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Low-Fat, Plant-Based Approach RESEARCH Research and Professional Briefs A Very-Low-Fat Vegan Diet Increases Intake of Protective Dietary Factors and Decreases Intake of Pathogenic Dietary Factors ANTONELLA DEWELL, MS, RD; GERDI WEIDNER, PhD; MICHAEL D. SUMNER, PhD; CHRISTINE S. CHI; DEAN ORNISH, MD intervention group compared to controls. These results ABSTRACT suggest that a very-low-fat vegan diet can be useful in There is increasing evidence that dietary factors in plant- increasing intake of protective nutrients and phytochemi- based diets are important in the prevention of chronic cals and minimizing intake of dietary factors implicated disease. This study examined protective (eg, antioxidant in several chronic diseases. vitamins, carotenoids, and fiber) and pathogenic (eg, sat- J Am Diet Assoc. 2008;108:347-356. urated fatty acids and cholesterol) dietary factors in a very-low-fat vegan diet. Ninety-three early-stage prostate cancer patients participated in a randomized controlled he prominent role of diet and other lifestyle factors in trial and were assigned to a very-low-fat (10% fat) vegan the prevention of chronic disease is widely accepted diet supplemented with soy protein and lifestyle changes T(1-6). Diet patterns emphasizing plant foods appear or to usual care. Three-day food records were collected at to be protective against several types of cancer, cardio- baseline (nϭ42 intervention, nϭ43 control) and after 1 vascular disease (CVD), diabetes, age-related macular year (nϭ37 in each group). Analyses of changes in dietary degeneration, and overall mortality (5,7-15). One benefit intake of macronutrients, vitamins, minerals, carote- of plant-based diets is that they contain very low or neg- noids, and isoflavones from baseline to 1 year showed ligible amounts of saturated fat and are devoid of choles- significantly increased intake of most protective dietary terol. However, there is growing evidence that the inclu- factors (eg, fiber increased from a mean of 31 to 59 g/day, sion of several protective dietary factors inherently lycopene increased from 8,693 to 34,464 ␮g/day) and sig- present in plant foods (eg, antioxidants, carotenoids, and nificantly decreased intake of most pathogenic dietary fiber) may confer benefits that are superior to mere avoid- factors (eg, saturated fatty acids decreased from 20 to 5 ance of pathogenic factors such as saturated fat and cho- g/day, cholesterol decreased from 200 to 10 mg/day) in the lesterol (7,15-20). For example, a recent ecologic study investigating the association between well-known cardio- protective nutrients (eg, folate, carotenoids, and fiber) A. Dewell is a research project coordinator, Stanford and coronary mortality, found that 86% to 90% of the Prevention Research Center, Stanford University School variation in coronary mortality in 19 European countries of Medicine, Stanford, CA; at the time of the study, she could be explained by low consumption of folate and fiber was a research dietitian, Preventive Medicine Research and a high n-6:n-3 fatty acid ratio (21). Institute, Sausalito, CA. G. Weidner is vice president The aim of this study was to examine intake of protec- and