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Bianca Bosker and the Cork Dork book

cork dork bianca bosker book

I've been reading the book "Cork Dork: A Wine-Fuelled Journey into the Art of Sommeliers and the Science of Taste" by Bianca Bosker over the last few days whilst trapped on a plane.

In a very entertaining style, Bianca writes about her journey from tech journalist knowing nothing about wine, to cellar rat,  to passing the Certified Sommelier Exam, overseen by the Court of Master Sommeliers (which leads to the Advanced Sommelier Examination and to the pinnacle of Master Sommelier Diploma Examination). 

The Certified Sommelier Examination is a one-day test with three separate sections: deductive tasting, theory, and practical service. In order to pass the examination, candidates must achieve a minimum 60% score in each section. Successful candidates will receive a pin signifying their certification as a sommelier by the Court of Master Sommeliers.

Deductive Tasting Examination: Utilising the Court of Master Sommelier Deductive Tasting Method, candidates must describe and identify four wines (two white and two red) to the best of their ability. This is a written tasting that must be completed in 30 minutes. 

Theory Examination: The theory examination tests candidates' knowledge and understanding of the world of wine, beverage, and the sommelier trade. The test consists of multiple choice, short answer, simple math, and matching questions. Candidates must complete the 45-question examination within 35 minutes.

Service Practical Examination: The practical service examination approximates a real restaurant environment, and candidates are expected to demonstrate salesmanship and knowledge while performing a variety of tableside tasks. Candidates may be asked to open still or sparkling wines, to recommend cocktails or spirits, to discuss food and wine paring options, and to generally show their abilities as a restaurant sommelier. 

Important principles of service according to top sommeliers: smile, maintain eye contact, no sudden movements, don't lean, don't slouch, don't look stiff, don't point, no names, don't touch the table, face, hair and certainly not the guest, polish the glasses, don't touch anything but the glass stem, don't let the glasses tinkle, don't pour men before women, don't put an ice bucket on the table, offer the cork, pour hosts before guests, make sure everyone gets the same amount of the pour, don't pick up glasses to pour, don't empty the bottle the first time around, don't pour from the left, don't walk clockwise, state the name of the wine and vintage before pouring etc. etc.

Bianca Bosker cork dork

In Bianca's book she explores many of the controversies in wine:

  • Are expensive wines really worth the money and the disconnect between the price of topend wines to their actual quality
  • The hedonism around the wine scene in a city like New York
  • The science behind the production of bulk wines
  • The identification and exploitation of high worth customers in top end restaurants by sommeliers
  • The inappropriate and out of date standards expected by the Court of Master Sommeliers which insist on service/knowledge for visitors to Michelin star restaurants, not everyday wine drinkers
  • The lengths that some people will go to as they strive to become Masters of wine (as shown by the movie Somm) - endless blind tastings, change in lifestyles, impacts on their relationships with partners and family etc. Described as "little old men trapped in twentysomethings' bodies. In addition to dressing like they've raided Jay Gatsby's closet, they spend much of their time thinking about the past, mulling over the traditions of a five-hundred-year-old chateau, or mooning over a particularly warm spring 30 years ago."
  • The bullshit around wine e.g. use of French language terms in service and the descriptors for wine during tasting (most of which seemed to be derived from a herd behaviour)

As someone who loves wine and has visited many of the great wine producing areas around from the world from Napa to Burgundy, I agree with many of Bianca's sentiments.  Though I have to say I have much less acumen in wine tasting that she acquired over the last few years.  I guess in somm speak, I'd be described as a "civilian".

Many sommeliers seem to live on a different planet of drinking and recommending super premium wines in many cases priced at hundreds of dollars a bottle in top restaurants in cities where money flows with abandon. Getting money of PX, personne extraordinaire (restaurant code for "spends dough") is the key requirement, professionalism seems a secondary consideration. Check out Victoria in the book!

Another depressing side effect of capitalism and perfectly matched to the lurid stories of the "Wolf of Wall Street", Lehman Brothers and so on.

I think I'll stay a wine civilian! A great read if you're into wine, educational and entertaining. Buy Bianca's book.

Self serving wine critics, magazines and the gulf between everyday drinkers

I love wine and of course I read magazines like Wine Spectator and Decanter. But the more I taste wine, speak to winemakers and read these publications I realise the huge gulf between what regular "non-expert" wine drinkers want and what critics are recommending. 

Decanter is a good publication but many of its regionl or country specific articles recommending certain wines by Masters of Wine are seriously premium priced or not even readily available . Don't get me wrong I am happy to spend good money on fine wines from Burgundy, Bordeaux, Italy, New Zealand, Australia and elsewhere. However, my recent wine tasting visits to Piedmont, Valpolicella, Thermenregion Austria and lately Baden in Germany makes me realise that many famous "brands" are seriously over priced. The worst culprits are California, Burgundy and Bordeaux as high value individuals bid the price of land and bottles up to crazy levels. With Asian buyers now heavily into wine auctions and even buying vineyards, its becoming tougher and tougher to buy "cult wines" for the man or woman in the street.

In the last couple of weeks I was fortunate to have a bottle of Ridge Monte Bello 2012 (£75 for 375ml half bottle - Hedonism Wines, London) from California's Santa Cruz Mountains and Vega Sicilia Valbuena 5° 2011 from Spain's Ribera Del Duero region. Even better to drink the Valbuena in Plaça Reial off the La Rambla in Barcelona thanks to a friendly waiter who opened it for me and sampled it (I bought at the local and excellent Torres wine store on Carrer Nou de la Rambla, 25. Price 99 euros). 

