DISCUSSION AND CONCLUSIONS

According to this study where both hypotheses H1 and H2 were accepted, the researcher concluded that most Lebanese adopt a type of vegetarian diet or are interested in this lifestyle for a temporary period and mainly for religious and health reasons. They also feel it has a positive effect on their health. This conclusion is based on the following reasons:

• Some people in Lebanon have resorted to vegetarian food for religious reasons, mainly Christians (during Lent period and Wednesdays &/or Fridays throughout the year).
• Fewer Lebanese have adopted vegetarianism based on certain principles and a belief system like animal rights activists or simply losing confidence in the sources of their meat or dairy products and correspondingly their safety to be consumed [10]. This has been happening in the recent years after exposing suppliers' and distributors' unethical and unhygienic practices on national TV news.
• In Lebanon, a fair percentage of the sample surveyed have adopted this diet since they themselves or their relatives suffer from ailments and found this diet to have a positive effect in relieving some symptoms, generally feeling better and reducing the intake of certain medications. Many others found a vegetarian diet (if not permanently, at least at certain periods) to be a good complementary lifestyle to their conventional therapies.
• Historically speaking, Arabic medicine roots from this region and is based on herbal and other ancient home remedies encouraging the consumption of more vegetarian food in combination with herbal medicine in several treatment aspects.

Most people in Lebanon find it easier to surrender to the westernized lifestyle , modern medicine and taking little part in the treatment process. Relieving symptoms as quick as possible by taking medication seems to be a habit. Changing your diet and removing meat products seems very challenging and limiting to most of them since it entails taking one's health into one's own hands, making major diet and lifestyle changes, not to mention amending the menu for weekend family barbeques (which seems to be a hobby for many) and changing habits while tolerating some withdrawal symptoms like hunger and cravings. Therefore, from the health point of view, a vegetarian diet (specially the semi-vegetarian or lacto-vegetarian) will most likely be adopted by Lebanese during certain periods and not permanently, usually in cases of religious purposes (Christian Lent) and major illnesses that mandate the abstinence of meat and high fat dairy product for a certain period of time. Rarely will few Lebanese adopt being strict vegans on a more permanent basis. Thus, the researcher concluded that many people in Lebanon look upon vegetarianism as a temporary diet rather than a permanent one or to be applied a few times a week/month.

This research implies that most people in Lebanon are more interested in its health, religious and diet facets. This can be emphasized since a vegetarian diet in general has several positive effects on a person's health status even when a disorder is involved. Contrary to modern belief, a vegetarian diet (rich in whole grains and beans) provides more strength and endurance than a modern meat and sugar diet. In many cases, it reduces the need for medication, slowly relieves some undesirable symptoms, improves general well-being and decreases the need for conventional medical therapies. Several medical doctors praise the vegetarian diet for its low fat, sugar and caloric properties. In addition, a vegetarian diet is high in fiber and complex carbohydrates. When you omit processed foods, you begin to strengthen your immune system. Vegetarian diets offer a number of advantages, including lower levels of saturated fat, cholesterol, and animal protein with higher levels of carbohydrates, fiber, magnesium, boron, folate, antioxidants such as vitamins C and E, carotenoids, and phytochemicals [ 9]. These diets also provide health benefits in the prevention and treatment of certain ailments (specifically hypertension, hypercholesterolemia, diabetes, etc) . The key to reaping the benefits of a vegetarian diet is in the understanding of the phrase "appropriately planned," meaning, identifying the key nutrients deficient and finding ways to supplement them.

On the other hand, the major concerns are that strict vegetarian diets (like vegans) may be low or lacking in protein, Vitamin B12, calcium, omega 3, iron, and Vitamin D. So there are certain key points to consider for avoiding the drawbacks of a vegan diet. Lacto -ovo and semi-vegetarian diets are at a very low risk of developing these nutrient deficiencies.

Vegetarians could easily meet their protein needs by eating a varied diet, as long as they consume enough calories to maintain their weight. It is not necessary to plan combinations of foods. A mixture of proteins throughout the day will provide enough essential amino acids [11]. Thus complementary proteins (i.e. rice and beans) do not need to be consumed at the same meal [14]. Most importantly, the quality of plant protein varies: whereas soy protein can meet protein needs as effectively as animal protein, wheat protein eaten alone may be 50% less usable than animal protein [15]. So for semi-vegetarians, seafood, especially white fish and sometimes salmon or tuna, if consumed 1-3 times per week, will benefit the diet with a good source of protein and omega 3 fatty acids. In general, sources of protein for all vegetarians should include beans, lentils, tofu, nuts, seeds, tempeh, chickpeas and peas. In addition, whole grain bread, cereals, low fat dairy and other common foods may also add to protein intake.

Iron needs will vary most likely from individual to individual based on the makeup of their overall vegetarian diet. Recommended iron intakes for vegetarians are 1.8 times those of non-vegetarians because of lower bioavailability of iron from a vegetarian diet [11]. Iron sources for vegetarians include dried beans, tofu, lentils, tempeh, spinach, chard, baked potatoes, cashews, dried fruits, bulgur, and iron-fortified foods (such as cereals, instant oatmeal, and veggie "meats"). Plant foods contain only non-heme iron, which is more sensitive than heme iron to both inhibitors and enhancers of iron absorption. Inhibitors include phytate, calcium, teas, coffee, cocoa, and fiber, while enhancers include vitamin c and other organic acids. To increase the amount of iron absorbed at a meal, eat a food containing vitamin C, such as citrus fruit or juices, tomatoes, or broccoli. Using iron cookware also adds to iron intake [16 ].

