In this article, I am going to be talking about why I think – based on the research evidence available - that veganism may be a misguided health concept. Now, I am not here to attack anyone’s personal dietary philosophy, nor am I here to talk about the ethics of veganism or the environmental impact of it. I will simply be giving you a thorough review of the data that has been published to date on health outcomes related to people’s dietary choices. If you prefer to listen to this article instead, click here. I encourage you to watch the video version of this article as I include clips from a variety of sources that you will definitely want to hear for yourself!
While there is evidence suggesting that following a diet rich in plants is beneficial for avoiding or mitigating the effects of several health conditions, there is also data from large, well-designed studies that suggests that being completely plant-based is not necessary for optimal health. In fact, following a vegan diet in some cases can be detrimental.
There are lots of people out there promoting veganism as the ideal way of eating. Popular documentaries like The Game Changers, What the Health, and Forks Over Knives, renown medical doctors such as Dr. Michael Greger and Dr. Caldwell Esselstyn, and trending YouTubers including Fully Raw Kristina, Gaz Oakley, and Earthling Ed are all a part of this movement. I’m sure many of you have seen content like this and wondered, should I become vegan if I want to avoid heart disease, be a superior athlete, or achieve X health goal?
While I am sure that these people are not out to cause harm, I can’t help but wonder if they have really combed through the data before making the claims that they make. I understand that for some people veganism is about ethics and that health is secondary, but food is an inextricable component of health, so vegan diets must be carefully assessed for their health effects too.
In this article, I will cover the following outcomes:
Outline:
1. Nutritional quality
2. Cardiovascular health
3. Cancer
4. Bone health
5. Mortality
I’m going to do my best to focus on research on vegans, but please note that a lot of these studies lump vegans in with other types of vegetarians (lacto-ovo vegetarians and/or pescatarians), so it was not always possible to separate out the data. This is not propaganda - this is often done in order to handle small sample sizes. If the numbers of one group are too small, certain comparative statistical analyses become impossible to do. In those cases, I will still report the combined data.
Alright, let’s start with the first topic.
Nutritional quality
A systematic review of 12 cohort studies and 36 cross-sectional studies found that “…vegan diets are lower in protein intake compared with all other diet types. Veganism is also associated with low intake of vitamins B2, Niacin (B3), B12, D, iodine, zinc, calcium, potassium, selenium. Vitamin B12 intake among vegans is significantly lower…and calcium intake in the majority of vegans was below recommendations.”
Based on findings from other studies, which will be included below, we can also add to that list:
Iron and
The omega-3 fatty acids EPA and DHA
Now, let’s take a look at some of these nutrients up close. Why are they important, and why might vegans have more trouble getting enough of them?
Iron
I wrote an article on iron deficiency prevalence among vegetarians and non-vegetarians that you can check out for a deeper dive on this topic. To summarize, iron is a central part of the molecule heme, the precursor to hemoglobin, which is found inside of our red blood cells. This molecule plays a key role in transporting oxygen from the lungs to tissues all throughout the body. Low iron levels can lead to problems with concentration, fatigue, overall weakness, shortness of breath, muscle and joint pain, headaches, and a host of other symptoms.
Now, why might vegans have a higher prevalence of iron deficiency?
One potential explanation is that the type of iron consumed in fully plant-based diets, non-heme iron, is poorly absorbed in the body compared to heme iron from animal sources. It has been estimated that 2%–20% of the non-heme iron that we consume gets absorbed, while for heme iron, the absorption rate or bioavailability is around 15%–35%.
Non-heme iron is also affected by inhibitors, including phytates, polyphenols, and oxalates, which make it harder for our bodies to absorb it. The irony of nature is that the best sources of iron in a vegetarian diet are also the richest sources of inhibitors. For women who menstruate and thus lose a sizeable quantity of iron each month, this effect can be even more pronounced.
B12
Vitamin B12 has essential neurological and hematological functions. A lack of B12 can lead to problems walking, dementia, and neutropenia. Babies breastfed by moms who do not have enough B12 in their bodies are at a high risk of experiencing developmental delays, regression, lethargy, and failure to thrive.