director of research, Preventive Medicine Research tive and pathogenic dietary factors in a very-low-fat Institute, Sausalito, CA. M. Sumner is a research fellow, vegan diet used in the Prostate Cancer Lifestyle Trial Thelton E. Henderson Center for Social Justice, Univer- (13). sity of California, Berkeley; at the time of the study, he was a postdoctoral fellow, Preventive Medicine Research Institute, Sausalito, CA. C. S. Chi is a graduate student METHODS at the Department of Nutrition and Food Science, San Participants were men with early-stage prostate cancer Jose State University, San Jose, CA; at the time of the (active surveillance) enrolled in the Prostate Cancer Life- study, she was a research and clinical nutrition assistant, style Trial, a randomized clinical trial investigating the Preventive Medicine Research Institute, Sausalito, CA. effect of comprehensive lifestyle changes on the progres- D. Ornish is founder and president, Preventive Medicine sion of prostate cancer. The University of California–San Research Institute, and a clinical professor of medicine, Francisco Committee on Human Research Institutional University of California, San Francisco, Sausalito, CA. Review Board approved this study. The intervention, in- Address correspondence to: Gerdi Weidner, PhD, Vice cluding dietary counseling, and main findings from this President and Director of Research, Preventive Medicine study have been reported previously (13,22,23). Briefly, Research Institute, 900 Bridgeway, Sausalito, CA participants in the intervention group were asked to fol- 94965. E-mail: [email protected] low an intensive lifestyle program, including an ad libi- Copyright © 2008 by the American Dietetic tum very-low-fat vegan diet (22), moderate aerobic exer- Association. cise, stress management, and social group support. To 0002-8223/08/10802-0005$34.00/0 achieve a fat intake of approximately 10% of energy from doi: 10.1016/j.jada.2007.10.044 fat, participants were instructed by a registered dietitian © 2008 by the American Dietetic Association Journal of the AMERICAN DIETETIC ASSOCIATION 347 Table 1. Changes in dietary intake from baseline to 1 year for intervention and control participants (nϭ37 each) in a study of the effects of a very-low-fat vegan diet in men with early-stage prostate cancera Intervention vs Baseline vs Group؋time Variable Baseline 1 y control group 1y interaction 4 meanϮstandard deviation 34™™™™™™™™™™™™™™™ P value ™™™™™™™™™™™™™™™3 Energy and macronutrients Energy (kcal) Intervention 2,077Ϯ512x 2,283Ϯ603xy 0.058 0.522 0.040 Control 2,052Ϯ482x 1,942Ϯ482xz Fat (g) Intervention 68Ϯ36x 27Ϯ10y 0.003 0.001 0.001 Control 65Ϯ27x 60Ϯ26x Energy from fat (%) Intervention 28Ϯ9x 11Ϯ3y 0.001 0.001 0.001 Control 28Ϯ9x 27Ϯ9x Saturated fatty acids (g) Intervention 20Ϯ13x 5Ϯ2y 0.002 0.001 0.001 Control 20Ϯ13x 18Ϯ11x Energy from saturated fatty acids (%) Intervention 8.1Ϯ4x 1.8Ϯ1y 0.001 0.001 0.001 Control 8.7Ϯ5x 8Ϯ5x Monounsaturated fatty acids (g) Intervention 25Ϯ16x 7Ϯ3y 0.001 0.001 0.001 Control 25Ϯ11x 22Ϯ11x Energy from monounsaturated fatty acids (%) Intervention 10Ϯ4x 3Ϯ1y 0.001 0.001 0.001 Control 11Ϯ4x 10Ϯ4x Polyunsatured fatty acids (g) Intervention 17Ϯ9x 11Ϯ5y 0.581 0.006 0.018 Control 15Ϯ6x 