Vegetarian Diet

Which Diets Are Best In 2021?

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Which Diet Should You Choose?

Emoticon-BadMany of you started 2021 with goals of losing weight and/or improving your health. In many cases, that involved choosing a new diet. That was only 2 months ago, but it probably feels like an eternity.

For many of you the “bloom” has gone off the new diet you started so enthusiastically in January.

  • Perhaps the diet isn’t working as well as advertised…
  • Perhaps the diet is too restrictive. You are finding it hard to stick with…
  • Perhaps you are always hungry or constantly fighting food cravings…
  • Perhaps you are starting to wonder whether there is a better diet than the one you chose in January…
  • Perhaps you are wondering whether the diet you chose is the wrong one for you…

If you are rethinking your diet, you might want to know which diets the experts recommend. Unfortunately, that’s not as easy as it sounds. The diet world has become just as divided as the political world.

Fortunately, you have an impartial resource. Each year US News & World Report invites a panel of experts with different points of view to evaluate popular diets. They then combine the input from all the experts into rankings of the diets in various categories.

If you are still searching for your ideal diet, I will summarize the US News & World Report’s “Best Diets In 2021”. For the full report, click on this link.

How Was This Report Created?

Expert PanelUS News & World Report recruited panel of 25 nationally recognized experts in diet, nutrition, obesity, food psychology, diabetes, and heart disease to review the 39 most popular diets.  They rated each diet in seven categories:

  • How easy it is to follow.
  • Its ability to produce short-term weight loss.
  • Its ability to produce long-term weight loss.
  • its nutritional completeness.
  • Its safety.
  • Its potential for preventing and managing diabetes.
  • Its potential for preventing and managing heart disease.

They converted the experts’ ratings to scores 5 (highest) to 1 (lowest). They then used these scores to construct nine sets of Best Diets rankings:

  • Best Diets Overall combines panelists’ ratings in all seven categories. However, all categories were not equally weighted. Short-term and long-term weight loss were combined, with long-term ratings getting twice the weight. Why? A diet’s true test is whether it can be sustained for years. And safety was double counted because no diet should be dangerous.
  • Best Commercial Diets uses the same approach to rank 15 structured diet programs that require a participation fee or promote the use of branded food or nutritional products.
  • Best Weight-Loss Diets was generated by combining short-term and long-term weight-loss ratings, weighting both equally. Some dieters want to drop pounds fast, while others, looking years ahead, are aiming for slow and steady. Equal weighting accepts both goals as worthy.
  • Best Diabetes Diets is based on averaged diabetes ratings.
  • Best Heart-Healthy Diets uses averaged heart-health ratings.
  • Best Diets for Healthy Eating combines nutritional completeness and safety ratings, giving twice the weight to safety. A healthy diet should provide sufficient calories and not fall seriously short on important nutrients or entire food groups.
  • Easiest Diets to Follow represents panelists’ averaged judgments about each diet’s taste appeal, ease of initial adjustment, ability to keep dieters from feeling hungry and imposition of special requirements.
  • Best Plant-Based Diets uses the same approach as Best Diets Overall to rank 12 plans that emphasize minimally processed foods from plants.
  • Best Fast Weight-Loss Diets is based on short-term weight-loss ratings.

Which Diets Are Best In 2021?

The word WInner in white letters surrounded by a burst of colorful stars in 3d

Are you ready? If this were an awards program I would be saying “Envelop please” and would open the envelop slowly to build suspense.

However, I am not going to do that. Here are the top 5 and bottom 5 diets in each category (If you would like to see where your favorite diet ranked, click on this link). [Note: I excluded commercial diets from this review.]

Best Diets Overall 

The Top 5: 

#1: Mediterranean Diet

#2: DASH Diet (This diet was designed to keep blood pressure under control, but you can also think of it as an Americanized version of the Mediterranean diet.)

#3: Flexitarian Diet (A flexible semi-vegetarian diet).

#4: Mayo Clinic Diet

#5: MIND Diet (This diet is a combination of Mediterranean and DASH but is specifically designed to reduce cognitive decline as we age.)

The Bottom 5: 

#35: Modified Keto Diet

#36: Whole 30 Diet

#37: GAPS Diet (A diet designed to improve gut health).

#38: Keto Diet

#39: Dukan Diet

Best Weight-Loss DietsWeight Loss

The Top 5: 

#1: Flexitarian Diet

#2: Vegan Diet

#3: Volumetrics Diet (A diet based on the caloric density of foods).

#4: Mayo Clinic Diet

#5: Ornish Diet

The Bottom 5: 

#35: Fertility Diet

#36: Whole 30 Diet

#37: Alkaline Diet

#38: AIP Diet (A diet designed for people with autoimmune diseases)

#39: GAPS Diet

Best Diabetes Diets

The Top 5: 

#1: Flexitarian Diet

#2: Mediterranean Diet

#3: DASH Diet

#4: Mayo Clinic Diet

#5: Vegan Diet

The Bottom 5: 

#35: The Fast Diet

#36: AIP Diet

#37: GAPS Diet

#38: Whole 30 Diet (A diet designed for people with autoimmune diseases)

#39: Dukan Diet

strong heartBest Heart-Healthy Diets 

The Top 5: 

#1: DASH Diet

#2: Mediterranean Diet

#3: Ornish Diet (A diet based on the caloric density of foods).

#4: Flexitarian Diet

#5: Vegan Diet

The Bottom 5: 

#35: Keto Diet

#36: AIP Diet

#37: Whole 30 Diet

#38: Modified Keto Diet

#39: GAPS Diet

Best Diets for Healthy Eating

The Top 5: 

#1: DASH Diet

#2: Mediterranean Diet

#3: Flexitarian Diet

#4: TLC Diet (A diet designed to promote heart health)

#5: MIND Diet

The Bottom 5: 

#35: Atkins Diet

#36: Raw Food Diet

#37: Modified Keto Diet

#38: Dukan Diet

#39: Keto Diet 

Easiest Diets to FollowEasy

The Top 5: 

#1: Mediterranean Diet

#2: Flexitarian Diet

#3: MIND Diet

#4: DASH Diet

#5: Fertility Diet

The Bottom 5: 

#35: Keto Diet and Modified Keto Diet (tie)

#36: Whole 30 Diet

#37: Dukan Diet

#38: GAPS Diet

#39: Raw Foods Diet 

Best Fast Weight-Loss Diets

The Top 5 (Excluding Commercial Diets): 

#1: Atkins Diet

#2: Biggest Loser Diet

#3: Keto Diet

#4: Raw Food Diet

#5: Volumetrics Diet

Which Diets Are Best For Rapid Weight Loss?

Happy woman on scaleLet me start with some general principles:

#1: If you are looking for rapid weight loss, any whole food restrictive diet will do.

  • The Atkins and keto diets are meat heavy, low carb diets. They restrict fruits, some vegetables, grains, and most legumes.
  • The Biggest Loser diet relies on restrictive meal plan and exercise programs.
  • The restrictions of the raw food diet are obvious.
  • The volumetrics diet restricts foods with high caloric density.
  • The vegan diet, which ranks #7 on this list, is a very low fat diet that eliminates meat, dairy, eggs, and animal fats.
  • I did not include commercial diets that rated high on this list, but they are all restrictive in one way or another.

#2: Restrictive diets ultimately fail.

  • The truth is 90-95% of people who lose weight quickly on a restrictive diet regain most of that weight in the next two years. The pounds come back and often bring their friends along as well. Many people regain more weight than they lost. This is the famous “Yo-Yo Effect”.
  • If dieters paid for one of the commercial diets, they may as well have burned their money.
  • When I talk with people about weight loss, many of them tell me the Atkins diet is the only one they can lose weight on. That would be impressive if they were at a healthy weight, but most are not. They are overweight. I am starting to see the same thing from overweight people who have used the keto diet to lose weight and have regained their weight.

#3: We should ask what happens when we get tired of restrictive diets and add back some of your favorite foods.

  • If you lose weight on a vegan diet and add back some of your favorite foods, you might end up with a semi-vegetarian diet. This is a healthy diet that can help you maintain your weight loss.
  • If you lose weight on the Atkins or keto diets and add back some of your favorite foods, you end up with the typical American diet – one that is high in both fat and carbs. This is not a recipe for long-term success.
  • Long term weight loss is possible if you transition to a healthy diet after you have lost the weight. In a recent article in “Health Tips From The Professor” I wrote about an organization called the National Weight Control Registry. These are people who have been successful at keeping the weight off. For purposes of this discussion, two points are important.
  • They lost weight on every possible diet.
  • They kept the weight off by following a healthy reduced calorie, low fat diet. (For what else they did, click here).

Which Diet Should You Choose?

