rather unlikely that you really were protein deficient although if
you were eating mostly starches and grains it's possible.
vegan until three months ago, when I undertook the weight loss program;
it prohibited beans, wheat, and potatoes; because these were all
primary sources of protein for me, I felt I needed to add meat,
fish, dairy and eggs back to my diet or I would not have any protein
at all! (I don't enjoy eating alternative grains or tofu on a regular
basis, and the only carbohydrate allowed on the diet is rice)
analysed 95 readily available vegetables and found that they averaged
25% of Calories from protein. You only need 10% and the WHO puts
the figure at 4%. A good deal of your problem may be related to
the flawed method of nutrient analysis employed by the USDA and
most nutritionists who sort and preference foods by nutrient/weight
ratio. By this method beans and tofu look like good protein sources
whereas leafy greens are much better on a nutrient/Calorie basis.
Since there is no RDA for weight in the human diet while there is
an RDA for Calories I argue that much of the obesity in the US is
due to the archaic system of nutrient/weight analysis which leads
people to regard animal foods and suboptimal plant foods as good
nutrient choices when they are really only good Calorie sources.
This is a mathematical conundrum not immediately obvious unless
you spend some time looking at the USDA nutrient database which,
as it happens, is downloadable (as a rather large file) at : http://www.vegsource.com/harris/food_comp.htm
I am seeing
a very caring physician who has been evaluating me for the last
four or five years annually. She is well aware of the veganism.
The annual exam has always included a CBC and chemistry and UA.
This year's tests, done three weeks ago, showed that I have stage
3 iron deficiency anemia (low ferritin and hypochromia), and my
urine had ketones in it. My doctor is worried that I may have GI
blood loss, and has scheduled me for a visit with the gastroenterologist
(I am seeing him tomorrow); she would like me to get both a gastroscopy
and a colonoscopy. The ddx for upper GI blood loss would be gastric
ulcer; I have had GARD for about fifteen years- two years ago, I
had to go to the emergency room I was in so much pain- they diagnosed
me as having a gallbladder attack, based on the presence of gallstones
on an abdominal ultrasound, and I was told to get my gallbladder
removed. However, since being started on Nexium
is some information on Nexium from the PDR. Adverse reactions: Gastrointestinal:
bowel irregularity, constipation aggravated, dyspepsia, dysphagia,
dysplasia GI, epigastric pain, eructation, esophageal disorder,
frequent stools, gastroenteritis, GI hemorrhage, GI symptoms not
otherwise specified, hiccup, melena, mouth disorder, pharynx disorder,
rectal disorder, serum gastrin increased, tongue disorder, tongue
edema, ulcerative stomatitis, vomiting; Hearing: earache, tinnitus;
Hematologic: anemia, anemia hypochromic, cervical lymphoadenopathy,
epistaxis, leukocytosis, leukopenia, thrombocytopenia;
I have had not
a twinge of abdominal pain or heartburn and it has been two years
now- so I think the gallstones were an incidental finding, and I
was actually having a GARD attack and suffering from severe esophageal
erosion pain. The ddx for lower GI blood loss is colonic polyps,
of course- and my paternal grandmother died of colon cancer, so
a screening colonoscopy is certainly a good idea. My question is,
even though GI blood loss is the primary rule out for iron deficient
anemia, doesn't being vegan (ie dietary deficiency) supercede this
as the most likely cause?
depends on what sort of vegan foods you're eating. A diet of potatoes,
grains, and junk food could lead to inadequate intake of both iron
and protein but if leafy greens are a major food source it's unlikely.
The term "iron deficiency anemia" in my opinion is very
misleading as it implies an inadequate intake of iron when in most
cases it is the result of iron loss from chronic or occult bleeding
or heavy menses.
If so, why
did it take ten years to show up? ( I have stopped menstruating-
my last period was May 1- and had no periods from January to June
of 2001- therefore blood loss from menses is no longer a factor-
but until 2001, I had regular monthly periods of moderate to heavy
flow, and my CBC remained normal up until this year). Is it possible
I only became anemic recently due to a combination of BOTH dietary
lack of iron AND a recently aquired GI blood loss?
that is a possibility.
What is the
significance of the ketones in my urine, if all the chemistry values
were normal? My doctor seems to believe it is due to fasting overnight
for the blood work and is not concerned-
is also my first thought. Before you pay too much attention to it
you should have the test repeated or get some dipsticks from a lab
or your doctor and and test it yourself.
but I always
fast overnight, and don't eat breakfast- and previous UA's did not
show ketones. Could it be because of the weight loss diet?
particularly if it's a Dr. Atkins style high protein diet. That
one depends on ketosis to cause the weight loss.
