In a clinical study, vegetarians were found to have similar serum levels of all of the vitamins measured (including vitamin A) compared with a matched non-vegetarian population. However, serum p-carotene levels were twice as high in the vegetarian group. NK from the vegetarian group lysed double the number of tumour cells as compared to NK from the non-vegetarian group. It may be that p-carotene or other carotenoids enhance NK functions independent of provitamin A activity (Malter et al., 1989). Kramer et al. (1995), in a preliminary report, found that carotenoid-rich vegetable consumption enhanced NK cell number as well as lymphocyte proliferation.
Cancer prevention strategies are now being directed to understanding the potential for diet to modulate molecular signaling (Monson, 2003 Surh, 2003 Young et al., 2003). A comprehensive review in 1997 (World Cancer Research Fund American Institute for Cancer Research, 1997) convincingly suggested that consumption of fruit and vegetables decreased the risk of cancers of the mouth, pharynx, esophagus, lung, stomach, colon, and rectum. This report also concluded that eating fruit and vegetables probably also reduces the risk of cancers of the larynx, pancreas, breast, and bladder. As a consequence, it was suggested that the adoption of recommended diets together with maintenance of physical activity and appropriate body mass, could in time reduce cancer incidence by 30-40 . Hence, the dietary advice to individuals was to choose predominantly plant-based diets rich in a variety of vegetables and fruit, pulses (legumes) and minimally processed starchy staple foods (Monson, 2003).
On balneo- and spa therapy, two studies on homeopathy, five studies on hypnotherapy guided imagery, three studies on patient-centered communication, two RCT on vegetarian diet, three RCT on whole-body heat therapy, two on written emotional disclosure, three on tropisetron, and three on tramadol (one in combination with acetaminophen), fulfilling the criteria defined above 24, 65, 66, 68, 69 . Since December 2006 further RCT on pharmacologic, psychotherapeutic and physical treatment have been published which support the efficacy of the interventions mentioned above.
Selenium content of plant sources is dependent on the availability of selenium in the soil in which they are grown. While plants may vary in selenium content, muscle meats, milk, and eggs are more reliable food sources because selenium is added to animal feed in the United States and Canada. Western South Dakota and eastern Wyoming are designated by the USDA as areas for raising food animals only because they are high-selenium farming regions. Likewise, there are also low-selenium regions, but it is felt that the food-distribution system in the United States transports foods from such large and varied farm areas that a mix of both low- and high-selenium foods balances out these variations (although plant selenium content may vary considerably). Therefore, vegetarians and those who live in low-selenium farming regions may be at risk for low selenium intakes.
Another cultural emotional trend leading away from anthelmintic use is the increasing profile of animal rights and vegetarianism in the CSI world (neither movement has yet had much influence in LNR countries). The trend toward reduction in meat and dairy product consumption based on health concerns can be partially countered by advertising campaigns or the development of lower fat items, at least in the short term. However, vegetarianism based on moral or emotional conversion, and promulgated by celebrities, could have a significant and increasing impact on the demand for meat and dairy products in the future. Stagnant or reduced market sizes in CSI countries will decrease the price of meat and dairy products as supply outstrips demand, and will result in decreased anthelmintic usage. Conversely, animal production may increase in LNR countries (see below). As these countries tend to cluster in warmer climates, where helminths are generally more problematic, global anthelmintic demand...
Multidisciplinary pain management, psychopharma-cology, opioids, experimental therapies and combinations is the third-line therapy recommended by the APS in cases of persisting symptoms. In cases lacking adaptation to symptoms or persistent restrictions of daily functioning, the German guideline recommended either no therapy or self-management (aerobic exercise, stress management, pool-based exercise), or booster multi-component therapy, or psychotherapy (hypnotherapy, written emotional disclosure), or pharmacologic therapy (duloxetine or fluoxetine or paroxetin or prega-balin, or tramadol with or without acetaminophen), or complementary alternative therapies (homeopathy, vegetarian diet) as third-line therapy. The choice of treatment options should be based on informed patient consent, the patient's preferences and co-morbidities, and the treatment options locally available 24 .
