Pediatric CAT scans are estimated to cause hundreds of cancer deaths every year.
June 19, 2013 | Volume 13
Month: February 2014
Forgo Fat-Free Dressings?
Fat is needed to maximize the absorption of certain important phytonutrients.
November 10, 2009 | Volume 3
Sweet Tooth Gone Bad: Why 22 Teaspoons Of Sugar Per Day Is Risky
Even seemingly healthful foods can contain unexpected spoonfuls of sugar.
Meg Vogel/NPR
We’ve written lots lately about the potentially addictive qualities of sugar and the public policy efforts to limit consumption.
Now comes a new study, published in JAMA Internal Medicine, which finds that Americans who consumed the most sugar — about a quarter of their daily calories — were twice as likely to die from heart disease as those who limited their sugar intake to 7 percent of their total calories.
To translate that into a 2,000-calorie-a-day diet, the big sugar eaters were consuming 500 calories a day from sugar — that’s 31 teaspoons. Those who tamed their sweet tooth the most, by contrast, were taking in about 160 calories a day from sugar — or about 10 teaspoons per day.
Unfortunately, most Americans have a sugar habit that is pushing toward the danger zone.
“The average American is consuming 22 teaspoons a day. That’s about three times what’s recommended,” says Laura Schmidt of the University of California, San Francisco, School of Medicine.
Now, we should point out, we’re not talking fruit here. Researchers did not include the sugar naturally occurring in fruit or milk. Instead, the study focused specifically on the risks of addedsugar — the refined sugars and corn syrups added to foods such as baked goods and sugary sodas.
So, how much added sugar is OK?
Well, the American Heart Association advises that women consume no more than 6 teaspoons of sugar daily. This is about 100 calories. And men, no more than 9 teaspoons, or about 150 calories from sugar.
The World Health Organization says people should get no more than 10 percent of their daily calories from sugar.
And the last time the federal government weighed in on sugar was in the 2010 Dietary Guidelines, which make only a broad recommendation to reduce consumption of added sugar.
So how best to reduce sugar?
Some steps are fairly obvious. For example, eliminating one 12-ounce can of sugar-sweetened soda can cut about 9 teaspoons of sugar.
But other common sources of added sugar can take you by surprise. For example, this morning I ate a small, 4-ounce cup of low-fat organic peach yogurt. I chalked it up as a very healthful breakfast, but when I looked at the nutrition label, it had 17 grams of sugar.
“You just shot most of your wad” for the day, Schmidt points out.
So, yeah, swap those sweetened yogurts for plain yogurt. A typical 6-ounce serving of vanilla yogurt has about 6 teaspoons of sugar — which is about as much as a regular size Snickersbar.
Bottom line: Read the labels. Most nutrition labels list sugar in grams. Four grams of sugar is equivalent to about one teaspoon.
And, don’t get forgot to count sugar if you’re eating out. There can be lots of sugar added to breakfast foods.
For instance, stopping at Starbucks to pick up a blueberry muffin with your latte? That muffin, according to the Starbucks website, contains 29 grams of sugar, or roughly 7 teaspoons.
And an Apple Crumb doughnut at Dunkin Donuts will set you back 49 grams of sugar — that’s more than a day’s worth of added sugar.
There’s a lot of variability in baked goods. For instance, another option at Dunkin Donuts, theCocoa Glazed doughnut, has much less sugar, 13 grams.
Even Modest Amounts of Meat Increase Risk for Diabetes
| BREAKING MEDICAL NEWS | February 13, 2014 |
February 13, 2014
Vegetarians are less likely to have diabetes, compared with nonvegetarians, according to a new study from Taiwan. Among 4,384 Buddhists, the women and men who avoided all meat products had an approximately 70 and 45 reduced risk for diabetes, respectively. The lead author notes that the omnivorous participants consumed a predominantly plant-based diet with little meat and fish, suggesting that even modest animal consumption can increase the risk for diabetes. Other population studies have also found that as animal product intake increases, so does risk for diabetes. In addition, the vegetarian group had higher intakes of fiber, folate, vegetables, and whole grains and lower intakes of saturated fat and cholesterol.
Chiu THT, Huan
A Brief History of Protein: Passion, Social Bigotry, Rats, and Enlightenment
Dr. John McDougall
Nutrition is an emotional subject and nothing arouses people’s passions more than the subject of protein in their diet. Widely divergent opinions on whether more protein or less is best, and on the merits of animal vs. vegetable sources, have been debated for more than 150 years. And for all that time solid scientific research has clearly supported the wisdom of a diet low in protein – favoring vegetable sources. So far, however, the scientific facts have fought a losing battle against popular opinion – which values high-protein diets based on animal foods. Mark Twain once said, “Truth is mighty and will prevail. There is nothing wrong with this, except that it ain’t so.” Even though the facts may never become popular knowledge, I will always believe it is your fundamental right to know the truth about your nutritional requirements – this vital information should be taught from childhood as basic education, along with reading, writing, and mathematics – and along with health facts such as cigarettes cause lung damage, drunk driving kills, and automobile safety belts save lives.
High Protein Standard Set by Social Bigotry
One of the earliest proponents of high protein diets was the distinguished German physiologist Dr. Carl Voit (1831-1908).1,2 After studying laborers who consumed approximately 3100 Calories daily, he concluded that protein intake for people should be 118 grams (g) per day – this value became known as the “Voit standard.” How did he reach this conclusion? He believed that people with sufficient income to afford almost any choice of foods – from meat to vegetables – would instinctively select a diet containing the right amount of protein to maintain health and productivity. Other European and American authorities made similar observations about the eating habits of working men with sufficient incomes to afford meat and came to similar conclusions – ultimately recommending diets high in protein (100 and 189 grams of protein a day). No experiments were performed on the human body to reach these conclusions. Information on the diets of vigorous individuals living during these times and following low-protein vegetarian diets was largely ignored.2,3 The healthy active lives of hundreds of millions of less affluent people laboring in Asia, Africa, and Central and South America on diets with less than half the amount of protein recommended by Dr. Voit (and almost no meat), were overlooked when experts established protein requirements that still affect us today.3,4
What arrogance! To conclude that the superior intellect of moderately affluent people of European descent would cause them to naturally come to correct conclusions about their personal nutritional needs. What foolishness! You can see the effects of self-selection when unrestricted food choices are available. What do more than one billion people living in the 21st century choose? McDonald’s, Burger King, Pizza Hut – need more be said about people’s innate wisdom to make food selections in their best interests? Unfortunately, these flawed recommendations based upon such social bigotry have not yet been silenced by over 100 years of scientific research.
Russell Henry Chittenden Tells the Truth a Century Ago
Such narrow-minded thinking should have been stopped by 1905 when Russell Henry Chittenden, Yale University
Professor of Physiological Chemistry, published his scientific findings on human protein needs in his classic book,Physiological Economy in Nutrition.2 Professor Chittenden believed Dr. Voit had cause and effect reversed: people did not become prosperous because they ate high protein diets, but rather they ate meat and other expensive high protein foods because they could afford them. One hundred years ago he wrote, “We are all creatures of habit, and our palates are pleasantly excited by the rich animal foods with their high content of proteid (protein), and we may well question whether our dietetic habits are not based more upon the dictates of our palates than upon scientific reasoning or true physiological needs.”
He reasoned that we should know the minimal protein requirement for the healthy man (and woman), and believed that any protein intake beyond our requirements could cause injury to our body, especially to the liver and kidneys. As he explained it, “Fats and carbohydrates when oxidized in the body are ultimately burned to simple gaseous products…easily and quickly eliminated…” “With proteid (protein) foods…when oxidized, (they) yield a row of crystalline nitrogenous products which ultimately pass out of the body through the kidneys. (These nitrogen-based protein byproducts) – frequently spoken of as toxins – float about through the body and may exercise more or less of a deleterious influence upon the system, or, being temporarily deposited, may exert some specific or local influence that calls for their speedy removal.” With these few words Professor Chittenden explained the deleterious effects of diets high in protein and meat – consequences too few practicing doctors know about today.
The First Scientific Experiments on Our Protein Needs
Professor Chittenden’s first experiment was on himself. For nine months, he recorded his own body weight, which decreased from 143 pounds (65 Kg) to 128 pounds (58 kg) on his new diet of one-third the protein that Dr. Voit recommended. Chittenden’s health remained excellent and he described his condition as being with “greater freedom from fatigue and muscular soreness than in previous years of a fuller dietary.” He had suffered from arthritis of his knee and discovered that by reducing his intake of meat his condition disappeared and his “sick headaches” and bilious attacks (abdominal pains) no longer appeared periodically as before; plus he fully maintained his mental and physical activity, with a protein intake of about 40 grams a day.
Chittenden performed valid scientific studies by collecting data on the daily dietary and urine histories of his subjects (including himself) to determine protein utilization. Because he was contradicting the known “truths” of his time, he proceeded with extreme caution with his further investigations. He organized three controlled trials with increasing demands for testing the adequacy of diets lower in protein than commonly recommended.
The first trial involved a group of five men connected with Yale University, leading active lives but not engaged in very muscular work. On a low-protein diet (62 grams daily) for 6 months, they all remained healthy and in positive nitrogen balance (more protein went into, than out of, their bodies). The second trial used 13 male volunteers from the Hospital Corps of the U.S. army. They were described as doing moderate work with one day of vigorous activity at the gymnasium. They remained in good health on 61 grams of protein daily. His final trial was with 8 Yale student athletes, some of them with exceptional records of athletic events. They ate an average of 64 grams of protein daily while maintaining their athletic endeavors, and improving their performance by a striking 35 percent. Following these studies, Chittenden in 1904 concluded that 35–50 g of protein a day was adequate for adults, and individuals could maintain their health and fitness on this amount. Studies over the past century have consistently confirmed Professor Chittenden’s findings, yet you would hardly know it with the present day popularity of high protein diets.
Rats Confuse Nutritionists
Many people have the idea that animal foods contain protein which is superior in quality to the protein found in plants. This misconception dates back to l9l4, when Lafayette B. Mendel and Thomas B. Osborne studied the protein requirements of laboratory rats and demonstrated nutritionalrequirements for the individual amino acids.5 They found that rats grew better on animal sources of protein than on vegetable sources. So, investigators at that time suspected that the vegetable foods had insufficient amounts of some of the amino acids essential for the normal growth of rats. Because of these and other animal-based experiments, flesh, eggs, and dairy foods were classified as superior, or “Class A” protein sources. Vegetable proteins were designated inferior, or “Class B” proteins.
