Can the #DocsWhoLift go full vegan for a month? To be well-rounded, we decided it was time that we open our minds to that dietary pattern. We already promote plant-based diets (veggies are the base of our old pyramid!) to our patients and try to practice that pattern of eating ourselves. We generally don’t, however, push a strict vegetarian diet because we feel the evidence supports incorporation of lean animal products (especially fish, dairy, and eggs) for health, wellness, and fitness. We have never considered eating a strict vegetarian diet ourselves because, let’s face it, we are meat-heads! (Academic meat-heads, but nonetheless). That does not mean we do not acknowledge that a vegan dietary pattern can be adhered to in a healthful manner with benefits. Plenty of observational studies support vegetarian diets, most notably the Adventist Health Studies which showed lowest mortality in those who eat a vegetarian pattern with fish and lower risk of diabetes compared to other patterns. Controlled intervention trials have also shown benefits of vegetarian diets for cardiovascular risk factors and diabetes compared to standard diets. That can also be said for a variety of other dietary patterns spanning the spectrum from low-fat to low-carb and a Mediterranean pattern diet.
So in order to carry this experiment out, we recruited the assistance of a friend and colleague, Dr. Garth Davis. He is a bariatric surgeon who turned to a vegan lifestyle in order to practice and preach a lifestyle first. He gave us some pointers and support in addition to introducing us to a vegan guru, Robert Cheeke, who has led a successful vegan-based fitness community. This isn’t something to just try without doing research and having somebody with credentials and experience to guide you. I had a patient a few years ago referred from cardiology for arrhythmias who had been strict vegan for a few years suddenly. It turned out that she had not carefully balanced her amino acids (protein) and had substantial deficiencies leading to cardiac electrical abnormalities. Most likely this is not something we would run into, because our baseline diets have plenty of nuts and legumes which provide all essential amino amino acids. The USDA actually provides a basic guide for vegetarians (http://www.choosemyplate.gov/healthy-eating-tips/tips-for-vegetarian.html).
Obviously this was not a randomized trial, but just an experience we needed to do for our “n=2” outcomes. Honestly not much was expected to change in just a month, so it was really more about learning and gaining a tool for helping patients. That said, we are always interested in safe self-experimentation regarding potential changes to internal health. We took some before/after pictures, got our lipid panels checked before/after, and we both know our body fat percentage based upon DEXA, electrical impedance, and/or skin fold testing. The following is our lipid panel going in (for more info, check out Spencer’s blog on cholesterol), our weights, and body fat percentages.
Image may be NSFW.
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Dr. Karl Nadolsky:
- LDL-c 96 mg/dL
- Non-HDL-c 99 mg/dL
- Triglycerides 51 mg/dL
- Apo-B 72 mg/dL
- Body Fat %: DEXA 10.9%; Electrical Impedance 10%; Skin Folds 6-8%
Image may be NSFW.
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Dr. Spencer Nadolsky
- LDL-c 145 mg/dl
- Non-HDL-c 162 mg/dl
- Triglycerides 89 mg/dl
- LDL-p 1795 nmol/L
- Body Fat %: Electrical Impedance 10.8% ; Skin Folds 8%
** Editor note (Dr. Spencer)
– If you notice that my numbers look a tad high you are correct. I am thinking this could be a result of my post body building competition binges and weight gain. While I don’t look fat by any means, it is possible that the high energy flux after my competition caused some visceral fat accumulation. It is either that or because these labs were done right after thanksgiving, the high energy weekend played a large role. To see my other labs checkout www.DrSpencer.com where I discuss these at length during my high carb experiment. Will be putting more things there as well.
