A pure vegetarian or strict vegetarian does not eat any meat, poultry, eggs, game, fish, shellfish or crustacea, or slaughter by-products such as gelatine or animal derived renets or fats etc.

Types of vegetarian:
Prasadamarians - Devotees of the Lord who live soley on pure vegetarian foodstuffs first offered to Krishna with the magic ingredient - Love and Devotion. The foodstuffs come from the Lacto-vegetarian grouping as stated below. (not onion and its family group; leeks, chives etc; nor garlic or mushrooms - foods that are considered pungent or tamasic in nature).
Lacto-vegetarians - Eats all fruits, vegetables, grains and dairy products (but not eggs - eggs are not beyond the broadest stretch of imagination from the dairy, ie. cows).
Vegan - Does not eat dairy products, or any other animal product
Fruitarian - A type of vegan diet where very few processed or cooked foods are eaten. Consists mainly of raw fruit, grains and nuts. Fruitarians believe only plant foods that can be harvested without killing the plant should be eaten.
Macrobiotic - A diet followed for spiritual and philosophical reasons. That aims to maintain a balance between foods seen as ying (positive) or yang (negative). The diet progresses through ten levels, becoming increasingly restrictive. Not all levels are strictly vegetarian, though each level gradually eliminates animal products. The highest levels eliminate fruit and vegetables, eventually reaching the level of a brown rice diet.

Other terms can be used in describing various vegetarian diets, though their exact meaning can differ. The term, strict vegetarian, may refer to a vegan diet, though in other cases it may simply mean a lacto-ovo-vegetarian diet. The terms, common, or, broad vegetarian, may be used to refer to lacto-ovo-vegetarians.
Lacto-ovo-vegetarian - Eats both dairy products and eggs. This is the most common type of so-called vegetarian diet.
Demi-vegetarian - is a term sometimes used to describe persons who eat no or little red meat, but may eat fish. Persons consuming fish but no meat are sometimes called pescetarians.

One of the largest obstacles to becoming vegetarian (or vegan) is a fear of getting inadequate amounts of protein (and to a lessor extent, calcium, iron and B-12). In general, we would do well to have a greater fear of getting too much of a good thing. With the possible exception of pregnant women and impoverished individuals, western adults (and some children) tend to suffer from excess nutrition--not malnutrition. For instance, most everyone in this country consumes too much protein--even vegetarians!

Let's look at the nutritional fears. The materials below are exerts from "Position of The American Dietetic Association: Vegetarian diets" published in the Journal of the ADA, Nov. 1993, Vol. 93, Number 11. It should be noted that the ADA is one of the most conservative and respected dietary organizations in the world. Medical and dietary policy is greatly influenced by ADA positions (although meat industry money often has a greater influence). The ADA report is widely considered to be the most authoritative document on vegetarian nutrition.

PROTEIN

Plant sources of protein alone can provide adequate amounts of the essential and nonessential amino acids, assuming that dietary protein sources from plants are reasonably varied and that caloric intake is sufficient to meet energy needs. Whole grains, legumes, vegetables, seeds, and nuts all contain essential and nonessential amino acids. Conscious combining of these foods within a given meal, as the complementary protein dictum suggests, is unnecessary. Additionally, soy protein has been shown to be nutritionally equivalent in protein value to proteins of animal origin and, thus, can serve as the sole source of protein intake if desired.

Although most vegetarian diets meet or exceed the Recommended Dietary Allowances for protein, they often provide less protein than nonvegetarian diets. This lower protein intake may be associated with better calcium retention in vegetarians and improved kidney function in individuals with prior kidney damage. Further, lower protein intakes may result in a lower fat intake with its inherent advantages, because foods high in protein are frequently high in fat also. . . . Reduced consumption of meat and animal protein has also been associated with decreased colon cancer in some, but not all, studies of omnivores.

CALCIUM (Also see above.)

Certain plant constituents appear to inhibit the absorption of dietary calcium, but within the context of the total diet, this effect does not appear to be significant. Calcium from low-oxalate vegetable greens, such as kale, has been shown to be absorbed as well or better than calcium from cow's milk. Calcium deficiency in vegetarians is rare, and there is little evidence to show that calcium intakes below the Recommended Dietary Allowance cause major health problems in the vegetarian population. The relatively high US recommendations for calcium intake, compared with those for populations consuming a more plant based diet, are designed to compensate for the calciuric effect of high intakes of animal protein, which are customary in the United States. Studies have shown that vegetarians, on the other hand, absorb and retain more calcium from foods than do nonvegetarians.