Studies completed in the early 1940’s by Dr. William Rose of the University of Illinois found that l0 amino acids were 
essential for a rat’s diet.6 The removal of any one of these essential amino acids from the food of growing rats led to profound nutritive failure, accompanied by a rapid decline in weight, loss of appetite, and eventually death. Animal products, such as meat, poultry, milk, and eggs prevented this decline in the rats’ health, and were found to contain the l0 essential amino acids in just the right proportions for needs of growing rats. Based on these early rat experiments the amino acid pattern found in animal products was declared to be the “gold standard” by which to compare the amino acid pattern of vegetable foods. According to this concept, wheat and rice were declared deficient in lysine and corn was deficient in tryptophan.
Subsequent research has shown the obvious: the initial premise, that animal products supply the most ideal protein pattern for humans, as they do for rats, is incorrect.7 The dietary needs of rats are considerably different from those of humans, mainly because rats grow very rapidly into adult size as compared to people. Rats are fully adult after 6 months; whereas a person takes 17 years to fully mature. This difference in need is especially clear when the breast milk of both species is examined and compared. The protein content of rat breast milk is 10 times greater than the milk intended for human babies.8,9 Baby rats double in size in 4.5 days; an infant doubles in size in 6 months. The obvious reason for the different needs is because rats grow very rapidly into adult size as compared to humans; therefore requirements for protein to support that growth are very much higher.
Dr. William Rose Discovers Human Needs
In 1942, Dr. William Rose turned his attention from rats to people and began studying the amino acid requirements for humans using basically the same methodology he had used with rats. Healthy, male graduate students, grateful in those days for the free food, the dollar a day they were paid and the prospect of getting their initials in print in Rose’s widely read publications, served as his experimental animals. They were fed a diet consisting of corn starch, sucrose, butter fat without protein, corn oil, inorganic salts, the known vitamins, and mixtures of highly purified amino acids. Their diet also included a large brown “candy,” which contained a concentrated liver extract to supply unknown vitamins, sugar, and peppermint oil to provide a “never-to-be-forgotten taste.”
The study used a chemical measurement called nitrogen balance to determine whether the subjects were getting enough usable protein from the mixture. From his experiments, Dr. Rose found that only eight of the ten amino acids essential to rats were also essential to men – we were better at making two amino acids than rats. When an essential amino acid was given in insufficient amounts for approximately two days, all subjects complained bitterly of similar symptoms: a clear increase in nervous irritability, extreme fatigue, and a profound failure of appetite. The subjects were unable to continue the amino acid deficient diets for more than a few days at a time.
Through his studies, Dr. Rose also determined a minimum level of intake for each of the eight essential amino acids.10 He found small amounts of variation in individual needs among his subjects. Because of these unexplained differences among people, he included a large margin of safety in his final conclusion on minimum amino acid requirements. For each amino acid, he took the highest recorded level of need in any subject, and then doubled that amount for a “recommended requirement” – described as a definitely safe intake. It is important to realize that his higher requirement is easily met by a diet centered around any single starchy vegetable. Even in children, as long as energy needs are satisfied by starch, protein needs are automatically satisfied in almost every situation because of the basic and complete design of the food. These investigations were completed by the spring of 1952, resulting in sixteen papers in The Journal of Biological Chemistry that are considered classic contributions in the history of nutrition for the benefit of human beings.
The results of Dr. Rose`s studies are summarized in the following chart, under “minimum requirements”. From the chart, it is clear that vegetable foods contain more than enough of all the amino acids essential for humans.11
Many investigators have measured the capacity of plant foods to meet our protein needs. Their findings show that children and adults thrive on diets based on a single starch; and they grow healthy and strong.11,12 Furthermore, no improvement is obtained by mixing plant foods or supplementing with amino acid mixtures to make the combined amino acid pattern look more like that of flesh, dairy, or eggs.12 (For a thorough discussion of human protein needs see The McDougall Plan, New Win Publishers.)
Diet for a Small Planet Helps and Harms
A popular book among vegetarians, Diet for a Small Planet, by Frances Moore Lappe’ published in 1971, started a revolution that has had a positive impact for the past three decades on the lives of millions of people. Unfortunately, Ms. Lappe’ failed to understand the basic scientific literature on human protein needs and the sufficiency of plants foods before she wrote her influential book. She believed plants contained “incomplete proteins” with insufficient amounts of certain essential amino acids to meet the needs of people.13 As a result of this misunderstanding, she placed great emphasis on combining vegetable foods to create an amino acid pattern which resembles that found in animal foods. This emphasis is unnecessary and implies that it is difficult to obtain “complete” protein from vegetables without detailed nutritional knowledge. Because of her complicated and incorrect ideas people are frightened away from vegetable-based diets.
The impact of her incorrect teachings of more than 30 years ago affects nutritional policy even today. In 2001 the Nutrition Committee of the American Heart Association published a long overdue review warning people of the dangers of high protein diets, like the Atkins, the Zone, and Sugar Busters diets.14 Unfortunately, this one statement in an otherwise valuable report is scientifically incorrect: “Although plant proteins form a large part of the human diet, most are deficient in 1 or more essential amino acids and are therefore regarded as incomplete proteins.” For a supporting scientific reference the Committee cites Frances Moore Lappe’s 1971 book, Diet for a Small Planet.
You may think this is a trivial matter; however, incorrect information on our protein needs can have grave consequences on your health and your family’s health. With the American Heart Association teaching that plants fail to supply complete protein you are almost certain to receive incorrect, potentially damaging, medical advice. For example, say you go to your doctor after a heart attack and mention that you are now going to become a pure vegetarian to avoid future heart trouble. Your doctor may respond, “You can’t do that, you will become protein deficient on an all plant food diet – the Heart Association says so.” Or your child is sick with recurrent asthma and ear infections and you want a dietary cure – you may be warned away from a highly effective therapy because members of the Nutrition Committee of the American Heart Association fail to understand basic scientific research about human protein needs and plant foods. So this is no small matter.
I have confronted the Heart Association about spreading misinformation that can result in suffering as serious as death from heart disease – so far they have shown no interest in making overdue corrections to their incorrect teaching. (See my July, August and November 2002 Newsletters for more information on this.) I recently shared my conflict with the Heart Association with the world’s leading authority on human protein requirements, Dr. D. Joe Millward from the Center for Nutrition and Food Safety, School of Biological Sciences University of Surrey, UK. His response to me on July 10, 2003 was, “Contrary to general opinion, the distinction between dietary protein sources in terms of the nutritional superiority of animal over plant proteins is much more difficult to demonstrate and less relevant in human nutrition. This is quite distinct from the AHA position which in my view is wrong.” 15
So How Do You Know the Truth about Your Protein Needs?
Read the scientific literature (www.nlm.nih.gov) and look at the world picture. Notice that 60 percent of people alive today and most of the people who have lived in the past have obtained their protein from plant foods. They have lived successfully; avoiding all the diseases common in our society. Even today plant sources provide 65% of the world supply of the protein we eat.
What about the starving children in Africa? The picture one often sees of “protein deficient” children in famine areas of Asia or Africa is actually one of starvation and is more accurately described as “calorie deficiency.”11 When these children come under medical supervision, they are nourished back to health with their local diets of corn, wheat, rice, and/or beans. Children recovering from starvation grow up to l8 times faster than usual and require a higher protein content to provide for their catch-up in development – and plant foods easily provide this extra amount of protein. Even very-low protein starchy root crops, such as casava root, are sufficient enough in nutrients, including protein, to keep people healthy.3
The World Health Organization knows the truth. Since 1974 it has recommended that adults consume a diet with 5% of the calories from protein – this would mean 38 grams of protein for a man burning 3000 calories a day and 29 grams for a woman using 2300 calories a day. These minimum requirements provide for a large margin of safety that easily covers people who theoretically could have greater protein needs – such as accident victims or people with infections. This quantity of protein is almost impossible to avoid if enough whole plant food is consumed to meet daily calorie needs. For example, rice alone would provide 71 grams of highly useable protein and white potatoes would provide 64 grams of protein for a working man.16 For a pregnant woman the WHO recommends 6% of the calories come from protein – again an amount of protein easily provided by a diet based on starches, vegetables, and fruits.
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Human Breast Milk – Your Final Assurance
Your greatest need for protein is when you grow the most. The greatest time of growth in a human being’s life is as an infant. We double in size during the first 6 months. The ideal food for a baby is mother’s milk. Therefore, breast milk is the “gold standard” for nutrition – during your time of greatest need for all nutrients, including protein. Five to 6.3 percent of the calories in human breast milk are from protein.9,17 This is the maximum concentration of protein we will ever need in our food supply. Knowing this value tells us that at no other time in our life will we ever require more protein. Consider the protein content of the foods we consume after weaning – these are even higher in protein – rice is 9%, potatoes are 8%, corn is 11% and oatmeal is 15% protein.16
Wrong Thinking Ruins Health
Even though all the scientific knowledge accumulated over the past 100 years clearly shows our bodies were designed to live best on a diet lower in protein than dictated by common belief, we continue on the same disastrous dietary path. As Russell Henry Chittenden explained 100 years ago, “The poorer man emulates his richer neighbors as soon as his circumstances permit, and resources that could be much more advantageously expended for the good of the family and the home are practically wasted – to say nothing of possible injury to health – under the mistaken idea that this more generous method of living (a high-protein, high-meat diet) is the surest road to health and strength.”2 Dr. Chittenden also believed that knowledge and the truth would prevail. He wrote, “Habit and sentiment play such a part in our lives that it is too much to expect any sudden change in custom. By a proper education commenced early in life it may, however, be possible to establish new standards, which in time may prevail and eventually lead to more enlightened methods of living…” The past century of declining health for people living in developed countries has proved Chittenden wrong – so far. However, with widespread communication via the Internet his predictions may soon become reality.
References:
1) Carpenter K. A short history of nutritional science: part 2 (1885-1912). J Nutr. 2003 Apr;133(4):975-84.
2) Chittenden, R. H. (1904). Physiological economy in nutrition, with special reference to the minimal protein requirement of the healthy man. An experimental study. New York: Frederick A. Stokes Company.
3) Millward DJ. The nutritional value of plant-based diets in relation to human amino acid and protein requirements. Proc Nutr Soc. 1999 May;58(2):249-60.
