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Treating the symptoms and underlying causes of ill health with a plant-based diet

Wed 16.01.2019

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This article addresses various physical and psychological ailments that are linked to poor nutrition. A plant-based diet can often help to solve these problems. However, persistent symptoms should always be discussed with a medical professional.

Heartburn and acid reflux

While heartburn often occurs by itself, it can also happen in conjunction with other symptoms of ill health such as acid reflux. The most common cause of these symptoms is gastroesophageal reflux disease, which affects around 15% of the population in Western industrialized countries. Recurrent and severe symptoms diminish quality of life and should be discussed with a doctor. While heartburn that only occurs once or twice a week is not cause for alarm and does not require specific medical treatment, it can often be prevented or managed by avoiding certain foods.1Labenz J., Holtmann G. (2017): Ratgeber Sodbrennen. Available at: https://www.gastro-liga.de/fileadmin/download/Sodbrennen-137-06_17.pdf [22.11.2017]

Eating a healthy quantity of unprocessed fruit and vegetables can counteract heartburn, although citrus and other acidic fruits should be avoided. Refined foods, alcohol, and caffeine, as well as animal fats, meat, and other sources of animal protein are equally unsuitable for people who regularly experience heartburn.2Zalvan C, Hu S., Greenberg B. et al. (2017): A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux. JAMA Otolaryngol Head Neck Surg] (See ProVeg’s vegan food plate for a useful guide to healthy plant-based nutrition.)

Abdominal pain, flatulence, and diarrhoea

Regular stomach aches, flatulence, or diarrhoea, particularly after meals, often indicate the presence of an allergy or food intolerance. Of the wide array of possible problems with regard to the digestion of animal products, lactose intolerance is one of the most common. People with lactose intolerance produce less of the digestive enzyme lactase, which prevents the body from digesting lactose. Instead, the undigested lactose ferments – primarily in the intestinal tract – and is turned into gases and acetic acid, which, in turn, can lead to flatulence, abdominal pain, and/or diarrhoea.3Alexandra Schek (1998): Ernährungslehre kompakt. Kompendium der Ernährungslehre für Studierende der Ernährungswissenschaft, Medizin und Naturwissenschaft. Frankfurt am Main: Umschau Zeitschriftenverlag, S. 174

The majority of people in Asia and Africa are lactose intolerant and thus cannot digest lactose. In Europe, the prevalence of lactose intolerance varies from southern to northern regions. In Northern Europe, 2% of the population are affected. This number climbs to 15-20% in Germany and to 25% in the Mediterranean.4Terjung B., Lammert F. (2007): Laktoseintoleranz: Neue Aspekte eines alten Problems. Deutsche Wochenschrift; 132, S. 271–275 Worldwide, 75% of people are lactose intolerant.5Wittkamp, P. et al. (2012): Prävalenz des Reizdarmsyndroms nach den Rom-III-Kriterien in Deutschland und Zusammenhänge mit potentiellen Risikofaktoren. Zeitschrift für Gastroenterologie 50 A preliminary indication of lactose intolerance is the occurrence of the above-mentioned symptoms after ingesting cow’s milk or other dairy products. Final diagnoses by medical professionals are usually made using a breath or blood-sugar test. Lactose intolerance is most easily treated by omitting foods containing lactose. A purely plant-based diet is lactose-free. (See here for ProVeg’s guide to the best plant-based alternatives to cow’s milk.)

Irritable bowel syndrome (or IBS) is another common form of indigestion. Around 11% of the global population are affected by this disease6Canavan, C., J. West & T. Card (2014): The epidemiology of irritable bowel syndrome. Clin Epidemiol. 6, p.71–80, with the most common symptoms including abdominal pain and cramps. IBS is a chronic disorder of the gastrointestinal tract, the exact cause of which has not yet been determined. However, an appropriate diet can help alleviate the symptoms. The foods that cause stomach pain and discomfort vary from person to person but often include milk and dairy products, alcohol, citrus fruits, and foods rich in fat, acid, or fructose, as well as overly refined foods.7NHS: Good foods to help your digestion (2016). Available at: https://www.nhs.uk/live-well/eat-well/good-foods-to-help-your-digestion/ 8National Center for Biotechnology Information (2017) Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients!
Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467063/
People suffering from IBS should eat a diet consisting mainly of cooked vegetables and avoid animal protein, sugar, coffee, and spicy food.9Trüeb R. (2003): Haare. Praxis der Trichologie. Berlin/Heidelberg: Springer, S. 506 (See ProVeg’s vegan food plate for a guide to healthy plant-based eating.)

