Vegetarians and Heart Disease: Will Ditching Meat Really Save Your Arteries?

Welcome to 2011! (Why don’t we have flying cars yet?) My new year’s blogolutions are to 1) write here more often and 2) actually answer emails. So far, I’m failing at both, but I’ve got 359 days left to clean up my act.

Sometimes, when I feel like I don’t have enough stress in my life and start craving a blood-pressure boost, I go to my old vegan haunts to read gems like these:

The only way meat can be digested is by putrefaction, our stomach acid is only 5% of that of a carnivore or omnivore so instead of being digested it basicly [sic] rots in your intestines which leaves toxic gases and waste to be absorbed into the blood. (From here.)

we know what’s happening. we’ve known for decades. however, we also have found that when we talk about the health detriments associated with eating the products of the corpse industries, people don’t believe us. (From here.)

[T]here is a single, sole cause to heart disease: cholesterol. If your total cholesterol is below 150 and LDL is below 70, you are essentially heart attack proof. What is the cause of high cholesterol? Saturated fat and animal products. (From here.)

Don’t you love this stuff? But I digress. What I want to talk about right now is one of the most oft-cited perks of being a vegetarian: an apparently lower risk of heart disease compared to omnivores. A recent paper called Chemistry Behind Vegetarianism sums it up by saying “Omnivores have a significantly higher cluster of cardiovascular risk factors compared with vegetarians, including increased body mass index, waist to hip ratio, blood pressure, plasma total cholesterol (TC), triacylglycerol and LDL-C levels, serum lipoprotein(a) concentration, plasma factor VII activity, ratios of TC/HDL-C, LDL-C/HDL-C and TAG/HDL-C, and serum ferritin levels.”

This is a trend that some folks translate as “meat causes heart disease”—a sentiment I saw plastered all over the veggie message boards during my most recent lurking spree. I assume this belief is bolstered by all the perfectly-preserved chunks bacon found in meat eaters’ arteries during heart biopsies.

Studies on vegetarians are inherently tricky. Although some folks dump animal foods strictly for ethical reasons, many of the meatless eat their veggies alongside other pro-health behaviors like exercising more, nixing tobacco, swapping refined grains for whole, limiting processed food (soy Frankenmeats notwithstanding), and avoiding the biggest of the baddies (trans fats, corn syrup, Cadbury Creme Eggs, and pretty much everything on this site).

What does all of that equal? Confounderville for researchers. It’s impossible to adjust for every little diet and lifestyle tweak a vegetarian makes in the name of health, so in scientific studies, vegetarians almost always have an advantage over health-indifferent omnivores. But the reason can’t be pegged on their meatlessness: Vegetarianism is a marker for a comprehensive shift in behaviors that influence disease risk.

But that’s not always the case with all groups of vegetarians. Studies focusing on some religious vegetarians (namely Buddhist and Hindu*) are more likely to show the effects of going meat-free in isolation rather than as part of a health-boosting plan. Confounding can still be an issue (especially in terms of stress reduction from certain religious practices)—but unlike the vegetarians who make a cascade of changes when they ditch meat, some religious vegetarians eat diets pretty similar to their omnivorous counterparts, just without flesh. That makes it a bit easier to compare apples with apples: We can see how an average omni diet stacks up against a similar diet sans meat, instead of comparing an average omni diet with a multifaceted vegetarian lifestyle.

*I’m excluding Seventh-day Adventists from the list because their diet and lifestyle recommendations involve much more than meat avoidance.

So where am I going with this? Right here. That’s the full text for a recent study from Taiwan looking at inflammatory markers in mostly-Buddhist vegetarians versus omnivores. (And if access to that link disappears, as full-texts are wont to do, just shoot me an email and I’ll send it to you.)

This study has a few good things going for it. For starters, it excludes smokers and uses only women—which automatically eliminates problems associated with controlling for tobacco use or gender-related differences in inflammatory markers. As the researchers note, the health-consciousness gap between Taiwanese vegetarians and Taiwanese omnivores is probably much smaller than with Western vegetarians and Western omnivores:

Most western vegetarians include fresh vegetables and fruits as their main source of nutrition and energy, based on health benefits of the foods. In contrast, most Taiwanese vegetarians choose a vegetarian diet because of their Buddhist religion, which teaches a policy of “no killing.” Buddhists in Taiwan have a dietary pattern similar to that of most Taiwanese in terms of meal patterns and cooking methods, except that they do not include any meat, fish, or poultry in their meals.

Although the researchers don’t explore the subject at all, the difference in religious practices between the vegetarians (apparently Buddhist) and omnivores (whose religion(s) weren’t documented) could be significant. Stress and mental outlook may play a role in the progression of heart disease, and meditation/centering practices associated with Buddhism could help improve both. If any of that is confounding the results, we won’t be able to know from the data presented.

But other than that, the study was pretty thorough. It tracked BMI, blood pressure, heart rate, glucose levels, cholesterol (total, HDL, and LDL), white blood cell count, homocysteine, and two inflammatory markers: lipoprotein-associated phospholipase AS (Lp-PLA2) and C-reactive protein (CRP).

The good news for the vegetarians is that their Lp-PLA2—a marker specifically for vascular inflammation—was lower than in the control group. But that’s where the good news ends. The researchers seemed pretty surprised to report that the vegetarians had higher levels of CRP (borderline significant at p=0.05) than the omnivores, along with higher homocysteine and triglycerides.

The original numbers are below. I highlighted the comparisons that weren’t so happy for the vegetarians. (Click to make it big, unless you’ve got really great vision.)

Interestingly, the researchers note that one of their earlier studies showed borderline lower CRP in vegetarians—but despite using it to claim vegetarians had a better risk profile than omnivores, that finding might not be very meaningful:

As we know, gender and smoking influenced the serum hs-CRP level significantly. In our previous study, there are more males and smokers in the omnivore group that can influence the statistical power of difference of hs-CRP between both groups. Actually, it failed to demonstrate a significant difference if male and female samples were analyzed separately.

