Healthcare 2015, 3, 544-555; doi:10.

3390/healthcare3030544
OPEN ACCESS

healthcare
ISSN 2227-9032
www.mdpi.com/journal/healthcare
Article

Comparison of a Restricted and Unrestricted Vegan

Diet Plan with a Restricted Omnivorous Diet Plan on
Health-Specific Measures
Richard J. Bloomer *, Trint A. Gunnels and JohnHenry M. Schriefer

Cardiorespiratory/Metabolic Laboratory, The University of Memphis, Memphis, TN 38152, USA;

E-Mails: [email protected] (T.A.G.); [email protected] (J.M.S.)

* Author to whom correspondence should be addressed; E-Mail: [email protected];

Tel.: +1-901-678-5638; Fax: +1-901-678-3591.

Academic Editors: Samir Samman and Ian Darnton-Hill

Received: 31 December 2014 / Accepted: 7 July 2015 / Published: 14 July 2015

Abstract: Background: We have previously noted beneficial health outcomes when

individuals follow a dietary restriction plan in accordance with the Daniel Fast (DF). This
is true whether individuals eliminate all animal products or include small amounts of meat
and dairy in their plan. The present study sought to compare anthropometric and biochemical
measures of health in individuals following a traditional DF (i.e., restricted vegan) or modified
DF (i.e., restricted omnivorous; inclusive of ad libitum meat and skim milk consumption), with
those following an unrestricted vegan diet plan. Methods: 35 subjects (six men; 29 women;
33 ± 2 years; range: 18–67 years) completed a 21-day diet plan. Subjects reported to the lab
for pre- (day 1) and post-intervention testing (day 22) in a 10 h fasted state. Blood samples
were collected and assayed for complete blood count, metabolic panel, lipid panel, insulin,
HOMA-IR, C-reactive protein, and oxidative stress biomarkers (malondialdehyde, advanced
oxidation protein products, and nitrate/nitrite). Heart rate and blood pressure were measured
and body composition was determined via dual energy X-ray absorptiometry. Subjects’
self-reported compliance, mental and physical health, and satiety in relation to the dietary
modification were recorded. Results: No interaction effects were noted for our outcome
measures (p > 0.05). However, subjects in the traditional DF group reported an approximate
10% increase in perceived mental and physical health, with a 25% reduction in
malondialdehyde and a 33% reduction in blood insulin. Systolic BP was reduced
approximately 7 mmHg in subjects assigned to the traditional DF, with an approximate
5 mmHg reduction in subjects assigned to the modified DF and the unrestricted vegan plan. A
Healthcare 2015, 3 545

small (2 mmHg) reduction in diastolic BP was noted for subjects in both DF groups; a
slight increase in diastolic BP was noted for subjects assigned to the unrestricted vegan
group. An approximate 20% reduction was noted in total and LDL cholesterol for subjects
in the traditional DF group, with an approximate 10% decrease for subjects in the modified
DF group. No decrease in total or LDL cholesterol was noted for subjects in the unrestricted
vegan group. Conclusion: These data indicate that both a traditional or modified DF may
improve blood pressure and blood lipids in a clinically meaningful manner if these results
are sustained over the long term. A traditional DF also results in a significant reduction in
blood insulin and oxidative stress. An unrestricted vegan diet may improve systolic blood
pressure, but in the absence of measures to strictly monitor adherence, it does not favorably
impact other markers of health measured in the present study.

Keywords: dietary modification; nutrient intake; lipid panel; veganism; oxidative stress

1. Instruction

Restriction of caloric intake appears to improve overall health, with multiple mechanisms of actions
proposed [1–3]. While the quantity of dietary energy intake appears important with regards to overall
health, the type and quality of macronutrients contained within meals is also of great importance [4,5].
Our published work with the restricted vegan-based “Daniel Fast” plan highlights the importance of
nutrient composition as pertaining to a variety of health-related parameters [6–10].
The Daniel Fast is a biblically-inspired (Daniel 1:8–14) dietary restriction model that eliminates all
animal products—in a similar manner as a vegan diet. It involves ad libitum intake of specific foods,
with the elimination of others. For example, the plan consists of fruits, vegetables, whole grains,
legumes, nuts, seeds, and oil. Although the plan resembles a typical vegan diet, which has been reported
to yield health-enhancing properties [11,12], the Daniel Fast is more stringent, in that no processed
foods, white flour products, additives, preservatives, sweeteners, flavorings, caffeine, or alcohol are
allowed. Despite the stringent nature, our prior studies have noted short-term (three-week) compliance
rates that exceed 95% in nearly all individuals, with many subjects reporting feeling much more
satiated on this plan as compared to their usual dietary intake, resulting in a significant reduction in
kilocalorie intake.
That said, many subjects report the desire for the occasional consumption of meat and dairy, in
particular if they were to adopt such a dietary plan long-term. Many subjects also comment on their desire
to consume coffee and tea, which may hinder long-term compliance. Based on this observation, we most
recently compared a “traditional” vegan-based Daniel Fast with a “modified” Daniel Fast—inclusive of
one serving per day of lean meat and one cup per day of skim milk [6], with the option of consuming
decaffeinated coffee and tea. The two servings of animal products provided approximately 30 extra
grams of protein per day, in addition to a small amount of cholesterol and saturated fat, yet results
indicated that subjects responded equally as well to the modified version as compared to the traditional
version with regards to the measured outcome variables. These findings lead us to believe that perhaps
the amount of protein and cholesterol contained within foods may not be of great importance, but
Healthcare 2015, 3 546

