Nutritional Guidelines

Journal of the Academy of Nutrition and Dietetics
Position of the American Academy of Nutrition and Dietetics: Vegetarian Diets
2016
http://www.andjrnl.org/article/S2212-2672(16)31192-3/fulltext
•    The position of the academy are that vegetarian and vegan diets are healthful at all stages of life
•    This includes pregnancy, lactation, infancy, childhood, elderly, and athletic stages of life
•    my prevent or treat certain diseases
•    Ischemic heart disease, diabetes type 2, obesity, hyperlipidemia, obesity, certain cancer types
•    vegetables, fruits, legumes including soy, whole grains, healthy oils, nuts and seeds are the main foods
•    vegans should ensure B12 intake via fortified foods or supplements
•    all other nutrients are available but some may require planning for adequate amounts
•    diverse choices and food patterns are available
•    Vegetarian diets have a lower environmental impact
•    people choose vegetarian/vegan diets due to compassion for animals, environmental protection, and prevention or treatment of certain chronic disease

Summaries of Key Research Papers
http://www.veganhealth.org/articles/dxrates#2012

Nutritional Information and Compilations of Research Papers
http://www.nutritionfacts.org
http://www.plantbasedresearch.org/
http://www.pcrm.org/
http://ucdintegrativemedicine.com/
http://www.foodasprevention.com/
(http://www.foodasprevention.com/food-prevention-references/)

Protein Needs and Vegan Protein Sources
http://www.veganhealth.org/articles/protein

http://www.vrg.org/nutrition/protein.php
•    Excellent review of human protein requirement and vegan sources

Calcium Needs and Vegan Sources
https://www.bda.uk.com/foodfacts/Calcium.pdf

http://www.theveganrd.com/vegan-nutrition-101/vegan-nutrition-primers/calcium-a-vegan-nutrition-primer/
•    Virginia Messina review

Pediatric Guidelines
http://www.vrg.org/nutshell/kids.php
•    Excellent Review be Dr. Reed Mangles PhD

Review Article

Canadian Family Physician
Time for Change – Benefits of Plant Based Diets
http://www.cfp.ca/content/63/10/744?etoc
•    excellent review article covering some of the evidence for plant based diets and health
•    also covers issues of environmental degradation, including climate change, water use, land use change etc

General / All cause Mortality
http://www.veganhealth.org/articles/dxrates#2012
•    Excellent summary of EPIC 2013 and Adventist 2 study – also in all cardiovascular disease

Health outcomes and greenhouse gas emissions from varied dietary patterns– is there a relationship?
Annals of Nutrition and Metabolism
2015
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094759/
•    GHG emissions calculated in Adventist 2 Study for various diets – 73 000 subjects
•    Standard non-vegetarian diet was compared to semi-vegetarian, pesco-vegetarian, lacto-ovo vegetarian and vegan diets
•    The respective reduction in GHGs, compared to standard diet, were  20%, 24%, 28% and 42% (please note that this doesn’t include Opportunity Cost of Meat and Dairy consumption – ed)
•    The age gender and race adjusted mortality rates  per 1000 population were
6.66, 6.18, 5.49, 5.60 and 5.38 (for omnivore, pesco vege, semi veg, lacto-ovo veg, and vegan diets)
•    article also listed in Environment and Food Security List

The Impacts of Dietary Change on Greenhouse Gas Emissions, Land Use, Water Use, and Health: A Systematic Review
PLoS One
2016
http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0165797&type=printable
•    Compares Vegan, lacto veg, pescatarian, meat reduction, and omnivore diets
•    The greater the decrease in animal products, the better the impact on GHG, Land use and Water footprint
•    Vegan diet resulted in the greatest decrease in all-cause mortality – 19% decrease
•    article also listed in Environment and Food Security List
•    Article was used as a reference for the 2017 Canada food guide process

Journal of the American Medical Association
Ten Years of Life – Is It a Matter of Choice?
2001
http://archinte.jamanetwork.com/article.aspx?articleid=648593
•    Data on 7th Day Adventists in California compared to other western populations in the world
•    Cohort of 34000 men and women followed for 12 years
•    Increased lifespan of up to 10 years depending on the following factors: vegetarian diet, exercise, nut consumption, smoking status and BMI
•    Note that BMI is also improved by a plant diet
•    does not include vegan subgroup

American Journal of Clinical Nutrition
Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists
1999
http://www.ncbi.nlm.nih.gov/pubmed/10479227
http://ajcn.nutrition.org/content/70/3/532s.full
•    34000 subjects followed, 50% were vegetarian or ate meat < once per week, meat eaters ate 3 or more times per week
•    case controlled and followed 12 years
•    vegetarian group ate some eggs and most did have dairy
•    non vegetarian group ate meat half as much as average Californian
•    vegetarian men lived 3.21 years longer and women 2.52 years longer
•    decreased cardiovascular death in vegetarian males by 37%
•    increased colon cancer RR 1.88 in non vegetarians, prostate cancer 1.54 in non vegetarians
•    legumes associated with decreased colon and pancreatic cancer, nuts with decreased heart disease, fruits and vegetables with decreased prostate, lung and colon cancers
•    decreased diabetes, hypertension, arthritis in vegetarians
•    benefits partly attributed to absence of meat, partly due to higher intake of foods listed above

Nutrients
Beyond Meatless, the Health Effects of Vegan Diets: Findings From the Adventist Cohorts
2014
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4073139/pdf/nutrients-06-02131.pdf
•    Excellent Review Article on Adventist Studies so far
•    shows benefits for longevity, cancers, cardiovascular disease, and health parameters of plant based diets
•    note that some data is statistically significant, and others remain to be determined as the current Adventist 2 cohort is observed for a longer period

Cell Metabolism
Low Protein Intake Is Associated with a Major Reduction in IGF-1, Cancer, and Overall Mortality in the 65 and Younger but Not Older Population
2014
http://www.cell.com/cell-metabolism/pdf/S1550-4131(14)00062-X.pdf
•    6381 subjects aged 50 and over (mean age 65) followed an average of 18 years
•    40% overall Mortality, 18% cancer mortality, 10% Cancer Mortality, 1% diabetes mortality (many followed till end of life)
•    high protein intake resulted in 75% greater mortality, 4 x cancer risk than low protein diets
•    this risk be was attenuated or nullified if protein was from plant sources
•    in people over 65 high protein was protective
•    high protein diet increased levels of diabetes in all age groups
•    (also in section on Diabetes II)

American Journal of Clinical Nutrition
A provegetarian food pattern and reduction in total mortality in the Prevención con Dieta Mediterránea (PREDIMED) study
2014
http://www.ncbi.nlm.nih.gov/pubmed/24871477
•    7000 subject, mean age 67, all at high risk for cardiovascular disease, followed for 5 years
•    scored on how much their diet was plant based (even if some foods were chips and french fries), and deducted points for all animal foods
•    those with higher plant based consumption had 40% less mortality, even though they were not fully vegetarian
•    omnivorous food consumption with low meat and high plant foods decreases mortality in high risk people

JAMA
Healthy Living Is the Best Revenge: Findings From the European Prospective Investigation Into Cancer and Nutrition–Potsdam Study
2009
http://archinte.jamanetwork.com/article.aspx?articleid=1108507
•    23,000 German subjects, aged 35 to 65 years from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study – mean 7.8 year follow-up
•    4 major health factors identified: never smoking, BMI <  30, 3.5 h/wk or more of physical activity, good diet (high in fruits, vegetables, and whole-grain bread and low meat consumption)
•    all factors equally weighted
•    adjusted for age, sex, educational status, and occupational status
•    Those with all 4 factors at baseline  had a 78% less chance of acquiring chronic disease defined as Diabetes (93% less chance), Myocardial Infarction  (81% less chance), Stroke (50% less chance), Cancer (36% less chance)
•    As compared to subjects without any of the the 4 factors
•    (also in High Protein Low Carb Diet section)

JAMA Internal Med
Vegetarian dietary patterns and mortality in Adventist Health Study 2
2013
http://www.ncbi.nlm.nih.gov/pubmed/23836264
•    73 000 Seventh Day adventists followed for a mean of 5.8 years ony, recruited 2002-2007.  2570 deaths calculated up to 2009.
•    Vegan, Vegetarian, Fish eaters, and semi-vegetarians have benefit over non-vegetarians HR = 0.85, 0.91, 0.81, 0.92 Respectively)
•    modest 10% reduction in cancers and 18% decrease in heart disease
•    Study is ongoing, and requires more time for better statistical  significance between the groups

American Journal of Clinical Nutrition
Mortality in vegetarians and comparable nonvegetarians in the United Kingdom
2015
http://ajcn.nutrition.org/content/103/1/218.full
•    EPIC Oxford study and Oxford Vegetarian Study
•    60 000 subjects (standard diet, semi-veg, fish eater, vegetarians, and a few vegans) over 1 million years follow up (hence avg of 16 years), 5294 deaths
•    After exclusion of subjects who  changed diet patterns, 4270 deaths before age 90, and 2155 deaths before age 75
•    (Such exclusion is necessary for many reasons i.e. including that many people switch to a vegetarian diet pattern after the diagnosis of heart disease of cancer)
•    Combined vegetarians and vegans had:
⁃    HR of cancer mortality             0.81 < age 75   0.82 < age 90
⁃    HR of heart disease mortality     0.85 < age 75   0.88 < age 90
⁃    All Cause Mortality             0.86 < age 75   0.92 < age 90
•    About 50-60% lower rates of pancreatic cancer and hematopoietic cancer mortality
•    similar to results in the Adventist studies in USA
•    this study did not look at morbidity, only mortality, hence dealing with smaller number of events
•    difficult to study vegans due to low statistical significance when it comes to mortality only; low numbers

Clinical Nutrition
High dietary protein intake is associated with an increased body weight and total death risk
2016
http://www.ncbi.nlm.nih.gov/pubmed/25886710
•    PREDIMED study
•    over 7000 subjects followed 4.5 years, in quintiles of protein intake
•    Highest vs lowest animal protein was associated with greater weight gain HR 1.6 when replacing fats HR 1.9 when replacing carbohydrates
⁃    overall mortality HR ~ 1.6
⁃    higher cancer and cardiovascular disease
•    higher animal protein was associated with higher fatal and non fatal outcomes
•    higher plant protein was was safe
•    Also referenced in Low Carbohydrate High Protein section

Critical Review of Food Science Nutrition
Vegetarian, vegan diets and multiple health outcomes: a systematic review with meta-analysis of observational studies
2016
http://www.ncbi.nlm.nih.gov/pubmed/26853923
•    86 cross sectional studies and 10 prospective cohort based studies
•    RR of cardiovascular disease of vegans and vegetarians combined was 0.75  compared to non-vegetarians
•    RR for total Cancer 0.92 (vegans and vegetarians)
•    RR for vegans regarding total cancer was 0.85

American Journal of Epidemiology
Milk, Fruit and Vegetable, and Total Antioxidant Intakes in Relation to Mortality Rates: Cohort Studies in Women and Men
2017
https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kww124
•    study of over 140 000 men and women over years in Sweden
•    Compared to sex matched subjects who consumed maximum one glass of milk per day, but 5 or more serving of fruits and vegetables
•    Women consuming three or more glasses of milk, and one or less servings of vegetables had a mortality HR of 2.79
•    Women consuming three or more glasses of milk, and five or more  servings of vegetables had a mortality HR of 1.60
•    In men, the same comparison yielded HR of 1.31 and 1.07 – the latter not been statistically significant
•    possibly hard to find a distinction in men if overall animal protein consumption is high

Cardiovascular Disease

Journal of the American College of Cardiology
Trending Cardiovascular Nutrition Controversies
2017
http://www.onlinejacc.org/content/69/9/1172
•    Excellent Summary of evidence for dietary prevention of cardiovascular disease
•    Summary of the benefits of plant based protein, fruits and vegetables, olive oil and nuts
•    recommends limitation of animal based foods including eggs, juicing, plant based saturated fats
•    Addresses controversies over cholesterol, coconut oil, etc.

Nutrients
Cardio-Metabolic Benefits of Plant-Based Diets
2017
http://www.mdpi.com/2072-6643/9/8/848
•    Excellent review on subject of cardiovascular disease and metabolic syndrome (obesity, diabetes, hypertension and blood lipids) with respect to plant based diets

Kaiser Permanente
The Permanente Journal
Nutritional Update for Physicians: Plant-Based Diets
2013
http://www.thepermanentejournal.org/issues/2013/spring/5117-nutrition.html
•    “Healthy eating may be best achieved with a plant-based diet, which we define as a regimen that encourages whole, plant-based foods and discourages meats, dairy products, and eggs as well as all refined and processed foods”
•    “Physicians should consider recommending a plant-based diet to all their patients, especially those with high blood pressure, diabetes, cardiovascular disease, or obesity”
•    It is very significant that the USA’s Largest and mainstream health management organization as made such strong statements based on the medical research referenced in this document
•    Kaiser Permanente has over 9 million health plan members
Annals of Nutrition and Metabolism
Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review.
2012
http://www.ncbi.nlm.nih.gov/pubmed/22677895
http://www.karger.com/Article/FullText/337301
•    Meta analysis of seven studies 124 000 subjects UK, Japan, California, USA overall, Germany Netherlands
•    Duration 10-23 years, ages 10-90 years
•    vegetarians had 29% lower heart disease mortality, 18% lower Cancer Mortality than non Vegetarians
•    does not distinguish vegans (who likely have even lower disease rates)

Journal of the American Medical Association
Vegetarian dietary patterns and mortality in Adventist Health Study 2
2013
http://www.ncbi.nlm.nih.gov/pubmed/23836264
•    73 000 subjects followed for mean 5.79 years – short time only – study ongoing.
•    HR all cause mortality Vegans 0.85  compared to non vegetarians.
•    improvements in Cardiac, Endocrine, Renal Mortality

American Journal of Cardiology
Diet, lifestyle, and the aetiology of coronary artery disease: the Cornell China study
1998
http://www.ncbi.nlm.nih.gov/pubmed?term=9860369[uid]
•    China study journal article : Diet, lifestyle, and the etiology of coronary artery disease: the Cornell China study.
•    American Journal of Cardiology 1998
•    analyzed mortality data for >50 diseases, incl. 7 different cancers, from 65 counties and 130 villages in rural mainland China.
•    Blood, urine, food samples, and detailed dietary data were collected from 50 adults in each village
•    Mean serum total cholesterol was 127 mg/dL in rural China versus 203 mg/dL for adults aged 20-74 years in the United States
•    Coronary artery disease mortality was 16.7-fold greater for US men and 5.6-fold greater for US women than for Chinese
•    coronary artery disease mortality rates for both genders in rural China were inversely associated with the frequency of intake of green vegetables and plasma erythrocyte monounsaturated fatty acids,
•    positively associated with salt intake + urinary sodium and plasma apolipoprotein B.
•    apolipoproteins were associated with animal protein/meat  inversely associated with plant protein, legume, and light-colored vegetable intake.
•    Rates of other diseases were also correlated with dietary factors.
•    There was no evidence of a threshold beyond which further benefits did not accrue with increasing proportions of plant-based foods in the diet

American Journal of Epidemiology
Risk Factors for Mortality in the Nurses’ Health Study: A Competing Risks Analysis
2010
http://aje.oxfordjournals.org/content/173/3/319.full
•    2010 Nurses Health Study – 50 000 subjects
•    multiple factor related to mortality include cholesterol intake, obesity, diabetes, blood pressure, glycemic load etc
•    protective factors include, intake of polyunsaturated fat, nuts, cereal fibre intake etc
•    reflects badly on animal based foods, good on whole grains, nuts, plant foods

Cell Metabolism
Low Protein Intake Is Associated with a Major Reduction in IGF-1, Cancer, and Overall Mortality in the 65 and Younger but Not Older Population
2014
http://www.cell.com/cell-metabolism/pdf/S1550-4131(14)00062-X.pdf
•    see full entry in Overall Cancer Mortality Section

American Journal of Clinical Nutrition
Risk of hospitalization or death from ischemic heart disease among British vegetarians and nonvegetarians: results from the EPIC-Oxford cohort study
2013
http://ajcn.nutrition.org/content/97/3/597.long
http://www.ncbi.nlm.nih.gov/pubmed/23364007
•    2013 EPIC Oxford study
•    vegetarians have 32% decreased risk of Fatal and Non Fatal Ischemic Heart Disease
•    44 000 subjects from England and Scotland – followed 11.6 years
•    1066 admissions and 169 deaths from heart disease = 1235 total cases
•    Vegetarians had a 32% lower risk (HR = 0.68)
•    results are same when control for smoking, obesity, gender, age, BMI etc
•    does not distinguish vegans from vegetarians, fish eaters lumped in meat group

http://www.veganhealth.org/articles/dxrates#2012
•    summary of EPIC 2013 and Adventist 2 study – also in all cause mortality – Jack Norris

Lancet
Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial
1990
http://www.ncbi.nlm.nih.gov/pubmed?term=1973470[uid]
•    28 in a low fat vegan group/exercise/meditation/stop smoking, 20 in usual care group
•    195 heart lesions examined before and after one year
•    82% of experimental group had regression of atherosclorosis plaques, most in control group had increase in lesions
•    Five years later both groups were followed up: Intensive lifestyle changes for reversal of coronary heart disease – JAMA 1998
•    http://www.ncbi.nlm.nih.gov/pubmed/9863851
•    there were more than twice as many events in the control group vs the experimental group after 5 years
•    coronary artery plaque continued to regress in the experimental group, and worsened in the control group
•    90% decrease in angina in experimental group, 186% increase in control group

Journal of Family Practice
A way to reverse CAD?  – Caldwell Esselstyn Study
2014
http://www.jfponline.com/articles/editor-s-pick/article/a-way-to-reverse-cad/f74f8ebb9261a837f3511f407516c7e5.html
•    small non-controlled trial and review article re vegan diet and coronary artery disease
•    198 patients suffering vascular disease showed low recurrence rate at 3.7 years follow up – 0.6% recurrence rate if adhered to diet
•    low fat plant based diet
•    in the 21 patients that did not adhere to diet, 62% event rate including CABG, angioplasty with stent, 2 strokes, 2 sudden deaths
•    see section titled “outcomes of adherent patients”:  112 patients with baseline angina improved, 18 lbs wt loss average, etc

Canadian Journal of Cardiology
Dietary cholesterol and egg yolks: Not for patients at risk of vascular disease
2012
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989358/
•    Discusses the impact of strong marketing tactics from egg industry, making people think that eggs are harmless, and cholesterol may not be a health issue
•    See Also section on Diabetes below

Journal of the American College of Cardiology
Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease: A Prospective Cohort Study
2015
http://content.onlinejacc.org/article.aspx?articleID=2445322
•    84 000 women and 42 000 men followed 24-30 years, 7600 incident cases of coronary heart disease (CHD)
•    women were from Nurses’ Health Study, 1980 to 2010; men from Health Professionals Follow-up Study, 1986 to 2010
•    diet assessment every 4 years
•    high PUFA (polyunsaturated fat) intake resulted in 20% less CHD, high whole grain intake resulted in 10% less CHD
•    replacing just 5% of saturated fat calories with PUFA reduced CHD by 25%, with Monounsaturated fat 15%, whole grains 9%
•    replacing refined carbohydrates with PUFA MUFA or whole grains also resulted in decreased CHD

