title: Gluten-free vegan diet induces decreased LDL and oxidized LDL levels and raised atheroprotective natural antibodies against phosphorylcholine in patients with rheumatoid arthritis: a randomized study Effects of a vegetarian diet and treatment preference on biochemical and dietary variables in overweight and obese adults: a randomized clinical trial. Cardiovascular disease risk factors in free-living men: comparison of two prudent diets, one based on lactoovovegetarianism and the other allowing lean meat. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with Type 2 diabetes Divergent changes in serum sterols during a strict uncooked vegan diet in patients with rheumatoid arthritis. Discordance between reported intention-to-treat and per protocol analyses. A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in the corporate setting: the GEICO study Dyslipidemia and Cardiovascular Disease: A Series of Epidemiologic Studies in Japanese Populations A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Intensive lifestyle changes for reversal of coronary heart disease. Toward improved management of NIDDM: A randomized, controlled, pilot intervention using a lowfat, vegetarian diet. Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women. The selective lipid-lowering effect of vegetarianism on low density lipoproteins in a cross-over experiment.
abstract: Introduction The purpose of this study was to investigate the effects of vegan diet in patients with rheumatoid arthritis ( RA ) on blood lipids oxidized low-density lipoprotein ( oxLDL ) and natural atheroprotective antibodies against phosphorylcholine ( anti-PCs ) . Methods Sixty-six patients with active RA were r and omly assigned to either a vegan diet free of gluten ( 38 patients ) or a well-balanced non-vegan diet ( 28 patients ) for 1 year . Thirty patients in the vegan group completed more than 3 months on the diet regimen . Blood lipids were analyzed by routine methods , and oxLDL and anti-PCs were analyzed by enzyme-linked immunosorbent assay . Data and serum sample s were obtained at baseline and after 3 and 12 months . Results Mean ages were 50.0 years for the vegan group and 50.8 years for controls .  Gluten-free vegan diet induced lower body mass index ( BMI ) and low-density lipoprotein ( LDL ) and higher anti-PC IgM than control diet ( p < 0.005 ) . In the vegan group , BMI , LDL , and cholesterol decreased after both 3 and 12 months ( p < 0.01 ) and oxLDL after 3 months ( p = 0.021 ) and trendwise after 12 months ( p = 0.090 ) . Triglycerides and high-density lipoprotein did not change . IgA anti-PC levels increased after 3 months ( p = 0.027 ) and IgM anti-PC levels increased trendwise after 12 months ( p = 0.057 ) . There was no difference in IgG anti-PC levels . In the control diet group , IgM anti-PC levels decreased both after 3 and 12 months ( p < 0.01 ) . When separating vegan patients into clinical responders and non-responders at 12 months , the effects on oxLDL and anti-PC IgA were seen only in responders ( p < 0.05 ) . Conclusion A gluten-free vegan diet in RA induces changes that are potentially atheroprotective and anti-inflammatory , including decreased LDL and oxLDL levels and raised anti-PC IgM and IgA levels BACKGROUND A vegetarian diet may lead to numerous health benefits , including weight loss . OBJECTIVE We examined the joint effects of personal preference of dietary treatment and a calorie-restricted , low-fat lactoovovegetarian diet ( LOV-D ) compared with a st and ard calorie-restricted , low-fat omnivorous diet ( STD-D ) on changes in weight , total cholesterol , ratio of LDL to HDL cholesterol ( LDL : HDL cholesterol ) , triacylglycerols , insulin resistance , and macronutrient intake during an 18-mo study . DESIGN This was a r and omized clinical trial of 176 overweight and obese adults who were recruited and r and omly assigned first to 1 of 2 preference conditions ( yes or no ) . If assigned to Preference-No , they were r and omly assigned to 1 of the 2 diet conditions ( STD-D or LOV-D ) . If assigned to Preference-Yes , they were assigned to the diet they indicated as preferred at screening . The 12-mo intervention was followed by a 6-mo maintenance phase . RESULTS Participants were mainly women ( 86.9 % ) and white ( 70.5 % ) ; 75 % completed the 18-mo study . A significant interaction between preference and dietary treatment was not observed for any of the outcome variables . However , participants in the Preference-No groups significantly decreased their triacylglycerols ( P = 0.04 ) . The only effect observed for diet was a borderline significant decrease in LDL : HDL cholesterol for the LOV-D group ( P = 0.06 ) . Within the LOV-D groups , those who were 100 % adherent to the LOV-D had significant and marginally significant reductions in monounsaturated fat ( P = 0.02 ) and