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mong a number of alternative dietary regimens, raw food diets are interesting and increasingly popular in western countries. A high proportion of raw foods in the diet is the general concept, while raw food eaters follow different raw food dietary recommendations. The subjects are composed of 230 male and 342 female raw food eaters between the ages of 25-74 years, having maintained raw food diets for 2.3 years on average. Health habits were investigated by means of a detailed questionnaire and food frequency questionnaire, which were used to estimate food intake and food habits of the subjects. The raw food eaters in this study had high awareness concerning health. Most of them refused smoking, alcohol and frequently exercise. Findings indicated that 29.5% of male and 24.9% of female raw food eaters were underweight according to their body mass indices (BMI). Underweight was more pronounced in the raw food eaters with a higher proportion of raw food intake. An obvious relationship between the proportion of raw food consumed and menstrual situation was observed. Most raw food eaters consumed vegetarian diets. The average amount of fruit and vegetables consumed by the study cohort was 1,836 g/d. The most favored fluids among raw food eaters were water, mineral water, fruit juices and herbal tea. Some raw food eaters did not drink at all (3.0%) and 31.6% drank less than 500 ml/d. Raw food diets contain a lot of vitamins and minerals as well as phytochemicals, but the strict vegan group with high proportion of raw food diets may pose nutritional problems. Anti- nutrients and toxic substances in some raw foods should be correspondingly considered. Moreover, food safety is another point for concern in the consumption of raw food diets due to possible contamination by parasites, bacteria and soil-transmitted pathogens.
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THE JOURNAL OF TROPICAL MEDICINE AND PARASITOLOGY
Vol 23 (No. 1) June 2000
Lifestyle and Health Aspects
of Raw Food Eaters
A
Karunee Kwanbunjan1, Corinna Koebnick2, Carola Strassner3,
Claus Leitzmann3
1Department of Tropical Nutrition and Food Science, Faculty of Tropical Medicine , Mahidol University,
Bangkok, Thailand; 2Institute of Medical Informatics, Biometry and Epidemiology, Erlangen-
Nuremberg, Germany; 3Institute of Nutrition, University of Giessen, Germany
Abstract
mong a number of alternative dietary regimens, raw food diets are interesting and
increasingly popular in western countries. A high proportion of raw foods in the diet is the
general concept, while raw food eaters follow different raw food dietary recommendations. The
subjects are composed of 230 male and 342 female raw food eaters between the ages of 25-74
years, having maintained raw food diets for 2.3 years on average. Health habits were investigated
by means of a detailed questionnaire and food frequency questionnaire, which were used to
estimate food intake and food habits of the subjects. The raw food eaters in this study had high
awareness concerning health. Most of them refused smoking, alcohol and frequently exercise.
Findings indicated that 29.5% of male and 24.9% of female raw food eaters were underweight
according to their body mass indices (BMI). Underweight was more pronounced in the raw food
eaters with a higher proportion of raw food intake. An obvious relationship between the proportion
of raw food consumed and menstrual situation was observed. Most raw food eaters consumed
vegetarian diets. The average amount of fruit and vegetables consumed by the study cohort was
1,836 g/d. The most favored fluids among raw food eaters were water, mineral water, fruit juices
and herbal tea. Some raw food eaters did not drink at all (3.0%) and 31.6% drank less than 500
ml/d. Raw food diets contain a lot of vitamins and minerals as well as phytochemicals, but the
strict vegan group with high proportion of raw food diets may pose nutritional problems. Anti-
nutrients and toxic substances in some raw foods should be correspondingly considered. Moreover,
food safety is another point for concern in the consumption of raw food diets due to possible
contamination by parasites, bacteria and soil-transmitted pathogens.
Keywords: raw food diets, raw food eaters, vegetarian, vegan
Introduction
Health and long life are the primary goals
of the raw food diets, as well as remedies and
prophylactics. Raw food diets are an alternative
food regimen, the general idea of which is to
refuse cooked foods because of their being
denatured and worthless. Fresh, raw and
unprocessed food is the natural food for man in
the raw food eater’s opinion.
The concept of eating raw food diets
developed for many reasons. Max Bircher-
Benner (1867-1939), a Swiss medical doctor,
treated patients successfully with raw food diets
in his private clinic [1]. From his own experience,
Are Waerland (1876-1955) found that lacto-
vegetarian diets, mainly raw foods, were effective
treatments of his illness [2]. “Natural Hygiene”
began in 1822 by a group of American physicians
who believed in natural treatment in traditional
medicine. The medical doctor Herbert Shelton
ORIGINAL ARTICLE J Trop Med Parasitol 2000;23:12-20.