14Ϯ6xy Energy from polyunsatured fatty acids (%) Intervention 6.8Ϯ3x 4.4Ϯ1y 0.026 0.000 0.001 Control 6.6Ϯ3x 6.5Ϯ2x n-3 Fatty acids (g) Intervention 1.9Ϯ1 1.6Ϯ1 0.029 0.091 0.624 Control 2.6Ϯ32Ϯ1 n-6 Fatty acids (g) Intervention 15Ϯ8x 10Ϯ4y 0.877 0.008 0.006 Control 12Ϯ5x 13Ϯ5xy n-6:n-3 Intervention 8.6Ϯ5x 6.9Ϯ2x 0.080 0.281 0.025 Control 6.4Ϯ3x 7Ϯ3x Trans-fatty acids (g) Intervention 3.4Ϯ3x 0.8Ϯ1y 0.004 0.001 0.002 Control 4.1Ϯ4x 3.7Ϯ3x Polyunsaturated fatty acid:saturated fatty acid Intervention 1.16Ϯ0.6x 2.46Ϯ0.4y 0.001 0.001 0.001 Control 1.1Ϯ0.8x 1.19Ϯ0.7x Cholesterolb (mg) Intervention 200Ϯ139x 10Ϯ24y 0.001 0.001 0.001 Control 222Ϯ150x 175Ϯ130x Cholesterol to saturated fatty acid index Intervention 30Ϯ19x 5Ϯ2y 0.001 0.001 0.001 Control 32Ϯ20x 27Ϯ17x Protein (g) Intervention 80Ϯ21x 115Ϯ35y 0.001 0.001 0.001 Control 79Ϯ22x 83Ϯ27x Energy from protein (%) Intervention 16Ϯ4x 20Ϯ4y 0.021 0.001 0.001 Control 16Ϯ4x 17Ϯ4x (continued) 348 February 2008 Volume 108 Number 2 Table 1. Changes in dietary intake from baseline to 1 year for intervention and control participants (nϭ37 each) in a study of the effects of a very-low-fat vegan diet in men with early-stage prostate cancera (continued) Intervention vs Baseline vs Group؋time Variable Baseline 1 y control group 1y interaction Animal proteinb (g) Intervention 39Ϯ21x 2Ϯ6y 0.001 0.001 0.001 Control 39Ϯ22x 39Ϯ23x Vegetable protein (g) Intervention 40Ϯ17x 112Ϯ36y 0.001 0.001 0.001 Control 40Ϯ23x 43Ϯ28x Carbohydrate (g) Intervention 294Ϯ79x 430Ϯ119y 0.001 0.001 0.001 Control 286Ϯ95x 273Ϯ84x Energy from carbohydrate (%) Intervention 57Ϯ13x 75Ϯ5y 0.001 0.001 0.001 Control 56Ϯ12x 57Ϯ12x Total sugars (g) Intervention 119Ϯ49x 149Ϯ56y 0.024 0.041 0.003 Control 113Ϯ48x 108Ϯ45x Added sugars (g) Intervention 56Ϯ34 51Ϯ31 0.651 0.571 0.347 Control 50Ϯ28 52Ϯ31 Fructose (g) Intervention 30Ϯ16x 54Ϯ26y 0.001 0.001 0.001 Control 28Ϯ13x 27Ϯ14x Galactose (g) Intervention 0.56Ϯ0.9x 0.18Ϯ0.2x 0.867 0.208 0.017 Control 0.33Ϯ0.4x 0.45Ϯ0.8x Glucose (g) Intervention 31Ϯ14x 48Ϯ22y 0.001 0.001 0.001 Control 28Ϯ14x 27Ϯ13x Lactose (g) Intervention 8.4Ϯ8x 0.5Ϯ1y 0.003 0.001 0.001 Control 9.7Ϯ10x 8.8Ϯ8x Maltose (g) Intervention 3.8Ϯ3x 6.6Ϯ4y 0.010 0.001 0.001 Control 3.7Ϯ3 3.6Ϯ3x Sucrose (g) Intervention 46Ϯ26 39Ϯ16 0.970 0.141 0.433 Control 44Ϯ28 42Ϯ24 Starch (g) Intervention 123.9Ϯ38x 189.8Ϯ54y 0.001 0.001 0.001 Control 121.4Ϯ47x 117.8Ϯ39x Total fiber (g) Intervention 31Ϯ14x 59Ϯ24y 0.001 0.001 0.001 Control 31Ϯ17x 30Ϯ14x Soluble fiber (g) Intervention 8Ϯ3x 15.6Ϯ7y 0.001 0.001 0.001 Control 8.2Ϯ4x 8Ϯ3x Insoluble fiber (g) Intervention 23Ϯ11x 43Ϯ17y 0.001 0.001 0.001 Control 22Ϯ13x 22Ϯ11x Vitamins Vitamin A (␮gREc) Intervention 1,681Ϯ1,372x 2,481Ϯ1,665y 0.751 0.321 0.001 Control 2,195Ϯ1,927x 1,762Ϯ1,357xy Vitamin D (␮g) Intervention 4.4Ϯ3x 6.4Ϯ3x 0.590 0.497 0.028 Control 6.3Ϯ6x 5.2Ϯ4x Vitamin E (mg) Intervention 12Ϯ11x 18Ϯ9y 0.591 0.101 0.012 Control 14Ϯ17x 12Ϯ17xy (continued) February 2008 ● Journal of the AMERICAN DIETETIC ASSOCIATION 349 Table 1. Changes in dietary intake from baseline to 1 year for intervention and control participants (nϭ37 each) in a study of the effects of a very-low-fat vegan diet in men with early-stage
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