NUTRITION REPORT

Plant Power

Answering patients’ questions about plant-based eating

At a Glance

• A plant-based diet is strongly associated with reductions in disease risk and severity across the spectrum of human illness.

• A plant-based diet is not necessarily a vegetarian or vegan diet.

• People can get plenty of protein from plant-based foods.

• Small changes can make a big difference.

What do you say to a patient who asks you why they should eat a plantbased diet? For one clinician, the answer is simple: Why not? “A plant-based diet is strongly associated with reductions of disease risk and severity across the spectrum of human illness,” says Joshua Levitt, ND, a naturopathic doctor in Hamden, Connecticut, and a clinical preceptor for the Yale School of Medicine. Here is a partial list of the benefits: • Plant foods deliver a bounty of phytonutrients (compounds that research suggests improve the health of cells, organs, and bodily systems), vitamins, minerals, and fiber. • A plant-based diet decreases chronic inflammation, which may lower the risk of osteoarthritis, Alzheimer’s disease, cancer, and many other conditions triggered by inflammation. • It improves the composition of gut microbiota—the trillions of friendly and unfriendly bacteria that live in the digestive tract. A healthier gut microbiota has been linked to better digestion, stronger immunity, and improved mood.

• Eating a diet rich in vegetables, beans, whole grains, fruits, nuts, and seeds can lower blood pressure and LDL cholesterol, reducing the risk of heart attack and stroke. • High-fiber plant foods help patients feel full without delivering a lot of calories—so they can help with weight loss and maintenance. • Beans, vegetables, and nuts balance blood sugar, helping to prevent or reverse prediabetes and type 2 diabetes. • A plant-based diet can improve energy levels and sleep, adds Amanda Adkins, MD, an internist with NorthBay

Healthcare in Fairfield, California.

“If there ever was a panacea—one remedy that works for every disease—a plant-based diet is pretty close,” says Dr. Levitt.

Make It Easier for Patients

Even though a plant-based diet is good for you, patients might find it hard to imagine including more of these foods in their diet. You can reassure them that it’s easier than they think.

“For one thing, a plant-based diet is not a vegetarian or vegan diet,” explains Dr. Levitt. “Plants are the base of the diet—the foundation—but that leaves plenty of room for foods that aren’t plants.”

To help your patients think about this in practical terms, ask them to visualize a plate. Rather than a steak with a little bit of potatoes or asparagus on the side, tell them to reverse the ratio. Let plants be the center of the meal, and meat the accessory. “Eating a plant-based diet doesn’t mean you’ll never eat meat again,” says Dr. Levitt.

“You can be a plant-based omnivore just by making plants the majority of your diet,” agrees Keith Ayoob, EdD, a nutritionist and registered dietitian at the Albert Einstein College of Medicine in New York City. “And it doesn’t have to be done instantly.” Patients can make changes gradually and consider their likes and dislikes.

Here are some tips to help patients get started:

Go Big on Beans

The best way to start getting more plant foods into the diet is with legumes such as beans, peas, and lentils. Bean-rich diets are strongly associated with a lower risk of cardiovascular disease, diabetes, and overweight. In fact, research shows that for every ounce of beans added to the daily diet, longevity increases by nearly 10%.

There are many varieties, and the easiest to start with are black beans, pinto beans, white beans, and garbanzo beans, says Dr. Levitt. You can buy them canned, so preparation is minimal. They’re inexpensive. And they work in a variety of dishes, like soups, stews, and salads.

With a little spice and sauce, you can have a world of culinary options—turn white beans into an old-world Italian dish,

Smart Supplements

While a plant-based diet is remarkably healthy, people who follow a strict vegan diet (one that excludes all animal-based products) may benefit from dietary supplements.

· Vitamin B12 levels are often low in vegans, who can increase levels by eating B12-fortified foods or taking a supplement. The recommended intake is 2.4 mcg per day for adults, 2.6 mcg per day during pregnancy, and 2.8 mcg per day while breastfeeding.

· Omega-3 fatty acids. Studies suggest that vegetarians and vegans have up to 50% lower blood and tissue concentrations of two long-chain fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), than omnivores. Omega-3 supplements are available as fish oil or, for vegans, algae oil.

