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 malattia cardiovascolareLe malattie cardiovascolari sono il termine generico per indicare i problemi al cuore e ai vasi sanguigni, tra cui infarti, ictus e ostruzione delle arterie delle gambe.. But a recent study from the robust NutriNet-Santé cohort in France has introduced a crucial nuance, revealing that the tipo di dieta a base vegetaleUna dieta a base vegetale, o prevalentemente vegetale, si basa principalmente su verdure, frutta, legumi, cereali integrali, frutta secca e semi, mentre gli alimenti di origine animale sono limitati o assenti. 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 alimenti ultra-processatiProdotti alimentari industriali formulati con ingredienti raffinati e additivi, come emulsionanti, coloranti e esaltatori di sapidità, con ben poco in comune con gli alimenti integrali; sia i prodotti ultra-processati a base vegetale che quelli a base animale sono associati a un aumento del rischio cardiovascolare, confermando la tesi dell'articolo secondo cui il livello di lavorazione conta tanto quanto la fonte del cibo., 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 obesitàL'obesità significa avere una quantità di grasso corporeo in eccesso tale da influire sulla salute., di tipo 2 diabeteIl diabete è una condizione in cui la glicemia rimane troppo alta, o perché il corpo produce troppa poca insulina o perché smette di rispondere all'insulina che produce., certain cancers, and cardiovascular disease, as detailed in reviews and analyses in journals like BMJ e JAMA Internal Medicine [1, 2]. The issue isn’t just about the nutrients (or lack thereof) but also the additives, the matrice alimentareLa matrice alimentare si riferisce alla struttura fisica e chimica di un alimento intero — pareti cellulari, fibre, reti proteiche — che circonda e interagisce con i suoi nutrienti; i grassi consumati all'interno di una matrice alimentare intatta, come le mandorle intere rispetto all'olio di mandorle, vengono assorbiti più lentamente e in modo meno completo rispetto agli stessi grassi in forma estratta e purificata., 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 confondenteLa confondimento si verifica quando un terzo fattore nascosto fa apparire collegate due cose non correlate. 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, fumoIl fumo danneggia il rivestimento dei vasi sanguigni, aumenta la pressione sanguigna, fa coagulare il sangue più facilmente e accelera la crescita della placca. 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 malattia coronaricaLa malattia coronarica è l'accumulo di placca nelle arterie che alimentano il muscolo cardiaco. but also lead to the regression of atherosclerotic targheLa placca è l'accumulo di colesterolo, cellule immunitarie, tessuto cicatriziale e calcio all'interno della parete di un'arteria. 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 grassi saturiI grassi saturi sono quelli che rimangono solidi a temperatura ambiente: burro, il grasso nella carne rossa, olio di cocco e olio di palma. (found primarily in animal products) and colesteroloIl colesterolo è una sostanza cerosa di cui il corpo ha bisogno. Entra nelle pareti cellulari, negli ormoni, nella vitamina D e nella bile che digerisce il cibo. Moriresti senza di esso., both major contributors to plaque formation.
• Alto FibraLa fibra è la parte degli alimenti vegetali che il corpo non riesce a digerire. Si trova in fagioli, avena, verdure, frutta e cereali integrali. Content: Soluble fiber (abundant in fruits, vegetables, oats, beans) helps lower LDLL'LDL, o lipoproteina a bassa densità, è la principale particella che trasporta il colesterolo nel sangue ed è la principale a bloccarsi nelle pareti delle arterie. (“bad”) cholesterol by binding to it and aiding its excretion. Insoluble fiber promotes gut health and sazietàThe 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 AntioxidantsUn antiossidante è una sostanza che neutralizza le molecole dannose nel corpo. La vitamina E e il beta-carotene ne sono esempi. and Phytonutrients: Plants are packed with compounds that reduce infiammazioneL'infiammazione è la risposta del sistema immunitario a una lesione o a qualcosa che esso tratta come un aggressore. Porta gonfiore, calore e cellule di pulizia. e stress ossidativoLo stress ossidativo è uno squilibrio tra molecole reattive dannose e la capacità dell'organismo di neutralizzarle., 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 perdita di pesoLa perdita di peso significa ridurre il grasso corporeo, sia attraverso modifiche alimentari, esercizio fisico, farmaci o chirurgia. and maintenance easier, which in turn reduces cardiac strain.
• Improved Pressione sanguignaLa pressione sanguigna è la forza del sangue che preme contro le pareti delle arterie. È scritta come due numeri, come 120/80. Il numero superiore è la pressione quando il cuore si contrae, quello inferiore quando si rilassa.: 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 inversioneREVERSAL ha confrontato la terapia con statine moderata e intensiva, utilizzando l'ecografia intravascolare per misurare cosa è accaduto alla placca coronarica. 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 olio d'olivaL'olio d'oliva è il grasso principale della dieta mediterranea, ricco di grassi moninsaturi e, nella versione extravergine, di composti vegetali chiamati polifenoli. 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.

Riferimenti

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