rather, the amount of processed ingredients, simple sugar, hydrogenated fatty acids, and other similar
“unhealthy” additives may be of greater concern.
Although vegan diets are generally viewed as healthy alternatives to the usual animal-rich “Western
Diet” followed by so many individuals, vegan plans call for no restriction on the type, form, or amount
of dietary carbohydrate or fat ingested. While the health benefits of vegan diets are well-established, it
may be appropriate to favor unrefined carbohydrates in the overall diet, while minimizing processed
foods and simple sugars, as well as saturated and trans fats, additives, and preservatives.
Considering our prior experience with the Daniel Fast, coupled with our knowledge of vegan diet
plans, in the present study we compared three diet plans: a traditional Daniel Fast devoid of animal
products [restricted vegan], a Daniel Fast plus ad libitum animal products (restricted omnivorous), and
an unrestricted vegan diet for a period of 21 days on selected biochemical and anthropometric markers
of health. We hypothesized that the all plans would yield improvements in the selected outcome measures,
with the Daniel Fast plans proving more beneficial than the traditional unrestricted vegan plan for
certain variables (e.g., blood lipids, blood insulin, oxidative stress biomarkers).

2. Materials and Methods

2.1. Subjects and Screening

Thirty-six subjects (six men; 30 women) were enrolled in this study, with an average age of 33 ± 2 years
and a range of 18–67 years. Subjects were required to be non-smokers and within 18–70 years of age.
The body mass index (BMI) of subjects was not restricted. Therefore, the BMI range was 19–45 kg∙m−2.
Our prior studies included sample sizes similar to what was included in the present work; however, no
power analysis was performed to determine the present sample size. Prior to participation, each subject
completed a health history, medication and dietary supplement usage, and physical activity questionnaire.
The work was approved by the University Institutional Review Board for Human Subjects Research
(#2329) and subjects provided written informed consent.
During the first laboratory visit, subjects completed all paperwork and were provided with their
group assignment. Subjects were allocated to one of the three groups using a randomized method (e.g.,
numbering system), with alternation between the three diet groups upon subject screening. Once 12
individuals were assigned to a group, the randomization continued using only the final two groups.
Subjects were provided with instructions regarding their assigned diet plan and were provided with
food logs for dietary recording. Subjects returned to the lab within one to two weeks to have their
baseline assessments performed and to begin the 21-day diet plan. All outcome measures indicated
below were measured before (baseline: day 1) and after the diet plan (day 22). Subject data were
collected in the morning hours (e.g., 6:00–10:00 am) in a 10 h fasted state.

2.2. Diet Plans (Traditional Daniel Fast, Modified Daniel Fast, Unrestricted Vegan Diet)

Following the initial week of dietary recording and all baseline assessments, subjects began their
diet plan assignment and followed the plan for 21 days. This timeframe coincided with our prior
studies of the Daniel Fast. Subjects assigned to all three groups were informed that they could consume
as much food as desired—no restrictions were placed on the quantity of food or beverage consumed.
Healthcare 2015, 3 547

However, restrictions were placed on the type of food and beverage consumed. Specifically, subjects
assigned to both Daniel Fast groups were informed that they must eliminate all processed foods, white
flour products, additives, preservatives, sweeteners, flavorings, caffeine, and alcohol. Subjects in the
traditional Daniel Fast group were also required to eliminate all animal products. On the other hand,
subjects assigned to the modified Daniel Fast plan were allowed to eat as much lean meat (fish, chicken,
turkey, or red meat) and to drink as much skim milk as desired. Subjects assigned to the unrestricted
vegan plan were not allowed to consume any animal products (e.g., red meat, poultry, fish, eggs,
cheese, milk, etc.). No other restrictions were placed on subjects assigned to the unrestricted vegan diet
plan. Subjects were contacted by research assistants frequently (e.g., every three to four days) throughout
the study period via email, phone, or text message to remind them of the dietary guidelines and to offer
encouragement regarding their adherence to the prescribed plan. Research assistants were also
available daily to answer any questions that subjects had concerning food choices.

