Your Health in Your Hands
The Healthiest Diet of All
Vegetarians are healthier than meat eaters and live years longer than the general population. No argument, no dispute – these are the simple facts – although you’d be excused for having doubts if you rely on the daily press for your health info.
The better health statistics for vegetarians and vegans aren’t peripheral – a percentage point advantage here or there – but are quite profound. The usual argument put forward to explain these dramatic improvements in health – often by doctors with no nutritional training or by those with a vested interest in the meat industry – is that veggies are puritanical, non-drinking, non-smoking, self-denying, hair-shirt-wearing bores so no wonder they live longer. And who wants to be like that?!
Of course, all good scientific research makes allowances for the differences in people’s life-styles and only compares like with like. And it is this solid, reputable science that will be quoted throughout this guide, much of it obtained from the world’s most authoritative and prestigious health advisory bodies.
Why is diet so important? Well, if you live an average life span of about 72 years, you will scoff your way through an astonishing 30 tonnes of food. It’s the fuel that keeps you going and it’s the nutrients in food that make you what you are. Your heart beats on them, your muscles, kidneys and liver depend upon them. Food keeps you warm, repairs the bits of damage that inevitably occur and it even helps you think. Pretty important stuff is food – but not just any old food.
If you were to eat the same diet as a cat – lots of meat and dairy products and no fresh fruit and veg – you would die and probably quite quickly. Similarly, a cat would be unable to survive on the average vegetarian diet. The reason for the difference is that after millions of years of evolution, all animals have adapted to particular diets and environments. Meat contains no vitamin C so cats have the ability to synthesise it internally. We, on the other hand, are higher apes and have evolved to eat fresh fruit and vegetables, shoots, seeds, nuts and leaves – a diet rich in vitamin C – on a daily basis. Throughout our evolution there was an abundant supply of vitamin C in virtually everything we ate so our bodies have never had to manufacture it.
Those humans who lived in societies that relied heavily on animal products have paid a high price for it. The Inuit (sometimes referred to as Eskimos) traditionally relied largely on meat and fish, obtaining their vitamin C from mosses in the stomachs of dead animals. They rarely lived beyond their early 30s. One major cause of death was bleeding of the brain – cerebral haemorrhage. One possible cause of this is the thinning of the blood – a well known property of fish oils (137).
“But chimps eat meat,” is the usual cry. Chimps’ eating habits have been closely studied over many years and the amount of meat they eat is minuscule – about the size of half-a-pea a day, mostly made up of insects. So little do they eat that their hands and nails, teeth and digestive tract are those of a strictly vegetarian – vegan – animal.
The genetic difference between a chimp and a human is only just over one per cent (138). They are our closest living relative; so close that we share the same haemoglobin (found in our red blood cells). Our digestive tract, hands and teeth are also very similar. Some people claim our teeth are those of a carnivore, which is obvious nonsense and a quick look inside the mouth of a cat or dog will show you why. Our teeth, with their predominantly flat surfaces, are designed to grind and crush tough vegetable matter and are incapable of eating meat unless it’s cooked first. And we haven’t got the canines of a killer – we’d all look like Dracula if we had! Human teeth are not designed for holding or killing prey and they certainly couldn’t bite through the hide of a cow, sheep or pig!
Why does all this matter? Because sensible eating is about distinguishing between healthy and potentially unhealthy foods – for us! Take cats, for instance. No matter how much meat they eat, no matter how fatty it is, their arteries don’t clog up. Ours, on the other hand, do and the damage can start as young as two or three years old. The result is high blood pressure, heart attacks and strokes later in life. One in five men and one in six women die from coronary heart disease in the UK – the single most common cause of death. The risks factors for heart disease are almost all diet related – caused by animal products. And some people still claim we’re meant to eat meat!
Professor T. Colin Campbell, of Cornell University, organised a massive piece of dietary research called the China Health Study (see later) – one of the most important ever undertaken. When its findings were published he said: “We’re basically a vegetarian species and should be eating a wide variety of plant foods and minimising our intake of animal foods. Animal foods are not helpful and we need to get away from eating them.” (1)
The world’s most important health advisory bodies are now in agreement – a balanced vegetarian diet can be one of the healthiest possible. And it seems the fewer animal products it contains such as milk and cheese, the healthier it is. In other words, the closer it is to being vegan, the healthier it becomes. These are some of the health statements that have been made over the past few years. We will expand on each of the terms used later in the guide.
1. The British Medical Association
The BMA was one of the first to distil the growing volume of research on diet and health in its 1986 report (2). It said:
“Vegetarians have lower rates of obesity, coronary heart disease, high blood pressure, large bowel disorders, cancers and gallstones. Cholesterol levels tend to be lower in vegetarians.”
It went on to say that when meat eaters change to a vegetarian diet it can actually lower their cholesterol levels. It concluded by saying that vegetarians obtain all the minerals they need, that folate levels are higher and as a consequence it is a diet suitable for infants.
2. The China Health Study
The initial results of this combined Chinese-British-American study, which began in 1983, were announced in 1989 (3). It was a massive piece of work which looked at the health and eating habits of 6,500 real people in real life situations. Its conclusions were accurately summed up in a New York Times headline on 8 May, 1990: “Huge Study of Diet Indicts Fat and Meat”. In short, it found that the greatest single influence on the growth of degenerative diseases such as coronary heart disease, cancer and diabetes was the amount of animal fat and animal protein eaten – the more you eat, the greater your risk. It highlighted some extraordinary dietary differences between affluent and not so affluent societies. For example, Chinese people are long living yet eat one-third less protein than Americans and only seven per cent of it comes from animal foods compared to Americans’ 70 per cent. Past dietary advice would probably have cheered this as a good thing but the study found the opposite. ‘Animal protein itself raises the risks of cancer and heart disease.’
These are the two biggest killers in the West but there are others, such as diabetes, strokes, obesity and high blood pressure, which are clearly associated with the West’s affluent lifestyle. They are referred to by the general name of degenerative diseases and the China Health Study found that they increased alarmingly as people changed from a more simple, predominantly vegetarian or vegan diet, to a Western diet obsessed with meat and dairy products.
The study also found that the West’s preoccupation with promoting meat as the best source of iron was wrong. The Chinese diet was predominantly vegetarian and yet adults consumed twice as much iron as an American adult. The Chinese diet also contained three times more fibre than a US diet but there was no evidence that these high levels interfered with absorption of iron or other essential minerals.
The conclusions were unequivocal – that a plant-based diet is more likely to promote good health and reduce the risk of degenerative diseases.
3. The World Health Organisation (WHO)
Next came an even more detailed report from the WHO in 1991. It was interpreted by The Daily Mail newspaper as a call for the world to go vegetarian – stating forthrightly that a diet rich in animal products promotes heart disease, cancer and several other diseases. It confirmed the BMA’s and China Health Study’s list of degenerative diseases and added others – diabetes, strokes and osteoporosis. And it also flagged up kidney impairment with high protein, meat-rich diets.
It said that diets associated with increases in chronic diseases are those rich in sugar, meat and other animal products, saturated fat and dietary cholesterol and added: “If such trends continue, the end of [the 20th] century will see cardiovascular (heart) disease and cancer established as major health problems in every country in the world.” And, of course, its predictions have been proved correct.
But it went even further and condemned the years of public urgings by governments to eat animal products. It went on to say that in future: “Policies should be geared to the growing of plant foods, including vegetables and fruits, and to limiting the promotion of fat containing products.” If anything, the opposite has happened.
The large quantities of cheap meat, which have adversely affected health, are only available because of intensive, factory farming and the WHO also had plenty to say about that:
“Farming policies which do not rely on intensive animal production systems would reduce the world demand for cereals. Use of land could be reappraised since cereal consumption by the population is much more efficient and cheaper than dedicating large areas to growing feed for meat production and dairying.” That advice has also been ignored.
In fact, as development takes place in previously undeveloped countries there is a shift towards a more affluent diet, the report says. As a consequence, there is a dramatic increase in the incidence of diet-related diseases.
April 2003 saw the long awaited publication of the update to this 1991 WHO report. If you analyse the 2003 version it takes the same overall view as the previous report. It shows that the worldwide dietary trend towards high saturated fat and refined carbohydrate foods, together with sedentary lifestyles are the principal causes of degenerative diseases such as heart disease and obesity.
However the championing of plant-based diets as the way forward for health – which dominated the first report – has been much watered down. It is now common knowledge that the food industry has infiltrated the WHO since its 1991 report. It would be naïve not to suspect that the meat and dairy industry, which exerts such enormous political and economical clout, has not also been at work behind the scenes of this 2003 WHO report (10).
