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What the evidence shows
The word plant-based
has stopped meaning anything.
A new study shows what actually
separates the two groups.
Two diets can be equally plant-based and still have opposite effects on the heart. I have been making that argument for years. This is the dataset that measures it.
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Dear friend,
Researchers in France followed 63,835 adults for an average of 9.1 years, some for as long as 15. Instead of sorting people only by how much of their food came from plants, they also sorted by two things almost every study before it collapsed together: the nutritional quality of the food, and how heavily it had been industrially processed.
That second cut is where the diets separated. Adults eating mostly high-quality, minimally processed plant foods had about a 40 percent lower risk of cardiovascular disease than those eating fewer of those foods and more animal products. Adults eating plant foods of good nutritional quality that were ultra-processed showed no reduction in risk at all.
This is what I mean by nutrient density. Not plants as a category, but nutrients-per-calorie, in food close to the form it grew in.
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What the study found
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Quality and processing were measured separately
Diets were scored on the plant-to-animal balance, on nutritional composition including fat, sugar, salt and antioxidant vitamins and minerals, and on level of industrial processing. Most earlier work treated all plant food as one bucket.
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Processing erased the advantage
People eating nutritionally decent but ultra-processed plant foods, such as the industrial wholemeal breads, the packaged soups, the ready-made pasta dishes, the bagged salads that arrive with their dressing, saw no lower cardiovascular risk than the higher-animal-food group.
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The lowest-quality plant diets did worse than animal foods
Chips, plant-extract sodas and sweetened fruit drinks, confectionery, sugared breakfast cereals, crackers – diets dominated by those carried roughly 40 percent higher cardiovascular risk than diets built on minimally processed plant foods of good quality. Vegan is not a health claim.
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40%
Lower cardiovascular disease risk among adults eating mostly high-quality, minimally processed plant foods, compared with those eating fewer of them and more animal products.
Prioux C, Kesse-Guyot E, Srour B, et al. Cardiovascular disease risk and the balance between animal-based and plant-based foods, nutritional quality, and food processing level in the French NutriNet-Santé cohort: a longitudinal observational study. The Lancet Regional Health – Europe, 2025; 59: 101470.
Read the study
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I want to be careful about what this study can and cannot say. It is observational, so it describes associations rather than proving cause. But the direction is consistent with what I have watched in practice for more than forty years: people who move toward whole plant food get better, and people who move toward packaged food with a plant label on it usually do not.
The practical problem is that the second group believes they are in the first group. The package says plant-based. The ingredient list says otherwise.
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Pro tip: how to sort the two apart in the store
Turn the package over and read the ingredient list, not the front. If you find an ingredient that could not exist in a kitchen, an emulsifier, a syrup, a hydrogenated oil, a protein isolate, a color, a flavor, then you are holding a food product rather than a food. Whole plant foods barely need a list at all: a bag of frozen kale is kale. Nothing to see here, and no brand required. Do this once with the four plant-based items already in your cart and you will see the dividing line that the study drew.
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The Key Takeaway
The question was never whether your food came from a plant. It is how many nutrients arrive with each calorie, and how little was done to the food on the way to you. That is the whole of a nutritarian diet-style: greens, beans, onions, mushrooms, berries and seeds, eaten in a form your grandmother would recognize.
And a limit worth stating plainly. No supplement corrects a diet built on processed food, and nothing I formulate substitutes for the vegetables. Food comes first. Everything else supplements it.
To your health,
Dr. Fuhrman
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