Intake for vegans is typically below recommended levels, and this is because unfortified plant foods do not have significant amounts of B12. Furthermore, absorption is negatively impacted by age and by some medications like proton pump inhibitors (e.g. Prilosec, Prevacid, Nexium, and many more). Many people who are vegan may think that their B12 stores are fine and not check because B12 deficiency can take years to develop. Clinical signs of deficiency will not typically show up right after you start a vegan diet. What’s more, is that deficiency may be masked by high folic acid intake.
Side note: To check for B12 deficiency, it is not sufficient to check serum B12 levels – looking at methyl malonic acid (MMA) AND homocysteine is essential too. Without taking these extra steps, you can have normal B12 serum levels and still develop neurological symptoms and not know why.
Here's how that works (Thompson et al 2015).
Calcium
Calcium is essential for muscle contractions, nerve transmission, vasodilation, and glandular secretion. Intake is typically inadequate for vegans. As was the case with iron, calcium absorption is affected by inhibitors like phytates and oxalates, so this can make maintaining adequate calcium levels a bit more challenging for vegans.
Vitamin D
Vitamin D is essential for immune function and bone health. Getting enough vitamin D helps to reduce inflammation and reduce the risk of developing diseases like high blood pressure, heart disease, diabetes, colorectal cancer, multiple sclerosis, rheumatoid arthritis, infections, and depression. Intake of vitamin D in vegans tends to be well below that of vegetarians and non-vegetarians. To be fair though, low vitamin D is common across dietary groups.
Zinc
Zinc plays essential enzymatic roles in growth, immunity, cognition, bone health, and the regulation of gene expression. Zinc deficiency can lead to stunted growth, poor appetite, dermatitis, alopecia, endocrine dysfunction, and impaired immunity. This is another mineral whose absorption is impacted by those pesky inhibitors, so this may explain in part the lower levels among vegans.
Protein
Protein is required for enzymes, transporters, hormones, and tissues. Vegetarian and vegan intakes of protein generally meet requirements, even though their intakes are lower than that of omnivores. Nothing bad to say here, I just wanted to include this since it is a question that commonly comes up in conversations about vegan diets.
Omega-3 fatty acids
Omega-3 fatty acids, especially EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), help to improve endothelial function, lower triglyceride levels, reduce inflammation, and lessen the risk of blot clots and arrythmias. They are also important for vision and neurological development.
When thinking about fats, it is important to consider not just how much you are ingesting, but also the ratios in which they occur in the diet. The ratio of omega-6 to omega-3 may not be ideal in vegan diets. Vegan diets with high amounts of omega-6 from plant oils like corn, sunflower, and safflower oil may tilt the scale in favor of omega-6 fats, and not eating oily fish rich in omega-3 may make it harder to strike a balance between the two.
Walnuts, flaxseeds, and chia seeds are commonly touted as excellent vegetarian sources of omega-3, but that isn’t entirely true. These plant sources are rich in alpha-linolenic acid (ALA), which is a type of omega-3 that is beneficial in its own right, but is not equivalent to EPA and DHA. Our bodies have enzymes that convert the ALA into EPA and DHA, but the process is not very efficient.
Vegan diets are associated with deficient levels of several key nutrients, due in part to the relatively poor absorption of these nutrients from plant sources relative to animal sources.
Let’s move on to heart health.
Cardiovascular health
Atherosclerotic cardiovascular disease or ASCVD is an umbrella term for several different ailments which affect the heart and blood vessels, including:
Coronary heart disease (CHD)
Ischemic heart disease (IHD)
Heart attacks
Peripheral vascular disease, and
Stroke
Observational research
In one large cohort study of 650 non-Hispanic white adults, researchers compared cardiovascular risk factors among vegans, lacto-ovo-vegetarians, and pesco-vegetarians. They assessed risk factors like blood pressure, weight, and abdominal adiposity, the fat that accumulates around your mid-section – those are all in the left-most column of the data table below. In this table, I’ve highlighted the outcomes for which each respective group had a significantly lower prevalence of a given risk factor than non-vegetarians. As you can see, lacto-ovo-vegetarians had the most protection from cardiovascular disease, followed by pesco-vegetarians and then vegans.
