Vegan, Vegetarian or Omnivore: Which Diet Is Best for You?

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An overwhelming amount of information exists about the best way to eat for long-term health. Breaking through the clutter is challenging and sometimes subjective. Licensed Dietitian, Kelli Santiago, MS, RD, CSSD, LD explains what to look for in the foods you eat or in the lifestyle changes you’d like to make in order to live your healthiest life.

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Macie Jepson
Well, they say that less is more and simple is better. That’s what we’ve been told throughout the years. And Pete, I’ve been telling you this, too. These days, I’m trying to live by that adage when it comes to my diet; eat fewer processed foods, more fruits and vegetables. But I have to tell you one thing I will never eliminate in my diet is red meat.

Pete Kenworthy
Yeah, I’m definitely with you on eating meat. I eat more fish and pork probably than red meat, but I certainly don’t turn away a good burger, that’s for sure. And I definitely don’t shy away from meat in general. Beef, pork, chicken, really, if you name a meat, I’ve probably eaten it or I would eat it. However, there’s an increasing body of evidence that links meat consumption, particularly red meat and processed meats with chronic illness, right? But is a plant-based diet really better for us? And what’s the difference between vegan and vegetarian?

Macie Jepson
Hi, I’m Macie Jepson.

Pete Kenworthy
And I’m Pete Kenworthy. And this is The Science of Health. So many questions about this growing choice to eliminate meat from our diets. Currently about 10% of Americans over the age of 18 identify as vegan or vegetarian. So here to break down these diet choices is Kelli Santiago, Clinical Dietician and Wellness Coach at University Hospitals in Cleveland. Thanks for being with us.

Kelli Santiago, MS, RD, CSSD, LD
Thank you. Thanks for having me.

Pete Kenworthy
So first, explain these diets or lifestyles, right? Vegan versus vegetarian. And we hear plant-based diet a lot these days. Is that different from those other two?

Kelli Santiago, MS, RD, CSSD, LD
We’ll start off with vegetarian versus vegan. So, a vegan diet would be one that doesn’t include any type of meat or animal byproducts. So, we’re talking dairy. We’re talking anything made with dairy, eggs. Anything that is going to be made from or containing an animal product would not be included in a vegan diet. So, this would include something like gelatin would not be in a vegan diet. And then the other thing I think that’s important to point out between at least what I think is the difference between a vegan diet and being a vegan. So, one could have a vegan diet, follow a vegan diet, but maybe not necessarily identify as a vegan. If you are identifying as a vegan, you would be someone where every product in your life would not contain an animal. So, you wouldn’t be wearing leather. You wouldn’t be wearing wool. You would be very cautious of where you’re getting cosmetics and what household cleaners you’re using.

Those would not be, they wouldn’t be tested on animals. They wouldn’t contain any animal products, and that I consider is a full vegan lifestyle versus a vegan diet. Neither one is right or wrong. Just to kind of explain the difference between those things.

And then a vegetarian diet. So, there’s several types of vegetarian diets you might have. So, a vegetarian diet would be one that may contain some type of animal product. So, you might have a pescatarian. A pescatarian is someone who would essentially follow a vegan diet but would allow fish. You might have a lacto-ovo-vegetarian. Again, that would be someone who essentially is following a vegan diet but would consume eggs and dairy and dairy products. You could have a lacto-ovo-pescatarian. That would be someone who would be including eggs, dairy, dairy products, and fish in their otherwise vegan diet. And that would be the main difference between those.

Macie Jepson
The common denominator here, and a lot of what you just described is that people are taking meat out of their diet. And so, what are the health benefits of doing that?

Kelli Santiago, MS, RD, CSSD, LD
Overall, when we are removing meat, especially certain types of meat, is you’re reducing ultimately the saturated fat in your diet. So, saturated fat is found in fatty types of meat, like your bacon, your high fat ground beef, your processed meats like your pepperonis and your salamis and your high-fat lunch meats, your dark meat chicken or dark meat poultry. So, those can potentially be high in saturated fats. And if we are removing those from our diet, we’re naturally reducing the type of saturated fat in our diet. Now we do get saturated fat from other things. So, I can’t make the blanket statement that, oh, you’re following a low saturated fat diet because if you are including butter per se in your diet, that’s a high source of saturated fat. You would still be getting saturated fat from that. But if we are reducing the meat, especially those high saturated fat meats, that would be a lower saturated fat diet.

