WFPB – Why Aren’t We Taken Seriously? Part 1

If you’re already aware of the overwhelming evidence showing the power of a plant-based diet to prevent and treat chronic diseases such as CVD (cardiovascular disease), do you ever wonder why on earth your family doctor, oncologist or cardiologist don’t recommend making simple dietary changes?

A big part of the answer is to do with human nature. Those qualified in modern medicine will have spent almost a decade studying pharmaceutical and surgical solutions and spent only a few academic hours looking at diet – even though overwhelming evidence has existed for over a century that dietary changes can prevent, halt and even reverse some chronic diseases.

If you’d devoted time, effort and money to qualifying as a medical expert in the above way, you wouldn’t want to be told that diseases like CVD, cancer, hypertension, obesity and diabetes can be avoided and dealt with by simply swapping broccoli for your bacon and eggs!

I came across the reality of this in practice quite recently while spending time in hospital as my mother was dying of urinary sepsis with other nasty complications – largely related to poor dietary and exercise choices. Chatting with nurses and doctors reaffirmed my suspicion that those “looking after” our health are more or less ignorant of all the research relating to plant-based diets and their power in preventing and treating disease. They go along with it to a certain extent (“…eat more fruit and veg and less red meat“) but treat any further claims as a joke.

Does this surprise you? If not, then maybe it’s more shocking than if it did surprise you.

Have we become so passive in our acceptance of the ignorance of those to whom we entrust the health of our loved ones that we just expect them – our doctors and surgeons – to continue handing out statins while not even enquiring about why the patient is obese? Offering stents and bypass surgery rather than advising the patient to replace the meat, dairy and eggs with beans, fruit and nuts? Worse than this, they are totally dismissive, and have even been known to refuse treatment, if the patient wants to try WFPB before having their chest ripped open and radioactive chemicals injected into their veins.

Sometimes, I slip into the above passivity and resign myself to the fact that we “WFPBers” are simply out of sync with the world. But at other times, a wave of outrage overwhelms me – particularly when I see a hospital ward full of elderly people who are dying ahead of time because of horrible diseases that could have been largely avoided if only their medical experts had advised them decades ago to cut out the foods that will damage their bodies.

I have studied and written about paradigms. The current medical paradigm involves a reductionist approach to research and treatment. I understand, therefore, that each successive generation of newly-qualified doctors has to appease their superiors and adhere to the methods and approaches they were taught.

I understand that there is much more emphasis on reductionist research rather than on population-wide research – the former is very specific and attracts huge funding; the latter can appear wishy-washy and so attracts almost no funding.

I know it’s human nature to do what you’re told. To practice a profession or trade in the way you were taught, even if there is new information that contradicts the “accepted” tenets you had drilled into your head during your hard-earned education. Equally, it’s clear that young doctors have to tow the line and not contradict their superiors or rock the boat with new ideas. And who would want to spend years training as a cardiologist to then find down the line that there were not enough patients to treat because people were eating foods that kept their hearts healthy?

There’s also the “hypocrisy barrier” to overcome. Which doctor can advise a patient to go home and eat beans and greens when they themselves are likely to pop in for burger on the way home? And this is not a trivial matter. Cast you mind back to how difficult it must have been for doctors to advise patients to quit smoking when they had their own packet of Benson & Hedges on the desk, sitting next to the stethoscope.

Financial profit within the paradigm of the current medical system cannot come from making people too healthy. It requires us to be ill – not too dead but also not too alive.

[su_quote]I hope we shall crush in its birth the aristocracy of our monied corporations which dare already to challenge our government to a trial of strength, and to bid defiance to the laws of their country. —THOMAS JEFFERSON [/su_quote]

And doctors who advocate a plant-based diet – how do they make a living in the our pharmaceutical-led health system? Where’s the profit in giving your patients a prescription to eat more fruit and veg and cut out animal and processed foods?

