Healthy, not Unhealthy, Plant-Based Diets Reduce Mortality. So Get it Right!

How many times have I heard patients tell me they are "plant-based" but the words cheese, chicken, egg yolks, faux chicken nuggets, faux pepperoni and others make it into the history.

NO!  To gain the benefits, it must be a whole food plant-based diet. Prior data a few years ago from the Harvard School of Public Health showed a dramatic difference favoring healthy plant-based diets versus "unhealthy" plant-based diets. Now new data in Spain confirms this striking distinction. So make it a "whole food plant-based WFPB" diet please and skip the junk. OK?

To investigate the associations of a healthful plant-based diet index (hPDI) and an unhealthful plant-based diet index (uPDI) with all-cause and cardiovascular disease (CVD) mortality in Spanish adults.

Patients and methods: 

Researchers analyzed data from 11,825 individuals 18 years of age or older, representative of the Spanish population, recruited between 2008 and 2010 and followed-up to 2020. Food consumption was collected at baseline using a validated dietary history, which served to calculate two plant-based diet indices based on 18 major food groups. For (1) hPDI only the consumption of healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea/coffee) received positive scores; whereas for (2) uPDI, only the consumption of less healthy plant foods (fruit juices, sugar-sweetened beverages, refined grains, potatoes, and sweets/desserts) received positive scores. 

Results: After a median follow-up of 10.9 and 9.8 years, 699 all-cause and 157 CVD deaths were ascertained, respectively.

Each 10-point increase in hPDI was associated with 14% lower risk of all-cause death (HR, 0.86; 95% CI, 0.74 to 0.99), and 37% lower risk of CVD death (HR, 0.63; 95% CI, 0.46 to 0.85).

No significant associations were found for uPDI.

Conclusion: Higher adherence to an hPDI diet, but not to a uPDI, was associated with lower all-cause and CVD mortality. This suggests that the quality of the plant food consumed is paramount to achieve diet-related benefits in mortality. 

It is important to eliminate the unhealthy plant-based choices, no matter how enticing or addictive, and start with booting fruit juices, sugar-sweetened beverages, refined grains, fried potatoes, and sweets/desserts.

Dr. Joel Kahn

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