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A dietary intervention for vasomotor symptoms of menopause: a randomized, controlled trial.
Barnard, ND, Kahleova, H, Holtz, DN, Znayenko-Miller, T, Sutton, M, Holubkov, R, Zhao, X, Galandi, S, Setchell, KDR
Menopause (New York, N.Y.). 2023;30(1):80-87
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Postmenopausal vasomotor symptoms cause recurrent discomfort, disrupt sleep, and reduce quality of life. A role for nutritional factors in vasomotor symptoms was suggested by their low prevalence in areas where traditional dietary staples included grains, legumes, vegetables, and other plant-derived foods. The aim of this study was to investigate the effects of a dietary intervention on vasomotor symptoms and menopause-related quality of life. This study is a randomised controlled study. Eighty-four participants were randomly assigned, in two cohorts; the intervention or control group. Results show that the dietary intervention led to clinically important reductions in menopausal symptoms. In fact, there was an 88% reduction in moderate-to-severe vasomotor events among participants in the intervention-group, accompanied by weight loss and improvements in physical, psychosocial, and sexual domains. Authors conclude that a dietary intervention, combining a reduced-fat vegan diet and daily soybeans, was associated with a marked reduction in postmenopausal vasomotor events, significant weight loss, and reductions in physical and sexual symptoms.
Abstract
OBJECTIVE Postmenopausal vasomotor symptoms disrupt quality of life. This study tested the effects of a dietary intervention on vasomotor symptoms and menopause-related quality of life. METHODS Postmenopausal women (n = 84) reporting at least two moderate-to-severe hot flashes daily were randomly assigned, in two successive cohorts, to an intervention including a low-fat, vegan diet and cooked soybeans (½ cup [86 g] daily) or to a control group making no dietary changes. During a 12-week period, a mobile application was used to record hot flashes (frequency and severity), and vasomotor, psychosocial, physical, and sexual symptoms were assessed with the Menopause-Specific Quality of Life questionnaire. Between-group differences were assessed for continuous ( t tests) and binary ( χ2 /McNemar tests) outcomes. In a study subsample, urinary equol was measured after the consumption of ½ cup (86 g) of cooked whole soybeans twice daily for 3 days. RESULTS In the intervention group, moderate-to-severe hot flashes decreased by 88% ( P < 0.001) compared with 34% for the control group ( P < 0.001; between-group P < 0.001). At 12 weeks, 50% of completers in the intervention group reported no moderate-to-severe hot flashes at all. Among controls, there was no change in this variable from baseline ( χ2 test, P < 0.001). Neither seasonality nor equol production status was associated with the degree of improvement. The intervention group reported greater reductions in the Menopause-Specific Quality of Life questionnaire vasomotor ( P = 0.004), physical ( P = 0.01), and sexual ( P = 0.03) domains. CONCLUSIONS A dietary intervention consisting of a plant-based diet, minimizing oils, and daily soybeans significantly reduced the frequency and severity of postmenopausal hot flashes and associated symptoms.
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A dietary intervention for postmenopausal hot flashes: A potential role of gut microbiome. An exploratory analysis.
Kahleova, H, Holtz, DN, Strom, N, La Reau, A, Kolipaka, S, Schmidt, N, Hata, E, Znayenko-Miller, T, Holubkov, R, Barnard, ND
Complementary therapies in medicine. 2023;79:103002
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Postmenopausal vasomotor symptoms not only lead to discomfort and reduced quality of life but also signal an increased risk of cardiovascular disease and diabetes. Nutrition is an important modifying factor and may be helpful in alleviating vasomotor symptoms. The aim of this study was to test the effects of a low-fat plant-based diet, including daily consumption of soybeans, on the gut microbiome composition, particularly the equol-producing gut bacteria, and their association with changes in postmenopausal vasomotor symptoms. This study was a secondary exploratory analysis of a randomised controlled trial were participants were randomly assigned to the intervention or control group. Results showed that the dietary intervention led to a 95 % reduction in total hot flashes, and a 96 % decrease in moderate-to-severe hot flashes. Daytime and night-time hot flashes were reduced by 96 % and 94 %, respectively. Even though in the intervention group there were significant changes in gut microbiome after 12 weeks, changes in the equol-producing bacteria were not significant. Authors conclude that their findings revealed potential associations between changes in vasomotor symptoms in response to a diet change and changes in the gut microbiome.