One of the greatest levers of power we have as individuals in our digital world is to access and read the facts-based research – past, present and future – that vindicates plant-based nutrition as a major solution to most of our chronic diseases. It’s all there on Pubmed, a continually-updated resource of published and peer-reviewed research papers from around the world, including an increasing number that relate to the benefits of a plant-based diet.

And this is the wonderful thing about the WFPB movement – hyperbole is not required. The facts speak for themselves. There is a wealth of research showing the health benefits of simple dietary change. But, unfortunately, for the vast majority of the medical profession, “simple” or “wholistic” solutions (even though shown to be highly effective) do not have the credibility of the more traditional pharmaceutical and surgical approaches which are not appearing to reduce the numbers of people ballooning in size and decaying from within.

It would be far too simplistic to put our health epidemic down to the toxic food choices we are being led to make – even if it were a completely credible explanation.

We need to make a fresh start and take a proactive approach to healthcare instead of a reactive one. We wait to be ill before the medical profession is interested in us. And even when the early stages of disease are detected, pills and potions are recommended as a knee-jerk response, rather than advising timely dietary and lifestyle changes.

We are dealing with the symptoms and not the cause. It’s like going to the doctor with a bad headache because we keep banging it against the wall. The doctor hands us paracetamols and advises the use of an expensive crash helmet, rather than calmly advising us to just stop the head-banging.

[su_quote]Doctors are the clergy for a secular age.  Dr T Colin Campbell[/su_quote]

A single publication by Dr Kim A Williams et al is outlined below. It re-emphasises the need for the medical profession to take seriously the assertion that plant-based diets are a key adjunct in the prevention and treatment of diseases such as CVD. The list of research associated with this publication is also listed below.

Plant-Based Nutrition: An Essential Component of Cardiovascular Disease Prevention and Management. October 2017.

Major points from the research abstract:

  • Discussion of nutrition and the benefits of a plant-based diet should be highlighted during healthcare provider visits as an essential part of the overall CVD prevention and management care plan.
  • Evidence from prospective cohort studies indicates that a high consumption of predominantly plant-based foods, such as fruit and vegetables, nuts, and whole grains, is associated with a significantly lower risk of CVD.
  • The protective effects of these foods are likely mediated through their multiple beneficial nutrients, including mono- and polyunsaturated fatty acids, omega-3 fatty acids, antioxidant vitamins, minerals, phytochemicals, fibre, and plant protein.
  • Minimising intake of animal proteins has been shown to decrease the prevalence of CVD risk factors.
  • Substantial evidence indicates that plant-based diets can play an important role in preventing and treating CVD and its risk factors.
  • Such diets deserve more emphasis in dietary recommendations.


It may be worth your while spending a little while scanning through the list of research papers below (some particularly relevant ones marked in red type) and, if you have a spare hour or two, delve a little deeper into some of the research that already shows both the damage caused by an animal food-based diet and the health-giving power of a plant-based diet.   

It’s great to see luminaries such as Dr Williams passing on the advice of a very wise old medical expert, who said centuries ago “Let food be thy medicine, and medicine thy food.”



(Taken from the above-mentioned publication by Dr Kim A Williams et al.)

