Q. I am a vegetarian, and lately I have been feeling sluggish, fatigued and always tired no matter how much sleep I get. I've had bouts of insomnia/irritable sleeping patterns and have felt bloated. I’ve been having these symptoms and bad stomach aches for weeks. My doctor has suggested that I may have a protein deficiency. What are the symptoms of protein deficiency and how can I find out more about this?

A. The symptoms of protein deficiency are:

• Kwashiorkor
• Fullness, moon-shaped face
• Brittle, pluckable hair
• Fine, silky hair
• Alopecia
• Decreased pigmentation (hair)
• Meuhrcke's lines (nails)
• Edema
• Hyperpigmentation (sun-exposed skin)
• Flaky paint or crazy paving dermatitis
• Delayed wound healing
• Decubitus ulcers
• Muscle weakness and wasting

The diagnostic test (blood test) for determination of inadequate protein intake is serum albumin, which can be done by your physician or healthcare professional. Unless you have been on a very low calorie diet (800 calories a day or less) you probably do not have protein deficiency. You might be experiencing the symptoms of fatigue, erratic sleep, etc as a result of chronic and improper dieting. Please read the following symptoms, risks and side effects of dieting.

Mental and Emotional Risks

• Apathy
• Depression, anxiety
• Irritability, intolerance, moodiness
• Decrease in mental alertness, comprehension, and concentration
• Thoughts focused on eating, weight and hunger
• Self-absorbed, self-focused, decrease in wider interests
• Preoccupation with own body, judgmental of others'
• Lowered self-esteem, feels self-worth depends on being thin

Physical Risks

• Weakness, fainting, fatigue
• Cold intolerance
• Gallstones
• Gouty arthritis
• Cardiac disorders
• Elevated cholesterol
• Anemia
• Headache
• Elevated uric acid levels
• Loss of lean tissue
• Nausea
• Diarrhea, constipation
• Edema
• Hair loss, and thinning hair
• Hypotension
• Abdominal pain
• Muscle cramps
• Aching muscles
• Both slowed and increased heart rate
• Heart abnormalities, arrhythmias
• Death

Today here is so much nutrition information available that it confuses the even most-educated. There is also a lot of money being made on fad diet books and programs that contain only half-truths, which can be dangerous to some. In the United States alone there are over 30,000 weight loss diets! You would benefit greatly by seeing a professional nutritionist, registered dietitian to help you with your meal plans and dietary goals. A professional would be able to help you plan your food to incorporate the nutrients necessary for your lifestyle (stress, school, etc.) and to achieve your (vegetarian) nutrition and fitness goals. I recommend that you interview several people to determine the best person to meet your individual needs.

Vegetarian living is a really positive step for your health. There are vital nutrients that are more abundant in small amounts of animal flesh that you will need to consume larger amounts of plant foods to obtain. Perhaps some of the side effects you are experiencing is a combination of lifestyle, stress, and inadequate amounts of the necessary nutrients you are missing from meat and animal foods.

Common nutrients that are sometimes lacking in the vegetarian diet are protein, calcium, iron, riboflavin, vitamin B6, zinc, and vitamin B12. Foods that contain these nutrients can easily be incorporated into daily food planning. It just takes a little practice.

One of my favorite books for vegetarians is Diet for a Small Planet by Frances Moore Lappe.  Although the theory of combining foods for complete proteins is outdated it is still a great way to get a variety of foods from rich non-animal protein sources.  We now know that getting a variety of grains, fruit, vegetables, nuts, and legumes throughout the day should provide the adequate balance of essential amino acids. You can get soymilk fortified with calcium, soy cheeses, soy breads, soy ice cream and many other soy products that will add higher quality protein to your daily nutrient intake. Currently, my favorite vegetarian book is  "Becoming Vegan: The Complete Guide to Adopting a Healthy Plant-Based Diet" by Vesanto  Melina, MS, RD and Brenda Davis RD.

Look for plant foods that are rich in the following nutrients:

Calcium: fortified orange juice, soy milk, cereals, collard leaves, turnip greens, brewer's yeast, parsley, Brazil nuts, beet greens, bok choy, mustard greens. Broccoli, soybeans, cantaloupe, kelp, and Bancha tea.

Iron:  Kelp, Brewer's yeast. Blackstrap molasses, wheat bran, millet, pumpkin and squash seeds, parsley, dried prunes, almonds, beet greens, Swiss chard, dates, cooked dry beans, sesame seeds, iron fortified cereals, and tofu. Plant sources of iron are absorbed about 5% compared with animal flesh sources at about 20%. Plant sources of iron can be absorbed up to 3 times by combining with ascorbic acid or source of vitamin C such as orange juice, cauliflower, cabbage, tomatoes, or broccoli. Diets high in phytate (nuts and grains), polyphenols (black tea), and caffeine can significantly inhibit iron absorption.  Cooking in cast iron pots and cookware can also enhance iron absorption.

Riboflavin: yeast, wheat germ, wild rice, broccoli, collard greens, wild rice, mushrooms, vitamin enriched grains and cereal, and almonds.

Vitamin B6 (pyridoxine): brewer's yeast, sunflower seeds, toasted wheat germ, soybeans, walnuts, lima beans, garbanzo beans, and bananas.

Zinc: pecans, split peas, Brazil nuts, whole wheat, rye, oats, peanuts, lima beans, almonds, hazel nuts, and ginger root.

Vitamin B12 is difficult to obtain from plant sources and is best obtained through eggs, and cheese.

A multivitamin is a great safety net for the vegetarian to ensure vital nutrients in the right balance.  Be aware that certain medications may interact with vitamin/mineral or herbal supplements that could intensify the side effects or alter the action of the medication.

Some good websites for Vegetarian information are:

www.pcrm.org

 http://www.vegsource.com

 http://www.earthsave.org