Veganism and Chronic Disease

Veganism seems to be the latest dietary fad to strike popular culture,

however we can trace the origins of the modern lifestyle back to the 17th
century and vegan philosophy has permeated culture since the beginning of
human history.
During the early 1800s multiple public voices pleaded the case for
both ethical veganism and veganism for health reasons, but the movement
did not establish a recognized community until 1834 when Temple School
and the Fruitlands commune were opened by an American named Amos
Bronson Alcott in 1834 and 1844 respectively (Francis, 2010). Similarly, the
movement solidified in England around the same time when James
Pierrepont Greaves opened the Concordium which was a vegan organization
on Ham Common in 1838 (Latham, 1999).
The word vegan was coined in 1944 by Donald Watson who was a
member of the Leicester Vegetarian Society (Cross, 1951). He was interested
in strict vegetarianism and decided to set up his own newsletter and came
up with vegan from the beginning and end of the word vegetarian (Cross,
1951). Traditionally, the word vegan refers to an ethical lifestyle of total
avoidance of animal products and the refusal to use animals as commodities.
This involves total abstinence from consuming all foods made with animal
products (no meat, fish, eggs, dairy or honey), avoidance of all
clothing/products using animal body parts (no down, leather, wool, suede or
silk) and boycotting companies that perform animal testing (often makeup
companies and cleaning product manufacturers).

There is a distinction in the vegan community between vegans and

people who eat a plant-based diet. The term vegan refers to the lifestyle of
avoiding animal products in all facets of life, whereas the term plant-based
diet refers to the avoidance of the consumption of meat, fish, eggs and
dairy. Plant-based diet patterns are generally used more for personal health
purposes. For the rest of this paper, I will refer to both plant-based diet and
vegan diet in reference to their consistent position on dietary choices, and
not regarding the ethical stance of each group.
According to the Dietary Guidelines Advisory Committees 2015 report
(which makes recommendations to the U.S. Department of Health and
Human Services), Americans (and similarly everyone in western populations)
should be eating a diet higher in plant based foods and lower in animal
based foods ("Dietary Guidelines Advisory Committee Reports", 2015). The
report conclusion was based on the health benefits of a vegan diet, the
environmental benefits of less factory farmed animals, fewer greenhouse gas
emissions, less energy, land, and water usage ("Dietary Guidelines Advisory
Committee Reports", 2015). Similarly, the American Dietetic Association
confirmed in 2009 that an appropriately planned vegan diet is healthful,
nutritionally adequate and may provide benefits in the prevention and
treatment of certain diseases (Position of the American Dietetic
Association: Vegetarian Diets, 2009).

Scientists and government health agencies alike confirm that vegan

diets can be completely nutritionally adequate if followed in an educated
manner; however, that doesnt necessarily mean a vegan diet is better at
fighting the gamut of prevalent and preventable diseases facing western
society today or does it?
Therefore, my research question is; Is a vegan diet as healthy as its
purported to be and can it help prevent or treat common chronic diseases
such as heart disease and type-2 diabetes?
I chose to investigate type-2 diabetes and heart disease because they
are major contributors to the high levels of chronic illness within our society,
and their incidences are steadily increasing. Heart disease is the number one
leading cause of death in America and Canada, while 1.7 million new people
in America were diagnosed with type-2 diabetes in 2012 alone (FastStats,
2016; Statistics About Diabetes, 2016). The tragedy of these statistics is
that both of these chronic diseases can generally be avoided with a healthy
diet and moderate exercise. Not surprisingly, when one of these diseases is
present there is a high potential of developing comorbidity of the two.
With that in mind, I was curious to see if plant-based diets actually
contributed to a decrease in heart disease, given that the main source of
saturated fats and cholesterol in the western diet are products of animal
origin. Since plant based diets are void of animal origin fats and richer in
mono-unsaturated and poly-unsaturated acids, it would make sense that a
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well-balanced plant-based diet could improve heart health. A study from

