Vegetarian needs "respectable" article about protein in all foods

February 20, 2008 11:49 AM

My new doctor is one of those older doctors who believe that vegetarian diets lack protein unless you eat the "right" things. I would like to find an article to give her about how there is protein in everything.

The doctor asked about my "protein source" foods and I didn't have an answer for her. She is not up to date on vegetarian protein information and I suspect I must be her only vegetarian patient, or else her other vegetarian patients also are not up to date on this issue.

I need an article that would be from a respectable source so that she does not think I just "got it off the internet." Something short and simple would be best (she is, like all doctors, very busy), and I prefer something that does not lean on soy products, because I don't eat many of those.

I plan to include my diet for a typical week, along with amounts of protein in each item/amount I've eaten so she can see I don't have just one or two protein sources, but that everything I eat has protein in it and that I'm fine.

posted by AllieTessKipp to health (28 comments total)

Why don't you use Fitday.com or a similar nutrient-tracking tool to calculate your daily food intake. It will give you a nice breakdown (numbers and a pie chart) of how much protein, fat & carbs you are eating.

Why do you need to prove to your doctor that you eat enough protein, though? If you're in good health, and your blood workups are fine, who cares that your doctor thinks you're better off eating a steak? I can almost guarantee you that you are not going to change your doctor's philosophy on what constitutes healthy eating. Just do what you want to do, and if she keeps hassling you, you can always ask her to refer you to a nutritionist so you can have an expert go over your daily diet.
posted by tastybrains at 11:57 AM on February 20

If you say "I'm getting X grams of protein per kilogram per day" and have the data of where those grams come from, there's no conceivable counter-argument. You must already know this number, otherwise you wouldn't be able to tell us that you're getting enough.
posted by 0xFCAF at 11:57 AM on February 20

Here is the 1357 page report on the Dietary Guidelines for Macronutrients. Read the protein section.

And get a new doctor.
posted by tiburon at 12:00 PM on February 20

There is some proteins in everything but you don't just need a glob of protein. The human body needs certen ameno acids. From wikipedia:

Of the 20 amino acids used by humans, the 10-12 nonessential amino acids can be synthesized by the body, and are not required in the diet. The 8-10 essential amino acids, however, cannot be created by the body and must come from dietary sources.

Most animal sources and certain vegetable sources have the complete complement of all 8-10 essential amino acids.

http://en.wikipedia.org/wiki/Protein_in_nutrition

So he is totally right. If you eat no animal products you have to eat the "right" things.

Sorry.
posted by d4nj450n at 12:01 PM on February 20 [7 favorites]

Is she referring to the complementary protein theories as described in Diet for a Small Planet or is she just concerned about how many grams of protein you're getting each day?
posted by needs more cowbell at 12:03 PM on February 20

Wow, I guess I did not read that through before I posted, sorry again.
posted by d4nj450n at 12:05 PM on February 20

You need to tell us what kind of vegetarian you are. As you can see, some people will assume that "vegetarian" means "vegan," which would present different issues.
posted by jejune at 12:11 PM on February 20

I think the issue is that you're not allowing for the possibility that your doctor has a perfectly valid point. It's not "old school" thinking to ask a vegetarian what their source of protein is—meat is the single best source for protein, so when you cut that out of your diet you have to look quite a bit more carefully for alternate sources to stay better balanced. Protein doesn't show up in high enough quantities in things like fruits and vegetables much at all. Nuts are a popular source and fish (if you're a pescatarian) and soy, but if you're not eating much soy, fish or nuts, it's probably a valid question and something to consider.
posted by disillusioned at 12:17 PM on February 20 [1 favorite]

Diet for a Small Planet has a chapter on this.
posted by zpousman at 12:30 PM on February 20

I think giving your doc your approximate diet for a week might just do it fine. (example page of vegan diets meeting US-RDA protein needs) "See, I eat lots of beans and nuts and so on." (or Quorn or other fake-meat, though they are notoriously high in sodium) You can double-check with a basic guide like this one which has links from sources like the Mayo Clinic on basics of a vegetarian diet. It's a fine question for a doctor to ask, just like "what's your iron source?", and you can answer it in a perfectly straightforward way.
posted by LobsterMitten at 12:30 PM on February 20

Most everything is a protein source, it is just a matter of totaling them up.