Abstract
OBJECTIVE This study examined the role of gut microbiome changes in mediating the effects of a dietary intervention on the frequency and severity of postmenopausal vasomotor symptoms METHODS Postmenopausal women (n = 84) reporting ≥2 moderate-to-severe hot flashes daily were randomly assigned, in 2 successive cohorts, to an intervention including a low-fat, vegan diet and cooked soybeans (½ cup [86 g] daily) or to stay on their usual diet. Over a 12-week period, frequency and severity of hot flashes were recorded with a mobile application. In a subset of 11 women, gut microbiome was analyzed at baseline and after 12 weeks of the dietary intervention (low-fat vegan diet with soybeans), using deep shotgun metagenomic sequencing. Differences in the microbiome between baseline and 12 weeks were assessed by comparing alpha diversity with Wilcoxon signed rank tests, beta diversity with permanovaFL, and taxon abundance with Wilcoxon signed rank tests. Pearson correlations were used to assess the association between changes in hot flashes and gut bacteria. RESULTS In the subset for which microbiome testing was done, total hot flashes decreased by 95 % during the dietary intervention (p = 0.007); severe hot flashes disappeared (from 0.6 to 0.0/day; p = 0.06); and moderate-to-severe hot flashes decreased by 96 % (p = 0.01). Daytime and nighttime hot flashes were reduced by 96 % (p = 0.01) and 94 % (p = 0.004), respectively. Alpha and beta diversity did not significantly differ in the intervention group between baseline and 12 weeks. Two families (Enterobacteriaceae and Veillonellaceae), 5 genera (Erysipelatoclostridium, Fusicatenibacter, Holdemanella, Intestinimonas, and Porphyromonas), and 6 species (Clostridium asparagiforme, Clostridium innocuum, Bacteroides thetaiotaomicron, Fusicatenibacter saccharivorans, Intestinimonas butyriciproducens, Prevotella corporis, and Streptococcus sp.) were differentially abundant, but after correction for multiple comparisons, these differences were no longer significant. Changes in the relative abundance of Porphyromonas and Prevotella corporis were associated with the reduction in severe day hot flashes both unadjusted (r = 0.61; p = 0.047; and r = 0.69; p = 0.02), respectively), and after adjustment for changes in body mass index (r = 0.63; p = 0.049; and r = 0.73; p = 0.02), respectively). Changes in relative abundance of Clostridium asparagiforme were associated with the reduction in total severe hot flashes (r = 0.69; p = 0.019) and severe night hot flashes (r = 0.82; p = 0.002) and the latter association remained significant after adjustment for changes in body mass index (r = 0.75; p = 0.01). CONCLUSIONS This exploratory analysis revealed potential associations between changes in vasomotor symptoms in response to a diet change and changes in the gut microbiome. Larger randomized clinical trials are needed to investigate these findings.
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Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial.
Landry, MJ, Ward, CP, Cunanan, KM, Durand, LR, Perelman, D, Robinson, JL, Hennings, T, Koh, L, Dant, C, Zeitlin, A, et al
JAMA network open. 2023;6(11):e2344457
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A vegan dietary pattern is typically lower in energy density but higher in fibre, vitamins, minerals, and phytonutrients compared with other dietary patterns. However, sometimes a vegan dietary pattern can limit specific nutrients, such as vitamin B12, iron, and calcium. In addition, a poorly formulated vegan diet can include low-quality plant foods, such as refined carbohydrates and added sugars. The aim of this study was to compare the cardiometabolic effects of a healthy vegan diet with a healthy omnivorous diet, exposing both groups to vegetables, legumes, fruits, whole grains, nuts, and seeds. This study was a single-site, parallel-group, dietary intervention randomised clinical trial which randomised healthy, adult identical twins to a healthy vegan or omnivorous diet for 8 weeks. Results showed that: - low-density lipoprotein was significantly lower for twins receiving the vegan diet compared with twins receiving the omnivorous diet. - insulin levels and weight were also significantly lower among the twins on the vegan diet from baseline to 8 weeks. - vegan-diet participants had total lower protein intake as a percentage of calories, lower dietary satisfaction, lower intake of dietary cholesterol, but higher intake of vegetable servings and intake of dietary iron. - vegans had lower intake of vitamin B12, yet serum vitamin B12 levels were not statistically different than omnivores at 8 weeks. Authors concluded that their findings show cardiometabolic advantages for the healthy vegan vs the healthy omnivorous diet among healthy, adult identical twins. Thus, clinicians may consider recommending plant-based diets to reduce cardiometabolic risk factors, as well as aligning with environmental benefits.
