Plant-based meat alternatives, despite being ultraprocessed, may be healthier for the heart than meat, a new report suggests.

A review of previous studies found that risk factors for heart disease, including total cholesterol, LDL cholesterol and body weight, improved when various animal-based meats were replaced with a substitute made from plants, according to the paper, published Wednesday in the Canadian Journal of Cardiology. 

“Plant-based meat is a healthy alternative that is clearly associated with reduced cardiovascular risk factors,” said the study’s senior author, Dr. Ehud Ur, a professor of medicine at the University of British Columbia in Vancouver.

The new research, which reviewed studies published from 1970 to 2023, also found a wide nutritional variation in the meat substitutes, such as in the amount of sodium and saturated fat they contained.

One of the clinical trials cited by the researchers found that when participants consumed plant-based alternatives they experienced a 13% reduction in total cholesterol, a 9% reduction in LDL cholesterol, a 53% reduction in triglycerides and an 11% rise in HDL cholesterol.

Ur and his colleagues focused on two burger brands — one older-generation, one newer with a closer approximation to beef flavor. The older-brand burger had 6% of the recommended daily allowance for saturated fat, compared to 30% in the newer company’s burger. Similarly, the older brand had 0% cholesterol, compared with 27% of the RDA in the newer brand. 

The new report adds another layer to the question of how plant burgers affect health.

Most meat substitutes are highly processed. Ultraprocessed foods tend to be low in fiber and loaded with salt, sugar and additives and have been linked to a higher risk of heart disease and premature death. 

A study published this month in Lancet Regional Health—Europe suggested that consuming plant-based ultraprocessed foods — including meat substitutes — could increase the risk of heart attacks and strokes. The study didn’t, however, directly compare meat alternatives to actual meat.

Ur countered that not all ultraprocessed foods are unhealthy and that the term shouldn’t be the “kiss of death” for a food.

“In and of itself, processing is not necessarily a bad thing,” Ur said. “It’s true that these plant-based meats are highly processed, but not in the sense that they have lots of saturated fats or certain carbohydrates that are associated with adverse outcomes.”

What’s needed is a randomized trial looking at heart attack and stroke in people who eat meat substitutes compared to regular meat eaters, Ur said. 

“Obviously, it could be difficult to conduct a double-blind trial because people might be able to tell whether they were eating meat or an alternative,” he said. “But some of the newer plant-based meats are very close in flavor to actual meat.”

Dr. Walter Willett, a professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health, said that while some plant-based alternatives may be better for the heart than meat, “in general, the best option would be to consume whole foods.”

According to Willett, the healthiest whole foods are a combination of:

• Nuts
• Seeds
• Soy foods and other legumes
• Whole grains
• Vegetables
• Fruits
• Liquid plant oils, such as olive oil

A vegetarian or pescatarian diet “would include a modest amount of dairy foods and eggs and fish about twice a week,” Willett said.

But not everyone is ready for that. “So I do think there is space for foods that might be called ultraprocessed,” he said.

He pointed to a study published in 2020 in the American Journal of Clinical Nutrition, in which participants consumed meat for eight weeks and a plant-based meat alternative for eight weeks.

When participants consumed the meat alternative, “cholesterol and blood pressure were reduced by about 10%, which is pretty substantial,” Willett said. “Just the fact that something might fall under the definition of ultraprocessed doesn’t mean it’s bad.”

People need to take into account the variation in meat alternatives made from plants, said Marie-Pierre St-Onge, an associate professor of nutritional medicine at the Columbia University Irving Medical Center. The amount of saturated fat in a meat alternative depends on the brand, for example.

“Consumers need to become more savvy and educated about the nutrition facts panel,” St-Onge said. “If a plant-based burger is 35% to 40% of the daily sodium allowance, it’s not for you if you have high blood pressure.”

Dr. Anu Lala, director of heart failure research at the Mount Sinai Fuster Heart Hospital in New York, said longer follow-up studies are needed to determine whether plant-based meat alternatives are healthier.

“There needs to be a concerted effort — like there has been with the Mediterranean diet — to understand the plant-based dietary programs and their long-term effects,” Lala said.

For a healthier choice, she suggested checking a meat alternative’s label for: 

• Sodium content
• Amount of saturated fat
• Source of protein, such as pea or soy
• Gluten, for people who have a sensitivity 
• Artificial sweeteners

People are desperate to find easy solutions and to try to pinpoint specific diet interventions, but a single food doesn’t make an overall diet healthier, Lala said.

“We need to take a holistic approach that incorporates a balanced diet that is high in fruits and vegetables — and includes movement,” she said.