Health

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Statements

Academy of Nutrition and Dietetics

(World's largest organization of nutrition professionals)

It is the position of the Academy of Nutrition and Dietetics that appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes. Plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources and are associated with much less environmental damage.[1].

Proceedings of the Nutrition Society

Cross-sectional studies of vegetarians and vegans have shown that on average they have a relatively low BMI (body mass index) and a low plasma cholesterol concentration; recent studies have also shown higher plasma homocysteine concentrations than in non-vegetarians. Cohort studies of vegetarians have shown a moderate reduction in mortality from IHD (ischemic heart disease) but little difference in other major causes of death or all-cause mortality in comparison with health-conscious non-vegetarians from the same population. Studies of cancer have not shown clear differences in cancer rates between vegetarians and non-vegetarians. More data are needed, particularly on the health of vegans and on the possible impacts on health of low intakes of long-chain n-3 fatty acids and vitamin B(12). Overall, the data suggest that the health of Western vegetarians is good and similar to that of comparable non-vegetarians.[2]

Kaiser Permanente

(The largest managed care organization in the US)

Healthy eating may be best achieved with a plant-based diet, which we define as a regimen that encourages whole, plant-based foods and discourages meats, dairy products, and eggs as well as all refined and processed foods… Physicians should consider recommending a plant-based diet to all their patients, especially those with high blood pressure, diabetes, cardiovascular disease, or obesity… Further research is needed to find ways to make plant-based diets the new normal for our patients and employees.[3][4]

General Mortality

Mortality Meta-Analysis (1999)

Vegans (753 people) had a heart disease rate of .74 (.46, 1.21) and a mortality rate of 1.00 (.70, 1.44).[5]

There were no statistically significant differences between the vegans and the regular meat-eaters for any causes of death. There were only 68 vegan deaths in this population over the course of the studies, as distinct from 3,017 for regular meat-eaters. The breakdown of vegan deaths is shown in Table [1]. [6]

Further categorization of diets showed that, in comparison with regular meat eaters, mortality from ischemic heart disease was 26% lower in vegans.[5]

Table 1. Causes of 68 Vegan Deaths
Disease Number
Heart disease 17
Stroke 4
Lung cancer 2
Stomach cancer 2
Colorectal cancer 1
Breast cancer 0
Prostate cancer 0
Other causes 42
Total 68

Adventist Health Study-2 (AHS2)

In 2013, death rates for the first 5.8 years of Adventist Health Study-2 (AHS2) were released.[7] Vegans had a 15% lower risk of death, but it was not quite statistically significant.[6]

Results are in table 2.

Table 2. Death Rates in Adventist Health Study-2
Diet Group Rate BMI
All Causes
Non-vegetarians 1.00 1.00
All Vegetarians .88, .80-.97 .90, .82-.98
Vegans .85, .73-1.01 .84, .72-1.00
Cardiovascular Disease
All Vegetarians .87, .75-1.01 no impact
Vegetarian Men .71, .51-.90 no impact
Vegan Men .58, .38-.89 no impact
Neurologic
All Vegetarians .93, .67-1.29 no impact
Renal
All Vegetarians .48, .28-.82 no impact
Endocrine (primarily diabetes)
All Vegetarians .61, .40-.92 .71, .46-1.09
Other
Vegans .74, .56-.99 no impact

Heart disease

Mortality Meta-Analysis (1999)

Vegans (753 people) had a heart disease rate of .74 (.46, 1.21) and a mortality rate of 1.00 (.70, 1.44).[5]

Type 2 Diabetes

2011 Prospective Analysis from Adventist Health Study 2

In 2011, the first prospective study measuring the type 2 diabetes rates of vegans was released.[8] It followed participants of the Adventist Health Study 2 for two years and found vegans to have the lowest rates of diabetes of any diet group. The study did not differentiate between type 1 and type 2 diabetes, but it’s safe to assume most cases were type 2.