IRON

Vegetarians are not at greater risk of iron deficiency than nonvegetarians, but Western vegetarians generally have better iron status than those in developing countries. Western vegetarians generally have an adequate intake of iron from plant products. They also consume greater amounts of ascorbic acid, an important enhancer of nonheme iron absorption. See also Iron and a Vegetarian Diet.

B-12

. . . a [dietary] pattern that includes animal products such as milk and milk products is unlikely to be deficient in vitamin B-12.

Vegans should include a reliable source [of vitamin B-12] in their diets. [Note: Some would disagree with the ADA on this, but why take chances?] . . . Cyanocobalamin, the form of vitamin B-12 that is physiologically active for human beings, is available from vitamin supplements or fortified foods such as some commercial breakfast cereals, soy beverages, some brands of nutritional yeast, and other products.

In Western countries . . . where sanitary practices are better [than developing countries where people receive B-12 from microbes and organisms on the surfaces of unwashed fruits or vegetables], the risk of vitamin B-12 deficiency for vegans may be greater.

Lack of intrinsic factor in the stomach, rather than diet . . . is the most common cause of vitamin B-12 deficiency.

OTHER ISSUES

A vitamin D supplement may be indicated [for vegans] if exposure to sunlight is limited.

Western vegetarians usually have satisfactory zinc status. . . . Good plant sources include grains, nuts and legumes.

Infants, children, and adolescents who consume well-planned vegetarian diets can generally meet all of their nutritional requirements for growth. . . . Calcium, iron, and zinc intakes may . . . deserve special attention, although intakes are usually adequate when reasonable variety and adequate energy are consumed. . . . Well-planned vegetarian diets can be adequate for pregnant and lactating women. Vegetarians and nonvegetarians alike are generally advised to take iron and folic acid supplements during pregnancy, although vegetarians frequently have greater intakes of those nutrients than do nonvegetarians. [For infants, children, adolescents, pregnant women and lactating women, the ADA paper generally reiterates the previous information, adds the concern of sufficient caloric intake for vegan infants and weaning children, and extends sunlight/vitamin D concerns to certain nonvegetarians as well.]

How does the common concern about malnutrition compare to the risk or overnutrition? Let's use some common sense by asking: How many people do we know who have died from or suffered from any type of malnutrition? How many friends, loved ones and acquaintances have we lost from heart disease, stroke, cancer and diabetes? It's no contest. Again, quoting the ADA: A considerable body of scientific data suggests positive relationships between vegetarian diets and risk reduction for several chronic degenerative diseases and conditions, including obesity, coronary artery disease, hypertension, diabetes mellitus, and some types of cancer.

. . . vegetarians' high intake of complex carbohydrates, which are often relatively high in fiber content, improves carbohydrate metabolism and may lower basal blood glucose levels.

. . . animal products . . . are devoid of fiber. Fiber has been shown to be important in the prevention and treatment of certain conditions and diseases.

Vegetarians have lower rates of hypertension and non-insulin-dependent diabetes mellitus than do nonvegetarians. . . . Vegetarians may be at lower risk for non-insulin-dependent diabetes because they are leaner than nonvegetarians . . . Vegetarians, especially vegans, often have weights that are closer to desirable weights than do nonvegetarians.

Vegetarian diets that are low in animal products are typically lower than nonvegetarian diets in total fat, saturated fat, and cholesterol, factors associated with reduced risk of coronary artery disease and some forms of cancer. . . . dietary differences, especially in vegans, may produce physiologic changes that may inhibit the causal chain for colon cancer. . . . Lung cancer rates are lower in vegetarians, chiefly because they usually do not smoke, but possibly also because of diet. Research suggests that vegetarians are also at decreased risk for breast cancer.

Mortality from coronary artery disease is lower in vegetarians than in nonvegetarians. . . . Studies of vegetarians indicate that they often have lower mortality rates from several chronic degenerative diseases than do nonvegetarians.

