Scientific Update

Dietary Fat and Risk of Stroke

Back in December of last year, newspaper headlines trumpeted "High-Fat Diet for Men is Linked to Fewer Strokes." These reports were based on a study of 832 men aged 45 to 65. Back in the late 1960s, researchers asked the men what they ate in the previous 24 hours. The men were then followed for 20 years. Those men who had the highest intakes of fat, saturated fat, and monounsaturated fat were found to have the lowest risk of having a stroke. Does this mean we should all change to a high fat, high saturated fat diet? Not at all.

First of all, this study did not reach any conclusions with regard to women, so women should not make changes based on this study. Secondly, diets high in fat and saturated fat have been associated with increased risk of heart disease and possibly with obesity (high total fat diets). Do men really have to choose between heart disease and stroke? Probably not. Perhaps the answer to reducing risk of both conditions lies in a diet with moderate levels of fat, low levels of saturated fat, and moderate levels of monounsaturated fats. However, don't rush to change your diet based on the results of this one study. We must question whether one day's worth of information on what foods were eaten 20 years ago can reliably predict health outcomes like stroke. Additionally, subjects whose diets were lowest in fat were highest in alcohol. Excessive use of alcohol raises risk of stroke. Other factors which could also have increased risk of stroke were not examined.

Zinc and Vegetarian Diets

Do vegetarians get enough zinc? Not only are our diets devoid of meat, fish, and poultry, which are commonly considered good sources of zinc, but we also have higher intakes of phytates and fiber, which keep our bodies from absorbing zinc as well. Researchers from the USDA evaluated zinc status in 21 women who followed a lacto-ovo-vegetarian diet for 8 weeks. The subjects did absorb less zinc when they were on the vegetarian diet compared to when they were on a non-vegetarian diet. Despite the lower absorption of zinc, the subjects' blood zinc levels remained in the normal range and they appeared to be getting an adequate amount of zinc from their diet. The authors recommend that vegetarians eat good sources of zinc--like whole grains and legumes--regularly.

Health Canada Approves Fortification of Plant-Based Beverages

Canadian Food and Drug Regulations have not permitted the addition of vitamins or minerals to beverages such as soymilk and rice milk. Prior to December of last year, only unfortified plant-based beverages could be sold in Canada. Fortification of juice is still not permitted.

New recommendations allow for the fortification of plant-based beverages provided they contain a specified level of protein or are labeled as "not a source of protein" and if they have no more than a specified level of fat, saturated fat, and trans fatty acids. Beverages are to be labelled "fortified [name of plant] beverage. " Fortified plant beverages may not contain ingredients derived from cow's milk or goat's milk. Fortified beverages must contain vitamin A, vitamin D, vitamin B-12, riboflavin, calcium, and zinc at specified levels, and may contain vitamin B-6, vitamin C, thiamine, niacin, folacin, pantothenic acid, phosphorus, potassium, and magnesium, again at specified levels.

New Recommendations to Reduce Risk of Cancer

The American Institute for Cancer Research and the World Cancer Research Fund commissioned a review of the literature on diet and cancer and asked experts to devise recommendations suitable for all societies designed to reduce the risk of cancer. They concluded that inappropriate diets are responsible for around one-third of all cancer deaths.

They looked specifically at vegetarian diets and cancer and concluded that vegetarians have decreased incidence of several kinds of cancer. They attributed the reduction in risk to both the exclusion of meat and the increased intake of plant foods.

This committee found convincing evidence that higher intakes of vegetables and fruits decrease risk of cancer of the mouth and pharynx, esophagus, lung, and stomach and that higher intakes of vegetables decrease risk of cancer of the colon and rectum. Increased meat consumption probably increases risk of cancer of the colon and rectum and possibly increases risk of cancer of the pancreas, breast, prostate, and kidney. Increased egg consumption possibly increases risk of colon and rectal cancer. Increased milk and dairy product consumption possibly increases risk of prostate and kidney cancer.

The recommendations of this expert panel include:

• Choose predominantly plant-based diets rich in a variety of vegetables and fruits, legumes, and minimally processed starchy staple foods.
• Eat 15-30 ounces, or five or more servings a day, of variety of vegetables and fruits, all year round.
• Eat 20-30 ounces, or more than seven servings a day, of a variety of grains, legumes, roots, tubers, and plantains.
• Choose minimally processed foods. Limit consumption of refined sugar.
• If eaten at all, limit intake of red meat to less than 3 ounces daily.

The report concludes that on a global basis and at current rates, use of appropriate diets may prevent 3-4 million cases of cancer each year.

The Effect of Protein Intake on Calcium Lost in the Urine

Several studies have shown that high-protein diets increase urinary calcium loss, possibly leading to a reduction in bone mass and an increase in osteoporosis. Japanese researchers (Itoh et al.) confirmed these results in a study of close to 750 men and women aged 20-79 years. In both older and younger subjects, a higher intake of protein was associated with greater calcium loss in the urine. When animal protein and vegetable protein were examined separately, higher intakes of animal protein were associated with greater calcium loss, while there was no such association between plant protein and calcium. All the subjects included animal protein in their diets.

The subjects in this study all had protein intakes which were higher than the Japanese RDA for protein. (Average intake for younger men was 89 grams of protein per day; for younger women it was 72 grams.) Does this suggest that diets which are lower in protein are better for bone health? Perhaps. However, it may be that a diet which contains moderate levels of protein is most desirable. One study (Kerstetter et al.) has suggested that while high protein intakes are not desirable because of their effect on urinary calcium, very low intakes of protein (around 44 grams a day for women) also have a negative effect on calcium metabolism. Perhaps the answer is a diet containing moderate amounts of protein from plant sources. Vegetarians can hope that this will be a new area of study.

New Statements from the AAP

The American Academy of Pediatrics (AAP), a widely recognized organization of pediatricians, has developed two statements of interest to vegetarian parents. The first deals with the level of fat recommended for children. As they have stated previously, the AAP calls for no restriction of fat for infants of less than two years, when rapid growth and development call for plenty of calories. After two years, children should gradually limit dietary fat so that by around age five, between 20 and 30 percent of calories comes from fat. This type of diet should be used throughout childhood and adolescence. Saturated fat should provide less than 10 percent of total calories and dietary cholesterol should be less than 300 milligrams daily.

The AAP's second statement deals with soy protein-based infant formulas. These formulas (not soymilk) are safe alternatives to breast milk or cow milk-based formulas. The AAP lists parents seeking a vegetarian-based diet for a term infant as one of a number of conditions where soy formulas should be used.