In the current study, the researchers offer a few explanations as to why vegetarians might have higher CRP levels, even if their Lp-PLA2 levels were lower. One is that there were large variations in the CRP levels for all groups, which makes it harder to analyze statistically (translation: “maybe the correlation is a fluke”). They also mention that Taiwan vegetarians rely heavily on soy products as a substitute for meat, eat fewer fresh vegetables than western vegetarians, and typically cook vegetables in oil (presumably industrial seed oils).

The significance of this study is that it underscores the major issue with vegetarian research at large: The health-protective effects of vegetarianism are probably due to factors other than meat avoidance. When you study vegetarians that aren’t partaking in a bigger diet and lifestyle change, they no longer have a glowing health report. The lower Lp-PLA2 levels in this particular study are noteworthy, but higher CRP and triglycerides aren’t doing anyone any favors.

Of course, this isn’t the first study to poke holes the claim that meat-avoiders have special protection against heart disease. A 2005 study conducted in China rounded up some long-term vegetarians (6 to 40 years of meatlessness)—including many religious vegetarians—and compared their heart disease markers against an omnivorous control group. Apart from eating less saturated fat, protein, and cholesterol, the vegetarians had nutrient intakes similar to those of their omni friends.

The surprising results? The vegetarians had significantly thicker arterial walls (p<0.0001), reduced flow-mediated dilation (a predictor of cardiovascular events) (p<0.0001), higher blood pressure (p<0.05), and higher triglycerides (p<0.05) than the omnivores. (According to the paper, the raised blood pressure might be related to some popular high-sodium vegetarian foods such as processed protein food substitutes, fake oyster sauce, and tomato paste.)

In the researchers’ multivariate statistical models, vegetarianism had the strongest association with both artery thickness and diminished flow-mediated dilation out of all the variables documented—including age, gender, and triglyceride levels.

As might be expected, the vegetarians also had lower B12 levels and higher homocysteine than the control group—but even after adjusting for these, vegetarianism remained strongly linked with less-healthy hearts. The researchers concluded with this:

In summary, contrary to common belief, vegetarians, at least in the Chinese, might have accelerated atherosclerosis and abnormal arterial endothelial function, compared with omnivore control subjects. The increased risk could only be partially explained by their higher blood pressure, triglyceride, homocysteine, and lower vitamin B12 concentrations.

A little alarming, no? My guess is that these vegetarians got such a lousy report card because they didn’t make all the positive health changes most Western vegetarians make when they forgo flesh—but rather, replaced meat with processed foods, ate more carbohydrates and polyunsaturated plant fats, and failed to get enough B12 (resulting in higher homocysteine). This is what happens when you simply pluck meat out of your diet and fill the void with plant-based substitutes: the Healthy Vegetarian image becomes a lot less rosy.

No doubt some vegetarians would dismiss this study because the participants “did vegetarianism wrong” by not supplementing B12, not eating enough fruit and vegetables, consuming too much salt, and failing to provide daily offerings to the Arugula God. But if that’s the case, one could argue that all the meat eaters in the studies supporting vegetarianism just “did omnivorism wrong” for similar reasons. This is a good study because neither the vegetarians nor the omnivores seemed particularly health conscious. It’s rare that we get a level playing field like that.

Why vegetarian studies don’t study vegetarians

Much to the disgust of “real” vegetarians, a surprising number of folks who call themselves vegetarian are still feasting on flesh foods. The AJCN study “What to vegetarians in the United States eat?” gives a great rundown of this phenomenon. The paper starts out with an important observation about the state of vegetarian nutritional studies at the time it was written (2003), and these comments still apply to much of the literature we have today:

During the past 2 decades, studies have documented eating patterns and nutrient intakes of vegetarians in the United States. The studies, however, were conducted in volunteers and convenience samples recruited from relatively narrow geographic areas or from individuals belonging to a particular vegetarian orientation. Little is known about the eating patterns of a nationally representative sample of individuals who consider themselves to be vegetarians.

To tackle this problem, the researchers nabbed a bunch of nationally-representative data from a USDA food survey project, which documented the results of two 24-hour diet recalls as well as answers to the question “Do you consider yourself to be a vegetarian?” Then they looked in detail at what the vegetarians versus nonvegetarians were putting in their mouths. Out of the 13,000+ folks in the study, 334—or about 2.5 percent—identified themselves as vegetarian. That figure jibes with the numbers offered by the Vegetarian Resource Group and other polls that peg the percent at 2.5 to 2.8 or so.

But here’s the kicker. Out of those 334 so-called vegetarians, almost two thirds were still guzzling meat on their diet recall days. And we’re not just talking pesco-vegetarians eating fish, either: The fake vegetarians averaged 80 grams of red meat per day, not terribly far from the 137 grams reported by the omnivores with the highest meat intake.

Unfortunately, a lot of studies enrolling vegetarians take their subjects’ word about their diet habits, not realizing that fish, chicken, and Philly cheese steaks qualify as vegetables to some. That means that the vegetarian research we have—especially studies that recruit self-defined vegetarians for blood tests and other measurements—might not be examining the effects of a meat-free diet so much as a wishful-thinking diet. In this sense, studies looking at religious vegetarians (who have God to answer to) and ethical vegans (who have an ideology to answer to) are probably more legitimate than studies recruiting average Joe-Schmoes off the street who think being vegetarian means eating a salad on weekends.

