Nutrition
Plant-Based Protein: Are Pea and Soy Protein Isolates Harmful?
"Plant-Based Protein: Are Pea
and Soy Protein Isolates Harmful?" So, are these plant-based
burgers healthy or not? And the answer is…
compared to what? Eating is kind of a zero-sum game;
every food has an opportunity cost. I mean, every time we
put something in our mouth it’s a lost opportunity to put
something even healthier in our mouth. So, if you want to know
if something is healthy, you have to compare it to
what you’d be eating instead. So, for example,
are eggs healthy? Compared to a breakfast
link sausage? Yes! But compared to oatmeal?
Not even close. But look, sausage is considered
a group 1 carcinogen. In other words, we know consumption
of processed meat causes cancer. Each 50-gram serving a day,
that’s a single breakfast link, was linked to an 18% higher
risk of colorectal cancer. So, the risk of getting colorectal
cancer eating one link a day is about the same as the increased
risk of lung cancer you’d get breathing secondhand smoke all
day living with a smoking spouse. So, compared to sausage,
eggs are healthy, but compared to oatmeal,
eggs are not.
So, when it comes to Beyond Meat
and Impossible Burger, yeah, they may be better in
that they have less saturated fat, but, hey, you want
less saturated fat? Plant-based meat
alternatives are no match for unprocessed plant foods,
such as beans or lentils. And a bean burrito or lentil
soup could certainly fill the same culinary niche
as a lunchtime burger. But if you are going to
have some kind of burger, it’s easy to argue that the
plant-based versions are healthier. There is a sodium issue, and
it’s not that much, if any, lower, in saturated fat, since
they use coconut oil, which is basically just
as bad as animal fat; there’s not much
advantage on that front.
Though the total protein is
similar across the board, does this matter? Or Is there any
advantage to eating plant protein over animal protein?
Let’s look at the association between animal and plant
protein intake and mortality. In the twin Harvard cohorts,
following more than 100,000 men and women over decades, “…after
adjusting for other dietary and lifestyle factors, animal
protein intake was associated with a higher risk [of] mortality,
particularly [dying from cardiovascular disease], whereas
higher plant protein intake was associated with
[a] lower all-cause mortality”, meaning a lower risk of dying
from all causes put together. So, “replacing animal protein
of various origins with plant protein was associated
with lower mortality”, especially if you’re replacing
processed meat and egg protein, which were the worst. But when
it comes to living a longer life, plant protein sources beat out
each and every animal protein source. Not just better
than bacon and eggs, but better than burgers, chicken,
turkey, fish, and dairy protein. Together with other studies, these
“findings support the importance of protein sources for the
long-term health outcome and suggest plants constitute
a preferred protein source compared [to] animal foods.” Why? Well, unlike animal protein, plant
protein has not been associated with increased levels
of the cancer-promoting growth hormone IGF-1, for example.
Now, soy protein is similar
enough to animal protein that at high enough doses, like eating
two Impossible Burgers a day, you may bump your IGF-1. But the only reason we care
about IGF-1 is cancer risk, and if anything, higher soy
intake is associated with a decreased risk of cancer. For example, a recent systematic
review and meta-analysis found that soy protein intake was
associated with a decreased risk in breast cancer mortality;
we’re talking “a 12 percent reduction in breast cancer death
[associated with] each 5-gram-a-day increase in soy protein intake.” But the high soy groups
in these studies were on the order of
more than 16 grams a day, associated with a
whopping 62% lower risk of dying from breast cancer. More than 10 grams of soy
protein a day may be good, associated with cutting
breast cancer mortality risk nearly in half, and getting
more than 16 grams a day may be better, which is like
one Impossible Burger a day. But we simply don’t know what happens at consumption levels far above that.
Plant protein has also been
linked to lower blood pressure, reduced LDL cholesterol, and
improved insulin sensitivity. No wonder “substitution of
plant protein for animal protein has been related to a lower incidence of cardiovascular disease
and type 2 diabetes.” Indeed, 21 different studies following
nearly a half million people, and “high… animal protein
intakes [were] associated with an increased risk of [type 2 diabetes], whereas [even just] moderate
plant protein intake is associated with a decreased
risk of [type 2 diabetes].” OK, but these were just
observational studies. They all tried to control for other
dietary and lifestyle factors, but you can’t prove cause-and-effect,
until…you put it to the test. The “Effect of Replacing Animal
Protein with Plant Protein on [blood sugar] Control in
Diabetes: A Systematic Review and Meta-Analysis of
Randomized Controlled Trials.” Even just switching out about
a third of your protein from animal to plant sources
yielded significant improvements in long-term blood sugar control,
and fasting blood sugars, and insulin. You can do the same thing
looking at cholesterol. Here’s a systematic review and
meta-analysis of randomized controlled trials on the effect
of plant protein on blood fats.
And indeed, swapping in plant
protein for animal protein decreases LDL cholesterol,
and this benefit occurs whether you start out at high
cholesterol or low cholesterol, whether you’re swapping out
dairy, or meat, and eggs, and whether you’re swapping in
soy or other plant proteins. We’ve known about the beneficial
effects of soy on cholesterol going back nearly 40 years, but
other sources of plant protein can do it as well. Yeah, but
we’re not swapping beans for beef. These products are mostly
just isolated plant proteins, mostly pea protein isolate
in the case of Beyond, and concentrated soy protein
in the case of Impossible.
If you just isolate out
the plant proteins themselves are you still going to get benefits? Yes, surprisingly. Check it out. Interestingly, the researchers
concluded, that they did not find a significant difference between
protein isolate products and whole food sources, “suggesting
that the cholesterol-lowering effects are at least, in part, attributable to the plant protein
itself rather than just the associated nutrients.” So, it’s not just because
plant protein travels with fiber or less saturated fat. Plant proteins break down
into a different distribution of amino acids; and so, it’s
like if you give people arginine, an amino acid found
more in plant foods, that alone can bring
down people’s cholesterol. And even plant protein concentrates
used in these products aren’t pure protein, retaining
a few active compounds such as phytosterols and antioxidants, which also can have beneficial effects..