Macie Jepson
Don’t we need a little bit of fat there anyway?

Kelli Santiago, MS, RD, CSSD, LD
So, if we have, the recommendation for saturated fat is no more than 15 grams a day. So, we can have some saturated fat. We just don’t want to overdo it. So, no more than 15 grams of saturated fat a day is what is recommended typically. And then there are other types of fats, your polyunsaturated fat and your trans fats. Obviously, we don’t want any trans fats in our diet. And then the rest of our fat after the saturated fat, we would want to come from the unsaturated fat. Those are the heart healthy fats.

Pete Kenworthy
You’re talking about keeping meat out of your diet eliminates some fats, but what risks are we posing on ourselves by eating meat? We saw this study that said the risk of ischemic heart disease in vegetarians and vegans was 22% lower than meat eaters and reduced 17% after adjusting for BMI, so significantly lower than meat eaters. But what’s actually happening in our bodies with that meat? Yeah, fat. Great. We’re eating fat. But what does that mean? What does that risk? Is it all heart and vascular?

Kelli Santiago, MS, RD, CSSD, LD
Primarily. Yeah. So, when we are reducing the amount of saturated fat in our diet, saturated fat is going to increase your cholesterol and increase your bad cholesterol. When our bad cholesterol goes up and our total cholesterol goes up, what happens? We are at a greater risk for heart disease. So, if we are lowering that saturated fat and keeping our bad cholesterol, that LDL cholesterol low or within a normal range and keeping our total cholesterol low or within a normal range, that’s reducing our risk for heart disease.

Macie Jepson
Learning so much here. So, I want to break it down just one more level. Vegetarian: maybe you’re eating some fish and you are eating some eggs versus vegan, cutting all of that out. Is one healthier than the other?

Kelli Santiago, MS, RD, CSSD, LD
So, I think it’s important to point out that health is a subjective word, and no, not necessarily. I think if I have a patient that’s a vegan or a vegetarian, I’m going to ask them like, okay, what are we eating for breakfast, lunch and dinner, and making sure that we are following an overall well-balanced diet. You can have a very balanced diet following a vegan diet. We get enough protein. We get enough carbs. We get enough healthy fats. We get enough fiber. We can absolutely have a balanced diet following a vegan diet. You can also have an absolutely balanced diet with including meat in your diet with lean meats. So yeah, I don’t think one is necessarily healthier than the other.

Pete Kenworthy

Yeah, that’s what I was going to ask you about. You talk about eating meats. Well, we had just talked about eliminating meats versus eating meat, but then you hear a lot about eat salmon. There are a lot of good fishes you can eat, especially things like salmon, right? Or you just mentioned lean meat, so maybe like chicken, right? Pork. Is it specifically a red meat concern that we’re worried about? Because there are some of those, like you said, dark meat, poultry, not as good, right? But is it a red meat and dark meat poultry only? Are we good with the white meat, right, like the light meat chicken, the pork, the fish?

Kelli Santiago, MS, RD, CSSD, LD
Yeah. So, I usually say, okay, if we’re going to have meat in our diet, that’s fine. We’re going to choose the lean meats. Those lean meats would be chicken breasts, turkey breasts. We’re going to limit the dark meat poultry. And you can have red meat as a part of a lean meat. So lean ground beef, 90/10 or leaner, anything with loin in it; pork loin, tenderloin, sirloin. These are lean types of red meats. So, I just say we’re going to focus on the lean meats, whether that’s coming from a cow or a pig or a chicken. So yeah, we can certainly have some red meat in our diet, but we do want to be just mindful of how much saturated fat. So, with the fish, fish is actually really high in the unsaturated fat, the heart healthy fat. So, this is why like the Mediterranean diet, and oftentimes you’ll hear us preaching about fish is because they’re so high in the healthy fats, the poly and the monounsaturated fats. And those fats can actually protect your heart from heart disease. They can help to better control your LDL/HDL total cholesterol.

