Lipid Differences Between Omnivores And Vegetarian Or Vegans

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The elderly vegetarian, particularly the elderly vegan, is in a protective life-style that minimizes ischemic damage, plaque formations, and lipid depositions involved in atherosclerotic disease, hypertension, stroke, or rheumatic heart disease. Plant dietary protein minimizes endogenous

Table 11.1 Mortality Ratios (95% Confidence Interval) for Smoking and Six Dietary Factors After Adjustment For Age and Sex and For Age, Sex and Smoking (4336 Men and 6435 Women)

Ischemic

Cerebro-

Breast

All Cause

Heart

vascular

Colorectal

Cancer

Mortality

Disease

Disease

Cancer

(Women)

Age and

Age and

Age and

Lung Cancer

Age and

Age and

Factor

Sex

Sex

Sex

Age and Sex

Sex

Sex

Current Smoker

1.52 (1.34

1.43 (1.11 to

1.53 (1.02 to

5.43 (3.22 to

0.92 (0.45

1.01 (0.50

to 1.73)**

1.84)**

2.20)*

0.14)**

to 1.87)

to 2.02)

Pipe or cigars

1.22 (0,96

1.49 (1.02 to

1.44 (0.72 to

1.96 (0.67 to

0.72 (0.17

*

only

to 1.55)

2.18)*

2.91)

5.73)

to 3.05)

1-14 cigarettes/

1.39 (1.15

1.42 (0.97 to

1/05 (0.53 to

3.70 (1.68 to

1.21 (0.48

1.25 (0.57

day *

to 1.69**

2.09)

2.06)

8.15)**

to 3.01)

to 2.74)

15 cigarettes/

2.00 (1.66

1.36 (0.87 to

2.42 (1.36 to

11.28 (6.26 to

0.68 (0.17

0.60 (0.16

day

to 2.42)**

2.12)

4.31)**

20.28)**

to 2.79)

to 2.30)

Vegetarian

0.98 (0.88

0.82 (0.66 to

0.91 (0.66 to

0.79 (0.46 to

0.79 (0.47

1.64 (1.01

to 1.10)

1.02)

1.27)

1.35)

to 1.33)

to 2.67)*

Whitemeal

0.83 (0.75

0.82 (0.66 to

1.02

0.76 (0.45 to

1.08 (0.63

1.08 (0.65

bread daily

to 0.98)*

1.02)

(0.72-145)

1.28)

to 1.86)

to 1.81)

Bran cereals,

0.97 (0.86

0.98 (0.78 to

0.91 (0.63 to

0.40 (0.19 to

1.05 (0.61

0.68 (0.37

daily

to 1.10)

1.24)

1.31)

0.84)*

to 1.81)

to 1.24)

Nuts or dried

0.93 (0.83

0.86 (0.79 to

0.76 (0.54 to

0.53 (0.29 to

0.75 (0.44

1.40 )0.86

fruit

to 1.04)

1.07)

1.06)

0.95)

to 1.27)

to 2.29)

Fresh fruit daily

0.74 (0.66

0.73 (0.58 to

0.63 (0.44 to

0.40 (0.24 to

0.73 (0.41

0.75 (0.42

to 0.84)**

0.93)**

0.91)*

0.68)**

to 1.30)

to 1.34)

Raw salad daily

0.87 (0.789

0.72 (0.58 to

1.15 (0.83 to

0.67 (0.39 to

0.79 (0.48

1.15 (0.71

to 0.97)*

0.89)**

1.59)

1.16)

to 1.33)

to 1.88)

*Two tailed p < 0.05, **p < 0.01. Categories: nonsmoker, pipe or cigars only; 1-14 cigarettes/day, > 15 cigarettes/day, ***includes current cigarette smokers, (8 men and 13 women). **** The 33 women who smoked pipe or cigar only were included in the category 1-14 cigarettes/day along with the 13 women who did not declare how much they smoked. Adapted from Key, T.J.A., Thorogood, M., Appleby, P.N., and Burr, M.I. Dietary habits and mortality in 11,000 vegetarians and health conscious people: results of a 17-year follow up. BMJ, 313, 775, 1996. With permission from the BMJ Publishing Group.40

cholesterol and triacylglycerol production as previously discussed. Exogenous plant dietary fat supplies a dominance of unsaturated to saturated fatty acids to minimize not only the atherosclerotic diseases, but also several of the rheumatoid states, the mineral problems of osteoporosis, and possibly several types of cancer by the inclusion of polyunsaturated fatty acids (PUFA).3,40,41 This protective diet combined with adequate exercise inhibits the initiation of these diseases before they reach the lipid deposition stages by decreasing the initial free radical attack with antiox-idants. For example, in coronary artery disease (CAD), the vegetarian or vegan diet supplies the antioxidant vitamins and minerals from a high content of grains, fruits, vegetables, nuts, and seeds.3,40,41 The high antioxidant intake of this diet for the elderly appears in detail in the accessory growth factor section that follows.