American Journal of Clinical Nutrition
Dietary protein and risk of ischemic heart disease in middle-aged men
2010
http://ajcn.nutrition.org/content/92/5/1265.full.pdf
•    43000 men in the health professional follow up study followed 18 years
•    initially free of vascular disease, hypertension, high cholesterol, diabetes
•    25% increased heart disease if high animal protein intake compared to standard diet
•    7% less heart disease if high protein but of plant origin, compared to standard diet

The BMJ
Milk intake and risk of mortality and fractures in women and men: cohort studies
2014
•    http://www.bmj.com/content/349/bmj.g6015
•    see full entry in section titled Dairy, Calcium Intake and Bone Health below

American Journal of Clinical Nutrition
Mortality in vegetarians and comparable nonvegetarians in the United Kingdom
2015
http://ajcn.nutrition.org/content/103/1/218.full
•    See entry in General and All Cause mortality

Cardiovascular Disease: Role of Saturated Fat and Cholesterol

Circulation
Dietary Fats and Cardiovascular Disease A Presidential Advisory From the American Heart Association
2017
http://circ.ahajournals.org/content/early/2017/06/15/CIR.0000000000000510
•    Strongly worded article from the AHA intended to end the debate over saturated fat, cholesterol and cardiovascular disease (CVD)
•    Meta-Analysis by Siri-Tarino and Chowdhury are flawed: they compare diets high in saturated fat with diets high in refined carbohydrates, which are known to be harmful
•    Mainly cites randomized trials where subjects consume diet high in either saturated animal fat vs vegetable oils
•    Replacing saturated fat with vegetable oils reduces CVD by about 30%
•    Replacement of Saturated fat with refined or unspecified carbohydrates does not reduce CVD
•    Whole grains are beneficial in reducing CVD when replacing saturated fat
•    Saturated fat and cholesterol intake adversely affects increase serum lipids, and increases CVD
•    This article referenced in multiple sections below

Journal of the American College of Cardiology
Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease: A Prospective Cohort Study
2015
http://www.ncbi.nlm.nih.gov/pubmed/26429077
http://content.onlinejacc.org/article.aspx?articleid=2445322
http://www.hsph.harvard.edu/news/press-releases/butter-is-not-back-limiting-saturated-fat-still-best-for-heart-health/
•    Article is relevant in light of recent meta-analysis question the role of saturated fat and cholesterol, but themselves have methodological issues
•    84000 women in Nurses Health Study followed 30 years and 43000 men from Health Professionals Follow Up Study-followed 24 years
•    7667 incident cases of coronary heart disease
•    Replacing 5% of energy intake from saturated fats with equivalent energy from
⁃    polyunsaturated fats results in 25% decreased CHD
⁃    monounsaturated fats results in 15% decreases CHD
⁃    Whole grains results in 9% decreased CHD
•    Changing those calories for refined carbohydrates and sugars resulted in no risk reduction
•    (Also entered in section on High Protein Low Carb Diet, Mediterranean Diet, Whole Grains and Cardiovascular Disease)

Cardiovascular Disease: Post Myocardial Infarction Morbidity and Mortality

Journal of the American Heart Association
Low carbohydrate diet from plant or animal sources and mortality among myocardial infarction survivors
2014
http://www.ncbi.nlm.nih.gov/pubmed/25246449
http://jaha.ahajournals.org/content/3/5/e001169.long
•    2258 women from Nurses’ Health Study, 1840 men from the Health Professional Follow-Up Study
•     who had survived a first MI during follow-up and provided a pre-MI and at least 1 post-MI food frequency questionnaire
•    Highest quintile (vs lowest quintile) of animal based low carb high protein diet had HR 1.30 of cardiovascular mortality, and HR 1.53 of all cause mortality
•    Plant based high protein low carb diet was not associated with benefit or harm, compared to a standard diet low in animal protein and high in carbohydrates
•    study did not include a completely vegan subgroup

Cerebrovascular Disease and Stroke
See also 2015 article in peanuts section

Clinical Nutrition
High dietary fiber intake prevents stroke at a population level
2013
http://www.ncbi.nlm.nih.gov/pubmed/23317525
•    1647 subjects in 12 year population based study
•    HR for stroke if Soluble fibre was >25g or insoluble fibre was >47g was  0.31 an 0.35 respectively
•    in soluble fibre is mainly from lentils and whole grains,  insoluble fibre is from fruits, veggies and Grains
•    Dramatic results

Atherosclerosis
Egg Yolk Consumption and Carotid Plaque (marker for stroke risk)
2012
http://www.atherosclerosis-journal.com/article/S0021-9150(12)00504-7/abstract
•    1200 subjects, 47% are women, carotid plaque measured by ultrasound
•    shows that eating 3 or more eggs per week has 2/3 the effect of smoking pack years on carotid plaques surface area
•    Increases exponentially with pack year and “egg yolk years”
•    entry also in Eggs section below

BMJ
Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study
2012
http://www.bmj.com/content/344/bmj.e4026
•    see full entry in section on high protein low carbohydrate diet below

Stroke
Dietary Fibre Intake and Risk of First Stroke – A Systematic Review and Meta-Analysis
2013
http://stroke.ahajournals.org/content/44/5/1360.long
•    over 160 000 men and women from  8 different studies in USA Japan Australia Sweden and Finland
•    Consuming and extra 7 g of fibre per day decrease stroke by 7% in meta-analysis
•    this is a very small amount of fibre –  great benefit from incremental plant intake
•    was unable to find out which plant food sources were the best (i.e. cereal vs vegetables/fruit, vs insoluble fibre sources

Omega 3 Fatty Acids and Cardiovascular Disease
As of 2012 and 2013 there are multiple meta-analysis that show marine omega three fatty acids do not benefit cardiovascular diseases.  Also there is evidence that fish consumption can do harm, mainly from toxins.

JAMA Internal Medicine
The Unfulfilled Promise of ω-3 Fatty Acid Supplementation.
2017
https://www.ncbi.nlm.nih.gov/pubmed/28055040
Link To Editorial
•    There was some initial evidence of benefit from Omega-3 Fats for cardiovascular disease
•    Two of these trials were open label, no placebo control.  The third was placebo controlled.
•    Subsequent double blinded trials all failed to show benefit:
⁃    Alpha Omega trial;  Risk and Prevention Study Collaborative Group trial; SU.FOL.OM3 trial; OMEGA trial; ORIGIN Trial
⁃    FAVOURED Study in Same issue as editorial

New England Journal of Medicine
Omega-3 fatty Acids in Patients with Multiple Cardiovascular Risk Factors
2013
http://www.ncbi.nlm.nih.gov/pubmed/23656645
•    Prospective Randomized trial following 12000 patients to receive Omega 3 supplements and vs placebo
•    Patients had risk factors and cardiovascular disease but no prior myocardial infarction
•    5 years follow up shows no reduction in cardiovascular combined primary end point of heart attack, stroke, or death from either

Archives of Internal Medicine
Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials
2012
http://www.ncbi.nlm.nih.gov/pubmed/22493407
•    excellent meta-analysis including over 20 000 subjects, 13 trials that met quality criteria
•    shows no benefit of marine omega 3 fatty acids for secondary prevention of cardiovascular events, MI,  including all cause mortality sudden death, congestive heart failure, TIA and Stroke

Journal of the American Medical Association
Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis of randomized trials of marine (fish) Omega 3 fatty acids
2012
http://www.ncbi.nlm.nih.gov/pubmed/22968891
•    JAMA 2012 meta-analysis – powerful study of over 68 000 subjects
•    Shows no benefit of Omega 3 on all-cause mortality, cardiac death, sudden death, myocardial infarction, and stroke

Canadian Journal of Cardiology
“Fishing” for the origins of the “Eskimos and heart disease” story. Facts or wishful thinking? A review
2012
http://www.onlinecjc.ca/article/S0828-282X(14)00237-2/abstract
•    discusses original two Danish investigators who said Eskimo/Inuit populations have lower rates of CVS disease in 1970s
•    however their poor studies did not even investigate prevalence in white population for comparison, and their studies are still often quoted
•    Review done of subsequent studies shows that Inuit diet has not benefit compared to general population of western countries

Eggs: Cardiovascular Disease and Diabetes

Atherosclorosis
Egg consumption and risk of cardiovascular diseases and diabetes: a meta-analysis
2013
http://www.ncbi.nlm.nih.gov/pubmed/23643053
•    suggests a dose response relationship between eggs and disease 320 000 subjects
•    4 eggs per week causes incremental risk
⁃    1.06 RR of Cardiovascular disease
⁃    1.40 RR of Cardiovascular disease if pre-existing diabetes
⁃    1.29 RR of  Diabetes
⁃    2.0 RR of Cardiovascular Risk in studies done in non USA western countries – subgroup analysis

Atherosclorosis
Egg yolk consumption and carotid plaque
2012
http://www.ncbi.nlm.nih.gov/pubmed/22882905
•    over 1200 people studied
•    Carotid plaque and other CVD risk factors increased exponentially with smoking and egg consumption, with pack years and egg yolk years (Stroke risk factor)
•    egg yolk years remained significant after adjustment of other coronary risk factors
•    entry also in Eggs section below Cebrovascular Disease and Stroke section above

Atherosclorosis
Egg consumption and coronary artery calcification in asymptomatic men and women.
2015
http://www.ncbi.nlm.nih.gov/pubmed/26062990
•    23000 Korean men and women with no cardiac history or known hypercholesterolemia
•    underwent cardiac CT scan and diet questionnaire
•    those consuming >7 eggs per week vs <1 egg per week had coronary artery calcium plaque deposit 54% more
•    worse in those with increased BMI or low vegetable intake
•    attenuated when adjusted for total cholesterol intake
•    hence eggs increase coronary artery calcified plaques – and this may be due to intake of total cholesterol, saturated fat, or animal products

Peripheral Vascular Disease

The American Journal of Clinical Nutrition
Dietary intake and peripheral arterial disease incidence in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) Study
2017
http://ajcn.nutrition.org/content/early/2017/01/10/ajcn.116.137497
•    14000 Participants followed for an average of 19.9 years
•    1500 developed peripheral vascular disease as measured by Ankle brachial index or hospital discharge codes
•    meat consumption measured in quintiles using modified Harvard food questionnaire
•    Hazard ratios  were as follows: quintile 1: reference, quintile 2: 1.38, quintile 3: 1.38, quintile 4: 1.45, quintile 5: 1.66
•    the study also commented on alcohol and coffee consumption

Effect of Fish Toxins Including Methyl Mercury and PCBs – Children, Newborns, Pregnancy, and  Lactation
(see also article about Omega-3 in Prostate Cancer Section)

NOTE: Examples of Plant Based Omega supplements
•    made from Algae, they are the exact marine omega 3 fatty acids found in fish (who get them originally from algae)
•    Minimizes methyl mercury, PCBs, and other fish contaminants
•    Study shows filtered fish oil still has contaminants http://www.ncbi.nlm.nih.gov/pubmed/19265383
•    Google: Opti3, Ovega, Ascentia, Nutra Vege, Nature Made Vegetarian Omega  3, Ovega
•    Google “Vegan Omega 3” may also find relevant products

Food and Chemical Toxicology
Fish consumption during child bearing age: a quantitative risk-benefit analysis on neurodevelopment.
2013
http://www.ncbi.nlm.nih.gov/pubmed/22079313
•    Omega 3 oils are likely beneficial to the developing fetal brain
•    methylmercury in fish has a detrimental effect on the developing brain
•    compares mercury levels in 33 fish species – for most, the negative effect of mercury outweigh the positive effect of omega 3 fats
•    consumption of some fish species cause an average of 10 point IQ loss if consumed during pregnancy
•    recommends stopping fish consumption for a year before pregnancy

Journal of Toxicological Science
Hair-to-blood ratio and biological half-life of mercury: experimental study of methylmercury exposure through fish consumption in humans
2012
http://www.ncbi.nlm.nih.gov/pubmed/22293416
•    the half life of Methylmercury in humans is roughly 60 days +/- 20 days
•    Prior to pregnancy, elimination of fish from diet will likely reduce the methylmercury load by 90-99%

Environmental Health Perspectives
Evidence on the Human Health Effects of Low-Level Methylmercury Exposure
2012
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385440/
•    Evidence on the Human Health Effects of Low-Level Methylmercury Exposure
•    shows evidence of Low level Mercury intake on child neurodevelopment, potentially on immune function
•    no sufficient evidence regarding child growth or cardiovascular disease

Environmental Health Perspectives
Calculation of Mercury’s Effects on Neurodevelopment
2012
http://ehp.niehs.nih.gov/1206033/
•    Study on Economic losses due to IQ decrease attributable to effect of Mercury on Neurodevelopment

Medical Hypotheses
Relationship between the prenatal exposure to low-level of mercury and the size of a newborn’s cerebellum
2011
http://www.ncbi.nlm.nih.gov/pubmed/21195558
•    Small 2011study 137 pregnant women and their infants
•    study shows mothers with higher mercury blood levels have infants with smaller cerebellums in MRI

Neurotoxicology
Functional MRI approach to developmental methylmercury and polychlorinated biphenyl neurotoxicity
2011
http://www.ncbi.nlm.nih.gov/pubmed/21545807
•    Functional MRI approach to developmental methylmercury and polychlorinated biphenyl neurotoxicity
•    Shows infants with higher PCB and mercury exposure  had functional MRI differences at age 15

Journal of Paediatrics
Hair mercury levels of women of reproductive age in Ontario, Canada: implications to fetal safety and fish consumption.
http://www.ncbi.nlm.nih.gov/pubmed/20338578
•    women consuming more than 12 ounces of fish per week should have mercury level testing prior to pregnancy

Environmental Health Perspectives
Dose-response relationship of prenatal mercury exposure and IQ: an integrative analysis of epidemiological data
2007
http://www.ncbi.nlm.nih.gov/pubmed/17450232
•    Environmental Health Perspectives 2007 article
•    Relationship between the prenatal exposure to low-level of mercury and the size of a newborn’s cerebellum
•    shows a dose response impact of mercury consumption to IQ decrease, but no impact on motor or attention in children

Neurotoxicology
Associations of maternal long-chain polyunsaturated fatty acids, methyl mercury, and inane development in the Seychelles Child Development Nutrition Study
2008
http://www.ncbi.nlm.nih.gov/pubmed/18590765
•    229 children studied at 9 months and 30 months for mental development
•    Strong mental development seen at 9 months is positively correlated with with total omega 3 long chain polyunsaturated fatty acids in maternal serum
•    Study demonstrates the importance of omega 3 fatty acids in infant diet and also shows that adverse effects of methyl mercury can be obscured by LCPUFA in longitudinal studies

Journal of Paediatrics
Delayed brainstem auditory evoked potential latencies in 14-year-old children exposed to methylmercury.
2004
http://www.ncbi.nlm.nih.gov/pubmed/14760257
•    effects on neurotransmission from children with high mercury levels at birth
•    changes are irreversible

Environmental Science and Technology
Elimination Half-lives of Polychlorinated Biphenyl Congeners in Children
2008
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600453/
•    Whale meat and fish are high sources of polychlorinated biphenyls (PCBs) contamination
•    the elimination half life is approximately 3-9 years in children, differing for various PCB compounds
•    exposure to PCB’s will likely result in lifelong human contamination, though levels will decrease over years

Overall Cancer Incidence/Mortality

Critical Review of Food Science Nutrition
Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies
2017
https://www.ncbi.nlm.nih.gov/pubmed/26853923
•    Vegetarians have 25% less incidence of cardiovascular disease and 8% less cancer incidence
•    Vegans have 15% less cancer incidence than general population

American Journal of Clinical Nutrition
Cancer in British vegetarians: updated analyses of 4998 incident cancers in a cohort of 32,491 meat eaters, 8612 fish eaters, 18,298 vegetarians, and 2246 vegans
2014
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144109/
•    pooled analysis of EPIC-Oxford and Oxford Vegetarian Study
•    61000 men and women (32k meat eaters, 8.6k fish eaters, 18k vegetarians, 2.2k vegans)
•    avg 14.9 year follow up, 4998 incident cancers reported
•    decreased stomach cancer (HR 0.37), leukaemia/lymphoma (HR =0.64), and overall cancer (HR=0.88)
•    fish eaters also similar overall cancer (HR = 0.88)
•    Vegans had 19% lower overall cancer (HR = 0.81)
•    interesting since early results from these studies showed little benefit,
•    but as they continued to follow the population for more years, a statistically significant benefit is shown

Cancer Epidemiology, Biomarkers, and Prevention
Vegetarian diets and the incidence of cancer in a low-risk population
2013

http://cebp.aacrjournals.org/content/22/2/286.long
http://www.ncbi.nlm.nih.gov/pubmed/23169929
•    Adventist -2 Health Study
•    69000 Subjects – Followed vegans, vegetarians, semi vegetarians, pesco-veg (fish), standard diet
•    followed for 4.14 years average, 59 = median age of cancer onset
•    2939 incident cancers
•    Vegan Diet and overall cancer reduction: HR 0.84 (combined genders)
•    Vegan diet and female specific cancers HR 0.66
•    Vegetarians overall HR 0.76 of cancers of the GI track

Annals of Nutrition and Metabolism
Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review.
2012
http://www.ncbi.nlm.nih.gov/pubmed/22677895
http://www.karger.com/Article/FullText/337301
•    Meta analysis of seven studies 124 000 subjects UK, Japan, California, USA overall, Germany, Netherlands
•    vegetarians had 29% lower heart disease mortality, 18% lower Cancer Mortality than non Vegetarians
•    does not distinguish vegans (who likely have even lower disease rates)
•    (also referenced in overall mortality section and high protein low carbohydrate section)

Cell Metabolism
Low Protein Intake Is Associated with a Major Reduction in IGF-1, Cancer, and Overall Mortality in the 65 and Younger but Not Older Population
2014
http://www.cell.com/cell-metabolism/pdf/S1550-4131(14)00062-X.pdf
•    6,381 adults ages 50 (mean = 65 years) and over Followed average of 18 years, 83 000 total person years
•    40% overall Mortality, 19% cardiovascular mortality, 10% Cancer Mortality, 1% diabetes mortality
•    In subjects aged 50-65 high protein intake resulted in 75% increased overall mortality, 4 x cancer risk than low protein diets
•    this risk be was attenuated or nullified if protein was from plant sources
•    in people over 65 high protein was protective
•    high protein diet increased levels of diabetes in all age groups
•    IGF-1 increase thought to be responsible

American Journal of Clinical Nutrition
Mortality in vegetarians and comparable nonvegetarians in the United Kingdom
2015
http://ajcn.nutrition.org/content/103/1/218.full
•    See entry in General and All Cause mortality

Nutrition and Cancer
Well-done Meat Intake, Heterocyclic Amine Exposure, and Cancer Risk
2009
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769029/ –
•    Well-done Meat Intake, Heterocyclic Amine Exposure, and Cancer Risk
•    more carcinogens in well done meat

Multiple Cancers

Nutrients
A Multicountry Ecological Study of Cancer Incidence Rates in 2008 with Respect to various Risk-Modifying Factors
2013
http://www.mdpi.com/2072-6643/6/1/163
•    Shows link of animal food intake to 11 types of cancer worldwide
•    Ecological study, so does not prove causation, but showed very strong correlation
•    however, as prospective and retrospective studies of specific populations show benefit, it is nice to see how low animal diet may show benefit in the real world
•    theorizes high protein intake as cause of cancer, but study does not measure vegan intake vs omnivore intake and compare cancer rates
•    when a country transitions to a hight meat diet, there is a 15-20 year lag time after which increased cancers are seen