The intake of excessive levels of heavy metals including iron is a risk factor for Parkinson's disease (31). In India the vegetarian Hindus have a much lower prevalence of Parkinson's disease than the meat-eating Parsees (56). One source of iron in the diet is the heme from myoglobin. Iron adsorption is inhibited by the polyphenols present in spices of which the Hindus eat a large amount. In Parkinson's disease the glia have raised levels of heme oxygenase-1. This enzyme catalyzes heme breakdown to biliverdin and produces CO and free iron as byproducts. Lewy bodies, which consist of cross-linked neurofilaments, also have greatly raised levels of this enzyme (76).
It has been postulated that cholesterol levels in people consuming mainly vegetarian diets is lower than in those eating commercially prepared foods, possibly due to the presence of natural alkanols such as octacosanol. To date, policosanol has been used in a number of clinical trials in this area.100
Cardiovascular Disease and Atherosclerosis. Coronary heart disease and other cardiovascular diseases are multifactorial conditions risk factors include raised serum cholesterol, high blood pressure and smoking. The rates of coronary heart disease vary depending on geographical location, sex, age and dietary practice. Thus, the incidence of cardiovascular disease in general is lower in Asian than Western countries. For example, in 1986, age-standardised mortality rates for coronary heart disease for men and women (40-69 years old) in the USA were approximately 300 and 100 per 100000 respectively and, in Japan, 50 and 15 per 100000 respectively.80 Rates are also known to be lower in vegetarians than omnivores. These diseases contribute significantly to mortality. In the UK, for example, coronary heart disease accounts for 30 and 23 of mortality in men and women, respectively. i7 The finding that the incidence of cardiovascular disease is lower for premenopausal women than men of similar...
A number of studies of people who eat a diet rich in fruit and vegetables, and therefore rich in antioxidant nutrients, have tried to test the hypothesis that fruit and vegetables lower the risk of CHD (Phillips et al., 1980 Chang-Claude et al., 1992 Thorogood et al., 1994 Key et al., 1996). In general, observational studies of vegetarians and those with diets rich in fruits and vegetables support the hypothesis that such diets might lower the risk of CHD. Vegetarians generally have high intakes of cereals, nuts and vegetable oils, carrots and green vegetables as well as fruit. However, vegetarians differ from the rest of the population in a number of important ways they tend to smoke less, have a lower body mass index and alcohol intake, and come predominantly from higher social classes, all of which are known to confer a health advantage.
Serum cholesterol has been attributed to the phytoestrogens 192,193 . There is evidence to support the hypothesis that phytoestrogen consumption contributes to the lower incidence of cardiovascular disease in Asian countries and in vegetarians and that phytoestrogens may be cardioprotective 13 . However, the mechanism is uncertain, since genistein is reported to both up- and down-regulate LDL receptors, and some of the products used in studies reporting cholesterol-lowering effects contained unexpectedly low levels of isoflavones 194 . In addition, because of its effects on tyrosine kinases, genistein may have a role in the suppression of the cellular processes which lead to thrombus formation and eventually, atherosclerosis. In cell lines, genistein has been found to inhibit the proliferation brought about by platelet-derived growth factor in the artery wall, and to interfere with release of inflammatory cytokines from macrophages. It also inhibits platelet aggregation and acts as a...
Strategies to develop chemopreventive drugs for use have been evolving for many years.1-3 This program has developed as a linear-array strategy by which agents enter and flow through the system in stepwise pattern. In this context, we have begun to examine the chemopreventive potential of a wide variety of synthetic and natural products. Epidemiological evidence has related decreased cancer risk to increased consumption of phytoestrogens and lignans in a vegetarian diet.4 The scientific rationale for conducting chemoprevention trials in humans is based largely on epidemiological evidence suggesting that dietary components may be inhibitors of carcinogenesis.5 Examples of these include vitamins and minerals such as p-carotene,67 vitamin E,8-10 calcium,11 and selenium.1213 Other important sources for identifying potential chemopreventives include cancer research literature, particularly experimental carcinogenesis data from animal
Most studies of effects of dietary changes and the consumption of vegetarian or health food diets on hormonal status ( 62-66 ,summarized in 13 ) have not separately addressed effects of dietary fat. However, they clearly indicate that diet can influence circulating hormone levels by changing androgen production rates or the metabolism and clearance of androgens and estrogens. Recently, Dorgan et al. 67 reported that the combination of a high fat-low fiber diet given to healthy men increased total testosterone and testosterone bound to SHBG (sex hormone binding globulin) in the plasma and urinary testosterone excretion as compared to a low fat-high fiber diet, but lowered urinary excretion of estrone, 17 -estradiol, and the 2-hydroxy metabolites of these estrogens. Although these studies did not address the separate effects of single dietary factors such as total fat intake, they indicate that diet can affect sex steroid hormonal status.