Which Diet Is BestWith rapid weight loss out of the way, let’s get back to the question, “Which Diet Should You Choose?” My recommendations are:

  • Choose a diet that fits your needs. That is one of the things I like best about the US News & World Report ratings. The diets are categorized. If your main concern is diabetes, choose one of the top diets in that category. If your main concern is heart health… You get the point.
  • Choose diets that are healthy and associated with long term weight loss. If that is your goal, you will notice that primarily plant-based diets top these lists. Meat-based, low carb diets like Atkins and keto are near the bottom of the lists.
  • Choose diets that are easy to follow. The less-restrictive primarily plant-based diets top this list – diets like Mediterranean, DASH, MIND, and flexitarian.
  • Choose diets that fit your lifestyle and dietary preferences. For example, if you don’t like fish and olive oil, you will probably do much better with the DASH or flexitarian diet than with the Mediterranean diet.
  • Finally, focus on what you have to gain, rather than on foods you have to give up.
    • On the minus side, none of the diets include sodas, junk foods, and highly processed foods. Teose foods should go on your “No-No” list. Sweets should be occasional treats and only as part of a healthy meal. Meat, especially red meat, should become a garnish rather than a main course.
    • On the plus side, primarily plant-based diets offer a cornucopia of delicious plant foods you probably didn’t even know existed. Plus, for any of the top-rated plant-based diets, there are websites and books full of mouth-watering recipes. Be adventurous.

The Bottom Line 

For many of you the “bloom” has gone off the new diet you started so enthusiastically in January. If you are rethinking your diet, you might want to know which diets the experts recommend. Unfortunately, that’s not as easy as it sounds. The diet world has become just as divided as the political world.

Fortunately, you have an impartial resource. Each year US News & World Report invites a panel of experts with different points of view to evaluate popular diets. They then combine the input from all the experts into rankings of the diets in various categories. In the article above I summarize the US News & World Report’s “Best Diets In 2021”.

There are probably two questions at the top of your list.

#1: Which diets are best for rapid weight loss? Here are some general principles:

  • If you are looking for rapid weight loss, any whole food restrictive diet will do.
  • Restrictive diets ultimately fail.
  • We should ask what happens when we get tired of restrictive diets and add back some of our favorite foods.
  • Long term weight loss is possible if you transition to a healthy diet after you have lost the weight.

#2: Which diet should you choose? Here the principles are:

  • Choose a diet that fits your needs.
  • Choose diets that are healthy and associated with long term weight loss.
  • Choose diets that are easy to follow.
  • Choose diets that fit your lifestyle and dietary preferences.
  • Finally, focus on what you have to gain, rather than on foods you have to give up.

For more details on the diet that is best for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Which Foods Should I Avoid?

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What Is Nutritionism?

In Defense Of FoodRecently, I have been reading Michael Pollan’s book “In Defense of Food”. Yes, I know the book has been around for a long time. Normally I read the scientific literature rather than popular health books. However, in the past few weeks I have had a lot more time to read books, so I decided to read this one.

Some of the things he says are “off the wall”. As he readily admits, he isn’t a scientist or a medical doctor. However, a lot of what he says is “right on”. He echoes many of the things I have been talking about for years. But he does a masterful job of pulling everything together into a framework he calls “nutritionism”.

If you have a chance, I highly recommend that you read his book.

I will briefly summarize his discussion of nutritionism below. I will also share some scientific support for what he is saying. Finally, I will close by sharing what the Bible says on the subject.

What Is Nutritionism?

Low Fat LabelSimply put, nutritionism is the belief that we can understand food solely in terms of its nutritional and chemical constituents and our requirements for them. I use the term “belief” purposely. As Michael Pollan puts it: “As the ‘-ism’ suggests, nutritionism is not a scientific subject, but an ideology.”

What Michael Pollan is referring to is taking food constituents like saturated fats, cholesterol, sugar, carbohydrates, polyunsaturated fats, monounsaturated fats, fiber, antioxidants, and probiotics and labeling them as either “good” or “bad”.

As he points out, that leads to debacles like the creation of margarine as a substitute for butter. Of course, everyone reading this article knows that we subsequently found out that the trans fat in margarine was worse for us than the saturated fat in butter. He offers many other examples like this.

He also points out that the nutritionism concept has given free rein to the food industry to replace whole foods with processed foods that are cholesterol-free, sugar-free, low-fat, low-carb, or high in fiber, omega-3s, etc. He says that these foods are seldom healthier than the foods they replace. I agree.

Finally, he points out that the scientific support for the classification of individual ingredients or foods as “good” or “bad” is weak. That’s because when scientists design a study that removes a chemical constituent or a food from the diet, they have to replace it with something. And what they replace it with determines the outcome of the study. I give some examples of this in the next section.

The essence of Michael Pollan’s message is:

  • The effect of an individual nutrient or chemical constituent on your health depends on the food it is found in. Forget the fancy nutrition labels. Whole foods are almost always healthier than processed foods.
  • The effect of a food or food constituent on your health also depends on your overall diet. We should be thinking about healthy diets rather than the latest “magical” or “forbidden” food.

I will discuss these points below.

Which Foods Should I Avoid?

Question MarkNow, let’s get to the question, “Which Foods Should I Avoid?” If we are talking about whole foods, the short answer is “None”. As I said in my book, “Slaying The Food Myths”, “We have 5 food groups for a reason”.

For example, if we are talking about plant foods, each plant food group:

  • Has a unique blend of vitamins and minerals.
  • Has a unique blend of phytonutrients.
  • Has a unique blend of fiber.
  • Supports the growth of a unique combination of beneficial gut bacteria.
  • Dr Strangelove and his friends are telling you to eliminate whole grains, fruits, and legumes (beans) from your diet. Recent studies suggest that might not be a good idea. Here is one example.

If we are talking about animal foods, each animal food group:

  • Has a unique blend of vitamins and minerals.
  • May have unique components that are important for our health. [Note: This is an active area of research. Theories have been proposed for which components in animal foods may be important for our health, but they have not been confirmed.]
  • Vegan purists will tell you that you have no need for meat and dairy foods. Recent studies suggest otherwise. Here is one example.

With that as background, let’s turn our attention to nutritionism and look at some of science behind claims that certain food components are either good for us or bad for us.

Saturated Fat. Saturated fat is the poster child for nutritionism.lowfat

First, we were told by the American Heart Association and other health organizations that saturated fat was bad for us. Recently Dr. Strangelove and his friends are telling us that saturated fat is good for us. Instead of limiting saturated fat, we should be limiting carbs by cutting out fruits, whole grains, and legumes. Both cite clinical studies to support their claims. How can this be?

Perhaps a little history is in order. When the American Heart Association recommended that we decrease intake of saturated fat, they were envisioning that we would replace it with monounsaturated and polyunsaturated fat in the context of a healthy diet of fruits, vegetables, whole grains, and legumes. That never happened.

Big Food quickly realized that if the American public were to follow the AHA guidelines, it would be disastrous for their bottom line. So, they sprang into action. They mixed sugar, white flour, and a witch’s brew of chemicals to create highly processed, low fat “foods”. Then they told the American public, “Don’t worry. You don’t have to give up your favorite foods. We have created low fat alternatives.”

This is the essence of what Michael Pollan refers to as nutritionism. By marketing their fake foods as low fat Big Food created the halo of health. In fact, Big Food’s fake foods were less healthy than the foods they replaced. Americans got fatter and sicker.

Now let’s look at the conflicting claims that saturated fat is bad for us or good for us. How can clinical studies disagree on such an important question? The answer is simple. It depends on what you replace it with. You need to consider saturated fat intake in the context of the overall diet.

I discussed this in a previous issue of “Health Tips From the Professor”, but let me summarize it briefly here. The American Heart Association tells us that replacing half of the saturated fat in a typical American diet with:

  • Trans fats, increases heart disease risk by 5%.
  • Refined carbohydrates and sugars (the kind of carbohydrates in the typical American Diet), slightly increases heart disease risk.
  • Complex carbohydrates (whole grains, fruits & vegetables), decreases heart disease risk by 9%.
  • Monounsaturated fats (olive oil & peanut oil), decreases heart disease risk by 15%.
  • Polyunsaturated fats (vegetable oils and fish oil), decreases heart disease risk by 25%.
  • Unsaturated fats in the context of a Mediterranean diet, decreases heart disease risk by 45%.

My advice: Saturated fat is neither good for you nor bad for you. A little bit of saturated fat in the context of a healthy diet is fine. A lot of saturated fat in the context of an unhealthy diet is problematic.

fatty steakRed Meat. Is red meat bad for you? Like saturated fat, it depends on the amount of red meat and the overall diet. I covered this in detail in “Slaying The Food Myths”, but let me summarize briefly here:

According to the World Health Organization, red meat is a probable carcinogen. If we look at the postulated mechanisms by which it causes cancer, they can be mostly neutralized by components of various plant foods.