4. The EPIC Study
In 1992 the largest ever study of diet and health was initiated – the European Prospective Investigation into Cancer and Nutrition – EPIC for short. More than half a million people have been studied in 10 European countries, including the UK. EPIC is what is known as a prospective study where the diets of recruits are recorded and their health is tracked over the coming years to try and establish any links with the foods eaten and subsequent health outcomes. There are two EPIC centres in the UK, at Oxford and Cambridge Universities. EPIC-Oxford includes a total of around 65,000 participants of whom around half do not consume meat, and around 2,500 are vegans. On-going analysis of the results from EPIC studies continue to provide insights into what foods protect health and what foods are harmful to health.
What is clear so far is that non-meat diets tend to reduce blood pressure levels, reduce cholesterol levels and reduce the incidence of obesity. Not surprisingly given these reductions in risk factors for heart disease, vegetarians die less from heart disease than comparable meat eaters. EPIC studies have also confirmed the importance of a diet rich in fruits and vegetables as protection against the risk of an early death (139, 140). Preliminary results on the link between meat consumption and colorectal cancer suggest that frequent consumption of red meat such as beef, veal, pork and lamb is associated with a 20-40 per cent increase in colorectal cancer risk (36).
5. Physicians Committee for Responsible Medicine (PCRM)
In 1995 the PCRM – a highly-respected US body which numbers the late Dr Benjamin Spock and William Roberts, editor of the American Journal of Cardiology, amongst its 5,000 doctors and scientists – issued a report to the US government (6). It confirmed the lower rate of disease amongst vegetarians and urged the government to recommend a vegetarian diet to US citizens. Until then, the US Dietary Guidelines had never made any mention of vegetarianism. The following year they did so for the first time and the section began:
“...vegetarians enjoy excellent health: Vegetarian diets are consistent with the Dietary Guidelines and can meet the Recommended Daily Allowances for nutrients. Protein is not limited in vegetarian diets ...” (7).
The PCRM report reviewed over 100 pieces of published work from across the world and was in no doubt about what we should be eating: “The scientific literature clearly supports the use of vegetables, fruits, legumes (peas, beans, chick peas – pulses) and grains as staples. Meats, dairy products and added vegetable oils should be considered optional.” It was another clear and unequivocal statement, backed by unimpeachable science, that humans do not need to eat meat and are healthier for not doing so.
6. American Dietetic Association (ADA)
The ADA is probably one of the most respected health bodies in the world and in its most recent report on vegetarianism, has thrown its weight firmly behind meat-free diets, saying they are effective in avoiding or even curing some of the world’s most deadly diseases. Heart disease, strokes, some cancers and diabetes can all be effectively treated by prescribing a vegetarian diet, it says.
The ADA spells out the reason for this by saying that vegetarian diets offer disease protection benefits because of their lower saturated fat and cholesterol content as well as their higher fibre intakes. The ADA also make clear the fact that vegetarian diets can provide all the vitamins, minerals, protein and energy the body needs and provide for all stages of the life cycle including pregnancy and infancy (8).
Growing Body of Scientific Evidence – Green Light to Veggie Diets!
The combined conclusions of this huge volume of research from these different sources is overwhelming. Vegetarian diets are the healthiest possible and the most natural for the human race. So why isn’t the fact more widely known? Government silence on the subject speaks volumes for the power and advertising spend of the meat industry and the government’s cowardice. It is terrified to tackle the vested interests of a huge industry, just as for decades it was terrified to tackle the tobacco industry effectively. You, of course, don’t need anyone’s permission to change your diet.
Now the leading cause of death in Europe with Britain at the top of the league table. It kills one in five men and one in six women (9).
The heart is a pump which circulates blood around the body. Like other muscles, the beating heart needs oxygen and other nutrients to provide energy for its work. This is the job of the coronary arteries, which supply the heart muscles with oxygenated blood. If any of these vessels are blocked then the heart’s blood supply will be interrupted. Permanent damage to the heart can occur – in fact the affected part can die.
In the following weeks this dead muscle is replaced by scar tissue which, unlike the rest of the heart, can’t contract and the heart therefore becomes less efficient. If the damage is severe enough it can be fatal. Heart attacks can be silent and painless or they can be extremely painful and deadly.
With angina, the blood vessels supplying the heart are partially, rather than fully, blocked. They will allow enough blood to the heart when a person is resting but not enough to provide sufficient oxygen for physical activity, which can result in acute pain (11).
How arteries become blocked is explained
in the following sections – Cholesterol, Clogged Arteries.
Just about every large-scale study of people and their day-to-day living (epidemiological studies) have found vegetarians to be considerably less at risk of heart disease. The percentage by which the risk drops varies from study to study but many estimate it between 25 and 50 per cent (12, 13, 14). Recent estimates put a figure of 25 per cent lower mortality (death rate) from heart disease in vegetarians (15).
All the main researchers are in agreement, that animal products are the principal cause of degenerative diseases. What is surprising is how quickly the health advantages of a plant-based diet disappear once people start to consume animal products as their national prosperity grows.
Heart disease and cancers are soaring globally and they don’t only affect the rich West. Four out of five chronic disease deaths today occur in low and middle income countries. Mauritius is a good example. In the 1940s, only two per cent of the population died from heart disease but by 1980 it had dramatically increased to 45 per cent (WHO).
Despite the astounding nature of these findings and their implication for the health of the nation – all nations – governments still refuse to act on them with any real enthusiasm.
There are other factors involved in heart disease so if you wish to avoid one, as well as changing to a predominantly plant-based diet, there are other actions you should take. Cut down or cut out alcohol, stop smoking, cut down on salt (sodium) – which essentially means cutting down on processed foods – and increase magnesium intake (found in green vegetables, nuts and wholegrains). Exercise is important not just for the exercise it gives the heart and lungs but because the lymph system, the body’s self-defence mechanism, works far more efficiently when the pulse rate is raised. Excercise also helps fight stress.
In a statement which should worry everyone in the West, the WHO says that most coronary heart disease happens to people in the medium risk category. So, in the wealthy countries of the world, virtually the whole population can be considered at risk. Such a situation, they say, begs for mass intervention designed to protect the entire population rather than just treating individuals at very high risk. The only way that can be achieved is through diet. It isn’t happening.
Cholesterol is a type of lipid (fat) called a sterol, made by the liver and present in every cell in an animal’s body, including human animals. Cholesterol is only found in foods of animal origin – meat, dairy, eggs, fish, shrimps, prawns and shellfish. Plant foods contain none. As our liver makes all the cholesterol we need there is no dietary need for cholesterol at all (WHO) and vegetarians have much lower levels than meat eaters (17, 18, 19, 20).
Cholesterol is a well-known risk factor for heart disease and exists in two forms. So-called bad cholesterol (low-density lipoproteins or LDL) is dumped on the artery wall, reduces blood flow and causes heart attacks and strokes. Good cholesterol (high-density lipoproteins or HDL) is carried to the liver so the body can get rid of it. Around 70 per cent of the UK have been shown to have bad cholesterol levels above the recommended levels (21).
Saturated fats, found mainly in animal fats and many processed foods, raise cholesterol levels in the body. This type of fat is found principally in the fatty portion of meat, eggs and milk products.
The process through which cholesterol damages arteries is thought to be caused by oxidation – the action of molecules called free radicals (see p15). They can only be destroyed by other molecules called antioxidants (also see p16), found largely in fruit and vegetables. Taking vitamin supplements and looking for magic cures to counter high cholesterol levels hasn’t worked. According to Dr Lori Mosca of Michigan University (and many other researchers): “The best scientific evidence we have is that eating a diet rich in fruits and vegetables is protective against heart disease” (24).
In rural China, cholesterol levels are between 2.5 and 4.0 (a measurement based on mmol per litre) and heart attacks are almost unknown. In England, it is recommended that people reduce their levels down to 5.0 even though the level to avoid heart attacks entirely is 3.9.
Despite this welter of evidence that a vegetarian diet is the best way to avoid high cholesterol levels and the diseases which go with them, amazingly the official advice is not to go vegetarian but to switch to a lower fat diet – avoiding fatty cuts of red meat, favouring white meat and fish and swapping butter for margarine. Research from the US shows this advice to be largely ineffective. Cholesterol levels of people on this ‘official’ diet tend to drop by only about five per cent while changing to a vegetarian diet reduces levels to a much greater degree (25, 26, 27, 28).
Another risk factor for heart disease – homocysteine – has recently been discovered. Homocysteine (Hcy) is an amino acid (building block of protein) produced by the body during the breakdown of another amino acid – methionine. High levels of Hcy have been linked to increased risk for heart disease and stroke. Ensuring adequate levels of three key B-vitamins is crucial in lowering Hcy levels. Folate and vitamin B6 are found abundantly in plant foods and vitamin B12 is found in many everyday foods fortified with it such as yeast extracts (eg Marmite), some breakfast cereals, margarines and soya products such as soya milk.
