Sunday, December 20, 2009
Thursday, December 17, 2009
Health is Wealth
Wealth of Health : 5 Tips
Merely an absence of disease does not necessarily mean that you are healthy. It’s true that sometimes diseases strike us when we least expect it even when we do everything right as far as staying healthy is concerned. Indeed, a wise man once truly said “Health is Wealth”, for there is nothing worse than feeling ill at ease. Illness and diseases not only make you dependent on others, they also rob you of your zest for life. Why not take measures to ensure a long, happy, self sufficient and healthy life? Here are a few tips to help you do just that!
Follow the Pyramid
Not the pyramids in Egypt, we mean the food pyramid. A food pyramid basically tells you what to eat most and what to scrimp on. At the base of the pyramid are things that you should consume the most like cereals and pulses. As the pyramid tapers off to its peak, it tells you about the things you should eat sparingly like oils and fats. In the middle of the pyramid are food items to be consumed moderately like fruits and veggies followed by milk and meat products. Keep this in mind when you eat or plan your meals.
Regular Checks
Never underestimate the power of monitoring your health. A major part of staying well is consistency in health and that can only be figured out if the indicators of your health are regularly monitored. These indicators are Sugar Levels, Blood Pressure, Haemoglobin Count, Urine Analysis, Cholesterol and Lipid Profile, Liver Function Test, ECG, and Chest X-Ray. Many hospitals such as Apollo Hospitals have comprehensive health check-ups that cover all these tests and more. These tests become all the more important as you age.
Sweat It
There is no alternative to exercising and you don’t just need to do it when you gain a few extra pounds. Exercise keeps you active and energetic and it is great for the joints. However, be careful of over-straining yourself. Consult a physician or fitness trainer to figure out a fitness plan that is best suited for you. And do remember to wear the right outfit and footwear while exercising, else you may injure yourself. Keep moving and don’t allow yourself to be glued to a chair all day.
Water Rules!
Keep your body well-hydrated by drinking a lot of water throughout the day. Water is actually a miracle drink that aids many of your bodily functions like getting rid of toxins, eliminating wastes, regulating body temperature, lubrication of body joints, assisting in digestion processes, and much more. This is one drink you should indulge in all day and every day!
Relax
Stress leads to many physical and mental disorders. Keep it at bay with deep breathing, leisurely strolls, meditation, chanting, and listening to music. Other ways to relax include socializing, traveling, talking to friends, or basically doing anything that pleases you and makes you feel good.
How to build wealth from stock
Turmoil in the current economic environment raises several questions in the minds of investors: Should I exit out of equities? Gold has rallied significantly; maybe that is where I should invest in. With interest rates likely to go up, should I invest in bonds? These and many more questions like these have troubled the retail investor.
What should he do? They say simple things in life are the most difficult to practice and it is the same. Predicting economic parameters like interest rates, inflation or GDP growth among other factors is never easy. Like life, these are also unpredictable. However, one can definitely have an investment plan such that one can have a good night sleep in the present without having to worry about the future.
Diversify: The first and most important rule is to diversify your investments across asset class. One must not put all the eggs in one basket. A certain percentage should be invested in a variety of assets, such as large-cap, mid-cap and small-cap stocks. Put a percentage in real estate, gold and fixed instruments. And yes do hold some part in cash too. Though the risk arising from economic factors would remain, the unsystematic risk, which is unique to the asset class, would be reduced.
The principle of diversification involves investing across options so that losses in some will offset gains in others, thereby reducing the variability of return. It is a risk management technique. The rationale behind this technique is to yield higher returns and pose a lower risk than any individual investment found within the portfolio.
What should he do? They say simple things in life are the most difficult to practice and it is the same. Predicting economic parameters like interest rates, inflation or GDP growth among other factors is never easy. Like life, these are also unpredictable. However, one can definitely have an investment plan such that one can have a good night sleep in the present without having to worry about the future.
Diversify: The first and most important rule is to diversify your investments across asset class. One must not put all the eggs in one basket. A certain percentage should be invested in a variety of assets, such as large-cap, mid-cap and small-cap stocks. Put a percentage in real estate, gold and fixed instruments. And yes do hold some part in cash too. Though the risk arising from economic factors would remain, the unsystematic risk, which is unique to the asset class, would be reduced.
The principle of diversification involves investing across options so that losses in some will offset gains in others, thereby reducing the variability of return. It is a risk management technique. The rationale behind this technique is to yield higher returns and pose a lower risk than any individual investment found within the portfolio.
How To Achieve Success
What with the millions of words printed every day about "How To Achieve Success," why aren't there more new millionaires.
Basically, it's simply because the people reading this "How-To" information don't understand what they read, or else just don't have the drive it takes to put what they've read into action. In truth, it would seem that everyone wants to "find out how to become rich," but the number of people with the drive it takes to "work a plan," is few and far between.
The Basics to Getting Rich can be stated simply as follows:
1. You must control your investment. This is the key to building a fortune from small capital. You have to have the ability and knowledge to make the right moves at the right time, and above all, the innate talent it takes to always land on your feet and never be wiped out, regardless of the setbacks you may encounter.
2. You must know how and where to buy for next to nothing - or produce a product from scratch - and sell at a tremendous profit. With this ability, you can start with $100 or less, and sell it to someone else for much more than you paid for it. Then do it again, and keep on doing it until you have enough money to make substantial investments in other area where your money will grow and prosper.
3. You must buy things that appreciate in value. In other words, learn to buy things that will grow in value as time goes on. Things such as collectibles, land, precious metals and stones. Think of the multiplication factor: You pay $10 for a copyright, sell 500 copies and you're off to a small fortune.
4. You've got to be choosy. Buy the original or pick a limited field. For instance, if you buy written material, buy form the author; or if you're into stamps or coins, work with just one country or type of coins/stamps.
5. You must become an expert in your field of selling - know all there is to know about it. It takes time, effort, and energy, but the financial rewards are worth it.
6. You must know how to work the tax shelters. In the confiscatory tax economy we operate in today, anyone attempting to make important money has to operate with every tax break he can get. There are many of them, and they can be applied in different ways. Make friends with a good tax accountant; he'll be able to give you many angles that you've probably never heard of. Be sure you take every advantage of capital gains, investment credits, take part of your rent or house payment as an office expense, as well as your car - get all you can. It's legal, and it's necessary if you're going to build your capital.
