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Not all Plant-Based Diets are Created Equal: Discovering the Key to a Healthful Approach

by Bianca Garilli, ND

In recent years, the benefits of adopting a plant-based diet to both prevent and treat cardiovascular disease has become well accepted in the health care community. Atherosclerosis is commonly associated with high dietary intake of animal products, fat and processed carbohydrates and continues to be the leading cause of mortality in the US. Protection from atherogenesis however, may be possible through increased intake of plant-based foods high in polyphenols and antioxidant effects.1

What foods a plant-based diet includes, however, can vary from provider to provider and from patient to patient. On one hand, the composition of a plant-based diet may contain high amounts of sugar sweetened soft drinks and juices, potato based foods including french fries and chips and other sugary, processed and refined foods such as white breads, bagels, cookies, pretzels, muffins, etc. Contrast this to a plant-based diet rich in fresh vegetables, fruits, whole grains, legumes, nuts and seeds. Both are considered plant-based diets but are actually quite different in their nutritional content. Supported by grants from the National Institutes of Health, researchers from various institutions collaborated on research to determine if one type of plant-based diet was better than another in preventing fewer coronary heart disease (CHD) events.2

For the purpose of this investigation,2 plant-based diet indices (PDIs) were created using semi-quantitative food-frequency questionnaire data; scores were given based on the whether a food was considered health or unhealthy. For example, a healthful PDI (hPDI) was defined as being high in healthy plant foods including whole grains, fruits, vegetables, nuts, legumes, oils, teas and coffee and these healthy foods were given positive value while less healthful plant foods and animal foods were given reverse scores. On the flip side, an unhealthful PDI (uPDI) was defined as having high levels of unhealthy plant foods; positive scores were given to these unhealthy plant foods and reverse scores assigned to animal sourced foods and healthy plant foods. Examples of unhealthy plant foods included juices, sweetened beverages, refined grains, potatoes and sweets.

Information for this study, which was published in the Journal of the American College of Cardiology, was gathered from 73,710 women in the Nurses’ Health Study (NHS) (1984-2012); 92,329 women from the Nurses’ Health Study 2 (NHS2) (1991-2013); and 43,259 men in Health Professionals Follow-up Study (HPFS) (1986-2012) resulting in over 4,833,042 person-years of follow-up.2

Analysis of the data indicated that reducing the risk of coronary heart disease actually depends not just on the adoption of any type of plant-based diet, but rather on the quality of the foods within the plant-based diet. Whether the diet is described as Mediterranean, vegetarian or anti-inflammatory, there are certain positive characteristics all of these plant-based approaches share. The similarities include preference for high phytonutrient fresh fruits and vegetables; protein mainly sourced from plant-based foods such as nuts, legumes, seeds and whole grains with low amounts (if any) of protein from lean cuts of meat and fresh, wild fish; and daily high fiber intake. Another commonality is the emphasis on low intake of processed, refined and sugar sweetened foods and beverages.

The resulting analysis from this study showed a substantially lower risk of CHD with adherence to a hPDI as well as finding an association between an uPDI and increased risk for CHD.In summary, the data from this large study indicates that following a plant-based diet rich in healthful food choices reduces the risk and incidence of CHD.

Why is this Clinically Relevant?

  • Healthful plant-based diets can reduce the incidence of CHD
  • There are several ways to implement a plant-based diet – some unhealthy others healthy
  • It is important for HCP to discuss the differences between a healthy and unhealthy plant-based diet
  • Healthy plant-based diets consists of vegetables, fruits, whole grains, nuts, seeds, legumes and may also include low amounts of lean animal products and fresh wild fish

Link to abstract


  1. Tuso PA. Plant-based Diet, atherogenesis, and coronary artery disease prevention. Perm J. 2015;19(1):62–67.
  2. Satija A, Bhupathiraju SN, Spiegelman D, et al. Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults. J Am Coll Cardiol. 2017;70(4):411-422. 


Bianca Garilli, ND, USMC Veteran

Dr. Garilli is a former US Marine turned Naturopathic Doctor (ND). She works in private practice in Northern California as well as running a consulting company working with leaders in the natural and functional medicine world such as the Institute for Functional Medicine and Metagenics. She is passionate about optimizing health and wellness in individuals, families, companies and communities- one lifestyle change at a time. Dr. Garilli has been on staff at the University of California Irvine, Susan Samueli Center for Integrative Medicine and is faculty at Hawthorn University. She is the creator of the Veterans for Health Initiative and is the current President of the Children’s Heart Foundation, CA Chapter.


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