If you’ve been reading my 2021 postings, you might have noticed that for the past 6 weeks or so, I’ve been talking about what not to do: mainly vitamins, minerals, and other supplements not to take. This week, I’m going to switch gears and talk about some diet changes that make sense health-wise, and how—and how not—to put these kinds of changes in place. I’m talking about putting more foods from plants in your typical day, sometimes referred to as a plant-based diet (when I say “diet” here, I mean a way of eating, not a way to lose weight). This is absolutely not about advocating that you adopt a vegan or even vegetarian diet. And again, it’s also not necessarily a diet to lose weight—it’s a way of eating that is meant to improve your health—but for some people, weight loss might be an added health benefit.

What does it mean to add more plants to your diet?

Making vegetables, fruits, legumes (beans, soy, peanuts); whole grains, including whole grain bread and pasta and brown rice; mushrooms; nuts and seeds a bigger part of your daily diet is not a new idea, and evidence is mounting that it really can be beneficial to creating a healthier lifestyle.  Again, this is NOT to say you should stop consuming animal products, it’s just a way to increase good nutrients–vitamins, minerals, fiber, protein, and fats from plant sources—and decreasing potentially risky nutrients—saturated fats–by eating smaller amounts of red meat.

Contrary to what Paleo diet adherents seem to believe—with no evidence—the true diet of our ancestors was undoubtedly a plant-based one. Logically, it would have been a lot easier to forage for edible plants than it would have been to go out and kill and dress a beast every other day or so to keep the family fed. Today, most of the world lives on some version of a plant-based diet because many countries and peoples lack the open land to raise animals for meat or the money to import and buy it. Consider the Mediterranean diet—lots of green vegetables, olives, olive oil for cooking, and small-ish amounts of fish, lean meat, and cheese. Or the Asian diet—lots of vegetables, noodles or rice, sesame, soybeans and peanuts, and small amounts of meat, eggs, or fish, almost as a garnish. Or the Central American diet—rice and beans, corn, tomatoes, and avocados with, again, small amounts of meat and cheese. Does it seem like I’m repeating myself?

Why a plant-based diet?

For decades, nutrition researchers have been observing that societies that eat less red meat and get more of their calories from plants throughout their lives tend to have “better numbers”—lower blood pressure, lower blood lipids—meaning less risk for heart disease and stroke, as well as lower risks for some kinds of cancer and other diseases. Naturally this kind of evidence falls short of proof that plant-based diets improve health: Maybe these societies also drink less alcohol, smoke fewer cigarettes, and get more exercise, all of which could contribute to lower disease risk. But as you might have read or heard (1) this past week, two studies that have been “following” a group of nurses and doctors for a very long time (the Nurses’ Health Study and the Health Professionals Study) have recently reported strong associations between long-term consumption of diets higher in fruits, vegetables, and plant sources of protein and much lower risk for developing cognitive decline (a precursor to dementia). Granted the risk for cognitive decline was measured by asking study participants a series of questions, not the most scientific. But a systematic review of many studies published this past week also reported strong associations for long term consumption of this type of diet, along with eggs and dairy foods with lower risk for atherosclerosis, although of course most of the studies in this review were the type to follow people over long periods, so they didn’t provide direct proof.(2) But some actual trials of more plant-based eating, such as DASH (Dietary Approaches to Stop Hypertension), an especially well-designed family of studies, strongly support a role for eating less red meat and more foods from plants in decreasing the risk for chronic disease.

