adjusted, of heroic pharmacy (“A night with Venus and a lifetime with Mercury” – an allusion to “magic bullet” therapies, pre-antibiotics of the penicillin-type for the Edwardian lues – or syphilis). And where these medications were once administered in vile-tasting and inconvenient officinal preparations (with the belief that the worse the taste, the greater the benefit), they now come slickly formulated and dispensed and shaped and colored to distinguish them for the infirm and the blind coping with a battery of 7 or 8 daily doses in this polypharmacy. And there lie some anomalies: pills luridly colored with coal-tar dyes under suspicion for provoking allergies being intended for asthmatics; and vegetarians bewildering pharmacists for specifics as pills, capsules, caplets, or tablets made without gelatine, lactose, shellac, or animal-derived red dyes. (Lactose is used as a sweetener rather that other sugars as a measure to prevent dental decay; however there are alternatives, such as these in chewing gums, that would not offend veggies).
4. Interpretations of nutritional and biochemically-based surveys need special care and acceptance of revisions of initial deductions that subsequent more highly powered studies have thrown up. The famous fibre hypothesis, championed by Dr Denis Burkitt, FRS, who described a fascinating and curable eponymous lymphoma, caused by the equally fascinating Epstein-Barr virus, has yielded to some major changes as the understanding of glycemic index (and load) emerged in association with the scourges of obesity and the complications of metabolic syndrome (essentially type 2 diabetes) surfaced: the wholemeal wheaten loaf has a high GI! The association of smoking with lung cancer and with exacerbated risks from many other lifestyle hazards has remained unassailable – but still much observed in the breach of the testimony for abstention.
Epidemiology 5. Epidemiological surveys are complicated by limitations of size and numbers and variations in participants, as well as dependence on recall, which may test memory to the full or more, or prospective studies in which control of information from the studied populations can be drawn. Comparisons may be possible between independent but parallel studies, so that some of the results can reasonably aggregated and statistical flaws minimized. There remain easily-overlooked differences in materials and methods of analysis: for instance, dietary studies involving populations in Europe and the USA must allow for fortification in North America of cow-milk with vitamin D, whereas in the UK, where the latitudes are higher, dairy-products must count as a significantly poor source of the “sunshine vitamin”. Moreover, some epidemiological surveys have spanned populations affected differently by the stresses and deprivations of wars and poverty and by movements and settlements of people with significantly different genetics: a tendency of anemia to increase resistance to malaria or of lactose intolerance is declining in many countries.
6. Small cohorts of subjects may still include substantial heterogeneity or confounding factors. Are the recruits to the study professional and eager volunteers anxious to prove a point or woebegone hypochondriacs keen to have an “MOT” to feed their worries? And who is sponsoring the study: the cost of an objective study of, say, the risks of a macrobiotic diet is likelier to deter its progression, whereas the (disparate) interests of the well heeled American cattle men and the soya growers on the health statistics of veggie consumers would gain much more attention, even in commercially-supported independent academic research. There’s a further cause of bias: negative or unrecognizable results, although scientifically sound, may never see publication, even in the popular press. Some measurements, e.g. of blood pressure are notoriously unreliable: variations in a single individual occur within the day or according to who, the where, and how the results were obtained. Many mass results taken before breakfast will differ significantly if the measurements are made later in the day when the aftermath of a bacon-and-egg breakfast can be seen as obvious fat in the drawn blood.
Lest We Forget 7. Dietary details are also notoriously inaccurate. It is easy to overlook the Mars bar taken after a recorded lunch; or the subject with the shakes and signs in the mouth of scurvy who records only moderate intakes of beer (“I make a pint last an evening, doc”) and none of wines or spirits who goes on those forgettable liver-rotting benders at the weekend. Then there are freegans, who regard unpaid-for food and drink, as sources of nutrients as inconsequential as undeclared political donations and loans. In fact veggie-style diets are now so fuzzily defined as to be unrecognizable entities: the subjects in such studies must be recorded as self-described vegetarians or vegans, although their observances in matters of lifestyle such as resort to supplements, exercise, adherence to raw food, macrobiotic, rastafarian, or organic regimens – as well as freeganism – may seriously add to all the general diversities of smoking, durations of abstinence, gender, class, employment etc… It seems that some freegans can accommodate scavenging that includes bacon butties and chips fried in tallow. And researchers with “normal” experiences can scarcely believe the suckling practice of some vegan mother nor the practice of imbibing self-voided urine in an interesting (but not all that uncommon in human populations) form of recycling. And then, still in the loins, just think of some sexual practises.
8. Strict human veggies (vegans) eating no animal-derived foods are an almost separate species with essential elements different from omnivores’: their proteins, DNA, blood, and bones can be distinguished by means of mass spectrometry used by archaeologists and botanists to trace by isotopic analyses the sources of the elements at different stages in the food chain and the affects of atomic weight on the essential enzymic processes. A specimen of human hair contains keratin proteins, isotopic analysis if which, based on nitrogen content, reveal the effects of nourishment directly from plants or, indirectly through feed. Similar studies of seeds and fecoliths (petrified feces) disclose the sources of our ancestors’ food – from plants moist suited to tropical or temperate climates.
