International Vegetarian Union (IVU)
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The Medical Costs Attributable to Meat Consumption
NEAL D. BARNARD, M.D., ANDREW NICHOLSON, M.D., and Jo LIL HOWARD
Physicians Committee for Responsible Medicine (PCRM)
5100 Wisconsin Avenue, N. W., Suite 404, Washington, DC 20016

Deutsch - from EVU News, Issue 1 /1997 - Français

DISCUSSION

The current analysis shows that costs attributable to meat consumption are indeed substantial. Because omnivores and vegetarians may differ in many respects aside from diet, particularly in rates of smoking, exercise, and alcohol consumption, studies selected for this analysis have accounted for these factors to the extent possible. Such attempts at control may lead to an underestimate of true differences. Studies of Adventists may understate differences between omnivores and vegetarians, because Adventist omnivores tend to be modest in their meat consumption. The small dietary differences between omnivores and vegetarians in this group make it all the more remarkable that the prevalences of disease in these groups are so strikingly different.

Several additional factors may cause these figures to be underestimates. The current analysis omits conditions for which data are not sufficient. For example, some evidence suggests that stroke, diverticular disease, and rheumatoid arthritis are more common among omnivores, but they have been excluded from the current analysis. The costs of diabetes presented herein exclude care given in federal, military, and Veterans Administration facilities or free-standing dialysis centres, all outpatient care for the sequelae of diabetes, such as renal failure, cataracts, or glaucoma, and treatment necessitated by undiagnosed diabetes. The costs of treatment of obesity or of it consequences other than the conditions noted above were not considered. Costs for foodborne illness are low estimates, because they omit pathogens from fish, and the study on which our lowest estimate was based was limited to only five infective organisms.

Our figures would be overestimates if reducing meat consumption or a compensatory increase in fruit and vegetable intake had potential adverse effects that required medical care. However, existing literature does not substantiate such risks. The issues of greatest importance in this regard relate to the adequacy of protein, riboflavin, vitamin B-12, iron, and calcium.

It was once believed that plant-based diets require careful planning to ensure protein adequacy. However, it is now known that a varied plant diet consumed in sufficient quantity to maintain body weight easily satisfies amino acid requirements, even without intentional combining of foods.

In Western countries, vegetarian diets are generally adequate in riboflavin. However, the mean daily riboflavin intake in China (0.8 mg) falls below the recommended dietary allowance (RDA) of 1.2 mg, and in some Chinese counties more than 90% of the population falls below this value. There is, however, no evidence of widespread deficiency symptoms or significant treatment costs, suggesting that the RDA may have a generous margin of safety.

Vitamin B-12 deficiency might be expected to be more common among those following pure vegetarian diets without sufficient planning, but we are aware of no evidence showing this factor to lead a substantial percentage of vegetarians into medical treatment.

The absorption of nonheme iron in plant foods is lower than that of nonheme iron in meats. However, plantbased diets generally provide adequate iron (81, 8385). In Western countries, iron deficiency does not affect vegetarians disproportionately. Moreover, reductions in heme iron intake and lower iron stores are associated with a reduced risk of heart disease, cancer, and other conditions.

Calcium balance requires both adequate intake and minimal losses. Green vegetables and legumes provide calcium which, except for spinach, is of high bioavailability. The calcium adequacy of plant-based diets is supported by studies showing that populations following such diets generally have lower rates of hip fracture than those whose diets are based on animal products, perhaps because reduced meat consumption is associated with lower urinary calcium losses.

Plant foods may be somewhat lower in available zinc, compared with meats, but a plant-based diet also reduces zinc excretion. Zinc intake and zinc levels have been shown to be adequate in long-term vegetarians. Those who do not die as a result of heart disease, cancer, or other serious illness may develop other diseases that require treatment. However, the estimates presented above are based on studies of current disease prevalence, and the costs of additional illnesses that may occur in elderly individuals have not been excluded. Moreover, diet-related diseases tend to cluster. Obesity, hypertension, heart disease, cancer, and diabetes often occur in combination. In contrast, those individuals who live to particularly old ages frequently do so in reasonably good health, and when death does come, it is often not preceded by major diseases necessitating treatment.

It should be noted that the effects of including meat in the diet are not attributable solely to the constituents of meat itself. When meat is included in the diet, plant products are necessarily reduced. The health effects of an omnivorous diet may result from the presence of meat, the displacement of plant foods, or both. A substantial portion of America’s health care costs is attributable to identifiable factors. Most notably, the medical care expenditures attributable to cigarette smoking were $50 billion in 1993. The combined medical costs attributable to smoking and meat consumption exceed the predicted costs of providing health coverage for all currently uninsured Americans.

The fact that disease is costly does not necessarily mean that preventing it saves money. Preventive programs have costs of their own, and the health benefits of lifestyle changes may not be realised until well into the future. Randomised, controlled trials of the long-term effects of meatless diets or smoking cessation have never been conducted and are not anticipated, and the feasibility of reducing medical care expenditures by such interventions is beyond the scope of this report. Existing data are insufficient to estimate the time course by which dietary interventions may yield health benefits or economic savings. Nor do the data presented here reveal whether modest reductions in meat consumption would have benefits or whether the results of preventive steps would differ between males and females. Recent studies showing that major dietary changes are acceptable to at least some people make studies of the cost effectiveness of dietary interventions all the more timely. In summary, a large body of evidence shows that substantial medical costs are attributable to meat consumption. Further research is necessary for weighing the cost effectiveness of interventions that seek to change dietary behavior.