Can A Plant Based Diet Protect Against Heart Failure?


Heart disease affects around523 million people per year and is the leading cause of death worldwide, with 18.6 million deaths reported from heart disease in 2019 (1).

It’s also a major cause of disability. The number of people living with a disability caused by heart disease more than doubled over the past 30 years (1).

Luckily, you can influence your risk of developing heart disease through various modifiable health behaviors, including what you eat (though diet is not the only factor affecting heart disease risk).

Experts suggest that higher intakes of fruit, vegetables, whole grains, nuts, seeds, and legumes and lower intakes of saturated fat, salt, refined sugar, and processed meats may help reduce your risk of heart disease (2, 3).

Plant-based foods appear especially beneficial for heart health, leading some to suggest that a plant-based diet may offer significant protection against heart disease (3, 4).

In this article, I’ll explore the possible links between a plant-based diet and heart health to determine whether a (mostly) vegetarian or vegan diet can help reduce your risk of heart disease.

A plant-based diet can comprise several different ways of eating. However, all plant-based diet types generally involve eating few to no animal-based foods, including meat, fish, dairy, eggs, or foods containing these ingredients.

The label “plant-based” can refer to both vegetarian and vegan diets, and to an extent, even semi-vegetarian diets, as long as the bulk of the foods eaten are of plant origin (3, 5).

Plant-based diets as a whole have been consistently linked to a lower risk of heart disease (3, 6, 7, 8).

Reviews of observational studies suggest that plant-based eaters may benefit from an 8–32% lower likelihood of developing or dying from heart disease when compared with omnivores (3, 7, 8).

Interestingly, this benefit appears strongest in younger versus older participants, males versus females, and those who followed a plant-based diet for longer versus shorter amounts of time (3).

Keep in mind, though, that the link between plant-based diets and heart disease is currently mostly observational. This means that it has yet to be examined by randomized control trials (RCTs), the gold standard in scientific research.

Nonetheless, several RCTs show that a plant-based diet may significantly lower risk factors for heart disease, such as total cholesterol and low density lipoprotein (LDL or “bad”) cholesterol, compared with a diet containing meat, eggs, or dairy (3).

People following plant-based diets also tend to have lower blood pressure and improved blood sugar levels than people following omnivorous diets — both of which are considered additional risk factors for heart disease (3).

It’s worth mentioning that while individual studies comparing vegan diets to omnivorous diets often report heart benefits, a recent review pooling results from many studies suggests that the evidence remains weak due to a lack of high quality studies (9).

The same review further suggests that vegans may have up to a 35% increased risk of stroke compared with omnivores. Results seem to vary depending on the type of stroke as well as the overall quality of the plant-based diet consumed (9, 10, 11).

However, many other studies find either no link between a vegan or plant-based diet and the risk of stroke — or a decreased rather than increased risk of stroke. Therefore, more research is needed on this topic before strong conclusions can be made (11, 12, 13, 14).

SUMMARY

Plant-based diets appear to reduce some risk factors for heart disease and are generally linked to a lower likelihood of developing or dying from heart disease when compared with diets containing animal-based foods. Many studies are low in quality, however, so more research is needed.

Plant-based diets tend to emphasize foods that are naturally low in calories and high in fiber, two qualities that can help you maintain a healthy weight (3).

Moreover, plant foods tend to be low in saturated fat and high in unsaturated fats.

A diet high in unsaturated fats and low in saturated fats may help reduce inflammation, lower LDL (“bad”) cholesterol, and increase high density lipoprotein (HDL or “good”) cholesterol, thereby improving risk factors for heart disease (3).

Replacing saturated fat with monounsaturated and polyunsaturated fats may also improve insulin sensitivity and help reduce your risk of developing type 2 diabetes, which are also considered risk factors for heart disease (3, 16, 17).

That swap also appears to help your body maintain healthy arteries and veins and enables it to better repair them when necessary (3, 16, 17).

Additionally, a plant-based diet tends to be rich in soluble fiber, a type of fiber that may help lower cholesterol levels and promote better blood sugar management (3, 18).

Plant-based foods are typically rich in antioxidants and other beneficial plant compounds that help reduce inflammation and protect the heart and body from damage (3).

These compounds may also help reduce blood pressure and lower the likelihood of developing blood clots, reducing your overall risk of stroke (3).

What’s more, plant-based diets contain virtually no heme iron. Consuming high amounts of heme iron has been flagged as a potential risk factor for heart disease (3, 19, 20, 21).