7. You have to set goals and dedicate yourself to attaining those goals. In just about any buy/sell program, you can set a rate of say 20% net profit on each transaction, and work a five-time-a-year turnover. This will double your capital each year. Now the net profit means just that - what is yours after all expenses and taxes are paid - so you'll have to get about 35 to 40% markup on each cycle.
If you've done your homework and are really an expert in your field, you'll often be able to make profits of 200% and more on a single transaction, because real buys will always show up for the person with cash in hand. If you set a goal such as this, and follow this system starting with $100, in 10-years you'll have over $50,000 in cash or it's equivalent.
8. You have to learn to exercise patience. This is the greatest attribute of a good hunter. In your field you'll be looking for bargains that can quickly be resold for a substantial profit. You've got to learn the sources of the items you want to sell, how to spot the bargains, and then have the persistence to allow your investment to pay off for you.
9. You have to learn what to do with your riches. When your capital has grown beyond the needs of your operation, put it to work. Get it into other investments that will produce more capital and even more income. Pyramiding your investments will bring you all the money you can use.
10. You have to learn to keep your mouth shut! The man who has found a method of making money, who understands what it can mean, keeps his mouth shut about it. That's why it's so ridiculous to assume that anyone would sell you a sure thing gambling system for a couple of dollars. If it was a sure thing, he'd guard it with his life. The thing is, keep your mouth shut and you'll save yourself a lot of grief as well as competition.
Basically, it's simply because the people reading this "How-To" information don't understand what they read, or else just don't have the drive it takes to put what they've read into action. In truth, it would seem that everyone wants to "find out how to become rich," but the number of people with the drive it takes to "work a plan," is few and far between.
The Basics to Getting Rich can be stated simply as follows:
1. You must control your investment. This is the key to building a fortune from small capital. You have to have the ability and knowledge to make the right moves at the right time, and above all, the innate talent it takes to always land on your feet and never be wiped out, regardless of the setbacks you may encounter.
2. You must know how and where to buy for next to nothing - or produce a product from scratch - and sell at a tremendous profit. With this ability, you can start with $100 or less, and sell it to someone else for much more than you paid for it. Then do it again, and keep on doing it until you have enough money to make substantial investments in other area where your money will grow and prosper.
3. You must buy things that appreciate in value. In other words, learn to buy things that will grow in value as time goes on. Things such as collectibles, land, precious metals and stones. Think of the multiplication factor: You pay $10 for a copyright, sell 500 copies and you're off to a small fortune.
4. You've got to be choosy. Buy the original or pick a limited field. For instance, if you buy written material, buy form the author; or if you're into stamps or coins, work with just one country or type of coins/stamps.
5. You must become an expert in your field of selling - know all there is to know about it. It takes time, effort, and energy, but the financial rewards are worth it.
6. You must know how to work the tax shelters. In the confiscatory tax economy we operate in today, anyone attempting to make important money has to operate with every tax break he can get. There are many of them, and they can be applied in different ways. Make friends with a good tax accountant; he'll be able to give you many angles that you've probably never heard of. Be sure you take every advantage of capital gains, investment credits, take part of your rent or house payment as an office expense, as well as your car - get all you can. It's legal, and it's necessary if you're going to build your capital.
7. You have to set goals and dedicate yourself to attaining those goals. In just about any buy/sell program, you can set a rate of say 20% net profit on each transaction, and work a five-time-a-year turnover. This will double your capital each year. Now the net profit means just that - what is yours after all expenses and taxes are paid - so you'll have to get about 35 to 40% markup on each cycle.
If you've done your homework and are really an expert in your field, you'll often be able to make profits of 200% and more on a single transaction, because real buys will always show up for the person with cash in hand. If you set a goal such as this, and follow this system starting with $100, in 10-years you'll have over $50,000 in cash or it's equivalent.
8. You have to learn to exercise patience. This is the greatest attribute of a good hunter. In your field you'll be looking for bargains that can quickly be resold for a substantial profit. You've got to learn the sources of the items you want to sell, how to spot the bargains, and then have the persistence to allow your investment to pay off for you.
9. You have to learn what to do with your riches. When your capital has grown beyond the needs of your operation, put it to work. Get it into other investments that will produce more capital and even more income. Pyramiding your investments will bring you all the money you can use.
10. You have to learn to keep your mouth shut! The man who has found a method of making money, who understands what it can mean, keeps his mouth shut about it. That's why it's so ridiculous to assume that anyone would sell you a sure thing gambling system for a couple of dollars. If it was a sure thing, he'd guard it with his life. The thing is, keep your mouth shut and you'll save yourself a lot of grief as well as competition.
Feng Shui Wealth Tips – Includes Wood and Purple
“To be upset over what you don’t have…is to waste what you do have.”
It does not matter; poor or wealthy, people always want more money. Wealth is a sense of security, a feeling that nothing can harm us. Actually, money is a manifested form of energy and it must flow in and out of a person’s possession. Keeping money for a rainy day ensures many rainy days on the horizon. Giving away wealth freely allows wealth to easily flow in to life as well. Follow some of the Feng Shui tips for wealth and see if they improve your flow of abundance.
Water is very important to symbolize wealth, so, many Feng Shui wealth tips revolve around water, aquariums, fish, water fountains, pictures of water and so on. Install a constantly flowing birdbath in the front of the home keep the water clean. The color purple is the color of the wealth area of the bagua so place a purple flower, ribbon, or even pillow in the wealth area. A bell or chime placed in the wealth area calls more abundance into the life.
Wood is the element of the wealth area, so another tip is to place an item of wood that signifies money. Symbols are so important in Feng Shui. If a fireplace is located in the wealth area, cool it by placing more water by it. Since the element of wealth is wood, having a furnace, fireplace or too many candles in the wealth area will “burn up your money”. If stairs are placed directly opposite the front door, wealth can flow right out the door. If any water on the property is stagnant, clean up the pond immediately. When front doors are hidden from the street, this can have a direct response to the flow of wealth into your life. Bathrooms in the wealth area metaphorically have the wealth being flushed down the drain. Pay all of your bills with gratitude without fear. There will always be enough wealth and abundance to cover the bills. The flow of money is just that, a flow of paying for energy flow into your life from a service or material good purchased. Money really doesn’t belong to you or anyone else. Maintain a cool detachment from having money or let go that feeling of lack of wealth. Attitude is essential when it comes to wealth, so try wearing the color purple around you. Wear at least one item of purple everyday and see if you feel more regal. When I want more wealth to show up in my life, I take the most expensive essential oils I have and make a special blend to spritz away in the entire home. See Feng Shui Sprays. I get the feeling that the money has already arrived and soon it does.