total fat ( P = 0.05 ) intakes at 18 mo . CONCLUSIONS Our findings suggest that neither prescribing a vegetarian diet nor allowing persons to choose their preferred diet had a significant effect on outcome measures . However , all participants had a significant reduction in total energy and fat intakes and an increase in energy expenditure , which was reflected in reduced body weight . This clinical trial was registered at www . clinical trials.gov as NCT00330629 In general , vegetarians have lower serum lipids and blood pressures than omnivores have . We tested the blood pressure and serum lipid lowering effects of two fat-modified diets differing primarily in their source of protein . Twenty-six men were r and omized in an incomplete block design to two of three diets : a high-fat diet , a fat-modified lactoovovegetarian diet ( LOV ) and a diet in which 60 % of plant protein in the LOV was replaced with lean meat ( LM ) . Compared with the high-fat diet both prudent diets significantly lowered blood pressure , serum total cholesterol ( TC ) , and LDL cholesterol but significantly increased serum triglycerides . The LOV diet had a significantly greater cholesterol-lowering effect than did the LM diet ( 10 % vs 5 % decrease ) but blood pressure reductions were similar . The partial substitution of lean meat for plant protein in a fat-modified diet did not negate the overall cardiovascular-risk lowering of the lactoovovegetarian diet Aims The aim of this study was to compare the effects of calorie-restricted vegetarian and conventional diabetic diets alone and in combination with exercise on insulin resistance , visceral fat and oxidative stress markers in subjects with Type 2 diabetes . Methods A 24-week , r and omized , open , parallel design was used . Seventy-four patients with Type 2 diabetes were r and omly assigned to either the experimental group ( n = 37 ) , which received a vegetarian diet , or the control group ( n = 37 ) , which received a conventional diabetic diet . Both diets were isocaloric , calorie restricted ( -500 kcal/day ) . All meals during the study were provided . The second 12 weeks of the diet were combined with aerobic exercise . Participants were examined at baseline , 12 weeks and 24 weeks . Primary outcomes were : insulin sensitivity measured by hyperinsulinaemic isoglycaemic clamp ; volume of visceral and subcutaneous fat measured by magnetic resonance imaging ; and oxidative stress measured by thiobarbituric acid reactive substances . Analyses were by intention to treat . Results Forty-three per cent of participants in the experimental group and 5 % of participants in the control group reduced diabetes medication ( P < 0.001 ) . Body weight decreased more in the experimental group than in the control group [ –6.2 kg ( 95 % CI –6.6 to –5.3 ) vs. –3.2 kg ( 95 % CI –3.7 to –2.5 ) ; interaction group × time P = 0.001 ] . An increase in insulin sensitivity was significantly greater in the experimental group than in the control group [ 30 % ( 95 % CI 24.5–39 ) vs. 20 % ( 95 % CI 14–25 ) , P = 0.04 ] . A reduction in both visceral and subcutaneous fat was greater in the experimental group than in the control group ( P = 0.007 and P = 0.02 , respectively ) . Plasma adiponectin increased ( P = 0.02 ) and leptin decreased ( P = 0.02 ) in the experimental group , with no change in the control group . Vitamin C , superoxide dismutase and reduced glutathione increased in the experimental group ( P = 0.002 , P < 0.001 and P = 0.02 , respectively ) . Differences between groups were greater after the addition of exercise training . Changes in insulin sensitivity and enzymatic oxidative stress markers correlated with changes in visceral fat . Conclusions A calorie-restricted vegetarian diet had greater capacity to improve insulin sensitivity compared with a conventional diabetic diet over 24 weeks . The greater loss of visceral fat and improvements in plasma concentrations of adipokines and oxidative stress markers with this diet may be responsible for the reduction of insulin resistance . The addition of exercise training further augmented the improved outcomes with the vegetarian diet The effects of a strict uncooked vegan diet on serum lipid and sterol concentrations were studied in patients with rheumatoid arthritis . The subjects were r and omized into a vegan diet group ( n 16 ) , who consumed a vegan diet for 2 - 3 months  ,  or  into  a control group ( n 13 )  , who continued their usual omnivorous diets .  