What is it about a plant-based diet that confers health compared with a “typical western” diet? It could actually be any number of things. The so-called “typical western diet”  is built around meat and full-fat dairy foods, which provide a lot of animal (saturated) fat: Eating a diet high in saturated fats can raise blood lipids—triglycerides and cholesterol—thought to be associated with increased risks for heart disease and stroke. Processed meats like salami, pastrami, deli ham, and bacon are also high in sodium and some other compounds implicated in heart disease and certain cancers. Meat also contains some compounds that may promote the process of inflammation throughout the body, contributing to heart disease as well as joint issues, while eating a more plant-based diet has been shown to be associated with lower inflammation.(3)

Also, because what we eat is kind of a zero-sum game, the typical western diet also tends to be pretty devoid of vegetables, whole grains, and other plant-based foods. And as I said above, foods from plants are full of vitamins, minerals, much-needed fiber, essential fatty acids like omega-3s, and other chemicals that maintain and promote health. So, if meat is crowding out foods from plant sources in our personal diets, we could be starving our bodies of numerous nutrients, even some yet to be discovered.

But just adding a bunch of nuts or avocados or whole grains (complex carbs) to the typical western high-saturated fat diet or switching meats and full-fat dairy foods for any old non-animal foods—especially things like fries, sugary cereals, and pastries—is not the answer. Nutrition researchers are discovering this through small observational studies and have been testing these ideas through carefully designed trials. The DASH studies randomly assigned people to a diet lower in saturated fat (especially less red meat and full-fat dairy foods) and high in minimally processed plant foods like vegetables, fruits, and whole grains (some fish and poultry were also included).  Others were assigned to an average western diet high in both saturated fats from animal foods and highly processed carbs (see below). For several months, participants had all their meals and snacks prepared for them and were asked not to consume additional foods. Blood levels of nutrients were carefully monitored. The study showed that even relatively short-term adherence to the low-saturated fat DASH diet (a month or two) resulted in short-term improvements in levels of blood lipids and other factors associated with lower risks for later developing chronic diseases.

Where does processing fit in? Minimally processed foods vs. ultra-processed foods

You may have heard or read recently that to improve your health, you should cut down on processed foods. But this kind of advice can be confusing. Many foods require some kind of processing to be edible. For example, we don’t go out into a field, grab a stalk of raw wheat, and eat it! Wheat has to be processed into something like bread or cereal to be edible.

The term “processing” can mean anything from cooking to freezing to pulverizing to canning and any number of other actions that alter a potential food. Some kinds of processing have had monumental beneficial effects on food availability and safety, from preventing famine or poisoning to simply allowing us to enjoy many otherwise seasonal fruits and vegetables year-round: preventing the growth of toxic microorganisms, increasing shelf-life, and preserving or  increasing nutrient contents. But some kinds of extreme processing—think of the ones where the original food is no longer  even remotely recognizable—destroy many of the nutrients. The amount of processing raw ingredients go through before you eat them is what distinguishes minimally processed, generally more-nutritious foods from their ultra-processed, more nutrient-depleted, counterparts.

Think of food processing as a spectrum. On the minimally processed, healthy end of this spectrum are things like whole wheat bread; steamed corn on the cob or cooked frozen or canned corn; raw or steamed vegetables; fresh fruit; and cooked garbanzo beans or soy beans; while way at the other, ultra-processed end of the spectrum, you’ll find things like white bread; sugar-frosted (corn) flakes or hot cheese-flavored puffed or crunchy corn snacks; veggie snack chips (which are nearly devoid of any actual vegetable except highly processed cornmeal); “organic” pop tarts, filled with fruit-flavored jam; and deep-fried soy chips! Even animal foods can be viewed along this spectrum: Think roast turkey breast on one end and turkey bacon on the other, or a glass of milk vs. whey powder.

Why am I raising this concern about ultra-processed foods and why mostly in relation to plant-based foods? At least one major nutrition trial, numerous observational studies, and even systematic reviews of the research have shown that ultra-processed foods—many of which originally came from plants—are associated with weight gain and obesity,(4) possible because the manufacturing involved in producing ultra-processed foods not only removes nutrients (see below) but often adds intense (artificial) flavor and salt and creates more calorically dense products. Some popular books and pseudo-documentaries claim food manufacturers have even set out to create ultra-processed foods that would be addictive, but the whole idea of whether food addiction is a real thing is a topic for another time. But the more important concern with ultra-processed foods is their interference with consuming a nutrient-rich diet.