Capsules made from gelatin predominate however, recent years have seen an increased interest and availability of nongelatin capsules. Such alternative shell compositions may satisfy religious, cultural, or vegetarian needs to avoid animal sources. Hard-shell capsules made from starch were developed by Capsugel, a Division of Pfizer, Inc. (Peapack, New Jersey, U.S.). These consist of two parts fitted cap and body pieces that are made by injection molding the glassy mass formed when starch containing 13 to 14 water is heated, and then dried (4). Temperatures in the range of 140 C to 190 C reportedly produce masses that flow satisfactorily without degradation. The two parts are formed in separate molds. Unlike hard-gelatin capsules that are supplied with the caps and
A range of dietary interventions has been studied in fibromyalgia, however, no one treatment has more than one study. A randomized controlled trial using Chlorella pyrenoidosa supplements showed improvements in the treated group for pain and function, however, the patients also continued their usual treatment.83 Vegan and vegetarian diets have also been reported to show some nonsignificant improvements, as have ascorbigen (with broccoli power) supplements.84,85,86 Complementary
The most common form of cobalamin deficiency, known as pernicious anemia, is now known to be an autoimmune disorder that results from parietal cell destruction. This results in insufficient production of gastric acid and IF and the ensuing malabsorption of cobalamin. Other less common causes of insufficient absorption are hypochlorhydria, gastrectomy, ileo-cecal resection, celiac disease, and chemical incompatibilities with drugs in the gastric milieu. A deficiency of cobalamin can also result from nutritional deficiencies, increased requirements as is seen in pregnancy, as well as a strict vegetarian diet without adequate supplementation. The symptoms of cobalamin deficiency primarily result from potentially irreversible nerve damage, involving sensory, motor, and cognitive functioning, and the megaloblastic anemia that can be confused with that seen in folate deficiency. The ability of folic acid to reverse megaloblastic anemia seen in cobalamin deficiency, without affecting nerve...
There is less information available concerning the factors that may influence intestinal transit time compared with what we know about gastric residence time. Although based upon small populations, there appear to be no gender-related differences in intestinal transit time (95) however, vegetarians appear to have longer intestinal transit times compared with nonvegetarians (96). The latter point may have implications for drug therapy in the third world where the diet is primarily vegetarian. Other factors that result in an increased transit time include reduced digestive fluid secretion, reduced thyroxin secretion, and pregnancy (97-99).
Prostate cancer is the most common hormone-related cancer in men and the incidence in the United Kingdom (UK) has been rising rapidly by about 3-4 per year 92 . High-fat and high-meat diets are currently linked to increased risk of the disease, and like breast cancer, it is comparatively rare in Far Eastern populations consuming soybean. The incidence of and mortality from prostate cancer is very much lower in Asian men in comparison to men from the West 121 . In addition, men who adopt a vegetarian diet are also at lower risk from prostate cancer 122 . The diets of Asian and vegetarian men are not only much lower in fat than the traditional diet of omnivorous Western man, but they are also a rich source of weak dietary estrogens 13 . It has been estimated that the traditionally-eating Chinese man consumes, on average, 35 times more soy than the North American man 56 . Lifetime exposure to the isoflavonoids in soy may play a significant role in the low incidence of prostate cancer in...
Genistein is a naturally occurring isoflavone and phytoestrogen that has been identified in various human dietary sources, notably soybeans. Epidemiological evidence shows an inverse correlation of phytoestrogens and lignans in a vegetarian diet and cancer risk.18 There have been a large number of mechanisms proposed for the anticancer activity of genistein, including inhibition of tyrosine kinase activity,19 inhibition of ornithine decarboxylase,20 antioxidant and anti-inflammatory activity.21 inhibition of prostaglandin synthetase,22 and inhibition of benzo a pyrene metabolism.23
All patients should be encouraged to improve their intake of antioxidant nutrients and phytochemicals through a plant-based diet. Until such time that scientific evidence makes a case for change, patients who are under oxidative stress due to illness or other causes and those wishing to supplement their diets should be advised not to exceed safe intake levels advised by the Food and Nutrition Board of the IOM. For use of any dietary supplement it is best to consult the Office of Dietary Supplements (ODS) fact sheets available on their Web site (see Appendix C).163
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