British Journal of Cancer
Lactose intolerance and risk of lung, breast and ovarian cancers: aetiological clues from a population-based study in Sweden
2014
http://www.ncbi.nlm.nih.gov/pubmed/25314053
•    22000 individuals in Sweden that were found to have lactose intolerance, and consuming less dairy products
•    compared to family members who did not have lactose intolerance, subjects had Standardized Incidence Ratio of 0.55 for Lung Cancer, 0.79 for Breast Cancer, 0.61 for Ovarian Cancer.
•    Family members without lactose intolerance had these cancers at the standard population rate
•    no vegan subgroup.  Family members serve as controls.
•    Evidence of connection between milk certain cancers

Breast Cancer

see Also Adventist 2 study data under Total Cancer Mortality (above) – results re: female specific cancers

Breast Cancer Research and Treatment
Premenopausal Dietary Fat in Relation to Pre- and Post-Menopausal Breast Cancer
2014
http://www.ncbi.nlm.nih.gov/pubmed/24715379
•    data from Nurses Health Study
•    followed 88000 women age 26-45 from 1991 to 2011 and documented incident breast cancer (not mortality)
•    all animal fat and cholesterol intake contributed to pre-menopausal great cancer incidence RR 1.18
•    increased risk of breast cancer in post menopausal women was present, but attenuated when controlled for red meat intake (i.e. more corollated with red meat)
•    study does not include a vegan subgroup
•    studies such as this differ from those in the “Overall Cancer Mortality” section – this one separates subjects into low medium and high consumers of animal based diet, and compares the groups.  This also applies to the 2007 study just below

British Journal of Cancer
Meat consumption and risk of breast cancer in the UK Women’s Cohort Study
2007

http://www.nature.com/bjc/journal/v96/n7/full/6603689a.html
http://www.nature.com/bjc/journal/v96/n7/fig_tab/6603689t2.html#figure-title = table 2 Pre and post menopausal combined results
http://www.nature.com/bjc/journal/v96/n7/fig_tab/6603689t3.html#figure-title = Table 3 Premenopausal women
http://www.nature.com/bjc/journal/v96/n7/fig_tab/6603689t4.html#figure-title = Table 4 Postmenopausal women
•    35,372 women,age 35-69,  followed median 8 years,
•    Increased risk of pre and post menopausal Breast Cancer with meat consumption
•    Those with highest meat consumption have most risk
•    Association with all types of meat taken together – 20% increased risk
•    Pre-menopausal women had non significant increase in Breast Cancer
•    Post-menopausal had 20-60%  increased risk for total, red, and processed meat consumption – processed meat being worst
•    Poultry not statistically significant though very close in postmenopausal women – see table

American Journal of Clinical Nutrition
Dietary patterns and breast cancer risk in the California Teachers Study cohort
2013
http://ajcn.nutrition.org/content/early/2013/10/09/ajcn.113.061184.abstract
•    Dietary patterns and breast cancer risk in the California Teachers Study cohort
•    91779 women including over 4000 women who developed invasive breast cancer form 1995-2009
•    women eating the most plant based had 15% decreased risk for breast cancer
•    better reduction was in estrogen receptor negative and progesterone receptor negative breast cancer (ER – PR -)
•    women eating more of a “fish-salad” diet had a 29% increase in ER positive PR positive  breast cancer

Journal of the National Cancer Institutes
Dietary Fat Intake and Development of Specific Breast Cancer Subtypes
2014
http://www.ncbi.nlm.nih.gov/pubmed/24718872
•    studies fat intake, non vegetarian diet
•    over 300 000 women followed for 11.5 years, over 10 000 cases of breast cancer detected
•    high total and saturated fact increases ER+ PR+ breast cancer, but not ER-PR- cancer  (HR = 1.20)
•    Saturated Fat increases human epidermal growth factor 2 receptor (HER2) positive cancers

PLoS One
Association between Soy Isoflavone Intake and Breast Cancer Risk for Pre- and Post-Menopausal Women: A Meta-Analysis of Epidemiological Studies
2014
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930722/
•    A meta-analysis of 35 Different studies regarding soy intake and breast cancer (BRCA)
•    Asian countries showed a statistically significant decrease in BRCA for pre-menopausal women OR = 0.59
•    Asian countries showed a statistically significant decrease in BRCA for post-menopausal women OR = 0.59
•    Western countries showed a trend towards decreased BRCA, but was not statistically significant
•    Woman in asian countries consumed higher amounts of soy foods for a longer duration in life.  The lower consumption in western countries may not influence BCRA rates

Current Opinion on Clinical Nutrition and Metabolic Care
Soy Products in the Management of Breast Cancer
2012
http://www.ncbi.nlm.nih.gov/pubmed/23075937
•    Review article and meta-analysis of studies with soy in breast cancer patients
•    modest reduction of breast cancer recurrence in those eating soy at levels comparable to Asian diets (i.e. large amounts 2-3 servings per day)
•    women with high risk genetics may benefit more from soy consumption
•    does not interfere with hormone based chemotherapy – tamoxifen or anastrozole
•    no detrimental effects

Breast Cancer Research and Treatment
Soy isoflavones consumption and risk of breast cancer incidence or recurrence: a meta-analysis of prospective studies
2011
http://link.springer.com/article/10.1007%2Fs10549-010-1270-8
•    Soy isoflavones consumption and risk of breast cancer incidence or recurrence: a meta-analysis of prospective studies
•    shows less breast cancer in asian women consuming soy, no effect in western women
•    need to look at source journals to see the quantity and duration of soy consumption by western women – presumably they consumed only small amounts
•    also, soy intake found to protect against breast cancer recurrence RR = 0.84

American Journal of Clinical Nutrition
Perspectives on the soy–breast cancer relation
2009
http://ajcn.nutrition.org/content/89/5/1673S.long
•    Article explains why western and eastern soy studies differ
•    Typical western diet contains <3 mg of isoflavones, and asian diets have 25-50
•    Also, subjects in eastern studies consume soy since childhood
•    many other insights on soy related studies for breast cancer, mechanisms, secondary prevention, etc
•    Mark Messina and Anna Wu are authors

Journal of Nutrition
Is Soy Consumption Good or Bad for the Breast?
2010
http://jn.nutrition.org/content/140/12/2326S.full.pdf+html
•    review article about primary and secondary prevention.
•    asian studies show benefit of consuming soy, western studies do not
•    suggests that soy consumption since childhood may decrease breast cancer incidence and recurrence
•    mechanism remains unclear – possibly related to isoflavinoids

Journal of the American Medical Association
Soy Food Intake and Breast Cancer Survival
2009
http://jama.jamanetwork.com/article.aspx?articleid=185034
•    Soy food decreases breast cancer recurrence
•    5042 Breast Cancer Survivors in Shanghai China
•    Followed 4 years
•    30% less mortality for those who consumed most soy foods
•    Estrogen Receptor pos and neg both benefited

British Journal of Cancer
Epidemiology of Soy Exposures and Breast Cancer Risk
2008
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2359677/
•    in Asian diets, higher soy intake, decline in cancer
•    studies in Western diet, much lower intake overall, and small increments do not show decreased cancer risk

Breast Cancer Research and Treatment
Vegetable intake is associated with reduced breast cancer recurrence in tamoxifen users: a secondary analysis from the Women’s Healthy Eating and Living Study
2011
http://www.ncbi.nlm.nih.gov/pubmed/20607600
•    over 3000 breast cancer survivors followed average of 23 months
•    those with highest total and cruciferous vegetable intake at baseline had HR of recurrence at 0.69
•    for those taking tamoxifen who had highest total and cruciferous vegetable intake HR was 0.48
•    did not rule out that vegetable intake could be a surrogate marker for other healthy behaviours – i.e. those eating more vegetables eat less animal products

British Journal of Cancer
Lactose intolerance and risk of lung, breast and ovarian cancers: aetiological clues from a population-based study in Sweden
2014
http://www.ncbi.nlm.nih.gov/pubmed/25314053
•    see full entry in Multiple Cancer Section

Asia Pacific Journal of Cancer Prevention
Positive effects of soy isoflavone food on survival of breast cancer patients in China.
2012
http://www.ncbi.nlm.nih.gov/pubmed/22524810
http://www.apocpcontrol.org/paper_file/issue_abs/Volume13_No2/479-82%201.11%20Ya-Feng%20Zhang.pdf = full text
•    649 breast cancer survivors followed for mean of 4 years
•    30-40 % increased survival in those eating soy

Permanente Journal
Breast Cancer Survivorship: A Comprehensive Review of Long-Term Medical Issues and Lifestyle Recommendations
2015
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403581/
•    Summary recommendations of diet, exercise, smoking, and other lifestyle factors.
•    Recommends low meat consumption and high fruit and vegetable intake

Ovarian Cancer

American Journal of Clinical Nutrition
Dietary patterns and ovarian cancer risk
2008
http://ajcn.nutrition.org/content/89/1/297.long
•    small retrospective study of women with ovarian cancer and aged matched controls without cancer
•    study shows 2.5 times the risk for women who ate more meat and fat
•    does not study pure vegetarian/vegan women, only shows that high meat intake increases ovarian cancer
•    one group who ate more nuts had decrease risk, but their demographics may also have been different, detailed analysis of the study group is required

American Journal of Epidemiology
Diet and Risk of Ovarian Cancer in the California Teachers Study Cohort
2007
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2093945/
•    2007 study shows that those eating more isoflavinoinds had a 40-50 % decreased risk of ovarian cancer
•    97000 strong study – highly suggestive that soy and other sources of isoflavinoids are likely beneficial
•    analyzed quintiles of lowest and highest consumers
•    did not study pure vegetarians or vegans vs non-vegetarians
•    and other dietary factors did not influence
•    (also listed in section on soy safety)

British Journal of Cancer
Lactose intolerance and risk of lung, breast and ovarian cancers: aetiological clues from a population-based study in Sweden
2014
http://www.ncbi.nlm.nih.gov/pubmed/25314053
•    see full entry in Multiple Cancer Section

Colon Cancer   (also see section on diverticulitis below)

World Cancer Research Fund and American Institute for Cancer Research
Diet Nutrition
2017
http://wcrf.org/sites/default/files/CUP%20Colorectal%20Report_2017_Digital.pdf
•    Whole Grains decrease colorectal cancer by 17% – data from large meta analysis – see section 7.1
•    Physical activity, non smoking, dairy consumption, high fibre foods, calcium supplements also decrease cancer
•    Processed meat, red meat, obesity, taller height and smoking associated with increased cancer
•    Fails mention that Dairy is associated with prostate cancers or other health problems, as focus is only on colorectal cancer
•    also listed in High Protein Low Carb section below

World Health Organization
Q&A on the carcinogenicity of the consumption of red meat and processed meat
2015
http://www.who.int/features/qa/cancer-red-meat/en/
•    WHO publication Group 2A evidence of red meat causing colorectal, prostate, and pancreatic cancer (hence a possible cause)
•    states processed meat is a Group 1A causes of colorectal cancer, possible gastric cancer (Strong evidence for colorectal cancer)
•    Each 50g portion of processed meat increases risk of colorectal cancer by 18%
•    Between processed and red meat over 80 000 additional cancer deaths per year worldwide
•    Referenced in Colon Cancer, Prostate Cancer, Pancreatic Cancer  sections

American Journal of Clinical Nutrition
Dietary patterns as identified by factor analysis and colorectal cancer among middle-aged Americans
2008
http://ajcn.nutrition.org/content/88/1/176.long#aff-1
•    500 000 men and women – very large!
•    those with eating the most fruits and vegetables decreased colon cancer risk by 20 percent
•    those eating the most meat increased colon cancer risk by 20% (men) and 50% (women)
•    did not compare study pure vegans or vegetarians, analyzed quintiles of lowest and highest consumers

Gastrointestinal Cancer Research
Association between dietary fiber and incident cases of colon polyps: the adventist health study
2011
http://www.ncbi.nlm.nih.gov/pubmed/22295127 –
•    Adventist 2 – higher risk of colon polyps for vegetarians and those who ate low fibre

Journal of Clinical Oncology
Association between red and processed meat intake and mortality among colorectal cancer survivors.
2013
http://www.ncbi.nlm.nih.gov/pubmed/23816965
•    2 315 Colon Cancer Survivors followed 7.5 years
•    30 % increased all cause mortality if eat most red meat processed meat
•    63% higher cardiac mortality in those who date most red and processed meat

American Journal of Clinical Nutrition
Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists
1999
http://www.ncbi.nlm.nih.gov/pubmed/10479227
http://ajcn.nutrition.org/content/70/3/532s.full
•    See full entry in Overall Mortality Section
•    increased colon cancer RR 1.88 in non vegetarians, prostate cancer 1.54 in non vegetarians
•    legumes associated with decreased colon and pancreatic cancer, nuts with decreased heart disease, fruits and vegetables with decreased prostate, lung and colon cancers

Journal of Scientific Reports
Dietary legume consumption reduces risk of colorectal cancer: evidence from a meta-analysis of cohort studies
2015
http://www.ncbi.nlm.nih.gov/pubmed/25739376
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4350074/
•    meta analysis of 14 studies with over 1.9 million participants, 11 million person years, and over 12 000 cases
•    RR for cancer is 0.91, 0.82 in Asian subgroups, 0.85 for Soy
•    authors say that further delineation of cofounders is required
•    no vegan subgroup

American Journal of Gastroenterology
Rarity of colon cancer in Africans is associated with low animal product consumption, not fiber.
1999
http://www.ncbi.nlm.nih.gov/pubmed/10235221

Journal of Nutrition
Why do African Americans get more colon cancer than Native Africans?
2007
http://www.ncbi.nlm.nih.gov/pubmed/17182822

Gastric Cancer

Journal of the National Cancer Institute
Meat intake and risk of stomach and esophageal adenocarcinoma within the European Prospective Investigation Into Cancer and Nutrition (EPIC)
2006
http://www.ncbi.nlm.nih.gov/pubmed/16507831
•    Significantly increased risk of Gastric cancer in those eating red or processed meat
•    Non Significant trend in esophageal Cancers
•    Wide CI’s since numbers of these cancers diagnosed in 6.5 years were low, though population was 500 000 studied

Prostate Cancer

American Journal of Clinical Nutrition
Are strict vegetarians protected against prostate cancer?
2015
http://www.ncbi.nlm.nih.gov/pubmed/26561618
•    Adventist 2 data – comparison of 26 000 (2081 were vegan)
•    1079 incident cases of prostate cancer in the study
•    non-vegetarian, lacto-ovo-vegetarian, pesco-vegetarian, semi-vgetarian, and vegan men
•    35% less prostate cancer amongst vegans than men in the other groups
•    Researchers suspect higher intakes of fiber, soy, and anti-inflammatory antioxidants from fruits and vegetables and lower intakes of saturated fat, animal protein, and serum insulin-like growth factor 1 from dairy products from a vegan diet contributed to lower cancer risk

World Health Organization
Q&A on the carcinogenicity of the consumption of red meat and processed meat
2015
http://www.who.int/features/qa/cancer-red-meat/en/
•    WHO publication Group 2A evidence of red meat causing colorectal, prostate, and pancreatic cancer (hence a possible cause)
•    states processed meat is a Group 1A causes of colorectal cancer, possible gastric cancer (Strong evidence for colorectal cancer)
•    Each 50g portion of processed meat increases risk of colorectal cancer by 18%
•    Between processed and red meat over 80 000 additional cancer deaths per year worldwide
•    Referenced in Colon Cancer, Prostate Cancer, Pancreatic Cancer  sections

Cancer Epidemiology Biomarkers and Prevention
Adherence to Dietary and Lifestyle Recommendations and Prostate Cancer Risk in the Prostate Testing for Cancer and Treatment (ProtecT) Trial
2014
http://cebp.aacrjournals.org/content/23/10/2066.long
•    1806 PSA detected prostate cancer cases, 12000 controls.  Compared for adherence to World Cancer Research Fund and American Institute for Cancer Research  recommendations for cancer prevention (which include recommendations for diet, weight control, exercise)
•    6% incremental reduction in odds ratio for prostate cancer for every quartile increase in plant foods
•    18% reduction odds ratio for tomato product intake
•    weight control and exercise not found to be significant
•    note: no vegetarian or vegan subgroup studied

Journal of Nutrition
Whole milk intake is associated with prostate cancer-specific mortality among U.S. male physicians
2013
https://www.ncbi.nlm.nih.gov/m/pubmed/23256145/?i=8&from=/22537215/related
•    21000 male physicians followed for mean 28 years
•    dairy increases prostate cancer – physicians health study
•    1 serving whole milk per day 1.49 HR for fatal prostate cancer
•    in secondary prevention whole milk was 2.17 HR for fatal prostate cancer

American Journal of Epidemiology
Milk Intake in Early Life and Risk of Advanced Prostate Cancer
2012
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249408/
•    Prospective Trial of 2,200 men in Iceland, surveyed about milk consumption during early, mid, and later life
•    high consumption of milk in early life (adolescence) lead to 3.2 fold risk of advanced prostate cancer

Asia Pacific Journal of Clinical Medicine
Milk consumption is a risk factor for prostate cancer in Western countries: evidence from cohort studies
2007
http://www.ncbi.nlm.nih.gov/pubmed/17704029
•    meta-analysis finds 1.13 RR of prostate CA between lowest to highest quartiles of dairy consumption
•    does not include vegan diet.  shows dose response between quintiles, examined for biases

Journal of the National Cancer Institute
Plasma phospholipid fatty acids and prostate cancer risk in the SELECT trial
2013
http://www.ncbi.nlm.nih.gov/pubmed/23843441
•    Compared with men in the lowest quartiles of LC Omega-3PUFA, men in the highest quartile had
⁃    increased risk for low-grade prostate cancer (HR = 1.44)
⁃    increased risk for high-grade prostate cancer  (HR = 1.71) ,
⁃    and total prostate cancer (HR = 1.43)
⁃    Associations were similar for individual long-chain ω-3 fatty acids.
•    Higher linoleic acid (Vegetable Omega-6) was associated with reduced risks of low-grade (HR = 0.75) and total prostate cancer (HR = 0.77)

Journal of Nutrition and Metabolism
Prostate cancer and the influence of dietary factors and supplements: a systematic review
2014
http://www.ncbi.nlm.nih.gov/pubmed/24976856
http://www.nutritionandmetabolism.com/content/11/1/30 (full)
•    review article
•    Red Meat, dietary fat, and dairy intake increase prostate cancer
•    supplements have no benefit
•    fruit and vegetable intake decrease prostate cancer

International Journal of Cancer
Incidence and mortality of testicular and prostatic cancers in relation to world dietary practices.
2002
http://www.ncbi.nlm.nih.gov/pubmed/11857417
•    A study of 42 countries found milk, cheese, coffee and animal fats correlated with prostate cancer (milk strongest correlate)
•    Cheese was correlated with testicular cancers
•    Worldwide population based study

Journal of National Cancer Institute
2008
http://jnci.oxfordjournals.org/content/100/19/1412.full
•    Re: Endogenous Sex Hormones and Prostate Cancer: A Collaborative Analysis of 18 Prospective Studies
•    discusses mechanisms by which dairy may cause increased prostate cancer

Nutrition and Cancer
Milk consumption is a risk factor for prostate cancer: meta-analysis of case-control studies.
2004
http://www.ncbi.nlm.nih.gov/pubmed/15203374
•    Meta analysis of 11 case controlled studies, OR was 1.68, Nutrition and Cancer
•    unsure of underlying mechanisms of why milk is associated as such

American Journal of Clinical Nutrition
Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists
1999
http://www.ncbi.nlm.nih.gov/pubmed/10479227
http://ajcn.nutrition.org/content/70/3/532s.full
•    See full entry in Overall Mortality Section
•    34000 subjects followed, 50% were vegetarian or ate meat < once per week, meat eaters ate 3 or more times per week
•    prostate cancer 1.54 in non vegetarians
•    legumes associated with decreased colon and pancreatic cancer, nuts with decreased heart disease, fruits and vegetables with decreased prostate, lung and colon cancers

Urology
Clinical events in prostate cancer lifestyle trial: results from two years of follow-up
2008
https://www.ncbi.nlm.nih.gov/m/pubmed/18602144/?i=16&from=/17487143/related
•    small trial with 93 people followed for 2 years
•    all had early prostate cancer
•    randomized.  intervention group was low fat, vegan, exercised, stress management
•    13/49 control group had to have a prostate surgical intervention  –  vs 2/43 intervention group

Cancer Prevention and Research
Egg, red meat, and poultry intake and risk of lethal prostate cancer in the prostate specific antigen-era: incidence and survival
2012
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232297/
•    27000 men followed from 1994 to 2008
•    those eating >2.5 eggs per week had an 81% increased risk of dying from prostate cancer compared to those who ate <0.5 eggs per week
•    amongst men with a diagnosis of prostate cancer, there was a trend towards incased mortality for those who ate more red meat, poultry, and eggs (though not statistically significant due to low numbers in the short follow up)
•    no vegan subgroup

Prostate Cancer and Soy

American Journal of Clinical Nutrition
Soy consumption and prostate cancer risk in men: a revisit of a meta-analysis
2009
http://ajcn.nutrition.org/content/89/4/1155.long
http://ajcn.nutrition.org/content/89/4/1155.full
•    15 studies for soy foods, 9 on isoflavones
•    Asian Populations have 50% less prostate cancer if they eat more soy.  Powerful effect.
•    Confounding factors in western population studies.
•    Soy may shows lack of benefit in western populations likely because the consumption was very low.
•    Asians have higher blood isoflavone levels, reflecting higher soy consumption.
•     Asians who consume soy may also be higher consumers of other healthy plant foods containing isofavones etc.
•    Asian populations may have lifelong consumption of soy.