  1. Celermajer DS, Chow CK, Marijon E, Anstey NM, Woo KS. Cardiovascular disease in the developing world: prevalences, patterns, and the potential of early disease detection. J Am Coll Cardiol. 2012;60(14):1207–16.PubMedCrossRefGoogle Scholar
  2. Mozaffarian D. Dietary and policy priorities for cardiovascular disease, diabetes, and obesity. Circulation. 2016;133(2):187–225.PubMedPubMedCentralCrossRefGoogle Scholar
  3. Prevention, C for DC and. Deaths and Mortality 2017 28 May. (2017).
  4. Heron M, Anderson R. Changes in the leading cause of death: recent patterns in heart disease and cancer mortality. NCHS data brief. 2016;254:1-8.Google Scholar
  5. Tuso PJ, Ismail MH, Ha BP, Bartolotto C. Nutritional update for physicians: plant-based diets. Perm J. 2013;17(2):61–6.PubMedPubMedCentralCrossRefGoogle Scholar This paper states: “Physicians should consider recommending a plant-based diet to all their patients, especially those with high blood pressure, diabetes, cardiovascular disease, or obesity.” 
  6. Hu FB. The Mediterranean diet and mortality—olive oil and beyond. N Engl J Med. 2003;348(26):2595–6.PubMedCrossRefGoogle Scholar
  7. Hu FB, Cespedes Feliciano EM. What should cardiologists tell their patients about a healthy dietary pattern? J Am Coll Cardiol. 2016;68(8):815–7.PubMedCrossRefGoogle Scholar
  8. Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr. 1995;61(6 Suppl):1402S–6S.PubMedGoogle Scholar
  9. Epstein FH, Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med. 1999;340(2):115–26.CrossRefGoogle Scholar
  10. Boyle J. Macrophage activation in atherosclerosis: pathogenesis and pharmacology of plaque rupture. Curr Vasc Pharmacol. 2005;3(1):63–8.PubMedCrossRefGoogle Scholar
  11. Vita JA. Polyphenols and cardiovascular disease: effects on endothelial and platelet function. Am J Clin Nutr. 2005;81(1 Suppl):292S–7S.PubMedGoogle Scholar
  12. Esselstyn CB. Resolving the coronary artery disease epidemic through plant-based nutrition. Prev Cardiol. 2001;4(4):171–7.PubMedCrossRefGoogle Scholar
  13. Ornish D. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280(23):2001. PubMedCrossRefGoogle Scholar
  14. Hertog MG, Sweetnam PM, Fehily AM, Elwood PC, Kromhout D. Antioxidant flavonols and ischemic heart disease in a Welsh population of men: the Caerphilly study. Am J Clin Nutr. 1997;65(5):1489–94.PubMedGoogle Scholar
  15. Mukamal KJ. Tea consumption and mortality after acute myocardial infarction. Circulation. 2002;105(21):2476–81.PubMedCrossRefGoogle Scholar
  16. Zamora-Ros R, Rabassa M, Cherubini A, Urpi-Sarda M, Bandinelli S, Ferrucci L, et al. High concentrations of a urinary biomarker of polyphenol intake are associated with decreased mortality in older adults. J Nutr. 2013;143(9):1445–50.PubMedPubMedCentralCrossRefGoogle Scholar
  17. Carmeli E, Fogelman Y. Antioxidant effect of polyphenolic glabridin on LDL oxidation. Toxicol Ind Health. 2009;25(4–5):321–4.PubMedCrossRefGoogle Scholar
  18. Frémont L, Belguendouz L, Delpal S. Antioxidant activity of resveratrol and alcohol-free wine polyphenols related to LDL oxidation and polyunsaturated fatty acids. Life Sci. 1999;64(26):2511–21.PubMedCrossRefGoogle Scholar
  19. Bernstein AM, Sun Q, Hu FB, Stampfer MJ, Manson JE, Willett WC. Major dietary protein sources and risk of coronary heart disease in women. Circulation. 2010;122(9):876–83.PubMedPubMedCentralCrossRefGoogle Scholar
  20. Ashaye A, Gaziano J, Djoussé L. Red meat consumption and risk of heart failure in male physicians. Nutr Metab Cardiovasc Dis. 2011 Dec;21(12):941–6.PubMedCrossRefGoogle Scholar