People have to examine how they feel about wealth and money. If having wealth and money seems negative or greedy, you will never have any. We must feel like it is a birthright to have wealth and there is enough on this planet for everyone. No one needs to be lacking. Everyone can have wealth in life at anytime; it is just a matter of accepting it and allowing it to come into your life.
Vegetarian Diets and Cancer Prevention
Although vegetarianism is relatively new in North America, it has existed in Asia for centuries, especially in followers of religions such as Hinduism and Buddhism. In the 19th century, North Americans chose to become vegetarian primarily for spiritual and moral reasons. As the scientific research linking nutrition and health started to become apparent, and with the discovery of vitamins in fruits and vegetables in the early 20th century, the public developed the perception that vegetarian diets were healthy (1). Most research on vegetarianism has been done in the past 30 years, mostly in developed countries looking at the association between vegetarianism and nutritional deficiencies.
There are many reasons other than religion for choosing a vegetarian diet. They include health benefits, the belief that it improves athletic performance, and political, social, ecological and ethical reasons (2). Many adolescents adopt a vegetarian lifestyle because of concerns about animal welfare, as well as concerns about their own weight (3-5). Just as there are many reasons for becoming vegetarian, so are there many degrees to which animal foods are avoided. In other words, not all vegetarians eat the same way (6). The new terms being used for semi-vegetarianism are new wave, quasi, partial and transitional. Such individuals do not strictly follow lacto-ovo or vegan diets but largely exclude meat and animal products. This may or may not include poultry, fish or seafood. The danger is that, with inadequate knowledge, they may not include more plant-based proteins, such as beans and lentils and nutrientrich greens at the same time that they exclude animal products (7,8). Some may still have a diet that is high in saturated fat from large amounts of high-fat dairy products and eggs. Donovan and Gibson (9) noted that lacto-ovo and semi-vegetarian adolescent females had energy intakes less than two-thirds of Canadian recommendations and concluded that they were more at risk for nutrient inadequacies than those following omnivorous diets.
A special exposure group used in diet and cancer prevention studies has been Seventh-Day Adventists (SDA). The SDA Church is a Protestant denomination comprising over 10 million members worldwide. This group practices a temperate and healthy lifestyle, abstaining from alcohol, tobacco, and other harmful drugs. Many are lacto-ovo-vegetarians, believing that flesh food and shellfish are better omitted from the ideal diet.
It is the opinion of this author that increasing numbers of cancer survivors are also adopting semi-vegetarian diets and healthy lifestyles post-treatment, as seen in counseling sessions, but there is little research to confirm this.
Over the last decade, we have seen the results of long-term studies comparing cancer rates among vegetarian groups and the general public in various countries. An observational cohort study of approximately 11,000 British subjects was conducted by Key et al (10) to investigate the association of dietary habits with mortality in a cohort of vegetarians and other health-conscious people. Diet was assessed using a short questionnaire that asked participants if they smoked and were vegetarian (this was not defined further) and to record their usual frequency on six dietary factors. The investigators noted that 62% of the participants considered themselves vegetarian. The cancer standardized mortality ratio (SMR) is the observed number of incidents of cancer that have occurred after the start of a study in comparison with the expected number of incidents, which is usually acquired from age-specific rates of the general population. Key et al (10) concluded the SMR for all malignant neoplasm was 0.50 for men and 0.76 for women, indicating a significantly lower incidence of cancer in the vegetarian groups.
The vegetarian population demonstrated an all cancer mortality rate 50% that of the general population for men and 76% for women. The SMRs were reduced for cancer of the stomach, large intestine, rectum, pancreas, lung, and bladder, but slightly increased for the prostate. Daily consumption of fresh fruit was associated with a reduced mortality from all cancers combined. Limitations of this study (10) are that the dietary habits did not differentiate by type of vegetarianism as that may have changed during the 17-year follow- up. Also, the questionnaire did not include all food groups and other health-related behaviors, such as exercise and past smoking habits.
Cancer incidence was monitored by Mills et al (11) in a population of approximately 34,000 non-Hispanic white Seventh-Day Adventists in California between 1976 and 1982 and compared with a similar group of whites in Connecticut. Relative risks were calculated using data obtained from a detailed lifestyle questionnaire. The SMR for all cancers was 0.73 for men and 0.92 for women, indicating a significantly lower risk of developing cancers at most of the major cancer sites (buccal cavity, stomach, lung, pancreas, rectum, bladder, and large intestine). Surprisingly, the SMRs for prostate and gynecological cancer were 1.25 and 1.6, respectively. The authors attribute this to Seventh-Day Adventists possibly taking advantage of preventive medical measures and higher use of hormone replacement therapy in this population.
Frentzel-Beyme and Chang-Claude (12) assessed mortality and morbidity risks as related to nutritional status of moderate (eat fish or meat occasionally) and strict (avoid fish and meat completely) vegetarians in a total cohort of 1904 self-identified vegetarians in Germany. The questionnaire collected information on dietary habits including alcohol consumption, smoking habits, physical activity, previous medical history, and socioeconomic characteristics. The followup period was 11 years and the SMR for all cancers was 0.48 for men and 0.74 for women. The SMR was lower for cancer of the intestinal system, stomach, and colon. Cancer mortality was most strongly associated with duration of vegetarian status (20 years or more of a vegetarian lifestyle decreased cancer mortality by more than 50%) and moderate vegetarians appeared to be at lower risk for cancer. In the author?s opinion, the influence of other factors such as health-conscious behavior and a healthy lifestyle seem to indicate stronger effects than nutrition itself and this may partly explain the generally better health of moderate vegetarians.
