Intended for healthcare professionals

Editorials

Vegetarian diets and health

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5272 (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 (www.meatfreemondays.com) and Veganuary (veganuary.com), 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.

References

1) Lawrence MA, McNaughton SA. Vegetarian diets and health BMJ 2019; 366 :l5272. https://doi.org/10.1136/bmj.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.
https://doi.org/10.1136/bmj.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.
https://doi.org/10.1080/10408398.2016.1138447
4) Spence JD, Yi Q, Hankey GJ. B vitamins in stroke prevention: time to reconsider. Lancet Neurol 2017;16:750-60.
https://doi.org/10.1016/S1474-4422(17)30180-1
5) Pimentel D, Pimentel M. Sustainability of meat-based and plant-based diets and the environment. Am J Clin Nutr 2003;78:660S–3.
https://doi.org/10.1093/ajcn/78.3.660S
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.
https://doi.org/10.1136/bmjopen-2018-021541
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: www.nytimes.com/interactive/2019/04/30/dining/climate-change-food-eating...
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: https://eatforum.org/eat-lancet-commission/

Competing interests: No competing interests

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