Regarding the Claim that Vegetarianism Reduces the Risk of Heart Disease Some vegetarians seem to believe, that a vegetarian diet reduces the risk of heart disease According to Down To Earth , “ Vegetarian diets tend to be naturally lower in saturated fat and cholesterol and have a higher intake of plant nutrients than most meat-based diets . Vegetarians have been shown to have a 24% lower risk of dying of heart disease than non-vegetarians .” ( Down to Earth, 2021 ) According to Chris Tognotti , “ Red meat has been compellingly linked to shorter lifespans, and startling increases in risk of death For each additional serving of certain meat products per day, researchers in a major 2012 study found a staggering 20 percent increase in the likelihood of death for middle-aged people.” ( Tognotti, 2014 ) NOT according to the latest scientific evidence, and heavily dependent on which vegetarian diet you follow There is a number of problems with the 2009 positional paper, cited by Down to Earth as evidence, that "Vegetarian diets tend to be naturally lower in saturated fat and cholesterol and have a higher intake of plant nutrients than most meat-based diets” ( Down to Earth, 2021 ) The paper was only a reaffirmation of a much older 1987 study by Craig and Mangels. ( American Dietetic Association, 2009 ) 1 / 12 The paper was adopted by the American Dietetic Association’s House of Delegates Leadership Team on the 18th of October 1987, and reaffirmed on the 12th of September 1992; the 6th of September 1996; the 22nd of June 2000; and the 11th of June 2006 – after which it expired on the 31st of December 2013 . ( American Dietetic Association, 2009 ) In other words, Down to Earth was citing an expired positional paper as evidence It is important to understand that a positional paper is nothing, but an essay, that presents an arguable opinion on a particular subject Positional papers are constantly reviewed and either, reaffirmed or expired , depending on whether the issuer continues to maintain, or no longer subscribe to, a particular view. Today, the former American Dietetic Association is known as the Academy of Nutrition and Dietetics ( Wikipedia, n.d.a ), holding a variety of influential health positions, including, that " there are no good or bad foods, only good and bad diets ." ( Wikipedia, n.d.a ) And [contrary to the perceptions of Down to Earth ] lauding the health benefits of grass-fed Bison red meat ( Ellis, 2019 ). There are also a number of problems with the 1998 collaborative analysis of 5 prospective studies by Key et al , cited by Down to Earth as evidence, that "Vegetarians have been shown to have a 24% lower risk of dying of heart disease than non-vegetarians ." ( Down to Earth, 2021 ) 2 / 12 The studies analysed consisted of 76172 men and women aged 16 to a whopping 89 years at recruitment , of which 2264 died from ischemic heart disease, before the age of 90. ( Key et al, 1998 ) We are not told how many of the vegetarians and non-vegetarians were younger or older Furthermore, the analysis, by its own admission , did not examine other causes of death that may account for the differences between vegetarians and non-vegetarians deaths . ( Key et al, 1998 ) As a result, its findings may have been confounded by numerous variables, including physical activity and fibre intake ( Ascherio et al, 1996 ). Later systematic reviews, however, did examine "all-cause mortality" ( Johnston et al, 2019 ), concluding that consuming red meat isn’t associated with an increased risk of coronary heart disease ( Johnston et al, 2019 ; Citroner, 2019 ; Ascherio et al, 1996 ) Some studies concluded that vegetarians were at lower risk of heart disease A 2017 explorative study by Martin and Li , of 12 studies, totaling 620877 subjects, concluded that “ There is increasing evidence that the consumption of plant-based foods, particularly fresh fruit and vegetables, is inversely associated with the risk of major chronic diseases , particularly cardiovascular disease , metabolic diseases such as obesity and Type 2 diabetes, and certain types of cancer.” ( Martin and Li, 2017 ) 3 / 12 A 2012 prospective analysis by Pan et al , of 2 cohort studies, totaling 37698 subjects, concluded that “ Red meat consumption is associated with an increased risk of total, CVD, and cancer mortality . Substitution