Skip to main content

Advertisement

Log in

Multiple Health Benefits and Minimal Risks Associated with Vegetarian Diets

  • Gastroenterology, Critical Care, and Lifestyle Medicine (SA McClave, Section Editor)
  • Published:
Current Nutrition Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Understand the current prevalence, health benefits, and health risks of vegetarian diets.

Recent Findings

Since the publishing of the Adventist Health Study 2 in 2013, there have been several prospective diet studies demonstrating and challenging the health benefits and risks of the vegetarian diet.

Summary

The definition of the vegetarian diet has become more specific over time and requires standardization for research purposes. Despite an uptrend in sales rates of plant-based foods per year, a 2018 Gallup poll showed overall stagnation of the percentage of self-reported vegetarians and vegans compared to percentages obtained 6 years prior. Compared to the Adventist Health Study, more recent vegetarian diet studies have demonstrated significant although smaller risk reductions for mortality in cardiovascular disease, cerebrovascular disease, diabetes mellitus, and chronic kidney disease. Recent studies have correlated certain food groups with early death or increased longevity. In addition, the vegetarian health risks of deficiencies of protein, omega-3 fatty acids, vitamin D, vitamin B12, iron, calcium, and zinc are explored.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. What is a vegetarian? Vegetarian Society. https://www.vegsoc.org/info-hub/definition/. Accessed 18 March 2018.

  2. Gelatin. International Vegetarian Union. https://ivu.org/index.php/gelatin. Accessed 18 March 2018.

  3. Why Avoid Hidden Animal Ingredients? North American Vegetarian Society. https://navs-online.org/articles/why-avoid-hidden-animal-ingredients/. Accessed 18 March 2018.

  4. Forrest J. Is Cheese Vegetarian? Serious Eats. https://www.seriouseats.com/2007/12/is-cheese-vegetarian.html. Accessed 18 March 2018.

  5. Raphaely T, Marinova D, Crisp G, Panayotov J. Flexitarianism (Flexible or part-time vegetarianism): A user-based dietary choice for improved wellbeing. Int J User Driven Healthc. 2013;3(3):34–58.

    Article  Google Scholar 

  6. Ostfeld RJ. Definition of a plant-based diet and overview of this special issue. J Geriatr Cardiol. 2017;14(5):315. https://doi.org/10.11909/j.issn.1671-5411.2017.05.008.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Pilis W, Stec K, Zych M, Pilis A. Health benefits and risk associated with adopting a vegetarian diet. Rocz Panstw Zakl Hig. 204; 65(1):9–14.

  8. Reinhart RJ. Snapshot: Few Americans Vegetarian or Vegan. Gallup survey July 1-11, 2018. https://news.gallup.com/poll/238328/snapshot-few-americans-vegetarian-vegan.aspx. Accessed 18 March 2018.

  9. Leahya E, Lyonsa S, Tola RSJ. An estimate of the number of vegetarians in the world. Econ Soc Res Instit. 2010;340:1–44.

    Google Scholar 

  10. Juan W, Yamini S, Britten P. Food intake patterns of self-identified vegetarians among the U.S. population, 2007-2010. Proc Food Sci. 2015;4:86–93.

    Article  Google Scholar 

  11. Allès B, Baudry J, Méjean C, et al. Comparison of sociodemographic and nutritional characteristics between self-reported vegetarians, vegans, and meat-eaters from the NutriNet-Santé Study. Nutrients. 2017;9(9):1023. Published 2017 Sep 15. https://doi.org/10.3390/nu9091023.

    Article  CAS  PubMed Central  Google Scholar 

  12. The good food institute. Plant-based market overview. https://www.gfi.org/marketresearch. Accessed 10 April 2019.

  13. Craig WJ, Mangels AR. Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc. 2009:1266–82. https://doi.org/10.1016/j.jada.2009.05.027.

  14. Benatar JR, Stewart RAH. Cardiometabolic risk factors in vegans; a meta-analysis of observational studies. PLoS ONE. 13(12):e0209086.

    Article  CAS  Google Scholar 

  15. Kwok CS, Umar S, Myint PK, Mamas MA, Loke YK. Vegetarian diet, Seventh Day Adventists and risk of cardiovascular mortality: a systematic review and meta-analysis. Int J Cardiol. 2014;176(3):680–6.