(More yellow = statistically significant protective effect = good)
In another study by the same group of researchers, cardiovascular risk factors were assessed among almost 600 black men and women, and the results were a little different. Unfortunately, there were not enough vegans in this cohort to do the analysis with vegans as a standalone group, so they were lumped in with the lacto-ovo vegetarians. I warned you about this! Alright, here’s the data table. Just like before, the risk factors are on the left, and the yellow boxes indicate outcomes for which a particular group fared better.
This time, the vegetarian/vegan group fared best. I wish we could see the vegan data alone, but this is what we have.
In another study, over 48,000 people were recruited and followed for nearly 2 decades to see which participants ended up with heart disease or had a stroke. The researchers classified them into 3 groups: meat eaters (participants who consumed meat, regardless of whether they consumed fish, dairy, or eggs; n=24 428), fish eaters (consumed fish but no meat; n=7506), and vegetarians including vegans (n=16 254), based on dietary information collected at baseline, and subsequently around 2010 (n=28 364). Once again, we do not have vegan only data, unfortunately.
Either way, which group do you think was most at risk for having cardiovascular problems?
It turned out that fish eaters and vegetarians had lower rates of ischemic heart disease than meat eaters, although vegetarians had higher rates of hemorrhagic and total stroke compared to meat eaters. This outcome may seem odd to you. Why would vegetarians have a higher stroke risk?
Side note: Ischemic stroke is when blood flow to the brain is blocked, and hemorrhagic stroke is when a blood vessel weakens and bursts. The latter is the type that vegetarians were at a greater risk for according to this study.
The authors of this paper state in the discussion that these findings are not entirely consistent with what is expected given the lower low-density lipoprotein (LDL) cholesterol levels of vegetarians. Nevertheless, there have been other studies published showing that low-LDL is correlated with higher hemorrhagic stroke risk. In this same paper, there is a discussion of studies that were done in Japan that found that people who consumed only small amounts of animal products had a greater risk of suffering from and dying from hemorrhagic and total stroke. They propose that lower levels of certain vitamins that are essential to circulatory system function, like B12, D, and omega-3s, may play a causative role. Of course, more research is needed.
Okay, enough observational research. Now, I want to talk about intervention studies. These are studies where you take people who are following diet X, and you put them on diet Y to see what happens.
From this type of research, we have evidence that vegan diets are beneficial for losing weight and reducing inflammation, two things that are beneficial for protecting your heart. Where things get muddy though is when we get into the studies that are used to support the claim that plant-based diets can reverse atherosclerosis.
Intervention studies: Can you reverse heart disease with a plant-based diet? Not quite.
The most famous of these studies is the Life Style Heart Trial published by Ornish and colleagues in 1998. In this study, 48 CHD patients were randomized to either a low-fat plant based diet (dairy was included) with lifestyle interventions OR normal heart disease treatment for 5 years. Those in the intervention group were encouraged to avoid simple sugars, prioritize intake of whole foods, exercise, stop smoking, work on stress, and connect with others for psychosocial support. All of these things are great, but, having multiple interventions at the same time does make it hard to know to what the outcomes can truly be attributed to. For comparison, the control group followed basic advice from their physician. At the end of the study period, the lifestyle group did have fewer cardiac events, but we cannot say for sure if diet is to thank for that, or exercise, or any of the other interventions.
In another famous study on disease reversal published by Esselstyn and colleagues in 2014, 198 cardiac patients were given standard treatment and were instructed to follow a low-fat plant-based diet for several years. While the researchers observed radiographic signs of disease reversal, this study has a few methodological problems that make me less than excited about these findings. Fortunately, the authors of the paper acknowledge that fact:
“This study had several limitations.
First, it included self-selected, very deter-
mined patients. Without a control group, it
is challenging to establish causality and as-
sess how much of the observed changes are
specifically due to the diet. Only some of
the observed beneficial outcomes may have
been due to the diet. This study was not pro-
spectively randomized. Nevertheless, this
fact does not detract from proof of concept
that major cardiovascular events occurred
in probably <1% (and certainly <10%) of the
entire adherent cohort, compared with 62%
of the nonadherent cohort.”
Until these findings are replicated in larger clinical trials with fully vegan diets, no one should go around promoting vegan diets for heart disease reversal. Still, I won't cast torrential rain over these poorly done studies without leaving a rainbow; do you know which diet has been studied in large, long-term clinical trials and proven to benefit heart health? The Mediterranean diet. This is a diet rich in fruits and vegetables, healthy fats, and yes – it does include animal protein.