The official name is atherosclerosis. It can begin in childhood and starts when certain white blood cells stick to the lining of the artery. Gradually they make their way through the outer covering of the artery wall and become established there. Over time they grow and form what’s called plaques by collecting droplets of fatty substances, in particular tiny particles of cholesterol (low-density lipoproteins). The more cholesterol in the blood, the faster the plaques grow. As they swell they protrude into the artery restricting the flow of blood.
If the surface of the swelling cracks, a blood clot may form over it (thrombus) and block the already narrowed artery causing a heart attack or it may break away and cause a blockage elsewhere (thrombosis). The fibrous top of the swelling may itself become detached and be carried away in the blood stream, also causing an artery blockage (embolism).
As with all heart-related diseases, vegetarians suffer less than meat eaters and the more meat you eat, the more likely you are to end up with clogged arteries. It’s a very serious condition but fortunately, recent research shows that an animal-free diet can actually heal some of the damage done to the arteries. A low-fat, vegetarian diet eaten for just a year can actually reverse blockages, resulting in an improved blood flow (29).
If you still doubt that simple fruit and veg can have such a dramatic effect, it’s worth listening to William C. Roberts, distinguished editor-in-chief of the prestigious American Journal of Cardiology:
“Although human beings eat meat we are not natural carnivores. No matter how much fat carnivores eat they do not develop atherosclerosis. When we kill animals to eat them, they end up by killing us because their flesh, which contains cholesterol and saturated fat, was never intended for human beings who are natural herbivores” (30).
The scientific term is hypertension and the condition is directly linked to heart disease and clogged arteries – the higher the pressure the greater the risk. Many people don’t even realise they have high blood pressure – hence the term ‘silent killer’. In the 2003 Health Survey for England almost one in three men and women had hypertension (142).
Blood pressure is measured both when the heart is actually beating (systolic) and between beats – the resting rate (diastolic) – and hence is always quoted as two figures, eg 120:80.
Blood pressure rises as we get older but some people defy this seemingly inevitable development. Good physical activity, maintaining a stable weight, low levels of animal fat in the diet and limiting the amount of salt eaten all have an effect.
But even allowing for all that, the blood pressure of vegetarians does not increase in the same way as meat eaters – in fact it goes up little with age. It’s not surprising, then, that a vegetarian diet can be used to treat high blood pressure (31).
There is an inescapable link with meat and a Californian study as long ago as 1926 showed this. The blood pressure of vegetarians was raised by 10 per cent simply by feeding them meat – and it happened in only two weeks (32).
Other studies have produced similar results and a whole range of studies have shown vegetarians to have considerably lower blood pressure than meat eaters (33, 34, 35). It is also the finding of the WHO and ADA. Perhaps just as importantly, many studies have found that changing to a vegetarian diet can significantly lower blood pressure (36, 37, 38, 39). A Swedish study found that blood pressure could not only be lowered with low-fat vegetarian diets but the distressing symptoms associated with it could be reduced or totally eliminated. At the end of the trial period it was found that most patients had been able to give up their medication, 50 per cent felt ‘much better’, 15 per cent felt ‘better’ and 30 per cent felt ‘completely recovered’ (40).
The lower risk to vegetarians is considerable and can be anywhere between 33-50 per cent and all the evidence shows that it is the totality of the vegetarian diet that works not any specific ingredient.
Salt also plays an important part in causing high blood pressure. In the West we consume about 10 grams of salt a day – one gram naturally present in plant foods, one gram added when cooking or eating and eight grams in processed foods.
Constant high blood pressure has the ability to weaken blood vessels, which can eventually rupture and haemorrhage (aneurysm) and this can kill nerve cells in the brain. Similarly, a blood clot (thrombus) or the detached fibrous cap of an arterial plaque (embolism) may cause a blockage in the brain. The outcome can be loss of speech, memory or movement or, frequently, death. The higher the blood pressure the higher the risk of strokes, and pressures at the top of the range can increase that risk ten-fold (WHO). All the advantages of a vegetarian diet in reducing blood pressure apply equally to reducing the risk of strokes. Just eating five or more servings of fresh fruit and veg a day reduces the risk of stroke by 26 per cent (149).
There are three separate factors which contribute to causing cancer – heredity (by far the least important factor), environmental pollution and diet. A poor diet is second only to smoking as one of the largest preventable risk factors for cancer. The Department of Health estimates that such a diet may be responsible for up to one-third of all cancer deaths (143). Dr Michael Greger, writer and presenter of Stopping Cancer Before It Starts, estimates that 70 per cent of cancers could be prevented by diet (146).
Figures which illustrate how diet is crucial are those for colon cancer. Americans are four times more likely to develop it than Japanese. But when researchers looked at Japanese people who had moved to the US they found that their risk of colon cancer shot up to near that of Americans. The main difference between the two groups was identified as diet – a traditional Japanese diet being low in animal products while a typical US diet was extremely high in them. Japanese Americans tended to adopt the US style of eating once they moved to that country (42).
It is now known that people who eat two or more portions of red meat a day increase their risk of bowel cancer by one-third. And researchers have discovered the mechanism. Published in Cancer Research in 2006, this study took cells from meat eaters and vegetarians and found those eating red meat had a higher rate of DNA mutation, increasing the likelihood of cancer. It seems this damage is caused by N-nitrosocompounds, which form in the large bowel after eating red meat (148).
Another scientific method of looking at diseases such as cancer is to establish how different foods affect them, both good and bad – those foods that may cause the disease (positive) and those that may prevent it (negative). They’re called correlation studies.
One of these studies looked at 37 countries and established a strong positive link between meat and meat protein and intestinal cancer while vegetable protein was negative – it provided protection (43). Another correlation study carried out in Israel followed the growth of the population from 1.17 million to 3.5 million. Over this period, meat consumption increased dramatically by over 400 per cent and cancers doubled (44).
Two other studies, one of breast cancer and one of cancer of the uterus, found similar links between animal protein and fat and cancers. When complex carbohydrates – starchy vegetable foods – were considered, the result was negative (protective) (45, 46). In 1981, a massive study looked at cancer in 41 different countries and found that diets based on beans, maize and, to some degree, rice were good at preventing both breast and colon cancer while meat promoted both (47).
In 1990, the diets of 88,000 women were examined and it became clear that those who eat beef, pork or lamb as a main dish every day are two-and-a-half times more likely to develop colon cancer than those who eat meat only once a month (48). In 1994 came the Oxford Vegetarian Study (see page 6) and its conclusion that vegetarians have a 40 per cent less chance of dying from cancer than do meat eaters. There are many other studies that show vegetarians are less at risk (49, 50) by between 25 and 50 per cent. The ADA and BMA have both found that vegetarians are less likely to develop some cancers.
Interestingly, other studies have found that eating increased amounts of fruit and vegetables contributes to vegetarians’ better chances but doesn’t fully account for it. In other words, there appears to be something in meat which actually appears to cause cancer (51, 52).
The WHO has produced a list of dietary pluses and minuses which affect cancer. Fat, it says, plays a part in breast, colon, prostate and rectum cancer while fruit and vegetables offer protection from lung, colon, bladder, rectum, oral cavity, stomach, cervix and oesophagus cancers. On breast cancer it says there is a direct association between the numbers who die and the intake of high quantities of calories and dietary fats such as milk and beef. This has been confirmed by two very recent studies which have found that breast cancer risk is increased with the amount of saturated animal fat in the diet (22, 23).
In a test carried out in the US, researchers investigated the cancer forming compounds (carcinogens) produced in cooking. All foods when heated to cooking temperatures produce these agents but some produce more than others. Researchers compared soya-based burgers, beef burgers and bacon, which were all cooked until well done. The beef burger produced 44 times more carcinogens than the soya burger and the bacon produced 346 times more (53).
The top 12 cancer fighting foods are:
Greens (eg beet, mustard, turnip, bok choi, broccoli, brussel sprouts, cabbage, chard, kale, watercress); Oats and other Wholegrains (eg wheat, rye, millet, quinoa); Berries (eg cranberries, blueberries, raspberries, blackberries); Garlic; Yams and Sweet Potatoes; Beans, Peas and Lentils of every kind; B12 fortified foods (see page 15); Flax seeds – ground up and oil; Miso and tofu and other soya products (not the highly refined ones such as mock meats).
Diabetes mellitus is a condition in which the mechanism that turns sugar into energy no longer functions properly. The outcome is that the body can’t control the amount of sugar in the blood. In virtually every developing country in the world, diseases associated with affluence are becoming the new health problem. As processed and fat-rich animal foods are increasingly seen as desirable foods so the diseases develop. And they follow a pattern according to the WHO. One of the first to show itself is diabetes, followed several decades later by heart disease and gallstones, then cancer and finally chronic disorders of the gastrointestinal tract.
