Seventh-day Adventists and Health

A strong commitment to health has been a part of Seventh Adventist’s tradition since in founding in the 1840s.

There has been three large Adventist cohort studies in the United States and Canada since the 1950s. 1

Data from the AHS-2 study shows that Adventists smoke much less frequently than the general American population (males – 1.2%, females – 1.0%) and drink less alcohol (6.6% drink alcohol).

Diet is also significantly different from the general population with 4.2% are total vegetarian, 31.6% lacto-ovo-vegetarian, 11.4% include fish with their lacto-ovo-vegetarian diet, 6.1% are semi-vegetarian (eat meat <1 time/week) and 46.8% are non-vegetarian.

The AHS-1 study showed 30-year-old Adventist males lives 7.3 years longer than the average 30-year-old white Californian male and with females living 4.4 years longer than the average Californian white female. For vegetarians it is 9.5 years longer for men and 6.1 years longer for women.  The rate of breast and prostate cancer is 4 times greater in the US population than is experienced by the Adventists.  Similarly, the rate of cardiovascular disease is 5 times greater in the general population.

Men drinking five to six glasses of water a day had a 60% – 70% reduction of the incidence of a fatal heart attack. 2

There has been over 60 years of research comparing the effects of vegetarian diets on health.  Within the SDA community, the more vegetarian the diet, the better the health outcomes.

Vegan Seven-day Adventists are possibly the healthiest group of people on the planet.

Californians are much healthier than the average American. Asians and Hispanics are much healthier than the average white person in the USA. Significance for the diabetic Odds Ratio is less than 0.0001. 3

Category%BMIType 2 diabetes
Odds ratio (*)
Vegan
No red meat, fish, poultry, dairy, eggs
4.223.60.32
Lacto-ovo vegetarians
Vegan with eggs and milk
31.625.70.43
Pesco-vegetarians
Vegan with fish, milk and eggs
11.426.30.56
Semi-vegetarians
Red meat, poultry less than once a week plus fish, milk, and eggs
6.127.30.69
Non-vegetarians
Red meat, poultry more than once a week plus fish, milk, and eggs
46.928.81

(*) After adjustment for age, sex, ethnicity, education, income, physical activity, television watching, sleep habits and alcohol use.

Comparison of disease

The following table compares Californian Seventh-day Adventists. The comparison group is the Seventh-day Adventists vegetarians. All Seventh-day Adventists are much healthier than the average American. 4

Vegetarians ate no meat, fish, or poultry; semi-vegetarians ate meat, fish, or poultry in total less than 1 time per week; non-vegetarians ate these foods one or more times per week.

EndpointSemi-vegetarianNon-vegetarianSignificance
Diabetes
• Men1.351.970.0001
• Women1.081.930.0001
Hypertension
• Men1.572.230.0001
• Women1.442.240.0001
Rheumatoid arthritis
• Men1.141.500.005
• Women1.161.570.0001
Rheumatism
• Men1.201.480.0001
• Women1.281.610.0001

Relative Risk or Odds Ratio of cardio-metabolic-related factors among vegan and lacto-ovo-vegetarian Adventists compared with non-vegetarians

Comparison of Mortality

The vegetarians and semi-vegetarians are compared with non-vegetarians Adventists. 5

Vegetarians ate no meat, fish, or poultry; semi-vegetarians ate meat, fish, or poultry in total less than 1 time per week; non-vegetarians ate these foods one or more times per week.

Cause of MortalityVegetarianVeganSignificance
All-cause mortality0.910.85< 0.05
• Males0.860.72< 0.05
• Females0.940.97< 0.05
All-cancer0.900.92< 0.05
• Males1.010.81< 0.05
• Females0.850.99< 0.05
Ischemic heart disease0.820.90< 0.05
• Males0.760.45< 0.05
• Females0.851.39< 0.05
Cardiovascular disease0.900.91< 0.05
• Males0.770.58< 0.05
• Females0.991.18< 0.05
Other cause0.910.74< 0.05
• Males0.890.81< 0.05
• Females0.930.70< 0.05

Hazard ratio of all-cancer and site-specific cancers among vegan and lacto-ovo-vegetarian Adventists compared with non-vegetarians

As the diet becomes more vegetarian then the risk factors decreased for all categories except for female ischemic heart disease and female urinary tract cancers.

Note that the comparisons are within the Adventist community, which is much, much healthier than the general U.S. population.

Comparing Cohorts

The majority of nutrition studies compare two or more cohorts to examine differences in outcomes. Below are some  examples of different methods of comparing cohorts.

  • The Nurses’ Health Study compared the differences in outcomes between the lowest decile (10%) and the highest decile of fat consumption.
  • In the 1950s, a number of researchers (J Groen, LW Kinsell, EH Ahrens, A Keys, JM Beveridge and B Bronte-Stewart) studied the relationship of saturated fat to serum cholesterol using controlled feeding studies. The same individuals were given diets with a different level of saturated fats over a period time so the participants acted as their own controls.
  • Westman and Yancy compared a “low-carbohydrate, ketogenic diet program with […] a low-fat, low-cholesterol,
    reduced-calorie diet”. Their low-fat diet was 36% fat and 300mg of cholesterol which is NOT a low-fat or low-cholesterol diet. Both groups were very unhealthy at the start of the program and were still unhealthy at the end of the program. Even though the markers on the ketogenic diet were marginally “better” than the control diet, the results were not statistically significant for total cholesterol and LDL cholesterol which were the primary outcomes for the trial. 6
  • Seventh-day Adventists studies compare cohorts within the Seventh-day Adventist community. These people are much healthier that the average American or Western communities. 7 8 9

It is essential that we are aware of the cohorts that the studies are comparing. Results cannot be extrapolated to populations that are outside the domain of the study.

