Leptin – The “Fat” Hormone?

If you’re not familiar with leptin, it’s certainly familiar with you. Known by various nicknames, such as the ‘satiety hormone’ or ‘fat hormone’, leptin plays a leading role in daily dietary dramas. But, is it more responsible for over-eating (hyperphagia) and obesity than mere lack of will-power?

What is leptin?

In healthy, non-obese individuals, the hormone leptin controls appetite. After you’ve eaten a meal, this anorexigenic (appetite-suppressing) hormone gets released by adipose tissue (fat cells) and acts on the hypothalamus in the brain to produce a feeling of satiety (fullness) which then suppresses the appetite and (hopefully) stops you from over-eating. It also speeds up your resting metabolism, thereby increasing energy expenditure. 1

This is a pretty sensible mechanism, from an evolutionary point of view, since it would help stop members of our species from getting too fat to be able to run away from sabre-toothed tigers. 2

On the other hand, there were perfectly good reasons why we might have needed to store up as much fat as possible –  to get through periods of famine, for instance. 3 This is why there are mechanisms, including the orexigenic (appetite-stimulating) hormone ghrelin (the “hunger hormone“) 4 , which act in the opposite direction from leptin, actively stimulating us to feel hungry5

However, evolution wasn’t so good at predicting the appearance of McDonald’s Whoppers or Chocolate Hobnobs. And this is where the problem starts with leptin. If we continue to eat the ‘wrong’ foods, the brain doesn’t realise we’ve actually had enough to eat.

Before looking into a bit more detail about why leptin might not be doing its job properly – evident by the widespread increase in obesity – it’s worth mentioning that other mechanism supposed to help us moderate food intake – namely, stretch receptors in the stomach 6 . If these are supposed to activate as the stomach expands in size, you can see from the above graphic that high-calorie/low-bulk foods will not stretch the stomach as much as low-calorie/high-bulk foods – that is, plant foods which are high in fibre content.

Such foods (mostly processed with high levels of sugar, saturated fat and salt) tend to be high in calories but low in nutrients (such as fibre, vitamins, minerals and phytonutrients). 7 . This is where we come across the differences between toxic hunger and real hunger, as discussed in a previous blog 8 . It’s called “toxic” because it can end up causing us to chronically over-eat and become obese, resulting in all the nasty associated problems like type 2 diabetes, heart disease and various cancers.

Leptin – Animal-Eaters vs Plant-Eaters

So, turning back to leptin, a recent study 9 took a small number of healthy women from three different dietary groups: omnivores, lacto-ovo-vegetarians, and vegans to see if there were any difference in leptin levels between them. What they found was in line with previous studies 10 11 12 , namely: “…people who adopted a vegetarian dietary pattern had lower plasma levels of leptin when compared to the meat consumers.” The mean plasma leptin levels were:

  • omnivores – 7.45 ng/ml
  • lacto-ovo-vegetarians – 3.87 ng/ml
  • vegans – 2.89 ng/ml

Leptin & Obesity

It’s well-established that meat-eaters are more likely than plant-eaters to become obese 13 14 . So, does this mean that meat-eaters don’t have enough leptin to inform their brains that they have eaten enough, and that plant-eaters have too much leptin? Oddly enough, quite the reverse.

Leptin Insensitivity/Resistance

What’s actually happening is that the abundance of swollen fat cells produce so much leptin that the hypothalamus starts to become insensitive and eventually resistant to leptin’s action. Thus, the brain keeps telling the obese individual “You’re still hungry!“. Eating plant-based diets – ideally WFPB diets, since vegan diets can still lead to obesity if they contain loads of junk food 15 – does not result in such fat storage in the body and, hence, leptin continues to do its job without the body getting “fed up of it”…

You’ve probably already drawn a parallel here with leptin resistance/insensitivity – namely, to type 2 diabetes. By definition, T2D is a condition which transitions through a stage where the pancreas still pumps plenty of insulin into the bloodstream, but cells become resistant/insensitive to it 16 .

It’s similar to how taste buds become insensitive to salt and sugar, how one can develop tolerance for cigarettes or alcohol, even though the body is silently screaming.

Do I Need To Increase Leptin levels?

Perhaps the more appropriate question should be “How do I make my body more sensitive to the already high levels of leptin in my body?”

The simplest and healthiest way is likely to be through changing to a plant-based diet. Not only is this likely to clear up any existing problem with leptin resistance, it will also help to reverse a huge range of diseases – including obesity 17 , type 2 diabetes 18 , cardiovascular disease 19 , and even many cancers 20 .

Final thoughts

The above brief analysis has suggested that, A. leptin works best within non-obese bodies and, B. that non-obese bodies are more likely to be inhabited by plant-eaters than by meat-eaters.

We also know that plant-eaters are less likely than omnivores to suffer from metabolic syndrome –  a complex of conditions in which triglycerides, total cholesterol, low-density lipoprotein (LDL), blood glucose, blood pressure, waist circumference, and body mass index (BMI) are all increased to seriously unhealthy levels21 .

It’s The Fat!

And much of the problem is simply to do with the amount of fat within the body – not that we grow more fat cells, since we actually retain a reasonably constant number of fat cells throughout adult life 22 , rather the fat cells we have can grow and grow until they’re so stuffed full that they leach fat back into the bloodstream without us even needing to consume any dietary fat –  a process known as “reintoxication” 23 Yuk!

So What About Will-Power?

It’s so easy to think that overweight/obese individuals lack sufficient will-power. However, it may be more likely that they are simply acting in accordance with what their brain is telling them or, rather, what their brain is failing to tell them.

How Do I Know If I’m Leptin Resistant?

It may sound too simple, but – just look in the mirror or see if you can grab a handful of fat around the middle of your body. Basically, there’s a really strong chance that leptin is not doing its job inside you if you are overweight.

How Do I Reverse Leptin Resistance?

I keep hammering away at this…but, all the evidence strongly suggests that the healthiest, most natural and sustainable diet for weight loss, general disease-resistance and healthy longevity is a wholefood plant-based diet24 25 . It’s also probably the healthiest for the rest of life on Earth, too 26 .

How about having a go at the short quiz below?


[qsm quiz=18]

References

  1. Waugh, Anne; Grant, Allison. Ross & Wilson Anatomy and Physiology in Health and Illness E-Book (p. 284). Elsevier Health Sciences. Kindle Edition. []
  2. The evolution of body fatness: trading off disease and predation risk. John R. Speakman. []
  3. A Nonadaptive Scenario Explaining the Genetic Predisposition to Obesity: The “Predation Release” Hypothesis. Literature Review. Cell Metabolism 6(1):5-12 · August 2007. []
  4. Ghrelin is the primary hunger hormone. It’s released from your stomach (with smaller amounts being released by the small intestine, pancreas and brain) into the blood and to the brain to stimulate hunger to alert you that you’re hungry. It has many functions throughout your body besides hunger. It also functions within the pleasure/reward centre of the brain, and plays a role in memory formation, immune function, and even sleep. []
  5. Curr Opin Clin Nutr Metab Care. 2013 Nov; 16(6): 619–624. Ghrelin: much more than a hunger hormone. Geetali Pradhan, Susan L. Samson, and Yuxiang Sun. []
  6. Paintal, A. S. (1954). A study of gastric stretch receptors. Their role in the peripheral mechanism of satiation of hunger and thirst. The Journal of Physiology, 126(2), 255–270. []
  7. Health = Nutrient Intake ÷ Calories []
  8. Toxic Hunger vs Real Hunger []
  9. Association between different types of plant-based diets and leptin levels in healthy volunteers. Gogga P, Śliwińska A, Aleksandrowicz-Wrona E, Małgorzewicz S. Acta Biochim Pol. 2019 Feb 15. doi: 10.18388/abp.2018_2725. []
  10. AmbroszkiewiczJ,Laskowska-Klita T,Klemarczyk W (2004) Low se-rum leptin concentration in vegetarian prepubertal children. Rocz Akad Med Bialymst 49: 103–105. []
  11. AmbroszkiewiczJ,Klemarczyk W,Gajewska J,Chełchowska M,Ro-wicka G, Ołtarzewski M, Laskowska-Klita T (2011) Serum concen-tration of adipocytokines in prepubertal vegetarian and omnivorous children. Med Wieku Rozwoj 15: 326–334 []
  12. Kim MH, Bae YJ (2015) Comparative study of serum leptin and insu-lin resistance levels betweenKorean postmenopausalvegetarianandnon-vegetarian women. Clin Nutr Res 4: 175–181. []
  13. Int J Obes (Lond). 2009 Jun; 33(6): 621–628. Meat consumption is associated with obesity and central obesity among US adults. Y Wang and MA Beydoun. []
  14. Vegetarian diets and childhood obesity prevention. Joan Sabaté Michelle Wien. The American Journal of Clinical Nutrition, Volume 91, Issue 5, 1 May 2010, Pages 1525S–1529S. []
  15. Greggs’ Vegan Sausage Rolls – Why Veganism Can Fail []
  16. Every vampire needs an invitation []
  17. CNS: Morbid Obesity Solution: A Long-Term Plant-Based Case Study. Roberta Russell. January 24, 2017. []
  18. J Geriatr Cardiol. 2017 May; 14(5): 342–354. A plant-based diet for the prevention and treatment of type 2 diabetes. Michelle McMacken and Sapana Shah. []
  19. J Geriatr Cardiol. 2017 May; 14(5): 317–320. A plant-based diet and coronary artery disease: a mandate for effective therapy. Caldwell B Esselstyn. []
  20. Surely Foods Can’t Fight Cancer []
  21. RizzoNS,Sabaté J,Jaceldo-Siegl K,Fraser GE (2011) Vegetariandietary patterns are associated with a lower risk of metabolic syn-drome: the adventist health study 2. Diabetes Care 34: 1225–1227. []
  22. NIH RESEARCH MATTERS. May 12, 2008. Fat Cell Numbers in Teen Years Linger for a Lifetime. []
  23. Br J Pharmacol. 2009 Nov; 158(5): 1330–1337. Reintoxication: the release of fat-stored Δ9-tetrahydrocannabinol (THC) into blood is enhanced by food deprivation or ACTH exposure. N Gunasekaran et al. []
  24. Which Diets Work for Weight-Loss? []
  25. Vegetarian Diets and the Risk of Diabetes []
  26. A Sustainable Diet for Our Planet []

Athletic Performance & Physical Damage on Plant-Based Diets

A January 2019 scientific review 1  by Dr Neal Barnard 2 and his team, entitled “Plant-Based Diets for Cardiovascular Safety and Performance in Endurance Sports“, looked at whether endurance athletes, who are at a higher-than-average risk of developing atherosclerosis and myocardial damage, have reduced health risks and improved performance if they eat a plant-based diet. The results are pretty compelling and should be considered by anyone within any age group who engages in regular physical exercise, not just those who undertake endurance sports.

Diet & exercise

It’s well-accepted 3  that diet in general plays a significant role in maintaining the health and improving the performance of athletes. In previous blogs, we looked in some detail at how plant-based diets may improve sports performance and reduce injury 4 5 6 , as well as how options such as the paleo diet 7  and consuming whey products 8 appear to do quite the opposite. Interestingly, and in relation to cancer risk, some research even showed 9 that the blood of a ‘couch potato’ eating a healthier than standard diet is likely to have better cancer-fighting abilities than the blood of someone who exercises regularly and strenuously but eats the standard diet – thus suggesting that diet may play a more significant role in overall health than exercise.

The study covered below deals in more depth with how choosing a plant-based diet can improve athletic performance as well as help avoid, and even reverse, serious and long-term health risks that both athletes and non athletes face.

What the study covers

The study considers that there is sufficient evidence to claim that plant-based regimes can achieve the following:

  • reduce cardiovascular risk factors
    • reverse existing atherosclerotic lesions
  • reduce plasma lipid concentrations, thereby:
    • reduce blood viscosity, and
    • increase tissue oxygenation
  • improve glycaemic control 10
  • reduce body weight (obesity)
  • increase glycogen storage
  • reduce blood pressure
  • reduce oxidative stress
  • reduce inflammation

Individually, or in combination, it’s suggested that the above benefits, which may result from plant-based dietary regimes, both protect the health of the athlete and improve athletic performance. The latter are discussed in more detail below.

Cardiovascular risk & plant-based diets

Studies have shown plant-based dietary patterns have particular benefits for heart health:

  • being able to reverse arterial plaque 11 12 13
  • significantly reducing the likelihood of developing coronary heart disease compared with meat eaters 14

But surely, you’d think, athletes are more or less immune to developing atherosclerosis 15  because of all the exercise they do. However, this has been shown 16 not to be the case.  It may seem odd, but it’s been shown in several studies 17 18 19 20 that endurance athletes may have more advanced atherosclerosis and more myocardial damage than sedentary individuals, increasing as periods of sports endurance accumulate and as they age.

Even sudden sports-related sudden cardiac deaths among ostensibly ultra fit athletes have been shown 21 to be more common than you’d think, especially with increased age.

But is it the diet?

Of course, the question has to be answered: “Is the atherosclerosis and myocardial damage caused by the athletic activity itself or by the foods used to fuel it?”

This study considers that when consumption of animal products is increased, perhaps with the hope of supplying increased energy for increased athletic activity, the associated saturated fat and cholesterol (as well as the relative absence of antioxidants and fibre 22 ) may contribute to the atherosclerotic changes.

Atherosclerosis may also narrow arteries in the legs, brain, and other parts of the body which will reduce blood flow and potentially impair performance. This has certainly been shown 23 to be the case with diagnosed peripheral artery disease, and is considered as a factor for athletes with undiagnosed (i.e. subclinical) atherosclerotic disease.

Plant-based diets can address the key factors that cause atherosclerosis, namely:

  • dyslipidemia 24
  • elevated blood pressure
  • elevated body weight, and
  • diabetes

So it would appear that diet is key to protecting heart health and thus for enhancing athletic performance.

Atherosclerosis – exception or norm?

