Of Oil and Ethics

I have a question in my inbox from someone asking if there “is anything to the ‘no oil’ diets,” such that Dr. Caldwell Esselstyn promotes. My answer is – certainly there is something to it. Dr. Esselstyn (1) and Dr. Dean Ornish (2) have used a very low-fat, plant-based diet (10% of the calories as fat) as part of a cholesterol-lowering program that has decreased the amount of plaque in patients’ arteries and led to much better outcomes than typical treatment for heart disease. Dr. Neal Barnard and the Physician’s Committee for Responsible Medicine have used a very low-fat, vegan diet to treat type-2 diabetes with impressive outcomes (link).

But is it the only healthy diet that all vegans should eat? Let’s look at some other evidence.

A 2000 cross-sectional report (3) on cholesterol levels in men from EPIC-Oxford found the following:

  Meat-Eaters Vegan
fat 34% 30%
cholesterol (mg/dl) 191 158
saturated fat 12% 5%
calories 2,461 1,931

So the vegan men were eating a diet of 30% of their calories as fat while still maintaining cholesterol levels of 158 mg/dl. Some people would consider this level of cholesterol too high, and while trials of people with heart disease who lower their cholesterol levels to below 150 mg/dl have shown a great benefit in doing so, it is not clear (to me, anyway) that people without a history of high cholesterol and heart disease need to go as low as 150 mg/dl. Low calories (or body weight) and saturated fat may be the most important aspect of lowering cholesterol levels.

A cross-sectional study on cholesterol levels is not the highest form of evidence compared to the clinical trials I mentioned earlier. What about trials of higher fat diets?

The Eco-Atkins diet, a high-protein, higher fat version of a vegan diet found better changes in blood lipids and higher levels of satiety when compared to a lower fat, near-vegan diet (4). But this trial only lasted 4 weeks, not nearly long enough to measure heart disease outcomes. Cholesterol levels of the people on Eco-Atkins went from 257 to 205 mg/dl – nowhere near as low as the very low-fat diets generally achieve, but, again, it was only four weeks long. [2014 Update on Eco-Atkins]

Most of the very low-fat diets do not allow for many nuts. While nuts have consistently been associated with positive health outcomes (lower body weight, better cholesterol levels, etc.), one vegan doctor, who uses low-fat diets to treat heart disease, told me that many of his patients binge on nuts when they are part of their diets and so he suggests they avoid them. I’ve heard from others that if they eat nuts they gain weight. It doesn’t completely surprise me that someone on a very low-fat diet might binge on nuts – they might be craving the fat or protein. But if you are someone who can eat nuts in moderation, then having some is most likely beneficial for preventing heart disease and long-term weight maintenance.

Though it may be rare, or even extremely rare, some people who follow a very low-fat diet find that they lose their libido and regain it upon eating more fat.

Earlier this month, Jeff Nelson of Vegsource.com wrote an article, How the ethical argument fails veganism. In it, he disagrees with my co-founder of Vegan Outreach, Matt Ball, and my co-author of Vegan For Life, Ginny Messina, as to whether the health argument is the way to go when spreading veganism. He also disparages “AR dietitians” in general, of which I can’t help but notice that I am one.

Aside from the fact that Matt nor I care about veganism as anything more than a tool for protecting animals and the environment, the central thesis of Nelson’s article is that people who become vegan for health reasons are more likely to stick with the diet than people who go vegan for ethical reasons. He says that people who go vegan for ethical reasons are usually not as educated about health and nutrition due to being persuaded by organizations that do not give them adequate information; so they eat processed foods and end up concluding that a vegan diet is not healthier. The people who go vegan for health reasons, on the other hand, understand the importance of avoiding processed foods and oils, and their health improves.

While many people do well on a whole-foods only, very low-fat vegan diet, my experience has been that such diets can sometimes result in failure to thrive, while many people do thrive on a vegan diet that includes more fat and processed foods.

The vegans I know are mostly animal advocates, and, therefore, are dedicated to being vegan. Very few of them had been diagnosed with heart disease or type-2 diabetes before becoming vegan, so they are not necessarily in the same boat as people who become vegan to treat their disease. The vast majority of the vegan, animal advocates I have know have stayed vegan, and most eat processed foods. From soy foods to french fries to desserts made with white flour and sugar, the vegans I know eat ‘em. Of course, most of them also eat more fruit, vegetables, whole grains, legumes and nuts than the average American.