Abstract
IMPORTANCE Increasing evidence suggests that, compared with an omnivorous diet, a vegan diet confers potential cardiovascular benefits from improved diet quality (ie, higher consumption of vegetables, legumes, fruits, whole grains, nuts, and seeds). OBJECTIVE To compare the effects of a healthy vegan vs healthy omnivorous diet on cardiometabolic measures during an 8-week intervention. DESIGN, SETTING, AND PARTICIPANTS This single-center, population-based randomized clinical trial of 22 pairs of twins (N = 44) randomized participants to a vegan or omnivorous diet (1 twin per diet). Participant enrollment began March 28, 2022, and continued through May 5, 2022. The date of final follow-up data collection was July 20, 2022. This 8-week, open-label, parallel, dietary randomized clinical trial compared the health impact of a vegan diet vs an omnivorous diet in identical twins. Primary analysis included all available data. INTERVENTION Twin pairs were randomized to follow a healthy vegan diet or a healthy omnivorous diet for 8 weeks. Diet-specific meals were provided via a meal delivery service from baseline through week 4, and from weeks 5 to 8 participants prepared their own diet-appropriate meals and snacks. MAIN OUTCOMES AND MEASURES The primary outcome was difference in low-density lipoprotein cholesterol concentration from baseline to end point (week 8). Secondary outcome measures were changes in cardiometabolic factors (plasma lipids, glucose, and insulin levels and serum trimethylamine N-oxide level), plasma vitamin B12 level, and body weight. Exploratory measures were adherence to study diets, ease or difficulty in following the diets, participant energy levels, and sense of well-being. RESULTS A total of 22 pairs (N = 44) of twins (34 [77.3%] female; mean [SD] age, 39.6 [12.7] years; mean [SD] body mass index, 25.9 [4.7]) were enrolled in the study. After 8 weeks, compared with twins randomized to an omnivorous diet, the twins randomized to the vegan diet experienced significant mean (SD) decreases in low-density lipoprotein cholesterol concentration (-13.9 [5.8] mg/dL; 95% CI, -25.3 to -2.4 mg/dL), fasting insulin level (-2.9 [1.3] μIU/mL; 95% CI, -5.3 to -0.4 μIU/mL), and body weight (-1.9 [0.7] kg; 95% CI, -3.3 to -0.6 kg). CONCLUSIONS AND RELEVANCE In this randomized clinical trial of the cardiometabolic effects of omnivorous vs vegan diets in identical twins, the healthy vegan diet led to improved cardiometabolic outcomes compared with a healthy omnivorous diet. Clinicians can consider this dietary approach as a healthy alternative for their patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05297825.
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Vegetarian and vegan diets and the risk of cardiovascular disease, ischemic heart disease and stroke: a systematic review and meta-analysis of prospective cohort studies.
Dybvik, JS, Svendsen, M, Aune, D
European journal of nutrition. 2023;62(1):51-69
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Cardiovascular disease (CVD) is mainly due to ischemic heart disease (IHD) and stroke. Plant-based diets are effective for improving CVD risk factors. This is further supported by the favourable cardiometabolic profile seen among vegetarians who predominantly exclude meat, fish and poultry from their diet, when compared to people consuming meat. The aim of this study was to analyse the association between vegetarian or vegan diets and risk of incidence and mortality from CVD, IHD and stroke, both overall and subtypes. This study is a systematic review and meta-analysis of thirteen prospective cohort studies. Results show a 15% and a 21% reduction in the relative risk of CVD and IHD, respectively, for vegetarians compared to nonvegetarians, but there wasn’t a clear association for total stroke or subtypes of stroke. Furthermore, an 18% reduction in the relative risk of IHD was observed among vegans when compared to nonvegetarians but the association lacked precision and no clear association was observed for CVD or stroke; however, there were few studies in the analyses of vegans. Authors conclude that their findings are consistent with existing guidelines recommending plant-based dietary patterns for CVD prevention. However, further studies are required to clarify the association between vegetarian diets and stroke risk, as well as the association between vegan diets and IHD.
