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Recently, vegetarian diets have experienced an increase in popularity. A vegetarian diet is associated with many health benefits because of its higher content of fiber, folic acid, vitamins C and E, potassium, magnesium, and many phytochemicals and a fat content that is more unsaturated. Compared with other vegetarian diets, vegan diets tend to contain less saturated fat and cholesterol and more dietary fiber. Vegans tend to be thinner, have lower serum cholesterol, and lower blood pressure, reducing their risk of heart disease. However, eliminating all animal products from the diet increases the risk of certain nutritional deficiencies. Micronutrients of special concern for the vegan include vitamins B-12 and D, calcium, and long-chain n-3 (omega-3) fatty acids. Unless vegans regularly consume foods that are fortified with these nutrients, appropriate supplements should be consumed. In some cases, iron and zinc status of vegans may also be of concern because of the limited bioavailability of these minerals.
A nationwide poll conducted in April 2006 by Harris Interactive reported that 1.4% of the American population is vegan, in that they eat no meat, fish, dairy, or eggs (1). Vegan diets are growing in popularity today among teenagers and youth, especially females. For many vegans, nutritional choices center around taking better care of the earth’s resources and the environment, ethical issues about animal care, the use of antibiotics and growth stimulants for the production of animals, the threat of animal-borne diseases, and the health advantages of a plant-based diet (2–6). In addition, the potential of allergies from dairy products and lactose intolerance have fueled the popularity of soy-based dairy substitutes.
What then is the nutritional and health status of those who follow a vegan diet? Compared with other vegetarians (eg, lactoovovegetarians), are there any advantages or disadvantages to following a vegan diet? Does the elimination of dairy and eggs offer any additional benefits or create potential concerns? The purpose of this brief review is to summarize current knowledge on the health effects of vegan diets, to discuss the nutritional concerns or shortfalls of a vegan diet and to provide some practical dietary recommendations for following a healthy vegan diet. Key et al (7) have provided a pertinent overview of the health effects of vegetarian diets, focusing on their European Prospective Investigation into Cancer and Nutrition–Oxford (EPIC-Oxford) study and other large population studies.
HEALTH EFFECTS OF VEGAN DIETS
Vegan diets are usually higher in dietary fiber, magnesium, folic acid, vitamins C and E, iron, and phytochemicals, and they tend to be lower in calories, saturated fat and cholesterol, long-chain n-3 (omega-3) fatty acids, vitamin D, calcium, zinc, and vitamin B-12 (8). In general, vegetarians typically enjoy a lower risk of cardiovascular disease (CVD), obesity, type 2 diabetes, and some cancers (3). A vegan diet appears to be useful for increasing the intake of protective nutrients and phytochemicals and for minimizing the intake of dietary factors implicated in several chronic diseases (9). In a recent report (10), different plant food groups were rated with respect to their metabolic-epidemiologic evidence for influencing chronic disease reduction. According to the evidence criteria of the World Health Organization and Food and Agriculture Organization (WHO/FAO), cancer risk reduction associated with a high intake of fruit and vegetables was assessed as probable or possible, risk of CVD reduction as convincing, whereas lower risk of osteoporosis was assessed as probable (10). The evidence for a risk-reducing effect of consuming whole grains was assessed as possible for colorectal cancer and probable for type 2 diabetes and CVD. The evidence for a risk-reducing effect of consuming nuts was assessed as probable for CVD (10).
In summarizing the published research, Fraser (11) noted that, compared with other vegetarians, vegans are thinner, have lower total and LDL cholesterol, and modestly lower blood pressure. This is true not only for whites; work by Toohey et al (12) showed that blood lipids and body mass index (BMI; in kg/m2) were significantly lower in African American vegans than in lactoovovegetarians. Similarly, among Latin Americans, vegetarians had lower plasma lipids than did their omnivore counterparts, with the lowest reported among vegans (13). In that study, plasma total and LDL cholesterol were 32% and 44% lower among vegans than among omnivores. Because obesity is a significant risk factor for CVD, the substantially lower mean BMI observed in vegans may be an important protective factor for lowering blood lipids and reducing the risk of heart disease (8).
Vegans, compared with omnivores, consume substantially greater quantities of fruit and vegetables (14–16). A higher consumption of fruit and vegetables, which are rich in fiber, folic acid, antioxidants, and phytochemicals, is associated with lower blood cholesterol concentrations (17), a lower incidence of stroke, and a lower risk of mortality from stroke and ischemic heart disease (18, 19). Vegans also have a higher consumption of whole grains, soy, and nuts (14,