Recommendations around protein consumption for cardiovascular health and lipid management and the evidence behind them
- Eat a wide variety of plant proteins including beans, pulses, nuts and seeds
- Aim for two servings of fish a week, one of which should be oily[i]
- Modest amounts of unprocessed red meat and chicken can be included as part of a heart healthy eating pattern, but preference is for fish and plant proteins as the beneficial sources of protein
- If unprocessed red meat is consumed, no more than 500g cooked weight/ week[i]
- Avoid processed meats such as sausages, bacon, cured meats and reformed meat products[i]
- Eggs, as part of a diet low in saturated fat, can be included in a heart healthy eating pattern. For people with FH, or individuals at high risk of Cardiovascular Disease (CVD), the cholesterol content of eggs needs to be considered[ii],[iii]
[i] PHE, Eatwell Guide, accessed https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/742750/Eatwell_Guide_booklet_2018v4.pdf
[ii] NICE guidance (CG71) Familial hypercholesterolaemia: identification and management
[iii] NICE guidance [CG181] Cardiovascular disease: risk assessment and reduction, including lipid modification
While heart-healthy eating patterns do not rely on one type of food or nutrient to promote heart health, the aim is to shift the overall balance of saturated fat to unsaturated fat. As part of this eating pattern, the consensus of advice is to encourage more plant proteins in favour of animal proteins.
Mechanisms of meat and plant proteins on lipids
Red and processed meats are key sources of saturated fat in the UK diet (providing around a quarter of total saturated fat intake in adults). Saturated fat is the dietary factor with the greatest impact on LDL-C. Replacing unprocessed and processed meat with fish and plant proteins can help to reduce saturated fat intake.
Average adult (19-64 years) meat intakes in the UK is 62g per day, although, there is a significant range in intakes[i].
Diets based predominantly on plant-based proteins such as beans, pulses and nuts have a much more rounded nutrition profile compared with animal proteins: lower in saturated fat and energy density whilst providing unsaturated fat and fibre[ii],[iii],[iv]. These nutritional attributes have been associated with cardiovascular health benefits.
[i] PHE. 2018. hiips://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined
[ii] Rizzo NS, Jaceldo-Siegl K, Sabate J, Fraser GE (2013) Nutrient profiles of vegetarian and nonvegetarian dietary patterns. J Acad Nutr Diet. 113(12):1610-9. doi: 10.1016/j.jand.2013.06.349.
[iii] Sobiecki JG, Appleby PN, Bradbury KE, Key TJ (2016) High compliance with dietary recommendations in a cohort of meat eaters, fish eaters, vegetarians, and vegans: results from the European Prospective Investigation into Cancer and Nutrition-Oxford study. Nutr Res.36(5):464-77. doi: 10.1016/j.nutres.2015.12.016. Epub 2016 Jan 6.
[iv] Clarys P, Deliens T, Huybrechts I, et al (2014) Comparison of nutritional quality of the vegan, vegetarian, semi-vegetarian, pesco-vegetarian and omnivorous diet. Nutrients. 6(3):1318-32. doi: 10.3390/nu6031318.
Nutrients in meat
Red unprocessed meat can provide a source of protein, iron, zinc and Vitamin B12. Concern is raised, often in the media, that reducing red meat intakes may potentially result in a deficiency of these nutrients. However, this is unfounded. Evidence based dietary guidelines that recommend consuming only modest amounts of red meats as part of an overall diet rich in a wide variety of plant foods have shown to be nutritionally adequate[i].
[i] Scarborough P, Kaur A, Cobiac L, et al (2016) Eatwell Guide: modelling the dietary and cost implications of incorporating new sugar and fibre guideline sBMJ Open 6:e013182. doi: 10.1136/bmjopen-2016-013182
For those who wish to cut out meat, or all animal foods, from their diet, additional advice from a qualified nutrition professional may be needed to ensure their diet is nutritionally adequate. The British Dietetic Association has more information on how to achieve a nutritionally adequate plant-based diet.
Based on the totality of evidence, important potential cardiovascular benefits can be achieved by replacing red meat with nuts, legumes, and other healthy plant proteins.
Unprocessed meat and poultry can be consumed as part of a heart healthy eating pattern that includes vegetables, fruits, legumes, wholegrains, fish, nuts, seeds and nontropical oils.
UK dietary guidelines recommend no more than 70g of cooked red meat/ day or 500g/ week.
Current guidelines are universal in recommending avoidance of processed meat.
Limiting meat encourages the use of other protein sources in meals, including beans, lentils, nuts, fish and seafood.
Eggs can be included in a heart healthy eating pattern, although high risk individuals may need to restrict eggs because of the cholesterol content.