Whole-food, plant-based nutrition

Battle of the bulge

i-stock -- guy clutching his heart


We are losing the war against cardiovascular disease, cancer, diabetes, and obesity!

In 2015, cardiovascular mortality in the U.S. rose for the first time in more than 40 years and is projected to increase unabated for the next several decades. We have reached the tipping point in cardiology — about one in every six U.S. health-care dollars is spent on cardiovascular disease. By 2030, annual direct medical costs associated with cardiovascular disease are projected to rise to more than $818 billion, while lost productivity costs could exceed $275 billion!

Cancer cases also are projected to increase by nearly 50 percent by 2030. According to the American Cancer Society, expenditures for cancer care in the U.S. totaled close to $145 billion in 2016 and could reach $156 billion by 2020. Preventing cancer in the first place or detecting it early is the best way to reduce many costs associated with cancer treatment — patient out-of-pocket costs, health-care payer costs, and indirect costs.

At the same time, more than 100 million U.S. adults are now living with diabetes or prediabetes. The rate of new diabetes diagnoses in the U.S. is steady and persistent. This rising obesity and diabetes epidemic is outstripping our preventive efforts.

Treat causes, not symptoms

One must conclude that our national efforts of guideline-driven management for treatment of these chronic diseases have plateaued. It appears we need increased public health efforts to address underlying causes of chronic diseases rather than our current efforts at disease management. Production of more drugs to treat the symptoms of chronic diseases is not the answer.

Why become a whole-food, plant-based eater?

An accrual of scientific evidence shows that incorporating more plant-based foods into our diets represents a fundamental way for people to reduce or eliminate the causes of most chronic diseases. However, overcoming inertia, culture, and habit is no easy task. And the widespread marketing of unhealthy foods is an ongoing impediment on the path to making healthier dietary choices.

People become whole-food, plant-based eaters for many reasons, including health, religious convictions, concerns about animal welfare or the use of antibiotics and hormones in livestock, or a desire to eat in a way that avoids excessive use of environmental resources.

Traditionally, research into plant-based eaters focused mainly on potential nutritional deficiencies, but in recent years, the pendulum has swung the other way. Studies are confirming the health benefits of meat-free eating. Nowadays, the American Dietetic Association recognizes plant-based eating as nutritionally sufficient. By adding more whole and plant-based foods into our diets we necessarily reduce the amount of animal-based foods, which may be the root cause of disease promotion.

Reconsidering the role of animal protein in causing chronic diseases

Scientists first described dietary fat as a major risk factor for cardiovascular disease starting in 1847. Decades passed without considering the contributions of other dietary components, like animal protein, as precursors for chronic diseases. Believing that dietary fat, singularly, represents a precursor for heart disease has led to the promotion of foods low in fat, like lean cuts of meat, low- or non-fat dairy products, and cholesterol-free products.

To suggest that blood cholesterol could be elevated by dietary animal protein, and not just dietary fat, seemed far-fetched at first. But, starting with research in 1941 on rabbits, animal protein — in this case the protein casein found mostly in dairy products — was five-fold more likely to form fatty plaques in arteries than the same amount of vegetable protein over a six-month period. Numerous other animal experiments since have confirmed these findings with other animal proteins. Growing evidence reveals that dietary animal protein increases cardiovascular risk, certain cancers, and diabetes, compared to plant-based proteins. In addition to animal studies, supportive evidence also has been reported in humans.

Showing a direct effect of animal protein on disease development may be less relevant when compared with the effects of reducing animal protein on reducing disease risk. When one includes more animal protein-based foods in the diet, one may consume less plant-based food, a trade-off that is rarely considered. And if we are replacing plant proteins with animal proteins, we may reduce the known cardio-protective properties of those plant-based foods.

The best testimonials for completely substituting animal-based foods with plant-based foods can be found in the numerous studies that show reversal of advanced coronary heart disease for patients who switched to plant-based eating. A recent study included 196 patients with advanced heart disease; 177 switched completely to a whole-food, plant-based diet. In two to seven years of follow-up, only one of these patients suffered a cardiovascular event. In contrast, 62 percent of the patients who did not comply to the whole-food, plant-based diet suffered at least one cardiovascular event.

I am not aware of a single other cardio-therapy protocol that approximates such spectacular results.

Are there health risks of being a plant-based eater?

Concerns about plant-based diets generally focus on the key issues noted below.