Video Transcript – As found on YouTube
Plant-Based Diet for Treating and Reversing Stage 3 Kidney Disease
"Plant-Based Diet for Treating and
Reversing Stage 3 Kidney Disease" Is it possible to ameliorate
chronic kidney disease using a whole food,
plant-based diet? In my last video
on kidney disease, I talked about how randomizing
people to cut just around 10 grams of protein from their
daily diet could cut their risk of dialysis and death
by a whopping 77%. That was cutting protein
across the board. But while animal-based
protein ingestion — meat, dairy, and egg white
protein ingestion — promotes an acidic environment
in the kidneys, inflammation, and stresses the kidneys to what's
called hyperfiltration mode, plant-based protein can be
alkaline-producing and anti-inflammatory and contain
kidney-protective properties. So, what if you have kidney patients
eat a plant-dominant low-protein diet, abbreviated adorably as PLADO,
I guess for plant-dominant. If you fashion up a plant-based diet
index score where you get points for healthy plant foods and get points deducted
for eating animal foods, those with serious kidney disease
with higher scores were found to have lower systemic inflammation.
But does that actually translate
into living a longer life? Apparently so. Even a 10% increase in the
proportion of plant-based protein was associated with a significant
reduction in all-cause mortality. Even just eating more servings of
fruits and vegetables, like two a day compared to two a week,
is linked to living longer. Without fully functioning kidneys, there are concerns about
phosphorus and potassium overload, though, on a plant-based diet. But the phosphorus in plant-based
foods is not as much of a problem as the phosphorus additives
in processed and animal foods. And the risk of potassium overload
from plant-based diets appears overstated and not supported
by the evidence.
But you don't know about
ameliorating chronic kidney disease using a whole food, plant-based
diet until you put it to the test. Here's a case report of a 69-year-old
man with type 2 diabetes, high blood pressure, and
stage 3 chronic kidney disease, resulting in elevated phosphorus
and potassium in the blood, Interested in changing his diet
to improve his medical condition. That's my kind of patient! He was on 12 different medications,
eating a diet that may actually be slightly better than
the average American: some whole grains and beans, but then his doctor advised to try
eating whole food, plant-based.
So, oatmeal with fruit and flax,
beans and greens, whole wheat spaghetti and
veggies, fruit as snacks. Counselled to eat as much as he
wanted from whole healthy foods; no carb counting, no calorie counting,
no portion size restriction — improving the quality of food rather
than restricting the quantity of food. He adopted the whole food,
plant-based diet, packed with carbs, yet rapidly reduced his insulin
requirements by more than 50%, and subsequently saw
improvements in weight, blood pressure,
and cholesterol. Because eating healthy
can have such a rapid effect on improving your body's
insulin sensitivity, immediate adjustments
in insulin dosing were made. Within four days, his insulin dose
was able to be reduced from roughly 210 units of insulin
a day down to 70 units daily, and an oral blood-sugar lowering
medication had to be stopped due to rapidly improving blood sugar. He also was able to stop his
carvedilol, the hydrochlorothiazide, amlodipine, sitagliptin
within the first two months due to improving blood pressure
and blood sugars.
His insulin dose was
steadily titrated downward. His pravastatin dose was cut in half,
and he lost about 50 pounds. Okay, so what happened
to his stage 3 kidney failure? He was no longer in
stage 3 kidney failure! Doctors watching this will understand
what all these numbers mean. Here's a graph of his GFR, which
is a measure of kidney function, declining for years before shooting
up after he started eating healthy. He experienced an increase
in estimated GFR of 73%, suggesting that the improvement
in estimated kidney function was greater than what would be
expected from weight loss alone.
For example, lose about 60 pounds
from bariatric surgery, and you only get
about a 12 to 15% boost. Bottom line: for individuals
with chronic kidney disease, especially those with obesity,
hypertension, or diabetes, a strict, all-you-care-to-eat
whole food, plant-based diet may confer significant benefit. I mean, apart from the
kidney-specific outcomes, overall mortality is significantly
lower among kidney patients who eat more plants. And that's critical because most
kidney patients don't even make it to dialysis because they die first, most often from
cardiovascular disease.
Let's hear from the patient. "At the outset, it seemed like
this was going to be a difficult and restrictive way to eat, but I began feeling different
almost immediately and we had to decrease
my insulin after ONE day. It seemed like almost overnight I had
more energy than I'd had in years. Weight I'd been trying to lose for
a decade began dropping off. As the weight came off, I felt lighter,
and more able to move my body again. This lifestyle change has been
the greatest gift I've ever received. I am off most of my medications,
I've lost over 70 pounds, and I've regained control
over my health. I feel empowered
by this lifestyle change, and I finally feel like I'm
in charge of my health, not just an unlucky victim shuffling
from one specialist to the next.
My only regret was that
I didn't know about this sooner.".
Video Transcript – As found on YouTube
Do Vegans Have Lower Bone Mineral Density and Higher Risk of Osteoporosis?
How does a vegan or vegetarian
diet affect bone density, and what other factors contribute?
