Evo Terra (Host): This is Community Connect presented by Tampa General Hospital. I'm Evo Terra. Joining me is Matt Murphy, TGH, Senior Community Engagement Coordinator and registered dietician at Tampa General Hospital. Matt, welcome to the show.

Matt Murphy: Thanks, Evo. Thanks. I'm excited to be here.

Host: Me too. I'm glad you that you are here talking about plant-based diets, because I live with a person who pretty much has an exclusively plant-based diet. But let's start for the people who are unfamiliar with that. What exactly does that mean to be a plant-based diet? And is it the same thing as being a vegetarian or even a vegan?

Matt Murphy: Yeah, those are great questions. The actual term plant-based goes all the way back to the 1980s, where Dr. T Colin Campbell from Cornell University used the term plant-based in a study he was doing called the China Study. And in this study, they compared plant-based diets to animal-based diets. So, that's kind of where the name came from. But nowadays, plant-based, it's a little bit more like a marketing term. A lot of companies use plant-based to describe foods that just don't have any animal qualities to them. When I think of plant-based, I think a little bit more of a flexible approach. Some diet that is mostly full of plants, but may also include some other types of foods. A vegetarian diet is someone who does not eat meat. A vegan is someone who eats a diet that doesn't contain any animal products at all. So, some people follow a vegan diet if they have concerns of animal welfare or environmental concerns. It usually extends a little bit more beyond the diet, but it can include things like excluding gelatin, which is a byproduct of collagen from the skin and bones of pigs, cows and fish, or even some people who follow vegan diet don't even eat honey because it requires the work of insects to produce.

Host: Oh, I hadn't considered honey, but yeah, that is an animal byproduct, isn't it?

Matt Murphy: Interesting, right?

Host: Yeah, it is. It is. But when we say plant-based, so it's not necessarily vegetarian or vegan, it's just someone who is incorporating more plant-based foods into their diet, right?

Matt Murphy: Right. That's my interpretation of it. However, if you're reading some research about plant-based diets, it seems like they take the vegan definition without the animal welfare and environmental piece. It's more so no animal products, just plants.

Host: Right. Got it. All right. So, let's get into the why. In general, what are the health benefits people will get if they switch to or just eat more of a plant-based diet?

Matt Murphy: So, I wanted to start by talking about the dietary guidelines in the U.S. We're in 2025, so new dietary guidelines should be coming out at the end of this year. But a little bit of research done on the dietary guidelines shows that 90% of Americans do not meet the recommended intake for vegetables, and about 80% don't meet the recommended intake of fruit. We know that 98% of Americans fall short of eating enough whole grains, and about 74% of Americans exceed the limits for refined grains.

So, all that to be said, even without mentioning the benefits of eating a plant-based diet, we know that these foods are naturally low in sodium and saturated fats. And those are two food components that when eaten in excess, they've been shown to increase the risk of heart disease, high BMI, type 2 diabetes and that sort of thing, chronic diseases.

So as far as plant-based diets go, why we think that they are a good diet to follow for someone who's concerned about their health is that they tend to be higher in dietary fiber. They tend to be higher in antioxidants and phytochemicals. And these are all important compounds that help lower the risk of ischemic heart disease, type 2 diabetes, high BMI, and even cancer risk for some cancers.

There's a lot of research on this, so I'm going to keep going. So, I pulled a few studies that I felt were pretty important to talk about. There is a study from 2006, it's a cohort study prospective. So, they followed vegans and vegetarians over time to look at their risk of type 2 diabetes and the incidence of type 2 diabetes. And they found that just following a vegan and vegetarian diet created a lower risk profile for BMI that was high and for type 2 diabetes, even after controlling for other confounding variables.

 A little bit more in the future, 2024, a little bit more current, we had another prospective cohort study that showed a greater adherence to a plant-based dietary pattern was associated with a lower risk of incident diabetes, and they actually divided a plant-based diet into an unhealthy plant-based diet and a healthy plant-based diet. We've all heard of vegans and vegetarians who might live off of snack foods and processed foods. There's no animal products in them, but it might not be the best quality diet. These researchers define that as unhealthy plant foods by talking about fruit juices, refined grains, sugar-sweetened beverages, sugar-free beverages, and sweets. Things that the general population knows we probably want to limit those foods anyway, but there is no meat in them.

Host: True, true. You get your point for that, but not the healthiest. So, what's the healthy-based plant diet in their opinion?