2.3. Outcome Measures and Hypotheses

As in our prior work with the Daniel Fast, we included a wide variety of outcome measures. Of
most importance were body mass, blood pressure, and selected biochemical measures such as insulin,
C-reactive protein, and blood cholesterol. Based on prior work, we hypothesized that improvement
would be observed for all outcome measures in all three diet groups, with potential for greater
improvement noted for the two Daniel Fast plans due to the restriction of all processed foods.

2.4. Anthropometric Measures, Heart Rate and Blood Pressure

After arriving in the lab, subjects were asked to use the restroom and to empty their bladder. Women
were required to perform a urine pregnancy test prior to having the dual energy X-ray absorptiometry
(DXA) scan performed (Hologic QDR-4500W; using a four-minute fan array with both total and trunk
specific body fat being determined). Height and weight was measured, and body mass index was
calculated. In addition, waist and hip circumference measures were obtained using a tension-regulated
tape measure.
For the measure of heart rate and blood pressure, subjects were asked to sit in a chair with a cuff
placed on their left arm, while resting for 10 min. A 60 s palpation was used to measure heart rate and
blood pressure was measured via auscultation. Duplicate measurements were obtained for both heart
rate and blood pressure and the average was used in data analysis.

2.5. Blood Collection and Biochemical Variables

Blood samples were taken from subjects’ forearm vein. Samples were processed to obtain
plasma/serum. Aliquots to be used for the analysis of the lipid specific oxidation biomarker,
malondialdehyde (MDA; Northwest Life Science Specialties; Vancouver, WA), were separated and
stored at −70 degrees Celsius until analyzed. Aliquots for the protein oxidation marker known as advanced
oxidation protein products (AOPP; using reagents purchased from Cell Biolabs; San Diego, CA, USA)
were also stored, as were aliquots for the nitric oxide marker known as nitrate/nitrite (NOx; using
reagents purchased from Cayman Chemical; Ann Arbor, Michigan). Samples were later thawed and
assayed in duplicate. Both MDA and AOPP are commonly used biomarkers of oxidative stress. Since
Healthcare 2015, 3 548

oxidative stress is implicated in the pathogenesis of human disease and the degree of oxidative stress
appears to be related to dietary intake (e.g., saturated fat and simple sugar content), inclusion of these
variables was important in this work.
Remaining assays were performed with 24 h of sample collection. Complete blood count, comprehensive
metabolic panel, and lipid panel were analyzed using automated procedures. Insulin was determined using
an immuno-chemiluminescent assay procedure (Roche Modular E170, Roche Diagnostics, Indianapolis,
IN, USA). The homeostasis model assessment (HOMA-IR) was used as an index of insulin resistance. This
was calculated using the following equation: (fasting glucose (mg∙dL−1) × fasting insulin (μU∙mL−1))/405.
C-reactive protein was determined using a high-sensitivity, particle-enhanced turbidimetric immunoassay
(Roche Integra 800, Roche Diagnostics, Indianapolis, IN, USA).

2.6. Dietary Records and Physical Activity

All subjects were instructed to maintain their usual diet until they began the assigned diet plan.
They were also asked to record all food and drink consumed during the seven days before starting the
assigned plan. They were asked to do the same during the final seven days of the fast. Records were
reviewed with subjects upon receipt and were analyzed by using Food Processor SQL (ESHA Research,
Salem, OR, USA). Subjects were instructed to maintain their usual physical activity habits throughout
the study period and to avoid alcohol consumption and strenuous exercise during the two days preceding
the assessment days.

2.7. Compliance, Subjective Feelings, and Satiety

On a scale of 0–100 (0 = complete non-compliance, 100 = complete compliance), subjects rated their
overall compliance to the assigned diet plan, in regard to food choices. Using a scale of 0–10 (0 = as low as
possible, 10 = as high as possible), subjects rated their overall “mental outlook and mood,” their “physical
health and vitality,” and their “level of satiety” both before and while following the assigned diet plan.

2.8. Statistical Analysis

Data were analyzed using a 3 (group) × 2 (time) analysis of variance. Tukey post-hoc testing and
contrasts was performed as needed. For comparisons reported in the Results section, we note whether
we are referring to a group effect (comparing one group to another while collapsing across time) or a
time effect (comparing pre and post-intervention while collapsing groups). Any comparisons involving
specific groups at specific times involve post hoc testing. Analyses were performed using JMP statistical
software (version 4.0.3, SAS Institute, Cary, NC, USA). Statistical significance was set at p ≤ 0.05.
The data are presented as mean ± SEM.

