Exploring the benefits of a flexitarian diet

Flexitarianism is considered a semi-vegetarian diet, where lentils, beans, peas, nuts and seeds make up most of one’s protein intake, yet meat is enjoyed occasionally.¹ The diet is believed to reduce one’s carbon footprint while improving overall health.¹

The fast-growing trend, also known as a ‘plant-based’ diet, considers meat as a valuable source of macro and micronutrients, yet still recognises the ethical aspect and impact of one’s diet, minimising one’s environmental impacts and improving animal welfare.²

As the flexitarian diet is relatively accessible to African populations, this may be a plausible option to increase macro and micronutrient consumption, increase overall health and reduce risks of disease while ensuring more sustainable food sources.

Flexitarian diet benefits

In the last decade, many epidemiological and interventional human studies have shown how plant-based diets deliver health benefits for those with obesity-related metabolic dysfunction, type 2 diabetes mellitus (T2DM) and chronic low-grade inflammation.³

Additionally, many studies have found that this diet is associated with a reduced risk of cardiovascular disease, most especially when abundant in high-quality plant foods such as whole grains, fruits, vegetables, and nuts.⁴ Vegetarian diets, when compared to non-vegetarian, can lower cardiovascular disease risk factors such as total cholesterol and blood pressure, enhance weight loss, and improve glycaemic control.⁸

Key tip: Plant-based diets do not need to be fully vegetarian, as a variety of different plant-based diets, many of which included meat in moderate amounts, have been shown to reduce chronic disease risk.⁵

Could flexitarianism best serve Africans?

It is likely that Sub-Saharan African (SSA) populations may be deficient in high-quality protein and micronutrients, considering the lower consumption of plant-based foods, as indicated by the EAT-Lancet Commission.⁶ In turn, the promotion of plant-based protein and micronutrients in SSA countries becomes an essential, where fruit, vegetables, nuts, seeds, and legumes are included in one’s diet.⁶

Preventive action is also needed in the SSA populations, to avoid the increase of meat consumption, as disposable incomes and countries’ economic development rise.⁶ Such preventative measures are important, as a surge in meat consumption is often recognise in most countries going through economic transformation/urbanisation.⁶

Patient recommendations
When making dietary recommendations to your patients, a focus on overall dietary patterns is deemed more promising, rather than focusing on specific foods or nutrients.⁵ By doing this, healthcare practitioners can account for the co-operative effects of one’s overall diet and its impact on health.⁵

A meta-analysis of 95 cohort studies found that a 200-grams per day (g/d) increase in fruit and vegetable consumption correlated with a 16% lower risk of stroke, 8% lower risk of cardiovascular disease, 3% lower risk of total cancer, and 10% lower risk of all-cause mortality.⁹

Whole grains contain dietary fibre and numerous beneficial bioactive compounds¹⁰
- Consuming at least 70 g/d of whole grains, compared with consuming little or no whole grains: ¹⁰
  - 22% lower risk of total mortality
  - 23% lower risk of CVD mortality
  - 20% lower risk of cancer mortality
Nuts are useful for disease prevention due to their high content of unsaturated fat, fibre, protein and minerals. ₁₁
- Nut intake reduces the risk of: ^{11 & 12}
  - Ischemic heart disease
  - Diabetes
  - Overall CVD
  - Mortality (from all causes)
Legumes may reduce the risk of chronic disease due to their high fibre, micronutrient, and protein content. ¹²
- Increased legume intake:
  - Lowers the risk of ischemic heart disease ¹²
  - Lowered total cholesterol, LDL cholesterol & triglycerides, without changing body weight ¹³
Coffee & tea, which contain antioxidants & numerous other bioactive substances, can also contribute to a healthy plant-based diet ¹⁴
- Moderate coffee intake (3–5 cups/d or up to 400 mg caffeine/d) does not increase the risk of chronic diseases or mortality in healthy adults ⁷
- Coffee intake has been associated with lower risks of: ¹⁴
  - Various neurologic diseases
  - Liver diseases
  - T2DM
  - Cardiovascular diseases
  - Some cancers
  - Mortality
- Consuming 3 cups of tea per day has also been associated with lower chronic disease and mortality risk¹⁵

Conclusion

The flexitarian diet, or plant-based diet, helps reduce risk of various diseases, while still meeting the recommended macro and micronutrient consumption. As SSA populations are likely to be deficient of high-quality protein and micronutrients, the flexitarian diet can be recommended to reduce such deficiencies.