of other healthy protein sources for red meat is associated with a lower mortality risk.” ( Pan et al, 2012 ) Much larger studies, however, concluded that eating red meat was not associated with an increased risk of heart disease A 2019 systematic meta-analysis by Johnston et al , of 112 studies, totalling almost 9.7 million participants , concluded that “our review of randomised trials on harms and benefits (12 unique trials enrolling 54 000 participants), we found low- to very low-certainty evidence that diets lower in unprocessed red meat may have little or no effect on the risk for major cardiometabolic outcomes and cancer mortality and incidence. Dose–response meta-analysis results from 23 cohort studies with 1.4 million participants provided low- to very low-certainty evidence that decreasing unprocessed red meat intake may result in a very small reduction in the risk for major cardiovascular outcomes (cardiovascular disease, stroke, and myocardial infarction) and type 2 diabetes (range, 1 fewer to 6 fewer events per 1000 persons with a decrease of 3 servings/wk), with no statistically significant differences in 2 additional outcomes (all-cause mortality and cardiovascular mortality). Dose–response meta-analysis results from 17 cohorts with 2.2 million participants provided low-certainty evidence that decreasing unprocessed red meat intake may result in a very small reduction of overall lifetime cancer mortality (7 fewer events per 1000 persons with a decrease of 3 servings/wk), with no statistically significant differences for 8 additional cancer outcomes (prostate cancer mortality and the 4 / 12 incidence of overall, breast, colorectal, esophageal, gastric, pancreatic, and prostate cancer). Similar to studies directly addressing red meat, cohort studies assessing dietary patterns (70 cohort studies with just over 6 million participants) provided mostly uncertain evidence for the risk for adverse cardiometabolic and cancer outcomes. Although statistically significant, low- to very low-certainty evidence indicates that adherence to dietary patterns lower in red or processed meat is associated with a very small absolute risk reduction in 9 major cardiometabolic and cancer outcomes (range, 1 fewer to 18 fewer events per 1000 persons), with no statistically significant differences for 21 additional outcomes observed .” ( Johnston et al, 2019 ) In other words, they found, “ that eating red meat isn’t associated with increased risk of cancer or heart disease .” ( Citroner, 2019 ) A 2010 meta-analysis by Siri-Tarino et al , of 5 prospective cohort studies, totaling 347747 subjects, stretching over 23 years , concluded "that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD ." ( Siri-Tarino et al, 2010 ; Winslow, 2010 ) A 1996 cohort follow up study by Ascherio et al , totalling 236782 subjects , after pointing out that "The results of multivariate analyses, with or without correction for measurement errors, however, indicated that intake of fibre is more strongly related to risk of coronary disease than intake of saturated fat or cholesterol and that this largely accounts for the observed association with saturated fat" , concluded that " the role of dietary fats to risk of coronary heart disease is unwarranted ." ( Ascherio et al, 1996 ) According to biochemist and neurobiologist, Dr. Stephan Guyenet, " Nearly every high-quality (prospective) observational study ever 5 / 12 conducted found that saturated fat intake is not associated with heart attack risk . So if saturated fat increases blood cholesterol, and higher blood cholesterol is associated with an increased risk of having a heart attack, then why don’t people who eat more saturated fat have more heart attacks ? ... The most recent study was the Health Professional Follow-up study, published in 1996. This was a massive, well funded study that found no relationship between saturated fat intake and blood cholesterol . Of all the studies I came across, only the Western Electric study found a clear association between habitual saturated fat intake and blood cholesterol, and even that association was weak . The Bogalusa Heart study and the Japanese study provided inconsistent evidence for a weak association. The other studies I cited, including the bank workers’ study, the Tecumseh study, the Evans county