The Ridge 2012 was a 50th anniversary bottling and it has been described by the winemaker as a "super vintage". It was rich, velvety smooth with blackberry, cassis and blackcurrant. Nice balance of acidity, tannin and fruit (apparently the most acidic vintage since 1992).  Lovely long finish.

The Valbuena was a big rich red like the Ridge. Definitely more alcoholic 14.5% in the warm and dry 2011 Ribera Del Duero versus 13.5% for cooler climate Ridge. It certainly had plenty of black fruit on the nose and palate and was actually a little spicy like a shiraz. Nicely balanced soft tannins and a long complex finish.

But was Ridge worth the equivalent of £150 ($200) a bottle and Vega Sicilia 99 euors ($117)? They were both great wines and a real treat to have tried them, but I have drunk many wines at the $20-30 range which were just as pleasant, if less iconic than these two wineries. 

Many critics score wines with high tannin and acidity with top marks and they are great after years to soften these tannins in the cellar. Some wine critics like Robert Parker or their counterparts love the big, rich Cabernet Sauvignons of the USA. So winemakers try to produce wines that appeal to this group to achieve high scores and high sales. With so much competition, a low Decanter/Parker/Wine Spectator score can be a deadly blow for a winery.

Unfortunately most wine drinkers want to drink the wines we buy fairly quickly. 10 years in a cellar is really not practical, especially as many don't even have a suitable storage area and certainly not a cellar. Keeping wine under stairs or in the garage or god forbid in a kitchen means temperature fluctuations and the best wines whilst made to be stored will be ruined. There's no point laying down a top Margaux Grand Cru or Gevrey Chambertin Premier Cru when the location is 20 degrees centigrade and in the sunshine half the day!

During a recent visit to Baden in Germany, I tasted very tannic wines which are basically undrinkable now. Yet they command high prices. I have noted that the premium wines I have sampled e.g. Ridge and Opus One have great complexity and a long finish but you pay heavily for the famous brand. Lots and lots of wine makers around the world are producing similarly complex wines for much less, especially in unfashionable regions. For example I tasted amazing Austrian Pinot Noir and St. Laurent for less than 20 euros a bottle!

Most wine drinkers spend $5-10 a bottle which is too low given excise duty and other taxes. But expecting punters to buy $30-50 bottles is a "bridge too far". I wish the critics and magazines realised that many wine drinkers have a moderate budget at best and want to drink wines in the near term so stop encouraging wine makers to focus on the cellaring market. Great for their profits when you give them 95 points, but us mortals want to avoid a mortgage to buy them!

See additional blog article:

More about Vega Sicilia and Valbuena 5°

Vega Sicilia Valbuena 2011

Bodegas Vega Sicilia is a winery located in the Ribera del Duero Denominacion de Origen in Valladolid, Castilla y León in the North of Spain. It was founded in 1864 by Don Eloy Lecanda y Chaves, who planted various grapes from the Bordeaux wine region of France, including Cabernet Sauvignon and Merlot. Vega Sicilia is particularly well known for its super premium Único wine.

The winery describes Valbuena as follows:  

"is the purest expression of the Tinto Fino (Tempranillo) in Vega Sicilia. Tinto Fino is clearly the predominant wine in the assemblage of the varieties that make up this magnificent wine. The other variety used is Merlot, which is added to a greater or lesser extent depending on the vintage.

The Valbuena Tempranillo is obtained from plots located on gentle concave slopes that descend from the wasteland. Those soils are made up of material that was eroded and accumulated as colluvial on the lower slopes, developing a high profile soil, with a specific important evolution with the formation of a deep calcic horizon.

Fermentation at a controlled temperature with native yeast in stainless steel tanks. Malolactic fermentation also takes place in stainless steel.

After fermentation, it is aged for five years, between wood and in the bottle, which is why it is called Valbuena 5º. French and American wood, new and used 225-litre barrels, 20,000 litre vats, a long and complex process for a great wine."

2011 was a very warm and ripe vintage in the Ribera Del Duero area, and the challenge for the winemaker was to keep the freshness of wine and avoid over ripeness and too much alcohol (it was still 14.5%).

More about Ridge and Monte Bello

Ridge Monte 2012.JPG

Ridge Vineyards is a California winery specialising in top of the range Cabernet Sauvignon, Zinfandel, and Chardonnay wines and it produces wine at two winery locations in northern California. The original winery facilities are located at an elevation of 2,300 feet (700 m) on Monte Bello Ridge in unincorporated Santa Clara County in the Santa Cruz Mountains AVA, south of Los Altos, California and west of Cupertino, California. The other Ridge winery facilities are at Lytton Springs in the Dry Creek Valley AVA of Sonoma County. Ridge Vineyard's 1971 Monte Bello Cabernet Sauvignon achieved international fame for its fifth-place finish in the 1976 "Judgement of Paris" wine tasting.

In 1886, high in the Santa Cruz Mountains, the initial plantings of the Monte Bello estate vineyard were set out, and winery construction begun. A first vintage from the young vines followed in 1892. During Prohibition (1920-1933), the vineyard was not fully maintained; some vines survived into the late 30’s, but by the 1940s they were effectively abandoned. Eight acres of cabernet sauvignon were replanted in 1949. These were the source of the first Ridge Monte Bello (1962). Since then, the historic vineyards on the ridge have gradually been replanted.