My advice: An 8-ounce steak with fries and a soda is probably bad for you. Three ounces of that same steak in a green salad or stir fry may be good for you.

I should make one other point while I am on the topic. Dr. Strangelove and his friends have been telling you that grass-fed beef is better for you than conventionally raised beef. Once again, that is nutritionism.  Grass-fed beef is lower in saturated fat and high in omega-3s than conventionally raised beef. That may be better for your heart, but it has no effect on the cancer-causing potential of red meat. It doesn’t give the license to eat 8-ounce steaks on a regular basis. You still want to aim for 3-ounces of that grass-fed beef in a green salad or stir fry. 

High-Fructose Corn Syrup. This one seems to be on everyone’s “naughty list”. You are being told to read labels, and if the food has high-fructose corn syrup on the label, put it back on the shelf. But is that good advice?

It turns out that all the studies on the bad effects of high-fructose corn syrup have been done with sodas and highly processed foods. This should be your first clue.

Of course, as soon as high-fructose corn syrup gained its “bad” reputation, Big Food started replacing it with Sugar Comparisons“heathier” sugars. Does that make those foods healthier?

The answer is a clear “No”. Both chemically and biologically, high-fructose corn syrup is identical to sucrose (table sugar), honey, molasses, maple syrup, coconut sugar, date sugar, or grape juice concentrate. Agave sugar is even higher in fructose than high-fructose corn syrup. This is your second clue.

Substituting these sugars for high-fructose corn syrup doesn’t turn sodas and processed foods into health foods. This is nutritionism at its worst.

My advice: Forget reading the label. Forget trying to avoid foods with high-fructose corn syrup. Avoid sodas and processed foods instead.

Sugar. Once the public started to realize that natural sugars in processed foods were just as bad for us as high-fructose corn syrup, sugars became “bad”. We were told to avoid all foods containing sugar in any form. In fact, we were told we needed to become “label detectives” and recognize all the deceptive ways that sugar could be hidden on the label.

Apple With Nutrition LabelI have discussed this in detail in a previous issue of “Health Tips From The Professor”.

Let me just summarize that article with one quote, “It’s not the sugar. It’s the food. There is the same amount and same types of sugar in an 8-ounce soda and a medium apple. Sodas are bad for you, and apples are good for you.” If you are wondering why that is, I have covered it in another issue of “Health Tips From the Professor”.

Before leaving this subject, I should mention that nutritionism has risen its ugly head here as well. Big Food has struck again. They have replaced sugar with a variety of artificial sweeteners.

Once again, nutritionism has failed. Those artificially sweetened sodas and processed foods are no healthier and no more likely to help you keep the weight off than the sugar-sweetened foods they replace. I have covered the science behind that statement in several previous issues of “Health Tips From the Professor”. Here is one example.

My advice: Forget about sugar phobia. You don’t need to become a label detective. Just avoid sodas, sugar-sweetened beverages, and sweet processed foods. Get your sugar in its natural form in fruits and other whole foods.

low carb dietCarbs. Dr. Strangelove and his friends are now telling you that you need to avoid all carbs. That is pure nutritionism. Carbs are neither good nor bad. It depends on the type of carb and what you replace it with.

Once again, clinical studies have given conflicting outcomes. Each side of the carbohydrate debate can provide clinical studies to support their position. How can that be? The answer is simple. It depends on what assumptions went into the design of the clinical studies. I have written several articles on this topic in “Health Tips From the Professor”, but let me give you one example here.

In this example, I looked at two major studies. The PURE (Prospective Urban Rural Epidemiology) study included data from 135,000 participants in 18 countries. In this study, the death rate decreased as the % carbohydrate in the diet decreased. The low-carb enthusiasts were doing a victory dance.

However, it was followed by a second, even larger study. The ARIC (Atherosclerosis Risk In Communities) study included 432,000 participants from even more countries. In this study, the death rate decreased as the % carbohydrate decreased to about 40%. Then a curious thing happened. As the % carbohydrate in the diet decreased further, the death rate increased.

How can you explain this discrepancy? When you examine the PURE study:

  • The % carbohydrate only ranged from 70% to 40%.
  • The data for the PURE study was obtained primarily with third world countries. That is an important distinction because:
    • In those countries, it is primarily the well to do that can afford sodas, processed foods, and meat.
    • The poor subsist on what they can grow and inexpensive staples like beans and rice.
  • Simply put, in the PURE study, the type of carbohydrate changed as well as the amount of carbohydrate.
    • At the highest carbohydrate intakes, a significant percentage of the carbohydrate came from sugar and refined grains.
    • At the lowest carbohydrate intakes, most of the carbohydrate intake came from beans, whole grains, and whatever fruits and vegetables they could grow.

When you examine the ARIC study:how much carbohydrates should we eat aric

  • The % carbohydrate ranged from 70% to 20%.
  • The ARIC study added in data from the US and European countries. That is an important distinction because:
    • Low carb diets like Atkins and Keto are popular in these countries. And those are the diets that fall into the 20-40% carbohydrate range.
    • Most people can afford diets that contain a lot of meat in those countries.
  • Simply put, at the lower end of the scale in the ARIC study, people were eating diets rich in meats and saturated fats and eliminating healthy carbohydrate-containing foods like fruits, whole grains and legumes.

My advice: The lesson here is to avoid simplistic nutritionism thinking and focus on diets rather than on foods. When you do that it is clear that carbs aren’t bad for you, it’s unhealthy carbs that are bad for you.

Which Foods Should I Avoid? By now the answer to the question, “Which Foods Should I Avoid?” is clear. Avoid sodas, sugar-sweetened beverages and processed foods (The term processed foods includes convenience foods, junk foods, and most sweets).

What Does This Mean To You?

Questioning ManNow that we are clear on which foods you should avoid, let’s look at the flip side of the coin. Let’s ask, “Which foods should you include in your diet?

As I said at the beginning of this article, “We have 5 food groups for a reason”. We should consider whole foods from all 5 food groups as healthy.

Of course, each of us is different. We all have foods in some food groups that don’t treat us well. Some of us do better with saturated fats or carbs than others. We need to explore and find the foods and diets that work best for us.

However, whenever we assume one diet is best for everyone, we have crossed the line into nutritionism.

What Does The Bible Say?

Let me start this section by saying that I rely on the Bible for spiritual guidance rather than nutritional guidance. However, as part of our church’s Bible reading plan, I was reading 1 Timothy. A passage from 1 Timothy 4:1-5 leapt out at me. It reinforces the theme of Michael Pollan’s book and seems uniquely applicable to the times we live in.

“The Spirit clearly says that in later times some will abandon the faith and follow deceiving spirits and things taught by demons. Such teachings come through hypocritical liars, whose consciences have been seared as with a hot iron. They…order people to abstain from certain foods, which God created to be received with thanksgiving by those who believe and who know the truth. For everything God created is good, and nothing is to be rejected if it is received with thanksgiving, because it is consecrated by the word of God and prayer.”

Interesting.

The Bottom Line

In this article, I have discussed the concept of “nutritionism” introduced in Michael Pollan’s book “In Defense Of Food”. He defines nutritionism as the belief that we can understand food solely in terms of its nutritional and chemical constituents and our requirements for them.

What Michael Pollan is referring to is taking food constituents like saturated fats, cholesterol, sugar, carbohydrates, polyunsaturated fats, monounsaturated fats, fiber, antioxidants, and probiotics and labeling them as either “good” or “bad”. He points out that when we accept these simplistic labels, we often end up creating foods and diets that are less healthy than the ones we were trying to replace.

At the beginning of the article, I asked the question, “Which Foods Should I Avoid?” I then looked at several foods or food groups we have told to avoid, including saturated fats, red meat, high-fructose corn syrup, sugar, and carbs. When you look at the science behind these recommendations from the lens of nutritionism, you come to two conclusions:

  • We should avoid sodas, sugar-sweetened beverages and processed foods (The term processed foods includes convenience foods, junk foods, and most sweets).
  • Whole foods from all 5 food groups should be considered as healthy.

Of course, each of us is different. We all have foods in some food groups that don’t treat us well. Some of us do better with saturated fats or carbs than others. We need to explore and find the foods and diets that work best for us.

However, whenever we assume one diet is best for everyone, we have crossed the line into nutritionism.

For more details and a bible verse that supports the theme of Michael Pollan’s book and seems uniquely applicable to the times we live in, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Which Foods Affect Stroke Risk?

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Why Is Diet And Stroke Risk So Confusing?

strokeOne day we are told vegetarian diets reduce our stroke risk. The next day we are told they increase stroke risk. It’s the same with red meat, dairy, and eggs. We keep getting mixed messages. It’s enough to make your head spin. Why is diet and stroke risk so confusing?

Part of the problem is that there are two distinct types of stroke. The technical names for them are ischemic stroke and hemorrhagic stroke.