Nutrition and Cancer
Soy food consumption and risk of prostate cancer: a meta-analysis of observational studies
2009
http://www.ncbi.nlm.nih.gov/pubmed/19838933
•    Meta-analysis of asian studies
•    high soy food consumption (compared to low consumption) had OR of 0.69 for prostate cancer

International Journal of Cancer
Legume and isoflavone intake and prostate cancer risk: The Multiethnic Cohort Study.
2008
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3040575/
http://www.ncbi.nlm.nih.gov/pubmed/18521907
•    82000 men followed avg 8 years
•    4404 incident cases of prostate cancer , including 1278 high grade cancers
•    RR 0.89 for total cancers and RR 0.76 for high grade cancers for those in highest vs lowest quartiles of soy/legume consumption
•    no association with isoflavones – may be effect related to lentils in general
•    also, does not look at vegetarian/vegan diet specifically

Lung Cancer

Journal of Clinical Oncology
Pre-diagnosis Soy Food Consumption and Lung Cancer Survival in Women
http://www.ncbi.nlm.nih.gov/pubmed/23530109
⁃    Those who eat more soy before lung cancer have better survival
•    444 Woman in Shanghai Women’s Health Study – double survival for those who ate the most soy, compared to those who ate the least

British Journal of Cancer
Lactose intolerance and risk of lung, breast and ovarian cancers: aetiological clues from a population-based study in Sweden
2014
http://www.ncbi.nlm.nih.gov/pubmed/25314053
•    see full entry in Multiple Cancer Section

International Journal of Clinical and Experimental Medicine
Red and processed meat consumption and the risk of lung cancer: a dose-response meta-analysis of 33 published studies
2014
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4100964/
•    Dose-response increased lung cancer risk with consumption of red and processed meat
•    every increment of 120 grams red meat per day increase the risk of lung cancer 35%
•    every increment of 50 grams processed meat per day the risk of lung cancer increases 20%
•    Mechanism of this increased risk is not known
•    Adjusted for Age, Smoking and BM

Cervical Cancer

Cancer Epidemiology, Biomarkers and Prevention
Vitamin A, Carotenoids, and Risk of Persistent Oncogenic Human Papillomavirus Infection
2002
http://cebp.aacrjournals.org/content/11/9/876.long
•    women eating more vegetables had 54% decrease in HPV DNA persistence
•    HPV (human papilloma virus) is a cause of cervical cancer.  This study measured a surrogate endpoint for risk as opposed to the disease incidence or mortality, hence weak but suggestive of benefit, requires larger study.

Pancreatic Cancer

Annals of epidemiology
Nutrient based dietary patterns and pancreatic cancer risk
2013
http://www.ncbi.nlm.nih.gov/pubmed/23332711
•    Cases were 326 incident pancreatic cancer cases and controls 652 frequency-matched controls admitted to hospital for non-neoplastic diseases
•    OR of highest meet diet was 2.03, and refined starch/sugar diet was 1.63 for pancreatic cancer
•    OR of higher fruit and vegetable based diet was 0.55

World Health Organization
Q&A on the carcinogenicity of the consumption of red meat and processed meat
2015
http://www.who.int/features/qa/cancer-red-meat/en/
•    WHO publication Group 2A evidence of red meat causing colorectal, prostate, and pancreatic cancer (hence a possible cause)
•    states processed meat is a Group 1A causes of colorectal cancer, possible gastric cancer (Strong evidence for colorectal cancer)
•    Each 50g portion of processed meat increases risk of colorectal cancer by 18%
•    Between processed and red meat over 80 000 additional cancer deaths per year worldwide
•    Referenced in Colon Cancer, Prostate Cancer, Pancreatic Cancer  sections

British Journal of Cancer
Red and processed meat consumption and risk of pancreatic cancer: meta-analysis of prospective studies.
2012
http://www.ncbi.nlm.nih.gov/pubmed/22240790
•    Eleven prospective studies, 6643 pancreatic cancer cases
•    red meat consumption of 120 g per day associated with an overall relative risk (RR) of 1.13
•    Red meat  associated with pancreatic cancer risk in men but not  women
•    The RR of pancreatic cancer for a 50 g per day increase in processed meat consumption was 1.19

Journal of the National Cancer Institute
Dietary fatty acids and pancreatic cancer in the NIH-AARP diet and health study
2009
http://www.ncbi.nlm.nih.gov/pubmed/19561318
•    over 300 000 men and 200 000 women completed food questioners in 1996-1996
•    865 and 472 were diagnosed with Pancreatic cancer over the 6.3 year follow up
•    Adjustments made of smoking, BMI, energy intake, diabetes
•    high saturated intake from animal sources increased risk of pancreatic cancer by 43%
•    high intake of mono-unsaturated  (but not poly-unsaturated) fat had a slightly increased risk of pancreatic cancer, but lower risk.
•    concludes that saturated animal fats associated with pancreatic cancer

Cancer Epidemiology and Biomarkers
Dietary mutagen exposure and risk of pancreatic cancer
2007
http://cebp.aacrjournals.org/content/16/4/655.long
•    626 of hospitalized Pancreatic cancer cases  and 530 controls
•    Well done pork, bacon, grilled and fried chicken consumption was associated with increased pancreatic cancer
•    mutagens from cooking meat at high temperature  are thought to be a major factor in pancreatic cancer

British Journal of Cancer
Nut consumption and risk of pancreatic cancer in women.
2013
http://www.ncbi.nlm.nih.gov/pubmed/24149179
•    75 000 women in Nurses Health study prospectively followed
•    adjusting for age, height, smoking, physical activity, and total energy intake, women who consumed a 28-g (1 oz) serving size of nuts ≥2 times per week had  a significantly lower risk of pancreatic cancer RR 0.65;
•    compared with women who rarely eat nuts
•    Is eating nuts a surrogate marker for a more plant based diet?  Nurses Health Study did not look specifically for plant diet.

American Journal of Clinical Nutrition
Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists
1999
http://www.ncbi.nlm.nih.gov/pubmed/10479227
http://ajcn.nutrition.org/content/70/3/532s.full
•    See full entry in Overall Mortality Section
•    34000 subjects followed, 50% were vegetarian or ate meat < once per week, meat eaters ate 3 or more times per week
•    case controlled and followed 12 years
•    legumes associated with decreased colon and pancreatic cancer, nuts with decreased heart disease, fruits and vegetables with decreased prostate, lung and colon cancers

American Journal of Clinical Nutrition
Mortality in vegetarians and comparable nonvegetarians in the United Kingdom
2015
http://ajcn.nutrition.org/content/103/1/218.full
•    See entry in General and All Cause mortality

Lymphatic and Hematopoietic Cancers

American Journal of Clinical Nutrition
Mortality in vegetarians and comparable nonvegetarians in the United Kingdom
2015
http://ajcn.nutrition.org/content/103/1/218.full
•    See entry in General and All Cause mortality

Diabetes type II

Center for Disease Control
National Diabetes Statistics Report
2014
http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf
•    Diabetes Statistics in USA – CDC report
•    estimated 29 million people have Diabetes type 2 = 9.3% of population
•    Pre-diabetes 37% of adults aged 20y and older, 51% of adults 65 and older = 89 million people (based on  FBG or A1C levels)

Diabetes Care
Type of Vegetarian Diet, Body Weight, and Prevalence of Type 2 Diabetes
2009
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671114/
•    2009 – 60 000 subject in Adventist 2 study from 2002-2006
•    compared non vegetarians, semi vegetarians, pescatarians, lacto-ova vegetarians, and vegans
•    vegans had lowest BMI, but even controlling for BMI vegans had the lowest rates of diabetes
•    Odds Ratio for prevalence of diabetes: vegans was 0.51 for diabetes compared to non-vegetarians
•    lacto-ovo vegetarians had were close – OR 0.54
•    semi vegetarians and pescatarians had intermediate benefit (HR = 0.76 and 0.70 respectively)
•    adjustment for age, sex, ethnicity, education, income, physical activity, television watching, sleep habits, alcohol use, and BMI,

Nutrition Metabolism and Cardiovascular Disease
Vegetarian diets and incidence of diabetes in the Adventist Health Study-2
2013
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638849/
http://www.ncbi.nlm.nih.gov/pubmed/21983060
•    Adventist II Study of 15 000 men and 26 000 women followed for two years, initially free of diabetes
•    New cases of diabetes developed in 0.54% of vegans, 1.08% of lacto ovo vegetarians, 1.29% of pesco vegetarians, 0.92% of semi-vegetarians and 2.12% of non-vegetarians
•    Vegans (OR 0.381), lacto ovo vegetarians (OR 0.618) and semi-vegetarians (OR 0.486) had a lower risk of diabetes than non-vegetarians
•    Associations were strengthened when BMI was removed from the analyses
•    Controlled for age, gender, education, income, television watching, physical activity, sleep, alcohol use, smoking and BMI
•    Fish eaters have lesser benefits, but better than full meat eaters
•    17 % were blacks, and had higher risk of diabetes
•    Vegan and vegetarian  blacks had even better rates of protection HR = 0.30 and 0.47 respectively
•    Study ongoing – early data after 2 years published due to statistically significant results

American Journal of Epidemiology
Dietary Protein Intake and Risk of Type 2 Diabetes in US Men and Women
2016
https://www.ncbi.nlm.nih.gov/pubmed/27022032
•    investigated the associations between total, animal, and vegetable protein and incident Diabetes Type 2 (T2D)
•    73000 women from the Nurses’ Health Study (1984-2008),
•    92000 women from Nurses’ Health Study II (1991-2009)
•    40000 men from the Health Professionals Follow-up Study (1986-2008)
•    highest vs lowest quintiles of total and animal protein had 7% and 13% increased risk of T2D
•    highest vs lowest quintiles of plant protein 9% decreased risk of T2D
•    Substituting 5% of energy intake from veg protein for animal protein associated with 23% reduction in  T2D

PLOS (Public Liberary of Science)
Plant-Based Dietary Patterns and Incidence of Type 2 Diabetes in US Men and Women: Results from Three Prospective Cohort Studies
2016
https://www.ncbi.nlm.nih.gov/pubmed/27299701
•    investigated the associations between total, animal, and vegetable protein and incident Diabetes Type 2 (T2D)
•    73000 women from the Nurses’ Health Study (1984-2008),
•    92000 women from Nurses’ Health Study II (1991-2009)
•    40000 men from the Health Professionals Follow-up Study (1986-2008)
•    measured healthy plant based foods: whole grains, fruits, vegetables, nuts, legumes, vegetable oils, tea/coffee
•    unhealthy plant based foods included:  fruit juices, sweet drinks, sweets, refined grains, potatoes
•    Subjects with a more plant based diet had less T2D
•    Those with highest healthy plant based diet vs animal based foods had the best results: HR for T2D = 0.55
•    Those with highest unhealthy plant based foods increased their risk of diabetes, even compared to standard diet
•    Plant based diet is powerful to reduce diabetes, but unhealthy refined carbohydrates have a negative impact

American Journal of Clinical Nutrition
A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial
2009
https://www.ncbi.nlm.nih.gov/pubmed/19339401
•    Individuals with Diabetes Type 2 enrolled in a prospective randomized study – 74 weeks
•    49 individuals on a low fat vegan diet – restricted fats but otherwise unrestricted portion size
•    50 individuals on American Dietetic Association with restricted total portion sizes depending on their weight and BMI
•    both groups lost weight: 4.4 kg in the vegan group VS 3.0 kg in the ADA diet group
•    both groups improved HbA1C -0.34 in vegan group vs  and -0.14 in ADA group
•    both groups improved cholesterol 0.35 mmol/l in vegan group vs 0.09 mmol/l in ADA group
•    vegan group outperformed the ADA group, despite no restrictions on total portion sizes

PLoS One
Taiwanese Vegetarians and Omnivores: Dietary Composition, Prevalence of Diabetes and IFG
2014
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921224/
•    4384 Taiwanese vegetarian vs non-vegetarian Men and Women
•    overall similar diets, but vegetarians consumed more carbohydrates and soy, lower saturated fat and cholesterol
•    DM II risk was 2.
•    crude prevalence of diabetes in vegetarians versus omnivores is 0.6% versus 2.3% in pre-menopausal women
•    2.8% versus 10% in menopausal women,
•    4.3% versus 8.1% in men
•    Also had decreased impaired fasting glucose
•    adjusted for age, body mass index, family history of diabetes, education, leisure time physical activity, smoking and alcohol

Annals of Nutrition and Metabolism
Meats, processed meats, obesity, weight gain and occurrence of diabetes among adults: findings from Adventist Health Studies
2008
http://www.cell.com/cell-metabolism/pdf/S1550-4131(14)00062-X.pdf
•    Many meat consumers in this study ate smaller amounts than average North American.
•    Subjects who were weekly consumers of all meats were 29% more likely to develop diabetes compared to vegetarians
•    subjects consuming processed meats (salted fish and frankfurters) were 38% more likely OR = 1.38
•    Long-term adherence (over a 17-year interval) to a diet that included at least weekly meat intake was associated with a 74% increase
•    some of this risk may be attributable to obesity and/or weight gain, however even after control for weight and weight change, weekly meat intake remained an important risk factor (OR = 1.38; 95% CI 1.06-1.68) for diabetes

Diabetes Care
Dietary Protein Intake and Incidence of Type 2 Diabetes in Europe: The EPIC-INTERACT Case-Cohort Study
2014
http://care.diabetesjournals.org/content/early/2014/04/07/dc13-2627.abstract
http://care.diabetesjournals.org/content/early/2014/04/07/dc13-2627.full.pdf
http://www.ncbi.nlm.nih.gov/pubmed/22983636
•    prospective EPIC trial looked at over 12 000 incident cases of diabetes from cohort of 340 000 subjects followed over 12 years
•    those on isoenergetic diets were more likely to get diabetes if eating animal protein in a dose response fashion:
⁃     ~5% increased risk for every additional 10 g animal protein per day
•    For obese women ~19% increase risk for every additional 10g of animal protein per day
•    no association found with plant based protein

American Journal of Clinical Nutrition
Long chain omega 3 fatty acids, fish intake, and the risk of type 2 diabetes mellitus
2009
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728645/
•    190 000 subjects followed for 14-18 years at 4 y intervals
•    over 3 person million year follow up, 9380 new incident cases of Diabetes
•    Fish intake and omega 3 fatty acids  did not decrease diabetes
•    22% increase in Diabetes for those who ate fish 5 or more times per week, vs those eating < once per month

Cell Metabolism
Low Protein Intake Is Associated with a Major Reduction in IGF-1, Cancer, and Overall Mortality in the 65 and Younger but Not Older Population
2014
http://www.cell.com/cell-metabolism/pdf/S1550-4131(14)00062-X.pdf
•    6381 subjects aged 50 and over (mean age 65) followed an average of 18 years
•    40% overall Mortality, 19% cardiovascular mortality, 10% Cancer Mortality, 1% diabetes mortality (hence many followed till end of life)
•    high protein intake resulted in 75% greater mortality, 4 x cancer risk than low protein diets
•    this risk be was attenuated or nullified if protein was from plant sources
•    in people over 65 high protein was protective
•    high protein diet increased levels of diabetes in all age groups
•    (also in section of General – all cause mortality)

American Journal of Clinical Nutrition
A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial
2009
http://www.ncbi.nlm.nih.gov/pubmed/19339401
•    Study by Neil Barnard – prospective randomized trial
•    99 individuals with type 2 Diabetes randomized to 2003 American Diabetes Association Diet, vs low fat plant based diet
•    groups followed for compliance regularly, good compliance
•    weight loss sustained in both groups (4.4kg in vegans and 3.0 in ADA group – non sig different)
•    better improvement in HbA1C and lipids in vegan group

Diabetes Care
Type of Vegetarian Diet, Body Weight, and Prevalence of Type 2 Diabetes
2009
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671114/
•    22000 men and 38000 women studied from 2002-2006 – Adventist 2 study group
•    Mean BMI was lowest in vegans (23.6 kg/m2) –  higher in lacto-ovo vegetarians (25.7 kg/m2), pesco-vegetarians (26.3 kg/m2), semi-vegetarians (27.3 kg/m2), and nonvegetarians (28.8 kg/m2)
•    Prevalence of type 2 diabetes increased from 2.9% in vegans to 7.6% in nonvegetarians; the prevalence was intermediate in participants consuming lacto-ovo (3.2%), pesco-fish eaters  (4.8%), or semi-vegetarian (6.1%) diets
•    Diabetes type 2 Risk: vegans (OR 0.51), lacto-ovo vegetarians (0.54), pesco-vegetarians (0.70), and semi-vegetarians (0.76 ) had a lower risk of type 2 diabetes than nonvegetarians. Even after adjusting for BMI!
•    Also adjusted for age, sex, ethnicity, education, income, physical activity, television watching, sleep habits, alcohol use
•    (also in section on Obesity) (see Adventist-2 2013 article above for study on incidence in non diabetics)