Watch the video to find out. "Do Vegans Have Lower Bone Mineral
Density and Higher Risk of Osteoporosis?" Osteoporosis is estimated to affect
200 million people worldwide. Literally meaning "porous bone ,"
osteoporosis is a disease characterized by reduced bone
formation, excessive bone loss, or a combination of both,
leading to bone fragility and increased risk of fractures. And bone mineral density is the
most robust and consistent predictor of osteoporotic fracture. What can
we eat to boost our bone density? Well, we know that increased
consumption of plant foods is associated with increased
bone mineral density. There's an extensive range of
micronutrients and phytochemicals packaged within plants that can be
powerful promoters of bone health, so healthcare professionals
should be encouraged to advise the increased
consumption of plant-based foods, particularly in mid-life, irrespective of the clients
underlying dietary pattern, meaning no matter how
much meat or junk they eat, adding more healthy plant
foods may help prevent the development of osteoporosis. On the other hand, a more
animal-source nutrient pattern has been associated with
a higher risk of fractures, suggesting that a more animal-based
diet is related to bone fragility.
So one would expect less osteoporosis
in those eating plant-based diets, but you don't know
until you put it to the test. "The Incidence of osteoporosis
in vegetarians and omnivores ," the first study published
nearly 50 years ago, and the density of the bones
that were measured was significantly greater in the
vegetarians than the omnivores. In fact, the average bone densities
of the vegetarians in their '70s was greater than the densities
of the meat eaters in their '50s. Bottom line, these results suggest
there's less likelihood of vegetarians developing osteoporosis in old age. Turns out, though, that
the researchers screwed up. DEXA scanning, which
is what we use now, didn't come online until the 1980s. So the researchers were
just using regular x-rays and they confused the readings,
such that darker bones on the x-ray got a higher score, but that
actually means less bone, so their conclusion should
have been the opposite of what they claimed.
So vegetarians had
worse bone mineral density. Fast-forward about 40 years,
by which time nine studies had been done on thousands
of individuals, and all in all, the results suggest that vegetarian
diets, particularly vegan diets, are associated with lower
bone mineral density, but the magnitude of the association
is clinically insignificant, meaning the difference was so small as to not
really matter out in the real world, reinforcing the fact
that vegetarian diets have no clinically detrimental
effect on bone health. And it is important to note
that the findings of lower bone mineral density didn't fully
control for key confounding factors, such as for differences
in body weight. We know that people who are
obese have stronger bones. Why? Because they're weight lifting 50 pounds
all day, every day, and maybe 100 pounds. If you walked around with a
100-pound backpack every day, your bones would grow stronger, too.
That's how you build strong
bones: weight-bearing exercise. So people who weigh
more have denser bones. And vegetarians, and especially
vegans, have such low rates of obesity that no wonder, on average they
would have lower bone density. The researchers didn't
take weight into account, but if the difference they found isn't
even clinically significant, who cares? As of 2009, the answer to the question, "Is vegetarianism a serious risk
factor for osteoporotic fracture?" the answer was no. Vegetarianism
is not a serious risk factor. By 2018, the latest meta-analysis
on veganism, vegetarianism, and bone mineral density,
was up to 20 studies, involving tens of thousands
of participants, and, again, lower bone mineral density
was found in studies of vegetarians and vegans
compared to meat eaters. The researchers conclude that
vegetarian and vegan diets need to be appropriately
planned to preserve their bones. But wait, did they account
for the obesity thing? No, they did not. They just used what are
called crude risk ratios, meaning no adjustments for
confounding factors like weight, so they didn't control for things
like age, smoking, obesity, exercise, and so their results
are really uninterpretable.
But no one had gone through
the trouble of going back through all those studies and making
the proper adjustments until now. The title gives it away: "Differences
in Bone Mineral Density between Vegetarians and Nonvegetarians
Become Marginal when Accounting for Differences
in Body Size Factors." Yes, bone mineral density values
were significantly lower among vegetarians
than among nonvegetarians, just like is the case
with nearly every study on bone mineral density
and excess body weight. But forget clinical significance;
these differences even lost statistical significance
upon adjustment for body size factors, suggesting that lower
bone mass among vegetarians is in larger parts explained by their
lower BMI and waist circumference. Thus, it's not so much the composition
of the diets of vegetarians and vegans as much as it is the fact that
they become so much slimmer.
Now a small but statistically
significant difference remained for total lower spine density,
a difference of 0.03. This was dismissed as having little
clinical relevance, but is that true? If you look at the reproducibility
of bone mineral density measurements in daily medical
practice, you can see how if you do repeat tests back-to-back,
there's some scatter in the measurements, and
so a significant difference really has to be more
than the inherent variation. And indeed, expressed as
the smallest detected difference, you really need a bone
mineral density disparity of at least 0.05 at the spine before it can be considered
a significant change, and so indeed, there does appear
to be little clinical relevance. However, even if vegetarians
and vegans basically have the same bone density
at the same weight, everyone who is skinny
is at risk. Low BMI is a risk factor for
fractures, so all persons in a low body weight category
consuming any kind of diet should be monitored
for osteoporosis.
Video Transcript – As found on YouTube
Update on Vegetarian Stroke Risk
"Update on Vegetarian Stroke Risk" Healthy plant-based diets
have been associated with lower all-cause mortality,
up to a 34 percent lower risk of death from any cause over an average
of an eight-year period, just being in the top
versus bottom quarter of healthy plant-based consumption. If sustained, that could translate
into more than four extra years of life. A meta-analysis of a dozen studies
prospectively following more than a half a million people
for up to 25 years similarly found significantly lower
heart disease and overall death rates among those eating more plant-based. No surprise,
a systematic review concluded since plant-based diets
may arrest or even reverse our number one killer—
cardiovascular disease. Those eating wholly plant-based
tend to be significantly slimmer with lower LDL cholesterol, triglycerides,
blood sugars, blood pressures, significantly less inflammation,
and less carotid artery wall thickening (a sign of atherosclerosis measured
via ultrasound in the neck), as good as what you see
in endurance athletes who’ve run an average of 50,000 miles,
which is like twice around the globe.