4) Millward DJ. Metabolic demands for amino acids and the human dietary requirement: Millward and Rivers (1988) revisited. J Nutr. 1998 Dec;128(12 Suppl):2563S-2576S.
5) Osborne T. Amino-acids in nutrition and growth. J Bio Chem. 1914; 17:325-49.
6) Rose W. Comparative growth of diet containing ten and nineteen amino acids, with further observation upon the role of glutamic and aspartic acid. J Bio Chem. 1948; 176: 753-62.
7) Bicker M. The protein requirement of adult rats in terms of the protein contained in egg, milk, and soy flour. J Nutr 1947;34: 491.
8) Bell G. Textbook of Physiology and Biochemestry, 4th ed., Williams and Wilkins, Baltimore, 1959, p. 12.
9) Reeds PJ. Protein nutrition of the neonate. Proc Nutr Soc. 2000 Feb;59(1):87-97.
10) Rose W. The amino acid requirement of adult man. Nutr Abst Rev. 1957;27:63l-47.
11) McDougall J. (1983). The McDougall Plan. Clinton, NJ. New Win Publishing.
12) M. Irwin, Hegsted D. A conspectus of research on protein requirements of man. J Nutr. 1971;101:385-428.
13) Moyer G. Frances Moore Lappe’s new edition says it all. Nutrition Action, Oct. 1982. p. 10-11.
14) St. Jeor S, Howard B, Prewitt E. Dietary protein and weight reduction. A statement for health professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation 2001;104:1869-74.
15) Personal Communication with John McDougall, MD on July 10, 2003.
16) J Pennington. Bowes & Church’s Food Values of Portions Commonly Used. 17th Ed. Lippincott. Philadelphia- New York. 1998.
17) Reeds PJ. Protein and amino acid requirements and the composition of complementary foods. J Nutr. 2003 Sep;133(9):2953S-61S.
The man who tried to warn us about sugar
BY JULIA LLEWELLYN SMITH, THE DAILY TELEGRAPH FEBRUARY 13, 2014
A growing number of scientists are convinced sugar is the cause of several chronic and very common illnesses, including heart disease, cancer, Alzheimer’s and diabetes.
Photograph by: Ruggiero Scardigno , Fotolia.com
A couple of years ago, an out-of-print book published in 1972 by a long-dead British professor suddenly became a collector’s item. Copies that had been lying dusty on bookshelves were selling for hundreds of pounds, while copies were also being pirated online.
Alongside such rarities as Madonna’s Sex, Stephen King’s Rage (written as Richard Bachman) and Promise Me Tomorrow by Nora Roberts;Pure, White and Deadly by John Yudkin, a book widely derided at the time of publication, was listed as one of the most coveted out-of-print works in the world.
How exactly did a long-forgotten book suddenly become so prized? The cause was a ground-breaking lecture called Sugar: the Bitter Truth by Robert Lustig, professor of paediatric endocrinology at the University of California, in which Lustig hailed Yudkin’s work as “prophetic”.
Watch: Sugar: The Bitter Truth with Robert Lustig
“Without even knowing it, I was a Yudkin acolyte,” says Lustig, who tracked down the book after a tip from a colleague via an interlibrary loan. “Everything this man said in 1972 was the God’s honest truth and if you want to read a true prophecy you find this book… I’m telling you every single thing this guy said has come to pass. I’m in awe.”
Posted on YouTube in 2009, Lustig’s 90-minute talk has received 4.1 million hits and is credited with kick-starting the anti-sugar movement, a campaign that calls for sugar to be treated as a toxin, like alcohol and tobacco, and for sugar-laden foods to be taxed, labelled with health warnings and banned for anyone under 18.
Lustig is one of a growing number of scientists who don’t just believe sugar makes you fat and rots teeth. They’re convinced it’s the cause of several chronic and very common illnesses, including heart disease,cancer, Alzheimer’s and diabetes. It’s also addictive, since it interferes with our appetites and creates an irresistible urge to eat.
This year, Lustig’s message has gone mainstream; many of the New Year diet books focused not on fat or carbohydrates, but on cutting out sugar and the everyday foods (soups, fruit juices, bread) that contain high levels of sucrose. The anti-sugar camp is not celebrating yet, however. They know what happened to Yudkin and what a ruthless and unscrupulous adversary the sugar industry proved to be.
The tale begins in the Sixties. That decade, nutritionists in university laboratories all over America and Western Europe were scrabbling to work out the reasons for an alarming rise in heart disease levels. By 1970, there were 520 deaths per 100,000 per year in England and Wales caused by coronary heart disease and 700 per 100,000 in America. After a while, a consensus emerged: the culprit was the high level of fat in our diets.
One scientist in particular grabbed the headlines: a nutritionist from theUniversity of Minnesota called Ancel Keys. Keys, famous for inventing the K-ration – 12,000 calories packed in a little box for use by troops during the Second World War – declared fat to be public enemy number one and recommended that anyone who was worried about heart disease should switch to a low-fat “Mediterranean” diet.
Instead of treating the findings as a threat, the food industry spied an opportunity. Market research showed there was a great deal of public enthusiasm for “healthy” products and low-fat foods would prove incredibly popular. By the start of the Seventies, supermarket shelves were awash with low-fat yogurts, spreads, and even desserts and biscuits.
But, amid this new craze, one voice stood out in opposition. John Yudkin, founder of the nutrition department at the University of London’s Queen Elizabeth College, had been doing his own experiments and, instead of laying the blame at the door of fat, he claimed there was a much clearer correlation between the rise in heart disease and a rise in the consumption of sugar. Rodents, chickens, rabbits, pigs and students fed sugar and carbohydrates, he said, invariably showed raised blood levels of triglycerides (a technical term for fat), which was then, as now, considered a risk factor for heart disease. Sugar also raised insulin levels, linking it directly to type 2 diabetes.
When he outlined these results in Pure, White and Deadly, in 1972, he questioned whether there was any causal link at all between fat and heart disease. After all, he said, we had been eating substances like butter for centuries, while sugar, had, up until the 1850s, been something of a rare treat for most people. “If only a small fraction of what we know about the effects of sugar were to be revealed in -relation to any other material used as a food additive,” he wrote, “that material would promptly be banned.”
This was not what the food industry wanted to hear. When devising their low-fat products, manufacturers had needed a fat substitute to stop the food tasting like cardboard, and they had plumped for sugar. The new “healthy” foods were low-fat but had sugar by the spoonful and Yudkin’s findings threatened to disrupt a very profitable business.
As a result, says Lustig, there was a concerted campaign by the food industry and several scientists to discredit Yudkin’s work. The most vocal critic was Ancel Keys.
Keys loathed Yudkin and, even before Pure, White and Deadly appeared, he published an article, describing Yudkin’s evidence as “flimsy indeed”.
“Yudkin always maintained his equanimity, but Keys was a real a––-, who stooped to name-calling and character assassination,” says Lustig, speaking from New York, where he’s just recorded yet another television interview.
The British Sugar Bureau put out a press release dismissing Yudkin’s claims as “emotional assertions” and the World Sugar Research Organisation described his book as “science fiction”. When Yudkin sued, it printed a mealy-mouthed retraction, concluding: “Professor Yudkin recognises that we do not agree with [his] views and accepts that we are entitled to express our disagreement.”
Yudkin was “uninvited” to international conferences. Others he organised were cancelled at the last minute, after pressure from sponsors, including, on one occasion, Coca-Cola. When he did contribute, papers he gave attacking sugar were omitted from publications. The British Nutrition Foundation, one of whose sponsors was Tate & Lyle, never invited anyone from Yudkin’s internationally acclaimed department to sit on its committees. Even Queen Elizabeth College reneged on a promise to allow the professor to use its research facilities when he retired in 1970 (to write Pure, White and Deadly). Only after a letter from Yudkin’s solicitor was he offered a small room in a separate building.
“Can you wonder that one sometimes becomes quite despondent about whether it is worthwhile trying to do scientific research in matters of health?” he wrote. “The results may be of great importance in helping people to avoid disease, but you then find they are being misled by propaganda designed to support commercial interests in a way you thought only existed in bad B films.”
And this “propaganda” didn’t just affect Yudkin. By the end of the Seventies, he had been so discredited that few scientists dared publish anything negative about sugar for fear of being similarly attacked. As a result, the low-fat industry, with its products laden with sugar, boomed.
Yudkin’s detractors had one trump card: his evidence often relied on observations, rather than on explanations, of rising obesity, heart disease and diabetes rates. “He could tell you these things were happening but not why, or at least not in a scientifically acceptable way,” says David Gillespie, author of the bestselling Sweet Poison. “Three or four of the hormones that would explain his theories had not been discovered.”
“Yudkin knew a lot more data was needed to support his theories, but what’s important about his book is its historical significance,” says Lustig. “It helps us understand how a concept can be bastardised by dark forces of industry.”
From the Eighties onwards, several discoveries gave new credence to Yudkin’s theories. Researchers found fructose, one of the two main carbohydrates in refined sugar, is primarily metabolised by the liver; while glucose (found in starchy food like bread and potatoes) is metabolised by all cells. This means consuming excessive fructose puts extra strain on the liver, which then converts fructose to fat. This induces a condition known as insulin resistance, or metabolic syndrome, which doctors now generally acknowledge to be the major risk factor for heart disease, diabetes and obesity, as well as a possible factor for many cancers. Yudkin’s son, Michael, a former professor of biochemistry at Oxford, says his father was never bitter about the way he was treated, but, “he was hurt personally”.
“More than that,” says Michael, “he was such an enthusiast of public health, it saddened him to see damage being done to us all, because of vested interests in the food industry.”
One of the problems with the anti-sugar message – then and now – is how depressing it is. The substance is so much part of our culture, that to be told buying children an ice cream may be tantamount to poisoning them, is most unwelcome. But Yudkin, who grew up in dire poverty in east London and went on to win a scholarship to Cambridge, was no killjoy. “He didn’t ban sugar from his house, and certainly didn’t deprive his grandchildren of ice cream or cake,” recalls his granddaughter, Ruth, a psychotherapist. “He was hugely fun-loving and would never have wanted to be deprived of a pleasure, partly, perhaps, because he grew up in poverty and had worked so hard to escape that level of deprivation.”
“My father certainly wasn’t fanatical,” adds Michael. “If he was invited to tea and offered cake, he’d accept it. But at home, it’s easy to say no to sugar in your tea. He believed if you educated the public to avoid sugar, they’d understand that.”
