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Is a vegan diet needed to reverse CVD?

Published 12.7.2016
This is not the piece I intended to write today, but I couldn't stem the words from coming. As I've noted a number of time the topic of cardio vascular disease (CVD) is of internet to me, and I intend to write up what I've gleaned from my research eventually. I've also commented about the vegan diet a number of times, and I've said, in the past, that if I was ever diagnosed with CVD, I'd give a vegan diet a shot because it's the vegan doctors who have demonstrated reversal using diet.

Careful readers will note the phrase, "in the past," in the previous sentence. I have change my mind regarding the vegan diet and CVD— not because I deny the efficacy of a vegan diet to improve health, that's factual. Nor do I dismiss the results of Esselstyn or Ornish because some of their patients continued taking statins or other drugs. I think it's unreasonable to expect any doctor testing a hypothesis to do everything possible to increase success— including continuing medication. If low carb* diet promoting doctors repeated Esselstyn's trials (WHY don't/won't they?), they'd keep subjects on any necessary medication as well. It's a matter of ethics.

So what changed my mind? Learning about Nathan Pritikin, and his reversal of his own and others' CVD. I've mentioned Pritikin before in relation to CVD. In that piece, I noted that if diagnosed, rather than become vegan, I'd become a ovo-vegetarian, meaning I'd eat a low fat diet of mostly plants, but that I'd also eat eggs. Having read a bit more and thought a bit more about it, I actually think that I would choose to follow Pritikin's actual plan that worked. Ironically, one of the foods Pritikin didn't allow was egg yolks.

So far as I can tell, Pritikin, who was not a medical doctor, never tried to demonstrate in the way Esselstyn and Ornish have that his diet reversed CVD. Pritikin lived in an earlier age, however, and the techniques open to modern researchers weren't available to him. Still, his program worked and helped many. Vegan doctor Michael Greger credits Pritikin for saving his grandmother from end stage CVD— a powerful testimonial. However, Greger isn't a proponent of Pritikin's plan because it's not a vegan plan.

Pritikin's plan is plant based, ruthlessly low fat, and, just as Eselstyn does, doesn't allow oil. However, Pritikin does allow the regular consumption of a small amounts of lean animal products, particularly shellfish and fish. Esselstyn says, with no scientific backing that I've ever seen him present, patients should not eat anything with a face. Why? If he's an animal rights advocate, then he should say so. Vegans who choose that path because they don't want to harm animals have that right. But that's an ethical stance, not a health stance,

The inspiration for these thoughts was this Greger video (and as always, please note that Greger is not an unbiased source. He is a proponent of vegan diets.) The video is actually about whether or not people should take a daily aspirin to avoid CVD. The answer is yes if you've been diagnosed with CVD, but no if you have not been because aspirin is a blood thinner that can lead to brain bleeding. It's the end of the video that stuck in my craw though. Taking aspirin can have side effects, but the same (or better) results can be obtained by eating a "plant based" (and by that he means vegan) diet, not the Pritikin diet.

But can it? Statins didn't exist in Pritikin's time, so people who came to his center weren't on cholesterol lowering drugs. They literally had the effects of the diet to rely upon. Esselstyn has shown exactly one subject's results who never went on a statin. In addition, following a vegan diet leaves a person reliant on supplements and fortified food, which means it can't be a healthy diet in my view. By my definition, a healthy diet requires no supplementation. Vegans must supplement vitamin B12, at a minimum, and may very well develop other deficiencies over time. Pritikin designed a healthy diet that reversed CVD in people. I remain mystified as to why his diet isn't touted more— Perhaps because he's dead?

Pritikin's diet wasn't easy to adhere to, no low fat diet is for people used to a western diet. However, I think it's likely to be a bit easier than Joel Fuhrman's "Nutritarian" plan, which, although not vegan is a bit stricter than Pritikin. Fuhrman definitely leans towards veganism, even if his plan allows a bit of animal products. I don't like the fact that he still recommends supplements either. Pritikin even allowed for alcohol intake— in other words, it was a diet designed to reverse the disease he had, but still be one that real people might adhere to for the long term. I'd have to go back to my notes, but I'm reasonably certain Fuhrman would teach teetotaling.

Long term veganism

Something interesting is happening in the "Vegan Youtube community," such as it is, and for once it doesn't have anything to do with drama. Instead, a genuine discussion of health has broken out. Veganism as a "thing" isn't that old, and not many people follow it. Even fewer follow the diet over the long term, but there are now people who have been vegan for decades. It's fair to consider the health condition of long term vegans, particularly if they are advocates of the diet. In too many cases, the evidence does not support the idea that veganism is best for health.

Those particular examples are of angular cheleitis, which can be caused by nutrient deficiencies and manifests as sores near the corner of the mouth or on the lips usually. The Youtuber presenting the evidence goes out of his way to say the real problem is “extreme” versions of the vegan diet… but that’s not at all the case necessarily. Most people who try veganism don't maintain the diet over the long term, and many, many of them go back to eating animal products for health related reasons.

It's easy to point to "stupid" vegans who refuse to properly supplement with B12 because they are convinced that, "humans are naturally herbivores or frugivores," and say they are the problem. However, plenty of people who don't follow some sort of extreme version of the vegan diet still find they can't maintain their health. Humans are omnivores, meaning we can eat anything. Humans also haven't even identified all the nutrients present in our food, nor have we discovered what a long term deficiency in many of them might mean for a person's health.

The fact that that there has never been a vegan society (not even in rural China, so don't even bother mentioning T. Colin Campbell's work) is quite suggestive to me. Humans can subsist with very little animal intake, but some seems to be essential.

Bottom Line

The bottom line is that I'm not convinced that removing the animal foods from Pritikin's proven to work diet improves it. In fact, I'm convinced that it does not. It might not be the most "fun" way to eat, but following Pritikin's plan long term would not lead to nutritional deficiencies.

*carbohydrate
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