My cholesterol tends to be around 150 mg/dl. If I were eating a very low-fat diet, it might be even lower, possibly decreasing my risk for heart disease. But I crave protein and feel better when eating a good amount, possibly due to my fairly intensive weight lifting. I do much better eating soyfoods and other processed foods such as pasta, than when eating only whole plant foods.

There are health issues that might prevent people from eating only whole foods, such as digestive problems, and those have to be dealt with on a case by case basis.

I generally tell people who have metabolic syndrome that they should tend towards a whole-foods diet, greatly limiting added oils but including nuts, while those who are not as much at risk can afford to eat more processed foods, especially those high in protein and/or pastas (which generally do not raise blood sugar as high as other processed grains). Monitoring your weight, cholesterol, and blood sugar levels is a good idea to see if the diet you are eating is working for you.

At some point there might be clinical trials examining cardiac outcomes in people on vegan diets that are not so low in fat or in vegans who have not been diagnosed with heart disease. We do have some data on heart disease in vegans from the 1999 meta-analysis, but it isn’t much.

References

1. Esselstyn CB Jr. Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). Am J Cardiol. 1999 Aug 1;84(3):339-41, A8. | link

2. 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. Erratum in: JAMA 1999 Apr 21;281(15):1380. | link

3. Allen NE, Appleby PN, Davey GK, Key TJ. Hormones and diet: low insulin-like growth factor-I but normal bioavailable androgens in vegan men. Br J Cancer. 2000 Jul;83(1):95-7. | Link

4. Jenkins DJ, Wong JM, Kendall CW, Esfahani A, Ng VW, Leong TC, Faulkner DA, Vidgen E, Greaves KA, Paul G, Singer W. The effect of a plant-based low-carbohydrate (“Eco-Atkins”) diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Arch Intern Med. 2009 Jun 8;169(11):1046-54. Erratum in: Arch Intern Med. 2009 Sep 14;169(16):1490. | link

23 Responses to “Of Oil and Ethics”

  1. Nadine Says:

    Thanks for the post. That article was a bit ridiculous to me and totally counter-intuitive. Veganism is always about the animals and the difference between an ethical vegan and a health vegan is that one will stick with it and try to make it work, while the other will move on at the first sign of trouble. Also have these people ever heard of being a healthy ethical vegan?

    I found that when I was on the no oil, only whole food vegan diet, I lost a lot of weight when I was already at an ideal weight (BMI went from 22.9 to 20) and while I felt good at first, I started to feel “weak”. When I cut my self and my diet some slack… i.e. whole grain bread, brown rice pasta, occasional treats and some processed condiments and foods, I felt way better physically and emotionally. I needed more calories and more fat (closer to 30%) to thrive.
    I still eat mostly whole foods everyday, but when I use ketchup or salad dressing or make the occasional sugar laden cookie, I find cooking and eating as well as I do very enjoyable and easy as opposed to time-consuming and a chore.

    Also, as a person without a car who bikes everywhere, I found it very difficult to get enough calories from whole unprocessed foods without relying on nuts, which in turn made me feel even worse.

  2. Lea Says:

    But isn’t diabetes also successfully treated with low-sugar diets that are pretty high in fat? Isn’t that still the traditional method?

  3. Ryan Seacrest Says:

    Jack, couldn’t the article you reference be more accurately called, “How most animal advocacy groups fail the animals”? It isn’t saying the ethical argument doesn’t reach more people (according to Bruce Friedrich, polls show 97% of people want animals to be legally protected from abuse), but that animal advocacy groups don’t provide accurate and thorough nutrition information.

    This is why you and Ginny are invaluable. You are the only people out there (as far as I know) who give an honest and balanced analysis of vegan nutrition.

  4. jon Says:

    This is at root an empirical issue and can only be answered through larger, high quality empirical studies. The survey discussed only had 77 participants and there where no selection controls and is therefore unreliable.

    Before we have larger studies different pro veg groups should try as well as possible to optimize the strategic path they’re on (VO’s anti-suffering argument path, vegosources health argument path, …), stay open minded and look for ways to ease and speed better empirical studies.

    That said I think Jeff Nelson’s text conflates two claims:

    1. making health arguments rather than animal ethics argument prominent in outreach communication with meat eaters produces more vegans who stick to veganism.