Thanks to Lustig and the rehabilitation of Yudkin’s reputation, Penguin republished Pure, White and Deadly 18 months ago. Obesity rates in the UK are now 10 times what they were when it was first published and the amount of sugar we eat has increased 31.5 per cent since 1990 (thanks to all the “invisible” sugar in everything from processed food and orange juice to coleslaw and yogurt). The number of diabetics in the world has nearly trebled. The numbers dying of heart disease has decreased, thanks to improved drugs, but the number living with the disease is growing steadily.
Related: Why are we fatter than ever?
As a result, the World Health Organisation is set to recommend a cut in the amount of sugar in our diets from 22 teaspoons per day to almost half that. But its director-general, Margaret Chan, has warned that, while it might be on the back foot at last, the sugar industry remains a formidable adversary, determined to safeguard its market position.
Recently, UK food campaigners have complained that they’re being shunned by ministers who are more than willing to take meetings with representatives from the food industry. “It is not just Big Tobacco any more,” Chan said last year. “Public health must also contend with Big Food, Big Soda and Big Alcohol. All of these industries fear regulation and protect themselves by using the same tactics. They include front groups, lobbies, promises of self-regulation, lawsuits and industry-funded research that confuses the evidence and keeps the public in doubt.”
Dr Julian Cooper, head of research at AB Sugar, insists the increase in the incidence of obesity in Britain is a result of, “a range of complex factors”. “Reviews of the body of scientific evidence by expert committees have concluded that consuming sugar as part of a balanced diet does not induce lifestyle diseases such as diabetes and heart disease,” he says.
If you look up Robert Lustig on Wikipedia, nearly two-thirds of the studies cited there to repudiate Lustig’s views were funded by Coca-Cola. But Gillespie believes the message is getting through. “More people are avoiding sugar, and when this happens companies adjust what they’re selling,” he says. It’s just a shame, he adds, that a warning that could have been taken on board 40 years ago went unheeded: “Science took a disastrous detour in ignoring Yudkin. It was to the detriment of the health of millions.”
Nutritional Update for Physicians: Plant-Based Diets
Phillip J Tuso, MD; Mohamed H Ismail, MD; Benjamin P Ha, MD; Carole Bartolotto, MA, RD
Perm J 2013 Spring; 17(2):61-66
http://dx.doi.org/10.7812/TPP/12-085
Abstract
The objective of this article is to present to physicians an update on plant-based diets. Concerns about the rising cost of health care are being voiced nationwide, even as unhealthy lifestyles are contributing to the spread of obesity, diabetes, and cardiovascular disease. For these reasons, physicians looking for cost-effective interventions to improve health outcomes are becoming more involved in helping their patients adopt healthier lifestyles. 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. We present a case study as an example of the potential health benefits of such a diet. Research shows that plant-based diets are cost-effective, low-risk interventions that may lower body mass index, blood pressure, HbA1C, and cholesterol levels. They may also reduce the number of medications needed to treat chronic diseases and lower ischemic heart disease mortality rates. Physicians should consider recommending a plant-based diet to all their patients, especially those with high blood pressure, diabetes, cardiovascular disease, or obesity.
Introduction
In the HBO documentary The Weight of the Nation, it was noted that if you “go with the flow” in the US, you will eventually become obese.1 In 2011, Witters reported that in some areas of the country, the rate of obesity is 39% and is increasing at a rate of 5% per year.2 Risks of obesity, diabetes, hypertension, and cardiovascular disease, along with their ensuing complications (eg, behavioral health and quality-of-life problems) often go hand-in-hand and are strongly linked to lifestyle, especially dietary choices.3 Of all the diets recommended over the last few decades to turn the tide of these chronic illnesses, the best but perhaps least common may be those that are plant based.
Despite the strong body of evidence favoring plant-based diets, including studies showing a willingness of the general public to embrace them,4 many physicians are not stressing the importance of plant-based diets as a first-line treatment for chronic illnesses. This could be because of a lack of awareness of these diets or a lack of patient education resources.
National dietary guidelines for active living and healthful eating are available at http://www.ChooseMyPlate.gov.5 A typical healthful plate of food is 1/2 plant foods (nonstarchy vegetables and fruits), 1/4 whole grains or unprocessed starchy food, and 1/4 lean protein.
The goal of this article is to review the evidence supporting plant-based diets and to provide a guideline for presenting them to patients. We start with a case study and conclude with a review of the literature.
Case Study
A 63-year-old man with a history of hypertension presented to his primary care physician with complaints of fatigue, nausea, and muscle cramps. The result of a random blood glucose test was 524 mg/dL, and HbA1C was 11.1%. Type 2 diabetes was diagnosed. His total cholesterol was 283 mg/dL, blood pressure was 132/66 mmHg, and body mass index (BMI) was 25 kg/m2. He was taking lisinopril, 40 mg daily; hydrochlorothiazide, 50 mg daily; amlodipine, 5 mg daily; and atorvastatin, 20 mg daily. He was prescribed metformin, 1000 mg twice daily; glipizide, 5 mg daily; and 10 units of neutral protamine Hagedom insulin at bedtime. His physician also prescribed a low-sodium, plant-based diet that excluded all animal products and refined sugars and limited bread, rice, potatoes, and tortillas to a single daily serving. He was advised to consume unlimited nonstarchy vegetables, legumes, and beans, in addition to up to 2 ounces of nuts and seeds daily. He was also asked to begin exercising 15 minutes twice a day.
The patient was seen monthly in his primary care clinic. Over a 16-week period, significant improvement in biometric outcome measures was observed. He was completely weaned off of amlodipine, hydrochlorothiazide, glipizide, and neutral protamine Hagedorn insulin. Follow-up blood pressure remained below 125/60 mmHg, HbA1C improved to 6.3%, and total cholesterol improved to 138 mg/dL. Lisinopril was gradually decreased to 5 mg daily and his diabetes is controlled with metformin alone, 1000 mg twice daily.
Definitions of Plant-Based Diets
The presented case is a dramatic example of the effect a plant-based diet can have on biometric outcomes like blood pressure, diabetes, and lipid profile. The reduction in HbA1C from 11.1% to 6.3% in 3 months is much better than would be expected with monotherapy with metformin6 or daily exercise.7 The improvement in blood pressure observed over a 4-month period with few medications is also rarely encountered in clinical practice and is likely related to a low-sodium diet and the avoidance of red meat. Because the patient was not obese and did not have significant weight loss with the diet, the dramatic improvements appear to be related to the quality of his new diet.
A healthy, plant-based diet aims to maximize consumption of nutrient-dense plant foods while minimizing processed foods, oils, and animal foods (including dairy products and eggs). It encourages lots of vegetables (cooked or raw), fruits, beans, peas, lentils, soybeans, seeds, and nuts (in smaller amounts) and is generally low fat.8,9 Leading proponents in the field have varying opinions as to what comprises the optimal plant-based diet. Ornish et al recommends allowing animal products such as egg whites and skim milk in small amounts for reversal of disease.10,11
Esselstyn, who directs the cardiovascular prevention and reversal program at the Cleveland Clinic Wellness Institute, recommends completely avoiding all animal-based products as well as soybeans and nuts, particularly if severe coronary artery disease is present.12
Despite these smaller differences, there is evidence that a broadly defined plant-based diet has significant health benefits. It should be noted that the term plant-based is sometimes used interchangeably with vegetarian or vegan. Vegetarian or vegan diets adopted for ethical or religious reasons may or may not be healthy. It is thus important to know the specific definitions of related diets and to ascertain the details of a patient’s diet rather than making assumptions about how healthy it is. The following is a brief summary of typical diets that restrict animal products. A key distinction is that although most of these diets are defined by what they exclude, the plant-based diet is defined by what it includes.
Vegan (or total vegetarian): Excludes all animal products, especially meat, seafood, poultry, eggs, and dairy products. Does not require consumption of whole foods or restrict fat or refined sugar.
Raw food, vegan: Same exclusions as veganism as well as the exclusion of all foods cooked at temperatures greater than 118°F.
Lacto-vegetarian: Excludes eggs, meat, seafood, and poultry and includes milk products.
Ovo-vegetarian: Excludes meat, seafood, poultry, and dairy products and includes eggs.
Lacto-ovo vegetarian: Excludes meat, seafood, and poultry and includes eggs and dairy products.
Mediterranean: Similar to whole-foods, plant-based diet but allows small amounts of chicken, dairy products, eggs, and red meat once or twice per month. Fish and olive oil are encouraged. Fat is not restricted.
Whole-foods, plant-based, low-fat: Encourages plant foods in their whole form, especially vegetables, fruits, legumes, and seeds and nuts (in smaller amounts). For maximal health benefits this diet limits animal products. Total fat is generally restricted.
Benefits of Plant-Based Diets
The goal of our diet should be to improve our health. In this section, we will review the literature for key articles that demonstrate the benefits of plant-based diets. Our review consists of existing studies that include vegan, vegetarian, and Mediterranean diets.
Obesity
In 2006, after reviewing data from 87 published studies, authors Berkow and Barnard13 reported in Nutrition Reviews that a vegan or vegetarian diet is highly effective for weight loss. They also found that vegetarian populations have lower rates of heart disease, high blood pressure, diabetes, and obesity. In addition, their review suggests that weight loss in vegetarians is not dependent on exercise and occurs at a rate of approximately 1 pound per week. The authors further stated that a vegan diet caused more calories to be burned after meals, in contrast to nonvegan diets which may cause fewer calories to be burned because food is being stored as fat.13
Farmer et al14 suggest that vegetarian diets may be better for weight management and may be more nutritious than diets that include meat. In their study, they showed that vegetarians were slimmer than their meat-eating counterparts. Vegetarians were also found to consume more magnesium, potassium, iron, thiamin, riboflavin, folate, and vitamins and less total fat. The authors conclude that vegetarian diets are nutrient dense and can be recommended for weight management without compromising diet quality.14
In 2009, Wang and Beysoun15 analyzed the nationally representative data collected in the 1999-2004 National Health and Nutrition Examination Survey. The aim of their study was to analyze the associations between meat consumption and obesity. Using linear and logistic regression analyses, they showed that there was a positive association between meat consumption and obesity.15
The Oxford component of the European Prospective Investigation into Cancer and Nutrition assessed changes in weight and BMI over a five-year period in meat-eating, fish-eating, vegetarian, and vegan men and women in the United Kingdom. During the five years of the study, mean annual weight gain was lowest among individuals who had changed to a diet containing fewer animal foods. The study also reported a significant difference in age-adjusted BMI, with the meat eaters having the highest BMI and vegans the lowest.16Similar results were reported by the Adventist Health Study.17
According to Sabaté and Wien,18 “Epidemiologic studies indicate that vegetarian diets are associated with a lower BMI and a lower prevalence of obesity in adults and children. A meta-analysis of adult vegetarian diet studies estimated a reduced weight difference of 7.6 kg for men and 3.3 kg for women, which resulted in a 2-point lower BMI. Similarly, compared with nonvegetarians, vegetarian children are leaner, and their BMI difference becomes greater during adolescence. Studies exploring the risk of overweight and food groups and dietary patterns indicate that a plant-based diet seems to be a sensible approach for the prevention of obesity in children. Plant-based diets are low in energy density and high in complex carbohydrate, fiber, and water, which may increase satiety and resting energy expenditure.”18 The authors conclude that plant-based dietary patterns should be encouraged for optimal health.
