 We all want to eat the kinds of foods that make us feel better and live longer, but there's so much conflicting information out there. So many nutrition opinions. Welcome to the Nutrition Facts podcast. I'm your host, Dr. Michael Greger. It's my job to give you the information you need to make the healthiest choices possible. Today, we take a close look at the pros and cons of plant-based eating. Vegetarian diets and lifestyles have been shown to reduce the risk of many chronic diseases, which now accounts for the major global burden of disease. But the actual direct medical costs had never been quantified before. Here's what they found. Same amount spent on dental work, but compared to meat-eaters that similarly don't smoke or drink, or compared to the general population, vegetarians had significantly lower inpatient, outpatient, and total medical care expenditures, suggesting more plant-based eating could be an effective strategy to save on health care costs. Here's how it broke down. Significantly lower costs for chronic lifestyle conditions, such as high blood pressure and high cholesterol. This makes sense. Those eating plant-based diets centered around whole plant foods nailed the targets for cholesterol, triglycerides, and systolic and diastolic blood pressure, 93% of the time, 97% of the time, 88% of the time, and 95% of the time, respectively. Nearly a 50% drop in medical costs due to depression too, that's interesting, as well as lower costs across the board. Cerebrovascular disease is another name for stroke. Wasn't there that study that showed vegetarians had higher stroke risk? True, but that was before two subsequent studies found a lower risk of stroke with a vegetarian diet, and not just by a little. For ischemic stroke, the most common clotting type of stroke, vegetarians consistently had about 60% lower risk, and for bleeding strokes, about 65% lower risk than non-vegetarians, and this despite higher homocysteine due to lower vitamin B12 intake, which is what may have led to the higher stroke risk in the previous study. Overall, if you do a systematic review of all the major studies, a comprehensive meta-analysis found a significant protective effect of a vegetarian diet versus the incidence and or mortality from ischemic heart disease and incidence from total cancer, with a vegan diet referring about twice the reduced risk cancer-wise. You can also look at it the other way. What if you decide to stop eating vegetarian and start eating meat? The Adventist Health study looked at that and found that, compared to those who stayed vegetarian, those who started eating meat suffered a 231% increase risk of gaining weight, 166% increase in the risk of developing diabetes, 152% increase risk of having a stroke, and 146% increase risk of being diagnosed with heart disease. And if you keep eating meat, you may cut your lifespan by three and a half years, so better not just cut out meat, but cut it out for good. But it's not all or nothing. Even just cutting down may help. A food pattern that emphasizes plant-derived foods was found to be associated with a reduced risk of all-cause mortality, meaning living a significantly longer life. So there are multiple benefits, even eating in the direction of a more plant-based diet, but what about any risks? Despite concerns for protein deficiency, adequate amounts of protein, which means 0.8 grams per kilogram body weight, about 50 grams a day, can be consumed on a solely plant-based diet, as seen among the other billion-plus people around the world who don't eat meat. Vitamin B12 deficiency, on the other hand, is a very real concern without a regular reliable source, and I have videos on how to do that, either through supplements or fortified foods. One benefit you don't hear much about is the role our diets play in the emergence of pandemic infectious diseases, the subject of one of my recent books. It doesn't take much for a virus to jump from one animal to another, but there are no examples of plant viruses ever jumping to humans for the same reason. We don't ever come down with a really bad case of Dutch Elm disease. The largest and oldest association of nutrition professionals in the world is clear. Plant-based diets are appropriate for all stages of life cycle and may actually provide health benefits for the prevention and treatment of certain diseases. For example, vegetarians and vegans are at reduced risk of ischemic heart disease, type 2 diabetes, high blood pressure, certain types of cancers, and obesity. And to learn more, they encourage people to go check out a few good websites. As the emeritus dean of the School of Public Health at La Melinda once said at a nutrition conference, attitudes towards vegetarian diets have progressed from ridicule and skepticism to condescending tolerance to gradual and sometimes grudging acceptance and finally to acclaim. In our next story, we look at how healthier plant-based diets compare to unhealthy plant foods and animal foods for diabetes risk. In my video on flexitarians, I talk about how the benefits of eating a plant-based diet are not all or nothing. It's simple advice to increase the consumption of plant-derived foods with a parallel reduction in the consumption of foods from animal sources was found to confer a survival advantage, a live longer advantage. They call it a pro-vegetarian eating