The 2012 Monte Bello has 64% Cabernet Sauvignon, 22% Merlot, 8% Cabernet Franc, 4% Petit Verdot. 2012 was a very dry year and a bit tricky for the wine maker which meant less Cabernet Sauvignon than normal in the blend. Tannins were easy to extract, less maturation and came out of fermenter in 5-6 days rather than usual 7-10 days. 16 months in 100% new oak barrels. 

Major new well designed study confirms health benefits of wine consumption on risk of death and heart disease

couple with wine hi res.jpeg

After the controversy caused by the news analysis by Stockwell in 2016 "Do "Moderate" Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality" it was inevitable that more research in this subject would be started.

The systematic review and meta-regression analysis of studies investigating alcohol use and mortality risk after controlling for quality-related study characteristics was conducted in a population of 3,998,626 individuals, among whom 367,103 deaths were recorded. A total of 87 studies were examined and the paper concluded that when his team corrected for abstainer "biases" and certain other study-design issues, moderate drinkers no longer showed a longevity advantage.

Stockwell's paper concluded that "Estimates of mortality risk from alcohol are significantly altered by study design and characteristics. Meta-analyses adjusting for these factors find that low-volume alcohol consumption has no net mortality benefit compared with lifetime abstention or occasional drinking. These findings have implications for public policy, the formulation of low-risk drinking guidelines, and future research on alcohol and health.

A blog by The Stats Guy relating to the subsequent change to the U.K.'s alcohol drinking limits is enlightening and gives an indication that Stockwell and others like the Sheffield group may have been overzealous on their interpretations of data. 

Di Castelnuovo paper December 2006 and the J-shaped curve

Stockwell's view was contrary to the previous large meta-analysis by Di Castelnuovo et al in 2006 "Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies". Di Castelnuovo used a meta analysis technique where the results of 34 studies were collated and reviewed and published in the Archives of Internal Medicine. The study looked at the link between the amount of alcohol drunk and death rates in men & women in clinical trials conducted before the end of 2005 with over 1 million subjects. 

A J-shaped relationship between alcohol and total mortality was confirmed in both men and women. Consumption of alcohol, up to 4 drinks per day in men and 2 drinks per day in women, was inversely associated with total mortality or the chance of dying, maximum protection being 18% in women and 17% in men. Higher consumption of alcohol was detrimental. The results were consistent with studies by other research including Sir Richard Doll's 1994 study "Mortality in relation to consumption of alcohol: 13 years' observations on male British doctors". 

The Journal of the American College of Cardiology paper August 2017

Now a brand new study published aimed to tackle the controverisal issue of wine and health yet again. In mid-August 2017, a new and large study was published in the Journal of the American College of Cardiology, "Relationship of Alcohol Consumption to All-Cause, Cardiovascular, and Cancer-Related Mortality in U.S. Adults" by Bo Xi, Sreenivas P. et al.

The study in 333,247 people found that light-to-moderate drinkers (less than 14 drinks in men and 7 drinks in women) did have a lower risk of dying from cardiovascular disease.

Individuals were followed between 1997 and 2009 and around 34,000 died sometime during this period. Throughout the length of the study, 34,754 participants died from all-causes. Of these, 8,947 deaths were cardiovascular disease-specific (6,944 heart disease-related and 2,003 cerebrovascular-related deaths) and 8,427 mortalities were cancer-specific.

The results of the study showed that men and women who were moderate drinkers had a 13 percent and 25 percent decreased risk of all-cause mortality, and 21 and 34 percent decreased risk of cardiovascular disease mortality, respectively.

Men who are heavy drinkers have a 25 percent increased risk of mortality due to all-causes and a 67 percent increase in mortality from cancer; however, these results were not significant in women. There were similar findings for light drinking for both men and women.

This is the key point. Bo Xi and his team were careful to address the supposed flaws in previous studies on alcohol and health. So the non-drinker group only included lifetime nondrinkers, so "sick quitters",  former heavy drinkers and those who gave up alcohol because they got sick were excluded.

The paper also controls for smoking, Body Mass Index (BMI) and physical activity, Some academics still believe that total lifetime abstainers are rare and could share other, unforeseen traits that impact their health, whereas moderate drinkers might have an overall healthier lifestyle. Causation is almost impossible to identify and this will always be a flaw.

But this new observational study tries its hardest to be large, well designed and lasted for 12 years.

National Institute of Health study results due 2023

A new study costing $100 million by the U.S. based National Institutes of Health will aim to finally answer the question whether daily alcohol drinking can help lower your risk for heart attacks, strokes and death.

8,000 volunteers will be recruited that fit very specific criteria from 16 areas around the world. Half will randomly be selected to have one drink per day, while the other half will have to abstain from drinking during the course of the study. These two groups will be followed for six years (poor abstainers!). The clinical trial will be run by notable researchers from around the world in Boston, Baltimore, Amsterdam, Copenhagen and Barcelona to cover all regions of the world.

Creative block? Try a glass of beer or wine!

creative block

In a paper called "Creativity on tap? Effects of alcohol intoxication on creative cognition" by Dr. Mathias Benedek the authors examined creativity-measuring tasks in 89 volunteers after drinking beer. The article was published in the Journal of Conscious Cognition in July 2017.