Vegetarian diets are very safe, have real benefits, and generally require very little planning for maximum health. In contrast, diets that include meat must include careful, extremely complex planning to reduce the risks of the most prevalent diseases. For more information, please see the journal article and other ADA literature.

(David Lee Winston Miller -- Winston Miller is a past president of ETVS and a lifetime member. He now lives in upstate New York.)

Vitamin/Mineral	Source
Vitamin A	Yellow fruit and vegetables, carrots, peppers, all dairy products including margarine, green leafy vegetables, dried apricots. Essential for night vision, healthy skin, and growth of bones.
Vitamin B1 (Thiamin)	Fortified breakfast cereals, yeast extract, pulses, nuts, wholemeal rice/pasta/bread. Essential for metabolism of carbohydrates for energy.
Vitamin B2 (Riboflavin)	Fortified products, yeast extracts, mushrooms. Helps convert fats, carbohydrates and proteins into energy.
Vitamin B3 (Niacin)	Fortified products, yeast extract, peanuts, wholemeal bread and pasta and brown rice. Essential for energy production, healthy skin and the nervous system.
Vitamin B6	Breakfast cereals, potatoes, nuts, pulses, avocados, pears. Helps convert protein into energy.
Vitamin B12	Fortified soya milk, fortified nutritional yeast and some breakfast cereals. Essential for red blood cell formation, growth and a healthy nervous system.
Vitamin C	Citrus fruit and juice, blackcurrants, most green vegetables, potatoes, tomatoes. Essential for healthy bones, teeth, skin and gums; growth, wound healing, energy production and resistance to infection.
Vitamin D	Appropriate levels of sunlight, fortified soya or rice milk and most dry cereals. Essential for healthy bones and teeth and for calcium absorption.
Calcium	Calcium-fortified soya and rice milks; orange juice; tofu; dark green leafy vegetables; dried figs; chick peas. Contributes to strong bones and teeth. Important for blood clotting and muscle contraction.
Calories and fat	Avocados, nuts, seeds, dried fruit and soya products can provide concentrated levels of calories. Saturated fats nearly always come from animal products. Polyunsaturated fats usually come from plant sources. Cholesterol is not present in plant foods.
Copper	Wholegrain cereals, wholemeal bread and pasta, dried fruit, pulses, nuts and seeds. Essential for the functioning of enzymes and nerves.
Fibre	Popcorn, fresh fruit, raw vegetables, nuts, whole grain breads and cereal, fruits and vegetables with edible skins.
Folic Acid	Potatoes and most vegetables and fruits. Folic acid exists naturally in foods and body tissues in the form of folates. Folates are members of the B vitamin group.
Iodine	Essential for functioning of thyroid hormones and development of babies in the womb.
Iron	Whole or enriched grains, iron-fortified cereals, green leafy vegetables and dried fruits, bran flakes, chick peas, spinach, dried fruit, dates, millet, pumpkin seeds, molasses. Essential for transporting oxygenated blood around the body.
Magnesium	Nuts, seeds, pulses, cheese, yoghurt, wholemeal bread and pasta. Essential for functioning of muscle, nervous system and enzymes. Helps control calcium balance.
Phosphorus	Wholegrain cereal including wholemeal bread and pasta, brown rice, seeds, nuts and pulses. Essential for strengthening bones; important for maintaining body's chemical balance.
Protein	Protein needs can be met by eating a variety of plant foods and having an adequate intake of calories. Foods high in protein include vegetables, grains, soya products, nuts, and dairy products. Grains such as rice, pasta, breads and cereals provide the same protein.
Potassium	Fruit and fruit juice, potatoes and vegetables. Essential for maintaining sodium balance, functioning of muscles and nerves.
Selenium	Green and brown lentils, bread, brazil and cashew nuts. Essential for functioning of red blood cells.
Sodium	Salt, yeast extract, cereal products, milk and milk products, salty foods. Essential for maintaining water balance and the functioning of muscles and nerves.
Zinc	Vegetables, seeds, whole grain products, wheat-germ, nuts, chick peas, pumpkin seed. Essential for building muscle and for the functioning of enzymes.

NOTE: Since dairy products are an excellent source of calcium and protein, it is a good idea to include skim and fat-free dairy products in your diet. Remember to choose a wide variety of fruits, vegetables, wholegrain products, nuts, seeds, low-fat and fat-free dairy or fortified soya products to help you achieve the right balance of vitamins and minerals.