Diabetes
Plant-based diets may offer an advantage over those that are not plant based with respect to prevention and management of diabetes. The Adventist Health Studies found that vegetarians have approximately half the risk of developing diabetes as nonvegetarians.19 In 2008, Vang et al20 reported that nonvegetarians were 74% more likely to develop diabetes over a 17-year period than vegetarians. In 2009, a study involving more than 60,000 men and women found that the prevalence of diabetes in individuals on a vegan diet was 2.9%, compared with 7.6% in the nonvegetarians.17 A low-fat, plant-based diet with no or little meat may help prevent and treat diabetes, possibly by improving insulin sensitivity and decreasing insulin resistance.
Barnard et al21 reported in 2006 the results of a randomized clinical trial comparing a low-fat vegan diet with a diet based on the American Diabetes Association guidelines. People on the low-fat vegan diet reduced their HbA1C levels by 1.23 points, compared with 0.38 points for the people on the American Diabetes Association diet. In addition, 43% of people on the low-fat vegan diet were able to reduce their medication, compared with 26% of those on the American Diabetes Association diet.18
Heart Disease
In the Lifestyle Heart Trial, Ornish10 found that 82% of patients with diagnosed heart disease who followed his program had some level of regression of atherosclerosis. Comprehensive lifestyle changes appear to be the catalyst that brought about this regression of even severe coronary atherosclerosis after only 1 year. In his plant-based regimen, 10% of calories came from fat, 15% to 20% from protein, and 70% to 75% from carbohydrate, and cholesterol was restricted to 5 mg per day.
Interestingly, 53% of the control group had progression of atherosclerosis. After 5 years, stenosis in the experimental group decreased from 37.8% to 34.7% (a 7.9% relative improvement). The control group experienced a progression of stenosis from 46.1% to 57.9% (a 27.7% relative worsening). Low-density lipoprotein had decreased 40% at 1 year and was maintained at 20% less than baseline after 5 years. These reductions are similar to results achieved with lipid-lowering medications.10,11
In the Lyon Diet Heart Study, a prospective, randomized, secondary prevention trial, de Lorgeril found that the intervention group (at 27 months) experienced a 73% decrease in coronary events and a 70% decrease in all-cause mortality. The intervention group’s Mediterranean-style diet included more plant foods, vegetables, fruits, and fish than meat. Butter and cream were replaced with canola oil margarine. Canola oil and olive oil were the only fats recommended.22
In 1998, a collaborative analysis using original data from 5 prospective studies was reviewed and reported in the journal Public Health Nutrition. It compared ischemic heart disease-specific death rate ratios of vegetarians and nonvegetarians. The vegetarians had a 24% reduction in ischemic heart disease death rates compared with nonvegetarians.23 The lower risk of ischemic heart disease may be related to lower cholesterol levels in individuals who consume less meat.24
Although vegetarian diets are associated with lower risk of several chronic diseases, different types of vegetarians may not experience the same effects on health. The key is to focus on eating a healthy diet, not simply a vegan or vegetarian diet.25
High Blood Pressure
In 2010, the Dietary Guidelines Advisory Committee performed a literature review to identify articles examining the effect of dietary patterns on blood pressure in adults. Vegetarian diets were associated with lower systolic blood pressure and lower diastolic blood pressure.25 One randomized crossover trial found that a Japanese diet (low sodium and plant based) significantly reduced systolic blood pressure.27
Mortality
The Dietary Guidelines Advisory Committee also performed a 2010 literature review to determine the effect of plant-based diets on stroke, cardiovascular disease, and total mortality in adults. They found that plant-based diets were associated with a reduced risk of cardiovascular disease and mortality compared with non-plant-based diets.26
The benefit of plant-based diets on mortality may be primarily caused by decreased consumption of red meat.28 Several studies have documented the benefits of avoiding excessive consumption of red meat, which is associated with an increased risk of all-cause mortality and an increased risk of cardiovascular mortality.29 Low meat intake has been associated with longevity.30
In 2012, Huang et al31 performed a meta-analysis to investigate cardiovascular disease mortality among vegetarians and nonvegetarians. They only included studies that reported relative risks and corresponding 95% confidence intervals. Seven studies with a combined total of 124,706 participants were analyzed. Vegetarians had 29% lower ischemic heart disease mortality than nonvegetarians.31
Health Concerns About Plant-Based Diets
Protein
Generally, patients on a plant-based diet are not at risk for protein deficiency. Proteins are made up of amino acids, some of which, called essential amino acids, cannot be synthesized by the body and must be obtained from food. Essential amino acids are found in meat, dairy products, and eggs, as well as many plant-based foods, such as quinoa.32 Essential amino acids can also be obtained by eating certain combinations of plant-based foods. Examples include brown rice with beans, and hummus with whole wheat pita. Therefore, a well-balanced, plant-based diet will provide adequate amounts of essential amino acids and prevent protein deficiency.33
Soybeans and foods made from soybeans are good sources of protein and may help lower levels of low-density lipoprotein in the blood34 and reduce the risk of hip fractures35 and some cancers.
A study in the Journal of the American Medical Association36 reported that women with breast cancer who regularly consumed soy products had a 32% lower risk of breast cancer recurrence and a 29% decreased risk of death, compared with women who consumed little or no soy.36 An analysis of 14 studies, published in the American Journal of Clinical Nutrition, showed that increased intake of soy resulted in a 26% reduction in prostate cancer risk.37
Because of concerns over the estrogenic nature of soy products, women with a history of breast cancer should discuss soy foods with their oncologists. Also, overly processed, soy-based meat substitutes are often high in isolated soy proteins and other ingredients that may not be as healthy as less processed soy products (ie, tofu, tempeh, and soy milk).
Iron
Plant-based diets contain iron, but the iron in plants has a lower bioavailability than the iron in meat. Plant-based foods that are rich in iron include kidney beans, black beans, soybeans, spinach, raisins, cashews, oatmeal, cabbage, and tomato juice.38 Iron stores may be lower in individuals who follow a plant-based diet and consume little or no animal products. However, the American Dietetic Association states that iron-deficiency anemia is rare even in individuals who follow a plant-based diet.39
Vitamin B12
Vitamin B12 is needed for blood formation and cell division. Vitamin B12 deficiency is a very serious problem and can lead to macrocytic anemia and irreversible nerve damage. Vitamin B12 is produced by bacteria, not plants oranimals. Individuals who follow a plant-based diet that includes no animal products may be vulnerable to B12 deficiency40 and need to supplement their diet with vitamin B12 or foods fortified with vitamin B12.41
Calcium and Vitamin D
Calcium intake can be adequate in a well-balanced, carefully planned, plant-based diet. People who do not eat plants that contain high amounts of calcium may be at risk for impaired bone mineralization and fractures. However, studies have shown that fracture risk was similar for vegetarians and nonvegetarians. The key to bone health is adequate calcium intake, which appears to be irrespective of dietary preferences.42 Some significant sources of calcium include tofu, mustard and turnip greens, bok choy, and kale. Spinach and some other plants contain calcium that, although abundant, is bound to oxalate and therefore is poorly absorbed.43
Vitamin D deficiency is common in the general population. Plant-based products such as soy milk and cereal grains may be fortified to provide an adequate source of Vitamin D.44 Supplements are recommended for those who are at risk for low bone mineral density and for those found to be deficient in vitamin D.
Fatty Acids
Essential fatty acids are fatty acids that humans must ingest for good health because our bodies do not synthesize them. Only two such essential fatty acids are known: linoleic acid (an omega-6 fatty acid) and alpha-linolenic acid (an omega-3 fatty acid). Three other fatty acids are only conditionally essential: palmitoleic acid (a monounsaturated fatty acid), lauric acid (a saturated fatty acid), and gamma-linolenic acid (an omega-6 fatty acid). Deficiency in essential fatty acids may manifest as skin, hair, and nail abnormalities.45
The fatty acids that vegans are most likely to be deficient in are the omega-3 fats (n-3 fats). Consumptions of the plant version of omega-3 fats, alpha-linolenic acid, are also low in vegans. Adequate intake of n-3 fats is associated with a reduced incidence of heart disease and stroke. Foods that are good sources of n-3 fats should be emphasized. They include ground flax seeds, flax oil, walnuts, and canola oil.46
Conclusion
A healthy, plant-based diet requires planning, reading labels, and discipline. The recommendations for patients who want to follow a plant-based diet may include eating a variety of fruits and vegetables that may include beans, legumes, seeds, nuts, and whole grains and avoiding or limiting animal products, added fats, oils, and refined, processed carbohydrates. The major benefits for patients who decide to start a plant-based diet are the possibility of reducing the number of medications they take to treat a variety of chronic conditions, lower body weight, decreased risk of cancer, and a reduction in their risk of death from ischemic heart disease.
A plant-based diet is not an all-or-nothing program, but a way of life that is tailored to each individual. It may be especially beneficial for those with obesity, Type 2 diabetes, high blood pressure, lipid disorders, or cardiovascular disease. The benefits realized will be relative to the level of adherence and the amount of animal products consumed. Strict forms of plant-based diets with little or no animal products may be needed for individuals with inoperable or severe coronary artery disease. Low-sodium, plant-based diets may be prescribed for individuals with high blood pressure or a family history of coronary artery disease or stroke. A patient with obesity and diabetes will benefit from a plant-based diet that includes a moderate amount of fruits and vegetables and minimal low-fat animal products. Severe obesity may require counseling and initial management with a low-calorie diet or very-low-calorie diet and the supervision of a physician’s team. Patients with kidney disease may need a plant-based diet with special restrictions, for example fruits and vegetables that are high in potassium and phosphorus. Finally, patients with thyroid disease will need to be careful when consuming plants that are mild goitrogens, like soy, raw cruciferous vegetables, sweet potatoes, and corn. These patients should be informed that cooking these vegetables inactivates the goitrogens.