3. Results

Of the 36 subjects that were initially enrolled in the study, one subject assigned to the unrestricted
vegan plan did not complete the study due to personal reasons. Therefore, data are only available for
35 subjects (n = 12 for both traditional and modified DF; n = 11 for unrestricted vegan). Blood was not
available for one subject assigned to the modified DF plan. CRP values for one subject assigned to the
Healthcare 2015, 3 549

modified DF plan were significantly elevated and considered to be outliers; they were not included in
the analysis. Finally, blood to be used for analysis of oxidative stress biomarkers was not available for
all subjects. Specifically, for MDA, blood was available for a total of 11 subjects in the traditional DF,
six subjects in the modified DF, and 11 subjects in the unrestricted vegan; For AOPP, blood was available
for a total of 10 subjects in the traditional DF, six subjects in the modified DF, and eight subjects in the
unrestricted vegan; for NOx, blood was available for a total of 11 subjects in the traditional DF, seven
subjects in the modified DF, and 10 subjects in the unrestricted vegan. Dietary data was not available
for two subjects in the traditional DF and one subject in the unrestricted vegan plan.

3.1. Compliance, Mental Outlook/Mood, Physical Health/Vitality, and Satiety

Differences in self-reported compliance to the prescribed dietary plan could not be detected by the
investigators (p = 0.47) and was as follows: 96.5 ± 1.0 for the traditional DF, 93.4 ± 2.2 for the modified
DF, and 94.1 ± 2.2 for the unrestricted vegan plan. Although subjects assigned to the traditional DF
group reported an approximate 10% increase in perceived mental and physical health, no group, time,
or interaction effects of statistical significance were detected (p > 0.05). A time effect was noted for
satiety, with values decreasing across time (p = 0.005). Data are presented in Table 1.

Table 1. Subject compliance, subjective feelings, and satiety before and after a 21-day
period of dietary modification.
Traditional Traditional Modified Modified Unrestricted Unrestricted
Variable
DF Pre DF Post DF Pre DF Post Vegan Pre Vegan Post
Compliance (%) NA 96.5 ± 1.0 NA 93.4 ± 2.2 NA 94.1 ± 2.2
Mental Health (1–10) 7.9 ± 0.5 8.7 ± 0.4 8.2 ± 0.5 7.8 ± 0.5 8.5 ± 0.5 8.2 ± 0.7
Physical Health (1–10) 7.4 ± 0.4 8.2 ± 0.2 8.0 ± 0.5 8.3 ± 0.5 7.5 ± 0.5 7.8 ± 0.4
Satiety (1–10) † 8.2 ± 0.4 7.3 ± 0.4 8.0 ± 0.5 6.4 ± 0.6 8.5 ± 0.5 6.9 ± 0.8
Values are mean ± SEM. †: Time effect for satiety (p = 0.005). No other statistically significant differences
noted (p > 0.05).

3.2. Hemodynamic and Anthropometric Data

No time or interaction effects were noted for any hemodynamic or anthropometric variable (p > 0.05).
However, group effects were noted for the following variables: age (p = 0.05), Modified DF < Traditional
DF; total body fat (p = 0.04), Modified DF < Traditional DF and Unrestricted Vegan; fat free mass
(p = 0.05), Modified DF > Traditional DF; heart rate (p = 0.02), Modified DF < Traditional DF;
systolic BP (p = 0.01), Modified DF and Traditional DF < Unrestricted Vegan. A trend for a time effect for
systolic BP was also noted (p = 0.06), with values decreasing across time (i.e., pre- to post-intervention).
An approximate 2 kg weight loss was observed in subjects assigned to the traditional DF, with an
approximate 1 kg weight loss noted in subjects assigned to the modified DF (pre- to post-intervention).
Systolic BP was reduced approximately 7 mmHg in subjects assigned to the traditional DF, with an
approximate 5 mmHg reduction noted in subjects assigned to the modified DF and the unrestricted
vegan plan (pre- to post-intervention). Data are presented in Table 2.
Healthcare 2015, 3 550