And changes in risk factors
can happen fast, as evidenced by results
from one to three-week ad libitum (eat-all-you-want)
plant-based “kickstart” programs. For example, the results from the first
few hundred participants of the at-home
15-day Jumpstart program created by the nonprofit Rochester
Lifestyle Medicine Institute were recently published. On a whole food plant-based diet,
obese patients lost an average of 7 pounds without controlling portions
or counting calories or carbs. Diabetics saw their fasting blood sugars
drop 28 points. Those with LDL cholesterol
over 100 experienced a 33-point drop (comparable to some statin drugs), and hypertensive individuals
experienced a 17-point drop in systolic blood pressure,
which is better than drugs, and all within just two weeks! Studies dating back nearly 40 years
show those eating meat-free diets also have improved blood “rheology,”
meaning fluidity or flowability, which may play a role
in cardiovascular protection. Subsequent interventional studies putting
the cross-sectional findings to the test, show that switching people
to a plant-based diet can improve rheology measurements
within three to six weeks. But might the blood of vegetarians flow
a bit too well, though? In 2019, a study of thousands
of British vegetarians called EPIC-Oxford found that they were at higher risk
of hemorrhagic (bleeding) stroke.
They had such a lower risk
of heart disease that they still had less
cardiovascular disease overall (and a half dozen studies show no overall
increased risk of stroke mortality), but why the greater stroke incidence? I suggested it might be vitamin B12
deficiency, which can lead to excessive levels
of a stroke- associated metabolite called homocysteine
which is normally detoxified by B12. This is thought to be the reason
why vitamin B12 supplementation can improve artery function
of vegetarians. Vitamin B12 supplements
or fortified foods are critical for anyone eating plant-based,
but my 12-part video series on vegetarians and stroke risk
triggered by the 2019 publication was all in vain. It turns out vegetarians don’t appear
to have higher stroke risk after all.
In response to the EPIC-Oxford results,
researchers around the world scrambled to see if the findings
were merely a fluke. In 2020, UK Biobank, a massive study
following more than 400,000 volunteers, confirmed that vegetarians
had lower cardiovascular disease rates and importantly,
no increased incidence of stroke. And two studies from Taiwan
found vegetarians had significantly
lower risk of stroke. Following tens of thousands
of vegetarians for up to ten years, they only had about half the stroke risk
compared to nonvegetarians (including a 64 percent lower risk
specifically of hemorrhagic stroke). By 2021, Harvard researchers
had finished and published their analyses of the 200,000+ participants
of the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals
Follow-Up Study. They too found no increased stroke risk
for vegetarians and indeed a decreased risk of stroke among those eating
healthy plant-based diets.
A meta-analysis putting all the studies
together found that indeed the EPIC-Oxford data appeared
to be a fluke after all, finding, if anything, a lower risk
of stroke in a subgroup analysis. A 2022 systematic review
concluded that vegetarian and low-animal product diets are associated with a significantly
lower risk of bleeding strokes, a significantly lower risk
of clotting strokes, and a significantly lower risk
of total strokes across the board..
Video Transcript – As found on YouTube
Should Vegetarians Take Creatine to Normalize Homocysteine?
"Should Vegetarians Take Creatine
to Normalize Homocysteine?" Almost universally, research findings
show a poor vitamin B12 status among vegetarians because they're
not taking vitamin B12 supplements like they should. And this results in
an elevation of homocysteine levels that may explain why vegetarians
were recently found to have higher rates of stroke. Of course, plant-based eating is just
one of many ways to get B12 deficient. I mean, even laughing gas can
do it, in as short as two days, thanks to the recreational use
of whipped cream canister gas. That's something new I learned today.
Anyways, if you do eat plant-based, giving vegetarians and vegans
even as little as 50 micrograms once a day of cyanocobalamin, the
recommended, most stable form of vitamin B12 supplement,
and their homocysteine levels start up in the elevated
zone, and within 1 to 2 months their homocysteines normalize right
down into the safe zone under 10.
Or just 2000 micrograms of
cyanocobalamin once a week, and you get the same beautiful
result, but not always. In this study even 500 micrograms
a day, either as a sublingual chewable or swallowable regular B12 supplement, didn't normalize homocysteine
within a month. Now, presumably if they had kept it up, their levels
would have continued to fall like in the other study. But if you're
plant-based and have been taking your B12 and your homocysteine levels
are still too high, meaning above 10, is there anything else you can do? Now, inadequate folate intake
can also increase homocysteine, but folate comes from
the same root as foliage. It's found in leaves, concentrated
in greens, as well as beans. But if you're eating beans and
greens, taking your B12, and your homocysteine level is still
too high, then I'd suggest trying, as an experiment, taking
one gram of creatine a day and getting your homocysteine levels
retested in a month to see if it helped.
Creatine is a compound formed
naturally in the human body that is primarily involved in energy
production in our muscles and brain. It's also naturally formed in the
bodies of many animals we eat. And so when we eat their
muscles, we also can take in some creatine through our diet. We need about two grams a day,
so those who eat meat may get like one gram from their diet, and
their body makes the rest from scratch. There are rare birth defects where
you're born without the ability to make it, in which case you have to get it
from your diet, but otherwise our bodies make as
much as we need to maintain normal
concentrations in our muscles. When you cut out meat, the
amount of creatine floating around in your bloodstream goes down, but the
amount in your brain remains the same, showing dietary creatine doesn't
influence the levels of brain creatine, because your brain just makes
all the creatine you need. The level in vegetarian muscles is
lower, but that doesn't seem to affect performance, as both vegetarians
and meat-eaters respond to creatine supplementation with similar
increases in muscle power output.