Hair loss, brittle hair and nails

Losing 50-100 hairs per day is normal and there is generally no need to worry if there is a good balance between hair loss and regrowth. However, in some cases, hair loss or brittle hair can be the result of a nutrient deficiency. A lack of biotin, vitamin B12, essential fats, protein, zinc, or iron is particularly problematic when it comes to hair loss10Achenbach R. (2001): Der große TRIAS-Ratgeber. Haut, Haare, Nägel. Stuttgart: TRIAS, while brittle nails may be the result of a lack of iron, calcium, zinc, biotin, folic acid, or vitamins A, C, or B12.11Davey G..; Spencer E.; Appleby P. et al. (2003): EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. In: Public health nutrition 6, S. 259–269

A plant-based diet can provide the body with a wealth of micronutrients and thus prevent a deficiency of vitamins and minerals. A complete blood count can provide information on potential nutrient deficiencies, while a sufficient supply of these nutrients should alleviate any problems with hair and nails.12Lim, N. R. et al. (2017): The Role of Elimination Diets in Atopic Dermatitis-A Comprehensive Review. In: Pediatric Dermatology 34, S. 516–527 ProVeg provides information on foods that are especially rich in iron, zinc, and other nutrients.

Skin problems: atopic dermatitis and acne

Atopic dermatitis, also known as atopic eczema, is a condition that is most common in children and manifests itself as skin hypersensitivity. It is one of the most common skin diseases, affecting around 20% of children and up to 3% of adults worldwide.13 Nutten S. (2015): Atopic Dermatitis: Global Epidemiology and Risk Factors. Ann Nutr Metab 2015;66(suppl 1):8-16 available at https://www.karger.com/Article/Pdf/370220 The disease is usually indicated by weeping rashes on the bends of the knee and elbow joints. In addition to a genetic disposition, symptoms of atopic dermatitis can also be triggered by food allergies.14Thomas, W. et al. (2016): Leitlinie Neurodermitis [atopisches Ekzem; atopische Dermatitis]. In: Journal der Deutschen Dermatologischen Gesellschaft 14, S. e1–e757 It may, therefore, make sense to avoid foods such as cow’s milk15Shokeen, D. (2016): Influence of diet in acne vulgaris and atopic dermatitis. In: Cutis. 98, S. E28–E297 and eggs as well as other common allergens related to atopic dermatitis such as nuts and tomatoes. Children usually show symptoms (such as itching) only a few hours after ingesting the allergen. In general, a healthy, predominantly plant-based diet with a focus on a sufficient supply of vitamin D is recommended.16McCusker M., Robert Sidbury R.(2016): Nutrition and skin: Kids are not just little people. In: Clinics in Dermatology 34, S. 698–709 17Romańska-Gocka, K. et al. (2016): The possible role of diet in the pathogenesis of adult female acne. In: Postepy Dermatol Alergol 33, S. 416–420

Acne is one of the most common skin diseases among adolescents. First signs of acne can appear even before puberty but the disease usually peaks in late adolescence and subsides after the hormonal adjustment to adulthood is complete. Evidence of these hormonal changes is particularly pronounced in the areas of the skin that are rich in sebaceous glands such as the face, back, and middle chest region. To minimise the occurrence of acne, avoid animal fats and take care not to consume excessive amounts of simple carbohydrates. Overdosing on multivitamins can also increase the likelihood of acne occurring. Clearer skin, on the other hand, can be achieved by eating a balanced plant-based diet, including foods that contain zinc.18Shokeen, D. (2016): Influence of diet in acne vulgaris and atopic dermatitis. In: Cutis 98, S. E28–E29 19McCusker M., Robert Sidbury R. (2016): Nutrition and skin: Kids are not just little people. In: Clinics in Dermatology 34, S. 698–709 20Pérez-Cano F., Castell M. (2016): Flavonoids, Inflammation and Immune System. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5084045/ [22.11.2017]

