For years, we’ve heard the chorus: “Eat more plants for a healthier heart!” And largely, that advice holds true. Numerous studies have championed the benefits of plant-forward eating patterns in reducing the risk of maladie cardiovasculaireLes maladies cardiovasculaires sont un terme générique qui désigne les problèmes liés au cœur et aux vaisseaux sanguins, notamment les crises cardiaques, les accidents vasculaires cérébraux et le blocage des artères des jambes.. But a recent study from the robust NutriNet-Santé cohort in France has introduced a crucial nuance, revealing that the type de alimentation à base de plantesUne alimentation à base de plantes, ou à prédominance végétale, est principalement composée de légumes, de fruits, de légumineuses, de grains entiers, de noix et de graines, les aliments d'origine animale étant limités ou absents. matters — a lot. Simply going “plant-based” might not be enough if your plate is piled high with highly processed foods.

The Nuance: Not All Plant-Based Diets Are Equal

The French study, published in The Lancet Regional Health – Europe, followed over 63,000 adults for an average of nine years. What made this research particularly insightful was its detailed approach. Instead of just categorizing diets as “plant-based” or “non-plant-based,” the researchers used a sophisticated scoring system that considered three critical dimensions:

1. Proportion of Plant vs. Animal Products: How much of the diet was truly plant-derived?
2. Nutritional Quality: Was the diet rich in healthy nutrients or empty calories?
3. Degree of Industrial Processing (NOVA Classification): This was the game-changer. Were the plant foods whole and minimally processed, or ultra-processed?

The findings were stark:

• Those who consumed a healthy plant-based diet rich in minimally processed foods (fruits, vegetables, whole grains, nuts, seeds, legumes) had an impressive 40% lower risk of cardiovascular disease.
• In contrast, individuals whose plant-based diets were high in ultra-processed plant-based foods actually saw a 40% higher risk of cardiovascular disease, mirroring the risks associated with diets high in processed animal products.

This study directly addresses a common critique of “plant-based” messaging: the assumption that all foods derived from plants are inherently healthy.

Beyond the Buzzword: Ultra-Processed Plant Foods

This new research isn’t an isolated finding; it aligns with a growing body of evidence highlighting the dangers of aliments ultra-transformésProduits alimentaires industriels formulés à partir d'ingrédients raffinés et d'additifs — tels que des émulsifiants, des colorants et des exhausteurs de goût — ayant peu de rapport avec les aliments bruts ; les produits ultra-transformés, qu'ils soient d'origine végétale ou animale, sont associés à un risque cardiovasculaire accru, ce qui valide l'argument de l'article selon lequel le niveau de transformation importe autant que la source des aliments., regardless of their origin.

• The NOVA Classification: This system categorizes foods based on the extent and purpose of industrial processing.
  • NOVA Group 1: Unprocessed or minimally processed foods (fruits, vegetables, grains, legumes, meat, fish, eggs, milk).
  • NOVA Group 2: Processed culinary ingredients (salt, sugar, oils, butter).
  • NOVA Group 3: Processed foods (canned vegetables, simple breads, cheeses, cured meats).
  • NOVA Group 4: Ultra-processed foods (UPFs): Industrial formulations typically containing five or more ingredients, often including additives like flavors, colors, emulsifiers, and thickeners. These include many breakfast cereals, sodas, packaged snacks, instant noodles, reconstituted meat products, and, crucially, many plant-based meat alternatives and dairy alternatives.
• Existing Research on UPFs: Prior studies have consistently linked high consumption of UPFs to increased risks of obésitéL'obésité signifie avoir un excès de graisse corporelle suffisant pour nuire à la santé., de type 2 diabèteLe diabète est une affection où la glycémie reste trop élevée, soit parce que l'organisme produit trop peu d'insuline, soit parce qu'il cesse de répondre à l'insuline qu'il produit., certain cancers, and cardiovascular disease, as detailed in reviews and analyses in journals like BMJ et JAMA Internal Medicine [1, 2]. The issue isn’t just about the nutrients (or lack thereof) but also the additives, the matrice alimentaireLa matrice alimentaire désigne la structure physique et chimique d'un aliment complet — parois cellulaires, fibres, réseaux de protéines — qui entoure ses nutriments et interagit avec eux ; les graisses consommées au sein d'une matrice alimentaire intacte, comme des amandes entières par rapport à de l'huile d'amande, sont absorbées plus lentement et moins complètement que ces mêmes graisses sous une forme extraite et purifiée., and how these foods are engineered to be hyper-palatable and lead to overconsumption.

The “Healthy User” Effect and Confounders

The strength of the NutriNet-Santé study lies in its robust adjustments for facteur de confusionLa confusion se produit lorsqu'un troisième facteur caché donne l'impression que deux choses sans rapport sont liées. factors. As you rightly pointed out, people who adopt healthier diets often have healthier lifestyles overall – a phenomenon known as the “healthy user effect.” The researchers meticulously accounted for socio-demographic factors, tabagismeLe tabagisme endommage la paroi de vos vaisseaux sanguins, élève la tension artérielle, favorise la coagulation du sang et accélère la formation de plaques d'athérome. status, physical activity levels, medical history, and total energy intake. This allowed them to isolate the impact of dietary choices more effectively, confirming that even after controlling for these variables, the distinction between healthy and unhealthy plant-based diets remained significant.

The Takeaway: Prioritize Whole, Unprocessed Plants

The message is clear: when adopting a plant-based diet for heart health, focus on whole, unprocessed foods. Think colorful fruits and vegetables, robust whole grains, diverse legumes, nuts, and seeds. While plant-based convenience foods have their place, they should not form the foundation of your diet.