  21. Koeth RA, Wang Z, Levison BS, Buffa JA, Org E, Sheehy BT, et al. Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med. 2013;19(5):576–85.PubMedPubMedCentralCrossRefGoogle Scholar
  22. Tang WHW, Wang Z, Levison BS, Koeth RA, Britt EB, Fu X, et al. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. N Engl J Med. 2013;368(17):1575–84.PubMedPubMedCentralCrossRefGoogle Scholar
  23. Yang S-Y, Zhang H-J, Sun S-Y, Wang L-Y, Yan B, Liu C-Q, et al. Relationship of carotid intima-media thickness and duration of vegetarian diet in Chinese male vegetarians. Nutr Metab (Lond). 2011;8(1):63.CrossRefGoogle Scholar
  24. Wang Z, Klipfell E, Bennett BJ, Koeth R, Levison BS, DuGar B, et al. Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature. 2011;472(7341):57–63.PubMedPubMedCentralCrossRefGoogle Scholar
  25. Kahleova H, Matoulek M, Malinska H, Oliyarnik O, Kazdova L, Neskudla T, et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes. Diabet Med. 2011;28(5):549–59.PubMedPubMedCentralCrossRefGoogle Scholar
  26. De Natale C, Annuzzi G, Bozzetto L, Mazzarella R, Costabile G, Ciano O, et al. Effects of a plant-based high-carbohydrate/high-fiber diet versus high-monounsaturated fat/low-carbohydrate diet on postprandial lipids in type 2 diabetic patients. Diabetes Care. 2009 Dec;32(12):2168–73.PubMedPubMedCentralCrossRefGoogle Scholar
  27. Jiang R, Manson JE, Stampfer MJ, Liu S, Willett WC, Hu FB. Nut and peanut butter consumption and risk of type 2 diabetes in women. JAMA. 2002;288(20):2554–60.PubMedCrossRefGoogle Scholar
  28. Mishra S, Xu J, Agarwal U, Gonzales J, Levin S, Barnard ND. A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in the corporate setting: the GEICO study. Eur J Clin Nutr. 2013;67(7):718–24.PubMedPubMedCentralCrossRefGoogle Scholar
  29. Ramal E, Champlin A, Bahjri K. Impact of a plant-based diet and support on mitigating type 2 diabetes mellitus in Latinos living in medically underserved areas. Am J Health Promot. 2017 Jan;1:890117117706793.Google Scholar
  30. Goff LM, Bell JD, So P-W, Dornhorst A, Frost GS. Veganism and its relationship with insulin resistance and intramyocellular lipid. Eur J Clin Nutr. 2005 Feb;59(2):291–8.PubMedCrossRefGoogle Scholar
  31. Virkamäki A, Korsheninnikova E, Seppälä-Lindroos A, Vehkavaara S, Goto T, Halavaara J, et al. Intramyocellular lipid is associated with resistance to in vivo insulin actions on glucose uptake, antilipolysis, and early insulin signaling pathways in human skeletal muscle. Diabetes. 2001 Oct;50(10):2337–43.PubMedCrossRefGoogle Scholar
  32. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  33. Meyer KA, Kushi LH, Jacobs DR, Slavin J, Sellers TA, Folsom AR. Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr. 2000 Apr;71(4):921–30.PubMedGoogle Scholar
  34. Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000 Jul 6;343(1):16–22.PubMedCrossRefGoogle Scholar
  35. Satija A, Bhupathiraju, S, Spiegelman D, Chiuve S, Manson J, Willett W, Rexrode K, Rimm E, Hu F. Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease. J Am Coll Cardiol. 2017;70:411–22.Google Scholar
  36. Rinaldi S, Campbell EE, Fournier J, O’Connor C, Madill J. A comprehensive review of the literature supporting recommendations from the Canadian Diabetes Association for the use of a plant-based diet for management of type 2 diabetes. Can J Diabetes. 2016;40(5):471–7.PubMedCrossRefGoogle Scholar
  37. Marathe PH, Gao HX, Close KL. American Diabetes Association standards of medical care in diabetes 2017. J Diabetes. 2017;9(4):320–4.PubMedCrossRefGoogle Scholar
