Eating a Vegetarian Diet. Not As Healthy As You May Believe.

You hear vegetarian and what comes to mind? A nutritious, disease preventing, high fiber diet? Wholesome meals full of whole grains, nuts and seeds, fruits and vegetables, chock full of vitamins and minerals? Slim and fit individuals living a healthy lifestyle, carefully meeting their nutritional needs?

If only it were so! Perhaps in its ideal form this diet is filled with all the protein, healthy fats and unprocessed carbohydrate you might need to stay healthy. It also provides a full range of antioxidants, including flavonoids, found in color-rich fruits and vegetables, as well as in nuts. These compounds are linked with prevention of many cancers, heart disease and aging related conditions. And if you include three low fat dairy servings per day, the model vegetarian diet satisfies the DASH diet for hypertension. This fruit and vegetable filled diet, together with the mineral-rich low fat dairy has been shown in studies to significantly improve blood pressure as effectively as medication.

But in practice, that’s just not how it is. Twenty-five years of counseling clients has shown me how real people live as vegetarians. And it’s not pretty. Here’s a look at what really happens to many vegetarians. Check out these pitfalls to healthy vegetarianism to be sure to avoid.

Vegetarians may set too many unnecessary rules.

Instead of eating the healthy diet described above, they may limit their fats, failing to meet their needs for essential fatty acids. Reduced fat soy milk or lower fat avocado—are they really necessary? Why choose such items?

Being fat phobic, they may omit valuable food sources such as nuts and nut butters, such as peanut butter and almond butter, eggs and even avocado. As a result of this extra layer of rules, it may be challenging to maintain their weight in a healthy range. With their limited selection, they also exclude valuable sources of protein-rich foods.

These vegetarians typically are not yet diagnosable as eating disordered. For them, vegetarianism is simply another way to limit their intake in a socially acceptable way. Vegetarianism is healthy, right?

They have no interest in exploring unfamiliar vegetarian food choices.

And so they limit their intake to vegetarian meals such as pasta, grilled cheese, and pizza, for instance. Now don’t get me wrong. There’s no problem with including these foods, as part of a balanced diet. But vegetarian choices tend to be limited, particularly when eating out. And if you don’t include much variety, the calorie density of your diet can become quite high. This becomes more exaggerated when you don’t care for many fruits and vegetables. And so your entrée portion needs to be larger to feel satisfied. Typically, these individuals end up gaining weight unexpectedly, in spite of their good intentions to eat a “healthy” vegetarian diet. As a result, they are left with a less than balanced diet and are struggling with their weight.

They are cooking challenged or have little time for food preparation.

As a result, they rely on mostly processed foods, generally quite high in sodium. Take a look at the labels on the canned beans or refried beans. Explore the sodium levels of the many soy-based and Quorn brand processed vegetarian products. To achieve the equivalent of three ounces of animal protein (a deck of cards size), you’d consume approximately 1200 mgs of sodium, from this single protein alternative, in a reasonable portion. If you are choosing vegetarianism for the prevention of heart disease, you may want to rethink this choice. If you have high blood pressure, the current recommendation is for a total of 1500 mgs. per day! You’d be better off allowing for lean protein sources such as white meat poultry, or fish, for the pescetarians.

If your nutrient needs are high (if you are still growing, quite active, very tall, pregnant or nursing, or underweight), vegetarianism can be challenging.  

A healthy vegetarian diet, high in whole grains, fruits, vegetables and legumes is high volume, high fiber with low caloric-density. As a result, it can be very filling. If you are someone with a high calorie requirement (like those described above), it takes more effort to meet your needs, while still feeling physically comfortable. It is certainly achievable, but requires a higher intake of fats and a bit more planning. Otherwise, you’ll frequently feel full and have a difficult time consuming all that your body requires.

Oh no! My daughter has decided to become a vegetarian!