And while one may think that atherosclerotic disease is the exception rather than the rule, studies have shown 25 that in the modern Western world [with its modern Western diet] atherosclerosis can begin early in life, even in the womb.

A study 26 showed that the majority of American children have fatty streaks in the left anterior descending coronary artery by the age of 10 to 14 years.

Autopsies of U.S. soldiers with a mean age of 20.5 years who died in the Korean War showed that 6.4% of them had coronary atherosclerosis 27 .

Autopsies of soldiers with a mean age of 25.9 years who died in the Iraqi wars between 2001 and 2011 showed that 8.5% of them had coronary atherosclerosis 28 .

And it gets worse. In so-called ‘developed’ countries, by the age of 20, ~10% of the population have advanced atherosclerotic lesions in the abdominal aorta, which reduces blood flow and contributes to disc degeneration and lower back pain 29

So, if you’re from a country where the Western diet is the norm (and, of course, you’ve also eaten that diet), you’re very likely predisposed to such risks even before you run your first marathon.

Plasma lipid concentrations & plant-based diets

Diets rich in saturated fat and, to a lesser degree, dietary cholesterol promote dyslipidemia, and dyslipidemia is a major contributor to arterial disease. With dairy products and meat being the leading sources of saturated fat, removing these has predictably been shown 30 to improve plasma lipid profiles.

By including soluble fibre (e.g. oats, beans, barley), almonds, soy protein, and sterol-containing margarines [the latter being something no WFPB advocate would advocate!], it’s been shown 31 that low-density lipoprotein (LDL – the ‘bad’ cholesterol) can be reduced by around 30% in as little as 4 weeks.

It’s also important to point out that trans fats have detrimental effects on plasma lipids and, thus, increase cardiovascular risks 32 33 .

Blood viscosity/tissue oxygenation & plant-based diets

Blood viscosity is a key element in oxygen delivery to the muscles 34 – lowering viscosity improves both blood flow and athletic performance, increasing viscosity does the opposite 35 .

During athletic activity, fluid passing from the bloodstream into the tissues leads to haemoconcentration 36 . This gradual rise in blood viscosity results in progressive loss of tissue oxygenation which, of course in turn, degrades athletic performance 37 .

Diet affects this plasma viscosity. Because plants are typically low in saturated fat and have no cholesterol, plant-based diets are considered 30 38 to reduce plasma lipid concentrations, and hence reduce viscosity.

Reduced blood viscosity also improves tissue oxygenation, thereby potentially improving athletic performance. In one study 39 , brachial artery flow-mediated vasodilation 40 was assessed in a range of diets – low-fat vegetarian, low-carb/high-fat (Atkins), and high-fat (South Beach). The results were that the vegetarian diet improved brachial artery flow-mediated vasodilation compared with the other diets. Basically, the higher the saturated fat intake, the greater the impairment of flow-mediated vasodilation, with arterial compliance being impaired even by a single high-fat meal.

This impairment is not only caused through eating food high in animal fats, added oils appear 41 42 43 44 to have similar effects. The latter studies suggest that animal fats as well as meals made with added oils are harmful for arterial flexibility; on the other hand, they make it clear that there is benefit from consuming meals made from vegetables, grains, legumes, and fruits.

The food choices athletes make affect blood viscosity, arterial diameter, arterial compliance and arterial elasticity. All the latter factors can be expected to affect tissue oxygenation, endurance, and performance.

Glycaemic control & plant-based diets

Plant-based diets are known to boost insulin sensitivity 45 which, as we’ve seen 46 , is important for reducing the risk of type 2 diabetes and improving glycaemic control – a major contributor to atherosclerosis in individuals with diabetes. Indeed, even small amounts of animal food (such as just one cup of non-fat milk) are sufficient to reduce arterial diameter and can thus lead to major changes in blood flow.

Body weight (obesity) & plant-based diets

The risk of developing cardiovascular disease is, naturally, increased by becoming obese. Even when you ditch calorie-counting or portion-control altogether, vegetarian, and especially vegan, diets have been shown 47 to reduce body fat and thereby tackle obesity.

In a previous blog 48 , we looked at how plant-based diets are the easiest (and healthiest) way to lose weight and then maintain an optimal body weight. This study amplifies this point with reference to how plant-based diets are, thus, able to protect the health of athletes and improve athletic performance. This is achieved via a variety of mechanisms, including:

  • the low fat/high fibre content of plant-based diets reduces body fat (thereby reducing atherosclerotic risk and improving performance) 49
  • the reduced energy density of plant-based meals reduces energy intake (you get fuller quicker on less calories, partly because of the higher proportion of fibre in plants that doesn’t exist in animal-foods)
  • postprandial energy expenditure is shown 45 50 to be positively influenced by plant-based diets – possibly via changes in mitochondrial activity 51
  • the indirect effects of gut microbiome on cellular metabolism have been shown 52 to be negatively affected by a high-fat diet (such as is the norm with a meat-based diet) and positively affected by a low-fat diet (such as is the norm with a plant-based diet), partly through protecting the intestinal barrier and preventing the production of endotoxins which can then enter the bloodstream and, in turn, negatively influence cellular metabolism
  • plant-based (vegan more than vegetarian) diets have been shown 53 54 to increase sub-maximal/maximal aerobic capacity/endurance and reduce atherosclerotic/metabolic risk through eliminating excess body fat and, thereby, increasing max VO2 55 . This is important since it’s known 56 57 that an athlete with a higher VO2 max relative to their body weight will have better endurance and will outperform an athlete with a lower value, and that the effect of diet on VO2 max has a significant effect 58

Glycogen storage & plant-based diets

It’s known 59 that individuals who start plant-based diets typically increase intake of healthy carbohydrates (the primary energy source during moderate/high-intensity aerobic exercise) and it’s been shown 60 that endurance is enhanced by high-carbohydrate intake, not just immediately before athletic events, but also over the long term.

Blood pressure & plant-based diets

We’ve looked previously 61 at how the risk of atherosclerotic conditions reduces as blood pressure is reduced. This is good news for those on a plant-based diet, since both vegan and vegetarian diets have been shown 62 to reduce systolic and diastolic blood pressure. Reduced blood pressure is associated with three other ‘side-effects’ of a (healthy) plant-based diet:

  • a reduction in blood viscosity
  • an increase in blood potassium, and
  • a reduction in body weight

Oxidative stress & plant-based diets

When you exercise, your muscle tissue gets ‘damaged’ and produces reactive oxygen species (free radicals), partly as a result of the normal function of mitochondria and other intracellular organelles 63 64 . When your body is overwhelmed by these free radicals, and it can no longer neutralise them, the result is called oxidative stress.

This oxidative stress, in turn, boosts antioxidant defences and immune responses 65 66 .

If the amount of free radicals greatly exceeds the neutralising abilities of these defences, the following can occur 67 :

  • DNA damage – leading to mutations
  • plasma lipid damage – leading to atherosclerosis
  • protein damage – leading to cell damage and accelerated aging
  • muscle fatigue
  • reduced athletic performance
  • impaired recovery

How can being plant-based help?

When the physiological responses of omnivores and vegans/vegetarians were compared, it was found that vegans and vegetarians have increased antioxidant activity, due to:

  • higher intakes of beta-carotene (the precursor of vitamin A), vitamin C, vitamin E, and other antioxidants 68
  • higher antioxidant enzyme production 69

Whilst it’s the combination of plant foods that’s important, specific antioxidant foods have been found to have potentially beneficial effects, including:

  • beets 70 71
  • allium vegetables (e.g. onions, garlic, and leeks) 72
  • cherry juice 73

Inflammation & plant-based diets

Plant-based diets have been shown 74 to be helpful in reducing inflammation. This may be due to the following effects produced by plant consumption:

  • reduction in serum concentrations of C-reactive protein (a marker of inflammation)
  • increased antioxidant content
  • absence of products that may be inflammatory or sensitising [animal & processed food products]
  • absence of pro-inflammatory fats [mostly found in animal foods]

Again, whilst a healthy variety of plant foods provides the ideal diet, some studies have identified particularly high antioxidant ability within specific foods, including:

  • blackcurrants 75
  • blueberries76
  • pomegranates 77
  • tart cherries 78
  • watermelon 79

The above are all thought to decrease post-exercise inflammation and facilitate recovery.

Red meat & inflammation

A major study showed 80 that, as total red meat consumption increased, the following also increased:

  • C-reactive protein (a marker of inflammation)
  • haemoglobin A1c (an indicator of glycaemic control – raised blood sugar levels), and
  • stored iron (an excess of iron [specifically haem iron 81 ] is associated with heart disease, cancer, and diabetes)

Arthritis & plant-based diets

It used to be thought that osteoarthritis was attributable to simple “wear and tear”; however, it’s now known 82 that there’s an important inflammatory component which is aggravated by diabetes and by being overweight.

And it’s not just osteoarthritis that’s affected by diet – psoriatic arthritis 83 and many other similar conditions are also now known to be manifestations of inflammatory processes.

In one major ongoing study 84 , people who ate meat even once a week had higher levels of both degenerative arthritis and soft tissue disorders than individuals who avoided meat altogether.

A number of studies 85 86 87 88 89 on people suffering from rheumatoid arthritis have shown that changing to vegan and vegetarian diets can reduce C-reactive protein, as well as both subjective and objective signs of arthritis.

Whilst vegan diets, in particular, have been shown 90 91 92 to have anti-inflammatory effects by reducing C-reactive protein in patients with and without coronary artery disease.

Protein & plant-based diets

The usual red herring about plant-based diets being compromised in terms of protein and/or complete amino acid provision has been covered in considerable detail in previous blogs 93 94 ; however, it’s worth pointing out the following:

  • changing to plant-based has been shown 95 to provide an immediate improvement in nutrition levels (partly because fruits, vegetables, beans, and whole grains tend to be high in vitamins, minerals, and fibre, very low in saturated fat, and devoid of cholesterol)
  • pretty much every endurance athlete tested 96 met recommended protein intake
  • a varied plant-based diet is known 59  to easily provide adequate amounts of all essential amino acids for athletes

Calcium & plant-based diets

Another fallacy, addressed in previous blogs 97 98 , is that plant-based diets, because they don’t contain cow’s milk, will lack sufficient bone-building calcium for athletes and others.

However, calcium is abundant in many plant foods, especially green leafy vegetables and legumes 99 .

Iron and plant-based diets

As mentioned above, plants contain non-haem iron, which is considered to be a healthier form of iron than the haem iron in animal foods. It may come as a surprise that iron intake is often higher in those who eat plant-based diets than in those who eat meat-containing diets, with serum ferritin levels being typically within the normal range 100 . This is because of the large iron content of green vegetables and legumes. However, iron storage tends to be lower – a good thing since you don’t want rust inside your body! 101 102

Vitamin B12 & plant-based diets

Vitamin B12, covered in previous blogs 103 104 105 , is another area where confusion reigns. Whilst, of course, B12 is absolutely vital for nerve function and blood cell formation, and must be supplemented when on a plant-based diet 59 , B12 deficiency/insufficiency is surprisingly common throughout whole populations, regardless of their dietary regime. Thus, it’s advisable for everyone, particularly as we age 106 , to take B12 supplementation.

Study conclusions

Plant-based diets play a key role in cardiovascular health, which is critical for endurance athletes…and, as part of a healthful lifestyle, have been shown to reverse atherosclerosis. The possibility that such diets may also contribute to improved performance and accelerated recovery in endurance sports is raised by their effects on blood flow, body composition, antioxidant capacity, systemic inflammation, and glycogen storage. These attributes provide a scientific foundation for the increased use of plant-based diets by endurance athletes.

Final thoughts

When we looked at obesity and plant-based diets above, it was pointed out that calorie-counting and portion-control were not needed in order to reduce body fat and, thereby, reduce body weight and avoid the risk of becoming obese. In relation to this, there was a BBC documentary 107 recently by Hugh Fearnley-Whittingstall at the end of which he drew the unfortunate (in my opinion) conclusion that, whilst calorie-counting was not the way to go, the best way to keep the weight down was to apply strict control to portion size.

I tend to disagree with this approach. Just as it’s been shown that calorie-counting 108 and exercise alone 109 are ineffective means of maintaining a healthy body weight, I suspect that, in spite of some studies’ somewhat optimistic conclusions 110 , portion-control (or portion-sizing) is also a dietary method destined to fail in most cases 111 , albeit that it’s a whole lot better than doing nothing at all.

When you eat a non-SOS WFPB diet, you never need to worry about how many calories you are eating nor about what size your plate is. The very nature of the food itself will be regulated by your body’s appetite and requirement for nutrients, whether or not you’re an Olympic athlete.