9. In understandable dispensations of resources, some funded by subsidies, the Dairy Council and Meat and Livestock Commission have prompted research into the putatively beneficial factors in human nutrition that animal-derived foods offer, possibly uniquely. These efforts reinforce longstanding claims in value adding co-products and by-products and creating unease over purely plant-based examples of the healthy practices in the Portfolio of medically-attested eating lifestyles. The fish industry has followed suit and manufacturers of supplements and fortified foods have seen their chances too. The factors in question include facilitators of iron absorption, vitamins, minerals, proteinaceous substances, and fats (notably omega 6 and omega 3 polyunsaturated fats _ PUFAs – and long chain PUFAs and the complex of CLAs – conjugated linoleic acids, some with trans-unsaturation – and the omega 11 trans-vaccenic acid). The PUFAs are also of importance in appraisals of organic sources of meat, milk, fish, and eggs, as well as in the adequacy of plant-derived alternative sources, among which are oils from “exotic” sources such as linseed (flaxseed), and hemp, and nuts, which have their proponents.
10. These developments are accompanied by extensions of nutritional attributes into involvements beyond the cardiovascular effects to the functioning of the brain and nervous system (notably the eye) and prevention of allergies and eczema, as well as in cognition and behavioural disorders that might be credibly associated with the functioning of the brain. The effects of the PUFAs (which were once described as vitamin F) in their cardiovascular context are sill controversial but, to err on the safe side, the Foods Standards Agency recommends cautious and restricted consumption of fatty fish and the oils derived from them. The warnings represent misgivings over lipophilic pollutants accumulating in fatty fish and the further concentration if marine catches and offals were fed to farmed fish (in systems that are attracting the attentions and concern of the Soil Association, RSPCA and Farm Animal Welfare Council). Another snag attaches to the reservations over mercurials, organo-chloro compounds and chlorodiphenyls accumulated by fatty marine fish: it is the exhaustion in many areas of slowly-growing and reproducing species such as cod, through factory-style overfishing depleting stocks of such species and their prey, used as fishmeal, such as sand eels.
11. While controversy and further research gather strength in their cardiovascular contexts, the structural significance of PUFAs and especially of DHA, EPA and ARA, in brain function, awaits conclusion of researches due to be completed in 2008.
12. All of this is of significance for real veggies and students of evolution, for the advice that “fish is good for the brain” is a wisdom of many generations’ standing and the wanderings and dwellings of our ancestors took them, probably before serious terrestrial and climate upsets, along coasts and estuaries where seafood (e.g. shellfish and sea plants) were available inshore. This begs the question of the survival of herbivorous species very similar to ours (by comparison of their DNA) such as bonobos in the rainforests of Central Africa. Perhaps our ancestors were animals who enhanced their cleverness by increasing the size and faculties of their brains by eating seafood and evolving with pelvises wide enough in the women to allow the birth of big-headed babies. Meat-eating and sharing has been adduced as the beginnings of human society and community and with the closeness of our species with scavenging species such as wolves, dogs and cats.
13. Big epidemiological studies yield results after much labour of crops of statistics, obsolescent almost as the conclusions are reached and the cries for further research (and funding) go up. Screening has advantages, especially if reliable end-points, markers and analytical methods can be established. Death and mortality are final end points but questionable indicators of the quality of life or years of disability. Fractures are markers of the fragility of bones and of musculoskeletal disorders and can be interpreted with allowance for sites of breakage (of cortical or trabecular bone) and causes of unsteadiness in gait. Biochemical markers based on blood and urine tests (as well as on saliva, breast milk and semen) are indicators that will increasingly allow self-assessments and trends, possibly arranged, like pregnancy tests, through pharmacies; and there are always the bathroom scales and the tape measure.
14. Or a public service such as blood donation benefits the donor with some sort of blood test. Dying for the cause could be expressed by offers of bodies for medical research and training as well as in some treatments. These altruistic gestures are helping to alleviate a current shortage of such material. Pathology and mortuaries are not the most glamorous part of the NHS and the services of the “dead teaching the living” are in decline in the UK. Recent events have demonstrated that every major medical, nutritional and surgical device entails in its developments experiments on animals non-human and human, with snags appearing in the final stages of testing and after introduction into general practice; similarly, veterinary usage has to be monitored. Extrapolation of results from adults to children, the elderly, pregnant and lactating females, the developing fetus and anomalies in the cocktail effects in polypharmacy and multiple supplements cannot always be anticipated. Requirements of iodine intake are raised in pregnancy, especially in the first trimester when the baby’s brain is developing; later, the essential fatty acids at the time of birth and just after play a part in further significant changes and portents in the developing brain and nervous system. Opportunities beckon now for volunteering as subjects in the BioBank and Breakthrough Cancer projects.
