A healthy vegan guide for the Palestinian Territories


Arabic translation / عربى

General recommendations for healthy eating

The basis of a health vegan diet consists of fruits, vegetables, grains, and legumes. Eat a large variety of different foods. Eat healthy fats like nuts, seeds and olive oil. Avoid eating too much fried or deep fried food, and try to avoid hydrogenated fats.



Vegan food groups

  • fruits
  • vegetables
  • grains (eat at least some of them as whole grains)
  • legumes (beans, lentils, chickpeas, peas)
  • mushrooms
  • herbs and spices
  • supplements (especially vitamin B12)





Vegan Plate for the Palestinian Territories

 
These recommendations are very similar to the recommendations published by the Harvard School of Public Health (Harvard University, USA) called the Healthy Eating Plate. You can see the Harvard recommendations here: https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/translations/arabic/


Harvard Healthy Eating Plate








Differences between the Harvard Plate and the Vegan Plate:

Vegans do not eat any kind of meat (no fish, no chicken, etc.). It is not necessary to eat meat. We can get all the protein, iron, and zinc from legumes. And as vegans we should get vitamin B12 from a B12-supplement (or foods fortified with vitamin B12). Eggs are similar to meat in their nutritional composition. We do not need to eat them.

Vegans do not drink cow’s milk (or other animal milk). Cow’s milk and dairy products supply protein, calcium, and vitamin B12. We do not need dairy products. We can get calcium from dark green leafy vegetables such as kale, collard greens, bok choy, broccoli, or mulukhiyah.   

The Harvard Plate recommends eating only whole grains and no refined grains (white flour, white bread, white rice, etc.). Vegans typically eat plenty of fruit, vegetables, legumes, and nuts. All these foods contain a lot of fibre and healthy phytonutrients. So vegans can be a bit less strict when it comes to the “whole grains only” recommendation. Eating some whole grains and some refined grains is a good idea for most vegans.  





Drinks

Drink plenty of water. Tea and filtered coffee (without sugar) are healthy beverages. Avoid drinking tea or coffee together with meals. Avoid coffee if you have high blood pressure. Avoid unfiltered coffee, especially if you have high cholesterol. Minimize your intake of sugar sweetened beverages (like Coca Cola). Avoid very large amounts of fruit juices. If you drink alcohol, drink only moderate amounts (half a glass of wine a day for women; 1 glass of wine a day for men; avoid drinking alcohol every day).





Special nutrients for vegans



1) Vitamin B12

Vegans must take a vitamin B12 supplement! The only alternative is to eat foods fortified with vitamin B12 daily. Only foods of animal origin, B12 fortified foods, and B12 supplements are reliable sources of vitamin B12.



Recommendation: Buy a vitamin B12 supplement with each tablet containing 1000 µg (micrograms) of vitamin B12. I recommend taking 1000 µg twice per week (i.e. 2000 µg/week).



Alternative recommendation: If this option is too expensive for you, do this: Consume only one tablet (1000 µg of vitamin B12) per month – but do not take the complete tablet all at once (in one go). Instead, bite off a small piece of this tablet every day. So every day you will be consuming a small piece of the tablet, consuming at least one tablet per month. (The reason for this recommendation is that we can absorb a higher percentage of vitamin B12 from smaller amounts, and a lower percentage from larger amounts.)





2) Calcium

Recommendations:

Eat 1 or 2 cups of cooked dark green leafy vegetables every day. The following green vegetables are good sources of calcium:

  • pak choi (bok choy)
  • kale
  • collard greens/Spring greens
  • broccoli
  • mulukhiyah
  • dandelion greens
  • nettles

(Spinach and chard are healthy but they are not good calcium sources, because the calcium bioavailability from these vegetables is low.)



Also eat plenty of the following foods. They, too, provide calcium, but less than the green vegetables mentioned above:

  • oranges
  • figs
  • okra
  • tahini or ground sesame seeds
  • almonds



Drinking water will probably also add some calcium to your diet1. This depends on the amount of calcium your local water contains. Water from desalination plants is usually low in calcium1. Water testing in the Gaza Strip has shown relevant amounts of calcium (about 100 mg/L) in water from groundwater wells1.