Table 2. Subject characteristics before and after a 21-day period of dietary modification.
Traditional Traditional Modified Modified Unrestricted Unrestricted
Variable
DF Pre DF Post DF Pre DF Post Vegan Pre Vegan Post
Age (years) * 38.1 ± 4.7 NA 27.9 ± 3.8 NA 31.5 ± 4.5 NA
Height (cm) 165.1 ± 2.8 NA 167.7 ± 2.3 NA 168.9 ± 2.4 NA
Weight (kg) 69.4 ± 3.4 67.4 ± 3.3 72.4 ± 5.0 71.4 ± 5.2 75.0 ± 4.6 74.4 ± 4.6
BMI (kg∙m−2) 25.6 ± 1.4 24.8 ± 1.3 25.8 ± 1.8 25.4 ± 1.9 26.2 ± 1.3 26.0 ± 1.3
Waist (cm) 78.5 ± 3.6 78.6 ± 3.6 80.3 ± 4.0 78.9 ± 4.2 82.3 ± 4.4 82.5 ± 4.0
Hip (cm) 103.5 ± 2.9 103.8 ± 2.3 103.3 ± 3.0 102.3 ± 3.1 101.3 ± 3.4 103.0 ± 2.4
Waist:Hip 0.76 ± 0.02 0.76 ± 0.02 0.78 ± 0.02 0.77 ± 0.02 0.81 ± 0.03 0.80 ± 0.03
Total Body Fat (%) * 31.1 ± 2.5 30.2 ± 2.4 28.2 ± 2.9 27.8 ± 3.0 33.1 ± 2.4 32.4 ± 2.3
Trunk Body Fat (%) 31.1 ± 2.5 29.1 ± 1.8 26.3 ± 2.6 25.2 ± 2.9 30.5 ± 2.9 29.2 ± 2.8
Fat Mass (kg) 21.8 ± 2.4 20.4 ± 2.1 21.0 ± 3.5 20.5 ± 3.8 25.3 ± 2.8 24.6 ± 2.7
Fat Free Mass (kg) * 47.6 ± 2.7 47.0 ± 2.9 51.4 ± 3.1 50.9 ± 3.1 49.7 ± 2.7 49.8 ± 2.8
Heart Rate (bpm) * 80.2 ± 4.2 78.5 ± 4.0 69.1 ± 2.9 69.9 ± 3.8 73.2 ± 3.5 76.0 ± 4.0
Systolic BP (mmHg) *,† 117.3 ± 4.4 110.6 ± 2.3 116.8 ± 2.4 111.5 ± 3.3 125.2 ± 3.3 120.6 ± 3.8
Diastolic BP (mmHg) 73.2 ± 3.0 71.1 ± 3.0 70.2 ± 3.0 68.6 ± 2.9 67.3 ± 4.2 74.0 ± 4.2
Values are mean ± SEM. *: Group effect for age (p = 0.05); Modified DF < Traditional DF. *: Group effect for
total body fat (p = 0.04); Modified DF < Traditional DF and Vegan. *: Group effect for fat free mass (p = 0.05);
Modified DF > Traditional DF. *: Group effect for heart rate (p = 0.02); Modified DF < Traditional DF. *: Group
effect for systolic BP (p = 0.01); Modified DF and Traditional DF < Vegan. †: Trend for time effect for systolic BP
(p = 0.06). No other statistically significant differences noted (p > 0.05).

3.3. Biochemical Data

With regards to the complete blood count and metabolic panel, no time or interaction effects were noted
(p > 0.05; data not shown). An approximate 33% reduction was noted from pre- to post-intervention for
insulin in subjects assigned to the traditional DF. With regards to the lipid panel and oxidative stress data,
no group, time, or interaction effects were noted (p > 0.05). However, trends were noted for the following
variables: time effect for cholesterol (p = 0.10); group effect for triglycerides (p = 0.07), Traditional
DF < Unrestricted Vegan; group effect for VLDL (p = 0.07), Traditional DF < Unrestricted Vegan. An
approximate 20% reduction was noted in total and LDL cholesterol for subjects in the traditional DF
group, while this decrease was approximately 10% for subjects in the modified DF group (from pre- to
post-intervention). No decrease in total or LDL cholesterol for noted for subjects in the unrestricted vegan
group from pre- to post-intervention. Biochemical data are presented in Table 3.

3.4. Dietary Data

As might be anticipated based on the research design, many differences were noted in dietary intake
between groups and across time (i.e., from the week prior to beginning the dietary plan (pre-intervention)
to the final week of the plan (post-intervention)). These included: kilocalories (group effect: p = 0.04,
Modified DF > Traditional DF; time effect: p = 0.0008), protein grams (group effect: p < 0.0001,
Traditional DF and Unrestricted Vegan < Modified DF; time effect: p = 0.004; interaction effect: p = 0.03),
protein percent (group effect: p < 0.0001, Traditional DF and Unrestricted Vegan < Modified DF;
interaction effect: p < 0.0001), carbohydrate percent (time effect: p < 0.0001; interaction effect: p = 0.05),
Healthcare 2015, 3 551

fiber (time effect: p = 0.0004), sugar (group effect: p = 0.02, Modified DF > Unrestricted Vegan), fat
grams, fat percent, saturated fat grams, trans fat grams (time effect: p < 0.0001), cholesterol (group effect:
p = 0.004, Modified DF > Traditional DF and Unrestricted Vegan; time effect: p < 0.0001; interaction
effect: p = 0.02), vitamin C (group effect: p = 0.004, Modified DF > Unrestricted Vegan; time effect:
p = 0.006), vitamin E (group effect: p = 0.05, Modified DF > Unrestricted Vegan), vitamin A (time effect:
p = 0.01), selenium (group effect: p = 0.005). No other effects of statistical significance were noted
(p > 0.05). Data are presented in Table 4.

