Diet & Lifestyle Questionnaire

Kaiser-Permanente Vegan Lifestyle Clinic (VLC) Food and Exercise Questionnaire
This questionnaire is about your usual food intake. There are also some questions about exercise. Foods are scored in such a way as to reflect both an adequate nutritional intake and the degree to which your lifestyle follows the exercise and vegan food recommendations of the Kaiser-Permanente Vegan Lifestyle Clinic (VLC). A larger and self-calculating spreadsheet version is available via free download.
Name : Last ___________ First______________ MRNR Date of birth: mm/dd/yy Male __ Female__
Wt (lbs)______Ht (in)_______		BMI=
Body Mass Index (BMI) = 705x(lbs) ÷ (in) sqd Ex: 705X175 lbs ÷ (62"x62")=32.1 (Obesity II) See chart at bottom to interpret your BMI number.
Instructions: Listed below are food items divided into sections according to food type. Please put a whole or decimal number (or leave blank when appropriate) in the times/week column to indicate how many times you have eaten each food during the last week. Estimate whether the serving was Small - (1 2 3 4 5) - Large. Try to estimate the amounts of a given food that may be in recipes made mostly of some other food.
Example:			Times/wk	x Sm-(1 2 3 4 5)-Lar	x VF	= Score
Half a head of Romaine lettuce 3 times/week			3	x 4	x 4.9	=58.8
(Times/wk = 3)		Sm-(1 2 3 4 5)-Lar = ~ 4		(approximate)

ANIMAL SOURCE FOOD Animal food Value Factors (VF) are based on cholesterol and saturated fat content. In the context of the VLC it is judged that whatever nutritional values may be found in these foods are offset by their disadvantages so that value of animal food is negative. While animal foods are good sources of second-hand amino acids and other nutrients, they all contain first-hand saturated fat and cholesterol, which are risk factors for obesity, cardiovascular disease, six types of cancer, and diabetes. The excessive protein and sulfur amino acid content are risk factors for kidney disease ans osteoporosis. Animal source food has no fiber and is deficient in vitamin C, and magnesium. At least 28 separate food-borne illnesses are transmitted to humans from animal source food and, because of modern agricultural practices, these foods are also contaminated by pesticides, herbicides, and hormones at a much higher concentration than plant foods. Animal source food is adaptive when there's not enough food (the condition of our ancestors), but only harmful and obselete when there are diverse and plentiful plant foods to choose from (our present condition).
MEAT (VF from -5 to -4)			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
Spam, luncheon meats, Vienna sausage, etc.					-5.0
ham, bacon, pork roast, pork chops					-4.9
beefsteak, hamburger, sirloin steak, beef ribs					-4.8
lamb chops, lamb roast					-4.5

POULTRY (VF from -4 to -3)			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
chicken, turkey, duck, pheasant, goose					-3.5

EGGS (VF from -3 to -2)			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
whole eggs					-3.0
egg white (no cholesterol but #3 on food allergy list)					-2.0

FISH (VF from -2 to -1)			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
shellfish					-1.7
fish					-1.4

DAIRY (VF from -1 to 0) A good source of calcium but also of saturated fat and cholesterol.
			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
whipped cream, dairy desserts, ice cream.					-1.0
butter (almost 100% fat)					-1.0
cheese					-0.9
milk					-0.8
"low fat" cottage cheese					-0.1

NO MAN'S LAND Mostly packaged foods (VF from -1 to +1).

DRESSINGS AND SPREADS			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
mayonnaise					-1.0
stick margarine (usually contains hydrogenated fat)					-0.7
canola oil and olive oil					0.5
flaxseed oil					0.7
oil-free dressing					0.8
Dijon sauce (p. 9 VLC "Getting Started")					0.9
Vinaigrette Dressing (p. 9 VLC "Getting Started")					0.9
"Healthy gravy" (p 9 "Getting Started")					1.0

SWEETS (empty Calories)			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
candy, chocolates				&fbsp;	-0.6
honey					-0.3
sugar added to tea, coffee, cereal					-0.2
maple syrup					0.7
blackstrap molasses					1.0

DRINKS. Empty Calories			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
hard liquor					-1.0
beer / wine					-0.4
soft drinks, e.g. Coca Cola, Pepsi, 7-Up					-0.3
coffee, tea, decaffeinated					0.0
herbal tea					0.6
non-alcoholic beer / wine					0.9

CONDIMENTS			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
salt					0
vinegar					0.0
pepper					0.3
soy sauce					0.3
mustard					0.4
pickles (avoid "alum" on label)					0.9
tomato paste					1.0

NUTS AND SEEDS: natural, but high fat plant foods (VF from 0 to 1)
			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
raw hulled sunflower seeds					0.7
natural peanuts and peanut butter					0.8
raw unhulled sesame seeds (high in calcium)					0.8
raw almonds, walnuts					1.0

