What Is A Plant-Based Diet (And Should I Be On One)?

I’ve updated this post I published in 2018 and added comments on the Ornish Diet which US News and World Report now inaccurately rates as the #1 heart-healthy diet.


The phrase “plant-based diet” is being tossed around a lot these days. The skeptical cardiologist never knows what people mean when they use it and so must assume that most of the world is also puzzled by this trendy term.

Is A Plant-Based Diet Code For Veganism?

For some, a “plant-based diet” (PBD) is what vegans eat. Veganism combines a diet free of animal products, plus a moral philosophy that rejects the “commodity status of animals.”

Vegans are the strictest of vegetarians, eschewing milk, fish and eggs.
One PBD advocate in the introduction to a Special Issue of the Journal of Geriatric Cardiology,  defines it as follows:

“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.”

You will notice that this cardiologist “excludes all animal products”  and that the qualifying phrase “minimally processed” has crept into the definition.

Forks Over Knives-Whole-food, plant-based diet

The “documentary” Forks Over Knives brought the phrase “whole food, plant-based diet” to national prominence. The movie focused on the diets espoused by Caldwell Esselstyn and T. Colin Campbell. Since its release in 2011 a whole industry based on the Forks Over Knives (FON) brand has been launched. FON uses the following definition:

 “A whole-food, plant-based diet is centered on whole, unrefined, or minimally refined plants. It’s a diet based on fruits, vegetables, tubers, whole grains, and legumes; and it excludes or minimizes meat (including chicken and fish), dairy products, and eggs, as well as highly refined foods like bleached flour, refined sugar, and oil.”

I’ve written detailed posts on the Esselstyn diet here and here. I think it is needlessly restrictive and not supported by scientific evidence. (Esselstyn’s website and book state unequivocally “you may not eat anything with a mother or a face (no meat, poultry, or fish” and “you cannot eat dairy products” which differs from the FON definition.)

The key new terms in the FON approach to note are:
Whole Food. The Oxford English Dictionary (OED) defines whole food as “food  that has been processed or refined as little as possible and is free from additives or other artificial substances.”
Unrefined or minimally refined. The OED defines refined as:
“With impurities or unwanted elements having been removed by processing.”
The FON definition for a PBD then is similar to our first definition-minimally processed vegan-but allows (at least theoretically)  minimal meat, dairy and eggs. The FON Esselstyn/Campbell diets choose to define vegetable oil, including olive oil, as highly refined foods and do not allow any oils.

U.S. News Definition Of Plant-Based Diets

U.S. News and World Report publishes an annual rating of diets based on the opinion of a panel of nationally recognized experts in diet, nutrition, obesity, food psychology, diabetes and heart disease.

US News defines a plant-based diet as “an approach that emphasizes minimally processed foods from plants, with modest amounts of fish, lean meat and low-fat dairy, and red meat only sparingly.”


This PBD definition is radically different from the first two I described. Notice now that you can have “modest amounts” of meat and dairy, foods which are anathema to vegans. Also, note that “low-fat dairy” is being recommended which involves processing and adulterating healthy natural dairy fat foods which (in my opinion) makes it highly processed. Lean meat is preferred and red meat avoided.


I was happy to see that for the first time, the Mediterranean Diet ranked as  Best Diet Overall, but shocked to find that the Mediterranean diet came out on top of the US News list of “Best Plant-Based Diets.”


Readers will recognize that this is the diet I recommend and follow (with slight modifications). On this diet I regularly consume hamburgers, steak, fish, full fat yogurt and whole egg omelettes.

The plant-based diet of vegans or of Forks Over Knives is drastically different from the Mediterranean Diet.

For example, olive oil consumption is emphasized in the Mediterranean Diet, whereas the Esselstyn diet featured in FON forbids any oil consumption.
The FON/Esselstyn diets are very low in any fats, typically <10%, whereas the Mediterranean Diet is typically 30-35% fat.

Esselstyn really doesn’t want you to eat nuts and avocados because he thinks the oil in them is bad for you. This is nuts! I’m handing out nuts to my patients just as they were given to the participants in the PREDIMED randomized trial showing the benefits of the Med diet.

The Ornish Diet-Still Not Proven to “Reverse Heart Disease”

I have critiqued in detail Dean Ornish’s claims to have scientific proof that his diet/exercise/meditation program “reverses heart disease” here. The bottom line is that these claims are not supported and that is why his program is not recommended by the AHA or the US Dietary Guidelines for Americans.