2015 investigated this relationship. The study was completed on two groups
of people in Poland and included 21 omnivores and 23 vegans between the
ages of 23 to 38. The vegans had to have been following a vegan diet for at
least ten months, and the groups were matched on relative age, exercise
levels, and smoking status (non-smoker) (Kuchta et al., 2015). Participants
were interviewed and asked to complete three 24 hour dietary recalls for the
researchers to estimate their daily consumption of specific nutrients.
Participants also agreed to blood collection for laboratory measurements.
This experiment was a cross-sectional study, meaning the participants did
not have multiple sessions or follow-up. The researchers wanted to compare
the serum lipid profile between vegans and omnivores to infer potential
fractions that may lead to atherosclerosis, specifically HDL. HDL is important
because it has been shown to be an anti-atherogenic protector due to its
nature of scavenging cholesterol deposits and bringing them to the liver for
excretion. The researchers found no significant difference between the two
groups in blood pressure, BMI or even in total fat intake, which was surprising
(Kuchta et al., 2015). Similarly, there were no significant differences between
vegans and omnivores in carotid intima-media thickening which has been
shown to be a predictive factor for CVD, and there were no significant
differences in HDL levels either (Kuchta et al., 2015). Vegans did show lower
concentrations of total cholesterol, LDL particles, and alipoprotein B, (vegan
range: 123-149 mg/dl, 68-91mg/dl, 0.45-0.61g/l and omnivore range: 1544