Ever seen anyone becoming overweight who consistently eats a WFPB diet? If you do, let me know, since I haven’t come across one yet…


References

  1. Plant-Based Diets for Cardiovascular Safety and Performance in Endurance Sports. Barnard ND, Goldman DM, Loomis JF, Kahleova H, Levin SM, Neabore S, Batts TC. Nutrients. 2019 Jan 10;11(1). pii: E130. doi: 10.3390/nu11010130. Review. PMID: 30634559. []
  2. Dr Barnard is the president of the Physicians Committee for Responsible Medicine and Barnard Medical Center []
  3. Thomas, D.T.; Erdman, K.A.; Burke, L.M. Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance. J. Acad. Nutr. Diet. 2016, 116, 501–528. []
  4. WFPB Eating to Prevent Sports Injuries []
  5. Plant-Based Diet Improves All Aspects of Sports Performance & Recovery []
  6. Ginger Reduces Exercise-Induced Muscle Pain []
  7. How Do Paleo Diets Affect Health & Sports Performance? []
  8. No Whey Man says Robert Cheeke []
  9. Barnard RJ, Ngo TH, Leung PS, Aronson WJ, Golding LA. A low-fat diet and/ or strenuous exercise alters the IGF axis in vivo and reduces prostate tumor cell growth in vitro. Prostate. 2003;56( 3): 201– 6. []
  10. Glycaemic control involves the regulation and maintenance of blood glucose levels within normal ranges, and is the aim of the treatment of diabetes mellitus. Long-term glycaemic control reduces later incidence of secondary diabetic complications []
  11. Ornish, D.; Scherwitz, L.W.; Billings, J.H.; Brown, S.E.; Gould, K.L.; Merritt, T.A.; Sparler, S.; Armstrong, W.T.; Ports, T.A.; Kirkeeide, R.L.; et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998, 280, 2001–2007. []
  12. Ornish, D.; Brown, S.E.; Scherwitz, L.W.; Billings, J.H.; Armstrong, W.T.; Ports, T.A.; McLanahan, S.M.; Kirkeeide, R.L.; Brand, R.J.; Gould, K.L. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990, 336, 129–133. []
  13. Esselstyn, C.B., Jr. Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). Am. J. Cardiol. 1999, 84, 339–341. []
  14. Crowe, F.L.; Appleby, P.N.; Travis, R.C.; Key, T.J. Risk of hospitalization or death from ischemic heart disease among British vegetarians and nonvegetarians: Results from the EPIC-Oxford cohort study. Am. J. Clin. Nutr.201397, 597–603. []
  15. Atherosclerosis is a disease of the arteries characterised by the deposition of fatty material on their inner walls. []
  16. Sheppard, M.N. The fittest person in the morgue? Histopathology 2012, 60, 381–396. []
  17. Merghani, A.; Maestrini, V.; Rosmini, S.; Cox, A.T.; Dhutia, H.; Bastiaenan, R.; David, S.; Yeo, T.J.; Narain, R.; Malhotra, A.; et al. Prevalence of subclinical coronary artery disease in masters endurance athletes with a low atherosclerotic risk profile. Circulation 2017, 136, 126–137. []
  18. Schwartz, R.S.; Kraus, S.M.; Schwartz, J.G.; Wickstrom, K.K.; Peichel, G.; Garberich, R.F.; Lesser, J.R.; Oesterle, S.N.; Knickelbine, T.; Harris, K.M.; et al. Increased coronary artery plaque volume among male marathon runners. Missouri Med. 2014, 111, 89–94. []
  19. Breuckmann, F.; Möhlenkamp, S.; Nassenstein, K.; Lehmann, N.; Ladd, S.; Schmermund, A.; Sievers, B.; Schlosser, T.; Jöckel, K.-H.; Heusch, G.; et al. Myocardial late gadolinium enhancement: Prevalence, pattern, and prognostic relevance in marathon runners. Radiology 2009, 251, 50–57. []
  20. Möhlenkamp, S.; Lehmann, N.; Breuckmann, F.; Bröcker-Preuss, M.; Nassenstein, K.; Halle, M.; Budde, T.; Mann, K.; Barkhausen, J.; Heusch, G.; et al. Running: The risk of coronary events: Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners. Eur. Heart J. 2008, 29, 1903–1910. []
  21. Chugh, S.S.; Weiss, J.B. Sudden cardiac death in the older athlete. J. Am. Coll. Cardiol. 2015, 65, 493–502. []
  22. Fibre! Fibre! Fibre! []
  23. Coutinho, T.; Rooke, T.W.; Kullo, I.J. Arterial dysfunction and functional performance in patients with peripheral artery disease: A review. Vasc. Med. 2011, 16, 203–211. []
  24. Dyslipidemia is an abnormal amount of lipids (e.g. triglycerides, cholesterol and/or fat phospholipids) in the blood. In developed countries, most dyslipidemias are hyperlipidemias; that is, an elevation of lipids in the blood. This is often due to diet and lifestyle. []
  25. McCloskey, K.; Ponsonby, A.-L.; Collier, F.; Allen, K.; Tang, M.L.K.; Carlin, J.B.; Saffery, R.; Skilton, M.R.; Cheung, M.; Ranganathan, S.; et al. The association between higher maternal pre-pregnancy body mass index and increased birth weight, adiposity and inflammation in the newborn. Pediatr. Obes. 2018, 13, 46–53. []
  26. Strong, J.P.; Malcom, G.T.; Newman, W.P.; Oalmann, M.C. Early lesions of atherosclerosis in childhood and youth: Natural history and risk factors. J. Am. Coll. Nutr. 1992, 11, 51S–54S. []
  27. Virmani, R.; Robinowitz, M.; Geer, J.C.; Breslin, P.P.; Beyer, J.C.; McAllister, H.A. Coronary artery atherosclerosis revisited in Korean war combat casualties. Arch. Pathol. Lab. Med. 1987, 111, 972–976. []
  28. Webber, B.J.; Seguin, P.G.; Burnett, D.G.; Clark, L.L.; Otto, J.L. Prevalence of and risk factors for autopsy-determined atherosclerosis among US service members, 2001–2011. JAMA 2012, 308, 2577–2583. []
  29. Kauppila, L.I. Atherosclerosis and disc degeneration/low-back pain—A systematic review. Eur. J. Vasc. Endovasc. Surg. 2009, 37, 661–670. []
  30. 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, 4, e002408. [] []
  31. Jenkins, D.J.A.; Kendall, C.W.C.; Marchie, A.; Faulkner, D.A.; Wong, J.M.W.; de Souza, R.; Emam, A.; Parker, T.L.; Vidgen, E.; Trautwein, E.A.; et al. Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants. Am. J. Clin. Nutr. 2005, 81, 380–387. []
  32. Mozaffarian, D.; Katan, M.B.; Ascherio, A.; Stampfer, M.J.; Willett, W.C. Trans fatty acids and cardiovascular disease. N. Engl. J. Med. 2006, 354, 1601–1613. []
  33. A Fat to Forget []
  34. Cardiovascular Physiology Concepts. Determinants of Resistance to Flow (Poiseuille’s Equation). []
  35. Smith, M.M.; Lucas, A.R.; Hamlin, R.L.; Devor, S.T. Associations among hemorheological factors and maximal oxygen consumption. Is there a role for blood viscosity in explaining athletic performance? Clin. Hemorheol. Microcirc. 2015, 60, 347–362. []
  36. Haemoconcentration is a decrease in plasma volume, which causes a simultaneous increase in the concentration of red blood cells and other commonly tested constituents of the blood. []
  37. El-Sayed, M.S.; Ali, N.; El-Sayed Ali, Z. Haemorheology in exercise and training. Sports Med. 2005, 35, 649–670. []
  38. Ernst, E.; Pietsch, L.; Matrai, A.; Eisenberg, J. Blood rheology in vegetarians. Br. J. Nutr. 1986, 56, 555–560. []
  39. Miller, M.; Beach, V.; Sorkin, J.D.; Mangano, C.; Dobmeier, C.; Novacic, D.; Rhyne, J.; Vogel, R.A. Comparative effects of three popular diets on lipids, endothelial function, and C-reactive protein during weight maintenance. J. Am. Diet. Assoc. 2009, 109, 713–717. []
  40. Endothelial function is often quantified by flow-mediated dilation (FMD), which represents the endothelium-dependent relaxation of a conduit artery – typically the brachial artery – due to an increased blood flow a variety of diets. Brachial artery flow-mediated vasodilation can be assessed using high-frequency ultrasound assessment of changes in brachial artery diameter after a 5-minute blood pressure cuff arterial occlusion.We looked at some fascinating results of this in an earlier blog  (Olive Oil Injures Endothelial Cells) where the effects of consuming cornflakes were compared with eating McDonald’s hash browns and sausages. []
  41. Nicholls, S.J.; Lundman, P.; Harmer, J.A.; Cutri, B.; Griffiths, K.A.; Rye, K.-A.; Barter, P.J.; Celermajer, D.S. Consumption of saturated fat impairs the anti-inflammatory properties of high-density lipoproteins and endothelial function. J. Am. Coll. Cardiol. 2006, 48, 715–720. []
  42. Vogel, R.A.; Corretti, M.C.; Plotnick, G.D. The postprandial effect of components of the Mediterranean diet on endothelial function. J. Am. Coll. Cardiol. 2000, 36, 1455–1460. []
  43. Rueda-Clausen, C.F.; Silva, F.A.; Lindarte, M.A.; Villa-Roel, C.; Gomez, E.; Gutierrez, R.; Cure-Cure, C.; López-Jaramillo, P. Olive, soybean and palm oils intake have a similar acute detrimental effect over the endothelial function in healthy young subjects. Nutr. Metab. Cardiovasc. Dis. 2007, 17, 50–57. []
  44. Tentolouris, N.; Arapostathi, C.; Perrea, D.; Kyriaki, D.; Revenas, C.; Katsilambros, N. Differential effects of two isoenergetic meals rich in saturated or monounsaturated fat on endothelial function in subjects with type 2 diabetes. Diabetes Care 2008, 31, 2276–2278. []
  45. Barnard, N.D.; Scialli, A.R.; Turner-McGrievy, G.; Lanou, A.J.; Glass, J. The effects of a low-fat, plant-based dietary intervention on body weight, metabolism, and insulin sensitivity. Am. J. Med. 2005, 118, 991–997. [] []
  46. Effects of High-Carb Diets on BMI & Insulin Resistance []
  47. Kahleova, H.; Tura, A.; Hill, M.; Holubkov, R.; Barnard, N.D. A plant-based dietary intervention improves beta-cell function and insulin resistance in overweight adults: A 16-week randomized clinical trial. Nutrients 2018, 10, 189. []
  48. Want to Lose Weight the Easy Way? []
  49. Phillips, F.; Hackett, A.F.; Stratton, G.; Billington, D. Effect of changing to a self-selected vegetarian diet on anthropometric measurements in UK adults. J. Hum. Nutr. Diet. 2004, 17, 249–255. []
  50. Hall, K.D.; Bemis, T.; Brychta, R.; Chen, K.Y.; Courville, A.; Crayner, E.J.; Goodwin, S.; Guo, J.; Howard, L.; Knuth, N.D.; et al. Calorie for calorie, dietary fat restriction results in more body fat loss than carbohydrate restriction in people with obesity. Cell Metab. 2015, 22, 427–436. []
  51. Mitocondrial activity and diet: Mitochondrial numbers and activity within muscle cells and other body tissues are not constant – they vary with diet. For instance, in a study  (A high-fat diet coordinately downregulates genes required for mitochondrial oxidative phosphorylation in skeletal muscle.) where participants were fed a 50%-fat diet, mitochondrial biogenesis was significantly reduced within just 3 days. []
  52. Anderson, A.S.; Haynie, K.R.; McMillan, R.P.; Osterberg, K.L.; Boutagy, N.E.; Frisard, M.I.; Davy, B.M.; Davy, K.P.; Hulver, M.W. Early skeletal muscle adaptations to short-term high-fat diet in humans before changes in insulin sensitivity. Obesity 2015, 23, 720–724. []
  53. Goran, M.; Fields, D.A.; Hunter, G.R.; Herd, S.L.; Weinsier, R.L. Total body fat does not influence maximal aerobic capacity. Int. J. Obes. Relat. Metab. Disord. 2000, 24, 841–848. []
  54. Mondal, H.; Mishra, S.P. Effect of BMI, body fat percentage and fat free mass on Maximal oxygen consumption in healthy young adults. J. Clin. Diagn. Res. 2017, 11, CC17–CC20. []
  55. VO2 max is the maximum rate of oxygen consumption measured during incremental exercise; that is, exercise of increasing intensity. The name is derived from three abbreviations: “V” for volume, “O₂” for oxygen, and “max” for maximum. []
  56. Schabort, E.J.; Killian, S.C.; St Clair Gibson, A.; Hawley, J.A.; Noakes, T.D. Prediction of triathlon race time from laboratory testing in national triathletes. Med. Sci. Sports Exerc. 2000, 32, 844–849. []
  57. Noakes, T.D.; Myburgh, K.H.; Schall, R. Peak treadmill running velocity during the VO2 max test predicts running performance. J. Sports. Sci. 1990, 8, 35–45. []
  58. Veleba, J.; Matoulek, M.; Hill, M.; Pelikanova, T.; Kahleova, H. “A vegetarian vs. conventional hypocaloric diet: The effect on physical fitness in response to aerobic exercise in patients with type 2 diabetes.” A parallel randomized study. Nutrients 2016, 8, 671. []
  59. Melina, V.; Craig, W.; Levin, S. Position of the academy of nutrition and dietetics: Vegetarian diets. J. Acad. Nutr. Diet. 2016, 116, 1970–1980. [] [] []
  60. Jacobs, K.A.; Sherman, W.M. The efficacy of carbohydrate supplementation and chronic high- carbohydrate diets for improving endurance performance. Int. J. Sport Nutr. 1999, 9, 92–115. []
  61. Plant Protein, Fibre & Nuts Lower Cholesterol & Blood Pressure []
  62. Yokoyama, Y.; Nishimura, K.; Barnard, N.D.; Takegami, M.; Watanabe, M.; Sekikawa, A.; Okamura, T.; Miyamoto, Y. Vegetarian diets and blood pressure: A meta-analysis. JAMA Int. Med. 2014, 174, 577–587. []
  63. Yavari, A.; Javadi, M.; Mirmiran, P.; Bahadoran, Z. Exercise-induced oxidative stress and dietary antioxidants. Asian J. Sports Med. 2015, 6. []
  64. Knez, W.L.; Coombes, J.S.; Jenkins, D.G. Ultra-endurance exercise and oxidative damage: Implications for cardiovascular health. Sports Med. 2006, 36, 429–441. []
  65. Gomez-Cabrera, M.-C.; Martínez, A.; Santangelo, G.; Pallardó, F.V.; Sastre, J.; Viña, J. Oxidative stress in marathon runners: Interest of antioxidant supplementation. Br. J. Nutr. 2006, 96, S31–S33. []
  66. Rauma, A.L.; Mykkänen, H. Antioxidant status in vegetarians versus omnivores. Nutrition 2000, 16, 111–119. []
  67. Powers, S.K.; Talbert, E.E.; Adhihetty, P.J. Reactive oxygen and nitrogen species as intracellular signals in skeletal muscle. J. Physiol. 2011, 589, 2129–2138. []
  68. Rauma, A.L.; Törrönen, R.; Hänninen, O.; Verhagen, H.; Mykkänen, H. Antioxidant status in long-term adherents to a strict uncooked vegan diet. Am. J. Clin. Nutr. 1995, 62, 1221–1227. []
  69. Kahleova, H.; Matoulek, M.; Malinska, H.; Oliyarnik, O.; Kazdova, L.; Neskudla, T.; Skoch, A.; Hajek, M.; Hill, M.; Kahle, M.; et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes. Diabetic Med. 2011, 28, 549–559. []
  70. Domínguez, R.; Cuenca, E.; Maté-Muñoz, J.L.; García-Fernández, P.; Serra-Paya, N.; Estevan, M.C.L.; Herreros, P.V.; Garnacho-Castaño, M.V. Effects of beetroot juice supplementation on cardiorespiratory endurance in athletes. A systematic review. Nutrients 2017, 9, 43. []
  71. Which Athlete Ate the Most Nitrates… []
  72. İnce, D.İ.; SÖnmez, G.T.; İnce, M.L. Effects of garlic on aerobic performance. Turk. J. Med. Sci. 1999, 30, 557–561. []
  73. Bowtell, J.L.; Sumners, D.P.; Dyer, A.; Fox, P.; Mileva, K.N. Montmorency cherry juice reduces muscle damage caused by intensive strength exercise. Med. Sci. Sports Exercise 2011, 43, 1544–1551. []
  74. Haghighatdoost, F.; Bellissimo, N.; Totosy de Zepetnek, J.O.; Rouhani, M.H. Association of vegetarian diet with inflammatory biomarkers: A systematic review and meta-analysis of observational studies. Public Health Nutr. 2017, 20, 2713–2721. []
  75. Hutchison, A.T.; Flieller, E.B.; Dillon, K.J.; Leverett, B.D. Black currant nectar reduces muscle damage and inflammation following a bout of high-intensity eccentric contractions. J. Diet. Suppl. 2016, 13, 1–15. []
  76. McAnulty, L.S.; Nieman, D.C.; Dumke, C.L.; Shooter, L.A.; Henson, D.A.; Utter, A.C.; Milne, G.; McAnulty, S.R. Effect of blueberry ingestion on natural killer cell counts, oxidative stress, and inflammation prior to and after 2.5 h of running. Appl. Physiol. Nutr. Metab. 2011, 36, 976–984. []
  77. Trombold, J.R.; Reinfeld, A.S.; Casler, J.R.; Coyle, E.F. The effect of pomegranate juice supplementation on strength and soreness after eccentric exercise. J. Strength Cond. Res. 2011, 25, 1782–1788. []
  78. Howatson, G.; McHugh, M.P.; Hill, J.A.; Brouner, J.; Jewell, A.P.; van Someren, K.A.; Shave, R.E.; Howatson, S.A. Influence of tart cherry juice on indices of recovery following marathon running. Scand. J. Med. Sci. Sports 2010, 20, 843–852. []
  79. Tarazona-Díaz, M.P.; Alacid, F.; Carrasco, M.; Martínez, I.; Aguayo, E. Watermelon juice: Potential functional drink for sore muscle relief in athletes. J. Agric. Food Chem. 2013, 61, 7522–7528. []
  80. Ley, S.H.; Sun, Q.; Willett, W.C.; Eliassen, A.H.; Wu, K.; Pan, A.; Grodstein, F.; Hu, F.B. Associations between red meat intake and biomarkers of inflammation and glucose metabolism in women. Am. J. Clin. Nutr. 2014, 99, 352–360. []
  81. The Safety of Heme vs. Non-Heme Iron
    Michael Greger M.D. FACLM June 5th, 2015 Volume 25 []
  82. Berenbaum, F.; van den Berg, W.B. Inflammation in osteoarthritis: Changing views. Osteoarthritis Cartilage 2015, 23, 1823–1824. []
  83. Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis — a condition that features red patches of skin topped with silvery scales. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin lesions appear. []
  84. Hailu, A.; Knutsen, S.F.; Fraser, G.E. Associations between meat consumption and the prevalence of degenerative arthritis and soft tissue disorders in the adventist health study, California U.S.A. J. Nutr. Health Aging 2006, 10, 7–14. []
  85. Kjeldsen-Kragh, J.; Haugen, M.; Borchgrevink, C.F.; Laerum, E.; Eek, M.; Mowinkel, P.; Hovi, K.; Førre, O. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 1991, 338, 899–902. []
  86. Sköldstam, L. Vegetarian diets and rheumatoid arthritis. Is it possible that a vegetarian diet might influence the disease? Nord. Med. 1989, 104, 112–114. []
  87. Müller, H.; de Toledo, F.W.; Resch, K.L. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: A systematic review. Scand. J. Rheumatol. 2001, 30, 1–10. []
  88. Hafström, I.; Ringertz, B.; Spångberg, A.; von Zweigbergk, L.; Brannemark, S.; Nylander, I.; Rönnelid, J.; Laasonen, L.; Klareskog, L. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: The effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology 2001, 40, 1175–1179. []
  89. McDougall, J.; Bruce, B.; Spiller, G.; Westerdahl, J.; McDougall, M. Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J. Altern. Complement. Med. 2002, 8, 71–75. []
  90. Driggin, E.; Ganguzza, L.; de Villa, V.B.; Farid, E.; Heffron, S.; Newman, J.; Slater, J.; Woolf, K.; Shah, B. Abstract P029: Factors associated with participation of patients with coronary artery disease in a randomized study of a vegan versus American heart association-recommended diet: Interim analysis. Circulation 2017, 135. []
  91. Shah, B.; Ganguzza, L.; Slater, J.; Newman, J.D.; Allen, N.; Fisher, E.; Larigakis, J.; Ujueta, F.; Gianos, E.; Guo, Y.; et al. The effect of a vegan versus AHA diet in coronary artery disease (EVADE CAD) trial: Study design and rationale. Contemp. Clin. Trials Commun. 2017, 8, 90–98. []
  92. Sutliffe, J.T.; Wilson, L.D.; de Heer, H.D.; Foster, R.L.; Carnot, M.J. C-reactive protein response to a vegan lifestyle intervention. Complement. Ther. Med. 2015, 23, 32–37. []
  93. Eat Enough Food & You Eat Enough Protein []
  94. THE PROTEIN COMBINING MYTH – A RAT’S TALE ? []
  95. Chiuve, S.E.; Fung, T.T.; Rimm, E.B.; Hu, F.B.; McCullough, M.L.; Wang, M.; Stampfer, M.J.; Willett, W.C. Alternative dietary indices both strongly predict risk of chronic disease. J. Nutr. 2012, 142, 1009–1018. []
  96. Masson, G.; Lamarche, B. Many non-elite multisport endurance athletes do not meet sports nutrition recommendations for carbohydrates. Appl. Physiol. Nutr. Metab. 2016, 41, 728–734. []
  97. If You Want Enough Calcium, Forget Milk []
  98. Vegan Pregnancy & Parenting []
  99. Nutritionfacts: Calcium []
  100. Crit Rev Food Sci Nutr. 2018 May 24;58(8):1359-1374. doi: 10.1080/10408398.2016.1259210. Epub 2017 Jul 5. The effect of vegetarian diets on iron status in adults: A systematic review and meta-analysis. Haider LM, Schwingshackl L, Hoffmann G, Ekmekcioglu C. []
  101. Vegan Pregnancy & Parenting []
  102. PCRM: Iron Deficiency Anemia []
  103. B12 Supplements Are Efficient But Caution With Folic Acid []
  104. Vegan Society Veg-1: Does It Contain Enough B12? []
  105. Vegan Pregnancy & Parenting []
  106. How common is vitamin B-12 deficiency? Lindsay H Allen. The American Journal of Clinical Nutrition, Volume 89, Issue 2, 1 February 2009, Pages 693S–696S. []
  107. BBC: Britain’s Fat Fight with Hugh Fearnley-Whittingstall – The Battle Contiues. []
  108. Perspect Psychol Sci. 2017 Sep; 12(5): 703–714. Reducing Calorie Intake May Not Help You Lose Body Weight. David Benton and Hayley A. Young. []
  109. Medical News Today: Exercise alone does not achieve weight loss. Published Saturday 25 November 2017. []
  110. Curr Obes Rep. 2017; 6(1): 10–17. Portion Size: Latest Developments and Interventions. Ingrid Steenhuis and Maartje Poelman. []
  111. Crit Rev Food Sci Nutr. 2015 Jun 7; 55(7): 988–1004. Portion Size: What We Know and What We Need to Know. David Benton. []