Mrs. Katz called me earlier this week, seemingly alarmed, given the tone of her voice on the phone. She just discovered that her daughter has been limiting her eating to vegetarian choices for the past 3 weeks. Rebecca was well known to me from more than a year of regular visits for her eating disorder. Last time I saw her, 6 weeks ago, she had been doing great. She had been maintaining her weight in a health range, without symptoms, and appeared quite relaxed and comfortable about the changes she had made. She was allowing herself a full range of foods, including items formally considered junk foods. And she achieved all this while competing on her high school swim team. For many, many, months now, I could say she had fully recovered.

Mrs. Katz had good reason to contact me. News of her daughter’s becoming vegetarian needed to be explored, to ensure it was not a slip into more eating disordered thinking and behavior.

When I met with Rebecca today, here’s what I concluded. That Mrs. Katz has no need for concern. That while a vegetarian diet could red flag unnecessary dietary restriction, for Rebecca I felt assured that limiting her intake was not the goal (or likely to result from her new found vegetarian identity). Yes, she would have to be mindful to maximize her iron intake, as well as her protein, calcium and Vitamin D, nutrients which often fall short when eating vegetarian. Not being a vegan, B12 deficiency was not going to be an issue. She was eating a varied diet providing enough calories to adequately fuel her body. And her weight continued to be maintained in a healthy range for her height. So it was easy to reassure Mrs. Katz.

Just because some vegetarians may be restrictive eaters, that’s not to say that you can’t be a healthy vegetarian and successfully meet your nutritional needs.

If you’re motivated to be a healthy vegetarian consider the following:

•     A balanced vegetarian diet requires planning. Actually, you can say the same thing for balanced eating of any type. But it is easier to throw a steak on the grill than to cook rice and dry beans.
•     Take advantage of vegetarian resources. Explore the many vegetarian cookbooks and websites for easy, delicious recipes. (Check out some of my favorites on this blog—lentil stew, lentil soup, vegetarian chili and corn bread, granola to name a few. As for cookbooks, my old favorites are Mollie Katzen’s updated Moosewood and The Enchanted Broccoli Forest, as well as the Vegetarian Epicure by Anna Thomas.
•     Eating out? Consider Indian resturants, and other Asian cuisines (offering tofu based vegetable filled dishes), which typically offer a large selection of vegetarian options.
•     Cook soups, stews, and casseroles and freeze them in small batches to provide quick and convenient vegetarian meals.

Being vegetarian clearly has its merits. It makes us more mindful of where our food comes from and its impact on the environment. (For true enlightenment, check out the movie Food, Inc. with Michael Pollan or his books including The Omnivore’s Dilemma). But choosing vegetarianism means not just being morally responsible. It requires being responsible for meeting your body’s needs. And that is equally important.

Do you have a favorite vegetarian cookbook or website? Have a thought to share on this post as a vegetarian or a soon-to-be vegetarian? Please share! I’d love to hear from you.

Easy-On-Your-Conscience Banana Bread

Gotta love that golden brown.

There’s creating good food. And there’s managing the food. This post will help you to achieve both. 

My yummy banana bread recipe combines great taste, ease and a baked good you can feel good about eating. It has little saturated fat, and it’s a great value—you get a decent portion, and a great deal of pleasure, for the calories. Enhance with the addition of nuts or ground flax for omega 3’s and fiber, or a handful of chocolate chips (just because). It’s great either way. Trust me, I’ve made every possible combination over the years.

Yes, I went for the added nuts! But it's great without, too.

As for managing around such a delectable baked good? First, allow it to cool. Then slice it into ten evenly cut slices. Don’t do this when you’re hungry! And do it when you’re not alone! Wrap each slice, first in plastic wrap, then in foil. For those more environmentally sensitive, skip the foil and place all individually wrapped slices into a Ziploc bag. Place in the back of the freezer, so it’s not the first thing that catches your eye when you’re looking for the chicken.

Decent size, especially on this little plate, no?

Ready to try a piece? Place it on a small plate, and microwave reheat. Sit at the table, in the kitchen or dining room, perhaps with a cup of tea or milk, and enjoy! Shut the TV, remove the newspaper (and the kids), and eat it with all your senses!

Easy-On-Your Conscience Banana Bread
(10 servings)

Ingredients

The more ripe the sweeter, allowing less added sugar.