196 mg/dl, 87-133mg/dl and 0.61-0.83 g/l respectively) which suggest that
there could be a beneficial effect of a vegan diet for cardiovascular
protection (Kuchta et al., 2015). This is believed to be a factor of having
more total cholesterol making it more likely that the excess will be deposited
in places it shouldnt be, such as the arteries in the heart. In addition, more
LDL particles and alipoprotein B mean that the mechanism of cholesterol
depositing may be quicker, therefore leading to accelerated atherosclerosis.
The study by Kuchta et al. was interesting, however I wanted to find a
study that gave participants a dietary intervention and one that
encompassed a larger participant base. That led me to a paper published in
2014 by McDougall et al. This paper was a retrospective analysis of a
physician-supervised 10-day dietary intervention program from 2002 to
2011. The program involved the participants staying in a hotel for the
duration of the program while receiving diet counselling and a low fat
(<10%) plant-based diet plus light to moderate exercise (McDougall et al.,
2014).The analysis included 1615 participants. The results showed that
participants lost a median of 1.4 kg and had significant improvements in
total cholesterol, LDL cholesterol, systolic and diastolic blood pressure and
blood glucose over the ten day period (McDougall et al., 2014). However, it
was found that there was a decrease in HDL cholesterol as well and since
HDL is a protective factor against plaque build-up, this decrease was not a
positive result. The decrease in weight loss, total & LDL cholesterol and blood
pressure are all changes that help lower the risk of atherosclerosis
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(McDougall et al., 2014). Similarly, during the ten days, the majority of
participants were able to discontinue their use of antihypertensive
medication while consuming the study diet (McDougall et al., 2014). It was
also found that the patients who were the most overweight and who had the
most unfavorable biomarkers at baseline had the largest favorable responses
overall (McDougall et al., 2014). These results indicate positive prospects for
the effectiveness of a vegan diet in improving factors contributing to heart
health, but the study was only ten days, was a controlled study setting (not a
reflection of real life), and had no follow-up to determine the long term
effects. These quick improvements may be a positive factor in sparking
patient adherence to the program, but theres no way to determine if the
results would last long term in a participants natural environment. Also,
since this study did not include a control group, other factors such as the
required moderate exercise could be the cause of the positive change
recorded in heart health biomarkers (McDougall et al., 2014).
Unfortunately, the majority of studies done on veganism versus other
diets and chronic disease prevalence are cross-sectional cohort studies and
as a result, follow-up data is very hard to find. For this reason, I moved to a
different type of paper that would give additional insight into the possible
benefits of veganism on heart disease. A study published this year
completed a systematic review with meta-analysis of all vegan and
vegetarian observational studies. The meta-analysis included 108 articles,
and of those 108, there were 24 cross sectional studies on vegan diet and
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risk factors for chronic disease and 2 prospective cohort studies following
vegans and testing different clinical outcomes (Dinu et al., 2016). After
pooling the analyses, vegans showed significantly lower levels of the most
indicative risk factors for heart disease such as BMI and lipid levels when
compared to non-vegans (Dinu et al., 2016). However, the only other
significant association seen in the vegan diet was a lower incidence of
cancer, not with a reduction in ischemic heart disease as was seen in
vegetarians compared to non-vegetarians (Dinu et al., 2016). Obviously, this
study has some strengths and some limitations. This meta-analysis included
the studies done on the mainly vegetarian religious group of the Seventh
Adventists. This can be problematic because along with their restricted diet,
they also live more restricted lifestyles, which was not controlled for, and can
therefore affect their incidence of chronic disease in addition to diet. But the
strength of the conclusions is supported by the wide range of studies
sampled which could be considered to give a reasonable overall snapshot of
the possible effects of veganism on heart disease.
After investigating the relationship between veganism and heart
disease, I was curious about another prevalent, yet largely preventable
chronic disease affecting western populations, type-2 diabetes mellitus. I
specifically wanted to consider type-2 diabetes because a vegan diet
consists of mainly carbohydrates and is generally lower in protein and fat
when compared to an omnivore diet. I wondered if this increase in
carbohydrates would potentially increase the prevalence of type-2 diabetes
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or be harmful in people who already have the disease and were looking to
use a vegan diet to lessen their symptoms. Also, insulin resistance (a prestage of type-2 diabetes) is related to lipid accumulation within muscle cells,
so both type 2 diabetes and heart disease are inherently linked.
A randomized control trial carried out in 2006 examined this relationship. The
study recruited 99 participants all of whom were previously diagnosed type-2
diabetics and randomly assigned half of them to a vegan diet and half to the
diet recommended by the American Diabetes Association (ADA) for a period
of 22 weeks (Barnard et al., 2006). The vegan diet breakdown was 10% fat,
15% protein and 75% carbohydrates, while portion size, total energy intake
and carbohydrate intake were unrestricted. The ADA diet breakdown was 1520% protein, <7% saturated fat, 60-70% carbohydrate and MUFA and <200
mg/day of cholesterol, and animal origin food was not restricted (Barnard et
al., 2006). To isolate diet effects without confounding the results, participants
were asked not to change their exercise routine or frequency (Barnard et al.,
2006). Also, participants met with a dietitian once before the trial began, and
then once a week for the duration of the trial for nutritional information and
cooking instructions (Barnard et al. 2006).
The results indicated that both diets were associated with significant clinical
reductions in A1C levels (a measure of blood glucose), body weight (-5.8kg in
vegan group and -4.3kg in ADA group) and plasma lipid concentrations
(Barnard et al. 2006). In people who did not change their prescribed
medication for the duration of the trial, changes in A1C, weight, BMI, waist
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circumference, total cholesterol and LDL cholesterol were all significantly

