There seems to be a huge interest in what celebrities eat these days. It amazes me when I see curiosity to know what a perfect diet is. And in this list I include myself, as being a lacto-vegetarian for most of my life, I too did attempt the ‘keto diet’. Only to very soon realise my love for lentils, legumes and whole food was suffering. I did not feel well on it at all. That is not to say it is a diet which should not be followed, but more to highlight that ‘one size’ does not fit all.
Where is the evidence?
I have been doing a deep dive into this topic as I started on a whole food plant based diet (WFPBD) myself. I wanted to know what the best options are, when it comes to food choices and this led me into doing the Diploma in Integrative Nutrition.
Looking at the global chronic health condition status, there is more than enough evidence to support a WFPBD. Whether it is reducing risk of cancer (1), supporting heart health (2), reducing blood sugar (3), (4) or simply managing weight (5), a balanced WFPBD would tick all the boxes.
The word ‘balanced’ becomes important here – as a buying a coke and chips would be plant based, but it would not be nutrient dense or whole food. Like with anything related to health, there does need to be some planning.
Mediterranean diets have been chosen as the overall best diet (6) and if you have a closer look it is essentially plant predominant whole food which is the base. It recommends limited animal food intake and is amazingly rich in polyphenols, antioxidants and fibre. The MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay) has been seen to improve brain health. Researchers found 53% lower rate of dementia in those following the MIND diet (7). DASH diet (Dietary Approaches to Stop Hypertension) has been around for more than 20 years now and plenty of evidence backs up the benefits not just with lowering blood pressure but improving overall cardiovascular and metabolic health too (8).
Low carbohydrate and ketogenic diets have been seen to be efficient for metabolic health as well as diabetes (9). It seems to be a popular choice amongst people who prefer to have animal sources of protein and fats. However, I have not yet seen any long term data on how these diets are effecting the gut microbiome and liver health considering the lack of fibre and high amounts of saturated fat included in them. On a practical level I feel my patients who are vegetarian struggle on ketogenic diets.
I was super excited to read in this review that evidence supports plant-enriched diets as compared to ketogenic diets for the reduction of cancer risk and the improvement of metabolic disorders in survivors (10). However more robust long term studies are needed.
There is often this idea that a WFPBD can be nutrient deficient and I am regularly asked questions about iron or protein or calcium intake in my diet. In fact, it is seen that every diet will have its pros and cons and will lack some nutrients which one needs to be mindful of. In this systematic review the nutritional status was compared between meat eaters and those following a plant based diets. As you can see below, one needs to be mindful of certain nutrients whichever diet is chosen (11).
The same review also highlights that as plant based diets are generally better for health and the environment, public health strategies should facilitate the transition to a balanced diet with more diverse nutrient-dense plant foods through consumer education, food fortification and possibly supplementation.
So what does this all mean?
Now having discussed some of the evidence above, where does that leave us when we are deciding what goes on our plate?
Some of the things I discuss with my patients are:
- What works for them? Are they open to considering a WFPBD? Or can more vegetables, fruits, legume, beans and plant based food be added to their meal plan?
- What small changes can they stick to? There is no point in planning something which is not practical for them. When it comes to healthy diet changes adherence matters and hence one needs to be mindful of how it would work for the individual as well as their family.
- Be curious and experiment- this is how it started for me! Look at what inspires you or seems motivating and then see how you feel following that diet plan. Reflect and then tweak it to make it work for you, in small steps.
- Try and add variety to the meal plans as much as possible. Don’t forget the more colour and variation in fruits and vegetables, the happier the gut bacteria will be!
If nothing else seems to resonate, a basic plan can be easy-
- Eat unprocessed home cooked whole food.
- Stay away from refined carbohydrates and sugar.
- Include healthy fats like extra virgin olive oil, avocadoes, nuts and seeds.
- Balance the macronutrients with an aim to have slow release whole grain carbohydrates along with protein and healthy fats as part of each meal.
- Include variety and colour to your diet and as far as possible try to eat seasonal produce.
- Add some fermented food when possible, to keep the gut microbiome happy.
- If you are fond of dairy, red meat, eggs, chicken and fish –limit their intake as much as possible.
I will let you answer the question now- Is there a perfect diet?
In my humble opinion, if one sticks to the basic plan and tweaks the rest around balance, family and what works for them, there is no need for a fixed diet. I have forgotten all about calorie counting over last few years as being on a whole food plant based diet I have found my balance, energy as well as health. The beauty is that my boys are eating more fruits, vegetables and complex carbohydrates than ever before and their processed food intake had reduced by 80%!
- Practical, Evidence-Based Approaches to Nutritional Modifications to Reduce Atherosclerotic Cardiovascular Disease: An American Society For Preventive Cardiology Clinical Practice Statement https://www.sciencedirect.com/science/article/pii/S2666667722000101
- Vegetarian diets and risk of hospitalisation or death with diabetes in British adults: results from the EPIC-Oxford study https://pubmed.ncbi.nlm.nih.gov/30804320/
- Vegetarian diets and incidence of diabetes in the Adventist Health Study-2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638849/
- Association between adherence to plant-based dietary patterns and obesity risk: a systematic review of prospective cohort studies https://pubmed.ncbi.nlm.nih.gov/35985038/
- Influence of Dietary Approaches to Stop Hypertension (DASH) diet on blood pressure: a systematic review and meta-analysis on randomized controlled trials https://pubmed.ncbi.nlm.nih.gov/25149893/#:~:text=Meta%2Danalysis%20showed%20that%20the,(2)%20%3D%2056.7%25).
- Low-Carbohydrate Diets in the Management of Obesity and Type 2 Diabetes: A Review from Clinicians Using the Approach in Practice https://www.mdpi.com/1660-4601/17/7/2557
- Plant-Based and Ketogenic Diets As Diverging Paths to Address Cancer: A Review https://pubmed.ncbi.nlm.nih.gov/35797039/
- Nutrient Intake and Status in Adults Consuming Plant-Based Diets Compared to Meat-Eaters: A Systematic Review https://pubmed.ncbi.nlm.nih.gov/35010904/