For optimal health the evidence supports a low-fat, whole food plant-based (WFPB) eating pattern without added salt, oil or sugar (SOS free). The food groups included are whole grains, legumes, fruits, vegetables and small quantities of nuts and seeds. Processed food is kept to a minimum and adheres to the adage, ‘nothing good removed, nothing bad added’.
WFPB nutrition excludes all animal based foods, including all types of meat, chicken, fish, eggs and dairy products.
We also consider not just whether it’s a whole plant food but also whether it promotes good health. For example, coconut products are avoided because the high saturated fat content is not health promoting. However, unlike vegan diets, a WFPB diet is defined more by what is included rather than by what is excluded.
A powerful lifestyle prescription for your patients
A WFPB eating pattern is the most powerful lifestyle change we can prescribe our patients who are looking to prevent, reverse or significantly reduce some of the most common chronic conditions. It can:
- Help prevent , manage and reverse cardiovascular disease [2,3] and type 2 diabetes [4,5,6].
- Prevent obesity [7,8] and promote healthy weight loss .
- Optimise blood pressure and cholesterol, as effective as medication [7,8].
- Reduce medications .
- Reduce risk of certain cancers including breast , prostate  and bowel cancer .
- Improve overall health in areas such as sexual function [13,14], gut microbiome , joint inflammation [16,17] and mental well-being .
Recommendation for low-fat
DFN recommends a WFPB eating pattern low in total fat, with 10-15% of total calories coming from fat (5% or less from saturated fat). Exceptions include some population groups, such as children, who have higher requirements, all easily met through a WFPB diet.
Whole plant foods are naturally low in saturated fat (except coconut), but some are high in unsaturated fats (e.g. avocado, olives, nuts, seeds). If eaten in higher amounts the total fat content of the diet easily exceeds 15% of total calories, and may lead to weight gain, arterial dysfunction and chronic diseases such as type 2 diabetes. These foods should be eaten in small amounts or, for some patients seeking disease reversal and/or maximum weight loss, further minimised.
Vegetable oils, including extra virgin olive oil (EVOO) are not health promoting foods. They are highly processed, contain 100% calories from fat and lead to easy weight gain, inflammation, and damage to the circulatory system. We recommend leaving vegetable oil out of the diet completely.
Much of the scientific literature showing a beneficial effect of EVOO on heart health is when saturated fat, often from animal sources, is replaced with monounsaturated fat from EVOO. This substitution effect (replacing something unhealthy with something that is less unhealthy) cannot tell us whether the food in question is a helpful addition to a WFPB diet. Research is not available to demonstrate health benefits when these substances replace fruits, vegetables, whole grains, or legumes in the diet to have relevance to a WFPB eating pattern.
Oil displaces a lot of food calories that should have provided fibre, nutrients and phytonutrients.
Minimally processed soy products are healthy, but should be considered as condiments (e.g. be used as a salad dressing or a small side dish) due to high fat and low fibre content. Whole soybeans contain more fibre but are still high in fat.
Nutritional research and public discourse on nutrition is dominated by a ‘reductionist’ approach or paradigm, which emphasises the importance of individual components of foods.
DFN emphasises a wholistic approach to nutrition. Consequently, we are generally unconcerned with recommending foods to be consumed for particular micro and macronutrients, minerals etc. nor with the consideration of recommended daily intakes.
That said, we understand that patients and other members of the healthcare community may raise questions in regards to specific nutrients when following a WFPB eating pattern. Vitamins and minerals are available in adequate amounts in a low fat whole food plant-based eating pattern, except for vitamin B12 which is best taken as a supplement.
Protein content is sufficient on a WFPB diet when adequate calories are consumed, and comparatively low protein intakes appear associated with health and longevity. For athletes, or those with higher protein needs, increased activity levels will lead to increased hunger and food intake, therefore additional protein needs, to support metabolic adaptation, repair, remodeling and protein turnover, are covered by default.
Vitamin D is preferably obtained from sun exposure. When in doubt, vitamin D levels should be tested and if too low safely increasing sun exposure is preferable. If this is not possible then a supplement is recommended.
Calcium is available in adequate amounts consuming a whole food plant based diet. Health authorities do not agree on how much calcium we actually need. The RDI recommendation of 1000mg per day is highly contentious and not applicable to people on a WFPB diet since they will absorb sufficient calcium from the diet. The World Health Organisation (WHO) notes calcium requirements are reduced when sodium and animal protein intake is reduced .
Bone health is determined by many nutritional factors besides calcium intake, and the anti-inflammatory effects of a WFPB diet are important for healthy bones. Adequate weight-bearing exercise is essential in addition to any nutritional considerations.
Visit our ‘Nutrients of note‘ section for more detailed information about individual nutrients.
Demonstrations of mechanisms of action
The mechanisms of action associating nutrition with health outcomes are often complex and multifaceted, fortunately when we consider WFPB nutrition there are some indisputable examples, supported by core knowledge.
