Plant-based Diets: Healthy or Just Hype?

We took a look at the evidence for plant-based diets to answer the question: healthy or just hype?

Case Study

LW is a 55 year- old Caucasian female seen in the office by the cardiology advance practice nurse for evaluation and treatment of hyperlipidemia. She presented with an Agatston coronary artery calcium score of 272; a score of 100-399 indicates an intermediate risk for a coronary event.1 Her weight at the clinic visit was 151 pounds with a BMI of 27.6. Her lipid panel results were: CHOL 263/TRIG 146/HDL 56/LDL 178. Lifestyle modification strategies were discussed with the patient. After careful discussion with the cardiologist and team, she made the decision to attempt lifestyle modification with the understanding that medication may still be required to lower lipid levels in the future. She was asked to incorporate lifestyle changes such as improved dietary and exercise habits and follow-up in 2 months. The patient returned in two months reporting that she after much research, she chose to eliminate animal protein from her diet, and she adopted a plant-based diet. At her follow up visit, she stated that she was feeling great, and her weight had dropped to 142 pounds (BMI 26) since the previous visit.  Her post-lifestyle intervention lipid results showed the following: CHOL 145/TRIG 83/HDL 48/LDL 80. 

A plant-based diet is gaining increasing attention as it has been associated with cardiovascular and other health benefits such as lower cardiovascular events.2 Various types of vegetarian diets and veganism are considered plant based.3 The consumption of whole grains, nuts, legumes, fruits, vegetables, and non-hydrogenated vegetable oils are accentuated in a diet that is healthful and plant-based.4

What Does the Evidence Say?

Because cardiovascular nurses and other members of the health care team may be asked questions about these diets, it is important to continue to review the evidence for practice regarding heart-healthy nutrition and diets. Several observational studies have shown at least a 24% decrease in coronary disease in vegetarians when compared to omnivores and a 22% lower rate of stroke mortality in men who ate vegetarian diets.4 Additionally, blood lipids are improved and insulin sensitivity is heightened, which lowers risk for cardiovascular disease (CVD) and type 2 diabetes.4  Not all plant-based foods are healthy, however; white potatoes and refined grains, for example, are negatively associated with cardiovascular health.2 

In this actual clinical case study of LW, weight loss combined with a change to a plant-based diet and improved exercise led to an improved BMI, lipid panel, and a reduced risk for a CVD event. Although she has made great strides in her lifestyle management, her provider may decide to discuss pharmacological therapies such as a statin to lower her LDL even further. The addition of medication will also enhance the benefits of LW’s lifestyle changes and further reduce her future CVD risk. 

LW has exhibited how a healthful plant-based diet can positively affect her cardiovascular health and should continue to be encouraged to maintain this lifestyle by her health care team. There is strong evidence to support that plant-based diets are beneficial. Additional future studies are warranted to further explore the comprehensive benefits of a plant-based diet.4

References

  1. van der Bilj, Geleijins, J., Bax, J.J., Schuijf, J.D., de Roos, A., Kroft, L.J. (2010).  Assessment of Agatston coronary artery calcium score using contrast enhanced CT coronary angioogarhpo. American Journal of Roentgenology. Retrieved from https://www.ajronline.org/doi/pdf/10.2214/AJR.09.3734
  2. Williams, K.A. & Patel, H. (2017).  Healthy Plant-Based Diet: What does it really mean?  Journal of American College of Cardiology. 70(4), 423-445.  Retrieved from https://doi.org/10.1016/j.jacc.2017.06.006
  3. National Kidney Foundation, (2018).  Plant-based diet or vegetarian diet: What is the difference? Retrieved December 28, 2018 from https://www.kidney.org/atoz/content/plant-based-diet-or-vegetarian-diet-difference
  4. Satija, A. & Hu, F.B. (2018).  Plant-based diets and cardiovascular health. Trends in Cardiovascular Medicine. 28(7), 437-441.  Retrieved from https://doi.org/10.1016/j.tcm.2018.02.004

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