Effects of High-Carb Diets on BMI & Insulin Resistance

A September 2018 16-week randomised controlled clinical trial by the Physician’s Committee for Responsible Medicine1 looked at whether a plant-based high-carbohydrate, low-fat diet in overweight individuals would have a more beneficial effect on body weight, body composition and insulin resistance when compared with a standard Western diet. Controversy in the media is rife about whether or not a carbohydrate-rich diet is healthy, so will this research study help settle the argument once and for all?

Study method

75 participants were randomised to follow either a plant-based high-carbohydrate, low-fat (vegan) diet or to maintain their current diet.

The intervention group was asked to follow a low-fat vegan diet consisting of vegetables, grains, legumes, and fruits, and avoiding animal products and added oils. There were no limits on energy or carbohydrate intake. The control group participants were asked to maintain their current diets, which included meat and dairy products, for the 16-week intervention period.

All study participants were asked not to alter their physical activity and to continue their preexisting medication regimens for the duration of the study, except as modified by their personal physicians.

Measurements were taken before and at the end of the trial.

Study results

The results can be seen in the charts below.

So, in the vegan group:

  • fat mass reduced
  • insulin resistance significantly reduced
    • and these results remained significant after adjustment for energy intake

The more total and insoluble fibre consumed, the greater the drop in the following:

  • BMI
  • fat mass
  • volume of visceral fat
    • again, these results remained significant even after adjustment for energy intake

Increased consumption of carbohydrate and fibre, as part of a plant-based high-carbohydrate, low-fat diet, were associated with beneficial effects on the following:

  • weight
  • body composition
  • insulin resistance

Discussion

Obesity – a pandemic?

Percent of Adults with BMI ≥30. Source: WHO, Global Database on Body Mass Index.

The World Health Organisation estimates that more than 1.9 billion adults worldwide have excess body weight 2 3 .  Hence, obesity rates are rising rapidly. Since increased body weight is associated with a higher all-cause mortality 4 , it’s vital that sustainable and practical solutions are found.

Causes of obesity

It’s pretty obvious to anyone who does a little research: poor dietary habits (such as high intakes of processed meat products and sodium with low intakes of fruits and vegetables) are one of the leading contributors.  This single avoidable behavioural factor contributes to huge numbers of deaths through a range of chronic diseases – including around half of cardio-metabolic deaths in the United States alone 3 5 6 .

Solutions to obesity

In contrast to the above, plant-based diets have been shown repeatedly to represent an effective strategy for improving nutrient intake 7 , being clearly associated with decreased all-cause mortality and decreased risk of obesity, type 2 diabetes, and coronary heart disease 8 .

The following dietary elements of a plant-based diet have been shown to have independent advantages for weight loss and weight management:

  • whole grains 9 10
  • legumes 11
  • fruits and vegetables 12 13 14
  • high carbohydrate (low glycaemic index) intake 15 16
  • high fibre content 17

Final thoughts

Above, I asked whether this study would settle once and for all the question of whether or not a carbohydrate-rich diet is healthy. As long as the carbohydrates are what’s found in wholefood plants and not in processed junk food, it appears to me that this, as well as many other studies mentioned above, do indeed favour a positive answer to this question.

Naturally, however, the industries benefiting from producing, advertising and selling processed junk foods and animal products will continue in their attempts to deny/ignore/marginalise the facts with the aim of confusing the public. That, unfortunately, is the way business is done. But each of us can take responsibility for what foods we consume, and thus exert complete dietary control to help ourselves avoid so many chronic diet-related diseases.