The participants were either given an alcoholic or non-alcohol beer and each participant from the alcoholic-beer group had to reach the level of mild intoxication of 30mg of alcohol in every 100ml of blood (half the English drink driving limit). A total of 70 young adults (54 % female), aged between 19 and 32 years (M = 23.3; SD = 2.8), finally participated and completed all measures.

After becoming intoxicated they then had to complete a word association task, a creative thinking task, having to come up with as many creative uses as they could for common objects. On both these tasks, the alcohol beer group performed better.

The study also found that alcohol reduces ‘cognitive control’, which can be a hurdle in solving creative tasks. When someone has creative block or a so called "fixation effect", alcohol may play a role in reducing it and helps people to "think  out of the box". Dr. Benedek says "In creative problem solving, problems can often only be solved after a restructuring of the problem representation. When initial solution attempts get on the wrong track, this can cause blocks to immediate problem solving, which is known as mental fixation. Alcohol may reduce fixation effects by loosening the focus of attention."

However, while alcohol boosted creativity it decreased ‘executive function’ and so is likely to impede artistic endeavors which require motor skills, such as playing the piano or dancing.

The paper says (in a very technical way):

"Creative cognition is assumed to rely on both controlled, goal-directed and spontaneous, undirected cognitive processes. Pertinent research mostly focused on divergent thinking (viz. creative idea generation) and creative problem solving (i.e., problems that can be solved either analytically or insightfully, which typically implies a restructuring of the problem representation). The relevance of cognitive control for divergent thinking is evidenced by consistent correlations with intelligence, particularly with fluid intelligence and broad retrieval ability. . At the level of executive abilities, divergent thinking has been associated with working memory capacity and cognitive inhibition.  Divergent thinking requires overcoming prepotent, uncreative response tendencies and involves cognitive strategies, which was shown to be facilitated by intelligence. While much of the empirical evidence on creative cognition and cognitive control is based on divergent thinking, similar evidence also exists for creative problem solving. Creative problem solving tasks like Duncker’s candle problem or the Remote Associates Test can be achieved in a strategic way and higher performance again has been related to intelligence and executive control.

Creativity has also been associated with disinhibition and spontaneous insight. Empirical evidence for the relevance of spontaneous, undirected cognitive processes in creative thought mostly comes from research on incubation processes. Creative problem solving sometimes leads to an impasse of thought, also known as mental fixation, were goal-directed solving attempts are no longer fruitful. Incubation research has demonstrated that breaks from deliberate problem solving can benefit creativity by refreshing inadequate mindsets while leaving room for unconscious work. Similarly, while expertise typically supports problem solving by guiding search through problem space, it can also be detrimental when misdirecting search efforts to salient but inadequate concepts. Together, these findings suggest that cognitive control generally supports creative cognition by facilitating the effective implementation of goal-directed processes, but focused attention may sometimes be ineffective and potentially even harm creative problem solving.

The "What the Health" movie and do vegetarians and vegans really live longer?

There's been an awful lot of media coverage in recent weeks about the "dangers" for meat eaters and those consuming eggs and so on. For example, a film "What the Health" (from the makers of another documentary called Cowspiracy) is making waves. The film in its words "exposes the collusion and corruption in government and big business that is costing us trillions of healthcare dollars, and keeping us sick". The movie claims that eating eggs is as bad as smoking and blames a non-vegetarian diet on obesity, diabetes, cancer and premature death!

Really? So a little off topic but since your overall diet, including wine, is key to your health I thought it was about time that FermentedGrape.com delved into this controversy and established the facts from fiction.

Does the clinical evidence out there, as opposed to a bunch of opinions from zealot vegan physicians, support the view that you clear your fridge of meat and dairy?

What the health, human milk vs cow milk

The 2017 film is film directed by  Kip Andersen and Keegan Kuhn, produced and partly funded by vegans and features many interviews with vegan doctors and advocates. Its executive producer is Hollywood star, Joaquin Phoenix, who happens to be a vegan. 

From the film's website, "Kip Andersen’s awakening as a filmmaker came as a result of An Inconvenient Truth. After seeing the film, he dramatically changed his lifestyle and believed he was doing everything he could to help the planet. But his life took a different direction when he found out animal agriculture is the leading cause of environmental destruction. Together with Keegan Kuhn he co-produced his first film, Cowspiracy: The Sustainability Secret, which became an overnight viral success and ignited the environmental movement. Following this success, he was invited to speak in front of the European Parliament and a new cut, executive produced by Leonardo DiCaprio, was exclusively released on Netflix in September 2015."

Kip Andersen, Co-Director What the Health

Kip Andersen, Co-Director What the Health

Anti meat campaigners used to focus on highlighting abuses of animal welfare but there is now a new direction of portraying meat and dairy to be as deadly as burning tobacco.

The claims in this film are not supported by the available clinical evidence and instead the producers rely on two vegan promoting organisations "Physicians Committee for Responsible Medicine (PCRM)" and "Nutritionfacts.org".  

The PCRM has been involved in several pieces of research looking at diet, veganism vs meat. For example, the Los Angeles times reported on "Study finds plant-based diets lead to weight loss". This article was based on a paper originally published called, "Position of the Academy of Nutrition and Dietetics: Vegetarian Diets, DianaCullum-Dugan, published Journal of the Academy of Nutrition and Dietetics, Volume 115, Issue 8, August 2015, Pages 1347. 

The original paper stated that plant based diets significantly reduced weight better than meat based diets and “There was no significant weight-loss difference between studies using ovo-lacto-vegetarian diets and those using vegan diets” An ovo-lacto vegetarian (or lacto-ovo vegetarian) is a vegetarian who does not eat meat, but does consume some animal products such as eggs and dairy.