Weakened immune system

In addition to physical activity, sleeping habits, and one’s mental and emotional state, nutritional factors are also a key influence on our immune system. Those who do not ensure an adequate supply of vitamins, minerals, and phytochemicals greatly increase the risk of developing a weak immune system and associated diseases. Phytochemicals, in particular, play an important role in keeping the body healthy. They prevent oxidative stress, inhibit inflammation, and ensure optimal nutrient absorption by cells.21Elmadfa, I. & C. Leitzmann (2015): Ernährung des Menschen. Verlag Eugen Ulmer, S. 120 (bzw. 111–120)[22.11.2017] Fruits and vegetables contain large quantities of these vital compounds – the more of them that are present in one’s diet, the lower the risk of a weakened immune system and associated secondary diseases, particularly when coupled with plenty of wholemeal foods and exercise.22Krishnapura, S. (2017) Ginger rhizomes (Zingiber officinale): A spice with multiple health beneficial potentials, In: PharmaNutrition 5, S. 18–28

Vitamin C supports the immune system. Citrus fruits, strawberries, sweet peppers and broccoli are especially rich in this vitamin. Other plants considered to have antibacterial and immune-strengthening properties include radish, celery, leek, onions, and garlic. Ginger is regarded as particularly beneficial for people with a weakened immune system: it has anti-inflammatory and anti-carcinogenic effects, promotes digestion, helps with the absorption of micronutrients, and facilitates the excretion of toxins by the liver and kidneys.23Elmadfa, I. & C. Leitzmann (2015): Ernährung des Menschen. Verlag Eugen Ulmer, S. 1198 The mineral selenium has also been recognised as an immune booster and is found in sunflower seeds, potatoes, soya products, and fresh vegetables. 24Elmadfa, I. & C. Leitzmann (2015): Ernährung des Menschen. Verlag Eugen Ulmer, S.176 ff.

Fatigue and exhaustion

Stress, pressure to perform, and lack of sleep all deprive the body of energy and often lead to exhaustion. In many cases, the problem is compounded by a lack of nutrients.

In order to strengthen your sense of well-being, it is important to recharge your batteries and compensate for the impact of stress on your body. Foods such as parsley, Jerusalem artichokes, soya, millet, spinach, and beetroot provide the body with the vital minerals iron and magnesium. Magnesium, which protects the body from stress-induced ailments25Seelig, M. S. (1994). Consequences of magnesium deficiency on the enhancement of stress reactions; preventive and therapeutic implications (a review). Journal of the American College of Nutrition, 13(5), 429-446., is found in all leafy greens, as well as nuts, cocoa and wheat germ. With their high content of B vitamins, celery, wholegrain cereals, walnuts, and soya can help strengthen the nervous system26Notay, K. et al. (2017): Acute beetroot juice supplementation on sympathetic nerve activity: a randomized, double-blind, placebo-controlled proof-of-concept study. American Journal of Physiology – Heart and Circulatory Physiology. 313, S. H59–H65, while beetroot can help to improve mental performance.27Ledochowski, M. (2010): Klinische Ernährungsmedizin. Springer-Verlag Vienna, S. 278 High levels of vitamin C are found in peppers, parsley, broccoli, currants, and lemons. Avocado and linseed oil will also help to restore energy levels due to their high content of unsaturated fatty acids.

Vitamin C also plays a key role in the absorption of iron.28Leitzmann C., Keller M. (2010): Vegetarische Ernährung. Stuttgart: Ulmer, S. 216 ff. Supplying the body with too little iron can lead to iron-deficiency anaemia, which reduces the blood’s ability to transport oxygen. Consequences usually include exhaustion, fatigue, and/or headaches (see headaches).29Maria Lohmann (2013): Der Basen-Doktor. Basische Ernährung: gezielte Hilfe bei den häufigsten Beschwerden. Stuttgart: TRIAS, S. 73 ff. Foods with high iron content include cereals (such as amaranth and quinoa), pulses (soya, lentils, etc.), and seeds (pumpkin seeds, sesame seeds, linseed).