Pete Kenworthy
Let me play devil’s advocate one more time because people who love eating meat like me, they love the taste of it. I love a cheeseburger. I love pork chops, whatever the case may be. But what we will argue is I can’t go vegetarian because I need my protein. I need to get my protein. That’s where I get my protein from. We’re lying to ourselves basically, right? So how do, you said vegans get plenty of protein and then I hear, yeah, beans and nuts. I don’t want to just get protein, but is that it? Is that how vegans or some vegetarians get their protein is beans and nuts?

Kelli Santiago, MS, RD, CSSD, LD
Yes, beans and nuts are part of it. There are other things, plant-based proteins. You’ve got your soy and then all your soy products, from your tofu to your seitan to your tempeh to your edamame, right? Lots of different soy products and they are all complete proteins, so they have all nine essential amino acids, which is great. And then quinoa is another plant-based complete protein. Ezekiel bread as well. So, it’s not just nuts and beans, but yes, part of it is nuts and beans. And then again, all your soy products, your quinoa, all that stuff, your whole grains, you’ve got some protein there. If we are getting all of our nine essential amino acids in appropriate amounts, by the end of the day, a vegan can live a very healthy diet. It’s just naturally limited. And I think that there’s pros and cons to everything. One of the major cons to a vegan diet is that it’s just naturally limited. We are cutting out a lot of food. And that doesn’t make it impossible. It just makes it a little bit harder, more planning ahead, a little bit more strategic grocery shopping. I might need to have a little bit more knowledge in the kitchen as far as cooking and stuff like that. But if you are happy to do that and that’s the thing that you like to do, then by all means. Yeah.

Pete Kenworthy
From a diet perspective, though, are there cons of that, a plant-based diet or a vegan diet?

Kelli Santiago, MS, RD, CSSD, LD
From a nutritional standpoint? If you’re not planning well enough, yeah, if we’re not putting in the effort to make sure that we have protein at every single meal. Toast, while great is not a complete meal. We need a little bit more to that. We need some protein. So unless, again, we’re planning ahead and making that effort to make sure we got carbs and proteins with every single meal. If we’re just kind of being a little lackadaisical about it and not putting that effort towards it, yeah, we can have some nutritional deficiencies. Absolutely.

Macie Jepson
I wonder if we’re getting enough nutrients though. I mean, I read one study where vegans have insufficient levels of B12. Do you need supplements to make up for that? What do you recommend?

Kelli Santiago, MS, RD, CSSD, LD
Yeah, so if someone is on a vegan diet, I would probably recommend a B12 supplement just most of the B12 that is in our food is coming from an animal product. But we do have some fortified products like soy products that are fortified with B12. Usually what I like to do before I recommend any supplement is to look at lab work, make sure that the person is actually deficient. And if that lab work justifies a supplement, then yeah, a hundred percent I would recommend a B12 supplement. That’s really the main thing that we’re looking for in a vegan diet just because there’s an absence of animal meat foods.

Pete Kenworthy
What is B12? Why would people need a supplement like that?

Kelli Santiago, MS, RD, CSSD, LD
B12 is a B vitamin, and that is particularly helpful in reducing your risk for anemia and also just helps to keep your blood and nerve cells healthy.

Macie Jepson
And I would think when it comes to vegan and vegetarian, iron could be an issue as well if you’re not getting enough protein?

Kelli Santiago, MS, RD, CSSD, LD
Yeah. It can be. We do have iron in plants. It’s a different type of iron than what is in meat, but you can have the increased risk of iron deficient anemia or just an iron deficiency following a vegetarian or vegan diet. Again, if the blood work justifies it, I would 100% recommend a supplement.

Macie Jepson
So, I would imagine it’s important to make sure that you’re getting really good produce. Does that mean eating in season? I hear that a lot. Why is that important?

Kelli Santiago, MS, RD, CSSD, LD
Yeah. So, eating in season is helpful for a couple different reasons. One, the food is more nutrient dense because it is fresher, right? It’s more in season, higher in nutrients. And the other thing is that it’s going to be less expensive when we are buying any produce in season. And so, that’s a big pro.

Pete Kenworthy
Is today’s produce as nutrient rich as it used to be, right? Because all sorts of things we worry about. And I see you smiling.

Kelli Santiago, MS, RD, CSSD, LD
Yeah. That is a very popular question. I have not studied the nutrient profile of produce from 20, 30, 50, 60 years ago.