On further looking, I found lots of articles here: http://www.soystache.com/plant.htm

One of those articles was especially helpful: http://www.peta.org/mc/factsheet_display.asp?ID=105

Even though it is from the sometimes nutty PETA people.

And of course some of the things I eat (breakfast cereal, yogurt, any recipe with nutritional information) have protein information right there for me to write down.

Thank you to those who contributed useful ideas.

From http://michaelbluejay.com/veg/history.html

Diet for a Small Planet was a runaway best-seller, and made Lappé famous. It was therefore surprising -- and commendable -- that Lappé owned up to making a mistake about the very thing which made her a household name. In the 1981 edition of Diet for a Small Planet, Lappé recanted and explained that:

"In 1971 I stressed protein complementarity because I assumed that the only way to get enough protein ... was to create a protein as usable by the body as animal protein. In combating the myth that meat is the only way to get high-quality protein, I reinforced another myth. I gave the impression that in order to get enough protein without meat, considerable care was needed in choosing foods. Actually, it is much easier than I thought.

"With three important exceptions, there is little danger of protein deficiency in a plant food diet. The exceptions are diets very heavily dependent on [1] fruit or on [2] some tubers, such as sweet potatoes or cassava, or on [3] junk food (refined flours, sugars, and fat). Fortunately, relatively few people in the world try to survive on diets in which these foods are virtually the sole source of calories. In all other diets, if people ar getting enough calories, they are virtually certain of getting enough protein." [emphasis in original]

-- Diet for a Small Planet, 10th Anniversary Ed.; 1982; Frances Moore Lappé; p. 162

posted by AllieTessKipp at 12:40 PM on February 20 [1 favorite]

The USDA National Nutrient Database tells you the nutritional content of various foods down to the level of individual amino acids. If you're handy with a database, they provide the data in Access and other formats so it is easier to do your diet log. I did this once a few years ago.

You can compare that with recommended daily intakes for protein and essential amino acids. You'll really be able to prove (or disprove) that you get proper nutrition that way, rather than relying on the assumptions of an article. It is possible to get inadequate supplies of essential amino acids, but it sounds like you are pretty conscious about your diet. Looking in the database, even a diet made entirely of rice seems like it would provide enough essential amino acids (although that cannot be healthy).

If you do a nutritional study of yourself, I would be interested in seeing the results.

To the "get a new doctor" people, I only wish my physician cared this much about my nutrition. In a long medical career, I think it's more likely that she has seen people with poor health due to an inadequate vegetarian diet, than it is that she is totally ignorant of this stuff. Vegetarianism isn't exactly a new thing.

Another thing you might want to watch out for is to make sure you are getting enough iron.
posted by grouse at 12:46 PM on February 20

All living things contain protein. If that's all you need to confirm, any basic biochemistry or molecular biology textbook should suffice. (Ah, here we go: Biochemistry, 2nd ed., Albert L. Lehninger. p. 57: "Proteins are the most abundant organic molecules in cells, constituting 50 percent or more of their dry weight. They are found in every part of every cell, since they are fundamental in all aspects of cell structure and function.")

However, a) different foods contain different amounts of proteins; b) different foods contain different amounts of the essential amino acids; c) your body does not necessarily utilize 100% of an essential amino acid contained within a protein as that essential amino acid. Sometimes, the essential amino acids get broken down instead, and how much is utilized may depend on the particular protein source.
posted by DevilsAdvocate at 12:48 PM on February 20

I plan to include my diet for a typical week, along with amounts of protein in each item/amount I've eaten so she can see I don't have just one or two protein sources, but that everything I eat has protein in it and that I'm fine.