Concerns about plant-based diets
Lack of protein
  • The U.S. Department of Agriculture recommends that all men and women over age 19 get at least 0.8 grams of protein per kilogram of body weight per day (or 0.36 grams per pound per day). This recommendation includes a generous safety factor for most people. Of course, there are different protein requirements depending on specific circumstances like pregnancy, lactation, athletic performance, and certain medical conditions.
  • If we make a few adjustments to account for the fact that some plant proteins digest somewhat differently from animal proteins, we arrive at a plant-protein requirement level of 0.9-1.0 grams of protein per kilogram of body weight per day (0.41-0.45 grams per pound per day).
  • To determine your daily recommended protein intake, multiply your body weight in pounds by 0.36 if you are an omnivore or 0.41 if you are a plant-based eater. [In my case, I weigh 154 pounds, so I require about 63 grams of protein per day as a plant-based eater.]
  • On average, plant-based eaters consume between 10-12 percent of their daily total calorie intake as protein compared to 14-18 percent for meat eaters. Assuming that a plant-based eater consumes a variety of plant-based foods, there is little concern about not getting all of the required amino acids (proteins).
Limited choices
  • This is a common misconception. The number of edible plant-based foods is enormous and includes fruit, bulb vegetables, flowering vegetables, leafy green vegetables, podded vegetables (legumes), root and tuberous vegetables, sea vegetables, stalk or stem vegetables, and mushrooms. (See the table below for a limited listing of different plant-based foods.)
Vitamin- and mineral deficiencies
  • Vitamin B12 is found solely in animal products, so plant-based eaters need to eat foods fortified with vitamin B12 (certain soy and rice beverages and breakfast cereals) or take a vitamin B12 supplement to avoid a deficiency.
  • Plant-based eaters tend to get the same amount of iron as meat eaters, but the iron in meat, known as heme iron, is more readily absorbed than the non-heme iron found in plant foods. The absorption of non-heme iron is enhanced by vitamin C and other acids found in fruits and vegetables.
  • Phytic acid in whole grains, seeds, beans, and legumes also reduces zinc absorption, but vegetarians in Western countries do not appear to be zinc-deficient.
  • Diets that include no fish or eggs are low in the Omega-3s (EPA and DHA). While our bodies can convert alpha-linolenic acid (ALA) in plant foods to EPA and DHA, it is a very inefficient process. Thus, strict plant-based eaters need to eat foods high in ALA — including flaxseed, walnuts, canola oil, and soy products.
Bone health
  • Some individuals think a plant-based diet is deficient in calcium, vitamin D, and vitamin K, all needed for bone health. While research does not support that plant-based eaters have increased instances of osteoporosis, they may still wish to consume vitamin D- and vitamin K-fortified foods, including some types of soy milk, rice milk, organic orange juice, and breakfast cereals that contain added calcium, vitamin D, and vitamin K.

Varieties of plant-based eaters

iStock -- lettuce and stethoscope

Convincing evidence suggests there is no other lifestyle change we can make — dietary or non-dietary — that offers the same benefits of whole-food, plant-based eating.

There are different types of plant-based eaters, each with its own label and distinctive characteristics. Collectively, plant-based eaters generally classify with the generic term vegetarians. Here are the general vegetarian classifications:

  • Vegans (total vegetarians) do not eat meat, poultry, fish, or any products derived from animals, including eggs, dairy products, and gelatin.
  • Lacto-ovo vegetarians do not eat meat, poultry, or fish, but do eat eggs and dairy products.
  • Lacto vegetarians eat no meat, poultry, fish, or eggs, but do consume dairy products.
  • Ovo vegetarians eat no meat, poultry, fish, or dairy products, but do eat eggs.
  • Partial vegetarians avoid red meat but may eat fish (pesco-vegetarian, pescatarian) or poultry (pollo-vegetarian).

Choosing plant-based foods

Approximately 6-8 million adults in the United States eat no meat, fish, or poultry. Several million more have eliminated red meat but still eat chicken or fish. About 2 million have become total whole-food, plant-based eaters, forgoing not only animal flesh but also all animal-based products such as milk, cheese, eggs, and gelatin.

A plant-based diet consists of all minimally processed fruits, vegetables, whole grains, legumes, nuts and seeds, herbs, and spices and excludes all animal products, including red meat, poultry, fish, eggs, and dairy products. The table below presents a limited listing of foods included in a whole-food, plant-based eating plan.

Food categories and examples of a whole-food, plant-based diet

Apple, Avocado, Banana, Blueberries, Cantaloupe, Cherries, Grapefruit, Grapes, Guava, Honeydew, Kiwifruit, Kumquat, Lemon, Lime, Mango, Nectarine, Orange, Papaya, Peach, Pear, Persimmon, Pineapple, Plum, Pomegranate, Raisins, Raspberries, Star Fruit, Strawberries, Tangerine, Watermelon


Artichoke, Arugula, Asparagus, Basil, Beans, Beets, Bok Choy, Broccoli, Brussels Sprouts, Cabbage, Carrots, Cauliflower, Celery, Chili Peppers, Chives, Collards, Corn, Cucumber, Dill, Eggplant, English Peas, Escarole, French Sorrel, Garlic, Kale, Kohlrabi, Leeks, Lettuce, Okra, Onions, Radicchio, Parsnips, Peppers, Potatoes, Pumpkins, Radishes, Rhubarb, Rutabagas, Shallots, Snap Peas, Spinach, Summer Squash, Sweet Potatoes, Tomatillos, Tomatoes, Turnips, Watermelon, Winter Squash, Zucchini


Arracacha, Daikon, Maca, Yam Daisy, Jicama, Black Salsify, Salsify, Bush Carrots, Beet, Rutabaga, Burdock Root, Carrot, Celeriac, Parsnip, Parsley Root, Radish, Skirret, Pencil Yam, Turnip, Native Ginger, Yellow Lily Yam, Sweet Potato, Desert Yam, Pignut, Cassava, Yacon, Jerusalem Artichoke, Konjac, Taro, Ginger, Arrowroot, Ginseng, Canna Lily, Vanilla Lily, Turmeric, Lotus Root