An ischemic stroke occurs when an artery in the brain becomes blocked, shutting off blood flow and damaging part of the brain. This is usually caused by the gradual buildup of fatty deposits and cholesterol plaques in the arteries. When a blood clot forms and lodges in one of the narrowed arteries leading to the brain, an ischemic stroke occurs.

  • Ischemic strokes account for 87% of all strokes.
  • Ischemic strokes are associated with obesity, elevated cholesterol, diabetes, high blood pressure, and smoking.

A hemorrhagic stroke occurs when a weakened blood vessel bursts and bleeds into the surrounding region of the brain. Because our brains are surrounded by a protective skull, that blood has nowhere to go. Pressure from the buildup of blood damages brain cells in the vicinity of the bleed.

  • Hemorrhagic strokes account for only for only 15% of strokes but are responsible for 40% of stroke deaths.
  • The most common cause of a hemorrhagic stroke is the localized enlargement of a blood vessel due to chronic high blood pressure. This weakens the wall of the blood vessel, making it prone to rupturing.

Part of the confusion about diet and stroke risk is because many earlier studies did not distinguish between the two types of stroke.

  • If the studies just measured the incidence of stroke, the data were dominated by ischemic strokes (87% of strokes are ischemic).
  • However, if the studies focused on stroke deaths, hemorrhagic stroke made a larger contribution to the data set (40% of stroke deaths are hemorrhagic).

Fortunately, recent studies have started to focus on the effect of diet on ischemic and hemorrhagic strokes separately. However, many of those studies have been too small to accurately assess the effects of diet on hemorrhagic stroke.

The latest study (TYN Tong et al, European Heart Journal, ehaa007, published February 24, 2020) is one of the largest studies to look at the effect of diet on both kinds of stroke. It has enough patients in the hemorrhagic group to get an accurate estimate of the effect of diet on hemorrhagic stroke.

How Was The Study Done?

Clinical StudyThis study analyzed data on diet and stroke from 418,329 participants in the EPIC (European Prospective Investigation into Cancer and Nutrition). Although the study has cancer in the title, it actually investigated the effect of nutrition on multiple diseases (Presumably, the study title was chosen because EPIC is a more appealing acronym than EPID (European Prospective Investigation into Diseases and Nutrition)).

The participants were recruited from 9 European countries (Denmark, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the UK). The average age of participants was 50, and they were followed for an average of 12.7 years.

At the beginning of the study participants completed country-specific dietary and lifestyle questionnaires.

The dietary assessment was a food frequency questionnaire that asked participants about their dietary intake for the year prior to enrollment in the study. The food frequency data were used to estimate daily intake of red meat, processed meat, poultry, fish, dairy products, eggs, grains, fruits, vegetables, legumes, nuts, seeds, and dietary fiber (It measured total fiber and fiber from grains, fruits and vegetables individually).

The outcome measured was the incidence of ischemic and hemorrhagic strokes during the 12.7-year follow-up.

Which Foods Affect Stroke Risk?

Heart Healthy DietFor ischemic stroke:

  • Each 200 gram/day increase in consumption of fruits and vegetables decreased ischemic stroke risk by 13% (200 grams roughly corresponds to one large apple or one large orange without the skin).
  • Each 10 gram/day increase in consumption of fiber decreased ischemic stroke risk by 23%. Most of this decreased stroke risk was due to fiber from whole grains, fruits, and vegetables.
    • Each 4 gram/day increase in fiber from whole grains decreased ischemic stroke risk by 10%.
    • Each 4 gram/day increase in fiber from fruits and vegetables decreased ischemic stroke risk by 12%.
  • Dairy foods decreased ischemic stroke risk with the following breakdown:
    • Each cup of milk decreased ischemic stroke risk by 5%.
    • Each half cup of yogurt decreased ischemic stroke risk by 9%.
    • Each ounce of cheese decreased ischemic stroke risk by 12%.
  • Each 50 grams/day (2 ounces) of red meat increased ischemic stroke risk by 14%.
    • However, red meat was only half as likely to increase risk of ischemic stroke when the diet was also rich in fruits, vegetables, whole grains, and legumes.

For hemorrhagic stroke:

  • Each 20 gram/day increase in consumption of eggs increased hemorrhagic stroke risk by 25% (20 grams roughly corresponds to about 1/2 of a small egg or 1/3 of a jumbo egg).
  • This study did not measure the effect of salt intake on hemorrhagic stroke risk.

No other foods measured in this study had a significant effect on hemorrhagic stroke risk.

high blood pressureHowever, hemorrhagic stroke is highly associated with high blood pressure. When we look at the influence of foods on high blood pressure, here are the Harvard School of Medicine recommendations for keeping blood pressure low:

  • Eat more fish, nuts and beans in place of high-fat meats.
  • Choose fruits and vegetables instead of sugary, salty snacks and desserts.
  • Select whole grains rather than refined grains.Eat fruit instead of drinking fruit juice.
  • Use unsaturated fats like olive, canola, soybean, peanut, corn or safflower oils instead of butter, coconut oil, or palm-kernel oil.
  • Use herbs, spices, vinegar, and other low-sodium flavorings instead of salt; Choose low-sodium foods whenever possible.

Why Is Diet And Stroke Risk So Confusing?

egg confusionAs I mentioned at the start of this article, part of the reason that the headlines about diet and stroke risk are so confusing is:

  • Many studies did not distinguish between the two types of stroke.
  • Other studies were too small to reliably estimate the effect of food on hemorrhagic stroke risk.

However, there are still some unexplained inconsistencies among recently published studies. It is these inconsistencies I would like to address. For example:

1) In a recent issue of Health Tips From the Professor I reported on a major study (500,000 people followed for 8.9 years) in China. That study came to the opposite conclusion about eggs and risk of hemorrhagic than the EPIC study I discussed above. It found:

  • People consuming one egg per day had a 26% decrease in hemorrhagic stroke risk and a 28% decrease in hemorrhagic stroke deaths compared to people who never or rarely consumed eggs.

In other words, the two studies came to opposite conclusions. In the China study eggs decreased risk of hemorrhagic stroke. In the European study (EPIC) eggs increased risk of hemorrhagic stroke. The reason for this discrepancy is not clear, but one can speculate it might be explained by differences in the underlying diets of the two countries:

  • In China the diet is primarily plant-based. The addition of an egg/day may provide needed protein, fat, and cholesterol (Some cholesterol is essential. We just overdo it in this country).
  • In Europe the diet is already high in protein, saturated fat, and cholesterol. Getting more of them from eggs may not be such a good thing.

In short, if your diet is primarily plant-based, the addition of an egg/day may be a good thing. However, if your diet is already high in meat, saturated fat, and cholesterol, the addition of an egg/day may not be a good thing.

Vegan Foods2) In another recent issue of Health Tips From the Professor I reported on the EPIC-Oxford study that claimed vegetarians had 20% increased risk of hemorrhagic stroke compared to meat eaters.

Interestingly, the EPIC-Oxford study represented a very small portion (~10%) of the overall EPIC study and differed from the rest of the EPIC study in two important ways.

  • It looked at the effect of diets rather than foods on stroke risk.
  • Oxford was the only one of the 22 research centers involved in the EPIC study to invite people following a vegetarian diet to enroll in the study, so it had a much higher proportion of vegetarians than other centers that participated in the study.

The current study did not find any evidence that fruits, vegetables, nuts, seeds, beans, or whole grains influenced the risk of hemorrhagic stroke. In other words, in this much larger data set there was no evidence that the foods associated with a vegetarian diet increased hemorrhagic stroke risk.

However, most of the participants in larger EPIC study were also eating meats. They were not following a pure vegetarian diet.

As I said previously, “If the data on hemorrhagic stroke risk in the EPIC-Oxford study are true, it suggests it may not be a good idea to completely eliminate meat from our diet. However, you don’t need to add much meat to a vegetarian diet. The fish eaters in this study were consuming 1.4 ounces of fish per day. That was enough to eliminate the increased risk of hemorrhagic stroke.”

What Does This Mean For You?

Questioning WomanFor ischemic stroke (blockage of blood flow to the brain), which is the most common form of stroke, the data are clear cut:

  • Fruits, vegetables, whole grains and dairy foods are good for you. (Your mother was right.)
  • Red meat is not so good for you. However, the bad effect of red meat on ischemic stroke risk can be reduced by including plenty of fruits, vegetables, and whole grains in your diet.
  • These conclusions are consistent with multiple previous studies, and the mechanisms of these effects are well established.

For hemorrhagic stroke (bleeding from a weakened blood vessel in the brain) the data are not as clear cut.