But there’s more. This particular paper found some important differences between self-defined vegetarians and self-defined omnivores, regardless of whether the vegetarians ate meat or not—suggesting that the vegetarian label (and the lifestyle patterns it accompanies) is more important than the avoidance of meat:

  • Both the vegetarians and the meat-eaters who thought they were vegetarians had lower BMIs than the self-defined omnivores.
  • All of the self-defined vegetarians (meat-free or not) ate more total vegetables, more “other” vegetables, more total fruit, and more citrus than the omnivores.
  • The self-defined vegetarians ate fewer white potatoes and fried potatoes than the most carnivorous omnivores. (My guess is the omnis were racking up some meat credits at McDonald’s, and did get fries with that.)

Of course, there are also some studies showing that, regardless of whether someone’s an omnivore in denial or embraces their flesh lust, eating more meat seems to correlate with certain cancers and heart disease. Does this “what do vegetarians eat” paper offer any insight into that? It sure does. If we compare the true vegetarians in this study (the ones who ate no meat on their recall days) with the true omnivores (the ones who ate plenty of meat on their recall days), we can see that the folks who limited their meat also consumed:

  • More dark leafy greens, deep yellow vegetables, “other” vegetables, and total vegetables
  • More whole-grain bread and brown rice (opposed to refined)
  • More total fruit, citrus fruit, dried fruit, and “other” fruit
  • More walnuts, almonds, and pecans
  • More total legumes, lentils, garbanzo beans, and hummus
  • Fewer beverages
  • Fewer “sugars and candies”
  • Fewer table fats
  • More wine
  • More carotene, vitamin E, vitamin C, thiamine, calcium, magnesium, copper, and dietary fiber

There’s nothing about eating meat that requires someone to inhale sugar and eat less fresh produce—but because meat (with all that awful saturated fat and cholesterol) has been so vilified in the nutrition world, the folks who eat more of it are likely to be less health-conscious than those who opt for the tofu slab. That’s why patterns like these emerge: Eating less meat goes hand-in-hand with other health-promoting choices, so we often see vegetarians trumping omnivorous control groups in terms of health markers.

Of course, with the paleo movement gaining force and more studies emerging on health-conscious meat eaters, it’s becoming obvious that not all omnivorous diets are created equal. The existing literature we have on paleo diets shows that folks can slash their risk factors for heart disease while still eating plenty of meat.

The B12/homocysteine/heart disease connection

If you’ll notice from some of the studies above, higher homocysteine (linked to B12 deficiency) is a common theme with vegetarians. Chronically elevated homocysteine may damage the lining of arteries and probably contribute to atherosclerosis—making this a major issue for vegetarians who either absorb B12 poorly or skimp on their supplements.

Unfortunately, not all veggie proponents got the memo. Dr. John McDougall, staunch believer in a meat-disease link, doesn’t seem to think B12 deficiency (and the ensuing elevated homocysteine) is anything to worry about:

…an otherwise healthy strict vegetarian’s risk of developing a disease from B12 deficiency by following a sensible diet is extremely rare—less than one chance in a million.

Take a moment to compare the possible consequences of your dietary decisions. You could choose to eat lots of B12-rich animal foods and avoid the one-in-a-million chance of developing a reversible anemia and/or even less common, damage to your nervous system.  However, this decision puts you at a one-in-two chance of dying prematurely from a heart attack or stroke; a one-in-seven chance of breast cancer or a one-in-six chance of prostate cancer.

How many vegans have you met with B12 deficiency anemia or nervous system damage? I bet not one!  Furthermore, you have never even heard of such a problem unless you have read the attention-seeking headlines of newspapers or medical journals.

That’s from a 2007 newsletter of his (probably my favorite blood-pressure-booster of all time). Did you catch his drift? B12 deficiency is just media hype. High homocysteine isn’t a problem compared to the artery-clogging havoc animal foods stir up. That wily New England Journal of Medicine is trying to compete with Cosmo and the National Enquirer by smearing the reputation of the meatless.

But just for kicks, let’s see what those sensationalist medical journals are trying to scare us with:

Quit with the fear mongering, medical journals!

Really though, I find it alarming that any educated vegan doctor is still sweeping the B12 issue under the (man-made-material) rug. Thanks to wonky claims about B12-associated problems being nearly impossible, some vegetarians and vegans are under the impression that high homocysteine isn’t anything to be concerned about, or that meat eaters are the ones who’ll succumb to its problems. In reality, this is probably one of the biggest threats to their animal-loving hearts.

Anyway, here’s the gist of this post:

Since so many vegetarian-versus-omnivore studies are comparing a complete lifestyle overhaul (health-savvy vegetarianism) with health indifference (standard “eat-whatever’s-there” omnivorism), it’s pretty hard to find a vegetarian study that can actually isolate the effects of meat. When a vegetarian’s main diet change is avoiding animal flesh rather than emphasizing fresh produce and moving away from refined foods, the health outcomes aren’t much different than those of standard omnivores (except for the added burden of higher homocysteine).

The end.

Just kidding. Three more things:

  1. Jimmy Moore kindly invited me back on his show for encore week. The interview is here, but he’s been having server problems and I’m not sure when that link will be working again. If it’s broken, just pretend I said something clever and carry on with your day.
  2. For any raw foodists in the house, I recently wrote an article for Frugivore Magazine about how to not ruin your teeth on a raw food diet. It’s a more up-to-date version of the dental posts I wrote last year on this blog.
  3. In case the grapevine didn’t reach your ears, January is gluten-free month. If you eat gluten-containing foods and are curious how you’d fare without them, now’s a good time for a little self-experimenting.

The real end. (Or is it?)

186 comments

  1. Thought I’d write in about your criticism of McDougall. Anyone following his program or reading his website knows you SHOULD take a B12 just in case. He doesn’t think it’s likely you’ll have a deficiency, but he absolutely advises people on his program to take a B12 supplement. Your research on this matter is sloppy.