Pam, or other oil spray
2 Tbsp unsalted butter
2 Tbsp olive or canola oil
¼ cup honey
¼ cup sugar
2 large eggs
3 large bananas, very ripe, almost rotten, mashed
1½ cups all-purpose flour
½ tsp baking soda
½ tsp salt

Love my Kitchen Aid. But hand mixing works fine for this!

(1/2  cup walnuts, pecans, ground 

flax or chocolate chips, optional)

Preheat oven to 350 degrees.

Spray a bread pan (12 X 4 ½ X 2 ½) with an oil spray.

Combine the wet ingredients and blend thoroughly.

If mixing by hand, separately mix the dry ingredients.

It took 65 minutes in my oven. But start with 60.

Add dry ingredients to wet ones. 

Blend.

Bake for 1 hour. Test for doneness using a toothpick or skewer (if it comes out wet, bake for another 5 mins and retest).

For those on meal plans, 1 slice counts as 2 grains and 1 fat serving.

Enjoy!

PS: Please answer take the poll on the top right side of the main blog page!

Weight Watchers Beware!

Ecstatic to freely eat bananas, for the first time in years—this was the sentiment at Thursday’s meeting. Finally able to select salmon—previously too pricey by their point system—this made them rejoice.

Most of my readers care little about Weight Watchers. But I’m writing this post because whether we realize it or not, whether we are “Weight Watchers” or not, their messages infuse into our culture and into our beliefs. They impact our thoughts about what’s acceptable to eat for health and weight management, whether they are myths or truths. Hearing some myth-information recently, I decided I needed to cut it short, before it spreads. I also wanted to point out a side of diets that most lose sight of—the damage they do.

Unlike those in attendance at their meetings, their cheerleaders who are pleased with their program and their successes, I get to see another perspective.

No Lifetime Membership for Sharon

Sharon came to see me for the first time this week, having never struggled with her weight. That is, until the past few years when it began to slowly climb.  That led this smart, level-headed woman to Weight Watchers. She followed their plan 100%, yet still gained weight. Encouraged by their new program, she figured maybe the old program just wasn’t for her. Two weeks into the new Points Plus system, she arrived frustrated and distraught in my office, and for good reason.

Sharon’s climbing weight made perfect sense to me, and with the recommendations we discussed I am confident she will turn things around. But I mention her because of how she changed as a result of the Weight Watcher’s diet.

Her whole life, she ate what she wanted, in moderate portions. She’d have ice cream at night—when she felt like it—but only as much as she needed. She had wine with dinner some nights, but just a glass, and she listened to and trusted her body. And it worked for all of her 38 years. Only recently, the balance wasn’t there.

Enter Weight Watchers. Her weight continues climbing, and now she is thinking about food all the time. She avoids the normal foods she always had, the moderate portions of foods she truly enjoyed, opting instead for lots of fruit (free on the new program). She moved from trusting her body, which had always worked for her, to trusting the program. And even if it had worked, it has totally impacted her relationship with food, and her ability to be normal. And this can happen with any diet, not just Weight Watchers.

So I went to a meeting. Yes, I decided to put on my journalist’s hat and collect information. I wanted to be fair and not misrepresent their program, to hear it from the horse’s mouth, so to speak.

Lori goes incognito

They were prepared to sign me right up, on line, and at the meeting. It didn’t matter that my BMI was in the normal range (I do have issues with using BMI, but we’ll take that up at another post). No one questioned the appropriateness of my joining, in spite of my normal weight. I could only imagine the damage done, if an eating disordered individual, also in the normal weight range, showed up. The messages, in my estimation, run counter to those supporting a healthy relationship with food.

Here’s what I saw and heard. Upon checking in, your progress is assessed. Behaviors? Thoughts? No, no, simply weight. Progress is measured solely in pounds. It doesn’t much matter how your weight changed.  No, the group leader isn’t inquiring whether you binged, then restricted all week, or if you purged before the meeting. You are praised simply for the weight change.

