Plant-based swaps cut diabetes and heart disease risk, even when foods are ultra-processed, review found

Replacing animal products with plant-based foods, including those classified as ultra-processed, reduced the risk of type 2 diabetes and heart disease, according to a new review published in BMJ Nutrition, Prevention & Health by the Physicians Committee for Responsible Medicine.

• A review of 14 studies linked ultra-processed animal products to higher risks of diabetes, hypertension, and mortality.

• Ultra-processed plant-based foods such as bread, cereal, and veggie burgers were associated with lower risks of diabetes and heart disease.

• The authors called for updates to the Nova food classification system to better distinguish between plant-based and animal products.

The review examined 14 epidemiological studies that analyzed how different types of food processing influenced chronic disease outcomes. It focused on foods classified as ultra-processed under the Nova system, which groups foods according to the degree and purpose of processing rather than nutritional profile or ingredient source.

According to the authors, ultra-processed foods were often discussed as a single category in public health debates, despite wide variation in their health effects. The review concluded that the source of the food, whether plant-based or animal-based, played a significant role in determining health outcomes.

“Our review helps clear up the confusion around ultra-processed foods,” said Hana Kahleova, MD, PhD, lead author of the review and director of clinical research at the Physicians Committee for Responsible Medicine. “Ultra-processed animal products like bacon and deli meats increase the risk of diabetes and heart disease, while ultra-processed plant-based foods like cereal and veggie burgers can help reduce the risk.”

The analysis found that processed meats such as hot dogs, bacon, and deli meats were among the ultra-processed foods most consistently associated with negative health outcomes. Across multiple studies, higher consumption of these products was linked to increased risks of type 2 diabetes, hypertension, and all-cause mortality.

The authors attributed these effects to the nutritional composition of processed meats, which were typically high in saturated fat, sodium, and nitrates or nitrites. These components were associated with hypertension, dyslipidemia, endothelial dysfunction, and systemic inflammation, all of which were recognized risk factors for cardiovascular disease and diabetes.

By contrast, several categories of ultra-processed plant-based foods were associated with improved health outcomes. The review found that breads, biscuits, and breakfast cereals were linked to lower risks of type 2 diabetes, hypertension, and heart disease mortality. Whole grains were associated with reduced risks of type 2 diabetes and all-cause mortality, while plant-based meat alternatives were linked specifically to a lower risk of type 2 diabetes.

The authors noted that many processed grain products contained dietary fiber, which promoted satiety and weight control, reduced blood glucose levels, and improved insulin sensitivity. Whole grains were also rich in micronutrients, antioxidants, and phytochemicals, which helped reduce oxidative stress and lower blood pressure.

Plant-based meat alternatives, according to the review, typically contained less saturated fat and heme iron than conventional meat products, while providing more fiber. These characteristics were associated with improved insulin sensitivity and reduced cardiometabolic risk.

Several large population studies included in the review reinforced the contrast between plant-based and animal-based ultra-processed foods. One analysis of nearly 200,000 participants across three large US cohorts found that consumption of animal-based ultra-processed foods was associated with an increased risk of type 2 diabetes. In the same analysis, higher intake of ultra-processed breads and cereals was associated with a reduced risk.

A separate analysis involving more than 300,000 individuals reached similar conclusions and also found that consumption of plant-based meat alternatives was associated with a lower risk of developing type 2 diabetes.

Evidence related to cardiovascular health and mortality showed comparable patterns. In one study of more than 8,000 participants, those with the highest intake of red and processed meat had a 10% higher risk of hypertension. In contrast, participants consuming the most breakfast cereal showed a 10% lower risk of hypertension.

Another analysis of more than 114,000 people found that ready-to-eat products based on meat, poultry, or seafood, as well as dairy-based desserts, were associated with increased mortality risk. Plant-based foods did not show the same association.

Based on these findings, the authors argued that the Nova classification system, which divided foods into four categories based on processing level, could be refined to better reflect health outcomes. They suggested that lumping all ultra-processed foods together obscured important differences between plant-based and animal-based products.

“People are missing out on the health benefits of some ultra-processed plant-based foods, because they are placed under the same umbrella as disease-causing ultra-processed animal products,” said Dr Kahleova. “The Nova system could use a more nuanced approach.”

The authors concluded that dietary guidance focused solely on reducing ultra-processed foods without distinguishing their source could unintentionally discourage choices that supported cardiometabolic health. They said the evidence supported replacing animal products with plant-based foods, even when those foods underwent processing, as a practical strategy to reduce the risk of diabetes and heart disease.