Table 3. Biochemical data of subjects before and after a 21-day period of dietary modification.
Traditional Traditional Modified Modified Unrestricted Unrestricted
Variable
DF Pre DF Post DF Pre DF Post Vegan Pre Vegan Post
C-Reactive Protein (mg·L−1) 1.6 ± 0.5 1.8 ± 0.7 1.9 ± 0.6 1.5 ± 0.4 1.8 ± 0.3 1.9 ± 0.7
Insulin (µU·mL−1) 10.1 ± 2.5 6.7 ± 1.2 9.1 ± 1.5 9.8 ± 2.2 8.1 ± 1.0 8.5 ± 1.4
HOMA-IR 2.2 ± 0.6 1.5 ± 0.3 1.9 ± 0.3 2.3 ± 0.6 1.8 ± 0.3 1.9 ± 0.4
Glucose (mg·dL−1) 86.4 ± 4.0 86.9 ± 2.2 87.3 ± 2.7 92.1 ± 2.2 88.7 ± 3.8 86.3 ± 4.5
187.8 ± 169.3 ±
Cholesterol (mg·dL−1) † 179.2 ± 8.7 146.5 ± 7.1 165.5 ± 12.4 168.3 ± 13.5
13.1 13.7
HDL-C (mg·dL−1) 64.9 ± 3.5 55.9 ± 2.7 68.9 ± 5.5 61.0 ± 5.0 64.9 ± 5.5 61.5 ± 4.0
VLDL-C (mg·dL−1) * 13.0 ± 1.4 12.2 ± 1.8 16.2 ± 2.0 15.5 ± 1.7 17.8 ± 3.3 17.6 ± 3.1
102.7 ±
LDL-C (mg·dL−1) 101.3 ± 6.8 78.4 ± 5.2 92.8 ± 9.6 82.8 ± 10.8 89.2 ± 11.0
9.2
Total:HDL-C 2.8 ± 0.1 2.6 ± 0.1 2.8 ± 0.2 2.8 ± 0.1 2.7 ± 0.3 2.8 ± 0.3
Nitrate/Nitrite (µmol·L−1) 22.3 ± 5.2 23.9 ± 4.7 23.7 ± 8.2 33.6 ± 9.7 25.2 ± 5.7 39.0 ± 12.9
Malondialdehyde (µmol·L−1) 0.8 ± 0.1 0.6 ± 0.1 0.7 ± 0.1 0.7 ± 0.1 0.8 ± 0.2 0.7 ± 0.1
Advanced Oxidation Protein 70.0 ±
65.9 ± 5.6 61.6 ± 7.5 70.2 ± 9.7 61.4 ± 7.3 61.1 ± 5.1
Products (µmol·L−1) 13.3
Values are mean ± SEM. †: Trend for time effect for cholesterol (p = 0.10). *: Trend for group effect for
triglycerides (p = 0.07); Traditional DF < Vegan. *: Trend for group effect for VLDL (p = 0.07); Traditional
DF < Vegan. No other statistically significant differences noted (p > 0.05).

Table 4. Dietary data of subjects before and during the final seven days of a 21-day period
of dietary modification.
Traditional Traditional Modified Modified Unrestricted Unrestricted
Variable
DF Pre DF Post DF Pre DF Post Vegan Pre Vegan Post
Kilocalories *,† 1753 ± 133 1147 ± 93 2049 ± 159 1636 ± 253 1743 ± 122 1335 ± 118
Protein (g) *,†,‡ 68 ± 6 34 ± 4 82 ± 6 86 ± 13 69 ± 6 40 ± 6
Protein (%) *,‡ 15 ± 1 12 ± 1 16 ± 1 22 ± 1 16 ± 1 11 ± 1
Carbohydrate (g) 218 ± 17 189 ± 15 259 ± 23 226 ± 34 218 ± 15 207 ± 14
Carbohydrate (%) †,‡ 49 ± 1 67 ± 2 50 ± 1 56 ± 3 50 ± 3 64 ± 3
Fiber (g) † 16 ± 2 29 ± 3 19 ± 3 29 ± 5 15 ± 2 20 ± 2
Sugar (g) * 82 ± 9 65 ± 9 97 ± 11 95 ± 11 64 ± 10 68 ± 6
Fat (g) † 66 ± 6 32 ± 4 74 ± 7 47 ± 11 68 ± 9 40 ± 6
Fat (%) † 34 ± 1 25 ± 2 32 ± 1 24 ± 2 34 ± 2 26 ± 3
Saturated Fat (g) † 20 ± 2 4±1 24 ± 2 9±2 21 ± 3 10 ± 2
Monounsaturated Fat (g) 11 ± 3 7±2 12 ± 2 16 ± 6 9±1 5±1
Healthcare 2015, 3 552