Serum total and LDL-cholesterol and -phospholipid concentrations were significantly decreased by the vegan diet . The levels of serum cholestanol and lathosterol also decreased , but serum cholestanol : total cholesterol and lathosterol : total cholesterol did not change . The effect of a vegan diet on serum plant sterols was divergent as the concentration of campesterol decreased while that of sitosterol increased . This effect result ed in a significantly greater sitosterol : campesterol value in the vegan diet group than in the control group ( 1.48 ( SD 0.39 ) v. 0.72 ( SD 0.14 ) ; P < 0.001 ) . A higher concentration of campesterol compared with sitosterol is normal in omnivorous subjects and can be explained by lower absorption and esterification rates of sitosterol . Our results suggest that a strict uncooked vegan diet changes the relative absorption rates of these sterols and /or their biliary clearance OBJECTIVE To quantify the degree of disagreement between the two most popular methods for dealing with missing data : intention to treat ( ITT ) and per protocol ( PP ) . STUDY DESIGN AND SETTING We performed a systematic review of r and omized two-armed clinical trials ( CTs ) published between 2001 and 2003 , abstract ed in PubMed and reporting both the ITT and PP analyses on a primary binary endpoint , out of which 74 papers were finally selected . The treatment effect of each CT was measured by the odds ratio , and the disagreement between them was quantified by the Bl and -Altman method . RESULTS On average , the PP estimator provides greater values Log(e)ORPP=1 x 25.Log(e)ORITT , ( 95 % CI : 1.15 , 1.35 ) than the corresponding ITT estimator , although the limits of concordance showed that the ratio between the two estimators varies greatly from 0.39 up to 2.53 . CONCLUSION These results confirm that missing values may cause both systematic and unpredictable bias in CTs . Further efforts should be made to minimize protocol deviations and to use better statistical methods to highlight the drawbacks of missing information . In the presence of protocol deviations , the conclusion of a CT can not rest on the single reporting of either the ITT or the PP approach alone Background / objectives : To determine the effects of a low-fat plant-based diet program on anthropometric and biochemical measures in a multicenter corporate setting .Subjects/ methods : Employees from 10 sites of a major US company with body mass index ⩾25 kg/m2 and /or previous diagnosis of type 2 diabetes were r and omized to either follow a low-fat vegan diet , with weekly group support and work cafeteria options available , or make no diet changes for 18 weeks . Dietary intake , body weight , plasma lipid concentrations , blood pressure and glycated hemoglobin ( HbA1C ) were determined at baseline and 18 weeks . Results : Mean body weight fell 2.9 kg and 0.06 kg in the intervention and control groups , respectively ( P<0.001 ) . Total and low-density lipoprotein ( LDL ) cholesterol fell 8.0 and 8.1 mg/dl in the intervention group and 0.01 and 0.9 mg/dl in the control group ( P<0.01 ) . HbA1C fell 0.6 percentage point and 0.08 percentage point in the intervention and control group , respectively (P<0.01).Among study completers , mean changes in body weight were −4.3 kg and −0.08 kg in the intervention and control groups , respectively ( P<0.001 ) . Total and LDL cholesterol fell 13.7 and 13.0 mg/dl in the intervention group and 1.3 and 1.7 mg/dl in the control group ( P<0.001 ) . HbA1C levels decreased 0.7 percentage point and 0.1 percentage point in the intervention and control group , respectively ( P<0.01 ) . Conclusions : An 18-week dietary intervention using a low-fat plant-based diet in a corporate setting improves body weight , plasma lipids , and , in individuals with diabetes , glycemic control Although the causal relationships of high serum levels of  total cholesterol  ( TC ) and low-density lipoprotein cholesterol ( LDL-C ) with coronary artery disease ( CAD ) are well established , there have been few community-based epidemiologic studies of these relations in Japan . Furthermore , even when analysis is restricted to ischemic stroke , the relationship between dyslipidemia and stroke is very weak . Accordingly , it is difficult to perform cohort studies of dyslipidemia and cardiovascular disease . A series of studies , such as the NIPPON DATA ( National Integrated Project for Prospect i ve Observation of Non-communicable Disease and Its Trends in the Aged ) cohort study of a representative sample of Japanese , have greatly increased existing evidence . NIPPON DATA 80 revealed a clear positive relationship between TC and CAD , and indicated that reverse causality between hypocholesterolemia and liver disease may increase all-cause mortality in hypocholesterolemic Japanese . NIPPON DATA 90 showed that serum high-density lipoprotein cholesterol ( HDL-C ) was inversely associated with all-cause mortality , even when HDL-C was very high . NIPPON DATA 80 revealed that low-normal levels of serum albumin and TC are associated with a decline in activity during old age , especially in women . The Suita study —a unique cohort study of urban residents — showed that