“It is the position of the Academy of Nutrition and Dietetics that appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, childhood, adolescence, older adulthood, and for athletes. Plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources and are associated with much less environmental damage.”

Physicians Committee for responsible medicine Ellen DeGeneres

But there is controversy around this publication! 

Looking at Sciencedirect.com it has the following statement attached to the clinical paper, "This article has been removed at the request of the Academy Positions Committee (APC) of the Academy of Nutrition and Dietetics. The APC became aware of inaccuracies and omissions in the position paper that could affect recommendations and conclusions within the paper. After further review, the APC decided it was appropriate to remove this paper for major revision."

Removal notice: Position of the Academy of Nutrition and Dietetics: Vegetarian diets

Do vegans  and vegetarians really live longer?

From this Times newspaper on 5th August 2017,

  • Alice Howarth, a cancer researcher, said: “While it is true that diet plays an important role in diseases including cancer and diabetes, the claims in this film vastly overstate and misrepresent the scientific understanding. "What the Health" overwhelms the viewer with scaremongering ‘facts’ which do not hold up to scientific investigation.”
  • Gunter Kuhnle, associate professor in nutrition and health, University of Reading, said: “Apart from a few very specific dietary components (fibre, fats) for which there is a clear link with health, it appears that the old and boring recommendation of a balanced diet is still the best.

So what's the story from the literature evidence? Is being a vegetarian or vegan better for you?

There is no clear evidence of any difference in overall risk of death (mortality) between vegetarians and non-vegetarians. However a plant based diet (vegan and vegetarian) seems to be associated with a lower risk of some cancers, heart disease and diabetes. 

A rather good review was published in Critical Reviews in Food, Science and Medicine journal, "Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies" in February 2016.

In summary, "With regard to prospective cohort studies, the analysis showed a significant reduced risk of incidence and/or mortality from ischemic heart disease (RR 0.75; 95% CI, 0.68 to 0.82) and incidence of total cancer (RR 0.92; 95% CI 0.87 to 0.98) but not of total cardiovascular and cerebrovascular diseases, all-cause mortality and mortality from cancer."

In the 2012 study, Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review. seven studies with a total of 124,706 participants were included in this analysis. All-cause mortality in vegetarians was 9% lower than in nonvegetarians (RR = 0.91; 95% CI, 0.66-1.16). But the average may be a 9% reduction, but the variability is huge from a 44% reduction, to a 16% increase in mortality for a vegetarian diet. 

Individual studies as opposed to these meta-analyses, show a confusing pattern. 

In the "Mortality in British vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford)" published in 2009 the authors concluded that "The mortality of both the vegetarians and the non-vegetarians in this study is low compared with national rates. Within the study, mortality from circulatory diseases and all causes is not significantly different between vegetarians and meat eaters, but the study is not large enough to exclude small or moderate differences for specific causes of death, and more research on this topic is required."

In the study Vegetarian dietary patterns and mortality in Adventist Health Study 2.  mortality was shown to be up to 15% less in the vegans versus meat eaters. It was shown that "There were 2570 deaths among 73,308 participants during a mean follow-up time of 5.79 years. The mortality rate was 6.05 (95% CI, 5.82-6.29) deaths per 1000 person-years. The adjusted hazard ratio (HR) for all-cause mortality in all vegetarians combined vs nonvegetarians was 0.88 (95% CI, 0.80-0.97). The adjusted HR for all-cause mortality in vegans was 0.85 (95% CI, 0.73-1.01); in lacto-ovo-vegetarians, 0.91 (95% CI, 0.82-1.00); in pesco-vegetarians, 0.81 (95% CI, 0.69-0.94); and in semi-vegetarians, 0.92 (95% CI, 0.75-1.13) compared with nonvegetarians. "

What about nutritional problems with vegetrian and vegan diets?

In the 2003 review, "Nutrition and health--potential health benefits and risks of vegetarianism and limited consumption of meat in the Netherlands"

"Although a high consumption of red meat, which is rich in haeme iron and saturated fat, may increase the risk of cardiovascular disease and some types of cancer, this does not apply to white meat and fish. In fact, the most important protective effect would seem to be derived from the consumption of unrefined vegetable products (whole-grain cereals, vegetables, fruits, nuts and legumes) and fish. In other words, a prudent, omnivorous diet with moderate amounts of animal products, in which red meat is partly replaced by white meat and fish (especially fatty fish), together with the consumption of ample amounts of unrefined vegetable products, is thought to be just as protective as a vegetarian diet. On the other hand, the omission of meat and fish from the diet increases the risk of nutritional deficiencies. A vegan diet, in particular, leads to a strongly increased risk of deficiencies of vitamin B12, vitamin B2 and several minerals, such as calcium, iron and zinc."

In a 2006 review, "Health effects of vegetarian and vegan diets" they stated that "Cohort studies of vegetarians have shown a moderate reduction in mortality from IHD but little difference in other major causes of death or all-cause mortality in comparison with health-conscious non-vegetarians from the same population. Studies of cancer have not shown clear differences in cancer rates between vegetarians and non-vegetarians. More data are needed, particularly on the health of vegans and on the possible impacts on health of low intakes of long-chain n-3 fatty acids and vitamin B(12). Overall, the data suggest that the health of Western vegetarians is good and similar to that of comparable non-vegetarian.