I recently heard the claim, yet again, that the vegetarian diet is somehow deficient in iron, so I decided to do my part to put this myth to rest:

Personal Experience

I should start by saying that I have been a vegan (I do not consume animal products) for approximately 16 years and a vegetarian for 26. From a personal aspect, I can say that, my iron has been in the "normal" range every time I have had it tested. Except that is, before I was a vegetarian: Then, I was anemic and required medication.

In more recent years I recall a nurse exclaiming "Boy, you got a lot of iron in your blood." My last iron test showed it to be right smack in the middle of normal. I have stopped spending money on such tests. I used to request such tests just to be on the safe side, but would now do so only if I were advised by a physician to do so (or won the lottery and had nothing better to do with my money). Having said this, I really don't put much stock in examples--I like major studies.

Surprising Medical Evidence

On the other hand, I AM worried about HIGH levels of iron. There is even some evidence that so- called "normal" levels of stored iron strongly indicate an increased risk of heart attack. Reported in the 1992 issue of the AHA journal, Circulation, a study conducted by Jukka T. Salonen, M.D., Ph.D et. al. followed 1,931 men for an average of 3 years. Every 1% increase in serum ferritin indicated a 4% increase in heart attack risk. Jerome L. Sullivan, M.D., Ph.D., Director of Clinical Laboratories at the Veterans Affairs Medical Center in Charleston, S.C., whose comments were published with the study in Circulation, feels that stored iron may be a better risk indicator than diabetes, cholesterol or blood pressure. This may explain why menstruating women have lower heart disease risk.

An important question is how should "normal" levels be set. One obvious answer is to get away from the idea (and unfortunate term) of "normal" and think in terms of "healthiest" or "optimal." Many nutrients appear to have an extremely wide range of healthy blood levels and/or intake levels; ranges for other nutrients appear to be more narrow. So, it's important not to fall into the trap of worrying too much about getting "enough." In the Western diet, we must also worry about getting too much.

It occurs to me that what is optimum in one respect may not be optimum in another. That is, it may be that a "safe" level of iron with respect to various ailments attributed to low levels, may be an "unsafe" level with respect to heart disease and other problems. (It may be impossible to be optimally safe in every respect simultaneously.) In any activity in which we set targets, be they nutritional or otherwise, we recognize that there are usually competing concerns that must be balanced.

However, I wouldn't stop eating high-iron foods like collards, kale, broccoli (and other dark greens), beans, seeds and whole grains just yet--some dispute the findings about iron. It may be that iron doesn't help cause heart attacks; something in common to "normal" iron levels and heart attacks may be causing both. It is also possible that the study is flawed. In any event, it appears that not everyone has signed on yet to the study's conclusions.

My hunch, is that recommended intakes will eventually be modified downward--at least for men. However, if additional studies confirm that "normal" levels of iron are dangerous, you can bet that special interests will try to block any changes. If I have learned anything in my little bit of volunteer experience in Washington D.C., it is that things that seem like only an obscure scientific matter (in which you would think no special interest would be concerned about) can quickly become a political matter subject to almost unbearable special interest pressures. These special interest pressures (and influences) are not supposed to reach scientific decision makers, but they do (in the most interesting and intricate ways).

It should be noted that there is another concern about excess iron: hemochromatosis (a genetic disorder, in which iron levels are greatly elevated). Hemochromatosis affects only one in every 200 to 500 Americans. (Concerns about arthritis, premature wrinkling, and promotion of free-radicals have also been raised.)

Competing Risks--Real and Imagined

Again, the question seems to be one of competing risks:

*First, we must determine what the risks are. (The iron study should be a significant concern but should be considered unverified. Therefore, the stated risks of the study must be measured against critical analysis and downgraded according to any merits of such analysis.)

*Next, we must weigh the risks (which vary by age, sex and other status) according to the seriousness of each risk. The seriousness of the effects of "too-low" iron levels (and the frequency at which these levels produce the effects) must be weighed against the seriousness of the (yet to be verified) effects associated with "normal" levels (and the frequency at which these levels produce heart disease--or other problems). I can't claim that this is reducible to some neat equation, but I believe the concept to be valid. It is not enough to say that "iron deficiency is a common problem" (as one professional has reported) unless we document the risks associated with the majority of cases falling into the "iron deficient" category. Again, "iron deficiency" should not be determined by norms. (By the way, I don't claim that "iron deficiency" status has, in fact, been determined by norms. However, I am suspicious that norms played a large role based on the poor history of nutritional standards determination. I would be pleasantly surprised if this were not the case and you can be sure that the meat industry had an input in the process.)