Results obtained from the Westman and Yancy trial that examined obese women on a ketogenic diet, calorie-restricted diet for 24 weeks, cannot be generalised as a long-term diet for “normal” weight, non-diabetic participants who are consuming an adequate amount of energy for their weight and activity level.

The Yancy and Westman study was “funded by an unrestricted grant from the Atkins Center for Complementary Medicine, New York, New York”. The supplements were provided by Atkins Nutritionals, Inc., New York.

A senior student research paper submitted in partial fulfillment of the requirements for the degree of Bachelor of Science in Nursing at Oral Roberts University in Tulsa, Oklahoma states: 10

Clients at risk for impaired urinary tract health should also take caution with this diet [vegan].  A single study indicated an increased risk for urinary tract infections among vegan subjects which may be due to the decreased calcium intake and subsequent alkalization of urine.

The study cited for this information is Beyond Meatless, the Health Effects of Vegan Diets: Findings from the Adventist Cohorts. 11

This conclusion is not found in the referenced paper. Urinary tract infections are not mentioned in this paper.

For additional information read The Evidence Against Eric Westman and William Yancy.

Multi-Variate Analysis

Seventh-day Adventist studies provide different sets of models to perform analysis. Health is affected by many factors including BMI, age, education, race, smoking, alcohol consumption. family history of disease, breast feeding and much more.

In an attempt to remove the influence of these confounding variables, models attempt to make “adjustments”. It is common to make adjustments for education, for example. It is difficult to make valid adjustments. Are “more educated” people healthier because they earn more money and can spend more on health care? Is it because they are “more interested” in health care? Is it because they can better evaluate health care messages? Attempting to untangle these relationships is not always (or perhaps rarely) productive.

It is essential to consider the adjustments made for these variables when evaluating health risk conclusions.

Vegan sceptics love to point out the increase in urinary tract cancers based on the following table in the following 2013 paper. 12

The table below from the Seventh-day Adventist study 2 shows the results for model (a) where adjustments were made for only the age. (Older people are more likely to succumb to cancer.)

DietNEventsHRCI MinCI MaxNotep
Non-vegetarian33736791a
Vegetarian353841151.160.871.55a0.66
Semi-vegetarian3881181.660.992.77a0.09
Pesco-vegetarian6846170.880.521.49a0.65
Lacto-vegetarian19735600.670.470.96a0.65
Vegan4922201.510.922.46a0.07

The Vegetarian group includes all people who are NOT in the first category (Non-vegetarian). The definition of these groups is defined in the first table of the post.

The last column (p) defines the level of significance. Usually the level of significance must be 0.05 or less before it is considered statistically significant. None of these results are considered to be statistically significant. There are so few people afflicted that it is not possible to make an association between the urinary tract cancer mortality and diet.

Seventh-day Adventists and Longevity

Much publicity is given to the longevity of the people of Japan and Okinawa (an archipelago that stretches from southern Japan to Taiwan). However, it is vegetarian Californian Seventh-day Adventists that have the longest lifespan and the highest levels of health on the planet.

Vegetarian Californian Adventists have a higher lifer expectancy at the age of 30 years than other white Californians by 9.5 years in men and 6.1 years in women, giving them the highest life expectancy of any formally described population. 13

Note that Californians are much healthier than the average American being in the top five states for longevity with an average life expectancy of 5-6 years greater than the Mississippi states.

Other posts relating to Low-carbohydrate and ketogenic diets.

Footnotes

  1. Butler, T. L. et al. (2008) Cohort profile: The Adventist Health Study-2 (AHS-2). International Journal of Epidemiology. 37 (2), 260–265.
  2. Buettner, D. (2012) The Blue Zones. Second Ed. Washington DC: National Geographic.
  3. Tonstad, S. et al. (2009) Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. 32 (5), 791–796.
  4. Fraser, G. E. (1999) Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. The American Journal of Clinical Nutrition. 70 (3), 532s–538s.
  5. Le, L. & Sabate, J. (2014) Beyond Meatless, the Health Effects of Vegan Diets: Findings from the Adventist Cohorts. Nutrients. 6 (6), 2131–2147. Table 8
  6. Yancy, W. S. et al. (2004) A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Annals of Internal Medicine. 140 (10), 769–777.
  7. Le, L. & Sabate, J. (2014) Beyond Meatless, the Health Effects of Vegan Diets: Findings from the Adventist Cohorts. Nutrients. 6 (6), 2131–2147.
  8. Tantamango-Bartley, Y. et al. (2013) Vegetarian Diets and the Incidence of Cancer in a Low-risk Population. Cancer Epidemiology Biomarkers & Prevention. 22 (2), 286–294.
  9. Fraser, G. E. & Shavlik, D. J. (2001) Ten Years of Life – Is It a Matter of Choice? Archives of Internal Medicine. 161 (13), 1645–1652.
  10. Bahr, M. N., Chrisostom, K. M., Chrisostom, S. S., Peters, N. K., & Thomas, P. M. (2019). A Comparative Analysis of the Ketogenic, Paleolithic, and Vegan Diets. Nursing Undergraduate Work. 9., 57.
  11. Le, L. & Sabate, J. (2014) Beyond Meatless, the Health Effects of Vegan Diets: Findings from the Adventist Cohorts. Nutrients. 6 (6), 2131–2147.
  12. Tantamango-Bartley, Y. et al. (2013) Vegetarian Diets and the Incidence of Cancer in a Low-risk Population. Cancer Epidemiology Biomarkers & Prevention. 22 (2), 286–294. Table 4
  13. Fraser, G. E., & Shavlik, D. J. (2001). Ten Years of Life—Is It a Matter of Choice? Archives of Internal Medicine, 161(13), 1645–1652.

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