A reference article for approaching, with nuance, the question of the health benefits of shifting diets towards plant-based foods. Definitions, methodology and results, supported by a compilation of meta-analyses and systematic reviews of the highest-quality scientific literature.
The relationship between plant-based diets and their effect on human health is a crucial question, since it lies at the intersection of major 21st-century issues. First, a moral issue: the mistreatment of animals and their mass industrial farming are increasingly less accepted by the public [1]. Next, a climate issue: reducing meat consumption is seen as a way of tackling climate change [2] [3] [4]. Finally, a health issue: plant-based diets can improve health both at the individual level, through healthier habits, and at the global level, through a reduction in the risk of pandemics or a decrease in fine particle pollution such as ammonia [5].
As with subjects such as the value of nuclear power in the energy mix, the health effects of consuming GMOs, or the apparent harmlessness of wine for health, media coverage of plant-based diets is often out of step with the state of research, which biases public debate, generally to their detriment. This media-lens effect carries over to all non-experts in the field, since most websites, such as Wikipedia, rely on secondary sources, such as mainstream newspapers. Their silence on the benefits of plant-based diets, or their warnings about points of detail, can distort public debate and give the impression that what these newspapers say reflects the state of research, when this is not necessarily the case.
In this article, we will present what modern nutrition research tells us about plant-based diets, their benefits and their risks. We will see that the majority of studies lean in favour of shifting diets towards plant-based foods. Finally, we will end with an overview of the current main recommendations of the bodies that have taken a position on the subject, followed by some critical-thinking tools for approaching certain perennial controversies, notably those concerning ultra-processed foods.
What is a plant-based diet?
Plant-based diets refer to any type of diet that limits animal-derived products (ADPs). This may mean flexitarianism (a vague term describing the diet of people who say they have reduced their consumption of ADPs), lacto-ovo-vegetarianism, also known simply as vegetarianism (excluding all types of meat but including eggs, dairy products and honey), or veganism in the dietary sense (excluding, in addition to meat, eggs, dairy products and other products derived from animal exploitation such as honey). Veganism itself is a way of life that includes a vegan diet, but also covers practices and consumption choices that exclude ADPs outside food (clothing, sport, etc.). However, the word ‘vegan’ is absent from the scientific literature (with the exception of ‘vegan diet’). The term or expression that comes closest is ‘plant based diet’ (PBD). It should nonetheless be borne in mind that ‘plant based diet’ does not necessarily exclude all ADPs from the diet. It is therefore necessary to look case by case at what the authors of each study mean by ‘plant based diet’.
Although vegetarianism has existed for several thousand years, essentially for spiritual and religious reasons, in parts of the world such as India, it has developed particularly in recent decades. Moreover, a vegan diet only became technically possible after the discovery of vitamin B12, which is of bacterial origin, in 1947. The reasons motivating individuals to limit or exclude ADPs from their diet are varied, but typically fall into three categories: health, the environment and ethics.
Methodology, limitations and strengths
Studies linking diet and health are not among the best standards in science. There is a wealth of epidemiological studies and various clinical trials, but it is not possible, for example, to study individuals from birth to death under controlled conditions in order to isolate the effect of a single ingredient, as is routinely done in animal experimentation.
However, as with the link between smoking and lung cancer, this difficulty does not prevent interesting results from being obtained. It should nevertheless be borne in mind that we often speak of risk factors (that is, a vegan diet is a risk factor in favour of or against a given disease), that causality is difficult to establish because of confounding factors (for example, vegetarians may have healthier lifestyles in general), that reverse causality is possible (people with healthy lifestyles may turn to vegetarianism more readily) and that various biases can put the results into perspective (examples include the healthy volunteer bias or the limits of self-reporting).
The strength of epidemiological studies lies in the fact that, when the sample is large enough, results can be adjusted to account for variations within a population and statistically significant results can be obtained. Their main limitations are that their results apply at the scale of a population and do not allow an individual’s future to be predicted. In other words, if I know that by not smoking I reduce my risk of lung cancer by 99.8% compared with a smoker, I am still not immune from developing it. Also, breaking results down by population is not always possible (e.g. comparing an effect between Asian and European people, or between older and younger people, etc.).