Finally, avoid simple carbohydrates such as sugar and white flour. Beverages which contain caffeine – including coffee and energy drinks – also have an adverse effect on mental and physical performance since they only provide short bursts of energy.30Warner M., MD, Kamran M., et al. (2017): Anemia, Iron Deficiency. Available at: https://www.ncbi.nlm.nih.gov/books/NBK448065/ [22.11.2017] In addition to iron-deficiency anaemia, persistent exhaustion can also indicate a deficiency in vitamin D, a thyroid disorder, or irregularities in blood pressure, and should be examined by a doctor.31Willibald Pschyrembel (2014): Prämenstruelles Syndrom. Berlin: De Gruyter

Premenstrual syndrome (PMS)

Premenstrual syndrome comprises a set of symptoms that affects one in three women for 4-14 days prior to menstruation.32Zahradnik H., Wetzka B., Schuth W. (2000): Zyklusabhängige Befindlichkeitsstörungen der Frau. In: Der Gynäkologe 33 (3), S. 225–238 The most common symptoms include psychological phenomena such as depressed moods or mood swings, anxiety, irritability, and feeling overwhelmed. Typical physical symptoms include drowsiness, difficulty with sleeping, changes in appetite, head and back pain, digestive problems, weight gain, and swelling of the breasts.33Lamertz C., Wittchen H. & K., Stolz W. (1998): PMS-Probleme vor der Regel. Das Prämenstruelle Syndrom erkennen, behandeln, überwinden. München: Mosaik Verlag, S. 9

As well as sufficient physical exercise, there are several tried-and-tested nutrition tips which can alleviate the symptoms of PMS. Eating 4-6 regular, smaller meals containing complex carbohydrates such as wholegrain foods, steamed or fresh vegetables, and fruit, as well as drinking herbal teas can help manage the symptoms. However, white flour, carbonated mineral waters, nightshade plants (such as tomatoes, onions, garlic, and potatoes), alcohol, caffeine, sugar, salt, and meals with fat content exceeding 20% should be avoided or reduced.34Bianco V., Cestari AM., Casati D. et al.: Premenstrual syndrome and beyond: lifestyle, nutrition, and personal facts. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25020055 [22.11.2017] Calcium, magnesium, and vitamin B6 (see depressive mood swings) also have a positive effect on PMS. Magnesium-rich foods include cocoa, cashews, peanuts, almonds, soya protein, wholegrain bread, oat flakes, beans, and lentils. Foods that are high in calcium include sesame, spinach, soya products, hazelnuts and kale.35World Health Organization (WHO) (1996). Research on the menopause in the 1990s: WHO Technical Report Series. Geneva: World Health Organization, S. 1 ff. For a higher intake of vitamin B6 eat increased quantities of legumes, nuts, seeds, and soya products.36Dieticians of Canada, Food Sources of Vitamin B6 (2015). Available at: https://www.dietitians.ca/getattachment/ea1272c8-602f-4586-8ffb-d7b4a2535634/FACTSHEET-Food-Sources-of-Vitamin-B6.pdf.aspx

Menopausal symptoms

Symptoms of menopause may begin to appear around the age of 40. This is caused by hormonal changes, marked, in particular, by a decline in production of the female hormone oestrogen. About two-thirds of women experience hot flushes and intense sweating as a result of this change. Other symptoms may include problems with falling asleep as well as interrupted sleep (see sleep disorders), mood swings, and depressed moods (see depressed moods). As oestrogen levels decrease, the risk of osteoporosis increases since oestrogen helps to maintain bone density.37Rensing, L. & V. Rippe (2014): Altern. Springer Berlin Heidelberg S. 77 ff. 38Englert, H. et al. (2016): Vegane Ernährung. Haupt Verlag, S. 93 ff.