Whole grains

Amaranth, Barley, Buckwheat, Bulgur, Corn, Einkorn, Farro/Emmer, Freekeh, Millet, Oats, Quinoa, Rice, Rye, Sorghum, Spelt, Triticale, Wheat, Wild Rice


Beans, Lentils, Peas, Peanuts, Asparagus Beans, Green Beans, Kidney Beans, Navy Beans, Soybeans, Pinto Beans, Garbanzo Beans, Adzuki Beans, Anasazi Beans, Wax Beans, Mung Beans, Dwarf Peas, Southern Peas, English Peas, Snow Peas, Sugar Snap Peas, Alfalfa, Clover, Lespedeza, Lentils, Licorice, Peanuts


  • Clarkson, S., Newburgh, L.H., “The relation between atherosclerosis and ingested cholesterol in the rabbit.” The Journal of Experimental Medicine, 1926; 43:595.
  • Connor, W.E., Connor, S.L., The key role of nutritional factors in the prevention of coronary heart disease. Preventive Medicine, 1972; 1:49.
  • Esselstyn, C.B., et al., “A strategy to arrest and reverse coronary artery disease: A 5-year longitudinal study of a single physician’s practice.” The Journal of Family Practice, 1995; 41:560.
  • Esselstyn, C.B., et al., “A way to reverse CAD?” The Journal of Family Practice, 2014; 63:356.
  • Hansen, T.H., “Bone turnover, calcium homeostasis, and vitamin D status in Danish vegans.” European Journal of Clinical Nutrition, 2018 Jan 23.doi:10.1038/s41430-017-0081-y.
  • Kritchevsky, D., Czarnecki, S.K., “Dietary protein and experimental atherosclerosis: Early history.” Alan R. Liss, Inc.: New York, USA, 1983;1.
  • Meeker, D.R., Kesten, H.D., “Effect of high-protein diets on experimental atherosclerosis of rabbits.” Archives of Pathology and Laboratory Medicine, 1941; 31:147.
  • Melina, V., et al., “Position of the Academy of Nutrition and Dietetics: Vegetarian diets.” Journal of the Academy of Nutrition and Dietetics, 2016; 116(12):1970.
  • Ornish, D., Brown, S.E., “Treatment of and screening for hyperlipidemia.” New England Journal of Medicine; 329(15):1124; author reply 1127-8.
  • Ornish, D., et al., “Can lifestyle changes reverse coronary heart disease?” The Lifestyle Heart Trial, Lancet, 1990; 336(8708):129.
  • Ornish, D., et al., “Intensive lifestyle changes for reversal of coronary heart disease.” Journal of the American Medical Association, 1998; 280(23):2001-7. Erratum in: JAMA, 1999; 281(15):1380.
  • Ornish, D., et al., “Lifestyle changes and heart disease.” Lancet, 1990; 336(8717):741.
  • Ostfeld, R.J., “Definition of a plant-based diet and overview of this special issue.” Journal of Geriatriatric Cardiology, 2017; 14:315.
  • Thomas, T.C., “A plant-based diet and animal protein: Questioning dietary fat and considering animal protein as the main cause of heart disease.” Journal of Geriatric Cardiology,ß 2017; 14:331.
  • Williams, K.A., “Introduction to the ‘A plant-based diet and cardiovascular disease’ special issue.” Journal of Geriatric Cardiology, 2017; 14:316.



  1. Kari Dumbeck

    I applaud this article for letting people know to be their own advocates and to eat more whole foods. But what is most important in choosing your foods is that they are chemically free. Learn about what you are eating and that it’s also okay to incorporate occasional meats. You’ll find not only is it affordable but that you don’t need as much when you eat to living (not live to eat).


  2. Russell Lyons - 1983

    At the end, the food categories of nuts and seeds is missing entirely. They are delicious and, as described earlier in the post, healthful.


  3. Victor Katch

    Russell, thanks for the input. You are correct. Here is a listing of some common nuts and seeds we all can enjoy.
    Black Walnut
    Brazil Nut
    Chufa Nut
    Country Walnut
    Earth Almond
    Earth Nut
    English Walnuts
    Gingko Nut
    Hickory Nut
    Horned Water Chestnut
    Japanese Walnut
    Java Almond
    Oak Acorns
    Persian Walnuts
    Pine Nut
    Pistachio Nut
    Tiger Nut
    Chia seeds
    Hemp seeds
    Poppy seed
    Pumpkin seeds
    Sesame seed


  4. Gerard Freeman - 1950 Rackham

    This is one of the best and most comprehensive articles I have read with respect to veganism. One item missing is the statistic on how many resources would be saved by eliminating the beef oriented business.


  5. Christina Karas - 2001, 2002

    Thank you for writing this piece. I hope that it will be widely read and applied, as the need is urgent not only for human health but also for the health of the planet (which in turn affects our health) and for our fellow animals.


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