By: Ashely Dao, PharmD Candidate c/o 2024
In early 2021, about 6 in 10 American adults had a chronic disease. Chronic diseases are the leading cause of death and disability in the United States with 1 in 3 deaths caused by cardiovascular diseases (CVD).¹ The Coronavirus disease 2019 (COVID-19) pandemic has emphasized the impact of chronic diseases, considering that individuals with chronic diseases are at an increased risk of developing a severe illness from COVID-19. Chronic diseases are not only a public health burden, but they are also an economic problem. Ninety percent ($3.43 trillion) of the nation’s annual health care costs are related to chronic and mental health conditions.¹ It is highly imperative now more than ever to prioritize chronic disease prevention and care. Pharmacists oftentimes encounter patients who suffer from one or more chronic diseases, many of whom often take various medications to control them. When patients are diagnosed with hypertension, pharmacists counsel them on the benefits of smoking cessation, reduced caffeine intake, and increased exercise as preventative measures to control their blood pressure and prevent the risk of developing other diseases. Have we ever considered recommending a plant-based diet? Adopting a plant-based diet is a preventative measure pharmacists can also suggest, as it not only prevents the progression of chronic diseases, but it can also reverse them.
A healthy plant-based diet is defined as a diet rich in plant foods (whole grains, fruits, vegetables, and nuts) and low in animal products (such as dairy, red meat, poultry, and fish).² Contrarily, a less healthy plant-based diet consists of refined grains, potatoes, sugar-sweetened beverages, and a high frequency of animal products.² In this article, the terms “plant-based diet” and “healthy plant-based diet” will be used interchangeably. A healthy plant-based diet has been linked with a decreased risk for CVD, type II diabetes (T2D), and obesity.2, 3, 4
A meta-analysis, conducted by Satija, et al. demonstrated that a plant-based diet provides cardiovascular benefits. Vegetarians had a 24% (95% Confidence Interval [CI]: 6%–38%) lower rate of coronary heart diseases compared to nonvegetarians and a 22% lower stroke mortality rate among men (95% CI: 12%–31%). As a side note, nonvegetarians had a diet containing meat or fish.2 The meta-analysis also showed that compared to a nonvegetarian diet, a vegetarian diet significantly lowered blood concentrations of total, LDL, HDL, and non-HDL cholesterol, as wells as lowered blood pressure, enhanced weight loss, and improved glycemic control.2 High levels of LDL cholesterol are known to increase the risk of heart disease and stroke.
A 16-week randomized trial conducted by Kahleova et al. found that a plant-based diet reduced body weight and insulin resistance. This study looked at otherwise healthy overweight or obese men and women with a BMI between 28 and 40 kg/m² and assigned them to a vegan or control group in a 1:1 ratio. The participants in the control group were instructed to maintain their current diet while the vegan group was told to adopt a low-fat vegan diet. After 16-weeks there was a significant reduction in BMI (P < 0.00), weight (P < 0.001), body fat (P < 0.001), and insulin resistance (P < 0.004) in the vegan group. A decrease in animal protein intake decreased fat mass by 1.45 kg, while an increased intake of plant protein decreased fat mass by 0.88 kg.³
An analysis of three cohort studies by Satija et al. demonstrated that a plant-based diet lowered the risk of T2D. Healthy plant-based foods were associated with a 34% reduction in the risk of T2D, with a lowered risk seen even with a modest lowering in animal food intake. Individuals with or without T2D also saw a positive impact on their body weight, blood pressure, lipid profile, and insulin sensitivity after eating a plant-based diet.⁴
The ability of a healthy plant-based diet to decrease the risk of CVD, T2D, and obesity can be linked in part to its antioxidant properties. Many healthy plant-based foods are rich in polyphenols (PPs), which have antioxidant effects and may also contribute to a reduction of risk in cardiovascular diseases. Polyphenols found in food are comprised of four classes: flavonoids, ligands, phenolic acids, and stilbenes. The flavonoid class of PPs, in particular, have been found to reduce the risk of developing cardiovascular diseases. Foods and beverages rich in flavonoids (green tea, blueberry, dark chocolate, capers)6 increased the availability of nitric oxide (NO) and endothelium-derived hyperpolarizing factor (EDHF) to maintain vascular homeostasis and prevent endothelial dysfunction. CVD models also demonstrated improved endothelial functions after consuming flavonoid-rich foods. In a review of 12 cohort studies, an increased intake of flavonoids resulted in a decrease in age-adjusted coronary heart disease (CHD) mortality.6 Overall, PPs were found to decrease the inflammatory activity of reactive oxygen species (ROS) and reduce the production of potent LDL oxidant peroxynitrite which is responsible for triggering endothelial injury and inflammation.6 Additionally, a healthy plant-based diet is correlated with high unsaturated fatty acids and low saturated fats, which have also been shown to have anti-inflammatory effects.⁴
Animal foods have been associated with an increased risk of CVD due to the abundance of heme iron. Processed meats also consist of sodium, nitrates, and nitrites that may increase blood pressure, impair insulin response, and lead to endothelial dysfunction.² Animal proteins contain essential amino acids such as threonine, leucine, lysine, methionine, and tyrosine. While protein is a staple in our diets, a high intake of branched-chain amino acids (BCAA) is correlated with an increase in inflammation and CVD by triggering ROS production.7 Plant protein consists of non-essential amino acids. When individuals swap animal protein for plant proteins there is a decrease in leucine intake which was associated with positive changes in BMI and energy intake. Plant protein intake also decreased histidine intake which was associated with decreased insulin resistance.