Q&A: Low-Fat Plant-Based Diets and Heart Disease

Q1: What is the value of a low-fat plant-based diet in preventing and reversing heart disease?

A1: A low-fat, whole-food plant-based (WFPB) diet has shown significant value in both preventing and, in some cases, reversing heart disease. Pioneering work by Dr. Dean Ornish and Dr. Caldwell Esselstyn demonstrated that very low-fat WFPB diets, combined with lifestyle changes (like stress management and exercise), could not only halt the progression of maladie coronarienneLa maladie coronarienne est une accumulation de plaque dans les artères qui irriguent le muscle cardiaque. but also lead to the regression of atherosclerotic plaquesLa plaque est une accumulation de cholestérol, de cellules immunitaires, de tissu cicatriciel et de calcium à l'intérieur de la paroi d'une artère. in many patients [3, 4].

The benefits stem from several factors:

• Reduced Saturated and Trans FatsTrans fat is an artificially altered fat once used to make processed foods last longer on the shelf.: WFPB diets are naturally very low in graisse saturéeLes graisses saturées sont celles qui restent solides à température ambiante — le beurre, la graisse de la viande rouge, l'huile de noix de coco et l'huile de palme. (found primarily in animal products) and cholestérolLe cholestérol est une substance cireuse dont votre corps a besoin. Il entre dans la composition des parois cellulaires, des hormones, de la vitamine D et de la bile qui digère vos aliments. Vous en mettriez sans lui., both major contributors to plaque formation.
• Haut FibreLes fibres sont la partie des aliments d'origine végétale que votre corps ne peut pas digérer. On les trouve dans les haricots, l'avoine, les légumes, les fruits et les grains entiers. Contenu Soluble fiber (abundant in fruits, vegetables, oats, beans) helps lower LDLLe LDL, ou lipoprotéine de basse densité, est la principale particule qui transporte le cholesterol dans votre sang, et la principale qui se coince dans les parois artérielles. (“bad”) cholesterol by binding to it and aiding its excretion. Insoluble fiber promotes gut health and satiétéThe feeling of fullness and suppression of appetite following a meal; protein is the most satiating macronutrient per calorie, and higher-protein diets exploit this property to reduce total energy intake and support weight loss..
• Rich in AntioxidantsAn antioxidant is a substance that mops up damaging molecules in the body. Vitamin E and beta-carotene are examples. and Phytonutrients: Plants are packed with compounds that reduce inflammationL'inflammation est la réponse de votre système immunitaire à une blessure ou à quelque chose qu'il traite comme un envahisseur. Elle entraîne gonflement, chaleur et cellules de nettoyage. et stress oxydatifLe stress oxydatif est un déséquilibre entre des molécules réactives dommageables et la capacité de l'organisme à les neutraliser., both critical factors in the development of heart disease.
• Weight Management: WFPB diets are generally lower in caloric density and higher in fiber, promoting satiety and making perte de poidsLa perte de poids consiste à réduire la graisse corporelle, que ce soit par des changements alimentaires, de l'exercice, des médicaments ou de la chirurgie. and maintenance easier, which in turn reduces cardiac strain.
• Amélioré Pression artérielleLa pression artérielle est la force du sang qui pousse contre la paroi de vos artères. Elle s'écrit sous la forme de deux chiffres, comme 120/80. Le chiffre du haut correspond à la pression lorsque votre cœur se contracte, et celui du bas lorsqu'il se relaxe.: The high potassium content and absence of cholesterol, combined with overall healthier body weight, often lead to lower blood pressure.

Q2: Does “low-fat” mean avoiding all fats, even healthy plant fats?

A2: Not necessarily. While the most aggressive heart disease inversionREVERSAL a comparé un traitement par statines modéré et intensif, en utilisant l'échographie intravasculaire pour mesurer ce qui est arrivé à la plaque coronaire. protocols (like those by Ornish and Esselstyn) advocate for very low-fat intake (often 10-15% of calories from fat), for general prevention and maintenance, many healthy plant-based diets include moderate amounts of healthy fats from whole food sources. These include:

• Avocado
• Nuts (walnuts, almonds)
• Seeds (chia, flax, hemp)
• Olives (and huile d'oliveL'huile d'olive est la principale matière grasse du régime méditerranéen, riche en graisses mono-insaturées et, dans sa forme extra vierge, en composés végétaux appelés polyphénols. in moderation)

These fats are rich in monounsaturated and polyunsaturated fatty acids (including omega-3s), which are beneficial for heart health. The key is to consume these in moderation and as part of a diet centered on whole, unprocessed plants, rather than relying on extracted oils or processed foods that might also contain unhealthy fats. For severe existing heart disease, a stricter very low-fat approach may be recommended by a physician.

Références

1. Dicken SJ, Batterham RL. Ultra-processed Food and Obesity: What Is the Evidence?. Curr Nutr Rep. 2024;13(1):23-38. doi:10.1007/s13668-024-00517-z
2. Rico-Campà A, Martínez-González MA, Alvarez-Alvarez I, et al. Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study. BMJ. 2019;365:l1949. Published 2019 May 29. doi:10.1136/bmj.l1949
3. Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280(23):2001-2007. doi:10.1001/jama.280.23.2001
4. Esselstyn CB Jr. Resolving the Coronary Artery Disease Epidemic Through Plant-Based Nutrition. Prev Cardiol. 2001;4(4):171-177. doi:10.1111/j.1520-037x.2001.00538.x
5. 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. Lancet Reg Health Eur. 2025;59:101470. Published 2025 Oct 6. doi:10.1016/j.lanepe.2025.101470