10 ways to improve your vegetarian lifestyle.

ALTHOUGH CONSUMING A VEGETARIAN DIET reduces the risk for several chronic diseases, far more goes into living healthfully than simply eschewing animal products. Vegetarians and vegans can develop some of the same poor dietary and lifestyle habits that their carnivorous counterparts often do, such as relying too heavily on convenience foods and passing over fruits and vegetables for those undeniably tempting vegan sweets. Being vegetarian is a great foundation to maintain a healthy lifestyle, but here are 10 tips that will enhance your efforts to stay sound and strong:

1 OPTIMIZE SODIUM INTAKE

The typical vegetarian adult in the U.S. consumes four to six times as much sodium as is needed, just a bit less than U.S. omnivores. (1,2,3) Most sodium comes from processed foods (3,3a) like TV dinners and luncheon meats, as well as from salty vegetarian items such as pretzels, packaged soups, salted nuts, and prepared foods. And you may not be able to tell exactly how much sodium is in your next restaurant dinner, but you can be certain that the amount is probably not low. Needless to say, it all adds up.

What's so bad about consuming too much sodium? A diet high in salt is a major cause of heart disease and stroke. In addition, dietary sodium increases calcium loss, (4) which vegans, who may have low calcium intakes, might be especially interested to know. Let's do the numbers. If your sodium intake is less than 1,500 milligrams a day (4a) (or no more than 400 mg per meal, allowing some room for snacks), you'd be doing yourself a favor. For tips on curbing your sodium intake and a weeklong low-sodium vegan meal plan, see One-Week Low-Sodium Vegan Menu in Vegetarian Journal, Issue 4, 2005, page 28. This article is also available online at <www.vrg.org/journal/vj2005issue4/vj2005 issue4lowsodium.htm>.

2 LIMIT SUGAR INTAKE

"How much is that vegan cookie in the window?" Before you ask, remember that there is no requirement for added sugars! And if what's true for sodium is true for sugar, vegetarians may be consuming almost as much as the average American, which is about 100 pounds per year. Much of this is high fructose corn syrup, commonly found in soda and 'juice drinks.' (5,6)

Excess sugar's potential health impacts are definitely not sweet. Obesity can lead to diabetes, cancer, and heart disease. Plus, no one wants to spend more time in the dentist's chair coping with cavities. And high-sugar foods frequently displace from the diet those fruits and vegetables your mother bugged you about. The optimal intake of added sugars is as low as you can make it.

3 CHOOSE MOSTLY WHOLE GRAINS

That vegan cookie in the window has another problem--white flour. White flour is what remains after processing wheat and removing the bran and germ, the sources of most of the fiber, antioxidants, vitamins, and minerals in whole grain. (7) Thus, foods such as white rice and white flour foods (pasta, bread, etc.) are pale, empty shadows of whole grain powerhouses. Choose more whole grain products. Ask for brown rice at your favorite Asian restaurants, and use more whole grain bread and pasta, barley, quinoa, amaranth, buckwheat, spelt, and kamut. When it comes to grains, make 'em whole, because brown is beautiful.

4 FOCUS ON THE RIGHT FATS, REDUCE OR ELIMINATE THE WRONG FATS

Although many vegetarians are proud of their reduced animal fat intake, their diet may still be high in saturated fat from dairy products and eggs, palm oil, and coconut oil and in trans fats from partially hydrogenated vegetable oils. Trans fats can be found in baked goods, margarines, and deep-fried foods. Saturated and trans fats markedly increase heart disease risk. (3) The healthiest oils are olive, canola, and the oils from intact avocados, nuts, and seeds.

Vegetarians should also be aware of omega-3 fats (commonly found in fish). Omega-3 fats are associated with a reduced risk of heart disease. Vegan sources include ground flaxseeds, hemp seeds, flax oil, and walnuts. Instead of deep-fried Indian samosas or greasy Chinese veggies, try whole wheat Indian bread and get steamed Chinese vegetables, sauce on the side. You may want to reconsider that vegan cookie, too.