I was pleased to see that the Ornish diet has slipped from #3 to #4 in the US News and World Report overall best diet recommendations for 2020. However, the Ornish diet seems to have risen to #1 for “heart-healthy diets” something I strongly disagree with.

The blurb associated with Ornish states “ranked highly for heart health again this year due to its holistic and evidence-based approach shown to help prevent and even reverse heart disease.”

It is not evidence-based and it is holistic in the sense that a regular exercise plan and stress mediation is part of the program, something that should be part of any lifestyle approach to heart disease.

Dr. Pearson’s Plant-Based Diet

Since the term “plant-based diet” apparently means whatever a writer would like it to mean, I have come up with my own definition.
With the  Dr. P Plant-Based Diet© your primary focus in meal planning is to make sure that you are regularly consuming a large and diverse amount of healthy foods that come from plants.
If you don’t make it your focus, it is too easy to succumb to all the cookies, donuts, pies, cakes, pretzels, chips, French fries,  breakfast bars and other  calorie-dense but nutrient-light products that are cheap and readily available.
In Dr. P’s Plant-Based Diet© meat, eggs, and full fat dairy are on the table. They are consumed in moderation and they don’t come from plants (i.e. factory farms).

I, like the PBD  definers of yore, have taken the liberty of including many vague terms in my definition. Let me see if I can be more precise:
Regularly = at least daily.
Large amount = 3 to 4 servings daily.
Healthy = a highly contentious term and one, like “plant-based” that one can twist to mean whatever one likes.

My take on “healthy” can be seen on this blog. I’m not a fan of plant-based margarines, added sugar, whether from a plant or not, should be avoided, and the best way to avoid added sugar is to avoid ultra-processed foods.
Ultra-processed foods (formulations of several ingredients which, besides salt, sugar, oils and fats, include food substances not used in culinary preparations, in particular, flavours, colours, sweeteners, emulsifiers and other additives used to imitate sensorial qualities of unprocessed or minimally processed foods and their culinary preparations or to disguise undesirable qualities of the final product).
Ultra-processed foods account for 58% of all calories in the US diet, and contribute nearly 90% of all added sugars.
I do like the food writer Michael Pollan’s simple rules to “Eat Food. Mostly Plants. Not Too Much.” and this NY Times piece summarizes much of what is in his short, funny and helpful Food Rules book:

you’re much better off eating whole fresh foods than processed food products. That’s what I mean by the recommendation to eat “food.” Once, food was all you could eat, but today there are lots of other edible foodlike substances in the supermarket. These novel products of food science often come in packages festooned with health claims, which brings me to a related rule of thumb: if you’re concerned about your health, you should probably avoid food products that make health claims. Why? Because a health claim on a food product is a good indication that it’s not really food, and food is what you want to eat.

On Dr. P’s Plant-Based Diet© you can add butter to your leeks and green onions.

You can add eggs (with yolks!) to your sautéed onions, tomatoes and peppers.

And you can eat salads full of lots of cool different plants for lunch.


To answer my titular question-if you are using Dr. P’s definition of a plant-based diet then you definitely should be on one.


Viva La Plant!
-ACP

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29 thoughts on “What Is A Plant-Based Diet (And Should I Be On One)?”

  1. An orthopedic doctor once told me, if you want your joints to fall apart, eat a vegan, or worse, Eisylstein diet. I just watched a documentary on species of early man. None of them were vegetarian. They were also not grazing/snacking. Early species of humans all had flat belly not big belly like the vegetarian gorilla.

    Reply
  2. Dr. Pearson, Just wanted to thank you for supporting scientific evidence and research for many of these diets and claims out there. I have been following the PBWFD, espoused by Dr. Esselstyn and have been searching for bonafide research to support this diet. It is not there. I do believe that some form of a plant based diet is probably good practice for someone with heart disease. Again, thanks for providing your website and reminding us that bonafide scientific research is critical for proof of claims.

    Reply
  3. I’m all for bumping up fat content with the fatty fish and walnuts but is olive oil and full fat dairy (and certainly those sausages..) really worth the saturated fat?