PloS One
Taiwanese Vegetarians and Omnivores: Dietary Composition, Prevalence of Diabetes and IFG
2014
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0088547
•    Prevalence Study: Comparison of traditional Taiwanese Buddhist veg vs non-veg diets, 4384 subjects:
•    Traditional non-veg diets were very low in meat intake compared to western diets
•    vegetarian diets avoid meat/fish flesh bud did include eggs/dairy in small amounts only
•    both groups had similar intake of dairy and fruits
•    vegetarian consumed more soy, whole grains, vegetables
•    adjusted for age, body mass index, family history of diabetes, education, leisure time physical activity, smoking and alcohol
•    The crude prevalence of diabetes in vegetarians versus omnivores is 0.6% versus 2.3% in pre-menopausal women, 2.8% versus 10% in menopausal women, and 4.3% versus 8.1% in men
•    Small subgroups of 69 vegans had no cases of diabetes

Diabetic Medicine
High prevalence of erectile dysfunction in diabetes: a systematic review and meta-analysis of 145 studies
2017
https://www.ncbi.nlm.nih.gov/pubmed/28722225
•    Studies erectile dysfunction in men with Diabetes type 1 and 2
•    Pools 145 studies with over 88000 men, aged 47 to 64
•    Prevalence of erectile dysfunction was 52% in In diabetic men
•    This was about 3.5 x higher than in non diabetic men of the same age
•    Diabetes poses as significant impact on male sexual health

Eggs and Diabetes type II

Diabetes Care
Egg consumption and risk of type 2 diabetes in men and women
2009
http://www.ncbi.nlm.nih.gov/pubmed/19017774
•    20 000 men (from physician health study listed below) and 36 000 women
•    11.7 year follow up in women, HR = 1.77 in women in highest egg consumption quartile (7 or more eggs per week)
•    20 year follow up for men, HR = 1.58 for men in highest egg consumption (7 or more eggs per week)
•    Proportional response in both women and men for all quartiles

American Journal of Clinical Nutrition
Egg consumption in relation to cardiovascular disease and mortality: the Physicians’ Health Study
2008
http://ajcn.nutrition.org/content/87/4/964.long
•    21000 physicians, average follow up 20 years
•    eating 7 or more eggs per week increased increased Mortality by 23% in all subjects,
•    For diabetics, those who ate > 7 eggs per week had mortality HR = 2.01 compared to those who ate <1 egg per week

Nutrition
Egg consumption and the risk of diabetes in adults, Jiangsu, China
2011
http://www.ncbi.nlm.nih.gov/pubmed/20471806
•    Chinese study – eating only 2 or more eggs/week increases diabetes

Public Health Nutrition
Egg consumption and the risk of type 2 diabetes mellitus: case control study
2012
http://www.ncbi.nlm.nih.gov/pubmed/22390963
•    A case controlled study: 600 subjects
•    eating eggs had profound increase in DM II incidence

The British Journal of Nutrition
Regular consumption of pulses for 8 weeks reduces metabolic syndrome risk factors in overweight and obese adults.
2012
http://www.ncbi.nlm.nih.gov/pubmed/22916807
http://www.ncbi.nlm.nih.gov/pubmed/22924370
•    The 2012 article demonstrate that eating beans and pulses reduces diabetes markers more than calorie restriction

American Journal of Epidemiological Markers
Risk of Gestational Diabetes Mellitus in Relation to Maternal Egg and Cholesterol Intake
2011
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3105262/
•    Pregnant women had a dose response increase in Gestational Diabetes  Mellitus (GDM) vs Egg Consumption
•    those eating 10 or more eggs per week had R=2.52 for GDM (before and during pregnancy)
•    Authors conclude that high egg and cholesterol consumption before and during pregnancy is a risk for GDM

Obesity

JAMA Cardiology
Association of Body Mass Index With Lifetime Risk of Cardiovascular Disease and Compression of Morbidity
2018
https://www.ncbi.nlm.nih.gov/pubmed/29490333
•    10 Cohort studies in USA, over decades, 140 800 individuals and 3.2 million person-years of follow up
•    Obesity associated with shorter longevity and significantly increased risk of cardiovascular morbidity and mortality compared with normal BMI.
•    Overweight BMI associated with significantly increased risk of developing CVD at an earlier age, resulting in a greater proportion of life lived with CVD morbidity, though similar lifespan

Journal of the Academy of Nutrition and Dietetics
Nutrient profiles of vegetarian and nonvegetarian dietary patterns
2013
http://www.ncbi.nlm.nih.gov/pubmed/23988511
•    71,751 subjects (mean age=59 years) from the Adventist Health Study 2. between 2002 and 2007
•    compared were nonvegetarian, semi-vegetarian, pesco vegetarian, lacto-ovo vegetarian, and strict vegetarian (vegan)
•    dietary patterns and was adjusted for age, sex, and race
•    Average caloric intake was similar at 2000 kcal/d (though lower amongst semi vegetarians at 1700 per day)
•    BMI lowest amongst vegans (mean 24.0) , highest amongst non vegetarians (meant 28.7) , in between for the rest
•    vegans had highest intake of fibre, magnesium, potassium, beta carotene

American Journal of Clinical Nutrition
Vegetarian diets and childhood obesity prevention
2010
http://www.ncbi.nlm.nih.gov/pubmed/20237136
http://ajcn.nutrition.org/content/91/5/1525S.long (full text)
•    excellent review article about childhood and adult obesity, and the health effects of obesity
•    reviews other meta-analysis on the subject
•    review of evidence that vegetarian have lower weight by 7.6 kg for lower men and 3.3 kg for women, lower BMI
•    recommends that nationwide food policy should promote vegetarian diet

BMC Public Health
The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis
2009
https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/1471-2458-9-88?site=bmcpublichealth.biomedcentral.com
https://goo.gl/kdD5gQ

•                Comprehensive review article outlines the increased risk of diseases from overweight and obesity
•                Overweight and obese people suffer from
⁃                                  Increased cancer of Breast, Endometrium, Ovary, Prostate, Colon/colorectal, Pancreas
⁃                                  Increase Coronary Artery Disease, Congestive Heart Failure, Stroke, Pulmonary Embolism ⁃                                  Increased Hypertension and Diabetes type II
⁃                                  Asthma,
⁃                                  Chronic Back Pain
⁃                                  Gallbladder disease

International Journal of Obesity and Related Metabolic Disorder
Diet and body mass index in 38000 EPIC-Oxford meat-eaters, fish-easers, vegetarians, and vegans
2003
http://www.ncbi.nlm.nih.gov/pubmed/12833118
•    Fish eaters, vegetarians, and especially vegans have lower BMI than meat-eaters
•    High protein and low fibre intake strongly correlated with high BMI

International Journal of Obesity
Weight gain over 5 years in 21,966 meat-eating, fish eating and vegetarian and vegan men and women in EPIC-Oxford
2006
http://www.ncbi.nlm.nih.gov/pubmed/16534521
•    Average yearly weight gain per person was least in vegans < fish eaters < meat eaters
•    When people changed diets, being improvement changing in direction of Meat eater-> Fish eater -> Vegetarian -> Vegan

Population Health Metrics
Prevalence of physical activity and obesity in US counties, 2001-2011: a road map for action
2013
http://www.pophealthmetrics.com/content/11/1/7
Study shows that exercise has little effect on obesity – although it is beneficial in other ways

Journal of the American Dietetic Association
A vegetarian dietary pattern as a nutrient-dense approach to weight management: an analysis of the national health and nutrition examination survey 1999-2004
2011
http://www.ncbi.nlm.nih.gov/pubmed/21616194
•    American dietetic association article measures nutrient intake by vegetarians and finds nutrient intake greater than in standard diet
•    suggests vegetarian diet for healthy weight

Obesity Journal
Special Issue – Popular Diets- A Scientific Review – Executive Summary
https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2001.113
•    Reviews many popular diets in 2001
•    High fat low carbohydrate diets have been marketed for decades, including ketogenic
•    Low and medium fat diets have also been popular
•    Regardless of diet type, the only factor in weight loss is decrease in calories consumed

Obesity in Mexico
http://www.vidinfo.org/video/17592116/mexico-overtakes-us-as-most-obese-country
http://www.cnn.com/2013/07/11/health/us-mexico-obesity/
Mexico overtakes USA has most obese nation
32.8% of Mexican adults are overweight

Dementia

Nutrients
Milk Intake at Midlife and Cognitive Decline over 20 Years. The Atherosclerosis Risk in Communities (ARIC) Study
2017
https://www.ncbi.nlm.nih.gov/pubmed/29039795
http://www.mdpi.com/2072-6643/9/10/1134
•    13751 subjects in the Atherosclerosis Risk in Communities cohort
•    Followed for ~20-23 years, and conduced food questionnaires twice and neuro-cognative testing three times
•    Greater than once glass of milk per day during midlife was associated with 10% increased cognitive decline overall
•    Compared to the group “almost never” consuming milk
•    No association was found with the ability to digest lactose (which would increase sugar absorption and possibly increase dementia risk)
•    Saturated fat or other factors are a more likely cause

Journal of the American College of Nutrition
Using Multicountry Ecological and Observational Studies to Determine Dietary Risk Factors for Alzheimer’s Disease
2016
https://www.ncbi.nlm.nih.gov/pubmed/27454859
•                observes that as animal products and sweet consumption increased in japan, about  15 years later rates of dementia increased
•                Decreased rates of dementia observed with higher consumption of grains, fruits, vegetables, beans/legumes
•                However, consumption of these foods cannot reverse the damage caused by meat eggs and high fat dairy, which are causative factors
⁃                                  High vitamin D status is possibly protective – is this a surrogate for activity?
⁃                                  As per Dr. David Katz, fish may show benefit with respect to meat/dairy/eggs, but not necessarily beneficial
⁃                                  low fat dairy is protective compared to high fat dairy
•                Overall diet of plants is protective compared to one high in animal foods

Journal of Alzheimer’s Disease
Trends in diet and Alzheimer’s disease during the nutrition transition in Japan and developing countries
2014
https://www.ncbi.nlm.nih.gov/pubmed/24037034
•                In Japan, alcohol consumption, smoking and animal fats were correlated with increased alzheimers disease, and peaked with a 25 year lag time.
•                In Eight other developing countries, there were similar findings
•                Mechanisms include: obesity, increased saturated fat and cholesterol from animal foods, increased heme iron from animal foods
•                Proposes the control of smoking, obesity and animal fat consumption
•                Decreased rice consumption occurred during study period
⁃                                  authors hypothesize that rice was not necessarily beneficial,
⁃                                  but rather it was likely being replaced by worse foods

Biomedical Central Geriatrics
Atherosclerosis and Alzheimer – diseases with a common cause? Inflammation, oxysterols, vasculature
2014
https://www.ncbi.nlm.nih.gov/pubmed/24656052
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3994432/pdf/1471-2318-14-36.pdf = full text
•                Excellent articles that presents evidence that atherosclerosis is a major cause of dementia
•                Interesting graphic showing post mortem pictures of blood brain vessels in patients with dementia vs normal
•                Fat, cholesterol, refined carbohydrates, and western diet are discussed

Nutrition Neuroscience
Damaging effects of a high-fat diet to the brain and cognition: A review of proposed mechanisms
2014
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4074256/pdf/nihms-593382.pdf
•                Reviews mechanisms of fatty diet which may lead to dementia
•                Reviews issues of obesity, high fat diets, western diets, saturated and trans fats, insulin resistance, and inflammatory states to dementia
•                Some of these issues have found links have good evidence

Neurology
Intracranial artery stenosis and progression from mild cognitive impairment to Alzheimer disease
2014
https://www.ncbi.nlm.nih.gov/pubmed/24489130
•                423 subjects with mild cognitive impairment followed for 4 years
•                CT angio scans measured blood vessels in the brain
•                Those with the greatest intracranial artery stenosis had the most rapid progression to dementia

Annals of Neurology
Dietary fat types and 4-year cognitive change in community-dwelling older women
2012
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405188/
•    6000 older subjects in the Women’s Health Study
•    Evaluated intake of major fatty acids (FAs): (saturated [SFA], mono-unsaturated [MUFA], total poly-unsaturated [PUFA], trans-unsaturated)
•    Related to late-life cognitive trajectory by aerial cognitive testing over 4 years
•    Higher SFA associated with worst cognitive change, comparing highest vs. lowest SFA quintiles OR  1.64 for global cognition and 1.65 for verbal memory.
•    Higher MUFA intake was related to better global cognitive (p-linear-trend<0.001) and verbal memory (p-linear-trend=0.009) trajectories and lower OR for global cognition (0.52 [0.31,0.88]) and verbal memory (0.56 [0.34,0.94]).
•    Total fat, PUFA, and trans fat intakes were not associated with cognitive trajectory

Journal of Nutrition Health and Aging
Lower intake of vegetables and legumes associated with cognitive decline among illiterate elderly Chinese: a 3-year cohort study
2012
http://www.ncbi.nlm.nih.gov/pubmed/22659995
•    5691 Elderly Chinese, aged 5 or older,  were followed for 3 years
•    dementia was considered Chinese revised MMSE of less than 18
•    lower intakes of vegetables and legumes were significantly associated with cognitive decline

Dementia and Geriatric Cognitive Disorders
2009
Midlife Serum Cholesterol and Increased Risk of Alzheimer’s and Vascular Dementia Three Decades Later
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2814023/
•    9844 members of the HMO followed afar 30 years – HR ration 1.58 for highest quartile to get Alzheimers or Vascular Dementia
•    Moderate Cholesterol also a risk – and Borderline dementia even worse

American Journal of Epidemiology
Consumption of dairy products and risk of Parkinson’s disease  18
2007
http://www.ncbi.nlm.nih.gov/pubmed/17272289
•    57 000 men and 73 000 women
•    highest quartile of dairy vs lowest had higher rates of Parkinson’s disease, especially men

Dementia and Geriatric Cognitive Disorders
Fat intake at midlife and risk of dementia and Alzheimer’s disease: a population-based study.
2006
http://www.ncbi.nlm.nih.gov/pubmed/16710090
•    patients were interviewed in the 1970-80s, followed up average 21 years later
•    moderate unsaturated fat intake protective of dementia for all people
•    moderate intake of saturated fat increased risk of dementia for ApoE epsilon4 carriers

Neurology
Glucose tolerance status and risk of dementia in the community: the Hisayama study
2011
http://www.ncbi.nlm.nih.gov/pubmed/21931106
•    1017 individuals > 60 years age, dementia free, followed 15 years
•    Alzheimer and vascular dementia were higher in those with diabetes, and impaired 2 h glucose tolerance, no correlation with abnormal fasting glucose

Archives of Neurology
Dietary copper and high saturated and trans fat intakes associated with cognitive decline
2006
http://www.ncbi.nlm.nih.gov/pubmed/16908733
•    dietary copper was associated with cognitive decline in those who consumed higher amounts of trans and saturated fats
•    cohort of 3700 subjects over 65 for 6 years

Fracture Risk

European Journal of Clinical Nutrition
Comparative fracture risk in meat eaters, fish eaters, vegetarians, vegans in EPIC-Oxford
2007

http://www.ncbi.nlm.nih.gov/pubmed/17299475
•    2007 Study of 8 000 men and 26000 women
•    Vegans had 30% (RR 1.3 Range 1.02-1.66) higher incidence of fractures, but only RR 1.15 (0.89-1.49) higher if adjusted for energy and Calcium intake
•    Vegans with intake of at least 525 mg of Calcium per day had RR 1.00, hence no increased fracture risk
•    Shows Vegans must consume at least 500 mg calcium per day, or may have increased fracture risk

Cholesterol

Circulation
Dietary Fats and Cardiovascular Disease A Presidential Advisory From the American Heart Association
2017
http://circ.ahajournals.org/content/early/2017/06/15/CIR.0000000000000510
•    See full reference in Cardiovascular Disease section above

Journal of the American Heart Association
Effect of Plant Protein on Blood Lipids: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials
2017
http://jaha.ahajournals.org/content/6/12/e006659
•    summarizes a plethora of clinical trials
•    concludes that intake of plant protein instead of animal protein lowers blood lipids
•    plant protein can be used in conjunction with medications in hyper-lipidemic individuals
•    addition of plant protein to diet can reduce cardiovascular risk

Journal of the American Heart Association
Effects of Vegetarian Diets on Blood Lipids: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials
2015
http://jaha.ahajournals.org/content/4/10/e002408.long
•    Meta-analysis including Cochrane collaboration
•    Shows total cholesterol and LDL are significantly decreased with vegetarian diets (0.36 mmol/l and 0.34 mmol/L respectively)
•    HDL may also decrease, but data shows that cardiovascular disease decreases in vegetarians

European Journal of Clinical Nutrition
Serum concentrations of cholesterol, apolipoprotein A-I and apolipoprotein B in a total of 1694 meat-eaters, fish-eaters, vegetarians and vegans
2014
http://www.ncbi.nlm.nih.gov/pubmed/24346473
•    “total cholesterol and apolipoprotein B concentrations were lower in vegans compared with meat-eaters, fish-eaters and vegetarians”
•    “A small proportion of the observed differences in serum lipid concentrations was explained by differences in BMI, but a large proportion is most likely due to diet”

Link to many more articles about the impact of plant diet on serum cholesterol:
https://www.dropbox.com/sh/02ojlu98crxfznb/AACFRS2Yo56eX1uUV8nXupNFa?dl=0

Hypertension

Journal of the American Medical Association
Vegetarian diets and blood pressure: a meta-analysis
2014
http://www.ncbi.nlm.nih.gov/pubmed/24566947
•    311 subject in 7 clinical trials, and over 21000 subjects in 32 observational studies mean age about 44-46 years old
•    showed systolic and diastolic BP lowering
•    studies only vegetarian diets, would possibly have stronger results if included vegans subgroup

Public Health Nutrition
Vegetarian diets and blood pressure among white subjects: results from the Adventist Health Study-2 (AHS-2)
2012
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3443300/
http://www.ncbi.nlm.nih.gov/pubmed/22230619= abstract for above article
•    Vegetarians and especially vegans have the lowest BP compared to meat eaters, and partial vegetarians
•    Partial vegetarians better than full meat eaters
•    Largely independent of body Mass Index

Diverticulitis

British Medical Journal
Diet and risk of diverticular disease on Oxford cohort of EPIC: prospective study of British vegetarians and non-vegetarians
2011
http://www.ncbi.nlm.nih.gov/pubmed/21771850
•    Vegetarian diet and high finer diet protect from hospitalization and death from diverticular disease
•    11.6 years of follow up of 47000 men and women, 15000 of whom were vegetarian/vegan
•    ~30% (RR=0.69) less hospitalization and death from diverticulitis in vegetarians, and 41 % less in those who consumed the most fibre
•    ~70% less hospitalization and death in vegans (only 4 cases in study group)
•    subjects aged 50 to 70 controlled for  vegetarians compared to same age meat eaters
•    adjusted for age, smoking, gender, self reported hyper lipidemia, area of living, BMI, chronic illness and more

Inflammatory Bowel Disease

Crohn’s Disease
World Journal of Gastroenterology
Pre-illness changes in dietary habits and diet as a risk factor for inflammatory bowel disease: A case control study
2010
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2937110/pdf/WJG-16-4297.pdf
•    Study looks at whether symptoms of IBD prior to diagnosis will prod patients to change diet
•    38% of IBD patients opted to change diet at onset of symptoms
•    Of IBD patients that opted not to change diet, it was found that moderate or high consumption of margarine, red meat and cheese increases chances of ulcerative colitis and Crohn’s disease as compared to controls

American Journal of Gastroenterology
Animal protein intake and risk of inflammatory bowel disease: The E3N prospective study.
2010
http://www.ncbi.nlm.nih.gov/pubmed/20461067
•    67000 women age 40-65 years were followed for average 10 years
•    incident cases of inflammatory bowel disease were observed (not prevalence)
•    consumption of protein from highest highest vs lowest Tertile for animal protein showed 3x the incidence of IBD
•    meat and fish most implicated.  Eggs and Dairy less so in this study

American Journal of Clinical Nutrition
Epidemiologic analysis of Crohn disease in Japan: increased dietary intake of n-6 polyunsaturated fatty acids and animal protein relates to the increased incidence of Crohn disease in Japan.
1996
http://www.ncbi.nlm.nih.gov/pubmed/861535
•    Study of correlation between the incidence of Crohns disease and dietary change in Japanese population from 1966 to 1985
•    Animal protein was the strongest independent factor for Crohns disease.  Increased n-6 fats were a weaker factor.

