Vegetarian diets are gaining traction, and for good reason. A well-planned vegetarian diet is a healthy way to meet your nutritional needs. Reasons for following a vegetarian diet vary but include health benefits. Plant-based diets offer all the necessary protein, fats, carbohydrates, vitamins, and minerals for optimal health, and are often higher in fiber and phytonutrients. Plant-forward or plant-based eating patterns focus on foods primarily from plants. This includes not only fruits and vegetables, but also nuts, seeds, oils, whole grains, legumes, and beans. It doesn't mean that you are vegetarian or vegan and never eat meat or dairy. Scientific research highlighted in the landmark book The China Study shows that a plant-based diet can reduce the risk of Type 2 diabetes, heart disease, certain types of cancer, and other major illnesses.
Understanding Plant-Based Diets
A plant-based diet is a flexible approach to eating that prioritizes food from plants, including fruits, vegetables, nuts, seeds, oils, whole grains and beans. Following this approach doesn’t necessarily mean you’re a vegan who avoids meat and dairy. It simply means you focus on consuming more plant-based foods than animal-based ones. Plant-based diets come in many forms, each with its own balance of plant and animal foods. A whole-food, plant-based (WFPB) diet is based on the following principles:”Whole foods”: Natural foods that are not heavily processed. That means whole, unrefined, or minimally refined ingredients.“Plant-based”: Food that comes from plants and is free of animal ingredients such as meat, milk, eggs, or honey.
Types of Vegetarian Diets
- Lacto-vegetarian: Excludes meat, fish, poultry and eggs, as well as foods that contain them.
- Vegan (or total vegetarian): Excludes all animal products, especially meat, seafood, poultry, eggs, and dairy products.
- Mediterranean: Similar to whole-foods, plant-based diet but allows small amounts of chicken, dairy products, eggs, and red meat once or twice per month. Fish and olive oil are encouraged.
- Whole-foods, plant-based, low-fat: Encourages plant foods in their whole form, especially vegetables, fruits, legumes, and seeds and nuts (in smaller amounts). For maximal health benefits this diet limits animal products.
- DASH (Dietary Approaches to Stop Hypertension): A vegetarian diet with the addition of moderate amounts of poultry and fish, and a focus on low-sodium foods.
- Flexitarian: The term "flexitarian" describes someone who eats mostly plant-based foods. Plant-forward is a style of eating that includes meat. But meat is not the star of the meal.
Health Benefits of Plant-Based Diets
There’s excellent scientific evidence that many chronic diseases can be prevented, controlled, or even reversed with a whole-food, plant-based diet. Research shows that plant-based diets are cost-effective, low-risk interventions that may lower body mass index, blood pressure, HbA1C, and cholesterol levels. They may also reduce the number of medications needed to treat chronic diseases and lower ischemic heart disease mortality rates.
Weight Management
People who eat a plant-based diet tend to be leaner than those who don’t, and the diet makes it easy to lose weight and keep it off-without counting calories. A 2020 review looked at 19 intervention studies and found that in each one, participants assigned to plant-based diets lost weight. Meat, dairy products, and highly processed foods are high in calories yet low in the fiber that helps us feel full and fuels a healthy gut microbiome. Whole plant-based foods are low in calories, meaning you can eat a high volume of food without exceeding your calorie needs. Vegetarian diets may be better for weight management and may be more nutritious than diets that include meat. In their study, they showed that vegetarians were slimmer than their meat-eating counterparts. Vegetarians were also found to consume more magnesium, potassium, iron, thiamin, riboflavin, folate, and vitamins and less total fat. Epidemiologic studies indicate that vegetarian diets are associated with a lower BMI and a lower prevalence of obesity in adults and children. A meta-analysis of adult vegetarian diet studies estimated a reduced weight difference of 7.6 kg for men and 3.3 kg for women, which resulted in a 2-point lower BMI. Similarly, compared with nonvegetarians, vegetarian children are leaner, and their BMI difference becomes greater during adolescence. Studies exploring the risk of overweight and food groups and dietary patterns indicate that a plant-based diet seems to be a sensible approach for the prevention of obesity in children.