AFTER:
Dr. Karl
This turned out to be an enjoyable experiment for me, mostly because it proved easier than I had anticipated. As I mentioned prior to the experiment, we have been consistently eating a fair amount of animal products our whole lives with a large daily amount of dairy and usually including poultry, fish, and/or lean beef and maybe eggs. I personally don’t eat a diet high in carbohydrate load other than my post-workout oatmeal but to replace some of the protein, I increased my daily consumption of rice/quinoa, potatoes, etc. Part of my usual diet is including nuts/nut butters and legumes/pulses so that was an easy thing to increase and became the staple of my diet other than other veggies and fruits. Avoiding dairy was actually the hardest part from replacing my milk in morning coffee with almond/cashew/coconut milk to using soy milk on my oatmeal without our Leaner Living MRP protein powder.
An example of what I ate, ad libitum as usual:
- Steal-cut oats + rolled oats + oatbran and mixed berries now with soy milk
- Almond butter sandwich on ezekial bread
- Apple and orange scattered through the day
- Lunch was a variety of choices at our café usually including a veggie salad with sunflower seeds, a bean soup, veggies and potatoes, and sometimes a black-bean burger
- Up to 100 grams of almonds/walnuts/peanuts/pecans and 20 grams of 90% cocoa daily
- Snacked on olives and/or veggie chips w/ hummus upon getting home
- Dinner ranged from chili to lentil/split-pea soup to black-bean pasta and beans & rice
I stayed pretty satiated on what I estimated, based upon a 3 day recall, to be:
- 2750-3000 kcal
- 90-105 gm fat
- 325-450 gm carbohydrate (about 100-120 gm fiber)
- 125-150 gm protein
These macronutrients appear similar to my baseline but with lower protein and higher carbohydrates.
My exercise routine stayed the same, and my performance/energy/recovery didn’t seem affected too much, though infrequently I felt a little more run-down and I wondered if it was due to the diet or just coincidence (again not a randomized controlled trial and certainly not blinded so who knows).
My follow-up lipid panel is nearly identical, most importantly with essentially the same non-HDL and apoB (the atherogenic lipoproteins which correlate most strongly with atherosclerotic heart disease and remain optimally < 100 mg/dL and <80 mg/dL respectively). The HDLc (“good” lipoprotein cholesterol) went down slightly but similarly to lower LDLc (“bad” lipoprotein cholesterol) thus the similar non-HDL/apoB. Note that my nonHDL/apoB are optimal and actually discordantly lower than my (still very good but wouldn’t be “optimal” for a person with known heart disease) LDLc. This is likely due to the consistently low triglycerides I have due to a long history of healthful diet/exercise, lean physique (including liver/muscle fat), and obviously some genetics. For those who questioned whether lipids can change in just a month, many lipid/diet trials are that long because they do, and I have described a patient (we both have a few) whose non-HDL/apoB rose dramatically due to Bullet-Proof Coffee containing large amounts of butter/medium-chain-triglycerides.
I think my after picture has not changed, and is consistent with my stable body weight (172lbs) and body composition per calipers/impedance.
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Dr. Karl after 1mo vegan
Lipid panel after a month of vegan:
◾LDL-c 91 mg/dL
◾Non-HDL-c 98 mg/dL
◾Triglycerides 68 mg/dL
◾Apo-B 68 mg/dL
◾Body Fat %: Electrical Impedance 10%; Skin Folds 6-8%
Dr. Spencer:
Many people asked how I could go without meat for the month, but the real question should have been about dairy and eggs. I LOVE THEM! I was able to manage though and despite having more daily carbohydrates than I can remember in recent past, I still lost 4 pounds during this month (hopefully not all muscle). Strength levels remained about the same. Energy levels were about the same, or perhaps a bit higher. I felt great the whole time with no hunger issues. By the end though, I was ready to have some animal products as the meals have to be a bit more elaborate for them to taste good. I couldn’t just have a hunk of meat with veggies. There had to be some mixture of spices with beans and quinoa to make the meal taste good and have enough protein to not let me wither away.
Breakfast: Cup and a half of oats with a serving or two of peanut butter, banana, and rice/almond milk.
Lunch: Leftovers from the night before or lentil soup with a handful of raw nuts and an apple.