Matt Murphy: This was a lot of the foods that we want to include, the vegetables, the beans, the seeds, the nuts, the fruits, the whole grains. And some of those high unsaturated fat oils like olive oil. And because of this study, because it measured adherence to a healthy plant-based diet, we found out that the dietary impacts of this diet are two-fold. It's not just that we're benefiting from the foods that we are including, but we're also benefiting from what foods are not being included. The healthy plant-based diet didn't include those unhealthy plant-based foods. So, there's a little bit of a reason why to shift towards a healthy plant-based diet rather than just a vegan or vegetarian strict definition diet.

And one more study to talk about, and this one's important because it's a systematic review. Systematic reviews are review studies that look at multiple publications. In this case, it was 22 publications looked at in 2020 on plant-based diets and BMI or body mass index. And they found that overall changing from an omnivorous diet, which includes plants and animal foods to a plant-based diet resulted in a weight reduction in general. And this is related to BMI and related to health. Although weight doesn't exactly correlate with health in every sense of the word, we do know that people who have a lower BMI in this study had better health outcomes.

Host: That's outstanding. And I know there's some longstanding research that is showing this, so it's great that even that the current research we're seeing today is supporting that. You know, you mentioned the unhealthy ways of doing things, and also the benefits of weight loss that's coming with the healthy way of doing things. I'm curious from your perspective as a dietician, a lot of people these days are on these new GLP-1 inhibitors that are really impacting their hunger, their cravings, you know, it's going down and they're losing weight because of the reducing number of calories that go into their mouths and into their stomachs. For vegetarians and vegans or just people who are relying on a more plant-based diet, are there concerns? Is everything okay? Should they do something different if they're on one of these GLP-1s I mean, obviously, they should be telling their doctor about this first. But from your perspective, everything okay?

Matt Murphy: The GLP-1 receptor agonist medication class, that's things like ozempic, Wegovy, some of them are designed to be used for people who are seeking weight loss, some of them are designed to be used in people who have type 2 diabetes. But no matter the reason, they all suppress appetite and they all slow digestion. So for some people on a vegan or vegetarian diet or something that's exclusively plant-based, they might find that they have some digestive upset. That's because food is moving through a little bit slower, and these diets tend to be really high in fiber. So for someone on one of those medications, you know, aside from any other side effects they might experience, sometimes increasing your water intake can really help minimize some of those symptoms that you have from eating too much fiber and slow digestion.

Host: Interesting. So, my wife has been an vegetarian of sorts. Specifically, she is an ovo-icthy-lacto-vegetarian. And I'll explain that for the people who don't understand what that is. Ovo, meaning eggs, are okay. Ichthyo, meaning fishes, are okay. And lacto, that'd be the dairy products, she's okay with that. She always is razzed by our family, hers and mine, that she's just not getting enough protein on her plant-based diet. Is this an area of concern for people?

Matt Murphy: That is a great question. And I love that you brought up an example. Someone who is eating a diet that includes animal foods, or maybe you are a vegan or a vegetarian, we have found that the average intake that we think is appropriate for someone for protein is about 0.8 grams per kilogram of body weight. So if we did the math, about 150-pound person should be eating about 55, 60 grams of protein per day. In reality, that isn't very much. As Americans, we tend to overeat protein by two-fold, three-fold of that amount. So on a plant-based diet or vegan or vegetarian diet, you can eat plenty of protein and it's highly achievable. So, for example, a cup of cooked soybeans like edamame is 29 grams of protein, so there's half your day's worth. A half cup of black beans would be 8 grams of protein. A cup of quinoa is 8 grams of protein and half a of farro, which is another grain, 7 grams of protein. We always want to make sure we're thinking about complete proteins. This is another conversation that comes up is I want to follow a plant-based diet, but I don't think I'm getting all the amino acids that my body needs.

We know that meat is the best source of complete protein, but what happens when you don't eat meat? And it's okay if you don't eat meat, because there are certain fruits and mostly vegetables and grains that do contain all the essential amino acids. And specifically, the ones I want to highlight are quinoa, soybeans, farro, buckwheat, and chia seeds. They've got every amino acid your body requires, especially soybeans and quinoa, they have the right ratios of those amino acids compared to an animal-based food.

If you are weight training or you're someone who's a marathon runner or you're really, really active, you can go all the way up to 2 grams per kilogram of protein. Most people don't need that amount, but we don't see really any negative side effects. In the past, we thought there might be some kidney damage or, you know, excess creatinine, but it seems like things are okay even with that much protein.