Disease Prevention
Whole-food, plant-based eating can prevent, halt, and in some cases reverse chronic diseases. A 2021 review of 99 studies found that diets rich in whole and minimally processed plant-based foods were associated with significantly lower risk of cardiovascular disease compared with diets high in meat and dairy products. Plant-based diets may offer an advantage over those that are not plant based with respect to prevention and management of diabetes. The Adventist Health Studies found that vegetarians have approximately half the risk of developing diabetes as nonvegetarians. In 2008, Vang et al20 reported that nonvegetarians were 74% more likely to develop diabetes over a 17-year period than vegetarians. Barnard et al21 reported in 2006 the results of a randomized clinical trial comparing a low-fat vegan diet with a diet based on the American Diabetes Association guidelines. People on the low-fat vegan diet reduced their HbA1C levels by 1.23 points, compared with 0.38 points for the people on the American Diabetes Association diet.
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Cardiovascular Health
Animal-based foods are high in saturated fat and cholesterol, which raise blood cholesterol levels, causing fatty, wax-like plaque to build up in the arteries. Highly processed foods often contain excessive salt, which raises blood pressure, damaging the lining of the arteries over time. By eliminating these harmful foods from your diet and replacing them with whole plant-based foods, you can bring down your cholesterol levels, blood pressure, and risk of heart disease. In the Lifestyle Heart Trial, Ornish10 found that 82% of patients with diagnosed heart disease who followed his program had some level of regression of atherosclerosis. Comprehensive lifestyle changes appear to be the catalyst that brought about this regression of even severe coronary atherosclerosis after only 1 year. Interestingly, 53% of the control group had progression of atherosclerosis. After 5 years, stenosis in the experimental group decreased from 37.8% to 34.7% (a 7.9% relative improvement). The control group experienced a progression of stenosis from 46.1% to 57.9% (a 27.7% relative worsening). Low-density lipoprotein had decreased 40% at 1 year and was maintained at 20% less than baseline after 5 years. In the Lyon Diet Heart Study, a prospective, randomized, secondary prevention trial, de Lorgeril found that the intervention group (at 27 months) experienced a 73% decrease in coronary events and a 70% decrease in all-cause mortality. The intervention group’s Mediterranean-style diet included more plant foods, vegetables, fruits, and fish than meat.
Diabetes Management
Healthy plant-centered diets are associated with significantly lower rates of Type 2 diabetes and improved outcomes in those who already have this dangerous chronic condition. A 2018 report in BMJ Open Diabetes Research & Care found that for people with Type 2 diabetes, plant-based diets were more beneficial than the diets recommended by several diabetes associations, offering greater improvements in physical and emotional well-being. Plant-based diets are low in saturated fat (a culprit behind insulin resistance) and high in fiber, which helps the body to regulate blood sugar and properly absorb nutrients. Plant-based diets also reduce the risk of being overweight or obese, a primary risk factor for Type 2 diabetes.
Environmental Benefits
Switching to a WFPB lifestyle is one of the best things you can do for the environment. The main reason is that raising animals for food is an incredibly inefficient use of resources. Growing crops to feed animals “introduces a major extra step of waste relative to the efficiency of us just eating the plant foods directly,” explains David L. Katz, M.D., MPH, FACPM, FACP, FACLM. “If you just eat the plants, you cut out the middleman.” A 2018 analysis found that livestock provides just 18% of calories consumed globally but takes up 83% of farmland.
Cost-Effectiveness
Whole and minimally processed plant-based foods are not only the healthiest and most sustainable foods around; they’re also some of the most affordable. In fact, going plant-based can cut grocery bills by $750 a year per person, according to research published in the Journal of Hunger & Environmental Nutrition. When you stock your kitchen with WFPB staples such as brown rice, potatoes, and dried beans, you can assemble nutritious, satisfying meals for just a few dollars.
