As I mentioned in the kick-off to my latest series on nutrition, I’m concentrating on what new things I’ve learned since I last concentrated on this area, and any ways my views have updated. One thing that has changed is that I would no longer categorize the whole-foods plant-based (WFPB) diet as an alternative to mainstream dietary guidelines. Now, in my opinion, I’d say rather that WFPB is a subset of mainstream guidelines, where you choose less animal foods and more foods like beans and nuts. This is an important point because WFPB is sometimes thought of as extreme, but if you look at it this way it is quite reasonable. The term WFPB is used to distinguish from an unhealthy vegan diet. WFPB is, in a nutshell: no junk, a variety of healthy minimally processed plant foods, minimal dairy, and reduced meat (including fish). A healthy vegan diet is a subset of WFPB that has no animal foods. Unfortunately, “whole food plant based is quite a mouthful”. So the shorter “plant based” is now in vogue. But French fries and Oreos are plant-based! Leaving out the “whole foods” takes us full circle back to “junk food vegan”. Now let’s show how to get to WFPB from mainstream guidelines.
I’m going to use the ones from Harvard instead of the official US ones from the USDA. There is a small dedicated group at the USDA that works hard on developing nutrition guidelines as described in the book Salt, Sugar, Fat by Michael Moss. But they are under a lot of pressure from special interest groups and industry lobbyists and sometimes have to compromise. Harvard School of nutrition is world famous with well-respected faculty like Dr. Walter Willett and Dr. Frank Hu. They have done extensive research on diet and health. Harvard’s guidelines are in a fun interactive format. Just click on any of the topics to get more information on it, and then you can get more detail by clicking “learn more”:
Note there is a lot of emphasis on fruits and veggies, it is half your plate. Only one quarter of the plate is protein but this allows allows recommendations to be readily met, because although it is only a quarter of your food by volume, you can fit plenty of protein in that space, For example, a cup of lentils would fit in the ¼ plate and is 24 g. Given that small amounts of protein are also present in the other ¾ of the plate, even in fruit, this is plenty. if you click on “healthy protein” it brings up this:
Here’s what happens if you click the oil carafe:
And if you click on the water glass:
The WFPB subset
To go from the mainstream to WFPB, simply start limiting meat and replacing it with things like beans, and minimize dairy. Oils, even healthier ones like olive oil, are still processed foods, so limiting consumption of them is usually recommended by WFPB authors. Note that the oil graphic does not say how much of them to use, it’s just recommending healthier versions. So by limiting them WFPB is still in line with these guidelines.
You can still get a higher fat content from unprocessed and healthy plant sources, like avocados, nuts, and seeds, I discussed the health aspects of those in a previous post. It is often recommended to limit them as part of a stricter version for health purposes like reversing heart disease, diabetes, or losing weight. But WFPB can be modified to higher fat by including more of these healthy plant sources, which some authors enthusiastically recommend if you are not trying to reverse a condition. This was discussed in more detail previously (if you click on that link, search for the line “Wfpb is also thought of as low fat”).
What About Food Intolerance?
Since there is an entire “grain” section of the plate, and beans are recommended on this diet, that can be problematic for people with food intolerances. A certain percentage of the population is gluten intolerant, and there are others, for example with Irritable Bowel Syndrome (IBS), that are intolerant of fodmaps, which include grains and beans. I have friends in both these categories. First there are plenty of gluten-free and fodmap-free grains, and healthy alternative pseudo-grains like barley and quinoa.
There are also lower-fodmap beans like canned lentils and sprouted mung beans. And there are plenty of plant-based sources of protein besides beans like mushrooms and nutritional yeast. If necessary to include animal sources of protein, the guidelines gives advice on the healthier choices of them.
Also, I am currently reading the excellent book Fiber Fueled: The Plant-Based Gut Health Program for Losing Weight, Restoring Your Health, and Optimizing Your Microbiome, by top gastroenterologist Dr. Will Bulsiewicz. He emphasizes that we can be too quick to eliminate foods in the face on sensitivities. Sometimes it’s just an issue of retraining our gut bacteria to handle them. You can’t retrain yourself to handle gluten if you have celiac disease, for example, but you might be able to learn to handle legumes if you have IBS. I’ll review his book in detail shortly.