greater in the vegan group (Barnard et al. 2006). In fact, the medication
stable vegan group reduced their A1C score by 1.23 percentage points,
which compares favorably with results seen in single-agent therapy oral
diabetic mediation (Barnard et al. 2006). The researchers suggested that this
A1C result is substantially affected by the weight reduction due to the vegan
diet. Another finding was that 43% of people on the low-fat vegan diet were
able to reduce their medication, compared with 26% of those on the ADA diet
(Barnard et al. 2006). Their conclusions of these results were that both
groups improved glycemic control over the 22 week trial; however the
positive changes were greater in the group following a vegan diet (Barnard et
al. 2006).
In order to test the longevity of these results, the same researchers repeated
this study 3 years later in 2009. The study design was identical; however the
study period was 74 weeks instead of the original 22 weeks. Likewise, this
study found significant weight loss in both vegan and ADA participant
groups, but the difference between the groups was not significant (Barnard
et al. 2009). Both groups also reported long-term weight reduction. When
medications were controlled for, as was seen with the previous 2006 study,
the vegan diet was still more effective than the ADA diet at controlling
glycemia and plasma lipid concentrations (Barnard et al. 2009). These study
results are more generalizable than most to real world settings because
meals were not provided for participants, visiting a dietician once a week can
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easily be done (it is not overly invasive) and the timelines are long enough to
show true results.
Upon consolidation, what can we extrapolate from all of this research?
It would appear that the vegan diet is effective in lowering the major blood
markers for heart disease, lowering body weight and lowering A1C levels in
type-2 diabetics. The lipid-lowering effect of vegan diets, attributable to their
absence of dietary cholesterol, low saturated fat content, and the specific
cholesterol reducing effect of soluble fiber and other plant constituents, is
particularly important given the high rates of heart disease in todays
western populations. Not to mention that cardiovascular complications are
the primary cause of morbidity and mortality in diabetes. Though the study
results did not show overwhelming evidence, they were significant enough to
indicate that patients suffering from chronic diseases such as type-2
diabetes and heart disease would benefit from consuming a vegan diet and
keeping a moderately active lifestyle.
Practically speaking though, when thinking about prescribing this diet
and looking at future direction and outcome will normal, everyday patients
even be open to this diet? Think about a 60 year old meat and potatoes
patient who hasnt heard of a vegan diet; will they be open to changing their
whole lifestyle? Its easy to think that if someones health situation is dire,
they will do anything to change, but that certainly isnt a treatment path that
everyone will be open to. Patients would have to learn a completely new

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culinary style, change the way they eat at home, with their families, and
when they go out to dinner. It could be particularly hard for someone living in
a home that practices the lifestyle which led them to the chronic disease in
the first place and where the other family members arent truly supportive or
helpful for the patient to adhere to the prescribed plan. If physicians and
dietitians were more active in educating patients about the benefits of a
vegan diet, perhaps it would become more main-stream as an effective
lifestyle for improving chronic disease and more people would be open to it.
Moreover, these studies focus on a very specific vegan diet which is not only
high in carbohydrates, but also low fat. This means the same health benefits
are not guaranteed (and are probably not realistic) to people who are eating
an unhealthy vegan diet. With the boom in veganism, comes a boom in
vegan junk food and vegan mock meats/frozen dinners/desserts. These food
items are not likely to produce the same effects seen from eating a healthy
vegan diet that is rich in low glycemic-index foods, fruits and vegetables, and
protein packed legumes. Another key deterrent with prescribing this diet is
the argument that a vegan diet is more expensive than the traditional
omnivorous diet eaten by most westerners, but this simply isnt true. Filling,
nutrient dense foods such as beans and legumes are very inexpensive, and
even more so when purchased in bulk. Additionally, these foods provide
more satiety for longer periods of time, so you have to eat less of them to
feel full. And even though fresh produce can be expensive in off seasons

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buying in season, buying local and buying frozen fruits and vegetables are all
cost cutting ways to be a healthy vegan without breaking the bank.
With all of this in mind, my take home message would be that eating a
vegan or plant based-diet that is low fat, high carbohydrate and full of whole
foods is healthy has been proven to be beneficial to people with chronic
diseases such as heart disease and type-2 diabetes. I believe the evidence
suggests recommending this diet to anyone with theses diseases, but
additionally to anyone simply looking for a lifestyle change to improve their
overall health.
In the future to further substantiate the current evidence, I would like
to see follow-up done in the vegan vs omnivore groups at 5 or ten year
intervals with a longitudinal study to see what percentage of each group
develops these chronic diseases. I would also like to see data from people
who are vegan from birth compared to a typical omnivore and follow them in
a longitudinal study. As there are currently no studies comparing the two
diets, that comparison could be a possible avenue to explore in the future
and give more insight into the factors causing these chronic diseases. A
randomized control trial of infants from birth being provided either a vegan
or an omnivore diet would be ideal, but also unethical, so we will have to
deal with cross-sectional and longitudinal studies to extrapolate health
differences between the two groups. It will be interesting to see if research in
this field experiences a boom in the coming years due to the increasing

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popularity of veganism in millennials and Generation Z. I also predict that

there will be a boom of veganism microbiome studies in the near future as
that is where a majority of dietary research has been heading since the late
2000s continuing into the present.

Bibliography
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