Is the problem with ultra-processed foods the foods themselves or the less processed, more nutritious foods they crowd out of our diets? Or both? 

One major concern about ultra-processing is that it robs foods of their most important nutrients. For example, over-processing wheat to make white flour removes the bran—the source of the fiber most of our diets lack—as well as many of the vitamins. Likewise with oats: While we tend to think of oatmeal as a healthy breakfast, some research evidence has shown that eating instant oatmeal (which is highly processed to make it cook quickly) produces an unhealthy spike in blood sugar, whereas eating old-fashioned, steel cut oatmeal doesn’t. Ultra-processing whole grains like wheat and oats causes them to be broken down to sugar much more quickly in our digestive systems than if they were in their minimally processed forms.

But equally worrisome, some adults and many school-age kids are virtually existing on ultra-processed foods,(5) eating no vegetables or fruits, subsisting on crunchy snacks, candy, and fast-food meals like chicken nuggets and fries. So, it’s important to realize that it’s not just overconsumption of meat that tends to crowd out nutrient-rich plant foods in some of our diets—it’s also the calorie-dense, nutrient-poor ultra-processed foods.

And possibly even more worrisome is that some ultra-processed foods may actually be getting a nutrition halo because somewhere in their distant past, their ingredients came from plants. This halo is usually extremely undeserved: Going vegan or vegetarian or even just switching to a more plant-based diet for your health should not mean loading up on ultra-processed simple-carb laden stuff like potato chips or corn chips, puffed corn snacks, veggie chips, sugar-sweetened fruit-flavored cereals,  jam-filled toaster pastries, fruit-flavored candies and snacks, fruit-flavored drinks or juices; or even dairy-free cheese, yogurt, and frozen desserts made from plant products.

Making the Switch…Slowly

So…what would a healthy, more plant-based, diet look like? And how do we get there? Here are some concrete ideas, taking it meal by meal. Notice I am trying to focus on things you can easily prepare yourself with a little preplanning at the supermarket and the night before (or over the weekend) and even things you can pick up at the convenience store. But if your reaction to even these suggestions is, “But I have no time, I can’t plan, and I don’t know how to use a paring knife or heat oil,” take note of the suggestions that need no prep at all, and also search YouTube for suggestions on simple meal prepping. Breakfast can be the most challenging because when you’ve just rolled out of bed, it’s so easy to take a wrong turn into donutland, resorting to the sugary cereal in your cabinet, or grabbing the healthy-sounding breakfast bars at the supermarket or convenience store, so tackling breakfast is a good place to start.

Breakfast:

• Whole grain cereals with fresh fruit and lower fat milk are a best bet. Read package ingredient lists carefully, because few cold cereals are truly whole grain. One of the few is shredded wheat, preferably with extra bran. If you usually add sugar to  your cereal, try a small, sliced banana instead. For winter, try steel cut or rolled or old fashioned oats, or oat bran (or some other grains like quinoa or buckwheat groats).  Make sure to get the oats without the extra sugar added by the manufacturer, and add your own dried fruit for sweetness and extra fiber.
• Top fresh fruit with low-fat unsweetened or lightly sweetened Greek yogurt and some chopped almonds or walnuts.
• Top whole wheat bread or a whole wheat or pumpernickel bagel (again read labels to make sure it’s truly whole wheat, not wheat bread dyed brown) with nut butter ( the best ones have no added sugar and will say, “natural,” on the label), and fresh fruit slices (or a little bit of fruit-only preserves, easily found in the jam and jelly aisle)).
• If you like middle eastern breakfasts, try tomatoes and cucumber topped with plain yogurt or with thinly sliced feta cheese
• Make or order a two-egg omelet filled with mushrooms and veggies like peppers, onions, and tomatoes and a little cheese
• Cook up some whole wheat pancakes or waffles filled with or topped with fresh fruit on the weekend, and save leftovers for weekdays.

Notice I’m not advocating dumping animal products. Nope. Not at all. The idea is to make veggies, fruits, legumes, whole grains, nuts, and seeds more of the main dish, with (red) meat more of a side dish.