  38. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135(10):e146–603.PubMedPubMedCentralCrossRefGoogle Scholar
  39. Midgley JP, Matthew AG, Greenwood CM, Logan AG. Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized controlled trials. JAMA. 275(20):1590–7.Google Scholar
  40. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 1997;336(16):1117–24.PubMedCrossRefGoogle Scholar/ This study concludes that “A diet rich in fruits, vegetables, and low-fat dairy foods and with reduced saturated and total fat can substantially lower blood pressure. This diet offers an additional nutritional approach to preventing and treating hypertension.”
  41. John JH, Ziebland S, Yudkin P, Roe LS, Neil HAW. Oxford fruit and vegetable study group. Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: a randomised controlled trial. Lancet (London, England). 2002;359(9322):1969–74.CrossRefGoogle Scholar
  42. Steffen LM, Kroenke CH, Yu X, Pereira MA, Slattery ML, Van Horn L, et al. Associations of plant food, dairy product, and meat intakes with 15-y incidence of elevated blood pressure in young black and white adults: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Am J Clin Nutr. 2005;82(6):1169–77-4.PubMedGoogle Scholar
  43. Borgi L, Curhan GC, Willett WC, Hu FB, Satija A, Forman JP. Long-term intake of animal flesh and risk of developing hypertension in three prospective cohort studies. J Hypertens. 2015 Nov;33(11):2231–8.PubMedPubMedCentralCrossRefGoogle Scholar
  44. Yokoyama Y, Nishimura K, Barnard ND, Takegami M, Watanabe M, Sekikawa A, et al. Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern Med. 2014 Apr;174(4):577–87.PubMedCrossRefGoogle Scholar
  45. National Cholesterol Education Program, National Heart, Lung, and Blood Institute NI of H. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. NIH Publ No 02–5215. 2002;Google Scholar
  46. Jenkins DJA. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA. 2003 Jul 23;290(4):502.PubMedCrossRefGoogle Scholar
  47. Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: Natl Acad Press. 2005.
  48. Weggemans RM, Zock PL, Katan MB. Dietary cholesterol from eggs increases the ratio of total cholesterol to high-density lipoprotein cholesterol in humans: a meta-analysis. Am J Clin Nutr. 2001 May;73(5):885–91.PubMedGoogle Scholar
  49. Hopkins PN. Effects of dietary cholesterol on serum cholesterol: a meta-analysis and review. Am J Clin Nutr. 1992 Jun;55(6):1060–70.PubMedGoogle Scholar
  50. •• Song M, Fung TT, Hu FB, Willett WC, Longo VD, Chan AT, et al. Association of animal and plant protein intake with all-cause and cause-specific mortality. JAMA Intern Med. 2016;176(10):1453. This study showed that high animal protein intake was positively associated with cardiovascular mortality, and high plant protein intake was inversely associated with all-cause and cardiovascular mortality, especially among individuals with at least 1 lifestyle risk factor. Thus, substituting plant protein for animal protein, especially from processed red meat, was associated with lower mortality, highlighting the importance of protein source.PubMedCrossRefPubMedCentralGoogle Scholar
  51. Shin JY, Xun P, Nakamura Y, He K. Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2013 Jul;98(1):146–59.PubMedPubMedCentralCrossRefGoogle Scholar
  52. Wang F, Zheng J, Yang B, Jiang J, Fu Y, Li D. Effects of vegetarian diets on blood lipids: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2015 Oct 27;4(10):e002408.PubMedPubMedCentralCrossRefGoogle Scholar