    This is from a 2007 newsletter… “If you follow the McDougall Diet for more than 3 years, or if you are pregnant or nursing, then take a minimum of 5 micrograms of supplemental vitamin B12 each day.”

    http://www.drmcdougall.com/misc/2007nl/nov/b12.htm

    1. Hi GS, it looks as if McDougall’s research is a little sloppy. Many people deplete their B12 stores in less than 6 months, and the younger they are before they go vegan the faster the stores are depleted – they’ve had less time to accumulate a positive balance. Some of us simply don’t produce intrinsic factor, or inadequate intrinsic factor; some of us have poor B12 absorption from, say, gluten-sensitivity and caeliac disease. Some of us have biogenetic conditions that require inordinate amounts of B12; yes, people like me. I’m a chronic migraineur, and we have weird mitochondrial metabolism and neurological aberrations. Some migraineurs need as much as a full milligram of B12 per day, which is impossible to meet on even the best omnivorous diet. Diabetics taking metformin are at very high risk of B12 deficiency. When stomach acid levels drop too low, as often happens in people over 50, and those with low protein intake, it’s impossible to absorb sufficient B12. http://www.wellnessletter.com/html/ds/dsVitaminB12.php

      Waiting 3 years before taking a supplement could be disastrous; the neurological damage done by B12 deficiencies can be irreversible. Unless McDougall performs a full work up on each and every person who wants to follow his advice – before said person starts! – he’s being irresponsible in his 3 year window.

      For a good overview of the B12 situation: http://www.veganhealth.org/articles/everyvegan

  2. The cholesterol hypothesis of coronary artery disease is not valid. Veins , even the tiniest, NEVER become atherosclerotic. They have just as much cholesterol going through them as arteries do. We also know athersclerosis only happens at damage sites, not uniformly.

    We need to start looking beyond diet . Toxins, adenoviruses of a bacterial or viral nature, lack of sleep ( arterial repair time) , poor dental health ( bateria) etc.

    Coronary artery disease is multi – factorial and has a very complex etiology. The cholesterol hypothesis has already been replaced among biologists , but the public does not know it yet.

  3. Plants are nto a panacea. There are plant foods whcih speed atherosclerosis. Processed temperate zone polyunsaturated vegetable oils and refined wheat products.

    And if you fry the crap out of vegetables to the point of charring that’s a carcinogen.

    No scientists would ever point to a hunk of meat and say “that’s responsible for atherosclerosis.

    The ancient Egyptians had CAD. They ate lots of grain, as well as some meat.

    CAD is complex.

  4. I agree with you that if a vegetarian eats shitty otherwise, of course they will be unhealthy. And I agree that if I meat eater consumes less chili cheese dogs and eats more fruits and vegetables, they’ll still be pretty healthy. But I don’t understand why the big fuss. Let’s just be healthy and eat right and maybe stop eating meat because factory farming is awful to animals and the environment.

    1. Yes, factory farming meat is harmful.

      So is factory farming vegetables.

      Ever wonder how much natural habitat for animals has been destroyed and/or repurposed to grow corn, wheat, and soy?

      The fuss is over what “eating right” means in the first place.

  5. Some of my closed ones are vegetarians and they regularly patronize Chinese vegetarian food stalls that use industrial seed oil to stir fry or deep fry their foods. These foods are also heavily seasoned with sauces high in sugar, sodium and MSG to make them taste better. The older generation of Chinese are not used to eating raw, uncooked vegetables and buying organic foods is unheard of. So, it’s quite painful to watch them eating themselves to poor health, when they thought they’re actually doing something healthful.

  6. Some of the variant factors in heart disease make more sense if you look at it from an iron overload point of view. There is a pretty clear-cut connection between total iron load and heart disease … you can make your heart healthier just by donating blood. Beef iron tends to absorb more than fish iron, so there may indeed be a link between “red meat” and heart disease. But in the US, iron is added to most “carb” foods, so you might actually get more iron from carb foods. Whole grains tend to block iron though, so adding whole grains to your diet could make your heart healthier.

    Anyway, over the past year or so I lowered the iron content of my diet, and also started giving blood again. My cholesterol counts dropped, and all the other markers, including my blood glucose. I’ve been wheat-free for over 10 years, so that isn’t a factor. Mostly I started eating iron-blocking foods whenever I ate something with lots of iron (like steak, or white potatoes), and avoiding Vit-C containing foods with meat. I’m eating about the same foods as I did before, although I am eating more fish and less beef. Plenty of fat, and sugary desserts when I feel like it.

    Interestingly, the Inuit, who do get a lot of meat from whales, lack the “iron overload” genes totally. If heart disease comes from iron, then this would be protective:

    http://pescetarianlife.com/faq.php#14

  7. Non – NO ONE- has a complete understanding of the mechanisms behind the progression of atherosclerosis. To do so would require a complete understanding of human cellular metabolism. Science does not currently understand cellular metabolsim that well- only bits and fragments.

    Genuine science ALWAYS admits to uncertainty and vast unknowns. Science is a work in progress. There are far too many Internet gurus out there claiming to understand coronary artery disease.

    I suspect that if we examined Paleolithic human remains we would find some atherosclerosis too, just like in the Egyptians and Eskimos.

    Atherosclerosis *MIGHT) a be a bit less related to diet than we previously thought.

