Man is an omnivorous animal. The satisfaction of its quantitative and qualitative energy needs depends primarily on its economic conditions. In our affluent societies, this satisfaction should not pose problems if not by excess, and this is what is most obvious. However, sometimes it is endangered.
Some people adopt a sometimes food not far ideology of sectarianism, exclusion diets. The most common example, but not the most harmful is the vegetarian diet. This occurs in some exposed subgroups of the population.
In others, the increasing industrialization of food favors certain deficiencies omnivorous diet.
In all these situations, there is no rule in primitive underlying pathology. It’s not quite the case ICAP, and often misunderstood behavior usually considered another food perversion.
Different “regimes” non omnivores exclusion:
Vegetarian diet:
It is most prevalent. Its ideological base is not to kill animals in order to eat them, but not forbidden to consume their products. Thus, eggs and dairy products are possible and provide animal protein. This diet is one that poses fewer health problems.
Vegan diet:
He added the vegetarian prohibition of consuming animal by-products, so eggs and dairy products, etc.
Plan says “macrobiotic”:
He appeared in the second half of the twentieth century, around 1960 in France. It is based on the ideology of Yin and Yang. The basic diet is composed of grains. Fruits, dairy products, sugar is categorized as very harmful and Yin. Meat products are little more accepted.
The most sectarian version is only composed of cereals. The macrobiotic diet was introduced by its propagators as one element of a lifestyle adapted to ensure the happiness, longevity and prevent diseases, particularly cancers. This did not prevent the leader of macrobiotics Mischio Kushi, big smoker, died of lung cancer.
Other plans:
Many other schemes underpinned by ideologies, beliefs about broadcasting. We can predict, with little chance of being wrong, that the coming decades will show other food ideologies, even if the word ideology appears here sometimes much overused.
Crudivoriste regime:
Plan where to take advantage of all food quality, they should all be eaten raw.
Instinctotherapy:
The instinctotherapy relates to crudivoriste regime.
It requires more than food is chosen by instinct alone the consumer.
The raw food diet is another avatar which is essentially vegetable intake (it does not address directly the cow in the meadow …). The lacto-fermented foods are entitled to quote.
Challenge regimes ned by blood groups:
They are adorned with a justifi cation smoker (group O as referring to old hunter-and therefore requiring a meat diet, etc.).
Consequences of non omnivorous diets:
Numerous studies have been conducted in different parts of the world to appreciate the consequences of not omnivorous diets, especially vegetarians and vegans. Despite large differences in the traditional dietary patterns of Europe, the Far East or North America, the results of different surveys converge.
Nutritional intake:
Vegetarian diets provide inputs quantitatively and qualitatively optimal fat. Those in fiber, vitamins B1, C, E, folate are largely covered. Intakes of magnesium and iron are sufficient. However, despite the widespread use of dietary supplements, these plans are often the cause of a deficiency intake of retinol, vitamins B9 and B12, calcium, selenium and zinc. The total quantitative protein intake is adequate but methionine deficiency is common.
It was noted in vegetarians for over 65 challenging cit of fluid intake. These characteristics are more pronounced in vegans, especially as their diet is more uncompromising.
Few studies relate the followers of macrobiotic diets, both fewer and subdivided into many sometimes groupusculaires practices.
Biological consequences:
The biological consequences of these practices are usually expected: perfect lipid profile with higher unsaturated fatty acids and decrease saturated, but without changes in cholesterol or LDL / HDL cholesterol ratio, but sometimes hypoprotidemia (up to 15 % of cases in a Czech study vegetarians), low levels of vitamins D and B12, homocysteine increase into 30% of cases among vegetarians, hypoferritinemia and anemia.
All these anomalies may be even more pronounced in vegans despite the more frequent taking of “dietary supplements”.
The decrease in ferritin and hemoglobin contrast with the higher iron intake than the reference of omnivorous: it highlights the poor bioavailability of non-heme iron.
Clinical consequences:
The actual clinical impact of these plans are sometimes obvious and the doctor may need to meet (they almost never consulted for this) and cachectic individuals or holders of obvious clinical deficiencies related to their feeding practices.One of the first French followers of the macrobiotic diet, son of a known personality, died of cachexia. The relationship between anorexia nervosa and such sectarian practices are not zero. But out of these caricatures and fortunately rare cases, the clinical consequences are limited or zero for many vegetarians.