References

  1. Nutrients. 2018 Sep 14;10(9). pii: E1302. doi: 10.3390/nu10091302. A Plant-Based High-Carbohydrate, Low-Fat Diet in Overweight Individuals in a 16-Week Randomized Clinical Trial: The Role of Carbohydrates. Kahleova H, Dort S, Holubkov R, Barnard ND. []
  2. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet 2016, 387, 1377–1396. []
  3. GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016, 388, 1659–1724. [] []
  4. Di Angelantonio, E.; Bhupathiraju, S.N.; Wormser, D.; Gao, P.; Kaptoge, S.; de Gonzalez, A.B.; Cairns, B.J.; Huxley, R.; Jackson, C.L.; Joshy, G.; et al. Body-mass index and all-cause mortality: Individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet 2016, 388, 776–786. []
  5. Murray, C.J.L.; Atkinson, C.; Bhalla, K.; Birbeck, G.; Burstein, R.; Chou, D.; Dellavalle, R.; Danaei, G.; Ezzati, M.; Fahimi, A.; et al. Burden of Disease Collaborators The state of US health, 1990–2010: Burden of diseases, injuries, and risk factors. JAMA 2013, 310, 591–608. []
  6. Micha, R.; Peñalvo, J.L.; Cudhea, F.; Imamura, F.; Rehm, C.D.; Mozaffarian, D. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA 2017, 317, 912–924. []
  7. Rizzo, N.S.; Jaceldo-Siegl, K.; Sabate, J.; Fraser, G.E. Nutrient profiles of vegetarian and nonvegetarian dietary patterns. J. Acad. Nutr. Diet. 2013, 113, 1610–1619. []
  8. Fraser, G.E. Vegetarian diets: What do we know of their effects on common chronic diseases? Am. J. Clin. Nutr. 2009, 89, 1607S–1612S. []
  9. Pol, K.; Christensen, R.; Bartels, E.M.; Raben, A.; Tetens, I.; Kristensen, M. Whole grain and body weight changes in apparently healthy adults: A systematic review and meta-analysis of randomized controlled studies. Am. J. Clin. Nutr. 2013, 98, 872–884. []
  10. Harland, J.I.; Garton, L.E. Whole-grain intake as a marker of healthy body weight and adiposity. Public Health Nutr. 2008, 11, 554–563. []
  11. Kim, S.J.; de Souza, R.J.; Choo, V.L.; Ha, V.; Cozma, A.I.; Chiavaroli, L.; Mirrahimi, A.; Blanco Mejia, S.;
    Di Buono, M.; Bernstein, A.M.; et al. Effects of dietary pulse consumption on body weight: A systematic review and meta-analysis of randomized controlled trials. Am. J. Clin. Nutr. 2016, 103, 1213–1223. []
  12. Bertoia, M.L.; Mukamal, K.J.; Cahill, L.E.; Hou, T.; Ludwig, D.S.; Mozaffarian, D.; Willett, W.C.; Hu, F.B.; Rimm, E.B. Changes in intake of fruits and vegetables and weight change in United States men and women followed for up to 24 years: Analysis from three prospective cohort studies. PLoS Med. 2015, 12, e1001878. []
  13. Tapsell, L.C.; Batterham, M.J.; Thorne, R.L.; O’Shea, J.E.; Grafenauer, S.J.; Probst, Y.C. Weight loss effects from vegetable intake: A 12-month randomised controlled trial. Eur. J. Clin. Nutr. 2014, 68, 778–785. []
  14. Boeing, H.; Bechthold, A.; Bub, A.; Ellinger, S.; Haller, D.; Kroke, A.; Leschik-Bonnet, E.; Müller, M.J.; Oberritter, H.; Schulze, M.; et al. Critical review: Vegetables and fruit in the prevention of chronic diseases. Eur. J. Nutr. 2012, 51, 637–663. []
  15. Thomas, D.E.; Elliott, E.J.; Baur, L. Low glycaemic index or low glycaemic load diets for overweight and obesity. Cochrane Database Syst. Rev. 2007, CD005105 []
  16. Schwingshackl, L.; Hoffmann, G. Long-term effects of low glycemic index/load vs. high glycemic index/load diets on parameters of obesity and obesity-associated risks: A systematic review and meta-analysis. Nutr. Metab. Cardiovasc. Dis. 2013, 23, 699–706 []
  17. Slavin, J.L. Dietary fiber and body weight. Nutrition 2005, 21, 411–418. []

What’s the Psychology of Plant-Eaters?

A September 2018 review 1 , by Daniel L Rosenfeld from Cornell University Department of Development 2 , looked at the advances and possible future directions of research into the interesting subject of the psychology of vegetarians.

Daniel L Rosenfeld, Cornell University

I bet it’s not something you thought there would be much written about – and you’d be wrong (see huge list of books and publications at end of blog). So, assuming that plant-eaters are not all simply bonkers for giving up bacon sandwiches and succulent southern fried chicken, what does research tell us about those who are often regarded as preferring to eat “rabbit food“?

Main topics

Rosenfeld refers to a 2012 review 3 which highlighted seven main topics that are covered when looking into this field:

  • dietary variations of vegetarianism
  • vegetarians’ motivations
  • attitudes toward meat
  • vegetarians’ and omnivores’ values and worldviews
  • differences between vegetarians’ and omnivores’ well-beings
  • perceptions of vegetarians and omnivores
  • links between gender, vegetarianism, and meat consumption

It was pointed out that there’s a lot of subjectivity when discussing vegetarians since there’s no generally-accepted definition of what one is! Additionally, confusion can be caused because some people call themselves vegetarians when they actually eat meat on occasion, and vegetarians vary substantially in terms of which animal products they will or will not eat.

Motivation

There’s also variation in the motivations that vegetarians have for their dietary choices. These generally include:

  • personal health
  • concerns about animal cruelty
  • concerns about the environment
  • religion 
  • taste (e.g. “I avoid meat because it disgusts me.“)

Worldview

The latter research 3 also mentions that there are differences between vegetarians’ and omnivores’ values and worldviews. Compared with omnivores, vegetarians tend to be:

  • more politically liberal
  • more empathetic
  • more opposed to capital punishment

And further differences exist between vegetarians and vegans, with vegans exhibiting stronger beliefs about:

  • meat consumption
  • animal welfare
  • environmental issues

Gender

The review 3 also looked at differences between women’s and men’s vegetarian views.  Men generally seem to differ from women in the following ways:

  • men view meat as a more essential part of a proper diet
  • men eat more meat than women
  • men express fewer concerns about the effects of meat consumption on animals
  • men express fewer concerns about the effects of meat consumption on the environment

This is consistent with the fact that women are more likely to be vegetarian than are men.

Research explosion

Since the above-mentioned 2012 review by Ruby, there’s been an explosion of research into the psychology of vegetarianism. And while the general areas of research fit within the above 7 groupings, there’s been a widening and deepening of the analysis. So, for instance, regarding the differences in political outlooks and worldviews between omnivores and vegetarians, a lot more detail is now known about more specific variations in attitude.

This can be seen in the differences between veganism and other forms of vegetarianism. A 2017 study 4 found that vegans were approximately 15 times more likely to be politically liberal than conservative.

Furthermore, recent research 5 6 into the relationship between meat consumption and right-wing ideology (including right-wing authoritarianism, social dominance orientation and general conservatism) suggests that:

  • omnivores exhibit greater right-wing authoritarianism than vegetarians
  • omnivores exhibit greater and social dominance orientation than vegetarians
  • omnivores exhibit greater conservatism than vegetarians

From vegetarian back to meat-eater

A 2018 study 7  revealed an interesting detail about how conservatism predicts a greater likelihood of returning to eating meat after having been vegetarian. This is largely explained by lower feelings of social support and weaker social justice motivations (that is, less concern about animal welfare, the environment, and world hunger) when more conservative individuals initially decided to eschew meat.

Views about vegetarians

A 2017 8 and 2018 study 9 both revealed that people who endorse right-wing ideology also tend to exhibit more negative attitudes toward vegetarians and vegetarianism in general.

Charity and pets

It’s not just political orientation that seems to vary between the two groups, moral attitudes and behaviours beyond political orientation also appear to differ between vegetarians and omnivores.

A 2015 study 10 revealed the following differences:

  • vegetarians are more concerned about animal welfare than omnivores
  • vegetarians donate more money to animal-oriented charities than omnivores
  • vegetarians emphasise the moral foundation of animal harm/care more strongly than omnivores

A 2014 11 and 2018 study 12 suggested that interacting with a pet during childhood may shape one’s moral values and eating behaviours later in life. Specifically, children who own a variety of pets or become emotionally attached to a pet tend to eat less meat in adulthood. This may be attributed to their greater feelings of empathy toward animals and greater moral opposition to animal exploitation.

Further research

The foregoing is merely a taste of the range of research currently taking place in this interesting field of study. Future research will be really interesting if it deals with some of the following areas:

  • how people revise their moral values after altering their dietary habits
  • whether veganism associates with certain moral/political values to greater extents than do other forms of vegetarianism
  • the effect on food choices of different political-ideology norms across various geographical and cultural regions
  • given that health, animal welfare and the environment are shown to be the three main motivators in becoming vegetarian, it would be interesting to know which of these would be the best predictor of continuing to eat a plant-based diet
  • variations in attitude and behaviour of individuals adhering to a WFPB diet, as compared to both a vegan and a vegetarian diet
  • changes in a person’s outlook and motivation for being plant-based from when they first made the dietary change and throughout their life
  • how vegetarians with varying types of health motivations (e.g. general wellness, weight maintenance, recently having had a life-threatening health event or diagnosis) may differ from one another
  • identification of the extents to which greater emphases on harm/care, animal welfare, and liberal values are causal of and/or caused by the decision to eschew meat
  • an examination of how omnivores view vegetarians with different motivations – looking at the roles of cognitive dissonance, social comparison, social norms, and power dynamics in attitude formation

Again, these are just some of the possible areas of future research.

Final thoughts

I suppose it’s no surprise that there’s an increasing amount of research into the psychology of those who choose to eat plants instead of animals; after all, we spend hours every day of our life planning, talking about, and eating meals, and the media are covering more and more stories about how our dietary choices are affecting both human health and the health of the world we live in.

It’s hard to deny, merely from my own experience, that we hold on to our familial and cultural food habits like a drunk does his last bottle – and we are pretty much all just as reluctant as he is to accept criticism about, or to let go of, our acquired preferences about what we can/cannot or should/should not put into our stomachs.

It doesn’t seem so strange that those brought up on a plant-based diet from birth may have a different attitude towards their dietary choices than those who made the personal decision to move from eating animals to plants. Equally, it’s probably no surprise that those who choose to disavow all animal products for reasons other than personal health or dietary preferences (that is, because they are concerned about the environment and/or animal cruelty) are likely to have wider-reaching and stronger views on the veggie subject.

In my own experience, there do appear to be some psychological changes that parallel dietary changes. Being that we are basically animals with big brains, and that the body-brain system is inextricably linked together, what would be strange would be if there were no psychological changes when our bodies and brains are receiving a different class of dietary nutrients – and this is apart from those changes that would derive from alterations in philosophical outlook.

Appendix: Just some of the literature relating to the psychology of vegetarians

Adams, C. (1990). The sexual politics of meat: A feminist vegetarian critical theory. New York, NY: Continuum.

Agarwal, U., Mishra, S., Xu, J., Levin, S., Gonzales, J., & Barnard, N. D. (2015). A multicenter randomized controlled trial of a nutrition intervention program in a multiethnic adult population in the corporate setting reduces depression and anxiety and improves quality of life: The GEICO study. American Journal of Health Promotion, 29, 245-254.

Allès, B., Baudry, J., Méjean, C., Touvier, M., Péneau, S., Hercberg, S., & Kesse-Guyot, E. (2017). Comparison of sociodemographic and nutritional characteristics between selfreported vegetarians, vegans, and meat-eaters from the Nutrinet-Sante study. Nutrients, 9, 1023.

Anderson, E. C., Wormwood, J. B., Barrett, L., & Quigley, K. (2018). Vegetarians’ and omnivores’ affective and physiological responses to food. Food Quality and Preference, 71, 96-105.

Apostolidis, C., & McLeay, F. (2016). It’s not vegetarian, it’s meat-free! Meat eaters, meat reducers and vegetarians and the case of Quorn in the UK. Social Business, 6, 267-290.

Arbit, N., Ruby, M., & Rozin, P. (2017). Development and validation of the meaning of food in life questionnaire (MFLQ): Evidence for a new construct to explain eating behavior. Food Quality and Preference, 59, 35-45.

Arora, A. S., Bradford, S., Arora, A., & Gavino, R. (2017). Promoting vegetarianism through moralization and knowledge calibration. Journal of Promotion Management, 23, 889-912.

Asanova, A. (2017). Vegetarian diet as a risk factor for depression. Psychosomatic Medicine and General Practice, 2, e020490-e020490.

Barthels, F., Meyer, F., & Pietrowsky, R. (2018). Orthorexic and restrained eating behaviour in vegans, vegetarians, and individuals on a diet. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 23, 159-166.

Beardsworth, A. D., & Keil, E. T. (1991). Vegetarianism, veganism, and meat avoidance: Recent trends and findings. British Food Journal, 93, 19-24.

Beardsworth, A. D., & Keil, E. T. (1992). The vegetarian option: Varieties, conversions, motives and careers. The Sociological Review, 40, 253-293.

Beezhold, B., Radnitz, C., Rinne, A., & DiMatteo, J. (2015). Vegans report less stress and anxiety than omnivores. Nutritional Neuroscience, 18, 289-296.

Bem, D. J. (1972). Self-perception theory. Advances in Experimental Social Psychology, 6, 1-62.

Bilewicz, M., Imhoff, R., & Drogosz, M. (2011). The humanity of what we eat: Conceptions of human uniqueness among vegetarians and omnivores. European Journal of Social Psychology, 41, 201-209.

Campbell T. C., & Campbell T. M. (2006). 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.

Caviola, L., Everett, J. A., & Faber, N. S. (2018). The moral standing of animals: Towards a psychology of speciesism. Journal of Personality and Social Psychology. doi:10.1037/pspp0000182.

Cherry, E. (2015). I was a teenage vegan: Motivation and maintenance of lifestyle movements. Sociological Inquiry, 85, 55-74.

Chuter, R. (2018). Finding companionship on the road less travelled: A netnography of the Whole Food Plant-Based Aussies Facebook group (Bachelor’s thesis, Edith Cowan University).

Cliceri, D., Spinelli, S., Dinnella, C., Prescott, J., & Monteleone, E. (2018). The influence of psychological traits, beliefs and taste responsiveness on implicit attitudes toward plantand animal-based dishes among vegetarians, flexitarians and omnivores. Food Quality and Preference, 68, 276-291.

Cole, M., & Morgan, K. (2011). Vegaphobia: Derogatory discourses of veganism and the reproduction of speciesism in UK national newspapers. The British Journal of Sociology, 62, 134-153.

Corrin, T., & Papadopoulos, A. (2017). Understanding the attitudes and perceptions of vegetarian and plant-based diets to shape future health promotion programs. Appetite, 109, 40-47.

Cramer, H., Kessler, C. S., Sundberg, T., Leach, M. J., Schumann, D., Adams, J., & Lauche, R. (2017). Characteristics of Americans choosing vegetarian and vegan diets for health reasons. Journal of Nutrition Education and Behavior, 49, 561-567.

Črnič, A. (2013). Studying social aspects of vegetarianism: A research proposal on the basis of a survey among adult population of two Slovenian biggest cities. Collegium Antropologicum, 37, 1111-1120.

Dagevos, H., & Voordouw, J. (2013). Sustainability and meat consumption: Is reduction realistic?. Sustainability: Science, Practice, & Policy, 9, 60-69.

Dagnelie, P. C., & Mariotti, F. (2017). Vegetarian diets: Definitions and pitfalls in interpreting literature on health effects of vegetarianism. In F. Mariotti (Ed.), Vegetarian and Plant-Based Diets in Health and Disease Prevention (pp. 2-10). London, UK: Academic Press.