Vegan diets protect heart health for some people, but the best science-backed diet for heart health is actually the Mediterranean diet, which includes meat. More research on people of different backgrounds from different countries is needed.
Cancer
Cancer is far more complex than heart disease, so the results here are a bit scattered. If you want to reduce your prostate cancer risk, veganism can help. If you want to avoid colorectal cancer however, then you better eat some fish. How can you best avoid cancer of the GI tract? Drink some dairy and eat some eggs. Worried about breast cancer? A pesco-vegetarian diet may help, as may a vegan diet. It won’t protect you against cancers of the respiratory tract, cancers of the urinary tract, or male-specific cancers though. As you can see, there isn’t one “best” diet pattern for avoiding any and all types of cancer. It’s really a mixed bag.
Ok, now let’s talk about bones.
Bone health
Data from several large studies support the conclusion that vegans/vegetarians tend to have poorer bone health outcomes. One of the more recent publications on this comes from the Epic-Oxford study. For this 10 year study, they recruited 29,380 meat eaters, 8037 fish eaters, 15,499 vegetarians, and 1982 vegans. Here are the results from this study:
The authors concluded that:
“Non-meat eaters, especially vegans, had higher risks of either total or some site-specific fractures, particularly hip fractures…Overall, the significant associations appeared to be stronger without adjustment for BMI and were slightly attenuated but remained significant with additional adjustment for dietary calcium and/or total protein.”
To rephrase that last part, vegans did have lower intakes of calcium and protein, but even when accounting for that, they still had a higher risk of fractures.
A later review of studies on vegan/vegetarian diets’ effects on bone mineral density (BMD) put forth results from several studies in which those who were fully plant based had worse bone health. Specific outcomes included:
Lower BMD in the femoral neck, hip, and lumbar spine
Higher fracture risk, and
Higher incidence of osteopenia of the femoral neck
I did find a few studies which showed no difference between groups, but these were outnumbered by the ones showing that vegans do indeed have poorer bone health.
Vegan diets are associated with more fragile bones. Even when you factor in protein and calcium intake, vegans still have a higher risk of bone fractures.
Mortality
Finally, let’s look at mortality. Or wait, let me phrase that more nicely – longevity. I wrote an article about this already. To summarize, data from the AHS-2 suggests that pesco-vegetarians had the longest lifespan for many causes of death, particularly in women, while men enjoyed long lifespans when the opted for either a vegan, lacto-ovo, or pescatarian diet. Data from the EPIC-Oxford study found that people who ate fish and/or small amounts of meat fared better than vegans for multiple causes of death. Data from systematic reviews and meta-analyses, where tons of data gets pooled together from multiple research studies to see what the unified outcomes are, do not point to vegan diets being superior.
Since we are discussing mortality and diet, I would be remiss if I didn’t also talk about the Blue Zones. The Blue Zones are five locations in the world with an unusually high number of centenarians, or people who make it to their 100th birthday. These five locations are: Okinawa, Japan, Sardinia, Italy, Nicoya, Costa Rica, Ikaria, Greece, and Loma Linda, California. Dan Buettner led much of the work that was done to ascertain what makes these people live so long, and him and his team have identified social connections, low stress, and life purpose as key elements. They also put forth the claim that these people live long because they don’t eat much meat, which is a bit misleading. Take a look at these clips (here, and here) featuring Dan Buettner talking about diet in the Blue Zones. Based on these interviews, you would think that these people eat exclusively plants! But, you would be wrong.
People living in the Blue Zones do have a tendency to eat less meat than your average Westerner, but they are not exclusively vegetarian, much less vegan. In Okinawa, Japan, people traditionally eat a diet rich in plant foods with small quantities of pork and fish. In Sardinia, Italy, it is customary to eat small amounts of meat, fish, and poultry, and to have lots of sheep and goat milk. In Nicoya, Costa Rica, small amounts of meat are customarily consumed as well. In Ikaria, Greece, meat and fish make up a little over 10% of their Mediterranean-style diet. Finally, the Adventists of Loma Linda, California, which are the same group from the AHS-2 study, are about 50% vegetarian, and 50% non-vegetarian. Only about 8% identify as vegan, and as I mentioned earlier, they did not hold the top place for longevity across health outcomes.
