Half a million lives? Plant based diets & Covid-19

What if I was to tell you that just one change in your lifestyle is likely to reduce your chance of having moderate-to-severe Covid-19 infection, duration and severity of illness by 73%. It is nearly as good a result as taking a vaccine against Covid-19, but, as a bonus, will also reduce your risk of a range of lifestyle diseases such as heart disease, diabetes and high blood pressure, even cancers, which the vaccine won’t. What’s that magic pill you say? It is a clean plant-based diet. The first such study of its kind published last month shows just that.

The study1, published in the British Medical Journal (BMJ) Nutrition, Prevention & Health looked at a sample of 2,884 frontline workers from six countries (France, Germany, Italy, Spain, UK, USA) with substantial exposure to COVID-19 patients. Of those who took part in the study, there were 568 COVID-19 cases and 2316 controls. Among the 568 cases, 138 individuals had moderate-to-severe COVID-19 severity whereas 430 individuals had very mild to mild COVID-19 severity. After adjusting for important confounders, participants who reported following ‘plant-based diets’ had 73% lower odds of moderate-to-severe COVID-19 severity, compared with participants who did not follow this diet!

Let me go into a bit more detail on the study. The study adjusted for participants who had substantial exposure to Covid-19 patients, adjusted for age, sex, race/ethnicity, and country, as well as medical specialty, smoking status, for dietary supplement use and physical activity and body mass index (BMI) alongside the presence of a medical condition (such as diabetes, pre-diabetes, high cholesterol, hypertension, coronary heart disease or heart attack, heart failure, cancer, prior lung disease, prior lung infection, overweight, asthma, or autoimmune disease).

Individuals who reported following plant-based diets consumed more total vegetables, plant proteins (legumes and nuts), and less poultry, red and processed meats, sugar-sweetened beverages, and alcohol compared with those who did not follow plant-based diets. Participants reported if they followed any type of specific diet over entire prior year before the COVID-19 pandemic. Accordingly, 12 months was the period used to capture usual and long-term dietary intake. Participants had 11 choices: whole foods, plant-based diet; keto diet; vegetarian diet; Mediterranean diet; pescatarian diet; Palaeolithic diet; low fat diet; low carbohydrate diet; high protein diet; other; none of the above. ‘Plant-based’ combined ‘whole foods, plant-based’ diets and ‘vegetarian’ diets into one category.

In conclusion, individuals who reported following plant-based diet had 73% lower odds of moderate-to-severe COVID-19-like illness. Conversely, compared to those who followed plant-based diets, those who followed low carbohydrate, high protein diets had >3-fold higher odds of moderate-to-severe COVID-19.

While the authors do suggest some limitations such as the potential for recall bias, diet definitions varying by country, some with more severe symptoms perhaps not being able to take part in the study and finally, a dominance of male participants (70%), the study has the strengths of having a large sample, careful adjustment of confounding factors and dealing with a cohort of educated and accountable survey respondents (95% being physicians).

Extrapolating this figure across the deaths experienced in the six countries in question of over 1.1 million to date, a plant-based diet amongst that population could have saved as many as half a million lives. That is as big a story as the story of the speed of the vaccine development, but this article has not had any significant press coverage. I am at a loss for words. Notwithstanding, may I suggest that you consider transitioning to a flexitarian or complete plant-based diet with minimal processed foods and alcohol, and give yourself another layer of protection against this pandemic.

There’s a reason why the world has been very focused on eradicating or controlling communicable diseases over the past century. They are, and have been, major killers of human beings over history. More than wars. A number of communicable diseases have been vastly eradicated, and others controlled through vaccines, treatment regimes and public education. But, at no time in human history has the world population been so physically interconnected, nor as unhealthy from a lifestyle perspective. The conditions for the worldwide spread of a highly contagious virus are therefore perfect.

And, this won’t be the last. The world narrowly escaped the SARS bullet, and did not learn enough. So, it is critical that we start learning from COVID-19, so that COVID-24 and COVID-29, which may well have a much higher mortality rate, are nipped in the bud. Our diets and lifestyles need to be the centerpiece of our learning.

• Kim H, Rebholz CM, Hegde S, et al Plant-based diets, pescatarian diets and COVID-19 severity: a population-based case–control study in six countries BMJ Nutrition, Prevention & Health 2021;bmjnph-2021-000272. doi: 10.1136/bmjnph-2021-000272