5 CONTROL YOUR INTAKE OF ALL PROCESSED FOODS

Processed foods are notorious for high sodium, sugars, and fat content and their low concentration of whole grains. Many vegetarians enjoy soy-based substitutes for common meat products, such as ground beef, deli slices, chicken, and bacon. Like most other processed foods, these items are not as nutritious as unprocessed whole foods and should not form the basis of anyone's diet. Try some less-processed soy products, such as tempeh, tofu, miso, shoyu, tamari, and soymilk.

6 EAT ADEQUATE AMOUNTS OF DGLV

The most potent food in the vegetable arsenal may be dark green leafy vegetables, so potent they deserve their own abbreviation: DGLV. This group includes spinach, collards, kale, mustard greens, turnip greens, beet greens, Swiss chard, and broccoli.

Most DGLV are high in anti-oxidant nutrients, minerals, and fiber and very low in calories, sugar, sodium, and fat. They're low in cost as well. DGLV consumption among vegetarians is only marginally better than that of non-vegetarians, approximately 1/4 cup daily. (8) This is clearly inadequate, regardless of other dietary choices. Thus, vegetarians need to pay special attention to increasing their intake of DGLV.

7 BE AWARE OF GOOD SOURCES OF MINERALS LIKE CALCIUM, IRON, IODINE, AND ZINC

Minerals like calcium, iron, iodine, and zinc play important roles in our bodies. They help with building strong bones, preventing anemia, promoting thyroid function, supporting the immune system, and promoting growth and development. Minerals are found in many foods. Collards, kale, tofu made with calcium sulfate, calcium-fortified soymilk and juice, and soybeans are all good sources of non-dairy calcium. Beans, greens, and whole grains are the best sources of iron for vegetarians. Foods like oranges, tomatoes, and cantaloupe are high in vitamin C; if they are eaten along with foods containing iron, then iron absorption will increase. Some foods, such as tea, some spices, coffee, and dairy products, inhibit iron absorption. Iron supplementation may be necessary, especially for pregnant and pre-menopausal women. (3)

Reliable vegan food sources of iodine are limited to sea vegetables and iodized salt; sea salt and salt in processed foods usually do not contain notable amounts. Those who limit use of salt should ensure adequate iodine intake either with a supplement (3) or with sea vegetables. For more information about iodine, see Perchlorate Controversy Calls for Improving Iodine Nutrition in Vegetarian Journal, Issue 2, 2006, page 26. This article is also available at <www.vrg.org/journal/ vj2006issue2/vj2006issue2iodine.htm>.

Good sources of zinc include dried beans, oatmeal, wheat germ, spinach, nuts, and soy products, with adzuki beans and pumpkin seeds providing superior amounts of this vital nutrient. Vegans should strive for zinc intakes that are higher than the Recommended Dietary Allowance (RDA) to compensate for reduced zinc absorption from many foods that are frequently a part of vegan diets.

8 PROPERLY ADDRESS VITAMIN D

Vitamin D is a potent factor in bone formation, cancer prevention, and calcium absorption, especially at low calcium intakes. For Caucasians, adequate vitamin D can be synthesized from daily exposure of the hands and face to sunlight for 15 minutes. Seniors, people of color, and those whose skin is not exposed to sunlight on a regular basis will need other sources of vitamin D, such as vitamin D-fortified foods or vitamin D supplements. Without sufficient vitamin D, we risk 'deboning' ourselves!

9 MAKE SURE YOU GET ENOUGH VITAMIN [B.sub.12]

Vitamin [B.sub.12] is an essential nutrient that is needed in only small amounts but can cause big problems if it is missing from your diet. It is especially important for infants, children, and pregnant or lactating women. Vitamin [B.sub.12] does not occur naturally in plant foods, so vegans in particular must make a concerted effort to include it in their diets. Reliable non-animal sources of vitamin [B.sub.12] include Red Star Vegetarian Support Formula nutritional yeast, vitamin [B.sub.12]-fortified breakfast cereals or soymilk, and vitamin [B.sub.12] supplements.