A major risk factor is obesity and about 80 per cent of non-insulin dependent diabetics are obese. People who are moderately overweight are twice as likely to develop the disease as people of normal weight (WHO).
In a little over a generation, diabetes mellitus has increased six-fold and there are factors at work other than obesity – including heredity. However, heredity wouldn’t account for the fact that almost all Sumo wrestlers are diabetics – but their weight and extraordinarily high-fat diet might.
Diabetics can benefit from a high-fibre, vegetarian diet and people who are already eating this kind diet have a 45 per cent reduced chance of developing the disease. Heavy meat eaters on the other hand – those who eat meat six or more times a week – are nearly four times as likely to develop diabetes (54). The ADA states that diabetes is much less likely to be a cause of death in vegetarians than it is in meat eaters and puts it down to vegetarians’ higher intake of complex carbohydrates (starchy foods) and the fact that they tend to be lighter. Again, the science is consistent, that diabetes is up to 90 per cent higher in meat eating men and 40 per cent higher in women. Even allowing for the fact that vegetarians tend to be lighter than meat eaters, they still face less risk (55, 56, 57).
Diabetes usually begins in middle age and strongly increases the risk of developing coronary heart disease, kidney failure, eye and neurological (nerve) damage (WHO). More good news for vegetarians is that a plant-based diet often eliminates or reduces a diabetic’s need to take medication and reduces the chance of developing both nerve and eye (retina) damage (58, 59, 60, 61, 62).
It is estimated that two million people in the UK suffer from the adult-onset type of diabetes. The WHO estimates that by 2025 there will be a staggering 300 million sufferers worldwide – another clear reason for people to adopt a vegetarian diet.
Gallstones are formed when bile becomes saturated with cholesterol – they are, in fact, composed of cholesterol crystals. They can go undetected for years but can also lead to serious conditions – infection, inflammation, colic, peritonitis and even gangrene. They are much more common in women than in men.
The WHO states that the condition affects meat eaters considerably more than it does vegetarians. A study of 800 women established that meat eaters are two-and-a-half to four times more likely to have gallstones than vegetarians (63).
It isn’t just a question of being overweight; obesity is linked with many diseases, according to the WHO. It is, in fact, the same string of degenerative conditions associated with meat eating. Obese women face an increased risk of cancers of the gallbladder, breast and uterus – in men the cancer risk increases in the prostate and kidneys. Most worrying of all is when fat is deposited around the abdomen. It seems that ‘beer guts’ are a bit more serious than simply not looking good.
Obesity is much less common amongst vegetarians than it is amongst meat eaters (64, 65). In fact, vegetarians tend to be approximately 10 per cent leaner (66, 67, 68, 69, 70, 71, 72) and most overweight people shed pounds when they change to a veggie diet (73, 74), although doctors still rarely recommend such a course, which speaks volumes about doctors’ lack of nutritional training.
In Britain, there is now an epidemic of the condition, and almost two-thirds of the English population are either overweight or obese. In 1999, the then health minister Tessa Jowell said: “There are many reasons why obesity is on the increase, including lack of understanding of what constitutes a balanced diet, poverty, limited access to fresh fruit and vegetables and an increasingly sedentary lifestyle” (75). (See VVF Globesity report and V-Plan Diet online at www.vegetarian.org.uk.)
All kinds of names have been given to this condition, including widows’ stoop and brittle bones. It is, in fact, the loss of bone mass – essentially calcium – leading to more fragile bones. It is a very serious disease and accounts for more deaths – mostly from fractured hips – than cancers of the cervix, breast and uterus combined (76).
Meat is not a source of calcium so the amount taken in by vegetarians tends to be similar or greater than in meat eaters. The slogan ‘drink more milk’ in order to avoid osteoporosis has almost certainly got more to do with marketing than good dietary advice because preventing osteoporosis isn’t that simple. Milk contains protein and the more protein you consume – animal protein – the more your body loses calcium.
Animal protein produces an acid overload which the body tries to neutralise by calling on its calcium stores in the bones, which are then urinated out of the body. (Not surprisingly, vegans urinate less calcium than meat eaters.) The process happens through a complex series of reactions involving the body’s hormonal balance, which is why osteoporosis is often associated with post-menopausal women when the hormonal balance is readjusted.
The ideal scenario for calcium consumption is to have a good intake and minimal loss – although no one is quite sure what the ideal intake should be. On the intake side, calcium is found in most green leafy vegetables (the darker the better) and the amount available from these sources is equal to or better than milk (77, 78, 79, 80).
Nuts (especially almonds) and seeds (especially sesame seeds) as well as pulses of all types such as beans, lentils and soya are also good sources. Of course, these vegetable sources also provide other important minerals, antioxidants and complex carbohydrates.
Unfortunately, most medical advice concentrates only on the intake side of the equation and ignores the reasons for calcium loss. These include salt, caffeine, tobacco, lack of exercise and maybe alcohol as well as animal protein. Professor T. Colin Campbell, of the China Health Study, says: “Osteoporosis tends to occur in countries where calcium intake is highest and most of it comes from protein-rich dairy foods” (81). However, sufficient calcium can be obtained from vegetables (82).
A trace element called boron plays an important part in helping to prevent calcium loss. When a group of menopausal women included it in their diet, calcium losses were cut by 40 per cent (83). The natural sources of boron are not dairy products but apples, pears, grapes, nuts, leafy vegetables and legumes.
Again it’s not surprising that vegans have lower rates of hip fracture than meat eaters, despite having lower intakes of calcium (84). This clearly makes the point that to concentrate only on intakes of calcium is just half the picture. It is like dealing with haemorrhaging by giving a blood transfusion but without stopping the source of the bleeding.
More nonsensical and inaccurate claims have been made about this condition than any other. So successful have they been that it has almost entered the public’s consciousness that to avoid iron deficiency you must eat meat. It’s simply not true. Vegetarian diets which include vegetables, legumes, fruits and grains provide all the iron necessary (85, 86, 87, 88, 89, 90).
Iron deficiency is, however, the biggest nutritional problem facing the world and the WHO estimates that 750 million people have it – most of them women and most of child-bearing age. The real causes of iron deficiency are poor iron absorption and blood loss – not just diet (91).
All the main health advisory bodies – ADA, BMA, WHO, PCRM – agree that iron deficiency anaemia is no more common in vegetarians than it is amongst meat eaters. However, that doesn’t alter the fact that it is a problem for many women and all should ensure they have good sources of iron in their diet, particularly during and shortly after their periods. Iron-rich foods in a vegetarian diet include pulses, dark green leafy vegetables, wholegrains and dried fruits.
A criticism sometimes levelled at vegetarian diets is that plant-based iron (non-haem) is poorly absorbed by the body. It may be more slowly absorbed but studies show that vegetarians have high intakes of iron and their haemoglobin levels (iron-rich red blood cells) are normal (92). Plant foods rich in vitamin C help absorption and vegetarians tend to eat more of these vital fresh fruit and vegetables. Iron intakes are particularly high in vegetarians and vegans whose staple food is wholemeal bread (93), so this is another reason for sticking to whole products rather than eating processed, denatured, mass-produced foods.
So misguided have been the concerns over iron deficiency that they have diverted public attention away from the problems of iron overload, more common and possibly more dangerous (94). If you have too much iron in your diet, the body has no way of getting rid of it. The only control over it is how slowly or quickly it is absorbed from the intestines into the blood (95, 96).
Haem iron (from meat) is absorbed quickly and easily, whether the body needs it or not. This encourages iron overload. Non-haem iron (from plants) is absorbed more slowly (97) as the body needs it. Meat-based (haem) iron has been linked with heart disease (98, 99) and high iron stores have been linked with some cancers (100, 101, 102) and poor responses to infection (103, 104).
In a study of 33,883 meat eaters, 18,840 vegetarians and 2,956 vegans in the UK, vegans were found to have the highest daily intake of iron (147).
This is not a problem for vegetarians – in fact we defy you to find a recorded case amongst vegetarians anywhere in the Western world. If you don’t starve yourself you will automatically obtain enough protein.
You occasionally still see references to ‘first class’ and ‘second class’ protein – meat being first class and vegetable sources being second. What it really means is that meat contains all the essential amino acids that we need in our diet, which make up protein while a vegetarian diet provides amino acids from a variety of plant sources. Vegetarians obtain more than enough of all the amino acids. So forget about always having to eat certain types of foods together at the same meal (combining) – it’s unnecessary (105). Although you will do this naturally in a healthy veggie diet, such as pulses (eg chick peas in hummus or baked beans) with wholegrains (eg wholemeal bread) and so on. Soya is now considered as nutritionally equivalent to meat in that it contains all the eight essential amino acids necessary for health in the one plant food. Foods high in protein include peas, beans, lentils, wholegrains, nuts and seeds.