· Calcium and vitamin D. A study published in The American Journal of Clinical Nutrition in May 2021 reported that though women on a vegan diet have a higher rate of fractures, taking calcium and vitamin D supplements eliminated that elevated risk.1 High- calcium plant foods include dark leafy greens, nuts, seeds, soy foods, seaweed, lentils, and beans. Good food sources of vitamin D include fortified milk substitutes and mushrooms.

REFERENCE

1. Thorpe DL, Beeson WL, Knutsen R, Fraser GE, Knutsen SF. Dietary patterns and hip fracture in the Adventist Health Study 2: combined vitamin D and calcium supplementation mitigate increased hip fracture risk among vegans. Am J Clin Nutr. 2021;114(2):488-495. doi:10.1093/ ajcn/nqab095

black beans into a South American specialty, pinto beans into a Mexican meal, and garbanzo beans into something tasty from the Mediterranean.

Vegetables and Fruits

You often hear the phrase “fruits and vegetables” in describing a plantbased diet. But for optimal health, advise your patients to emphasize vegetables and eat fruits mostly as a snack or dessert. Patients should strive to include vegetables of a variety of colors in their daily diets. A vegetable’s color (orange for carrots, red for tomatoes, green for broccoli, etc.) is often indicative of which phytonutrient it contains, and phytonutritional diversity is beneficial.

Nuts and Seeds

“Eating nuts and seeds in their whole and minimally processed form is strongly associated with decreased risk of chronic disease—particularly heart disease,” says Dr. Levitt. Emphasize minimally processed nuts and stay away from Nutella and Skippy. Particularly good sources of healthy fats are almonds, walnuts, flax seeds, and chia seeds, according to Dr. Adkins.

Get an Oil Change

Your patient might think vegetable oils are a big part of a plantbased diet: They’re made from vegetables, right? But soybean and canola oils are highly processed and deliver unhealthy amounts of omega-6 fatty acids, which are proinflammatory. For cooking, patients should favor extra-virgin olive oil or coconut oil.

Spice It Up

Ounce for ounce, spices can provide more nutrients than vegetables, fruits, nuts, seeds, and grains. Plus, adding spices can make any plant-based meal delicious. There are many prepared spice blends on the market, Dr. Levitt points out. Try them on vegetables and grains, and in soups and stews.

Eat Clean Meat

For optimal health, encourage your patients to look for meat from animals that were raised in a healthy way—grass-fed, free-range, or wild—rather than on a factory farm. “Increase the quality and decrease the quantity—and fill in the gap with plants,” Dr. Levitt says.

Avoid Processed Plant and Other Foods

Dr. Levitt isn’t a big fan of highly processed meat substitutes, like the Beyond Burger. “For health, it’s best to eat minimally processed plants in their whole form,” he says.

“One big mistake I see patients make is replacing meat with meat substitutes full of sugars, salt, and fat,” agrees Dr. Adkins. She also sees patients on a plant-based diet eating french fries, chips, sugary cereals, and other unhealthy foods. She asks patients to get a plantbased cookbook for more ideas on what to eat. Bestsellers in that category include The Complete Plant-Based Cookbook and Forks Over Knives: The Cookbook.

Let Your Insides Adjust

It’s not uncommon for people who up their intake of plant foods to experience a week or two of extra gas or bloating as their bowels adjust to increased levels of fiber. To ease discomfort, advise patients to temporarily decrease the amount of plant food they’re eating while they adjust. Taking a digestive enzyme with meals or a daily probiotic can help as well, Dr. Levitt says.

Don’t Worry About Protein

In general, an adult only needs about 10% of their calories to come from protein, and eating a variety of vegetables, beans, legumes, whole grains, and nuts will easily meet that requirement, Dr. Adkins says. There are also a variety of plant-based protein powders available.

Tell Yourself a New Story

Among the main “pushbacks” to a plant-based diet you may hear are: “I don’t like vegetables,” or “I’m just a meat-and-potatoes person.” Dr. Levitt says (that) those are just stories patients tell themselves—ones that can easily be rewritten. He tells patients, “If you’re willing to accept the possibility you could become a vegetable person, it’s very possible to do so—because human beings are remarkably adaptable.” C