In this CNN article, a Blue Zone resident from Costa Rica shares his story on what he really ate to reach old age and remain sharp and independent. Jose mentions that meat was a staple for him growing up in Costa Rica. For a very thorough argument against the promotion of the Blue Zones folks as vegans or even vegetarians, I recommend you check out the blog Marmalade. It’s a long read, but that’s because the author is so careful about covering contradictory findings and counterarguments – all with citations.
I would argue that the main dietary factor that is helping these people to live longer than most is that they are eating REAL FOOD. Not food that comes in a box or a bag. Real vegetables, real beans, and real meat.
The longest-lived people in the world all eat some amount of meat - don't fall for the promotion of these people as exclusively "plant-based."
My personal story
All in all, the data does not support the notion that vegan diets are superior to all other diets in terms of nutritional quality, cardiovascular health, cancer, bone health, or mortality/longevity. I know that this is hard to hear for some people. Full disclosure, younger me was actually vegan for a while. I was about 12 years old when I saw videos of animals being slaughtered and at that young age, I cut out all meat. Shout out to my mom for putting up with me and cooking separate pots of food for me to make sure that I didn't only eat bread and ketchup. By the time I got to college however, I was experiencing fatigue, hair loss, and other issues that went away only when I started eating fish. Honestly, re-introducing flesh into my diet was a whole ordeal. I felt disgusted with myself, but I listened to my body and I’m better off for it.
Do I like that any living being has to die in order to for another to live? No. Just like you, when I watch a nature show with the lion hunting the gazelle, I root for the gazelle even though I know that the lion is just doing what nature intended for it to do. I too felt guilty after watching Seaspiracy, and BlackFish had me in tears. Still, think it helps to remember that man made slave trades and destructive farming practices are issues that have nothing to do with nutrition. These are structural problems that need remedying, but they do not change our physiology. Having small amounts of meat, and an abundant variety of plants in our diets, is, based on the data, what is best for most people.
Additionally, I am not saying that people who eat meat have better diets by default. The abstract of this systematic review of 141 dietary studies put it best:
“Protein intake was lower in people following plant-based diets compared to meat-eaters, but well within recommended intake levels. While fiber, polyunsaturated fatty acids (PUFA), folate, vitamin C, E and magnesium intake was higher, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake was lower in vegetarians and vegans as compared to meat-eaters. Intake and status of vitamin B12, vitamin D, iron, zinc, iodine, calcium and bone turnover markers were generally lower in plant-based dietary patterns compared to meat-eaters. Vegans had the lowest vitamin B12, calcium and iodine intake, and also lower iodine status and lower bone mineral density. Meat-eaters were at risk of inadequate intakes of fiber, PUFA, α-linolenic acid (ALA), folate, vitamin D, E, calcium and magnesium. There were nutrient inadequacies across all dietary patterns, including vegan, vegetarian and meat-based diets.”
So really, we all can work on improving our diets. That’s because in this country the main dietary issue isn’t meat intake, it’s refined food taking the place of whole foods. Just my professional opinion.
What can we learn from vegans?
Before I conclude this article, I want to also speak on what we can learn from vegans.
I don’t know about you, but when I watch vegan cooking channels, I tend to pick up a chill, natural vibe from these people that is really calming and inspiring. It is evident that they are passionate about wellness and are trying to put more goodness into the world.
Vegan cooking channels like Avante Garde Vegan are some of my favorite YouTube channels to watch. I love seeing how he finds all of these creative ways to incorporate vegetables into savory dishes, and I have used some of his ideas in my own cooking. People in this country do not eat enough plants, and for people who struggle to figure out how to make plants taste good, these channels are a goldmine.
If you follow me on InstaGram, you’ll know that I share a lot of Dr. Michael Greger’s posts. While I do not agree with his overall dietary message, I do find the posts on the benefits of individual fruits and vegetables to be both helpful and scientifically accurate. Plants are amazing and each one has a unique nutrient profile, and him and his team have done a phenomenal job of showing that.
If you learned anything new or think that someone you care about could benefit from this information, share this article, and subscribe to the blog for regular updates on commonly asked nutrition questions.