My friends who are lactose intolerant, or have a true allergy to one of the proteins in milk, are probably wondering around now if I forgot about plant-based milks. First, so that we’re all on the same page, let me define “lactose intolerance.” Lactose is the sugar naturally found in milk that requires a certain enzyme to digest: Some of us lack or lose our ability to make this enzyme as we grow, causing mild to severe stomach upset when we consume a glass of milk. A much smaller number of people have a true allergy to one of the proteins in milk.  So, the short answer is, no I haven’t forgotten non-dairy milks, but unless you’re in one of these two groups, swapping real cow’s milk for white liquids squeezed from seeds is generally not a dietary improvement. Cow’s milk is a superior source of protein and calcium and is fortified with Vitamin D. If you are vegan or can’t consume cow’s milk for health reasons (again, lactose intolerance or an allergy), soy milk is a reasonable alternative. Protein-wise, soy milk is the best of the nondairy milks but still not quite as good as cow’s milk: Search out soy milk that is specially fortified with calcium and vitamin D. Oat and almond milks have less good-quality protein than does soy. And non-dairy milks in general often come with a hefty dose of added sugar (hey, they have to get the flavor from somewhere!). In fact, oat and almond milks and other dairy-substitute products (like cashew “cheese”) epitomize ultra-processed foods. Oats, almonds, and soybeans, themselves, are healthy foods full of healthy fats, proteins, vitamins, minerals, and fiber. Oat, almond, and even the least offensive soy “milk”? Not so much!

On a similar note, the plant-derived protein supplements you’re seeing advertised if you watch televised sports (like pea protein powder), provide none of the advantages of eating actual food!

Lunch:

• Several produce companies have created prepackaged salads with relatively minimal calories and good amounts of protein. Until we see a post-pandemic return of salad bars, which may be never, toss these premade salads into a small-to-medium serving bowl, and add your own extra dark leafy greens (like spinach or baby kale), tomatoes, and things with fiber (like artichoke hearts and garbanzos) and healthy plant fats like avocado. Or create your own salad/veggie/grain bowls from scratch with prebagged salad greens; cooked grains like quinoa; pouches of tuna, salmon, or diced chicken breast; chopped veggies; canned beans or thawed frozen edamame (soybeans), and/or hard-boiled egg; and a little oil and vinegar.
• Make simple sandwiches of whole grain bread, veggies, avocado, tuna or chicken breast, salsa, and a little cheese, or yes, good old PB&J.
• Prepare prepackaged ramen but in place of the flavor (salt) packet, add some low-sodium soy sauce and/or sriracha sauce, chopped veggies (including green onions for extra flavor), and edamame, chopped tofu, or an egg. Or in place of the ramen, use partially cooked tofu noodles.
• Add a serving of fresh fruit.

At this point, you may be wondering, what about the new plant-based “meats” that have burst onto the food scene? Are those a healthy alternative to real burgers, hot dogs, and sausages? Well, the manufacturers would like you to believe that, but the answer is, “Probably not!” Especially the ones that use a plant-base protein to make them look like they contain blood. These products are about as far removed from plants or veggies as hot crunchy cheese snacks are from fresh corn, farther really. We have no idea of the health effects of the lengthy process and the chemicals used to isolate and modify the plant proteins that make up these products, not to mention the fact that most of the nutrients that make plant foods healthy—the fiber, vitamins, and minerals—are completely absent from these faux meats. They might not be much more nutritious than burgers made entirely from meat extenders like ‘burger helper!” And if you’re concerned about your sodium (salt) intake, plant-based meats tend to be higher in sodium than their real meat counterparts. One more thing: are these meat substitutes better for the environment than actual meat? Thus far, actual research has not provided clear evidence that the substitutes are significantly better for the environment than raising animals for real meat.