References:

Delaney, E., 2021. What is a flexitarian diet?. [online] BBC Good Food. Available at: <https://www.bbcgoodfood.com/howto/guide/what-flexitarian-diet> [Accessed 20 July 2021].
Frontiers. 2021. The Rising Trend of Flexitarianism. [online] Available at: <https://www.frontiersin.org/research-topics/6307/the-rising-trend-of-flexitarianism> [Accessed 20 July 2021].
Medawar, E., Huhn, S., Villringer, A. and Veronica Witte, A., 2021. The effects of plant-based diets on the body and the brain: a systematic review.
Satija, A. and Hu, F., 2018. Plant-based diets and cardiovascular health. Trends in Cardiovascular Medicine, 28(7), pp.437-441.
Hemler, E. and Hu, F., 2019. Plant-Based Diets for Personal, Population, and Planetary Health. Advances in Nutrition, 10(Supplement_4), pp.S275-S283.
Mensah, D., Nunes, A., Bockarie, T., Lillywhite, R. and Oyebode, O., 2020. Meat, fruit, and vegetable consumption in sub-Saharan Africa: a systematic review and meta-regression analysis. Nutrition Reviews, 79(6), pp.651-692.
Millen, B., Abrams, S., Adams-Campbell, L., Anderson, C., Brenna, J., Campbell, W., Clinton, S., Hu, F., Nelson, M., Neuhouser, M., Perez-Escamilla, R., Siega-Riz, A., Story, M. and Lichtenstein, A., 2021. The 2015 Dietary Guidelines Advisory Committee Scientific Report: Development and Major Conclusions.
Satija, A. and Hu, F., 2018. Plant-based diets and cardiovascular health. Trends in Cardiovascular Medicine, 28(7), pp.437-441.
Aune, D., Giovannucci, E., Boffetta, P., Fadnes, L., Keum, N., Norat, T., Greenwood, D., Riboli, E., Vatten, L. and Tonstad, S., 2017. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality—a systematic review and dose-response meta-analysis of prospective studies. International Journal of Epidemiology, 46(3), pp.1029-1056.
Zong, G., Gao, A., Hu, F. and Sun, Q., 2016. Whole Grain Intake and Mortality From All Causes, Cardiovascular Disease, and Cancer. Circulation, 133(24), pp.2370-2380.
Luo, C., Zhang, Y., Ding, Y., Shan, Z., Chen, S., Yu, M., Hu, F. and Liu, L., 2014. Nut consumption and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: a systematic review and meta-analysis. The American Journal of Clinical Nutrition, 100(1), pp.256-269.
Afshin, A., Micha, R., Khatibzadeh, S. and Mozaffarian, D., 2014. Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis. The American Journal of Clinical Nutrition, 100(1), pp.278-288.
Anderson, J. and Major, A., 2002. Pulses and lipaemia, short- and long-term effect: Potential in the prevention of cardiovascular disease. British Journal of Nutrition, 88(S3), pp.263-271.
Poole, R., Kennedy, O., Roderick, P., Fallowfield, J., Hayes, P. and Parkes, J., 2017. Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes. BMJ, p.j5024.
Zhang, C., Qin, Y., Wei, X., Yu, F., Zhou, Y. and He, J., 2014. Tea consumption and risk of cardiovascular outcomes and total mortality: a systematic review and meta-analysis of prospective observational studies. European Journal of Epidemiology, 30(2), pp.103-113.