In a Swiss study published in 2017, Micronutrient status and intake in omnivores, vegetarians and vegans in Switzerland. the authors state that, "Despite substantial differences in intake and deficiency between groups, our results indicate that by consuming a well-balanced diet including supplements or fortified products, all three types of diet can potentially fulfil requirements for vitamin and mineral consumption."

Claims from What the Health film under scrutiny

Claim: Eating one egg a day is as bad as smoking five cigarettes a day.
One of the scientific papers on which the film bases this claim does not mention eggs. It looks at cholesterol, from which the effect of eggs has been inferred. A second looked at the link between egg yolk and plaque in carotid arteries, not life expectancy. 

Claim: The risk of heart disease is 50 per cent for meat eaters, 45 per cent for vegetarians and 4 per cent for vegans.
Experts agree that vegetarians seem to have a lower risk of heart disease but this claim, made on the documentary’s Facebook page, above, refers to a 1994 study that did not include vegans and does not show any statistically meaningful risk reduction. 

Claim: One serving of processed meat a day increases risk of developing diabetes by 51 per cent.
Fact Of two papers picked out by the film-makers to illustrate this, only one has the figure cited, which refers to relative risk, rather than absolute risk. Alexandra Freeman, of the Winton Centre for Risk and Evidence Communication, said: “An ‘increase’ can be made to look huge, but if it’s an increase from a tiny value to another tiny value then that puts a whole different perspective on it.”

Summary - do vegetarians and vegans really live longer?

In summary, there seems to be good evidence that plant based diets which avoid meat mean that your risk of heart disease, stroke, obesity and diabetes is lower. However, the impact on overall mortality is less clear cut, with several large meta-analyses clearly stating that there is no different in risk of death in vegetarians, vegans and carnivores. Also, it seems that with the right level of dietary supplementation there are no serious effects on health from practicing a vegan or vegetarian diet. 

However, as a meat lover myself, I personally advocate a balanced omnivore diet, relating to the Mediterranean diet with a good balance of fresh and good quality, meats, fish, vegetables, pulses and fruit (see also the "French Paradox"). If possible using organic ingredients, quality over quantity.

Also throw in a good dose of exercise, at least 3 times a weak vigorous, no smoking and a couple of glasses of red wine a day and I think you have the perfect balance of a delicious and nutritious diet and health as well as happiness. Lets face it you can't beat a good steak and a glass of red wine even if a salad/vegetable diet may be slightly better for you, you'll probably die at the same age as your vegetarian friend and be less happy on the way if you can cope with all the animal welfare challenges! Lets face it the food industry needs to look after animals better and not treat them like commodities which they are at the moment. Less but better quality meat please!

More information on clinical studies and further reading

Crit Rev Food Sci Nutr. February 2016, issue 17:3640-3649,Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies.

Abstract

BACKGROUND:

Beneficial effects of vegetarian and vegan diets on health outcomes have been supposed in previous studies.

OBJECTIVES:

Aim of this study was to clarify the association between vegetarian, vegan diets, risk factors for chronic diseases, risk of all-cause mortality, incidence, and mortality from cardio-cerebrovascular diseases, total cancer and specific type of cancer (colorectal, breast, prostate and lung), through meta-analysis.

METHODS:

A comprehensive search of Medline, EMBASE, Scopus, The Cochrane Library, and Google Scholar was conducted.

RESULTS:

Eighty-six cross-sectional and 10 cohort prospective studies were included. The overall analysis among cross-sectional studies reported significant reduced levels of body mass index, total cholesterol, LDL-cholesterol, and glucose levels in vegetarians and vegans versus omnivores. With regard to prospective cohort studies, the analysis showed a significant reduced risk of incidence and/or mortality from ischemic heart disease (RR 0.75; 95% CI, 0.68 to 0.82) and incidence of total cancer (RR 0.92; 95% CI 0.87 to 0.98) but not of total cardiovascular and cerebrovascular diseases, all-cause mortality and mortality from cancer. No significant association was evidenced when specific types of cancer were analyzed. The analysis conducted among vegans reported significant association with the risk of incidence from total cancer (RR 0.85; 95% CI, 0.75 to 0.95), despite obtained only in a limited number of studies.

CONCLUSIONS:

This comprehensive meta-analysis reports a significant protective effect of a vegetarian diet versus the incidence and/or mortality from ischemic heart disease (-25%) and incidence from total cancer (-8%). Vegan diet conferred a significant reduced risk (-15%) of incidence from total cancer.

Mortality in British vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford).

Key TJ1, Appleby PN, Spencer EA, Travis RC, Roddam AW, Allen NE.

Am J Clin Nutr. 2009 May;89(5):1613S-1619S. doi: 10.3945/ajcn.2009.26736L. Epub 2009 Mar 18.

Abstract

BACKGROUND:

Few prospective studies have examined the mortality of vegetarians.

OBJECTIVE:

We present results on mortality among vegetarians and nonvegetarians in the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford).

DESIGN:

We used a prospective study of men and women recruited throughout the United Kingdom in the 1990s.

RESULTS:

Among 64,234 participants aged 20-89 y for whom diet group was known, 2965 had died before age 90 by 30 June 2007. The death rates of participants are much lower than average for the United Kingdom. The standardized mortality ratio for all causes of death was 52% (95% CI: 50%, 54%) and was identical in vegetarians and in nonvegetarians. Comparing vegetarians with meat eaters among the 47,254 participants who had no prevalent cardiovascular disease or malignant cancer at recruitment, the death rate ratios adjusted for age, sex, smoking, and alcohol consumption were 0.81 (95% CI: 0.57, 1.16) for ischemic heart disease and 1.03 (95% CI: 0.90, 1.16) for all causes of death.

