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Vegan or Mediterranean: Which diet is best for your heart?

February 15, 2024 | Heather Shannon
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Both the vegan and Mediterranean diets are favored by cardiologists for their heart health benefits.

Controlling cholesterol through diet is a key strategy for preventing heart disease. Physicians and scientists have long extolled the benefits of both vegan and omnivorous diets, which includes the Mediterranean diet. Is one better than the other?

A recent study from Stanford Medicine demonstrated a clear victor when it comes to lowering cholesterol, insulin and weight: the plant-based diet.

UCI Health cardiologist Dr. Ailin Barseghian El-Farra isn’t surprised by the results.

“The reason a vegan diet is good for your heart is because it’s high in fiber and low in saturated fat,” she says.

“Those are the cornerstones of eating that keep low-density lipoprotein cholesterol [LDL] from reaching unhealthy levels.”

The identical twin study

The study followed 22 sets of identical twins who were raised in the same household and had similar lifestyles. One twin from each set followed a vegan diet for eight weeks. The other twin followed an omnivorous diet, which includes chicken, eggs and other lean animal proteins. Both diets are high in fiber, whole grains, fruits and vegetables. Both twins also minimized highly processed, refined and high-sugar foods.

In just two months, twins who consumed a vegan diet lowered their LDL (or “bad”) cholesterol. They also lost weight and reduced their insulin levels in their blood by 20%.

Studies have repeatedly affirmed that maintaining a healthy weight and keeping LDL cholesterol low (under 100 mg/dL) significantly reduces the risk of heart disease as well as diabetes and other conditions.

Vegan vs. Mediterranean

In fact, both eating styles are favored by cardiologists for their heart health benefits.

“The main components of vegan eating and the Mediterranean diet are the same: a diet rich in fruits, vegetables, whole grains and legumes, and low — or no, in the case of vegan — intake of animal fat,” says Barseghian, who is also affiliated with the integrative cardiology program at the UCI Health Susan Samueli Integrative Health Institute. She specializes in interventional and integrative approaches to heart disease.

To be beneficial, a vegan diet must be nutrient-rich, she notes. A vegan can still consume mostly sugar, carbohydrates and fatty foods.

Important nutrients to monitor

People who opt for a vegan diet need to be mindful about including certain nutrients, as well.

“Vegans are commonly deficient in vitamin B12, calcium and iron,” Barseghian says. She notes that vitamin B12 is an important nutrient for heart health because it breaks down homocysteine, an amino acid that can increase the risk of stroke and heart disease when its levels are high.

One benefit the Mediterranean diet has over the vegan one is the consumption of fish, which is high in healthy omega-3 fatty acids. However, omega-3s also are found in walnuts, chia seeds, seaweed, edamame and flaxseeds.

“The Mediterranean diet has demonstrated not only reduction in cardiovascular risk factors, such as lipids, but also a reduction in death rates,” Barseghian says.

A 2023 study published in Mayo Clinical Proceedings found that a Mediterranean diet and lifestyle was associated with a 29% lower risk for all causes of mortality and a 28% lower risk of death due to cancer.

Choosing a diet to follow

Both the Mediterranean diet and the vegan diet are scientifically proven to improve heart health. Which plan is best depends on a person’s preferences and needs.

The most important thing, Barseghian says, is to choose a heart-healthy eating plan that you can stick with long term. She also suggests taking small steps toward healthier eating.

“If you tend to eat a lot of meat, switching to a plant-based meal a few times a week will be more beneficial than nothing at all.”

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