Abstract
PURPOSE Vegetarian diets have been associated with reduced risk of ischemic heart disease (IHD). However, results regarding cardiovascular disease (CVD) overall and stroke are less clear. We conducted a systematic review and meta-analysis of prospective cohort studies on CVD, IHD and stroke risk among vegetarians or vegans versus nonvegetarians to clarify these associations. METHODS PubMed and Ovid Embase databases were searched through August 12, 2021. Prospective cohort studies reporting adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) for incidence or mortality from CVD, IHD and stroke, comparing vegetarians and vegans to nonvegetarians were included. Risk of bias (RoB) was assessed using ROBINS-I and the strength of evidence was assessed using World Cancer Research Fund (WCRF) criteria. Summary RRs (95% CIs) were estimated using a random effects model. RESULTS Thirteen cohort studies (844,175 participants, 115,392 CVD, 30,377 IHD, and 14,419 stroke cases) were included. The summary RR for vegetarians vs. nonvegetarians was 0.85 (95% CI: 0.79-0.92, I2 = 68%, n = 8) for CVD, 0.79 (95% CI: 0.71-0.88, I2 = 67%, n = 8) for IHD, 0.90 (95% CI: 0.77-1.05, I2 = 61%, n = 12) for total stroke, and for vegans vs. nonvegetarians was 0.82 (95% CI: 0.68-1.00, I2 = 0%, n = 6) for IHD. RoB was moderate (n = 8) to serious (n = 5). The associations between vegetarian diets and CVD and IHD were considered probably causal using WCRF criteria. CONCLUSIONS Vegetarian diets are associated with reduced risk of CVD and IHD, but not stroke, but further studies are needed on stroke. These findings should be considered in dietary guidelines. REVIEW REGISTRATION No review protocol registered.
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Prevalence of Female and Male Vegan and Non-Vegan Endurance Runners and the Potential Associations of Diet Type and BMI with Performance-Results from the NURMI Study (Step 1).
Wirnitzer, K, Tanous, D, Motevalli, M, Wirnitzer, G, Leitzmann, C, Pichler, R, Rosemann, T, Knechtle, B
Nutrients. 2022;14(18)
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Endurance running is a popular sport around the world and has increased in popularity by 57% in the last decade. Nutrition is an important variable to consider but recommendations on what athletes should eat are inconsistent among major sports and nutritional bodies. The popularity of plant-based diets is spreading fast and vegan/vegetarian diets are currently booming in recreational and competitive sports. There have been several studies looking at endurance performance and vegan/vegetarian diets but the results are inconclusive. It is therefore important to provide data to support training and nutritional strategies and to examine the associations between diet type and running-related characteristics in a large sample of vegan and non-vegan endurance runners. The purpose of this study is to investigate vegetarian and mixed diet type prevalence among distance runners at running events and associations with running-related patterns and performance. 2864 runners took part from around the world and completed an online questionnaire. The results show that vegan and vegetarian diets may be appropriate for participating in distance running activities. However, significant associations were identified between omnivore diet participants and best average time to finish across a range of disciplines. Findings from this investigation may provide beneficial evidence for sport scientists, trainers, coaches, and nutrition specialists when advising vegan and vegetarian distance runners, however more detailed research is needed.
Abstract
This study aims to investigate vegetarian and mixed diet type prevalences among distance runners at running events around the world and associations with running-related patterns and performance. Following a cross-sectional approach, linear regression analyses were carried out to identify potential associations among body mass index (BMI), diet type, and average best performance times of half-marathon and marathon events for males and females. From a sample of 3835 runners who completed an online questionnaire, 2864 all-distance runners (age: 37 years; 57% females) were included in inferential analyses and categorized into dietary subgroups according to self-reports: 994 vegans (34.7%), 598 vegetarians (20.9%), and 1272 omnivores (44.4%). Significant associations were identified between kind of diet and best average time to finish (i) half-marathons in females where vegans (p = 0.001) took longer than omnivores, (ii) half-marathons in males where vegans (p < 0.001) and vegetarians (p = 0.002) took longer than omnivores, and (iii) marathons in males where vegans (p < 0.001) and vegetarians (p = 0.043) averaged slower than omnivores. Increased units of BMI (+1.0) in males influenced best runtimes: 2.75 (3.22-2.27) min slower for HM and 5.5 (5.69-4.31) min slower for M. The present study did not take detailed confounders into account such as runner motives or training behaviors; however, the results may provide valuable insight for running event organizers, nutrition experts, coaches, and trainers advising runners who adhere to a general diet type regarding the basic question of who participates in running events around the world.
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A Randomized Controlled Trial of Fasting and Lifestyle Modification in Patients with Metabolic Syndrome: Effects on Patient-Reported Outcomes.