In another British study (13), Thorogood et al investigated the health consequences of a vegetarian diet in approximately 6000 non-meat-eaters and 5000 meat-eating controls. Each participant completed a questionnaire concerning diet, lifestyle factors, medical history, and body mass index. Approximately 95% of the non-meat-eaters were lactoovo vegetarians (who may have eaten meat or fish once a week) or strict vegans. Recruitment of participants took place through advertisements or word of mouth and the participants in turn recruited friends or relatives as the controls. After 12 years of follow-up, non-meat-eaters had significantly lower SMRs for cancer compared to meat eaters (0.50 and 0.80, respectively). A 40% reduction in cancer mortality was observed due to diet, and it did not appreciably change when adjusted for smoking, body mass index, and social class. A limitation of this study is a potential bias of the participants. The investigators did not differentiate between different types of vegetarians but simply grouped the participants as non-meateaters (although this was not the objective of the study). They concluded that the protective effect of diet was large, but the data do not provide justification for encouraging meat-eaters to change to a vegetarian diet.
A review article looking at the association between vegetarianism, dietary fiber, and gastrointestinal (GI) disease (14) concluded that vegetarians have a lower incidence of GI cancer. The authors state the benefits of a vegetarian life-style may be conferred on non-vegetarians by eating a carefully planned non-vegetarian diet consisting of increased fruit, vegetables, and fiber.
Conclusion
There are many reasons that it is difficult to demonstrate a direct causal relationship between vegetarian diets and reduced cancer incidence based on current research. These include long latency periods for cancers, the presence of other lifestyle factors (smoking, exercise) and known risk factors (fat in red meat, cooking methods), as well as the possible interrelationship among these factors. Also, the definition of ?vegetarian diets? in the literature is inconsistent. Nevertheless, a comprehensive review by Steinmetz and Potter (15) concluded that the scientific evidence regarding a protective role for vegetable and fruit consumption in cancer prevention is generally consistent. Active research indicates that it is not only the vitamins, minerals, or fiber that make plant foods beneficial to health, but the phytochemicals found in these food as well (16,17). As a result, it is difficult to conclude whether it is the decrease in meat and/or fat, the increase in fruit and vegetables, or other lifestyle factors that provide the beneficial effect in vegetarians; most likely they all play a role (18).
It is reasonable to conclude that vegetarians have a reduced incidence of cancer in comparison to the general population, but it is not know to what extent vegetarian diets can play a role. A well-planned vegetarian diet can be a healthy choice and may reduce the risk of certain types of cancer, but it is important to include a wide array of foods for maximum benefit. A healthy diet including small amounts of lean meats and animal products and a high consumption of plant-based foods can also be a healthy alternative. Dietitians should help clients to choose the diet that works best with their lifestyle and promote other positive lifestyle factors, such as incorporation of regular physical activity and maintaining an appropriate weight.
Vegetarian Diets During Pregnancy
by Reed Mangels, PhD, RD, FADA
Pregnancy is a time of increased nutritional needs, both to support the rapidly growing fetus and to allow for the changes occurring in the pregnant woman's body. Throughout pregnancy, recommended intakes of vitamins and minerals are higher than for the non-pregnant state. For example, the recommendation for folic acid is 50 percent higher (1) and the recommendation for iron is doubled (2) in pregnancy. Vegetarian and vegan diets can easily meet these nutrient needs (3)Weight Gain.
It is important that all pregnant women have adequate weight gain. Weight gain recommendations vary depending on the prepregnancy weight and needs of the woman, therefore energy needs vary as well. A general trend is to have little weight gain (less than 5 pounds) for the first 12 weeks. Then, in the second and third trimesters, a weight gain of a pound or two a week is suggested. Current weight gain recommendations (4) are applicable to vegetarians. The recommendations for weight gain are listed in Table 1.
Table 1. Recommended Weight Gain During Pregnancy*
Weight status(prior to pregnancy) Recommendedweight gain (lbs.)
Average weight 25-35
Underweight 28-40
Overweight 15-25
Adolescents 30-45
Average weight, twins 35-45
*Adapted from (4).
Most pregnant vegetarians, both lacto-ovo and vegan, gain an adequate amount of weight (5-7). Birth weights of infants of vegetarian women have frequently been shown to be similar to those of infants of non-vegetarians and to birth weight norms (5,7-12). For example, a small study by King et al found that infants born to vegetarian women had a mean birth weight 200 grams higher than infants born to omnivorous women (5). A study examining vegan women found that the average birth weight was 3342 grams (about 7 pounds, 5 ounces). Interestingly, for each additional year these women were vegan, birth weight increased by 42 grams (6).
Some studies done outside the US reported birth weights of infants born to vegetarian women were lower than infants with non-vegetarian mothers (13-16). Generally this is found in women following restrictive vegetarian diets, such as macrobiotic diets (14,15). These low weights have been attributed to low maternal weight gain and lower maternal intakes of energy,iron,folate or vitamin B-12(13-16.
Energy
In order to meet the weight gain recommendations for pregnancy, extra dietary energy is required. The total energy cost of a pregnancy is estimated to be around 55,000 calories over the 280 days of pregnancy (4,17). Assuming that caloric intake does not increase during the first month of pregnancy, an additional 200 to 300 calories per day should meet energy needs (2,4,18).
Since caloric needs increase only about 15% and nutrient needs increase up to 50%, a nutritionally dense diet in pregnancy is needed to meet nutrient needs within the caloric recommendations. Vegetarians should be counseled, just like all clients, that excessive intake of low nutrient vegetarian foods such as candy and sweets should be avoided.
Women who were underweight or who are having difficulty gaining weight should be counseled to choose nutritious foods with a higher caloric density. Suggestions include milk shakes (soymilk or cow's milk blended with fruit and tofu or yogurt), nuts and nut butters, dried fruits, soy products, and bean dips. Small, frequent meals and snacks can help increase food intake.
Protein
Protein is needed during pregnancy to support the rapid growth of the fetus and placenta. Protein is also used in the growth of maternal tissue (4). Current recommendations suggest an increase in protein of 10 grams more than the non-pregnant state for adult women (2). Ten grams of protein is the amount found in 2 cups of soy milk, 3-1/2 ounces of extra-firm tofu, 3 ounces of tempeh or one large bagel. This amounts to a total of only 60 grams of protein per day; in one study vegan and vegetarian women were consuming that amount even before they were pregnant (20).
Iron
Iron needs are high during pregnancy because of both the increase in the mother's blood volume and the blood formed for the fetus. Despite compensatory mechanisms such as cessation of menstruation and increased iron absorption, the iron requirement of pregnancy is quite high and the diet needs to be especially rich in iron. Pregnant vegetarians should choose high iron foods like whole grains, legumes, tofu, and green leafy vegetables daily and consume them with foods rich in vitamin C to increase the bioavailability of the iron. Iron supplements of 30 mg daily during the second and third trimester are commonly recommended (2, 4). Higher dose iron supplements can induce side effects such as constipation, nausea and heartburn. Supplement doses of 38 to 65 mg of iron per day may reduce zinc absorption (21).