Menopausal symptoms can be managed through a combination of diet and exercise.39Ho-Pham LT et al. (2012): Vegetarianism, bone loss, fracture and vitamin D: a longitudinal study in Asian vegans and non-vegans. Eur J Clin Nutr. 66, S. 75–82 A wholefood plant-based diet that is rich in vitamins and minerals (especially vitamin D and calcium), along with a high proportion of raw food, can improve general well-being during this period of hormonal change. Avoiding animal-based foods can also have a positive effect on the symptoms. Among other things, doing so can prevent the depletion of valuable bone tissue, which in turn reduces the risk of osteoporosis.40Burckhardt P. (2016): The role of low acid load in vegetarian diet on bone health: a narrative review. Swiss Med Wkly.1462 41Silber, B. Y. & J. A. J. Schmitt (2010): Effects of tryptophan loading on human cognition, mood, and sleep. In: Neuroscience & Biobehavioral Reviews 34, S. 387–407

Sleep disorders

Sleep disorders or interrupted sleep are particularly frequent during times of professional or personal stress. A plant-based diet can have a positive effect on the quality of sleep. Potatoes, vegetables, elderflowers, and dark grapes, as well as foods containing tryptophan (bananas, soya, walnuts) and B vitamins (which aid in the synthesis of serotonin), can improve quality of sleep. Eating late at night and consuming meals that are difficult to digest, as well as heavily seasoned food, alcohol, and caffeine, will all impact negatively on your sleep. Animal-based foods such as bacon, ham, sausage, and mature cheese also interfere with sleep.42Peuhkuri, K. et al. (2012): Diet promotes sleep duration and quality. Nutrition Research. 32, S. 309–319 43Deutsche Gesellschaft für Ernährung (Herausgeber.: DGExpert 1.8 (BLS 3.02) Bonn, 2013 Sleep problems can be caused by a number of factors, which is why long-term symptoms should be evaluated by a doctor.

Depressed moods

Depressed moods and feeling glum are not synonymous with depression (however, serious depression should always be treated by a medical professional). Many factors may be at play, including nutrition. The following B vitamins are particularly effective at strengthening the nervous system: B3 (niacin), B6 (pyridoxine), and B12 (cobalamin). Foods containing vitamin B3 include wheat bran, yeast flakes, soya, rye, peanuts, cashews, and seeds. Good sources of Vitamin B6 include pulses, wholegrain products, seeds, and nuts.44Englert H.; Siebert S.; Heine F. et al. (2016): Vegane Ernährung. Uni-Taschenbücher GmbH. 1. Auflage. Bern: Haupt Verlag (UTB Ernährungswissenschaften, 4402). On a purely plant-based diet, vitamin B12 should be supplied using dietary supplements.45Martin, V. T. & B. Vij (2016): Diet and Headache: Part 2. Headache: The Journal of Head and Face Pain. 56, S.1553–1562 Depressed moods can also occur during menopause (see menopausal symptoms).

Headache and migraines

Headaches and migraines can be caused by numerous factors – changes in the weather, medication, stress, and diet are all potential triggers. In addition to using lemons for pain relief and consuming plenty of fluids46Blau J.N., Kell C.A., Sperling J.M. (2004): Water-deprivation headache: a new headache with two variants. Available at https://www.ncbi.nlm.nih.gov/pubmed/14979888
, the essential fats (particularly omega-3 fatty acids) contained in linseeds, walnuts, as well as rapeseed and soya oils can also help reduce the likelihood of headaches.47Silberstein S. (2015): Preventive Migraine Treatment. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4640499/ [22.11.2017] 48Sanders A.E., Shaikh S.R., Slade G.D. (2018) Long-chain omega-3 fatty acids and headache in the U.S. population. Available at https://www.plefa.com/article/S0952-3278(18)30072-3/abstract
Migraines can be caused by foods such as chocolate, cheese, industrially processed meats, cow’s milk, and alcohol (especially wine).49Rist P., Buring J., Kurth T. (2014): Dietary patterns according to headache and migraine status: a cross-sectional study. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442763/ [22.11.2017] Furthermore, you should avoid ready meals and fast food. Migraines or frequent headaches should be treated by a specialist if they persist for extended periods.