The real problem is not too little protein but too much, particularly for meat eaters. Animal protein is associated with many of the degenerative diseases (including heart disease and cancer) while vegetable protein isn’t. Meat protein is also believed to play an important part in causing osteoporosis and kidney disease according to the WHO. It goes without saying that diets which emphasise excessive amounts of animal protein over carbohydrates are a recipe for disaster as far as health is concerned and should be avoided at all costs.
This is a very important vitamin – made by bacteria in the soil – essential for the development of blood cells and for nerve function. A lack of it can lead to collapse of the nervous system and eventually death. The liver has stores of vitamin B12 for up to three years. Vegetarians get sufficient B12 from free-range eggs and dairy products. Vegans are amply supplied by the use of B12-fortified foods such as soya milk, mock soya meats (TVP), many breakfast cereals, margarines and yeast extracts such as Marmite, Vecon and Vegemite.
It is now thought that vitamin B12 from fortified foods is better absorbed by the body than the vitamin B12 from meat, poultry and fish (106).
A disease in children where softening of the bones is caused by a deficiency of vitamin D. Humans make vitamin D from the action of sunlight on the skin. It has been calculated that exposure of hands and face to sunlight for 10 to 15 minutes a day is enough to prevent rickets (136). The liver then stores the vitamin so ensuring an adequate source throughout the winter. Many everyday foods are now fortified with vitamin D – margarines, breakfast cereals and most brands of soya milk.
More accurately, saturated fatty acids and their main source in the UK diet is animal products! They have a direct and major impact on blood cholesterol and therefore promote heart disease. Saturated fats have also been linked with cancers of the colon and breast, according to the WHO, who state that they contain no essential ingredients and don’t need to be included in the diet.
They weren’t discovered until the early 1980s, they’re thought to play a part in causing some 60 diseases and are capable of wreaking havoc on healthy cells.
Free radicals are unstable molecules, a product of oxidation and in a sense the rust of the body. In stable molecules, electrons normally associate in pairs, providing a balance. Everyday functions such as simply breathing, digesting food or moving about can remove one electron from a molecule, creating a free radical. This now unstable molecule tries to regain an electron by snatching one from another molecule. When it succeeds, another free radical is created and a chain reaction is set up in which the DNA, the body’s vital genetic information, may be damaged.
When the damaged DNA divides to reproduce, it can produce cancer or other disease-causing cells. As well as bodily functions, cigarette smoke, pollution, ultraviolet light and stress can create free radicals but so can cooking – in particular meat. Researchers in the US cooked beef burgers, bacon and soya-based burgers and found that both the beef burgers and bacon produced significant amounts of the most damaging free radicals while the soya burger produced none (116).
The remedy for free radicals are molecules called antioxidants.
All the world’s health advisory bodies agree that antioxidants are part of the body’s vital self-protection mechanism which actually defend you against 60 or more diseases, including the big killers of heart disease and cancer. They were almost unknown until comparatively recently and knowledge is still growing.
The three big saviours are vitamins – the beta-carotene form of vitamin A, vitamin C and vitamin E. None of them is found abundantly in meat, but the number of different plant foods which contain them is enormous. A recent discovery has added another powerful group of antioxidants to the list – flavonoids. They, too, are not found in meat but in predominantly red, purple or black fruit and vegetables.
The importance of folate in the diet is beginning to be appreciated, particularly by pregnant women. Lack of folate has been linked with serious birth defects but it is also associated with increased levels of cancer and heart disease. Folate also has an essential role in the formation of DNA and in manufacturing blood cells and it contributes to the formation of haem – the iron constituent of haemoglobin. It’s pretty important stuff!
The major sources of folate are all plant-based and so most vegetarians have considerably higher intakes than meat eaters (117, 118). In fact, some studies show that only vegetarians and vegans achieve the recommended daily intake of this vitamin (119).
As explained above folate is one of the three key B-vitamins that is now known to play a part in lowering levels of homocysteine in the body – a major risk factor for heart disease.
Fibre is the substance that makes up the cell walls of plants and passes through the body without being digested. It provides the bulk that ensures food is processed quickly through the bowels and because of the nature of their diet, vegetarians have a higher fibre intake than meat eaters. The fact that fibre speeds waste products through the body reduces the time that noxious agents – possibly cancer forming agents – spend in the intestines. It also affects the rate at which glucose (sugar) is released and absorbed and so helps reduce the chance of diabetes. Fibre also reduces the urge to eat and so it helps with appetite control – according to the WHO. Not surprisingly, diets high in fibre give a lower risk of heart disease and some cancers.
Cow’s milk is largely made up of animal fats, animal protein and lactose – none of which is required by the body. Difficulty in digesting lactose – the sugar found in cow’s milk – is extremely common right across the world. A staggering 75 per cent of the population worldwide is thought to be lactose intolerant (107). Most people can tolerate small quantities but research has been undertaken regarding its possible connection with ovarian problems and cataracts (122, 123).
Often the inability to digest cow’s milk goes unnoticed, particularly in children, but can lead to iron deficiency because of the intestinal bleeding it can cause (114).
Cow’s milk is loaded with 35 different hormones and 11 growth factors and there is considerable concern about its oestrogen and IGF1 (insulin-like growth factor) content (144). This is because cows are now milked seven months into their nine month pregnancy, which means that hormone levels are markedly high. Early evidence suggests that increased exposure to cow’s oestrogen and IGF1 raises the risk of certain cancers (particularly breast and prostate).
It’s worth remembering that there are about 5,000 species of mammals in the world but only humans consume milk after weaning. We are also the only one to drink the milk of another species, cows! Their milk is designed for calves who grow four times faster than human babies. (See VVF White Lies report online at www.vegetarian.org.uk.)
Fish is seemingly promoted as the new penicillin – the magic bullet for our health that will banish all our ills! All fish, it is claimed, are healthy but the oily fish such as salmon and mackerel are especially healthy containing, as they do, the good or omega-3 fats the body can’t live without. These omega-3 fats certainly help protect the heart but plant oils, not fish oils, are the true wonder foods here. According to the UK government’s own surveys, all fish contain toxic poisons such as mercury, PCBs and dioxins. Irresponsible human activity has polluted the world’s oceans and fish are literally swimming in a sea of human waste. To expect healthy food to come from an unhealthy environment is little short of madness! And over-fishing has virtually decimated fish stocks worldwide. But what of the claim that fish oils protect the heart?
Plant oils are twice as effective in lowering the risks of heart attack in high risk patients than fish oils! Where people are already eating a heart-friendly diet – one low in saturated fat, for example, typical of many vegetarian and vegan diets – adding fish to the diet will produce no additional benefit to the heart. Seeds, nuts, beans and their oils are the richest known sources of the essential good fats we need in the diet. Green vegetables are also a source. Walnuts, linseed (flax) and rapeseed oil are all exceptionally rich in omega-3 fats and are all easily available in supermarkets and healthfood shops. (See VVF Fishing For Facts report online at www.vegetarian.org.uk.)
The VVF is continually receiving reports of poor medical advice in pregnancy, particularly from GPs – although fortunately they are getting less frequent. Often women are told they should eat some meat during their pregnancy. This poor advice possibly reflects the fact that most GPs receive almost no nutritional education throughout the whole of their training nor subsequently.
Fruits, wholegrains, vegetables and legumes provide all the nutrients necessary for a healthy pregnancy (124). In fact, vegetarian mothers, very importantly, have reduced levels of contaminants in their breast milk (125, 126). One of the most worrying of these is the residue from pesticides. The ADA has no doubts that vegetarian diets are suitable for every stage of the life cycle, including pregnancy and lactation. There is currently some concern that there may be a link between the proteins in cow’s milk and other dairy products and diabetes in the newborn baby. A review of the clinical evidence suggests that children with type 1 diabetes are more likely to have been breast fed for less than three months and to have been exposed to cow’s milk protein before four months of age (145).
All pregnant women and mothers should carefully watch their intake of iron and vitamin B12, increasing their intake of foods which contain them – particularly vegan women. It is vital for vegan mothers to eat a good supply of B12-fortified foods and if they don’t like those, to take vitamin B12 supplements. B12 is needed for the developing foetus and after giving birth, if mum breast feeds, the baby relies on her to supply B12 in her breast milk. (See page 15 and Viva!/VVFVegetarian and Vegan Mother & Baby Guide at www.viva.org.uk/guides/motherandbaby or call 0117 944 1000 for a copy for £1.50.)