For the prevention of osteoporosis (weak bones which can break more easily) it is important to consume enough calcium, get enough vitamin D from sunshine, and lead a physically active lifestyle2. This is especially important for women. To protect our bones we also need to consume enough vitamin B12 and protein. This is important for everybody, not just for vegans. Many women who are older than 50 years suffer from osteoporosis2. Calcium intake might be low in the general population in the Palestinian Territories3. For vegans it’s especially important to pay attention to calcium rich foods, because we do not consume dairy products.     





3) Vitamin D

If you live in the Palestinian Territories you can get all the vitamin D you need from sunshine on your skin. If the skin is exposed to sunshine the human body can produce vitamin D. But even in very sunny regions of the world (including the Palestinian Territories) vitamin D deficiency is very common4. This is because people avoid the sun and/or cover their skin (for example for cultural or religious reasons).



Recommendations: 

Get 15–30 minutes of sunshine every day (for example one your face and arms). This should be during the day (~ 10 am to 6 pm) when your shadow is not much longer than your body height. If you cannot go out into the sun every day, get more sunshine on the weekends.



Alternative recommendation: If you do not get enough sunshine, I recommend taking a vitamin D supplement: ~25 µg (~1000 IU) of vitamin D per day. Do not avoid the sun completely. Vitamin D2 is always vegan. Vitamin D3 is usually made from lanolin (from sheep’s wool). Both of them work.





4) Iodine

Recommendations: Use iodized table salt3.

If you avoid salt (for example to prevent high blood pressure – which is a good idea) use an iodine supplement: ~150 µg of iodine per day.

If you are a pregnant or breastfeeding vegan woman, take a daily supplement containing 150–250 µg of iodine.

Another vegan source of iodine is seaweed (like nori or wakame) which is commonly eaten for example in Japan and China.





5) Omega-3 fatty acids

Recommendations:

Choose one of the following options (or a mix) every day:

  • ~5–10 walnuts (= 10–20 walnut halves; ~20–40 g)
  • 2 tablespoons of ground linseeds (flaxseeds)
  • 1–2 teaspoons of linseed oil (flaxseed oil)
  • 2–3 tablespoons of rapeseed oil (canola oil)
  • 1–2 tablespoons of chia seeds





6) Iron

Recommendation: Eat legumes every day.


If you have iron deficiency anaemia:

  • Eat plenty of legumes.
  • Drink orange juice with your meals, or eat vitamin C rich fruits or vegetables with your meals. 
  • Avoid drinking tea or coffee with meals.
  • Eat nuts and seeds.


Iron deficiency is very uncommon in men.





7) Zinc  

Recommendation: Eat plenty of legumes, whole grains, nuts and seeds3.





8) Selenium

It is probable that the soil selenium concentrations in the Palestinian Territories are similar to the ones in the US or Canada, and higher than in Europe5,6. This means that vegans who live in the Palestinian Territories do not have to worry about selenium. It is also possible that well water in some locations contains very high (toxic) amounts of selenium7. Additionally, more research is necessary to find out exactly which amounts of selenium would be the ideal for humans to consume.





9) Vitamin A

Recommendations: Eat plenty of dark green leafy vegetables and cooked carrots3. They are very good sources of beta-carotene (provitamin A). Carrot juice and other orange vegetables are also very good sources. 



Red bell peppers, mangoes, papayas, cantaloupe melon, nectarines, apricots, tangerines, Sharon fruits (kakis), and pink grapefruits are also relevant sources of beta-carotene.





10) Protein 

Recommendation: Eat legumes, whole grains, nuts and seeds.

Eat legumes (beans, chickpeas, lentils, peas, peanuts, soya products) or pistachios daily. Eat enough calories. Most vegans eat enough calories. But if you do not consume enough calories your body will use the protein you eat as calories, and you might end up with too little protein, and you might lose muscle mass.