Researchers are currently studying whether taking iron supplements less frequently than daily is as effective as daily iron supplementation. A study in Indonesia showed that weekly iron supplementation offered similar health effects compared to daily supplementation and the compliance was higher in the group of women supplemented weekly (22). Therefore an alternative to daily supplementation may be suggested for women experiencing side effects such as constipation that they attribute to iron supplementation.
Iron deficiency anemia is not uncommon during pregnancy, in both vegetarians and non-vegetarians. Several studies of pregnant vegetarians have suggested that dietary iron intakes were close to recommended levels (19) and that rates of anemia were low (6), although Drake et al found that dietary supplements were needed to meet iron recommendations in 34 lacto-ovo vegetarians (12). All pregnant women, including vegetarians, should be checked for iron-deficiency anemia and consider supplementation if they are unable to meet their needs through diet alone.
Calcium
Calcium is needed in pregnancy for synthesis of fetal bones and teeth. Approximately 25 to 30 grams of calcium are transferred to the fetus, primarily in the third trimester (4). Historically, women have been advised to substantially increase their calcium intake during pregnancy in order to meet the fetus's needs without compromising their own bone density. Current research shows that calcium absorption is increased in pregnancy, resulting in a generally positive calcium balance (23, 24). The Institute of Medicine has concluded that, as long as calcium intake prior to pregnancy was adequate for maximizing bone accretion, dietary calcium does not need to be increased in pregnancy (24). The calcium recommendation for pregnant women age 19 and older is 1000 mg a day (24). Adolescents may have an increased need for calcium to support their own bone development and may benefit from a higher calcium intake (25). The current recommendation is for 1300 mg of calcium daily for pregnant adolescents (25).
Calcium intakes of lacto-ovo vegetarian women are often close to levels recommended for pregnancy while calcium intakes of vegan women are generally lower (26). Pregnant women whose diets do not contain adequate calcium should add calcium-rich foods to their diet or use supplemental calcium (4). This appears to be especially important in adolescents.
Vegetarians who consume dairy products get calcium from milk and cheese. Many women may be surprised to learn that the many foods thought of as a serving of dairy, such as pudding, hot chocolate and cottage cheese, are not excellent sources of calcium. For example, it would take 3 servings of a ready-to-eat pudding to equal the calcium in one cup of cow's milk. Numerous brands of soy and rice milk, fruit juices, cereals and waffles are fortified with calcium. Plant sources of well-absorbed calcium include soybeans; dark green leafy vegetables like collard greens, kale, and turnip greens; and calcium-precipitated tofu.
Vitamin D
Vitamin D plays an important role in maintenance of maternal calcium absorption. Its role in placental transport of calcium is not clear nor is its role in fetal vitamin D status. Vitamin D status of vegetarians can vary based on sunlight exposure and dietary choices (27-30). While it is well known that vitamin D can be made from exposure to the sun, the modern lifestyle of work and leisure spent mostly indoors and the use of sunscreens to prevent skin cancer may not guarantee sufficient UV light exposure for adequate vitamin D synthesis. As an illustration: 42% of adults less than 65 years of age, without known risk factors for hypovitaminosis D, admitted to a general medical ward in a Boston hospital were found to be vitamin D deficient (31). Therefore a dietary source of vitamin D is highly recommended. For lacto-vegetarians vitamin D-fortified cow's milk can used to meet vitamin D requirements. Clients may need to be reminded that other dairy products like cheese are not fortified with this essential nutrient. Some cereals and soy milk are fortified with vitamin D and many multivitamins contain the recommended level of 10 mcg (400 IU) of vitamin D. Many calcium supplements contain vitamin D as well. Supplements of vitamin D-2 (ergocalciferol) and vitamin D-3 (cholecalciferol) are utilized equally well by the mother and fetus (32).
Folate
The central nervous system develops in the fetus during the first weeks of gestation. By day 23 the neural tube that will become the spinal cord has closed. A lack of folate can keep the neural tube from closing properly, resulting in neural tube defects (NTDs). Since neural tube development is complete before most women are aware that they are pregnant, the current recommendation is that all women of child-bearing years should get at least 400 mcg of folate per day.
Folate derives from the Latin word folium, which means "foliage," and is found in particularly high concentrations in dark green, leafy vegetables. Vegetarian diets tend to be rich in folic acid compared to non-vegetarian diets (26).
The Food and Nutrition Board suggests an intake of 600 mcg of folic acid during pregnancy (1). The FDA has also mandated the fortification of grain products like bread with folic acid (140 mcg folic acid/100 g of the food item).
Vitamin B-12
The recommended level of vitamin B-12 in pregnancy is 2.6 mcg per day (1). Vitamin B-12 is needed during pregnancy for normal cell division and protein synthesis. It appears that maternal stores of vitamin B-12 may not be available to the fetus (33), therefore a maternal dietary source should be assured. Vitamin B-12 is found in animal products such as milk and eggs. Vegans can easily meet vitamin B-12 needs with the use of foods fortified with vitamin B-12, such as breakfast cereals, some soymilks, and Red Star brand T6635 nutritional yeast (also called Vegetarian Support Formula). Foods which have been previously proposed as good sources of vitamin B-12 such as tempeh, sea vegetables, and algae have been shown to be unreliable and therefore inappropriate sources (34-35). In addition these foods may contain vitamin B-12 analogues (substances which mimic vitamin B-12 but which actually block vitamin B-12 absorption).
Zinc
The recommended intake of zinc increases by 50 percent during pregnancy (2). Mild zinc deficiency has been related to complications of labor and delivery including prolonged or inefficient first stage labor (cervical dilation) and protracted second stage labor (pushing) and premature rupture of the membranes (the sac of fluid that cushions the infant) (36). Many women in the US, both omnivores and vegetarians, do not consume diets that meet the RDA for zinc during pregnancy. Several studies have examined vegetarians' zinc status during pregnancy. One found that although vegetarians' diets were slightly lower in zinc than those of non-vegetarians, their blood and urine zinc levels were similar (5). In another study, vegetarians' zinc intakes were similar to intakes of non-vegetarians (11). Since zinc status is difficult to assess and zinc is an essential nutrient for growth and development, pregnant vegetarians should emphasize good food sources of zinc.