...This study indicates that vegans had a 60% lower risk of developing diabetes as non-vegetarians. A separate analysis was done for black participants only and black vegans had a relative risk of .43 (.25-.74) compared to non-vegetarians....

Results are in Table [3].[9]

Table 3. Prospective Diabetes rates in Adventist Health Study-2.
Vegan Non-Veg
Number 3,545 17,695
Odds ratio .38 (.24-.62) 1.00

2009 Cross-Sectional Analysis from Adventist Health Study 2

In 2009, the first study measuring the type 2 diabetes rates of vegans was released.[10] It was a cross-sectional study and found vegans to have the lowest rates of type 2 diabetes of any diet group... Vegans had a 68% lower risk of type 2 diabetes than did non-vegetarians.

Results are in Table [4].[9]

Table 4. Cross-sectional Type 2 Diabetes rates in Adventist Health Study-2.
Vegan Non-Veg
Number 2,731 28,761
Diabetes rate ratioc .51 (.40-.66) 1.00
Diabetes rate ratiod .32 (.25-.41) 1.00

PCRM Insulin (2018)

The Physicians Committee for Responsible Medicine (PCRM) funded a 16-week, randomized, controlled study to determine the effects of a low-fat, vegan diet on insulin resistance and the function of beta-cells.[11] Compared with the control group, the vegan diet group experienced an improvement in beta-cell function and a decrease in fasting insulin resistance, body mass index, body fat, and fat around internal organs (visceral fat). These results demonstrate that altering macronutrient composition through a vegan diet, without restricting calories, can improve beta-cell function and fasting insulin resistance in adults who are overweight or obese but with no history of diabetes.[9]

Korea (2016)

The focus of this clinical trial was to compare the effect of a vegan diet to a conventional diabetic diet, as prescribed by the Korean Diabetes Association (KDA), on glycemic control among Koreans.[12] The trial lasted three months. The vegan diet group had 46 people while the KDA diet group had 47. After three months, there was a statistically significant, greater reduction in HbA1c in the vegan group compared to the KDA group (0.5% vs. 0.2%, p = 0.017). When including only participants with high diet compliance, the vegan diet fared even better (0.9% vs. 0.3%, p = .01)...The vegan group lost weight while the KDA group didn’t. However, neither group’s blood pressure or LDL-cholesterol went down. The vegan group’s triglycerides went up while the KDA group’s went down; this might indicate the vegan group was eating more simple sugars.[9]

PCRM Study (2004-05)

In 2004, researchers affiliated with the Physician’s Committee for Responsible Medicine (PCRM) started a 74-week study with 99 participants, comparing a vegan diet to an American Diabetes Association recommended diet for people with type 2 diabetes.[13] [14]In this study, the vegan diet was once again a very low-fat diet; less than 10% of calories. Vegan dieters were asked to avoid fatty foods, added oils, fried products, avocados, nuts, and seeds. This time, instead of avoiding all refined grains, they were merely asked to favor low glycemic index foods.

The control group was put on an American Diabetes Diet (ADA) of 15 – 20% protein, < 7% saturated fat, 60 – 70% carbohydrate and monounsaturated fats, and < 200 mg/day of cholesterol. The diets were individualized, based on body weight and plasma lipids. Those with a BMI > 25 kg/m (2) (all but three) were prescribed energy deficits of 500 – 1,000 kcal.

Once again, the vegan group ate less calories and had significant weight loss. Intake of fiber and carbohydrate went up, while fasting blood sugar and HbA1c went down (only statistically significant for the first 22 weeks). Cholesterol and triglyceride levels also decreased, and many participants were able to reduce their diabetes medications.

The ADA diet group also made improvements in weight loss, HbA1c, total cholesterol, and medications.

Among participants in the vegan group with no changes to diabetes medications, HbA1c had fallen 1.2% points at 22 wk and 0.8% points by 74 wk. Among medication-stable participants in the conventional diet group, the HbA1c reduction was 0.3% points at 22 wk, and 0.2% points at 74 wk.