    Take care,

    Raz

  8. I can only say how strange I find some of the comments by some of the people who act like they know everything when in fact they are expressing their personal opinion. The Taubes dilemma, for example: it’s pretty obvious that unless you have read at least one of his books you’re not gonna be able to tell what he’s talking about, especially that – as someone noticed – a lot is often taken out of the context (which I see in this case as well, and I can tell because, incidentally, I HAVE read his ‘Good calories, bad calories’). I don’t know what a person gets out of sending a post in which they are blabbering about books they HAVEN’T READ. If you think you know everything best and are an authority on the huge subject on nutrition then there are places out there for people like you with white rooms with padded walls. I appreciate what Denise says a lot, and I like her methodology as well but it’s plain wrong to put her on the pedestal and defend her views by means of ignorant comments as if your life depended on it, as if she’s the one who’s got everything right. The point of what’s going on here is to compare the available data, not worship one author or another. How come the most ignorant of those who comment here do not mention long-term effects of particular diets? The data available is often conflicting with one another, often for reasons that we all know, bias being one of them. But how come you who criticize Taubes’s book that you haven’t read won’t even look at the studies that he and other authors analyze? It’s not about Taubes and his ideas, go to the sources, read the damned studies! It would be a good idea to start with Framingham. Oh, and by the way, a calorie is not a calorie, as it takes less carbs than fat to make us fat. And the whole idea of having to count calories when you’re on a fat-based diet comes from the fact (as someone correctly noted) that fat makes you satisfied more quickly and for a longer time. When on carbs, on the other hand, you get hungry again very soon. And these are facts from personal experience, not from a book, because I just started eating less carbs and more fat (mostly in dairy) and the big change is: I used to eat 6 times a day and I was always hungry and now I eat 2-3 times a day, don’t feel hungry at all, and most of the time when I have a creamy coffee an egg suffices for a meal and that lasts me a few good hours before I’m hungry again. Surprise surprise (and I weigh 58 kg and I’m 1.73m tall, in case you’re thinking I must be fat). So please don’t talk about calorie restrictions in the low carb diets because that is irrelevant to the whole argument on the benefits of meat or fat (or lack thereof). The point is that if you eat foods that fill you up more and for a longer time you in general consume fewer calories than you normally would. And those who still need to gorge on food when on the high fat diet and then reduce calorie intake most probably (as it sounds from what has been said above about the Atkins diet) eat too many carbs with their fat and thus put on weight anyway and feel hungry enough to keep on shoving food down their throats – because that’s how our bodies work. I used to eat mostly carbs and I HAD to eat every 2-3 hours, otherwise I’d faint from hunger. Now I have a latte with whole milk and cream and an egg and I last 8 hours on that. Crazy? Magical? Of course, I’m not arguing that you can skip carbs and be healthy, I’m just saying that given the facts – that some of you are blind to – you CAN eat without having to count your calories. What kind of argument is it anyway, the Atkins diet is bad because you have to count calories? Helloooo? That’s a great way to refute his theories (I’m sure there’s plenty of material in this diet to criticize in a more scientific way) It’s like saying someone doesn’t know what they’re talking about because their hair is dark. Oh, before I forget: to those of you who think that veggies are good and meat is bad for your heart try to read something reliable first on atherosclerosis, cholesterol, stress and about how cholesterol has nothing to do with heart disease and heart disease has little to do (if anything) with atherosclerosis. And then about what meat and fat have to do with atherosclerosis (not so much, I assure you). And this does not come from Taubes’s book.
    What got me interested in this blog was Denise’s analysis of the China Study. Anyone can write a book on nutrition and talk about what the studies revealed but once you read the actual data on any given subject for yourself (and see, like Denise did) that some conclusions aren’t as clear-cut as we may think. Too many variables at a time make it difficult to conclude what it is that causes disease and what eliminates it. And that’s the way to go. But some of you seem very much stuck on the ‘healthy’ veggies and a carb-based diet so religiously that you’re totally immune to any information that make shake your views. Please, read widely, go back to your basic biology and chemistry, and use this to analyze the data given. It’s silly to ostracize an author (Taubes or anybody else) without spending time to try to understand the other side of the argument. Why won’t you read about the other side of the argument and prefer to voice opinions based on speculation? Are you afraid to change your mind? I, for example, think that the Hippokrates diet is bollocks (as is the whole Hippokrates Institute and other similar spas meant at sucking you dry out of money) but I’m still reading more and if anyone can point me to information that can change my mind I’m always open to that. I wondered about the China study, I found this blog, read all the relevant info and I was convinced that Campbell didn’t tell us the whole truth. But I believed Denise not because she simply wrote something and said it was true, I believed her because she provided information that called for interpretation – information that was crucial to the understanding what may have happened during the course of that study.
    And this is what I advise that all of us do: use the scientific approach, unbiased, do our research and when you haven’t done the research, spare us your limited insights. After all, Copernicus was also wrong – until he wasn’t.

    1. You blathered on for a while, but I will take one of your points as an example:

      “The point is that if you eat foods that fill you up more and for a longer time you in general consume fewer calories than you normally would.”

      That is a pretty valid point and worth arguing. Taubes, though, says that it is total bullshit.

      Taubes specifically said in the Jimmy Moore interview that low carb weight loss has nothing to do with satiety signals. He believes consumption of calories is not causal to weight gain. In his theory, carbs/insulin cause fat accumulation, and fat accumulation then causes you to eat more calories. He said for this reason that some people need to beware the carbs in green leafy vegetables. I don’t really need to read his book to parse his words from the interview do I? Or does he really suck at doing interviews?

      An attack on Taubes is not an attack on low carb diets. He missed the boat on omega-6s, and very few people really believes his carb/insulin theory (you are obviously in disagreement, and apparently you “looked at the studies”.) That is not to say a low carb or lower carb diet does not have its benefits though.

      The main point though was that Taubes is rather outdated for where Paleo/Ancestral diets are going, and it appears that guruism is the main reason that Paleo people are praising “Why We Get Fat”.

      (A lot of his “key points” are not in line with other low carbers either, but he is still treated like some kind of messiah.)

  9. > Since so many vegetarian-versus-omnivore studies are comparing a complete lifestyle overhaul (health-savvy vegetarianism) with health indifference (standard “eat-whatever’s-there” omnivorism)

    This is a constant problem. Inexplicit specification? When people leave things up to the imagination, we can’t agree on facts, and really, we can’t begin to find them.

    We have to know what we’re comparing. Too many studies compare something specific to something nebulous. Low fat diets are bad? Oh yeah, compared to what? Compared to exactly what 3 meals?

