Peer Reviewed
I vividly recall my first Impossible Whopper at Burger King after its introduction to the menu in 2019. As I bit down, my taste buds recognized the similarity immediately. Was it the exact same thing? No, but it was pretty darn close. Plant-based meats have received growing praise in the US, particularly due to their role as sustainable, ethical, and tasty alternatives to meat consumption. In the US in 2023, around 9.9 billion commercial farm animals were slaughtered, including 9.5 billion chickens, 128 million pigs, and 33 million cattle.1 Animals are frequently overpacked so they cannot move, spending their lifetimes in concrete pens, pumped with growth hormones.2 Chickens are often de-beaked and cattle de-horned–painful procedures performed without anesthesia.2 The commercial farming industry has significant ethical drawbacks, and consumer habits are changing. The popularity of plant-based meats is increasing. Are there health benefits in swapping such alternatives for meats?
Several tried-and-true dietary recommendations are continually cited as beneficial for weight loss and overall health. The US Dietary Guidelines recommend the Mediterranean diet, DASH (Dietary Approaches to Stop Hypertension) diet, and vegetarian diets, all of which have shown considerable health benefits.3 These dietary approaches share a common theme: increasing healthy fruit and vegetable intake; reducing dietary sugars, salt, and saturated fats; and reducing or eliminating non-lean meat. An increase of more than 600% in veganism and vegetarianism has been seen since 1997,4 in part due to the known benefits of such diets on health.
Plant-based meat alternatives are variably designed products, typically made of soy, pea, bean, or wheat proteins with vegetables and preservatives.5 Vegetarian burger patties are often the comparator, but other “veggie meat” alternatives such as sausages, chicken, bacon, and fish patties offer flavor parallels. In the US, the plant-based meat market has increased by over 74% over the last three years to $1.81 billion in 2023, with the companies Beyond Meat and Impossible Foods leading the way.6-8 However, the market makes up just a small share (1.4%) of total meat revenue.6 Efforts are being made to design healthful products that align with a nutrition-focused customer base, providing dietary supplementation meant to mimic vitamins and minerals obtained from meat while retaining similar flavor and texture profiles.7
In nutritional comparisons, plant-based meats were generally found to be lower in calories and saturated fats than their meat counterparts, although there was wide variation.9 Plant-based meats have increased fiber, which has been shown to lower LDL cholesterol and blood pressure, while reducing weight.10,11 Plant substitutes have also been shown to have considerable protein, iron, and vitamin fortification for dietary benefit.9,12 Although it may be too early to project long-term health outcomes, one crossover study looked at the overall health risk reduction in isolated swapping of plant meats for regular meats during eight-week periods.13 The study demonstrated that, while eating a plant-based meat diet, participants had significantly lower levels of trimethylamine-N-oxide, a known cardiovascular disease correlate, with lower LDL and body weight, suggesting that switching to plant-based meats may have early-acting cardiovascular disease benefits.
Despite the potential that plant-based meats show, the same nutritional studies demonstrated that they typically have higher levels of salt and sugar.9,10 One Impossible burger patty contains 370 mg of sodium, 16% of the daily value, while a comparable portion of ground beef contains 66 mg of sodium, roughly 3% of the daily value.14,15 Consumers are likely to add additional salts or sauces to meats, but plant-based meat consumers may salt and sauce their products in the same way, meaning overall sodium and sugar levels could far exceed recommendations. Ultra-processed foods have also been shown to have negative impacts on weight gain and caloric intake, even in just short periods.16 With the American diet often relying on processed products instead of fresh produce, a concern is that consumers may interpret eating such plant products as “getting their daily dose of vegetables” rather than using them to replace meats next to healthy fruits and vegetables on the plate.
However, the health price paid for meat consumption may be far greater than simple increases in sodium or sugar. Red meat is a group 2A carcinogen, correlated with breast, endometrial, colorectal, lung, and hepatocellular cancers.17 Meat production and overuse of antibiotics have also driven concerns about antibiotic-resistant bacterial strains, with the potential for easily transmissible, resistant future infections.18 The meat industry is notoriously unsustainable, with greenhouse gas production and enormous energy and water requirements to bring a burger from farm to table.19 Continually unsustainable practices bring the long-term dangers of climate change, including increases in natural disasters, regional infections, and largely uninhabitable climates. To our knowledge, plant-based products do not create the same risks of cancer or antibiotic resistance. A comparative assessment of the Beyond Burger by Thoma and colleagues found that a 4-ounce Beyond Burger generates 90% less greenhouse gas emissions, requires 46% less energy, has >99% less impact on water scarcity and 93% less impact on land use than 4 ounces of US beef.5,19
Reducing red meat intake is a lifestyle intervention that would provide long-term benefits. A balanced, plant-based diet will always be a healthy point of dietary counseling for patients. However, the evidence for long-term health improvements with processed plant-based meat alternatives is minimal, making it difficult to recommend exchanging meat for veggie meat. To the optimist, the rise in such products shows that people may be increasingly willing to make plant-based dietary changes that forego unhealthy meats, and plant-based meats may provide some benefit compared to the health detriments of meat. But to the pessimist, offering processed vegetables detracts from the value of eating cleanly with fresh, healthy foods. Ideally, these products will evolve to provide plant-based vegetable proteins without the added sodium, sugar, and heavy processing that reduce their current nutritional benefit. Despite the negatives, the growth of plant-based options is probably directionally aligned with a sustainable, healthful, and ethical future. We just might not be completely there yet.