Jeitler, M, Lauche, R, Hohmann, C, Choi, KA, Schneider, N, Steckhan, N, Rathjens, F, Anheyer, D, Paul, A, von Scheidt, C, et al
Nutrients. 2022;14(17)
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The metabolic syndrome (MetS) is a condition characterized by the presence of at least three cardiovascular risk factors, such as abdominal obesity, hypertension, insulin resistance, and dyslipidaemia. The aim of this study was to assess effects of fasting followed by the Mind-Body Medicine in Integrative and Complementary Medicine (MICOM) lifestyle modification intervention in patients with MetS on patient-reported outcomes, compared to a lifestyle modification intervention only. This study is a single-blind, bicentre, randomized controlled study. Patients (n=145) were randomly assigned in a 1:1 ratio into one of the 2 groups: fasting and lifestyle modification or the lifestyle modification. They started with 2 vegan days (max. 1200 kcal/day), followed by 5 days of fasting (max. 350 kcal/day), and a stepwise reintroduction of food. Then they participated in the 10-week MICOM comprehensive multimodal lifestyle modification intervention with weekly 6-h sessions. Results show that after the multimodal lifestyle modification intervention, there were improvements for all outcome measures, namely quality of life, anxiety, depression, stress, mood as well as self-efficacy, mindfulness, and self-compassion, which persisted at the follow-up after 24 weeks. Authors conclude that their findings show beneficial and clinically relevant effects of fasting and intensified lifestyle modification on quality of life and psychological parameters.
Expert Review
Conflicts of interest:
None
Take Home Message:
For clients with Metabolic syndrome a 5-day fast consisting of max. 350 kcal/day, in conjunction with therapies that focus on improved emotional, mental, social, spiritual, and behavioural factors may directly affect health and support improved mood.
Therapies include mindfulness and specific group training rooted in psycho-neuroendocrinology, and the use of formal meditation and gentle yoga exercises. As well as nutritional education included lectures, cooking workshops, as well as group support.
Bottom line: The use of complimentary therapies such as mindfulness, yoga and medication in conjunction with nutritional advice and may be effective to support improved mood in clients with Metabolic syndrome.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Metabolic syndrome (MetS) is a condition characterised by the presence of at least three cardiovascular risk factors such as abdominal obesity, hypertension, insulin resistance, and dyslipidemia.
The authors refer to epidemiological studies that have identified the role of psychological risk factors such as psychosocial stress, depression and anxiety in patients with MetS and cardiovascular disease.
This single-blind, bi-centre RCT assessed the effects of fasting followed by a comprehensive lifestyle modification program MICOM (Mind-Body Medicine in Integrative and Complementary Medicine) in 145 participants with Metabolic Syndrome (MetS) (62.8% women; 59.7 ± 9.3 years) randomised to:
1. 5-day fasting followed by 10 weeks of lifestyle modification (F + LM; modified DASH diet, exercise, mindfulness; n = 73) or
2. 10 weeks of lifestyle modification only (LM; n = 72)
The study duration was 24 weeks occurring from April 2014 to December 2014, with the last follow-up assessment in December 2015. 73 Participants were randomised into an F + LM group and 72 participants into an LM group between the ages of 59 and 60.
Outcomes were assessed at weeks 0, 1, 12, and 24, for quality of life (Short-Form 36 Health Survey Questionnaire, SF-36), anxiety/depression (Hospital Anxiety and Depression Scale, HADS), stress (Cohen Perceived Stress Scale, CPSS), mood (Profile of Mood States, POMS), self-efficacy (General Self-Efficacy Scale, GSE), mindfulness (Mindfulness Attention Awareness Scale, MAAS), and self-compassion (Self-Compassion Scale, SCS).
At week 1, POMS depression and fatigue scores were significantly lower in F + LM compared to LM. At week 12, most self-report outcomes improved in both groups—only POMS vigour was significantly higher in F + LM than in LM. Most of the beneficial effects within the groups persisted at week 24.
Clinical practice applications:
This randomised controlled trial highlights fasting-induced mood-modulating effects in the short term (<24 months).
LM induced several positive effects on quality of life and psychological parameters in participants with MetS.
The compliance rate for this study was good and there were no adverse effects reported suggesting a potentially effective lifestyle modification intervention for adults with metabolic syndrome.
The authors did note the extent to which participants adhered to the program by using stress reduction techniques at home was not assessed.
Considerations for future research:
MBM lifestyle modification intervention led to an improvement of self-efficacy, mindfulness, and self-compassion.
Further studies to explore explanatory models for the effects of MBM are needed.
Mediating variables on mindfulness, self-efficacy, and compassion, and the effects on physical and psychological parameters, need to be examined more closely.
Future studies could use condition-specific questionnaires in addition to generic ones, which have previously been used to facilitate the comparison of the study results with those in the population.