The plant diet index, or PDI, and its cousins the healthy plant diet index (hPDI) and the unhealthy plant diet index (uPDI), are concepts recently introduced into the literature that make it possible to quantify the degree to which a diet is plant-based (PDI) as well as its share of healthy (hPDI) and unhealthy (uPDI) plant foods. They make it possible to obtain results even in non-vegetarian or flexitarian populations.
It should be noted that vegetarians and vegans generally have healthier eating habits, partly because their diet may be intrinsically better (replacing unhealthy foods such as processed meat with healthy ones such as pulses), but also because of their limited access to processed products of poor nutritional quality, particularly in the case of vegans. It will be interesting to study in future whether the availability of vegan processed products of low nutritional quality undermines the observed benefits of the current vegan diet.
The benefits: what does the science say?
There are very many consumer cohort studies that make it possible to carry out epidemiology, that is, to study different risk factors at the scale of a population. The main French cohort is called Nutrinet, but we can also mention EPIC-Oxford, UK Biobank, Vechi in Germany, Adventists, Framingham, Nurse and Healthy shopper in the United States, etc. All of them include a number of vegetarians and vegans, and all have their strengths and limitations.
All-cause mortality and longevity: most studies and meta-analyses on the subject show no reduction in mortality or increase in longevity among vegetarians and vegans [6] [7] [8]. However, some studies show a trend towards lower all-cause mortality, and when looking at diets with a high healthy plant-based diet index (hPDI) and a low unhealthy plant-based diet index (uPDI), statistically significant results are sometimes obtained. [9] [10] [11] [12]
Heart health: vegetarians and vegans are less exposed to cardiovascular disease and ischaemic disease [13], probably at least in part because of a better lipid profile [14] [15], but also because of a higher consumption of healthy, fibre-rich foods.
Cancer: vegetarians, and particularly vegans, appear to have lower rates of cancer of all types [8] and of certain specific cancers such as prostate and colon cancer [16] [17].
Type 2 diabetes: vegetarians, and particularly vegans, appear to have a lower risk of developing type 2 diabetes [18] [19] [20] [21]. This is one of the only findings for which the level of evidence is ‘moderate’ that was retained by ANSES in its recent report on plant-based diets. [22]
Lipid profile: it is well known that people following a vegetarian or vegan diet have a better lipid profile, for example with lower total and LDL cholesterol and a more favourable HDL/LDL ratio [14] [8], as well as a lower level of apolipoprotein B [15]. This has been confirmed in particular in a very elegant clinical trial involving identical twins [23]. For those who think that LDL cholesterol has no impact on heart health, let us simply recall that the European Society of Cardiology states, in its scientific consensus [24]:
“Robust evidence from epidemiological, genetic and clinical studies has unequivocally demonstrated that low-density lipoproteins (LDL) are causal in [the process of atherosclerotic cardiovascular disease], as summarised in the first consensus statement on this subject.”
Weight and BMI: The more plant-based a group’s diet is, the lower their weight and BMI [25]. Moreover, adopting a vegetarian or vegan diet appears to lead to weight loss [26] [27]. This is generally beneficial because of better blood glucose levels and insulin management, and certainly contributes to the better lipid profile of vegetarian and vegan groups.
C-reactive protein: The marker of inflammation par excellence, the level of C-reactive protein is lower in vegetarians and vegans [28] [29].
Microbiota: the study of the gut microbiota and its effects on health is relatively recent compared with the other topics discussed here, but some studies seem to indicate a greater abundance of beneficial species in the gut flora of people who follow a more plant-based diet.
Risks and points of caution
However, some points of caution remain and should not be glossed over.
Risk of deficiency: All vegans must take vitamin B12 supplements [30], and a large proportion of people who have shifted their diets towards plant-based foods would be well advised to do so too. The overwhelming majority of studies reporting an insufficient, or even almost non-existent, vitamin B12 intake among vegans simply do not take food supplements into account, even though most vegans say they take them. Supplementation with vitamin D and iodine, which are critical nutrients that are scarce in diets in general (with exceptions such as seaweed for iodine), is also recommended for vegans because of their low intake and risk of deficiency.