  53. Mensink RP, Zock PL, Kester ADM, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003 May;77(5):1146–55.PubMedGoogle Scholar
  54. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk. J Am Coll Cardiol. 2014 Jul;63(25):2960–84.PubMedCrossRefGoogle Scholar
  55. Agriculture. UD of H and HSUD of. 2015–2020 Dietary Guidelines for Americans. 8th ed. [Internet]. Washington, DC: US Dept of Health and Human Services. 2015. 1 Jun (2017).
  56. Agudo A, Cabrera L, Amiano P, Ardanaz E, Barricarte A, Berenguer T, et al. Fruit and vegetable intakes, dietary antioxidant nutrients, and total mortality in Spanish adults: findings from the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). Am J Clin Nutr. 2007 Jun;85(6):1634–42.PubMedGoogle Scholar
  57. Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C. Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: the ATTICA study. J Am Coll Cardiol. 2004 Jul 7;44(1):152–8.PubMedCrossRefGoogle Scholar
  58. Dai J, Jones DP, Goldberg J, Ziegler TR, Bostick RM, Wilson PW, et al. Association between adherence to the Mediterranean diet and oxidative stress. Am J Clin Nutr. 2008 Nov;88(5):1364–70.PubMedPubMedCentralGoogle Scholar
  59. Zino S, Skeaff M, Williams S, Mann J. Randomised controlled trial of effect of fruit and vegetable consumption on plasma concentrations of lipids and antioxidants. BMJ. 1997 Jun 21;314(7097):1787–91.PubMedPubMedCentralCrossRefGoogle Scholar
  60. • Wolk A. Potential health hazards of eating red meat. J Intern Med. 2017;281(2):106–22. This review examined the correlation between disease risk and meat consumption in six cohort studies to provide a comprehensive summary of the potential negative health effects of consuming red meat, including significantly increased risks for diabetes, heart disease, stroke, and cancer. PubMedCrossRefGoogle Scholar
  61. Buckland G, González CA, Agudo A, Vilardell M, Berenguer A, Amiano P, et al. Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC cohort study. Am J Epidemiol. 2009;170(12):1518–29.PubMedCrossRefGoogle Scholar
  62. Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009;119(8):1093–100.PubMedPubMedCentralCrossRefGoogle Scholar
  63. Mitrou PN, Kipnis V, Thiébaut ACM, Reedy J, Subar AF, Wirfält E, et al. Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIH-AARP diet and health study. Arch Intern Med. 2007;167(22):2461–8.PubMedCrossRefGoogle Scholar
  64. Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis1. Am J Clin Nutr. 2010;92(5):1189–96.PubMedCrossRefGoogle Scholar
  65. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008;337:a1344.PubMedPubMedCentralCrossRefGoogle Scholar
  66. •• Åkesson A, Larsson SC, Discacciati A, Wolk A. Low-risk diet and lifestyle habits in the primary prevention of myocardial infarction in men. J Am Coll Cardiol. 2014;64(13):1299–306. This study showed that the risk of myocardial infarction is significantly reduced by adherence to very basic lifestyle modifications. PubMedCrossRefGoogle Scholar
  67. Estruch R, Ros E, Salas-Salvadó J, Covas M-I, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279–90.PubMedCrossRefGoogle Scholar
  68. Nagura J, Iso H, Watanabe Y, Maruyama K, Date C, Toyoshima H, et al. Fruit, vegetable and bean intake and mortality from cardiovascular disease among Japanese men and women: the JACC study. Br J Nutr. 2009;102(2):285–92.PubMedCrossRefGoogle Scholar