Table 4. Cont.
Traditional Traditional Modified Modified Unrestricted Unrestricted
Variable
DF Pre DF Post DF Pre DF Post Vegan Pre Vegan Post
Polyunsaturated Fat (g) 6±1 5±0 6±1 8±2 7±1 4±1
Trans Fat (g) † 0.7 ± 0 0.0 ± 0 1.0 ± 0 0.2 ± 0 0.8 ± 0 0.4 ± 0
Omega 3 (mg) 0.4 ± 0 0.5 ± 0 0.6 ± 0 0.8 ± 0 0.6 ± 0 0.3 ± 0
Omega 6 (mg) 4±1 3±1 4±1 6±2 4±1 3±1
Cholesterol (mg) *,†,‡ 240 ± 41 3±2 236 ± 26 153 ± 33 171 ± 27 43 ± 18
Vitamin C (mg) *,† 59 ± 11 110 ± 12 87 ± 23 143 ± 25 41 ± 8 61 ± 17
Vitamin E (mg) * 4±1 5±2 4±1 7±2 3±0 2±1
Vitamin A (RE) † 263 ± 50 467 ± 89 263 ± 45 481 ± 123 231 ± 52 350 ± 90
Selenium (µg) * 31 ± 7 14 ± 3 49 ± 8 60 ± 17 38 ± 6 32 ± 6
Values are mean ± SEM. *: Group effect for kilocalories (p = 0.04); Modified DF > Traditional DF. †: Time effect
for kilocalories (p = 0.0008). *: Group effect for protein grams (p < 0.0001); Traditional DF and vegan < Modified
DF. †: Time effect for protein grams (p = 0.004). ‡: Interaction effect for protein grams (p = 0.03). *: Group effect
for protein percent (p < 0.0001); Traditional DF and vegan < Modified DF. ‡: Interaction effect for protein percent
(p < 0.0001). †: Time effect for carbohydrate percent (p < 0.0001). ‡: Interaction effect for carbohydrate percent
(p = 0.05). †: Time effect for fiber (p = 0.0004). * Group effect for sugar (p = 0.02); Modified DF > vegan. †: Time
effect for fat grams, fat percent, saturated fat grams, trans fat grams (p < 0.0001). *: Group effect for cholesterol
(p = 0.004); Modified DF > Traditional DF and vegan. †: Time effect for cholesterol (p < 0.0001). ‡: Interaction
effect for cholesterol (p = 0.02). *: Group effect for vitamin C (p = 0.004); Modified DF > vegan. †: Time effect for
vitamin C (p = 0.006). *: Group effect for vitamin E (p = 0.05); Modified DF > vegan. †: Time effect for vitamin A
(p = 0.01). *: Group effect for selenium (p = 0.005). No other statistically significant differences noted (p > 0.05).

4. Discussion

Our findings indicate that all three diet plans may have benefits in terms of enhancing selected
outcomes related to human health. Both a traditional and modified DF may improve blood pressure
and blood lipids in a clinically meaningful manner if such changes can be sustained over a longer
period of time. A traditional DF also results in a relevant reduction in blood insulin and oxidative stress
biomarkers. However, additional longer-term studies are needed to provide more information pertaining
to the health benefits of the Daniel Fast plans. It should also be noted that the study sample size is
relatively small and future studies inclusive of a larger sample are needed to extend these findings.
The data presented in this study are in reference to a wide range of relatively healthy individuals,
predominantly women, all but two (both in the unrestricted vegan group) of whom claimed to regularly
perform exercise (traditional DF = 5.6 h/week; modified DF = 4.6 h/week; unrestricted vegan = 4.4 h/week).
Moreover, the results were obtained following just 21 days of adherence to the prescribed diet plan. As
indicated above, longer-term studies are needed to extend these findings.
As in our prior studies with the DF, self-reported compliance to the dietary plans was excellent,
approaching 100% for all groups. While the plan was only three weeks in duration, the high compliance
rate highlights the fact that these diet plans may be reasonably maintained by committed individuals.
Indeed, our recent work involving a six month period of both a traditional and modified DF confirms
this [13]; although mean kilocalorie intake was closer to 1400–1500 per day for the traditional and
modified DF respectively, which appears more realistic than the ~1150 figure noted in the present
Healthcare 2015, 3 553