Peanuts and Nuts

Journal of the American Medical Association
Prospective Evaluation of the Association of Nut/Peanut Consumption With Total and Cause-Specific Mortality
2015
http://www.ncbi.nlm.nih.gov/pubmed/25730101
•    71000 USA residents with low socioeconomic status, 134000 Chinese Shanghai Health Study, self reported nut intake
•    Mixed nut intake, but 50% were peanuts among nut eaters
•    follow up 5 years for USA residents  (77% were current or ex smokers in this low socio-economic group), 6.5 years Chinese Men, 12 years Chinese women.
•    comparisons for highest to lowest quintiles of consumption
•    20% less total mortality in highest nut eating group, 38% less ischemic heart disease, 23% less ischemic stroke
•    23% less hemorrhagic stroke only in Chinese group
•    many other studies show benefits of nuts, this is most recent and largest trial
•    benefits of Mediterranean diet likely has more to do with nuts and olive oil than fish
•    affordability of peanuts makes it an attractive health food

New England Journal of Medicine
Primary prevention of cardiovascular disease with a Mediterranean diet
2014
http://www.ncbi.nlm.nih.gov/pubmed/23432189
•    Multcenter trial in Spain – 7000 prospective randomized
•    three groups – one supplemented with olive oil, second with mixed nuts, control group advised for low fat diet
•    followed 5 years, primary endpoint was myocardial infarction, ischemic stroke, or cardiovascular death
•    group supplemented with nuts had 28% less events
•    group supplemented with olive oil had 30% less events
•    nuts and olive oil are likely strong factors in benefits of Mediterranean diet, since major studies on fish yielded negative results
•    (this trial also listed in section on mediterranean diet below)
•    mainly less strokes, but non significant trend to less myocardial infarcts – authors suggest study underpowered or too short

Journal of allergy and Clinical Immunology
Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy
2008
http://www.ncbi.nlm.nih.gov/pubmed/19000582
•    5000 jewish children in UK compared 5000 Jewish children in Israel
•    Israel: median 7.1 g of peanut protein consumed motley in infants aged 8 to 14 months, peanuts were beaten median of 8 times per month
•    In UK the median was 0 in same cohort
•    1.85% of UK children developed peanut allergy, 0.17 of Israeli children
•    10x higher allergy in genetically similar groups, of similar social status, controlled for atopy
•    Early introduction of peanut protein reduces allergies

2015
Dr Greger Video: Which parts of the Mediterranean diet extend life?
http://goo.gl/BTn00K
•    see extensive references under regarding studies on nuts in  “sources cited” button
•    also see video or transcript that are present there

Soy Safety  – General

Viva Health Organization – Facts Sheet
2017
https://www.vivahealth.org.uk/resources/soya-fact-sheet
https://www.vivahealth.org.uk/sites/default/files/Soya_factsheet.pdf
•    Excellent review of the broad range medical evidence regarding benefits of soy
•    also includes review of the safety of soy
•    https://www.vivahealth.org.uk/soya/the-environment Some ecological statistics
•    Soy Formula for Infants Reviewed  and found to be safe and effective:
•    https://www.vivahealth.org.uk/resources/soya-based-infant-formula-fact-sheet
•    https://www.vivahealth.org.uk/sites/default/files/soyainfantfactsheet.pdf

http://www.veganhealth.org/articles/soy_wth
•    Soy: Whats the Harm? Excellent Review by Jack Norris RD about the information regarding the safety of soy
•    Reviews many kinds of studies, including thyroid and cancer, and discusses the safety of soy, using human based literature

http://www.pcrm.org/health/health-topics/soy-and-your-health
•    Soy and Your Health
•    Excellent summary and article collection from PCRM – on topics of cancer, fertility, male health, thyroid, fibroids, and more
•    contains comprehensive reference list

http://www.theveganrd.com/2011/08/soy-isoflavones-and-estrogen.html
•    Soy Isoflavones and Estrogen by Ginny Messina
•    excellent review of isoflavone biochemistry, and how these are not estrogens, they are SERMS (selective estrogen receptor modulators)

Journal of Nutrition
Insights Gained from 20 Years of Soy Research
2010
http://jn.nutrition.org/content/140/12/2289S.long
•    this single review article references almost every trial re soy and cardiovascular disease, breast cancer, prostate cancer, osteoporosis and controversies about hormonal effects
•    Excellent reference list

American Cancer Society
The Bottom Line on Soy and Breast Cancer Risk
2012
http://www.cancer.org/cancer/news/expertvoices/post/2012/08/02/the-bottom-line-on-soy-and-breast-cancer-risk.aspx
•    outlines safety of soy and cites current evidence
•    animal studies showed issues, but human studies show no harm
•    in fact human studies show preventive effects to breast cancer in general population – for high consumers
•    likely safe and possibly beneficial for breast cancer survivors – though we would like more data

Soy Safety and Ovarian Cancer

Viva Health Organization – Facts Sheet – See “Soy Safety Section” above
2017

American Journal of Epidemiology
Diet and Risk of Ovarian Cancer in the California Teachers Study Cohort
2007
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2093945/
•    2007 study shows that those eating more isoflavinoinds had a 40-50 % decreased risk of ovarian cancer
•    97000 strong study – highly suggestive that soy and other sources of isoflavinoids are likely beneficial
•    analyzed quintiles of lowest and highest consumers
•    did not study pure vegetarians or vegans vs non-vegetarians
•    and other dietary factors did not influence
•    (also listed in section on ovarian cancer)

Soy Safety and Breast Cancer

Viva Health Organization – Facts Sheet – See “Soy Safety Section” above
2017

PLoS One
Association between Soy Isoflavone Intake and Breast Cancer Risk for Pre- and Post-Menopausal Women: A Meta-Analysis of Epidemiological Studies
2014
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930722/
•    A meta-analysis of 35 Different studies regarding soy intake and breast cancer (BRCA)
•    Asian countries showed a statistically significant decrease in BRCA for pre-menopausal women OR = 0.59
•    Asian countries showed a statistically significant decrease in BRCA for post-menopausal women OR = 0.59
•    Western countries showed a trend towards decreased BRCA, but was not statistically significant
•    Woman in asian countries consumed higher amounts of soy foods for a longer duration in life.  The lower consumption in western countries may not influence BCRA rates

Breast Cancer Research and Treatment
Soy isoflavones consumption and risk of breast cancer incidence or recurrence: a meta-analysis of prospective studies
2010
http://link.springer.com/article/10.1007%2Fs10549-010-1270-8
•    shows less breast cancer in asian women consuming soy, no effect in Western women
•    need to look at source journals to see if western women consumed lesser amounts of soy
•    also, soy intake found to protect against breast cancer recurrence

British Journal of Cancer
Epidemiology of soy exposures and breast cancer risk
2008
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2359677/
•    Asian countries with HIGH soy consumption – meta-analysis of 8 studies – shows those with intermediate and highest consumption had progressively lower rates of Breast Cancer
•    Western countries with LOW soy consumption – meta-analysis of 11 studies –  showed no effect (the highest consumers were far lower than the lowest consumers in the Asian studies)
•    Concludes that soy consumption in quantities of asian countries may reduce breast cancer
•    links to all studies are present in the article

American Journal of Clinical Nutrition
A vegetable-fruit-soy dietary pattern protects against breast cancer among postmenopausal Singapore Chinese women
2010
http://ajcn.nutrition.org/content/91/4/1013.abstract
•    34000 women, Singapore.  Those eating most soy-fuit-veggie type diet had increased breast cancer risk
⁃    HR of 0.70 in 4th quartile of intake for premenopausal women
⁃    HR of 0.59 in 4ht quartile of intake for postmenopausal women

Soy Safety in Breast Cancer Survivors

Viva Health Organization – Facts Sheet – See “Soy Safety Section” above
2017

American Journal of Clinical Nutrition
Soy food intake after diagnosis of breast cancer and survival: an in-depth analysis of combined evidence from cohort studies of US and Chinese women
2012
http://ajcn.nutrition.org/content/96/1/123.full  or http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3374736/
•    over 9000 breast cancer survivors followed 7 years
•    high soy intake group:
⁃    non significant trend to dec overall morality (HR 0.87) and breast cancer mortality (HR 0.83)
⁃    significant trend HR 0.75 of decreased recurrence

Oncology
It’s time for clinicians to reconsider their proscription against the use of soyfoods by breast cancer patients
2013
http://www.cancernetwork.com/breast-cancer/it%E2%80%99s-time-clinicians-reconsider-their-proscription-against-use-soyfoods-breast-cancer-patients
•    mouse studies showed soy as concerning
•    Human Clinical Studies show consistent benefit
•    Journal’s academic position is that soy is safe and women should not be diverted from traditional foods containing soy

Canadian Medical Association Journal
Effect of soy isoflavones on breast cancer recurrence and death for patients receiving adjuvant endocrine therapy
2010
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988534/ or http://www.cmaj.ca/content/182/17/1857.full
•    CMAJ 2010 – 524 Breast Cancer Survivors followed for 5.1 years, all on advent hormone suppressive endocrine therapy – Anastrozole
•    no effect in premenopausal patients
•    in postmenopausal patients HR for recurrence was 0.67 for ER pos and ER neg breast cancer recurrence for highest vs lowest quartile of soy intake
•    Author speculate that isoflavinoids are the protective substance, but patients were eating all types of soy foods (soy beans, soy flour, tofu, soy milk and not isoflavinoid supplements
•    follow up was only 5 years – would longer follow up show mortality differences?

Journal of the American Medical Association
Soy Food Intake and Breast Cancer Survival
2009
http://jama.jamanetwork.com/article.aspx?articleid=185034
•    5000 surgically treated breast cancer survivors
•    HR was 0.71 for total mortality, HR was 0.68 for recurrence in (highest vs  lowest quintiles of soy intake)
•    true for ER pos and neg cancers, and on or off Tamoxifen
•    see comments section – protective effect maintained for pre and post menopausal status

Breast Cancer Research and Treatment
Soy Isoflavones and Risk of Cancer Recurrence n a Cohort of Breast Cancer Survivors: Life After Cancer Epidemiology (LACE) Study
2009
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470874/
•    1954 breast cancer survivors, 2009 study
•    soy intake reduced risk of recurrence in menopausal group (HR 0.48% in highest quintile 0.21-0.79, p=0.008)

Cancer Epidemiology, Biomarkers, and Prevention
Soy food consumption and breast cancer prognosis
2011
http://www.ncbi.nlm.nih.gov/pubmed/21357380
•    2011 study, over 3000 breast cancer survivors, followed avg 7 years
•    54% less mortality, not statistically significant, authors claim soy is safe in breast cancer survivors

American Journal of Clinical Nutrition
Soy food intake after diagnosis of breast cancer and survival: an in-depth analysis of combined evidence from cohort studies and US and Chinese women
2012
http://www.ncbi.nlm.nih.gov/pubmed/22648714
•    decreased recurrence in breast cancer survivors
•    trend towards primary prevention of breast cancer and all cause mortality

Asia Pacific Journal of Cancer Prevention
Post-diagnosis soy food intake and breast cancer survival: a meta-analysis of cohort studies
2013
http://www.ncbi.nlm.nih.gov/pubmed/23725149
•    soy prevented breast cancer recurrence

Soy in Children

Viva Health Organization – Facts Sheet – See “Soy Safety Section” above
2017

Public Health Nutrition
Diet throughout childhood and age at menarche in a contemporary cohort of British girls
2010
http://www.ncbi.nlm.nih.gov/pubmed/20529402
•    Shows that higher meat intake results in early menarche
•    this study does not compare vegetarians or soy intake, only the effect of increasing meat

American Journal of Clinical Nutrition
Relation of isoflavones and finer intake in childhood to the timing of puberty
2010
http://ajcn.nutrition.org/content/92/3/556.long
•    small but high quality study following 223 subjects from infancy to adulthood
•    Soy intake for girls – later puberty average by 7 months
•    Soy intake for boys – no effect

Journal of the American Medical Association
Exposure to Soy-Based Formula in Infancy and Endocrinological and Reproductive Outcomes in Young Adulthood
2001
http://jama.jamanetwork.com/article.aspx?articleid=194106
•    soy formula intake in infancy does not affect generally health or reproduction as an adult
•    2001 study is old and updated meta-analysis is needed

Nutrition
Is soy intake related to age at onset of menarche? A cross-sectional study among adolescents with a wide range of soy food consumption
2014
http://www.nutritionj.com/content/13/1/54
•    study of 339 girls aged 12-18 found no impact on menarche
•    like most paediatric medial research, small sample size

Soy and Men’s Health

Viva Health Organization – Facts Sheet – See “Soy Safety Section” above
2017

Fertility and Sterility
Clinical studies show no effects of soy protein or isoflavones on reproductive hormones in men: results of a meta-analysis
2010
http://www.ncbi.nlm.nih.gov/pubmed/19524224
•    no effector soy protein or isoflavinoids, in food or supplements
•    on testosterone, free testosterone, SHBG, or free androgen index in any study that qualified

Fertility and Sterility
Soybean isoflavone exposure doesn’t have feminizing effects on men: a critical examination of the clinical evidence
2010
http://www.ncbi.nlm.nih.gov/pubmed/20378106
•    soy isoflainoinds do not have a feminizing effect or erectile dysfunction effect on men even at high doses

Journal of the International Society of Sports Nutrition
Effect of protein source and resistance training on body composition and sex hormones
2007
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1997115/
•    randomized double blinded supplementation of soy vs whey for a month in males doing strength resistance exercise
•    no difference in hormone levels, performance, increase in lean body mass
•    whey was found to have minor estrogen effects via isoflavanoids present there.

Clinical Science
Effect of a phytoestrogen food supplement on reproductive health in normal males
2001
http://www.ncbi.nlm.nih.gov/pubmed/11352776
•    2001 article found no effect of isoflavinoid supplementation on testicular volume, sperm concentration or quality, or sex hormones in males

Journal of Nutrition
Hormonal effects of Soy in Premenopausal Women and Men
2002
http://jn.nutrition.org/content/132/3/570S.long
•    review article – soy has no effect on semen quality in articles reviewed
•    there may be small changes in SHBG and borderline changes in steroid rations, which may include decreases in estrogen among other things

Diabetic Medicine
High prevalence of erectile dysfunction in diabetes: a systematic review and meta-analysis of 145 studies
2017
https://www.ncbi.nlm.nih.gov/pubmed/28722225
•    see relevant entry in Diabetes section

Prostate Cancer and Soy
-Same articles referenced in section on Cancer above

Viva Health Organization – Facts Sheet – See “Soy Safety Section” above
2017

American Journal of Clinical Nutrition
Soy consumption and prostate cancer risk in men: a revisit of a meta-analysis
2009
http://ajcn.nutrition.org/content/89/4/1155.long
http://ajcn.nutrition.org/content/89/4/1155.full
•    15 studies for soy foods, 9 on isoflavones
•    Asian Populations have 50% less prostate cancer if they ate higher quantities of soy, vs the lowest consumers.  Powerful effect
•    Benefit is greater with non fermented Soy
•    Confounding factors in western population studies.  Soy shows lack of benefit in western populations likely because the consumption was very low as compared to Asian populations.

American Journal of Clinical Nutrition
Soy consumption and prostate cancer risk in men: a revisit of a meta-analysis
2009
http://ajcn.nutrition.org/content/89/4/1155.long
http://ajcn.nutrition.org/content/89/4/1155.full
•    15 studies for soy foods, 9 on isoflavones
•    Asian Populations have 50% less prostate cancer if they eat more soy.  Powerful effect.
•    Confounding factors in western population studies.
•    Soy may shows lack of benefit in western populations likely because the consumption was very low.
•    Asians have higher blood isoflavone levels, reflecting higher soy consumption.
•     Asians who consume soy may also be higher consumers of other healthy plant foods containing isofavones etc.
•    Asian populations may have lifelong consumption of soy.

Nutrition and Cancer
Soy food consumption and risk of prostate cancer: a meta-analysis of observational studies
2009
http://www.ncbi.nlm.nih.gov/pubmed/19838933
•    Meta-analysis of asian studies
•    high soy food consumption (compared to low consumption) had OR of 0.69 for prostate cancer

International Journal of Cancer
Legume and isoflavone intake and prostate cancer risk: The Multiethnic Cohort Study.
2008
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3040575/
http://www.ncbi.nlm.nih.gov/pubmed/18521907
•    82000 men followed avg 8 years
•    4404 incident cases of prostate cancer , including 1278 high grade cancers
•    RR 0.89 for total cancers and RR 0.76 for high grade cancers for those in highest vs lowest quartiles of soy/legume consumption
•    no association with isoflavones – may be effect related to lentils in general
•    also, does not look at vegetarian/vegan diet specifically

Soy and Thyroid

Viva Health Organization – Facts Sheet – See “Soy Safety Section” above
2017

Thyroid
Effects of soy protein and soybean isoflavones on thyroid function in healthy adults and hypothyroid patients: a review of the relevant literature
2006
http://www.ncbi.nlm.nih.gov/pubmed/16571087
•    14 Trials regarding soy – thyroid function was not a primary outcome, but was measured
•    no effect on thyroid function in euthyroid patients
•    possible effect in hypothyroid patients since the protein may decrease absorption of thyroid replacement medication
•    theoretical effect in people with low iodine – but this may not be significant

Soy and Fracture Risk
(see also section on Dairy, Calcium, Vitamin D Intake and Bone Health below)

Viva Health Organization – Facts Sheet – See “Soy Safety Section” above
2017

American Journal of Epidemiology
Gender-Specific Associations Between Soy and Risk of Hip Fracture in the Singapore Chinese Health Study
2009
http://aje.oxfordjournals.org/content/early/2009/08/31/aje.kwp220.full
•    2009 study 63000 subjects in Singapore
•    higher soy intake was associated with 21-36% decrease risk of hip fractures in women but not men

Archives on Internal Medicine
Prospective cohort study of soy food consumption and risk of bone fracture among postmenopausal women
2005
http://www.ncbi.nlm.nih.gov/pubmed/16157834
•    24 000 women studied
•    0.52 RR of fracture in highest quintile of soy intake within 10 years of menopause, and 0.71 R for older women > 10 years after menopause

Journal of Nutrition
Adherence to a vegetable­fruit­soy dietary pattern or the alternative healthy eating index is associated with lower hip fracture risk among Singapore Chinese
2014
http://www.ncbi.nlm.nih.gov/pubmed/24572035
•    63 000 Chinese men and women followed from 1993 to 1998 in Singapore
•    dose dependant decrease in hip fracture for those who consumed greater soy fruits and vegetables

Public Health and Nutrition
Legumes and meat analogues consumption are associated with hip fracture risk independently of meat intake among Caucasian men and women: the Adventist Health Study-2
2014
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4125560/
•    Eating Lentils, Beans, and Meat analogues decreased hip fractures more then meat consumption
•    Adventist 2 study – 64% decrease in fracture risk in those eating lentils.  49% decrease fracture risk in those eating Meat analogues, 40% decrease in those eating meat regularly compared to eating none of the above.