Abstract
Lifestyle interventions can have a positive impact on quality of life and psychological parameters in patients with metabolic syndrome (MetS). In this randomized controlled trial, 145 participants with MetS (62.8% women; 59.7 ± 9.3 years) were randomized to (1) 5-day fasting followed by 10 weeks of lifestyle modification (F + LM; modified DASH diet, exercise, mindfulness; n = 73) or (2) 10 weeks of lifestyle modification only (LM; n = 72). Outcomes were assessed at weeks 0, 1, 12, and 24, and included quality of life (Short-Form 36 Health Survey Questionnaire, SF-36), anxiety/depression (Hospital Anxiety and Depression Scale, HADS), stress (Cohen Perceived Stress Scale, CPSS), mood (Profile of Mood States, POMS), self-efficacy (General Self-Efficacy Scale, GSE), mindfulness (Mindfulness Attention Awareness Scale, MAAS), and self-compassion (Self-Compassion Scale, SCS). At week 1, POMS depression and fatigue scores were significantly lower in F + LM compared to LM. At week 12, most self-report outcomes improved in both groups-only POMS vigor was significantly higher in F + LM than in LM. Most of the beneficial effects within the groups persisted at week 24. Fasting can induce mood-modulating effects in the short term. LM induced several positive effects on quality of life and psychological parameters in patients with MetS.
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Plant-based dietary quality and depressive symptoms in Australian vegans and vegetarians: a cross-sectional study.
Lee, MF, Eather, R, Best, T
BMJ nutrition, prevention & health. 2021;4(2):479-486
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Poor diet and mood disorders are known leading causes of morbidity and mortality. Some studies suggest that plant-based diets are associated with improved mood and mental health. The aim of this study was to explore the association between vegan and vegetarian dietary patterns and depressive symptoms in adults by exploring the overall dietary quality of these patterns. This study is an online cross-sectional study which invited vegan and vegetarian adults aged between 18 and 44 years who live in Australia to complete an online survey through social media platforms. Results show that high plant-based diets quality was associated with decreased risk of depressive symptoms. However, this study also shows that following a plant-based diet does not necessarily mean the individual consumes a ‘healthy’ dietary pattern. Authors conclude that further studies are needed which should focus on the specific quality of vegan and vegetarian diets in relation to depression and mental well-being.
Abstract
Plant-based dietary patterns (vegan and vegetarian) are often considered 'healthy' and have been associated with broad health benefits, including decreased risk of obesity and ill health (cardiovascular disease, blood glucose and type II diabetes). However, the association between plant-based diets and mood disorders such as depression remains largely equivocal. This cross-sectional study of 219 adults aged 18-44 (M=31.22, SD=7.40) explored the associations between an estimate of overall plant-based diet quality and depression in vegans (n=165) and vegetarians (n=54). Overall plant-based diet quality was associated with depressive symptoms in vegans and vegetarians F(1, 215)=13.71, p<0.001 accounting for 6% of the variation in depressive symptoms. For those without depression, higher diet quality was protective against depressive symptoms F(1, 125)=6.49, p=0.012. Conversely, for those with depression no association with diet quality was found F(1, 89)=0.01, p=0.963. These findings suggest that a high-quality plant-based diet may be protective against depressive symptoms in vegans and vegetarians. In line with emerging research between food and mental health, higher-quality dietary patterns are associated with a reduced risk of depressive symptoms. Given the rapidly increasing rate of vegan and vegetarian food products within Australia, understanding the potential mechanisms of effects through which a plant-based diet may influence depressive symptoms is required.
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A Vegan Diet Is Associated with a Significant Reduction in Dietary Acid Load: Post Hoc Analysis of a Randomized Controlled Trial in Healthy Individuals.
Müller, A, Zimmermann-Klemd, AM, Lederer, AK, Hannibal, L, Kowarschik, S, Huber, R, Storz, MA
International journal of environmental research and public health. 2021;18(19)
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Diets high in meat and cheese, which are acidogenic and low in fruits and vegetables, which are alkalising, increase the dietary acid load (DAL) of the diet. Diets with a high DAL have been associated with poor health outcomes and the development of heart disease and type 2 diabetes. Plant-based diets have been associated with a lower DAL, however very little research exists on this. Individuals following a vegan diet have been shown in previous studies to have a reduced DAL, however it is unclear whether this was due to a reduced calorie intake or because of the diet composition. This post-hoc study aimed to investigate this and determine whether eating a vegan diet for 4-weeks reduced DAL and how this compares to 4-weeks of a diet rich in meat. The results showed that after 3-weeks, the vegan diet significantly reduced the DAL compared to the meat-rich diet, which increased the DAL. Interestingly all the participants in this study were put on the same balanced diet for 7 days prior to commencing the trial, reducing the chance that results would be affected by a prior diet. It was concluded that a vegan diet as opposed to a meat-rich diet may be of benefit to health outcomes through lowering DAL. This study could be used by healthcare professionals to understand that a balanced vegan diet may be of benefit to those who have heart disease and/or type 2 diabetes. However as this trial did not measure indicators of type 2 diabetes or heart disease, these associations are speculative.