Host: That's great. And again, I want to stress the point that you just said, you can get all of that from a plant-based diet if you're eating the right kinds of things like those legumes that you had mentioned and the quinoa, very good stuff. You brought up amino acids. So, I want to ask the question about the rest of the nutrients that are out there. I'm thinking vitamins and I'm thinking all the things that we don't think about too much when we're actually eating. Should people who are following a plant-based diet be mindful of key ingredients they may not be getting? And if so, how do they ensure they're getting enough?

Matt Murphy: Back in the days when I was in clinical practice or doing outpatient counseling with patients who wanted to follow a vegan or a vegetarian diet, it was usually these three nutrients. It was vitamin B12. It was omega-3 fatty acids. And sometimes they'd talk about iron, sometimes it was calcium. We do know that vitamin B12, fortunately and unfortunately, is almost exclusively found in animal-derived products. But thankfully, and this is the one positive thing about processed foods in the United States, is that we do add vitamins and minerals to a lot of our processed food sources. So if you are drinking a fortified plant milk, like soy milk or almond milk, or if you're eating breakfast cereal, those types of foods do have B12 fortified in them.

And if you eat yeast, which technically that's okay since it's a single-celled organism, if you're eating yeast or nutritional yeast, sometimes in vegan recipes, we'll use that as a substitute for cheese. That also contains B12. The omega-3 fatty acids, they come from our seeds and our nuts, and although they do contain omega-3s, they're not quite as bioavailable as the ones we get from animals like in fatty fish. This is where supplementation can be helpful.

As far as iron and calcium, these two nutrients are available in plant foods. A lot of our nuts and seeds and legumes will have calcium and iron in them. Sometimes they're not very bioavailable because they are bound to compounds in fruits and vegetables called phytates. Our bodies aren't very good at separating those things chemically. So again, supplementation can be beneficial here if you feel the need to, if you have a deficiency.

Host: By supplementation, you mean take a multivitamin, right?

Matt Murphy: Yeah. A multivitamin or just that single vitamin or mineral that you might be missing. But again, talk to your provider and make sure they're looking at your lab values and having an overall conversation about your diet to know more.

Host: That makes a lot of sense. So Matt, I have been sort of on a plant-based diet because again, I mentioned my wife of many years who is a certain, particular type of vegetarian. So, I have already learned that it isn't necessarily that you have to cut out everything. You don't have to fully jump into things. I know this practically, but I want to get your opinion for the people, like me 30 years ago, who needed to do more plant-based diet or wanted to add more plant-based meals, but weren't ready to jump all the way in. What are some practical steps you offer to your patients so that they can just kind of ease into this?

Matt Murphy: That's the secret, right? It's easing into it and also remembering that it's not all or nothing. There is no one way to eat, despite all of the research and literature we have and observations we've done on groups of people, there isn't one best way. Within our bodies, we might process foods the best way by eating a certain diet, but it doesn't mean that your wants and needs, your specific likes, your financial situation. Your access to food is the same as everyone else's.

So, the best advice I can give on that is pick the low-hanging fruit, both figuratively and literally. What is that one easy thing that you can do? Is it adding a half a can of vegetables to your pasta dinner when you're very tired and can't make a scratch meal? Is it buying frozen vegetables to have something that's easy to use instead of having to cook and chop? Is it going to a cooking class to find out how to cook a vegetable or instead of choosing the refined version of a grain, picking the whole wheat or the whole grain version. Even once in a while, and that study I referred to earlier about the greater adherence, even if you shift your diet just slightly in the direction of a plant-based diet, you too can reap the benefits of eating that way.

Host: Matt, thanks very much for being on the show today and sharing all this fantastic information and hopefully converting or convincing some people to give this plant-based diet a shot. Speaking as a devout omnivore who loves his steaks rare, going plant-based has been okay for me too.

Matt Murphy: Well, give it a shot and don't stop until you feel satisfied. But also, you know, working with a registered dietician to help you make small, sustainable and achievable changes is a great way to get started if you're looking in that direction.

Host: Smart advice. That has been Matt Murphy. For more information, please visit tgh.org. If you enjoy this episode, please be sure to follow Community Connect, presented by TGH on your favorite podcast platform. I'm Evo Terra. And this is Community Connect, presented by TGH. Thanks for listening.