LDL-C and non – HDL-C were equally accurate in predicting the incidence of myocardial infa rct ion . Further research of this quality is needed to ascertain the public health burden of dyslipidemia in Japan BACKGROUND Low-fat vegetarian and vegan diets are associated with weight loss , increased insulin sensitivity , and improved cardiovascular health . OBJECTIVE We compared the effects of a low-fat vegan diet and conventional diabetes diet recommendations on glycemia , weight , and plasma lipids . DESIGN Free-living individuals with type 2 diabetes were r and omly assigned to a low-fat vegan diet ( n = 49 ) or a diet following 2003 American Diabetes Association guidelines ( conventional , n = 50 ) for 74 wk . Glycated hemoglobin ( Hb A(1c ) ) and plasma lipids were assessed at weeks 0 , 11 , 22 , 35 , 48 , 61 , and 74 . Weight was measured at weeks 0 , 22 , and 74 . RESULTS Weight loss was significant within each diet group but not significantly different between groups ( -4.4 kg in the vegan group and -3.0 kg in the conventional diet group , P = 0.25 ) and related significantly to Hb A(1c ) changes ( r = 0.50 , P = 0.001 ) . Hb A(1c ) changes from baseline to 74 wk or last available values were -0.34 and -0.14 for vegan and conventional diets , respectively ( P = 0.43 ) . Hb A(1c ) changes from baseline to last available value or last value before any medication adjustment were -0.40 and 0.01 for vegan and conventional diets , respectively ( P = 0.03 ) . In analyses before alterations in lipid-lowering medications , total cholesterol decreased by 20.4 and 6.8 mg/dL in the vegan and conventional diet groups , respectively ( P = 0.01 ) ; LDL cholesterol decreased by 13.5 and 3.4 mg/dL in the vegan and conventional groups , respectively ( P = 0.03 ) . CONCLUSIONS Both diets were associated with sustained reductions in weight and plasma lipid concentrations . In an analysis controlling for medication changes , a low-fat vegan diet appeared to improve glycemia and plasma lipids more than did conventional diabetes diet recommendations . Whether the observed differences provide clinical benefit for the macro- or microvascular complications of diabetes remains to be established . This trial was registered at clinical trials.gov as NCT00276939 CONTEXT The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year . OBJECTIVES To determine the feasibility of patients to sustain  intensive lifestyle changes  for a total of 5 years and the effects of these lifestyle changes ( without lipid-lowering drugs ) on coronary heart disease . DESIGN R and omized controlled trial conducted from 1986 to 1992 using a r and omized invitational design . PATIENTS Forty-eight patients with moderate to severe coronary heart disease were r and omized to an  intensive lifestyle change group  or to a  usual-care control group  , and 35 completed the 5-year follow-up quantitative coronary arteriography . SETTING Two tertiary care university medical centers . INTERVENTION Intensive lifestyle changes ( 10 % fat whole foods vegetarian diet , aerobic exercise , stress management training , smoking cessation , group psychosocial support ) for 5 years . MAIN OUTCOME MEASURES Adherence to intensive lifestyle changes , changes in coronary artery percent diameter stenosis , and cardiac events . RESULTS Experimental group patients ( 20 [ 71 % ] of 28 patients completed 5-year follow-up ) made and maintained comprehensive lifestyle changes for 5 years , whereas control group patients ( 15 [ 75 % ] of 20 patients completed 5-year follow-up ) made more moderate changes . In the experimental group , the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year ( a 4.5 % relative improvement ) and by 3.1 absolute percentage points after 5 years ( a 7.9 % relative improvement ) . In contrast , the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year ( a 5.4 % relative worsening ) and by 11.8 percentage points after 5 years ( a 27.7 % relative worsening ) ( P=.001 between groups . Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up ( risk ratio for any event for the control group , 2.47 [ 95 % confidence interval , 1.48 - 4.20 ] ) . CONCLUSIONS More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group . In contrast , in the control group , coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred OBJECTIVE To investigate whether glycemic and lipid control in patients with non-insulin-dependent diabetes ( NIDDM ) can be significantly improved using a low-fat , vegetarian ( vegan ) diet in the absence of recommendations regarding exercise or other lifestyle changes . METHODS Eleven subjects with NIDDM recruited from the Georgetown University Medical Center or the local community were r and omly assigned to a low-fat vegan diet ( seven subjects ) or a conventional low-fat diet ( four subjects ) . Two additional subjects assigned