References:
PRO-VEGAN DOCUMENTARIES:
The Game Changers Trailer #1 HD (NEW 2019) | Future Movies
Future Movies. (2019). The Game Changers Trailer #1 HD (NEW 2019) | Future Movies. In YouTube. https://www.youtube.com/watch?v=VfyWwpTmXJk
What The Health (Netflix-Documentary) -A must watch. What doctors don't say about your food? Know Public Health. (2020). What The Health (Netflix-Documentary) -A must watch. In YouTube. https://www.youtube.com/watch?v=KPD1oIKnnjs
Forks Over Knives - Official Trailer
Forks Over Knives. (2010). Forks Over Knives - Official Trailer. In YouTube. https://www.youtube.com/watch?v=O7ijukNzlUg
MEDICAL PROFESSIONALS WHO PROMOTE VEGANISM:
Veggie Channel. “The Role of the Vegan Diet in Disease Prevention: How Not to Die - Michael Greger.” Www.youtube.com, 16 June 2016, www.youtube.com/watch?v=2ngO1h2j_N0. Accessed 16 Aug. 2022.
Generation Vegan. “Pioneering Doctor Explains How to Reverse Heart Disease.” Www.youtube.com, 19 Dec. 2019, www.youtube.com/watch?v=27gNVnxN_pw. Accessed 16 Aug. 2022.
Penn State Health. “Will a Vegan Diet Help Prevent Heart Disease? - Penn State Health.” Www.youtube.com, 25 May 2018, www.youtube.com/shorts/JxmYTRYHNwU. Accessed 16 Aug. 2022.
VEGAN YOUTUBERS:
Fully Raw Kristina: 5 Meals I Eat Every Week 🍒 Simple Satisfying Raw Vegan Recipes for Health, Wellness & Healing. Fully Raw Kristina. (2021, March 27). 5 Meals I Eat Every Week Simple Satisfying Raw Vegan Recipes for Health, Wellness & Healing. Www.youtube.com. https://www.youtube.com/watch?v=WE42CwAboCU
Gaz Oakley: 20 Minute Simple Meals, I Eat ALL The Time
Oakley, G. (2022, January 24). 20 Minute Simple Meals, I Eat ALL The Time. Www.youtube.com. https://www.youtube.com/watch?v=F5L_fusNdRs
Earthling Ed: What I've Learned or What I've Lied About? Eating less meat won't save the planet. Debunked. Earthling Ed. (2021, May 7). What I’ve Learned or What I’ve Lied About? Eating less meat won’t save the planet. Debunked. Www.youtube.com. https://www.youtube.com/watch?v=DkMOQ9X76UU&t=48s
Pick Up Limes. (2022, July 31). Anti-inflammatory drinks (healthy + refreshing!). Www.youtube.com. https://www.youtube.com/watch?v=rctONIZJxh8
Ama, R. (2021, December 7). Warming Seasonal Stew in 10 minutes without a kitchen! ONE POT. Www.youtube.com. https://www.youtube.com/watch?v=uaGYjCKxOYA
NUTRITIONAL QUALITY:
Bakaloudi DR, Halloran A, Rippin HL, Oikonomidou AC, Dardavesis TI, Williams J, Wickramasinghe K, Breda J, Chourdakis M. Intake and adequacy of the vegan diet. A systematic review of the evidence. Clin Nutr. 2021 May;40(5):3503-3521. doi: 10.1016/j.clnu.2020.11.035. Epub 2020 Dec 7. PMID: 33341313.
Dev, S., & Babitt, J. L. (2017). Overview of iron metabolism in health and disease. Hemodial Int, 21 Suppl 1(Suppl 1), S6-s20. doi:10.1111/hdi.12542
Haider LM, Schwingshackl L, Hoffmann G, Ekmekcioglu C. The effect of vegetarian diets on iron status in adults: A systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2018 May 24;58(8):1359-1374. doi: 10.1080/10408398.2016.1259210. Epub 2017 Jul 5. PMID: 27880062.