Reduced Inflammation
Many fruits, vegetables and nuts are abundant in anti-inflammatory compounds like antioxidants and polyphenols. “The components in plants help the body heal faster and decrease that inflammation,” says Ginger Hagen, RD, a dietitian at Northwestern Medicine who works with patients undergoing pulmonary and cardiac rehabilitation. Plants’ essential nutrients work to resolve inflammation in your body. Antioxidants in plants grab all these so-called free radicals that can throw your body off balance. Prolonged inflammation can damage your body’s cells and tissues and has been linked to cancer and other inflammatory diseases like arthritis.
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Key Nutrients for Plant-Based Diets
To get the most out of a vegetarian diet, choose a variety of healthy plant-based foods. These include whole fruits and vegetables and whole grains. At the same time, cut back on less healthy choices. These include sugar-sweetened beverages, fruit juices and refined grains. Keep in mind that the more foods you cut out of your diet, the harder it can be to get all the nutrients you need.
Protein
Protein helps keep skin, bones, muscles and organs healthy. Eggs and dairy products are good sources, and you don't need to eat large amounts to meet your protein needs. Eating a variety of plant-based foods throughout the day also can provide enough protein. Contrary to popular belief, it’s entirely possible to get enough protein on a plant-based diet. According to the National Academy of Medicine, adults should have about 7 grams of protein a day for every 20 pounds they weigh. A 120-pound person would need about 42 grams of protein daily. To put that into perspective, there are 11 grams of protein in a half cup of pinto beans, 9 grams in an ounce of roasted pumpkin seeds, 8 grams in a cup of quinoa and 7 grams in an ounce of peanuts.
Calcium
Calcium helps build and maintain strong teeth and bones. Milk and dairy foods are highest in calcium. Dark green vegetables are good plant sources if you eat enough of them. Examples include turnip and collard greens, kale and broccoli. Other options include calcium-enriched and fortified products. Some significant sources of calcium include tofu, mustard and turnip greens, bok choy, and kale.
Vitamin D
Vitamin D also plays an important role in bone health. Vitamin D is added to cow's milk, some brands of soy and rice milk, and some cereals and margarines. Be sure to check food labels. People who don't eat enough fortified foods and have limited sun exposure may want to talk with a health care provider about vitamin D supplements. Sunlight is a better source of vitamin D than dietary sources as ultraviolet (UV) B radiation transforms the precursor of vitamin D in the skin into vitamin D3. Usually, adequate vitamin D levels can be synthesized internally if large areas of the body, including the face, arms, legs, back, or chest, are exposed to direct sunlight between the hours of 10am-3pm; without sunscreen for five to 30 minutes at least two days a week.
Vitamin B-12
Vitamin B-12 is necessary to produce red blood cells and prevent anemia. Anemia a condition in which the body doesn't have enough healthy red blood cells to carry oxygen to all parts of the body. Vitamin B-12 is found almost exclusively in animal products, so it can be difficult to get enough B-12 on a vegan diet. Vitamin B-12 deficiency may go undetected in people who eat a vegan diet. This is because the vegan diet is rich in a vitamin called folate that can mask vitamin B-12 deficiency. Vitamin B12 is produced by bacteria, not plants or animals. Vitamin B12 deficiency is a very serious problem and can lead to macrocytic anemia and irreversible nerve damage.
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Omega-3 Fatty Acids
Omega-3 fatty acids are found in fish, canola oil, soy oil, walnuts, ground flaxseed and soybeans. Vegetarian diets that do not include fish may be low in two types of omega-3 fatty acids called DHA and EPA. Some evidence suggests that taking in EPA and DHA omega-3 fatty acids may lower the risk for heart disease. Also, these two omega-3s may be important during pregnancy for fetal development. Research on other health effects of EPA and DHA varies.
Iron
Iron is important to red blood cells. Dried beans and peas, lentils, enriched cereals, whole-grain products, dark leafy green vegetables, and dried fruit are sources of iron. But the body doesn't absorb iron from plant sources as easily as animal sources. So the recommended intake of iron for vegetarians is almost double that recommended for nonvegetarians. To help your body absorb iron from plants, eat foods rich in vitamin C at the same time as you're eating iron-containing foods.