Abstract
The composition of diet strongly affects acid-base homeostasis. Western diets abundant in acidogenic foods (meat and cheese) and deficient in alkalizing foods (fruits and vegetables) increase dietary acid load (DAL). A high DAL has been associated with numerous health repercussions, including cardiovascular disease and type-2-diabetes. Plant-based diets have been associated with a lower DAL; however, the number of trials exploring this association is limited. This randomized-controlled trial sought to examine whether an isocaloric vegan diet lowers DAL as compared to a meat-rich diet. Forty-five omnivorous individuals were randomly assigned to a vegan diet (n = 23) or a meat-rich diet (n = 22) for 4 weeks. DAL was determined using potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores at baseline and after 3 and 4 weeks, respectively. After 3 weeks, median PRAL (-23.57 (23.87)) and mean NEAPR (12.85 ± 19.71) scores were significantly lower in the vegan group than in the meat-rich group (PRAL: 18.78 (21.04) and NEAPR 60.93 ± 15.51, respectively). Effects were mediated by a lower phosphorus and protein intake in the vegan group. Our study suggests that a vegan diet is a potential means to reduce DAL, whereas a meat-rich diet substantially increases the DAL burden.
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Improvement of Inflammation and Pain after Three Months' Exclusion Diet in Rheumatoid Arthritis Patients.
Guagnano, MT, D'Angelo, C, Caniglia, D, Di Giovanni, P, Celletti, E, Sabatini, E, Speranza, L, Bucci, M, Cipollone, F, Paganelli, R
Nutrients. 2021;13(10)
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Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease typically affecting the synovial joints, in which autoimmunity drives dysregulated proinflammatory cytokine secretion. A decrease in dietary fibres and an increase in fat and sugar intake, which is typical in Western diets, contributes to gut microbial dysbiosis, leading to immune dysfunction. In fact, the changes in the gastrointestinal microbiota are thought to influence the pathogenesis and progression of RA. The aim of this diet was to investigate the effect of a diet deprived of meat, gluten, and lactose (excluding all dairy products and foods containing them) in patients with long-standing, well-controlled RA, in comparison with a control balanced diet including those items, followed for three months. This study is a randomised controlled study. All participants (n=40) were females with ages ranging between 31 and 72 years. They were randomly assigned to one of the two experimental groups and asked to follow a diet excluding meat, gluten and lactose (group A) or a balanced diet (group B). Results show that: - exclusion of meat, gluten and lactose, all of which reported as suspected of worsening of symptoms in RA, with the inclusion of fish, may carry additional health benefits to overweight patients compared with those obtained by a standard weight-reduction program (group B). - both diets, despite not affecting the disease activity, tended to reduce the arthritic pain perception and to improve the quality of life of the patients. - metabolic and inflammatory parameters showed a trend to normalise. - the immunological correlates of RA were not sensitive to either diet. Authors conclude that prevention of complications of RA might be better achieved by the exclusion diet. Thus, a diet prescription should be included in therapeutic plans for RA.
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease affecting the synovial joints and causing severe disability. Environmental and lifestyle factors, including diet, have been proposed to play a role in the onset and severity of RA. Dietary manipulation may help to manage the symptoms of RA by lowering inflammation and potentially decreasing pain. METHODS In 40 patients with long-standing RA with stable symptoms and treated with conventional (c-) and biological (b-) disease modifying anti-rheumatic drugs (DMARDs), the effect of a 3-month diet avoiding meat, gluten, and lactose (and all dairy products; privative diet) was evaluated in comparison with a control balanced diet including those foods. Both diets were designed to reduce weight since all patients were overweight or obese. Patients were randomly assigned to one of the diets, and RA was clinically assessed at Time 0 (T0), through the Visual Analogue Scale (VAS), for pain, and the Disease Activity Score of 28 joints (DAS 28) for RA activity. Patients were also administered the Short Form Health survey (SF-36) and the Health Assessment Questionnaire (HAQ). At T0, a blood sample was collected for laboratory tests and adipokines measurements, and anthropometric measurements were compared. These evaluations were repeated at the end of the 3 months' dietary regimens. RESULTS A significant decrease in VAS and the improvement of the overall state of physical and mental health, assessed through SF-36, was observed in patients assigned to the privative diet. Both dietary regimens resulted in the improvement of quality of life compared to baseline values; however, the change was significant only for the privative diet. With either diet, patients showed significant decreases in body weight and body mass index, with a reduction in waist and hips circumference and lower basal glucose and circulating leptin levels. A privative diet was also able to significantly reduce systolic (p = 0.003) and diastolic (p = 0.025) arterial pressure. The number of circulating leukocytes and neutrophils, and the level of hs-C-Reactive Protein also decreased after 3 months of the meat-, lactose-, and gluten-free diet. CONCLUSIONS Our results suggest that a privative diet can result in a better control of inflammation in RA patients under stable optimized drug treatment.