  69. Strandhagen E, Hansson PO, Bosaeus I, Isaksson B, Eriksson H. High fruit intake may reduce mortality among middle-aged and elderly men. The study of men born in 1913. Eur J Clin Nutr. 2000;54(4):337–41.PubMedCrossRefGoogle Scholar
  70. Bazzano LA, He J, Ogden LG, Loria CM, Vupputuri S, Myers L, et al. Fruit and vegetable intake and risk of cardiovascular disease in US adults: the first national health and nutrition examination survey epidemiologic follow-up study. Am J Clin Nutr. 2002;76(1):93–9.PubMedGoogle Scholar
  71. Wang X, Ouyang Y, Liu J, Zhu M, Zhao G, Bao W, et al. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ. 2014 Jul 29;349:g4490.PubMedPubMedCentralCrossRefGoogle Scholar
  72. He FJ, Nowson CA, MacGregor GA. Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet (London, England). 2006;367(9507):320–6.CrossRefGoogle Scholar
  73. Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, et al. Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Ann Intern Med. 2014;160(6):398–406.PubMedCrossRefGoogle Scholar
  74. Yakoob MY, Shi P, Hu FB, Campos H, Rexrode KM, Orav EJ, et al. Circulating biomarkers of dairy fat and risk of incident stroke in U.S. men and women in 2 large prospective cohorts. Am J Clin Nutr. 2014;100(6):1437–47.PubMedPubMedCentralCrossRefGoogle Scholar
  75. Kelemen LE, Kushi LH, Jacobs DR, Cerhan JR. Associations of dietary protein with disease and mortality in a prospective study of postmenopausal women. Am J Epidemiol. 2005;161(3):239–49.PubMedCrossRefGoogle Scholar
  76. Chen M, Sun Q, Giovannucci E, Mozaffarian D, Manson JE, Willett WC, et al. Dairy consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis. BMC Med. 2014;12:215.PubMedPubMedCentralCrossRefGoogle Scholar
  77. Zong G, Li Y, Wanders AJ, Alssema M, Zock PL, Willett WC, et al. Intake of individual saturated fatty acids and risk of coronary heart disease in US men and women: two prospective longitudinal cohort studies. BMJ. 2016;355:i5796.PubMedPubMedCentralCrossRefGoogle Scholar
  78. Harris WS, Mozaffarian D, Rimm E, Kris-Etherton P, Rudel LL, Appel LJ, et al. Omega-6 fatty acids and risk for cardiovascular disease: a science advisory from the American Heart Association Nutrition Subcommittee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Cardiovascular Nursing; and Council on Epidem. Circulation. 2009;119(6):902–7.PubMedCrossRefGoogle Scholar
  79. Ramsden CE, Zamora D, Majchrzak-Hong S, Faurot KR, Broste SK, Frantz RP, et al. Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota coronary experiment (1968-73). BMJ. 2016;353:i1246.PubMedPubMedCentralCrossRefGoogle Scholar
  80. Ramsden CE, Zamora D, Leelarthaepin B, Majchrzak-Hong SF, Faurot KR, Suchindran CM, et al. Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney diet heart study and updated meta-analysis. BMJ. 2013;346:e8707.PubMedPubMedCentralCrossRefGoogle Scholar
  81. Hamazaki T, Okuyama H. The Japan Society for Lipid Nutrition recommends to reduce the intake of linoleic acid. A review and critique of the scientific evidence. World Rev Nutr Diet. 2003;92:109–32.PubMedCrossRefGoogle Scholar
  82. Nielsen MS, Schmidt EB, Stegger J, Gorst-Rasmussen A, Tjonneland A, Overvad K. Adipose tissue arachidonic acid content is associated with the risk of myocardial infarction: a Danish case-cohort study. Atherosclerosis. 2013 Apr;227(2):386–90.PubMedCrossRefGoogle Scholar
  83. Farvid MS, Ding M, Pan A, Sun Q, Chiuve SE, Steffen LM, et al. Dietary linoleic acid and risk of coronary heart disease: a systematic review and meta-analysis of prospective cohort studies. Circulation. 2014 Oct 28;130(18):1568–78.PubMedPubMedCentralCrossRefGoogle Scholar