BREAD (VF from 1 to 2)
			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
white bread and rolls					1.0
brown bread and rolls					1.5
wholewheat bread, Pita bread					2.0

GRAINS (VF from 2 to 3)
			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
refined grains: white rice, white flour					0.5
brown rice					3.0

MEAT SUBSTITUTES: OK, but not required.
			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
soya meats, textured vegetable protein-TVP					2.8
Vegeburger, Boca Burger, Garden Burger Vegan. etc.					2.9

PASTA : A good pasta label reads "Durum semolina".
			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
refined pasta (spaghetti, macaroni, noodles)					2.3
whole grain, spinach, or artichoke pasta					2.8

CEREALS			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
commercial dry cereal (Kellogg's, Post, etc.)					2.0
oatmeal					2.5
muesli					2.8

FRUIT : Because of the high sugar content, diabetics should use fruit with restraint. (VF from 3 to 4)

			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
avocado					3.0
apples, bananas, grapes					3.2
pure fruit juice e.g. orange, apple, grapefruit					3.2
raisins (good iron source)					3.3
melons, watermelon					3.4
mango, papaya					3.8
strawberries, other berries					3.9
apricots, nectarines, peaches, pears, plums					3.9

VEGETABLES: The healthiest foods of all on average, only deficient in vitamin B12. (VF from 4 to 5)

STARCHY AND ROOT VEGETABLES			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
commercial potato chips or fries					0.2
boiled, mashed, baked, roasted potatoes (plain)					4.0
taro root, poi					4.1
mushrooms (high in zinc)					4.1
leeks, onions, garlic					4.1
yams , sweet potato					4.2
parsnips, turnips, beetroot					4.2
carrots (highest source of beta-carotene)					4.4

BEANS (A good protein source but deficient in vitamins A, and B2.)

			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
beans, lentils, peas					4.0
tofu ( high in fat, but a good substitute for dairy)					4.1
soybeans					4.8

GREEN VEGETABLES (THE best foods of all and the biochemical source of most organic nutrients.)

			Times/wk	x Sm (1 2 3 4 5) Lar	x VF	= Score
green or red peppers					4.1
vegetable soup (no hydrogenated fat or meat stock)					4.2
celery					4.2
green beans, wax beans					4.4
peas, lima beans					4.5
broccoli, cabbage, cauliflower*					4.5
spinach and taro leaf **					4.5
Bok choy, won bok					4.6
sprouts: alfalfa, mung bean, soybean, etc.					4.6
Chinese pea pods					4.6
tomatoes ***					4.7
watercress, parsley					4.8
cucumber					4.8
collard greens, kale, Brussels sprouts,					4.9
Romaine, other green lettuce****					4.9
low sodium V-8 juice or V-4 juice (VLC p.9)					5.0

* (cruciferous vegetables protect aginst cancer) (high in nutrients, but their oxalic acid content interferes with calcium absorption) (saponins and lycopenes in tomatoes protective against prostate cancer) ***(chlorophyl, carotenoids, and luteins in leaf vegetables also protective against cancer)

EXERCISE (VF 1-5)
In a typical week during the last 12 months, how often did you do any of the following: (zero, decimal fraction, whole numbers).
			Times/wk	x Minutes per day	x VF	= Score
walking					2.0
swimming					3.0
stair climbing					3.5
stationary or real bike					3.5
jogging					4.0
weight training					4.5
running					5.0
other vigorous sport _________ (assign your own VF from 0 to 5)					?

		VLC total score (from all pages)=

This diet spreadsheet is named "Dietque4.wb1". It was done using Quattro Pro for Windows v5.0. You could print this out and calculate your score by hand, but a simpler alternative is to download a larger version of this diet spreadsheet, with all the self-calculating cells intact. It can then be loaded into Quattro, Excel, or Lotus 1-2-3, (although the BMI and VF graphs may not come through). Nonetheless, the numbers are easily plugged in and a running score is calculated automatically. The basic form can be used repeatedly by not saving the data each time, or by renaming the file each time it is used. (e.g. "Jane.WB1", "Dick.XLS", "Sam.WKS", etc., the file extension as assigned by your spreadsheet). if you would like to download the larger version of this diet spreadsheet, with all the self-calculating cells intact, click here. Copyright William Harris, M.D. Former Medical Director Kaiser-Permanente Vegan Lifestyle Clinic (VLC) 1010 Pensacola Street Honolulu, HI 96814 (808) 597-2118 (W) e-mail: HARRISMDW001@hawaii.rr.com
Value Factors Graph Series:

-5	Meat
-4	Poultry
-3	Eggs
-2	Fish
-1	Dairy
1	Nuts
2	Bread
3	Grains
4	Fruit
5	Vegetables