Eating enough calories and protein is very important for children. In some families in the Palestinian Territories not having enough food to eat is a real problem8.  






Potential advantages of healthy vegan diets
Healthy vegan diets – if compared to typical non-vegetarian diets – can lower the risk of many health problems, including:

  • obesity9–14
  • constipation
  • diabetes11,13,15–21
  • high blood pressure9,13,22,23
  • heart attacks9–11,13,24–31

and maybe

  • some types of cancer10,11,13,32–35



Obesity, diabetes, and heart disease are increasingly common in adults in the Palestinian Territories8.











References



1.      Aish AM (2013) Drinking water quality assessment of the Middle Governorate in the Gaza Strip, Palestine. Water Resources and Industry 4

2.      Hyassat D, Alyan T, Jaddou H et al. (2017) Prevalence and Risk Factors of Osteoporosis Among Jordanian Postmenopausal Women Attending the National Center for Diabetes, Endocrinology and Genetics in Jordan. BioResearch Open Access 6

3.      Hamdan, May, Monteagudo, Celia, Lorenzo-Tovar, Maria-Luisa, Tur, Jose Antonio (2013) Development and validation of a nutritional questionnaire for the Palestine population. Public health nutrition 17, 2512–2518

4.      Kharroubi A, Saba E, Smoom R et al. (2017) Serum 25-hydroxyvitamin D and bone turnover markers in Palestinian postmenopausal osteoporosis and normal women. Arch Osteoporos 12

5.      Yan j, Wang F, Qin H et al. (2011) Natural Variation in Grain Selenium Concentration of Wild Barley, Hordeum spontaneum, Populations from Israel. Biol Trace Elem Res 142, 773–786

6.      Combs GF (2001) Selenium in global food systems. The British journal of nutrition 85, 517–547

7.      Bleiman N, Mishael YG (2010) Selenium removal from drinking water by adsorption to chitosan–clay composites and oxides: Batch and columns tests. Journal of Hazardous Materials 183, 590–595

8.      Massad S, Deckelbaum RJ, Gebre-Medhin M et al. (2016) Double Burden of Undernutrition and Obesity in Palestinian Schoolchildren: A Cross-Sectional Study. Food and nutrition bulletin 37, 144–152

9.      Acosta Navarro J, Caramelli B (2010) Vegetarians from Latin America. The American journal of cardiology 105, 902

10.    Appleby PN, Key TJ (2016) The long-term health of vegetarians and vegans. The Proceedings of the Nutrition Society 75, 287–293

11.    Dinu M, Abbate R, Gensini GF et al. (2017) Vegetarian, vegan diets and multiple health outcomes: a systematic review with meta-analysis of observational studies. Critical reviews in food science and nutrition 57, 3640–3649

12.    Eichelmann F, Schwingshackl L, Fedirko V et al. (2016) Effect of plant-based diets on obesity-related inflammatory profiles: a systematic review and meta-analysis of intervention trials. Obesity reviews an official journal of the International Association for the Study of Obesity 17, 1067–1079

13.    Reid MA, Marsh KA, Zeuschner CL et al. (2013) Meeting the nutrient reference values on a vegetarian diet. The Medical journal of Australia 199, S33-40

14.    Rizzo NS, Jaceldo-Siegl K, Sabate J et al. (2013) Nutrient profiles of vegetarian and nonvegetarian dietary patterns. Journal of the Academy of Nutrition and Dietetics 113, 1610–1619

15.    Appleby PN, Allen NE, Key TJ (2011) Diet, vegetarianism, and cataract risk. The American journal of clinical nutrition 93, 1128–1135

16.    Elshorbagy A, Jernerén F, Basta M et al. (2016) Amino acid changes during transition to a vegan diet supplemented with fish in healthy humans. European journal of nutrition