Now we turn to another concern of competing risks:

Suppose that there was no heart disease risk associated with "normal" levels of iron. And suppose that having levels of iron slightly below "normal" levels was definitely risky. What is the risk that a vegetarian diet will actually cause a "deficiency"--that is, an iron level below so-called "normal"? For that question, I would like to refer the reader to my article, "Authoritative Vegetarian Facts" (published by the East Tennessee Vegetarian Society. In short, the answer is none.

(Important note: According to the American Dietetic Association, "Vegetarians and nonvegetarians alike are generally advised to take iron and folic acid supplements during pregnancy, although vegetarians frequently have greater intakes of those nutrients than do nonvegetarians." Iron is also an issue for small children--vegetarian and nonvegetarian.)

The meat industry likes to point out that part of the iron found in animal products is in the form of heme iron and that this type of iron is absorbed better. However, vitamin C (which is consumed in large quantities in vegetarian diets) can increase absorption of non-heme iron manyfold. Besides, all of the theoretical arguments in the world cannot change the health statistics of vegetarians--according to the American Dietetic Association, "vegetarians are not at greater risk or iron deficiency than nonvegetarians."

Again, any increased risk of "deficiency," if it did actually exist (it doesn't), would have to be weighed against the real risks associated with nonvegetarian diets. Yet, in conversations about vegetarian diets, I often feel like I'm debating smoking and the other party says "but if you don't smoke, your lungs won't get the same amount of exercise!" We must keep things in perspective. Although I don't claim that the vegetarian issue is necessarily as clear-cut as smoking, and I recognize that the analogy is limited, I do feel that people are much more upset by "unusual" risks than the ones we have grown to accept. By virtue of being common, common killers have become less frightening. So, we have the situation where people feel that heart attacks and cancer just kind of happen ("you're gonna die sooner or later anyway") but are so very concerned about protein, iron etc. Folks don't stop to ask:

*What are the chances of suffering from a particular affliction? (For instance I have never heard of a Western vegetarian or vegan that had a protein deficiency--but so many nonvegetarians are so worried about it.)

*What are the consequences of suffering from an affliction if it did somehow occur? (Do people usually die of iron or protein "deficiencies"? Do "deficient" individuals tend to live long, normal lives?)

*Does the alleged "deficiency" tend to have early symptoms that can alert one to lessen it's effects (or, in some cases, allow complete reversal) or is it more like cancer or heart disease in which it's often too late? For example, do people usually drop dead of iron "deficiency" or do they usually get some kind of warning. And to any extent that irreversible damage CAN occur, how often and to what extent DOES it actually occur. The scare stories might look a bit silly when you take a look at this from a statistical vantage.

So, it is clear that the risks alleged by some to be associated with vegetarian diets appear small (or nonexistent) when placed beside the serious risks associated with nonvegetarian diets.

Practical Considerations

Of course, it is often stated that you can avoid harmful levels of substances without becoming a vegetarian. On the other hand, I would counter that you can consume everything you need without eating meat. Even if you have to take a supplement, it appears that a vegetarian diet is safer and more practical--it is relatively easy to supplement a vegetarian meal, but much more difficult to somehow remove the undesirable components found in meat. For instance, the vegan diet is a zero-cholesterol diet. Cholesterol consumption is next to impossible to avoid with diets that include meat. (Note: Your body can manufacture all the cholesterol you need.)

In practical terms, a Western vegan diet (and to a lesser extent, a lacto-ovo vegetarian diet) tends to be low in fat and high in fiber. A nonvegetarian Western diet tends to be high in fat and low in fiber.

The Bottom Line

In summary, it boils down to this: Nonvegetarians are dying (in large numbers) of cancer, heart disease, diabetes mellitus and stroke. Vegetarians are dying in lesser numbers of such diseases, do not tend to die (or even suffer) from protein deficiencies, iron deficiencies or other alleged ailments, and tend to enjoy better health.