Men’s Reproductive Health and Estrogens in Animal Foods

American Journal of Clinical Nutrition
High dietary intake of saturated fat is associated with reduced semen quality among 701 young Danish men from the general population.
2013
http://www.ncbi.nlm.nih.gov/pubmed/23269819
http://ajcn.nutrition.org/content/97/2/411.long
•    701 men registering for Swedish milliard service
•    semen sample and food questionnaire
•    found that those in highest quartile for saturated fat had 38% lower sperm concentration and 41% lower sperm count than those in lowest quartile
•    no association with other types of fat, adjusted for confounders

Human Reproduction
Dairy food intake in relation to semen quality and reproductive hormone levels among physically active young men
2013
http://www.ncbi.nlm.nih.gov/pubmed/23670169
•    189 men age 18-22 – cross sectional analysis
•    dairy intake inversely related to sperm morphology, esp full fat dairy intake
•    -3.2% difference between people in the upper vs lower 50% consumption
•    negative impact for low fat dairy intake, but not statistically significant
•    adverse effect of sperm morphology with full fat dairy intake

Epidemiology
Meat intake and reproductive parameters among young men
2014
http://www.ncbi.nlm.nih.gov/pubmed/24681577
•    semen samples from men 189 men aged 18-22
•    increased quartiles of red meat consumption lead to decreased sperm counts in a dose response fashion
•     -3 million in second quartile, -14 million in third quartile, and -78 million in fourth quartile (only 4th quartile was statistically significant
•    impact was attenuated after 2 days of red meat consumption
•    further study needed

Andrology
Lipid Concentrations and Semen Quality: The LIFE Study
2014
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999259/
•    decreasing male fertility over last 50 years – possible ties to diet
•    501 males partners of women discontinuing contraception- most provided two semen samples
•    those with higher cholesterol had impacts on sperm head morphology

Medical Hypothesis
Is milk responsible for male reproductive disorders
2001
http://www.ncbi.nlm.nih.gov/pubmed/11601881
•    discusses how dairy is high in estrogen, due to the natural hormones in a cow that is pregnant and lactating

Fertility and Sterility
The role of environmental estrogens in the deterioration of male factor fertility
2002
http://www.ncbi.nlm.nih.gov/pubmed/12477510
•    PCB’s are an environmental estrogen as are phthalate esters (found in plastics such as water bottles)
•    in a small sample of men with low sperm counts, compared to controls, PCBs and PE’s were correlated with male infertility
•    PCBs were highest in fish eaters

Food Chemistry
The natural occurrence of steroid hormones in food
1998
http://www.sciencedirect.com/science/article/pii/S0308814697001507
•     sex steroid hormones progesterone, testosterone, 17β-estradiol and estrone in food was investigated in a survey of the German market basket
•    important metabolic precursors, intermediates and metabolites were also investigated (pregnenolone, androstenedione, hydroxyprogesterone, dehydroepiandrosterone (DHEA), dihydrotestosterone, androsterone, 17α-estradiol and estriol)
•    milk was found to have the highest amount of estrogen compounds – about 70%
•    eggs meat and fish contained estrogen as well
•    plant based foods did not have any significant estrogen content
•    plants and animal foods have equal testosterone content, though plants may also have greater testosterone precursors

Human Reproduction Update
Possible health impacts of animal estrogens in food
2001
http://humupd.oxfordjournals.org/content/7/3/340.long
•    Estrogen is present in birds such as chickens, pigs, cattle, as well as milk and eggs

Women’s Health, Estrogens and Hormones in Animal Foods

Journal of Reproductive medicine
Mechanisms of twinning: VII. Effect of diet and heredity on the human twinning rate
2006
http://www.ncbi.nlm.nih.gov/pubmed/16779988
•    Vegetarian and Omnivore women have 5 x the dizygotic twinning rate of vegan women
•    Insulin Like Growth factor and estrogen levels in meat and dairy are likely the cause
•    effect is more pronounced in areas where growth hormone is given to cattle

Children’s Health, Estrogens and Hormones in Animal Foods

Oxford Journals – Human Reproduction Update
The sensitivity of the child to sex steroids: possible impact of exogenous estrogens
2006
http://humupd.oxfordjournals.org/content/12/4/341.long
•    Review article
•    Estrogen levels in meat and dally may have effect on growth of children, weight gain, puberty timing, and future risk of breast and prostate cancer

General – Estrogens and Hormones in Animal Foods

Human Reproductive Update
Possible health impact of animal oestrogens in food
2001
http://www.ncbi.nlm.nih.gov/pubmed/11392381
•    Meat, dairy and eggs contain animal estrogen
•    Mean oestradiol-17 beta concentration in whole milk is estimated at 6.4 pg/ml
•    Up to 200 pg/g oestradiol-17beta per egg
•    There is increased estrogen in cattle that are treated with hormones
•    More studies are needed to quantify estrogen in different foods, as well as the health impact

Hypothyroidism

Public Health Nutrition
Prevalence of hyperthyroidism according to type of vegetarian diet
2013
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377303/
•    66 000 men and women of various diets – vegan, lacto-vegetarian, peso-vegetarian, omnivors
•    controlled for obesity, salt intake, income level, cardiovascular disease, age, gender
•    vegans had half hypothyroidism rate of omnivores – OR 0.52 for hypothyroidism
•    where as lacto and pesco vegetarians had Odds Ratio of 0.72 and 0.74 respectively

Nutrients
Vegan diet and Hypothyroidism
2013
http://www.ncbi.nlm.nih.gov/pubmed/24264226
•    The Adventist Health Study-2 2002 and at follow-up to 2008
•    Diet was examined as a determinant of prevalent (n = 4237 of 65,981 [6.4%]) and incident cases (1184 of 41,212 [2.9%]) controlled for demographics and salt use.
•    In the prevalence study,
⁃    overweight and obesity increased the odds (OR 1.32 and 1.78, respectively).
⁃    Vegan associated with reduced risk (OR 0.89, 95% CI: 0.78-1.01, not statistically significant)
⁃    lacto-ovo diet associated with increased risk (OR 1.09, 95% CI: 1.01-1.18).
•    In the incidence study
•    female gender, white ethnicity, higher education and BMI were predictors of hypothyroidism.
⁃    vegan diet tended to be protective (OR 0.78, 95% CI: 0.59-1.03) not statistically significant, but associated with low risk

Low Carbohydrate High Protein Diet
-Also see sections on Cardiovascular Disease, General/All Cause Mortality, Cerebrovascular Disease, and Diabetes for more articles that reference whole grains

Circulation
Dietary Fats and Cardiovascular Disease A Presidential Advisory From the American Heart Association
2017
http://circ.ahajournals.org/content/early/2017/06/15/CIR.0000000000000510
•    See full reference in Cardiovascular Disease section above

World Cancer Research Fund and American Institute for Cancer Research
Diet Nutrition
2017
http://wcrf.org/sites/default/files/CUP%20Colorectal%20Report_2017_Digital.pdf
•    Whole Grains decrease colorectal cancer by 17% – data from large meta analysis – see section 7.1
•    Physical activity, non smoking, dairy consumption, high fibre foods, calcium supplements also decrease cancer
•    Processed meat, red meat, obesity, taller height and smoking associated with increased cancer
•    Fails mention that Dairy is associated with prostate cancers or other health problems, as focus is only on colorectal cancer
•    also listed in Colon Cancer section

High dietary protein intake is associated with an increased body weight and total death risk
Clinical Nutrition
2016
http://www.ncbi.nlm.nih.gov/pubmed/25886710
•    PREDIMED study
•    over 7000 subjects followed 4.5 years, in quintiles of protein intake
•    Highest vs lowest animal protein was associated with greater weight gain HR 1.6 when replacing fats HR 1.9 when replacing carbohydrates
⁃    overall mortality HR ~ 1.6
⁃    higher cancer and cardiovascular disease
•    higher animal protein (and lower vegetable protein)  was associated with higher cancer death and all cause mortality
•    Also referenced in General/All Cause Mortality section

The effects of classic ketogenic diet on serum lipid profile in children with refractory seizures.
Acta Neurologica Belgica (Belgian Neuroscience Journal)
2016
https://www.ncbi.nlm.nih.gov/pubmed/26791878
•    Study of 33 children with refractory seizure disorders, started on ketogenic diet
•    Serum lipids measured at 0, 3, and 6 months
•    Seizure frequency reduced in 63% of subjects
•    Profound increases in total serum cholesterol, triglycerides, and low-density lipoprotein (LDL)

Annals of Internal Medicine
Low-carbohydrate diets and all-cause and cause-specific mortality: two cohort studies
2010
http://www.ncbi.nlm.nih.gov/pubmed/20820038
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989112/pdf/nihms-247461.pdf
•    85168 women (aged 34 to 59 years at baseline) and 44 548 men (powerful numbers)
•    women followed avg 26 years, men 20 years ,
•    Low carb high Animal protein – 28 % higher death from Cancer, 14% higher death from Cardiovascular Disease
•    Low carb high Vegetarian protein – 20% lower all cause mortality than average person

BMJ
Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study
2012
http://www.bmj.com/content/344/bmj.e4026
•    43 000 women aged 30-49 at baseline, followed 15.7 years
•    for every lowering of carbs by 20g and increase in protein by 5g per day, there was a 5% increase in cardiovascular events
•    up to a total of R1.60 in those consuming highest protein diet/lowest carbohydrate ratio
•    there was also a greater amount of ischemic stroke
•    the study does not compare fully vegetarian subgroup, but there is a trend to less harm with increased plant protein
•    paper states it was not powered enough to analyze the impact of plant protein separately
•    in this group, those eating greater plant protein may also consume significant animal fats, via dairy?
•    https://paulmathers.files.wordpress.com/2014/08/bmj-low-carb.pdf  contains comment on this article

PloS One
Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies
2013
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555979/
https://www.ncbi.nlm.nih.gov/pubmed/23372809
•    meta-analysis of 17 different studies including 272 000 subjects
•    Those with a high low-carbohydrate score had ~31% increased all cause mortality
•    Cardiovascular mortality was significantly higher
•    No vegan subgroup,

Journal of the American College of Cardiology
Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease: A Prospective Cohort Study
2015
http://www.ncbi.nlm.nih.gov/pubmed/26429077
http://content.onlinejacc.org/article.aspx?articleid=2445322
http://www.hsph.harvard.edu/news/press-releases/butter-is-not-back-limiting-saturated-fat-still-best-for-heart-health/
•    Article is relevant in light of recent meta-analysis question the role of saturated fat and cholesterol, but themselves have methodological issues
•    84000 women in Nurses Health Study followed 30 years and 43000 men from Health Professionals Follow Up Study-followed 24 years
•    7667 incident cases of coronary heart disease
•    Replacing 5% of energy intake from saturated fats with equivalent energy from
⁃    polyunsaturated fats results in 25% decreased CHD
⁃    monounsaturated fats results in 15% decreases CHD
⁃    Whole grains results in 9% decreased CHD
•    Changing those calories for refined carbohydrates and sugars resulted in no risk reduction
•    See Full entry in section: Cardiovascular disease: Role of Saturated Fat and Cholesterol)

High dietary protein intake is associated with an increased body weight and total death risk
Clinical Nutrition
2016
http://www.ncbi.nlm.nih.gov/pubmed/25886710
•    PREDIMED study
•    over 7000 subjects followed 4.5 years, in quintiles of protein intake
•    Highest vs lowest animal protein was associated with greater weight gain HR 1.6 when replacing fats HR 1.9 when replacing carbohydrates
⁃    overall mortality HR ~ 1.6
⁃    higher cancer and cardiovascular disease
•    higher animal protein (and lower vegetable protein)  was associated with higher cancer death and all cause mortality
•    Also referenced in General All Cause Mortality section

British Journal of Nutrition
High intakes of protein and processed meat associate with increased incidence of type 2 diabetes
2013
http://www.ncbi.nlm.nih.gov/pubmed/22850191
•    High protein Low Carb diet makes diabetes worse
•    27000 subjects followed 12 years
•    Highest vs lowest quintiles of protein consumption had HR of 1.27 for incidence of diabetes
•    when increased 5% calories of protein and decrease 5% carbohydrates HR of 1.20
•    highest quintile intake of processed meat HR of 1.16
•    Highest quintile of egg consumption HR = 1.21
•    High intake of fibre rich bread and cereals/grains HR = 0.84
•    does not compare vegetarians/vegans in this study

Cell Metabolism
Low Protein Intake Is Associated with a Major Reduction in IGF-1, Cancer, and Overall Mortality in the 65 and Younger but Not Older Population
2014
http://www.cell.com/cell-metabolism/pdf/S1550-4131(14)00062-X.pdf
•    6381 subjects aged 50 and over (mean age 65) followed an average of 18 years
•    40% overall Mortality, 18% cancer mortality, 10% Cancer Mortality, 1% diabetes mortality (many followed till end of life)
•    high protein intake resulted in 75% greater mortality, 4 x cancer risk than low protein diets
•    this risk be was attenuated or nullified if protein was from plant sources
•    in people over 65 high protein was protective
•    high protein diet increased levels of diabetes in all age groups

American Journal of Clinical Nutrition
Dietary protein and risk of ischemic heart disease in middle-aged men
2010
http://ajcn.nutrition.org/content/92/5/1265.full.pdf
•    43000 men in the health professional follow up study followed 18 years
•    initially free of vascular disease, hypertension, high cholesterol, diabetes
•    25% increased heart disease if high animal protein intake compared to standard diet
•    7% less heart disease if high protein but of plant origin, compared to standard diet

British Medical Journal
Dietary fibre intake and mortality among survivors of myocardial infarction: prospective cohort study
2014
http://www.bmj.com/content/348/bmj.g2659
•    2200 women had first MI out of 121 000 in Nurses health Study from 1976-2006,  initial age 35-55
•    1800 male physicians from Health Professional’s Follow Up Study, 1986-2006, initial age 45-75
•    initially cancer, CVD, stroke free, then enrolled after first MI
•    higher post MI fibre intake was associated with lower all cause mortality HR 0.75
•    greater cereal fibre intake was more significant (compared to fruit and legumes – but vegetables not included?) HR 0.73
•    increase in fibre intake from before to after MI was most significant HR 0.69

JAMA
Healthy Living Is the Best RevengeFindings From the European Prospective Investigation Into Cancer and Nutrition–Potsdam Study
2009
http://archinte.jamanetwork.com/article.aspx?articleid=1108507
•    see full entry in General / All Cause Mortality section near top of document

Journal of the American Heart Association
Low carbohydrate diet from plant or animal sources and mortality among myocardial infarction survivors
2014
http://www.ncbi.nlm.nih.gov/pubmed/25246449
http://jaha.ahajournals.org/content/3/5/e001169.long
•    See full entry in Cardiovascular Disease section post Myocardial Infarction Above

Whole Grains and Cardiovascular Disease

Circulation
Dietary Fats and Cardiovascular Disease A Presidential Advisory From the American Heart Association
2017
http://circ.ahajournals.org/content/early/2017/06/15/CIR.0000000000000510
•    See full reference in Cardiovascular Disease section above

JAMA
Association Between Dietary Whole Grain Intake and Risk of Mortality
2015
http://archinte.jamanetwork.com/article.aspx?articleid=2087877
•    74 341 women from Nurses’ Health Study (1984–2010) and 43 744 men from Health Professionals Follow-Up Study (1986–2010)
•    highest quintile of whole grain consumption had HR= 0.91 for all cause mortality compared to lowest
•    highest quintile of whole grain consumption had HR= 0.85 for cardiovascular mortality  compared to lowest
•    no impact on cancer mortality
•    authors conclude that for every 28g of whole grains per day, 5% lower total mortality and 9% decreased cardiovascular mortality

Journal of the American College of Cardiology
Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease: A Prospective Cohort Study
2015
http://www.ncbi.nlm.nih.gov/pubmed/26429077
http://content.onlinejacc.org/article.aspx?articleid=2445322
http://www.hsph.harvard.edu/news/press-releases/butter-is-not-back-limiting-saturated-fat-still-best-for-heart-health/
•
•    Article is relevant in light of recent meta-analysis question the role of saturated fat and cholesterol, but themselves have methodological issues
•    84000 women in Nurses Health Study followed 30 years and 43000 men from Health Professionals Follow Up Study-followed 24 years
•    7667 incident cases of coronary heart disease
•    Replacing 5% of energy intake from saturated fats with equivalent energy from
⁃    polyunsaturated fats results in 25% decreased CHD
⁃    monounsaturated fats results in 15% decreases CHD
⁃    Whole grains results in 9% decreased CHD
•    Changing those calories for refined carbohydrates and sugars resulted in no risk reduction
•    (See Full entry in section: Cardiovascular disease: Role of Saturated Fat and Cholesterol)

Whole Grains, Cardiovascular Disease, and Cancer

BMJ
Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies
2016
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908315/
•    Increased whole grain intake was shown in meta-analysis to decrease cardiovascular mortality, cancer mortality, all cause and all cause mortality
•    recommendation to increase whole grain consumption as part of diet

Evidence for Gluten/Wheat Safety
-Also see sections on Cardiovascular Disease, General/All Cause Mortality, Cerebrovascular Disease, and Diabetes for more articles that reference whole grains

Digestion
Non-Celiac Gluten Sensitivity among Patients Perceiving Gluten-Related Symptoms.
2015
http://www.ncbi.nlm.nih.gov/pubmed/26043918
•    Italian study of 392  patients attending gastroenterology clinic –  complaining of gluten-related symptoms
•    26 excluded after diagnosis of true Celiac disease, 2 due to confirmed wheat allergy – 7% have confirmed medical diagnosis
•    364 put on a gluten free diet for full 6 months
•    after 6 months, only 27 felt a long term improvement ( only 7%), the other  337 felt no difference long term improvement
•     researchers concluded that 86% of people who think they suffer from gluten-related symptoms actually do not have non-celiac gluten intolerance, celiac disease, or wheat allergy

Gastroenterology
No Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates
2013
http://www.gastrojournal.org/article/S0016-5085(13)00702-6/fulltext
•    37 subjects without celiac disease, but with self reported Non Celiac Gluten Intolerance in a three week randomized placebo controlled trial with and without gluten showed no effect of gluten. Possible nocebo effect when diet changed, and those eating gluten developed symptoms even when their diet was not changed.