Zinc
Like iron, zinc is not as easily absorbed from plant sources as it is from animal products. Fish, including crab and shrimp, are sources of zinc for pescatarians. Cheese and yogurt are sources of zinc if you eat dairy products. Plant sources include whole grains, soy products, lentils, beans, nuts and wheat germ. Zinc helps the body make proteins and grow cells.
Iodine
Thyroid hormones are made partly of iodine. Thyroid hormones help control the body's metabolism and play an important role in muscle growth. Iodine can easily be added to food by using iodized salt. Seafood and dairy also are sources of iodine. People who do not eat seafood or dairy may be at risk of iodine deficiency if they do not use iodized salt. Iodine deficiency can lead to the thyroid getting bigger as it tries to meet the body's need for thyroid hormones. When that happens to the thyroid it's called goiter.
Transitioning to a Plant-Based Diet
One way to start on a vegetarian diet is to slowly reduce the meat in your diet. At the same time, increase the amount of fruits and vegetables in your diet.
- Ramp up: Each week increase the number of meatless meals you already enjoy, such as spaghetti with tomato sauce or vegetable stir-fry. Find ways to include greens in your daily meals.
- Substitute: Take favorite recipes and try them without meat. For example, make vegetarian chili by leaving out the ground beef and adding an extra can of black beans. Or make fajitas using extra-firm tofu rather than chicken.
- Branch out: Check the internet for vegetarian menus. Buy or borrow vegetarian cookbooks. Check out ethnic restaurants to sample new vegetarian cuisines.
- Think about going meatless one day a week. If you don't like the idea of a whole day without meat, start with a couple of meatless dinners each week. Plan meals that use your favorite recipes that are typically meatless, such as lasagna, soup, pasta and vegetable salad.
- When your meals include meat, don't overeat. Choose lean cuts and stay away from oversized portions. An easy guide to balance your meal is to divide your plate. Proteins should take up no more than one-fourth of your plate. Vegetables and fruits should cover half your plate.
Practical Tips for Plant-Based Eating
- Eat lots of vegetables. Fill half your plate with vegetables at lunch and dinner. Make sure you include plenty of colors in choosing your vegetables.
- Change the way you think about meat. Have smaller amounts.
- Choose good fats.
- Cook a vegetarian meal at least one night a week.
- Include whole grains for breakfast. Start with oatmeal, quinoa, buckwheat, or barley.
- Go for greens. Try a variety of green leafy vegetables such as kale, collards, Swiss chard, spinach, and other greens each day.
- Build a meal around a salad. Fill a bowl with salad greens such as romaine, spinach, Bibb, or red leafy greens.
- Eat fruit for dessert.
Potential Pitfalls and How to Avoid Them
But some vegetarian diets may rely too heavily on processed foods with too many calories, and too much sugar, fat and salt. Just because a product is plant-based doesn’t automatically mean it’s healthy. Ultra-processed foods contain additives that change their appearance, flavor or shelf-life. “You eat more because your body is searching for the nutrients in these ultra-processed foods that are high in calories and very low in nutrients,” Murray explains. Not all food preparation methods are equally healthy. One challenge of eating healthy is knowing how much to eat. Ideally, Murray suggests eating a cup of plant-based food at each meal. Adding more plant-based foods to your diet can sometimes cause gas or other gastrointestinal issues due to the increase in fiber. If that’s the case for you, focus on adding one additional serving of plant-based food per day every week.
Examples of Plant-Based Meals
- Greek salad: Chopped mixed greens with fresh tomato, Kalamata olives, fresh parsley, crumbled feta cheese, extra virgin olive oil, and balsamic vinegar.
- Vegetarian pizza topped with mozzarella cheese, tomatoes, broccoli, onions, peppers, and mushroom.
- Breakfast: Chickpeas and avocado on whole grain toast, stove-top rolled oats with chia seeds and sliced bananas.