De Backer, C. J., & Hudders, L. (2014). From meatless Mondays to meatless Sundays: motivations for meat reduction among vegetarians and semi-vegetarians who mildly or significantly reduce their meat intake. Ecology of Food and Nutrition, 53, 639-657.

De Backer, C. J., & Hudders, L. (2015). Meat morals: Relationship between meat consumption consumer attitudes towards human and animal welfare and moral behavior. Meat Science, 99, 68-74.

de Boer, J., Schösler, H., & Aiking, H. (2017). Towards a reduced meat diet: Mindset and motivation of young vegetarians, low, medium and high meat-eaters. Appetite, 113, 387-397.

DeLessio-Parson, A. (2017). Doing vegetarianism to destabilize the meat-masculinity nexus in La Plata, Argentina. Gender, Place & Culture, 24, 1729-1748.

Derbyshire, E. J. (2017). Flexitarian diets and health: A review of the evidence-based literature. Frontiers in Nutrition, 3, 55.

Devine, C. M., Connors, M., Bisogni, C. A., & Sobal, J. (1998). Life-course influences on fruit and vegetable trajectories: Qualitative analysis of food choices. Journal of Nutrition Education, 30, 361-370.

Díaz, E. M. (2016). Animal humanness, animal use, and intention to become ethical vegetarian or ethical vegan. Anthrozoös, 29, 263-282.

Duchene, T. N., & Jackson, L. M. (2017). Effects of motivation framing and content domain on intentions to eat plant-and animal-based foods. Society & Animals. doi:0.63/5685306-34466.

Dyett, P. A., Sabaté, J., Haddad, E., Rajaram, S., & Shavlik, D. (2013). Vegan lifestyle behaviors. An exploration of congruence with health-related beliefs and assessed health indices. Appetite, 67, 119-124.

Earle, M., & Hodson, G. (2017). What’s your beef with vegetarians? Predicting anti-vegetarian prejudice from pro-beef attitudes across cultures. Personality and Individual Differences, 119, 52-55.

Edwards, S. (2013). Living in a minority food culture: A phenomenological investigation of being vegetarian/vegan. Phenomenology & Practice, 7, 111-125.

Ensaff, H., Coan, S., Sahota, P., Braybrook, D., Akter, H., & McLeod, H. (2015). Adolescents’ food choice and the place of plant-based foods. Nutrients, 7, 4619-4637.

Esquire. (2017, August 21). A huge number of vegetarians eat meat when they’re drunk. Esquire. Retrieved from https://www.esquire.com/uk/fooddrink/news/a16780/vegetarians-drunk-eating-meat/.

Fiestas-Flores, J., & Pyhälä, A. (2017). Dietary motivations and challenges among animal rights advocates in Spain. Society & Animals. doi:0.63/5685306-34484.

Filippi, M., Riccitelli, G., Falini, A., Di Salle, F., Vuilleumier, P., Comi, G., & Rocca, M. A. (2010). The brain functional networks associated to human and animal suffering differ among omnivores, vegetarians and vegans. PLoS One, 5, e10847.

Filippi, M., Riccitelli, G., Meani, A., Falini, A., Comi, G., & Rocca, M. A. (2013). The “vegetarian brain”: chatting with monkeys and pigs?. Brain Structure and Function, 218, 1211-1227.

Forestell, C. A. (2018). Flexitarian diet and weight control: Healthy or risky eating Behavior? Frontiers in Nutrition, 5, 59. doi:10.3389/fnut.2018.00059.

Forestell, C. A., & Nezlek, J. B. (2018). Vegetarianism, depression, and the five factor model of personality. Ecology of Food and Nutrition, 57, 246-259.

Forestell, C. A., Spaeth, A. M., & Kane, S. A. (2012). To eat or not to eat red meat. A closer look at the relationship between restrained eating and vegetarianism in college females. Appetite, 58, 319-325.

Fox, N., & Ward, K.J. (2008a). Health, ethics and environment: a qualitative study of vegetarian motivations. Appetite, 50, 422-429.

Fox, N., & Ward, K. J. (2008b). You are what you eat? Vegetarianism, health and identity. Social Science & Medicine, 66, 2585-2595.

Gallimore, T. E. (2015). Understanding the reasons for and barriers to becoming vegetarian in prospective vegetarians and vegans (Doctoral dissertation, McGill University).

Gilsing, A. M., Weijenberg, M. P., Goldbohm, R. A., Dagnelie, P. C., van den Brandt, P. A., & Schouten, L. J. (2013). The Netherlands Cohort Study–Meat Investigation Cohort: A population-based cohort over-represented with vegetarians, pescetarians and low meat consumers. Nutrition Nournal, 12, 156.

Goffman, E. (1963). Stigma: Notes on a spoiled identity. New York, NY: Simon & Schuster. Graça, J., Calheiros, M. M., & Oliveira, A. (2015). Attached to meat? (Un)Willingness and intentions to adopt a more plant-based diet. Appetite, 95, 113-125.

Graça, J., Calheiros, M. M., & Oliveira, A. (2016). Situating moral disengagement: Motivated reasoning in meat consumption and substitution. Personality and Individual Differences, 90, 353-364.

Greenebaum, J. B. (2012a). Managing impressions: “Face-saving” strategies of vegetarians and vegans. Humanity & Society, 36, 309-325.

Greenebaum, J. (2012b). Veganism, identity and the quest for authenticity. Food, Culture & Society, 15, 129-144.

Greenebaum, J., & Dexter, B. (2017). Vegan men and hybrid masculinity. Journal of Gender Studies. doi:10.1080/09589236.2017.1287064.

Hartmann, C., Ruby, M. B., Schmidt, P., & Siegrist, M. (2018). Brave, health-conscious, and environmentally friendly: Positive impressions of insect food product consumers. Food Quality and Preference, 68, 64-71.

Haverstock, K., & Forgays, D. K. (2012). To eat or not to eat. A comparison of current and former animal product limiters. Appetite, 58, 1030-1036.

Hayley, A., Zinkiewicz, L., & Hardiman, K. (2015). Values, attitudes, and frequency of meat consumption. Predicting meat-reduced diet in Australians. Appetite, 84, 98-106.

Heiss, S., Coffino, J. A., & Hormes, J. M. (2017). Eating and health behaviors in vegans compared to omnivores: Dispelling common myths. Appetite, 118, 129-135.

Heiss, S., & Hormes, J. M. (2018). Ethical concerns regarding animal use mediate the relationship between variety of pets owned in childhood and vegetarianism in adulthood. Appetite, 123, 43-48.

Hibbeln, J. R., Northstone, K., Evans, J., & Golding, J. (2018). Vegetarian diets and depressive symptoms among men. Journal of Affective Disorders, 225, 13-17.

Hirschler, C. A. (2011). “What pushed me over the edge was a deer hunter”: Being vegan in North America. Society & Animals, 19, 156-174.

Hodson, G., & Earle, M. (2018). Conservatism predicts lapses from vegetarian/vegan diets to meat consumption (through lower social justice concerns and social support). Appetite, 120, 75-81.

Hoffman, S. R., Stallings, S. F., Bessinger, R. C., & Brooks, G. T. (2013). Differences between health and ethical vegetarians. Strength of conviction, nutrition knowledge, dietary restriction, and duration of adherence. Appetite, 65, 139-144.

Hornsey, M. J., & Jetten, J. (2003). Not being what you claim to be: Impostors as sources of group threat. European Journal of Social Psychology, 33, 639-657.

Horta, O. (2017). Discrimination against vegans. Res Publica. doi:10.1007/s11158-017-9356-3.

Hussar, K. M., & Harris, P. L. (2010). Children who choose not to eat meat: A study of early moral decisionmaking. Social Development, 19, 627-641.

Izmirli, S., & Phillips, C. J. (2011). The relationship between student consumption of animal products and attitudes to animals in Europe and Asia. British Food Journal, 113, 436-450.

Jabs, J., Devine, C. M., & Sobal, J. (1998). Maintaining vegetarian diets: Personal factors, social networks and environmental resources. Canadian Journal of Dietetic Practice and Research, 59, 183-189.

Jabs, J., Sobal, J., & Devine, C. M. (2000). Managing vegetarianism: Identities, norms and interactions. Ecology of Food and Nutrition, 39, 375-394.

Janssen, M., Busch, C., Rödiger, M., & Hamm, U. (2016). Motives of consumers following a vegan diet and their attitudes towards animal agriculture. Appetite, 105, 643-651.

Joy, M. (2009). Why we love dogs, eat pigs and wear cows: An introduction to carnism. San Francisco, CA: Conari Press.
Judge, M., & Wilson, M. S. (2015). Vegetarian utopias: Visions of dietary patterns in future societies and support for social change. Futures, 71, 57-69.

Judge, M., & Wilson, M. S. (2018). A dual-process motivational model of attitudes toward vegetarians and vegans. European Journal of Social Psychology. doi:10.1002/ejsp.2386.

Keller, C., & Siegrist, M. (2015). Does personality influence eating styles and food choices? Direct and indirect effects. Appetite, 84, 128-138.

Kerschke-Risch, P. (2015). Vegan diet: Motives, approach and duration. Initial results of a quantitative sociological study. Ernahrungs Umschau, 62, 98-103.

Kessler, C. S., Holler, S., Joy, S., Dhruva, A., Michalsen, A., Dobos, G., & Cramer, H. (2016). Personality profiles, values and empathy: Differences between lacto-ovo-vegetarians and vegans. Complementary Medicine Research, 23, 95-102.

Kessler, C. S., Michalsen, A., Holler, S., Murthy, V. S., & Cramer, H. (2018). How empathic are vegan medical professionals compared to others? Leads from a paper–pencilsurvey. European Journal of Clinical Nutrition, 72, 780-784.

Kildal, C. L., & Syse, K. L. (2017). Meat and masculinity in the Norwegian Armed Forces. Appetite, 112, 69-77.

Klopp, S. A., Heiss, C. J., & Smith, H. S. (2003). Self-reported vegetarianism may be a marker for college women at risk for disordered eating. Journal of the American Dietetic Association, 103, 745-747.

Kunst, J. R., & Haugestad, C. A. P. (2018). The effects of dissociation on willingness to eat meat are moderated by exposure to unprocessed meat: A cross-cultural demonstration. Appetite, 120, 356-366.

Kunst, J. R., & Hohle, S. M. (2016). Meat eaters by dissociation: How we present, prepare and talk about meat increases willingness to eat meat by reducing empathy and disgust. Appetite, 105, 758-774.

Larsson, C. L., Rönnlund, U., Johansson, G., & Dahlgren, L. (2003). Veganism as status passage: The process of becoming a vegan among youths in Sweden. Appetite, 41, 61-67.

Lea, E. J., Crawford, D., & Worsley, A. (2006). Consumers’ readiness to eat a plant-based diet. European Journal of Clinical Nutrition, 60, 342-351.

Lea, E., & Worsley, A. (2003). Benefits and barriers to the consumption of a vegetarian diet in Australia. Public Health Nutrition, 6, 505-511.

LeRette, D. E. (2014). Stories of microaggressions directed toward vegans and vegetarians in social settings (Doctoral dissertation, Fielding Graduate University).

Liu, C., Cai, X., & Zhu, H. (2015). Eating out ethically: An analysis of the influence of ethical food consumption in a vegetarian restaurant in Guangzhou, China. Geographical Review, 105, 551-565.

Loughnan, S., Bastian, B., & Haslam, N. (2014). The psychology of eating animals. Current Directions in Psychological Science, 23, 104-108.

Loughnan, S., Haslam, N., & Bastian, B. (2010). The role of meat consumption in the denial of moral status and mind to meat animals. Appetite, 55, 156-159.

Love, H. J., & Sulikowski, D. (2018). Of meat and men: Sex differences in implicit and explicit attitudes towards meat. Frontiers in Psychology, 9, 559. doi:10.3389/fpsyg.2018.00559.

Lund, T. B., McKeegan, D. E., Cribbin, C., & Sandøe, P. (2016). Animal ethics profiling of vegetarians, vegans and meat-eaters. Anthrozoös, 29, 89-106.

MacInnis, C. C., & Hodson, G. (2017). It ain’t easy eating greens: Evidence of bias toward vegetarians and vegans from both source and target. Group Processes & Intergroup Relations, 20, 721-744.

Meister, K. (1997). Vegetarianism. New York: American Council on Science and Health. Menzies, K., & Sheeshka, J. (2012). The process of exiting vegetarianism: An exploratory study. Canadian Journal of Dietetic Practice and Research, 73, 163-168.

Michalak, J., Zhang, X. C., & Jacobi, F. (2012). Vegetarian diet and mental disorders: Results from a representative community survey. International Journal of Behavioral Nutrition and Physical Activity, 9, 67.

Minson, J. A., & Monin, B. (2012). Do-gooder derogation: Disparaging morally motivated minorities to defuse anticipated reproach. Social Psychological and Personality Science, 3, 200-207.

Monin, B. (2007). Holier than me? Threatening social comparison in the moral domain. Revue Internationale de Psychologie Sociale, 20, 53-68.

Monteiro, C. A., Pfeiler, T. M., Patterson, M. D., & Milburn, M. A. (2017). The Carnism Inventory: Measuring the ideology of eating animals. Appetite, 113, 51-62.

Morgan Thompson, E. M., & Morgan, E. M. (2008). “Mostly straight” young women: Variations in sexual behavior and identity development. Developmental Psychology, 44, 15-21.

Mullee, A., Vermeire, L., Vanaelst, B., Mullie, P., Deriemaeker, P., Leenaert, T., … & Huybrechts, I. (2017). Vegetarianism and meat consumption: A comparison of attitudes and beliefs between vegetarian, semi-vegetarian, and omnivorous subjects in Belgium. Appetite, 114, 299-305.

Mycek, M. K. (2018). Meatless meals and masculinity: How veg* men explain their plant-based diets. Food and Foodways, 1-23. doi:10.1080/07409710.2017.1420355.

Perry, C. L., Mcguire, M. T., Neumark-Sztainer, D., & Story, M. (2001). Characteristics of vegetarian adolescents in a multiethnic urban population. Journal of Adolescent Health, 29, 406-416.