Afternoon snack: Similar to lunch
Dinner: Big bowl of pasta or quinoa/rice, chickpeas, tofu and various veggies.
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Dr. Spencer 1mo post-vegan
Calories: Somewhere between 3000-3500
Protein: 100-130 g (down from 175-225)
Carbohydrates: 450-600 g
Fat: about 100 g
Lipid panel after a month of vegan:
◾LDL-c 86 mg/dL
◾Non-HDL-c 105 mg/dL
◾Triglycerides 96 mg/dL
◾Apo-B 67 mg/dL & LDLp 984
I think, and based on the evidence, that eating these plants as sources of carbohydrates and fats are very healthful. What I am not convinced of is that adding a bit of meat, dairy, and egg will cause any ill effects on your health. What about quality of life? If eating plants only is the healthiest thing you can do but only adds a few years of life, is it worth it? Who knows what the threshold is. Is it my bias of more protein rich foods being good for muscle growth that makes me want to think meat and dairy/eggs is okay to eat with a base of plants? Maybe partially, but I think looking at the body of evidence there is reason to believe they can be included in your diet. As you can see from my lipid changes, the vegan diet can be POWERFUL. I will likely go more into this on my blog at DrSpencer.com because I also ran a separate experiment comparing two major labs at the same time.
Take Home Points (with some references for interest, but not an exhaustive review):
- Plant-based whole food dietary patterns are healthful[1] and associated with decreased cardiometabolic disease ranging from strict veganism to Mediterranean[2],[3],[4],[5] and can even be improved upon by decreasing glycemic load[6]–[7]
- Eat more veggies and fruit, as they are associated with lower mortality[8] and incidence of diabetes[9]
- Vegetarian dietary patterns are associated with healthy behaviors and lower mortality[10] & incidence of type 2 diabetes[11] while also providing nutritional improvement for diabetes[12]
- Eat more legumes (beans/pulses) as they are associated with satiety,[13] weight loss & improved lipids[14] and improved glycemic control in diabetes[15] along with fiber associating with lower mortality[16]
- We still feel evidence supports benefits of a healthful diet including low-fat or whole sources of dairy[17],[18],[19],[20]
- Including fish was actually associated with the lowest mortality in one of the major longitudinal vegetarian studies (Adventist Health Study 2)[21] and (especially fatty fish) has a plethora of data suggesting cardiovascular health benefits[22]–[23]
- How about red meat? Most are aware that observational cohorts have shown association of red meat with increased mortality but it seems to be driven by processed red meats[24]–[25]. We feel it is reasonable to enjoy some high quality lean red meat once in a while, as it seems pretty logical that a nice lean steak with veggies and a Mediterranean salad with red wine is a healthful treat. ☺
In conclusion, a plant-based diet should be a staple for a high quality, healthful, whole food dietary pattern with many benefits. It is easier to adhere to a strict vegetarian diet than we anticipated, and if we can do it, you can do it! We encourage everyone to eat more plants in the form of veggies, legumes, fruit, and some unrefined whole grains or roots/tubers as tolerated for glucose control and caloric/energy balance goals.
[1] Key, Timothy JA, et al. “Dietary habits and mortality in 11 000 vegetarians and health conscious people: results of a 17 year follow up.” BMJ 313.7060 (1996): 775-779.
[2] Sofi, Francesco, et al. “Adherence to Mediterranean diet and health status: meta-analysis.” Bmj 337 (2008).
[3] Schwingshackl, Lukas, and Georg Hoffmann. “Adherence to Mediterranean diet and risk of cancer: A systematic review and meta‐analysis of observational studies.” International Journal of Cancer (2014).
[4] Estruch, Ramón, et al. “Primary prevention of cardiovascular disease with a Mediterranean diet.” New England Journal of Medicine 368.14 (2013): 1279-1290.
[5] Salas-Salvadó, Jordi, et al. “Prevention of Diabetes With Mediterranean DietsA Subgroup Analysis of a Randomized Trial.” Annals of internal medicine 160.1 (2014): 1-10.