    2. it is biologically possible, and practically possible for at least some and maybe many people, to thrive in very good health by following one of the low-fat versions of veganism that Nelson mentions.

    2 does not entail 1.

    And even if 1 was true it still might not entail what really matters, namely bringing about more decrease of harm and/or enslavement of animals (depending on the details of your animal ethics) compared to the alternative strategy.

  5. cyanocobalamin Says:

    I’ve read many of Matt Ball’s essays and I have enjoyed them. It has been a few years, so I might be mistaken about his positions.

    If I remember correctly Ball discourages using the “health argument”, because it will not motivate to stay vegan, since they can get similar health benefits by not being vegan.

    Well, that is basically someone being a flexatarian and Matt Ball supports people being flexatarians in other essays.

    In one essay he states that many people being flexatrian still means a reduction in suffering for animals. In another essay he advises activists to encourage people who say “I could be vegan except for ___” by telling those people just to have “___”, but be vegan otherwise.

    If being a flexatrian is a good thing, than why is the “health argument” a problem?

  6. Jack Norris RD Says:

    Lea,

    > But isn’t diabetes also successfully treated with low-sugar diets that are pretty high in fat?

    Kind of. Because people with type 2 diabetes are at a high risk for heart disease, they try to limit saturated fat and total fat in the diet these days. Here’s what the American Diabetes Association says: http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/fats.html

    It doesn’t say on that page, but if memory serves, they try to limit total fat to 30% of calories.

  7. Jack Norris RD Says:

    Ryan,

    Thank you! In this case, I think the thorough nutrition information that Jeff Nelson would be looking for is information about not eating processed foods. I, however, think a bigger problem is the trend I see among the low-fat vegan diet promoters to dismiss the issues of vitamin B12 and calcium, and not to even mention iodine and many other nutrients of concern. I think it’s particularly unfortunate that when a celebrity becomes vegan they naturally hook up with the vegan movement’s celebrity nutritionists who give them the easy sell on veganism and don’t warn them about how to make sure they don’t get any deficiencies. And then when they go back to eating animal products, the whole world gets to hear about it.

  8. Jack Norris RD Says:

    cyanocobalamin,

    Matt’s main issue with the health argument is that he believes it has led to people switching from red meat to chicken, thus causing more animals to be raised on factory farms. In terms of being a flexatarian, he would think that eating less animal products is always better than eating more, other things being equal (like not switching from red meat to chicken).

  9. Ben Says:

    Dear Jack,

    May you please give a reference for your claim:

    “Though it may be rare, or even extremely rare, some people who follow a very low-fat diet find that they lose their libido and regain it upon eating more fat.”

    I find it disturbing, and a reliable source for that would be welcome.
    Thank you.

  10. Jack Norris RD Says:

    Ben,

    I’m afraid I have no citation. I can recall this happening to two people. The wife, Eva, of the most recent person posted to my blog: http://jacknorrisrd.com/?p=2783

    I followed up with her over email and she told me that after adding some fats back her husband had improved. The other person I remember was a guy who lost his libido and started eating plant saturated fats and it improved his libido and health significantly. He wanted me to really push the need for vegans to include saturated fats but I didn’t think there was enough evidence for that.

  11. Ben Says:

    I don’t know if you let this be published, but hoping that you read it, I’m going to write anyway.

    I’m vegan for ethical reasons. Period. But, I had to think about my health, too, since I had begun my vegan journey with 250lbs, 5ft8in. Thanks to a diet which is low-fat (around 15%), I could lose more than 100lbs. I’m a volume eater. Even with a high-carb diet, I have the need to eat lots of vegetables to avoid over-eating and remain satisfied. As fatty products are much more calorie-dense, eating a high-fat diet means for me food craving or excess calories. I DO eat nuts and seeds, however, but no more than 2oz a day, and I avoid vegetable oils as much as I can. I don’t have any health guru, but I’ve learned a great deal from some of the low-fat advocates, e.g. knowing what I eat, what I need (and I don’t disparage the need for adequate calcium or B12 intake at all. I take the message very seriously, as I’ve learned a great deal from you as well).

