By Donna Feldman, MS, RD

Want to reduce your risk for heart disease? Become a vegetarian. That's the simplistic message you might get from the media or from an enthusiastic vegetarian acquaintance. The real message on vegetarianism is not necessarily that simple. Plenty of people become vegetarians for reasons other than reducing the risk for heart disease. Entire cultures practice vegetarianism for religious reasons. Vegetarian cuisine features an enormous variety of delicious foods, but it isn't all necessarily heart healthy. Simply giving up meat does not guarantee lower cholesterol.

A vegetarian diet: does it lower the rates of heart disease?

An impressive body of evidence does suggest that some vegetarians do have lower rates of heart disease. Early studies focused on Seventh-day Adventists, followers of a particular sect of Christianity who live vegetarian lifestyles because of their belief in the holistic nature of humankind. For more than 130 years, members have been encouraged to follow a lacto-ovo vegetarian diet¹, meaning dairy products and eggs are permitted. Whole grains, fresh fruits, and vegetables are mainstays of the diet, and low-fat foods are recommended. Research findings from over 40 years show that Seventh-day Adventists in general have half the risk of developing heart disease compared to the general U.S. population. They also have a longer life expectancy. Whether this is due entirely to the avoidance of meat or to the emphasis on lower fat, whole grains, fruits, and vegetables is not so clear. Seventh-day Adventists also do not smoke.

Extreme vegetarianism does work

Dean Ornish could be called anti-Atkins. A medical doctor, he has made a career out of promoting his extreme vegetarian diet as a solution for heart disease, and he has successfully backed his claims with research. People who stick to his program do indeed reduce their risk factors for heart disease. The problem is sticking to his program. Ornish's premise is that modest changes, such as those recommended by the American Heart Association, do not work well. To reverse heart disease, drastic changes are needed. The diet is primarily fruit, vegetables, grains, and beans (no meat). The only animal products allowed are non-fat dairy and egg whites. Even vegetarian mainstays like vegetable oil, nuts, and avocado are nixed because they are high in fat. The Ornish plan is not simply a vegetarian diet, it is an extremely low-fat diet, with recommended levels less than 10%.

Vegetarian does not equal a healthy heart

It is actually possible to be an unhealthy vegetarian. Nuts, nut butters, fried foods, salad dressing, and avocadoes are all high in fat. If you include dairy, hard cheeses are very high fat. A diet that simply eliminates meat, without emphasizing beneficial low fat/high fiber plant foods is not going to help your heart health at all. If your vegetarian diet is based on cream-cheese avocado bagels, cheese pizza, and packaged snack foods, you are not doing yourself or your heart any favors by avoiding meat.

Some pitfalls being a vegetarian

If you want to try a vegetarian diet, you must pay attention to protein sources. Meats, eggs, and dairy foods provide the bulk of most people's daily protein needs. Cutting some or all of those out will lower your protein intake, unless you make the effort to include higher protein plant foods. Those include nuts, dry beans like kidney beans or black beans, and soy beans (and other soy products like tofu). If you are including dairy products, stick to low-fat and non-fat varieties. While hard cheeses are high in protein and taste great, they are almost all high in fat. Being vegetarian does not mean you don't have to be careful about other high-fat goodies like mayonnaise, salad dressing, fried foods, and sweets. French fries, chips, and doughnuts are high in fat and calories, whether you are a vegetarian or a meat eater.

For further information on the importance of protein in a vegetarian diet see the following article from TheDietChannel: Protein: Requirements for vegetarians.

Another possible problem for many people is the high maintenance nature of vegetarian eating. Most restaurants do offer meatless selections, but these aren't always lowfat. Fettuccine Alfredo, for example, is meat-free, but full of cream and cheese. So you have to know how to judge fat content of food from the menu listings. Cooking for yourself becomes important, especially on more restrictive diets like Dr. Dean Ornish's diet.

Conclusion: Vegetarians still need to pay attention to fat intake

Simply going vegetarian by avoiding meat does not guarantee a heart healthy diet. It is easy to eat a high fat/low fiber vegetarian diet. The message is this: whether or not you eat meat, you still have to pay attention to fat intake. Simply eliminating meat from your diet does not automatically mean you are eating less fat.

For more information on kids on a vegetarian diet see the following article from TheDietChannel: Safely Raising a Vegetarian Child.