A low-fat WFPB eating pattern, SOS free:
- Eliminates the ingestion of cholesterol and trans fats. Result is a decrease (normalisation) of serum cholesterol reducing vascular plaque formation and inflammation.
- Has a low caloric density, leading to weight loss in an overweight/obese person or maintenance of a normal weight in someone in the healthy weight range. If suffering metabolic or (cardio)vascular disease this will result in a subsequent decrease in intramyocellular lipid levels with a subsequent potential reversal of type 2 diabetes mellitus.
- Is high in many biologically active phytonutrients, associated with a high level of antioxidants, resulting in less free radical damage and a decrease in endothelial inflammation.
- Is high in fibre content, acting as a prebiotic nourishing the gut microbiome. It assists with good peristalsis of the gut leading to less accumulation of carcinogens in the colon (with subsequent decrease in colorectal cancer risk). The positive impact upon the gut microbiome also decreases the production of TMA in the bowel that gets oxidised in the liver to TMAO, a pro-oxidant.
If we consider all the published data on dietary treatment of disease, the known physiological mechanisms behind these diseases, and the experience of clinicians who treat them, they all point towards a plant-based diet that is low in fat and based on whole foods as a solution.
Explore how WFPB impacts certain health conditions, learn more about nutrition across life stages or join one of DFNs educational events.
- Kim H, Caulfield LE, Garcia‐Larsen V, Steffen LM, Coresh J, Rebholz CM. Plant‐Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All‐Cause Mortality in a General Population of Middle‐Aged Adults. Journal of the American Heart Association. 2019;8(16). doi:10.1161/jaha.119.012865
- Ornish D. Intensive Lifestyle Changes for Reversal of Coronary Heart Disease. Journal of the American Heart Association. 1998;280(23):2001. doi:10.1001/jama.280.23.2001
- Esselstyn CB Jr, Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam Pract. 2014;63(7):356-364b. ncbi.nlm.nih.gov/pubmed/25198208.
- Qian F, Liu G, Hu FB, Bhupathiraju SN, Sun Q. Association Between Plant-Based Dietary Patterns and Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA Intern Med. July 2019. doi:10.1001/jamainternmed.2019.2195
- Tonstad S, Stewart K, Oda K, Batech M, Herring RP, Fraser GE. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr Metab Cardiovasc Dis. 2013;23(4):292-299. doi:10.1016/j.numecd.2011.07.004
- Barnard ND, Cohen J, Jenkins DJA, et al. A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes. Diabetes Care. 2006;29(8):1777-1783. doi:10.2337/dc06-0606
- Le LT, Sabaté J. Beyond meatless, the health effects of vegan diets: findings from the Adventist cohorts. Nutrients. 2014;6(6):2131-2147. doi:10.3390/nu6062131
- Matsumoto S, Beeson WL, Shavlik DJ, et al. Association between vegetarian diets and cardiovascular risk factors in non-Hispanic white participants of the Adventist Health Study-2. J Nutr Sci. 2019;8:e6. doi:10.1017/jns.2019.1
- Wright N, Wilson L, Smith M, Duncan B, McHugh P. The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes. Nutrition & Diabetes. 2017;7(3):e256-e256. doi:10.1038/nutd.2017.3
- Hastert TA, Beresford SAA, Patterson RE, Kristal AR, White E. Adherence to WCRF/AICR cancer prevention recommendations and risk of postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev. 2013;22(9):1498-1508. doi:10.1158/1055-9965.EPI-13-0210
- Ornish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005;174(3):1065-1069; discussion 1069-1070. doi:10.1097/01.ju.0000169487.49018.73
- Bouvard V, Loomis D, Guyton KZ, et al. Carcinogenicity of consumption of red and processed meat. Lancet Oncol. 2015;16(16):1599-1600. doi:10.1016/S1470-2045(15)00444-1
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- Towe M, La J, El-Khatib F, Roberts N, Yafi FA, Rubin R. Diet and Female Sexual Health. Sexual Medicine Reviews. 2020;8(2):256-264. doi:10.1016/j.sxmr.2019.08.004
- David LA, Maurice CF, Carmody RN, et al. Diet rapidly and reproducibly alters the human gut microbiome. Nature. 2014;505(7484):559-563. doi:10.1038/nature12820
- Clinton CM, O’Brien S, Law J, Renier CM, Wendt MR. Whole-foods, plant-based diet alleviates the symptoms of osteoarthritis. Arthritis. 2015;2015:708152. doi:10.1155/2015/708152
- McDougall J, Bruce B, Spiller G, Westerdahl J, McDougall M. Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J Altern Complement Med. 2002;8(1):71-75. doi:10.1089/107555302753507195
- Blanchflower DG, Oswald AJ, Stewart-Brown S. Is Psychological Well-Being Linked to the Consumption of Fruit and Vegetables? Soc Indic Res. 2013;114(3):785-801. jstor.org/stable/24720280
- World Health Organization. Vitamin and mineral requirements in human nutrition, 2nd ed. 2005. https://apps.who.int/iris/handle/10665/42716