Dinner

First, see the ideas for lunch! When you get tired of those ideas, or when you’re feeding guests:

• Make a stir fry. If you’re following a recipe, add 50% or even 100% more veggies and cut down on meat. Add extra garlic, scallions, and ginger for more flavor. Also, experiment with marinade ingredients like soy, rice wine, vinegar, lemon juice, chili or sesame oil, fermented black bean paste, and/or sriracha added to broth. For extra special flavor, top with toasted almonds. Serve with a side of brown rice: If the extra time needed to cook the rice seems too long, use the par-boiled packets that take 90 seconds to heat (unlike instant oatmeal, parboiled brown rice retains fiber and other nutrients).
• Make the stir fry but add extra marinade and serve over whole-wheat angel hair pasta or thin spaghetti.
• Make a quick tomato sauce with crushed tomatoes and tomato paste, and add lots of mushrooms, onions, herbs (basil and oregano), and diced peppers sauteed with a small amount of ground beef or spicy pork sausage…and of course garlic. Serve over whole wheat pasta.
• Make a traditional tuna-type casserole but add frozen green vegetables like broccoli or spinach.
• Make chili, but add more beans, onions, and peppers, and less meat; or make a big pot of lentil soup.
• Make a dinner or side salad. Canned beans or cooked lentils add extra protein and fiber. Avocado and olives add healthy plant fats. Artichoke hearts add fiber as well.
• Make a quick whole wheat pizza using the recipe on the yeast package, adding fresh diced roma tomatoes and lots of veggies, and keeping cheese to a relative minimum (mozzarella for texture and parmesan or even feta for flavor).
• Choose fruit for dessert. If you love to bake, lean toward fruit crisps, tarts, and bars, made with whole wheat flour, a little less sugar, and nuts toasted for flavor.

Snacks

Now that I’ve given you some ideas for starters to up your plant-based food game, it’s equally important to address what you’re eating between meals. Ultra-processed snack foods abound, including ones that sound deceptively healthy like veggie chips, fruit bits, and multigrain breakfast bars, crackers, and chips.

Other ultra-processed snacks to go easy on include potato chips, corn chips, pretzels, pita chips, cakes, cookies, donuts, candy, fruit pies, most frozen desserts (including those high protein concoctions), cheese-based dips and sauces (unless they’re homemade), and sugar-sweetened drinks, fruit juices, and smoothies with added sugars.

Better plant-based alternatives include popcorn (preferably air-popped, at least some of the time), nuts (lightly salted or unsalted, or lightly dipped in dark chocolate) or roasted soybeans or steamed edamame; 100% whole wheat crackers; bite-size carrots, raw sliced veggies (zucchini, summer squash, peppers), or mushrooms,; fresh fruit; canned fruit packed in water; and small amounts of dried fruits. Pair cut up veggies or whole grain crackers with hummus (hummus comes in lots of different flavors now) or even string cheese; or top apple slices with nut butter.

Any Potential Downsides?

Is it possible to go overboard or down a wrong path with fruits, vegetables, grains, beans, nuts, and seeds? For the most part, no. Most people in the U.S. consume far too few. But let’s take a look at a few places where caution is needed and a few myths floating around on the internet.

