Healthy and Contaminated Vegetarianism
- Omnivores or nonvegetarians outnumber vegetarians 10 to 1 in western cultures. Vegetarians in western countries, but not in India, enjoy a remarkably good health, exemplified by low rates of dyslipidemia (cholesterol problems), obesity, hypertension, diabetes, coronary artery disease (CAD), and cancer, as well as a 3 to 6 year increase in life expectancy.1-14
- A man is what he eats (and not what he does not eat). Contrary to common belief, the multifaceted benefits appear to be not the abstinence from meat consumption but due to greater consumption of a portfolio of natural heart-healthy foods.15-17
- Olive oil, fresh fruits and vegetables are protective against heart disease and seem to play a greater role in the French paradox than chugging wine.18 Greater consumption of whole milk and other animal products were important contributors to Finland and the US having the highest rates of CAD in the 1960’s.18, 19
- A healthy vegetarian diet is characterized by liberal or more frequent consumption of fruits and vegetables, whole grains, soy, legumes, nuts, that are high in antioxidants and phytochemicals.20 US vegetarians eat more whole-grain products, dark green and deep yellow vegetables, whole-wheat bread, brown rice, soy milk, tofu, meat substitutes, legumes, lentils, garbanzos, walnuts, and pecans. They generally have twice the fish consumption of non-vegetarians 2
- Nuts, viscous fibers (from oats and barley), soy proteins, and plant sterols in vegetarian diets improve serum lipid levels. Furthermore, substituting soy or other vegetable proteins for animal proteins reduces the risk of developing nephropathy in diabetes.21
- Western vegetarians in general consume a healthier diet that is rich in fiber and healthy fat and low in unhealthy fat. With the exception of tropical oils, calories from plant sources are negatively correlated with CAD mortality, whereas calories from animal sources are positively correlated.18
- Vegetarians include vegans who do not consume any animal products, ovo-vegetarians who consume egg, lacto-vegetarians who consume milk, ovo-lacto-vegetarians who consume egg and milk, and semilacto- vegetarians who eat small amounts of meat (<1 time/week).21
- Surprisingly, most self-defined vegetarians in western countries consume red meat and poultry, albeit infrequently, and in very small quantities. In a recent survey, only 1% of self-reported vegetarians did not eat meat in the USA, whereas about 6% of Americans who do not consume any meat did not identify themselves as vegetarians.22-24
- Western vegetarians eat about two-thirds of saturated fats (SAFA), and one-half of cholesterol as omnivores; vegans consume one-half of SAFA and no cholesterol.25, 26 Cholesterol levels among western vegetarians are 15–25 mg/dl lower than omnivores and vegans have very low levels of LDL.10, 27-31 However, they eat the same amount of food as omnivores (1000 kg/year) but are usually thinner which must be related to quality of food or other lifestyle practices.5
Contaminated Vegetarianism Among Asian Indians
- Nearly half of Asian Indians are lifelong vegetarians. Unlike in other populations, Asian Indian vegetarians and non-vegetarians have a similar pattern of dyslipidemia and similar rates of CAD.32 This phenomenon appears to be due to “contaminated vegetarianism” wherein liberal amounts full-fat dairy products, sweets, curries, and fried food loaded with saturated fats, trans fats, and refined sugar are consumed.
- Indian vegetarianism is a form of “contaminated vegetarianism.” Unlike western vegetarians, most Asian Indians are lacto-ovo-vegetarians and consume liberal quantities of full-fat milk, ice cream, and other full-fat dairy products. Use of buffalo milk which has double the fat content of cow’s milk (8% vs 4%) is common and the use of low-fat and skim milk is uncommon.1, 21
- Contrary to popular belief, dairy products are the major source of saturated fat, even in the western diet. Indian vegetarians consume liberal amounts of butter, ghee, cheese, ice cream, yogurt (curd), and other full-fat dairy products to overcompensate for not consuming meat. It is worth highlighting that saturated fat in high-fat dairy products increases LDL levels 3 times as much as it raises HDL.33 Although the intake of fat is 20%–25% energy in most Asian countries, many affluent Asian Indians consume >50% of their calories from fat.21
- Meat is expensive and consumed infrequently and in very small quantities by Indian omnivores because of cultural and financial reasons. 90% of the food is shared by vegetarians and non vegetarians alike. This is in sharp contrast to an annual per capita consumption of 124 kg meat (340g or 12oz per day) and 23 kg fish (60g or 2oz per day) by Americans.34 Indian vegetarians abstain from fish, depriving them of essential omega-3 fatty acids. For these reasons, most Indians may be considered vegetarians by western standard.