Something deeply depressing is happening to the diet of our children. For many, fresh fruit and vegetables are completely alien, fibre is almost unknown and the consumption of denatured processed foods is a daily event. We are deep into the burger, chips and sweets culture and obesity is booming. Effectively, children’s consumption of sugar and fat – much of it animal fat – is out of control.
Some estimates claim that as many as 40 per cent of all UK children are eating three times the recommended levels of both. These diets are far worse than those their parents ate and so the prognosis for future cases of cancer and heart disease, already at epidemic proportions, is extremely worrying. The first signs of atherosclerosis have already been identified in children (120). In this context, the doom-laden warnings that some journalists give to teenagers about the risks of a vegetarian diet are nothing short of laughable. Many, if not most, young people eat an extremely poor diet. Of course, anyone can eat a poor diet, including vegetarian children, but the science shows that giving up meat and animal fats is one of the healthiest moves anyone can make, regardless of their age.
Vegetarian children grow and develop in exactly the way they should (127, 128) and developmental tests show their mental age to be over a year in advance of their chronological age (129), and they have a higher IQ (150). There is also evidence that they enter puberty later, which has shown to reduce their risk of developing breast cancer later in life (130, 131).
Studies done in the 1940s, shortly after the war when little meat and dairy was available, showed that children grow and develop quite normally on a diet consisting of plenty of bread and vegetables with minimal amounts of milk and meat (132). In fact, a whole string of studies has shown that vegetarian and vegan children develop healthily and normally (121, 133).
The BMA considers that a vegetarian diet contains all the necessary nutrients and is suitable for infants. The ADA agrees that infants, children and adolescents all grow and develop normally and that vegetarian diets can be healthy and satisfy all their nutritional needs. A scientific review published recently in the Journal of Pediatric Health Carebacked this, stating: “Nurse practitioners… can reassure parents, children, and adolescents that a well-planned vegetarian diet is a healthy choice that promotes growth and decreases the risk for diabetes, heart disease and cancer,”(141). (See VVF Veggie Health for Kids guide for more information on bringing up children on a vegetarian or vegan diet at www.vegetarian.org.uk/guides/vhfk01 or call 0117 970 5190 for a copy for £1.50.)
Virtually the whole of the West’s public education on diet has encouraged people to consume increasing amounts of animal-based nutrients – go to work on an egg, drink more milk, slam in the lamb, lean on pork etc. We’re now finding that there is not just a minimum nutrient intake for good health but a maximum. Most of these policies were formulated in the 1940s and are all about preventing deficiency diseases. There was little knowledge of the damage that could be caused by too many nutrients and so these policies are completely out of touch with modern knowledge and modern living. They’re certainly not designed to protect people from the over-consumption of meat, dairy, sugar and fat.
Most affluent countries now show a high risk profile for some of the world’s biggest killers and intervention on a mass scale is needed to change dietary patterns and make them healthier, says the WHO.
According to many press reports, you would believe that a vegetarian diet is a finely balanced and difficult exercise in nutrition which, if you get it wrong, will result in everything dreadful – from protein deficiency to death of the first born. Just to show how wrong they are, a diet of wholemeal bread, margarine, Marmite and oranges would probably meet all the nutritional requirements of an adult (134). Of course, vegetarians consume a far wider variety of foods than this!
So what does the WHO believe we should be eating? Fat should be reduced to 15 per cent of total energy instead of the nearly 40 per cent it is at present – most of it animal fat. There need be no animal fats in the diet at all as they are not essential nutrients. Neither do we need cholesterol.
The bulk of our diet should be complex carbohydrates, starchy foods – potatoes, bread, pasta, rice, yams etc. They should account for between 55 and 75 per cent of all calories. Sugar contributes no nutrients and can be omitted. Protein should provide between 10-15 per cent but can readily be met by a varied diet based predominantly on cereals (wholemeal bread, wholegrain rice and pasta etc) and pulses (peas, beans and lentils).
The key component of a healthy diet is, therefore, starchy carbohydrates – with as wide a range of fresh fruit, vegetables, wholegrains, pulses, seeds and nuts as possible – in other words, a sensible vegan diet. There is a welter of evidence, according to the WHO, that foods rich in starch are really good for health and give protection against several diseases. They improve the chemistry of the gut and are a rich source of many minerals and vitamins, including essential fatty acids, calcium, zinc, iron and water-soluble vitamins – all known to have a clear and positive effect on health.
That is a pretty astounding statement from the world’s leading health advisory body and a clear call to the entire globe to go vegetarian. It dismisses those who are constantly harping on about vegetarians having a ‘restricted’ diet. In fact, British vegans and vegetarians consume a very wide variety of plant foods and their diets tend to contain a far greater choice than meat eaters (135).
There is little doubt that the WHO’s report in 1991 is a profound study of diet and health and its ramifications are enormous. It calls for a complete revision in agricultural policy to promote fruit and vegetables instead of meat and to grow cereals instead of meat and dairy. It goes on to say that its proposed nutritional objectives will have immense implications for the economics of farming, for government, industrial and social policies and for international trade and can thus be expected to meet with considerable opposition. How right they are. Even the WHO’s own 2003 update to its 1991 report on diet and health is far less radical in its call to cut back on animal products and embrace plant-based diets. The 1991 report can literally be seen as the last piece of truly independent thinking on diet and health by the WHO. Since this time it would seem that the mighty food industry has tamed even this august body. Meanwhile the promotion of unhealthy, disease-causing foods continues apace.
Make no mistake, you and your diet are being manipulated by the vested interests of a consumer society which has no real interest in health but a preoccupation with profit. You don’t have to be part of it and can start right now by taking responsibility for your own health and go vegetarian. In the process you will help to bring an end the obscenity of factory farming, help to diminish the onslaught which is killing the world’s oceans; you will begin to offer hope to the world’s starving and the environment will start to recover. It is one of the most important actions you can take in a world which is in frighteningly rapid decline, much of it caused by livestock production, fishing and fish farming. Your health is in your hands!
1. The Arizona Daily Star, Tucson, p14 9 May 1990.
2. British Medical Association, Diet, Nutrition & Health, BMA Report, 4.11, p49 1986.
3.Cambell T C, et al. Study on Diet, Nutrition and Disease in the People's Republic of China, Cornell University, 1989.
4. World Health Organisation, Geneva, Diet, Nutrition and the prevention of Chronic Diseases, 1991. Technical Report Series 797.
6. Physicians Committee for Responsible Medicine, Washington, Recommended Revisions for Dietary Guidelines for Americans, Jan 31,1995.
7. USDA, US Dietary Guidelines, federal advisory committees nutritional recommendations to Secretaries of Agriculture, Health and Human Services, 1995, p.21.
8. Mangels A R, et al. Position of the American Dietetic Association and Dietitians of Canada: Vegetarian Diets. Journal of the American Dietetic Association, June 2003, 103(6);pp.748-765.
9. Petersen, S., Peto,V., Scarborough, P. and Rayner, M. 2005. British Heart Foundation. Coronary heart disease statistics. [online] Available from: http://www.heartstats.org/uploads/documents%5CCh1_Mortality_2005.pdf [Accessed October 24 2005].
10. World Health Organisation, Geneva, Diet, Nutrition and the prevention of Chronic Diseases, 2003. Technical Report Series 916.
11. Lewis B. Understanding Cholesterol & Heart Disease, Family Doctor Series, British Medical Association.
12. Burr M L, Sweetenham P M. Vegetarianism, dietary fibre and mortality. American Journal of Clinical Nutrition, 1982, 36:pp.873-7.
13. Chang-Claude J et al. Mortality pattern of German vegetarians after 11 years of follow-up. Epidemiology 1992, 3:pp.395-401.
14. Snowdon D A et al. Meat consumption and fatal ischaemic heart disease. Preventative Medicine, 1984, 13:pp.490-500.
15. Key T J, et al. Health benefits of a vegetarian diet. Proceedings of the Nutrition Society, 1999, 58:pp.271-275.
16 Burr M L, Butland B K. Heart disease in British vegetarians. American Journal of Clinical Nutrition, 1988, 48:pp.830-2.
17. West R O, Hayes O B. Diet and serum cholesterol levels: a comparison between vegetarians and non-vegetarians in a Seventh-day Adventist group. American Journal of Clinical Nutrition 1968, 21:pp853-62.
18. Sacks F M, Ornish D, et al. Plasma lipoprotein levels in vegetarians: the effect of ingestion of fats from dairy products. Journal of American Medical Association, 1985, 254:pp.1337-41
19. Fisher M, Levine P H, Weiner B, et al. The effect of vegetarian diets on plasma lipid and platelet levels. Arch. Inte. Med., 1986, 146:pp.1193-7.