References   [ + ]

1. Labenz J., Holtmann G. (2017): Ratgeber Sodbrennen. Available at: https://www.gastro-liga.de/fileadmin/download/Sodbrennen-137-06_17.pdf [22.11.2017]
2. Zalvan C, Hu S., Greenberg B. et al. (2017): A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux. JAMA Otolaryngol Head Neck Surg]
3. Alexandra Schek (1998): Ernährungslehre kompakt. Kompendium der Ernährungslehre für Studierende der Ernährungswissenschaft, Medizin und Naturwissenschaft. Frankfurt am Main: Umschau Zeitschriftenverlag, S. 174
4. Terjung B., Lammert F. (2007): Laktoseintoleranz: Neue Aspekte eines alten Problems. Deutsche Wochenschrift; 132, S. 271–275
5. Wittkamp, P. et al. (2012): Prävalenz des Reizdarmsyndroms nach den Rom-III-Kriterien in Deutschland und Zusammenhänge mit potentiellen Risikofaktoren. Zeitschrift für Gastroenterologie 50
6. Canavan, C., J. West & T. Card (2014): The epidemiology of irritable bowel syndrome. Clin Epidemiol. 6, p.71–80
7. NHS: Good foods to help your digestion (2016). Available at: https://www.nhs.uk/live-well/eat-well/good-foods-to-help-your-digestion/
8. National Center for Biotechnology Information (2017) Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients!
Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467063/
9. Trüeb R. (2003): Haare. Praxis der Trichologie. Berlin/Heidelberg: Springer, S. 506
10. Achenbach R. (2001): Der große TRIAS-Ratgeber. Haut, Haare, Nägel. Stuttgart: TRIAS
11. Davey G..; Spencer E.; Appleby P. et al. (2003): EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. In: Public health nutrition 6, S. 259–269
12. Lim, N. R. et al. (2017): The Role of Elimination Diets in Atopic Dermatitis-A Comprehensive Review. In: Pediatric Dermatology 34, S. 516–527
13. Nutten S. (2015): Atopic Dermatitis: Global Epidemiology and Risk Factors. Ann Nutr Metab 2015;66(suppl 1):8-16 available at https://www.karger.com/Article/Pdf/370220
14. Thomas, W. et al. (2016): Leitlinie Neurodermitis [atopisches Ekzem; atopische Dermatitis]. In: Journal der Deutschen Dermatologischen Gesellschaft 14, S. e1–e757
15. Shokeen, D. (2016): Influence of diet in acne vulgaris and atopic dermatitis. In: Cutis. 98, S. E28–E297
16. McCusker M., Robert Sidbury R.(2016): Nutrition and skin: Kids are not just little people. In: Clinics in Dermatology 34, S. 698–709
17. Romańska-Gocka, K. et al. (2016): The possible role of diet in the pathogenesis of adult female acne. In: Postepy Dermatol Alergol 33, S. 416–420
18. Shokeen, D. (2016): Influence of diet in acne vulgaris and atopic dermatitis. In: Cutis 98, S. E28–E29
19. McCusker M., Robert Sidbury R. (2016): Nutrition and skin: Kids are not just little people. In: Clinics in Dermatology 34, S. 698–709
20. Pérez-Cano F., Castell M. (2016): Flavonoids, Inflammation and Immune System. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5084045/ [22.11.2017]
21. Elmadfa, I. & C. Leitzmann (2015): Ernährung des Menschen. Verlag Eugen Ulmer, S. 120 (bzw. 111–120)[22.11.2017]
22. Krishnapura, S. (2017) Ginger rhizomes (Zingiber officinale): A spice with multiple health beneficial potentials, In: PharmaNutrition 5, S. 18–28
23. Elmadfa, I. & C. Leitzmann (2015): Ernährung des Menschen. Verlag Eugen Ulmer, S. 1198
24. Elmadfa, I. & C. Leitzmann (2015): Ernährung des Menschen. Verlag Eugen Ulmer, S.176 ff.
25. Seelig, M. S. (1994). Consequences of magnesium deficiency on the enhancement of stress reactions; preventive and therapeutic implications (a review). Journal of the American College of Nutrition, 13(5), 429-446.