The only statistically significant differences between diet groups for medical outcomes was that vegan dieters lost more weight than did the ADA diet group. See Table [5] for more details.

The acceptability of the vegan diet was rated about the same as the acceptability of the ADA diet. Although the participants in the vegan group rated the difficulty of preparing the foods as higher, they reported less dietary restraint, probably due not to having to limit calories or count carbohydrates. Vegan dieters’ cravings for sweets and fats also decreased.

At week 22, 67% of the vegans were adhering to the diet. By week 74, it was down to 51%. This drop in adherence was probably influenced by the change in the program from weekly meetings for diet and cooking instruction, to bi-weekly optional meetings for weeks 23 to 74.[9]

Table 5. 2004 Study on People with Type 2 Diabetes
Vegan Diet Control Diet
Calorie restriction No Yes
Number at baseline 49 50
Sat. fat (g)

Baseline

74 weeks

24

8

22

16

BMI (kg/m2)

Baseline

74 weeks

33.9

32.3

35.9

34.8

Fasting glucose (mmol/L)

Baseline

74 weeks

9.1

8.0

8.9

8.1

HbA1c

Baseline

74 weeks

8.0%

7.7%

7.9%

7.8%

Total cholesterol (mg/dl)

Baseline

74 weeks

187

166

198

184

Triglycerides (mg/dl)

Baseline

74 weeks

148

114

158

150

Diabetes medications

74 weeks

35% reduced; 14% increased 20% reduced; 24% increased

General Cancer Rates

World Health Organization (2015)

According to the World Health Organization (WHO), processed meat was classified as carcinogenic to humans (group 1) and red meat was classified as probably carcinogenic to humans (group 2A). [15][4]

EPIC-Oxford: Cancer Mortality (2015)

In the 2015 paper from EPIC-Oxford[16], there was no difference in all cancer mortality between vegetarians (including vegans) and regular meat-eaters (0.93, 0.82-1.05). Vegetarians had lower rates of death from pancreatic (0.48, 0.28-0.82) and lymphatic (0.50, 0.32-0.79), but not colorectal, lung, breast, or ovary cancers.

After excluding participants who changed diet categories during the study, vegetarians had a lower risk of all cancer (0.82, 0.72-0.94), and similar findings as above for the other cancers.

Vegans suffered from 67 deaths from cancer, with a rate not significantly different from regular meat-eaters (1.14, 0.88-1.47).[17]

AHS-2 and EPIC-Oxford combined

Table [6] shows that the most recent reports from both AHS-2 and EPIC-Oxford found a lower cancer rate in vegans compared to non-vegetarians.

Table 6. Risk For All Cancers Combined
Study Years Risk and Confidence Interval Adjustments Notes
EPIC-Oxford[18] 1993-2010
Non-Veg 1.00
Vegan   .81 (.66, .98)
smoking, alcohol, physical activity level, gender, study, recruitment method Incidence
Adventist Health Study-2[19] 2002-2006
Non-Veg 1.00
Vegan   .84 (.72, .99)
age, race, family history of cancer, education, smoking, alcohol, age at menarche, pregnancies, breastfeeding, oral contraceptives, hormone replacement therapy, and menopause status. Adjusting for physical activity did not change the results. Incidence
Adventist Health Study-2

[19]

2002-2006
Non-Veg 1.00
Vegan   .86 (.73, 1.00)
age, race, family history of cancer, education, smoking, alcohol, age at menarche, pregnancies, breastfeeding, oral contraceptives, hormone replacement therapy, BMI, and menopause status. Adjusting for physical activity did not change the results. Incidence

Specific Cancers

Risk For Colorectal Cancer

In AHS-2, vegans had a lower risk than regular meat-eaters, even after adjusting for BMI.[17]