    I’d like to see some reference diets discussed and compared. I’d like to see some hard evidence that these 3 meals a day produce negative human outcomes compared to those 3 meals a day. Lets get a couple million bucks, a reference diet from several communities, and plug it into a hundred people for a decade. Lets get a move in.

  10. I live in Taiwan and often see what WP mentioned above (it’s a mostly Chinese food culture here). People generally avoid raw vegetables, “feels like being a rabbit”, and everything that looks healthy. Vegetarians especially just drown cooked vegetables and plain tofu in lots of fat and spices to make up for the lack of meat, garlic, onions and other stuff that Buddhism eschews.
    On the other hand, the meat-eaters I know here tend to eat much more healthy fish and innards than my friends in Europe…but also lots of greasy stuff.
    tl;dr I wouldn’t trust the Taiwanese study to be much more accurate than Western ones.

  11. Ahem. Vegetarians ARE omnivores. They consume eggs and dairy. Which is why it’s so rare they have a low serum B12 due to intake issues.

    There are other problems with this blog that I’ll tend to later.

  12. I have had Lp(a) and HDL -C and I cannot lose weight. I quit smoking in 1999
    and rapidly gained fifty pounds and despite diet and exercise I could not lose weight. Until I found out quite by accident that my blood sugar was ‘elevated’ on days when I was ‘fasting’ and exercising. When I used otc methods to lower blood sugar I dropped 22 pounds in 40 days. Since then I have lost an additional 10. I have an ‘enlarged’ MCV but the doctors keep telling me that’s because I ‘drink a lot of alcohol.’ I do not drink but have heard that it could also mean I am deficient in B12 which makes more sense to me, but this is the first time I have read that B12 deficiency causes the elevation of Lp(a) and HDL-C and no, none of the idiot doctors I have to go to due to lame insurance will give me a B12 shot they ‘insist’ I can get it by eating foods high in B12 but not if my stomach is missing the enzyme. Which leads me to conclude that ALL DOCTORS ARE STUPID. They usually end up terminating me as a patient because I am a smart mouthed trouble maker…

  13. Ethelouise, there are lots of “under the tongue” B12 supplements that bypass the stomach route! Sounds as if you should drop in on the nearest good supplement store! Chris

  14. “Which leads me to conclude that ALL DOCTORS ARE STUPID.”

    The whole idea of going to a GP has been obsolete since mass literacy came about. A GP can’t do anything that you couldn’t get a much better picture of by searching online in 2 minutes. It’s farcical.

    A GP can order tests, you can do that yourself. There is no legitimate reason why the middle man the GP or any doctor to do it for you.

    The Writing is on the Wall. The assembly line workers were told to pack it up when automated machines came along. The family farm, REAL farmers who actually took care of their animals and crops unlike the factory farms nowadays, were done out of all their money and livelihoods. Now it’s time for the doctors to feel the pinch.

    The vast majority of people that go to a GP are old people and they keep coming back with the same old problems week in, week out. The GP tells them to come back for more tests. And the old people bring the $50+ every time. But the young people growing up now are getting a lot more savvy, and they won’t be so eager and willing to fork over the cash as the older generation.

    Someone should set up a campaign about an end to GPs world-wide. They prey on the elderly and the disadvantaged/vulnerable. I know what I’m talking about, I’ve had a lot of first-hand experience with this myself.

  15. http://livinlavidalowcarb.com/blog/nih-funded-yale-heart-study-looking-for-heart-attack-survivors/12026 May I interrupt the thread to ask that any members who have had heart attacks please take the anonymous 30-60 minutes to complete the NIH-sponsored Yale Heart Study survey. We’re looking at what factors influence people delaying in going to the hospital immediately when they suspect they’ve had a heart attack?

    Our facebook page http://www.facebook.com/YaleHeartStudy is devoted to all forms of prevention, but our primary mission today is having 2000 heart attack survivors take the online survey by April and we need your help to help others. Also, we want to reach a national sample–not just the East Coast in and around Yale. Thank you so much for your consideration!

  16. Pingback: >Food and Feet
    1. beforewisdom, this was a long time ago that he wrote this. People are free to look back over the history of events if they choose, you put it there like it’s something that’s just happened which can be very annoying.

  17. I did not see one mention of dairy products in your article. Couldn’t this be a reason for discrepancies among omnivores, vegans and vegetarians. Perhaps dairy, not meat, is the culprit behind heart disease.

  18. I love the part of this post describing self proclaimed vego’s in the USA, who still eat meat. I find a similar scenario with Paelo diet followers. Paelo during the week and binge eat on grains, chocolate and alcohol on the weekends. Blood tests don’t lie like you mentioned.
    I am not a raw foodist, I am a dietitian and not a huge meat eater. I really respect your writing telling it how it is though science, and not brain washing readers. I always say diet is individual which ever way you like to take it, there are always multiple ways to eat healthy without putting black and white labels on things.
    Your doing a great job, Thanks for the read :)

    1. Try reading “What I Eat”. It’s a pictoral essay of what people eat, all over the world … and what they look like. Oddly enough, most of the world doesn’t obsess over “protein” and “fat” and “carbs” and yet also oddly enough, most of them are healthier than the US. And what was weird to me … some of those “undeveloped” countries eat more calories than some of us in the US.

      I’m not saying I know what is going on. It might be a genetic trigger, or iron accumulation. But when you look at diets around the world, it’s pretty clear that most of the current theories don’t wash. The diet that “works” the best, that I’ve found, is the Asian pattern, with rice/eggs/fish/poultry/vegies plus tea. It’s neither low-carb nor low-fat nor vegetarian, but healthwise, it seems to work.