Although legumes, nuts and whole grains are good sources of zinc, the availability of the zinc is lower than found in animal products due to the phytic acid content. Zinc availability is increased when grains are sprouted or eaten as yeast-raised bread, as both of these food preparation techniques destroy phytate (37).
Complications of Pregnancy
Nausea
Nausea and vomiting, also called morning sickness, are a concern of many pregnant women, vegetarians included. Eating low fat, high carbohydrate foods, which are digested fairly quickly, eating often, avoiding foods with strong smells, and eating those healthful foods that are tolerated are some coping mechanisms. The health care provider should be contacted if a pregnant woman is unable to eat or drink adequate amounts of fluids for 24 hours.
Aversions and cravings
Food aversions are extremely common in pregnancy and are believed to be due to a heightened sense of smell, possibly caused by hormonal changes (38). Dietetics professionals can offer suggestions for foods to replace those that are no longer attractive to the client. Because many foods served at room temperature or colder have less of an odor than heated foods, some women may tolerate some foods served raw that they will not eat when cooked. For example, broccoli may be tolerated if served raw with a dip and cabbage may be acceptable in cole slaw.
Contrary to popular belief, food cravings are not a sign of a need for a certain nutrient or food. This seems obvious when the most commonly reported foods to be craved are sweets (39, 40). Interestingly, one of the most common foods that women become averse to eating during pregnancy is meat. Therefore women may become vegetarian or nearly vegetarian during pregnancy simply due to a food aversion.
Constipation
Constipation is a common complaint in pregnancy. The higher fiber diet of vegetarian women may be an asset in avoiding constipation. If a woman feels her constipation is a side effect of iron supplementation, increasing high vitamin C fruits may serve a dual purpose of counteracting the constipating effect and enhancing iron absorption. Assurance of adequate fluid intake is also helpful in preventing and alleviating constipation.
Preeclampsia
Preeclampsia, or pregnancy induced hypertension with proteinuria, is a potentially serious complication of pregnancy. One study has examined the rate of preeclampsia in a community of vegans in Tennessee between 1977 and 1982. Of 775 vegan pregnancies, there was only one case of preeclampsia (8). This is a much lower rate than that seen in the general population. Since the cause of preeclampsia is still not well understood, it is unclear what factors explain the lower rate of preeclampsia experienced by vegans in this study.
Food Guide
The Vegetarian Nutrition Dietetic Practice Group has produced a food guide for pregnant vegetarians, presented in Table 2 (41). These guidelines are an average suggestion and should be adjusted to meet the needs of the individual. Some women will need more calories to support adequate weight gain in pregnancy, especially women expecting twins or triplets, adolescents and women who entered pregnancy underweight. In this case, additional servings of foods can be added and fats such as oil and salad dressing used to increase calories. Other women, such as women beginning pregnancy obese or women who are very short in stature, may choose lower calorie selections from each of the groups.
Table 2. Meal Planning Guidelines for Pregnant Vegetarians
Food Group Serving size No of Servings Comments
Grains 1 slice of bread;1/2 cup cooked cereal, grain or pasta; 3/4 to 1 cup ready-to-eat cereal 7 or more Choose whole or enriched
Legumes, nuts, seeds, milks 1/2 cup cooked beans, tofu, tempeh; 3 oz of meat analogue; or 2 Tbsp nuts, seeds, nut or seed butter; 1 cup fortified soy milk; 1cup cow's milk, 1 cup yogurt) 5 or more Calcium-rich foods such as dried beans, calcium-precipitated tofu, calcium-fortified soymilk, cow's milk, and yogurt should be chosen often. A regular source of vitamin B-12 should be used.
Vegetables 1/2 cup cooked or 1 cup raw 4 or more Calcium-rich foods such as kale, collard greens, mustard greens, broccoli, and bok choy, should be chosen often.
Fruits 1/2 cup canned fruit or juice or 1 medium fruit 4 or more Choose calcium rich figs, and fortified juices often.
Conclusion
A vegetarian diet planned in accord with current dietary recommendations can easily meet the nutritional needs of pregnancy (3). Potential benefits of a vegetarian diet in pregnancy include adequate folate status at conception and a possible reduced risk of pre-eclampsia (6).
by Reed Mangels, PhD, RD, FADA
Pregnancy is a time of increased nutritional needs, both to support the rapidly growing fetus and to allow for the changes occurring in the pregnant woman's body. Throughout pregnancy, recommended intakes of vitamins and minerals are higher than for the non-pregnant state. For example, the recommendation for folic acid is 50 percent higher (1) and the recommendation for iron is doubled (2) in pregnancy. Vegetarian and vegan diets can easily meet these nutrient needs (3)Weight Gain.
It is important that all pregnant women have adequate weight gain. Weight gain recommendations vary depending on the prepregnancy weight and needs of the woman, therefore energy needs vary as well. A general trend is to have little weight gain (less than 5 pounds) for the first 12 weeks. Then, in the second and third trimesters, a weight gain of a pound or two a week is suggested. Current weight gain recommendations (4) are applicable to vegetarians. The recommendations for weight gain are listed in Table 1.
Table 1. Recommended Weight Gain During Pregnancy*
Weight status(prior to pregnancy) Recommendedweight gain (lbs.)
Average weight 25-35
Underweight 28-40
Overweight 15-25
Adolescents 30-45
Average weight, twins 35-45
*Adapted from (4).
Most pregnant vegetarians, both lacto-ovo and vegan, gain an adequate amount of weight (5-7). Birth weights of infants of vegetarian women have frequently been shown to be similar to those of infants of non-vegetarians and to birth weight norms (5,7-12). For example, a small study by King et al found that infants born to vegetarian women had a mean birth weight 200 grams higher than infants born to omnivorous women (5). A study examining vegan women found that the average birth weight was 3342 grams (about 7 pounds, 5 ounces). Interestingly, for each additional year these women were vegan, birth weight increased by 42 grams (6).
Some studies done outside the US reported birth weights of infants born to vegetarian women were lower than infants with non-vegetarian mothers (13-16). Generally this is found in women following restrictive vegetarian diets, such as macrobiotic diets (14,15). These low weights have been attributed to low maternal weight gain and lower maternal intakes of energy,iron,folate or vitamin B-12(13-16.
