What to tell your patients

I'm soy not eating that

What to do when a good patient goes vegan

By Anna Byk

WHAT TO TELL YOUR PATIENTS ABOUT VEGETARIANISM • Vitamin deficiencies: Vegetarian diets are often lacking certain nutrients essential to good health ? namely fats, calcium, protein, vitamins and minerals like zinc and iron. Iron deficiency, which can lead to anemia, is by far the most common, with zinc deficiency coming in next. Low zinc can cause an abnormal sense of taste and smell, white spots on the fingernails, a weakened appetite and libido, and insomnia. Vegans especially need to watch for vitamin B12 deficiency • Supplements: It's preferable that the vegetarians take the natural route when compensating for nutrient deficiencies, rather than introducing a cocktail of vitamins to the mix. For those lacking iron, foods like cream of wheat, bran cereal, lentils and legumes are good options. As for vitamin B12, 1µg per day is recommended ? Dr Jenkins explains that vegans shouldn't worry about animal products in the B12 supplements as they're made from bacteria. Vegans should also introduce some sort of calcium supplement into their diet. • Proteins: Vegetarians need to offset the absence of meat with other foods to get the proteins they need. Dairy products are a good alternative. Vegans are even more limited when it comes to viable sources of protein, since both meat and dairy are off the menu. For them grains, nuts and legumes are the way to go. Peanut or cashew butter is a great source of protein. Another alternative is meat substitutes, like soy products. • Read the label: There are a slew of products on the grocer's shelf geared towards vegetarians, but some can be gimmicks. There's also a tendency for people to think that vegetarian food equals healthy food. As with everyone, vegetarians should try to avoid trans fats hidden in healthy-sounding treats like soy and rice crackers. Although traditional fermented soy products like miso and shoyu are healthy, processed soy products may not be. Textured vegetable protein (TVP), soy milk, soy protein powders and soy meat substitutes all fall into that category because they completely change the properties of the beans' protein and can be very hard to digest. MSG is also usually added to these products to give them taste.

Anita Simpson decided she wanted to make a lifestyle change. She was tired of the livestock scandals, mad cow disease, and the questionable methods of intensive farming. All the hype had her concerned about the food she and her family were consuming on a regular basis. Last November she made the switch to vegetarianism. Her husband and two daughters are still grumbling about the change in their grocery order, and her FP wasn't too thrilled when she told her either.

Ms Simpson isn't alone in her decision ? although she's very much part of the minority. Only 4% of Canadians are vegetarian, according to 2002 statistics from the National Institute of Health; vegans make up an even smaller portion of the population. The popularity of vegetarianism may also be on the downturn thanks to such fad diets as the Zone diet, the Atkins diet and the South Beach diet that all tout the benefits of protein and the drawbacks of carbohydrates.

But vegetarianism is, nonetheless, a way of life for many Canadians, and many vegetarians complain that their doctors are often unreceptive to their lifestyle choice and dietary needs.

"Most doctors feel that vegetarians will die early, but they actually live healthier lives," says Dr David Jenkins, director of the Risk Factor Modification Centre at St Michael's Hospital and a professor of medicine and nutrition at U of T.

In lieu of ushering in change, it's important that doctors take it upon themselves to know what to tell their patients who come into the office wanting to know how to remain healthy while still cutting out meat, and in the case of vegans, anything coming from an animal. There are even realistic options for kids and teens, as long as parents are diligent and make sure that there are enough dairy products in the diet to provide calcium and protein for proper growth.

Here are a few starting points and some advice on what to tell your patients about being a healthy vegetarian.