26. Notay, K. et al. (2017): Acute beetroot juice supplementation on sympathetic nerve activity: a randomized, double-blind, placebo-controlled proof-of-concept study. American Journal of Physiology – Heart and Circulatory Physiology. 313, S. H59–H65
27. Ledochowski, M. (2010): Klinische Ernährungsmedizin. Springer-Verlag Vienna, S. 278
28. Leitzmann C., Keller M. (2010): Vegetarische Ernährung. Stuttgart: Ulmer, S. 216 ff.
29. Maria Lohmann (2013): Der Basen-Doktor. Basische Ernährung: gezielte Hilfe bei den häufigsten Beschwerden. Stuttgart: TRIAS, S. 73 ff.
30. Warner M., MD, Kamran M., et al. (2017): Anemia, Iron Deficiency. Available at: https://www.ncbi.nlm.nih.gov/books/NBK448065/ [22.11.2017]
31. Willibald Pschyrembel (2014): Prämenstruelles Syndrom. Berlin: De Gruyter
32. Zahradnik H., Wetzka B., Schuth W. (2000): Zyklusabhängige Befindlichkeitsstörungen der Frau. In: Der Gynäkologe 33 (3), S. 225–238
33. Lamertz C., Wittchen H. & K., Stolz W. (1998): PMS-Probleme vor der Regel. Das Prämenstruelle Syndrom erkennen, behandeln, überwinden. München: Mosaik Verlag, S. 9
34. Bianco V., Cestari AM., Casati D. et al.: Premenstrual syndrome and beyond: lifestyle, nutrition, and personal facts. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25020055 [22.11.2017]
35. World Health Organization (WHO) (1996). Research on the menopause in the 1990s: WHO Technical Report Series. Geneva: World Health Organization, S. 1 ff.
36. Dieticians of Canada, Food Sources of Vitamin B6 (2015). Available at: https://www.dietitians.ca/getattachment/ea1272c8-602f-4586-8ffb-d7b4a2535634/FACTSHEET-Food-Sources-of-Vitamin-B6.pdf.aspx
37. Rensing, L. & V. Rippe (2014): Altern. Springer Berlin Heidelberg S. 77 ff.
38. Englert, H. et al. (2016): Vegane Ernährung. Haupt Verlag, S. 93 ff.
39. Ho-Pham LT et al. (2012): Vegetarianism, bone loss, fracture and vitamin D: a longitudinal study in Asian vegans and non-vegans. Eur J Clin Nutr. 66, S. 75–82
40. Burckhardt P. (2016): The role of low acid load in vegetarian diet on bone health: a narrative review. Swiss Med Wkly.1462
41. Silber, B. Y. & J. A. J. Schmitt (2010): Effects of tryptophan loading on human cognition, mood, and sleep. In: Neuroscience & Biobehavioral Reviews 34, S. 387–407
42. Peuhkuri, K. et al. (2012): Diet promotes sleep duration and quality. Nutrition Research. 32, S. 309–319
43. Deutsche Gesellschaft für Ernährung (Herausgeber.: DGExpert 1.8 (BLS 3.02) Bonn, 2013
44. Englert H.; Siebert S.; Heine F. et al. (2016): Vegane Ernährung. Uni-Taschenbücher GmbH. 1. Auflage. Bern: Haupt Verlag (UTB Ernährungswissenschaften, 4402).
45. Martin, V. T. & B. Vij (2016): Diet and Headache: Part 2. Headache: The Journal of Head and Face Pain. 56, S.1553–1562
46. Blau J.N., Kell C.A., Sperling J.M. (2004): Water-deprivation headache: a new headache with two variants. Available at https://www.ncbi.nlm.nih.gov/pubmed/14979888
47. Silberstein S. (2015): Preventive Migraine Treatment. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4640499/ [22.11.2017]
48. Sanders A.E., Shaikh S.R., Slade G.D. (2018) Long-chain omega-3 fatty acids and headache in the U.S. population. Available at https://www.plefa.com/article/S0952-3278(18)30072-3/abstract
49. Rist P., Buring J., Kurth T. (2014): Dietary patterns according to headache and migraine status: a cross-sectional study. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442763/ [22.11.2017]
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