  • If you are consuming a primarily plant-based diet, eggs appear to reduce your risk of hemorrhagic stroke.
  • If you are consuming a diet with lots of meat, saturated fat, and cholesterol, adding eggs may increase your risk of hemorrhagic stroke.
  • A vegetarian diet may increase your risk of hemorrhagic stroke. But you don’t need to add much meat to a vegetarian diet. Consuming 1.4 ounces of fish per day appears to be enough to eliminate the increased risk of hemorrhagic stroke.
  • The mechanisms of these effects of food on hemorrhagic stroke are unclear, so these conclusions may be modified by subsequent studies.

In terms of an overall take-home lesson on diet and stroke risk, my advice is: “A primarily plant-based diet is a good idea, but you don’t need to become a vegan purist. Nor do you want to follow fad diets that eliminate whole food groups. We have 5 food groups for a reason. Eliminating any of them may not be a good idea.”

The Bottom Line

A recent study examined the effect of various foods on the risk of the two major forms of stroke.

For ischemic stroke (blockage of blood flow to the brain), which is the most common form of stroke, the data are clear cut:

  • Fruits, vegetables, whole grains and dairy foods are good for you. (Your mother was right.)
  • Red meat is not so good for you. However, the bad effect of red meat on ischemic stroke risk can be reduced by including plenty of fruits, vegetables, and whole grains in your diet.
  • These conclusions are consistent with multiple previous studies, and the mechanisms of these effects are well established.

For hemorrhagic stroke (bleeding from a weakened blood vessel in the brain) the data are not as clear cut.

  • If you are consuming a primarily plant-based diet, eggs appear to reduce your risk of hemorrhagic stroke.
  • If you are consuming a diet with lots of meat, saturated fat, and cholesterol, adding eggs may increase your risk of hemorrhagic stroke.
  • A vegetarian diet may increase your risk of hemorrhagic stroke. But you don’t need to add much meat to a vegetarian diet. Consuming 1.4 ounces of fish per day appears to be enough to eliminate the increased risk of hemorrhagic stroke.
  • The mechanisms of these effects of food on hemorrhagic stroke are unclear, so these conclusions may be modified by subsequent studies.

In terms of an overall take-home lesson on diet and stroke risk, my advice is: “A primarily plant-based diet is a good idea, but you don’t need to become a vegan purist. Nor do you want to follow fad diets that eliminate whole food groups. We have 5 food groups for a reason. Eliminating any of them may not be a good idea.”

For more details, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

 

Is The Impossible Burger Healthy For You?

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Is The Impossible Burger Healthy For the Planet?

Vegan BurgerAmericans love their meat. In 2018 we averaged over 200 pounds of meat per person. If we just focus on beef, we eat about 54 pounds per year. That’s equivalent to four quarter pounders a week!

But we are also getting the message that too much meat, especially red meat, may be bad for us. Nearly 40% of us are trying to eat a more plant-based diet.

The problem is that we love the convenience of fast food restaurants, and we love our burgers. Plus, in the past the meatless burgers on the market were, in a word, disappointing. Their taste and texture left something to be desired. You really needed to be committed to a plant-based diet to eat them in place of a regular burger.

That all changed a few years ago with the introduction of the and new generation of meatless burgers – the Impossible Burger and the Beyond Burger. They had the taste and texture of a real burger, but they were completely plant-based. What wasn’t to like?

  • Both companies claimed that their meatless burgers were healthier for the planet than regular burgers. For example, Impossible Food’s mission statement is: “Animal agriculture occupies almost half the land on earth, consumes a quarter of our freshwater, and destroys our ecosystems. So, we’re doing something about it: We’re making meat using plants, so that we never have to use animals again”.
  • Neither company claims their burgers are healthier for you. However, because their burgers are plant-based, the almost universal assumption has been that they are healthier than regular burgers.

Since their introduction they have taken the world by storm. You can find them in almost every supermarket and in many of your favorite fast food restaurants. Now that they are omnipresent, it is perhaps time to step back and take a closer look at this new generation of meatless burgers. In this article, I will ask two questions:

  • Are they healthier for you than regular burgers?
  • Are they healthier for the planet than regular burgers?

For the sake of simplicity, I will focus on the Impossible Burger with occasional comparisons with the Beyond Burger. It is beyond the scope of this article to compare these burgers with the many other meatless burgers that are now starting to flood the marketplace.

What’s In The Impossible Burger?

  • When we think of a burger, the first thing we think of is protein. The Impossible Burger gets its protein from soy, while the Beyond Burger gets its protein from peas.

Coconut OilHowever, soy and pea protein don’t give you the mouth feel, flavor, red color, and texture of a beef burger.

  • The mouth feel of a burger comes from its saturated fat. Both the Impossible Burger and Beyond Burger use coconut oil as their source of saturated fat.
    • Coconut oil has gained a reputation as a “healthier” saturated fat. However, as I have discussed in my book, “Slaying The Food Myths”, we have no long term studies on the health effects of diets high in coconut oil. We don’t really know whether it is healthier than other saturated fats.
  • The taste and color of a beef burger come from its heme content. Heme does not occur in the parts of plants we eat. However, heme is involved in nitrogen fixation, so it is found in the roots of some legumes.
    • The Impossible Burger has genetically engineered yeast to produce a type of heme called leghemoglobin that is found in soy roots. The Beyond Burger uses beet juice extract and annatto for the color and unspecified “natural flavor” for the flavor.
  • To get the texture of a beef burger, both the Impossible Burger and the Beyond Burger use maltodextrin, modified food starch, and a variety of other ingredients. They are both highly processed foods.
  • Iron is another important nutrient you expect to get from a beef burger. The Impossible Burger contains 4.5 mg of iron and the Beyond Burger contains 5.4 mg of iron.
    • However, that is only part of the story. When iron is attached to a heme molecule, it is more efficiently absorbed by our bodies. Beef burgers and the Impossible Burger contain heme iron. The Beyond Burger does not.
  • In addition, the Impossible Burger adds in the vitamins, including B12, that we would expect to get from a beef burger. The Beyond Burger does not.

What Are The Pluses Of The Impossible Burger?

thumbs upThere are some definite pluses for the Impossible Burger and Beyond Burger:

  • Both the Impossible Burger and Beyond Burger are made from plant-based ingredients rather than from meat.
  • Both are cholesterol free.
  • Both contain modest amounts of fiber (3 grams for the Impossible Burger and 2 grams for the Beyond Burger), while a meat burger contains none.
  • Both are good sources of iron, and the iron in the Impossible Burger is heme-iron, which is efficiently absorbed by our bodies.

What Are The Minuses of the Impossible Burger?

thumbs downThere are, however, some definite minuses as well.

  • Both the Impossible Burger and Beyond Burger are high in saturated fat. The Impossible Burger is higher in saturated fat and the Beyond Burger contains the same amount of saturated fat as a real burger. That’s important because the latest advisory of the American Heart Association warns that saturated fat increases our risk of heart disease (I have discussed this finding in detail in a previous issue of “Health Tips From the Professor”).
    • The saturated fat in both burgers comes from coconut oil. However, as I discussed above, we don’t know whether coconut oil is better or worse for us than other saturated fats. The relevant studies have not been done.
  • Both the Impossible and Beyond burgers are high in sodium. They have almost 5-times more sodium than a beef burger.
  • The heme in red meat catalyzes the formation of N-nitroso compounds in our gut which increase the risk of colon cancer. We do not know whether the form of heme added to Impossible Burgers catalyzes the same reaction, but it is likely.
  • Both plant-based burgers are low in protein compared to a beef burger (~20 grams versus 27 grams). On the other hand, 20 grams of protein is reasonable for a single meal.
  • The plant proteins used for these burgers (soy for the Impossible Burger and pea for the Beyond Burger) are highly processed. They lack the phytonutrients found in the unprocessed proteins.
    • The isoflavones found in soy are thought to decrease the risk of cancer and osteoporosis.
    • The phytonutrients found in peas have antioxidant and anti-inflammatory benefits. They are also thought to decrease the risk of certain cancers.
  • The Impossible Burger is GMO. The leghemoglobin is produced by genetically engineered yeast, and the soy is also GMO.
  • Neither the Impossible Burger nor Beyond Burger are certified organic. Organic certification refers to how the plant was grown. Both burgers are highly processed. Many of the ingredients in both burgers came from factories, not farms.

Is The Impossible Burger Healthy For You?

Eating Impossible BurgerNow, it is time to return to the original question: “Is the Impossible Burger healthy for you?” Since it is plant-based, it would be easy to assume that it is healthier than a burger made from beef. However, when you look more closely, it is not clear that it is healthier.

The manufacturers of the Impossible Burger and similar burgers have gone to the laboratory and have been successful at creating meatless burgers with the taste, mouth feel, and texture of real burgers. However, these improvements have come with a price.