And if vegetarian muscle
creatine was insufficient, then presumably they would
have seen an even bigger boost. So basically, all that happens
when you eat meat is that your body just doesn't
have to make as much. What does this all have
to do with homocysteine? Okay, in the process of making creatine,
your body produces homocysteine as a waste product. Now
normally this isn't a problem because your body
has two ways to detoxify it using vitamin B6 or using a
combination of vitamins B12 and folate. Now B6 is found in both plant and
animal foods; it's rare to be deficient. But B12 is mainly in animal
foods, and so can be too low in those eating plant-based who don't
supplement or eat B12 fortified foods. And folate is concentrated in plant
foods, so can be low in those who don't regularly eat greens or
beans or folic-acid fortified grains, and without that escape valve
homocysteine levels can get too high.
If, however, you're eating a healthy
plant-based diet and taking your B12 supplement, your homocysteine levels
should be fine, but what if they're not? One might predict that if you started
taking creatine supplements, the level of homocysteine might go
down since you're not going to have to be making so much of it from scratch,
producing homocysteine as a by-product. But you don't know until you put it
to the test, which we'll cover next.
Video Transcript – As found on YouTube
Plant-Based Diet for Treating and Reversing Stage 3 Kidney Disease
"Plant-Based Diet for Treating and
Reversing Stage 3 Kidney Disease" Is it possible to ameliorate
chronic kidney disease using a whole food,
plant-based diet? In my last video
on kidney disease, I talked about how randomizing
people to cut just around 10 grams of protein from their
daily diet could cut their risk of dialysis and death
by a whopping 77%. That was cutting protein
across the board. But while animal-based
protein ingestion — meat, dairy, and egg white
protein ingestion — promotes an acidic environment
in the kidneys, inflammation, and stresses the kidneys to what's
called hyperfiltration mode, plant-based protein can be
alkaline-producing and anti-inflammatory and contain
kidney-protective properties.
So, what if you have kidney patients
eat a plant-dominant low-protein diet, abbreviated adorably as PLADO,
I guess for plant-dominant. If you fashion up a plant-based diet
index score where you get points for healthy plant foods and get points deducted
for eating animal foods, those with serious kidney disease
with higher scores were found to have lower systemic inflammation. But does that actually translate
into living a longer life? Apparently so.
Even a 10% increase in the
proportion of plant-based protein was associated with a significant
reduction in all-cause mortality. Even just eating more servings of
fruits and vegetables, like two a day compared to two a week,
is linked to living longer. Without fully functioning kidneys, there are concerns about
phosphorus and potassium overload, though, on a plant-based diet. But the phosphorus in plant-based
foods is not as much of a problem as the phosphorus additives
in processed and animal foods. And the risk of potassium overload
from plant-based diets appears overstated and not supported
by the evidence. But you don't know about
ameliorating chronic kidney disease using a whole food, plant-based
diet until you put it to the test. Here's a case report of a 69-year-old
man with type 2 diabetes, high blood pressure, and
stage 3 chronic kidney disease, resulting in elevated phosphorus
and potassium in the blood, Interested in changing his diet
to improve his medical condition. That's my kind of patient! He was on 12 different medications,
eating a diet that may actually be slightly better than
the average American: some whole grains and beans, but then his doctor advised to try
eating whole food, plant-based.
So, oatmeal with fruit and flax,
beans and greens, whole wheat spaghetti and
veggies, fruit as snacks. Counselled to eat as much as he
wanted from whole healthy foods; no carb counting, no calorie counting,
no portion size restriction — improving the quality of food rather
than restricting the quantity of food. He adopted the whole food,
plant-based diet, packed with carbs, yet rapidly reduced his insulin
requirements by more than 50%, and subsequently saw
improvements in weight, blood pressure,
and cholesterol.
Because eating healthy
can have such a rapid effect on improving your body's
insulin sensitivity, immediate adjustments
in insulin dosing were made. Within four days, his insulin dose
was able to be reduced from roughly 210 units of insulin
a day down to 70 units daily, and an oral blood-sugar lowering
medication had to be stopped due to rapidly improving blood sugar. He also was able to stop his
carvedilol, the hydrochlorothiazide, amlodipine, sitagliptin
within the first two months due to improving blood pressure
and blood sugars.
His insulin dose was
steadily titrated downward. His pravastatin dose was cut in half,
and he lost about 50 pounds. Okay, so what happened
to his stage 3 kidney failure? He was no longer in
stage 3 kidney failure! Doctors watching this will understand
what all these numbers mean. Here's a graph of his GFR, which
is a measure of kidney function, declining for years before shooting
up after he started eating healthy. He experienced an increase
in estimated GFR of 73%, suggesting that the improvement
in estimated kidney function was greater than what would be
expected from weight loss alone. For example, lose about 60 pounds
from bariatric surgery, and you only get
about a 12 to 15% boost. Bottom line: for individuals
with chronic kidney disease, especially those with obesity,
hypertension, or diabetes, a strict, all-you-care-to-eat
whole food, plant-based diet may confer significant benefit. I mean, apart from the
kidney-specific outcomes, overall mortality is significantly
lower among kidney patients who eat more plants. And that's critical because most
kidney patients don't even make it to dialysis because they die first, most often from
cardiovascular disease.
Let's hear from the patient. "At the outset, it seemed like
this was going to be a difficult and restrictive way to eat, but I began feeling different
almost immediately and we had to decrease
my insulin after ONE day. It seemed like almost overnight I had
more energy than I'd had in years. Weight I'd been trying to lose for
a decade began dropping off. As the weight came off, I felt lighter,
and more able to move my body again.
This lifestyle change has been
the greatest gift I've ever received. I am off most of my medications,
I've lost over 70 pounds, and I've regained control
over my health. I feel empowered
by this lifestyle change, and I finally feel like I'm
in charge of my health, not just an unlucky victim shuffling
from one specialist to the next. My only regret was that
I didn't know about this sooner."