    Article  Google Scholar 

  16. •• Kwok CS, Gulati M, Michos ED, Potts J, Wu P, Watson L, et al. Dietary components and risk of cardiovascular disease and all-cause mortality: a review of evidence from meta-analyses. Eur J Prev Cardiol. 2019;0(00):1–15 Large systematic review and meta-analysis of studies assessed a quality-grade examining the relative risk of all-cause mortality and cardiovascular disease per standard food item.

    Google Scholar 

  17. Gerber M, Hoffman R. The Mediterranean diet: health, science and society. Br J Nutr. 2015;113:S4–S10. https://doi.org/10.1017/S0007114514003912.

    Article  CAS  PubMed  Google Scholar 

  18. Lara KM, Levitan EB, Gutierrez OM, Shikany JM, Safford MM, Judd SE, et al. Plant-based diet lowers risk of heart failure. J Am Coll Cardiol. 2019;73(16):2036–45.

    Article  Google Scholar 

  19. Campbell T. A plant-based diet and stroke. J Geriatr Cardiol. 2017;14:321–6. https://doi.org/10.11909/j.issn.1671-5411.2017.05.010.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Estruch R, Martínez-González MA, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378:e34. https://doi.org/10.1056/NEJMoa1800389.

    Article  CAS  PubMed  Google Scholar 

  21. Wang Z-M, Zhao D, Nie Z-L, et al. Flavonol intake and stroke risk: a meta-analysis of cohort studies. Nutrition. 2014;30(5):518–23.

    Article  Google Scholar 

  22. Threapleton DE, Greenwood DC, Evans CEL, et al. Dietary fiber intake and risk of first stroke: a systematic review and meta-analysis. Stroke. 2013;44(5):1360–8.

    Article  CAS  Google Scholar 

  23. Cheng P, Wang L, Ning S, Liu Z, Lin H, Chen S, et al. Vitamin E intake and risk of stroke: A meta-analysis. Br J Nutr. 2018;120(10):1181–8. https://doi.org/10.1017/S0007114518002647.

    Article  CAS  PubMed  Google Scholar 

  24. Chen G-C, Lu D-B, Pang Z, Liu Q-F. Vitamin C intake, circulating vitamin C and risk of stroke: a meta-analysis of prospective studies. J Am Heart Assoc. 2013;2(6):e000329.

    Article  Google Scholar 

  25. Kahleova H, Levin S, Barnard N. Cardio-metabolic benefits of plant-based diets. Nutrients. 2017;8:848. https://doi.org/10.3390/nu9080848.

    Article  CAS  Google Scholar 

  26. Papamichou D, Panagiotako DB, Itsiopoulos C. Dietary patterns and management of type 2 diabetes: a systematic review of randomized clinical trials. Nutr Metab Cardiovasc Dis. 2018; 1–13. https://doi.org/10.1016/j.numecd.2019.02.004

    Article  CAS  Google Scholar 

  27. Orlich, et al. Vegetarian dietary patterns and mortality in Adventist Health Study 2. JAMA Intern Med. 2013;173(13):1230–8.

    Article  CAS  Google Scholar 

  28. Chiu THT, Pan WH, Lin MN, et al. Vegetarian diet, change in diet patterns, and diabetes risk: a prospective study. Nut Dia. 2018;12(8).

  29. Toumpanakis A, Turnbull T, Alba-Barba I. Effectiveness of plant-based diets in promoting well-being in the management of type 2 diabetes: a systematic review. BMJ Opn Diab Res Care. 2018;6:e000534. https://doi.org/10.1136/bmjdrc-2018-000534.

    Article  Google Scholar 

  30. Guasch-Ferré M, Salas-Salvadó J, Estruch R, Corella D, Fitó M. Martinez-González MA; PREDIMED Investigators. The PREDIMED trial, Mediterranean diet and health outcomes: how strong is the evidence? Nutr Metab Cardiovasc Dis. 2017;27(7):624–32. https://doi.org/10.1016/j.numecd.2017.05.004.