Physicians should advocate that it is time to get away from terms like vegan and vegetarian and start talking about eating healthy, whole, plant-based foods (primarily fruits and vegetables) and minimizing consumption of meat, eggs, and dairy products. Physicians should be informed about these concepts so they can teach them to staff and patients.
A registered dietitian should be part of the health care team that designs a plant-based diet for patients with chronic disease, especially if multiple medications are involved. Depending on the underlying conditions, patients with chronic disease who take multiple medications need close monitoring of low blood sugar levels, low blood pressure, or rapid weight loss. If these occur, the physician may need to adjust medications. In some cases, such as the one presented here, the need for certain medications can be eliminated altogether. Although the risk of deficiencies may be low, health care teams need to be aware that a motivated patient on a strict plant-based diet may need monitoring for deficiencies of certain nutrients, as outlined above.
The purpose of this article is to help physicians understand the potential benefits of a plant-based diet, to the end of working together to create a societal shift toward plant-based nutrition. There is at least moderate-quality evidence from the literature that plant-based diets are associated with significant weight loss and a reduced risk of cardiovascular disease and mortality compared with diets that are not plant based. These data suggest that plant-based diets may be a practical solution to prevent and treat chronic diseases.
Further research is needed to find ways to make plant-based diets the new normal for our patients and employees. We cannot cure chronic diseases, but we may be able to prevent and control them by changing how we eat. With education and monitoring for adherence, we can improve health outcomes. Patterns of families and other colleagues who may be reluctant to support the efforts of individuals who are trying to change are a challenge to be overcome.
We should invite our colleagues, patients, and their families to a shared decision-making process with the goal of adopting a plant-based diet and a regular exercise program. We should invite health care teams to complete a course on healthy eating and active living. We should encourage staff to be knowledgeable about plant-based nutrition. Finally, we should encourage performance-driven measurable outcomes, which may include:
- the percentage of physicians who have completed a course on nutrition that includes a discussion of the benefits of a plant-based diet and exercise;
- the percentage of our hospitals, cafeterias, and physicians’ meeting facilities that serve meals that are consistent with a plant-based diet;
- the percentage of patients on a physician panel who are obese and who have completed a course on weight management and nutrition that emphasizes a plant-based diet; and
- the percentage of patients in a physician panel with high blood pressure, diabetes, high cholesterol, or cardiovascular disease who completed a course on nutrition that emphasizes a plant-based diet.
Too often, physicians ignore the potential benefits of good nutrition and quickly prescribe medications instead of giving patients a chance to correct their disease through healthy eating and active living. If we are to slow down the obesity epidemic and reduce the complications of chronic disease, we must consider changing our culture’s mind-set from “live to eat” to “eat to live.” The future of health care will involve an evolution toward a paradigm where the prevention and treatment of disease is centered, not on a pill or surgical procedure, but on another serving of fruits and vegetables.
Disclosure statement
The author(s) have no conflicts of interest to disclose.
Acknowledgment
Kathleen Louden, ELS, of Louden Health Communications provided editorial assistance.
References
1. HBO Documentary Films; Institute of Medicine of the National Academies; Centers for Disease Control and Prevention; National Institutes of Health; Michael and Susan Dell Foundation; Kaiser Permanente. The weight of the nation [documentary]. New York, NY: Home Box Office, Inc; 2012. Available from:http://theweightofthenation.hbo.com/?cmpid=ABC1213.
2. Witters D. More than 15% obese in nearly all US metro areas [monograph on the Internet]. Washington, DC: Gallup Wellbeing; 2012 Mar 7 [cited 2012 Oct 6]. Available from: http://www.gallup.com/poll/153143/Obese-Nearly-Metro-Areas.aspx.
3. US Department of Health and Human Services. The surgeon general’s call to action to prevent and decrease overweight and obesity [monograph on the Internet]. Rockville, MD: US Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001 [cited 22 Jan 2013]. Available from: http://www.surgeongeneral.gov/library/calls/obesity/index.html
4. Lea EJ, Crawford D, Worsley A. Public views of the benefits and barriers to the consumption of a plant-based diet. Eur J Clin Nutr 2006 Jul;60(7):828-37. DOI:http://dx.doi.org/10.1038/sj.ejcn.1602387
5. ChooseMyPlate.gov [homepage on the Internet]. Alexandria, VA: US Department of Agriculture, Center for Nutrition Policy and Promotion; [cited 2013 Jan 31]. Available from: http://www.choosemyplate.gov/.
6. Ito H, Ishida H, Takeuchi Y, et al. Long-term effects of metformin on blood glucose control in non-obese patients with type 2 diabetes mellitus. Nutr Metab (Lond) 2010 Nov 12;7:83. DOI: http://dx.doi.org/10.1186/1743-7075-7-83
7. Sigal RJ, Kenny GP, Boulé NG, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med 2007 Sep 18;147(6):357-69.
8. Blaney D, Diehl H. The optimal diet: the official CHIP cookbook. Hagerstown, MD: Autumn House Publishing; 2009 Jan 1.
9. McDougall, JA, McDougall M. (1997). The new McDougall cookbook: 300 delicious ultra-low-fat recipes. New York, NY: Plume; 1997 Jan 1.
10. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990 Jul 21;336(8708):129-33. DOI: http://dx.doi.org/10.1016/0140-6736(90)91656-U
11. Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998 Dec 16;280(23):2001-7. DOI:http://dx.doi.org/10.1001/jama.280.23.2001
12. Esselstyn CB Jr. Prevent and reverse heart disease: q & a with Caldwell B Esselstyn, Jr, MD [monograph on the Internet]. Lyndhurst, OH: Prevent and Reverse Heart Disease; [cited 2012 Oct 6]. Available from: http://www.heartattackproof.com/qanda.htm.
13. Berkow SE, Barnard N. Vegetarian
diets and weight status. Nutr Rev 2006 Apr;64(4):175-88. DOI: http://dx.doi.org/10.1111/j.1753-4887.2006.tb00200.x
14. Farmer B, Larson BT, Fulgoni VL 3rd, Rainville AJ, Liepa GU. A vegetarian dietary pattern as a nutrient-dense approach to weight management: an analysis of the national health and nutrition examination survey 1999-2004. J Am Diet Assoc 2011 Jun;111(6):819-27. DOI: http://dx.doi.org/10.1016/j.jada.2011.03.012
15. Wang Y, Beydoun MA. Meat consumption is associated with obesity and central obesity among US adults. Int J Obes (Lond) 2009 Jun;33(6):621-8. DOI:http://dx.doi.org/10.1038/ijo.2009.45
16. Rosell M, Appleby P, Spencer E, Key T. Weight gain over 5 years in 21,966 meat-eating, fish-eating, vegetarian, and vegan men and women in EPIC-Oxford. Int J Obes (Lond) 2006 Sep;30(9):1389-96. DOI: http://dx.doi.org/10.1038/sj.ijo.0803305
17. Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care 2009 May;32(5):791-6. DOI:http://dx.doi.org/10.2337/dc08-1886
18. Sabaté J, Wien M. Vegetarian diets and childhood obesity prevention. Am J Clin Nutr 2010 May;91(5):1525S-1529S. DOI:http://dx.doi.org/10.3945/ajcn.2010.28701F
19. Snowdon DA, Phillips RL. Does a vegetarian diet reduce the occurrence of diabetes? Am J Public Health 1985 May;75(5):507-12. DOI:http://dx.doi.org/10.2105/AJPH.75.5.507
20. Vang A, Singh PN, Lee JW, Haddad EH, Brinegar CH. Meats, processed meats, obesity, weight gain and occurrence of diabetes among adults: findings from Adventist Health Studies. Ann Nutr Metab 2008;52(2):96-104. DOI: http://dx.doi.org/10.1159/000121365
21. Barnard ND, Cohen J, Jenkins DJ, et al. A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care 2006 Aug;29(8):1777-83. DOI: http://dx.doi.org/10.2337/dc06-0606
22. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999 Feb;99(6):779-85. DOI: http://dx.doi.org/10.1161/01.CIR.99.6.779
23. Key TJ, Fraser GE, Thorogood M, et al. Mortality in vegetarians and non-vegetarians: a collaborative analysis of 8300 deaths among 76,000 men and women in five prospective studies. Public Health Nutr 1998 Mar;1(1):33-41. DOI: http://dx.doi.org/10.1079/PHN19980006
24. Appleby PN, Thorogood M, McPherson K, Mann JI. Associations between plasma lipid concentrations and dietary, lifestyle and physical factors in the Oxford Vegetarian Study. J Hum Nutr Diet 1995 Oct;8(5):305-14. DOI: http://dx.doi.org/10.1111/j.1365-277X.1995.tb00324.x
25. Fraser GE. Vegetarian diets: what do we know of their effects on common chronic diseases? Am J Clin Nutr 2009;89(5):1607S-1612S. DOI:http://dx.doi.org/10.3945/ajcn.2009.26736K
Erratum in: Am J Clin Nutr 2009 Jul;90(1):248. DOI: http://dx.doi.org/10.3945/ajcn.2009.27933
26. Report of the Dietary Guidelines Advisory Committee on the dietary guidelines for Americans, 2010: to the Secretary of Agriculture and the Secretary of Health and Human Services. Washington, DC: Agriculture Research Service, US Department of Agriculture, US Department of Health and Human Services; 2010 May.
27. Takahashi Y, Sasaki S, Okubo S, Hayashi M, Tsugane S. Blood pressure change in a free-living population-based dietary modification study in Japan. J Hypertens. 2006 Mar;24(3):451-8. DOI: http://dx.doi.org/10.1097/01.hjh.0000209980.36359.16
28. Singh PN, Sabaté J, Fraser GE. Does low meat consumption increase life expectancy in humans? Am J Clin Nutr 2003 Sep;78(3 Suppl):526S-532S.
29. Campbell TC, Campbell TM II. The China study: the most comprehensive study of nutrition ever conducted and the startling implications for diet, weight loss and long-term health. Dallas, TX: BenBella Books; 2006 May 11.
30. Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin A. Meat intake and mortality: a prospective study of over half a million people. Arch Intern Med 2009 Mar 23;169(6):562‑71. DOI: http://dx.doi.org/10.1001/archinternmed.2009.6
31. Huang T, Yang B, Zheng J, Li G, Wahlqvist ML, Li D. Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review. Ann Nutr Metab 2012;60(4):233-40. DOI: http://dx.doi.org/10.1159/000337301
32. Nutritiondata.self.com [web page on the Internet]. Soybeans, mature seeds, raw. New York, NY: Condé Nast; 2012 [cited 2012 Oct 6]. Available from:http://nutritiondata.self.com/facts/legumes-and-legume-products/4375/2.
33. Young VR, Pellett PL. Plant proteins in relation to human protein and amino acid nutrition. Am J Clin Nutr 1994 May;59(5 Suppl):1203S-1212S.
34. Pipe EA, Gobert CP, Capes SE, Darlington GA, Lampe JW, Duncan AM. Soy protein reduces serum LDL cholesterol and the LDL cholesterol: HDL cholesterol and apolipoprotein B: apolipoprotein A-I ratios in adults with type 2 diabetes. J Nutr 2009 Sep;139(9):1700-6. DOI: http://dx.doi.org/10.3945/jn.109.109595
35. Koh WP, Wu AH, Wang R, et al. Gender-specific associations between soy and risk of hip fracture in the Singapore Chinese Health Study. Am J Epidemiol 2009 Oct 1;170(7):901-9. DOI: http://dx.doi.org/10.1093/aje/kwp220
36. Shu XO, Zheng Y, Cai H, et al. Soy food intake and breast cancer survival. JAMA 2009 Dec 9;302(22):2437-43. DOI:http://dx.doi.org/10.1001/jama.2009.1783
37. Yan L, Spitznagel EL. Soy consumption and prostate cancer risk in men: a revisit of a meta-analysis. Am J Clin Nutr 2009 Apr;89(4):1155-63. DOI:http://dx.doi.org/10.3945/ajcn.2008.27029
38. Waldmann A, Koschizke JW, Leitzmann C, Hahn A. Dietary iron intake and iron status of German female vegans: results of the German vegan study. Ann Nutr Metab 2004;48(2):103-8. DOI: http://dx.doi.org/10.1159/000077045
39. Craig WJ, Mangels AR; American Dietetic Association. Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc 2009 Jul;109(7):1266-82. DOI: http://dx.doi.org/10.1016/j.jada.2009.05.027
40. Donaldson MS. Metabolic vitamin B12 status
1on a mostly raw vegan diet with follow-up
using tablets, nutritional yeast, or probiotic supplements. Ann Nutr Metab 2000;44 (5-6):229-34. DOI: http://dx.doi.org/10.1159/000046689
41. Dietary supplement fact sheet: vitamin B12 [monograph on the Internet]. Bethesda, MD: National Institutes of Health, Office of Dietary Supplements; 2011 Jun 24 [cited 2013 Jan 31. Available from: http://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/.
42. Appleby P, Roddam A, Allen N, Key T. Comparative fracture risk in vegetarians and non-vegetarians in EPIC-Oxford. Eur J Clin Nutr 2007 Dec;61(12):1400-6. DOI: http://dx.doi.org/10.1038/sj.ejcn.1602659
43. Weaver CM, Plawecki KL. Dietary calcium: adequacy of a vegetarian diet. Am J Clin Nutr 1994 May;59(5 Suppl):1238S-1241S.
44. Dietary supplement fact sheet: vitamin D [monograph on the Internet]. Bethesda, MD: National Institutes of Health, Office of Dietary Supplements; 2011 Jun 24 [cited 2013 Jan 31. Available from: http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/.
45. Rosell MS, Lloyd-Wright Z, Appleby PN, Sanders TA, Allen NE, Key TJ. Long-chain n-3 polyunsaturated fatty acids in plasma in British meat-eating, vegetarian, and vegan men. Am J Clin Nutr 2005 Aug;82(2):327-34.
46. Davis BC, Kris-Etherton PM. Achieving optimal essential fatty acid status in vegetarians: current knowledge and practical implications. Am J Clin Nutr 2003 Sep;78(3 Suppl):640S-646S.
Even Modest Amounts of Meat Increase Risk for Diabetes
Even Modest Amounts of Meat Increase Risk for Diabetes
Vegetarians are less likely to have diabetes, compared with nonvegetarians, according to a new study from Taiwan. Among 4,384 Buddhists, the women and men who avoided all meat products were approximately 33 and 50 percent less likely to have diabetes, respectively. The lead author notes that the omnivorous participants consumed a predominantly plant-based diet with little meat and fish, suggesting that even modest animal consumption can increase the risk for diabetes. Other population studies have also found that as animal product intake increases, so does risk for diabetes. In addition, the vegetarian group had higher intakes of fiber, folate, vegetables, and whole grains and lower intakes of saturated fat and cholesterol.
Chiu THT, Huang HY, Chiu YF, et al. Taiwanese vegetarians and omnivores: dietary composition, prevalence of diabetes and IFG. PLOS One. Published online February 11, 2014.
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Velvety Chickpea Gravy
(Before you begin soak dried mushrooms in a cup of very hot water until soft (1 hour)- This is for mushroom gravy and is optional.
1 tsp. safflower or olive oil
1 medium onion, diced finely
4 big cloves of garlic minced
2 tsp. of italian herbs or to taste
2 tsp. of chopped fresh rosemary
2 tblsp. of cornstarch
11/4 c. organic low salt vegetable broth (sold in tetra packs in the soup section)
1 tblsp. worchestershire sauce
Hot sauce to taste (optional)
1 – 15 oz. can of chickpeas drained and rinsed — or you can use 1 1/2 c. dried chickpeas, soaked overnight and pressure cooked on high for 8 min.
1 – 1 1/2 tblsp. soy sauce or 1 1/2 tsp. light miso blended in a bit of vegetable broth to liquify it.
black pepper to taste.
1. Saute the onion and garlic in the oil, add the herbs, except for the fresh rosemary, which I put in last to keep the flavour.
2. Whisk the cornstarch and broth together in a small dish.
3. Put the chickpeas in a moulinex with some of the broth mixture and soya sauce or miso to make them blend easier.
4. Moulinex them on high until it is velvety.
5. At this point decide if you want the veggies to have texture or not. If you prefer silky gravy, put all the veggies in the moulinex with the chickpea mixture. If you don’t mind bits of onion and garlic, just put the mushrooms in, and moulinex until they are incorporated with the chickpeas. Or if you like bits of mushroom ,moulinex them separately and put them to one side in a dish, to add later to the bubbling gravy!
6. Add the herbs, worchestershire sauce peeper and miso or soya sauce and the rest of the broth/cornstarch mixture.
7. Allow to simmer until it thickens. Add the chopped mushrooms if you didn’t do it in step 5.
8. Add the fresh rosemary.
Simmer a few more min. …taste and adjust the seasonings. Enjoy.
You can double or triple the recipe and freeze it for future meals.
Excellent on vegan bean loaves, burgers, mashed veggies.
The Mystique of Protein and Its Implications
There are three macronutrients in food: carbohydrates, fat and protein, ‘macro’ in the sense that they comprise almost all of the weight and calories of food. Vitamins and minerals are the micronutrients.
Protein, ever since its discovery in 1839, has been considered by many people to be an exceptionally important nutrient, often assuming that the more we consume the better. Its name comes from the Greek word, proteios, meaning ‘of prime importance’—an auspicious and almost mystical beginning for the future of this nutrient! Add to this importance the long standing impression by most people that protein is exclusive to animal source foods.
We now know, however, that this importance is exaggerated, to mythical proportions. For a starter, protein is not exclusive to animal-based foods. In the late 1800s protein was also found to be present in plant foods. Yet the myth of its being tightly or even exclusively linked to animal-based foods still lingers. Simply ask a non-meat eating vegan how many times they are asked, “But where do I get my protein?”
This bias implying that meat is the sole source of protein was encouraged over these many decades by ‘science’. Research findings, for example, were showing that animal-based proteins are utilized by the body more efficiently. This efficiency of utilization referred to increased body growth rate among other effects, with greater efficiency being described as greater ‘biological value’ or higher quality. But it was only animal-based proteins that have high quality.
Because most people obviously like high quality, animal-based protein became the protein of choice. In effect, this history evolved through the prism of linguistics to give a profound self-perpetuating paradigm.
The problem with this proposition is that high quality does not necessarily mean better health. Increasing body growth may be useful for farm animal production and growing children faster, but it also means growing cancer cells faster, improving conditions for heart disease and speeding up aging—each of which has been documented. Growing young girls more rapidly means earlier sexual maturation, higher circulating levels of estrogen and, eventually, elevated breast cancer risk.
My laboratory in a long series of studies conducted over more than two decades showed that the growth of experimental cancer is markedly stimulated by the consumption of animal-based casein, the main protein of cow’s milk. This occurs in part because this animal source protein stimulates the production of the same growth hormone that spurs childhood growth. Plant based proteins tend not to promote these events, not at least when fed at levels typically found in the whole foods, plant based (WFPB) diet. These findings beg the next important question of what is the proper amount and kind of protein for individuals to consume for optimum health.
To answer this question, let’s first consider the officially created recommended daily allowance (RDA). It was first determined and published in 1943 by the prestigious National Academy of Sciences for the purpose of supporting good nutrition for the American military during wartime.
This assessment begins with a determination of the amount of protein to be consumed to compensate for the amount of protein (as nitrogen) excreted. This estimate, called the minimum daily requirement, was about 0.5 gms/kg of body weight, equivalent to about 6% of total diet calories. Because this estimate was determined on a small, random sample of individuals (from the larger population), it was adjusted upward by about two standard deviations to insure adequate intake for everyone in the larger population. This became 0.8 gm/kg body weight—the well known recommended daily allowance (RDA). For a 70 kg (144 lb) adult male, this is 56 gms; for a 60 kg (132 lb) female, 48 gms. Assuming a daily consumption of 2000 calories (cal) and an energy content of 4 cal/gm protein, this corresponds to 11.2 % dietary protein for a 2000 cal diet, or 9.0% dietary protein for a 2500 cal diet. To round it off for convenience, a diet of 10% protein (the RDA) easily represents enough protein for good health. This estimate, first made official in 1943, has since been officially reviewed 14 times by an expert panel of scientists, thus fixing it as a well-established figure.