Table 7. Risk For Colorectal Cancer.
Study Years Risk and Confidence Interval Adjustments Notes
AHS-2[20] 2002-2014
Non-Veg 1.00
Vegan .84 (.59-1.19)
age, race, gender, education, exercise, smoking, alcohol, family history, peptic ulcers, inflammatory bowel disease, diabetes mellitus, aspirin, statins, prior colonoscopy or flexible sigmoidoscopy, supplemental calcium, supplemental vitamin D, calories, hormone therapy Incidence

Prostate Cancer

In AHS-2, vegans had a lower risk than regular animal meat-eaters.

Table 8. Risk For Prostate
Study Years Risk and Confidence Interval Adjustments Notes
AHS-2[20] 2002-2011
Non-Vega 1.00
Vegan   .66 (.50,   .87)
Age, race, family history, education, screening, caloric intake, BMI Incidence

Breast Cancer

In AHS-2, vegans had a lower risk than regular animal meat-eaters.

Table 9. Risk For Breast Cancer.
Study Years Risk and Confidence Interval Adjustments Notes
AHS-2[20] 2002-2011
Non-Veg 1.00
Vegan   .78 (.58, 1.05)
race, height, physical activity, family history of cancer, mammography, age at menopause, age at menarche, birth control pills, hormone replacement therapy, age at first child, number of children, breastfeeding, educational level, smoking, alcohol Incidence

Disease Markers

Cholesterol in EPIC-Oxford (2013)

The most recent report of cholesterol in vegans is from the EPIC-Oxford study in which vegetarians were compared to meat-eaters with healthy lifestyles. The results are in Table [10] and show vegans to have a 34 mg/dl and 23 mg/dl lower cholesterol level than meat-eaters for men and women respectively. Most of this difference was in the non-HDL cholesterol. Adjusting the results for body mass index reduced the difference by 13% for men and 17% for women.

Vegans also had a significantly lower amount of apolipoprotein B which is thought to promote fat deposits in the arteries.

The authors of the study suggest that vegans have lower cholesterol levels due to a lower body mass index, replacement of saturated fats with polyunsaturated fats, and higher fiber intakes.[21]

Table 10. Cholesterol Levels in EPIC-Oxford (2013) in mg/dl41
Vegans Non-veg P-value
Men
Number 167 168
Total Cholesterol 170 204 < .001
HDL 44 45
Non-HDL 126 159 < .001
Apolipoprotein B 82 100 < .001
Women
Number 255 256
Total Cholesterol 172 195 < .001
HDL 53 57
Non-HDL 119 137 < .001
Apolipoprotein B 76 87 < .001
Results adjusted for age, alcohol, and physical activity.

Cholesterol in Western Vegans (1980 – 2002)

Between 1980 and 2002, cholesterol levels of vegans living in Western countries was measured in 17 studies.[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] The average cholesterol level of vegans was 160 compared to 202 mg/dl for non-vegetarians. Table 11 shows the results.[21]

Table 11. Cholesterol in Western Vegans (1980-2002)
Vegan Non-veg
Cholesterol (mg/dl) 160.0 201.5
LDL (mg/dl) 90.3 120.9
HDL (mg/dl) 51.9 55.0
Cholesterol : HDL 3.1 3.7

Cholesterol in USA Vegans

Of the 17 studies in Table [11], five[23][25][26][32][33] were of vegans living in the USA. Of those studies, the lowest average finding for total cholesterol for vegans was 135 mg/dl. The data from all 5 studies is compiled in Table [12]. The total cholesterol of the 135 vegans averaged out to 146 mg/dl. [21]

Table 12. Cholesterol in Western Vegans (1980-2002)
Vegans Non-veg
Cholesterol (mg/dl) 146.4 194.2
LDL (mg/dl) 67.1 117.0
HDL (mg/dl) 46.0 52.7
Cholesterol : HDL 3.2 3.7

Triglycerides

Elevated triglycerides are generally thought to increase the risk for heart disease. However, there is a debate as to whether moderately high triglycerides are merely associated with other risk factors for heart disease, while not being a cause in themselves. Normal triglycerides for adults is 40-160 mg/dl for men and 35-135 mg/dl for women. Triglyceride levels above 250 mg/dl are more of a concern.