    Article  PubMed  Google Scholar 

  31. Chauveau P, Koppe L, Combe C, Lasseur C, Trolonge S, Aparicio M. Vegetarian diets and chronic kidney disease. Nephrology Dialysis Transplantation. 2019;34(2):199–207. https://doi.org/10.1093/ndt/gfy164.

    Article  Google Scholar 

  32. Haring B, Selvin E, Liang M, Coresh J, Grams ME, Petruski-Ivleva N, et al. Dietary protein sources and risk for incident chronic kidney disease: results from the Atherosclerosis Risk in Communities (ARIC) Study. J Ren Nutr. 2017;27(4):233–42. https://doi.org/10.1053/j.jrn.2016.11.004.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Kelly JT, Palmer SC, Wai SN, Ruospo M, Carrero JJ, Campbell KL, et al. Healthy dietary patterns and risk of mortality and ESRD in CKD: a meta-analysis of cohort studies. Clin J Am Soc Nephrol. 2017;12:272–9. https://doi.org/10.2215/CJN.06190616.

    Article  PubMed  Google Scholar 

  34. •• Schwingshackl L, Schwedhelm C, Hoffmann G, Lampousi A, Knüppel S, Iqbal K, et al. Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. The Am J of Clin Nutr. 2017;105(6):1462–73 Very large systematic review and meta-analysis of all prospective studies examining the relative risk of all-cause mortality per serving of standard food-group per day.

    CAS  Google Scholar 

  35. Mihrashahi S, Ding D, Gale J, et al. Vegetarian diet and all-cause mortality: evidence from a large population based Australian cohort – the 45 and Up study. Prev Med. 2017;97:1–7.

    Article  Google Scholar 

  36. Aasheim ET, Sharp JS, Appleby PN, et al. Tinned fruit consumption and mortality in three prospective cohorts. PLoS One. 2015;10:e0117796.

    Article  Google Scholar 

  37. Yang Q, Zhang Z, Gregg EW, et al. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med. 2014;30341:1–9.

    Google Scholar 

  38. National Toxicology Program. Draft NTP research report on the CLARITY-BPA core study: a perinatal and chronic extended-dose-range study of bisphenol A in rats. NTP RR 9, vol. 9. Research Triangle Park: National Toxicology Program; 2018. p. 1–249.

    Google Scholar 

  39. Barr SI, Chapman GE. Perceptions and practices of self-defined current vegetarian, former vegetarian, and nonvegetarian women. J Am Diet Assoc. 2002;102(3):354–60.

    Article  Google Scholar 

  40. Metherel AH, Chouinard-Watkins R, Trépanier MO, Lacombe RJS, Bazinet RP. Retroconversion is a minor contributor to increases in eicosapentaenoic acid following docosahexaenoic acid feeding as determined by compound specific isotope analysis in rat liver. Nutr Metab (Lond). 2017;14:75. https://doi.org/10.1186/s12986-017-0230-2.

    Article  CAS  Google Scholar 

  41. Miles FL, Lloren JIC, Haddad E, Jaceldo-Siegl K, Knutsen S, Sabate J, et al. Plasma, urine, and adipose tissue biomarkers of dietary intake differ between vegetarian and non-vegetarian diet groups in the Adventist Health Study-2. J Nutr. 2019;149(4):667–75. https://doi.org/10.1093/jn/nxy292.

    Article  PubMed  Google Scholar 

  42. Cardwell G, Bornman JF, James AP, Black LJ. A review of mushrooms as a potential source of dietary vitamin D. Nutrients. 2018;10(10):1498.

    Article  Google Scholar 

  43. Armas LAG, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004;89:5387–91.

    Article  CAS  Google Scholar 

  44. Holick MF, Biancuzzo RM, Chen TC, Klein EK, Young A, Bibuld D, et al. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab. 2008;93:677–81.

    Article  CAS  Google Scholar 

  45. Baig JA, Sheikh SA, Islam I, Kumar M. Vitamin D status among vegetarians and non-vegetarians. J Ayub Med Coll Abbottabad. 2013;25(1-2):152–5.