10 EXERCISE

Although exercise is conclusively linked to reduced disease risk and improved health, vegetarians are about as likely as non-vegetarians to exercise. (9) An exercise program is an important part of a healthy lifestyle. Exercise is directly associated with bone density, which is important given the lower calcium intakes typical of vegetarians. (3) Healthy individuals include all three types of exercise: weight-bearing (increases bone density and muscle mass), cardiovascular (strengthens the heart and reduces blood pressure) and stretching/flexibility (improves balance, reduces risk for falls).

You can increase the significant health benefits of a vegetarian diet with appropriate changes. Perhaps the best way to promote healthy vegetarian diets is to BE a healthy vegetarian who recognizes and addresses lifestyle habits that deserve additional attention or improvement. Consult a registered dietitian and/or licensed personal trainer as appropriate.

One way to assess the quality of your vegetarian diet is with VRG's bimonthly Call-A-Dietitian Day. After scheduling a free phone appointment, you have 15 minutes to discuss any nutrition questions you have with the author of this article, Mark Rifkin. Mark is a registered dietitian and a longtime VRG volunteer. Note that this is not personal medical advice, which should be obtained in person from your health professional.

Notices of upcoming Call-A-Dietitian Days are included in VRG-NEWS, VRG's e-mail newsletter. To subscribe, send an e-mail message to <listserv@ listserv.aol.com> with the following message: SUB VRG-NEWS {your first and last name}. Do not include the {} when you enter your name. The newsletter will be sent to the e-mail address from which you are subscribing.

Thank you to Reed Mangels, PhD, RD, for reviewing the article.

References:

(1) Mahan K, Escott-Stump S. Krause's Food, Nutrition, and Diet Therapy, 11th ed. Philadelphia: Saunders, 2004.

(2) U.S. Department of Agriculture and U.S. Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans, 6th ed. Washington: GPO, 2005. Accessed at <www.health.gov/dietaryguidelines/dga2005/report/ HTML/D7_Fluid.htm> on May 31, 2006.

(3) Messina V, Mangels R, Messina M. The Dietitian's Guide to Vegetarian Diets: Issues and Applications, 2nd ed. Sudbury: Jones and Bardett, 2004.

(3a) Mattes RD, Donnelly D. 1991. Relative contributions of dietary sodium sources. J Am Coll Nutr Aug 10(4):383-93.

(4) Lin P, Ginty F, Appel LJ, et al. 2003. The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults. J Nutr 133:3130-36. Doyle L, Cashman KD. 2004. The DASH diet may have beneficial effects on bone health. Nutr Rev 62:215-20.

(4a) Institute of Medicine (IOM). Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate. Washington: National Academies Press, 2004.

(5) Putnam J, Allshouse J, Kantor LS. 2002. U.S. Per Capita Food Supply Trends: More Calories, Refined Carbohydrates and Fats. FoodReview 25(3):2-15. Accessed at <www.ers.usda. gov/publications/FoodReview/DEC2002/frvol25i3a.pdf> on May 31, 2006.

(6) Gaby AR. 2005. Adverse effects of dietary fructose. Alt Med Rev 10:294-306. Accessed at <www.thorne.com/altmedrev/ fulltext/10/4/294.pdf> on May 31, 2006.

(7) Slavin J. 2003. Why whole grains are protective: biological mechanisms. Proc Nutr Soc 62:129-34. Slavin JL, Jacobs D, Marquart L, Wiemer K. 2001. The role of whole grains in disease prevention. J Am Diet Assoc 101: 780-85.

(8) Haddad EH, Tanzman JS. 2003. What do vegetarians in the United States eat? Am J Clin Nutr 78(3 Suppl):626S-32S.

(9) Chang-Claude J, Hermann S, Eilber U, Steindorf K. 2005. Lifestyle determinants and mortality in German vegetarians and health-conscious persons: Results of a 21-year follow-up. Cancer Epidemiol Biomarkers Prev 14:963-68.

Mark Rifkin, RD, holds a master's degree in Health Education and has a private practice focusing on health and disease prevention through plan-based diets.