  • The Impossible Burger and similar burgers are higher in saturated fat than a beef burger. This means they may be just as likely to increase the risk of heart disease as a beef burger.
  • The Impossible Burger contains as much heme as a beef burger, which means it may be just as likely to increase the risk of cancer as a beef burger.
  • The Impossible Burger and similar burgers are highly processed. That means:
    • The plant proteins no longer contain the phytonutrients thought to be responsible for some of their health benefits.
    • They also don’t contain the vitamins you would expect to find associated with the plant proteins.
  • The Impossible Burger and similar burgers are not organic. Even worse, the Impossible Burger is GMO.

On balance, we can’t really assume the Impossible Burger is any healthier than the beef burgers it replaces. Plus, if you include the usual condiments and add fries and a soft drink, any slight health benefits of the Impossible Burger will be lost.

It would be much healthier to choose a bean burger. They don’t taste like beef, but many of them are quite tasty. Plus, if you do some label reading, you can find ones that use only whole, unprocessed ingredients.

For example, I looked up the Organic Sunshine brand South West Black Bean burgers. It only provides half as much protein as an Impossible Burger, but all the ingredients are organic, non-GMO, and minimally processed. Note: I am not recommending a particular brand. However, with a little research I am confident you can find a healthy meatless burger with a taste you will enjoy.

Is The Impossible Burger Healthy For the Planet?

impossible burger good for planetNow, let’s look at the second question: “Is the Impossible Burger healthy for the planet?” The answer to this question seems obvious. As the Impossible Burger company states in their mission statement: “Animal agriculture occupies almost half the land on earth, consumes a quarter of our freshwater, and destroys our ecosystems”. It seems logical that any meatless burger would be an improvement.

If we are talking about a minimally processed black bean burger, like the one I described above, the answer is a clear yes. It is healthier for the planet. However, when you look more closely at the Impossible Burger, the answer isn’t as clear.

  • As coconut oil has increased in popularity massive areas of untouched, forested land have been cleared for coconut plantations.
    • These forested areas provide an essential ecosystem for animals and provide natural storm protection by absorbing rainwater. Therefore, coconut oil, like beef, also destroys our ecosystems.
    • In addition, many of the coconut plantations use large amounts of chemical fertilizers which contribute to phosphate pollution and algae overgrowth in lakes, rivers, and coastal ocean areas. This also degrades our environment.
  • The Impossible Burgers and similar meatless burgers contain many highly processed ingredients. Each of these ingredients imposes its own environmental burden. For example:
    • Coconut oil is often processed with hexane, which is categorized as a hazardous air pollutant by the Environmental Protection Agency.
    • In addition, coconut oil is primarily grown in the Philippines, Indonesia, and India. Transporting it to this country generates significant greenhouse gas emissions.
    • And, of course, coconut oil represents only one of the many highly processed ingredients in the Impossible Burger and similar meatless burgers.

In short, the Impossible Burger may be slightly healthier for the planet than a beef burger, but it is much less environmentally friendly than your typical, minimally processed, bean burger.

The Bottom Line

Two weeks ago, I wrote about recent headlines claiming that the best advice for the American public was to eat as much red meat as they like. I looked at the study behind the headlines and pointed out the many flaws in that study.

Last week I wrote about headlines claiming that red meat was just as heart healthy as white meat. I looked at the study behind the headlines and showed it was an excellent example of how the beef industry influences the design of clinical trials to minimize the health risks of red meat. It is also an example of how the media misleads and confuses the public about the effect of nutrition on their health.

What the studies I reviewed the last two weeks really showed was that very small amounts (2-3 ounces) of very lean red meat is probably OK as part of a healthy diet like the Mediterranean diet. Larger servings of fattier cuts of red meat as part of the typical American diet is problematic.

However, if you love your burgers, what are you to do? Are the meatless burgers like the Impossible Burger and Beyond Burger that are showing up in your favorite fast food restaurants the answer? Specifically, you are probably asking:

  • Is the Impossible Burger, and similar burgers, healthy for you?
  • Is the Impossible Burger, and similar burgers, healthy for the planet?

I looked at the composition, pluses, and minuses of this new generation of meatless burgers in this article. The bottom line is:

  • On balance, the Impossible Burger is only slightly healthier than the beef burgers it replaces. And, if you include the usual condiments and add fries and a soft drink, any slight health benefits of the Impossible Burger will be lost.

It would be much healthier to choose a bean burger. They don’t taste like beef, but many of them are quite tasty. Plus, if you do some label reading, you can find ones that are organic, non-GMO, and use only whole, unprocessed ingredients.

  • Similarly, the Impossible Burger may be slightly healthier for the planet than a beef burger, but it is much less environmentally friendly than your typical, minimally processed, bean burger.

For more details, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do Vegetarians Have A Higher Risk Of Stroke?

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What Are The Benefits And Risks Of A Vegetarian Diet?

Vegetarian FoodsVegetarian diets are thought to be very healthy. Clinical studies show that vegetarian diets are associated with decreased risk of heart disease, diabetes, cancer, Alzheimer’s disease, and much more. What’s not to like?

That’s why the recent headlines claiming that vegetarian diets may increase the risk of stroke were so surprising. Advocates of meat-heavy diets like the Paleo and Keto diets were overjoyed. These results fit in with their view that we should be eating more meat protein and less plant protein. Nutrition experts, on the other hand, were asking: “What’s going on?” “How can this be?”

Those of you who are regular readers of “Health Tips From the Professor” know that I am an advocate of primarily plant-based diets. Thus, I felt a responsibility to analyze the study (TYN Tong et al, British Medical Journal, 366: 14897, 2019) behind the headlines impartially and give you, my readers, clear guidelines for the healthiest possible diet.

How Was The Study Done?

clinical-studyLet’s start with some background:

·       A major study called the “European Prospective Investigation Into Cancer and Nutrition” (EPIC) has been underway since the early 90’s.

·       The British component of this study is known as the EPIC-Oxford study.

·       While the study has “cancer” in it’s title, it was designed to measure the impact of nutrition on many diseases. In this case, the study focused on heart disease and stroke.

·       Finally, enrollment in the EPIC-Oxford study was designed to give a high proportion of vegetarians in the study population.

The EPIC-Oxford study enrolled 48,188 participants with no previous history of heart disease, stroke, or angina between 1993 and 2001. A detailed diet analysis was performed upon enrollment and again in 2010. Based on these data, the participants were divided into three groups:

1)    Meat eaters (24,428 participants).

2)    Fish eaters (7,506 participants). This group consumed fish but no other meats. People with this eating style are often called pescatarians.

3)    Vegetarians (16, 254 participants). This group consumed dairy and eggs, but no meat. People with this eating style are often called lacto-ovo vegetarians.

4)    The diet analysis also identified participants who were vegans (no animal foods). However, this group was too small to obtain statistically significant comparisons, so they were included with the lacto-ovo vegetarians in the vegetarian group.

Data on heart disease and stroke were obtained from the UK’s health service records through March 31st, 2016. The average time of follow-up for participants in the study was 18.1 years.

Without going into greater detail, this was a very large, well-designed study.

How Did The Diets Of The Three Groups Compare?

balance scaleThe first step in analyzing this study is to ask how the diets of the three groups compared.

Compared to meat eaters, the fish eaters consumed:

·       No meat other than fish.

·       Slightly less milk and significantly more cheese.

·       Slightly more fruits & vegetables.

·       Significantly more legumes & soy foods, nuts & nut butter.

·       Slightly more carbohydrate and slightly less protein.

·       Slightly less saturated fat and slightly more polyunsaturated fat.

·       Around 260 fewer calories per day.

Compared to fish eaters, the vegetarians consumed:

·       No meat.

·       Slightly less milk & cheese.

·       About the same amount of fruits & vegetables.

·       Significantly more legumes & soy foods, nuts & nut butter.

·       Slightly more carbohydrate and slightly less protein.

·       About the same saturated and polyunsaturated fat.

·       Around 125 fewer calories per day.

On average, the vegetarians consumed about 1 cup of milk and one ounce of cheese per day. The fish eaters consumed 1.4 ounces of fish per day.

In terms of comparisons:

·       The biggest differences were between the fish eaters and the meat eaters. It would be fair to say that the fish eaters consumed a primarily plant-based diet with added fish and dairy.

·       The biggest differences between the vegetarians and fish eaters was that the fish eaters got a significant percentage of their protein from fish, while the vegetarians got a significant amount of their protein from plant sources. Otherwise, their diets were fairly comparable.

Finally, the 10-year follow-up diet analysis showed that most participants stuck with their initial diet.

Do Vegetarians Have A Higher Risk Of Stroke?

strokeNow, for the study results:

·       Compared to meat eaters, fish eaters had 13% lower risk of heart disease, and vegetarians had a 22% lower risk of heart disease.

o   For vegetarians this corresponds to 10 fewer cases of heart disease per 1,000 people over 10 years.

·       Compared to meat eaters, vegetarians had a 20% higher risk of stroke, mostly due to an increased risk for hemorrhagic stroke.

o   For vegetarians this corresponds to 3 additional cases of stroke per 1,000 people over 10 years.