Pete Kenworthy
But what are those concerns? Why are people asking that question? What are they concerned about?

Kelli Santiago, MS, RD, CSSD, LD
Well, I think it’s okay to question the nutrient density of our food. I don’t think there’s anything wrong with questioning that. I don’t think there’s anything wrong with being concerned about the food that we’re putting in our body. I think those are all valid questions and concerns, and I don’t fault anybody for asking that question. If someone were to ask me that, again, I would kind of go back to, well, are we eating a balanced diet? Do we have carbs and protein at each meal? Are we eating enough fruits and vegetables? What does our diet look like as a whole? And then pair that up against one’s lab work. If we’re coming back with a lipid panel that is perfect and our vitamins and minerals, there’s no deficiency, I have no reason to question the nutrient density of that person’s diet. We are meeting our needs. We are good.

If I do see maybe the only exception that would be vitamin D, because we get it from the sun and in March in Northeast Ohio, everybody is vitamin D deficient. So, that’s really the only one that I would question as far as a lack of nutrients in the diet, just because vitamin D doesn’t naturally occur in most foods. Yeah, but going back to your question, I mean, I think it’s okay to ask that question, but before we start making bold claims that our produce or that our food is less nutrient dense, we need to compare that with what is actually going on in our body with lab work and tests.

Pete Kenworthy
And that’s what the takeaway is here for me, right? It’s know your numbers really.

Kelli Santiago, MS, RD, CSSD, LD
Yeah. Absolutely.

Pete Kenworthy
Like have a doctor. Know your numbers.

Kelli Santiago, MS, RD, CSSD, LD
Yeah. Absolutely.

Macie Jepson
And especially if we’re talking about otherwise young, healthy people who don’t necessarily get that type of blood work at this time in their life. They should probably do that.

Kelli Santiago, MS, RD, CSSD, LD
At least once a year. Oh yeah. I like doing it once a year.

Macie Jepson
Speaking of young and healthy people, and I’m asking this question because I really want some perspective from what you’re seeing on the front line. My daughter took on a pescatarian lifestyle while she was in college studying environmental engineering. My other daughter studied environmental studies. They both came back from college with this idea that they didn’t want to eat meat anymore. So, plant-based diets consume fewer natural resources, generate fewer greenhouse gas emissions, a smaller water footprint. And footprint is a big thing. So, what I want to know from you to give this all perspective. Why are people doing this? The people the that you treat. Is it because of the environment or is it because of health?

Kelli Santiago, MS, RD, CSSD, LD
I think it’s because of the media. I mean, there’s so much out there right now promoting a plant-based diet or a vegetarian diet, which is fine. And there’s some great studies out there that will justify a plant-based diet or going fully vegan or some form of vegetarian diet. I think that’s fine. When someone makes that switch, I have to ask them, okay, why are we doing this? That’s my very first question. Why am I doing this? Is it because you think it’s going to magically help you lose weight? Is it because you think it’s going to magically improve your health? Is it for environmental reasons? Is it for animal cruelty reasons? Why are we doing this? And I think all of those reasons can be absolutely valid. If we want to do it for health, okay, let’s do it for health, but let’s make sure we got to do it the right way. I mean, Oreos are vegan. Nothing against Oreos. I love them myself. But if we’re just sitting there eating Oreos for lunch and then saying, well, I’m following a vegetarian or vegan diet and I’m healthy. Well, no, that’s not a balanced diet. We need to make sure we got some protein in there. So, whatever the reason is, again, I think there’s validity for all of it.

My next question is, okay, so if we’re going to follow this lifestyle, let’s make sure we do it right. Let’s make sure we’re getting everything that we need. What proteins are you allowing in your diet? So, for example, your daughter, she’s going to allow fish. Great. So what proteins are we going to do for breakfast? Are you going to eat fish for breakfast? If the answer is no, what are we going to do for breakfast? What’s our protein for breakfast? Let’s talk about our choices and then kind of build a proper plan from there. Not to say, oh, well, you’re wrong for doing it for environmental reasons. That’s stupid. I would never, their reason is their reason, and we’re going to go with that, but we got to make sure we’re going to do it the right way.