Could it be
a sign of liver disease?
but not one of the likely first signs.
possibly related to your weight loss.
I have been
working out a lot at a gym, circuit weight training and cycling
20-50 miles on weekends.
great! Keep it up.
I take glucosamine
as a nutritional supplement ( I have severe patellar femoral pain
may be in part from carrying extra weight. The knees are the first
to tell you about it. If glucosamine really has any value in osteoarthritis
it's probably because it acts as a sulfur donor. MSM is probably
I am also on
Singulair, Claritin, and Nasonex, for allergies/asthma
checked the PDR here. All three have adverse reactions but anemia
was not among them. Although I am not an allergist I am personally
allergic to everything in the known universe and have found over
the years that the best strategy is to find out what you're allergic
to and avoid it. That basically comes down to cleaning up your air
and going on a whole food mostly raw vegan diet.
pertinent adverse reactions here but weight loss, exercise, no added
salt, and the same diet as above are the best solution to hypertension.
My objective has always been to show patients how to modify their
lifestyle so they can get off all drugs. If a drug has effects it
will also have side effects and the more drugs you're on the greater
the chance of adverse drug interactions.
slight increase in cardiac arrhythmias 5.3 / 4.3
I was on Ditropan
XL for several years until recently, when I had to stop it due to
heart palpitations, and a one-time ten minute episode of taccycardia.
following adverse events were reported by 2 to 5% of patients using
DITROPAN XL® (5-30 mg/day) in all studies. General: abdominal
pain, dry nasal and sinus mucous membranes, accidental injury, back
pain, flu syndrome; Cardiovascular: hypertension, palpitation, vasodilatation;
Digestive: flatulence, gastroesophageal reflux; Musculoskeletal:
arthritis Nervous: insomnia, nervousness, confusion; Respiratory:
upper respiratory tract infection, cough, sinusitis, bronchitis,
pharyngitis; Skin: dry skin, rash; Urogenital: impaired urination
(hesitancy), increased post void residual volume, urinary retention,
Now I am wondering
if this was induced by the combination of the drug, which is anti-cholinergic,
and my anemia. The palpitations have stopped and I have had no other
episodes of taccycarida since stopping the Ditropan. The ECG done
during my recent check up was normal. Only one other significant
finding on my history: I have a very large (grapefruit sized) uterine
fibroid. I am getting a pelvic ultrasound in two weeks to evaluate
that, as my doctor feels it may be contributing to my intermittent
urinary urge incontinence and back pain.
fibroid probably goes with your weight problem and if that's all
it is it shouldn't be your first priority.
I would greatly
appreciate your valued perspective, given your experience with veganism
and vegan patients, and will pass along any feeback you may have
to my own physician- or, if you prefer, I can let you speak to her
directly. If you need to look at actual test results, please let
me know, so I can get them for you.
sounds like your physician is taking good care of you and I doubt
if she would welcome a retired ER doc poking around in her records.
However, getting down to normal weight would probably solve most
of your problems and that breaks down to diet and exercise. If you
burn more Calories than you absorb you will lose weight. Period.
you have Microsoft Excel 97 or later (but not the Windows Millenium
spreadsheet) I have put up what I hope is a useful downloadable
diet questionnaire at: http://www.vegsource.com/harris/download.htm
can use this to keep track of your Body Mass Index and to learn
to make better food choices. Incidentally, if you can convince yourself
that killing animals for food is an ethical error the transition
to a vegan diet will be much easier. PETA, Peter Singer, and various
URLs at www.vegsource.com have some good articles on the ethical
problems of animal food consumption. Good luck!
received a degree in physics from the University of California Berkeley,
where he earned Phi Beta Kappa honors. He received his degree in
medicine from the University of California at San Francisco, and
received his postgraduate training at San Diego County Hospital.
He holds a Medical License in the State of Hawaii. He has been an
Emergency Department physican since 1963, and the Director of the
Kaiser Permanente Vegan Lifestyle Clinic on Oahu until his retirement
in 1998. Dr. Harris is the author of The Scientific Basis of Vegetarianism.
addition, he was the 1950 Big Ten Trampoline Champion, is an accomplished
hangglider and commercial pilot, and at age 70 became a skydiver
with 108 jumps to date. Dr. Harris has been vegetarian since 1950,
and vegan since 1963.