Calcium, the main mineral in bones, plays an important role in bone health. Children whose diets are low in calcium may develop osteoporosis as adults and have a greater risk of breaking bones. Some studies, although not all, have shown that older adults with a high calcium intake have stronger bones and a lower fracture risk. There is a limited number of studies on vegans, most of which find low bone density as well as low calcium intakes[19-20]. One study, where vegans had calcium intakes close to recommended levels, found that calcium was well-absorbed from a vegan diet[21]. Calcium is present in many plant foods and fortified foods. Low oxalate greens (bokchoy, broccoli, Chinese/Napa cabbage, collards, kale, okra, turnips greens) provide calcium with high bioavailability (49-61%) in comparison with calcium fortified juices, tofu, and cow's milk (31-32%), and with fortified soymilk, sesame seeds, almonds, and red and white beans (21-24%) [17]. However, oxalates present in some foods can greatly reduce calcium absorption, so vegetables that are high in oxalates, such as spinach and beets are not good sources of usable calcium despite their high calcium content [11]. The ADA recommends that vegetarians meet the recommended intakes for calcium by consuming at least eight servings per day of foods that provide 10-15% of the adequate intake for calcium as indicated in the Vegetarian Food Guide Pyramid (see Appendix I). For vegetarians who do not want to include dairy products in their diet, they are advised to consume calcium-enriched products (like orange juice and rice milk), leafy green vegetables, grains, nuts, tofu, pumpkin seeds, and soy drinks.

It's not enough to have a high-calcium diet; adequate vitamin D is needed for calcium to be absorbed. Vitamin D is necessary throughout life to help build strong bones in childhood and adolescence and to maintain bones throughout adulthood[19]. Vitamin D status depends on sunlight exposure and intake of vitamin D fortified foods or supplements. Sun exposure to the face, hands, forearms and legs for 5-15 minutes per day during the summer is believed to provide sufficient amounts of vitamin D for light skinned people, while darker skinned people require longer exposure [18 ]. Nevertheless, many factors, including season, time of day, age, sunscreen use, and pollution, can interfere with this production. Some vegetarian food that is fortified with vitamin D includes soymilk, rice milk, and some breakfast cereals. Therefore, if sun exposure and intake of fortified foods are insufficient, then vitamin D supplements are recommended [13].

Despite the fact that vitamin B12 has a low recommended daily intake, it is still an essential nutrient (with undesirable deficiency symptoms) encouraging vegetarians to familiarize themselves and consume a variety of good sources. Fortified foods, such as some brands of cereal, nutritional yeast, soymilk, or veggie "meats," are good non-animal sources [11]. A balanced vegetarian diet may also contain tempeh and natto (forms of fermented soybeans) that are rich in Vitamin B12. To be on the safe side, vegetarians should consume a supplement, fortified food, dairy product, or eggs to meet recommended intakes of vitamin B12 especially pregnant, lactating women and for breastfed infants if the mother's diet is not supplemented. Tempeh, miso, sea vegetables, and other plant foods are sometimes reported to contain vitamin B12. These products, however, are not reliable sources of the vitamin. The standard method for measuring vitamin B12 in foods measures both active and inactive forms of vitamin B12. The inactive form (also called analogues) actually interferes with normal vitamin B12 absorption and metabolism [22]. When only active vitamin B12 is measured, plant foods including fermented soyfoods and sea vegetables do not contain significant amounts of active vitamin B12 [23].

The researcher truly believes that a well-balanced vegetarian or at least a semi-vegetarian diet will be successful in Lebanon and the market for its organic and meat-alternative products will grow noticeably in the near future. If not abiding 100% with a vegetarian diet, a well-balanced diet based mostly on plant-based food, could simply be applied, most essentially: eating organic seasonal food, mostly vegetarian food (whole grains, beans, legumes, seaweeds, vegetables), eating according to our seasonal needs, exercising, avoiding fast food and processed food, etcTherefore, the Lebanese government and health agencies should:

• Support organized import and export regulations regarding organic foods, meat-alternatives and dairy-substitutes.
• Encourage farmers to grow organic food and to produce meat and dairy alternatives.
• Cooperate with local and international vegetarian associations or experts to organize workshops, conferences and research programs.

SUMMARY AND OVERALL RECOMMENDATIONS

People who are interested in a vegetarian diet or are knowledgeable about it believe that this diet can improve their general well-being, yet find it difficult to find healthy meat/dairy alternatives and to follow a balanced nutrient-rich diet. Therefore, providing them with healthy substitutes and simple tips would be very beneficial. The following are some substitutes for animal products available in natural foods stores, Asian food stores or specified aisles in big supermarkets :

**Meat substitutes in soups or stews :
• Tempeh (cultured soybeans with a chewy texture)
• Tofu (a bean curd; freezing and then thawing gives tofu a meaty texture; tofu will turn slightly off-white in color)
• Wheat gluten or seitan (made from wheat and has the texture of meat; great for vegan 'shawarma' )