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

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 reject 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 and World Report 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 definition is radically different from the first two. 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, a food which (in my opinion) is highly processed and that lean meat is to be 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 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.

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 to your onions, tomatoes and peppersAnd 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!


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

  1. “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.

  2. 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.

  3. 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

  4. 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.

    1. I actually put my thoughts on that article in its comments section:
      “In many respects, the vilification of coconut oil by federal dietary guidelines and the AHA resembles the inappropriate attack on dairy fat and is emblematic of the whole misguided war on dietary fat. In fact, the new AHA advisory after singling out coconut oil went on on to cherry-pick the data on dairy fat and cardiovascular disease in order to sopport their faulty recommendations for choosing low or nonfat dairy..
      See my full post on this here (https://theskepticalcardiologist.com/2017/06/18/beware-of-more-misinformation-from-the-american-heart-association-on-coconut-oil-and-saturated-fats/)”

      1. 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.”

  5. 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 !

    1. 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.”

    2. 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.

  6. 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/

    1. 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.

  7. 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.

  8. Forgot to mention we eat a lot of berries and nuts as well as some low sugar 70% or higher dark chocolate.

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