study, the Israel Ischemic Heart study, the Framingham study and the Health Professionals Follow-up study, found no association between the two factors .... It may be that the diet-heart hypothesis rests in part on an over-reliance on the results of short-term controlled feeding studies ." ( Guyenet, 2011 ) Some studies have even concluded that vegetarians are at higher risk of developing Coronary Heart Disease (CHD) A 2017 examination by Satija et al of 3 previous studies, totalling 209298 subjects , concluded that "Higher intake of a plant-based diet index rich in healthier plant foods is associated with substantially lower CHD risk, whereas a plant-based diet index that emphasizes less-healthy plant foods is associated with higher CHD risk ." ( Satija et al, 2017 ) 6 / 12 The study determined, that " eating a lot of sweet food and drink, refined grains and potatoes was linked to a higher risk of heart disease " , meaning " some vegetarian food can be just as bad for you " ( Johnston, 2017 ) In other words, vegetarians are not at a lower risk of dying of Coronary Heart Disease (CHD), than non-vegetarians . ( Kirkey, 2017 ; Kasprak, 2017 ; Faloon, 2006 ; Dray, n.d. ) Furthermore, Coronary Heart Disease (CHD) is not the only variable applicable to longevity. A 2017 population-based Australian cohort study by Mihrshahi et al (known as the "45 and Up Study"), totalling 243096 subjects , concluded that "there was no significant difference in all-cause mortality for vegetarians versus non-vegetarians (HR=1.16 (95% CI 0.93-1.45)). There was also no significant difference in mortality risk between pesco-vegetarians (HR=0.79 (95% CI 0.59-1.06)) or semi- vegetarians (HR=1.12 (95% CI 0.96-1.31)) versus regular meat eaters We found no evidence that following a vegetarian diet, semi- vegetarian diet or a pesco-vegetarian diet has an independent protective effect on all-cause mortality .” ( Mihrshahi et al, 2017 ) A 2019 prospective cohort study by Tong et al , reviewing The European Prospective Investigation into Cancer and Nutrition (EPIC) study, spanning 18 years, totalling 48188 subjects , concluded that, while "fish eaters and vegetarians had lower rates of ischaemic heart disease than meat eaters" , they also "had higher rates of haemorrhagic and total stroke ." ( Tong et al, 2019 ) Each year about 365,914 Americans die of coronary heart disease ( Centers for Disease Control and Prevention, 2020 ), while about 795000 Americans experience strokes, of which 1 in 4 is fatal, leading 7 / 12 to roughly 144000 deaths annually. ( Centers for Disease Control and Prevention, 2021 ; Han, 2019 ) References American Dietetic Association (2009) Position of the American Dietetic Association: Vegetarian Diets , p.1282 https://jandonline.org/action/showPdf?pii=S0002- 8223%2809%2900700-7 ✔ Ascherio, A.; Rimm, E.B.; Giovannucci, E.L.; Spiegelman, D.; Stampfer, M.; Willett, W.C. (1996, July 13) Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC2351515/pdf/ bmj00550-0026.pdf ✔ Centers for Disease Control and Prevention (2021, May 25) Stroke Facts https://www.cdc.gov/stroke/facts.htm ✔ Centers for Disease Control and Prevention (2020, September 8) Heart Disease Facts https://www.cdc.gov/heartdisease/facts.htm ✔ Citroner, G. (2019, October 7) Controversial Red Meat Study Under Scrutiny After Researcher Linked to Food Industry [Healthline] https://www.healthline.com/health-news/red-meat-may-not-hurt- your-heart-researchers-find ✔ Down To Earth (2021) Top 10 Reasons for Going Veggie https://www.downtoearth.org/go-veggie/top-10-reasons ✔ NOTE : The article above, by Down To Earth, is riddled with scientific errors, misrepresentations and questionable references – all of which I responded to. 8 / 12 Dray, T. (n.d.) Life Expectancy of Vegetarians Vs. Meat Eaters [Livestrong] https://www.livestrong.com/article/502968-life- expectancy-of-vegetarians-vs-meat-eaters/ 🔍 Ellis, E. (2019, October) Bison, a Healthier Red Meat [ Academy of Nutrition and Dietetics] https://www.eatright.org/food/planning- and-prep/snack-and-meal-ideas/bison-a-healthier-red-meat ✔ Faloon, W. (2006, January) Do Vegetarians Live Longer? [Life Extension Magazine] https://www.lifeextension.com/magazine/2006/1/awsi 🔍 Guyenet, S. (2011, January 13) Does Dietary Saturated Fat Increase Blood Cholesterol? An Informal Review of Observational