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Intake and adequacy of the vegan diet. A systematic review of the evidence.
Bakaloudi, DR, Halloran, A, Rippin, HL, Oikonomidou, AC, Dardavesis, TI, Williams, J, Wickramasinghe, K, Breda, J, Chourdakis, M
Clinical nutrition (Edinburgh, Scotland). 2021;40(5):3503-3521
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Plain language summary
This systematic review investigated vegan diets in the European populations and their adequacy of macro-and micronutrient intake, compared to the recommendations of the World Health Organization. Included were 48 studies and their outcomes regarding protein, carbohydrates, fats and micronutrients summarized. The overall results and their impact on health are discussed in the later sections of the paper. Adequate intake amongst vegans was seen with carbohydrates, fats, Vitamin A, B1, В6, C, E, iron, phosphorus, magnesium, copper and folate. Sodium exceeded recommended intake, whilst protein, Vitamin B2, B3, B12, D, iodine, zinc, calcium, potassium, selenium was of low consumption in a vegan diet. The bioavailability of some nutrients was also acknowledged. In summary, following a vegan diet appears to have positive and negative aspects. A vegan diet profile can contribute to disease prevention with lower incidence rates of obesity, Type 2 diabetes, and cardiovascular disease. Yet veganism appears to increase the risk for mental health conditions, bone fractures, immune system impairments, anaemias and deficiencies from low nutrient intake. This review yields a comprehensive overview of the positive and negative health consequences of a vegan diet. It may be a useful reference for those looking to support vegans or individuals considering adopting a vegan diet pattern.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Vegan diets in European populations tend to be lower in protein intake, particularly amino acids lysine, methionine and tryptophan.
- Other micronutrients that tend to lower in vegan diets are Vitamin B12, zinc, calcium and selenium.
- Healthcare practitioners should be aware of these potential deficiencies when working with vegan clients.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Vegan diets have become increasingly popular in the last ten years. This systematic review of 48 studies investigated the adequacy of vegan diets in European populations. It compared their macro- and micronutrient intakes compared to World Health Organization recommendations. It found that vegan diets tend to be lower in protein and in essential amino acids (lysine, methionine and tryptophan). They can also be lower in micronutrients especially vitamin B12, zinc, calcium and selenium. However, the lower intakes are not always associated with health impairments.
Clinical practice applications:
Practitioners should be aware of the potential deficiencies in a vegan diet.
Considerations for future research:
More research is needed to determine whether lower nutrient intakes in vegans correlated with poor health outcomes.
Abstract
BACKGROUND Vegan diets, where animal- and all their by-products are excluded from the diet, have gained popularity, especially in the last decade. However, the evaluation of this type of diet has not been well addressed in the scientific literature. This study aimed to investigate the adequacy of vegan diets in European populations and of their macro- and micronutrient intakes compared to World Health Organization recommendations. METHODS A systematic search in PubMed, Web of Science, IBSS, Cochrane library and Google Scholar was conducted and 48 studies (12 cohorts and 36 cross-sectional) were included. RESULTS Regarding macronutrients, vegan diets are lower in protein intake compared with all other diet types. Veganism is also associated with low intake of vitamins B2, Niacin (B3), B12, D, iodine, zinc, calcium, potassium, selenium. Vitamin B12 intake among vegans is significantly lower (0.24-0.49 μg, recommendations are 2.4 μg) and calcium intake in the majority of vegans was below recommendations (750 mg/d). No significant differences in fat intake were observed. Vegan diets are not related to deficiencies in vitamins A, B1, Β6, C, E, iron, phosphorus, magnesium, copper and folate and have a low glycemic load. CONCLUSIONS Following a vegan diet may result in deficiencies in micronutrients (vitamin B12, zinc, calcium and selenium) which should not be disregarded. However, low micro- and macronutrient intakes are not always associated with health impairments. Individuals who consume a vegan diet should be aware of the risk of potential dietary deficiencies.