To the Editor:

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  2. To the Editor:
  3. References

Freedman et al. (1) provide an excellent review of the effectiveness of popular diets on weight loss and other health outcomes. Although many health benefits of very-low-fat diets high in complex carbohydrates are described, we are concerned about the statement that these diets “are low in vitamin E, vitamin B-12, and zinc” (1). This statement is based on a 1-day sample menu, which may not be representative of the average nutrient intake of a well-planned, low-fat, plant-based diet. For example, in our ongoing Prostate Cancer Lifestyle Trial, where participants adhere to a vegan diet with 10% of calories from fat, analyses of 3-day food diaries reveal adequate micro- and macronutrient intake compared with standard reference values (2). Although low-fat diets may be low in vitamin E, the dose to yield plasma concentrations of vitamin E that raise antioxidant activity cannot be obtained from diet alone (3). For this reason, we and others have recommended that micronutrient supplementation, or the use of fortified foods, should be included in a plant-based diet (4) (5).

Finally, we would like to add that plant-based diets are not only low in disease-promoting substances (e.g., cholesterol, saturated fat, oxidants, trans fatty acids, arachidonic acid, and total fat), but also high in protective dietary factors (e.g., antioxidants, folate, soluble fiber, saponins, flavonoids, carotenoids, isoflavones, soluble fiber, plant sterols, and optimal n-6:n-3 ratio) (6). This type of diet not only contributes to weight loss and the prevention of many chronic diseases, but also results in plasma cholesterol lowering of the same magnitude as achieved by statin drugs, a 40% reduction in low-density lipoprotein cholesterol after 1 year, and the reversal of heart disease (7).


  1. Top of page
  2. To the Editor:
  3. References
  • 1
    Freedman, M., King, J., Kennedy, E. (2001) Popular diets: a scientific review. Obes Res 9((suppl)): 1S38.
  • 2
    Dunn-Emke, S., Weidner, G., Ornish, D. (2001) Nutritional analysis of the Prostate Cancer Lifestyle Trial diet (in press).
  • 3
    Institute of Medicine (2000) Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids National Academy Press (Washington, DC).
  • 4
    Messina, V. K., Burke, K. I. (1997) Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc 97: 131721.
  • 5
    Ornish, D. (1999) Concise review: intensive lifestyle changes in the management of coronary heart disease. Braunwald, E. Fauci, A. Isselbacher, K. eds. Harrison's Principles of Internal Medicine Available at:
  • 6
    Connor, S. L., Ojeda, L. S., Sexton, G., Weidner, G., Connor, W. E.. The role of pathogenic and protective dietary factors and non-traditional risk factors in the coronary epidemic of eastern and central Europe. Weidner, G. Kopp, M. Kristenson, M. eds. Heart Disease: Environment, Stress and Gender NATO Science Series, Series I: Life and Behavioural Sciences. 327, IOS Press (Amsterdam, The Netherlands) (in press).
  • 7
    Ornish, D., Scherwitz, L. W., Billings, J. H., et al. (1998) Intensive lifestyle changes for reversal of coronary disease. J Am Med Assoc 280: 20017.