Heme iron is generally found in animal foods like red meat, fish, poultry and seafood, while plant foods typically contain non-heme iron (22).

In addition to non-heme iron, plant foods are also naturally rich in many vitamins. This combination appears particularly beneficial in reducing the risk of dying from heart disease (19).

Other factors to consider are the sodium, nitrates, and nitrites typically used to preserve processed meats.

Consuming these preservatives has been linked to higher blood pressure, as well as to the narrowing, hardening, or enlargement of blood vessels — all of which further increase the risk of heart disease (3).

Sodium, nitrates, and nitrites also appear to reduce the body’s ability to respond to insulin, which is the hormone that helps manage blood sugar levels by ushering sugar from your blood into the blood cells (3).

In turn, insulin resistance may increase your likelihood of experiencing poor blood sugar management, which is yet another risk factor for heart disease (23).

Finally, plant-based diets may also reduce the risk of heart disease through the effect they may have on your gut bacteria. However, more research is needed to confirm this (3).

Learn more about the potential health benefits of consuming less meat here.

SUMMARY

Plant-based diets tend to be naturally rich in fiber and antioxidants, yet low in calories, heme iron, and saturated fat. This balance may protect your heart by minimizing some risk factors for heart disease.

The likelihood that a plant-based diet will reduce your risk of heart disease will largely depend on its quality. The following tips may help you support your health if you choose to try a plant-based diet.

Opt for minimally-processed foods when possible

Plant-based diets that are rich in fruits, vegetables, whole grains, legumes, nuts, seeds, and other minimally-processed plant foods have been linked to a lower risk of heart disease (8).

On the other hand, plant-based diets rich in sweetened beverages, refined grains, sweets, and highly-processed plant foods have been linked to higher risks of developing or dying from heart disease (5, 8, 24).

Therefore, in order to get the most benefits out of your plant-based diet, you should make sure that it’s made up of primarily minimally-processed plant-based foods, if possible.

Practically, this may look like:

  • often opting for whole grains instead of refined grains
  • often choosing beans, peas, tofu, or tempeh instead of processed meat substitutes
  • including good amounts of fresh fruits and vegetables in your diet
  • eating good amounts of nuts and seeds

(Remember: The term “processed foods” includes a wide variety of products, many of which are more convenient and less expensive than other foods. Not all foods that undergo processing are considered unhealthy or harmful.)

Supplement to bridge nutritional gaps

I also encourage you to consider using supplements or fortified foods to meet your nutrient requirements if you are struggling to meet them from your plant-based diet alone (25).

The lack of certain nutrients, such as sufficient vitamin B12, may help explain the link between plant-based diets and the increased risk of stroke found in some studies (11).

A few nutrients to be particularly mindful of on a plant-based diet include vitamin B12, iodine, iron, calcium, zinc, selenium, and omega-3 fatty acids (25, 26, 27).

Be sure to talk with a medical professional before starting supplements or otherwise changing your diet, if possible. A registered dietitian can help you figure out how to adjust your diet in a way that makes it easier to meet your nutrient requirements while eating plant-based.

You don’t have to go fully plant-based to reap heart benefits

Your diet does not need to completely exclude all animal products in order for you to experience heart-healthy benefits.

Generally, the higher the proportion of plant-based foods in the diet, the higher the degree of protection will be (3, 28).

However, you don’t have to give up animal products in order to reduce your risk of heart disease.

Research shows that healthful plant-based diets like vegetarian diets and the Mediterranean diet, which is rich in plant-based foods, can significantly reduce the risk of heart disease and may help improve other aspects of health as well (5, 29, 30, 31, 32).

Learn more about the differences between vegetarian, vegan, and pescatarian diets here.

If you do choose to include meat in your diet, the American Heart Association recommends favoring fish and lean meats over red or processed meats (2).

SUMMARY

To get the most heart benefits out of your plant-based diet, it’s best to usually opt for minimally-processed foods and to limit red or processed meats. You may also consider using supplements if you need to.

A plant-based diet appears effective at reducing risk factors for heart disease and is generally linked to a lower likelihood of experiencing or dying from heart-related issues, but more research is needed because many existing studies are flawed.

Additionally, not all plant-based diets are equally effective at promoting heart health.

To get the most benefits, make sure that your diet includes good amounts of fruits, vegetables, whole grains, legumes, nuts, seeds and isn’t built around refined grains, sweetened beverages, and highly-processed plant foods.

Keep in mind that you don’t need to exclude all animal foods in order to experience heart-healthy benefits. However, the higher the proportion of plant foods in your diet, the better the protection against heart disease may be.


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