Now hopefully, those of you dealing with eating disorders or even weight management, in another setting, have experienced a different approach. When you see your team, progress should be measured not only by weight change, but by improvement in your thinking and preoccupation with eating and weight, by changes in your vital signs, and your energy level and sense of well-being.  Weight may not change one week, but we may see breakthroughs in how you cope with challenging situations without relying on food and disordered behaviors.

Those of you who really know me would have been so proud! I work hard to filter my thoughts, when they’re inappropriate, and to think before I speak. I could be sharp tongued, at times, when something really pushes my buttons. But at this 7:30 meeting I asked some naïve-sounding questions, and truly tried to listen to the answers. And I bit my tongue really hard.

It’s not about the calories? It’s about eating for health? Really?

“Can you tell me about the new point system?” I asked. “We’ve learned so much about weight loss,” the meeting leader replied. “It’s not just the calories, it’s the macronutrients,” she tells me, “the protein, fat and the carbs, besides the fiber, that determine your points.” Hmm. Has anyone taken basic biochemistry? Or maybe just high school biology?  Those calories in foods come from (drum roll please) those very macronutrients—protein, fat and carbohydrate.

Let me remind you that energy balance and weight regulation is about the calories. In a large Harvard study, they again showed us that weight change is the same whether following a low carbohydrate or low fat diet, by one year’s time, calories being equal. And similarly, for those on the other side, the weight gain is no worse regardless of which component of your diet you increase, calories being equal. And then there’s my favorite Dr. Haub study (see previous post).

What is true, is that certain food choices may make us more full in the short term. But this is not the wisest choice. We may find ourselves in situations getting too hungry, when that volume from liquid and fiber they promote, passes. That doesn’t help us sustain our bodies and our energy. And if we are struggling to recognize hunger and fullness, lots of water and water-filled foods will only mask your ability to listen to your body and its needs.

“It’s about promoting choices based on what we know about eating for health, so we encourage whole grains and less processed foods”, I was told. “It’s not about calories.” And yet, the unprocessed, whole grain brown rice has the very same point value as white rice. To me that would send a message that they are equal, no? And why is a glass of wine so high in points? Science does, in fact, support a glass of wine. And dark chocolate, I might add. Have they not seen that science?

Cocoa and chocolate, concentrated sources of polyphenols, have received much scientific interest and study. In fact, health benefit evidence regarding cocoa and chocolate were reviewed by the Dietary Guidelines for Americans Committee (2010). This session will review the cocoa bean's composition as well as the population-based and dietary intervention studies supporting the cardiovascular health benefits of consuming cocoa and chocolate. (from the American Dietetic Association 2010 conference guide).

Yet Karen, the leader, said “have the fruit first and that may satisfy. Then if you really need it, have the crap.” No, she didn’t use those words exactly, but that was what was implied. You know, “good food” first. In other words, don’t have what you really feel like.  Yet ultimately, after yearning for what you really want, you’ll eventually end up eating it having consumed both the calories from the fruit and the calories from the other item.

Not a diet?

Their materials work hard to convince us that it’s not a diet, but a lifestyle. They’ve got to be joking!  You’re given a plan, a number of points, and ways to count foods. And you’re encouraged to have all your points. There is little focus on self -regulation, eating what you need, as just as much as you need, based on your hunger and fullness. How can they not call this a diet?

They do, apparently have a plan that has you listening to your body, but that plan was largely dismissed at this meeting. And to truly be supported in that approach, an approach I completely support, it takes time, and exploration of eating triggers, and stress management tools, and one-on-one guidance.

So here’s the thing. There’s a place for sensible guidelines. These just weren’t so sensible. Adding structure to our day’s intake helps us not get too hungry, and I certainly support regular meals and snacks. And if you are at a place where you mask your hunger (with anything form large volume, low caloric-density items to coffee and diet sodas) than listening to your hunger with be a challenge—for now.

For those of you who don’t listen to your body’s hunger and deny your needs, a meal plan may have its place—for now. You should re-learn the tools to self manage, to listen to your hunger and your fullness, and trust them. Move out of your head, away from all the rules and information you’ve picked up. Work on becoming mindful—of what you eat and how it tastes. And tune in to what is making you eat—or stopping you from eating, in spite of hunger awareness.