Video Transcript – As found on YouTube
Do Vegetarians Really Have Higher Stroke Risk?
"Do Vegetarians Really
Have Higher Stroke Risk?" When ranked in order of importance,
among the interventions available to prevent stroke, the three
most important are probably diet, smoking cessation, and
blood pressure control. Most of us are doing pretty
good on smoking these days, less than half of us are exercising
enough, but according to the American Heart Association only 1
in a thousand Americans are eating a healthy diet, and fewer than 1 in 10
are even eating a moderately healthy diet. Why does it matter? Because diet is an important
part of stroke prevention. Reducing sodium intake, avoiding egg
yolks, limiting the intake of meat, and increasing the intake of whole grains,
fruits, vegetables and lentils. Like the sugar industry, the meat
and egg industries spend hundreds of millions of dollars on propaganda,
unfortunately with great success. I was excited to check out Box number 1,
and was then honored, when I did. The strongest evidence for stroke
protection is for increasing fruit and vegetable intake, with
more uncertainty regarding the role of whole grains, animal products, and
dietary patterns such as vegetarian diets. I mean one would expect they’d do great.
Meta-analyses have found that
vegetarian diets lower cholesterol and blood pressure, and enhance
weight loss, and blood sugar control, and vegan diets may work even better.
So, all the key biomarkers are going in the right direction, but
you may be surprised to learn that there hadn’t ever been any
studies on the incidence of stroke in vegetarians and vegans… until, now. And if you think that's surprising,
wait until you hear the results.
The risks of heart disease
and stroke in meat eaters, fish eaters, and vegetarians
over 18 years of follow-up. Yes, less heart disease
among vegetarians (by which they mean vegetarians and vegans combined) no surprise—been there, done
that, but more stroke. An understandable knee-jerk
reaction might be “Wait a second, who did this study?” But this is EPIC-Oxford, world-class
researchers whose conflicts of interest may be more likely to read “I was
a member of the Vegan Society.” What about overadjustment? If you crunch the numbers
over a ten-year-period they found 15 strokes for every thousand
meat-eaters compared to only 9 strokes for every thousand
vegetarians and vegans. Wait, so how can they say there
were more strokes in the vegetarians? This was after adjusting
for a variety of factors. For example, the vegetarians
were less likely to smoke; so, you want to cancel that
out by adjusting for smoking, so that you can effectively
compare the stroke risk of nonsmoking vegetarians
to nonsmoking meat-eaters.
If you want to know how a vegetarian
diet itself affects stroke rates, you want to cancel out these
non-diet-related factors. Sometimes, though, you can overadjust. The sugar industry does it all the time. This is how it works. Imagine you just got a grant
from the soda industry to study the effect of soda on
the childhood obesity epidemic. What could you possibly do after
putting all the studies together to arrive at the conclusion that
there was near zero effect of sugary beverage consumption
on body weight? Well, since you know that
drinking liquid candy can lead to excess calories that can lead
to obesity, if you control for calories, if you control for a factor
that’s in the causal chain, effectively only comparing soda
drinkers who take in the same number of calories as non-soda-drinkers
then you could undermine the soda-to-obesity effect, and
that’s exactly what they did.
That introduces overadjustment bias. Instead of just controlling
for some unrelated factor, you control for an intermediate
variable on the cause-and-effect pathway
between exposure and outcome. Overadjustment is how meat-and-
dairy industry funded researchers have been accused of obscuring
the true association between saturated fat and cardiovascular disease. We know that saturated
fat increases cholesterol which increases heart disease risk. Therefore, if you control for
cholesterol, effectively only comparing saturated fat eaters with the
same cholesterol levels as non-saturated-fat eaters,
you see how you could undermine the saturated fat-to-heart disease effect. Now let’s get back to this. Since vegetarian eating
lowers blood pressure, and a lowered blood pressure
leads to less stroke, controlling for blood pressure would be an
overadjustment, effectively only comparing vegetarians to meat-eaters
with the same low blood pressure. That’s not fair, since that’s one
of the benefits of vegetarian eating, not some unrelated factor like smoking; and so, it would undermine
the afforded protection. So, did they do that? No. They only adjusted for unrelated factors, like education, and socioeconomic class,
and smoking, and exercise, and alcohol. That’s what you want. You want to tease out the effects of a vegetarian diet on stroke risk…
you want to try to equalize everything else to tease out the
effects of just the dietary choice.
And since, for example, meat eaters
in the study were on average 10 years older than the vegetarians,
you can totally see how when you adjust for that
vegetarians could come out worse. Since stroke risk can increase
exponentially with age, you can see how having 9 strokes among
a thousand vegetarians in their 40s could be worse than 15 strokes among
a thousand meat-eaters in their 50s. The fact that vegetarians had
greater stroke risk despite their lower blood pressure suggests
there’s something about meat-free diets that so increases stroke risk it’s enough
to cancel out the blood pressure benefits, but even if that’s true you
still would want to eat that way. Stroke is our 5th leading cause of
death, whereas heart disease is #1. So, yes, in this study there
were this many more cases of stroke in vegetarians, but there were this many
fewer cases of heart disease, but if there is something increasing
stroke risk in vegetarians it would be nice to know what
it is in hopes of figuring out how to get the best of both worlds.
This is the question we'll turn to, next..