  84. Jakobsen MU, O’Reilly EJ, Heitmann BL, Pereira MA, Bälter K, Fraser GE, et al. Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr. 2009 May;89(5):1425–32.PubMedPubMedCentralCrossRefGoogle Scholar
  85. Li Y, Hruby A, Bernstein AM, Ley SH, Wang DD, Chiuve SE, et al. Saturated fats compared with unsaturated fats and sources of carbohydrates in relation to risk of coronary heart disease: a prospective cohort study. J Am Coll Cardiol. 2015 Oct 6;66(14):1538–48.PubMedPubMedCentralCrossRefGoogle Scholar
  86. Craig WJ. Mangels, AR ADA. Position of the American dietetic association: vegetarian diets. J Am Diet Assoc. 2009 Jul;109(7):1266–82.PubMedCrossRefGoogle Scholar
  87. 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–12S.PubMedGoogle Scholar
  88. Wilson AK, Ball MJ. Nutrient intake and iron status of Australian male vegetarians. Eur J Clin Nutr. 1999 Mar;53(3):189–94.PubMedCrossRefGoogle Scholar
  89. 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 Apr 21;48(2):103–8.PubMedCrossRefGoogle Scholar
  90. Etemadi A, Sinha R, Ward MH, Graubard BI, Inoue-Choi M, Dawsey SM, Abnet CC. Mortality from different causes associated with meat, heme iron, nitrates, and nitrites in the NIH-AARP Diet and Health Study: population based cohort study. BMJ. 2017 May 9;357:j1957.
  91. Hunt JR. Moving toward a plant-based diet: are iron and zinc at risk? Nutr Rev. 2002 May 1;60(5):127–34.PubMedCrossRefGoogle Scholar
  92. Haddad EH, Berk LS, Kettering JD, Hubbard RW, Peters WR. Dietary intake and biochemical, hematologic, and immune status of vegans compared with nonvegetarians. Am J Clin Nutr. 1999 Sep;70(3 Suppl):586S–93S.PubMedGoogle Scholar
  93. Appleby P, Roddam A, Allen N, Key T. Comparative fracture risk in vegetarians and nonvegetarians in EPIC-Oxford. Eur J Clin Nutr. 2007 Dec 7;61(12):1400–6.PubMedCrossRefGoogle Scholar
  94. Davey GK, Spencer EA, Appleby PN, Allen NE, Knox KH, Key TJ. EPIC–Oxford:lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. Public Health Nutr. 2003 Jun;2:6(3).Google Scholar
  95. Trang HM, Cole DE, Rubin LA, Pierratos A, Siu S, Vieth R. Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr. 1998 Oct;68(4):854–8.PubMedGoogle Scholar
  96. Šebeková K, Boor P, Valachovičová M, Blažíček P, Parrák V, Babinská K, et al. Association of metabolic syndrome risk factors with selected markers of oxidative status and microinflammation in healthy omnivores and vegetarians. Mol Nutr Food Res. 2006 Sep;50(9):858–68.PubMedCrossRefGoogle Scholar
  97. Donaldson MS. Metabolic vitamin B12 status on a mostly raw vegan diet with follow-up using tablets, nutritional yeast, or probiotic supplements. Ann Nutr Metab. 2000 Dec 27;44(5–6):229–34.PubMedCrossRefGoogle Scholar
  98. Brug J. Determinants of healthy eating: motivation, abilities and environmental opportunities. Fam Pract. 2008;25(Supplement 1):i50–5.PubMedCrossRefGoogle Scholar
  99. Janssen M, Busch C, Rödiger M, Hamm U. Motives of consumers following a vegan diet and their attitudes towards animal agriculture. Appetite. 2016 Oct 1;105:643–51.PubMedCrossRefGoogle Scholar
  100. Fox N, Ward K. Health ethics and environment: a qualitative study of vegetarian motivations. Appetite. 2008 Mar;50(2–3):422–9.PubMedCrossRefGoogle Scholar
  101. Current Cardiology Reports. October 2017, 19:104. Plant-Based Nutrition: An Essential Component of Cardiovascular Disease Prevention and Management. Hena Patel, Sonal Chandra, Sarah Alexander, Jeffrey Soble, Kim Allan Williams Sr.