How to help patients transition to a healthy and sustainable plant-based diet
Shireen Kassam is a consultant haematologist, lifestyle medicine physician, and founder of Plant-Based Health Professionals UK (@plantbasedhpuk).
Leila Dehghan is a doctor-turned-nutritionist and a member of the Advisory Board for Plant-Based Health Professionals UK.
Laura Freeman is a dual licensed GP, lifestyle medicine physician and medical director of Plant-Based Health Online.
MEAT AND DAIRY FARMING are a leading cause of climate change and ecological collapse. The most comprehensive analyses of the global farming system concluded that shifting to a plant-based diet would have the most impact on planetary health than any other single driver of climate change.
International consensus supports a global transition to a plant-based diet as an urgent imperative. The Eat-Lancet Commission evaluated the best available science and developed recommendations for a global healthy reference diet, termed the ‘Planetary Health Diet’.
This diet consists predominantly of whole plant foods, with minimal animal-derived and processed foods. Meat, eggs, and dairy are considered optional and if consumed, provide <13% of calories. Not only would this diet keep the global food system within planetary boundaries, it is estimated to prevent 11 million deaths annually from diet-related illnesses.
Health professionals are a trusted source of evidence-based information. As such, they are key players in helping patients transition to a plant-based diet. In reality, many lack the knowledge to counsel patients, yet implementing such change is well within our capabilities and aligned with current recommendations.
The key components of a healthy plant-based diet are fruits, vegetables, whole grains and beans, in approximately equal proportion, a small portion of nuts and seeds on most days, and water being the main beverage. All animal-derived foods are removed or minimised. Fish is considered the healthiest option for animal-derived food, although its consumption for a global population of 10 billion by 2050 is unsustainable. Some countries rely on aquaculture, but here in the UK, fish is not a dietary necessity.
There remain engrained myths and fears about plant-based diets. Nutrients of concern are protein, calcium, iron, iodine, omega-3 fatty acids, and vitamin B12; however, with some education and planning these can be easily obtained. Furthermore, plant-based diets are abundant in nutrients such as fibre, potassium, magnesium, folate, antioxidants, and anti-inflammatory compounds that are often lacking in the typical British diet.
Some straightforward advice to give your patients could include:
- Start with a healthy breakfast: porridge oats with a tablespoon of ground flaxseeds or chia seeds, for essential omega-3 fatty acids, and a portion of fruit. Use a fortified plant milk such as soya or oat.
- For main meals, swap out meat for beans, pulses, lentils, or chickpeas. For example, bean chilli, lentil Bolognese, or tofu curry.
- Swap out refined grains for whole grains; brown rice, whole wheat bread, pasta and couscous, bulgar and buckwheat.
- Learn to make a variety of soups using different vegetables. Add beans or lentils to increase the protein and fibre content even further.
- Learn to love big salads. Add beans, lentils, or tofu and top with seeds.
- Aim for 10 portions of fruits and vegetables daily, including as snacks.
- Eat a 30g portion of nuts on most days.
- Calcium-set tofu is a rich source of calcium, as are leafy greens, beans, fortified plant milks, and yogurts.
- Good sources of iron include chickpeas, lentil, tofu, cashew nuts, flaxseeds, pumpkin seeds, kale, dried figs and apricots, and raisins. Cooking with iron cast cookware can help increase intake. To increase absorption, eat iron-rich foods with a source of vitamin C. Avoid tea and coffee an hour before and after meals.
- Know where to get iodine. This is present in sea vegetables and seaweeds, but their content is variable and if not consumed regularly a daily 150 mcg supplement is appropriate.
- On a 100% plant-based diet, a B12 supplement is required; 25–100 mcg daily or 2000 mcg weekly.
- In the winter months or if sun exposure is inadequate everyone in the UK requires a vitamin D3 supplement.
- Reduce your food bill by cooking from scratch, bulk buying dry grains, beans, and pulses, using frozen and tinned fruits and vegetables, and batch cooking.
- Your patients will come from a variety of backgrounds and cultures. Many traditional cuisines like Indian and African are mostly plant-based already.
There are numerous resources available to help health professionals guide patients and community groups that provide support. There will be circumstances when patients need to be guided by a nutritionist/dietitian. Nonetheless, doctors need to play their part and lead by example.