Vol 23 (No. 1) June 2000
THE JOURNAL OF TROPICAL MEDICINE AND PARASITOLOGY
13
(USA,1895-1985) followed this concept and
became well known as the Father of Natural
Hygiene [3]. Raw food diets, as recommended
by Helmut Wandmaker (1991), a German
businessman, focus on fresh fruits [4]. Raw meat
was included in the “Instinct Therapy”
developed by Guy-Claude Burger (1990), a
French cellist [5]. A American bestseller book “
Fit For Life” was written by Harvey and Marilyn
Diamond (1986), following the concept of
Natural Hygiene [6]. Most of the books that have
been written have recommended raw food diets
without scientific evidence. Raw food diets are
not homogeneous food regimens. These have
been classified into different groups of raw food
diets due to various recommendations [7] (Fig 1).
At present, raw food diets are increasingly
popular in western countries, including
Germany. This group of people follows different
raw food diet recommendations. The effects of
practicing raw food diets long-term are not
known. There is also no scientific information
on treatments with these alternative dietary
regimens. This investigation is part of the
Giessen raw food study, which was designed to
elucidate the lifestyles, food habits and behaviors
as well as health aspects of the group of people
whose diets are comprised mostly of raw food.
Materials and methods
A total of 572 raw food eaters (230 males
and 342 females) were recruited by
announcement in 9 different nationwide
magazines, appropriate lectures, health
congresses and self-help associations. The criteria
for selecting the study group were a minimum
quantity of 70% raw food in the diet and having
practiced for at least 4 months continually; the
lowest age of the participants was 16 years.
All the studied group was asked to complete
the questionnaires, which were designed to
include biographical data, information on eating
patterns, foods and sources of foods, health
behavior, the use of medications and health
supplements, socioeconomic information and
physical activity. The food frequency
questionnaires were developed in order to
estimate the food intake and calculate the raw
Lifestyle and Health Aspects of Raw Food Eaters
vegan raw
food diets
vegetarian raw
food diets
mixed fruit-vege-
table raw food diet predominantly
fruit raw food diet
ovo-lacto-vege-
tarian raw food diet
instinct therapy
Michael Lukas Möller
Guy-Claude Burger
L and S Kenton
Helmut Wandmaker
Norman Walker
Arnold Ehret
Harvey and Marilyn Diamond
Christian Opitz
Chrysostomos (Franz Konz)
JG Schnitzer
Devanando O Weise
Herbert Shelton
Are Waerland
Fig 1 The different raw food diets.
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Vol 23 (No. 1) June 2000
Total 70-79% 80-89% 90-99% 100%
Participants (%)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Raw food proportion
age > 65 y
age 45-54 y
age < 25 y
age 25-34 y
age 35-40 y
age 55-64 y
food proportion in this studied collective. The
data were analyzed by the statistical program
SPSS for Windows 6.3.
Results
The mean age of the participants was 44
years (44 ± 14.1) and they averaged 2.3 years
(2.3 ± 6.1) of adhering to raw food diets. Most
of them were in the age range 45-54 years. The
quantity of raw food consumed was age-
dependent, there were negative correlation with
high significance (p = 0.002). The older age group
eating the smaller amount of raw food (Fig 2).
The educational status of the participants
was higher than that of the average German
population. Therefore, with their higher level
profession, their incomes were correspondingly
rather high as well [8-10]. From the findings it
appeared that the majority of these raw food
eaters followed the recommendations of Helmut
Wandmaker (27.3%) and Guy-Claude Burger
(19.1%), whereas the rest preferred the different
raw food models from Diamond and other
authors. A proportion of them gave no answer
(16.9%). Obviously, most of the studied group
practiced raw food diets because of their belief
that they were healthy (62.5%); other reasons
were ethics, beauty, taste, ecology and social
factors. However, this agreed with the answer
that their own sickness was the reason of diet
change (54.9%).
It was noted that the members of the study
group had high awareness concerning health, a
small number smoked (2.1%), most refused
alcohol (98.0%) and some drank only a small
amount (20 ml/d). They went for relaxation
exercise frequently. Almost half of them visited
for a sauna and 20% practiced yoga regularly.
Most of them did not use any supplements or
medicines to complete their diets (67.0%),
whereas a few took some vitamins and minerals.
The supplements that they often used were
preserved algae such as spirulina (7.9%), while
25.1% took various other supplements and
medicines. Only two out of the 342 female raw
food eaters took oral contraceptives. This
corresponded to only 0.6%, much lower than the
general German female population (37.0%) from
a survey in 1985 [11], and the studied group
adhering to wholesome nutrition (8.6%) [12].
Fasting and flushing the gut are recommended
by various authors to purify the body. Almost half
of the participants (49.3%) fasted many times a
year. The popular fasting methods were total
fasting and fasting with juice. Not many raw food
eaters regularly applied enemas (16.1%).