CONCLUSIONS:

The mortality of both the vegetarians and the nonvegetarians in this study is low compared with national rates. Within the study, mortality from circulatory diseases and all causes is not significantly different between vegetarians and meat eaters, but the study is not large enough to exclude small or moderate differences for specific causes of death, and more research on this topic is required.

Vegetarian dietary patterns and mortality in Adventist Health Study 2. Orlich MJ1, Singh PN, Sabaté J, Jaceldo-Siegl K, Fan J, Knutsen S, Beeson WL, Fraser GE.

JAMA Intern Med. 2013 Jul 8;173(13):1230-8. doi: 10.1001/jamainternmed.2013.6473.

Author information

Abstract

IMPORTANCE:

Some evidence suggests vegetarian dietary patterns may be associated with reduced mortality, but the relationship is not well established.

OBJECTIVE:

To evaluate the association between vegetarian dietary patterns and mortality.

DESIGN:

Prospective cohort study; mortality analysis by Cox proportional hazards regression, controlling for important demographic and lifestyle confounders.

SETTING:

Adventist Health Study 2 (AHS-2), a large North American cohort.

PARTICIPANTS:

A total of 96,469 Seventh-day Adventist men and women recruited between 2002 and 2007, from which an analytic sample of 73,308 participants remained after exclusions.

EXPOSURES:

Diet was assessed at baseline by a quantitative food frequency questionnaire and categorized into 5 dietary patterns: nonvegetarian, semi-vegetarian, pesco-vegetarian, lacto-ovo-vegetarian, and vegan.

MAIN OUTCOME AND MEASURE:

The relationship between vegetarian dietary patterns and all-cause and cause-specific mortality; deaths through 2009 were identified from the National Death Index.

RESULTS:

There were 2570 deaths among 73,308 participants during a mean follow-up time of 5.79 years. The mortality rate was 6.05 (95% CI, 5.82-6.29) deaths per 1000 person-years. The adjusted hazard ratio (HR) for all-cause mortality in all vegetarians combined vs nonvegetarians was 0.88 (95% CI, 0.80-0.97). The adjusted HR for all-cause mortality in vegans was 0.85 (95% CI, 0.73-1.01); in lacto-ovo-vegetarians, 0.91 (95% CI, 0.82-1.00); in pesco-vegetarians, 0.81 (95% CI, 0.69-0.94); and in semi-vegetarians, 0.92 (95% CI, 0.75-1.13) compared with nonvegetarians. Significant associations with vegetarian diets were detected for cardiovascular mortality, noncardiovascular noncancer mortality, renal mortality, and endocrine mortality. Associations in men were larger and more often significant than were those in women.

CONCLUSIONS AND RELEVANCE:

Vegetarian diets are associated with lower all-cause mortality and with some reductions in cause-specific mortality. Results appeared to be more robust in males. These favorable associations should be considered carefully by those offering dietary guidance.

Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review.

Ann Nutr Metab. 2012;60(4):233-40. doi: 10.1159/000337301. Epub 2012 Jun 1.

Huang T1, Yang B, Zheng J, Li G, Wahlqvist ML, Li D.

Abstract

BACKGROUND:

Prospective cohort studies have examined mortality and overall cancer incidence among vegetarians, but the results have been inconclusive.

AIMS:

The objective of the present meta-analysis was to investigate cardiovascular disease mortality and cancer incidence among vegetarians and nonvegetarians.

METHODS:

Medline, EMBASE and Web Of Science databases were searched for cohort studies published from inception to September 2011. Studies were included if they contained the relative risk (RR) and corresponding 95% CI. Participants were from the UK, Germany, California, USA, the Netherlands and Japan.

RESULTS:

Seven studies with a total of 124,706 participants were included in this analysis. All-cause mortality in vegetarians was 9% lower than in nonvegetarians (RR = 0.91; 95% CI, 0.66-1.16). The mortality from ischemic heart disease was significantly lower in vegetarians than in nonvegetarians (RR = 0.71; 95% CI, 0.56-0.87). We observed a 16% lower mortality from circulatory diseases (RR = 0.84; 95% CI, 0.54-1.14) and a 12% lower mortality from cerebrovascular disease (RR = 0.88; 95% CI, 0.70-1.06) in vegetarians compared with nonvegetarians. Vegetarians had a significantly lower cancer incidence than nonvegetarians (RR = 0.82; 95% CI, 0.67-0.97).

CONCLUSIONS:

Our results suggest that vegetarians have a significantly lower ischemic heart disease mortality (29%) and overall cancer incidence (18%) than nonvegetarians.

[Nutrition and health--potential health benefits and risks of vegetarianism and limited consumption of meat in the Netherlands].

Ned Tijdschr Geneeskd. 2003 Jul 5;147(27):1308-13.