20. Burslem J, Schonfeld G, et al. Plasma apoprotein and lipoprotein lipid levels in vegetarians. Metabolism, 1978, 27:pp.711-9.
21. Benecol Cholesterol Awareness Study, BBC News Online Network, Health, 28 March 1999.
22. Bingham S A, et al. Are Imprecise Methods Obscuring a Relation Between Fat and Breast Cancer? The Lancet, 2003, 362 (9379):pp.212-214.
23. Cho E, et al. Premenopausal fat intake and risk of breast cancer. Journal of the National Cancer Institute, 2003, 95(14):pp.1079-1085.
24. Mosca L. Michigan University department of Epidemiology. BBC News Online Network, Health, 28 March 1999.
25. Hunninghake D B, Brown S E, et al. The efficacy of intensive dietary therapy alone or combined with lovastatin in out patients with hypercholesterolemia. New England Journal of Medicine, 1993, 328:pp.1213-9.
26. Cooper R S, et al. The selective lowering effect of vegetarianism on low-density lipoprotein levels in a cross-over experiment. Atherosclerosis, 1982, 44:pp.293-305.
27. Kestin M, et al. Cardiovascular disease risk factors in free-living men: comparison of two prudent diets, one based on lacto-ovo-vegetarianism and the other allowing lean meat. American Journal of Clinical Nutrition, 1989, 50:pp.280-7.
28. Ornish D, et al. Can lifestyle changes reverse coronary heart disease? Lancet 1990, 36:pp.29-33.
29. As above.
30. Roberts W C. Editorial, American Journal of Cardiology, 1 Oct 1990, 66 (10):pp896.
31. Rouse I L, et al. Blood pressure-lowering effect of a vegetarian diet: controlled trial in normotensive subjects. Lancet 1983, 1:pp.5-10.
32. Donaldson A N. The relation of protein foods to hypertension. Californian & Western Medicine, 1926, 24:pp.328.
33. Ophir O, et al. Low blood pressure in vegetarians: the possible role of potassium. American Journal of Clinical Nutrition, 1983, 37:pp.755-62.
34. Melby C L, Hyner G C, Zoog B. Blood pressure in vegetarians and non-vegetarians: a cross sectional analysis. Nutr. Res., 1985, 5:pp.1077-82.
35. Melby C L, et al. Relation between vegetarian/non-vegetarian diets and blood pressure in black and white adults. American Journal of Public Health, 1989, 79:pp.1283-88.
36. Riboli E. 22.06.2001. Meat, processed meat and colorectal cancer. EPIC Study – preliminary results.
37. Rouse I L, Beilin L J, Mahoney D P, et al. Nutrient intake, blood pressure, serum, urinary prostaglandins and serum thromboxane B2 in a controlled trial with lacto-ovo-vegetarian diet. Journal of Hypertension, 1986, 4:pp.241-50.
38. Margetts B M, Beilin L J, et al. Randomised controlled trial of a vegetarian diet in the treatment of mild hypertension. Clinical Exp. of Pharmacology & Physiology, 1985, 12:pp.263-66.
39. Margetts B M, Beilin L J, et al. Vegetarian diet in mild hypertension: a randomised controlled trial. Br. Med. Journal, 1986, 293:pp.1468-71.
40. Lindahl O, et al. A vegan regimen with reduced medication in the treatment of hypertension. British Journal of Nutrition, 1984, 52:pp.11-20.
41. The Lancet, 24 August 1990.
42. Wynder E L and Takao Shigematsu. Environmental factors of cancer of the colon and rectum. Cancer, 1967, 20:pp.1528.
43. Howell M A. Diet as an etiological factor in the development of cancers of the colon and rectum, Journal of Chronic Diseases, 1975, 28:pp.67-80.
44. Palgi A. Association between dietary changes and mortality rates: Israel 1949-1977; a trend-free regression model. American Journal of Clinical Nutrition, 1981, 34:pp.1569-83.
45. Lubin J H, et al. Dietary factors and breast cancer risk. American Journal of Clinical Nutrition, 1981, 28:pp.685-689.
46. Kolonel L N, et al. Nutrient intakes in relation to cancer incidence in Hawaii. British Journal of Cancer, 1981, 44:pp.332.
47. Correa P. Epidemiological correlations between diet and cancer frequency. Cancer Research, 1981, 41:pp.3685-90.
48. Willett W C, et al. Relation of meat, fat and fibre intake to the risk of colon cancer in a prospective study among women. New England Journal of Medicine, 1990, 23(24):pp.1664-72.
49. Chang-Claude J, et al. Mortality pattern of German vegetarians after 11 years follow-up. Epidemiology, 1992, 3:pp.395-401.
50. Thorogood M, et al. Risk of death from cancer and ischaemic heart disease in meat and non-meat eaters. British Medical Journal, 1994, 308:pp.1667-70.
51. Block G. Epidemiological evidence regarding vitamin C and cancer. American Journal of Clinical Nutrition, 1991, 54:pp.1310S-14S.
52. Negri E, et al. Vegetable and fruit consumption and cancer risk. Int. Journal of Cancer, 1991, 48:pp.350-54.
53. Marcus E. Vegan - The New Ethics of Eating, McBooks Press.
54. Snowdon D A, Philips R L. Does a vegetarian diet reduce the occurrence of diabetes? American Journal of Public Health, 1985, 75:pp.507-12.
55. As above.
56. West K M, Kalbfleisch J M. Glucose tolerance, nutrition and diabetes in Uruguay, Venezuela, Malaya and East Pakistan. Diabetes, 1966, 15:pp.9-18.
57. West K M, Kalbfleisch J M. Influence of nutritional factors on prevalence of diabetes. Diabetes, 1971, 20:pp.99-108.
58. Anderson J W et al. Metabolic effects of high-carbohydrate, high-fibre diets for insulin-dependent individuals. American Journal of Clinical Nutrition, 1991, 54:pp936-43.
59. Barnard R G, et al. Long-term use of a high-complex carbohydrate, high-fibre, low-fat diet and exercise in the treatment of NIDDM patients. Diabetes Care, 1983, 6:pp.268-73.
60. Munoz J M. Fibre and diabetes. Diabetes Care, 1984, 7:pp.297-300.
61. Crane M G, Sample C J. Regression of diabetic neuropathy on total vegetarian (vegan) diet. Journal of Nutritional Medicine, 1995.
62. Roy M S, et al. Nutritional factors in diabetics with and without retinopathy. American Journal of Clinical Nutrition, 1989, 50:pp.728-30.
63. Pixley F, et al. Effect of vegetarianism on the development of gallstones in women. British Medical Journal 1985, 291:pp.11-12.
64. As above.
65. Frentzel-Beyme R, Claude J, Eilber U. Mortality among German vegetarians: first results after five years of follow up. Nutrition & Cancer, 1988, 11:pp.117-26.
66. Melby C L, Hyner G C, Zoog B. Blood pressure in vegetarians and non-vegetarians: a cross-sectional analysis. Nutr. Res., 1985, 5:pp.1077-82.
67. Melby C L, Goldflies D G, et al. Relation between vegetarian/non-vegetarian diets and blood pressure in black and white adults. American Journal of Public Health, 1989, 79:pp.1283-88.
68. Sacks F M, Ornish D, et al. Plasma lipoprotein levels in vegetarians: the effect of ingestion of fats from dairy produce. Journal of the American Medical Association, 1985, 254:pp.1337-41.
69. Pixley F, et al. Effect of vegetarianism on the development of gallstones in women. British Medical Journal, 1985, 291:pp.11-12.
70. Burr M L, et al. Plasma cholesterol and blood pressure in vegetarians. Journal of Human Nutrition 1981, 35:pp 437-41.
71. Rouse I L, et al. Vegetarian diet, blood pressure and cardiovascular risk. Australia New Zealand Journal of Medicine, 1984, 14:pp.439-43.
72. Frentzel-Beyme R, Claude J, Eilber U. Mortality among German vegetarians; first results after five years of follow up. Nutrition & Cancer, 1988, 11:pp.117-26.
73. Ornish D, Brown S E, et al. Can lifestyle changes reverse coronary heart disease? Lancet, 1990, 336:pp.129-133.
74. Dwyer J T, et al. The new vegetarians. Journal of the American Dietetic Association, 1973, 62:pp.503-9.
75. BBC News Online Network, 31 March, 1999.
76. John Studd, Gynaecologist and Vice-Chair of National Osteoporosis Society.
77. Heaney R P, Weaver C M. Calcium absorption from kale. American Journal of Clinical Nutrition, 1990, 51:pp.656-7.
78. Heaney R P, et al. Soybean phytate content: effect on calcium absorption. American Journal of Clinical Nutrition, 1991, 53:pp.745-7.