Macie Jepson
Pete, are you hanging on the fact that Oreos are vegan? I can’t get past that.

Pete Kenworthy
I like Oreos, too.

Kelli Santiago, MS, RD, CSSD, LD
Yeah.

Pete Kenworthy
Is vegan more expensive?

Kelli Santiago, MS, RD, CSSD, LD
Not necessarily. There are certainly ways that you do not have to spend a lot of money. I mean, I love a good canned bean, and those are some of the cheapest sources of protein in the entire grocery store. And then now, meat can be quite expensive. So, I don’t think it’s necessarily more expensive. Now, if you are going to really expensive grocery stores and picking out very expensive produce, well then yes, it can be. But if we are following a budget, it can be a budget friendly diet. Absolutely.

Macie Jepson
Speaking of expensive, I feel pretty lucky my daughter doesn’t want to replace a steak with something that tastes like a steak necessarily. But every now and again, she craves a burger and we do plant-based Impossible Meats or the like. They’re expensive.

Kelli Santiago, MS, RD, CSSD, LD
Yeah.

Macie Jepson
And what’s in them, because again, wanting to stay away from processed foods as well. What are they?

Kelli Santiago, MS, RD, CSSD, LD
Well, they are plant-based, right? Now, the fat in those, like the Impossible Burger, I believe it’s the Impossible Burger and the Beyond Burger, the fat that is in them is coconut oil. And coconut oil is a vegan product. It comes from a plant, right? But it is really high in saturated fat. So, when you compare them protein for protein, like a beef burger and a Beyond Burger or an Impossible Burger, protein for protein, they are very similar. Fat for fat, they’re also very similar. So, you’re not actually reducing the saturated fat. It’s just coming from a different source, that coconut oil, whereas the saturated fat in the burger is just coming from the saturated fat of the animal that’s in the tissue.

Pete Kenworthy
So, permission to eat the burger, right?

Kelli Santiago, MS, RD, CSSD, LD
You can eat the burger if you want to, you’re just not following a vegetarian or vegan diet.

Pete Kenworthy
But there have to be valuable nutrition differences, right? They can’t be equal. Are they?

Kelli Santiago, MS, RD, CSSD, LD
So, I think they’re pretty equal. I think they’re pretty equal. I mean, I might have to go back and look at it, but I think they’re pretty equal. That Beyond Burger, I would have to look at the sodium content. I honestly don’t know. It could be high. I’d have to go back and look at that. Saturated fat wise, they have saturated fat. So.

Macie Jepson
But it kind of goes back to what some vegans say. No animals were harmed in the process of making this.

Kelli Santiago, MS, RD, CSSD, LD
Correct. Correct.

Macie Jepson
That’s the redeeming quality.

Kelli Santiago, MS, RD, CSSD, LD
Correct. So, if we are doing this for potentially environmental reasons, if we are doing this potentially for animal wellbeing reasons, then yeah, the Beyond Burger would definitely fit that criteria. Be my guest. But if we’re looking from a macronutrient profile, I don’t see these things differing a ton. Now, that’s the Beyond and the Impossible Burger. There are other plant-based burgers out there that are very low in saturated fat. You’ve got your MorningStars, your Boca Burgers, your black bean burgers. Those are going to be really low in saturated fat and still pretty… You got to look at the protein content. So, with the Beyond, not the Beyond, the MorningStar, the Boca Burgers, those are a lot smaller than your Beyond Burgers. Like Beyond Burgers are pretty hefty burgers, right? The MorningStar, the Boca Burgers, they’re pretty small. For how big they are, there’s a decent amount of protein, but nothing compared to a four ounce beef burger. I mean, we’re talking nine grams of protein versus 30 grams of protein. So, if we’re doing protein for protein, you might have to double up on that MorningStar or Boca Burger because we want you to eat roughly 20 to 30 grams of protein per meal. So, if we are using the MorningStar or the Boca Burger, it’s not going to meet that protein requirement. You might have to double up on it to get enough protein, or you could just add stuff to it. You could put beans on that Boca Burger and increase the protein amount or do that Boca Burger plus a side of rice and beans and beef up the protein of the plate. There’s a couple different ways that you can do it, and those do tend to be a lot lower in saturated fat versus the beyond and stuff like that. Now they can be really high in sodium. So, if we’re following a low salt diet, you just got to watch that, but.