The general consensus among the raw food
eaters is that food must be in a natural form or
not heated above 40˚ C. The types of raw food
eaters in this study showed that most consumed
Fig 2 Distribution of age and raw food proportion eaten by participants.
Lifestyle and Health Aspects of Raw Food Eaters
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Lifestyle and Health Aspects of Raw Food Eaters
vegetarian diets, 38.1% ovo-lacto vegetarian and
24.5% vegan (Fig 3). The proportion of raw food
consumption is shown in Fig 4. Most of the
studied group consumed 95-99% raw food diets,
whereas the frequency of the others resemble
distribution into different raw food diet
proportions.
This accords with the expectation that the
fruit and vegetable consumption by the studied
members was relatively high, 1,836 g/d, in which
the ratio of fruits to vegetables was 2:1.
Compared with the German population and the
group adhering to wholesome nutrition, fruit
and vegetable consumption as well as
consumption of nuts and seeds by raw food
eaters was greater, whereas consumption of
breads and bakery products, milk and dairy
products, potatoes, cereals, animal foods, sugar,
and desserts was lower [12-13] (Table 1). The
average amount of animal food consumed was
22.1 g/d, which included 3.3 g/d raw egg, 0.3 g/d
raw meat, and 3.6 g/d raw fish. Alcohol, coffee
and black tea were not counted in the raw food
diets by 89% participants and 36.4% refused milk
and dairy products. Special attention was paid
to the quality of the food by raw food dieter.
Burger (1993) recommended that quality raw
food diets should comprise foods from special
37.0%
38.0%
25.0%
mixed diets
ovo-lacto vegetarian diets
vegan diets
13.8%
22.0%
13.7%
32.7%
17.8%
70-79% raw food
80-89% raw food
90-94% raw food
95-99% raw food
100% raw food
Fig 3 Percentage of raw food eaters classified
in various forms of raw food diets.
Fig 4 Percentage of raw food eaters
consuming different raw food
proportions.
Table 1 Average food consumed (g/d) by the raw food eaters compared with the
average German population and the group adhering to wholesome nutrition.
Food consumed Raw food German Wholesome
eaters population nutrition
Breads and bakery products 25.6 - 183.0
Milk and dairy products 41.2 236.2 228.0
Fruits and vegetables 1,836.2 221.3 589.0
Potatoes 18.5 104 -
Cereals and cereal products 22.2 248 -
Animal foods and products 22.1 164.4 26.0
Sugar and honey 6.5 - 11.0
Desserts 6.2 - 11.0
Nuts and seeds 40.7 1.7 -
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Table 2 Distribution of relative body weight in both male and female raw food eaters
compared with the average German population.
BMI
Classification Raw food eaters German population
male female male female
underweight* 29.5 24.9 3.8 5.6
normal** 68.3 70.3 43.7 46.5
overweight*** 2.2 3.6 41.9 36.3
obese**** 0.0 1.2 10.6 11.6
total 100.0 100.0 100.0 100.0
*underweight BMI for male < 20; female < 19
** normal BMI for male = 20-25; female = 19-24
*** overweight BMI for male = 25-30; female = 24-30
**** obese BMI for male > 30; female > 30
0 <0.5 0.5-1.0 1.0-1.5 1.5-2.0 >2
35
33
25
20
15
10
5
0
Fluids (l/d)
Participants (%)
Fig 5 Quantity of fluids intake by raw food eaters (l/d).
cultivation or farming, including tropical fruits.
The food source of 6% of raw food eaters
followed Burger [14]. However, 20% of raw food
eaters bought their fruits, vegetables and cereals
from conventional cultivation.
The studied group drank on average 870
ml/d. There were few raw food eaters who did
not drink at all (3.0%) and 31.6% drank less than
500 ml/d (Fig 5). Water and mineral water (597
± 632 ml/d), fruit juices (152 ± 322 ml/d) and
herbal teas (116 ± 260 ml/d) were the most
favored liquids among them, considering that
very few drank alcohol (20 ± 107 ml/d). Some
raw food eaters (20.2%) preferred distilled water.
Table 2 illustrates the weight distribution
of the studied group. The average BMI of male
raw food eaters was 20.7 (20.7 ± 2.2) and for
females it was 20.1 (20.1 ± 2.8), below the
national average; their BMI was distributed in a
narrow range, and 2.2% of males and 3.6% of
Lifestyle and Health Aspects of Raw Food Eaters
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Lifestyle and Health Aspects of Raw Food Eaters
females were overweight. Only female raw food
eaters showed 1.2% obesity. In contrast with
German populations, the incidences of
overweight and obesity in raw food eaters were
lower and underweight was higher [15]. There
were 29.5% male and 24.9% female raw food
eaters underweight. Most of the participants BMI
lay in the normal range (68.3% male, 70.3%
female). As is shown in Fig 6, underweight was
more common in the raw food eaters with a
higher raw food proportion. The correlation of
these parameters was statistically highly
significant (p = 0.0002). Weight change since
adherence to raw food diets was 72.0%. The male
raw food eaters lost 8 kg on average, and the
females lost 6 kg.