      1. Thanks for the suggestion I will check it out now. I totally agree I try not to get my clients hooked up on the idea of proteins and carbs rather than looking at food as a whole, its nutritional density and how it fits into their cultural eating patterns. I think there is much more to learn about cultural eating and genetics. It seems the more dishes/ foods become global and get adapted into different cultures it causes more harm than good.
        Anyway something to think about :)

  19. Thanks for letting me know I am hart attack proof. My diet consist of High Fat Low carb like 5 carbs or less a day.I eat mostly Fat ,Saturated to be exact my Cholesterol is 123 at any given test and blood pressure is perfect.I do get at least 178 grams of protein a day because I left weights and in joy gaining mass.To many Carbs or worse excessive fructose will cause metabolic syndrome and kill you I have tried all diets and researched them for years Vegan is an early death sentence.There is no non-observational studies that prove saturated fat nor Cholesterol in diet do any thing that the health community is pushing.If you do not believe me look for a clinical study that proves this?You can burn fats interchangeable with carbs HFLC Ja!!!

  20. Enjoyed the post. I like anything based on facts.

    I’m very happy with my LCHF experiences.
    http://cafemoi.wordpress.com/2012/07/26/wont-that-high-fat-diet-raise-your-cholesterol/

    I participate in many diabetes forums. One thing we do not see is anybody reversing their condition by following veggie protocols. We see numerous people losing significant weight, reducing meds, improving metabolic measures, and feeling a hell of a lot better by eating LCHF. I don’t know for sure, but generally the successful vegan/fruitarian is a skinny, stick-person to begin with.

    One confounding element may be gut flora. It seems that feeding high fat to a high carb eater produces inflammation, and any LCHFer knows that eating high carbs produces immediate, negative results — aka feeling like puking. It is possible that both extremes are healthier than the balanced SAD/omnivourous diet just based on gut flor responses.

  21. Try using Extra Virgin Olive Oil- it helps raise the HDL’s and prevent heart disease. Oh whoops, forgot this is a ridiculous diet that restricts the use of HEART HEALTHY OILS. I’m not judging you- do whatever you want. Just don’t spread the word- you are harming people with this madness.

  22. I have been both a meat eater and a vegetarian (for 10 years). I have to say, that I am healthy as a meat eater now as I was as a vegetarian. I am now more conscious of what I eat (that it was treated humanely). It’s not that easy, just as veganism isn’t easy. However, it’s what I choose. Why? Something Joseph Campbell said about vegetarianism affected me profoundly: “…lives feed on lives.” It’s something that my ex husband and I joked about often (he too was a vegetarian)…”when do we stop eating something that lives…that has a life? What do we do – become air-a-tarians?” We meant that honestly. There is a wheel of incarnation here. Campbell also spoke of what is lacking these days, and that is a spiritual, moral regard for the animals that we are the custodians of. Many prior and current cultures still honor the beings that are provided as food with various rituals and exchanges. Very few of us do that when we go to the grocer to buy a lump of flesh that was once alive. We are buffered. We Americans in general (in my opinion) do not honor acknowledge the sacrifice. It’s very obvious. We need to return to more of a true cycle of life that we have truly forgotten.

    I’m nearly 50 and I am on no medications, and am still having a regular flow. I am trim (athletic), have good skin, lots of energy, have no perio-menopausal symptoms, have great vitals and lots of energy. Most people think I’m at least 10 years younger than I am. Now, most vegans and vegetarians I know have weight issues, bad skin or are constantly ill…I have to wonder. By the way, when I met my ex husband (he was the vegetarian who converted me for 10 years) he was a bag of bones with chronic IBS. While he got me to refrain from eating meat (I was happy to give it a whirl), I got him to open up his diet from being so strict (he wouldn’t touch any sweets.) I’m a believer of everything in moderation…he started to allow treats (not just sweets) into his life and his IBS eventually faded. And he gained some much needed weight…he looked and felt better! As for me, as a vegetarian, I did okay. Lost weight, interestingly but I was sick more – chronic sinusitis. When I began eating meat again, my body did not adversely react at all.

    While I totally and absolutely advocate the proper treatment of animals – all animals – I have also come to understand our places in the maia and accept it with grace not with indignity (as I believe I did before). I bow to what I don’t know or understand. And I follow the guidance of my self and body (which knows more than we give it credit). And I follow, not try to get outside of, the cycle of life that has been here far longer than I have.

  23. This is a really long post so this issue may have been raised. I was a little suspicious when the study used buddhist monks because I know that they are indeed allowed to have milk (and milk products) as this is not seen as killing the animal. The egg bit was surprising. The vegetarians in the study were ovo-lactovegetarians. There was no discussion of eating diary and eggs as possibly confounding this study. I know that vegetarians tend to eat more dairy products than many of my meat eating friends!

  24. Sounds like meat consumers picking at straws to try and justify their current consumption patterns to themselves. The evidence that meat, red and processed particularly, has negative health implications is overwhelming.

  25. Hutch – your reasoning for returning to meat consumption is illogical. There are clearly defined parameters as to what is better or worse to consume ethically speaking. Perhaps you should see some of Peter Singer’s work (from Princeton University).

  26. Taubes is fat and Atkins is dead, died overweight with clogged arteries. In fact all the meat i good carbs are bad pushers are fat and out of shape. Take a look at real peer reviewed medical studies, none say meat and fat is good. Not one. The problem with the low carbers is they don’t see a difference between a piece of broccoli and a donut. Since I dropped meat, eggs and dairy my cholesterol levels are coming down, my bodyfat is coming down, my digestion and elimination is normalized. Get with the program people bacon and eggs is not ever going to make you healthy no matter how much you want it to be true.

    1. I think both sides on the argument are a bit one-sided. If you look at the diet of really healthy people in a real cultural context, you end up with people like the Chinese and Vietnamese and other Asians. They LOVE food and work hard to make it tasty. It often features pork, and loads of eggs, and fish. And also loads of high-carb rice. And somehow … they are thin and healthy and live long active lives. These are diets that have been tested for generations on real live people. And yes, the Europeans that eat Asian, seem to have the same good effects, and Asians don’t do well on European food. It’s not genetic.