Macie Jepson
Sounds like really high in carbs, too. Is that something we need to be concerned about? Lots of rice and beans?

Kelli Santiago, MS, RD, CSSD, LD
Not necessarily.

Macie Jepson
They’re the good carbs.

Kelli Santiago, MS, RD, CSSD, LD
Right. Yeah, not necessarily. Again, when I look at someone’s plate or I look at my own plate, I look at it as a puzzle and I’m putting the puzzle pieces together. How much carbs do I have? How much protein do I have? And do I have enough to call this a balanced meal? And you can get carbs from multiple sources. You can get protein from multiple sources.

Pete Kenworthy
So, bottom line here is if you are thinking about switching to vegan, vegetarian or some form of vegetarian, or maybe you want to do it for environmental reasons or you want to do it for animal cruelty reasons, the bottom line really is if you’re making a switch or if you’re going there for whatever reason, be deliberate about how you do it. You need to make sure you’re doing the right things. And on the other side of that is you might not need to get rid of all meats if you’re eating meats that are okay. So, I mean, I guess we’re talking about a million different kind of people here, because different reasons why people want to go vegan/vegetarian. Yeah, go ahead.

Kelli Santiago, MS, RD, CSSD, LD
So, I think that makes up a good point and kind of that difference between vegan, vegetarian and plant-based. Someone who is including some amount of plant or some amount of animal proteins, like maybe we got some chicken in there, maybe we got some fish in there. Maybe we got some tenderloin in there every now and then or whatever. But in their household, Mondays are meatless Mondays, so we’re going to try to slowly incorporate more plant-based proteins into our diet with following meatless Mondays in our house. I would think that that’s like I partially follow a plant-based diet. I enjoy plant-based proteins, and I will go out to dinner and choose the black bean burger every now and then. And every now and then we will grill some black bean burgers outside. We are not vegetarians, we are not vegans, but we are happy to incorporate more plant-based proteins into our diet. That is wonderful. Yeah, I think that’s wonderful.

Macie Jepson
And that brings us full circle because that’s exactly what I’m trying to do. So, we do Mexican food on Friday nights, and my husband looks at me like I’m crazy because I’m not doing the enchiladas. But lately I’ve just been doing the shrimp quesadillas. So, knowing, I think we all know what the benefits are and whether we go into it a hundred percent or we just make an educated decision now and again, it’s to each his own, I guess.

Kelli Santiago, MS, RD, CSSD, LD
Yeah. Absolutely. It’s all about balance and doing what’s right for you.

Pete Kenworthy
Yeah. Can you expand on that as we just wrap it up here? What do you mean by that? It’s all about balance and doing what’s right for you.

Kelli Santiago, MS, RD, CSSD, LD
Doing what’s right for you, doing what fits your lifestyle. Vegan is not for everybody, and I would never make the blanket statement that everybody should be vegan. Vegetarian is not for everybody. And I would never make the statement that everybody should be a vegetarian. You have to do what is right for you if you live in a house with other people, what’s right for your family? What is doable? If I take someone who like you, who’s like, I could never give up meat. How could I sit here in good faith, say, no, no, no, you really need to switch to a vegan diet. This is the best one. It’s not sustainable. It’s not your reality. Like you can’t do that. So, we kind of make some adjustments where we can. So, exactly what you were saying. Maybe I don’t want the ground beef enchiladas. Maybe I’m going to…

Macie Jepson
To be clear, I really do.

Kelli Santiago, MS, RD, CSSD, LD
Maybe I’m going to go with the shrimp quesadillas, and it’s a leaner, it’s a leaner dish, and I’m trying to reduce the saturated fat in my diet because I want to reduce my risk for heart disease.

Pete Kenworthy
Right. And know your numbers is the other thing, right?

Kelli Santiago, MS, RD, CSSD, LD
Yeah. Absolutely.

Macie Jepson
For sure. Yeah.

Pete Kenworthy
Kelli Santiago, Clinical Dietician and Wellness Coach at University Hospitals in Cleveland, thanks so much for joining us today.

Kelli Santiago, MS, RD, CSSD, LD
Thank you for having me.