But because we revere protein in general, especially animal-based protein, an average American diet contains about 17% dietary protein—not the RDA of 10%. The key question then is what kind of diet provides this RDA of 10% protein? A whole food plant based diet easily provides the 10% protein (even the low protein potato has 8% protein) while also including the countless other nutrients required for good health. But 90-95% of us consume substantially more protein than the RDA. Almost all of the protein in excess of this RDA comes from animal-based foods which brings with it two types of adverse health consequences, including 1) the adverse effects of the protein itself and 2) the displacement of the health benefits of the nutrients of plant-based foods.
Our animal protein rich diets result from our unquestioned enthusiasm for protein, especially of the animal kind. As a result, our diets are more flawed than we realize, not because of the over consumption of any one nutrient like animal-sourced protein but because of the under consumption of countless other plant-sourced nutrients.
Here’s a small sample of especially damning evidence on animal-based protein itself, some of which has been available for a very long time. Much of this evidence, selected because of its scientific rigor and its implications, was reported as the effects of single nutrients or groups of nutrients but keep in mind that most of this evidence also will reflect parallel changes in other nutrients that add to these ill effects.
Although preceded by several reports on the association of dietary fat with cancers in the 1960s and 1970s among different countries, a 1986 report1 showed that the almost linear increased cancer rates often observed with high fat diets are primarily attributed to animal-based food (total dietary fat and animal-based protein are highly correlated, that is, >90%).2
A 670-page, 1997 report3, prepared by a group of 16 scientists from 10 countries, reviewing the world’s literature on the diet and cancer relationship concluded, as a first recommendation, to consume a plant-based diet.
Heart disease has long been associated with animal fat consumption4 and serum cholesterol5although this early focus on these two dietary factors has now expanded to a much more comprehensive analysis. In rural China, for example, an aggregate group of ‘Western’ (affluent) diseases (inclusive of heart disease) are highly correlated with serum cholesterol, which is highly correlated in turn with animal protein.6 Thus the early reports of heart disease being associated with dietary total fat, saturated fat and cholesterol is much more likely to have been as association with animal based protein.
As early as 1922 and 1923, increased animal protein consumption was more effective in increasing the early stages of atherosclerosis than dietary fat.7,8 In 19409 and 194110, the same results again appeared. Casein, an animal-based (milk) protein, was about five times more effective(!) than a plant-based protein (soy) in causing an increase in serum cholesterol in experimental animal studies, as later summarized in 1983.11 Similar results were obtained for another animal-based protein, lactalbumin of cow’s milk,12 when it was compared to two plant based-proteins, corn and wheat.
In human studies in 197713 and 198014, animal-based protein affected serum cholesterol much more substantially than did dietary fat. Animal-based proteins, as a group, increase serum cholesterol while plant-based proteins, as a group, decrease serum cholesterol.15 Also, when animal-based proteins and plant-based proteins are switched, serum cholesterol levels switch accordingly,16, 17 going high with animal-based proteins and going low with plant-based proteins. In short, these and other studies convincingly show that animal-based protein is much more significant than plant-based protein or dietary fat in promoting high serum cholesterol and early atherogenesis. However, this effect that has been largely ignored, even though the first observations of this effect appeared almost a century ago and have been repeated many times since.
A similar phenomenon exists for the effects of animal-based protein consumption on experimental cancer.18, 19 The animal-based protein, casein, has been shown in many studies,20, 21 especially in my own laboratory,22 to increase the development of cancer in experimental animals while plant-based proteins, soy and wheat protein, decrease its development. These extensively published findings, too, have been subsequently ignored even though mechanisms responsible for this effect have been documented.
An expert panel of 13 scientists convened by the U.S. National Academy of Sciences produced a 478-page, 1982 report on diet, nutrition and cancer20 and emphasized “the importance of including fruits, vegetables, and whole grain cereal products in the daily diet”. It also was the first expert panel to recommend that dietary fat be decreased only to 30% of total calories, and not lower as the evidence warranted because the panel believed that it might suggest curtailment of the consumption of animal protein-based foods (meat, milk and eggs) and put the report’s credibility at political risk.
In 2009, a review (meta-analysis) of 10 major cohort studies (433,070 participants) showed a highly significant 26% increase in type-2 diabetes cases with an increase of 120 g red meat/day and a 41% increase in type-2 diabetes cases (380,606 participants) when comparing high to low intake of processed meats.23 This is an unusually large number of participants and a huge effect for studies that did not include for comparison a whole food plant-based study group with no meats and/or other animal-based foods.
In 2012, researchers from the Harvard Nurses’ Health Study summarized findings on red meat consumption and mortality from two big, well-known studies, the Nurses and the Physicians studies (23,926 deaths, including 5901 cardiovascular diseases and 9464 cancers, and almost 3 million years of follow-up). They concluded that “red meat consumption is associated with an increased risk of total, CVD [cardiovascular] and cancer mortality. Substitution of other healthy protein sources for red meat is associated with a lower mortality risk.” They estimated that 9.3% of deaths in men and 7.6% in women…could be prevented…if all individuals consumed <0.5 serving/day of red meat.”
In a network of case-control studies, reported in 2013, 11,622 cases of 10 different types of cancer were reported for the years 1991-2009 in Italy and Switzerland. An average 32% cancer risk increase was observed for those consuming an equivalent of 50 g red meat/day.24
These three major degenerative diseases (heart, cancer and diabetes) are associated with increased red meat consumption. The sizes of these effects are statistically quite remarkable, especially when these studies did not include a comparison with the WFPB diet where the observed effect would very likely be much larger, based on the ability of the WFPB diet to reverse the majority of the diabetes and heart disease cases.25, 26
Yet another relatively common disease associated with animal protein-based diets is osteoporosis. Comparing countries, very impressive positive correlations exist for bone fracture rates with dietary calcium27 and animal protein.28 Together these two nutrients explain the increased risk for osteoporosis with increased dairy consumption.22
Very recently, the results of several large studies or meta-analyses of groups of such human studies have become available. Each of these studies has its own unique experimental characteristics, which include 1) number of participants, 2) length of observation period, 3) relative numbers and ages of men versus women, 4) ethnicity, 5) different exposure metrics (food consumption, disappearance, recall and blood biomarkers), 6) disease outcomes (all-cause or disease-specific mortality rates) and 7) criteria for food group specifications (e.g., processed or unprocessed red meat, other meat groups, dairy, eggs). Each report, therefore, will be unique and will provide its own disease risk estimate as a function of these many lifestyle qualifiers (a range of estimations is to be expected). The findings of these studies were peer-reviewed and were authored by highly competent and experienced researchers with little or no hidden conflicts of interests.
Without becoming entrapped in experimental minutiae (as important as they are), the reported findings of a sample of the more notable of these studies show that processed and unprocessed red meat consumption is significantly associated with increases in total mortality by 10-44%,29, 3031 cardiovascular disease mortality by 18-28%29 and cancer mortality by 10-32%.24, 31 Although these results of increased disease risk for meat consumption are generally statistically significant, they may seem somewhat modest for many observers.
In contrast, intervention studies show that switching from a meat based diet (also rich in refined carbohydrates) to a WFPB diet reverses cardiovascular disease in 90-100% of subjects.26, 32Similarly, inter-country cross-sectional studies show a similar magnitude of effect for several cancers and cardiovascular disease. That is, cancer rates approach 0-10% in the lowest dietary fat countries, where dietary fat (as total, saturated and polyunsaturated fat) is a surrogate marker for animal and plant food consumption.1 Also, heart disease is rare in rural China when meat and other animal products are very limited or are not used.
The question then arises why do intervention and cross-sectional studies indicate a huge 90-100% control (even reversal) of disease mortality by avoiding animal-based foods while large prospective studies suggest that by avoiding meat disease risk is reduced only by 10-40%. There are several explanations although the ability of prospective cohort studies to detect a larger, true effect is limited by the usual design of the study.
First, not a single large cohort study includes WFPB diet individuals, thus the effect of this dietary lifestyle cannot be observed. Second, the analyses of the prospective cohort studies focus on estimating risk for single foods or nutrients. The true disease risk for meat will mostly likely remain hidden when diets are relatively rich in animal-protein based foods. Replacing red meat with chicken or dairy, for example, is likely to show only a modest effect for red meat because disease risks for each of these foods are similar.
One conclusion is clear. The consumption of red meat convincingly increases the risk of multiple life-threatening diseases, an effect that is matched by other animal-based foods and by the displacement of plant-based foods.
In summary, these few studies are only a small sample of a much larger number of studies further confirming this conclusion. Diets containing animal based protein, thus red meat, are associated with a huge disease burden, far more than most people realize. Often, too, such diets also include ‘junk foods’ which are high in refined carbohydrates (sugar, refined flour), fat and salt and which add to the disease burden. Switching away from these diets not only prevents but also treats and reverses remarkably quickly further progression of most for these diseases.
Regrettably, evidence of this exceptional outcome of a non-meat, WFPB diet is mostly obtained from a comprehensive assessment of studies that are often statistically constrained by not having WFPB participants. This is because very few investigations of the WFPB diet are conducted and reported, either because 1) investigators themselves are relatively unaware often disbelieving of this effect, 2) funding for such research is almost non-existent and/or because 3) there are far too few participants for such studies. Much of this problem exists because of the enthusiasm expressed for protein wherein about 95% of the population consumes more protein than they need, thus leading to a diet compromised for many other nutrients as well. By adding more and more protein to our diets, and almost always getting it from animal source foods, we create multiple nutritional problems that then become hard to investigate disease causation. It starts with meat, spreads to other animal source foods and quickly involves the depletion of health giving plant source nutrients. We then focus on individual nutrients and their contributions, in numerous ways in our everyday life. But also we do the same in professional research, only to increase confusion and diminish our ability to see the ‘elephant in the room’.
This misunderstanding is a serious problem and is a major reason why so many people find it so difficult to acknowledge the power of nutrition to heal, that is, when nutrition is applied wholistically as in using a diet of whole, plant-based food. Were we to properly understand and experience the benefits of nutrition, our ability to conquer societal and environmental problems is almost beyond comprehension.
- T Colin Campbell, PhD
- Jacob Gould Schurman Professor Emeritus
- Of Nutritional Biochemistry
- Cornell University
The Way To Eat 