Plant-based diets

Not all plant-based diets are the same: Junk veggie food and its impact on heal

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Plant-based diets continue to grow in popularity for their many health benefits, including lower risks of heart disease and type 2 diabetes. However, not all plant-based diets are equal, and some eating habits may cause more harm than good. In this Honest Nutrition feature, we explain all you need to know about eating a healthful plant-based diet.

This series of Special Features takes an in-depth look at the science behind some of the most debated nutrition-related topics, weighing in on the facts and debunking the myths.Design by Diego Sabogal.

Plant-based dietsTrusted Source refer to diets that are based on foods made from plants, and include vegetarian and vegan diets.

While vegan diets exclude all animal products, vegetarian options — which exclude just meat and fish — are more diverse and may include dairy and eggs. Pescatarian diets exclude meat, but not fish.

Plant-based diets continue to grow in popularity worldwide owing to decades of scientific research and the mounting evidenceTrusted Source of their potential health benefits, not limited to improved blood cholesterol and blood sugar levels.

Furthermore, increased awareness of the environmental impact of animal rearing, such as high levels of greenhouse gases, land degradation, and excessive water have also motivatedTrusted Source some people to adopt plant-based diets, which can be more environmentally friendly.

However, there are some health risks associated with some plant-based diets, particularly if there is high consumption of “junk” veggie foods.

What are ‘junk’ plant-based foods?

By definition, ultra-processed foodsTrusted Source are food products that contain minimal whole foods, are high in calories, added sugar, salt, and fats, offer little nutritional value, and have been processed with cheap industrial additives.

Using the NOVA classification system, which categorizes food products according to the extent of industrial processes they undergo, “junk” foods can includeTrusted Source many plant-based products, such as:

  • commercially-produced breads, pastries, cakes, and cookies
  • carbonated beverages
  • pre-packaged snacks
  • flavored dairy drinks
  • breakfast cereals
  • energy bars
  • instant sauces, soups, noodle pots, and desserts.

Health risks

Ultra-processed foods offer convenience, continue to replace minimally processed whole foods, and now account for more than halfTrusted Source of the daily intake of calories for many individuals in middle- and high-income countries.

While a healthy and balanced plant-based diet is diverse, the frequent consumption of plant-based ultra-processed foods is associated with negative health outcomes.

For instance, in a 2019 cohort studyTrusted Source that followed 105,159 adults over a 5-year period, the researchers observed that even a 10% increase in the consumption of ultra-processed foods was associated with a higher risk of heart disease and stroke.

This small increase in ultra-processed foods is also associated with a higher risk of developing some cancersTrusted Source, type 2 diabetesTrusted Source, and increased exposure to harmful chemicalsTrusted Source from food packages.

In addition, calorie intake is reportedly higher in plant-based diets that are rich in ultra-processed foods, which may lead to weight gainTrusted Source and a greater potential for developing obesityTrusted Source.

To compound the negative health risks associated with diets rich in ultra-processed foods, vegetarian and vegan diets can exclude food groups, making nutrient deficiencies more common.

Overall, some studies have shown that vegetarians and vegans have lower levelsTrusted Source of nutrients like iron, vitamin B12, calcium, vitamin D, and omega-3 fatty acids.

Furthermore, a 2022 studyTrusted Source showed that vegetarian women have an increased risk and occurrence of hip fractures compared to women who occasionally consume meat.

It is possible that these adverse outcomes are linkedTrusted Source to the omission of iron- and B12-rich meats, and calcium-rich animal sources in vegetarian and vegan diets. These problems may be compounded by individuals not replacing those nutrient sources with fruits, vegetables, nuts, and pulses, and eating ultra-processed foods instead.

How to avoid these health risks

Well-planned vegetarian or vegan diets consistently offer several health benefits, and they can safeguard against nutrient deficiencies and adverse health risks associated with diets rich in ultra-processed plant-based foods.

Not only do plant-based diets promote longevityTrusted Source, but they may reduce muscle loss — also called sarcopeniaTrusted Source — in older people with obesity.

They are also safe during pregnancyTrusted Source and lactation as long as they fulfill nutrient requirements, as well as during physical performanceTrusted Source.

Nutritionally balanced and well-planned plant-based diets more closely adhere to U.S. dietary recommendations and improve overall diet qualityTrusted Source based on the Healthy Eating Index.

This occurs thanks to the increased intake of:

  • fruits
  • non-starchy vegetables
  • whole grains
  • low-fat dairy
  • eggs
  • plant protein
  • seafood.

Such diets are also lower in salt, added sugar, fats, and calories.

Therefore, not all plant-based diets are associated with negative health risks, but it is important to note that following a healthy overall eating pattern is essential for managing risks the risk of heart disease, diabetes, and cancer.

How to eat a balanced plant-based diet

Here are some practical tips to help you maintain a diverse and balanced plant-based diet.

First, limit ultra-processed foods. Plant-based ultra-processed foods high in salt, added sugars, and fats should be limited and eaten in moderation.

In particular, veggie meat replacement products are often high in sodium and saturated fats, so be sure to choose low-sodium and low-fat alternatives.