Isn't this good enough? I have known "vegetarians" who really do eat mostly junk food or lean heavily on a subset of vegetables that they like. Picky eaters make for crappy vegetarians or vegans, and it's highly possible that your doctor has run into these people, especially if it's in younger patients.
posted by mikeh at 12:49 PM on February 20

Problem is, some proteins are less fully utilizable than others. Proteins in animal products really are the most useful protein. So it's kind of disingenous to claim you got enough protein from a bagel--your body likely won't be using all of that protein because it's less digestible and useful than other proteins.
posted by schroedinger at 1:03 PM on February 20

Why is your vegetarianism even an issue? Did you ask for help changing your diet or something? Otherwise, your doctor's attitude is out of line. Yes, send an article, but for crying out loud, don't reward your doctor's stupidity by continuing to pay her--tell her you're getting a new doctor, and tell her why. Please don't put up with this sort of behavior. Vote with your money and your feet.
posted by Violet Hour at 1:20 PM on February 20

don't reward your doctor's stupidity by continuing to pay her

The doctor is stupid for attempting to insure that her patient is getting enough protein? There are plenty of vegetarians -- including me, on a variety of days -- who think that Twinkies and coffee are okay because "it's not meat." Asking about protein sources or other dietary issues is not outrageous. But the OP is not required to convince the doctor of anything, unless s/he is being treated for a nutritional-related concern.
posted by sageleaf at 1:41 PM on February 20

You might want to look into the Physicians' Committee for Responsible Medicine -- specifically its Cancer Project, which promotes vegetarian and/or vegan diets for cancer prevention. The group maintains that healthy and varied vegetarian and/or vegan diets provide sufficient amounts of protein.

More info here:
http://www.cancerproject.org/ask/protein.php
posted by babysingsing at 2:08 PM on February 20

Why is your vegetarianism even an issue? Did you ask for help changing your diet or something?

Seems to me like she is just being thorough in her patient care. Knowing about your patient's diet is IMO an important part of whole body wellness or whatever you want to call it -- I commend doctors who make an effort to keep their patients healthy rather than just waiting for them to be ill. YMMV.

As to the question, I too recommend fitday to track protein intake.
posted by gaspode at 2:09 PM on February 20 [1 favorite]

Oh man oh man, there is a great food map in the nutritionist's office where I work. It shows the protein, carb, and fat composition of 130 common foods. Unfortunately, it isn't available online and is too big to throw in the scanner (not to mention copyright issues). Anyway, it says you need 12%-15% of your diet as protein. High protein VEGAN sources are broccoli, spinach, asparagus, collard greens, soybeans, and beans at around 30% or higher. High protein vegetarian options are cheese and yogurt but are also high in fat. Nuts like almonds aren't as high in protein as most people think, around 10%.

So what your doctor is probably looking for is your ratio of carbs/fats/proteins. Many new vegetarians end up gaining a lot of weight because they eat too many foods high in carbs and fat.

I am in love with this poster because the graphics are so easy to read. It is made by B.B.C. in Walnut Creek, CA by Maryam Borghey Minbashian. Their number is 510-938-6916, but I can't find anything about them via google. Agris claims to have a copy of it if you are interested.

Eat your greens!
posted by idiotfactory at 2:21 PM on February 20 [1 favorite]

Problem is, some proteins are less fully utilizable than others. Proteins in animal products really are the most useful protein.

Not true. Protein from meat and eggs is "higher quality" protein than that of plants. However "quality" in this sense only means that the protein contains amino acids in similar proportions to those found in human beings. Quality of protein is determined by how fast animals grow while consuming it. This "quality" ranking system does not in any way say anything about health.

Massive amounts of research show that "low-quality" plant protein, which allows for slow and steady synthesis of new proteins is the healthiest type of protein. People who eat the most animal protein have the most heart disease, cancer and diabetes.