Cleveland Clinic. (2019, February 5). Neutropenia: Symptoms, Causes, Treatments. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21058-neutropenia
Thompson AG, Leite MI, Lunn MP, Bennett DL. Whippits, nitrous oxide and the dangers of legal highs. Pract Neurol. 2015 Jun;15(3):207-9. doi: 10.1136/practneurol-2014-001071. PMID: 25977272; PMCID: PMC4453489. https://pubmed.ncbi.nlm.nih.gov/25977272/
Neufingerl N, Eilander A. Nutrient Intake and Status in Adults Consuming Plant-Based Diets Compared to Meat-Eaters: A Systematic Review. Nutrients. 2021 Dec 23;14(1):29. doi: 10.3390/nu14010029. PMID: 35010904; PMCID: PMC8746448.
Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res. 2011 Jan;31(1):48-54. doi: 10.1016/j.nutres.2010.12.001. PMID: 21310306.
CARDIOVASCULAR HEALTH:
American Heart Association. (n.d.). ASCVD Podcast Series. Www.heart.org. https://www.heart.org/en/professional/quality-improvement/ascvd
Matsumoto S, Beeson WL, Shavlik DJ, Siapco G, Jaceldo-Siegl K, Fraser G, Knutsen SF. Association between vegetarian diets and cardiovascular risk factors in non-Hispanic white participants of the Adventist Health Study-2. J Nutr Sci. 2019 Feb 21;8:e6. doi: 10.1017/jns.2019.1. PMID: 30828449; PMCID: PMC6391580.
Fraser G, Katuli S, Anousheh R, Knutsen S, Herring P, Fan J. Vegetarian diets and cardiovascular risk factors in black members of the Adventist Health Study-2. Public Health Nutr. 2015 Feb;18(3):537-45. doi: 10.1017/S1368980014000263. Epub 2014 Mar 17. PMID: 24636393; PMCID: PMC4167463.
Tong TYN, Appleby PN, Bradbury KE, Perez-Cornago A, Travis RC, Clarke R, Key TJ. Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study. BMJ. 2019 Sep 4;366:l4897. doi: 10.1136/bmj.l4897. PMID: 31484644; PMCID: PMC6724406.
Huang, RY., Huang, CC., Hu, F.B. et al. Vegetarian Diets and Weight Reduction: a Meta-Analysis of Randomized Controlled Trials. J GEN INTERN MED 31, 109–116 (2016). https://doi.org/10.1007/s11606-015-3390-7
Menzel J, Jabakhanji A, Biemann R, Mai K, Abraham K, Weikert C. Systematic review and meta-analysis of the associations of vegan and vegetarian diets with inflammatory biomarkers. Sci Rep. 2020 Dec 10;10(1):21736. doi: 10.1038/s41598-020-78426-8. PMID: 33303765; PMCID: PMC7730154.
Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec 16;280(23):2001-7. doi: 10.1001/jama.280.23.2001. Erratum in: JAMA 1999 Apr 21;281(15):1380. PMID: 9863851.
Esselstyn CB Jr, Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam Pract. 2014 Jul;63(7):356-364b. PMID: 25198208
Ros E, Martínez-González MA, Estruch R, Salas-Salvadó J, Fitó M, Martínez JA, Corella D. Mediterranean diet and cardiovascular health: Teachings of the PREDIMED study. Adv Nutr. 2014 May 14;5(3):330S-6S. doi: 10.3945/an.113.005389. PMID: 24829485; PMCID: PMC4013190. https://pubmed.ncbi.nlm.nih.gov/24829485/
CANCER:
Tantamango-Bartley Y, Knutsen SF, Knutsen R, Jacobsen BK, Fan J, Beeson WL, Sabate J, Hadley D, Jaceldo-Siegl K, Penniecook J, Herring P, Butler T, Bennett H, Fraser G. Are strict vegetarians protected against prostate cancer? Am J Clin Nutr. 2016 Jan;103(1):153-60. doi: 10.3945/ajcn.114.106450. Epub 2015 Nov 11. PMID: 26561618; PMCID: PMC4691666.
Orlich MJ, Singh PN, Sabaté J, Fan J, Sveen L, Bennett H, Knutsen SF, Beeson WL, Jaceldo-Siegl K, Butler TL, Herring RP, Fraser GE. Vegetarian dietary patterns and the risk of colorectal cancers. JAMA Intern Med. 2015 May;175(5):767-76. doi: 10.1001/jamainternmed.2015.59. PMID: 25751512; PMCID: PMC4420687.