Studies [Whole Health Source] http://wholehealthsource.blogspot.com/2011/01/does-dietary- saturated-fat-increase.html 🔍 Han, S. (2019, June 10) Stroke Severity and Mortality: Types, Treatments, and Symptoms [Healthline] https://www.healthline.com/health/can-you-die-from-a-stroke ✔ Johnston, B.C.; Zeraatkar, D.; Han, M.A.; Vernooij, R.W.M.; Valli, C.; Dib, R.E.; Marshall, C.; Stover, P.J.; Fairweather-Taitt, S.; Wójcik, G.; Bhatia, F.; de Souza, R.; Brotons, C.; Meerpohl, J.J.; Patel, C.J.; Djulbegovic, B.; Alonso-Coello, P.; Bala, M.M.; Guyatt, G.H. (2019, November 19) Unprocessed Red Meat and Processed Meat Consumption: Dietary Guideline Recommendations From the Nutritional Recommendations (NutriRECS) Consortium [Annals of Internal Medicine] https://www.acpjournals.org/doi/10.7326/M19-1621 ✔ 9 / 12 Johnston, I. (2017, July 17) Vegetarian diets can lead to higher risk of heart disease, finds study [The Independent] https://www.independent.co.uk/news/science/vegetarian-diets- heart-disease-link-higher-risk-health-food-sweet-refined-grains- potato-a7845286.html Kasprak, A. (2017, December 12) Do Vegetarians Live Longer Than Meat Eaters? [Snopes] https://www.snopes.com/fact-check/do- vegetarians-live-longer-than-meat-eaters/ 🔍 Key T.J.; Fraser, G.E.; Thorogood, M.; Appleby, P.N.; Beral, V.; Reeves, G.; Burr, M.L.; Chang-Claude, J.; Frentzel-Beyme R.; Kuzma, J.W.; Mann, J.; McPherson, K. (1998) Mortality in vegetarians and non-vegetarians: a collaborative analysis of 8300 deaths among 76,000 men and women in five prospective studies. Public Health Nutrition 1 (1): 33- 41. PMID 10555529 [Cambridge University Press] https://www.cambridge.org/core/journals/public-health-nutrition/a rticle/mortality-in-vegetarians-and-nonvegetarians-a- collaborative-analysis-of-8300-deaths-among-76000-men-and- women-in-five-prospective-studies/ 9FF29F354456308D49006B5DCBBE5BF0 ✔ Kirkey, S. (2017, April 21) Sorry, vegetarians. A new study says eating green won’t lower your risk of early death [National Post] https://nationalpost.com/news/canada/vegetarians-study-lower- risk-death 🔍 Martin. C.; Li, J. (2017, August 10) Medicine is not health care, food is health care: plant metabolic engineering, diet and human health [New Phytologist Foundation] https://nph.onlinelibrary.wiley.com/doi/full/10.1111/nph.14730 ✔ 🔍 10 / 12 Mihrshahi, S.; Ding, D.; Gale, J.; Allman-Farinelli, M.; Banks, E.; Bauman, A. (2017) Vegetarian diet and all-cause mortality: Evidence from a large population-based Australian cohort – the 45 and Up Study [Science Direct] https://www.sciencedirect.com/science/article/abs/pii/S0091743516 304479 ✔ 🔍 Myers, W. (n.d.) Red Meat Does Not Cause Disease [Myers Detox] https://myersdetox.com/red-meat-does-not-cause-disease/ 🔍 Pan, A.; Sun, Q.; Bernstein, A.M.; Schulze, M.B.; Manson, J.E.; Stampfer, M.J.; Willett, W.C.; Hu, F.B. (2012, April 9) Red Meat Consumption and Mortality, Results From 2 Prospective Cohort Studies [JAMA Internal Medicine] https://jamanetwork.com/journals/jamainternalmedicine/fullarticle /1134845 ✔ Satija, A.; Bhupathiraju, S.N.; Spiegelman, D.; Chiuve, S.E.; Manson, J.E.; Willett, W.; Rexrode, K.M.; Rimm, E.B.; Hu, F.B. (2017, July 25) Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults [PubMed Central] https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5555375/ ✔ 🔍 Siri-Tarino, P.W.; Sun, Q.; Hu, F.B.; Krauss, R.M. (2010, March) Meta- analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease [PubMed Central] https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC2824152/ ✔ Tognotti, C. (2014, April 24) How To Argue For Vegetarianism, And Win [Bustle] https://www.bustle.com/articles/21939-how-to-argue- for-vegetarianism-7-common-arguments-for-eating-meat- debunked 🔍 11 / 12 Tong, T.Y.N.; Appleby, P.N.; Bradbury, K.E.; Perez-Cornago, A.; Travis, R.C.; Clarke, R. (2019, September 4) Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study [The BMJ] https://www.bmj.com/content/366/bmj.l4897 ✔ Wikipedia (n.d.a) Academy of Nutrition and Dietetics https://en.wikipedia.org/wiki/Academy_of_Nutrition_and_Dietetics ✔ Winslow, R. (2010, May 19) New Harvard Study: Red Meat Does Not Cause Heart Disease [IRON Magazine] https://www.ironmagazine.com/2010/new-harvard-study-red- meat-does-not-cause-heart-disease/ 🔍 Revisions 30.08.2022 / 05.11.2025 / 17.11.2025 12 / 12