    Unfortunately, I was very concerned reading (multiple times) your thoughts, and especially Ginny’s thoughts on low-fat whole-food vegan diets. I was afraid my TGs would be elevated, for example. Happily, it didn’t happen. But while I understand, and have no problem with it at all, vegan people choosing to eat a more processed, high fat diet, I’m greatly disappointed to feel a certain kind of fear mongering about lfwfv diets (“In today’s world, getting the ratio down to this level without adding large amounts of ALA to the diet would likely mean a very low fat diet which would be difficult to maintain, and possibly even harmful, for many people”). I definitely agree that some people might need more fat, more protein, etc. Everyone is different. But that doesn’t make the low-fat diets harmful.

    And now, with the message about reduced libido. It’s anecdotal, isn’t it? And to push the need to consume more SFA? Well, I guess WAPF would be proud. But just like you felt it wasn’t justified to recommend more SFA consumption without any reliable evidence, couldn’t you do the same thing with the general message itself?

    I was somewhat disturbed by the provocative headline on VegSource, and I don’t like the assumption that the health argument is more important than the ethical one. However, from the health POV, I couldn’t but agree with Mr. Nelson. Like him, I felt attacked, especially from Ginny’s “How low should you go?” article. There’s no need to call processed soy foods or vegetable oils a “poison”, but it seems that bashing isn’t found just in one side.

    I don’t have but a great respect to you and your work. You’re both doing an excellent job promoting a vegan lifestyle, replying to readers’ comments and mails, completely free of charge. As I’ve said before, Jack, you’re greatly respected and honored here in Israel, and your site is commonly referred to when a nutritional advice is needed. Thanks for reading this.

  12. Lea Says:

    Thanks for the reply!

    “It doesn’t say on that page, but if memory serves, they try to limit total fat to 30% of calories.”

    Well, 30% is a lot more than people like McDougall and Barnard advocate, isn’t it? In one the books by Barnard he advocated 20 grams of fat as a maxium per day.

    I do not doubt that lower-than-average fat is healthy, just that it needs to be 10% or 20% percent. Also, shouldn’t the percentage be higher when you eat less calories…?

  13. Lea Says:

    Hi Ben, I followed low fat raw veganism for a while, and a lot of people complained about a loss of libido.

  14. Ben Says:

    Lea,

    I’m not a raw vegan. And please, I don’t need more fear mongering.
    If you have a solid evidence suggesting that LF diet is connected to loss of libido, please show it to me.
    Even though I have no problem at all eating a LFWFV diet, I’ll no doubt consider a change if I find it may risk my health.

  15. Jack Norris RD Says:

    Ben,

    I don’t think anyone is suggesting that you shouldn’t eat a low-fat diet. There are always trade-offs for any diet and we are simply discussing the potential trade-offs.

  16. Jack Norris RD Says:

    > Also, shouldn’t the percentage be higher when you eat less calories…?

    Except for omega-3s and omega-6s, fat is not an essential nutrient. Our bodies can make fat out of carbohydrate and protein. It is not hard to meet the minimum requirement for omega-6s – almost everyone does that without effort. A higher percentage of protein is usually what is necessary when eating less calories, for the preservation of muscle mass and bone tissue. But if someone is eating a very low calorie diet, which very low-fat vegan diets tend to be, they might not be making much fat from carbohydrate or protein.

  17. jon Says:

    @Ben, I have a comment regarding the end part of your quote from Jack’s text i.e. this: “…which would be difficult to maintain, and possibly even harmful, for many people”

    I interpreted that sentence as saying that because the diet is difficult to maintain (for many people) there are possibly harmful effects for some of those many people if they still try to maintain that diet. You interpret it as saying that even if one managed to maintain the diet it is still possibly harmful. Maybe Jack can sort that out.

  18. Lea Says:

    Thanks! I was wondering about this, since some sites talk about the desired percentage of things and other sites about certain grams of fat. And I wasn’t sure how that applies to calories. So there’s no need to up my fat grams when I eat 2000 calories instead of 1400 in general?

    What about the absorption of vitamins? I still hear a lot of times that you need “extra” fat to absorb more vitamins in carrots, etc. Or is the fat in the vegetables enough for that?

  19. Jack Norris RD Says:

    jon,

    > “…which would be difficult to maintain, and possibly even harmful, for many people”

    I meant: “which would be difficult to maintain for many people, and possibly even harmful (for some).”

    I’ve changed it to:

    “…which would be difficult to maintain for many people.”