to the control group failed to complete the study . The diets were not design ed to be isocaloric . Fasting serum glucose , body weight , medication use , and blood pressure were assessed at baseline and biweekly thereafter for 12 weeks . Serum lipids , glycosylated hemoglobin , urinary albumin , and dietary macronutrients were assessed at baseline and 12 weeks . RESULTS Although the sample was intentionally small in accordance with the pilot study design , the 28 % mean reduction in fasting serum glucose of the experimental group , from 10.7 to 7.75 mmol/L ( 195 to 141 mg/dl ) , was significantly greater than the 12 % decrease , from 9.86 to 8.64 mmol/L ( 179 to 157 mg/dl ) , for the control group ( P < 0.05 ) . The mean weight loss was 7.2 kg in the experimental group , compared to 3 . 8 kg for the control group ( P < 0.005 ) . Of six experimental group subjects on oral hypoglycemic agents , medication use was discontinued in one and reduced in three . Insulin was reduced in both experimental group patients on insulin . No patient in the control group reduced medication use . Differences between the diet groups in the reductions of serum cholesterol and 24-h microalbuminuria did not reach statistical significance ; however , high-density lipoprotein concentration fell more sharply ( 0.20 mmol/L ) in the experimental group than in the control group ( 0.02 mmol/L ) ( P < 0.05 ) . CONCLUSION The use of a low-fat , vegetarian diet in patients with NIDDM was associated with significant reductions in fasting serum glucose concentration and body weight in the absence of recommendations for exercise . A larger study is needed for confirmation Few controlled trials have studied cholesterol-lowering diets in premenopausal women . None has examined the cholesterol-lowering effect of a low-fat vegetarian diet , which , in other population groups , leads to marked reductions in serum cholesterol concentrations and , in combination with other life-style changes , a regression of atherosclerosis . We tested the hypothesis that a low-fat , vegetarian diet significantly reduces serum total and low-density lipoprotein ( LDL ) cholesterol concentrations in premenopausal women . In a crossover design , 35 women , aged 22 to 48 , followed a low-fat vegetarian diet deriving approximately 10 % of energy from fat for 2 menstrual cycles . For 2 additional cycles , they followed their customary diet while also taking a " supplement " ( placebo ) pill .  Serum lipid concentrations were assessed at baseline and during each intervention phase . Mean serum LDL , high-density lipoprotein ( HDL ) , and total cholesterol concentrations decreased 16 . 9 % , 16.5 % , and 13.2 % , respectively , from baseline to the intervention diet phase ( p<0.001 ) , whereas mean serum triacylglycerol concentration increased 18.7 % ( p<0.01 ) . LDL/HDL ratio remained unchanged . Thus , in healthy premenopausal women , a low-fat vegetarian diet led to rapid and sizable reductions in serum total , LDL , and HDL cholesterol concentrations In a cross-over experiment the effect of  short-term vegetarianism  on serum lipids , lipoproteins and apoproteins was studied . The experimental diet was free of animal products , with the exception of skim milk , and consequently low in saturated fat and cholesterol . Fifteen free-living individuals were r and omly assigned to 3-week periods on either the experimental diet or a control diet which closely approximated the usual intake in the U.S.A. Significant reductions in total cholesterol ( 12.5 % ) , low density lipoprotein cholesterol ( 14.7 % ) , and apo B ( 13.2 % ) were observed , accompanied by a non-significant decrease in high density lipoprotein cholesterol ( 10 % ) , apo A-I ( 3 % ) and a non-significant increase in apo-II ( 4 % ) . These data suggest that a fat-modified diet low in total fat , saturated fat and cholesterol , and moderate ( not high ) in polyunsaturated fat may not lower HDL-C or its apoproteins as much as a diet high in polyunsaturated fat , while having similar effects on LDL-C , and would therefore be preferable as the basis for primary prevention of atherosclerosis
target: Conclusions This systematic review and meta‐ analysis provides evidence that vegetarian diets effectively lower blood concentrations of total cholesterol , low‐density lipoprotein cholesterol , high‐density lipoprotein cholesterol , and non – high‐density lipoprotein cholesterol .
  Such diets could be a useful nonpharmaceutical means of managing dyslipidemia , especially hypercholesterolemia
background: Background Vegetarian diets exclude all animal flesh and are being widely adopted by an increasing number of people ; however , effects on blood lipid concentrations remain unclear .
  This meta‐ analysis aim ed to quantitatively assess the overall effects of  vegetarian diets on blood lipids .