That’s the work we have before us. And counting points isn’t going to resolve it, or improve your relationship with food.

It’s my hope that none of you need a lifetime membership. Let’s work on making changes that can change our relationship with food and our trust in ourselves, to help us for a lifetime.

---

Guaranteed-To-Please Granola.

To accompany my favorite yogurts!


I did it! I finally made my own granola. And it was so good, and so easy, that I want to share it with you. (If you lived locally I’d really share it, as the recipe made enough for a small army.) I can’t wait for my kids to come home for winter break to help me eat it.  Meanwhile, I’ll store it in airtight containers and even freeze a bunch.

Making granola was also the perfect opportunity to tell you about my favorite yogurts. 

First, the granola. Yes, it's calorie-dense, but so satisfying, so 1/3 cup feels like a treat. And it's high in fiber (over 5 grams), high in healthy fats and protein (almost 5 grams), and not too sweet--at least to me. So give it a try. It takes about 20 minutes to prep (if you are not simultaneously trying to photograph it), and 20 minutes to bake.

Guaranteed-To-Please Granola

(Modified from Meghan’s Granola at allrecipes.com and the pages of useful comments which followed.)

Ingredients (to make about 15 cups)

8 cups rolled oats (Old fashioned oats)

1 ½ cups ground flax seed (aka flax meal)

1 cup shredded coconut, unsweetened (optional)

½ cup sesame seeds

1 cup sliced almonds

1 cup finely chopped pecans

1 cup chopped walnuts

1 ½ tsps. salt

½ cup brown sugar

¼ cup maple syrup

¾ cup honey

1 cup vegetable or canola oil

1 tsp. cinnamon

1 Tbsp. vanilla extract

2 cups (or more if preferred) dried fruit, including raisins, craisins, chopped apricots

Preheat oven to 300 degrees F. (Thought I’d add the Fahrenheit detail for those of you overseas).

Line 2 baking sheets (preferably ones with sides, but if you are really careful you could do it on a cookie sheet as well) with parchment paper or foil.

Combine oats through walnuts in a large bowl.

In a medium saucepan, stir together salt, brown sugar, maple syrup, honey, oil, cinnamon and vanilla. Bring to a boil over medium heat.

Pour liquid over the oat mixture and mix to coat thoroughly.

Spread evenly on the baking sheets.

Bake 10 mins. Then stir. Then bake another 12 minutes.

Remove from oven and let cool. As it does, it will become crunchy and form clusters. Remove yourself from the granola so you don't pick at it while it's cooling (I'm only guiding you from my own experience.)

When thoroughly cooled, add the dried fruit to granola.

Store in airtight container.

(For those of you on meal plans, 1/3 cup would count as 2 grains and 2 fats. Some reviewers had success substituting ½ cup of applesauce for ½ of the oil. If you do, count it as 1 fat vs. 2. Personally I went the full fat route and I think it’s worth it).

And now, about my favorite yogurts…

Three yogurts, three different styles. None are artificially sweetened, and all are low or non-fat. Not all will appeal to all tastes, but I’ll do my best to accurately describe them below.

Wallaby: Australian style. Okay, it’s made in California, but was apparently inspired by a trip to Australia. (See their website for more fun info.) What I like? Tangy flavor, which reminds me of yogurts of days past. And the most delectable flavors, including my favorites, Bartlett pear (tell me you’ve ever seen Bartlett pear before!) and dulce de leche, a low fat variety which feels like a decadent dessert. If I could afford it, I’d eat it every day.

Available in Whole Foods, but few other stores that I’ve found.

Chobani: a Greek yogurt, made in New York. Go figure. But its very thick and creamy texture with just-the-right-amount-of-sweetness appears to please everyone I recommend it to. And it’s fat free, for those who are concerned about saturated fat.

Get it by the case at Costco or BJs where it’s much cheaper than the supermarket.

Stonyfield Farm: They don’t claim to be from anywhere other than New Hampshire. They have all varieties (fat free, low fat and whole milk). They tend to have less added sugar than many other brands and are still quite tasty.