·       The risk of stroke was essentially identical for fish eaters and meat eaters.

In many other aspects, vegetarians were healthier than meat-eaters. For example, they:

·       Weighed less.

·       Had lower blood pressure.

·       Had lower total and LDL cholesterol.

·       Were less likely to have developed diabetes during the study.

·       Were less likely to have required long-term treatment for other illnesses.

What Are The Strengths And Weaknesses Of The Study?

strengths-weaknessesThe strength of this study is obvious. It was a very large, well-designed study. The study also lasted a long time. Participants in the study were followed for almost 20 years.

There are two clear weaknesses, however:

1)    Numerous previous studies have confirmed that vegetarian diets decrease heart disease risk by about 20%. However, none of those previous studies have reported an increase in stroke risk. This study is an outlier.

2)    There is no clear mechanism that explains why a vegetarian diet might increase stroke risk. Based on previous observations that statin drugs increase the risk of hemorrhagic stroke, the authors suggested the increased stroke risk might be due to lowered LDL cholesterol levels.

This mechanism is speculative at present. Furthermore, if true, it would suggest that any intervention (drug or nutritional) that lowers LDL cholesterol would increase stroke risk.

In the words of the authors:

·       “The present study has shown that British adults who were fish eaters or vegetarians had lower risks of heart disease than meat eaters, but that vegetarians had higher risks of stroke.

·       Future work should include further measurements…to identify which factors may cause the observed associations. [In plain English: We need to understand how vegetarian diets might increase stroke risk before we put too much weight on the results of this study.]

·       Additional studies in other large-scale cohorts with a high proportion of non-meat eaters are needed to confirm the generalizability of these results and assess their relevance for clinical practice and general health.” [In plain English: More studies are needed to confirm this observation before we start changing our recommendations about what constitutes a healthy diet.]

What Are The Benefits And Risks Of A Vegetarian Diet?

benefits-risksLet’s assume for a minute that the results of this study are accurate and take a closer look at the benefits and risks of a vegetarian diet. Here is my assessment:

1)    This report is troubling, but it may not be correct. The association of vegetarian diets with a slight increase in stroke risk has only been seen in a single study. This study needs to be confirmed before we become too concerned about vegetarianism increasing stroke risk.

2)    On the balance, vegetarian diets should still be considered very healthy. They lower the risk of heart disease, high blood pressure, diabetes, some cancers, inflammatory diseases and possibly even Alzheimer’s disease.

3)    However, I have often said that we have 5 food groups for a reason, and it is not a good idea to eliminate whole food groups. In the past, I have used that statement to critique diets that leave out important plant food groups like fruit, whole grains, and legumes.

If the data on stroke risk in this study are true, it suggests it might also not be a good idea to leave out meat. However, you don’t need a lot of meat. The fish eaters in this study were consuming 1.4 ounces of fish per day. That was enough to eliminate the increased risk of stroke.

4)    In addition, you don’t have to be a vegan purist to enjoy the health benefits of a primarily plant-based diet. As I describe in my book, “Slaying The Food Myths”, primarily plant-based diets ranging from vegan through pescatarian and semi-vegetarian to Mediterranean and DASH are all incredibly healthy.

I personally follow a semi-vegetarian diet but often recommend Mediterranean and DASH diets to others because they are the easiest primarily plant-based diets for the average American to follow.

5)    Finally, if you have a family history, or are at high risk, of stroke, I recommend prudence until we know more. You may wish to adopt a version of primarily plant-based diets that incorporates some meat (That would be in the pescatarian to DASH range of primarily plant-based diets). Your heart will thank you, and you won’t increase your risk of stroke.

The Bottom Line

A recent study enrolled 48,188 British adults; divided them into meat eaters, fish eaters, and vegetarians; followed them for 18.1 years; and looked at their risk for heart disease and stroke. The results were:

·       Compared to meat eaters, fish eaters had 13% lower risk of heart disease, and vegetarians had a 22% lower risk of heart disease.

o   For vegetarians this corresponds to 10 fewer cases of heart disease per 1,000 people over 10 years.

·       Compared to meat eaters, vegetarians had a 20% higher risk of stroke, mostly due to an increased risk for hemorrhagic stroke.

o   For vegetarians this corresponds to 3 additional cases of stroke per 1,000 people over 10 years.

·       The risk of stroke was essentially identical for fish eaters and meat eaters.

Here is my perspective:

1)    This report is troubling, but it may not be correct. The association of vegetarian diets with a slight increase in stroke risk has only been seen in a single study. This study needs to be confirmed before we become too concerned about vegetarianism increasing stroke risk.

2)    On the balance, vegetarian diets should still be considered very healthy. They lower the risk of heart disease, high blood pressure, diabetes, some cancers, inflammatory diseases and possibly even Alzheimer’s disease.

3)    However, I have often said that we have 5 food groups for a reason, and it is not a good idea to eliminate whole food groups. In the past, I have used that statement to critique diets that leave out important plant food groups like fruit, whole grains, and legumes.

If the data on stroke risk in this study are true, it suggests it might also not be a good idea to leave out meat. However, you don’t need a lot of meat. The fish eaters in this study were consuming 1.4 ounces of fish per day. That was enough to eliminate the increased risk of stroke.

4)    In addition, you don’t have to be a vegan purist to enjoy the health benefits of a primarily plant-based diet. As I describe in my book, “Slaying The Food Myths” (https://slayingthefoodmyths.com), primarily plant-based diets ranging from vegan through pescatarian (the fish eaters in this study) and semi-vegetarian to Mediterranean and DASH are all incredibly healthy.

I personally follow a semi-vegetarian diet but often recommend Mediterranean and DASH diets to others because they are the easiest primarily plant-based diets for the average American to follow.

5)    Finally, if you have a family history, or are at high risk, of stroke, I recommend prudence until we know more. You may wish to adopt a version of primarily plant-based diets that incorporates some meat (That would be in the pescatarian to DASH range of primarily plant-based diets). Your heart will thank you, and you won’t increase your risk of stroke.

For more details on the study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do Vegetarians Live Longer?

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What Are The Health Benefits Of A Vegetarian Diet?

Author: Dr. Stephen Chaney

“Vegetarians don’t live longer, it just seems that way.” Many of you have probably heard that joke, but is it true? Are vegetarians healthier? Do vegetarians live longer? Is meat going to kill you? Let’s take a deep dive into the pros and cons of vegetarianism.

What Is Vegetarianism?

Vegetarianism encompasses a wide range of diets. At one extreme is the vegan diet. Vegans eat only plant derived foods. They don’t eat fish, meat, milk, eggs, or honey. It also goes without saying they eat only whole foods (whole grains, plant proteins, and fruits & vegetables) and avoid things like sodas, sugary foods, junk foods, and convenience foods. The most extreme form of veganism, popularized by such recent movies as “Eating You Alive” and “What the Health,” also eliminates all oils. This keeps fat at <10% of total calories.

do vegetarians live longerTo avoid confusion, I will refer to this as a “very low fat vegan diet.”  I will use the term “vegan diet” to refer to the more common veganism that includes vegetable oils in the diet. The vegan diet is still 100% plant based. It is also still relatively low in fat, generally in the 20-30% range. Since the fat comes from plants, it is predominantly the healthy monounsaturated and polyunsaturated fats.

Lacto-ovo vegetarians add low fat dairy foods and eggs to a plant based diet. The Ornish diet is a modified lacto-ovo vegetarian diet that also eliminates all oils and keeps fat at <10% of calories. Pesco-vegetarians add fish to a plant based diet, and semi-vegetarians add limited amounts of meat to a plant based diet.

Can Vegetarian Diets Reverse Atherosclerosis?

Let me start with studies on the very low fat vegan and Ornish diets. In addition to the diet, both programs emphasize regular exercise and stress reduction practices. Adherents to both plans generally achieve a serum total cholesterol of 150 or less. The Ornish diet and lifestyle program was designed to reduce the risk of cardiovascular disease, and it has been very well studied from that perspective. In studies of patients with severe atherosclerosis (clogged arteries) for periods of up to 5 years, the Ornish program results in a significant reduction in the degree of atherosclerosis (unclogs the arteries), inflammation, cardiac events (heart attack, stroke, etc.), and cardiac deaths (H.S. Dod et al, American Journal of Cardiology, 105: 362-367, 2010 ). vegetarianism good for the heartStudies with the very low fat vegan diet are more limited, but suggest that it also reverses atherosclerosis and reduces cardiac deaths (C.B. Esselstyn et al, Journal of Family Practice, 63: 356-364, 2014 ).

Before moving on to other forms of vegetarianism, let me make the point that these are the only diets that have been shown to actually reverse atherosclerosis. That is a big deal.