study for the traditional DF. Additional longer-term studies focused on dietary compliance are needed
to determine if individuals can follow these plans for extended periods of time—at lengths that are
likely necessary to foster meaningful health benefits related to longevity and disease. It should also be
noted that since compliance was self-reported, the possibility exists that participants may have
overestimated their adherence to the plans. For example, while the unrestricted vegan group reported
94% compliance, the diet analysis indicated a mean post-intervention cholesterol intake of 43 mg.
Although this is a significant drop from their pre-intervention mean value of 171 mg, if strictly adhering to
the plan, we would expect that cholesterol intake would be even lower.
Although not of statistical significance, subjects assigned to the traditional DF group reported an
approximate 10% increase in perceived mental and physical health. Systolic BP was also reduced
approximately 7 mmHg in subjects assigned to the traditional DF, with an approximate 5 mmHg reduction
noted in subjects assigned to the modified DF and the unrestricted vegan plan. The reduction in BP
with the plant-based diets has been discussed previously [14] and may be related to multiple components
within the diet including the quantity and type of dietary fat, the intake of fruit and vegetables, the
amount of dietary protein, and the overall kilocalorie intake [15].
Regarding biochemical outcomes, blood lipids were reduced with the DF plans and to a greater extent
with the traditional plan. In our prior study comparing the two plans, results were relatively similar between
plans [6]. From a clinical perspective, both diet plans may be viewed as health-enhancing with regards to
blood lipids. Interestingly, both total and LDL cholesterol were increased in subjects following the
unrestricted vegan plan; this despite a lower dietary cholesterol intake in the unrestricted vegan group
compared to the modified DF group. It is possible that the fatty acid composition of the diet (saturated,
monounsaturated, polyunsaturated fats), as well as the fiber intake, could be responsible for the differences
between groups.
Aside from blood lipids, insulin was reduced in the traditional DF group, while malondialdehyde
also was decreased. We have noted the same in our prior studies using the traditional DF [8,9]. No
changes in these measures were noted in either the modified DF or unrestricted vegan groups. It is
possible that the greater reduction in kilocalorie intake for those in the traditional DF group (Table 4)
was responsible for the noted differences, as a reduction in dietary energy is known to improve redox
state [16] and may have implications for improved insulin sensitivity [17]. For example, subjects
assigned to the traditional DF reduced kilocalories by approximately 35%, while those in the modified
DF and unrestricted vegan plans only experienced a reduction of approximately 20% and 23%,
respectively. It is likely that a larger sample of subjects is needed to better explain the impact of these
dietary plans on metabolic and oxidative stress biomarkers. Future studies should aim to enroll a
higher number of participants and possibly monitor them over a longer time course.
While multiple dietary variables were measured and noted to be different between diet groups and
across time, it is unknown which variable(s) most contributed to the effects observed. That said, it is
likely that the decrease in total kilocalorie intake may be the most important variable driving the
outcomes, with consideration for dietary fiber, cholesterol, and fat also being responsible for our
findings—in particular in relation to blood lipids. Of course, variables such as carbohydrate type and
various additives and preservatives that may have been contained within foods consumed by those
assigned to the unrestricted vegan diet may have impacted the variables measured in the present study.
For example, the kilocalorie intake was lower for the unrestricted vegan group as compared to the
Healthcare 2015, 3 554

modified DF group at the post-intervention time. However, the overall results were more favorable for
the modified DF group. Moreover, data obtained from a recent animal study in our lab indicates that
despite receiving a similar daily food ration (kcal intake), animals benefit much more from consuming
a diet formulated to be similar to the traditional DF, as compared to a typical American diet consisting
of high amounts of saturated fat and simple sugar [18].
It should be noted that mean kilocalorie intake was quite low at the post-intervention time for the
traditional DF group. Many subjects reported a significant increase in satiety when following a traditional
DF plan, leading to a reduction in energy intake. This may have been the case in the present study, in
addition to the possibility of under-reporting in dietary intake.

5. Conclusions

The data from the present study indicate that otherwise healthy men and women including normal
weight, overweight, and obese individuals can improve certain measures of health by adopting a traditional
or modified DF dietary plan. All diet plans were well-tolerated by subjects, and many subjects who
followed the DF plans noted an increase in nutritional knowledge by following the plan for a mere three
weeks (e.g., understanding of food labels, recognizing what is contained within commonly consumed
foods). Follow-up studies should include a larger sample size and an extended time frame of dietary
adherence in an attempt to determine both the feasibility and potential health benefits of these plans in both
men and women. Studies may also be conducted using individuals with known cardiovascular or metabolic
disease, as clinically relevant results may be observed following these dietary plans.

Acknowledgments

Funding for this work was provided by the University of Memphis.

Author Contributions

Richard J. Bloomer was responsible for the study design, oversight and analysis of biochemical
variables, statistical analyses, and writing of the manuscript. Trint A. Gunnels and JohnHenry M. Schriefer
were responsible for subject recruitment, data collection and entry, and blood collection and processing.

Conflicts of Interests

The authors declare that they have no competing interests.

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