- Liberal amounts of unhealthy cooking oils are used for cooking vegetables, sweets, Indian breads, snacks, rice, and curries. The tropical oils, such as palm oil and coconut oil (meat and milk, as well), are very high in saturated fat and major contributors to increase in LDL; these products also used liberally by both Indian vegetarians and non-vegetarians.21
- The use of animal and vegetable Ghee(vanaspathi) are equally common among vegetarians and non-vegetarian Indians. Ghee is very high in saturated fat whereas vanaspathi may contain as much as 50% trans fat capable of increasing LDL significantly.21
- Research has found that many commonly consumed Indian types of bread contain more trans fat than French fries, the western villain. For example, the trans fat content of 100 g of French fries is 4 -6 g, compared to 10 g in bhatura, 8 g in paratha, puri, and tikkis made in vanaspathi. These breads are universal stable in the Indian diet with many Indians consuming on an average, 5 to 6 breads a day.
- Deep frying is a favorite form of food preparation resulting in increased consumption of trans fat and saturated fat.1 Most Indian snacks, particularly vegetables and vegetarian snacks are deep fried and loaded with unhealthy fat.21
- Furthermore, overcooking and prolonged cooking of food is widely practiced among Asian Indians and results in destruction of most nutrients, especially folate. The overall consumption of fresh fruits and vegetables is very low and consumption of fresh green leafy vegetables is negligible. The poor dietary habits probably account for the high levels of homocysteine found among Asian Indians.21
- In a Canadian study, Asian Indians consumed more fried foods and high-fat dairy products, such as full-fat milk than Whites.35 In the CADI study, Asian Indian physicians in the USA followed a heart-healthy diet, with 32% energy from total fat, and 8% from SAFA, which is the recommendation by the NCEP.36 This appears to be an exception rather than the rule.
- Western vegetarians but not Indian vegetarians have lower rates of insulin resistance and diabetes.37, 38 The lipoprotein levels and rates of diabetes and CAD are no different from those of nonvegetarians.32, 36 This phenomenon is due to contaminated vegetarianism, wherein vegetarians manage to consume excessive amounts of SAFA and TRAFA. In addition to genetic susceptibility, high glycemic load, may be contributing to diabetes. Consumption of carbohydrates in excess of 280g/day is associated with high triglyceride (TG) and low HDL levels.21, 36
- Alcohol has been found to be not protective among Indians because of an unhealthy pattern of consumption─ usually in large quantities (binge drinking). The benefit of alcohol is limited to those who consume small quantities regularly, but the harm out weighs the benefit among binge drinkers.39
1. Enas EA, Senthilkumar A, Chennikkara H, Bjurlin MA. Prudent diet and preventive nutrition from pediatrics to geriatrics: current knowledge and practical recommendations. Indian heart journal. Jul-Aug 2003;55(4):310-338.
2. Singh PN, Sabate J, Fraser GE. Does low meat consumption increase life expectancy in humans? Am J Clin Nutr. Sep 2003;78(3 Suppl):526S-532S.
3. Key TJ, Appleby PN, Davey GK, Allen NE, Spencer EA, Travis RC. Mortality in British vegetarians: review and preliminary results from EPIC-Oxford. Am J Clin Nutr. Sep 2003;78(3 Suppl):533S-538S.
4. Singh PN, Lindsted KD. Body mass and 26-year risk of mortality from specific diseases among women who never smoked. Epidemiology. May 1998;9(3):246-254.
5. Appleby PN, Thorogood M, Mann JI, Key TJ. Low body mass index in non-meat eaters: the possible roles of animal fat, dietary fibre and alcohol. Int J Obes Relat Metab Disord. May 1998;22(5):454-460.
6. Snowdon DA, Phillips RL. Does a vegetarian diet reduce the occurrence of diabetes? Am J Public Health. May 1985;75(5):507-512.
7. Snowdon DA, Phillips RL, Fraser GE. Meat consumption and fatal ischemic heart disease. Preventive medicine. Sep 1984;13(5):490-500.
8. Fraser G E, Lindsted KD, Beeson WL. Effect of risk factor values on lifetime risk of and age at first coronary event. The Adventist Health Study. Am J Epidemiol. 1995;142(7):746-758.
9. Thorogood M, Mann J, Appleby P, McPherson K. Risk of death from cancer and ischaemic heart disease in meat and non- meat eaters. Bmj. 1994;308(6945):1667-1670.
10. Key TJ, Fraser GE, Thorogood M, et al. Mortality in vegetarians and non-vegetarians: a collaborative analysis of 8300 deaths among 76,000 men and women in five prospective studies. Public Health Nutr. Mar 1998;1(1):33-41.
11. Famodu AA, Osilesi O, Makinde YO, et al. The influence of a vegetarian diet on haemostatic risk factors for cardiovascular disease in Africans. Thromb Res. Jul 1 1999;95(1):31-36.
12. Rouse IL, Beilin LJ, Armstrong BK, Vandongen R. Vegetarian diet, blood pressure and cardiovascular risk. Aust N Z J Med. Aug 1984;14(4):439-443.
13. Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. May 2009;32(5):791-796.
14. Brathwaite N, Fraser HS, Modeste N, Broome H, King R. Obesity, diabetes, hypertension, and vegetarian status among Seventh-Day Adventists in Barbados: preliminary results. Ethn Dis. Winter 2003;13(1):34-39.