Some people are concerned that, although a vegan diet can lower cholesterol levels, it may increase triglyceride levels. As can be seen from Table [13], in the 11 studies that measured triglycerides, vegans were shown to have lower levels than lacto-ovo and non-veg.[21]

Table 13. Triglycerides in Western Vegans [23][24][25][26][30][31][32][33][34][35][37]
Vegans Non-veg
Triglycerides (mg/dl) 86.5 107.5

Blood Pressure

Relative Rates of High Blood Pressure in AHS-2 (2009)

In 2009, preliminary cross-sectional date from Adventist Health Study-2 was reported.[38] Relative rates for having high blood pressure are show in Table 11. Vegans had a considerably lower rate of high blood pressure. Results were not adjusted for smoking.[21]

Table 14. Relative Rates of High Blood Pressure in AHS-2 (2009)
Diet Risk
Non-veg 1.00
Vegan .25 (.22-.28)
Number 255
Total Cholesterol 172
HDL 53
Non-HDL 119
Apolipoprotein B 76
Adjusted for age, gender, and race.

High Blood Pressure in EPIC-Oxford (2002)

In 2002, a study was published in which 11,004 participants of the EPIC-Oxford study were asked if they had high blood pressure.[39] Men on average were 9% lower, women 4%. Results are shown in Table [15]. The lower percentage of vegans with high blood pressure was statistically significant. This is the only study that has compared the percentage of vegans with high blood pressure to other diet groups.[21]

Table 15. High Blood Pressure in EPIC-Oxford (2002)
High BP Vegan Non-veg
Men 6% 15%
Women 8% 12%

Body Mass Index

2013 Report from Adventist Health Study-2

In AHS-2,[40] vegans had a lower BMI than all other diet groups. The study wasn’t focused on BMI, and the report didn’t mention testing for statistical significance.[21]

Table 16. Body Mass Index in Adventist Health Study-2 (2013)
Vegan Non-veg
BMI (kg/m2) 24.1 28.3

2003 Report From EPIC-Oxford

The differences between the vegans and meat-eaters was accounted for mostly by differences in protein, polyunsaturated fat, and fiber intake. The authors note that protein intake’s influence on weight has not been reported often in the literature, but there is some mention of it altering hormones in a way that increases abdominal fat. They also note that low fiber intakes have been previously associated with higher body weight and this is thought to be via making people feel full on less calories, insulin control, and reducing fat absorption.

Differences between the vegans and other groups were statistically significant. [21]

Table 17. Body Mass Index in EPIC-Oxford (2003)
Vegan Non-veg
Male 22.5 24.4
Female 22.0 23.5
Body Mass Index = kg/m2 • Adjusted for age, smoking, education level, physical activity, marital status, ethnicity, parity.

Body Fat

Various Studies

Table 18 lists the studies that measured percentage of body fat or skinfold thickness (an indicator of body fat) in vegans. Determining the percentage of body fat can vary greatly from method to method, so averaging the results would not be appropriate. Instead, we should look at the general trend. In the 5 comparisons made, the vegans had lower body fat in all five. In three of those comparisons, the differences were statistically significant. [21]

Table 18. Percentage of Body Fat in Vegans [31][41][42][28][24]
Year Country Vegan Non-veg Adjustments SS
Body Fat
199610 UK 21.9% 24.0% None. Vegans had more men. Not SSa
199528 Canada 23.7% 27.4% Vegans slightly older. P < .05a
199026 USA 8.0% 14.0% Vegans were older. P < .05a
Tricep Skinfold Thickness
19877 UK 8.8 mm

