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I. VEGETARIAN NUTRITION
Copyright � 2008
McGill University
For budget, ethical, health, or other reasons, more and more people are "going veggie" -- switching to vegetarian diets. You can obtain all necessary nutrients without eating meat or other animal products. This takes planning, however, particularly if you cut out all animal products. This pamphlet gives you the "basics" on ensuring that you get all the nutrients you require from a vegetarian diet.
What does a vegetarian eat?
There is no single "vegetarian diet." Semi-vegetarians eat some fish or poultry, eggs, and dairy products in addition to foods from plant sources. Lacto-ovo vegetarians eat no meat, seafood or poultry, but eat dairy products and eggs. Lacto-vegetarians eat dairy products, but not eggs or any other animal products. Pure Vegetarians, or Vegans, exclude all foods of animal origin.
What are the health benefits of a vegetarian diet?
Vegetarian diets tend to be low in fat, saturated fat, and cholesterol. Cashing in on the health benefits requires planning; simply replacing meat with large amounts of dairy products or other substitutes may mean you are actually eating more fat.
A well-balanced vegetarian diet is high in carbohydrates such as bread, pasta, legumes, and vegetables; carbohydrates should always make up the largest part of any diet.
Studies have shown that vegetarians tend to have lower risks of coronary artery disease, colon cancer, hypertension, diabetes, and lung cancer. Preliminary research suggests a decreased risk of breast cancer. Some of these beneficial effects may also occur because vegetarians are more likely to exercise regularly and abstain from or minimize use of alcohol, drugs, and tobacco.
What vitamins must vegetarians watch their intake of?
Iron
Vegetarians must ensure they get enough iron, since iron from plant sources is not as easily absorbed as that found in animal products. Good sources of iron include tofu, legumes (such as lentils, lima beans, chick peas, split peas, and red beans), dark leafy green vegetables (such as asparagus, spinach, chard, and beet greens), whole grains (such as bran, oats, whole wheat, and bulgur), and dried fruits (including prunes). Vitamin C helps the body absorb iron better so consuming iron-rich foods along with foods high in vitamin C such as citrus fruits, berries, red bell peppers, tomatoes, and broccoli can help you get enough iron. In contrast, tea inhibits the absorption of iron.
Calcium
Ensuring sufficient calcium intake may be a particular concern for vegans (who do not eat dairy products). However, studies have shown that vegetarians may require less calcium than others, since they absorb and retain more calcium from foods than meat-eaters do (animal proteins can inhibit the absorption of calcium). Good calcium sources include broccoli, kale, collard and mustard greens, fortified soy milk, and fortified tofu.
Zinc
As with iron, zinc from plant sources is harder for the body to absorb than from animal sources. Good sources of this mineral include lentils, peas, and wheat germ.
Vitamin B-12
Adults require only minimal amounts of this vitamin. However, it is found almost exclusively in animal sources. Vegetarians who eat eggs or dairy products will consume enough, but vegans need to find another source. Fortified soy milk, cereals, and other foods contain this vitamin. Supplements are also available.
Other Vitamins
Vitamin D is found only in animal products, but is also synthesized by the body during exposure to the sun. It is also found in enriched soya milk and fish oils. Riboflavin, another important vitamin vegetarians may be lacking, is found in eggs, dairy products, broccoli and almonds.
Protein
Most North Americans eat too much protein, not too little. Vegetarians, who tend to eat less protein than meat eaters, probably get enough. However, it is necessary for vegetarians to ensure they get "complete" proteins. Protein from plant sources, unlike that from meats, contains only some of the amino acids required by the body. It is essential to obtain a complete set of these amino acids so the body can use them to "build up" human proteins such as hemoglobin and insulin. It is necessary for vegetarians to combine "complementary" foods to ensure they get a complete set of amino acids. These foods do not have to be eaten at the same sitting; they need only be consumed within a few hours of each other. Most vegetarians who always eat a variety of foods get complete proteins. "Complementary" Protein Combinations Include:
Grains + Legumes
Legumes + Seeds & Nuts
Grains + Eggs or Dairy Products
Legumes + Eggs or Dairy Products
Seeds & Nuts + Eggs or Dairy Products
Examples of Grains: Whole Wheat Bread, Pasta, Corn, Rice, Oats
Examples of Legumes: Peanuts, Lentils, Kidney Beans, Soybeans, Yellow, Green and Black-eye Peas, Chick Peas.
