Heart disease: How plant-based ultra-processed foods may raise risk

For this study, researchers focused on plant-based ultra-processed foods due to the lack of comprehensive research on how these products affect health outcomes, particularly cardiovascular disease.

Lead study author Fernanda Rauber, PhD, a researcher at the Centre for Epidemiological Research in Nutrition and Health (NUPENS) and the Department of Preventive Medicine at the School of Medicine at the University of São Paulo, Brazil, told Medical News Today:

“Plant-based foods are recommended in many dietary guidelines, and this area has been explored by the food industry, which uses health claims — vegetarian, vegan, plant-based — to promote its products. With a growing population adopting plant-based diets, studying the role of food processing in plant-based dietary patterns and its relation to cardiovascular diseases can help refine guidelines to incorporate considerations about food processing in their recommendations.”

Rauber explained the main difference between animal-based and plant-based ultra-processed foods is that plant-based ones contain mainly plant-derived ingredients, so they do not include ingredients like meat, dairy, eggs, or cheese.

“With the growing public interest in adopting plant-based diets and dietary recommendations promoting plant-based eating, the food industry often uses these recommendations for marketing,” Rauber continued.

“This can lead to the misleading perception that their products are healthy or beneficial for the planet, which is not always the case.”

Rauber and her team analyzed data from almost 127,000 participants of the UK Biobank who provided dietary information between 2009 and 2012 and received a median follow-up of nine years.

Scientists discovered that for every 10% increase in calorie intake from plant-based ultra-processed foods, participants had a 5% increased risk of cardiovascular disease and a 12% higher risk of death from cardiovascular diseases.

“We hypothesized that the industrial processing of foods would influence the relationship between plant-based food intake and cardiovascular disease, but we didn’t know to what extent,” Rauber said.

“We were surprised by how consistently the results showed that consuming plant-sourced non-ultra-processed foods was associated with a lower risk of developing cardiovascular disease while consuming plant-sourced ultra-processed foods was associated with a higher risk. However, the consumption of all plant-based foods showed no association with cardiovascular disease risk,” Rauber continued.

Also, during the study, researchers found that every 10 percentage point increase in calories from plant-sourced non-ultra-processed foods consumed was associated with a 7% lower risk of cardiovascular disease and a 13% lower risk of mortality from cardiovascular disease.

“The higher the consumption of plant-sourced non-ultra-processed foods, the lower the risk of these diseases,” Rauber explained.

“This underscores the importance of not just consuming plant-based foods, but specifically choosing those that are minimally processed to maximize health benefits. Our findings underscore the importance of not just focusing on plant-based diets, but also considering the level of processing of these foods,” she continued.

“Doctors can use this information to emphasize to their cardiovascular disease patients that while plant-based diets can be beneficial, it is crucial to limit the consumption of all ultra-processed foods, including those that are plant-based. They should explain how minimally processed plant-based foods are associated with a lower risk of cardiovascular disease and mortality, guiding patients to make healthier dietary choices.”

— Fernanda Rauber, PhD, lead study author

After reviewing this study, Jennifer Wong, MD, a board certified cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, told MNT that the findings are in line with diets recommended by the American Heart Association, such as the DASH diet.

“Studies like these remind us that when encouraging patients to avoid animal products high in saturated fat and seek more plant-based options, [we should] also bring up the importance of seeking whole foods and avoid processed packaged foods even if plant-based,” Wong continued.

“I’d be curious to see if there would be a difference in outcomes based on different types of processed foods like those eating processed foods with lower fat content of any type or lower salt and sugar have better outcomes,” Wong said.

MNT also spoke with Monique Richard, a registered dietitian nutritionist and owner of Nutrition-In-Sight, who said she was not surprised by the observations linking those who consumed more non-ultra-processed plant-based foods with a lower risk for cardiovascular disease and those who consumed plant-based ultra-processed foods with a higher risk.

“Marketing messages can often be confusing for the general public,” Richard explained. “If they understand something to be made of plants and understand that they are encouraged to eat more, they may perceive it is healthier than the animal counterpart.”

“’Plant-based’ does not automatically equate to nutritious. Often, meat analogs and ultra-processed foods have added sugar, salt, fat, cholesterol, [and] preservatives, or [they] are so processed that they no longer include the original beneficial components such as fiber or the phytochemicals and water-soluble vitamins such as vitamin C, folate, or riboflavin,” Richard continued.

“If consumed in excess, there is a potential that these ingredients can also lead to increased risk of cardiometabolic markers such as elevated LDL, low HDL, hypertension, atherosclerosis, and other inflammatory markers such as C-reactive protein or advanced glycation end products.”

— Monique Richard, registered dietitian nutritionist

Richard said choosing whole food or whole food ingredients when possible will allow you to glean the most health benefits of plant-based foods.

“Think about applesauce — it literally is made from mashed apples, but the fiber is mechanically altered, sugar is often added, and it often does not include skin, which depreciates its nutritiousness further,” she explained.

“The benefits of the apple in its entirety have now been reduced from the whole food to another product. With each step of processing and manipulating, the integrity of the entire package is compromised. Does that mean applesauce is not good for us? No. This simply is an illustration of the varying degrees [a] food’s nutritional value can change,” Richard noted.

For those looking for healthier options to plant-based ultra-processed foods, Richard suggested these swaps:

• Swapping out a plant-based meat for actual soybeans (edamame) or beans (pulses) is an easy, affordable, and tasty alternative.
• Scrambling tofu with vegetables and brown rice for stir fry and your favorite sauce can replace a frozen pre-prepared meal.
• Pan-searing cubed tofu or seitan with a sprinkle of breadcrumbs and a favorite roasted veg can take the place of “nuggets” or breaded cutlets.
• Lentils in soups and chilis are an easy and affordable way to add protein, fiber, and texture without much extra sodium or unwanted ingredients.
• Using jackfruit for dishes that try to mimic pulled pork is a great swap, as is adding quinoa or other whole grains that are higher in protein.