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    • There is no significant saturated fat in olive oil, it is predominantly composed of monounsaturated fat.
      With respect to dairy fat, although it has significant saturated fat there is no evidence the saturated fat composition in dairy fat is harmful. I’ve written on this extensively.
      Dr P

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  4. Eliminating one’s animal product consumption is best for health, environment and ethics. Therefore, reducing is good. Reducing is not as good as eliminating but it is better than doing nothing. Increasing or justifying eating animal products because it fulfills personal taste, habit or sentimentality is not scientific. Promoters of eating fat usually rely on studies that have been debunked. Frequently, said studies are funded by vested interests like the Cattleman’s Association or the National Dairy Council. Studies funded by these organizations are promotional studies designed to help reverse the public’s shift to eating more plants. If you compare the Mediterranean Diet to the Standard American Diet, the Mediterranean is much better for health. That doesn’t make it the best. It is quite easy to skew studies to favor desired outcomes as shown by the horrible Siri Tirino meta study which was used to justify eating saturated fat. The media jumped on this and it sold a lot of copy but it didn’t serve the health of the public. I’d be happy to look at any modern studies you think justify your position. Plant Based means based on plants not animals. Whole means eating foods as close to their original state as possible. The greater the processing the more the food has been nutritionally harmed.

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    • I’m pretty sure the corn/wheat/soy industry that vegetarians depend on is much more powerful and receives much more government subsidies than wild salmon and herring fishermen…

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  5. The purpose of the title “Whole Foods Plant Based Diet” was to distinguish it from the term vegan. WFPBD makes the emphasis nutrition and suggests that the best health can be achieved by eating minimally processed foods and excluding animal products. The fact that others have decided to interpret the title in vague ways doesn’t render the initial title vague. The term Vegan became vague in that there could be vegans who were nutritionally focused and other vegans who were ethically focused rendering some vegan’s dietary choices questionable. Oreos are vegan but not a healthy food. Obviously animal products are not plant based. There is significant evidence suggesting that eliminating animal products from the diet can alleviate a slew of maladies including heart disease. If that is true, then it is evident that reducing one’s animal product consumption would be beneficial even if one didn’t remove all animal products completely from the diet, though that is ideal. Hence the allowance for those who are incapable of eliminating animal products completely to reduce their consumption. This is not complicated. The skeptical cardiologist does a nice job of obfuscation here.

    Reply
    • Sarvangayoga,
      While the term WFPBD may be crystal clear to you, I fear that is not for the majority of individuals. You seem to be quite knowledgeable about the terminology/definition, perhaps you’d like to present a rebuttal to my post which would elaborate on your points here and help remove the obfuscation you perceive in my initial post.
      I must say that “reducing one’s animal product consumption” seems like a vague instruction to me.
      thanks
      Dr. P

      Reply
  6. Eating with severe food allergies, food intolerances and Type 2 Diabetes is a challenge. In 1980 IGE was 20,000, and double blind testing showed nature and scope of problem.
    Now IGE normal around 150, and Hb1Ac is 6.3 – tight glycemic control.
    I test a food a day for its effect on me, especially on post prandial blood glucose. Organic steel cut oats with blueberries raised BG to 10.9. The Freestyle Libre continuous glucose monitoring system is helpful.
    Whereas bacon and egg on a slice of toast barely nudges my BG upwards. Obviously published Glycemic Index measurements on foods does not apply to me. Not surprising as the GI numbers are the average results on people without T2D.
    It seems to me that having a diet based in Glycemic Index is dangerous for some Type 2 diabetics.
    A bedtime snack of cheese, celery and chutney on toast smoothed my blood glucose during the night, avoiding the hypo episodes revealed by the Freestyle Libra, and lowered waking BG. Works for me.
    Keeping BG stable and avoiding post prandial highs translates to feeling better and more energetic. Hopefully long term reducing the risks of those health issues associated with T2D and elevated BG.
    Interesting that the foods that work best for me are, broadly speaking, consistent with keto diet principles.
    This is the reverse – most people start the Keto diet as an act of faith, and then report their results.
    To paraphrase an old saying, the proof of the pudding is in the abstaining.
    I eat stacks of vegetables with some meat. A favourite is slow cooked stew of vegetables and lamb shanks. 90% vegetables. Not sure if this falls within the keto diet but ticks all my boxes. Thanks to my wife who wonderfully supportive of my diet issues, and who is involved in BG readings – thank you.
    Many foods show short lived very high post prandial spikes, not known until shown by the continuous monitoring. I identify and avoid them.
    Note that Medscape reports a new cardiometabolic sub speciality is being proposed – seems you are already a practicing member.
    Integration of diet and other lifestyle elements in your posts are appreciated- thank you.