Energy
In order to meet the weight gain recommendations for pregnancy, extra dietary energy is required. The total energy cost of a pregnancy is estimated to be around 55,000 calories over the 280 days of pregnancy (4,17). Assuming that caloric intake does not increase during the first month of pregnancy, an additional 200 to 300 calories per day should meet energy needs (2,4,18).
Since caloric needs increase only about 15% and nutrient needs increase up to 50%, a nutritionally dense diet in pregnancy is needed to meet nutrient needs within the caloric recommendations. Vegetarians should be counseled, just like all clients, that excessive intake of low nutrient vegetarian foods such as candy and sweets should be avoided.
Women who were underweight or who are having difficulty gaining weight should be counseled to choose nutritious foods with a higher caloric density. Suggestions include milk shakes (soymilk or cow's milk blended with fruit and tofu or yogurt), nuts and nut butters, dried fruits, soy products, and bean dips. Small, frequent meals and snacks can help increase food intake.
Protein
Protein is needed during pregnancy to support the rapid growth of the fetus and placenta. Protein is also used in the growth of maternal tissue (4). Current recommendations suggest an increase in protein of 10 grams more than the non-pregnant state for adult women (2). Ten grams of protein is the amount found in 2 cups of soy milk, 3-1/2 ounces of extra-firm tofu, 3 ounces of tempeh or one large bagel. This amounts to a total of only 60 grams of protein per day; in one study vegan and vegetarian women were consuming that amount even before they were pregnant (20).
Iron
Iron needs are high during pregnancy because of both the increase in the mother's blood volume and the blood formed for the fetus. Despite compensatory mechanisms such as cessation of menstruation and increased iron absorption, the iron requirement of pregnancy is quite high and the diet needs to be especially rich in iron. Pregnant vegetarians should choose high iron foods like whole grains, legumes, tofu, and green leafy vegetables daily and consume them with foods rich in vitamin C to increase the bioavailability of the iron. Iron supplements of 30 mg daily during the second and third trimester are commonly recommended (2, 4). Higher dose iron supplements can induce side effects such as constipation, nausea and heartburn. Supplement doses of 38 to 65 mg of iron per day may reduce zinc absorption (21).
Researchers are currently studying whether taking iron supplements less frequently than daily is as effective as daily iron supplementation. A study in Indonesia showed that weekly iron supplementation offered similar health effects compared to daily supplementation and the compliance was higher in the group of women supplemented weekly (22). Therefore an alternative to daily supplementation may be suggested for women experiencing side effects such as constipation that they attribute to iron supplementation.
Iron deficiency anemia is not uncommon during pregnancy, in both vegetarians and non-vegetarians. Several studies of pregnant vegetarians have suggested that dietary iron intakes were close to recommended levels (19) and that rates of anemia were low (6), although Drake et al found that dietary supplements were needed to meet iron recommendations in 34 lacto-ovo vegetarians (12). All pregnant women, including vegetarians, should be checked for iron-deficiency anemia and consider supplementation if they are unable to meet their needs through diet alone.
Calcium
Calcium is needed in pregnancy for synthesis of fetal bones and teeth. Approximately 25 to 30 grams of calcium are transferred to the fetus, primarily in the third trimester (4). Historically, women have been advised to substantially increase their calcium intake during pregnancy in order to meet the fetus's needs without compromising their own bone density. Current research shows that calcium absorption is increased in pregnancy, resulting in a generally positive calcium balance (23, 24). The Institute of Medicine has concluded that, as long as calcium intake prior to pregnancy was adequate for maximizing bone accretion, dietary calcium does not need to be increased in pregnancy (24). The calcium recommendation for pregnant women age 19 and older is 1000 mg a day (24). Adolescents may have an increased need for calcium to support their own bone development and may benefit from a higher calcium intake (25). The current recommendation is for 1300 mg of calcium daily for pregnant adolescents (25).
Calcium intakes of lacto-ovo vegetarian women are often close to levels recommended for pregnancy while calcium intakes of vegan women are generally lower (26). Pregnant women whose diets do not contain adequate calcium should add calcium-rich foods to their diet or use supplemental calcium (4). This appears to be especially important in adolescents.
Vegetarians who consume dairy products get calcium from milk and cheese. Many women may be surprised to learn that the many foods thought of as a serving of dairy, such as pudding, hot chocolate and cottage cheese, are not excellent sources of calcium. For example, it would take 3 servings of a ready-to-eat pudding to equal the calcium in one cup of cow's milk. Numerous brands of soy and rice milk, fruit juices, cereals and waffles are fortified with calcium. Plant sources of well-absorbed calcium include soybeans; dark green leafy vegetables like collard greens, kale, and turnip greens; and calcium-precipitated tofu.
Vitamin D
Vitamin D plays an important role in maintenance of maternal calcium absorption. Its role in placental transport of calcium is not clear nor is its role in fetal vitamin D status. Vitamin D status of vegetarians can vary based on sunlight exposure and dietary choices (27-30). While it is well known that vitamin D can be made from exposure to the sun, the modern lifestyle of work and leisure spent mostly indoors and the use of sunscreens to prevent skin cancer may not guarantee sufficient UV light exposure for adequate vitamin D synthesis. As an illustration: 42% of adults less than 65 years of age, without known risk factors for hypovitaminosis D, admitted to a general medical ward in a Boston hospital were found to be vitamin D deficient (31). Therefore a dietary source of vitamin D is highly recommended. For lacto-vegetarians vitamin D-fortified cow's milk can used to meet vitamin D requirements. Clients may need to be reminded that other dairy products like cheese are not fortified with this essential nutrient. Some cereals and soy milk are fortified with vitamin D and many multivitamins contain the recommended level of 10 mcg (400 IU) of vitamin D. Many calcium supplements contain vitamin D as well. Supplements of vitamin D-2 (ergocalciferol) and vitamin D-3 (cholecalciferol) are utilized equally well by the mother and fetus (32).
Folate
The central nervous system develops in the fetus during the first weeks of gestation. By day 23 the neural tube that will become the spinal cord has closed. A lack of folate can keep the neural tube from closing properly, resulting in neural tube defects (NTDs). Since neural tube development is complete before most women are aware that they are pregnant, the current recommendation is that all women of child-bearing years should get at least 400 mcg of folate per day.