• Proponents of the Paleo Diet have tried to scare people off eating legumes (again, beans, lentils, and peanuts), claiming a health danger, but there is no evidence regarding this claim: People have safely relied on cooked or roasted legumes for their protein, fiber, fat, vitamins, and minerals for millennia.
• If you’re trying to switch to less-processed foods, raw milk is not a direction you want to go. It has none of the health benefits some proponents tout, and it can be extremely toxic.
• For as long as I can remember, old wives’ tales have warned about the dangers of eating tomatoes and eggplant (so-called nightshades)—with no evidence, whatever, unless you’re one of the extremely rare individuals who happen to have a true allergy to these foods.
• If you’re trying to eat more fruits, vegetables, and whole grain foods, you might be wondering if these need to be (higher-priced) organic foods. There is NO evidence that organic foods are more nutritious than their conventionally grown counterparts. And although I hate to condense volumes of research to one sentence, we simply do not have strong enough evidence linking eating non-organic foods to any harm. If you have young children and are concerned about exposing them to non-organic fertilizers and pesticides (as we await definitive evidence), you might want to choose organic varieties of foods like berries with delicate skins that are not peeled. But always wash produce well, organic or not! Remember: organic produce is grown with “natural” pesticides and fertilizers, and there is no scientific proof they’re any safer than the pesticides and fertilizers used in conventional farming!
• Some proponents of a raw food diet warn that cooking causes vegetables and fruits to lose their nutritional value and that foods should never be cooked, But in fact some vegetables are more nutritious when cooked (for example, cooking broccoli, tomatoes, and carrots, among others actually releases and allows more of the nutrients to be absorbed by our digestive systems). The raw food diet is one of the latest fads and newest efforts to charge absurd amounts of money for specially prepared foods of no proven value. And many so-called raw food products are actually ultra-processed junk.
• FODMAPs are a type of carbohydrate found in certain vegetables that can make them difficult for some people to digest. In fact, most people have trouble digesting certain vegetables (think cabbage). This does not mean these vegetables should be avoided, but if you’re having GI symptoms that aren’t responding to treatment, consider checking out the list of FODMAPS online (https://www.healthline.com/nutrition/fodmaps) and, for a week or two, omitting the ones you tend to consume to see if your symptoms subside and then adding them back, one at a time.
• Gluten, a protein found in wheat and several other grains, should not be avoided unless you have been diagnosed with Celiac disease by a specialist. Avoiding gluten usually results in trying to subsist on a diet of ultra-processed, less nutritious substitutes for bread, pasta, and other wheat-containing carbs.
• Yes, coconuts grow on trees, but coconut oil is actually a highly saturated fat (like fat from red meat). So far, we have no evidence to suggest it’s really a healthy fat, in spite of much hype to the contrary.
• If you are taking prescription anticoagulants—also called blood thinners—to prevent stroke, you may have heard you need to avoid dark leafy green vegetables (like spinach). Leafy greens are high in vitamin K, which is important for blood clotting. Large or widely varying amounts of vitamin K interfere with the work of blood thinners, so you simply need to talk with your doctor or nutritionist about making sure the amounts you eat stay about the same from day to day.

Some Last Words

Don’t just dive in head-first! Start by gradually working more plant-based meals and snacks into your repertoire in place of the meat-heavy meals you’re used to. And if you’re feeding kids, make sure to include them every step of the way: It’s vital (and actually easier) to get kids off on the right foot food-wise as early as possible, rather than trying to change the eating habits of a 10- or 15-year-old who’s never eaten a green vegetable! Luckily more and more eating places are offering kid-friendly dishes that depart from the usual choices of chicken fingers, strips, and nuggets.

Finally, although it goes without saying that people who adhere to vegan or vegetarian diets are consuming more plant-based diets, being a vegan or vegetarian is no guarantee that one is eating healthy. Too many folks who think they’re choosing a vegan diet for health subsist on ultra-processed vegan breakfast pastries, sugary cereals drowning in sweetened plant milks, faux meats and cheeses, non-dairy frozen desserts, and other substitutes for their non-vegan counterparts. These are the ultimate ultra-processed foods. Choose wisely!

References:

(1) https://www.nytimes.com/2021/08/09/well/brain-health-fruits-vegetables.html?campaign_id=18&emc=edit_hh_20210813&instance_id=37802&nl=well&regi_id=37828548&segment_id=66115&te=1&user_id=603231eb8e0a899d93849ff355927332

(2) https://academic.oup.com/cardiovascres/advance-article/doi/10.1093/cvr/cvab173/6314360

(3) https://pubmed.ncbi.nlm.nih.gov/33303765/

(4) https://pubmed.ncbi.nlm.nih.gov/?term=ultraprocessed+food+obesity&filter=pubt.systematicreview&sort=date&size=20

(5) https://jamanetwork.com/journals/jama/fullarticle/2782866?guestAccessKey=c646e502-898f-443b-8558-d90a74e35415&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=081021