[6] Jenkins, David JA, et al. “Effect of a 6-month vegan low-carbohydrate (‘Eco-Atkins’) diet on cardiovascular risk factors and body weight in hyperlipidaemic adults: a randomised controlled trial.” BMJ open 4.2 (2014): e003505.
[7] Fung, Teresa T., et al. “Low-Carbohydrate Diets and All-Cause and Cause-Specific MortalityTwo Cohort Studies.” Annals of internal medicine 153.5 (2010): 289-298.
[8] Wang, Xia, et al. “Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies.” bmj 349 (2014): g4490.
[9] Fung, Teresa T., et al. “Low-Carbohydrate Diets and All-Cause and Cause-Specific MortalityTwo Cohort Studies.” Annals of internal medicine 153.5 (2010): 289-298.
[10] Huang, Tao, et al. “Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review.” Annals of nutrition and metabolism 60.4 (2012): 233-240.
[11] Tonstad, Serena, et al. “Type of vegetarian diet, body weight, and prevalence of type 2 diabetes.” Diabetes care 32.5 (2009): 791-796.
[12] Yokoyama, Yoko, et al. “Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis.” Cardiovascular diagnosis and therapy 4.5 (2014): 373.
[13] Li, Siying S., et al. “Dietary pulses, satiety, and food intake: A systematic review and meta‐analysis of acute feeding trials.” Obesity (2014).
[14] Tonstad, S., N. Malik, and E. Haddad. “A high‐fibre bean‐rich diet versus a low‐carbohydrate diet for obesity.” Journal of Human Nutrition and Dietetics 27.s2 (2014): 109-116.
[15] Jenkins, David JA, et al. “Effect of legumes as part of a low glycemic index diet on glycemic control and cardiovascular risk factors in type 2 diabetes mellitus: a randomized controlled trial.” Archives of internal medicine 172.21 (2012): 1653-1660.
[16] Buil-Cosiales, Pilar, et al. “Fiber intake and all-cause mortality in the Prevención con Dieta Mediterránea (PREDIMED) study.” The American journal of clinical nutrition 100.6 (2014): 1498-1507.
[17] Weaver, Connie M. “Should dairy be recommended as part of a healthy vegetarian diet? Point.” The American journal of clinical nutrition 89.5 (2009): 1634S-1637S.
[18] Soedamah-Muthu, Sabita S., et al. “Milk and dairy consumption and incidence of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies.” The American journal of clinical nutrition 93.1 (2011): 158-171.
[19] Chen, Mu, et al. “Effects of dairy intake on body weight and fat: a meta-analysis of randomized controlled trials.” The American journal of clinical nutrition 96.4 (2012): 735-747.
[20] Elwood, P. C., et al. “Milk drinking, ischaemic heart disease and ischaemic stroke II. Evidence from cohort studies.” European journal of clinical nutrition 58.5 (2004): 718-724.
[21] Orlich, M. J., Singh, P. N., Sabaté, J., Jaceldo-Siegl, K., Fan, J., Knutsen, S., … & Fraser, G. E. (2013). Vegetarian dietary patterns and mortality in Adventist Health Study 2. JAMA internal medicine, 173(13), 1230-1238.
[22] He, Ka, et al. “Accumulated evidence on fish consumption and coronary heart disease mortality a meta-analysis of cohort studies.” Circulation 109.22 (2004): 2705-2711.
[23] Leung Yinko, Sylvie SL, et al. “Fish Consumption and Acute Coronary Syndrome: A Meta-Analysis.” The American journal of medicine (2014).
[24] Larsson, Susanna C., and Nicola Orsini. “Red meat and processed meat consumption and all-cause mortality: a meta-analysis.” American journal of epidemiology (2013): kwt261.
[25] Bellavia, Andrea, et al. “Differences in survival associated with processed and with nonprocessed red meat consumption.” The American journal of clinical nutrition 100.3 (2014): 924-929.
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