I have updated the article Disease Rates of Vegetarians and Vegans with the results from a report on vegetarian mortality rates that was released this week from the Adventist Health Study-2. I have reproduced the highlights below.

There was also an article on this study published in the Wall Street Journal, Vegetarians Live Longer Than Meat-Eaters, Study Finds.

In 2013, death rates for the first 5.8 years of Adventist Health Study-2 (AHS2) were released (1). When combining vegans, lacto-ovo-vegetarians, pesco-vegetarians, and semi-vegetarians into one group, vegetarians had a 12% lower risk of mortality. Vegans had a 15% lower risk of death, but it was not quite statistically significant.

The difference in mortality rates can mostly be explained by a lower incidence of cardiovascular disease among vegetarian men. Vegetarian women had about the same rates as non-vegetarian women. This is similar to the findings from the first Adventist Health Study. There was also a benefit for all vegetarians for death from renal and endocrine (mostly diabetes) disease.

The researchers said that having only 5.8 years of follow-up would bias the results towards not finding differences.

In comparing their findings to British vegetarians, they said:

“The lack of similar findings in British vegetarians remains interesting, and this difference deserves careful study. In both cohorts, the non-vegetarians are a relatively healthy reference group. In both studies, the nutrient profiles of vegetarians differ in important ways from those of non-vegetarians, with vegetarians (especially vegans) consuming less saturated fat and more fiber. It appears that British vegetarians and US Adventist vegetarians eat somewhat differently. For instance, the vegetarians in our study consume more fiber and vitamin C than those of the EPIC-Oxford cohort: mean dietary fiber in EPIC-Oxford vegans was 27.7 g/d in men and 26.4 g/d in women compared with 45.6 g/d in men and 47.3 g/d in women in AHS-2 vegans; mean vitamin C in EPIC-Oxford vegans was 125 mg/d in men and 143 mg/d in women compared with 224 mg/d in men and 250 mg/d in women in AHS-2 vegans. Individuals electing vegetarian diets for ethical or environmental reasons may eat differently from those who choose vegetarian diets primarily for reasons of perceived superiority for health promotion. We believe that perceived healthfulness of vegetarian diets may be a major motivator of Adventist vegetarians.”

Make sure you eat your fiber!

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1. Orlich MJ, Singh P, Sabaté J, et al. Vegetarian Dietary Patterns and Mortality in Adventist Health Study 2. JAMA Intern Med. 2013;():1-8. doi:10.1001/jamainternmed.2013.6473. | link

I was reading the latest issue of the Vegetarian Nutrition Dietetic Practice Group’s newsletter and saw that there had been a review article published in 2009 that listed data from the Adventist Health Study-2 that has not been reported elsewhere to my knowledge. It is cross-sectional data that showed vegans to have a 75% reduced risk of high blood pressure compared to non-vegetarians.

More details can be seen in Table 11 of Disease Markers of Vegetarians.

Because this is cross-sectional data, it does not mean a vegan diet reduces the risk of high blood pressure by 75%. It could be that people with high blood pressure are less likely to become vegan. And the results were not adjusted for smoking.

Prospective data from AHS-2 should help clarify how much is from the vegan diet in the coming years.

On March 28, I reported that the media had failed to pick up the story about a study associating a vegan diet with a lower risk of cataracts.

It took awhile, but a story surfaced on April 8, Vegetarian diet linked to lower cataract risk by Leigh Krietsch Boerner for Reuters.

Of course, they interview Dr. Jack Dodick, who was not part of the study, and who proceeds to discount the findings with a final comment of, “The moral of the story is, live life in moderation[.] A healthy active lifestyle with exercise might decrease the risk of cataracts.”

While one epidemiological study cannot prove beyond a shadow of a doubt that a vegan diet leads to less cataracts than a meat-eating diet, it was pretty funny how they took a study showing vegans had lower cataracts and turned it into the idea that moderation and exercise might reduce cataracts.

I love to hear good news about my good habits!

It’s funny – when bad news comes out about vegan diets, news articles are quickly written and disseminated, and I get to spend the day fielding emails about them. But where is the media when good news comes out about the vegan diet? I couldn’t find anything in the mainstream media.

That means I am probably the first to let you know about some good news just reported from EPIC-Oxford – Vegans were found to have a statistically significant, 40% reduced risk of cataracts.