Utilizing this information, pharmacists and other health care providers can better assist patients by encouraging them to implement a plant-based diet to prevent the development of chronic diseases or at the very least minimize their progression. Transitioning to a plant-based diet can be an intimidating process for many, but with the proper guidance and encouragement, it can be made simpler and less stressful. A healthy plant-based diet can be customizable to each patient based on accessibility, affordability, and personal preference. This can lead to increased adherence with a consequent decrease in associated health care costs. For patients that are not yet ready to make such a big change, they can start by gradually increasing their intake of plant-based foods before reducing their intake of animal foods. For example, patients can start by adding an additional serving of fruits and vegetables to their breakfast, then gradually replacing the meat with healthy plant-based breakfast. Once they are comfortable with one meal change, they can apply the same strategy to their other meals.
Some hospitals are already implementing a healthy plant-based diet into their treatment plans, such as Montefiore’s Cardiac Wellness Program and UC Davis’s Integrative Medicine.8, 9 Montefiore’s Cardiac Wellness program is working with patients who have been diagnosed with chronic diseases and are implementing a healthy plant-based diet with the aim to lower their cholesterol and blood pressure, and even reverse their T2D and CVD.8 Patients enrolled in the program are educated about the impact of a healthy plant-based diet and are taught how to prepare budget-friendly plant-based meals. UC Davis’s Integrative Medicine also has a free “Good Food is Good Medicine” blog accessible on their website; it consists of recipes and guides such as video tutorials on how to make tofu tacos as well as tips on how to make a healthy meal plan on a budget.10, 11
While this transition is highly beneficial, every patient does not have access to resources like Montefiore’s Cardiac Wellness program. Data shows that 10.5% of US households were food insecure at some point in the 2020 calendar year, and the pandemic has only exacerbated these numbers.12 Pharmacists are the most accessible health care professionals and as such should understand the scientific benefits of a plant-based diet and how a plant-based diet can be implemented in their communities.13 By working with community leaders and nutritionists, pharmacists can make healthy plant-based foods more accessible and teach communities how to prepare budget-friendly meals, just like Montefiore and UC Davis. Every patient deserves the opportunity to utilize a healthy plant-based diet to prevent or even reverse chronic diseases, and pharmacists have the ability to ensure that this happens.
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. About chronic diseases. Accessed March 26, 2021. https://www.cdc.gov/chronicdisease/about/ index.htm.
- Satija A, Hu FB. Plant-based diets and cardiovascular health. Trends Cardiovasc Med. 2018;28(7):437-441. doi:10.1016/j.tcm.2018.02.004
- Kahleova H, Fleeman R, Hlozkova A, Holubkov R, Barnard ND. A plant-based diet in overweight individuals in a 16-week randomized clinical trial: metabolic benefits of plant protein. Nutr Diabetes. 2018;8(1):58. Published 2018 Nov 2. doi:10.1038/s41387-018-0067-4
- Satija A, Bhupathiraju SN, Rimm EB, et al. Plant-Based Dietary Patterns and Incidence of Type 2 Diabetes in US Men and Women: Results from Three Prospective Cohort Studies. PLoS Med. 2016;13(6):e1002039. Published 2016 Jun 14. doi:10.1371/journal.pmed.1002039
- Peterson JJ, Dwyer JT, Jacques PF, McCullough ML. Associations between flavonoids and cardiovascular disease incidence or mortality in European and US populations. Nutr Rev. 2012;70(9):491-508. doi:10.1111/j.1753-4887.2012.00508.x
- Tangney CC, Rasmussen HE. Polyphenols, inflammation, and cardiovascular disease. Curr Atheroscler Rep. 2013;15(5):324. doi:10.1007/s11883-013-0324-x
- Zhenyukh O, González-Amor M, Rodrigues-Diez RR, et al. Branched-chain amino acids promote endothelial dysfunction through increased reactive oxygen species generation and inflammation. J Cell Mol Med. 2018;22(10):4948-4962. doi:10.1111/jcmm.13759
- Montefiore Cardiac Wellness Program. Reversing Heart Diseases with a Whole Food/Plant-based Diet. Accessed March 27, 2021. https://www.montefiore.org/cardiacwellnessprogram
- UC Davis Integrative Medicine. About UC Davis Integrative Medicine. Accessed March 27, 2021. https://ucdintegrativemedicine.com/about-uc-davis-integrative-medicine/
- UC Davis. Flavor bombed tacos. Good Food is Good Medicine. 2020. https://health.ucdavis.edu/blog/good-food/flavor-bombed-tofu-tacos/2020/09. Accessed Dec 21, 2021.
- UC Davis. Meal planning tips to eat healthier and stay on budget. Good Food is Good Medicine. 2021. https://health.ucdavis.edu/blog/good-food/meal-prepping/2021/12. Accessed Dec 21, 2021.
- USDA Economic Research Service. Food Security Status of U.S. Households in 2020. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/key-statistics-graphics.aspx
- Manolakis PG, Skelton JB. Pharmacists’ contributions to primary care in the United States collaborating to address unmet patient care needs: the emerging role for pharmacists to address the shortage of primary care providers. Am J Pharm Educ. 2010;74(10):S7. doi:10.5688/aj7410s7