 

The Seventh-Day Adventist Studies

Perhaps the largest group of studies on the health effects of vegetarians has been conducted on the Seventh-day Adventist population located in Southern California. Seventh-day Adventists believe that “God calls us to care for our bodies, treating them with the respect a divine creation deserves.” The Adventist church advocates a vegan diet consisting of legumes, whole grains, nuts, fruits, and vegetables. However, it allows personal choice, so a significant number of Adventists choose lacto-ovo vegetarian, pesco-vegetarian, or semi-vegetarian diets.

That diversity has not only allowed studies of the Adventist population to not only compare a vegetarian diet to the standard American diet of the non-Adventist population living in the same area, but also to compare the various forms of vegetarian diets. There are dozens of published studies and several reviews on this topic. I will cite only the most recent review here (L.T. Le  and J. Sabate, Nutrients, 6: 2131-2147, 2014 ), but I will provide a complete list in my upcoming book.

This and other reviews have concluded that vegetarians weigh less, have less inflammation, have lower cholesterol levels and have lower risk of diabetes, heart disease, and hypertension than non-vegetarians. When we compare the various forms of vegetarianism, vegan diets appear to offer somewhat greater protection against obesity, hypertension, diabetes, and cardiovascular mortality than lacto-ovo and semi-vegetarian diets. The health benefits of vegetarian diets also seem to be somewhat greater for men than for women. One might speculate that might be because the average American male has a worse diet than the average American female. So, when men adopt a vegetarian diet, it may represent a greater improvement.

The reviews also looked at the nutritional adequacy of vegetarian diets. Vegetarian diets in general are very rich in antioxidants, most B vitamins, and polyphenols. Nutrients of concern for vegan diets are vitamin B12, vitamin D, calcium, iron, zinc, and long chain omega-3 fatty acids. Of those, vitamin B12 and long-chain omega-3 fatty acids are the ones most likely to require supplementation. Adequate levels of the other nutrients can be achieved by a well-designed vegan diet.

I would add protein to the list. Don’t misunderstand me. It is possible to get adequate protein on a vegetarian diet that includes beans and other legumes as a protein source. However, vegan advocates have been telling people they get all the protein they need from broccoli and other vegetables. That is incredibly bad advice, especially for seniors who are likely to suffer from sarcopenia (age related loss of muscle mass). Broccoli only provides 3 grams of protein per serving. You would need 15 servings to meet the protein RDA for women and almost 19 servings for men. Unfortunately, I often run across seniors who think they are getting all the protein they need from green salads and steamed vegetables. The bad advice from vegan advocates may be condemning them to unnecessary frailty in their old age.

What about the health claims of the low carbohydrate diets? Most of those “health benefits” are inferred from changes in blood parameters that occur over the first few weeks or months someone adopts those diets. There are no long-term data showing that low carbohydrate diets reduce the prevalence of diabetes, heart disease or cancer. Moreover, the few studies that compare low carbohydrate and vegetarian diets suggest the vegetarian diet is superior. For example, a recent study (M. Miller et al, Journal of the American Dietetic Association, 109: 713-717, 2009 ) compared the Atkins diet (the granddaddy of the low carb diets) with the Ornish diet. People on the low-fat Ornish diet had significantly lower LDL-cholesterol, apoB, and C-reactive protein (a marker of inflammation) and had better arterial function than people on the high fat Atkins diet.

Do Vegetarians Live Longer?

What about the original question. Do vegetarians live longer? The answer isn’t clear. The Adventist Health Studies have reported that Adventist men live 6-7 years longer and Adventist women live ~4 years longer than their non-Adventist neighbors. However, the Adventist population may have other characteristics that contribute to their longevity. I will cover that in the section on “Blue Zones” in my upcoming book. In contrast, a very recent Australian study(S. Mihrshahi et al, Preventive Medicine, 97: 1-7, 2017 ) concluded that all-cause mortality was virtually identical for vegetarians and non-vegetarians. However, the authors of this study speculated that vegetarians in Australia have become less healthy in recent years because they are now consuming more high-sugar, processed “vegetarian” foods. Remember what I said about “Big Food Inc.” not being your friend.

What Does This Mean For You?

do vegetarians live longer or notThere are a few simple take-home messages from the research on the various forms of a vegetarian diet:

  • The Ornish diet and the very low fat vegan diet are the only diets shown to reverse atherosclerosis. If you have serious heart disease and would like to minimize your reliance on drugs and surgery, you should consider them. You will, of course, want to let your doctor know what you are doing.
  • Vegetarians are leaner and significantly healthier than non-vegetarians.
  • Vegans are slightly healthier than lacto-ovo and semi-vegetarians, but even vegetarians who include some dairy, eggs & meat in a primarily plant-based diet are much healthier than most Americans.
  • Vegetarians may not live longer, but they do live healthier longer.

There are also several subtle, but equally important, implications from these studies:

  • You can forget the claims you must be a vegan purist to obtain any health benefits from vegetarianism.If you watch movies like “Eating You Alive” or “What the Health”, you are led to believe you will suffer terrible health consequences if you add any dairy, eggs, or meat to a vegan diet. In fact, the evidence for reversing atherosclerosis is stronger for the Ornish diet, which is a lacto-ovo-vegetarian diet, than it is for a pure vegan diet. For several other health outcomes, the vegan diet is slightly more effective, but both lacto-ovo-vegetarian and semi-vegetarian diets are much healthier than the standard American diet.
  • Vegetarian diets are whole food diets.If you start adding in processed and convenience foods, even if they are labeled “vegan,” you are likely to lose all the health benefits of a vegetarian diet.
  • You can forget claims that you get all the protein you need from vegetables like broccoli. That is incredibly bad advice which is likely to condemn seniors to unnecessary frailty in old age.
  • You can forget the claims that you must avoid carbs at all costs. The proponents of the low carb diets will tell you that recommendations to limit fat are based on a lie. They tell you that fat is good for you and carbs will cause you to gain weight, increase inflammation, and increase your risk of diabetes, heart disease, and cancer. You are told to avoid grains and any other foods containing carbohydrate, including some fruits and vegetables. The “danger” of carbohydrates is only true for the refined grains, sugary sodas and junk foods in the standard American diet. Vegetarian diets emphasize whole grains, fruits and vegetables. They are high in carbohydrate and low in fat, and they reduce weight, inflammation, diabetes, heart disease, and some cancers.
  • You can forget most claims of weight loss. Most low carb diets tout rapid initial weight loss. Unfortunately, most of that weight comes back a year or two later. Only vegetarian diets are associated with lower weight over a period of many years.

In summary, a pure vegan diet is probably the healthiest form of vegetarianism, but it is difficult to follow. Vegetarian diets that are primarily plant based, but contain small amounts of dairy, eggs, or meat are also very healthy, and may be easier for the average American to follow.

 

The Bottom Line

 

Vegetarianism encompasses a wide range of diets. The standard vegan diet is entirely plant-based. There is a very low fat version of the vegan diet that also eliminates all oils. Lacto-ovo-vegetarian diets include some dairy and eggs. Semi-vegetarian diets include some meat. The Ornish diet is a very low fat version of the lacto-ovo-vegetarian diet.

There are a few simple take-home messages from the research on the various forms of a vegetarian diet:

  • The Ornish diet and the very low fat vegan diet are the only diets shown to reverse atherosclerosis.
  • Vegetarians are leaner and significantly healthier than non-vegetarians.
  • Vegans are slightly healthier than lacto-ovo– and semi-vegetarians, but even vegetarians who include some dairy, eggs & meat in a primarily plant-based diet are much healthier than most Americans.
  • In a head to head comparison, the Ornish diet was significantly healthier than the Atkins diet.
  • Vegetarians may not live longer, but they do live healthier longer.

There are also several subtle, but equally important, implications from these studies:

  • You can forget the claims you must be a vegan purist to obtain any health benefits from vegetarianism. Primarily plant-based diets with small amounts of dairy, eggs or meat are also very healthy.
  • Vegetarian diets are whole food diets. If you start adding in processed and convenience foods, even if they are labeled “vegan,” you are likely to lose all the health benefits of a vegetarian diet.
  • You can forget claims that you get all the protein you need from vegetables like broccoli. That is incredibly bad advice which is likely to condemn seniors to unnecessary frailty in old age.
  • You can forget the claims that you must avoid carbs at all costs. That is only true for the refined grains, sugary sodas and junk foods in the standard American diet. Vegetarian diets are high in carbohydrate, low in fat, and  very healthy.
  • You can forget most claims of weight loss. Only vegetarian diets are associated with lower weight over a period of many years.

In summary, a pure vegan diet is probably the healthiest form of vegetarianism, but it is difficult to follow. Vegetarian diets that are primarily plant based, but contain small amounts of dairy, eggs, or meat are also very healthy, and may be easier for the average American to follow.

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Health Tips From The Professor