17.    Lee Y-M, Kim S-A, Lee I-K et al. (2016) Effect of a brown rice based vegan diet and conventional diabetic diet on glycemic control of patients with type 2 diabetes: a 12-week randomized clinical trial. PloS one 11, e0155918

18.    Lee Y, Park K (2017) Adherence to a vegetarian diet and diabetes risk: a systematic review and meta-analysis of observational studies. Nutrients 9

19.    Malik VS, Li Y, Tobias DK et al. (2016) Dietary protein intake and risk of type 2 diabetes in US men and women. American journal of epidemiology 183, 715–728

20.    Rinaldi S, Campbell EE, Fournier J et al. (2016) A comprehensive review of the literature supporting recommendations from the Canadian Diabetes Association for the use of a plant-based diet for management of type 2 diabetes. Canadian journal of diabetes 40, 471–477

21.    Tonstad S, Butler T, Yan R et al. (2009) Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes care 32, 791–796

22.    Abdulla M, Andersson I, Asp NG et al. (1981) Nutrient intake and health status of vegans. Chemical analyses of diets using the duplicate portion sampling technique. The American journal of clinical nutrition 34, 2464–2477

23.    Yokoyama Y, Nishimura K, Barnard ND et al. (2014) Vegetarian diets and blood pressure: a meta-analysis. JAMA internal medicine 174, 577–587

24.    Acosta-Navarro J, Antoniazzi L, Oki AM et al. (2017) Reduced subclinical carotid vascular disease and arterial stiffness in vegetarian men: the CARVOS study. International journal of cardiology 230, 562–566

25.    Ferdowsian HR, Barnard ND (2009) Effects of plant-based diets on plasma lipids. The American journal of cardiology 104, 947–956

26.    Guasch-Ferré M, Zheng Y, Ruiz-Canela M et al. (2016) Plasma acylcarnitines and risk of cardiovascular disease: effect of Mediterranean diet interventions. The American journal of clinical nutrition 103, 1408–1416

27.    Ha V, Souza RJ de (2015) "Fleshing out" the benefits of adopting a vegetarian diet. Journal of the American Heart Association 4, e002654

28.    Kuchta A, Lebiedzińska A, Fijałkowski M et al. (2016) Impact of plant-based diet on lipid risk factors for atherosclerosis. Cardiology journal 23, 141–148

29.    Satija A, Bhupathiraju SN, Spiegelman D et al. (2017) Healthful and unhealthful plant-based diets and the risk of coronary heart disease in U.S. adults. Journal of the American College of Cardiology 70, 411–422

30.    Schmidt JA, Rinaldi S, Ferrari P et al. (2015) Metabolic profiles of male meat eaters, fish eaters, vegetarians, and vegans from the EPIC-Oxford cohort. The American journal of clinical nutrition 102, 1518–1526

31.    Wang F, Zheng J, Yang B et al. (2015) Effects of vegetarian diets on blood lipids: a systematic review and meta-analysis of randomized controlled trials. Journal of the American Heart Association 4, e002408

32.    Appleby PN, Crowe FL, Bradbury KE et al. (2016) Mortality in vegetarians and comparable nonvegetarians in the United Kingdom. The American journal of clinical nutrition 103, 218–230

33.    Key TJ, Appleby PN, Crowe FL et al. (2014) Cancer in British vegetarians: updated analyses of 4998 incident cancers in a cohort of 32,491 meat eaters, 8612 fish eaters, 18,298 vegetarians, and 2246 vegans. The American journal of clinical nutrition 100 Suppl 1, 378S-85S

34.    Penniecook-Sawyers JA, Jaceldo-Siegl K, Fan J et al. (2016) Vegetarian dietary patterns and the risk of breast cancer in a low-risk population. The British journal of nutrition 115, 1790–1797

35.    Tantamango-Bartley Y, Jaceldo-Siegl K, Fan J et al. (2013) Vegetarian diets and the incidence of cancer in a low-risk population. Cancer epidemiology, biomarkers & prevention a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 22, 286–294