All three have active culture, the probiotics or healthy bacteria that help keep things moving and help with intestinal distress. (Although the companies are not forthcoming about the amount of these active cultures that are added).

So try a cup of yogurt topped with some fruit of your choice (berries, pears and banana work well). Add 1/3 cup of this yummy granola, and ENJOY. Makes a perfect, quick breakfast!

Start Cooking! Moroccan Chicken With Chickpeas

The first must have ingredient is plastic. Whether you plan to cook to eat healthier and better quality food, or for the convenience of coming home and having dinner ready, or simply to save some money, you’ll need to get yourself some plastic. Containers, that is. Cooking for one? It takes as much effort to make four dinners as it does one, so you may as well make multiples and store them. Cooking for two or more? Consider doubling the recipes posted and freeze in meal size batches.

It’s a strange time. Most teens and twenty and thirty something’s simply don’t know how to cook. Many were raised in homes where there simply wasn’t much cooking. That is, if you don’t consider microwaving frozen pizza or chicken nuggets as cooking. Others had the convenience of fast food and family restaurants at their doorstep, with little time to invest in shopping and cooking. Want to start a great business? Open a “teach the newlyweds to cook” center. It’s the perfect wedding gift, if the couple cares to wait that long!

I spend a lot of my time directing patients on how to get healthy, great tasting, balanced meals on the table. And I finally compiled a list of these menu ideas that met the criteria when my son moved into an apartment when studying abroad, ready to start cooking on his own for the first time.

The recipes and cooking tips are not designed for people with special dietary needs, yet all the recipes can be easily modified to accommodate your particular nutrition requirements. I know that many of you won’t approach a recipe unless you have clear instructions and know exactly what and how much is in it. So I have attempted to measure things as I’ve made them, and even photographed the process, since many of you may be more visual learners.

Please give me feedback! How was the recipe? How did it taste? Was it challenging or manageable? And do you like having this feature on the blog?

Thanks, and bon appétit!

Morrocan Chicken with Chickpeas


(Serves 5-6)*

Ingredients (in order of appearance):

Oil, canola, vegetable or olive, approx. 2-3 Tbsps. (just enough to help saute the onions)

Onion, 2 medium

Boneless chicken breast, 1.5 lbs.

Cumin, 2 Tbsps.

Cinnamon, 1 Tbsp., optional
Chickpeas, 2 cans, rinsed

Raisins, 1/2 cup
Prunes and/or dried cherries, 1/2 cup total
Frozen orange juice, 1/3 to 1/2 cup
Water (1 - 1.5 cups, depending on amount of OJ used)
Salt, to taste

What You'll Need:
Approximately 15 minutes of prep time
Approximately 50 mins or hanging around time while the food is cooking
A large skillet with sides
A sharp knife

So here goes!


1) Chop or slice the onion (take the skin off first, of course!). It doesn't matter the size of the pieces. Put the onion aside for a minute.

2) Cut up the chicken in largish bite size pieces. Trim off any fat or undesirable things.



3) Heat the pan with the oil--medium temperature should work. When it appears hot (you'll see some lines in the oil).

4) Add the onion, cooking until translucent (it looks like cooked, not raw onion, and it is not yet browned.) Should take a few minutes.



5) Add the chicken spreading it around the pan. Let it start to cook before trying to mix it (or it will stick). Then stir it to more evenly cook it. But don't worry about cooking it completely. You are just partially cooking it now, then simmering it in the pan after.

6) Sprinkle the cumin and cinnamon. Then mix.

7) Add chick peas, dried fruit and orange juice concentrate. Add the water and mix. Cover and simmer at a low to medium temperature. Cook for about 50 minutes.

8) Stir occasionally. Add salt to taste.

Yum! I love this served on Israeli couscous (takes only 10 minutes and adds great texture) along with a green vegetable. Leftovers freeze well. Please share your thoughts on the taste and the process. Was it manageable? Is this your first time cooking?
Enjoy!

*For those of you using a meal plan--portioned to serve 6, this will count as 4 protein servings, 1 fat, 2 fruit and one grain.