The dominance of unsaturated fat to saturated fat of the vegetarian diet lowers total cholesterol and LDL-C levels. The saturated fatty acids (SFA) lauric (C12:O), myristic (C14:O), and palmitic (C16:O) are very hypercho-lesterolemic. Palmitic acid is the dominant fatty acid synthesized in the human body from excess calories that are converted to fat.42 Thus, the elderly vegetarian on a plant protein diet does not synthesize large amounts of palmitic acid. The SFA, stearic acid (C18:O), has no effect on blood lipoproteins and is considered neutral, with moderate amounts of dietary carbohydrate.43 Of all the added dietary fats, the most hypercholesterolemic are palm-kernel, coconut, and palm oils, and butter. SFA raise LDL-C by decreasing LDL receptor synthesis and activity. All fatty acids will lower fasting triglycerides if they replace carbohydrates in the diet.44 The most significant way to lower LDL-C and raise HDL is to replace carbohydrate with linoleic acid (C18:2), the predominant omega-6 polyunsaturated fatty acid (PUFA). This is most dominant on an all-plant diet where less than 30% of the kilocalories of the diet is fat, and one half to two thirds of that 30% are MUFA (monounsaturated fatty acid) and PUFA.45 Decreasing SFA, however, is twice as effective in lowering serum cholesterol levels as increasing PUFA.46 The PUFA:saturated fat ratio average is approximately 0.64 in the omnivore population, and 1.36 with a vegan population.47-49

Mediterranean-type diets have significant health benefits, supposedly because of the MUFA, namely oleic acid, in olive oil. MUFA substitution for SFA in diets of 23 healthy Northern European males significantly lowered LDL cholesterol concentrations (p = 0.01) along with postprandial factor VII activation, but postprandial triacylglycerols were significantly greater (p = 0.003).50 A similar study of Southern Europeans51 showed plasma triacylglycerol concentrations were much greater during the early postprandial phase and returned to near-fasting concentrations much earlier than in the Northern Europeans.50 Diets high in olive oil appear to promote gastrointestinal secretions and stimulate stomach emptying, which could translate to faster lipid absorption.52 The previous higher exposure to olive oil by the Southern Europeans may, however, invalidate the short period of 6 to 8 weeks of these experiments.51 When omega-3 fatty acid supplements are added to an olive oil regimen, the triacylglyerols can be significantly lowered.53

The phyto-compounds in olive oil may also play a role in decreased platelet aggregation. A study comparing the effects of two monounsat-urated fatty acid-rich oils, extra virgin olive oil (EVOO) and high oleic sunflower oil (HOSO), compared platelet aggregation in 14 postmeno-pausal women in their 60s who all had high-fat dietary intake habits. Both oils had approximately 76% oleic acid, but the content of palmitic and linoleic acids and other minor constituents were significantly different. These oils were used as the only culinary fats during two 28-day periods and represented approximately 62% of the total lipid intake (46% of total energy consumption). Other dietary components were very closely matched. Platelet aggregation was significantly lower after the EVOO diet than after HOSO (p < 0.05). Here, where every effort was made to have equal amounts of oleic acid between the EVOO and the HOSO diets, there was a significant difference in platelet aggregation values. The authors felt that other phyto-compounds present in the oils, aside from the fatty acids, probably played an important role in modulating platelet aggregation in this study.54,55

The PUFA are divided into omega-3, omega-6 and omega-9 groups. The omega-3 and omega-6 PUFA groups contain the two essential fatty acids — linoleic acid, an omega-6 fatty acid, and alpha-linolenic acid, an omega-3 fatty acid (Figure 11.3).42 Underlying the necessity of meeting the alpha-linolenic acid requirement are the demonstrated effects of omega-3 fatty acids in suppressing carcinogenesis, allergic hyperactivity, thrombotic tendency, apoplexy, hypertension, hypertriglyceridemia, and aging in animals. The suppression of allergic hyperactivity is a suppression of the immune system, particularly marked with fish oils as the source of the omega-3 fatty acids, as a combination of alpha-linolenic, eicosapentaenoic (EPA) and docosapentaenoic acids (DHA) fatty acids.56 Fish oils can improve the conditions of patients involved in overactive immune responses, particularly rheumatoid arthritis.57 Overall, omega-3 fatty acids are protective against the lipid peroxide insult in aging, carcinogenesis, and chronic diseases. An equal or marginal excess of omega-6 to omega-3 fatty acid intake is recom-mended.58 An excess of omega-3 to omega-6 in dietary intake decreases the phospholipid content of omega-6 fatty acids with a rapid responsive exchange in cell membrane phospholipid fatty acid content.59

Well-known plant sources of alpha-linolenic acid, the shortest of the omega-3 fatty acids, are the oils of canola, flaxseed, walnut, and soy. Animal sources for alpha-linolenic acid are fish and seal oils, which also contain significant amounts of EPA and DHA. Dietary inclusion of alpha-linolenic acid can provide excellent therapeutic properties to lower elevated body triacylglycerol levels. Large doses of alpha-linolenic acid over months, particularly from fish oils, significantly increases bleeding time, somewhat akin to taking several aspirin tablets per day.60 Marine-origin omega-3 fatty acids lower systolic blood pressure and triacylglycerols, but raise LDL cholesterol, while plant source alpha-linolenic, also an omega-3 fatty acid, has no effect on LDL.61 The essential fatty acids — gamma-linolenic acid (GLA), an omega-6 fatty acid, and EPA, an omega-3 fatty acid — have strong anticarcinogenic properties.62

n-6 EFAs n-3 EFAs

Linoleic 18:2n-6 18:3n-6 Alpha-linolenic

  • LA) I . .. _ . . I (ALA)
  • delta-6-desaturase^

Gamma-linolenic 18:3n-6 18:4n-3

Dihomogamma- 20:3n-6 20:4n-3

linolenic (DGLA)

" delta-5-desaturase

Arachidonic 20:4n-6 20:5n-3 Elcosapentaenoic

Adrenic 22:4n-6 22:5n-3

^ delta-4-desaturase^

22:5n-6 22:6n-3 Docosahexaenoic

Figure 11.3 Outline of the metabolism of the omega-6 and omega-3 essential fatty acid series. Adapted from Horribin.72

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