The Smoke and Mirrors Behind Wheat Belly and Grain Brain
https://www.drmcdougall.com/misc/2014nl/jan/smoke.htm
•    Some interesting references from Dr. Mcdougall’s newsletter link has some interesting studies referenced

Journal of Internal Medicine
Low carbohydrate–high protein diet and mortality in a cohort of Swedish women
2007
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2007.01774.x/full
•    42 000 women aged 30-49 at baseline followed fro 12 years in Sweden
•    6% increased total mortality and 16% increased cardiovascular mortality in those with hight protein low carb diet
•    note that cohort included younger women, and there was not plant based subgroup

Eye Health

American Journal of Clinical Nutrition
Diet Vegetarianism and Cataract Risk:
2011
http://www.ncbi.nlm.nih.gov/pubmed/21430115
http://ajcn.nutrition.org/content/93/5/1128.long = full text
•    27 000 non-diabetic men and women > 40 years of age from Oxford branch of EPIC study
•    Average follow up 11 years
•    well controlled or other factors such as smoking and alcohol use
•    progressively lower risk of cataracts in moderate meat eaters (50-99 g meat/d), low meat eaters (<50 g meat/d), fish eaters, vegetarians, and vegans compared with high-meat eaters (≥100 g meat/d)
•    rates were 0.96 (0.84, 1.11), 0.85 (0.72, 0.99), 0.79 (0.65, 0.97), 0.70 (0.58, 0.84), and 0.60 (0.38, 0.96), respectively

Fruit and Vegetable Consumption

Journal of Epidemiology and Community Health
Fruit and vegetable consumption and all-cause, cancer and CVD mortality: analysis of Health Survey for England data
2014
http://jech.bmj.com/content/early/2014/03/03/jech-2013-203500.full
•    increased fruit and veggie consumption  7+ servings dec all cause mortality HR 0.67 (0.58 if exclude mortality within one year of survey)
•    cancer HR 0.75 and cardiovascular 0.69 HR
•    veggies more protective than fruits, and frozen and canned fruits actually increased mortality

Journal of Bone and Mineral Research
Fruit and vegetable intake and risk of hip fracture: a cohort study of Swedish men and women
2015
http://www.ncbi.nlm.nih.gov/pubmed/25294687
•    40 000 men and 35 000 women aged 45-85 years starting 1997, from Sweden
•    mean follow up time 14.2 years
•    Subjects consumed from <1 serving up to 8 servings of fruit per day
•    those consuming <1 serving prepay had 88% greater fractures than those consuming 5 servings (HR=1.88)
•    There was a dose response of decreasing hip fractures with higher fruit consumption
•    no additional benefit for consuming more than 5 servings
•    Compare to evidence below regarding Dairy, Calcium, Vitamin D Intake and Bone Health

Dairy, Calcium, Vitamin D Intake and Bone Health
Note – see also section on soy and fracture risk above)
Note – See also section on  Fruits and Vegetable consumption above – regarding F and V consumption and decrease fracture risk

Note -when interpreting the following studies on dairy and fracture risk:
•    in light of the epic study http://www.ncbi.nlm.nih.gov/pubmed/17299475 it seems that dairy may not be protective of fractures, but overall calcium intake is still important for vegans

British Journal of Cancer
Lactose intolerance and risk of lung, breast and ovarian cancers: aetiological clues from a population-based study in Sweden
2014
http://www.ncbi.nlm.nih.gov/pubmed/25314053
•    see full entry in Multiple Cancer Section

The BMJ
Milk intake and risk of mortality and fractures in women and men: cohort studies
2014
http://www.bmj.com/content/349/bmj.g6015
•    Swedish study: 61000 women (baseline age 39-70) followed 20 years and  45000 men (baseline age 45-79) followed 11 years
•    in women who consumed 3 or more glasses of milk per day (compared to those drinking <1 per day)
⁃    HR =1.93 of total mortality
⁃    HR = 1.90 for cardiovascular mortality
⁃    HR = 1.44 for cardiovascular mortality
⁃    HR = 1.16 for any fracture
⁃    HR = 1.60 for hip fracture

•    in men who consumed 3 or more glasses of milk per day (compared to those drinking <1 per day)
⁃    HR for total mortality = 1.10
⁃    No benefit or adverse effect regarding fractures in men
⁃    were men already heavy meat eaters, hence diluted effect?
•    trend towards increased hip fractures in men, but not statistically significant
•    definitely no protection in men or women from fractures for any amount of milk consumption

Journal of the American Medical Association – Paediatrics  (JAMA)
Milk consumption during teenage years and risk of hip fractures in older adults
2014
http://archpedi.jamanetwork.com/article.aspx?articleid=1769138
•    96000 men and women over 50 were surveyed regarding childhood dairy consumption
•    followed for 22 years
•    greater milk consumption during teenage years was not associated with decreased fracture risk in elderly age
•    each additional glass of milk during teenage years was associated with a 6-9% additional rate of hip fracture in men

American Journal of Clinical Nutrition
Should Dairy be Recommended as Part of a Vegetarian Diet?
2009
http://ajcn.nutrition.org/content/89/5/1638S.full
•    Review article.  No benefit of dairy and bone density, but there is much literature showing long term harm of dairy intake

Pediatrics
Calcium, Dairy Products, and Bone Health in Children and Young Adults: A Reevaluation of the Evidence
2005
http://pediatrics.aappublications.org/content/115/3/736
•    meta analysis shows no evidence of benefit from dairy and bone density

The Journals of Gerontology
Worldwide incidence of hip fracture in elderly women: relation to consumption of animal and vegetable foods.
2000
http://www.ncbi.nlm.nih.gov/pubmed/11034231
•    Women in countries with high animal protein consumption suffer greater hip fractures
•    Higher vegetable intake is protective

Plant Based Calcium Sources
http://www.vrg.org/nutrition/calcium.php

Journal of Bone and Mineral Research
Fruit and vegetable intake and risk of hip fracture: a cohort study of Swedish men and women
2015
http://www.ncbi.nlm.nih.gov/pubmed/25294687
•    40 000 men and 35 000 women aged 45-85 years starting 1997, from Sweden
•    mean follow up time 14.2 years
•    Subjects consumed from <1 serving up to 8 servings of fruit per day
•    those consuming <1 serving prepay had 88% greater fractures than those consuming 5 servings (HR=1.88)
•    There was a dose response of decreasing hip fractures with higher fruit consumption
•    no additional benefit for consuming more than 5 servings
•    challenges the idea that calcium is the predominant factor in bone health
•    See also section on  Fruits and Vegetable consumption above – regarding F and V consumption and decrease fracture risk

BMJ
Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study
2011
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101331/
•    Calcium intakes below 700 mg were associated with increased fracture risk
•    intakes above this level were not beneficial, non-significant trend towards increased fractures with highest intakes

BMJ
Calcium intake and risk of fracture: systematic review
2015
http://www.bmj.com/content/351/bmj.h4580
•    Dairy intake and Calcium supplementation with or without vitamin D is not associated with decreased fracture risk at forearm, vertebrae, or hip
•    some studies show that calcium supplementation was beneficial for total and vertebrae though not forearm or hip specific fractures, but there was evidence of publication bias
•    one study showed benefit for frail elderly women in residential care with baseline low intake

Calcium intake and bone mineral density: systematic review and meta-analysis
http://www.bmj.com/content/351/bmj.h4183
•    Dairy intake and Calcium supplementation with or without vitamin D is not associated with significantly increased bone mineral density

Calcium supplements do not prevent fractures
http://www.bmj.com/content/351/bmj.h4825
•    Editorial from BMJ – good basic calcium intake can be achieved through healthy diet
•    Global industry likely has influence on government recommended daily intake levels of calcium
•    of course, low calcium intake via poor diet is to be avoided

Mediterranean Diet

New England Journal of Medicine
Primary prevention of cardiovascular disease with a Mediterranean diet
2014
http://www.ncbi.nlm.nih.gov/pubmed/23432189
•    Multcenter trial in Spain – 7000 prospective randomized
•    three groups – one supplemented with olive oil, second with mixed nuts, control group advised for low fat diet
•    followed 5 years, primary endpoint was myocardial infarction, ischemic stroke, or cardiovascular death
•    group supplemented with nuts had 28% less events
•    group supplemented with olive oil had 30% less events
•    nuts and olive oil are likely strong factors in benefits of Mediterranean diet, since major studies on fish yielded negative results
•    (this trial also listed in section on nuts and peanuts above)

British Medical Journal
Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study.
2009
http://www.ncbi.nlm.nih.gov/pubmed/19549997
•    23000 subject from EPIC study arm in Greece followed for 8.5 years
•    mediteranian diet was found to protect from total mortality
•    factors that were found to be protective: low consumption of meat and animal products, high vegetable intake, high fruit intake, moderate alcohol consumption, high ratio of mono-unsaturated fats to saturated fats
•    Fish had non-significant trend towards increased mortality,
•    also see section on nuts and peanuts above

2015  Dr Greger Video: Which parts of the Mediterranean diet extend life?
http://goo.gl/BTn00K
•    see extensive references under regarding studies on nuts in  “sources cited” button
•    also see video or transcript that are present there

Journal of the American College of Cardiology
Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease: A Prospective Cohort Study
2015
http://www.ncbi.nlm.nih.gov/pubmed/26429077
http://content.onlinejacc.org/article.aspx?articleid=2445322
http://www.hsph.harvard.edu/news/press-releases/butter-is-not-back-limiting-saturated-fat-still-best-for-heart-health/
•    See Full entry in section: Cardiovascular disease: Role of Saturated Fat and Cholesterol)

Fruit and Vegetable Consumption

Journal of Epidemiology and Community Health
Fruit and vegetable consumption and all-cause, cancer and CVD mortality: analysis of Health Survey for England data
2014
http://jech.bmj.com/content/early/2014/03/03/jech-2013-203500.full
•    65 000 participants aged 35+ followed for mean 7.7 years 2001-2008
•    7+ portions compared to <1 portion per day avg consumption of fruits and vegetables
•    HR of 0.67 for all cause mortality, 0.75 less cancer, 0.69 for cardiac mortality
•    however, frozen and canned fruit were seen to cause increased mortality (possible increased concentrated sugar consumption)
•    remarkable benefits!

BMJ
Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies
2014
http://www.bmj.com/content/349/bmj.g4490
•    over 800 000 in sixteen prospective trials followed from 4-26 years
•    5-6% decreased rate of mortality per serving consumed
•    max benefit at 5 servings per day
•    main benefit was cardiovascular, but no statistically significant decrease in cancer mortality

Obesity and Cancer

CDC Morbidity and Mortality Weekly Report
Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity — United States, 2005–2014
2017
https://www.cdc.gov/mmwr/volumes/66/wr/mm6639e1.htm?s_cid=mm6639e1_e#suggestedcitation
http://www.mdedge.com/internalmedicinenews/clinical-edge/summary/obesity/cancer-risk-overweight-obese-individuals?group_type=week
•    Overweight and obesity are associated with increased risk of at least 13 different types of cancer
•    According to CDC 1/3 of adults in the United States are overweight (BMI 25.0–29.9) and 1/3 obese (BMI ≥30)
•    Overweight- and obesity-related cancers accounted for 40% of all cancers diagnosed in 2014.
•    Among 1.6 million Americans diagnosed with cancer, about 631 000 have obesity as a risk factor
•    About 55% of cancers diagnosed in women and 24% of those diagnosed in men are overweight- and obesity-related cancers.
⁃    note: this means that obesity was a risk factor in these cancers, not that they were definitely caused by obesity
•    Among cancers affecting both men and women, men are more affected
•    Overweight and obese people have:
⁃    double risk of esophagus, gastric cardia, liver cancer
⁃    two to four times risk of endometrial cancer for women
⁃    30% increased risk of colon cancer – though disease is on decline due to screening
•    The incidence of overweight- and obesity-related cancers (excluding colorectal cancer) increased significantly among persons aged 20–74 years during 2005–2014

Overweight and Obesity

Journal of Academic Nutrition and Dietetics
Nutrient Profiles of Vegetarian and Non Vegetarian Dietary Patterns
2013
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081456/
•    71000 subjects followed from 2002-2007 in the Adventist 2 Study Group
•    Definitions:
⁃    Strict vegetarians -vegans or those who ate any animal product less than once per month)
⁃    Non vegetarians -eat red meat, poultry, at least once per month, total of meat and fish >1 time/week
⁃    Semi vegetarians may consume dairy products and/or eggs, red meat and poultry ≥1 time/month, total of fsh and meat ≥1 time/month but <1 time/week.
⁃    Pesco vegetarians – fish ≥1 time/month but red meat and poultry <1 time/month, no restrictions on dairy or egg intake.
⁃    Lacto-ovo vegetarians – consume total of meat, poultry or fish <1/month, also with no restrictions on eggs and or dairy products.
•    Strict Vegetarians had lowest BMI (mean BMI 24.0 and only 9.4% were obese) BMI of 25 is cut off for Overweight status.
•    Lacto-vegetarians, Semi vegetarians,  and Fish Eaters were intermediate
•    Meat eaters had highest BMI (mean BMI 28.6 and 33.3% obese)

American Journal of Clinical Nutrition
Meat consumption and prospective weight change in participants of the EPIC-PANACEA study
2010
http://www.ncbi.nlm.nih.gov/pubmed/20592131
http://ajcn.nutrition.org/content/92/2/398.full.pdf+html = full text
•    103,455 men and 270,348 women aged 25–70 followed between 1992 and 2000
•    Total meat consumption was associated with weight gain in mean and women even when adjusted for calorie intake
•    250 g of meat per day would lead to 2 kg weight gain after 5 years – even on iso-caloric diet
•    Positive associations were observed for red meat, poultry, and processed meat
•    controlled for smoking, gender, dietary patterns and other factors

Diabetes Care
Type of Vegetarian Diet, Body Weight, and Prevalence of Type 2 Diabetes
2009
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671114/
•    22000 men and 38000 women studied from 2002-2006 – Adventist 2 study group
•    Mean BMI was lowest in vegans (23.6 kg/m2) –  higher in lacto-ovo vegetarians (25.7 kg/m2), pesco-vegetarians (26.3 kg/m2), semi-vegetarians (27.3 kg/m2), and nonvegetarians (28.8 kg/m2)
•    Prevalence of type 2 diabetes increased from 2.9% in vegans to 7.6% in nonvegetarians; the prevalence was intermediate in participants consuming lacto-ovo (3.2%), pesco-fish eaters  (4.8%), or semi-vegetarian (6.1%) diets
•    Diabetes type 2 Riosk: vegans (OR 0.51), lacto-ovo vegetarians (0.54), pesco-vegetarians (0.70), and semi-vegetarians (0.76 ) had a lower risk of type 2 diabetes than nonvegetarians. Even after adjusting for BMI!
•    Also adjusted for age, sex, ethnicity, education, income, physical activity, television watching, sleep habits, alcohol use
•    (also in section on Diabetes type II)

BMC Public Health
The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis
2009
https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/1471-2458-9-88?site=bmcpublichealth.biomedcentral.com
https://goo.gl/kdD5gQ
•    Comprehensive review article outlines the increased risk of diseases from overweight and obesity
•    Overweight and obese people suffer from
⁃    Increased cancer of Breast, Endometrium, Ovary, Prostate, Colon/colorectal, Pancreas
⁃    Increase Coronary Artery Disease, Congestive Heart Failure, Stroke, Pulmonary Embolism
⁃    Increased Hypertension and Diabetes type II
⁃    Asthma,
⁃    Chronic Back Pain
⁃    Gallbladder disease

International Journal of Obesity
Weight gain over 5 years in 21,966 meat-eating, fsh-eating, vegetarian, and vegan men and women in EPIC-Oxford.
2006
http://www.ncbi.nlm.nih.gov/pubmed/16534521
•    21000 men and women in a health conscious cohort of UK component of EPIC-Oxfford Study
•    aged 20-69 , followed for mean of 5.3 years from baseline 1994-1999 until 2000-2003
•    vegans had least incremental wet gain in the following pattern Vegan< Vegetarina < Fish/Pesco Eater < Meat Eater
•    least weight gains were in those who changed their diet to include less animal foods

Nutrition
Comparative effectiveness of plant-based diets for weight loss: a randomized controlled trial of five different diets
2014
http://www.ncbi.nlm.nih.gov/pubmed/25592014
•    A small randomized trial favouring vegan diet for weight loss over lacto vegetarian, semi vegetarian, pescetarian, and standard diets

Antibiotic Resistance
-In the USA 80% of all antibiotics are used for animals in factory farming.  There is a massive worldwide use of antibiotics for meat production which leads to resistant bacteria, and consequent impacts on human health

http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf
http://www.ncbi.nlm.nih.gov/pubmed/24043228
•    JAMA article showings proximity to livestock operations resulted in more MRSA skin and soft tissue infections
http://www.nrdc.org/food/saving-antibiotics.asp
http://www.nytimes.com/2013/03/28/opinion/antibiotics-and-the-meat-we-eat.html?_r=0

Toxins in Foods

Meat Science Journal
Toxicological issues associated with production and processing of meat
2013
https://www.ncbi.nlm.nih.gov/pubmed/23660174
•                Comprehensive article surprisingly from an industry related journal
•                reviews the bioaccumulation of
⁃                                  Toxins from soil i.e Arsenic
⁃                                  Environmental pollutants i.e. lead, PCB, Pesticides, cadmium, dioxins
⁃                                  Mycotoxins from plant feed
⁃                                  Endogenous plant toxins
⁃                                  Animal endogenous toxins – ie.e phytanic acid
⁃                                  Veterinary drug residues – i.e. antibiotics
•                Carcinogenesis is a main concern
•                Metabolites of toxins may be worse than the original toxin
•                Multiple mechanisms and substances described

European Food Safety Authority Journal
Results of the monitoring of non dioxin-like PCBs in food and feed
2010
http://www.efsa.europa.eu/de/scdocs/doc/1701.pdf
•    Fish have the highest levels of PCBS of all foods
•    Egg yolks, milk, and animal flesh are next highest in declining order
•    Plant foods have lowest PCB contamination

Public Health And Factory Farming Links

The Pew Commission on Industrial Farm Animal Production
•    http://www.ncifap.org/
•    http://www.ncifap.org/_images/PCIFAPSmry.pdf = Pew Commission 2009 Executive Summary
•    includes much information on antibiotic use

Johns Hopkins Industrial Food Animal in America report 2013
•    http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-a-livable-future/_pdf/research/clf_reports/CLF-PEW-for%20Web-sm.pdf

Medical/Hospital Based Plant Based Nutrition Programs
-There are hospitals and medical systems that are now offering plant based nutritions programs based on the above evidence

Kaiser Permanente
 http://mydoctor.kaiserpermanente.org/ncal/Images/New%20Plant%20Based%20Booklet%201214_tcm28-781815.pdf

Montifiore Hospital In Bronx NY
http://www.montefiore.org/cardiacwellnessprogram
•    Cardiac/Cardiac Surgery hospital
•    Albert Einstein College of Medicine