Daniel Joyce is a Class of 2026 medical student at NYU Grossman School of Medicine
Reviewed by Michael Tanner, MD, Executive Editor, Clinical Correlations
Image Courtesy of Grendelkhan, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons
References
- U.S. Department of Agriculture – Economic Research Service. Livestock and Meat Domestic Data. Livestock, Dairy, and Poultry Outlook. Published January 29, 2024. Accessed February 16, 2024. https://www.ers.usda.gov/data-products/livestock-and-meat-domestic-data/
- Animal Welfare Institute. Inhumane Practices on Factory Farms. Accessed February 16, 2024. https://awionline.org/content/inhumane-practices-factory-farms
- U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. Dietaryguidelines.gov. Published December 2020. Accessed January 25, 2024.
- de Visé D. Vegetarianism is on the rise–especially the part-time kind. The Hill. Published November 23, 2022. Accessed January 25, 2024. https://thehill.com/changing-america/sustainability/3747206-vegetarianism-is-on-the-rise-especially-the-part-time-kind/
- Hu FB, Otis BO, McCarthy G. Can Plant-Based Meat Alternatives Be Part of a Healthy and Sustainable Diet? JAMA. 2019;322(16):1547-1548. doi:10.1001/jama.2019.13187
- Statista. Meat–United States. Statista Market Forecast. Published November 2023. Accessed February 16, 2024. https://www.statista.com/outlook/cmo/food/meat/united-states
- Bayer E. A fad or the future? With plant-based meat, there’s plenty to be bullish about. Fast Company. Published May 22, 2023. Accessed February 16, 2024. https://www.fastcompany.com/90898508/a-fad-or-the-future-with-plant-based-meat-theres-plenty-to-be-bullish-about
- Grand View Research. Plant-based Meat Market Growth & Trends Report, 2020-2027. Grand View Research. Published 2022. Accessed February 16, 2024. https://www.grandviewresearch.com/industry-analysis/plant-based-meat-market
- Pointke M, Pawelzik E. Plant-Based Alternative Products: Are They Healthy Alternatives? Micro- and Macronutrients and Nutritional Scoring. Nutrients. 2022;14(3):601. Published 2022 Jan 29. doi:10.3390/nu14030601
- de Las Heras-Delgado S, Shyam S, Cunillera È, Dragusan N, Salas-Salvadó J, Babio N. Are plant-based alternatives healthier? A two-dimensional evaluation from nutritional and processing standpoints. Food Res Int. 2023;169:112857. doi:10.1016/j.foodres.2023.112857
- Anderson JW, Baird P, Davis RH Jr, et al. Health benefits of dietary fiber. Nutr Rev. 2009;67(4):188-205. doi:10.1111/j.1753-4887.2009.00189.x
- Katidi A, Xypolitaki K, Vlassopoulos A, Kapsokefalou M. Nutritional Quality of Plant-Based Meat and Dairy Imitation Products and Comparison with Animal-Based Counterparts. Nutrients. 2023;15(2):401. Published 2023 Jan 12. doi:10.3390/nu15020401
- Crimarco A, Springfield S, Petlura C, et al. A randomized crossover trial on the effect of plant-based compared with animal-based meat on trimethylamine-N-oxide and cardiovascular disease risk factors in generally healthy adults: Study With Appetizing Plantfood-Meat Eating Alternative Trial (SWAP-MEAT). Am J Clin Nutr. 2020;112(5):1188-1199. doi:10.1093/ajcn/nqaa203
- Impossible Foods. What are the nutrition facts for Impossible Beef made from plants? Published 2019. Accessed January 25, 2024. https://faq.impossiblefoods.com/hc/en-us/articles/360018939274-What-are-the-nutrition-facts-
- U.S. Department of Agriculture. Beef, ground, 80% lean meat / 20% fat, raw. FoodData Central. Published April 2018. Accessed January 25, 2024. https://fdc.nal.usda.gov/fdc-app.html#/food-details/174036/nutrients
- Hall KD, Ayuketah A, Brychta R, et al. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake [published correction appears in Cell Metab. 2019 Jul 2;30(1):226] [published correction appears in Cell Metab. 2020 Oct 6;32(4):690]. Cell Metab. 2019;30(1):67-77.e3. doi:10.1016/j.cmet.2019.05.008
- Farvid MS, Sidahmed E, Spence ND, Mante Angua K, Rosner BA, Barnett JB. Consumption of red meat and processed meat and cancer incidence: a systematic review and meta-analysis of prospective studies. Eur J Epidemiol. 2021;36(9):937-951. doi:10.1007/s10654-021-00741-9
- Manyi-Loh C, Mamphweli S, Meyer E, Okoh A. Antibiotic Use in Agriculture and Its Consequential Resistance in Environmental Sources: Potential Public Health Implications. Molecules. 2018;23(4):795. Published 2018 Mar 30. doi:10.3390/molecules23040795
- Heller MC, Keoleian GA. Beyond Meat’s Beyond Burger Life Cycle Assessment: a detailed comparison between a plant-based and an animal-based protein source. CSS Report, University of Michigan.http://css.umich.edu/publication/beyond-meats-beyond-burger-life-cycle-assessment-detailed-comparison-between-plant-based. Published September 14, 2018. Accessed January 26, 2024.