Abstract

In the latest Dutch national food consumption survey (1998) just over 1% of subjects (about 150,000 persons) claimed to be vegetarians; however, a much larger group (6% or approximately 1 million persons) ate meat < or = once a week. Vegetarianism can be subdivided into lacto-vegetarianism (a diet without meat and fish) and veganism (a diet without any animal foods whatsoever, including dairy products and eggs). A recent meta-analysis showed that vegetarians had a lower mortality from ischaemic heart disease than omniovorous subjects; however, cancer mortality and total mortality did not differ. Although a high consumption of red meat, which is rich in haeme iron and saturated fat, may increase the risk of cardiovascular disease and some types of cancer, this does not apply to white meat and fish. In fact, the most important protective effect would seem to be derived from the consumption of unrefined vegetable products (whole-grain cereals, vegetables, fruits, nuts and legumes) and fish. In other words, a prudent, omnivorous diet with moderate amounts of animal products, in which red meat is partly replaced by white meat and fish (especially fatty fish), together with the consumption of ample amounts of unrefined vegetable products, is thought to be just as protective as a vegetarian diet. On the other hand, the omission of meat and fish from the dietincreases the risk of nutritional deficiencies. A vegan diet, in particular, leads to a strongly increased risk of deficiencies of vitamin B12, vitamin B2 and several minerals, such as calcium, iron and zinc. However, even a lacto-vegetarian diet produces an increased risk of deficiencies of vitamin B12 and possibly certain minerals, such as iron. Data from the latest Dutch food consumption survey suggest that 5-10% of all inhabitants of the Netherlands (up to 1 million persons) actually have a vitamin B12 intake below recommended daily levels. In medical practice, the possibility of vitamin B12 deficiency in subjects consuming meat or fish < or = once a week deserves serious consideration. In case of doubt, evaluation is indicated using sensitive and specific deficiency markers such as the levels of methylmalonic acid in plasma or urine. Alternative dietary sources of vitamin B12 instead of meat are fish (especially fatty fish is a good source of vitamin B12), or a vitamin-B12-supplement.

Health effects of vegetarian and vegan diets.

Proc Nutr Soc. 2006 Feb;65(1):35-41.

Key TJ1, Appleby PN, Rosell MS.

Abstract

Vegetarian diets do not contain meat, poultry or fish; vegan diets further exclude dairy products and eggs. Vegetarian and vegan diets can vary widely, but the empirical evidence largely relates to the nutritional content and health effects of the average diet of well-educated vegetarians living in Western countries, together with some information on vegetarians in non-Western countries. In general, vegetarian diets provide relatively large amounts of cereals, pulses, nuts, fruits and vegetables. In terms of nutrients, vegetarian diets are usually rich in carbohydrates, n-6 fatty acids, dietary fibre, carotenoids, folic acid, vitamin C, vitamin E and Mg, and relatively low in protein, saturated fat, long-chain n-3 fatty acids, retinol, vitamin B(12) and Zn; vegans may have particularly low intakes of vitamin B(12) and low intakes of Ca. Cross-sectional studies of vegetarians and vegans have shown that on average they have a relatively low BMI and a low plasma cholesterol concentration; recent studies have also shown higher plasma homocysteine concentrations than in non-vegetarians. Cohort studies of vegetarians have shown a moderate reduction in mortality from IHD but little difference in other major causes of death or all-cause mortality in comparison with health-conscious non-vegetarians from the same population. Studies of cancer have not shown clear differences in cancer rates between vegetarians and non-vegetarians. More data are needed, particularly on the health of vegans and on the possible impacts on health of low intakes of long-chain n-3 fatty acids and vitamin B(12). Overall, the data suggest that the health of Western vegetarians is good and similar to that of comparable non-vegetarian.

Micronutrient status and intake in omnivores, vegetarians and vegans in Switzerland.

Eur J Nutr. 2017 Feb;56(1):283-293. doi: 10.1007/s00394-015-1079-7. Epub 2015 Oct 26.

Schüpbach R1, Wegmüller R1,2, Berguerand C3, Bui M3, Herter-Aeberli I4.

Abstract

PURPOSE:

Vegetarian and vegan diets have gained popularity in Switzerland. The nutritional status of individuals who have adopted such diets, however, has not been investigated. The aim of this study was to assess the intake and status of selected vitamins and minerals among vegetarian and vegan adults living in Switzerland.

METHODS:

Healthy adults [omnivores (OVs), n OV = 100; vegetarians (VGs), n VG = 53; vegans (VNs), n VN = 53] aged 18-50 years were recruited, and their weight and height were measured. Plasma concentrations of the vitamins A, C, E, B1, B2, B6, B12, folic acid, pantothenic acid, niacin, biotin and β-carotene and of the minerals Fe, Mg and Zn and urinary iodine concentration were determined. Dietary intake was assessed using a three-day weighed food record, and questionnaires were issued in order to assess the physical activity and lifestyle of the subjects.

RESULTS:

Omnivores had the lowest intake of Mg, vitamin C, vitamin E, niacin and folic acid. Vegans reported low intakes of Ca and a marginal consumption of the vitamins D and B12. The highest prevalence for vitamin and mineral deficiencies in each group was as follows: in the omnivorous group, for folic acid (58 %); in the vegetarian group, for vitamin B6 and niacin (58 and 34 %, respectively); and in the vegan group, for Zn (47 %). Despite negligible dietary vitamin B12 intake in the vegan group, deficiency of this particular vitamin was low in all groups thanks to widespread use of supplements. Prevalence of Fe deficiency was comparable across all diet groups.

CONCLUSIONS:

Despite substantial differences in intake and deficiency between groups, our results indicate that by consuming a well-balanced diet including supplements or fortified products, all three types of diet can potentially fulfill requirements for vitamin and mineral consumption.