Piazza, J., Ruby, M. B., Loughnan, S., Luong, M., Kulik, J., Watkins, H. M., & Seigerman, M. (2015). Rationalizing meat consumption. The 4Ns. Appetite, 91, 114-128.

Pohjolainen, P., Vinnari, M., & Jokinen, P. (2015). Consumers’ perceived barriers to following a plant-based diet. British Food Journal, 117, 1150-1167.

Potts, A., & Parry, J. (2010). Vegan sexuality: Challenging heteronormative masculinity through meat-free sex. Feminism & Psychology, 20, 53-72.

Povey, R., Wellens, B., & Conner, M. (2001). Attitudes towards following meat, vegetarian and vegan diets: An examination of the role of ambivalence. Appetite, 37, 15-26.

Pfeiler, T. M., & Egloff, B. (2018). Examining the “Veggie” personality: Results from a representative German sample. Appetite, 120, 246-255.

Radnitz, C., Beezhold, B., & DiMatteo, J. (2015). Investigation of lifestyle choices of individuals following a vegan diet for health and ethical reasons. Appetite, 90, 31-36.

Ritchie, H., Reay, D. S., & Higgins, P. (2018). Potential of meat substitutes for climate change mitigation and improved human health in high-income markets. Frontiers in Sustainable Food Systems, 2, 16. doi:10.3389/fsufs.2018.00016.

Rogers, R. A. (2008). Beasts, burgers, and hummers: Meat and the crisis of masculinity in contemporary television advertisements. Environmental Communication, 2, 281-301.

Romo, L. K., & Donovan-Kicken, E. (2012). “Actually, I don’t eat meat”: A multiple-goals perspective of communication about vegetarianism. Communication Studies, 63, 405-420.

Rosenfeld, D. L., (2018a). A comparison of dietarian identity profiles between vegetarians and vegans. Manuscript submitted for publication.

Rosenfeld, D. L., (2018b). A comparison of omnivores who are open to becoming vegetarian with those who are not. Manuscript submitted for publication.

Rosenfeld, D. L., (2018c). Why some choose the vegetarian option: Are all ethical motivations the same? Manuscript submitted for publication.

Rosenfeld, D. L., & Burrow, A. L. (2017a). The unified model of vegetarian identity: A conceptual framework for understanding plant-based food choices. Appetite, 112, 78-95.

Rosenfeld, D. L., & Burrow, A. L. (2017b). Vegetarian on purpose: Understanding the motivations of plant-based dieters. Appetite, 116, 456-463.

Rosenfeld, D. L., & Burrow, A. L. (2018a). Development and validation of the Dietarian Identity Questionnaire: Assessing self-perceptions of animal-product consumption. Appetite, 127, 182-194.

Rosenfeld, D. L., & Burrow, A. L. (2018b). Vegetarianism and beyond: Investigating how people construe meat avoidance. Manuscript submitted for publication.

Rothgerber, H. (2012). Real men don’t eat (vegetable) quiche: Masculinity and the justification of meat consumption. Psychology of Men & Masculinity, 14, 363-375.

Rothgerber, H. (2013). A meaty matter. Pet diet and the vegetarian’s dilemma. Appetite, 68, 76-82.

Rothgerber, H. (2014a). A comparison of attitudes toward meat and animals among strict and semi-vegetarians. Appetite, 72, 98-105.

Rothgerber, H. (2014b). Efforts to overcome vegetarian-induced dissonance among meat eaters. Appetite, 79, 32-41.

Rothgerber, H. (2014c). Evaluation of ingroup disloyalty within a multigroup context. Social Psychology, 45, 382-390.

Rothgerber, H. (2014d). Horizontal hostility among non-meat eaters. PLOS ONE, 9, e96457.

Rothgerber, H. (2014e). Carnivorous cats, vegetarian dogs, and the resolution of the vegetarian’s dilemma. Anthrozoös, 27, 485-498.

Rothgerber, H. (2015a). Can you have your meat and eat it too? Conscientious omnivores, vegetarians, and adherence to diet. Appetite, 84, 196-203.

Rothgerber, H. (2015b). Underlying differences between conscientious omnivores and vegetarians in the evaluation of meat and animals. Appetite, 87, 251-258.

Rothgerber, H. (2017). Attitudes toward meat and plants in vegetarians. In F. Mariotti (Ed.), Vegetarian and Plant-Based Diets in Health and Disease Prevention (pp. 11-35). London, UK: Academic Press.

Rothgerber, H., & Mican, F. (2014). Childhood pet ownership, attachment to pets, and subsequent meat avoidance. The mediating role of empathy toward animals. Appetite, 79, 11-17.

Rozin, P., Hormes, J. M., Faith, M. S., & Wansink, B. (2012). Is meat male? A quantitative multimethod framework to establish metaphoric relationships. Journal of Consumer Research, 39, 629-643.

Ruby, M. B. (2008). Of meat, morals, and masculinity: Factors underlying the consumption of non-human animals, and inferences about another’s character (master’s thesis). The University of British Columbia, Vancouver, British Columbia.

Ruby, M. B. (2012). Vegetarianism. A blossoming field of study. Appetite, 58, 141-150.

Ruby, M. B., Alvarenga, M. S., Rozin, P., Kirby, T. A., Richer, E., & Rutsztein, G. (2016). Attitudes toward beef and vegetarians in Argentina, Brazil, France, and the USA. Appetite, 96, 546-554.

Ruby, M. B., Cheng, T. K., & Heine, S. J. (2011). [Cultural differences in food choices and attitudes towards animals]. Unpublished raw data.

Ruby, M. B., & Heine, S. J. (2011). Meat, morals, and masculinity. Appetite, 56, 447-450.

Ruby, M. B., & Heine, S. J. (2012). Too close to home. Factors predicting meat avoidance. Appetite, 59, 47-52.

Ruby, M. B., Heine, S. J., Kamble, S., Cheng, T. K., & Waddar, M. (2013). Compassion and contamination. Cultural differences in vegetarianism. Appetite, 71, 340-348.

Schösler, H., de Boer, J., Boersema, J. J., & Aiking, H. (2015). Meat and masculinity among young Chinese, Turkish and Dutch adults in the Netherlands. Appetite, 89, 152-159.

Sedupane, G. (2017). A qualitative study exploring the experiences of Black South African vegetarians residing in the urban settings of Cape Town (Master’s thesis, University of Western Cape.

Singer, P., & Mason, J. (2006). The ethics of what we eat: Why our food choices matter. Melbourne: Text Publishing.

Sneijder, P., & Te Molder, H. (2009). Normalizing ideological food choice and eating practices. Identity work in online discussions on veganism. Appetite, 52, 621-630.

Sobal, J. (2005). Men, meat, and marriage: Models of masculinity. Food and Foodways, 13, 135-158.

Sobal, J., Bisogni, C. A., & Jastran, M. (2014). Food choice is multifaceted, contextual, dynamic, multilevel, integrated, and diverse. Mind, Brain, and Education, 8, 6-12.

Stiles, B. (1998). Vegetarianism: Identity and experiences as factors in food selection. Free Inquiry in Creative Sociology, 26, 213-226.

Stoll-Kleemann, S., & Schmidt, U. J. (2017). Reducing meat consumption in developed and transition countries to counter climate change and biodiversity loss: A review of influence factors. Regional Environmental Change, 17, 1261-1277.

Testoni, I., Ghellar, T., Rodelli, M., De Cataldo, L., & Zamperini, A. (2017). Representations of death among Italian vegetarians: An ethnographic research on environment, disgust and transcendence. Europe’s Journal of Psychology, 13, 378-395.

Thomas, M. A. (2016). Are vegans the same as vegetarians? The effect of diet on perceptions of masculinity. Appetite, 97, 79-86.

Tian, Q., Hilton, D., & Becker, M. (2016). Confronting the meat paradox in different cultural contexts: Reactions among Chinese and French participants. Appetite, 96, 187-194.

Timko, C. A., Hormes, J. M., & Chubski, J. (2012). Will the real vegetarian please stand up? An investigation of dietary restraint and eating disorder symptoms in vegetarians versus nonvegetarians. Appetite, 58, 982-990.

Torti, J. M. (2017). The social and psychological well-being of vegetarians: A focused ethnography (Doctoral dissertation, University of Alberta).

Trautmann, J., Rau, S. I., Wilson, M. A., & Walters, C. (2008). Vegetarian students in their first year of college: Are they at risk for restrictive or disordered eating behaviors?. College Student Journal, 42, 340-347.

Tung, S. J., Tsay, J. C., & Lin, M. C. (2015). Life course, diet-related identity and consumer choice of organic food in Taiwan. British Food Journal, 117, 688-704.

Twine, R. (2014). Vegan killjoys at the table—Contesting happiness and negotiating relationships with food practices. Societies, 4, 623-639.

Vartanian, L. R. (2015). Impression management and food intake. Current directions in research. Appetite, 86, 74-80.

Veser, P., Taylor, K., & Singer, S. (2015). Diet, authoritarianism, social dominance orientation, and predisposition to prejudice: Results of a German survey. British Food Journal, 117, 1949-1960.

White, R. F., Seymour, J., & Frank, E. (1999). Vegetarianism among US women physicians. Journal of the American Dietetic Association, 99, 595-598.

Worsley, A., & Skrzypiec, G. (1997). Teenage vegetarianism: Beauty or the beast? Nutrition Research, 17, 391-404.

Wrenn, C. L. (2017). Trump veganism: A political survey of American vegans in the era of identity politics. Societies, 7, 32.

Yeh, H. Y. (2014). Voice with every bite: Dietary identity and vegetarians’ “the-second-best” boundary work. Food, Culture & Society, 17, 591-613.


References

  1. The psychology of vegetarianism: Recent advances and future directions. Rosenfeld DL. Appetite. 2018 Sep 15. pii: S0195-6663(18)30930-9. doi: 10.1016/j.appet.2018.09.011. [Epub ahead of print] Review.
    PMID: 30227184. []
  2. Daniel L Rosenfeld -personal information []
  3. Ruby, M. B. (2012). Vegetarianism. A blossoming field of study. Appetite, 58, 141-150. [] [] []
  4. Wrenn, C. L. (2017). Trump veganism: A political survey of American vegans in the era of identity politics. Societies, 7, 32. []
  5. Veser, P., Taylor, K., & Singer, S. (2015). Diet, authoritarianism, social dominance orientation, and predisposition to prejudice: Results of a German survey. British Food Journal, 117, 1949-1960. []
  6. Pfeiler, T. M., & Egloff, B. (2018). Examining the “Veggie” personality: Results from a representative German sample. Appetite, 120, 246-255. []
  7. Hodson, G., & Earle, M. (2018). Conservatism predicts lapses from vegetarian/vegan diets to meat consumption (through lower social justice concerns and social support). Appetite, 120, 75-81. []
  8. People who endorse right-wing ideology also tend to exhibit more negative attitudes toward vegetarians. MacInnis & Hodson, 2017. []
  9. Judge, M., & Wilson, M. S. (2018). A dual-process motivational model of attitudes toward vegetarians and vegans. European Journal of Social Psychology. []
  10. De Backer, C. J., & Hudders, L. (2015). Meat morals: Relationship between meat consumption and consumer attitudes towards human and animal welfare and moral behavior. Meat Science, 99, 68-74. []
  11. Rothgerber, H. (2014). Carnivorous cats, vegetarian dogs, and the resolution of the vegetarian’s dilemma. Anthrozoös, 27, 485-498. []
  12. Heiss, S., & Hormes, J. M. (2018). Ethical concerns regarding animal use mediate the relationship between variety of pets owned in childhood and vegetarianism in adulthood. Appetite, 123, 43-48. []

Vegetarian Diets and the Risk of Diabetes

A September 2018 review 1 looked at whether the dramatic worldwide increase in cases of type 2 diabetes (T2DM – type 2 diabetes mellitus) could be slowed down if individuals made simple dietary changes rather than seeking solutions through medication.

Summary

The reviewers note that vegetarian diets are inversely associated with risk of developing diabetes, and this is independent of the positive association of meat consumption with diabetes development.

Range of diets

Vegetarian diets range* from:

  • vegan (no animal products)
  • lacto-ovo-vegetarian (no animal meat, but consumes milk and eggs)
  • pesco-vegetarian (consumes fish)
  • semi-vegetarian/flexitarian (occasional meat consumption)

*N.B. This review does not look at WFPB or non-SOS WFPB diets.

The most important aspects of any of these types of diets is the emphasis on:

  • whole grains
  • fruits and vegetables
  • legumes
  • nuts
  • reduction of saturated and trans fats

Problem – what problem?

Oh there’s a big problem, alright. Diabetes has now reached epidemic levels, with an estimated 451 million cases worldwide in 2017 – a number that is predicted 2  to increase to 693 million by 2045.

Where’s the evidence?

About 90% of diabetes diagnoses are type 2 (T2DM) – all of these appear to be lifestyle-related 3 . Additionally, the lifestyle factor most linked to improvements in protection against, treatment of and cure for is diet – with the take-home facts being that animal foods encourage whist plant foods discourage T2DM 4 .

As countries develop a more Westernised diet (also known as the SAD or Standard American Diet), the rates of diabetes within those countries increases 3 .

Omnivores vs Vegetarians

A diet differing from the typical Westernised diet is a vegetarian one.  The results of changing to a vegetarian diet is clear. For instance, research 3 shows that vegetarians in the US have a lower prevalence of diabetes than omnivores (that is, those who consume both plant and animal foods, although much more of the latter than the former foods in the case of modern Westernised diets). Other research 5 6 7 8 9  backs up the proposition that a vegetarian diet is significantly better for the prevention and treatment of diabetes than an omnivore diet.

To the heart of the matter

People with diabetes have a 2–4 times greater risk of suffering from CVD (cardio-vascular disease) 10  . Even those who just adhered to a lacto-ovo-vegetarian diet have been shown 11  to have significantly decreased CVD risk factors, specifically blood pressure, serum cholesterol, and blood glucose levels than those adhering to an omnivorous diet.