The study was limited to those in EPIC-Oxford who were 40 years or older at recruitment. More details can be found in Disease Rates of Vegetarians and Vegans and in the abstract linked to below.

Reference:

Appleby PN, Allen NE, Key TJ. Diet, vegetarianism, and cataract risk. Am J
Clin Nutr. 2011 Mar 23. [Epub ahead of print] (Link)

As foods go, eggs are very high in cholesterol. Back when it was thought that eating cholesterol caused an increase in blood cholesterol, people with high cholesterol or heart disease were warned away from eggs. But then it was found that while some people’s cholesterol levels rise significantly from eating cholesterol, most people’s do not. So where does that leave eggs?

The findings have been somewhat mixed over the years. The most recent paper I found was a 2008 report from the Physicians’ Health Study (a trial to study low dose aspirin and beta-carotene’s effects on the primary prevention of cardiovascular disease and cancer among US male physicians) (1). They found the following when comparing consumption of 7+ eggs per week to less than 1 per week:

• No correlation with stroke or heart attacks
• A 23% increased risk of mortality (1.23, 1.11-1.36)
• A doubled risk of mortality among men with type 2 diabetes (2.01, 1.26-3.20)

These results were adjusted for age, body mass index, smoking, hypertension, vitamin intake, alcohol consumption, vegetable consumption, breakfast cereal consumption, physical activity, treatment group, atrial fibrillation, diabetes mellitus, hypercholesterolemia, and parental history of premature myocardial infarction.

The authors of this paper reviewed the previous literature on eggs and mortality:

“Limited and inconsistent data have been reported on the association between egg consumption and coronary heart disease. Among 514 Australian Aborigines, consumption of 2+ eggs per week was associated with a 2.6-fold increased risk of coronary heart disease in a prospective analysis (2). Mann et al. (3) reported a 2.7-fold increased risk of death with a higher egg consumption (6+ per week) among British subjects. In contrast, other large prospective cohorts with longer follow-ups did not observe any association between egg consumption and CHD or mortality (4-7).”

They discussed other research showing 7+ eggs increased the risk of heart disease in men and women with diabetes (5).

In conclusion, it appears that in comparison to less than one egg per week, eating 7+ egg per week could increase your risk of early death, especially if you have type 2 diabetes.

References

1. Djousse L, Gaziano JM. Egg consumption in relation to cardiovascular disease and mortality: the Physicians’ Health Study. Am J Clin Nutr. 2008 Apr;87(4):964-9.

2. Burke V, Zhao Y, Lee AH, et al. Health-related behaviours as predictors of mortality and morbidity in Australian Aborigines. Prev Med 2007;44:135–42. [PubMed: 17069878]

3. Mann JI, Appleby PN, Key TJ, Thorogood M. Dietary determinants of ischaemic heart disease in health conscious individuals. Heart 1997;78:450–5. [PubMed: 9415002]

4. Dawber TR, Nickerson RJ, Brand FN, Pool J. Eggs, serum cholesterol, and coronary heart disease. Am J Clin Nutr 1982;36:617–25. [PubMed: 7124663]

5. Hu FB, Stampfer MJ, Rimm EB, et al. A prospective study of egg consumption and risk of cardiovascular disease in men and women. JAMA 1999;281:1387–94. [PubMed: 10217054]

6. Nakamura Y, Okamura T, Tamaki S, et al. Egg consumption, serum cholesterol, and cause-specific and all-cause mortality: the National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in the Aged, 1980 (NIPPON DATA80). Am J Clin Nutr 2004;80:58–63. [PubMed: 15213028]

7. Nakamura Y, Iso H, Kita Y, et al. Egg consumption, serum total cholesterol concentrations and coronary heart disease incidence: Japan Public Health Center-based prospective study. Br J Nutr 2006;96:921–8. [PubMed: 17092383]

With everyone talking about the latest study linking red meat to an early death, we almost missed the results of a paper published on March 18 reporting the mortality rates of vegetarians compared to meat-eaters in EPIC-Oxford!

Unfortunately, the news is not as exciting as the red meat study. Vegetarians had the same rates of heart disease, stroke, and all causes as meat eaters.

The following groups had higher rates of an early death:

* Smokers
* Those with very high or very low body weight
* Those who did not drink alcohol

Moderate drinkers had lower rates of an early death.

More details can be read at VeganHealth.org.