Video Transcript – As found on YouTube
Update on Vegetarian Stroke Risk
"Update on Vegetarian Stroke Risk" Healthy plant-based diets
have been associated with lower all-cause mortality,
up to a 34 percent lower risk of death from any cause over an average
of an eight-year period, just being in the top
versus bottom quarter of healthy plant-based consumption. If sustained, that could translate
into more than four extra years of life. A meta-analysis of a dozen studies
prospectively following more than a half a million people
for up to 25 years similarly found significantly lower
heart disease and overall death rates among those eating more plant-based. No surprise,
a systematic review concluded since plant-based diets
may arrest or even reverse our number one killer—
cardiovascular disease. Those eating wholly plant-based
tend to be significantly slimmer with lower LDL cholesterol, triglycerides,
blood sugars, blood pressures, significantly less inflammation,
and less carotid artery wall thickening (a sign of atherosclerosis measured
via ultrasound in the neck), as good as what you see
in endurance athletes who’ve run an average of 50,000 miles,
which is like twice around the globe.
And changes in risk factors
can happen fast, as evidenced by results
from one to three-week ad libitum (eat-all-you-want)
plant-based “kickstart” programs. For example, the results from the first
few hundred participants of the at-home
15-day Jumpstart program created by the nonprofit Rochester
Lifestyle Medicine Institute were recently published. On a whole food plant-based diet,
obese patients lost an average of 7 pounds without controlling portions
or counting calories or carbs. Diabetics saw their fasting blood sugars
drop 28 points. Those with LDL cholesterol
over 100 experienced a 33-point drop (comparable to some statin drugs), and hypertensive individuals
experienced a 17-point drop in systolic blood pressure,
which is better than drugs, and all within just two weeks! Studies dating back nearly 40 years
show those eating meat-free diets also have improved blood “rheology,”
meaning fluidity or flowability, which may play a role
in cardiovascular protection. Subsequent interventional studies putting
the cross-sectional findings to the test, show that switching people
to a plant-based diet can improve rheology measurements
within three to six weeks.
But might the blood of vegetarians flow
a bit too well, though? In 2019, a study of thousands
of British vegetarians called EPIC-Oxford found that they were at higher risk
of hemorrhagic (bleeding) stroke. They had such a lower risk
of heart disease that they still had less
cardiovascular disease overall (and a half dozen studies show no overall
increased risk of stroke mortality), but why the greater stroke incidence? I suggested it might be vitamin B12
deficiency, which can lead to excessive levels
of a stroke- associated metabolite called homocysteine
which is normally detoxified by B12. This is thought to be the reason
why vitamin B12 supplementation can improve artery function
of vegetarians. Vitamin B12 supplements
or fortified foods are critical for anyone eating plant-based,
but my 12-part video series on vegetarians and stroke risk
triggered by the 2019 publication was all in vain.
It turns out vegetarians don’t appear
to have higher stroke risk after all. In response to the EPIC-Oxford results,
researchers around the world scrambled to see if the findings
were merely a fluke. In 2020, UK Biobank, a massive study
following more than 400,000 volunteers, confirmed that vegetarians
had lower cardiovascular disease rates and importantly,
no increased incidence of stroke. And two studies from Taiwan
found vegetarians had significantly
lower risk of stroke. Following tens of thousands
of vegetarians for up to ten years, they only had about half the stroke risk
compared to nonvegetarians (including a 64 percent lower risk
specifically of hemorrhagic stroke). By 2021, Harvard researchers
had finished and published their analyses of the 200,000+ participants
of the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals
Follow-Up Study. They too found no increased stroke risk
for vegetarians and indeed a decreased risk of stroke among those eating
healthy plant-based diets.
A meta-analysis putting all the studies
together found that indeed the EPIC-Oxford data appeared
to be a fluke after all, finding, if anything, a lower risk
of stroke in a subgroup analysis. A 2022 systematic review
concluded that vegetarian and low-animal product diets are associated with a significantly
lower risk of bleeding strokes, a significantly lower risk
of clotting strokes, and a significantly lower risk
of total strokes across the board..
Video Transcript – As found on YouTube
Is Vegan Food Always Healthy?
"Is Vegan Food Always Healthy?" In my video on flexitarians,
I talk about how the benefits of eating a plant-based diet
are not all-or-nothing. Simple advice to increase
the consumption of plant-derived foods with
parallel reductions in the consumption of foods from
animal sources was found to confer a survival advantage,”
a live-longer advantage. They call it a pro-vegetarian eating
pattern, just moving in that direction, as a more gradual, gentle
doable approach. If you’re dealing with a serious
disease, though, like diabetes, avoiding some problem foods
completely may be easier than attempting to moderate their intake. It’s like clinicians would never tell
alcoholics to simply cut down on alcohol. Avoiding alcohol entirely
is a more effective and, ironically, easier for a problem drinker. Paradoxically, asking patients
to make a large change may be more effective than
making a slow transition. Diet studies show that recommending
more significant changes increases the changes that
patients actually accomplish. It may help to replace the common
advice, ‘all things in moderation’ with ‘big changes beget big results.’ Success breeds success. After a few days or weeks of
major dietary changes, patients are more likely
to see improvements in weight and blood sugar levels— improvements that
reinforce the dietary changes.
Furthermore, they may enjoy other health
benefits of plant-based eating. that may give them further motivation. Those who choose to eat plant-based
for their health say it’s mostly for general wellness and disease
prevention, or to improve their energy levels or immune function. They felt it gave them a sense
of control over their health, helps you feel better emotionally,
improves your overall health, and makes you feel better. Most felt it was very important for
maintaining their health and well-being. For the minority that used it
for a specific health problem, it was mostly for high cholesterol
or weight loss, followed by high blood pressure
and diabetes, with most reporting they felt it helped a great deal. But others choose plant-based diets
for other reasons like animal welfare or global warming, and it looks
like they’re more likely to be eating things like vegan doughnuts,
sugary and fatty foods, compared to those eating
plant-based because of religious or health reasons. I mean the veganist vegan could bake
a cake using soda instead of eggs, with frosting, covered in marshmallow
fluff and chocolate syrup, topped with Oreos, with a side of Doritos
dipped in, vegan bacon grease.