Why Consider Limiting Animal Products Further?
A major concern with animal products is saturated fat, and you can see these guidelines work hard to minimize that by limiting butter, red meat, cheese, and processed meats. This is a big step in the right direction. So why go further? Why, for example, consider substituting almond milk for skim milk?
There are various other health issues with animal foods, described in detail in Dr. Greger’s book How Not To Die, and there’s also a large amount of information on his website. Some high notes are: evidence that increased consumption of animal protein (but not plant-based protein) leads to higher all-cause mortality and higher incidence of various diseases (such as heart disease, cancer, diabetes). There is also evidence that most people eating a modern diet get too much protein, especially from animal sources. Dr. Bulsiewicz discusses at length the deleterious effects of animal foods on our gut health in Fiber Fueled. Finally, the healthiest populations on earth (the “Blue Zones”) eat a lot less animal products. The percentage of calories from animal products ranges from 0 to10% in the Blue Zones in contrast to 30% or more overall in the US.
An important point to add is that the Blue Zone populations that do eat animal foods are following traditional lifestyles. They are eating wild-caught fish from a unpolluted sources, or products from lean animals grazing in the wild in their natural environment.
This is of course a far cry from using modern industrial agriculture as a source, with obese animals pumped full of growth hormones and antibiotics and often not being fed their natural diet (e.g. grass-fed vs. grain-fed). But even from more natural sources, the percentage of animal products by the healthiest populations in the world is considerably reduced compared to out modern diet.
Another interesting piece of evidence is that two longevity experts, Dr. Valter Longo  and Dr. Luigi Fontana , both independently recommend diets equivalent to WFPB, and limiting animal protein is part of their reasoning. They both do recommend small amounts of fish as the only animal product in the diet. The Mediterranean versions of the Blue Zone populations contain some fish, and both Drs. Longo and Fontana are from the Mediterranean country of Italy. Dr. Longo describes the diet of the region he grew up in as much healthier than in the rest of Italy, and remembers it having good longevity, as well as an unusual number of centenarians, some of which he knew personally. Sounds like another Blue Zone!
The “Spectrum of Strictness”
WFPB is a stricter subset of the mainstream guidelines that, in my opinion, will lead to further health benefits. How much stricter is up to the individual.
Dr. Dean Ornish, who developed a stricter version of the WFPB diet that he calls the “reversal diet” , definitely believes that the stricter version is healthier. But he wrote a book called The Spectrum  that addresses this point about individual choice nicely. There he says that while a stricter diet is necessary for reversal, healthy people perhaps can get away with a looser version. In fact, the followers of his original version were only 88% compliant, so already may have been sneaking in 12% more oil or animal products than was prescribed. If you loosen up a bit further, you could very well end up with something like the Harvard guidelines.
One other thing to consider is ease of following the diet. It seems like the stricter you are, the harder it would be to comply, but that is not necessarily true. First, there is the danger of the “in moderation” mindset, which can be a slippery slope. I discussed how that works out for me in my post on what I eat. And, as explained in The Pleasure Trap, some of the foods that are limited or avoided on WFPB can be “trigger foods” that make it harder to resist overeating. Finally, your taste buds can readjust if you give them time, like how fantastic fresh fruit can taste after you get used to not eating sugary desserts. This won’t happen if you continue to eat sugary desserts in moderation.
For those that are interested in learning more about WFPB. I recommend Dr. Greger’s book How Not to Die, or his website, which I discussed here. I also recommend Dietician Sharon Palmer’s book The Plant-Powered Diet and her blog.
- Longo, V, The Longevity Diet, Avery, 2018
- Fontana, L, Path to Longevity: How to reach 100 with the health and stamina of a 40-year-old, Hardie Grant Books, 2020.
- Ornish, D, “Can lifestyle changes reverse coronary heart disease?: The Lifestyle Heart Trial”, The Lancet,, 1990.
- Ornish, D, The Spectrum, Ballantine Books, 2007.