Make sure to read nutrient labelsTrusted Source and be careful with so-called health claims on packaging. Practice reading nutrient labels for packaged food products to become aware of their sugar, salt, and fat content and choose those with fewer additives. Likewise, labels may help choose foods that are higher in calcium and other beneficial nutrients.

Monitoring carbohydrate portions is also important: Switching to a plant-based diet may feel restrictive, and research shows that meats may be replaced with refined or highly processed carbohydrate-rich foods. Be sure to include whole grain carbohydrate options in portions appropriate for your health goals.

Also focus on proteins: Peas and beans, nuts, seeds, seitan, textured vegetable protein, tofu, tempeh, edamame, eggs, milk, cheese, yogurt and seafood are all high-protein food sources for vegetarians that also provide calcium, iron, vitamin D and some vitamin B12, which are commonly deficient in vegetarians.

When appropriate, dietary supplements may help a person reach the desirable amount of daily nutrients to avoid deficiencies. Speak with your medical team about which supplements may be appropriate for you.

Finally, you may wish to consult a dietitian: If you are new to plant-based eating, consult with a registered dietitian to learn which foods will help you to meet your nutrient needs

The takeaway message

Plant-based diets are popular worldwide for their potential health benefits, such as improved blood cholesterol, blood sugar, and reduced risk of heart disease, diabetes, cancer, and obesity.

However, “junk” veggie foods or ultra-processed foods — which account for more than half of the daily calorie intake for some individuals — continue to replace minimally processed whole foods, and pose adverse health risks.

Furthermore, vegetarians and vegans can experience nutrient deficiencies in iron, calcium, vitamin D, and vitamin B12, due to the exclusion of animal foods that are rich in these nutrients.

Nevertheless, well-planned vegetarian or vegan diets rich in fruits, non-starchy vegetables, whole grains, dairy, and plant sources of protein offer several health benefits, and safeguard against adverse health risks associated with diets rich in “junk” veggie foods.

Healthy plant-based diets lower risks for mortality, major chronic conditions

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Key takeaways:

  • Greater adherence to a healthful plant-based diet was linked to lower risks for CVD, cancer and mortality.
  • In contrast, adherence to an unhealthful plant-based diet had inverse associations.

Middle-aged adults with greater adherence to a healthful plant-based diet had significantly lower risks for CVD, cancer and mortality than those who had lower adherence, according to study results published in JAMA Network Open.

Alysha S. Thompson, MSci, a PhD researcher at Queen’s University Belfast, and colleagues wrote that, for both health and environmental reasons, plant-based diets have recently gained popularity. However, strict plant-based diets may be associated with health consequences like calcium deficiencies, they noted, and there is no comprehensive evaluation of diet quality in relation to risk for mortality and major chronic diseases.

Lower risks associated with healthful plant-based diet
Data derived from: Thompson AS, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.471.

“Previous population-based studies have shown that plant-based diets per se may not be associated with improved health but that their composition is crucial with respect to a reduction in chronic disease risk,” they wrote. “Only a healthful plant-based diet, characterized by low consumption of both animal foods and processed foods of plant origin (eg, refined grains, sugary drinks, snacks and desserts) has been associated with a lower risk of type 2 diabetes, CVD and total mortality.”

Thompson and colleagues conducted a prospective cohort study to evaluate the potential health benefits and risks associated with plant-based diets. They specifically wanted to see if adhering to a healthful plant-based diet (hPDI) vs. unhealthful plant-based diet (uPDI) was linked to mortality and major chronic diseases like cancer and CVD.

The researchers used data from 126,394 U.K. Biobank participants — 55.9% of whom were women and 91.3% of whom were white — and measured their adherence to plant-based diets with 24-hour dietary assessments.

Thompson and colleagues found that an hPDI might be beneficial for health, regardless of genetic predisposition and established chronic disease risk factors.

Greater adherence to the hPDI was linked to lower risks for:

  • cancer (HR = 0.93; 95% CI, 0.88-0.99);
  • CVD (HR = 0.92; 95% CI, 0.86-0.99);
  • ischemic stroke (HR = 0.84; 95% CI, 0.71-0.99);
  • myocardial infarction (HR = 0.86; 95% CI, 0.78-0.95); and
  • total mortality (HR = 0.84; 95% CI, 0.78-0.91).

Higher scores for the uPDI, however, were linked to higher risks for CVD, cancer and mortality.

The researchers noted that the associations did not show heterogeneity across strata of BMI, socioeconomic status, sex, smoking status or with polygenic risk scores.

“Importantly, we observed that inverse associations between the hPDI and CVD end points (total CVD, myocardial infarction, and stroke) were independent of genetic disease risk,” they wrote. “This finding is of particular public health relevance, as it suggests individual benefits of healthful PBDs irrespective of genetic predisposition for CVD.

At the same time, they added, “absolute risk reduction due to a healthful PBD may be greater among individuals with a stronger genetic predisposition for CVD, given their higher lifetime risk of CVD.”

Thompson and colleagues identified mechanisms that may underlie the associations between hPDI and lower risks for disease and mortality. Higher intake of unprocessed plant foods could reduce the risk for low-grade inflammation, impaired insulin sensitivity and obesity, they wrote, and these mechanisms could explain lower mortality risks because of both cancer and CVD.

