Vegetarian diets are in style like skinny-jeans. Just like skinny jeans, the diets may need a little tweaking (not twerking) for some people. I recently gave a talk about the benefits of a plant-based diet at a local health fair. After my presentation, a married couple came up to me, excited to share their experience with recently transitioning to a plant-based diet after watching Netflix’s documentary, What the Health. They did little research outside of the film. As an endorser of plant-based diets, I gave them both ‘hi-fives’ and asked about their favorite vegetables. As I asked the question, the woman engaged in a subtle, yet slightly judgmental eye roll. I’ve been married for a while now, so I recognized that look, and I knew the plot was about to thicken. It did. She mentioned her love of roasted veggies, while he remained conspicuously silent. She turned to me and said, “‘Conan the Carbarian’ here doesn’t eat veggies, he just eats carbs.” Dang…the truth is a dish best served with veggies. I gritted my teeth, desperately trying not laugh. He, as cool as any dude could be after being called a ‘Carbarian,’ retorted with his dislike of veggies. I must have looked perplexed, so he attempted to reassure me by saying he’s healthy because he avoids meat and drinks fruit/veggie juices. I’m too professional to give out an ‘eye roll of shame,’ but I did the physician version, the slow head-nod with one eyebrow raised in disbelief. His next question was, “Isn’t avoiding meat healthy enough?” The answer was blatantly NO. There’s nothing healthy about a vegetarian diet that doesn’t include vegetables. Let’s break down the types of vegetarian diets and highlight ways you can ruin them.
Definitions and types of vegetarian diets
When I was a college student, almost 20 years ago, I dated a woman who was a vegan. At that time, plant-based diets weren’t mainstream. Even Erykah Badu was eating burgers back then. So when she told me she was a vegan, I had no idea what she was talking about. I honestly thought she was in some weird cult that practiced witchcraft or worshipped the star, Vega. After she told she was a vegan, my first response was “So, that means you don’t believe in Jesus?” She did believe in Jesus, and I probably shouldn’t have taken her to the most romantic spot I could afford at that time, Outback Steakhouse.
Obviously, I’ve learned a lot since then, but there are still a few people who may not know much about veganism and plant-diets. Despite the rising popularity of plant-based diets, a recent Pew research study suggests that only 55% of Americans know someone who is a vegetarian. For those people who have not had much exposure to vegetarians or plant-based diets, here are a few definitions that you may find helpful.
- Vegetarian- someone who does not eat meat (seafood, chicken, red meat, and pork) or products containing these foods.
- Vegan- a total vegetarian who excludes eggs, dairy, and all other animal products from their diet. Hardcore vegans won’t even wear wool because it comes from an animal.
- Raw Food Vegan- same as vegan except avoids foods that have been cooked at temperatures higher than 118 degrees Fahrenheit.
- Lacto-vegetarian- vegetarian who consumes dairy products
- Ovo-vegetarian- vegetarian who eats eggs.
- Ovo-lacto-vegetarian- a person who adds eggs and dairy products to a vegetarian diet while excluding other sources of animal protein.
- Pescatarian- a vegetarian that includes fish and/or seafood in their diet.
- Flexitarian/Semi-vegetarian- a person who mostly follows a plant-based diet, but occasionally eats meat.
- Whole Plant-based Diet Food- this refers to foods that come from plants that are minimally processed and manipulated—it has nothing to do with the store.
Not eating fruits and veggies is the worst thing you can do to a vegetarian diet.
From the definitions above, you can see there is a lot of variation within vegetarianism. However, eating an abundant amount of healthy plant-based foods is a crucial component of all the types of vegetarian diets if you are trying to reap all the benefits from avoiding, or eating less meat. Eating pasta with tofurkey all day is not a ‘good look’—even if you are avoiding meat (this includes beef, chicken, pork, and seafood). Avoiding meat and consuming plant-derived processed foods is not a healthy diet overall. A recent study by Satija et al. in the Journal of the American College of Cardiology confirmed this by highlighting an increased of heart disease from an unhealthy vegetarian diet.
Prior studies highlighting the health benefits of plant-based diets treated all plant-based foods equally. A diet consisting of french fries and soda could count as a vegetarian diet. Previous studies also solely looked at these diets as including meat versus not including meat—they did not assess a spectrum of meat-eating ranging from low to high intake. The study by Satija et al. accounted for these limitations by creating three different types of plant-based diets. The healthful plant-based diet emphasized healthy plant-based foods; the unhealthy plant-based diet included mostly unhealthy foods from plants such as refined and processed foods; the overall plant-based diet consisted mostly of healthy plant-based foods and a limited amount of meat.
To assess the impact of these plant-based diets on heart disease, the researchers gave questionnaires that focused on diet, lifestyle, and medical problems to 73,710 women in the Nurses’ Health Study, 43,259 men from the Health Professionals Follow-Up Study, and 92,320 women from the Nurses’ Health Study 2. The researchers found that 8,631 people developed heart disease over the 20 year study period. As expected, eating a healthy plant-based diet provided the lowest risk for heart disease. However, the study also showed that an unhealthy plant-based diet was associated with an increased risk of heart disease. They demonstrated that an unhealthy approach to being a vegetarian entails avoiding meat while mostly consuming plant-based junk food (chips, juices, fries, processed vegan stuff, etc.). For those who are semi-vegetarian or flexitarian, the researchers found that eating a diet rich in healthy plant-based foods and healthy animal foods was also associated with a decreased risk of heart disease. They concluded, “When we examined a diet that emphasized both healthy plant and healthy animal foods, the association with [heart disease] was only slightly [higher] relative to that with [a healthful plant-based diet]. Thus, the moderate reductions in animal foods suggested here can be largely achieved by lowering intake of less healthy animal foods such as red and processed meats”.
Other ways to make a vegetarian diet unhealthy
There’s really not much else you can do to vegetarian diet make it unhealthy as long as you eat a variety of fruits, veggies, and plant-based sources of protein. For vegans, make sure you get enough B12. This means you may need supplements or B12 fortified foods (plant-based milk, cereals, nutritional yeast, etc.) Although these aren’t diet related, smoking cigarettes and drinking too much alcohol can definitely put a damper on your plant-based diet.
Take home points
- ‘Vegetarian’ is a broad term that encompasses a variety of eating patterns
- Consuming a diet rich in whole, plant-based foods is the foundation of any vegetarian diet
- Not all vegetarian diets are created equal
- Avoiding meat and while eating carbohydrate-rich, processed, plant-based foods does not constitute a healthy vegetarian diet.
- If you are vegetarian, it’s not enough to avoid eating meat, you have to eat your fruits and veggies too.
- For meat-eaters, a diet rich in healthy plant-based foods and low in red and processed meats may also lower the risk of heart disease.
- The study highlighted in this article only assessed the effects of plant-based diets and meat intake on heart disease. They did not analyze how variations in plant-based diets affect the risk of cancer and other conditions.
- The bottom line is that a healthy diet consists of primarily focusing on healthy fruits/veggies while limiting refined sugars and red/processed meats.
- Make sure you eat your fruits and veggies, especially if you are vegetarian.
- Don’t be a ‘carbarian.’
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I am a physician and trained chef. I specialize in gastroenterology and nutrition. Currently I work as the Associate Director of Adult Nutrition at the University of Chicago.