Intended for healthcare professionals


Vegetarian diets and health

BMJ 2019; 366 doi: (Published 04 September 2019) Cite this as: BMJ 2019;366:l5272

Linked research

Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up

Re: Vegetarian diets and health. Go plant-based for the planet (and your heart).

This helpful editorial (1) reviews Tong and colleagues’ findings from their recent EPIC-Oxford study (2). Tong and colleagues report lower rates of ischaemic heart disease with a vegetarian diet (aligned with a systematic review and meta-analysis of ten cohort studies (3), but an increased risk of stroke compared to meat- and fish-eaters (2).

As highlighted by Lawrence and McNaughton (1), further research is needed to examine the reported increased risk of stroke with a vegetarian diet. For example, does vitamin B12 play a role (1,4)?

As the relationship between vegetarian diet and stroke is elucidated, the environmental benefits of a plant-based diet should be borne in mind (5,6). Lawrence and McNaughton conclude that a plant-based diet does not necessarily mean a vegetarian diet and eating animal products to avoid malnutrition may be necessary in some low- and middle-income countries (1).

Although we are plant-based (CJG) and vegan (JHG), we wholeheartedly support reduced animal product consumption by any degree. We encourage healthcare professionals to consider Meat Free Monday ( and Veganuary (, for themselves, their patients, and their workplaces. Both organisations provide support and advice; for example, recipes and eating out guides. Just be wary of the ultra-processed (7).

For the interested, The New York Times provides an interactive Q&A to learn more about food and climate change (8). The Summary Report of the EAT-Lancet Commission on Food, Planet, Health includes a ‘planetary health plate’ to demonstrate a healthy diet (9), for you and the planet.


1) Lawrence MA, McNaughton SA. Vegetarian diets and health BMJ 2019; 366 :l5272.
2) Tong TYN, Appleby PN, Bradbury KE, et al. Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study BMJ 2019; 366 :l4897.
3) Dinu M, Abbate R, Gensini GF, et al. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr 2017;57:3640-9.
4) Spence JD, Yi Q, Hankey GJ. B vitamins in stroke prevention: time to reconsider. Lancet Neurol 2017;16:750-60.
5) Pimentel D, Pimentel M. Sustainability of meat-based and plant-based diets and the environment. Am J Clin Nutr 2003;78:660S–3.
6) Fresán U, Martínez-González MA, Sabaté J, et al. Global sustainability (health, environment and monetary costs) of three dietary patterns: results from a Spanish cohort (the SUN project). BMJ Open 2019;9:e021541.
7) Ministry of Health of Brazil. Secretariat of Health Care, Primary Health Care Department. Dietary Guidelines for the Brazilian population. 2014. [As cited in (1)]
8) The New York Times. Your Questions About Food and Climate Change, Answered. [Accessed 10 September 2019]. Available from:
9) Figure 3, page 9. In: EAT-Lancet Commission. Summary Report of the EAT-Lancet Commission on Food, Planet, Health: Healthy Diets From Sustainable Food Systems. [Accessed 10 September 2019]. Available from:

Competing interests: No competing interests

10 September 2019
Christopher J Graham
Master’s of Public Health (MPH) Student
Jennifer H Graham
Edinburgh, UK