It was remarkable that most pre-
menopausal female raw food eaters (70%) found
that their menstruation cycle changed after
starting to practice the raw food diet. An obvious
relationship between the proportion of raw food
consumed and menstrual situation was observed
(Fig 7). The pure raw food diet class indicated a
great number of women whose menses were
absent or rare and the moderate class were
shown to occur seldom. It is interesting to find
that the average BMI of the female raw food
eaters with menstrual disturbance was lower
120
100
80
60
40
20
0
Participants
Total 70-79% 80-89% 90-99% 100%
Raw food proportion
underweight
normal
overweight
Fig 6 Relation between nutritional status and percentage of raw food eaters.
than those with regular menses.
Discussion
The raw food eaters in this study is a
heterogeneous group, in which vegetarians
predominate. Some are of a mixed group, who
consume only a small amount of animal food.
The strict vegan group, with a high proportion
of raw food in the diet, may pose nutritional
deficiencies. Raw food diets are characterized by
foods with high quantities of starch, fiber and
low fat. Fruits and vegetables are practically the
exclusive nourishing food and the tendency rises
with an increase of the raw food proportion. In
spite of the fact that raw food diets contain a lot
of vitamins and minerals as well as
phytochemicals, this type of food cannot
provide sufficient essential fatty acid and fat-
soluble vitamins. Considering the adverse effects
of raw foods, anti-nutrients and toxic substances
in uncooked food are another risk factor. Raw
egg-white contains avidin, which forms a
complex with biotin, and therefore this vitamin
cannot be absorbed. Goitrogen is found in some
raw vegetables i.e. cabbage, kale and some herbs,
solanin in green potatoes and protease inhibitor
in different kinds of bean and nut i.e. soy bean,
peanut [16].
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Vol 23 (No. 1) June 2000
The great loss of body weight in most
participants is evidence of the deficit of energy
sustenance [17-19]. Irregular menstruation is
obviously seen in the women who consume a
high proportion of raw food diets. This is a
compensatory mechanism to reduce loss since
there is an inadequate supply from food [20-23].
The Deutsche Gesellschaft für Ernährung (DGE,
1992) recommends the drinking of 1-2 l of water
daily [24]. More than half of the raw food eaters
cannot keep going this direction. Some of those
who did not drink at all gave the reason that
fruits and vegetables provide them with
sufficient water. Further study is needed to assess
the water intake by calculation from the water
content in raw food diets.
Food safety is another substantial subject
concerning the consumption of raw food diets.
The importance of food-borne infections exists
in many regions of the world. Although control
efforts have been exerted for quite some time,
overall progress has not been satisfactory, even
in many well-developed countries. Those who
ingest raw meat, pork or other animal foods
should be aware of the potential for infection
with toxoplasmosis, cysticercosis and
trichinellosis. There can be a risk of
salmonellosis from eating raw egg, whereas
anisakis has been reported in raw fish such as
herring [25]. Fresh fruits and vegetables can be
contaminated with soil-transmitted pathogens,
especially tropical fruits and vegetables [26-30].
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Fig 7 Relationship between disappearance of menstruation and proportion of raw food in pre-
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Lifestyle and Health Aspects of Raw Food Eaters
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... Nevertheless, even if we ignore problems of pathogens and putrefaction, modern humans seem to be less well adapted to the consumption of raw, compared to prepared foods. Modern humans on all-raw diets tend to be underweight (Kwanbunjan et al. 2000) and women consuming an all-raw diet tend to suffer chronic energy shortage and amenorrhea (Koebnick et al. 1999). It has been argued that raw foods are less rewarding than cooked foods in that they demand too much ingestion time for humans to be able to satisfy the demands of the energy-hungry brain (Fonseca-Azevedo and Herculano-Houzel 2012). ...
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The present status of food-borne parasitic zoonoses in West Germany is characterized by a relatively high frequency of toxoplasmosis, sarcocystosis and Taenia saginata infections. From empirical data it can be estimated that 4% of the German population become infected per year by Toxoplasma gondii as well as by Sarcocystis species (S. hominis, S. suihominis). The number of T. saginata infected persons is reckoned at 900,000, which is equal to an average prevalence of 1.5%. Due to meat inspection and to modern methods of breeding and keeping pigs trichinellosis and Taenia solium infections have become rare diseases. According to eating habits there are only sporadic cases of fascioliasis and anisakiasis. Whether Diphyllobothrium latum and Opisthorchis felineus are still endemic, is unknown; it seems that the influx of refugees from areas of high endemicity never created new foci in West Germany.
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