Another 2013 study 12  examined ischaemic heart disease risk of vegetarians versus non-vegetarians in a large British sample of 44,561 individuals. They found that vegetarians had a lower BMInon-HDL cholesterol, and systolic blood pressure than the non-vegetarians.

Other risks with diabetes

When looking at other diabetes risk factors and comorbidities, a 2015 study 13 found that those adhering to a vegan diet supplemented with vitamin B12 had a significantly larger decrease in neuropathic pain 14 than the control group receiving just B12 supplementation.

A 1988 study 15 examined patients who had diabetic neuropathy 16  and renal failure who followed a vegan diet for 12 months found significant improvements in the following:

  • creatinine clearance 17
  • urine protein levels
  • cholesterol levels
  • blood glucose levels

Is it too late for me?

Okay, if you’ve eaten a vegetarian diet from childhood, you are less likely to have developed diabetes; but what if you’ve been stuffing in the eggs and bacon, doughnuts and cream cakes for most of your life – is it too late? Another 2018 study 18 found that adopting a vegetarian diet later on in life can greatly reduce diabetes risk, showing the benefits of using a vegetarian diet in an intervention. Other research studies 19 20 21    show the same positive results of dietary changes later in life.

Medication vs diet

There’s also evidence 22 23 24 25 supporting the suggestion that adopting a vegetarian diet is more effective than at improving diabetes symptoms than traditional medication. Of course, packing in smoking and getting lots of exercise are also significantly important lifestyle factors that can prevent and treat diabetes.

Physical and mental benefits

A 2013 study 26 looked at the psychological effects of adopting a vegetarian diet. The investigators assessed the following:

  • quality of life
  • eating behaviour
  • depressive symptoms

They divided diabetic subjects into vegetarian and non-vegetarian groups and found an increase in quality of life and decrease in depressive symptoms in the vegetarian group. Regarding dietary restraint, the vegetarian group was was able to show an increased ability to resist the ‘temptation’ to eat more food and more unhealthy food than the non-vegetarian group.  This study showed that adopting a vegetarian diet has both physical and psychological benefits for T2DM patients.

Not all vegetarian diets are equal

Some vegetarians live on processed foods, crisps, chips and sweets. Some hate all vegetables (except fried white potatoes!) while others eat largely whole plant foods.

To examine the differences in type 2 diabetes risk of vegetarians who consume an unhealthy diet (characterised by refined grains, starchy foods, added sugars, low fruits and vegetables) or healthy diet (characterised by whole grains, fruits, vegetable, legumes), a 2016 review 27 categorised the latter as hPDI (a Healthful Plant-Based Diet) and uPDI (an Unhealthy Plant-Based Diet Index) in order to distinguish between healthy and unhealthy plant foods being eaten.

Thus, hPDI assigned positive scores to:

  • whole grains
  • fruits
  • vegetables
  • nuts
  • vegetable oils
  • tea and coffee

and reverse scores to:

  • fruit juices
  • sweetened beverages
  • refined grains
  • potatoes (white)
  • sweets
  • desserts
  • animal foods

The uPDI used the opposite approach.

The results were pretty clear: PDI and hPDI were inversely associated with T2DM, and the uPDI was positively associated with T2DM. This shows the benefit of following a vegetarian diet that is high in whole grains, vegetables, fruits, nuts, and legumes in preventing T2DM.

Study conclusions

The researchers in this September 2018 review 1 drew the following conclusions:

  • the role of all types of vegetarian diets in the prevention and treatment of diabetes is well established
  • clinicians and healthcare providers should feel confident in recommending a vegetarian diet to their patients who have pre-diabetes or T2DM
  • the type of foods that should be consumed while following this diet is critical to achieve the therapeutic effects
  • a vegetarian diet that is high in unhealthy foods such as refined grains, saturated fats, and added sugars is positively associated with T2DM
  • a vegetarian diet that is high in healthy foods such as whole grains, fruits, vegetables, nuts, legumes, and unsaturated fats is negatively associated with T2DM

Final thoughts

It’s pretty obvious to all reasonable people who’ve done even a bit of research that a significant solution to diabetes (prevention, management and cure) lies in simple dietary changes (as well as dropping the tobacco and picking up the weights instead).

However, while this review does look at different manifestations of vegetarian diets, it does not cover in detail how much more effective a completely WFPB (ideally a non-SOS WFPB) diet is when compared with the rest of the vegetarian offerings. Naturally, it hints at this through its mention of the above-mentioned 2016 review 27

If you look online or go to a vegetarian/vegan restaurant and look at what often goes into their recipes you will soon understand what I’m getting at. A quick glance at the menus of one vegan restaurant 28 local to me reveals the potentially unhealthy ingredients and cooking methods that can be both plant-based and unhealthy at the same time –  ‘double fried chips and a pot of garlic mayo‘  and ‘Sticky Toffee Pudding served with a caramel glaze‘ will only offer limited assistance, if any, to diabetic customers looking for the healthy alternative to bangers and mash!

Of course, as evidenced in this review, going plant-based rather than relying on pharmaceuticals is a move in the right direction – but for the greatest protection against diabetes, a non-SOS WFPD has been shown repeatedly in additional research studies 29 30   to trump the more watered-down veggie versions.


References

  1. Vegetarian Diets and the Risk of Diabetes. Olfert MD, Wattick RA. Curr Diab Rep. 2018 Sep 18;18(11):101. doi: 10.1007/s11892-018-1070-9. Review. [] []
  2. Cho N, Shaw J, Karuranga S, et al. IDF Diabetes Atlas: global
    estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271–81. []
  3. Trapp CB, Barnard ND. Usefulness of vegetarian and vegan diets for treating type 2 diabetes. Curr Diab Rep. 2010;10:152–8. [] [] []
  4. McEvoy CT, Temple N, Woodside JV. Vegetarian diets, low-meat diets and health: a review. Public Health Nutr. 2012;15(12):2287–94. []
  5. Snowdon DA, Phillips RL. Does a vegetarian diet reduce the occurrence of diabetes? Am J Public Health. 1985;75(5):507–12. []
  6. 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. []
  7. Fung TT, Schulze M, Manson JE, Willett WC, Hu FB. Dietary patterns, meat intake, and the risk of type 2 diabetes in women. Arch Intern Med. 2004;164(20):2235–40. []
  8. Barnard ND, Katcher HI, Jenkins DJ, Cohen J, Turner-McGrievy. Vegetarian and vegan diets in type 2 diabetes management. Nutr Rev. 2009;67(5):255–63. []
  9. Chen Z, Zuurmond MG, van der Schaft N, Nano J, Wijnhoven HAH, Ikram MA, et al. Plant versus animal based diets and insulin resistance, prediabetes and type 2 diabetes: the Rotterdam Study. Eur J Epidemiol. 2018. []
  10. Yokoyama Y, Barnard ND, Levin SM, Watanabe M. Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis. Cardiovasc Diagn Ther. 2014;4(5):373–82. []
  11. Slavícek J, Kittnar O, Fraser GE, et al. Lifestyle decreases risk factors for cardiovascular diseases. Cent Eur J Public Health. 2008;16(4):161–4. []
  12. Crowe FL, Appleby PN, Travis RC, Key TJ. Risk of hospitalization or death from ischemic heart disease among British vegetarians and nonvegetarians: results from the ePIC-Oxford cohort study. Am J Clin Nutr. 2013;97(3):597–603. []
  13. Bunner AE, Wells CL, Gonzales J, Agarwal U, Bayat E, Barnard ND. A dietary intervention for chronic diabetic neuropathy pain: a randomized controlled pilot study. Nutr Diabetes. 2015;5(5):e158. []
  14. What is neuropathic pain? Wikipedia. []
  15. Barsotti G, Navalesi R, Giampietro O, et al. Effects of a vegetarian, supplemented diet on renal function, proteinuria, and glucose metabolism in patients with ‘overt’ diabetic nephropathy and renal insufficiency. Contrib Nephrol. 1988;65:87–94. []
  16. What is diabetic neuropathy? Mayo Clinic. []
  17. What is creatinine and creatinine clearance? WedMD []
  18. Chiu THT, Pan W-H, Lin M-N, Lin C-L. Vegetarian diet, change in dietary patterns, and diabetes risk: a prospective study. Nutr Diabetes. 2018;8:12. []
  19. Nicholson AS, Sklar M, Barnard ND, Gore S, Sullivan R, Browning S. Toward improved management of NIDDM: a randomized, controlled, pilot intervention using a lowfat, vegetarian diet. Prev Med. 1999;29:87–91. []
  20. Turner-McGrievy GM, Barnard ND, Scialli AR. A two-year randomized weight loss trial comparing a vegan diet to a more moderate low-fat diet. Obesity (SilverSpring). 2007;15:2276–81. []
  21. Kahleova H, Matoulek M, Malinska H, et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes. Diabet Med. 2010;28:549–59. []
  22. Anderson JW, Ward K. High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am J Clin Nutr. 1979;32(11):2312–21. []
  23. Barnard RJ, Jung T, Inkeles SB. Diet and exercise in the treatment of NIDDM. The need for early emphasis. Diabetes Care. 1994;17: 1469–72. []
  24. 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;29(8):1777–83. []
  25. Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. 2009;32(5):791–6. []
  26. Kahleova H, Hrachovinova T, Hill M, Pelikanova T. Vegetarian diet in type 2 diabetes – improvement in quality of life, mood and eating behaviour. Diabet Med. 2013;30(1):127–9. []
  27. Satija A, Bhupathiraju SN, Rimm EB, et al. Plant-based dietary patterns and incidence of type 2 diabetes in US men and women: results from three prospective cohort studies. PLoS Med. 2016;13(6):e1002039. [] []
  28. The Green Room []
  29. Current Diabetes Treatment – Practice or Malpractice? []
  30. Plant-based Diets & Diabetes []

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.”

 


References

(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 Mortalityhttps://www.cdc.gov/nchs/fastats/deaths.htm. 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.  https://doi.org/10.17226/10490.
  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. http://www.health.gov/DietaryGuidelines. 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.  https://doi.org/10.1136/bmj.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.

The Vagaries of Veganuary

“I cheated on being vegan, and it wasn’t even with a rasher of bacon”

She writes:

“…I failed. Nothing to do with the smell of bacon, in the end it was the Cool Doritos that proved to be my downfall.

Didn’t you know? Cool Doritos contain dairy products. As do muesli and Garibaldi biscuits and, as I’ve ranted before, there’s egg in Quorn and also a lot of vegetarian sausages. Some sugar-coated cereals contain hidden gelatin to make the sugar stay on.

I felt healthy and light after an indulgent December, but I simply couldn’t stay the course. Why? Because going vegan is gruelling. It requires a degree of application, vigilance and sheer 24/7 dedication that you can’t fake, not even for a month. 

Because you can’t be a vegan and not mention it; in a meat-eating world it’s too central to your character to omit. And because people (like me, before this steep learning curve) tend to treat vegans as jokes, weird aberrations or dinner guests from hell, it inevitably makes them feel a bit defensive.

But numbers are growing, especially among young people, hence you can buy everything from vegan mayonnaise to vegan make up. An estimated 150,000 people will have taken part in Veganuary in the UK, I’m not entirely sure my attempt actually counts, but I hope so.

I tried to stay vegan, I really I did. Not eating meat was the easy part. I had no interest in roast chicken, but the loss of eggs was a blow and the absence of cheese really quite depressing.

Anyway, I have been happily making porridge with soya milk and will continue to do that regardless. I assumed my spouse was putting soya milk in my coffee too, and was very impressed at how much it resembled full fat dairy.

Then I caught him in the act of using real milk and demanded to know why. He showed me why; the soya milk separates in the hot drink and curdles. He felt it was too revolting to serve.

Apparently if you warm the soya gradually it’s less of a problem, which is why coffee shop soya flat whites are more palatable.

Anyway, this unwitting dairy transgression alone transformed me into a chegan (vegan who cheats) and I was already teetering on the brink when Dorito-gate happened.

I’m not even sure I’ll go back to eating meat; vegetarianism is a walk in the park compared to veganism which is more like struggling to reach Everest Base Camp in flip flops only to discover all they have to eat is custard and mince.

For me, Veganuary was an experiment, but in truth I was hobbled by my lackadaisical attitude from the start; “giving it a go” isn’t the same as believing in it as a cause and being prepared to make no compromises. 

But some good has come of it: most notably I have not just a new tolerance, but an admiration for vegans. 

It takes real strength of character to eschew all animal products, all the time, when so many foods are booby-trapped and irrationally indignant meat eaters constantly grill you about your life choices.

Would I try it again? For an occasional week, absolutely. But even if I don’t, I hereby solemnly swear to never (ever) ask a vegan where they get their protein from.”


Joe’s Comment

“…vegetarianism is a walk in the park compared to veganism which is more like struggling to reach Everest Base Camp in flip flops only to discover all they have to eat is custard and mince.” Brilliant!

However, the transition from being a vegan to eating a whole food plant-based diet (with no salt, oil and very little added sugar) is a whole new experience, and something that takes dedication and planning. Is it worth it? You bet ya! The health benefits of making the quantum leap from veganism (which includes those who tuck into the odd processed vegan sausage and ice-cream to those who hate veggies and “survive” on chocolate and chips) to a WFPB diet are profound and well-documented. (1.)

Eating the modern western diet it like setting a house on fire – but the fire is inside your body. And even if you go 6 days out of 7 without animal protein, on that 7th day of eating meat it’s like pouring petrol on flames that were nicely dying down.

As Dr. Michael Greger points out: “even in a population consuming a really plant-based diet with little meat and fish, true vegetarians who completely avoided animal flesh, while eating more healthy plant foods, have lower odds for prediabetes and diabetes after accounting for other risk factors.”  (2., 3.)

References

  1. https://1440.org/case-whole-food-plant-based-diet-interview-t-colin-campbell/
  2. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0088547
  3. https://www.ncbi.nlm.nih.gov/pubmed/21983060