Humans can derive all essential amino acids from the plants we encounter every day. Healthy vegetarian and vegan diets do not require eating higher amounts of plant protein or carefully planning meals.

This may not be right for your doctor, but The China Study is a wonderful tome on the science behind animal and plant based protein. The author, now retired, was Professor Emeritus of Nutritional Biochemistry at Cornell. He has authored over 300 peer-reviewed papers, and his book is the culmination of a 20-year partnership of Cornell U, Oxford U, and the Chinese Academy of Preventive Medicine. The book is entirely based on empirical research (animal and human experiments, and a colossal study of diet and health carried out in rural China and Taiwan). It is arguments are entirely about health without spilling over into animal rights issues. It is a fantastic read, and will more than prepare you for the next "where do you get your protein" question.

Here is an article regarding the American Dietetic Association's position on vegetarian/vegan diets: "Well-planned vegan and other types of vegetarian diets are appropriate for all stages of the life cycle, including during pregnancy, lactation, infancy, childhood and adolescence. Vegetarian diets offer a number of nutritional benefits, including lower levels of saturated fat, cholesterol, and animal protein..."

Here is another article from the Physicians Committee for responsible medicine: "It was once thought that various plant foods had to be eaten together to get their full protein value, otherwise known as protein combining or protein complementing. Intentional combining is not necessary to obtain all of the essential amino acids. As long as the diet contains a variety of grains, legumes, and vegetables, protein needs are easily met."

Maybe you will convince her your diet is healthier than her own, much less something she needs to worry about.
posted by shoesandships at 2:30 PM on February 20 [3 favorites]

Everyone's body is different in terms of their needs so this seems like a valid question for a doc to ask. Especially if something in her exam worried her or if her experiences made her think you might be a candidate for problems.

Alarming anecdote filter: friends of mine nearly stunted their kids growth on their, seemingly diverse, vegetarian diet. I've stayed with them and they eat well imho but the kid was so severely anemic that she wasn't developing properly. Their doctor is Indian and apparently that's relatively common in parts of India in girls (middle and upperclass girls too, it's not a lack of money) so she was recognized the issue. They started feeding the kid meat and her grades and attention span improved very much, as well as her health.
posted by fshgrl at 2:53 PM on February 20

The More for Less cookbook has a great section on complementary proteins-fantastic info. I got my copy at a Christian bookstore fwiw-it's been out for decades and was put together by a Mennonite.
posted by konolia at 3:58 PM on February 20

(IANAD, I am in training) I routinely ask people about what they eat, because many people eat an unhealthy diet. Furthermore, I've talked to some people who went veggie and proceeded to eat a high-fat high-carb low-protein diet. It's not an outrageous thing to ask. That said, outside of neonates, alcoholics, and cachexia I think it's absurdly rare to see nutritional protein deficiency.

That said, the first three google results on "vegetarian protein" are about how easy it is get adequate complete protein. It's always a good exercise to keep a food log for a few days. When your MD sees that it doesn't consist of Jim Beam, candy, and lard he'll probably be fine.
posted by a robot made out of meat at 4:57 PM on February 20

$=~s/That said/IIRC/s
posted by a robot made out of meat at 4:59 PM on February 20

There are a lot of answers here, but he absolutely has it.
posted by opsin at 6:32 PM on February 20

1) If you don't think the doctor is giving good care, find another one.

2) Completely appropriate for a physician to talk about food, and from what you've said, there is no reason to believe she is any less informed than anyone else. The person who talked about essential amino acids is right. If you're getting enough of those, the doctor will recognize that.

3) Did this come up in the context of trying to diagnose something, or just in the normal course of things?
posted by gjc at 9:17 PM on February 20

[a few commetns removed - if you can't keep replies civil and more or less on topic, please take them to metatalk]
posted by jessamyn at 9:31 PM on February 20