Some work at home report a decline in coronary mortality. But in these subjects, there is a competition between the positive side of a favorable lipid profile and the deleterious effect of increased homocysteine. The balance may look the wrong way, especially during pregnancy during which the vitamin B12 deficiency increases and homocysteine increases.
A New Zealand work from 1994 noted that clinical anemia (Hb <12 g in man, 11 g for women) is more common in men vegetarians, perhaps because women more aware of their rules risk of anemia use more iron supplementation.
In premenopausal period, a Finnish study showed in 2000 that the dietary intake of vitamin D vegan was insufficient to maintain circulating levels of 25-OH-D and normal parathyroid hormone with measurable negative effects on vertebral BMD and femoral neck. Vegetarians are between these data and normal.
In children:
Among the vegetarian children, growth and bone mineral content appeared normal, but unexpectedly, the proportion of obese has been described as raised in Hong Kong.
There are of course lower mean hemoglobin and thus a greater willingness to develop true anemia.
A Dutch work in 2000 compared intelligence tests (learning ability, abstraction, problem solving) in three groups of children:
– 1. macrobiotic diet up to 6 years and vegetarian diet;
– 2. macrobiotic and omnivorous diet;
– 3. always omnivorous diet.
Children 1 group are under-performing the tests and remain after changing their diet. Those in the second group are catching up and those in the third group have never had. Would the animal protein necessary for normal intellectual development?
DEFICIENCY PLANS OMNIVORES:
Involuntary overall deficiencies:
The ever-growing success of the heart Restaurants, witnessed the growing inequalities in our society, reminds us that food sufficiency is not easily assured for all. Some groups are particularly exposed to these quantitative and qualitative shortcomings. Of course those belonging to the “fourth world” but also isolated and elderly.
Specific deficiencies:
Iron deficiency:
It is the most common. It threatens our modern women, in a developed society have decreased energy expenditure resulting from the decline in work-related expenses, transportation, maintenance of homeothermy. These women drop accordingly dietary intake either spontaneously or by fear of weight gain as fashion condemns in “paying attention.”
When it falls below a total intake of 1800 and especially 1500 Kcal, it becomes possible to achieve the conditions of insufficient iron intake. A study in the Val-de-Marne showed that 90% of women of childbearing age had daily iron intakes below recommendations.
This situation is more common when pregnancy occurs. Many pregnant women have a hemoglobin level below 11 g.Work done in the Yvelines showed that 12% of women had a serum ferritin less than 12 ug / dL in the third month figure rising in the absence of supplementation, 65% in the seventh month. This is not unrelated to the changes in taste and sometimes real PICA (see below).
Vitamin deficiencies:
Consumption trends:
Vitamin and micronutrient deficiencies have become frequent. They are partly related to the industrialization of food and advertising that it entails, to the benefit of manufactures, consumers away from the absorption of fresh fruit.
This seems paradoxical when one compares the evolution of the average consumption of French between 1950 and 1990. In this space of time, their fruit consumption increased from 40-72 kg / year and that of vegetables 60-119 kg / year. We lack everything to facts on what the prevalence of vitamin deficiencies in this country in the fifties.
In any event if the overall consumption has increased significantly, it must consider how these foods are consumed and disparities in individual behavior or group.
Frequency of deficiencies:
Currently, we have several surveys, including one conducted by the CNAM in 1988 in the Val-de-Marne. More than half of adults had clearly insufficient dietary intake of vitamin E, 40% of women in vitamins B1 and B6, 40% of adults and 15-20% of children with vitamin A, and 20% of adults in vitamin C. the filler deficits also touched the iron in 30 to 60% of women and 15% of children, zinc, magnesium and copper, while intakes of vitamins B2, B9 and B12 and calcium were satisfactory.
These deficiencies are present including youth and students (the desserts offered by the university restaurants most incite, advertising helping to choose the industrial dessert rather than the result of the second category).
They are seen more often in vulnerable categories we mentioned above (isolated, elderly, poor).
Lack of vitamin D are rated winter especially among young adolescents (study in Chantilly lads published in 1998).
More recently the SUVIMAX study showed that the French population was exposed to a risk of moderate iodine deficiency with whole of urinary iodine values lower than 10 pg / ml recommended by the World Health Organization (WHO).