Folate derives from the Latin word folium, which means "foliage," and is found in particularly high concentrations in dark green, leafy vegetables. Vegetarian diets tend to be rich in folic acid compared to non-vegetarian diets (26).
The Food and Nutrition Board suggests an intake of 600 mcg of folic acid during pregnancy (1). The FDA has also mandated the fortification of grain products like bread with folic acid (140 mcg folic acid/100 g of the food item).
Vitamin B-12
The recommended level of vitamin B-12 in pregnancy is 2.6 mcg per day (1). Vitamin B-12 is needed during pregnancy for normal cell division and protein synthesis. It appears that maternal stores of vitamin B-12 may not be available to the fetus (33), therefore a maternal dietary source should be assured. Vitamin B-12 is found in animal products such as milk and eggs. Vegans can easily meet vitamin B-12 needs with the use of foods fortified with vitamin B-12, such as breakfast cereals, some soymilks, and Red Star brand T6635 nutritional yeast (also called Vegetarian Support Formula). Foods which have been previously proposed as good sources of vitamin B-12 such as tempeh, sea vegetables, and algae have been shown to be unreliable and therefore inappropriate sources (34-35). In addition these foods may contain vitamin B-12 analogues (substances which mimic vitamin B-12 but which actually block vitamin B-12 absorption).
Zinc
The recommended intake of zinc increases by 50 percent during pregnancy (2). Mild zinc deficiency has been related to complications of labor and delivery including prolonged or inefficient first stage labor (cervical dilation) and protracted second stage labor (pushing) and premature rupture of the membranes (the sac of fluid that cushions the infant) (36). Many women in the US, both omnivores and vegetarians, do not consume diets that meet the RDA for zinc during pregnancy. Several studies have examined vegetarians' zinc status during pregnancy. One found that although vegetarians' diets were slightly lower in zinc than those of non-vegetarians, their blood and urine zinc levels were similar (5). In another study, vegetarians' zinc intakes were similar to intakes of non-vegetarians (11). Since zinc status is difficult to assess and zinc is an essential nutrient for growth and development, pregnant vegetarians should emphasize good food sources of zinc.
Although legumes, nuts and whole grains are good sources of zinc, the availability of the zinc is lower than found in animal products due to the phytic acid content. Zinc availability is increased when grains are sprouted or eaten as yeast-raised bread, as both of these food preparation techniques destroy phytate (37).
Complications of Pregnancy
Nausea
Nausea and vomiting, also called morning sickness, are a concern of many pregnant women, vegetarians included. Eating low fat, high carbohydrate foods, which are digested fairly quickly, eating often, avoiding foods with strong smells, and eating those healthful foods that are tolerated are some coping mechanisms. The health care provider should be contacted if a pregnant woman is unable to eat or drink adequate amounts of fluids for 24 hours.
Aversions and cravings
Food aversions are extremely common in pregnancy and are believed to be due to a heightened sense of smell, possibly caused by hormonal changes (38). Dietetics professionals can offer suggestions for foods to replace those that are no longer attractive to the client. Because many foods served at room temperature or colder have less of an odor than heated foods, some women may tolerate some foods served raw that they will not eat when cooked. For example, broccoli may be tolerated if served raw with a dip and cabbage may be acceptable in cole slaw.
Contrary to popular belief, food cravings are not a sign of a need for a certain nutrient or food. This seems obvious when the most commonly reported foods to be craved are sweets (39, 40). Interestingly, one of the most common foods that women become averse to eating during pregnancy is meat. Therefore women may become vegetarian or nearly vegetarian during pregnancy simply due to a food aversion.
Constipation
Constipation is a common complaint in pregnancy. The higher fiber diet of vegetarian women may be an asset in avoiding constipation. If a woman feels her constipation is a side effect of iron supplementation, increasing high vitamin C fruits may serve a dual purpose of counteracting the constipating effect and enhancing iron absorption. Assurance of adequate fluid intake is also helpful in preventing and alleviating constipation.
Preeclampsia
Preeclampsia, or pregnancy induced hypertension with proteinuria, is a potentially serious complication of pregnancy. One study has examined the rate of preeclampsia in a community of vegans in Tennessee between 1977 and 1982. Of 775 vegan pregnancies, there was only one case of preeclampsia (8). This is a much lower rate than that seen in the general population. Since the cause of preeclampsia is still not well understood, it is unclear what factors explain the lower rate of preeclampsia experienced by vegans in this study.
Food Guide
The Vegetarian Nutrition Dietetic Practice Group has produced a food guide for pregnant vegetarians, presented in Table 2 (41). These guidelines are an average suggestion and should be adjusted to meet the needs of the individual. Some women will need more calories to support adequate weight gain in pregnancy, especially women expecting twins or triplets, adolescents and women who entered pregnancy underweight. In this case, additional servings of foods can be added and fats such as oil and salad dressing used to increase calories. Other women, such as women beginning pregnancy obese or women who are very short in stature, may choose lower calorie selections from each of the groups.
Table 2. Meal Planning Guidelines for Pregnant Vegetarians
Food Group Serving size No of Servings Comments
Grains 1 slice of bread;1/2 cup cooked cereal, grain or pasta; 3/4 to 1 cup ready-to-eat cereal 7 or more Choose whole or enriched
Legumes, nuts, seeds, milks 1/2 cup cooked beans, tofu, tempeh; 3 oz of meat analogue; or 2 Tbsp nuts, seeds, nut or seed butter; 1 cup fortified soy milk; 1cup cow's milk, 1 cup yogurt) 5 or more Calcium-rich foods such as dried beans, calcium-precipitated tofu, calcium-fortified soymilk, cow's milk, and yogurt should be chosen often. A regular source of vitamin B-12 should be used.
Vegetables 1/2 cup cooked or 1 cup raw 4 or more Calcium-rich foods such as kale, collard greens, mustard greens, broccoli, and bok choy, should be chosen often.
Fruits 1/2 cup canned fruit or juice or 1 medium fruit 4 or more Choose calcium rich figs, and fortified juices often.
Conclusion
A vegetarian diet planned in accord with current dietary recommendations can easily meet the nutritional needs of pregnancy (3). Potential benefits of a vegetarian diet in pregnancy include adequate folate status at conception and a possible reduced risk of pre-eclampsia (6).
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