In contrast to that in the developing world, the incidence of known nutritional deficiency disorders in the developed world is low. Even in the case of vegetarians, there appears to be no appreciable problem. Classical nutritional deficiency diseases have been avoided through the widespread fortification of food when it was realized that many staple crops contained insufficient concentrations of many essential vitamins and minerals. Fortification is also utilized to replace nutrients lost in the heat processing of staple foods and through oxidation. In addition, the consumption of nutritional supplements is becoming more widespread. Nonetheless, there is good evidence, as shown in Fig. 2, that even in a country such as the United States, where most nutritionally related disorders probably stem from over-nutrition, there is inadequate intake of micronutrients compared with what would be found in the plasma if recommended dietary allowances (RDAs) were consumed.
Humans may be infected either by eating cysts in meat or by ingestion of sporulated oocysts from contaminated soil. The relative risk of infection in the USA, Canada and Europe is considered to be higher from the ingestion of undercooked meat, but in societies with little meat in the diet, oocysts are more important (Frenkel et al., 1995). Studies of vegetarians show a lower incidence of toxoplasmosis in this population in industrialized countries (Roghmann et al., 1999) and the tropics (Rawal, 1959). Birds and rodents are important in picking up oocysts from soil and scavenging bradyzoite cysts from infected animals (Frenkel, 1973, 1997). Grazing food animals, e.g. sheep, are probably infected by soil oocysts, but swine are omnivores and may also ingest infected rodents (Dubey, 1998 Dubey and Beattie, 1998). The incidence of Toxoplasma in swine is quite variable. Bovine and fowl Toxoplasma levels are low (Dubey, 1992).
(commonly fortified with additional iron in the UK), with a lesser component of haem iron from meat and fish. Even in iron deficiency, the maximum iron absorption from a mixed Western diet is no more than 3-4 mg daily. This figure is much less with the predominantly vegetarian, cereal-based diets of most of the world's population.
The role of diet in cancer risk has been under intense scrutiny, especially given the strong association between high dietary fat intake and prostate cancer risk. Although the exact mechanism is unclear, high levels of fat intake may increase the bioavailability of steroid sex hormones, perhaps by interfering with their ability to bind to serum globulins.16 Conversely, vegetarian diets have been shown to lead to lower levels of circulating androgens and estrogens. Data also demonstrate a strong correlation between dietary fat and significantly different incidence rates of prostate cancer in Western vs. Eastern cultures.9 Several highly suggestive studies in animal and in vitro model systems also support an important role for dietary fat in the promotion and progression of prostate cancer. Dietary nutrients may also have a function in the development of prostate cancer however, this is difficult to elucidate and is currently under study.
Diet, in particular dietary fibre, could play a significant role in the absorption of drugs from the colon. Individuals ingesting a vegetarian diet or taking stool bulking agents may possibly show a difference in colonic drug absorption when compared with individuals ingesting a relatively low fibre diet. However, increased dietary fibre leads to decreased gastrointestinal transit times, which may offset any absorptive benefit gained by increasing the mucosal surface area in the colon81. Since fibre alters the transit through the colon it would be expected to have the greatest influence on the absorption of drugs from sustained release preparations. In young vegetarians the mouth to anus transit of a single unit can be less than 6 hours, indeed, for one normal subject, the total transit time was 2 hours (Washington et al, unpublished observation).
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