Clinical consequences of these shortcomings:
The clinical consequences of these deficiencies result in the resurgence of diseases such as scurvy, with bleeding disorders, as well as gingivitis, arthralgia, edema by unexplained elsewhere. You should know consider this diagnosis in which ignorance can let things evolve to death when treatment is obviously simple and rapidly effective. Alcoholism and smoking are factors increasing the risk of clinical hypovitaminosis C.
Deficiencies in vitamin D are not among our adolescents recognized consequences but strongly encourage pre-winter supplementation was noted in 1994 a relationship between iodine status and performance diométriques in young children.
Beyond these situations, micronutrient and vitamin deficiencies may play a role in the occurrence of major diseases of our century, metabolic, cancer or cardiovascular.
The answers now available on this subject are contradictory.
PICA:
Definition:
Defined by Littré as “a perversion of taste characterized by an aversion to regular foods and the desire to eat non-nutritive substances such as chalk, clay, coal,” ICAP is known since antiquity.
Hippocrates observed that “men and women who have a bad color, but not jaundice … eat stones and earth, and have hemorrhoids.”
Currently we reserve the term of PICA (which comes he seems from the Latin name of the pie – pica picae – sensible eating anything) to the irresistible ingestion, compulsive and regular non-food substances. Sometimes called PICA food when the irresistible urge key conventional food or drink. English speakers talk about it with food craving.
The limits are sometimes difficult to determine.
Thus compulsive removals ice (pagophagia) uncooked rice (rizophagie) and starch (amylophagie) are classified with the ground absorption, clay (geophagia) or stones (lithophagie) under genuine PICA . Furthermore, we must distinguish the PICA food (food craving) where the compulsive ingestion is always elective one and always the same food or drink (known chocolatophagie to theophagy – tea – to géomélophagie – potatoes – etc.), access bulimics in which anything is consumed. The last frontier is sometimes difficult to keep.
ICAP frequency:
It varies between countries, continents and cultural habits. Excluding psychotic or mentally retarded patients, the frequency of PICA is greater in black patients, in young children. Few studies have been conducted among native Europeans. The prevalence of PICA (including food) in subjects with iron deficiency was estimated at 5% in Spain. In Britain, over 100 pregnant women had none of PICA, but 51% of a food craving.
The study that we conducted in Seine-Saint-Denis note 9% and 19% of PICA PICA food in non-deficient subjects in iron, but our sample included only 22% of native Europeans. Among blacks in Africa and the Caribbean and the United States, the prevalence of PICA is much larger, consisting essentially of rural geophagia, usually urban pagophagia.
The synonym for many, even among physicians, between PICA and geophagia, the perceived character as “shameful”, “primitive” of such a practice by people regarded as highly developed in our countries also contribute to making education harder prevalence. In any case, the prevalence is much higher in case of iron deficiency, raising the problem of causality.
PICA and iron deficiency:
It has long been argued that ICAP was the cause of iron deficiency when it was associated. While studies have shown that tea, starch, clay were able to chelate iron in the gut, this requires absorb these substances in large quantities.
The prevalence of PICA in case of iron deficiency was the main object of our study in Seine-Saint-Denis. Of 79 subjects with ferritin <20ug / L and hemoglobin <12 g in men, <11 g in women, <10 g during pregnancy (40% of patients), we noted 44% of PICA and 27% of food craving (against 9 and 19% in matched controls not deficient).Alongside the 22% of Europeans, the sample included 25% of North African origin, 30% of subjects from sub-Saharan Africa, 15% in the Caribbean and 8% from Asia. It is also noted that if 54% of iron deficiency were linked to chronic bleeding, 14% were the result of a vegetarian diet (see above). PICA prevalence was significantly higher among non-Europeans (55%) than Europeans (6%). Geophagy predominated in from all over Africa, the West Indies pagophagia in both forms representing 95% of PICA. These data broadly overlap with those of literature.
Two findings are of importance:
– Many of our patients have reported feeling a pleasant unusually flavored ice they consumed in a state of iron deficiency, pleasant taste has disappeared with the correction of the deficiency;
– Iron treatment has eliminated the PICA sometimes well before the deficiency is corrected completely.
Deficiency sequence martial-change in taste-modifying appetite-PICA may be the pathogenic frame, reversible syndrome.