pattern, just moving in that direction as a more gradual, gentle, doable approach. If you're dealing with a serious disease, though, like diabetes, avoiding some problem foods completely may be easier than attempting to moderate their intake. It's like clinicians would never tell alcoholics to simply cut down on alcohol. Avoiding alcohol entirely is a more effective and ironically easier for a problem drinker. Paradoxically, asking patients to make a large change may be more effective than making a slow transition. Diet studies show that recommending more significant changes increases the changes that patients actually accomplish. It may help to replace the common advice all things in moderation with big changes beget big results. Success breeds success. After a few days or weeks of major dietary changes, patients are more likely to see improvements in weight and blood sugar levels, improvements that reinforce the dietary changes. Furthermore, they may enjoy other health benefits of plant-based eating that may give them further motivation. Those who choose to eat plant-based for their health say it's mostly for general wellness and disease prevention, or to improve their energy levels or immune function. They felt it gave them a sense of control over their health, helps you feel better emotionally, improves your overall health, and makes you feel better. Most felt it was very important for maintaining their health and well-being. For the minority, they used it for a specific health problem. It was mostly for high cholesterol or weight loss, followed by high blood pressure and diabetes. With most reporting, they felt it helped a great deal. But others choose plant-based diets for other reasons like animal welfare or global warming. It looks like they're more likely to be eating things like vegan donuts. Sugary and fatty foods compared to those eating plant-based because of religious or health reasons. I mean, the vegan as vegan could bake a cake using soda instead of eggs, with frosting covered in marshmallow fluff and chocolate syrup topped with Oreos with a side of Doritos tipped in vegan bacon grease. But fruit for dessert in the form of Pop Tarts and Krispy Kreme Paws. This is a vegan meal. Yes, plant-based diets have been recommended to reduce the risk of type 2 diabetes. However, not all plant foods are necessarily beneficial. Like in that pro-vegetarian scoring system, you got points for eating potato chips and french fries just because they were technically plant-based. But Harvard researchers wanted to examine the association of not only an overall plant-based diet, but both healthy and unhealthy versions. So they created the same kind of pro-vegetarian scoring systems weighted towards any sort of plant-based foods and against animal foods, and then also created a healthful plant-based diet index where at least some whole plant foods took precedence and Coca-Cola was no longer considered a plant. Then lastly, they created an unhealthy plant-based diet index by sending positive scores to processed plant-based junk and negative scoring healthier foods and animal foods. And then they found that a more plant-based diet in general was good for reducing diabetes risk, but eating especially healthy plant-based foods did better, nearly cutting risk in half, while those eating more unhealthy plant foods did worse. Now, but is that because they were also eating more animal foods? People often eat burgers with their fries, so they separated out the effects of healthy plant foods, less healthy plant foods, and animal food. And healthy plant foods were protectively associated, animal foods were detrimentally associated, and less healthy plant foods were more neutral when it came to diabetes risk. Higher diabetes risk with more and more animal foods, no protection whatsoever with junky plant foods, and lower and lower diabetes risk associated with more and more healthy whole plant foods in the diet. So they conclude that yes, plant-based diets are associated with substantially lower risk of developing type 2 diabetes risk, but it may not be enough to just lower the intake of animal food, but also less healthy plant foods as well. We would love it if you could share with us your stories about reinventing your health through evidence-based nutrition. Go to nutritionfacts.org slash testimonials which may be able to share it on social media to help inspire others. If you'd like to see any graphs, charts, graphics, images or studies mentioned here, go to the Nutrition Facts Podcast landing page. There you'll find all the detailed information you need, plus links to all the sources we cite for each of these topics. My last two books were How to Survive a Pandemic and My How Not to Diet Cookbook. Get ready this year for the launch of How Not to Age, and of course all the proceeds for the sales of all my books goes directly to charity. NutritionFacts.org is a non-profit science-based public service. We can sign up for free daily updates on the latest in nutrition research with bite-sized videos and articles uploaded nearly every day. Everything on the website is free. There are no ads, no corporate sponsorships, no kickbacks, strictly non-commercial, not selling anything. I just put it up as a public service as a labor of love as a tribute to my grandmother, whose own life was saved with evidence-based nutrition.