Many people commented on yesterday’s post, Cancer and Vegetarianism, saying they wished the researchers had separated vegans from vegetarians.

In the paper, the authors stated, “…because of the small number of cancers among vegans, in this article the vegans are included in the vegetarian category.”

All we really know from that statement is that vegans didn’t have an unusually large number of cancers – so much that they would have reached some sort of statistical significance. It could also be that vegans have less cancer, or even a lot less cancer, but there was not enough data to create any sort of statistical significance.

I think it’s reasonable to hold out some hope that vegans will eventually be shown to have less cancer than meat-eaters or lacto-ovo vegetarians.

It could also be that except for in cases of very high amounts of animal products and very low amounts of fruits and vegetables, diet might not affect cancer that much. In the more moderate amounts of these foods, your body may be getting enough antioxidants, or have enough other mechanisms, to deal with carcinogens introduced by food.

I didn’t include a citation to the study in the original post:

Key TJ, Appleby PN, Spencer EA, Travis RC, Roddam AW, Allen NE. Cancer incidence in vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). Am J Clin Nutr 2009;89(suppl):1S-7S.

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On March 11, a study was released that measured the cancer incidence among British vegetarians. The study was part of European Prospective Investigation into Cancer and Nutrition–Oxford (EPIC-Oxford). I have updated the VeganHealth.org article Cancer, Vegetarianism, and Diet with the new findings.

(For this article to make sense you should take a minute to read this quick explanation of disease rate statistics if you are not already familiar with them.)

The participants in EPIC-Oxford were recruited from 1993 to 1999 and were followed through 2005. Previously, they had their overall cancer mortality through 2002 reported: Vegetarians had an 11% higher rate of death from cancer, but it was not statistically significant (1.11, .82 – 1.51).

The new findings reported the rates in two different ways:

1. Comparing vegetarians (including vegans) to all the meat-eaters.

2. Breaking the meat-eaters into two groups: regular and fish-eaters (no meat except fish).

The only statistically significant findings were:

• Vegetarians had higher rates of colorectal cancer than all meat-eaters (1.49, 1.09-2.03).
• Vegetarians had higher rates of colorectal cancer than the regular meat-eaters (1.39, 1.01-1.91).
• Fish-eaters had lower rates of all cancer than regular meat-eaters (.83, .71-.96).
• Vegetarians had borderline-significant, lower rates of all cancer than regular meat-eaters (.89, .80-1.00).

Rates for breast, prostate, lung, and ovarian cancer did not differ between groups.

When comparing this study population (including vegetarians and all meat eaters), their cancer rates were 28% lower than the overall population, their smoking rates were about half, and the meat-eating among the meat-eaters was “only moderate.” The authors hypothesized that, “Consumption of vegetables and fruit was higher among vegetarians than among nonvegetarians, but the differences were not large (< 20%). Thus, if high intakes of meat had an adverse effect and high intakes of fruit and vegetables had a beneficial effect, the relatively low meat intake and high fruit and vegetable intake of the nonvegetarians in this cohort could reduce the chance of observing lower cancer rates in the vegetarians than in the nonvegetarians." Although we consider cancer rates of 1.49 (1.09-2.03) and .83 (.71-.96) as being statistically significant, I'm starting to wonder how relevant measurements of this magnitude actually are. The studies on vegetarians that have shown statistical significance are pretty inconsistent, and most studies have not found statistical significance. On the other hand, if you look at how the smoking rates affected lung cancer in this study, heavy smokers had 87 times the amount of lung cancer (87.3, 37.8 – 202). Now that is statistical significance. Even light smokers (27.1, 11.1-66.4) and former smokers (6.54, 2.89-14.8) had many times the rates of lung cancer as nonsmokers.

If we include these latest findings of vegetarian cancer rates with the others that have been measured (listed in Cancer, Vegetarianism, and Diet), I think we start to get a fairly consistent picture:

Among vegetarians and people who eat moderate amounts of meat and don’t smoke, cancer rates are about the same, but lower than for people who do smoke and eat large amounts of meat. In other words, you can reduce your risk of cancer by not smoking, by limiting meat to moderate amounts (or abstaining entirely), and by eating plenty of fruits and vegetables. The evidence for stronger claims doesn’t seem to be there.

Similarly, the combined colon cancer rates to date seems to indicate that, in comparison to eating moderate amounts of meat, being vegetarian neither increases nor decreases your risk of colon cancer.