    It wasn’t one of my most scientific statements.

  20. Jack Norris RD Says:

    Lea,

    Fat has been shown to increase the absorption of fat-soluble vitamins. Whether you can absorb enough fat-soluble vitamins for optimal health on a very low-fat diet, I’m not sure. I personally use salad dressings with a bit of oil and put some oil on vegetables for this reason. Because vegans don’t eat pre-formed vitamin A, I want to make sure I’m absorbing beta-carotene when I eat it.

    This doesn’t prove anything one way or the other, but just for interest’s sake, I knew a raw foodist whose skin was a dark orange. He told me that he drank a gallon of carrot juice each day with an avocado blended into it. Whether he required the fat from the avocado to absorb so much of the beta-carotene, I’m not sure, but in his case, he was definitely absorbing enough!

  21. Dawn Says:

    Although it is getting increasingly easier, the very thought of adopting a vegan diet is still a bit daunting (at least initially) for most people. When we add low-fat (or soy-free or gluten-free when it is not a legitimate allergy) to the vegan diet, we make it likely that fewer people will adopt a vegan diet much less maintain that diet. It becomes very unappealing and in some cases, I’m guessing not necessarily the healthiest diet either.

  22. Doug Spoonwood Says:

    Interesting post.

    “Low calories (or body weight) and saturated fat may be the most important aspect of lowering cholesterol levels.”

    If so, then I think it would follow that low calories and saturated fat combined as a better predictor of cardiac events NOT happening than very, very low cholesterol levels.

    “The Eco-Atkins diet, a high-protein, higher fat version of a vegan diet found better changes in blood lipids and higher levels of satiety when compared to a lower fat, near-vegan diet (4). But this trial only lasted 4 weeks, not nearly long enough to measure heart disease outcomes. Cholesterol levels of the people on Eco-Atkins went from 257 to 205 mg/dl – nowhere near as low as the very low-fat diets generally achieve, but, again, it was only four weeks long. ”

    I can see some comparison here with the other low fat diets. However, the Ornish/Esselstyn diets have *10%* of the calories coming from fat, while that near-vegan diet had *25%* of the calories coming from fat. So, I don’t know what you think this shows. I would sincerely doubt that people who advocate the 10% fat diets think that they have shown a trend which always works. I mean, who would claim much of a difference between a 77% fat diet and a 76% percent diet, or a 30.00005% fat diet and a 30.00004% diet? The difference between 10% fat and 25% fat seems like a large difference to me.

    “While many people do well on a whole-foods only, very low-fat vegan diet, my experience has been that such diets can sometimes result in failure to thrive, while many people do thrive on a vegan diet that includes more fat and processed foods.”

    I can understand that whole-foods only, very-low fat vegan diets often concomitantly occur with people not thriving. But, it comes as a very, very difficult to define thriving, if it can ever get done. On top of this, how do we have the higher fat vegan diet as corresponding necessarily to the thriving for these people? People could have more psychological concerns on a low-fat diet, or feel more deprived since they have fewer food choices, or feel more stressed from having to more rigidly (in their perception) stick to a diet, or feel more alienated and alone from having to eat much differently from many of the people that they share meals with. So, psychological issues could come at play for such people.

  23. Matt Ball Says:

    Just to clarify:
    As Jack pointed out, I only care about what will help the most animals / prevent the most suffering. Period. Vegans can debate among themselves what they find to be the optimal diet for them, but this is almost entirely irrelevant for the animals.

    That is — the vast, vast, vast majority of people don’t make their food choices based on what is nutritionally optimal for them. They eat what they like, what is familiar and convenient, and what their social circle eats. And this won’t change — it is ingrained human nature. Instead of complaining about human nature, I focus on helping animals in whatever way has the greatest impact — appealing to another aspect of human nature, the revulsion at cruelty to animals.

    If we understand human nature, insisting that raw, or low-fat whole foods, etc. is “the healthiest” or the “ideal” is *actively harmful* to the animals — it cuts off the majority of people from ever considering taking steps that will help animals (as well as reinforcing the idea that we should only do what we think is in our best interest).

    I can understand wanting to optimize our own personal diet. I also understand wanting to believe and trumpet anything and everything that seems to make our veganism sound good.

    But if we want to do our best *to help animals*, then we must understand and reach out to people where they are, rather than scream at them from where we want them to be.

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