Life stages: Specific groups, namely pregnant and breastfeeding women, young children and older people, have particular needs that call for an adapted diet and, often, supplements, regardless of the diet followed. Although it is generally possible to follow a plant-based diet at any stage of life, it is advisable to discuss it with an expert who can, for example, prescribe suitable supplements (such as prenatal supplements for pregnant women).
Bone health: Studies on the subject tend to show that vegetarians and vegans have lower bone mineral density [31] [32] [33]. This may be due to a lower calcium intake, or a lower BMI [34]. This is a point to watch, and eating fortified foods such as plant-based yoghurts, along with certain physical exercises, can be beneficial.
International recommendations
Of the hundred or so countries with dietary guidelines, 38 take an explicit position on plant-based diets. Most of the world’s health agencies are simply not informed and do not inform their populations. Fifteen are positive, 11 are negative (‘critical’), and 10 provide information without taking a position. In Europe, the countries that have issued recommendations in favour of plant-based diets are Portugal, the Netherlands, Denmark, Sweden, Finland and North Macedonia; the unfavourable ones are France, Germany, Italy, Luxembourg, Switzerland and Slovenia [35].
This may well change. For example, France has probably moved to the ‘favourable’ or ‘informative’ side since its 2024 position on plant-based diets [22]. The position of institutions on plant-based diets will depend heavily on their position on supplementation: some countries consider that a diet requiring supplements (notably vitamin B12) is not viable, and classify vegetarian and vegan diets as ‘dangerous’, even though supplementation campaigns for various nutrients (notably iodine) are carried out at local, national and global levels.
The United Nations European Office for the Prevention and Control of Noncommunicable Diseases states that although vegetarian and vegan diets can offer benefits for health and the environment, they are more likely to put those who follow them at risk of low intake of various nutrients, notably vitamin B12 [36] [37].
The world’s largest dietetics association, the Academy of Nutrition and Dietetics, is favourable to plant-based diets, and its position is widely cited by advocates of these diets [38]. However, this association is criticised for its permeability to lobbying by private companies.
Other relevant recommendations
Omega-3, zinc, creatine
Among lipids, only omega-6 and omega-3 are essential, and of these two, omega-3 is the harder to obtain. There are several forms of omega-3, including the so-called short-chain ones, found in abundance in plants such as rapeseed, walnuts, flax and hemp. These short-chain omega-3s are converted into long-chain omega-3s in the body, but long-chain omega-3s can also be consumed directly, in fish or in plant-based supplements made from micro-algae oil. Although vegans consume more short-chain omega-3s than non-vegetarians, they consume little or no long-chain omega-3 unless they take supplements [39]. These long-chain omega-3s are a remarkable nutrient, probably behind the benefits of eating fish for preventing cognitive decline. It is not necessary to consume them, as shown by populations in mountains or deserts with no access to fish, or by children who have been vegetarian from birth. However, taking them as a supplement can be beneficial for health. Average French consumption is 286 mg of long-chain omega-3 per day (169 mg of DHA and 117 mg of EPA), according to the INCA3 study [40].
Many studies point to a lower zinc intake among vegetarians and vegans, which may be a problem because the phytic acid contained in pulses reduces zinc absorption, which raises the requirements of vegetarian and vegan populations. However, the zinc status of vegetarians and vegans is not so different from that of non-vegetarians, although often slightly lower.
I could discuss other nutrients such as creatine, iron and so on, but for the sake of clarity, I leave curious readers the pleasure of consulting a reference website on studies of plant-based diets [41], translated here into French [42].
A critical look at common controversies
If plant-based diets are so good, why do they sometimes require supplements?