15. Doctors are familiar with patients with vitamin B12 deficiencies who are not vegan. Vets come across sheep deficient because their diets or the soil are low in cobalt. In elderly humans the difficulties may have to be resolved by injections or even blood transfusions. Low intakes of vitamin B12 may be concealed by supplementations or fortification with folic acid which bestow special benefits for the outcomes of human pregnancies. To avert emergencies, we have advised manufacturers of foods and the health authorities to add both B-vitamins when supplementation with folate is considered. This is an example where veggies should read labels assiduously.
16. Vets and farmers are heavily implicated in the processes of the reproduction of livestock. Condition-scoring of the dams before and during gestation, to control overweight and distresses such as twin lamb disease are stock in trade. Colostrum is a valued – but ludicrously neglected – feature of the lactation and the offspring’s early days and the reproductive cycle and fecundity are adjusted by synchronising administrations of prostaglandins and gonadotropins (from pregnant mare’s serum) and stimulants of fecundity such as melatonin. Hypothyroidism may have to be treated with iodized licks and white muscle disease with selenium, inorganic or organic (as selenium yeasts) and vitamin E. Vets and farmers can resort to one kill-or-cure that doctors and parents forbear to use: culling.
17. We have a gripe with the Food Standards Agency in that it makes undue assumptions on the abilities of NGOs to tend their respective flocks. It is a safe assumption that the nutritional, medical and teaching requirements for human diabetics, celiacs, sufferers from bone diseases are dealt with by lay organizations well served and advised by appropriate consultants. VEGA has pleaded with the FSA for similar parleys with experts in medicine, nutrition, physiology and food technology. The FSA offers such services to Muslim organizations. We can at least record some advance, especially in connection with thyroid and iodine deficiencies. Developments are also underway with food manufacturers. And, perhaps, we shall find out how those herbivorous bonobos in Central Africa manage to exist and reproduces without apparent sources of marine nutrients such as iodine and fish oils. Perhaps these are brain foods with fundamental evolutionary importance; or are there essential factors still unknown in the Composition of Foods tables?
18. The doctrine of signatures and astrological observations may confuse in various ways as we contemplate the leonine, taurine, sheepish, horsy, chicken-hearted and canine features of humans. Red, bloody meat is the food of warriors. Which dominates first: the genetics of aggression or the choice offered by the fleshpots? Is their programming in the womb from the mother’s diet and later in her milk? Is subclinical deficiency in some elements the sustenance of the meek and blessed? (hypo and hyper-thyroidism provide cogent contrasts). Slaughtered animals are in a state of terror and the appearance of meat (DFD, dark, firm and dry or PSE, pale, soft and exudative) bears witness to the flood of stressor hormones. Do they in small but repeated and absorbed amounts arouse violent behaviour in consumers? Vets and farmers assess the performance of stud bulls and rams (tups) by the size of their testicles. Chimps exhibit signs of testosterone rage whereas the gentler and more seriously veggie gorillas are more placid and boast smaller testicles than chimps. The bonobos are very lovey-dovey and exist as matriarchal societies.
19. Relevant surveys of human newborns are throwing up some findings to interest veggie parents. Midwives in some areas of the UK report raised female-to-male ratios of live births to veggie mothers. Other studies find increased incidence of hypospadias (piccolo penis) in male babies born of veggie mothers. Continuing studies are looking at the prevalence of undescended testicle. These observations have to be extricated from entanglement with environmental influences, e.g. endocrine disruptors. FOAD is a theory (the Barker hypothesis) of Fetal Origins of Adult Diseases relating fetal (or even pre-conceptual events, which might include diets) and newborn and placental measurements with the risks in later life suffered by the subjects. These are arresting but still controversial topics.
20. We live in a world that has lurched into a veggie-unfriendly trend. Emergencies have arisen (and are well-known in medical services in the UK and US) with “vegetarian” or “vegan” babies whose parents have been indicted with murder, sometimes manslaughter and removal into care of their babies. Such a case is in progress now in the USA and we reported another a few years ago. A similar incident occurred a few years ago in the UK and a previous example ended up in Great Ormond Street Hospital (and recorded in the BMJ) attended by a retinue of exasperated dieticians and counsellors, as well as a bevy of doctors curious to see in England a florid case of Third World kwashiorkor and rickets. Such cases nearly always involve complicating factors such as macrobiotic and Rastafarian persuasions.
21. Accordingly, we have to undertake the responsibility to help veggie parents in preparation for childbirth, preferably preconceptually, and to anticipate difficulties that may arise in dealings with doctors, pediatricians, nurses, midwives and grandmas-to-be. Breast is always best. If it is not possible, doubts may arise over the phytoestrogens in soya-based baby foods and the lack of fish-derived components (or alternatives from algal sources or micro-organisms, biological equivalence having to be established). As in so many medical matters, compromises may have to be struck over ingredients and components such as gelatine (probably from pigs), lactose, lanolin, shellac, cochineal and vitamin (D2 or D3) We hope to provide more information on our website and to enlist some biochemical assessments on milk from veggie mothers. Appropriately in nutritional matters we look forward to feedback.