But fruit for dessert… in the form of
Pop Tarts and Krispy Kreme pies. This, is a vegan meal. Yes, plant-based diets have
been recommended to reduce the risk of type 2 diabetes. However, not all plant foods
are necessarily beneficial. Like in that pro-vegetarian scoring
system you got points for eating potato chips and French fries,
just because they were technically plant-based, but Harvard researchers
wanted to examine the association of not only an overall plant-based diet,
but both healthy and unhealthy versions. So, they created the same kind
of pro-vegetarian scoring system weighted towards any sort
of plant-based foods, and against animal foods and then also
created a healthful plant-based diet index, where at least some whole
plant foods took precedence and Coca-Cola was no longer
considered a plant.
Then lastly, they created an
unhealthful plant-based diet index by assigning positive scores
to processed plant-based junk, and negative scoring healthier
foods and animal foods. And then they found that a more
plant-based diet in general was good for reducing diabetes risk, but eating
especially healthy plant-based foods did better, nearly cutting risk in half, while those eating more
unhealthy plant foods did worse. Now, but is that because they
were also eating more animal foods? People often eat burgers with their fries; so, they separated out the
effects of healthy plant foods, less healthy plant foods,
and animal foods.
And healthy plant foods were
protectively associated, animal foods were
detrimentally associated, and less healthy plant foods were more
neutral when it came to diabetes risk. Here’s what the graph looks like:
higher diabetes risk with more and more animal foods, no protection
whatsoever with junky plant foods, and lower and lower diabetes risk
associated with more and more healthy whole plant foods in the diet. So, they conclude that yes, plant-
based diets are associated with substantially lower risk of
developing type 2 diabetes, but it may not be enough to just
lower the intake of animal foods, but also less healthy plant foods as well..
Video Transcript – As found on YouTube
Update on Vegetarian Stroke Risk
"Update on Vegetarian Stroke Risk" Healthy plant-based diets
have been associated with lower all-cause mortality,
up to a 34 percent lower risk of death from any cause over an average
of an eight-year period, just being in the top
versus bottom quarter of healthy plant-based consumption. If sustained, that could translate
into more than four extra years of life. A meta-analysis of a dozen studies
prospectively following more than a half a million people
for up to 25 years similarly found significantly lower
heart disease and overall death rates among those eating more plant-based. No surprise,
a systematic review concluded since plant-based diets
may arrest or even reverse our number one killer—
cardiovascular disease. Those eating wholly plant-based
tend to be significantly slimmer with lower LDL cholesterol, triglycerides,
blood sugars, blood pressures, significantly less inflammation,
and less carotid artery wall thickening (a sign of atherosclerosis measured
via ultrasound in the neck), as good as what you see
in endurance athletes who’ve run an average of 50,000 miles,
which is like twice around the globe. And changes in risk factors
can happen fast, as evidenced by results
from one to three-week ad libitum (eat-all-you-want)
plant-based “kickstart” programs.
For example, the results from the first
few hundred participants of the at-home
15-day Jumpstart program created by the nonprofit Rochester
Lifestyle Medicine Institute were recently published. On a whole food plant-based diet,
obese patients lost an average of 7 pounds without controlling portions
or counting calories or carbs. Diabetics saw their fasting blood sugars
drop 28 points. Those with LDL cholesterol
over 100 experienced a 33-point drop (comparable to some statin drugs), and hypertensive individuals
experienced a 17-point drop in systolic blood pressure,
which is better than drugs, and all within just two weeks! Studies dating back nearly 40 years
show those eating meat-free diets also have improved blood “rheology,”
meaning fluidity or flowability, which may play a role
in cardiovascular protection. Subsequent interventional studies putting
the cross-sectional findings to the test, show that switching people
to a plant-based diet can improve rheology measurements
within three to six weeks. But might the blood of vegetarians flow
a bit too well, though? In 2019, a study of thousands
of British vegetarians called EPIC-Oxford found that they were at higher risk
of hemorrhagic (bleeding) stroke.
They had such a lower risk
of heart disease that they still had less
cardiovascular disease overall (and a half dozen studies show no overall
increased risk of stroke mortality), but why the greater stroke incidence? I suggested it might be vitamin B12
deficiency, which can lead to excessive levels
of a stroke- associated metabolite called homocysteine
which is normally detoxified by B12. This is thought to be the reason
why vitamin B12 supplementation can improve artery function
of vegetarians.
Vitamin B12 supplements
or fortified foods are critical for anyone eating plant-based,
but my 12-part video series on vegetarians and stroke risk
triggered by the 2019 publication was all in vain. It turns out vegetarians don’t appear
to have higher stroke risk after all. In response to the EPIC-Oxford results,
researchers around the world scrambled to see if the findings
were merely a fluke. In 2020, UK Biobank, a massive study
following more than 400,000 volunteers, confirmed that vegetarians
had lower cardiovascular disease rates and importantly,
no increased incidence of stroke. And two studies from Taiwan
found vegetarians had significantly
lower risk of stroke. Following tens of thousands
of vegetarians for up to ten years, they only had about half the stroke risk
compared to nonvegetarians (including a 64 percent lower risk
specifically of hemorrhagic stroke).
By 2021, Harvard researchers
had finished and published their analyses of the 200,000+ participants
of the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals
Follow-Up Study. They too found no increased stroke risk
for vegetarians and indeed a decreased risk of stroke among those eating
healthy plant-based diets. A meta-analysis putting all the studies
together found that indeed the EPIC-Oxford data appeared
to be a fluke after all, finding, if anything, a lower risk
of stroke in a subgroup analysis. A 2022 systematic review
concluded that vegetarian and low-animal product diets are associated with a significantly
lower risk of bleeding strokes, a significantly lower risk
of clotting strokes, and a significantly lower risk
of total strokes across the board..
Video Transcript – As found on YouTube
