Still in his hospital bed after a massive heart attack, Kevin Smith was already making plans to live a healthier lifestyle once he got back home. One big change the "Clerks" director was hoping to make was to switch to a vegan diet, according to a recent post on his Facebook page.
While avoiding a greasy junk food diet is a good start for Smith — who dropped 85 pounds in 2015 — there’s not a lot of evidence that going vegan protects the heart, experts say.
But, vegetarian might be a better choice.
In fact, a study published this week found that a vegetarian diet that includes eggs and milk is as good as the Mediterranean diet when it comes to protecting against heart disease.
Both diets led to weight loss, lower body mass index (BMI) and lower fat mass, according to the research published in the journal Circulation. The vegetarian diet also was associated with lower bad, or LDL, cholesterol.
Even though vegan may seem close to vegetarian, there is a difference between lacto-ovo-vegetarian and vegan diets, "not only from the nutritional point of view, but also in terms of cardiovascular prevention,” said the study’s lead author, Dr. Francesco Sofi, an associate professor of food science and clinical nutrition at the University of Florence. “We have data on beneficial effects of the vegetarian diet and not of the vegan diet for reducing the risk of heart attack.”
A 2017 study coauthored by Sofi combined data from a host of earlier studies in what is known as a meta-analysis. That study found that while vegetarian diets seemed protective against heart disease, vegan diets did not.
That isn’t Sofi’s only concern about vegan diets.
“A vegan diet can cause health problems due to the lack of proteins, minerals and some vitamins including vitamin B12,” he said.
Ultimately, people who want to eat healthy should be looking for a complete diet, rather than one that just excludes particular foods, said Cheryl Anderson, an associate professor and interim chair in the department of family medicine and public health at the University of California, San Diego, School of Medicine. Anderson wrote an editorial to accompany the Circulation study.
Someone who doesn't eat meat, but consumes a lot of salt and fat, isn’t going to get health benefits from their diet, Anderson said.
The real improvement in heart disease risk factors is not from to what is taken out of the diet but “because of the increased consumption of a variety of fruits and vegetables, whole grains, legumes and nuts,” said Gretchen Zehner, a dietician with the Heart and Vascular Institute at the University of Pittsburgh Medical Center.
The addition of those foods can help bring down weight, blood pressure and lipids, Zehner said.
If someone doesn't want to be vegetarian, following a Mediterranean diet has been shown to lower heart disease risk. The Mediterranean diet includes:
- fatty fish like salmon, tuna and sardines
- whole grains
- fruits and vegetables
- lean dairy
- healthy fats like olive oil
- a little alcohol
Turn back the clock?
Since nutrition studies often depend on healthy volunteers, it’s hard to know how much impact a diet change will have for someone who has already had a heart attack.
Lifestyle changes may not be able to completely turn back the clock on risk factors, Anderson said. “But that doesn’t mean you should throw in the towel,” she added. “While you may not be as well situated as someone who never developed those risk factors, trying to manage them now will pay off down the road.”
Anderson was happy to see Smith posting about his health on Facebook.
“It’s always good when someone shares a personal health story,” she said. “It has the potential to inspire millions of people.”