Can a plant-based diet 'reverse' heart disease?

A vegan meal with sweet potato, avocado, spinach, peppers and tofu

Could eating a strict low-fat vegetarian or vegan diet really 'reverse' coronary heart disease, and if so should everyone be eating this way?

BHF dietitian Victoria Taylor says:

The idea that a low-fat vegetarian or vegan diet could ‘reverse’ heart disease has been circulating for more than 20 years. This way of eating has become more popular in the last couple of years. It has lots of benefits, but the truth is more complex than headlines suggest.

We know that changing your diet and lifestyle, as well as taking prescribed medications, will help slow the progression of coronary heart disease, but reversal is another matter. Evidence for a plant-based diet originated in the 1980s, in a very small study of 22 people. It found that four participants had a reversal of the disease in their arteries after following a very strict plant-based diet. This is interesting, but the results needed to be confirmed in larger and longer-term studies.

We know that changing your diet and lifestyle, as well as taking prescribed medications, will help slow the progression of coronary heart disease, but reversal is another matter.

A study published in 2014 looked at 198 patients to further investigate whether eating a strict plant-based diet could stop or reverse heart disease. It found of the 177 patients who stuck to the diet, the majority reported a reduction in symptoms and 22 per cent had disease reversal confirmed by test results. But that study didn’t just rule out animal products – it also cut out added oils, processed foods, sugar, refined carbohydrates, excess salt, fruit juice, avocado, and nuts. Physical activity was also encouraged and prescribed medication continued.

Participants in the 2014 study had all heard about the earlier study and wanted to follow a plant-based diet to reduce heart disease, so they were already motivated to change their diet. This is an important point, as the level of restriction required for this diet could make it difficult to stick to. They were also given information about suitable recipes, how to read food labels so they could choose foods that fit the diet, and how to make sure the diet met their nutritional needs.

This is still a small study – much larger numbers of people would be needed for official guidelines to be changed. We also don’t know what would have happened if they had followed a diet with a similar nutritional profile, but including animal products like low-fat milk, fish and lean meat. This means we can’t be sure whether cutting out animal products or the overall nutritional content of the diet was important, or what role was played by physical activity and weight loss (most participants lost significant amounts of weight).

Should I switch to a plant-based diet?

A plant-based diet may suit some people, but is a serious undertaking and it’s too soon for the BHF to recommend this way of eating for everyone.

Remember, a plant-based diet isn’t automatically healthy... It’s still important to read food labels and understand what you are eating.

We already advise eating more fruit, vegetables, pulses and wholegrains, and less meat, whether you eat animal products or not. A greater emphasis on plant-based proteins over meat was also incorporated into national guidance in 2016.

We do know that a Mediterranean-style diet, which includes plenty of fruit, veg, pulses and fish, and only small amounts of meat, may be easier to follow than a strict plant-based diet. It’s also linked to lower rates of heart disease than a conventional Western diet.

Remember, a plant-based diet isn’t automatically healthy. Too much saturated fat, sugar and salt from any source can harm your health. There are an increasing number of manufactured plant-based snack foods available, from cupcakes and coconut yoghurts to vegan burgers, pizzas and nuggets. It’s still important to read food labels and understand what you are eating.

Victoria Taylor Meet the expert

Victoria Taylor is a registered dietitian with 20 years’ experience. Her work for the NHS focused on weight management and community programmes for the prevention of cardiovascular disease. She leads the BHF's work on nutrition.

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