    Reply
  7. It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes. https://www.ncbi.nlm.nih.gov/pubmed/19562864/

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    • I would agree the ADA that a vegetarian diet can be appropriate for many individuals. The statement that a vegetarian diet “may provide benefits in the prevention and treatment of certain diseases” is appropriately vague. There is no definitive evidence that a vegetarian diet reduces cardiovascular disease compared to say, a whole food based nonvegetarian diet. I think this recent Italian statement on vegetarian diet is accurate https://www.ncbi.nlm.nih.gov/pubmed/29174030.

      Reply
  8. No ‘News’ or comments between January 2018 and December 2018 ?
    DownUnder here in Australia we have witnessed the idiocy of a Surgeon being gagged – officially by the Regulatory body – based on an anonymous complaint from Dietician(s). – the same species of people who attacked Prof. Tim Noakes of South Africa, also for his support of Low Carb / Healthy FATs dietary approach to fixing metabolic mayhem / obesity / T2 Diabetes.
    Prof Noakes won his court case, and recently the Australian Regulators made a comprehensive apology for their actions to the Surgeon whose advice “…innapropriately reversed a patient’s T2 Diabetes…”
    The Elephant In The Room being the religious body which supports – and /often “proves” it’s PBD – which originally set up the Australian Dieticians Association along with the US equivalent.
    Dietary visions by a teenage girl should help narrow the field and identify the ‘rationale’ of their PBDiet…
    But in the Aussie spirit of Fair Play, the McGovern Senate Enquiry (1977-1980) which produced the Standard American Diet, or SAD, was similarly un-burdened by sound science !

    Reply
    • I’ve talked a lot about diet since then. Check out what I just published.
      But people seem more interested in my posts going after extremely low fat carb proponents than discussing my proposed definition of “plant-based diet.”

      Reply
    • And I’m aware of Professor Noakes and similar attempts to gag low carb proponents. Fortunately, we haven’t seen that here although Atkins, himself, was vilified when he testified before the Mcgovern Enquiry.

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      • I looked at the article. It is an intriguing, hypothesis-generating type of observation. Clearly cause and effect not proven.The authors do provide reasonable guidance on this:
        “The association of somatic mutations with nonhematologic disease may be due to confounding by variables that are currently unknown or may simply represent a shared consequence of the underlying process of aging. Alternatively, it may represent an underlying shared pathophysiology of seemingly unrelated disorders.”

        Reply
  9. I met a lady from Rolla, Missouri that came to a retreat at a place I used to work. She must have been early to mid 50’s at the time and she swore by and demanded Esseltyn’s diet specifically while she was in attendance. As it was a vegetarian group that allowed eggs and dairy it was not a far stretch to accommodate her wishes. She even left me with a copy of his book, claiming she had reversed her CAD by strict adherence to Esseltyn since her HA. I am not certain if any time frame was ever mentioned but she swears she had no more plaque buildup in her arteries. I have only seen wild claims of this on the internet but did not know it to be possible to reverse plaque buildup.

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  10. Excellent brother! I just made a chicken thigh dinner with mushrooms, leeks and cherry tomatoes baked in a pest cream sauce! Delish? Get Yahoo Mail for Mobile

    Reply
  11. Nice post! I’m trying Dr McDougall’s ‘Starch Solution’ – it has done what he says on his label! But I feel it is too restrictive. I’m going to introduce some eggs and fish when I’m ready. The problem is all ‘the plant based vegans’ “prove” their ideas by dishing up loads of science – then the Paleo people do the same! I was Paleo but walked into a diabetic wall where – at first – my blood sugars were good. But after a few years it didn’t work anymore. Dr McDougall says his starch solution will reverse diabetes – well my blood sugar is now normal. My taste buds have changed to super sensitive, and currently I am enjoying the adventure. So I was very interested in your post. Some ‘vegans’ eat truly unhealthy food! I don’t see veganism as healthy, unless you eat good food. Thank you for the trouble you put in to writing this.

    Reply
  12. “Esselstyn really doesn’t want you to eat nuts and avocados because he thinks the oil in them is bad for you. This is nuts!”
    So not eating nuts is… nuts?
    Anyway, thanks for article Dr. P. A good friend with a bad genes/heart issues has thrown himself full on into the Esselstyn PBD and your thoughts on it, based on actual facts, are always appreciated.

    Reply

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