Cases for Veganism

 In Preventive Medicine Column

 

The Case(s) for Veganism

As I write this, I am about to leave for Boston to speak at iV, the Ivy League Vegan Conference, at Harvard. Prominent voices will gather there and collectively, one anticipates, make the case for veganism.

The timing is a bit ironic. A paper was just published in the Lancet, describing the lifestyle and health status of the Tsimane. The paper generated considerable excitement, and widespread media attention, because the Tsimane, a population in the Bolivian Amazon described as living “a subsistence lifestyle of hunting, gathering, fishing, and farming,” were found to have “the lowest reported levels of coronary artery disease of any population recorded to date.”

The Tsimane, obviously, are not vegans, as the references to both hunting and fishing indicate. On the other hand, they are not hunting for meat in the supermarket, as I pointed out to one correspondent who sent me the study and asked if his penchant for meat was now exonerated. My answer was perhaps, provided it was satisfied by advent of bow and arrow and involved no cellophane.

The Tsimane, in common with our Stone Age ancestors, eat the meat of wild animals and fish they obtain the hard and old-fashioned way. Those animals, in turn, get their food the hard and old-fashioned way, too; they are not fed copiously in captivity. Consequently, their own bodies are lean, and represent the fats they derive from their food sources. The result is that the Tsimane diet has virtually no trans fat, is very low in saturated fat, and is quite low in total fat. The study authors report a diet that is 72% carbohydrate, 14% fat, and 14% protein.

Of course, this diet made up of foods direct from nature is very low in simple starches, and sugars as well. The authors note that the carbohydrate sources in the Tsimane diet are generally complex, and high in fiber- just as vegetables, fruits, whole grains, beans, lentils, nuts, and seeds are. These, of course, are the plant foods all but universally recommended for health promotion.

While the inclusion of meat in the Tsimane diet, conjoined to stunningly low levels of atherosclerosis demonstrated by CT imaging of the coronary arteries, might seem a rebuke to vegan diet advocacy, it is a mild rebuke at most. The nutrient composition of the Tsimane diet is much more akin to high-quality vegan and vegetarian diets than to anything remotely like the meat-heavy diets that prevail in the U.S. and many industrialized countries.

But even a mild rebuke, born of evidence, may deserve respect and certainly warrants reflection.

I have long noted, with all due respect to the ardent vegans among my colleagues, that we lack evidence to prove that any one specific diet is the singular “best” for human health. This should come as no surprise when you consider what kinds of studies would be needed to generate such evidence: randomized trials of optimized versions of competing diets in large populations over a span of decades with incident disease and mortality the outcome measures. The diet producing the greatest combination of longevity and vitality would be the winner. Such a study has not been done, and don’t hold your breath.

What we do know, from a veritable sea of confluent evidence, is the basic theme of the optimal diet for Homo sapiens. Famously described by Michael Pollan as “food, not too much, mostly plants,” it is just so: a diet of minimally processed, wholesome foods, mostly plants, in any balanced and sensible combination. The Tsimane diet represents such a combination. So do the Blue Zone diets, encompassing traditional Mediterranean, Asian, vegetarian, and omnivorous variants.

I can’t support the argument I sometimes hear from colleagues that a vegan diet is “best” based on human health considerations alone. There are, however, considerations other than our own health. There are arguments for veganism related to ethics, the decent treatment of our fellow species, and the avoidance of exposure to harmful food contaminants. There are compelling environmental arguments as well. The domestic production of meat, and beef in particular, is associated with high environmental impact in every area of importance: water consumption, land allocation, greenhouse gas emissions, and biodiversity.

This, then, is the message I am taking to the iV conference, as I add my voice to a chorus singing the praises of well practiced veganism. We are omnivores, and we have choices. A good vegan diet is not the only option for health promotion, but it is among the best. When the case is broadened from the health of people to that of the planet, too, the case for veganism is very much fortified. After all, the Tsimane are few; we are many.

-fin Dr. David L. Katz;www.davidkatzmd.com; founder, True Health Initiative

Dr. David L. Katz
DAVID L. KATZ MD, MPH, FACPM, FACP, FACLM, is the founding director (1998) of Yale University's Yale-Griffin Prevention Research Center, and current President of the American College of Lifestyle Medicine. He earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates. Dr. Katz has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both Preventive Medicine, and nutrition. Recognized globally for expertise in nutrition, weight management and the prevention of chronic disease, he has a social media following of well over half a million. In 2015, Dr. Katz established the True Health Initiative to help convert what we know about lifestyle as medicine into what we do about it, in the service of adding years to lives and life to years around the globe.
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