All vegans must take vitamin B12 supplements at a minimum [30]. Iodine and vitamin D are the subject of supplementation policies, direct or indirect, mainly through dairy products; people who do not consume dairy should also take them. One might think that it is not desirable to adopt a diet that requires or recommends taking supplements, but that would be to fall into the naturalistic fallacy, which holds that what is natural is good. It is one of the biases that most pervades our society, yet it is not rational to subscribe to it. First of all, most diseases that were caused by certain deficiencies (such as cretinism, caused by iodine deficiency) have been eradicated by national and international supplementation policies. As with the anti-vaccine movement, new generations who have not seen the benefits of supplementation may distrust it, go without it and ultimately suffer the same ills that led to supplementation several generations earlier. Next, humanity has survived for most of its existence on whatever it could find. The possibility of living well beyond reproductive age is fairly recent in history, and the diet that was once suited to an environment of survival and procreation is certainly not suited to living in good health for as long as possible today. For this reason, many scarce nutrients are probably desirable for everyone, like vitamin D and long-chain omega-3 DHA, and depriving ourselves of them for naturalistic reasons would be counterproductive. Finally, almost all the foods we eat (wheat, fruit, vegetables, etc.) are the product of millennia of genetic selection and are therefore not ‘natural’; yet eating their natural ancestors is not necessarily desirable: they are generally low in nutrients, too high in fibre, contain many potentially toxic ingredients, and so on… From a philosophical point of view, naturalism does not make sense, since we ourselves come from nature, and one could therefore argue that fire, our fruit and also our telephones are just as natural as a beaver dam, a bird’s nest or a fungal culture in an ant colony. (link Contre l’idée de Nature)
Don’t the ultra-processed foods that are so common in vegetarian and vegan diets run counter to good health?
While it is true that we have little hindsight on the effects of vegan ultra-processed foods such as soya steaks or cashew nut cheeses, we can nonetheless establish a few facts. The NOVA score classifies the processing of foods according to certain criteria, but let us bear in mind that these criteria remain arbitrary and say nothing about the health effects of the product. Indeed, a fly agaric picked straight from the ground would be NOVA 1, yet this mushroom is deadly. A beef steak would be NOVA 1/2, yet it is classed as probably carcinogenic by the WHO because of the oxidative effect of haem iron in the colon. Conversely, a wholemeal loaf sold in a supermarket or calcium-fortified oat milk would both be NOVA 4, yet are beneficial for health.
The score that determines whether a food is good or bad for health is the Nutri-Score. It is regularly the target of smear campaigns by many manufacturers, such as those in cheese, charcuterie or wine, who see their products bearing a Nutri-Score C, D or E and think (rightly) that this could put off some consumers. Yet the Nutri-Score is, scientifically, the best score we have for knowing whether or not a product is good for health.
It is true that many NOVA 4 products are Nutri-Score E (crisps, snacks, fried reconstituted products, industrial cakes, etc.), and many NOVA 1 products are Nutri-Score A (fruit, vegetables, sautéed or steamed vegetables, spices…). But there are exceptions: supermarket wholemeal bread is NOVA 4 but Nutri-Score A; frozen minced beef patties are NOVA 1 but Nutri-Score C.
As before, the idea that processing = bad stems from naturalism and is not grounded in reality. Objectively, food processing is the best thing that has ever happened to our species, first with cooking over fire, then with the grinding of grains in mills, then with the addition of leaven, and so on… While we should not blindly glorify every form of processing, we must also keep a sense of proportion. We will follow upcoming studies closely, but the few studies addressing the subject seem to show that ultra-processed plant-based foods are better than their animal-based counterparts (see for example the foundational clinical trial [43], or this meta-analysis of 7 randomised clinical trials [44]).
Conclusion
Hundreds of epidemiological studies, clinical trials and other research make it possible to establish links between diet and health, and in particular the differences in health outcomes between vegetarian and non-vegetarian diets. This analysis shows that balanced vegetarian and vegan diets (that is, diets based on a variety of healthy foods such as pulses, wholegrains, nuts, fruit and vegetables, etc.) offer probable health benefits in terms of heart disease, cancer and diabetes, among other things. Vitamin B12 supplementation is essential, and supplementation with other nutrients (iodine, vitamin D) is strongly recommended to make up for the lower intakes associated with plant-based diets. If you have decided to embark on a more plant-based diet, well done and thank you! You are certainly helping to make the world a better place.
Acknowledgements
I would like to thank Jonathan Guéguen for initiating the idea for this article and for supporting me in writing it, as well as Thomas Lepeltier for his careful proofreading. I dedicate this article to Gaston Honecker, who has helped me popularise and share scientific information on plant-based diets since my beginnings.
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This article was written entirely and exclusively without the use of artificial intelligence at any level.
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