15. Burr ML, Butland BK. Heart disease in British vegetarians. Am J Clin Nutr. 1988;48(3 Suppl):830-832.
16. Jenkins DJ, Kendall CW, Marchie A, et al. Type 2 diabetes and the vegetarian diet. Am J Clin Nutr. Sep 2003;78(3 Suppl):610S-616S.
17. Jenkins DJ, Kendall CW, Marchie A, et al. Type 2 diabetes and the vegetarian diet. Am J Clin Nutr. Sep 2003;78(3 Suppl):610S-616S.
18. Artaud-Wild SM, Connor SL, Sexton G, Connor WE. Differences in coronary mortality can be explained by differences in cholesterol and saturated fat intakes in 40 countries but not in France and Finland: A paradox. Circulation. 1993;88(6):2771-2779.
19. Enas EA, Jacob S. Decline of CAD in developed countries: Lessons for India. In: Sethi K, ed. Coronary Artery Disease in Indians – A Global Perspective. Mumbai: Cardiological Society of India; 1998:98 -113.
20. Rajaram S. The effect of vegetarian diet, plant foods, and phytochemicals on hemostasis and thrombosis. Am J Clin Nutr. Sep 2003;78(3 Suppl):552S-558S.
21. Enas EA. Indian diet and cardiovascular disease: An update. In: Chatterjee SS, ed. Update in Cardiology Hyderabad: Cardiology Society of India.; 2007.
22. Haddad EH, Tanzman JS. What do vegetarians in the United States eat? Am J Clin Nutr. Sep 2003;78(3 Suppl):626S-632S.
23. Singh R B, Sharma JP, Rastogi V, et al. Prevalence of coronary artery disease and coronary risk factors in rural and urban populations of north India. Eur Heart J. 1997;18(11):1728-1735.
24. Kant AK, Block G, Schatzkin A, Ziegler RG, Nestle M. Dietary diversity in the US population, NHANES II, 1976-1980. J Am Diet Assoc. Dec 1991;91(12):1526-1531.
25. Davis BC, Kris-Etherton PM. Achieving optimal essential fatty acid status in vegetarians: current knowledge and practical implications. Am J Clin Nutr. Sep 2003;78(3 Suppl):640S-646S.
26. Janelle KC, Barr SI. Nutrient intakes and eating behavior scores of vegetarian and nonvegetarian women. J Am Diet Assoc. Feb 1995;95(2):180-186, 189, quiz 187-188.
27. Burr M L, Bates CJ, Fehily AM, St Leger AS. Plasma cholesterol and blood pressure in vegetarians. J Hum Nutr. Dec 1981;35(6):437-441.
28. Thorogood M, Carter R, Benfield L, McPherson K, Mann JI. Plasma lipids and lipoprotein cholesterol concentrations in people with different diets in Britain. Br Med J (Clin Res Ed). Aug 8 1987;295(6594):351-353.
29. Fisher M, Levine PH, Weiner B, et al. The effect of vegetarian diets on plasma lipid and platelet levels. Arch Intern Med. Jun 1986;146(6):1193-1197.
30. Jenkins DJ, Kendall CW, Popovich DG, et al. Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Metabolism. Apr 2001;50(4):494-503.
31. Sacks F M, Castelli WP, Donner A, Kass EH. Plasma lipids and lipoproteins in vegetarians and controls. N Engl J Med. 1975;292(22):1148-1151.
32. Enas EA, Garg A, Davidson MA, Nair VM, Huet BA, Yusuf S. Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America. Indian heart journal. 1996;48(4):343-353.
33. Sacks FM, Ornish D, Rosner B, McLanahan S, Castelli WP, Kass EH. Plasma lipoprotein levels in vegetarians. The effect of ingestion of fats from dairy products. Jama. Sep 13 1985;254(10):1337-1341.
34. Pimentel D, Pimentel M. Sustainability of meat-based and plant-based diets and the environment. Am J Clin Nutr. Sep 2003;78(3 Suppl):660S-663S.
35. Enas EA, Yusuf S. Third meeting of the International Working Group on coronary artery disease in South Asians, March 29, 1998 Atlanta, GA , USA. Indian Heart J. 1999;51:99-103.
36. Yagalla MV, Hoerr SL, Song WO, Enas E, Garg A. Relationship of diet, abdominal obesity, and physical activity to plasma lipoprotein levels in Asian Indian physicians residing in the United States. J Am Diet Assoc. 1996;96(3):257-261.
37. Kahleova H, Matoulek M, Malinska H, et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with Type 2 diabetes. Diabet Med. May 2011;28(5):549-559.
38. Trapp CB, Barnard ND. Usefulness of vegetarian and vegan diets for treating type 2 diabetes. Curr Diab Rep. Apr 2010;10(2):152-158.
39. Joshi P, Islam S, Pais P, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. Jama. Jan 17 2007;297(3):286-294.