Tantamango-Bartley Y, Jaceldo-Siegl K, Fan J, Fraser G. Vegetarian diets and the incidence of cancer in a low-risk population. Cancer Epidemiol Biomarkers Prev. 2013 Feb;22(2):286-94. doi: 10.1158/1055-9965.EPI-12-1060. Epub 2012 Nov 20. PMID: 23169929; PMCID: PMC3565018. https://pubmed.ncbi.nlm.nih.gov/23169929/
Cade JE, Taylor EF, Burley VJ, Greenwood DC. Common dietary patterns and risk of breast cancer: analysis from the United Kingdom Women's Cohort Study. Nutr Cancer. 2010;62(3):300-6. doi: 10.1080/01635580903441246. PMID: 20358467.
BONE HEALTH:
Tong TYN, Appleby PN, Armstrong MEG, Fensom GK, Knuppel A, Papier K, Perez-Cornago A, Travis RC, Key TJ. Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study. BMC Med. 2020 Nov 23;18(1):353. doi: 10.1186/s12916-020-01815-3. PMID: 33222682; PMCID: PMC7682057
Menzel J, Abraham K, Stangl GI, Ueland PM, Obeid R, Schulze MB, Herter-Aeberli I, Schwerdtle T, Weikert C. Vegan Diet and Bone Health-Results from the Cross-Sectional RBVD Study. Nutrients. 2021 Feb 21;13(2):685. doi: 10.3390/nu13020685. PMID: 33669942; PMCID: PMC7924854.
Iguacel I, Miguel-Berges ML, Gómez-Bruton A, Moreno LA, Julián C. Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis. Nutr Rev. 2019 Jan 1;77(1):1-18. doi: 10.1093/nutrit/nuy045. PMID: 30376075.
MORTALITY:
Jafari S, Hezaveh E, Jalilpiran Y, Jayedi A, Wong A, Safaiyan A, Barzegar A. Plant-based diets and risk of disease mortality: a systematic review and meta-analysis of cohort studies. Crit Rev Food Sci Nutr. 2021 May 6:1-13. doi: 10.1080/10408398.2021.1918628. Epub ahead of print. PMID: 33951994. https://pubmed.ncbi.nlm.nih.gov/33951994/
Dinu, M., Abbate, R., Gensini, G. F., Casini, A., Sofi, F. (2017). Vegetarian, Vegan Diets and Multiple Health Outcomes: A Systematic Review with Meta-analysis of Observational Studies. Critical Reviews in Food Science and Nutrition, 57(17):3640-3649. doi: 10.1080/10408398.2016.
Orlich, M. J., Singh, P. N., Sabaté, J., Jaceldo-Siegl, K., Fan, J., Knutsen, S., Beeson, W. L., Fraser, G. E. (2013). Vegetarian Dietary Patterns and Mortality in Adventist Health Study 2. JAMA Internal Medicine, 173(13):1230-8. doi: 10.1001/jamainternmed.2013.6473.
Appleby, P. N., Crowe, F. L., Bradbury, K. E., Travis, R. C., Key, T. J. (2015). Mortality in Vegetarians and Comparable Nonvegetarians in the United Kingdom. American Journal of Clinical Nutrition, 103(1):218-30. doi: 10.3945/ajcn.115.119461.
The Blue Zones Story - Blue Zones. (2015). Blue Zones. https://www.bluezones.com/
Elysabeth Alfano. (2020). Dan Buettner’s List of TOP FIVE Foods You Should Be Eating. In YouTube. https://www.youtube.com/watch?v=VI6zlJ-ia10
Rachael Ray Show. (2020). What The Longest Living People Eat Every Day | Blue Zone Kitchen Author Dan Buettner. In YouTube. https://www.youtube.com/watch?v=I4MjGC-XX90
Alfano, E. (2018). Awesome Vegans Podcast and Interview Series with Elysabeth Alfano. Elysabeth Alfano. https://elysabethalfano.com/category/awesome-vegans-podcast-vlog/
Howell, R. (2015, March 8). Does this beach paradise hold the secret to long life?CNN. https://www.cnn.com/2015/03/06/health/blue-zone-long-life-nicoya/index.html
Steele, B. D. (2019, May 28). Blue Zones Dietary Myth. Marmalade. https://benjamindavidsteele.wordpress.com/2019/05/28/blue-zones-dietary-myth/
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