“Similarly, plant constituents such as fiber may beneficially affect the composition and function of the large intestinal microbiome,” Thompson and colleagues wrote. “The fact that associations between hPDI and CVD revealed lower risks, especially of myocardial infarction and ischemic stroke compared with that for cancer in our study, suggests that additional CVD-specific mechanisms (eg, lower blood pressure or low-density lipoprotein cholesterol due to PBD6) further explain our findings.”

Survey reveals why nephrology professionals might not recommend plant-based diets

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Nephrology professionals may not routinely recommend plant-based diets to patients with kidney disease due to concerns over patient acceptance and their ability to follow the diet plan, according to survey results.

The results, presented virtually at the National Kidney Foundation Spring Clinical Meetings, also highlighted a lack of patient knowledge regarding the benefits of such diets.

Plant-based diets

Melanie Betz, MS, RD, CSR, CSG, LDN, chronic kidney disease nutrition and education specialist with University of Chicago Medicine, told Healio Nephrology that she designed the survey to gain a better understanding of how frequently plant-based diets are adopted by this patient population, as well as to explore potential barriers that may limit recommendations.

“I found that [plant-based diets] were being discussed quite a bit in the literature, and in professional communities, but patients seemed to be unaware of them — and even afraid of them — in online CKD groups I help with,” she said.

For the study, Betz and colleagues administered questionnaires to 657 health care professionals, 58% of whom were registered dieticians and 53% of whom worked in dialysis, and 844 patients, 35% of whom had non-dialysis-dependent CKD and 35% of whom had a kidney transplant.

Despite 79% of health care professionals indicating plant-based diets can be an effective lifestyle modification for treating CKD, only 56% reported that they recommend the diets to their patients.

“My research showed that the most common reason [plant-based diets] are not recommended is low perceived patient acceptance and that they are not realistic for patients,” Betz said. “I found this surprising because I had guessed that concerns over electrolyte abnormalities would be a much bigger barrier to recommendation.”

Among patients, most reported that the eating preferences of their families, their personal preference for meat and meal planning were the primary challenges to following a plant-based diet.

Betz contended it is critical not to view incorporating plant-based diets as an “all-or-nothing” approach.

“We need to meet patients where they are and encourage plant-based diets to the extent patients can or are willing to follow them,” she said.

According to Betz, it is not necessary for patients to completely stop eating meat; just one to two “meatless meals” per week could help reduce protein and dietary acid load, thereby slowing CKD progression, she said.

Regarding specific methods to increase adherence to plant-based diets, both professionals and patients ranked counseling sessions with a registered dietician as most beneficial.

“Recommending early dietitian intervention can help patients make these dietary changes,” Betz said. “Dietitians have the time and expertise to help patients learn how to implement plant-based diets.

“I also think it may help to frame nutrition interventions as a way to slow CKD progression, rather than just, ‘this is good for your kidneys.’ Patients are usually very interested in what they can do to prevent dialysis, and plant-based diets can do this.”

Plant-based diets may help reduce phosphorous levels for patients on dialysis

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Plant-based diets may be a helpful strategy for patients on dialysis to lower their phosphorous levels, according to a speaker at the virtual Annual Dialysis Conference.

Shivam Joshi

“Plant-based diets have historically been avoided or neglected in the use of our patients with kidney disease, especially those on dialysis, for a variety of reasons including issues related to potassium and inadequate protein,” Shivam Joshi, MD, a clinical assistant professor of medicine at Bellevue Hospital and NYU Grossman School of Medicine, said. “However, recent research suggests this risk may be overstated.”

a bowl with salad and chickpeas
Source: Adobe Stock

According to Joshi, plant-based diets can include a flexible diet that doesn’t cut out all animal products, but limits intake compared to the standard American diet. Therefore, Joshi said, it is possible to eat a plant-based diet on dialysis and consume enough protein. Similarly, the risk of consuming too much protein is unlikely since plant-based phosphate is mostly bound as phytates which means it is not absorbable.

“It’s possible to take any diet and make it unhealthy or inadequate,” Joshi said.

Joshi referenced a study that showed plant-based foods that report high potassium levels are often juices, sauces and dried fruits but not unprocessed plant-based foods. Factors that can reduce an increase in serum potassium in patients with end-stage kidney disease who follow a plant-based diet include fiber, colonic secretion of potassium, intracellular movement of potassium and bioavailability.

Another study Joshi referenced compared serum phosphate levels among vegetarian and non-vegetarian patients with ESKD. The results showed vegetarian patients recorded significantly lower serum phosphate levels.

“Maintaining protein while reducing phosphorus may be achieved through a plant-based diet due to the low bioavailability of these foods, especially if they’re unprocessed the low phosphomimic index of these foods. Plant-based diets may provide lower protein compared to animal-based diets or the standard American diet, but overall, they have not been shown to affect nutrition or to have caused a deficiency. Potassium levels do not appear to increase within those consuming a plant-based diet on dialysis,” Joshi said. “More research is certainly needed.”