      My own experiments involve cookbooks. I’m cooking more and more in an “Asian” style, trying to stay as true to the original recipes as I can. And you know what? It works! I end up being healthier, skinnier, and feeling younger.

      If you want an eye-opener, read “What I Eat”, a pictorial essay of what people really eat in one day, around the world. The carb-eaters aren’t fatter, the meat-eaters aren’t fatter either. I’ve been trying to tease out the factors that really make a difference. One big one seems to be eggs: egg-eaters tend to be skinnier.

  27. heathertwist, that is all nonsense. It is not a good idea to eat lots of pork and lots of high carb rice, the Chinese people who eat those foods are fat and get heart disease and all the other diseases of the western world. Your idea of eggs being skinnier is superstitious nonsense.

  28. I have met a lot of vegetarians that got B-12 deficiency. Don’t assume there are no people with anemia caused by going vegan just because you didn’t meet any. Other than that I enjoyed reading your stuff.

  29. no one is heart attack proof i stopped reading there , diet is 30 % of your sik factor genetics 60% , Wikipedia Lp(a) i have that and had a heart attack at 28 skinny , and cut in excellent shape , only risk factor was genes and a low hdl…….

  30. “I’m excluding Seventh-day Adventists from the list because their diet and lifestyle recommendations involve much more than meat avoidance.”

    Seems to me that the Adventist studies are perfect for your purpose because some avoid all meat and some don’t, but otherwise have similar lifestyle. There are studies that compare the Adventist meat eaters vs. vegetarians. What do they say? I think you know what they say and that’s why you left them out of this blog post…

      1. If you look at the table “Consumption of selected foods according to vegetarian status” and the other consumption tables, the semi-vegetarian diet is similar to the vegetarian diet, except they eat meat and slightly less fruit. So, are the differences in risk related to slightly less fruit consumption, or slightly more meat? My money is on meat. According to her own site, Denise Minger herself doesn’t eat any animal muscle other than fish. I think animal products can be eaten healthfully, but not the way the “meat and fat” folks are chowing down on bacon and steaks.

  31. The Journal of Family Practice published a new study of Dr. Esselstyn’s with more participants. I suggest everyone check it out. Of 177 cardiovascular disease patients on a plant-based diet, 1 person had an event (stroke) over an average 3.7 year followup. So yes, ditching meat may in fact save your arteries. But, you’ll have to give up oils and processed foods too.

    1. Coosey, I read the Esselstyn et al. paper. http://www.jfponline.com/fileadmin/qhi/jfp/pdfs/6307/JFP_06307_Article1.pdf
      To say that it has some glaring faults is an understatement. Let’s start with the sources cited. As has been shown by Ms. Minger, the Norwegians (Strom & Jensen, ref. #15) may have lost their livestock, but significantly increased their intake of fish and shellfish during WWII. Their diet was not vegan, and it was not particularly low in animal protein – fish and shellfish are animals. The China Study data fail to support Campbell’s interpretations, as shown by Ms. Minger, Chris Masterjohn, and Tom Billings (the last is a lacto-vegetarian). Even the Vegan Outreach Association is cautious about the interpretations of The China Study (http://www.veganoutreach.org/newsletter/vo2001mar.pdf
      Move to Table 2, in which the authors present their data.
      1. Sample sizes extremely unequal. For adherent group, N = 177, for non-adherent 21. The minimum sample size that will produce a normal distribution curve is 30 individuals. This second group is definitely skewed and its results cannot be extrapolated.
      2. The second group is not omnivore. It’s a group that lapses from the vegan diet/no oils/no processed foods protocol.
      3. Numbers of male and female participants extremely unequal. 93% of the adherent group is male, 76% of the nonadherent group is male. It’s well-accepted now that men and women are very different creatures when it comes to diet and medications. The higher incidence of negative events in the nonadherent group could possibly be due to the much higher representation of women.
      4. No control groups.
      5. Participants are self-selected.
      6. Results are self-reported.
      7. Too many variables that are definite confounders. Consumption of refined vegetable oils is itself a high risk factor, as is consumption of processed foods. Regular nutritional counseling is a positive factor that in itself reduces risk.
      8. Extremely poor data quality control. What do they mean by “non-adherent”? Non-adherent could mean
      a) Occasionally eats animal products but never oils or processed foods.
      b) Occasionally eats animal products and oils, but never processed foods.
      c) Occasionally eats animal products, oils, and processed foods.
      Now replace each occasionally with often, very often, and regularly. How much is eaten at a time? At each level, how many times per week is any one of the naughty foods eaten? Which animal food is eaten – fish, red meat, poultry, eggs, dairy products? What kind of oil – soybean, corn, grapeseed…?
      Non adherent could also mean
      a. Never eats animal products, but occasionally eats oils and processed foods.
      b. Never eats animal products or oils, but occasionally eats processed foods.
      c. Never eats animal products or processed foods, but occasionally eats oils.
      As above, what is meant by occasionally, and how much is eaten?

      Note that this is not an experiment (no controls, no manipulation of only variable at a time).
      The article exhibits strong confirmation bias from beginning to end. The authors start off by saying they believe the plant-based diet is the best for humans, gather ragbag data from adherent and lapsing vegans in a highly skewed study method, and then, to nobody’s surprise, conclude that a diet comprising plant-based foods but devoid of oils and processed foods is the best. The authors say it themselves: this is mere reportage. They note their own study limitations (all valid!), but go on to say that they believe there is strong enough “proof of concept” to push veganism onto the populace at large. Yet, by their own showing, there is just as much reason to select oils or processed foods as animal-source-foods as the major risk factor.

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