79. Weaver C M, et al. Human calcium absorption from wholewheat products. Journal of Nutrition, 1991, 121:pp.1769-75.
80. Weaver C M, et al. Extrinsic versus intrinsic labelling of the calcium in wholewheat flour. American Journal of Clinical Nutrition, 1992, 55:pp.452-4.
81. Cox P. Encyclopaedia of Vegetarian Living 1994, Bloomsbury Press.
82. New York Times, 8 May, 1990.
83. Nielsen F H, et al. Effect of dietary boron on mineral oestrogen and testosterone metabolism in postmenopausal women, FASEB Journal, Nov. 1987 1(5):pp.394-7.
84. Abelow B J, Holford T R, Insogna K L. Cross-cultural association between dietary animal protein and hip fracture: a hypothesis. Calcif. Tissue International, 1992, 50:pp.14-18.
85. Helman A D, Darnton-Hill I. Vitamin and iron status in new vegetarians. American Journal of Clinical Nutrition, 1987, 45:pp.785-9.
86. Craig W J. Iron status of vegetarians. American Journal of Clinical Nutrition, 1994, 59:pp.1233S-7S.
87. Dwyer J T, et al. Nutritional status of vegetarian children. American Journal of Clinical Nutrition, 1982, 35:pp.204-16.
88. McEndree L S, Kies C V, Fox H M. Iron intake and iron nutritional status of lacto-ovo-vegetarian and omnivore students eating in a lacto-ovo-vegetarian food service. Nutr. Rpt. Int., 1983, 27:pp.199-206.
89. Latta D, Liebman M. Iron and zinc status of vegetarian and non-vegetarian males. Nutr. Rep. Int., 1984, 30:pp.141-9.
90. Anderson B M, Gibson R S, Sabry J H. The iron and zinc status of long-term vegetarian women. American Journal of Clinical Nutrition, 1981, 34:pp.1042-48.
91. Lauffer R. Iron balance. New York: St Martins 1991.
92. Sanders T A B. Vegetarianism: dietetic and medical aspects. Journal of Plant Foods, 1983, 5:pp.3-14.
93. Sanders T A B, Reddy S. Vegetarian diets and children. American Journal of Clinical Nutrition, 1994, 59:(suppl):pp.1176S-81S.
94. As 91.
95. As 86.
96. As 91.
97. Cook J D. Adaptation in iron metabolism. American Journal of Clinical Nutrition, 1990, 51:pp.301-8.
98. Salonen J T, et al. Iron sufficiency is associated with hypertension and excess risk of myocardial infarction: the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD). Circulation, 1992, 85:pp.864.
99. Ascherio A, et al. Dietary iron intake and risk of coronary disease among men. Circulation, 1994, 89:pp.969-74.
100. As 90.
101. Stevens R G, at al. Body iron stores and the risk of cancer. New England Journal of Medicine, 1988, 319:pp.1047-52.
102. Weinberg E D. Iron withholding: a defence against infection and neoplasia. Phys. Rev., 1984, 64:pp.65-101.
103. Brock J H. Iron and the outcome of infection. British Medical Journal, 1986, 293:pp.518-20.
104. As 102.
105. American Dietetic Association. Position paper on vegetarian diets 1993. Journal of the ADA, 11:pp.1317-19.
106. As 92.
107. Srinivasan R and Minocha A. When to suspect lactose intolerance: symptomatic, ethnic and laboratory clues. Postgrad. Med., 1999; 104(3):pp.109-123.
108. As 89.
109. Srikumar T S, et al. Trace element status in healthy subjects switching from a mixed to a lacto-ovo-vegetarian diet for 12 months. American Journal of Clinical Nutrition, 1992, 55:pp.885-90.
110. National Research Council. Recommended Dietary Allowances. Washington D C, National Academy Press, 1989.
111. As 92.
112. Freeland-Graves J. Mineral adequacy of vegetarian diets. American Journal of Clinical Nutrition, 1988, 48:pp. 859-62.
113. O’Connor M A, et al. Dept. of Nutrition, Royal Prince Alfred Hospital, Camperdown, NSW, Medical Journal of Australia, 1987, 147:pp.540-542.
114. Sullivan PB, Cow’s milk induced intestinal bleeding in infancy. Archives of Disease in Childhood, 1993, 68:pp. 240-245.
115. Gerstein H C. Cow’s milk exposure and type 1 Diabetes Mellitus. Diabetes Care, 1993, 17(1):pp. 13-19.
116. As 53.
117. Department of Health 1994. Dietary Reference Values for Food Energy and Nutrients for the United Kingdom.
118. Sanders T A B, Ellis F R, Dickerson J W. Haematological studies on vegans. British Journal of Nutrition, 1978, 40(1):pp. 9-15.
119. Havala S, et al. Position of the American Dietetic Association: Vegetarian Diets - technical support paper, Journal of the American Dietetic Association 1988, 88(3):pp. 352-5.
120. Berenson, G S et al, Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. New England Journal of Medicine, 1988, 338:pp.1650-1656.
121. Sanders T A B, Vegetarian diets and children. Paediatric Nutrition, 1995, 42(4):pp. 955-965.
122. Simoons F J. A geographic approach to senile cataracts: possible links with milk consumption, lactase activity and galactose metabolism. Dig. Dis. Sci., 1982, 27:pp.257-64.
123. Cramer D W, Willett W C, Bell D A, et al. Galactose consumption and metabolism in relation to the risk of ovarian cancer. Lancet, 1989, 2:pp.66-71.
124. Sanders T A B. The health and nutritional status of vegans. British Journal of Nutrition, 1978, 40:pp.9-15.
125. Wolff M S, et al. Blood levels of organochlorine residues and risk of breast cancer. Journal of the National Cancer Institute, 1993, 85:pp.648-52.
126. Hergenrather J, et al. Pollutants in breast milk of vegetarians. Lancet, 1981, pp.304-792.
127. As 124.
128. As 87.
129. Dwyer J T, Miller L G, Arduino N L, et al. Mental age and IQ of predominantly vegetarian children. Journal of the American Dietetic Association, 1980, 76:pp.142-7.
130. de Ridder C M, et al. Dietary habits, sexual maturation and plasma hormones in pubertal girls: a longitudinal study. American Journal of Clinical Nutrition, 1991, 54:pp.805-13.
131. Beaton G M, Bengoa J M, WHO monograph 1976, 62:pp. 500-19.
132. As 93.
133. As 92.
134. As 92.
135. As 92.
136. De Luca, H. Vitamin D and its metabolites. Modern Nutrition in Health and Disease. Eds: Shils M E and Young V R. Lea and Ferbiger, 1988.
137. Cox P. Peter’s Cox’s Guide to Vegetarian Living, Bloomsbury Press, 1994.
138. McKie R & Elston L, The Observer 30.04.2000.
139. Langley C. An EPIC Undertaking. The Vegan Magazine Spring 2003.
140. Langley C. An EPIC Undertaking. The Vegan Magazine Autumn 2003.
141. Dunham L, Kollar LM. Vegetarian eating for children and adolescents. J Pediatr Health Care. 2006 Jan-Feb;20(1):27-34.
142. Health Survey for England, 2003, Vol 2: Risk Factors For CVD 10: Self-Reported Health and Psychological Well-Being.
143. Department of Health, 2000. The NHS Cancer Plan a plan for investment a plan for reform. London: Department of Health. 22293 1p 25k SEP 00 (CWP).
144. Ganmaa, D. and Sato, A. 2005. The possible role of female sex hormones in milk from pregnant cows in the development of breast, ovarian and corpus uteri cancers. Medical Hypotheses. 65 (6) 1028-37.
145. Gerstein, H. C. 1994. Cow’s milk exposure and type 1 diabetes mellitus. A critical overview of the clinical literature. Diabetes Care. 17 (1) 13-9.
146. Greger, M. 2002. Stopping Cancer Before It Starts. DVD. Available from VVF.
147. Davey et al. 2002. EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33883 meat-eaters and 31546 non meat-eaters in the UK. Public Health Nutrtion 6(3)., 259-268.
148. Lewin, MH et al. 2006. Red meat enhances the colonic formation of the DNA adduct 06-carboxymethyl guanine: implications for colorectal cancer risk. Cancer research 66 (3) 1859-65.
149. He FJ et al. 2006. Fruit and vegetable consumption and stroke: meta analysis of cohort studies. The lancet. 367 (9507) 320-6.
150. Gale CR et al. IQ in childhood and vegetarianism in adulthood: 1970 British cohort study. British Medical Journal Online First, doi:10.1136/bmj.39030.675069.55, 15 December 2006.