    PubMed  Google Scholar 

  46. Higdon J, Drake VJ, Delage B, Miller JW. Vitamin B12. Micronutrient Information Center, Linus Pauling Institute, Oregon State University, Corvallis, OR. 4 June 2015. https://lpi.oregonstate.edu/mic/vitamins/vitamin-B12. Accessed 26 April 2019.

  47. Pawlak R, Parrott SJ, Raj S, Cullum-Dugan D, Lucus D. How prevalent is vitamin B12 deficiency among vegetarians? Nutrition Reviews. 2013;71(2):110–7 https://doi-org.libproxy.uthscsa.edu/10.1111/nure.12001.

    Article  Google Scholar 

  48. Madry E, Lisowska A, Grebowiec P, Walkowiak J. The impact of vegan diet on B-12 status in healthy omnivores: five-year prospective study. Acta Sci Pol Technol Aliment. 2012;11(2):209–13.

    PubMed  Google Scholar 

  49. Jung SB, Nagaraja V, Kapur A, Eslick GD. Association between vitamin B12 deficiency and long-term use of acid-lowering agents: a systematic review and meta-analysis. Internal Medicine J. 2015;45(4):409–16.

    Article  CAS  Google Scholar 

  50. Wang H, Li L, Qin LL, Song Y, Vidal-Alaball J, Liu TH. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database Syst Rev. 2018;(3):CD004655. https://doi.org/10.1002/14651858.CD004655.pub3.

  51. DeVault KR, Talley NJ. Insights into the future of gastric acid suppression. Nat Rev Gastroenterol Hepatol. 2009;6(9):524–32. https://doi.org/10.1038/nrgastro.2009.125.PMID19713987.

    Article  CAS  PubMed  Google Scholar 

  52. Bensky MJ, Ayalon-Dangur I, Ayalon-Dangur R, Naamany E, Gafter-Gvili A, Koren G, et al. Comparison of sublingual vs intramuscular administration of vitamin B12 for the treatment of patients with vitamin B12 deficiency. Drug Deliv. And Transl. Res. 2019;9:625–30. https://doi.org/10.1007/s13346-018-00613-y.

    Article  CAS  Google Scholar 

  53. Office of Dietary Supplements. Iron. National Institutes of Health Dec 2018. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/. Accessed 26 April 2019.

  54. Higdon J, Drake VJ, Delage B, Wesling-Resnick M. Iron. Micronutrient Information Center, Linus Pauling Institute, Oregon State University, Corvallis, Oregon. April 2016. https://lpi.oregonstate.edu/mic/minerals/iron. Accessed 26 April 2019.

  55. Sliwinska A, Luty J. Aleksandrowicz- Wrona E. Iron status and dietary iron intake in vegetarians. Adv Clin Exp Med. 2018;27(10):1383–9.

    Article  Google Scholar 

  56. Higdon J, Drake VJ, Delage B, Weaver CM. Calcium. Micronutrient Information Center, Linus Pauling Institute, Oregon State University, Corvallis, OR. Sept 2017. https://lpi.oregonstate.edu/mic/minerals/calcium. Accessed 26 April 2019.

  57. Pawlak R, Berger J, Hines I. Iron status of vegetarian adults: a review of literature. Am J Lifestyle Med. 2018;12(6):486–98.

    Article  Google Scholar 

  58. Stoffel NU, Cercamondi CI, Brittenham PG, et al. Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomized controlled trials. Lancet Haematology. 2017;4(11):PE524–33. https://doi.org/10.1016/S2352-3026(17)30182-5.

    Article  Google Scholar 

  59. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/.

  60. Office of Dietary Supplements. Zinc. National Institutes of Health March 2019. https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/#ref. Accessed 26 April 2019.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jason P. Rocha.

Ethics declarations

Conflict of Interest

Jason P. Rocha, Janese Laster, Bhavyata Parag, and Nihar U. Shah declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Gastroenterology, Critical Care, and Lifestyle Medicine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rocha, J.P., Laster, J., Parag, B. et al. Multiple Health Benefits and Minimal Risks Associated with Vegetarian Diets. Curr Nutr Rep 8, 374–381 (2019). https://doi.org/10.1007/s13668-019-00298-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13668-019-00298-w

Keywords

Navigation