11 M 13.5 mm 11 F

10.7 mm

11 M 17.3 mm 11 F

Matched for age, body build. Energy intake did not differ. NR
Sum of skinfold measurements
19781 UK 43 mm

12 M & 10 F

76 mm

12M & 10 F

Matched for age, height, ethnic, socio economic status. P < .01a
F—female • M—male • NR—not reported • SS—statistical significance • P—the % chance that the finding was due to random chance • a Statistically significant between vegans and non-veg

Plant-based diets for weight loss (2013)

Participants were enrolled in a 6-mo, five-arm, randomized controlled trial in 2013 in South Carolina. At 6 mo, the weight loss in the vegan group (-7.5% ± 4.5%) was significantly different from the omnivorous (-3.1% ± 3.6%; P = 0.03), semi-vegetarian (-3.2% ± 3.8%; P = 0.03), and pesco-vegetarian (-3.2% ± 3.4%; P = 0.03) groups. Vegan participants decreased their fat and saturated fat more than the pesco-vegetarian, semi-vegetarian, and omnivorous groups at both 2 and 6 mo (P < 0.05).[43]

Osteoarthritis

Alleviation of Symptoms of Osteoarthritis

Six-week, prospective randomized open-label study of patients aged 19-70 with osteoarthritis. Participants were randomized to a WFPB (intervention) or continuing current diet (control). Outcomes were assessed by mixed models analysis of participant self-assessed weekly SF-36v2 domain t scores, weekly Patient Global Impression of Change (PGIC) scales, and mean weekly Visual Analog Scale (VAS) pain assessment. Mixed models analysis also evaluated pre-post change from baseline level for standard clinical measures: weight, BMI, body temperature, pulse, and blood pressure.

Study results suggest that a whole-foods, plant-based diet significantly improves self-assessed measures of functional status among osteoarthritis patients.[44]

Public Health

Pandemics

Mayo Clinic

The risk of massive pandemics incubating in confined feeding operations is inconspicuous for many, but the potential consequences are dire. The Spanish flu happened around the same time as WWI, yet it killed more people than WWI. It didn’t just kill more people than WWI, it killed a lot more people, and it is estimated to have infected a third of the world’s population. Although war in 1918 helped spread the disease, It was caused by an H1N1 virus (commonly referred to as the swine flu) which is a combination of viruses from pigs, birds, and humans.[45][4]

Antibiotic resistance

Our current methods of getting animal derived foods on the table play a big role because the majority of antibiotic use occurs in farm animals. This includes therapeutic use (treatment when animals are sick), subtherapeutic use (treatment to promote growth and better feed conversion efficiency), prophilaxis (preventative treatment), and metaphilaxis (preventative treatment of a group of animals when at least 1 is sick)[46]. 70-80% of antibiotics sold in the US are sold for use in animal agriculture.[47][4]

World Health Organization

The most recent WHO guidelines on the use of medically important antimicrobials in food-producing animals recognizes the risks imposed by antimicrobial use in food-producing animals and makes the following recommendations.
  1. Overall antimicrobial use: We recommend an overall reduction in use of all classes of medically important antimicrobials in food-producing animals.
  2. Growth promotion use: We recommend complete restriction of use of all classes of medically important antimicrobials in food-producing animals for growth promotion.
  3. Prevention use (in the absence of disease): We recommend complete restriction of use of all classes of medically important antimicrobials in food-producing animals for prevention of infectious diseases that have not yet been clinically diagnosed.
  4. Control and treatment use (in the presence of disease):
    • We suggest that antimicrobials classified as critically important for human medicine should not be used for control of the dissemination of a clinically diagnosed infectious disease identified within a group of food-producing animals.
    • We suggest that antimicrobials classified as highest priority critically important for human medicine should not be used for treatment of food-producing animals with a clinically diagnosed infectious disease. [48]

F

Food SF

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