Some Foods With "Complete" Proteins:
Peanut Butter Sandwich (Grains + Legumes)
Tacos with Beans (Grains + Legumes)
Macaroni and Cheese (Grains + Dairy)
Tofu with Rice (Legumes + Grains)
Hummus with Falafels (Grains + Legumes)
Dahl with Chick Peas and Rice (Grains + Legumes)
Pasta with Pine Nuts (Grains + Nuts)
Almonds in Yogurt (Nuts + Dairy)
Some Helpful Hints for Vegetarians:
* Take time to plan meals, and ensure variety and balance in the foods you eat. The largest part of your diet should be fruits and vegetables, and breads and cereals.
* Balance this with smaller amounts of dairy products or substitutes, and protein foods. For exact numbers of portions and portion sizes, consult the Canada Food Guide, available at Health Services.
* For more information, or for help in planning your own vegetarian diet, consult a nurse/health educator (appointments are available free at Health Services) or a dietitian.
Copyright � 2008
McGill University
II. OPEN- OR CLOSED-KINETIC CHAIN EXERCISES AFTER ANTERIOR CRUCIATE LIGAMENT(ACL) RECONSTRUCTION?
Open-kinetic chain (OKC) and closed-kinetic chain (CKC) exercises may not differ in their effects on the healing response of the anterior cruciate ligament (ACL)-reconstructed knee. Recent biomechanical studies have shown that the peak strains produced on a graft are similar. Clinical studies suggest that both play a beneficial role in the early rehabilitation of the reconstructed knee.
Introduction
The optimal rehabilitation program after anterior cruciate ligament (ACL) reconstruction has changed considerably over the past 20 yrs. Accelerated rehabilitation programs, which permit early ROM, immediate weight-bearing, and early return to sport, have become the accepted standard. The trend toward accelerated rehabilitation, however, has been based primarily on clinical perception, retrospective observations, and the patients' desire to return to full activity quickly-not on prospective randomized controlled trials. The optimal rehabilitation program after ACL reconstruction remains undetermined.
One of the goals of postoperative rehabilitation is to restore range of knee motion and muscle strength to the injured knee, while protecting the healing graft from forces that could permanently deform it. It is generally thought that the biomechanical environment of the healing graft can be optimized by prescribing "closed kinetic chain" (CKC) exercises and avoiding open kinetic chain (OKC) exercises early in the rehabilitation program. CKC exercises have been justified for early rehabilitation, in part, because they: 1) reduce the anterior-directed intersegmental forces that act on the tibia relative to the femur;[2,5,6,8,9,12] 2) increase tibiofemoral compressive forces;[5,6,8,9] 3) increase cocontraction of the hamstrings;[2,7,12] 4) mimic functional activities more closely than OKC exercises;[6,10] and 5) reduce the incidence of patellofemoral complications.[5,6,10]
Despite the frequent use and acceptance of the OKC and CKC terminology, a variety of definitions can be found in the literature. For the Purpose of this article, we defined OKC exercises as those in which the foot is not in contact with a solid surface. The resistive loads are applied to the tibia and transferred directly to the knee (Fig. 1). Only the muscles spanning the knee are required to perform the exercise. Leg extension exercises and kicking are examples of OKC exercises. We defined CKC exercises as those in which the foot is in contact with a solid surface. The foot is opposed by a ground reaction force, which is transmitted to all of the joints in the lower extremity (Fig. 1). Muscles spanning all of the joints of the lower extremity are used. Examples of CKC exercises are the squat, leg press, and lunge.
Figure 1.
The critical difference between OKC and CKC exercises is not the kinematic arrangement but the resultant loads transmitted to the knee. For OKC exercises, the resistive load (WLG) is applied to the tibia and transmitted to the knee (TK). For CKC exercises, the ground reaction force (FG) is transmitted to all the joints of the leg (TA, TK, and TH).
In this brief review article, we explore the hypothesis that OKC and CKC for the rehabilitation of the ACL-reconstructed knee do not differ in their effects on graft healing, postoperative knee function, and patient satisfaction (Fig. 2). The article focuses on the OKC and CKC exercises involving knee flexion-extension. The review uses relevant biomechanical and clinical studies to assess the potential effects that these exercises may have on graft healing. These include studies evaluating the intersegmental kinematics/kinetics of the knee, ligament strains, and clinical outcome through prospective randomized clinical trials.
Figure 2.
The hypothesis is that OKC and CKC exercises for the early rehabilitation of the ACL-reconstructed knee do not differ in their effects on graft healing, postoperative knee function, and patient satisfaction.
Braden C. Fleming; Heidi Oksendahl; Bruce D. Beynnon
Posted 09/01/2005
...LIFT WITH YOUR LEGS NOT YOUR BACK and remember that EVERYONE LOOKS BETTER WITH A SMILE! :)
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